2014 Rock County Community Needs Assessment
Overview • • • • • • • •
Purpose Methodology Demographics General Health Status Behavioral Risk Factors Maternal & Child Health Health Resource Availability Next Steps
Steering Committee • • • • • • • • • • • • •
Larry Bergen, Beloit Health System Alison Chouinard, Rock County Health Department Angela Flickinger, University of Wisconsin- Extension Rock County Richard H. Gruber, Mercy Health System Adam Loris, Mercy Health System Elizabeth Pohlman, Rock County Jean Randles, HealthNet of Rock County Lisa Rebman, Ederton Hospital and Health Services Katie Schroeder, Rock County Health Department Lori Stottler, Rock County Angie Sullivan, SSM Healthcare of Wisconsin Ladd Udy, Mercy Health System Karen Cain, Rock County Health Department
Purpose • To collect and analyze data regarding the health care infrastructure and needs of Rock County residents to understand: – Who comprises the community? – What are the strengths and weaknesses in the community that contribute to health? – What is the health status of the community?
• Community Health Needs Assessments are required by healthcare reform legislation – All hospitals must include an action plan based on a community health needs assessment when filing the IRS 990 form
Methodology • Primary research – Mailed Survey • Sample size= 2000 Rock County residents • Representative, random sample • Response rate= 32.8%
• Secondary research – – – – – –
Wisconsin County Health Rankings Wisconsin Department of Transportation Department of Education Wisconsin Department of Health Services U.S. Census Bureau Others
DEMOGRAPHICS
Population
Source: U.S. Census Bureau, American Community Survey, 1990, 2000, 2010 and American FactFinder, 2012.
Race and Ethnicity Race Distribution - Rock County, WI 1990
2000
2010
2012 (Est)
White
93.7%
91.0%
87.7%
90.4%
Black or African American
4.8%
4.6%
5.0%
3.9%
American Indian and Alaska Native
0.3%
0.3%
0.3%
0.3%
Asian
0.7%
0.8%
1.0%
1.0%
Other
0.5%
1.8%
3.7%
1.3%
xx*
1.5%
2.3%
3.1%
Two or more races
Source: U.S. Census Bureau, American Community Survey, 1990, 2000, 2010 and American FactFinder, 2012.
Age
Median Age of Rock County residents in 2012: 38.0 years
Source: U.S. Census Bureau, American Community Survey, 1990, 2000, 2010 and American FactFinder, 2012.
Socioeconomic Status
Source: U.S. Census Bureau, American Community Survey, Selected Economic Characteristics, 2012.
Socioeconomic Status
Source: U.S. Census Bureau, American Community Survey, Selected Economic Characteristics, 2012.
Socioeconomic Status • Median household income is $50,316 in Rock County – Lower than the state and national medians of $52,627 and $53,046, respectively
• 13.5% of Rock County residents lived below the poverty level in 2012 – Greater than the state average of 12.5% – Less than the national average of 14.9%
Source: U.S. Census Bureau, American Community Survey, Selected Economic Characteristics, 2012.
Socioeconomic Status
Source: Wisconsin Department of Public Instruction, Wisconsin Information Network for Successful Schools, 2013
Education
Source: U.S. Census Bureau, American Community Survey, Educational Attainment 2012.
GENERAL HEALTH STATUS
Health Status • Rock County ranked 62 out of 72 Wisconsin counties with respect to health outcomes (how healthy a county is) • 15% of Rock County residents reported fair or poor health – Rock County residents also report more physically and mentally unhealthy days than the state average
Source: Wisconsin County Health Rankings, 2014.
Community Perception Most Concerning "Health Problems" Cancers Obesity Heart Disease & Stroke Mental Health Problems Aging Problems Domestic Violence Child Abuse / Neglect Diabetes High Blood Pressure Teenage Pregnancy Motor Vehicle Crash Injuries Respiratory / Lung Disease Dental Problems Suicide Firearm-Related Injuries STDs Rape / Sexual Assault Infectious Diseases Other Homicide Terrorist Activities Infant Death HIV/AIDS
17.5% 14.0% 12.0% 10.4% 9.9% 9.5% 7.6% 5.8% 5.6% 5.5% 4.1% 1.5% 1.2% 0.9%
0.0%
10.0%
20.0%
32.8% 32.6% 29.1% 24.5%
30.0%
40.0%
Number of Times Selected
Source: 2014 Rock County Community Needs Survey
45.7% 45.6%
50.0%
53.0% 52.3%
60.7%
60.0%
70.0%
Self-Reported Health Status Very Good
210
32.0%
Good
361
55.0%
Fair
75
11.4%
Poor
8
1.2%
Very Poor
2
0.3%
Source: 2014 Rock County Community Needs Survey
Environmental Health • Rock County ranked 58 out of 72 Wisconsin counties in air and water quality and 59 out of 72 in the health of the overall physical environment • 2% of Rock County residents were exposed to water exceeding a violation limit in the past year • 2% of children 6 and under have elevated blood lead levels Source: Rock County Department of Health , County Health Rankings, 2012
BEHAVIORAL RISK FACTORS
Alcohol and Tobacco Use • 24% of adults in Rock County smoke – Exceeds percentage of adults who smoke in Wisconsin (18.7%) and in the U.S. (18.1%)
• Wisconsin has the highest rates of alcohol consumption, binge drinking, and heavy drinking in the nation – 26% of Rock County residents reported binge drinking within the past 30 days, compared to the state average of 24% Source: Statemaster Health Statistics, 2012; County Health Rankings, 2014; Kaiser Family Foundation, 2012
Tobacco Use
Source: Community Commons, Community Health Needs Assessment, Health Behaviors, 2012.
Preventative Care • With increased attention on healthcare costs and chronic disease, it is becoming increasing important for individuals to have the appropriate preventive care, from dental visits to cancer screenings, in order to maximize years of life and improve the likelihood of positive health outcomes • Not only are chronic conditions the most costly, but they are also among the most preventable.
Source: Centers for Disease Control & Prevention, Communities Putting Prevention to Work
Preventative Care WITHIN THE PAST 2 YEARS PERCENT
GREATER THAN 2 YEARS PERCENT
PERCENT
51.2%
2.9%
33.2%
96.5%
0.6%
1.2%
96.5%
0.6%
1.2%
80.2%
1.5%
9.9%
71.6%
2.5%
4.3%
70.8%
0.8%
20.4%
NEVER
Been tested for colon or rectal cancer? (adults age 50+) Had your blood cholesterol checked? (adults age 50+) Had your blood pressure checked by a doctor, nurse or other health professional? (adults age 50+) Had a mammogram? (women age 50+) Had a pap smear? (all women)
Been check for prostate cancer? (men age 50+)
Source: 2014 Rock County Community Needs Survey
Preventative Care AT LEAST ONCE A YEAR
EVERY 2 YEARS
EVERY 3 OR MORE YEARS
NEVER
PERCENT
PERCENT
PERCENT
PERCENT
44.5%
30.3%
15.2%
4.9%
75.8%
9.5%
7.9%
3.8%
80.2%
6.3%
6.6%
2.6%
40.1%
11.2%
16.2%
18.3%
22.4%
3.7%
9.0%
45.4%
Eye Doctor Family Doctor Dentist Gynecologist Chiropractor
Source: 2014 Rock County Community Needs Survey
Dental Health National
Wisconsin
a) Young children, aged 2–4 years
24%
35%
b) Children, aged 6–8 years
53%
55%
c) Adolescents, aged 15 years
51%
56%
a) Young children, aged 2–4 years
19%
26%
b) Children, aged 6–8 years
29%
20%
Dental caries (tooth decay) experience
Untreated caries (tooth decay)
Source: Wisconsin Department of Health Services, Burden of Oral Disease in Wisconsin - 2010
Obesity
Source: Community Commons, Community Health Needs Assessment, Health Outcomes, 2010.
Obesity • Obese adults in Rock County account for 30.2% of residents – Compared to 28.8% statewide
• Contributing to the obesity epidemic is physical inactivity – 19% of Rock County residents stated that they are physically inactive
Source: Wisconsin Department of Health Services, Rock County Community Needs Survey, 2014.
Chronic Conditions
Source: Community Commons, Community Health Needs Assessment, Health Outcomes, 2010.
Self-Reported Chronic Conditions NUMBER
PERCENT OF TOTAL RESPONDENTS
Heart Disease
20
8.2%
Diabetes
27
11.1%
Cancer
11
4.5%
Respiratory Problems
21
8.6%
Eye Disease
18
7.4%
Arthritis
9
3.7%
Other
24
9.8%
RESPONSE
Source: Rock County Community Health Needs Assessment Survey, 2014.
Hospitalizations • Leading causes for hospitalizations, excluding childbirth, include: – – – –
injuries (1484 cases) psychiatric conditions (1015 cases) coronary heart disease (528 cases) cancer (612 cases)
• The hospitalization rate for Rock County is 110.7 per 1000 persons – Less than the national average (112 per 1000) – Higher than the Wisconsin rate (100 per 1000)
Source: Wisconsin Department of Health Services, Profile for Rock County 2010.
Hospitalizations Average Charges for Selected Diseases in Rock County, WI - 2010 Disease
Average Charge
Hospitalization Charge per Capita
Injury-Related
$34,246
$317
Coronary Heart Disease
$51,948
$171
Cancers
$42,403
$162
Cerebrovascular Disease
$30,962
$82
Pneumonia & Influenza
$22,260
$59
Diabetes
$29,997
$48
Source: Wisconsin Department of Health Services, Profile for Rock County, 2010.
Infectious Disease
Reported STI Cases in Rock County, WI
2010
2011
2012
N
Rate
N
Rate
N
Rate
Chlamydia
669
417
776
484
724
452
Gonorrhea
73
46
83
52
109
68
Total Cases
Source: Rock County Health Department, 2013.
742
859
833
Injury Number of ED Visits and Hospitalizations for Selected Injuries - Rock County, WI ED Visits Hospitalizations 2010 2011 2012 2010 2011 2012 Cutting or Piercing Object 1011 1087 1216 35 52 47 Falls 3647 3629 4236 689 661 724 Fire, Heat, Chemical Burns 185 206 198 15 26 25 Firearms X 8 12 6 5 7 Machinery 91 89 75 10 13 8 Motor Vehicle Crash - Motorcyclist 64 58 76 27 20 28 Motor Vehicle Crash - Occupant 815 771 795 78 74 60 Motor Vehicle Crash - Pedal Cyclist 17 16 13 X X 6 Motor Vehicle Crash - Pedestrian 40 32 33 X 5 5 Non-Traffic Pedal Cyclist 193 194 234 24 8 13 Non-Traffic Transportation 150 135 127 22 23 22 Overexertion 1186 1082 1236 35 30 28 Poisoning 265 297 270 234 234 256 Struck By or Against Object or Person 1990 2099 2304 61 57 48 Suffocation 20 17 20 26 25 34
Source: Department of Health Services, Wisconsin Interactive Statistics on Health, 2012.
Suicides
Sources: Department of Health Services, Wisconsin Interactive Statistics on Health, 2010 and Rock County Department of Health, 2013.
Mental Health • Over 6% of respondents reported being diagnosed with a mental health illness within the past two years – Nearly 1/3 believe they were unable to access the care they needed
• Frequently cited reasons for not receiving healthcare: – Inability to pay for visit and/or medications – Services not close to home – Lack of awareness of services in community Source: Rock County Community Needs Survey 2014
MATERNAL AND CHILD HEALTH
Births
Source: Wisconsin Department of Health Services, Profile for Rock County, 2010.
Births
Source: Wisconsin Department of Health Services, Profile for Rock County, 2010.
Births & Prenatal Care • The birth rate for Rock County is 12.4 per 1,000, which is less than the state and national rates of 12.0 per 1,000 and 13.0 per 1,000, respectively • Pregnant women in Rock county are slightly less likely to attend their first prenatal visit within the first trimester compared to other women on the state and national level • About 17% of mothers report smoking during pregnancy in Rock County, compared to 13% throughout the state Source: Wisconsin Department of Health Services, Profile for Rock County 2010; Kaiser Family Foundation, 2012; WISH 2010
Infant Mortality
Source: Department of Health Services, Wisconsin Interactive Statistics on Health, 2010.
HEALTH RESOURCE AVAILABILITY
Access • Residents can receive hospital-based services at the four hospitals located in Rock County: – – – –
Beloit Memorial Hospital (Beloit) Edgerton Hospital (Edgerton) Mercy Hospital and Trauma Center (Janesville) St. Mary’s Hospital (Janesville)
• Health care services may also be received at little or no cost from several community health centers, including – HealthNet – Beloit Area Community Health Center
Access • Primary care and specialist physicians throughout Rock County provide – General primary care services – Advanced surgical interventions – Coordinated treatment plans for multiple chronic conditions
• 35% of residents receive care services outside the county. Reasons for leaving Rock County include: – – – –
Being instructed to do so by a doctor Inability to access care in the area Personal preference Insurance reasons
Source: Rock County Community Needs Survey 2014
Access If you go outside of Rock County for health care services, where do you go? Location Madison, WI Milwaukee, WI Walworth County, WI Monroe, WI Fort Atkinson, WI Marshfield, WI Rockford, IL Other
Source: Rock County Community Needs Survey 2014
Percent (%) 22.0% 1.7% 1.7% 0.6% 1.4% 0.8% 2.6% 4.3%
Insurance Coverage • 11% of Rock County residents under age 65 are uninsured – Greater than state average (10%) – Less than the national average (15.6%)
• Frequently cited reason for residents not having insurance: – Inability to pay premiums – Inability to quality for medical assistance programs Source: County Health Rankings and Community Needs Survey, 2014.
NEXT STEPS
Next Steps • Completion of surveys, secondary research, and MAPP assessments revealed some of the challenges that Rock County faces in providing health care services to its residents. These challenges, used to identify the Steering Committee’s priorities, include: – – – – –
Increasing levels of alcohol and drug abuse; Inadequate access to mental health professionals; Underutilization of dental health services; Poor lifestyle choices (e.g. smoking, inactivity); and Underutilization of certain preventive health screenings.
Next Steps • The Steering Committee will continue to monitor these health priorities and communicate the report’s findings to health care providers in Rock County. Committee members, and their respective organizations, will continue to collaborate to set goals and formulate action plans to ensure that the priority conditions are understood by – – – –
providers, administrators, school-board personnel, and most importantly, Rock County residents.