Texas Health Harris Methodist Hospital Alliance 2016 Community Health Needs Assessment
Community Health Needs Assessment Outline Report Contents • Background – About the Organizations – CHNA Overview & Executive Summary
• Service Area Demographics • Data Analysis – Secondary Data – Key Informant Interviews & Focus Groups – Online Community Survey
• Data Synthesis – Community Health Needs – Community Health Disparities – Community Health Barriers
• Prioritization – Methodology – 2016 Priority Health Topics
Appendix Contents I. County Level Data Scoring II. Secondary Data Sources III. Community Resources Cited in Primary Data IV. Organizations Represented in Focus Group & Key Informant Interviews V. Prioritization Participants VI. Evaluation of Actions Taken Since Preceding CHNA VII. Service Area Zip Codes VIII. CHNA Project Team & Hospital Leadership IX. IRS Checklist
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Background
About Texas Health Resources
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Mission To improve the health of the people in the communities we serve. Vision Texas Health Resources, a faith-based organization joining with physicians, will be the health care system of choice.
Values •
Respect – Respecting the dignity of all persons, fostering a corporate culture characterized by teamwork, diversity and empowerment.
•
Integrity – Conduct our corporate and personal lives with integrity; Relationships based on loyalty, fairness, truthfulness and trustworthiness.
•
Compassion – Sensitivity to the whole person, reflective of God's compassion and love, with particular concern for the poor.
•
Excellence – Continuously improving the quality of our service through education, research, competent and innovative personnel, effective leadership and responsible stewardship of resources.
Your feedback on this report is welcomed and encouraged. Please direct any questions or feedback to: Texas Health Resources System Services Community Health Improvement 612 E. Lamar Blvd., Suite 1400 | Arlington, TX 76011 Email: THRCHNA@texashealth.org Phone: 682-236-7990
About Healthy Communities Institute Healthy Communities Institute, a Xerox Corporation, was contracted by Texas Health Resources to conduct the 2016 Community Health Needs Assessment and to author the CHNA reports. Based in Berkeley, California, HCI provides customizable, web-based information systems that offer a full range of tools and content to improve community health, and developed the Healthy North Texas Platform. To learn more about Healthy Communities Institute please visit: www.HealthyCommunitiesInstitute.com
5 HCI’s mission is to improve the health, vitality, and environmental sustainability of communities, counties, and states
HCI Project Team & Report Authors Project Manager • Heather Cobb, MPH Secondary Data Lead • Rebecca Yae Primary Data Lead • Mari Rasmussen, MPH
Project Support: • Muniba Ahmad • Nicolia Eldred-Skemp, MPH • Claire Lindsay, MPH
About Texas Health Harris Methodist Hospital Alliance
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Texas Health Harris Methodist Hospital Alliance serves the communities of North Fort Worth, Keller, Haslet, Justin, Roanoke and the surrounding area with advanced medical treatments and an experienced staff that provides compassionate care. With a mission of improving the health of the people in the communities we serve, Texas Health Alliance and the physicians on its medical staff are committed to your well-being and the health and wellness of your family. Texas Health Alliance offers: • Emergency Department • Heart and Vascular • Imaging • Intensive Care • Occupational Health • Rehabilitation • Respiratory Therapy • Surgery • Women and Infants Care Texas Health Alliance is one of 103 facilities nationwide to be recognized for operating at the highest level of electronic medical record adoption: a paperless environment that helps improve efficiency, quality of care and patient safety. The hospital earned the Stage 7 award from Healthcare Information and Management Systems Society Analytics, the nation's major health information technology association. Stage 7 represents an "advanced patient record environment" and is the highest level on the electronic medical record adoption model used to track progress at hospitals and health systems. Texas Health Alliance is accredited by The Joint Commission for the Hospital Accreditation Program. Opened in 2012, Texas Health Alliance is a 74-bed hospital conveniently located near the intersection of Interstate 35W and Golden Triangle Boulevard.
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Community Health Needs Assessment Overview The Goal To improve the health of each hospital’s service area by using a data-based approach to address real community health needs and target resources where they are needed most.
Analyze Data & Gather Community Input
Prioritize Health Needs to be Addressed
Evaluate Actions Taken
CHNA 3-Year Cycle
• Mandated by the Affordable Care Act • Allows Hospitals to Maintain 501c3 Status Implementation Strategy
CHNA Report
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CHNA Process Overview & Executive Summary Community Input Collection
• In depth interviews and focus groups were conducted with individuals with public health expertise who were able to speak to the broad interests of the community and/or the needs of low-income/underserved populations. An online community survey was also distributed to collect input on community health needs, assets, and barriers from community members.
Primary Data Analysis
• The primary data gathered in the community input collection phase was analyzed by the two categories of “Key Informant/Focus Group” findings and “Online Community Survey” findings. Significant health needs, barriers, and assets/resources were identified by leveraging qualitative data analysis software from Dedoose© and Survey Monkey©.
Secondary Data Analysis
• The Healthy North Texas platform, which includes data on over 100 health indicators from vetted national and state sources, was leveraged along with Prevention Quality Indicator data from The DFW Hospital Council. HCI’s data scoring methodology was used to compare indicator values at national, state, and county levels as well as trends over time and Healthy People 2020 targets.
Data Synthesis & Significant Health Needs
Prioritization of Significant Health Needs
• The qualitative (community input/primary data) and quantitative (secondary data) analysis findings were synthesized to identify significant community health needs. Health needs were considered “significant” if at least two of the following data types cited the topic as a pressing health concern: Key Informant/Focus Group Findings, Survey Findings, Secondary Data Findings. • Key hospital staff and community stakeholders utilized the data analysis and synthesis findings to vote on which significant health needs will be prioritized for implementation strategy development consideration. Participants engaged in multiple rounds of voting and discussion and considered specific system-wide criteria for prioritizing significant health needs.
Texas Health Alliance’s Priority Health Needs for 2016 CHNA Mental Health & Mental Disorders
Older Adults & Aging
Exercise, Nutrition, & Weight
Diabetes
Service Area Demographics
Service Area Demographics Summary
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The demographics of a community significantly impact its health profile. Different race/ethnic, age, and socioeconomic groups may have unique needs and require varied approaches to health improvement efforts. This section explores the demographic profile of Texas Health Alliance’s service area. *All demographic estimates are sourced from the U.S. Census Bureau’s 2010-2014 American Community Survey unless otherwise indicated.
Service Area Population Count Total Population Count: 459,733
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Service Area Population by Age There are more people aged 5-17 and 25-64 years old in Texas Health Alliance’s service area compared to the state of Texas, and fewer people between the ages of 18-24 and 65 years old and above. 35.0%
29.3%
30.0%
28.1% 25.7%
25.0%
24.0% 22.1% 19.4%
20.0%
15.0% 10.9%
10.3% 10.0% 7.4% 7.4%
8.2%
7.3%
5.0%
0.0%
<5
5-17
18-24 Texas Health Alliance
25-44 Texas
45-64
65+
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Service Area Population by Race/Ethnicity 90.0% 81.6%
When compared to the state of Texas, Texas Health Allianceâ&#x20AC;&#x2122;s service area has a larger White and Asian population, and a smaller Black, Other, and Hispanic population.
80.0% 74.7%
70.0%
60.0%
50.0%
38.2%
40.0%
30.0%
20.0%
16.1% 11.9%
10.0%
5.4% 0.6% 0.5%
Black
3.7% 0.2% 0.1%
0.0%
White
6.4%
5.0% 4.1%
American Indian or Alaskan Native
Asian
Native Hawaiian or Pacific Islander
Texas Health Alliance
Texas
Other
3.6% 2.4%
Two or More Races
Hispanic
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Service Areaâ&#x20AC;&#x2122;s Social and Economic Characteristics 50.0%
Overall, Texas Health Allianceâ&#x20AC;&#x2122;s service area is faring better than Texas across social and economic metrics.
40.0%
$100,000
39.4% $80,000
27.1%
30.0%
29.3%
$40,000
10.0%
$20,000
0.0%
$0
People 25+ with a Bachelor's Degree or Higher 20.0%
Median Household Income 20.0%
Texas United States
$52,576 $53,482
$60,000
20.0%
Texas Health Alliance
$89,764
17.7% 15.6%
15.0%
15.0%
9.2%
10.0%
7.7%
10.0%
5.6%
5.5%
5.0%
5.0%
0.0%
0.0%
Unemployment Rate
People Living Below Poverty Level
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People Living Below Poverty Level by Race/Ethnicity All racial and ethnic subpopulations, except for White and American Indian/Alaska Native, have a significant number of people living below the federal poverty level. Overall, 5.5% of people in Texas Health Alliance's service area are living below the poverty level. 16.0%
14.0%
13.5%
12.0% 10.7% 10.1% 10.0%
9.3%
8.0%
7.1%
6.6% 6.0%
5.5% 4.1% 4.0%
2.0% 0.5% 0.0%
White, nonHispanic
Black or African American
American Indian or Alaska Native
Asian
Texas Health Alliance
Native Hawaiian or Other Pacific Islander
Other
Overall Value
Two or more Hispanic or races Latino
Service Area Population Living Below Poverty Line Zip Codes with Highest Percentage of Population Living Below Poverty Line: 76137 & 76180
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Service Area Households with No Vehicle Zip Codes with Highest Percentage of Households with No Vehicle: 76180
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HCIâ&#x20AC;&#x2122;s SocioNeeds Index
Income Poverty Unemployment Occupation Education Language
QQQQ QQQQ QQQQ
Index Value This index incorporates estimates for six different social and economic determinants of health that are associated with poor health outcomes. The indicators were standardized and averaged to create one composite index value for each zip code. Zip codes with higher values are estimated to have higher socioeconomic need, which is correlated with poorer health. More information can be found by clicking on the SocioNeeds Index tab at www.HealthyNTexas.org.
Service Area SocioNeeds Index Zip Codes with Highest Socioeconomic Need: 76148 & 76180
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Data Analysis
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Data Analysis Overview In order to determine the significant health needs for Texas Health Alliance’s service area population, multiple sources of data were analyzed: • Secondary data, or numerical health indicators, from the Healthy North Texas web platform were analyzed and scored based on their values. • Interviews and focus groups were conducted with community members who have a fundamental understanding of public health and represent the broad interests of the community. • An English-language community survey was distributed to people who live and work in the area.
Secondary Data
Interviews & Focus Groups
Significant Health Needs
Online Community Survey
Each data source listed above has its own set of strengths and limitations, so the findings from all three data sets were compared and studied together. If a health need appeared in more than one of the data sources, then that health need was considered to be significant for the community.
Data Analysis Secondary Data
Secondary Data Analysis Overview
This section describes how secondary data was collected and analyzed using the Healthy North Texas web platform, and HCI’s “Secondary Data Scoring” technique to rank and identify which health topics have the greatest room for improvement. Secondary data refers to data that has been collected from vetted local, state, and national sources. Examining secondary data allows us to compare numerical values for specific health indicators.
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Secondary Data
Interviews & Focus Groups Online Community Survey
Significant Health Needs
Secondary Data Analysis â&#x20AC;&#x201C; Healthy North Texas Platform
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Healthy North Texas (www.HealthyNTexas.org) is a publicly available data platform that was leveraged to conduct this assessment. The platform contains a dashboard of over 100 health and quality of life indicators from public state and national secondary data sources and is maintained by the Healthy Communities Institute.
Secondary Data Analysis – County-Level Secondary Data Scoring
Data scoring is a tool developed by HCI to systematically score and rank health indicators and topics. Data scoring summarizes the many types of comparisons for each indicator, which are then summarized by broader health topics.
Comparisons
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• Quantitatively score all possible comparisons
Indicators
• Summarize comparison scores for each indicator
Topics Each indicator score factors in how each county compares to other counties in Texas, other counties in the U.S., the Texas state value, the U.S. value, Healthy People 2020 targets, and the trend over the four most recent time periods of measure.
• Summarize indicator scores by topic area
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County Level Analysis â&#x20AC;&#x201C; Secondary Data Scoring
All indicators on the Healthy North Texas platform, along with PQI data provided by Texas Health, were analyzed and scored based on the comparisons to the right. Health indicators are grouped into topic areas for a higher level ranking of community health needs.
Texas Counties US Counties Texas State
US Value HP 2020
QQQQ QQQQ QQQQ
Trend
Indicator Score
Topic Score
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County Level Analysis â&#x20AC;&#x201C; Secondary Data Scoring Data Scoring Example: Calculating the topic score for Cancer The overall topic score represents the average of all health indicators relevant to the topic of cancer.
Cancer Topic Score: 1.50 Score range: Good
0
Bad
1
2
3
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Tarrant County Level Analysis â&#x20AC;&#x201C; Secondary Data Scoring The results below represent the data scoring for all health and quality of life topics for which data was available on the Healthy North Texas platform for Tarrant County.
Score range: Good
0
Bad
1
2
3
Data Analysis Interviews & Focus Groups
Interview & Focus Group Analysis Overview This section describes how interviews and focus groups with people who live and work in the community were conducted and analyzed to determine significant health needs. The interviews and focus groups captured valuable community input and provide additional insight into the communityâ&#x20AC;&#x2122;s significant health needs. Persons with public health expertise, the ability to speak on the needs of lowincome, underserved, or minority populations, and the ability to speak on the broad interests of the community were asked to act as key informants for interviews and as focus group participants.
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Secondary Data
Interviews & Focus Groups Online Community Survey
Significant Health Needs
Interview & Focus Group Analysis Six interviews were conducted between 12/8/15-1/29/16, and one focus group discussion took place on 1/19/16 with 17 attendees. Interview and focus group discussion questions were organized around the following themes and questions shown below: • Community Health Status: How would you rate the health status of the community? • Health Needs/Issues: What are the major health needs/issues you see in the community? • • •
Data gaps: Could you help us fill in data gaps by telling me a little about how [topic area] is impacting the community? Barriers: What are barriers to receiving care and for building a healthy community? Impact by population: Who in your community appears to struggle most with these issues you’ve identified and how does it impact their lives?
• Community Resources: Could you tell me about some of the strengths and resources in your community that address these issues, such as groups, initiatives, services, or programs?
• The Role of the Hospital: How can Texas Health better partner with you to improve the health of the communities we serve together?
• Vision of the Community: What is your vision for a healthy community?
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Interview & Focus Group Analysis
Notes from the interviews and the focus group discussion were transcribed and uploaded to the web-based qualitative data analysis tool, DedooseŠ. The transcriptions were coded by relevant health topic areas and themes. The frequency with which a health topic was discussed was used to assess the relative importance of that health and/or social need and determine the most pressing health needs of the community. The word cloud below illustrates the most prominent themes in the interviews and focus group discussions for Texas Health Alliance. Themes mentioned more frequently are displayed in larger font.
Source: Wordle.com
Interview and Focus Group Analysis - Results The results below represent the most frequently cited community health needs, barriers to community health, and populations most negatively affected by poor health outcomes according to the community members who were interviewed and focus group participants.
Top Community Health Needs 1. Exercise, Nutrition, & Weight 2. Access to Health Services 3. Economy 4. Environment 5. Mental Health & Mental Disorders 6. Substance Abuse 7. Older Adults & Aging
Top Barriers to Community Health 1. Transportation 2. Cultural/Language Barriers 3. Healthcare Navigation
Most Negatively Impacted Populations • • • •
Low-Income/Underserved Homeless Hispanic/Latino African-American
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Data Analysis Online Community Survey
Online Community Survey Analysis Overview An online survey was developed using Survey Monkey© in order to gain additional insight into community health needs. The link was distributed widely across Texas Health’s service area, and the results in this report are based on the cities and towns that comprise Texas Health Alliance’s service area.
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Secondary Data
Interviews & Focus Groups
Significant Health Needs
Online Community Survey
This was a convenience sample survey which means results may be vulnerable to selection bias and make the findings less generalizable. The online survey was conducted only in English, therefore the demographics of respondents may not mirror the actual demographics of the service area. A total of 506 people from Texas Health Alliance’s service area responded to the survey between 12/1/15 – 2/12/16. The results of the online community survey are highlighted on the following slides.
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Online Community Survey Results – Respondent Demographics • Gender: 27% Male, 73% Female • 21% of respondents were Healthcare Professionals • 67% have Bachelor’s Degree or higher **Note: Convenience Sample Survey, demographics of respondents do not mirror the actual demographics of the service area Race
Annual Household Income 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%
16% 16% 10% 10%
3%
3%
White Black or African American
Age 47%
50%
American Indian or Alaska Native
40%
Asian
30%
35%
18%
20%
White, 84%
19% 18%
Native Hawaiian and Other Pacific Islander 10%
Two or more races Other (please specify)
0%
0%
0%
<18
18-24
25-44
45-64
65+
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Online Community Survey Results â&#x20AC;&#x201C; Community Health Needs Results below pertain to what survey respondents feel are the greatest community health needs. Community Health Needs Obesity/Overweight
69%
Diabetes
45%
Heart Disease & Stroke
40%
Mental Health & Mental Disorders
34%
Substance Abuse (alcohol, tobacco, e-cigs, drugs, etc.)
32%
Cancer
31%
Clinical Prevention Services
22%
Injury, Violence & Safety
15%
Immunization & Infectious Diseases
14%
Respiratory/Lung Diseases (asthma, COPD, etc.)
13%
Oral Health
8%
Reproductive Health (family planning)
7%
Sexual Health (HIV, STD/I, etc.)
7% 0%
10%
20%
30%
40%
50%
60%
70%
80%
Online Community Survey Results â&#x20AC;&#x201C; Community Health Social Determinants
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Social determinants are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The results below show which social determinants respondents feel have the most significant impact on the health of their community. Social Determinants of Health Diet, Food and Nutrition
57%
Physical Activity and Exercise
41%
Access to Health Services
39%
Employment (jobs, etc.)
38%
Education
35%
Economy (housing, etc.)
31%
Transportation
25%
Language Barriers I Cultural Diversity
24%
Social Environment (faith, friendship, family, etc.)
17%
Environmental Quality (exposure to secondhand smoke,â&#x20AC;Ś 0%
12% 10%
20%
30%
40%
50%
60%
Online Community Survey Results â&#x20AC;&#x201C; Community Assets & Barriers to Health
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Results below pertain to respondentsâ&#x20AC;&#x2122; views on community assets and barriers to health Community Assets I consider my community to be safe.
Agree
Public transportation and other transit opportunities make accessing health services manageable.
Neutral
Agree
I and members of my community feel we have a voice in our community.
Neutral
Agree
Infrastructure in my community supports a healthy lifestyle.
Neutral
Agree
My community is knowledgeable of the health resources available to them.
Neutral
Agree 0%
40%
Disagree Disagree Disagree
Neutral
20%
Disagree
Disagree 60%
80%
100%
Community Barriers I, or someone I know, have delayed seeking health care due to cost in the last 12 months.
Agree
I, or someone I know, have delayed seeking health care due to wait times or limited appointment opportunity.
Neutral Disagree
Agree
There is a lack of resources related to health improvement in this community.
Agree
I, or someone I know, have had difficulty understanding a health professional because of a language barrier in the last 12 months.
Agree 0%
20%
Neutral
Neutral
Disagree
Neutral 40%
Disagree
Disagree 60%
80%
100%
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Online Community Survey Results â&#x20AC;&#x201C; Community Health Disparities Populations Highly Impacted by Poor Health Outcomes Low income
68%
Older Adults
57%
Children
33%
Persons with Disabilities
27%
Racial or Ethnic Populations 25% Results to the Teen and Adolescent 15% right pertain to Women 10% which Maternal, Fetal, and Infant 6% Refugees 6% racial/ethnic Men 4% groups and Lesbian, Gay, Bisexual, and Transgender 4% specific 0% 10% 20% 30% 40% populations Highly Impacted Race/Ethnic Groups respondents view Black or African American as being most HIspanic/Latino negatively Two or More Races 3% affected by poor Asian 1% health outcomes. American Indian or Alaska Native
1%
Native Hawaiian and Other Pacific Islander
0.2%
0.0%
10.0%
20.0%
50%
60%
70%
80%
36% 35%
30.0%
40.0%
Data Synthesis Identifying Significant Community Health Needs
Data Synthesis Overview
As mentioned in the data analysis overview of this report, each data source listed to the right has its own set of strengths and limitations. In order to gain a comprehensive understanding of the significant health needs for Texas Health Allianceâ&#x20AC;&#x2122;s service area, the findings from all three data sets were compared and studied together. This will be illustrated using a Venn diagram on the following slides.
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Secondary Data
Interviews & Focus Groups Online Community Survey
Significant Health Needs
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Data Synthesis Overview
The secondary data, interviews and focus group, and the online community survey were treated as three separate sources of data. The top five to seven health needs identified by each data source were analyzed for areas of overlap with the other two data sources. Health needs were determined to be significant if they were cited as a top need in at least two of the three data sources.
Top Needs in Secondary Data
Significant Significant Health Health Needs Significant Needs Health Needs Top Needs in Top Needs in Online Interviews & Significant Community Focus Group Health Survey Needs
Data Synthesis Results for Texas Health Harris Methodist Alliance
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Secondary Data • Other Chronic Conditions* • Children’s Health
Community Input
Online Community Survey
• Heart Disease & Stroke
*Topic Includes Indicators for: Kidney Disease, Osteoporosis, & Arthritis
• Older Adults & Aging
• Mental Health & Mental Disorders
• Diabetes • Cancer
• Substance Abuse • Exercise, Nutrition, Weight (Obesity) • Access to Health Services
• Economy • Environment
Interviews and Focus Group
Texas Health Alliance Significant Community Health Needs Summary
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Access to Health Services • •
Improved access to comprehensive, quality health care services is one of the HP2020 goals, and an important concern in order to improve health equity and quality of life. Topic area includes indicators of or directly related to health care provider rate, health insurance status, usual source of health care, and difficulties obtaining health care
Exercise, Nutrition, & Weight • •
Nutritious diets, regular physical activity, and healthy weight maintenance are all important aspects of chronic disease prevention. The HP2020 goal is to improve health and quality of life through these behaviors. Topic area includes indicators of or directly related to physical activity, obesity/overweight, and nutrition
Heart Disease & Stroke • •
Heart disease is the leading cause of death in the US. HP2020’s goal is to improve cardiovascular health through prevention, detection, and treatment of risk factors for heart attacks and strokes. Topic area includes indicators of or directly related to prevalence, complications, and deaths due to heart disease, stroke, high blood pressure, heart attack, etc.
Mental Health & Mental Disorders • •
Mental disorders are among the most common forms of disability. The HP2020 goal is to improve mental health through prevention and by ensuring access to appropriate, quality mental health services. Topic area includes indicators of or directly related to access to mental health care, prevalence of mental illness, and general mental health status
Older Adults & Aging • •
Older adults are among the fastest growing age group and are at high risk for developing chronic illness and related disabilities. The HP2020 goal is to improve the health, function, and quality of life of older adults. Topic area includes indicators of or directly related to health issues specific or especially pertinent to older adults (usually age 65+)
Substance Abuse • •
Substance use and abuse impact individuals, families, and entire communities. HP2020’s goal is to reduce substance abuse in order to protect the health, safety, and quality of life for all, especially children Topic area includes indicators of or directly related to alcohol abuse, tobacco use, illegal substance use, and abuse of prescription drugs
Significant Community Health Needs
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Exploring Significant Health Needs - Overview Slide
Data analysis findings relevant to the significant health needs identified in the data synthesis will be outlined on the following slides using the format below: Secondary Data Topic Score: Warning Indicators for health topic from secondary data scoring and comparison values
Quote from Key Informant or Focus Group Participant
Survey How the community health need ranked in online community survey
Major themes from key informant interviews and focus groups
Key Informant Interviews & Focus Group Discussions
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Access to Health Services Secondary Data Topic Score:
76.1% of adults had health insurance (US: 83.7%; HP2020: 100%) 90.3% of children had health insurance (US: 94%; HP2020: 100%) 59.0% of adults had visited a dentist (US: 67.2%)
Survey
3rd most impactful social determinant on Community Survey
•
•
Convenience and cost are big barriers to receiving care in the community. Cost is getting really outrageous – most people in the community have insurance but the problem comes along with high deductibles and high copays.
Difficult to access services due to time, location constraints, cost Need more accessibility of providers, preventive health options, and specialty services (e.g. oncology)
Key Informant Interviews & Focus Group Discussions
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Exercise, Nutrition, & Weight Secondary Data Topic Score: 18.5% of residents experienced food insecurity (US: 15.8%) 0.8 fast food restaurants per 1,000 population 29.4% of adults were obese (US: 27.6%)
Survey
1st
•
most pressing health need in Community Survey
•
(obesity/overweight)
•
•
The biggest health needs I see in the community are around nutrition and physical activity. With regards to nutrition, it’s issues of chronic disease, food security/deserts, and food prep skills. For physical activity, it’s obesity, chronic disease, and safety.
Difficult for all to access healthy foods Sedentary lifestyle contributes to obesity in children and adults Lack of nutritional education Physical activity and public safety
Key Informant Interviews & Focus Group Discussions
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Heart Disease & Stroke Secondary Data Topic Score:
46.9% of Medicare population had hyperlipidemia (US: 44.8%) 17.2% of Medicare population suffered from heart failure (US: 14.6%)
4.6% of Medicare population suffered from stroke (US: 3.8%)
Survey
3rd most pressing health need in Community Survey
Stress, overweight, obesity and all the chronic diseases that are associated with those issues such as cardiovascular disease, high cholesterol, hypertension, diabetes.
â&#x20AC;˘ Side effect of obesity and poor nutrition â&#x20AC;˘ Sedentary lifestyle is a contributing factor
Key Informant Interviews & Focus Group Discussions
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Mental Health & Mental Disorders Secondary Data Topic Score: 19.8% of the Medicare population had depression (TX: 16.2%) 13.7% of the Medicare population had Alzheimer’s disease or dementia (US: 9.8%)
Survey
4th most pressing health need in Community Survey
• • •
•
There needs to be more mental health care in the community. Health care doesn’t have to do just with physical health, but also mental health as well. There’s not enough resources for mental health in communities, it’s only found in large metropolitan areas and needs to be elsewhere too.
Mental health stigma Issues such as stress and depression Lack of resources and affordable facilities for uninsured Co-occurring mental health & substance abuse issues
Key Informant Interviews & Focus Group Discussions
52
Older Adults & Aging Secondary Data Topic Score:
6.3% of the Medicare population had asthma (US: 4.9%) 18.9% of the Medicare population had chronic kidney disease (TX: 16.6%)
8.2% of the Medicare population had cancer (TX: 7.1%)
Survey
2nd
•
most impacted population by health needs in Community Survey
•
•
•
There are many seniors in the community who do not have someone close that is caring for them – can lose their way on a daily basis during a very regular errand… Transportation is a really big issue for seniors to get to and from doctors appointments and other facilities.
Affordability of prescription medications Issues such as Alzheimer’s and dementia Rapidly growing senior population Food insecurity and housing
Key Informant Interviews & Focus Group Discussions
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Substance Abuse Secondary Data Topic Score: 20% of adults smoke (TX: 18.2%) 32.5% of deaths in automobile accidents were due to alcohol-impaired driving (US: 32.8%)
Survey
5th most pressing health need in Community Survey
•
• • • •
My community could be healthier if addictions were treated in a holistic way, affordably and regularly, without stigma. Need to care for the mind, body, and soul to treat the illness.
Tobacco smoking rates still high E-cigarette usage increasing Stigma associated with addiction Co-occurrence with mental health issues Concern with pain medication
Key Informant Interviews & Focus Group Discussions
Significant Community Health Disparities & Barriers
Investigating Health Disparities & Barriers
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Secondary Data: An important goal of the CHNA process is identifying unmet health needs in underserved populations. Health disparities and barriers were identified using the 3-pronged approach described to the right.
Index of Disparity: Identifies large disparities based on how far each subgroup (by race/ethnicity) is from the overall county value SocioNeeds Index: Identifies socioeconomic disparities by zip code
Primary Data: Key Informants and Focus Group Participants were asked which racial, ethnic, or special population groups were most negatively impacted with respect to community health concerns, and what barriers to health exist in their communities
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Texas Health Alliance Significant Health Disparities Disparity Findings in Primary Data •
Infant mortality in African-American population
Comments from Key Informants: The low-income population is struggling most… Some people need to take their stroke and heart attack medications but can’t [afford to take it] so end up having those events. Haslet has about 2,000 people in the city. The city has a higher income compared to other communities and most people (high 90%) have insurance. We don’t necessarily see many people of other races – medically don’t deal with many people who aren’t white in this area.
Disparity Findings in Secondary Data • Death Rate due to Diabetes among African Americans • Infant Mortality among African Americans • Suicide Rates Among Whites • Infants Born to Mothers with <12 years Education among Hispanics
Definitely a racial and ethnic disparity in our county with respect to African Americans, the county is also 1/3 Hispanic. In some areas resources are better, but in many places accessibility is an issue – it depends on socioeconomic status.
Zip Codes w/ Greatest Socioeconomic Need: • 76148 • 76180
57
Texas Health Alliance Significant Health Barriers Top 3 Barriers Cited by Key Informants & Focus Group Participants Transportation
Cultural/Language Issues
Healthcare Navigation
- Public transit options are limited - 1 zip code with >6% of pop. with no vehicle
- Cultural differences - Family beliefs - Distrust
- Lack of education on resources - Difficulty navigating system
Transportation is an issue for a variety of population groups, not just low income. There is the T bus line, but it doesn’t reach all parts of the city/county. And it also doesn’t run frequently. The trains still require someone to have a vehicle to get to the train.
It’s a case of accessing up to date resources within the community… and the perception that what is available is known by those living within the community. People not knowing what to do next. Communication between the educators and those needing help.
I’m seeing language and cultural barriers rising in the community, especially among seniors. This wasn’t an issue necessarily five years ago.
Community Barriers
I, or someone I know, have delayed seeking health care due to cost in the last 12 months.
Agree
I, or someone I know, have delayed seeking health care due to wait times or limited appointment opportunity.
Neutral
Agree
There is a lack of resources related to health improvement in this community.
Agree
I, or someone I know, have had difficulty understanding a health professional because of a language barrier in the… 0%
Agree 20%
Neutral
Neutral
Disagree
Disagree
Neutral 40%
Disagree
Disagree 60%
80%
100%
Texas Health Alliance Significant Health Topics & Barriers - Summary Significant Health Topics Access to Health Services Exercise, Nutrition, & Weight (Obesity) Heart Disease & Stroke Mental Health & Mental Disorders Older Adults & Aging Substance Abuse Significant Health Barriers Transportation Language/Cultural Barriers Healthcare Navigation & Literacy
Data synthesis revealed these significant health topics and barriers for Texas Health Allianceâ&#x20AC;&#x2122;s service area. The health topics and barriers on the left represent the full list of significant community health needs that were considered for prioritization.
58
Prioritization of Significant Community Health Needs
Prioritization Process & Criteria
60
To prioritize the significant health topics and barriers for Texas Health Alliance’s service area, key hospital staff and community stakeholders engaged in multiple rounds of voting and discussion on 5/17/16. For each round, prioritization participants were allowed a set number of votes. After each round of voting, participants discussed results and eliminated health topics with the lowest number of votes. Prior to the voting and discussion, prioritization participants were asked to consider how each significant health need applied to the following criteria: • Alignment w/National, State, or Local Initiatives: Does the health issue align with larger public health improvement efforts? • Magnitude: Does the issue affect a large percentage of your community’s population? • Economic Burden on Community: Does the health issue cause financial strain on individuals or the community as a whole? • Severity: Is there a high probability of complications (morbidity & mortality) associated with health issue?
• Opportunity to Intervene at Prevention Level: Can we address the health issue before it gets exacerbated?
61
Texas Health Alliance Priority Health Topics for 2016 CHNA
Significant Health Topics & Barriers
Texas Health Prioritization Criteria
Votes from Hospital Staff & Community Health Council
Texas Health Allianceâ&#x20AC;&#x2122;s Priority Health Topics for 2016 CHNA Mental Health & Mental Disorders
Older Adults & Aging
Exercise, Nutrition, & Weight
Diabetes
These priority health topics will subsequently be considered for implementation planning.
Appendices
The following information can be found in the Appendices: I. II. III. IV.
Data Scoring Outputs Secondary Data Sources Resources Cited from Community Input Organizations Represented in Focus Groups & Key Informant Interviews V. Prioritization Session Participants VI. Evaluation of Actions Taken Since Preceding CHNA VII. Service Area Zip Codes VIII.CHNA Project Team & Hospital Leadership IX. IRS Checklist
62
Appendices
Appendix I: Tarrant County Data Scoring SCORE 1.81 1.69 1.67 1.42 1.25 1.08
ACCESS%TO%HEALTH%SERVICES Adults+with+Health+Insurance Children+with+Health+Insurance Adults+who+Visited+a+Dentist NonNPhysician+Primary+Care+Provider+Rate Primary+Care+Provider+Rate Dentist+Rate
SCORE CANCER 2.67 Cancer:+Medicare+Population 2.25 Cervical+Cancer+Incidence+Rate Oral+Cavity+and+Pharynx+Cancer+Incidence+ 1.69 Rate 1.67 Pap+Test+History AgeNAdjusted+Death+Rate+due+to+Prostate+ 1.53 Cancer 1.50 Breast+Cancer+Incidence+Rate 1.50 Colon+Cancer+Screening 1.50 Prostate+Cancer+Incidence+Rate AgeNAdjusted+Death+Rate+due+to+Colorectal+ 1.44 Cancer AgeNAdjusted+Death+Rate+due+to+Breast+ 1.36 Cancer 1.33 All+Cancer+Incidence+Rate 1.22 AgeNAdjusted+Death+Rate+due+to+Cancer 1.22 AgeNAdjusted+Death+Rate+due+to+Lung+Cancer 1.17 Mammogram+History 1.00 Lung+and+Bronchus+Cancer+Incidence+Rate 0.89 Colorectal+Cancer+Incidence+Rate
SCORE 1.83 1.69 1.67 1.39
CHILDREN'S%HEALTH Children+with+Low+Access+to+a+Grocery+Store Children+with+Health+Insurance Child+Food+Insecurity+Rate LowNIncome+Preschool+Obesity
UNITS percent percent percent providers/100,0002population providers/100,0002population dentists/100,0002population
TARRANT+ COUNTY 76.1 90.3 59.0 51 58 53
UNITS percent cases/100,0002females
TARRANT+ COUNTY 8.2 9.1
cases/100,0002population percent
11.6 75.0
deaths/100,0002males cases/100,0002females percent cases/100,0002males
21.7 120.5 65.7 125.4
deaths/100,0002population
64 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2014 2014 2012 2014 2012 2013
HP2020 100.0 100.0
TEXAS 74.3 89.0 58.8 53 59 52
U.S. 83.7 94.0 67.2
HP2020 7.1
TEXAS 7.1 9.2
U.S. 7.9 7.7
93.0
10.6 74.6
11.3 78.0
2008:2012 2012
21.8
19.6 113.1 62.6 115.7
19.6 123.0 67.3 131.7
2008:2012 2008:2012 2012 2008:2012
15.9
14.5
15.4
14.7
2008:2012
deaths/100,0002females cases/100,0002population deaths/100,0002population deaths/100,0002population percent cases/100,0002population cases/100,0002population
21.1 441.1 168.6 46.4 79.5 62.6 40.2
20.7
38.6
21.0 417.8 164.6 43.5 72.0 58.1 40.2
21.3 453.8 166.4 45.0 77.0 63.7 41.9
2008:2012 2008:2012 2008:2012 2008:2012 2012 2008:2012 2008:2012
UNITS percent percent percent percent
TARRANT+ COUNTY 7.7 90.3 25.5 14.3
HP2020
TEXAS
U.S.
100.0
89.0 27.4
94.0 21.4
161.4 45.5
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012 2008:2012
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2010 2014 2013 2009:2011
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE 1.94 1.78 1.78 1.61 1.56 1.33 1.14
DIABETES Diabetes+Short@Term+Complication Diabetes:+Medicare+Population Uncontrolled+Diabetes Rate+of+Lower@Extremity+Amputation Diabetes+Long@Term+Complication Adults+with+Diabetes Age@Adjusted+Death+Rate+due+to+Diabetes
SCORE ECONOMY 2.17 Food+Insecurity+Rate 2.00 Homeownership Households+with+Cash+Public+Assistance+ 2.00 Income 1.92 Severe+Housing+Problems 1.89 SNAP+Certified+Stores Renters+Spending+30%+or+More+of+Household+ 1.78 Income+on+Rent 1.75 Students+Eligible+for+the+Free+Lunch+Program 1.67 Child+Food+Insecurity+Rate
UNITS hospitalizations/100,000 percent hospitalizations/100,000 hospitalizations/100,000 hospitalizations/100,000 percent
TARRANT+ COUNTY 71.9 28.0 13.0 21.1 124.6 9.6
deaths/100,0005population
21.0
UNITS percent percent
TARRANT+ COUNTY 18.5 56.5
percent percent stores/1,0005population percent percent percent
65 TEXAS 62.5 28.6 12.6 22.0 119.1 10.6
U.S.
22.0
21.2
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013 2012 2013 2013 2013 2012 Black+(42.8)+White+(17.7)+Other+ 200982013 (18.8)+Hisp+(28.6)
TEXAS 17.6 55.8
U.S. 15.8 56.9
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013 200982013
2.1 17.4 0.6
1.8 18.3
2.8
200982013 200782011 2012
49.3 48.3 25.5
49.1 53.1 27.4
52.3
200982013 201382014 2013
HP2020
HP2020
27.0
9.7
21.4
1.67
Families+Living+Below+Poverty+Level
percent
11.7
13.7
11.3
200982013
1.50
Children+Living+Below+Poverty+Level Low@Income+and+Low+Access+to+a+Grocery+ Store People+Living+200%+Above+Poverty+Level Low@Income+Preschool+Obesity Low@Income+Persons+who+are+SNAP+ Participants
percent
22.1
25.3
21.6
200982013
percent percent percent
8.1 65.6 14.3
61.2
65.8
2010 200982013 200982011
percent
31.6
1.50 1.50 1.39 1.33
1.33 1.11
People+Living+Below+Poverty+Level Unemployed+Workers+in+Civilian+Labor+Force
percent percent
15.2 4.0
Black+(19.7)+White+(5.1)+Asian+(12)+ AIAN+(10)+NHPI+(23.8)+Mult+(13.1)+ Other+(25.6)+Hisp+(23) Black+(33.6)+White+(8.5)+Asian+(17.1)+ AIAN+(18.6)+NHPI+(39.2)+Mult+(14.9)+ Other+(36.9)+Hisp+(32.5)
2007
17.6 4.4
15.4 5.2
200982013 Aug52015
Black+(24)+White+(7.6)+Asian+(14.8)+ AIAN+(15.6)+NHPI+(24.8)+Mult+(14.7)+ Other+(27.3)+Hisp+(24.7)
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE ECONOMY'(cont.)
1.00 0.72 0.50
People+65++Living+Below+Poverty+Level Median+Household+Income Per+Capita+Income
SCORE EDUCATION 2.08 StudentYtoYTeacher+Ratio 1.89 High+School+Drop+Out+Rate Infants+Born+to+Mothers+with+<12+Years+ 1.25 Education
UNITS
TARRANT+ COUNTY
percent dollars dollars
8.5 56853 28266
UNITS students/teacher percent
TARRANT+ COUNTY 16.1 7.3
percent
0.33
People+25++with+a+Bachelor's+Degree+or+Higher
percent
SCORE 1.92 1.89 1.86 1.83 1.83 1.83 1.75 1.75 1.58
ENVIRONMENT Severe+Housing+Problems SNAP+Certified+Stores Annual+Particle+Pollution Children+with+Low+Access+to+a+Grocery+Store Fast+Food+Restaurant+Density Grocery+Store+Density Annual+Ozone+Air+Quality Food+Environment+Index Farmers+Market+Density LowYIncome+and+Low+Access+to+a+Grocery+ Store People+65++with+Low+Access+to+a+Grocery+ Store Recreation+and+Fitness+Facilities Drinking+Water+Violations Households+with+No+Car+and+Low+Access+to+a+ Grocery+Store Access+to+Exercise+Opportunities Liquor+Store+Density
UNITS percent stores/1,0008population grade percent restaurants/1,0008population stores/1,0008population grade
1.50 1.33 1.33 1.25 1.00 0.75 0.61
HP2020
66 TEXAS
U.S.
11.3 51900 26019
9.4 53046 28155
TEXAS 15.4 6.6
U.S.
19.5
21.6
15.9
29.5
26.7
28.8
TEXAS 18.3
U.S.
HP2020
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* Black+(19.3)+White+(5.8)+Asian+(11.5)+ AIAN+(13.4)+NHPI+(0)+Mult+(12.3)+ 2009*2013 Other+(23.2)+Hisp+(17.3) 2009*2013 2009*2013 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013*2014 2014 Black+(13.5)+White+(6.8)+Other+ 2013 (11.5)+Hisp+(38) 2009*2013
markets/1,0008population
TARRANT+ COUNTY 17.4 0.6 B 7.7 0.8 0.1 F 6.4 0.01
percent
8.1
2010
percent facilities/1,0008population percent
2.5 0.1 1.7
6.6
2010 2012 FY82013*14
percent percent stores/100,0008population
1.3 96.7 5.1
84.3 7.0
2010 2015 2013
HP2020
6.4 0.03
10.4
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2007*2011 2012 2011*2013 2010 2012 2012 2011*2013 2015 2013
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE 2.17 1.89 1.83 1.83 1.83 1.75 1.67 1.67 1.61 1.58 1.50 1.39 1.33 1.33 1.33 1.33 1.00 0.75
SCORE 2.33 2.11 2.00 1.94 1.89 1.83 1.75 1.34 1.34 0.92 0.83
67
percent percent percent markets/1,000/population
TARRANT+ COUNTY 18.5 0.6 7.7 0.8 0.1 6.4 66.2 25.5 29.4 0.01
percent percent percent
8.1 14.3 25.0
percent
31.6
2007
percent facilities/1,000/population
2.5 0.1
2010 2012
percent percent
1.3 96.7
UNITS percent percent percent percent hospitalizations/100,000 percent
TARRANT+ COUNTY 46.9 17.2 4.6 7.7 64.3 58.8
deaths/100,000/population hospitalizations/100,000 hospitalizations/100,000
46.1 9.5 329.3
deaths/100,000/population percent
173.5 28.4
EXERCISE,(NUTRITION,(&(WEIGHT Food+Insecurity+Rate SNAP+Certified+Stores Children+with+Low+Access+to+a+Grocery+Store Fast+Food+Restaurant+Density Grocery+Store+Density Food+Environment+Index Adults+who+are+Overweight+or+Obese Child+Food+Insecurity+Rate Adults+who+are+Obese Farmers+Market+Density LowWIncome+and+Low+Access+to+a+Grocery+ Store LowWIncome+Preschool+Obesity Adult+Fruit+and+Vegetable+Consumption LowWIncome+Persons+who+are+SNAP+ Participants People+65++with+Low+Access+to+a+Grocery+ Store Recreation+and+Fitness+Facilities Households+with+No+Car+and+Low+Access+to+a+ Grocery+Store Access+to+Exercise+Opportunities
UNITS percent stores/1,000/population percent restaurants/1,000/population stores/1,000/population
HEART(DISEASE(&(STROKE Hyperlipidemia:+Medicare+Population Heart+Failure:+Medicare+Population Stroke:+Medicare+Population Atrial+Fibrillation:+Medicare+Population Hypertension Hypertension:+Medicare+Population AgeWAdjusted+Death+Rate+due+to+ Cerebrovascular+Disease+(Stroke) Angina+Without+Procedure Heart+Failure AgeWAdjusted+Death+Rate+due+to+Heart+ Disease Ischemic+Heart+Disease:+Medicare+Population
HP2020
30.5
TEXAS 17.6
6.4 65.1 27.4 29.2
23.8
U.S. 15.8
63.4 21.4 27.6 0.03
23.4
34.8
2010 200982011 2009
2010 2015
84.3
HP2020
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013 2012 2010 2012 2012 2015 2012 2013 2012 2013
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012 2012 2012 2012 2013 2012
TEXAS 45.4 16.5 4.2 7.0 56.3 57.8
U.S. 44.8 14.6 3.8 7.8
42.6 9.0 317.0
37.9
200982013 2013 2013
175.5 30.9
175.0 28.6
200982013 2012
55.5
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE 2.11 1.94 1.67 1.61 1.39 1.33 1.17 1.17 1.06
SCORE 2.14 1.97 1.64 1.61 1.47 1.25 0.58
IMMUNIZATIONS*&*INFECTIOUS*DISEASES Syphilis+Incidence+Rate Gonorrhea+Incidence+Rate Adults+65++with+Pneumonia+Vaccination+ Chlamydia+Incidence+Rate Bacterial+Pneumonia Adults+65++with+Influenza+Vaccination HIV+Diagnosis+Rate Tuberculosis+Incidence+Rate AgeWAdjusted+Death+Rate+due+to+Influenza+and+ Pneumonia
MATERNAL,*FETAL*&*INFANT*HEALTH Infant+Mortality+Rate Mothers+who+Received+Early+Prenatal+Care Babies+with+Low+Birth+Weight Babies+with+Very+Low+Birth+Weight Preterm+Births Infants+Born+to+Mothers+with+<12+Years+ Education Teen+Births
SCORE MEN'S*HEALTH AgeWAdjusted+Death+Rate+due+to+Prostate+ 1.53 Cancer 1.50 Prostate+Cancer+Incidence+Rate 1.06 Life+Expectancy+for+Males
SCORE MENTAL*HEALTH*&*MENTAL*DISORDERS 2.83 Depression:+Medicare+Population Alzheimer's+Disease+or+Dementia:+Medicare+ 2.61 Population 1.33
AgeWAdjusted+Death+Rate+due+to+Suicide
UNITS cases/100,000)population cases/100,000)population percent cases/100,000)population hospitalizations/100,000 percent cases/100,000)population cases/100,000)population
TARRANT+ COUNTY 8.2 134.5 69.5 433.5 240.8 64.9 11.8 4.0
deaths/100,000)population
13.9
UNITS deaths/1,000)live)births percent percent percent percent
TARRANT+ COUNTY 7.1 56.3 8.1 1.5 11.6
percent percent
19.5 2.7
UNITS
TARRANT+ COUNTY
deaths/100,000)males cases/100,000)males years
21.7 125.4 76.0
UNITS percent
TARRANT+ COUNTY 19.8
percent
13.7
deaths/100,000)population
10.6
68
HP2020
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2014 2014 2012 2014 2013 2012 2014 201072014
TEXAS 5.9 127.7 70.3 475.0 236.4 59.4 16.3 4.9
U.S.
14.6
15.5
TEXAS 5.8 59.2 8.3 1.4 12.0
U.S. 6.0 74.2 8.0 1.4 11.4
21.6 3.2
15.9 4.8
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013 2013 2013 2013 2013 Black+(13.5)+White+(6.8)+Other+ 2013 (11.5)+Hisp+(38) 2013 Black+(3.4)+White+(1.3)+Hisp+(4.2)
HP2020
TEXAS
U.S.
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY*
21.8
19.6 115.7 75.8
19.6 131.7 76.1
HP2020
TEXAS 16.2
U.S. 15.4
11.5
9.8
2012
11.6
12.3
200972013
90.0
1.0
HP2020 6.0 77.9 7.8 1.4 11.4
10.2
68.8
60.1
200972013
200872012 200872012 2010 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012
Black+(4.7)+White+(15)+Other+(6.9)+ Hisp+(4)
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE 2.83 2.83 2.83 2.67 2.50 2.33 2.22 2.11 2.00 1.94 1.83 1.83 1.78 1.67 1.33 1.33
1.00 0.83
OLDER&ADULTS&&&AGING Asthma:+Medicare+Population Chronic+Kidney+Disease:+Medicare+Population Depression:+Medicare+Population Cancer:+Medicare+Population Rheumatoid+Arthritis+or+Osteoarthritis:+ Medicare+Population Hyperlipidemia:+Medicare+Population Osteoporosis:+Medicare+Population Heart+Failure:+Medicare+Population Stroke:+Medicare+Population Atrial+Fibrillation:+Medicare+Population COPD:+Medicare+Population Hypertension:+Medicare+Population Diabetes:+Medicare+Population Adults+65++with+Pneumonia+Vaccination+ Adults+65++with+Influenza+Vaccination People+65++with+Low+Access+to+a+Grocery+ Store
People+65++Living+Below+Poverty+Level Ischemic+Heart+Disease:+Medicare+Population
SCORE ORAL&HEALTH Oral+Cavity+and+Pharynx+Cancer+Incidence+ 1.69 Rate 1.67 Adults+who+Visited+a+Dentist Adults+who+have+had+Permanent+Teeth+ 1.50 Extracted 1.08 Dentist+Rate
UNITS percent percent percent percent
TARRANT+ COUNTY 6.3 18.9 19.8 8.2
percent percent percent percent percent percent percent percent percent percent percent
33.2 46.9 7.6 17.2 4.6 7.7 11.9 58.8 28.0 69.5 64.9
percent
2.5
percent percent
8.5 28.4
UNITS
TARRANT+ COUNTY
cases/100,0001population percent percent dentists/100,0001population
69
HP2020
90.0
TEXAS 5.0 16.6 16.2 7.1
U.S. 4.9 15.5 15.4 7.9
30.8 45.4 7.0 16.5 4.2 7.0 11.3 57.8 28.6 70.3 59.4
29.0 44.8 6.4 14.6 3.8 7.8 11.3 55.5 27.0 68.8 60.1
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2010
11.3 30.9
9.4 28.6
TEXAS
U.S.
11.6 59.0
10.6 58.8
11.3 67.2
2008+2012 2012
42.9 53
42.8 52
44.5
2012 2013
HP2020
2009+2013 2012
Black+(19.3)+White+(5.8)+Asian+(11.5)+ AIAN+(13.4)+NHPI+(0)+Mult+(12.3)+ Other+(23.2)+Hisp+(17.3)
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY*
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE OTHER&CHRONIC&DISEASES 2.83 Chronic+Kidney+Disease:+Medicare+Population Alzheimer's+Disease+or+Dementia:+Medicare+ 2.61 Population Rheumatoid+Arthritis+or+Osteoarthritis:+ 2.50 Medicare+Population 2.22 Osteoporosis:+Medicare+Population
UNITS percent
TARRANT+ COUNTY 18.9
percent
U.S. 15.5
13.7
11.5
9.8
2012
percent percent
33.2 7.6
30.8 7.0
29.0 6.4
2012 2012
UNITS per*100*discharges hospitalizations/100,000 hospitalizations/100,000
TARRANT+ COUNTY 32.2 130.1 184.3
HP2020
TEXAS 33.0 128.8 180.8
U.S.
HP2020
TEXAS 18.3 1.8 9.4
U.S.
36.4
38.1
38.6
HP2020
TEXAS 5.0 27.1 11.3 70.3 236.4 406.5 59.4 43.5 10.9 4.9
U.S. 4.9
14.6 58.1
15.5 63.7
OTHER&CONDITIONS Perforated+Appendix Dehydration Urinary+Tract+Infection
SCORE 1.92 1.42 0.92
PREVENTION&&&SAFETY Severe+Housing+Problems Pedestrian+Death+Rate Death+Rate+due+to+Drug+Poisoning AgeXAdjusted+Death+Rate+due+to+ Unintentional+Injuries
UNITS percent deaths/100,000*population deaths/100,000*population
TARRANT+ COUNTY 17.4 1.5 8.4
deaths/100,000*population
30.2
RESPIRATORY&DISEASES Asthma:+Medicare+Population Asthma+in+Younger+Adults+(Ages+18X39) COPD:+Medicare+Population Adults+65++with+Pneumonia+Vaccination+ Bacterial+Pneumonia COPD+in+Older+Adults+(Ages+40+) Adults+65++with+Influenza+Vaccination AgeXAdjusted+Death+Rate+due+to+Lung+Cancer Adults+with+Asthma Tuberculosis+Incidence+Rate AgeXAdjusted+Death+Rate+due+to+Influenza+and+ Pneumonia Lung+and+Bronchus+Cancer+Incidence+Rate
UNITS percent hospitalizations/100,000 percent percent hospitalizations/100,000 hospitalizations/100,000 percent deaths/100,000*population percent cases/100,000*population
TARRANT+ COUNTY 6.3 40.3 11.9 69.5 240.8 440.5 64.9 46.4 10.8 4.0
deaths/100,000*population cases/100,000*population
13.9 62.6
SCORE 2.83 2.11 1.83 1.67 1.39 1.34 1.33 1.22 1.17 1.17 1.06 1.00
HP2020
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012
TEXAS 16.6
SCORE 1.83 1.56 1.34
0.25
70
1.4
90.0
45.5 1.0
1.5
11.3 68.8
60.1 45.0 13.3
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2013 2013 2013 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 200782011 2013 200682012 200982013 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012 2013 2012 2012 2013 2013 2012 200882012 2012 201082014 200982013 200882012
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix I: Tarrant County Data Scoring SCORE SOCIAL'ENVIRONMENT 1.83 Single<Parent+Households 1.72 Linguistic+Isolation
1.50 1.14
Children+Living+Below+Poverty+Level Voter+Turnout
UNITS percent percent
TARRANT+ COUNTY 33.0 6.5
percent percent
22.1 62.6
SCORE 1.83 1.58 1.50 0.92 0.61
SUBSTANCE'ABUSE Adults+who+Smoke Alcohol<Impaired+Driving+Deaths Adults+who+Binge+Drink Death+Rate+due+to+Drug+Poisoning Liquor+Store+Density
UNITS percent percent percent deaths/100,0003population stores/100,0003population
TARRANT+ COUNTY 20.0 32.5 17.7 8.4 5.1
SCORE 2.25 2.11 1.94
TRANSPORTATION Solo+Drivers+with+a+Long+Commute Workers+who+Drive+Alone+to+Work Mean+Travel+Time+to+Work
UNITS percent percent minutes
TARRANT+ COUNTY 39.3 82.7 26.0
Workers+Commuting+by+Public+Transportation Households+with+No+Car+and+Low+Access+to+a+ Grocery+Store
percent
0.6
percent
1.3
UNITS cases/100,0003females percent cases/100,0003females years
TARRANT+ COUNTY 9.1 75.0 120.5 80.2
deaths/100,0003females percent
21.1 79.5
1.83 1.00
SCORE 2.25 1.67 1.50 1.39 1.36 1.17
WOMEN'S'HEALTH Cervical+Cancer+Incidence+Rate Pap+Test+History Breast+Cancer+Incidence+Rate Life+Expectancy+for+Females Age<Adjusted+Death+Rate+due+to+Breast+ Cancer Mammogram+History
71
HP2020
HP2020 12.0 24.4
HP2020
5.5
TEXAS 33.2 8.0
U.S. 33.3 4.6
25.3 58.6
21.6 61.8
TEXAS 18.2 32.8 16.2 9.4 7.0
U.S. 19.6
TEXAS 35.1 79.9 25.0
U.S.
1.6
5.0
16.9 10.4
76.3 25.5
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2009*2013 2009*2013 Black+(33.6)+White+(8.5)+Asian+(17.1)+ AIAN+(18.6)+NHPI+(39.2)+Mult+(14.9)+ 2009*2013 Other+(36.9)+Hisp+(32.5) 2012 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2012 2009*2013 2012 2006*2012 2013 MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2009*2013 2009*2013 2009*2013 Black+(1.5)+White+(0.4)+Asian+(0.7)+ AIAN+(2.2)+NHPI+(0)+Mult+(0.4)+ 2009*2013 Other+(0.5)+Hisp+(0.6) 2010
HP2020 7.1 93.0
TEXAS 9.2 74.6 113.1 80.4
U.S. 7.7 78.0 123.0 80.8
20.7
21.0 72.0
21.3 77.0
MEASUREMENT+ PERIOD HIGH+RACE+DISPARITY* 2008*2012 2012 2008*2012 2010 2008*2012 2012
* AIAN = American Indian/AK Na<ve, NH = Na<ve Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Na<ve Hawaiian/Pacific islander, Mult = Mul<racial, Hisp = Hispanic/La<no
Appendix II: Sources for Secondary Data • • • • • • • • • • • • • • • • • •
American Community Survey American Lung Association Behavioral Risk Factor Surveillance System Centers for Medicare & Medicaid Services County Health Rankings Fatality Analysis Reporting System Feeding America Institute for Health Metrics and Evaluation National Cancer Institute National Center for Education Statistics PQI Data from Dallas-Fort Worth Hospital Council Texas Department of State Health Services Texas Education Agency Texas Secretary of State U.S. Bureau of Labor Statistics U.S. Census - County Business Patterns U.S. Department of Agriculture - Food Environment Atlas U.S. Environmental Protection Agency
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Appendix III: Resources – Community Input
73
Resources that were mentioned by key informants or focus group participants: • • • • • • • • • • • • • • • • •
AARP Baylor Blue Zones Churches Community Center (City of Fort Worth & Haslet) Cook Children’s Food Policy and Infant Health Council Health Department Healthy Moms Healthy Babies Healthy Communities Oversight Board Healthy Tarrant County Collaboration Immunization Council Infant Mortality Collaborative Library Runners and Walkers March of Dimes Meals on Wheels Schools Senior Citizens Services of Greater Tarrant County
• • • • • •
Special Olympics Tarrant County Breast Feeding Coalition Tarrant County Food Policy Council Tarrant County Voices for Health Texas Health Alliance University of North Texas Health Science Center • Victory Therapy • Wellness Alliance for Total Children's Health (WATCH) of Denton County
Texas Health Resource’s Community Connect database is an online tool to connect our patients and community members to free and reduced-cost services: https://texashealth.org/communityconnect
Appendix IV: Community Input Participants Organizations represented in focus groups and key informant interviews: • • • • • • • • • • • • • • • • • •
Cancer Support Community City of Haslet Fire Department City of Watagua Senior Center Community Storehouse Denton County Fort Worth Chamber North Area Council Fort Worth City Council District 4 Golden Triangle Rotary Greater Keller Chamber of Commerce Healthways, Blue Zones Fort Worth Healthy Tarrant County Collaboration Heritage Homeowners Association Hillwood Properties JPS Health Network Keller Independent School District parent Keller Senior Activities Center Keller United Methodist Church March of Dimes
• YMCA of Metropolitan Fort Worth Northpark • Northwest Independent School District School Health Advisory Council • Northwest Independent School District parent • Northwest Retired School Employees Association • Senior Citizens Services of Greater Tarrant County • Tarrant County College District • Texas A&M AgriLife Extension Service • Tarrant County Public Health • Texas Health Alliance Faith Community Nurse • Texas Health Alliance staff • United Way of Tarrant County • University of North Texas Health Science Center
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Appendix V: Prioritization Session Participants
75
The following individuals participated in the prioritization session: • Chelsea Abbott, Hillwood Properties • Kevin Allen, Texas Health Alliance • Janice Barnes, Northwest Retired School Employees Association • Jennifer Basham, Keller Senior Activities Center • Paige Boyd, Texas Health Alliance • Marjeta Daja, Texas Health Resources • Kathy Edwards, Texas Health Alliance • Mitzi Ellington, Texas Health Alliance • Shannon Fillion, Northpark YMCA • Mandy Forbus, Texas Health Alliance • Jennifer Fox, Texas Health Alliance • Laura Fuquay Redman, Texas Health Harris Methodist Hospital Southlake • Jesse Herrera, Tarrant County College District
• • • • • • • • • • •
Subuli Hunan, Texas Health Southlake Aly Layman, March of Dimes Aisha Madden, Texas Health Alliance Nolan Martin, Texas Health Alliance Sarah Mendoza, Texas Health Resources Stacy Pacholick, Grace Health Peggy Pearson, United Methodist Church of Keller Deidra Ritter, Texas Health Alliance Shirley Roberts, Grace Health Kristen Smith, Texas Health Alliance Valerie Snyder, City of Southlake
Appendix VI: Evaluation of Actions Taken Since Preceding CHNA Significant Health Need Identified in CHNA 2013
Chronic Disease
Planned Activities to Address Health Needs Identified in Preceding Implementation Strategy
Was Activity Implemented (Yes/No)
Results & Impact (Data Sources)
Implementation of Better Choices, Better Healthâ&#x201E;˘ Program*
Yes
Chronic Disease Self-Management/Diabetes Self-Management: 49 participants completed a six-week program designed to enable individuals to build the selfconfidence and motivation they need to manage the challenges of living with a chronic health condition (CHI Program Highlights - State Reports)
Maintainance of Entity-Based Chronic Disease Program
Yes
School District Health Fair: 276 health screenings were completed in partnership with the Keller Independent School District, including blood pressure screenings, BMI screenings, skin cancer checks, and mammograms (CBISA)
Yes
Community Collaborations: 69.8 staff hours were spent in service to 482 individuals through community coalitions & councils (CBISA)
Yes
Community Connect: The online resource guide was searched 289 times in Texas Health Alliance's service area (Aunt Bertha Dashboard)
Yes
A Matter of Balance: 19 participants completed an eight-session, evidence-based fall prevention program (CHI Program Highlights - State Report) Faith Community Nursing: 3 faith communities were served by faith community nurses (CHI Program Highlights - State Report) Hand Hygiene: 6100 hand hygiene kits were distributed during Halloween Hand Hygiene event in local neighborhoods (CHI Program Highlights - State Report) Youth Mental Health First Aid: 40 staff hours were dedicated to serving 56 registrants at four events focused on mental health wellness for youth (Advocate Records) Child Automobile Safety Initiative: 140 participants received education on child passenger safety and the risk of unintentional injury from motor vehicle collisions (CBISA)
Yes
Community Collaborations: 69.8 staff hours were spent in service to 482 individuals through community coalitions & councils, and the Community Health Improvement Advocate participated in the Healthy Tarrant County Collaboration, a partnership of hospitals, public health organizations, and universities working to build healthier communities (CBISA)
Sponsorship of Collaboratives Working to Address Chronic Disease Collaboration & Dissemination of an Area Resource Guide
Awareness, Literacy & Navigation (ALN)
76
Maintainance of Entity-Based ALN Programs
Sponsorship of Area Collaboratives Working to Address ALN *Chronic Disease Self-Management/Diabetes Self-Management
77
Appendix VII: Service Area Zip Codes For the purposes of this CHNA, the service area for Texas Health Alliance consists of Tarrant County, and is inclusive of the following zip codes:
• • • • • • • • •
76131 76137 76244 76034 76052 76054 76092 76148 76177
• • • • • •
76179 76180 76182 76247 76248 76262
Appendix VIII: CHNA Project Team & Hospital Leadership
• Mandy Forbus, Community Integration Director, Texas Health Alliance • Mina Kini, MS, MSW, Director of Multicultural & Community Health Improvement, Texas Health Resources • Catherine McMains, MPH, CPH, Community Benefit & Impact Specialist, Texas Health Resources • Marjeta Daja, MBA, MHA, Multicultural Health Specialist, Texas Health Resources • Clint Abernathy, President, Texas Health Alliance • Monika Mathur, MD, Chief Medical Officer, Texas Health Alliance • Kendra Slatton, DNP, RN, MSN, CDE, Chief Nursing Officer, Texas Health Alliance
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Appendix IX: IRS Checklist
79
The following checklist outlines the components necessary for a successful Community Health Needs Assessment as required by the IRS*: A definition of the community served by the hospital facility and a description of how the community was determined A description of the process and methods used to conduct the CHNA A description of how the hospital facility solicited and took into account input received from persons who represent the broad interests of the community it serves A prioritized description of the significant health needs of the community identified through the CHNA, along with a description of the process and criteria used in identifying certain health needs as significant and prioritizing those significant health needs A description of the resources potentially available to address the significant health needs identified through the CHNA An evaluation of the impact of any actions that were taken since the hospital facility finished conducting its immediately preceding CHNA to address the significant health needs identified in the hospital facilityâ&#x20AC;&#x2122;s prior CHNAs *These are summarized guidelines and should not be substituted for legal advice. For full information on IRS requirements please consult your attorney and visit: IRS Community Health Needs Assessment Rule 12/31/14