chna final 2018 - riverview health...chna overview to conduct the chna, the hospitals worked with a...
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TABLEOFCONTENTSSECTION PAGE
1. INTRODUCTIONANDORGANIZATIONALBACKGROUND 1
2. CHNAPROCESSOVERVIEW 3
3. REVIEWOFEXISTINGHEALTHINDICATORS 6
a. CharacteristicsofCountyResidents 7b. SocialandEconomicCharacteristics 7c. QualityofLifeIndicators 8d. HealthOutcomes 9e. ClinicalCharacteristics 10f. MortalityIndicators 11g. BehaviorsandBehavioralFactors12h. Summary 13
4. 2018COMMUNITYCHNASURVEY 14
a. SurveyMethods 14b. SurveyResults 19
i. DescriptionofParticipants 19ii. PerceptionsofHealthandWell-Being22iii. HealthCareAccess&Engagement25iv. PersonalHealth-RelatedBehaviors28v. SocialDeterminantsofHealth28vi. ImportanceofCommunityServices29vii. PerceivedPriorityHealthNeeds30viii. PerceivedPrioritiesforResourceAllocation32ix. ComparisonofNeedsandResources34
5. CHNAFOCUSGROUP 35
6. PRIORITIZATIONPROCESS 38
APPENDICESA. CommunitySurveyB. FocusGroupSummariesC. PrioritizationProcessSlidesD. PotentialCommunityResources
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1. INTRODUCTION,ORGANIZATIONALBACKGROUND,ANDSERVICEAREAIntroductionThisreportprovidesacomprehensiveoverviewofthe2018CommunityHealthNeedsAssessment(CHNA)conductedcollaborativelybyRiverviewHealth.ThechaptersofthisreportprovideanoverviewofthemethodsusedtoconducttheCHNA,summariesofexistinghealthindicatordatathatwasreviewed,primarydatathatwascollectedforpurposesoftheCHNA,andadescriptionoftheprocessandoutcomesofaprioritizationprocesstoestablishthehealthprioritiesthatwilldrivethehospital’sactivitiesinthesubsequentyears.AboutRiverviewHealthRiverviewHealthisacomprehensivehealthcarenetworkcomprisedofafull-service,156-bedhospitallocatedinNoblesville,Indianaaswellas25primaryandspecialtycarefacilitieslocatedthroughoutHamiltonCounty.AtRiverviewHealth,morethan350physicians—manyofwhomareboardcertifiedorfellowshiptrained—providehealthcareservicesin35medicalspecialties.Theirexpertise,coupledwithexceptionalspecialistsandnursingstaff,isoneofthereasonsRiverviewHealthisfrequentlyrecognizedforclinicalandserviceexcellence.Theorganization’sgoalistoprovidecompassionate,patient-centeredcaretoeveryoneinthecommunity.RiverviewHealthpromotesaprogressive,nurturingenvironment—andsupportsthecommunitythrougheducationalseminars,screeningsandothereventsaimedathelpingtheindividualandfamilystaywell.AsoneofthelargestemployersinHamiltonCounty,RiverviewHealthplaysanimportantroleinthelocalbusinesscommunityaswell.RiverviewHealthisanonprofitorganizationownedbyHamiltonCounty,thoughitdoesnotreceivetaxdollarsforoperatingexpenses.RiverviewHealthisgovernedbyaseven-memberBoardofTrusteesappointedbytheHamiltonCountycommissionerswhichoverseeshospitalpolicyandstrategicdirection.RiverviewHealthisaccreditedbyanumberofleadingregulatoryagencies,including:
• AmericanAcademyofSleepMedicine(AASM)• AmericanAssociationofBloodBanks(AABB)• AmericanAssociationofCardiovascularandPulmonaryRehabilitation(AACVPR)• AmericanCollegeofRadiology(ACR)• AmericanDiabetesAssociation(ADA)• CollegeofAmericanPathologists(CAP)• CommissiononAccreditationofRehabilitationFacilities(CARF)• CommissiononCancer(CoC)• HealthcareFacilitiesAccreditationProgram(HFAP)• SocietyofChestPainCenters(SCPC)
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AbouttheServiceAreaRiverviewHealthprovidesservicestopopulationsinHamiltonCounty,Indiana.TheserviceareadefinedfordatacollectioninthisCHNAwasHamiltonCounty.
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2.CHNAPROCESSANDMETHODSCHNAOverviewToconducttheCHNA,thehospitalsworkedwitharangeofcommunityandacademicpartnerstoconductacomprehensivecommunityhealthneedsassessment(CHNA).Thepurposeoftheassessmenttoidentifythesignificanthealthneedsinthecommunityandgapsthatmayexistinservicesprovided.Itwasalsodevelopedtoprovidethecommunitywithinformationtoassessessentialhealthcare,preventivecare,andtreatmentservices.Thisendeavorrepresentseffortstoshareinformationthatcanleadtoimprovedaccesstocareandqualityofcareavailabletothecommunity,whilereinforcingandaugmentingtheexistinginfrastructureofservicesandproviders.CHNAActivitiesandMethodsTheCHNAwasconductedbeginningin2017andbeingcompletedin2018,theresultsofwhicharereflectedinthisreport.Table1providesanoverviewoftheoverallprocessandspecificmethodsrelatedtoeach.Withineachrespectivesectionofthisreport,additionaldetailsregardingmethods,participants,andmeasuresareprovided.CHNAPartnersConductingtheCHNAnecessitatedcollaborationwitharangeofpublichealthandsocialservicepartnerstoensurethatdiversescientificandcommunity-basedinsightswereincludedthroughouttheprocess.Ofparticularimportancewastoensurethatindividualswhodirectlyorindirectlyrepresentedtheneedsofthreeimportantgroupsincluding:1)thosewithparticularexpertiseinpublichealthpracticeandresearch,2)thosewhoaremedicallyunderserved,low-income,orconsideredamongtheminoritypopulationsservedbythehospital,and3)thebroadercommunityatlargeandthosewhorepresentthebroadinterestsandneedsofthecommunityserved.Keypartnerorganizationsincluded:• TheUniversityofEvansville.Faculty,staff,andstudentsinpublichealthareascollaborated
withthehospitalonthedata-orientedaspectsoftheproject.• IndianaUniversitySchoolofPublicHealth.Facultyandstudentscollaboratedwiththe
hospitalthroughoutthesurveyprocess.• IndianaUniversityCenterforSurveyResearch.Facultyandstaffprovidedin-depth
technicalassistanceandguidancethroughoutthesurveyprocess,andworkedcloselywithRiverviewHealthandtheUniversityofEvansvilletofieldthecommunityhealthsurvey.
• MeasuresMatter,LLC.MeasuresMatterisacommunity-basedresearchconsultingfirmbasedinBloomington,IndianaandPalmSprings,California.MeasuresMatterconductedan
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independentanalysisofthesurveydataandalsofacilitatedtheprioritizationprocesswiththehospitalanditspartners.
• CountyHealthDepartment.RepresentativesoftheHamiltonCountyHealthDepartmentwereactiveparticipantsintheCHNAactivities.
• CommunityHealthandSocialServiceOrganizations.Awiderangeofcommunity-basedhealthandsocialserviceorganizationscollaboratedthroughouttheCHNAprocesstoconsiderdatafromtheCHNA,makedecisionsregardinghealthpriorities,andinitiateconsiderationsofsubsequentactionsbasedontheCHNA.Inparticular,awideanddiverserangeoforganizationalpartnersandcommunityconstituentsparticipatedinthefocusgroupdiscussions.ListingsofthosecommunitypartnersareincludedintheAppendicessectionofthisreport(AppendixB)andalsolistedinthePrioritizationProcesssectionasapplicable(Section6).
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Table1.DescriptionofCHNAActivitiesCHNAACTIVITIES DESCRIPTIONOFACTIVITIES
IdentificationoftheServicePopulation
Hospitalstaffworkedtogethertoidentifyitscommunityservedthroughareviewofpatient-relateddataandothergeographicboundariesrelatedtothehospital'sservicearea.
ReviewofExistingHealthIndicatorData
Incollaborationwithpublichealthresearchers,thehospitalconductedareviewofexistingdataandindicatorsrelevanttothisassessment.Subsequenttothisreviewofdata,keyinsightswereincorporatedintosubsequentCHNAactivitiesandconsideredduringtheselectionofhealthpriorities.
CommunityHealthSurvey
Incollaborationwithnineotherhospitalsystems,healthdepartmentrepresentatives,communityorganizations,andwithfacultyresearchersfromtheUniversityofEvansvilleandIndianaUniversityBloomington,asurveywasdevelopedandconductedtocollectdatafromresidentsinthehospital'sservicearea.Thesurveyprocessincludedarandomsamplethatrecruitedproportionatelyfromallzipcodesintheservicearea.
CommunityFocusGroupDiscussions
ThreecommunityfocusgroupdiscussionswereheldinHamiltonCounty.Thepurposeofthesefocusgroupwastoprovideaforumforin-depthconsiderationofthehealthissuesandpopulationsmostinneedofattentioninHamiltonCounty.
HealthNeedsPrioritizationSession
HospitalstaffheldameetingofkeystakeholdersandorganizationalleadershipinordertoreviewdatafromallactivitiesconductedfortheCHNA.Subsequenttoaformalpresentationanddiscussionofthedata,attendeesinthemeetingparticipatedinanominalgroupprocesstoidentifythetophealthneedsthatwouldinformthedevelopmentoftheimplementationplan.
ReviewofResourcesandPartners
BasedupontheresultsoftheCHNAactivities,alistoflocalresourcesandpartnershipsthatwouldberelevanttoaddressingtheneedsidentifiedviatheCHNAandthesubsequentimplementationplan.
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3.REVIEWOFEXISTINGHEALTHINDICATORSIntroductionThissectionofthereportprovidesanoverviewofexistingdataandindicatorsthatofferinsightintothehealthandsocialissuesoftheservicearea.ThesedatawereusedinarangeofwaysthroughouttheCHNAprocess,including:
• toinformthedevelopmentofissuesthatwouldbefurtherexploredinthe2018CHNACommunitySurvey,
• toguidespecificanalysesofdatafromthe2018CHNACommunitySurvey,• toprovidedatasummariesandotherinsightstocommunitymembers,organizational
stakeholders,andHospitalstaffduringCHNArelatedmeetingsanddiscussions,and• asafoundationforthereviewofongoingeffortsandkeydecisionsabouttheservices
offeredbytheHospital.DataSourcesToensureconsistencythroughouttheCHNAprocess,thereviewofexistingdataincludedthemostrecentlyavailabledatarelatedtothefollowingcommunityindicators:
• demographiccharacteristicsofresidentsintheservicearea,• socialandeconomiccharacteristicsoftheservicearea,• leadinghealthoutcomes,• clinicalcharacteristicsoftheservicearea,withafocusonaccesstocare,• qualityoflifeindicators,and• health-relatedbehaviorsandassociatedfactors.
Datapresentedinthissectionofthereportweresourcedfromthe2018versionofCountyHealthRankings&Roadmaps,aprojectofthePopulationHealthInstituteoftheUniversityofWisconsinthatissupportedbytheRobertWoodJohnsonFoundation.DataalsoincludedthosefromtheIndianaStateDepartmentofHealth.Throughoutthesedata,indicatorsarepresentedforthecountyofinterest,thestateofIndiana,andtheTopU.S.Performers(indicatorsthatrepresentthetop10%bestperformingcountiesinthecountry).Whilecomparisonsacrossthesedataarevaluableforidentifyingareasinaparticularcountywhereimprovementscanbemade,suchcomparisonsshouldalwaysbemadewithinthecontextofthevastdifferencesthatexistacrossthecountiesinthecountry.
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PopulationCharacteristicsDemographiccharacteristicsofaparticularregionprovideimportantinsightsforthedevelopmentanddeliveryofhealth-relatedservicesandprograms.HamiltonCountyislargelyhomogeneousintermsofracialandethnicitycharacteristicsalthoughitdoeshavealargerAsianpopulationthanthetypicalIndianacounty.Itisevenlysplitwithregardtogender,withlowproportionsofindividualslivinginareasconsideredrural.HamiltonCounty’spopulationof313,373personsissummarizedinTable2.Table2.CharacteristicsofHamiltonCounty’sPopulation
CountyPopulationCharacteristics HamiltonCounty Indiana
PopulationSize 313,373 6,633,053
%Below18yearsofage 27.8% 23.8%%65andolder 11.4% 14.9%
%Non-HispanicAfricanAmerican 4.0% 9.3%%AmericanIndianandAlaskanNative 0.2% 0.4%%Asian 6.0% 2.2%%NativeHawaiian/OtherPacificIslander 0.1% 0.1%%Hispanic 3.9% 6.8%%Non-Hispanicwhite 84.2% 79.6%
%NotproficientinEnglish 1% 2%
%Females 51.2% 50.7%
%Rural 5.60% 27.6%SocialandEconomicCharacteristicsSocialandeconomicfactorsarewellestablishedasimportantdeterminantsofhealthandwell-being.ForpurposesoftheCHNA,thesefactorsprovidevaluableinsightintothecontextofhealthandwell-beingindicatorsandofferafoundationforconsideringthemannerinwhichahospital’sprogramsareconnectedtoawidersocialservicesnetwork.HamiltonCounty’spopulationfaresbetterthanmanycommunitiesinIndiana,withhigherlevelsofeducationalattainment,lowerlevelsofpoverty,andlowerlevelsofunemployment.Thecounty,onmanysocialandeconomicindicators,performsatalevelequaltoorbetterthanthetopU.S.performers.Table3providesasummaryofprimarysocialandeconomicfactorsinHamiltonCounty.
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Table3.SocialandEconomicFactors,HamiltonCounty
SocialandEconomicFactors HamiltonCounty TopUSPerformers Indiana
Highschoolgraduation 94% 95% 87%Somecollege 86% 72% 62%Unemployment 3.20% 3.20% 4.40%Childreninpoverty 5% 12% 19%Incomeinequality 3.9 3.7 4.4
Childreninsingle-parenthouseholds 18% 20% 34%
Socialassociations 9.8 22.1 12.3Violentcrime(per100,000) 37 62 356Injurydeaths(per100,000) 37 55 70QualityofLifeIndicatorsSelf-reportedrankingsofoverallhealthstatus,andthenumberofdaysinagivenmonthforwhichindividualswouldratetheirphysicalandmentalhealthasbeingpoor,offerimportantinsightsintothefactorsthatofteninfluenceindividualstoseekcareorsupport,andsharewelldocumentedassociationswithcareoutcomes.Additionally,lowbirthweightiscommonlyusedasagaugefortheexistenceofmulti-facetedpublichealthproblems.HamiltonCountyperformsquitewelloneachoftheseimportantindicatorsasissummarizedinTable4.Table4.QualityofLifeIndicators
QualityofLifeIndicators HamiltonCounty TopUSPerformers Indiana
Poororfairhealth 10% 12% 18%Poorphysicalhealthdays 2.6 3 3.9Poormentalhealthdays 3.0 3.1 4.3Lowbirthweight 7% 6% 8%
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HealthOutcomesCommonhealthindicatorsthatprovideinsightintothegeneralhealthstateofacommunityincludeprematuremortality,infantmortality,chronicdisease(diabetes),infectiousdisease(HIV)andbothphysicalandmentaldistress.Ontheseindicators,HamiltoncountylargelyfaresbetterthantheaveragesforthestateofIndiana.However,whilethesevaluesplaceHamiltonCountywithinthetopquartilesofthestateonmostindicators,boththestateandcountyhavesomehealthoutcomesthatareworsethanthetopU.S.performingregionsandsuggestareasforcontinuingimprovement.Table5providesanoverviewoftheseleadinghealthindicatorsforHamiltonCounty.Table5.HealthOutcomeIndicators,HamiltonCountyHealthOutcomeIndicators HamiltonCounty TopUSPerformers IndianaPrematureage-adjustedmortality(per100,000) 210 270 390
Childmortality(per100,000) 30 40 60Infantmortality(per100,000) 4 4 7Frequentphysicaldistress 8% 9% 12%Frequentmentaldistress 9% 10% 13%Diabetesprevalence 9% 8% 11%HIVprevalence(per100,000) 88 49 196ClinicalCharacteristicsOfparticularimportancetothehospitalweredatathathelptoassessandconsiderissuesthatarecloselyalignedwiththenation’sobjectivestocontinueimprovingaccesstocare,reducinghealthcarecosts,andimprovingboththeproportionofthepopulationthathashealthinsurance(particularlychildren)andadherencetopreventivescreeningsandchronicdiseasemonitoring.UninsuredratesinHamiltonCounty,whilesimilartothestateaverage,aresimilartothetopperformingareasoftheU.S.,asisthecasewithmanyotherindicatorsforHamiltonCounty.HamiltonCounty,basedontheavailabilityofhealthcareproviders,ranksamongthebestcountiesinthestate,withtheexceptionofmentalhealthproviders.Otherindicatorsrelatedtopreventivescreeningandchronicdiseasemanagementarewithinthetoprangesofboththestateandnation.Table6providesasummaryoftheseclinicalcharacteristicsofHamiltonCounty.
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Table6.ClinicalCareCharacteristics,HamiltonCountyClinicalCharacteristics HamiltonCounty TopUSPerformers IndianaUninsured 6% 6% 11%Uninsuredadults 7% 7% 13%Uninsuredchildren 5% 3% 7%Primarycarephysicians 710:1 1,030:1 1,500:1Dentists 1,350:1 1,280:1 1,850:1Mentalhealthproviders 760:1 330:1 700:1Otherprimarycareproviders 1,566:1 782:01 1,367:1Preventablehospitalstays(per100,000) 33 35 57Diabetesmonitoring 89% 91% 85%Mammographyscreening 70% 71% 62%Healthcarecosts $9,281 $9,992LeadingCausesofMortalityAnexaminationoftheleadingcausesofmortalityprovidesvaluableinsightintothemajorhealthissuesfacingacommunity.Presentedintermsoftheratesofdisease-specificdeathby100,000membersofapopulation,thesedataserveasanindicatoroftheissuesmostlikelytorequiresignificantattentionfromhospitalsandotherhealthandsocialserviceorganizations.Whilethesedataaremortality-specific,theyalsohelptoserveasanindicatorofacommunity’smorbiditygiventhatmanyindividualslivewiththesediseasesforextendedperiodsoftime.Theyalsoprovideahelpfulguidetoprevention-focusedprogramsgiventhatbehavioraldeterminantsoftheseleadinghealthissuesarefairlyunderstood.Table7providesasummaryoftheseindicators.
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Table7.MortalityIndicatorsforHamiltonCounty,2016
RATES PER 100,000 Population(Age-Adjusted)
ALLCAUSES 922.14Malignantneoplasms(cancer) 125.61Malignantneoplasmofstomach 1.59Malignantneoplasmsofcolon,rectumandanus 11.41Malignantneoplasmofpancreas 10.00Malignantneoplasmsoftrachea,bronchusandlung 26.52Malignantneoplasmofbreast 9.83Malignantneoplasmsofcervixuteri,corpusuteriandovary 5.47Malignantneoplasmofprostate 7.34Malignantneoplasmsofurinarytract 7.54Non-Hodgkin'slymphoma 3.15Leukemia 5.37Othermalignantneoplasms 37.39
Diabetesmellitus 20.73Alzheimer'sdisease 27.73
Majorcardiovasculardiseases 184.33Diseasesofheart 142.13Hypertensiveheartdiseasewithorwithoutrenaldisease 6.98Ischemicheartdiseases 87.69Otherdiseasesofheart 47.45Essentialhypertensionandhypertensiverenaldisease 4.88Cerebrovasculardiseases(stroke) 34.4Atherosclerosis 0.36Otherdiseasesofcirculatorysystem 2.57
Influenzaandpneumonia 7.68Chroniclowerrespiratorydiseases 38.89Pepticulcer 0Chronicliverdiseaseandcirrhosis 6.69Nephritis,nephroticsyndromeandnephrosis(kidneydisease) 14.85Pregnancy,childbirthandthepuerperium 0.63Certainconditionsoriginatingintheperinatalperiod 3.56Congenitalmalformations,deformationsandchromosomalabnormalities 2.71Suddeninfantdeathsyndrome(SIDS) 0Symptoms,signsandabnormalclinicalandlaboratoryfindings,notelsewhereclassified(excludingSIDS) 3.34Allotherdiseases 130.62Motorvehicleaccidents 5.46Allotherandunspecifiedaccidentsandadverseeffects 25.18Intentionalself-harm(suicide) 12.13Assault(homicide) 0.71Allotherexternalcauses 1.26
ICD 10 Description of Mortality Causes
Source:IndianaStateDepartmentofHealth,EpidemiologyResourceCenter.SummaryProducedSeptember12,2017
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BehavioralFactorsForpurposesoftheCHNA,arangeofleadinghealthbehaviorindicatorswereassessed.Eachoftheselectedindicatorsshareimportantassociationswithleadingcausesofmorbidityandmortalityinthecountry.Table8providesanoverviewoftheleadinghealthbehaviorsthatnotonlyofferinsightsintothebehavioraldeterminantsofleadinghealthchallengesinHamiltonCountyandopportunitiesfortheongoingdevelopmentandimplementationofhealthandsocialserviceprograms.Table8.HealthBehaviorsandBehavioralOutcomes,HamiltonCountyHealthBehaviors HamiltonCounty TopUSPerformers IndianaAdultsmoking 13% 14% 21%Adultobesity 27% 26% 32%Foodenvironmentindex 8.8 8.6 7Physicalinactivity 16% 20% 27%Accesstoexerciseopportunities 89% 91% 77%Excessivedrinking 20% 13% 19%Alcohol-impaireddrivingdeaths 24% 13% 22%Sexuallytransmittedinfections 204.5 145.1 437.9Teenbirths 8 15 30Table9alsoprovidesanoverviewofadditionalbehavioralfactorsthatareimportantforthecontextoftheCHNAactivities.Table9.OtherBehavioralFactors,HamiltonCountyOtherBehavioralFactors HamiltonCounty TopUSPerformers Indiana
Foodinsecurity 9% 10% 14%
Limitedaccesstohealthyfoods 4% 2% 7%
Drugoverdosedeaths(per100,000) 11 10 20
Motorvehiclecrashdeaths(per100,000) 5 9 12
Insufficientsleep 30% 27% 36%
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SummaryAreviewofleadingindicatorsrelatedtothehealthandwell-beingofacommunityprovidesanimportantfoundationfortheremainingCHNAactivities.Thesedataofferinsightsintothefactorsunderlyingthehealthissuesthatareperceivedbyproviders,organizationalstakeholders,andcommunitymembersasbeingamongthoseneedingpriorityattention.ThesedatasummarieswereusedduringsubsequentCHNAactivities,receivingparticularattentionduringtheprioritizationprocessthatisdescribedinsectionsixofthisreport(PrioritizationProcess).
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2018COMMUNITYCHNASURVEYSurveyMethods
PurposeoftheSurveyTocollectprimarydatafromresidentsofcommunitiesinthehospital’sserviceareaofHamiltonCounty,asurveywasdesigned,fielded,andanalyzed.Thissectionofthereportincludesadescriptionofthesurveymethodsandtheresultsoftheresponsestothesurvey.SurveyDevelopmentTodevelopthesurveyusedfortheCHNA,thehospitalpartneredwithfacultyfromIndiana-baseduniversitieswhohadparticularexpertiseincommunity-basedsurveyresearch.Dr.WilliamMcConnelloftheUniversityofEvansvilleservedastheleadresearcherontheproject,inpartnershipwithDr.MichaelReeceandDr.CatherineSherwood-Laughlin(bothoftheIndianaUniversitySchoolofPublicHealth).TheUniversityofEvansvillecontractedwiththeCenterforSurveyResearch(CSR)atIndianaUniversitytoadministerthissurvey.ThesurveywasconductedwithapprovaloftheInstitutionalReviewBoard(IRB)oftheUniversityofEvansville.Planninganddevelopmentforthesurveybeganinthewinterof2017.TheuniversityfacultyjoinedacollaborativeofeightmajorhospitalsystemsthatservedpopulationsinIndianaandIllinois.Agoalofthecollaborativewastoalignsurveyactivitiesinordertoincreasecost-efficiencyandtoworktowardthedevelopmentofadatainfrastructurethatwouldbeusefulacrossthesystemsandalsoofenhancedutilitytothehealthandsocialserviceorganizationswithwhichthosehospitalspartneroninitiativestoimprovehealthintheirrespectivelocalcommunities.Usingaconstruct-basedapproachthatidentifiedtheleadingareastobeincludedonthesurvey,thehospitalsandfacultydevelopedasurvey.ThesurveyincludedmeasuresthathadbeenvalidatedforuseinsimilarprojectsbyotherresearchersandadditionalmeasuresthatweredevelopedbythepartnersforspecificneedsofthisCHNA.Thesurveycoveredtenmajorareas.Table10providesanoverviewoftheconstructscoveredinthesurveyandadescriptionofthemeasuresassociatedwitheachconstruct.AcopyofthesurveyisincludedasAppendixA.SampleDevelopmentDatawerecollectedviaarandomsampleofindividualsrepresentativeofthehospital’sservicearea.ThetargetpopulationforPhaseIofthe2018CommunityHealthNeedsAssessmentSurveyconsistedofnoninstitutionalizedadultresidents,aged18yearsorolder,inthecatchmentareastheparticipatinghospitals.Samplingwasperformedonahouseholdbasisusinganaddress-basedsample.
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Table10.SurveyConstructsandMeasures
Thefacultycollaboratedwiththehospitalstodeterminecatchmentareasusingcountyandzipcodeboundaries.Geographicareasthatweresharedbetweenhospitalswerereducedsuchthateachgeographicareawassampledonetime.Samplingwasdeterminedusingamultistagesamplingdesign.Atthefirststage,sampleunitsweredrawnrandomlyfromanaddress-basedsamplingframeofeacharea.SampleframeswerelimitedtoresidentialaddressesexcludingP.O.boxes(unlessmarkedinthesampleframeas‘onlywaytogetmail’),seasonal,vacant,throwback,anddrop-offpointaddresses.Atthe
SURVEYCONSTRUCTS DESCRIPTIONOFMEASURES
Demographics Thissectionincludedmeasuresrelatedtothesocio-demographicsofthesurveyparticipants,including:countyofresidence,age,gender,ethnicity,race,education,householdincome,employment,andnumberofadultsandchildreninhousehold.
PerceivedHealthandWell-Being
ThissectionincludedarevisedversionoftheU.S.CentersforDiseaseControlandPrevention'sHealth-RelatedQualityofLifemeasure.Itemsincludedthesingle-itemHRQOLassessmentofperceivedoverallhealthandadditionalassessmentsofphysicalhealth,mentalhealth,andsocialwell-being.Alsoincludedwasameasureofoveralllifesatisfactionandameasureofcurrentleveloflifestress.
HealthCareCoverageandRelationships Thissectionincludedasinglemeasureofwhethertheparticipanthadhealthinsuranceorsomeothertypeofcoverageforhealthcareandasinglemeasureofwhethertheyhadacurrentpersonalhealthcareprovider.
HealthCareEngagement Thissectionincludedameasurerelatedtothetypesofcarewithwhichtheparticipanthadengagedintheprevious12months.Atotalof14specifictypesofhealthcareengagementwereassessed.
Health-RelatedBehaviors Thissectionincludedameasurethataskedparticipantstoself-reporttheirparticipationinarangeofhealth-relatedbehaviors.Atotalof11healthbehaviorswereassessed.
HealthCareResourceChallenges
Thissectionincludedmeasuresrelatedtotheextenttowhichparticipantshadfoundthemselvesinneedofavoidingcareduetoalackoffiscalresources.Specificallyassessedwastheextenttowhichparticipantshadtoforegothreetypesofhealthcare,includingseeingamedicalprovider,fillingaprescription,andsecuringtransportationforahealthpurposeorappointment.
FeltSocialDeterminantsThissectionincludedmeasurestoassesstheextenttowhichparticipantsfelttheimpactoftenspecificsocialdeterminants,includingeconomics,education,communitycohesion,policy,environment,housing,psychosocial,transportation,socialecological,andemployment.
PerceivedPriorityHealthNeeds Thissectionincludedameasuretoassessparticipants'perceptionsoftheimportanceof21healthissuestotheirlocalcommunity.
PerceivedResourceAllocationPriorities Thissectionincludedameasuretoassessparticipants'perceptionsoftheextenttowhich21healthissueswereofpriorityfortheallocationofresourcesintheirlocalcommunity.
PerceivedImportanceofSocialandHealthServices Thissectionincludedameasuretoassesstheextenttowhichparticipantsperceived20differenthealthandsocialserviceprogramstobeofimportancetotheircommunity.
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secondstage,awithin-householdrespondentwasselectedbyaskingtheadultwiththemostrecentbirthdaytocompletethesurvey.Todevelopthehospital’ssamplearea,asetof4,445address-basedrecordsrepresentingthehospital’sservicepopulationwerepurchasedfromMarketingSystemsGroup(MSG).MSGusedproprietarysamplingmethodsandprovidedassuranceofappropriateandaccuratecoverageforthetargetpopulation.ThesamplelistdeliveredbyMSGincludedpostaladdressinformation,FIPScode(countydesignator),andappendeddemographicinformationforage,gender,Hispanicsurname,Asiansurname,numberofadultsataddress,numberofchildrenataddress,householdincomeclass,maritalstatus,ethnicity,andhomeownershipstatus.Uponreceiptofthesample,itwasstoredinasecuredatabasecreatedandmaintainedbytheCSRandwasreviewedandcorrectedforanyclericalerrors.Usingtheserecords,arecruitmentsamplewasconstructedforthehospital’sservicepopulation.DataCollectionThequestionnairewasprintedasafour-pagebookletonasingle11”x17”sheetwithafoldinthecenter.Eachquestionnairewasprintedwithaunique,numericsurveyidentifierthatmatcheduparecordinthesample.Aseparatesheetwasfoldedoverthequestionnaireandprintedwithacoverletter,studyinformationsheet,andreturnmailinginstructions.Thequestionnairepacketwasassembledina9”x12”windowedenvelopeandincludedan8¾”x11½”postage-paid,businessreplyenvelopeforsurveyreturns.Thefieldperiodforthe2018CommunityHealthNeedsAssessmentSurveywasApril2,2018,throughJune29,2018.Eachsampledaddressreceiveduptotwoquestionnaireattempts.TheaddressesweredividedintofourbatchesbasedonUSPSpre-sort,andeachbatchwasmailedoneatatimeoverthecourseofatwo-weekperiod.Thesecondquestionnaireforeachaddresswasmailedapproximately4weeksafterthefirstquestionnaire.Theaddressesofreturnedquestionnaireswereexcludedfromthelistsforthesecondquestionnaireattempt.Afterthesecondquestionnaireattempt,apostcardfollow-upwasreintroducedinhopesofincreasingresponse.Inadditiontoremindingpeopletomailintheircompletedquestionnaires,thepostcardalsoprovidedawebsiteaddressthatallowedpeopletotakethesurveyonlineasamemberofthesecondaryconveniencesample.PaperquestionnaireswerereturnedtoCSRinpostage-paid,businessreplyenvelopesprovidedinthequestionnairepacket.Completedsurveyreturnswerecounted,checkedforunclearmarks,batchedingroupsof50surveys,andscannedintoABBYYFlexiCaptureOCRsoftwarefordataprocessing.CSR’sscanningpartner,DataForce(dbaMJT,US),receivedthescannedsurveyimageselectronicallyandreviewedthedataviaABBYYFlexiCapturedataverificationsoftwaretoensurequalitycontrol.Missingresponsesandmultipleresponsestoasingleitemwereflagged.ThecompileddatawastransmittedbacktoCSRviaasecurefiletransferprotocol(SFTP)server.
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DataManagementAllsurveyswerereturnedtoCSRforscanningandorganization.DatafileswerestoredbyCSRonasecurefileserverandprocessedusingRstatisticalprogrammingsoftware.Respondent-providedcountiesandzipcodeswerecross-checkedagainstthesamplefile.Discrepanciesandmisspellingswereverifiedagainsttheoriginalscannedimageoftheresponseand,ifreasonablysimilar,correctedpriortofinaldatasubmission.Afterdataprocessing,identifierstoallowfilteringbyhospitalcatchmentareaandweightingvariableswereadded(onlyfortherandomsample).ThefinaldatasetwasconvertedtoaformatforanalysisinSTATAstatisticalanalysissoftwareandtransmittedtotheresearchersviaSlashtmp,IndianaUniversity’ssecurefiletransfersystem.WeightingofSamplesThissectionprovidesanoverviewofweightingactivitiesforthe2018CommunityHealthNeedsAssessment.Twoweightingadjustmentsweremadetoenhanceconsistencybetweenthesurveysampleandthecharacteristicsofthehospital’sservicepopulation.Thefirstwasabaseweightadjustmenttoaccountforunequalprobabilitiesofselectionwithinhousehold.Thesecondwasapost-stratificationadjustmenttoU.S.CensusBureau2012-2016AmericanCommunitySurveyfive-yearpopulationestimates.Thetwoweightingadjustmentsweremultipliedtocalculateapreliminaryfinalweightforeachhospital’scatchmentarea.Thesepreliminaryweightswerethentrimmedandscaledsothatthefinalweightssummedtothenumberofrespondentsineachcatchmentarea.DatasetpreparationandweightingactivitieswereconductedusingSASVersions13.1and14.1andExcel.AmericanCommunitySurveydatawereobtainedusingAmericanFactFinder(https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml).SurveyResponsePatternsRegardingtherandomsample,ofthe4,445address-basedrecordsreceivedduringsampleconstruction,4,113weredeemedeligibleforparticipationinthesurveyandreceivedrecruitmentmaterialsbymail.Ofthosehouseholds,atotalof505returnedacompletedsurvey.TheresponserateforHamiltonCountywasthus12.28%.Table11providesanoverviewofsurveyresponsesbyzipcodesincludedinthehospital’sservicepopulation.DataAnalysesDataanalyseswereconductedbyMeasuresMatter,LLC,aresearchconsultinggroupwithexpertiseincommunity-basedparticipatoryresearch.Priortoanalyses,MeasuresMatterstaffconsultedwiththehospitaltodevelopapreliminaryplanfortheanalysisofdataandthepresentationofresults.Toretaintheintegrityofthephaseonerandomsampleandthemethodologicalrigorofferedbythatsample,analyseswereconductedseparatelyforthephaseonerandomsampleandthephasetwoconveniencesample.
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Table11.HamiltonCountyResponsePatternsbyZipCode
County/Zip CountofRespondentHouseholdsCountofHouseholdsAssumed
Eligible ResponseRateHAMILTON 505 4113 12.28%46030 1 26 3.85%46031 1 19 5.26%46032 89 652 13.65%46033 73 463 15.77%46034 9 88 10.23%46037 55 526 10.46%46038 67 544 12.32%46040 5 64 7.81%46055 1 35 2.86%46060 60 553 10.85%46062 54 461 11.71%46069 13 72 18.06%46074 50 445 11.24%46077 2 21 9.52%46250 1 6 16.67%46256 2 15 13.33%46260 0 1 0.00%46280 21 119 17.65%46290 1 3 33.33%Total 505 4113 12.28%
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SURVEYRESULTS
DescriptionofParticipantsAtotalof505participantsreturnedacompletedsurveyfromthephaseonerandomsample.Inthissectionofthesurvey,theprimarypresentationofresultsincludesthese505individualsfromtherandomsample.CountyofResidence.Ofthe214participants,95.3%(n=481)indicatedthattheirprimaryresidencewaslocatedinHamiltonCounty.AlthoughallhouseholdsreceivingthesurveywerelocatedinHamiltonCounty,someparticipants(4.8%,n=24)refusedtoprovidetheircountyofresidenceorindicatedthatitwaslocatedinanadjacentcounty.Figure1providesanoverviewoftheparticipants’reportedcountyofresidence.AdultsandChildreninHousehold.Participantswereaskedtoindicatethenumberofadults(18yearsandover)andchildren(under18years)wholivedintheirhousehold.Oftheparticipants,76.1%(n=374)indicatedthattwoorfeweradultslivedinthehousehold.Ofthoseprovidingaresponsetothequestionaboutchildreninthehousehold,themajority(54.2%,n=274)indicatednochildrenundertheageof18yearsinthehome.Someparticipantsdidreportchildreninthehome,withmost(34.6%,n=174)indicatedtwoorfewerchildrenandonlyasmallproportion(10.3%,n=52)reportingthreeormorechildreninthehome.Gender.Participantswereaskedtoreporttheirgender.Morewomenparticipatedinthesurveythandidmen,andfewrefusedtorespondtothequestionaboutgender.Figure2providesanoverviewofparticipantgender.Mostparticipantsintheconveniencesamplewerealsowomen.
Figure1.Participant’sReportedCountyofResidence,by%ofParticipants
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Figure2.ReportedGenderofSurveyParticipants,by%ofParticipants
Age.Participantswereaskedtoprovidetheyearinwhichtheywereborn.Thosedataweresubsequentlyanalyzedtocomputetheestimatedageoftheindividualatthetimethesurveywasreturned.Figure3providesacategoricaloverviewoftheageofparticipants
Figure3.ReportedAgeofParticipants,by%inYears
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Race.Participantswereaskedtorespondtoaquestionregardingtheracewithwhichtheidentify.Participantswereinvitedtoselectmorethanonerace.Thevastmajority(92.2%,n=465)indicatedthattheywereof“Caucasian/White”race,with1.6%(n=8)describingtheirraceas“Black/AfricanAmerican”and5.6%(n=28)describingtheirraceas“Asian.”Lessthanonepercentselectedanyotherrace.Figure4providesanoverviewoftheracecharacteristicsandthoseindicatingtheirethnicityasHispanic.
Ethnicity.ParticipantswereaskedwhethertheywereofHispanic,Latino,orSpanishorigin.Slightlylessthanthreepercentofparticipants(2.5%,n=13)respondedintheaffirmative.
Figure4.ReportedRaceandEthnicity,byCategory%HouseholdIncome.Participantswereaskedtorespondtoaquestionregardingthetotalincomeofthehouseholdinwhichtheylived(includingallsources).Sevenparticipantsdidnotprovidearesponsetothisquestion.Asmallproportionofparticipants(6.7%,n=34)reportedtotalhouseholdincomeoflessthan$35,000.00,more(17.3%,n=87)reportedincomeofbetween$35,000.00and$74,999.00,andthelargestproportion(72.4%,n=366)reportedtotalhouseholdincomeof$75,000.00ormore.Figure5providesacategoricalsummaryofthereportedhouseholdincomeofparticipants.
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Figure5.ReportedTotalHouseholdIncome,byCategory%
LevelofEducation.Participantswereaskedtoreporttheirhighestlevelofattainededucationbasedonspecificcategories.Aproportionofparticipants(47.0%,n=395)reportedhavingcompletedanassociate’sorbachelor’sdegreefromacollegeoruniversityand35.4%(n=179)reportedhavingattainedagraduateorprofessionaldegree.Others(10.5%,n=53)indicatedthattheyhadadiplomaorcertificatefromatechnicalorvocationalschoolorthattheyhadcompletedsomecollege.Also,4.1%(n=20)reportedhavingreceivedahighschooldiplomaorGED,andonly1.4%(n=7)reportedthattheyhadsomehighschooleducationbuthadnotgraduated.Someindividuals(1.5%)chose“other”withoutclarificationandonparticipantchosenottoprovidearesponsetothisquestion.Employment.Participantswereaskedtodescribetheiremploymentstatus.Mostparticipantswereemployedfull-orpart-time(68.8%,n=348)and2.8%(n=14)describedthemselvesasunemployed.Others(16.4%,n=83)wereretired,7.3%were“homemakers,”and2.9%reportedbeingstudents.Participants’PerceptionsofHealthandWell-BeingParticipantswereaskedtorespondtofourquestionsthatsoughttocapturetheirperceptionsoftheircurrenthealthstatus.Participantswereaskedtoprovideanassessmentoftheiroverallhealth,theirphysicalhealth,theirmentalhealth,andtheirsocialwell-being.Additionally,participantswereaskedabouttheiroveralllifesatisfactionandtheirlevelofstress.Whileresponsestoeachareaassessedaredescribedbelow,Figures6,7,and8provideasummaryoftheparticipantresponses.
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OverallHealth.Participantswereasked“Wouldyousaythatingeneral,youroverallhealthis-”withfiveresponseoptionsrangingfrompoortoexcellent.Mostparticipantsratedtheiroverallhealthasverygood(41.7%,n=211),excellent(24.2%,n=122),orgood(24.4%,n=123).Theremainderassessedtheiroverallhealthasbeingfair(6.7%,n=34)orpoor(1.0%,n=5).PhysicalHealth.Participantswereasked“Wouldyousaythatingeneral,yourphysicalhealthis…”withfiveresponseoptionsrangingfrompoortoexcellent.Despitethevastmajoritywhoreportedtheiroverallhealthasbeingpositive,participantsdifferentiatedtheirlevelofhealthmorewhenbeingspecifictotheirphysicalhealth.Lessthanone-quarterofindividualscollectivelyratedtheirphysicalhealthasverygood(8.8%,n=45)orexcellent(1.3%,n=6).Largerproportionsofparticipantsratedtheirhealthasgood(32.0%,n=162),orfair(38.3%,n=193),withtheremainderratingtheirphysicalhealthaspoor(19.5%,n=98).MentalHealth.Participantswereasked“Wouldyousaythatingeneral,yourmentalhealthis…”withfiveresponseoptionsrangingfrompoortoexcellent.Themajorityofparticipantsratedtheiroverallhealthasverygood(40.9%,n=206),excellent(35.0%,n=117),orgood(19.5%,n=98).Theremainderassessedtheiroverallhealthasbeingfair(4.5%,n=23)orpoor(0.2%,n=1).SocialWell-Being.Participantswereasked“Wouldyousaythatingeneral,yoursocialwell-beingis…”withfiveresponseoptionsrangingfrompoortoexcellent.Themajorityofparticipantsperceivedtheiroverallsocialwell-beingtobelessthangood,withthelargestproportionofallparticipantsrespondingfair(41.2%,n=208)and36.1%(n=182)respondingwithpoor.Remainingparticipantsratedtheirsocialwell-beingasgood(19.4%,n=98),withtheremainderrespondingwithverygood(2.9%,n=14)orexcellent(0.4%,n=2).
Figure6.Participants’PerceptionsofHealthandWell-Being
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OverallLifeSatisfaction.Participantswereaskedtorespondtoasinglequestion“overallIamsatisfiedwithmylife”withfiveresponseoptionsrangingfromstronglydisagreetostronglyagree.Figure7providesanoverviewofresponsestothisitem.LevelofLifeStress.Participantswereaskedtoranktheircurrentleveloflifestressbyrespondingtoasingleitem“Pleaserankyourselfonascaleof1to10where1meansyouhave“littleornostress”and10meansyouhave“agreatdealofstress.”Figure8providesthepercentageofrespondentswhorankedthemselvesonthismeasure.
Participantsintheconveniencesampletendedtoreporthigherlevelsofstress,with29.9%describingtheirstressasbeinginthetoplevels(greaterthan8onscaleof1-10).Regardinglifesatisfaction,20.2%ofthoseintheconveniencesampledisagreedwiththestatement“overallI
amsatisfiedwithmylife.”
Figure7.ParticipantsAgreementwithLifeSatisfactionItem
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Figure8.RankingofLevelofLifeStressHealthCareAccessandEngagementParticipantswereaskedtorespondtoarangeofquestionsrelatedtotheircurrentlevelofhealth-carecoverageandalsoaskedtodescribethetypesofengagementtheyhadwiththehealthcaresystemintheircommunitywithinthe12monthspriortothesurvey.Alsoassessedwaswhetherparticipantshadfoundthemselvesinsituationswithinthepastyearthatmadeitnecessarytoforegosomelevelofhealthcarebasedonalackoffinancialresourcesorbecausetheyhadtoprioritizeothermatters. InsuranceorHealthCareCoverage.Participantswereasked“doyoucurrentlyhaveinsuranceorcoveragethathelpswithyourhealthcarecosts?”Oftheparticipants,thevastmajority(96.3%n=486)reportedthattheydidhavesuchcoverageorinsurance,while3.2%(n=16)responded“no.”Theremainingthreepercenteitherdidnotknowwhethertheyhadcoverageordidnotrespondtothisquestion. CurrentPersonalProvider.Participantswereasked“doyoucurrentlyhavesomeonethatyouthinkofasyourpersonaldoctororpersonalhealthcareprovider?”Mostparticipantsindicatedthattheydidhavesuchapersonalprovider(84.0%,n=424),while15.5%(n=78)responded“no.”Figure9providesanoverviewoftheresponsestothequestionsaboutinsuranceorhealthcarecoverageandthepresenceofapersonalhealthcareprovider.
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Figure9.Participants’ReportedInsuranceandPersonalProviderCharacteristicsHealthcareEngagement.Participantswereprovidedwithalistof14health-relatedservicesandtypesofhealthcareengagementandaskedwhethertheyhadreceivedorutilizedeachofthosewithinthepast12months.Table12providesasummaryoftheparticipants’responsestothisquestion,orderedfromthehighesttolowestlevelsofcareengagement.Table12.Participants’ReportedTypesofHealthCareEngagement(n=505)
TypeofHealthcareEngagement ReceivedPast12Months(%)
DidNotReceivePast12Months(%)
FilledPrescription 73.2 26.8DentalCare 70.2 29.8PhysicalExam 67.6 32.4ImmunizationsorPreventiveCare 51.3 48.7AcuteCare 31.0 69.0ChronicCare 17.4 82.6UrgentCare 16.3 83.7CareatEmergencyRoom 10.6 89.4PrenatalCare 9.9 90.1ScreenedforAnxietyorDepression 8.6 91.4
HospitalInpatientCare 8.4 91.6MentalHealthTreatment 7.3 92.7FamilyPlanningCare 5.5 94.5AddictionTreatment 1.4 98.6
96.3
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Percent ofParticipants Indicating"Yes"
HealthCareCharacteristics,%,(n=502)
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ResourcesandHealthcareEngagement.Participantswereprovidedalistofthreetypesofhealthcareengagementneedsincludingseeingaprovider,fillingaprescription,andfindingtransportationforcareandaskedtoindicatewhethertherehadbeenatimewithinthepast12monthsthattheycouldnotactuponthatneedbecause“theycouldn’tafforditorhadtoprioritizespendingmoneyonsomethingelse.”Lessthan20%ofparticipantsindicatedthatithadbeenthecasethattheyprioritizedsomethingovertheirhealthcareacrossthethreetypesassessed.Figure10presentsthisdata.Regardingseeingamedicalprovider,10.8%ofparticipants(n=55)indicatedthattheyhadaneedtoseeaproviderbutdidnotduetootherneeds.Regardingneedingtofillaprescription,11.8%,(n=60)indicatedthatthattheyhadaneedtoavoidfillingaprescriptionduetootherneeds.Regardingneedingtransportationforhealthcare,lessthanonepercentofparticipantsindicatedthattheyhadnotbeenabletoaccesstransportationduetootherneeds.
Figure9.Participants’ReportsofResourceChallengesandHealthCare
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DuringPast12Months,INeeded (oneofthefollowing)ButCouldn'tAffordItor
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PersonalHealth-RelatedBehaviorsOfinterestwasunderstandingtheextenttowhichparticipantshadparticipatedincertainbehaviorswithinthepast30days.Consideredwerebehaviorsthatwereconceptualizedashealthpromoting(e.g.,behaviorsperceivedbythehospitaltobesupportiveofone’shealthandwell-being)orhealthchallenging(e.g.,behaviorsperceivedbythehospitaltobechallengingtoone’shealthandwell-being).Table13providesasummaryofparticipants’self-reportedbehaviors.Table13.Participants’Self-ReportedHealthBehaviorsPast30Days(n=505)
HealthPromotingBehaviors %ReportingBehavior
CheckedBloodPressure 38.2GettingPlentyofSleep 56.1BeingPhysicallyActive 58.1EatingBalancedDiet 64.9TriedtoReduceStress 26.9TookPrescriptionforMentalHealth 15.5
HealthChallengingBehaviors %ReportingBehavior
UsedTobacco 3.9TookOpioidPrescribedtoMe 4.6TookOpioidNotPrescribedtoMe 0.3DrivingIntoxicated 0.7 SocialDeterminantsofHealthThoseconductingtheCHNAwereparticularlyinterestedinabetterunderstandingofwhetherparticipantsperceivedthatcertainsocialissues(oftenconsideredtobedeterminantofhealthstatus)wereimpactingtheirlives.Participantswereprovidedwithalistof10statementsandaskedtoreporttheextenttowhichthatstatementappliedtothem.Eachstatementreflectedaparticularsocialdeterminantofhealth.Thepurposeoftheseitemswastoassesstheextenttowhichparticipants“felt”specificcharacteristicsofsocialfactorsknowntoinfluencehealthoutcomes.Toassessthese,someitemswerewordedpositively.Forexample,“IfeelsafeintheplacewhereIlive”isapositivelywordeditemandthosereporting“never”or“seldom”tothatitemareamongthosewhohaveidentifiedasocialfactorthatcouldbeacteduponinthehealthandsocialservicesinfrastructuretoworkwithanindividualtohasconcernsabouthisorherhousingsituation.Negativelywordeditemslike“Iworryaboutbeingabletopaymyrentormortgage”areconsideredattheotherendoftheresponseoptions,withthoseresponding“sometimes,”
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“often,”or“always”beingamongthosewhomightbenefitfromeconomicoremploymentassistanceinwaystoreducetheimpactonhealth.Consistentlyacrosstheseitems,thereweresixparticipantswhodidnotrespondtoeachitemandthoseparticipantswerenotincludedinthesummaryprovided.Table14providesanoverviewoftheextenttowhichparticipantsperceivedthosestatementstobeamongthosethatappliedtothem.Highlightedinthistablearethesocialdeterminantswithendorsementof10%orgreaterthat,inatypicalsocialservicesetting,wouldindicateaneedforfurtherconsideration,discussion,ortriage.Table14.Participants’ReportsofFeltSocialDeterminants(n=501)
ImportanceofCommunity-BasedHealthandSocialServiceProgramsParticipantswereaskedtoprovidetheperspectivesontheextenttowhichhealthandsocialserviceprogramsareimportanttotheirlocalcommunity.Duringthesurvey,participantswereprovidedwithalistof20differentprogramsthatareoftenpresentinmanycommunities.Participantswereinconsistentwithregardtotheextenttowhichtheyprovidedanassessmentofeachprogramtype.Asaresult,resultsfromparticipantswereusedtocalculaterankingsofprogramendorsement.Ofthetwentyprograms,approximatelytwo-thirdswererankedasbeingeithermoderatelyorveryimportantbymorethan50%ofparticipants.Whiletheseresultsdoprovidesomeinsightintothetypesofprogramsperceivedasmostimportantintheirlocalcommunity,acrosstheboardthesedatadosuggestthatingeneralmostcommunitymembersperceivethegeneralnetworkofhealthandsocialserviceprogramstobeimportantonthewhole.
SocialDeterminant ItemAssessed TotalSampleResponses
PositivelyWordedSocialDeterminantItems PercentReporting"Never"or"Seldom"AppliestoMe
SocialEcology Ifeelthosearoundmearehealthy 0.9Education Iamsatisfiedwithmyeducation 4.4CommunityCohesion Imakeeffortstogetinvolvedinmycommunity 28.6Policy Ivotewhenthereisanelectioninmytown 11.0Environment Ifeelthatmytown'senvironmentishealthy(air,water,etc) 1.7Housing IfeelsafeintheplacewhereIlive 3.1Psychosocial Itrytospendtimewithothersoutsideofwork 10.2Transportation Ihaveaccesstosafeandreliabletransportation 0.7
NegativelyWordedSocialDeterminantItems PercentReporting"Sometimes,""Often"or"Always"AppliestoMe
Economy Iworryaboutmyutilitiesbeingturnedofffornon-payment 3.4Employment Iworryaboutbeingabletopaymyrentormortgage 7.9
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However,consideringthesedataintermsofthoseservicesthatparticipantsrankedas“very”importantdoesprovidevaluableinsightsintothosemostvalued.Table15providesalistoftheextenttowhichparticipantsratedaprogramtypeas“moderately”or“very”important,presentedinorderofhighesttolowestendorsement.Inthistable,highlightedseparatelyarethoseservicesrankedas“very”importantbymorethan50%or60%.
Table15.EndorsementofImportanceofCommunityPrograms(n=505)
CommunityPrograms Moderately/VeryImportant% Moderately
Important%
VeryImportant
%PhysicalActivity 93.2 41.1 52.1WalkingTrails/OutdoorSpace 88.4 27.8 60.6AgingServices 86.0 45.6 40.4MentalHealthCounseling 84.9 45.2 39.7SubstanceAbusePrevention&Treatment 79.9 35.8 44.1NutritionEducation 75.6 52.8 22.8GunSafetyEducation 69.8 34.6 35.2Free/EmergencyChildcare 56.5 33.3 23.2FamilyPlanning 55.4 35.2 20.2JobTraining/EmploymentAssistance 55.2 42.5 12.7ServicesforWomen,Infants,Children 52.3 31.1 21.2FoodPantries 52.1 34.3 17.8HealthInsuranceAssistance 50.5 34.2 16.3TransportationAssistance 40.4 33.2 7.2PrescriptionAssistance 38.7 31.6 7.1LegalAssistance 35.6 28.2 7.4FinancialAssistance 34.2 25.6 8.6HousingAssistance 32.5 25.3 7.2FoodStamps/SNAP 31.0 22.5 8.5NeedleExchange 29.9 18.3 11.6CommunityPerceptionsofPriorityHealthNeedsImportanttothedevelopmentoftheCHNAanditssubsequentImplementationPlanwastoassessthelocalhealthissueswhichcommunitymembersperceivedtobeofimportance.Thehospitaldevelopedalistof21differenthealthneedsthatarecommoninmanycommunitiessimilartothoseinHamiltonCounty.Surveyparticipantswereaskedtoselectfiveofthosecommunityhealthissuesthattheyperceivedtobeamongthemostimportantforthehospitalanditspartnerstoaddress.Accompanyingthelistofhealthissueswasastatementthatguidedsurveyparticipantsintheirselection.Thestatementread“Belowisalistofhealthissuespresentinmanycommunities.Pleasepickthefivethatyouthinkposethegreatesthealthconcernforpeoplelivinginyour
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community.”Table16providesasummaryoftheextenttowhicheachhealthissuewasselectedasoneofthetopfiveissuesbysurveyparticipants.Table16.PriorityHealthIssuesSelectedbyParticipantsasBeingAmongtheTop5MostInNeedofAttentionintheServicePopulation(n=505)
HealthIssue %SelectingIssueasOneofTop5NeedingAttention
Obesity 69.7Chronicdiseaseslikediabetes,cancer,andheartdisease 56.8
Mentalhealth 54.9Substanceuseorabuse 52.4Agingandolderadultneeds 43.2Alcoholuseorabuse 32.5Injuriesandaccidents 24.5Tobaccouse 19.6Suicide 18.9Reproductivehealthandfamilyplanning 15.6Disabilityneeds 15.4Environmentalissues 14.0Foodaccess,affordability,andsafety 13.2Childneglectandabuse 10.6Assault,violentcrime,anddomesticviolence 8.9Sexualviolence,assault,rape,orhumantrafficking 7.8
Poverty 7.6Dentalcare 5.9InfectiousdiseaseslikeHIV,STDs,andhepatitis 3.0Homelessness 2.1Infantmortality 1.7
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Whileparticipantswereabletoselectfromthefulllistof21healthissuesduringthesurvey,itwasdecidedtonarrowdownthepriorityissuestothetop50%duringthecommunityprioritizationsession.Figure11providesagraphicalpresentationofthetophealthissuessharedduringcommunitymeetingsforpurposesofinformingfutureinitiatives.
Figure11.MostFrequentlyEndorsedHealthIssuesasPriorityforActionCommunityPerceptionsofHealthIssuesNeedingPriorityResourceAllocationInadditiontoassessingtheextenttowhichparticipantsperceivedspecificneedsasbeingamongthemostimportantforactionintheircommunity,participantswerealsoaskedtoprovidetheirperceptionsoftheextenttowhichthosesame21issueswerealsoprioritiesfortheallocationofresourcesinthelocalcommunity.Participantsweregivenastatementtoconsiderpriortoindicatingtheirperceptions.Thestatementread“Previouslyyouwereaskedtopickissuesthatposethegreatesthealthconcerninyourcommunity.Ifyouhad$3andcouldgive$1tohelpsolvesomeofthese,whicharethethreetowhichyouwouldgive$1?”
69.7
56.8
54.9
52.4
43.2
32.5
24.5
19.6
18.9
15.6
15.4
0 10 20 30 40 50 60 70 80
Obesity
Chronicdiseaseslikediabetes,cancer,andheartdisease
Mentalhealth
Substanceuseorabuse
Agingandolderadultneeds
Alcoholuseorabuse
Injuriesandaccidents
Tobaccouse
Suicide
Reproductivehealthandfamilyplanning
Disabilityneeds
PercentofParticipants SelectingTopic asTop5Priority
LocalCommunityHealthNeedsSelectedasaTop5Issue,%(n=505)
Belowaresomeissuespresentinmanycommunities.PleasepickFIVE thatyouthinkposethegreatesthealthconcernforpeoplewholiveinyourcommunity.
DataReflectsTop11issuesfromtotallistof21possible.
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Aswasthecasewiththehealthissuesselectedasprioritiesforaction,itwasdecidedtonarrowdownthepriorityissuestothetop50%duringthecommunityprioritizationsession.Figure12providesagraphicalpresentationofthetoprankedissuesthatsurveyparticipantsselectedasprioritiesfortheallocationofresources.
Figure12.MostFrequentlyEndorsedHealthIssuesasPriorityforResourceAllocation
35.0
32.3
28.5
26.1
19.2
18.5
12.6
10.8
9.9
9.9
0 5 10 15 20 25 30 35 40
Chronicdiseaseslikediabetes,cancer,andheartdisease
Substanceuseorabuse
Obesity
Agingandolderadultneeds
Childneglectandabuse
Foodaccess,affordability,andsafety
Suicide
Sexualviolence,assault,rape,orhumantrafficking
Alcoholuseorabuse
Disabilityneeds
Percent ofParticipants IndicatingWouldGive$1ToIssues
Top10HealthIssuesSelectedAsPriorityforResourceAllocation,%(n=505)
Previously youwereaskedtopickissuesthatpose thegreatesthealthconcern inyourcommunity.
Ifyouhad$3andcould give$1tohelpsolvesomeofthese,whicharetheTHREEtowhichyouwould give$1?
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ComparisonofNeedsandResourcePriorities
Whileparticipantswereaskedtoprovideanassessmentofpriorityneedsandprioritiesforresourceallocationasseparatesurveyitems,acomparisonofthosepriorityrankingsprovideshelpfulinsightsintotheextenttowhichthereisconsistencybetweenthetwo.Figure13providessuchacomparisonandhighlightssomeinconsistencybetweenhealthissuesthatcommunitymembersbelievedwereapriorityneedingaddressedandthosethattheybelieveshouldbeapriorityfortheallocationofresources.
Figure13.ComparisonofPriorityNeedsandResourcePriorities
69.7
56.8
54.9
52.4
43.2
32.5
24.5
19.6
18.9
15.6
15.4
28.5
35.0
38.6
32.3
26.1
9.9
3.6
5.4
12.6
9.3
9.9
0 10 20 30 40 50 60 70 80
Obesity
Chronicdiseaseslikediabetes,cancer,andheartdisease
Mentalhealth
Substanceuseorabuse
Agingandolderadultneeds
Alcoholuseorabuse
Injuriesandaccidents
Tobaccouse
Suicide
Reproductivehealthandfamilyplanning
Disabilityneeds
TopHealthIssues ComparedtoPrioritizationforResourceAllocation(n=505)
%PriorityResourceAllocation %PriorityNeed
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5.COMMUNITYCHNAFOCUSGROUPDISCUSSIONSToprovideforadditionalopportunitiesforcommunitymemberstoprovidevaluableinsightsintothedecisionsmadeduringthe2018CHNAprocess,thehospital,incollaborationwithpartnerorganizationsandotherhospitals,heldaseriesoffocusgroupdiscussions.Thesefocusgroupdiscussionsprovidedopportunitiestogathercommunitymembers,providersoflocalhealthandsocialservices,andotherstakeholderstoreviewinformation,haveopenconversationsaboutlocalhealthneeds,andtooffersuggestionsforpriorityhealthtopicsthatshouldbeconsideredasthehospitalsmakedecisionsabouttheirprioritiesandsubsequentimplementationplan.Thissectionofthereportprovidesanoverviewofthefocusgroupdiscussionsandtherecommendationsemergingfromthosediscussions.AppendixBincludesalistingofthoseparticipatinginthefocusgroupsandasummaryoftheprocessandoutcomesofeachfocusgroup.FocusGroupsInApril2018,threefocusgroupdiscussionswereheld.ThosediscussionsincludedparticipantsfromawiderangeofparticipantsfromHamiltonCounty.ParticipantsAtotalof38communitymembersparticipatedinthefocusgroupdiscussions.Tobetterfacilitatediscussion,participantsweredividedintothreeseparategroups.Belowisasummaryofthenumberofparticipantsforeachfocusgroupdiscussion.FocusGroups #ofCommunityMembersParticipatingGroupOne 11 GroupTwo 15 GroupThree 12 Avarietyoforganizationtypes,includingschoolsystems,healthsystems,behavioralhealthorganizations,housing,socialservices,communityhealthcenters,seniorservices,thebusinesscommunity,andlocalpolicymakers,wererepresentedinthefocusgroups.Inthedetailedfocusgroupsummaries(AppendixB)asummaryoftheorganizationsrepresentedineachfocusgroupispresented.
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MethodsToconductthefocusgroupdiscussions,thefacilitatorsappliedagreatdealofconsistencyinboththeapproach,process,andtypesofinformationsharedwiththecommunitymembers.Theprocessforthefocusgroupdiscussionsincludedthefollowingactivities:
• Introductions
• Adescriptionofthepurposeofthediscussionandgroundrules
• Twoprimaryquestionsguidedthediscussions,including:
o Whatisthemostimportantunmetneedaffectingthehealthofyourcommunity?
o Consideringtheunmetneedyouindicated,whichofthefollowingtypesofindividualsaremostvulnerableinyourcommunity?
• Topicsemergingfromthesediscussionswerewrittenonlargesheetsofpaperandplacedonthewall.Eachparticipantwasprovidedagreensticker(indicatingtheir#1priority)andpinksticker(indicatingtheir2ndpriority)inordertoendorsethetopicsbasedoneachoftheprimaryquestions.
• Endorsementsforfirstandsecondprioritiesweretalliedanddiscussedfurtherforclarification
OutcomesEachfocusgroupselectedpriorityissuesandprioritypopulations.Collectively,acrossthethreegroups,afinallistofprioritieswasproduced.Figure14providesasummaryofthehighlyrankedprioritiesemergingfromeachgroupandasummaryofthefinaloutcomesacrossthethreegroups.Detailedsummariesoftheseoutcomesareprovidedinthefocusgroupnotes(AppendixB).
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Figure14.FocusGroupPriorities
HighPriorityIssues* HighPriorityPopulations*
Transportation IndividualsfacingMentalHealthDiagnosisAccesstoHealthServices IndividualswithSubstanceAbuseHistory
Housing IndividualsfacingMentalHealthDiagnosisTransportation ChildrenAccesstoHealthServices SeniorsChronicDiseaseManagement IndividualswithChronicConditions
IndividualswithSubstanceAbuseHistory
AccesstoHealthServices UninsuredandUnderinsuredTransportation IndividualsFacingMentalHealthDiagnosis
IndividualswithSubstanceAbuseHistoryChildren
**Inrankorder
CollectivePrioritiesAcrossGroupsPrioritiesbyFocusGroup
Housing
IndividualsFacingMentalHealthDiagnosis
IndividualswithSubstanceAbuseHistory
UninsuredandUnderinsured
Children
FocusGroupOne
FocusGroupTwo
FocusGroupThree
*Highpriorityissuesinrankorderbasedonparticipantendorsements.
FinalPriorityIssues** FinalPriorityPopulations**
Transportation
AccesstoHealthServices
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5.PRIORITIZATIONPROCESSToconsidertheCHNAdataandtoidentifythemosturgenthealthissuesthatwouldguidethehospital’sfuturepriorityareas,acomprehensiveprioritizationprocesswasconducted.RepresentativesofcommunityhealthorganizationsintheserviceareaandhospitalstaffparticipatedinameetingtoreviewdatacollectedfortheCHNA.Alistofcommunitypartnerorganizationsfromwhicharepresentativeparticipatedisincludedlaterinthissection.AcopyoftheslidesusedduringthepresentationofdataisincludedasAppendixC.Thesessionincludedthefollowingactivities:• AreviewofthepurposeofconductingtheCHNAandreflectionsondecisionsandactions
takeninresponsetothe2016CHNA.
• AreviewofdatawaspresentedbyarepresentativeofMeasuresMatter,LLC.ThatdatareviewincludedasummaryoftheexistinghealthindicatorsanddatafromtheCHNAsurvey.
• AnominalgroupprocessfacilitatedbyMeasuresMatter,LLCtofacilitatethegroup’s
selectionofpriorityhealthissuesforthe2018CHNA.Thatprocesswasconductedinthefollowingway:
o Participantswereprovidedwiththelistofhealthtopicsthatemergedasamong
thosehavingthemostsupportfrombothexistingdataandtheCHNAsurvey.ThatlistofhealthtopicsisprovidedinFigure14.Additionally,participantswereprovidedasummaryoftheoutcomesofthefocusgroupsaspresentedinFigure13intheprevioussectionofthisreport.
o Participantsweregiventheopportunitytoaddadditionaltopics.
o Participantswereeachprovidedwith5“stickydots”andaskedtoplacetheirdotsontheissuesthattheyeachfeltweremostinneedofprioritization.
o The“dots”oneachtopicweretalliedandadiscussionaboutthetopicsandany
specialconsiderationsforeachwasheld.ResultingPrioritiesAsaresultofbothphasesoftheprioritizationprocess,XissuesreceivedendorsementforprioritizationforRiverviewHealth.Thoseissuesincluded:
• ToBeAdded
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AlistofavailablecommunityhealthresourceswasalsoreviewedaspartoftheprocessandthepotentialpartnersforaddressingtheseneedsisincludedasAppendixD.
Figure14.OverlappinghealthissuesthatemergedfromsecondarydataandtheCHNAsurvey.