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2019 Community Health Needs Assessment MEMORIAL HERMANN NORTHEAST HOSPITAL HEALTH INSURANCE Board Approved June 27, 2019

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Page 1: MEMORIAL HERMANN NORTHEAST HOSPITAL...Memorial Hermann Northeast Hospital CHNA 2019 7 overall population health is the Community Benefit Corporation. At a market share of 26.1% in

2019 Community Health Needs Assessment

MEMORIAL HERMANN NORTHEAST HOSPITAL

HEALTHINSURANCE

Board Approved June 27, 2019

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Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Introduction&Purpose...............................................................................................................................4SummaryofFindings...................................................................................................................................4PrioritizedAreas..........................................................................................................................................5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 MemorialHermannNortheastHospital......................................................................................................6

Vision.......................................................................................................................................................6MissionStatement...................................................................................................................................6MemorialHermannHealthSystem.........................................................................................................6MemorialHermannNortheastHospitalServiceArea.............................................................................7

Consultants..................................................................................................................................................8

Evaluation of Progress Since Prior CHNA .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 PriorityHealthNeedsandImpactfromPriorCHNA....................................................................................9

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Overview....................................................................................................................................................11SecondaryDataSources&Analysis...........................................................................................................11

SecondaryDataScoring.........................................................................................................................11DisparitiesAnalysis................................................................................................................................12

PrimaryDataMethods&Analysis.............................................................................................................12CommunitySurvey.................................................................................................................................12KeyInformantInterviews.......................................................................................................................14

DataConsiderations...................................................................................................................................16Race/EthnicGroupings..........................................................................................................................17ZipCodesandZipCodeTabulationAreas..............................................................................................17

Prioritization..............................................................................................................................................17PrioritizationProcess.............................................................................................................................17

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Population..................................................................................................................................................20Age.............................................................................................................................................................21Race/Ethnicity............................................................................................................................................22Language....................................................................................................................................................24SocialandEconomicDeterminantsofHealth............................................................................................25

Income...................................................................................................................................................25Poverty...................................................................................................................................................27FoodInsecurity......................................................................................................................................30Unemployment......................................................................................................................................31Education...............................................................................................................................................32Transportation.......................................................................................................................................34SocioNeedsIndex®.................................................................................................................................37

Data Synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Priorit ized Signif icant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 PrioritizationResults..................................................................................................................................44AccesstoHealthcare..................................................................................................................................44

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EmotionalWell-Being................................................................................................................................53FoodasHealth...........................................................................................................................................57ExerciseIsMedicine...................................................................................................................................63

Non-Prioritized Significant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 OlderAdultsandAging..............................................................................................................................67Cancers......................................................................................................................................................68Education...................................................................................................................................................68Transportation...........................................................................................................................................69Children’sHealth.......................................................................................................................................70Economy....................................................................................................................................................71

Other Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 BarrierstoCare..........................................................................................................................................73Disparities..................................................................................................................................................73

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 AppendixA:EvaluationSincePriorCHNA.................................................................................................77AppendixB.SecondaryDataMethodology...............................................................................................95AppendixC.PrimaryDataMethodology.................................................................................................146AppendixD.PrioritizationTool................................................................................................................161AppendixE.CommunityResources.........................................................................................................164

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Executive Summary

Introduction & Purpose MemorialHermannNortheastHospital(MHNortheast)ispleasedtopresentits2019CommunityHealthNeedsAssessment(CHNA).ThisCHNAreportprovidesanoverviewoftheprocessandmethodsusedtoidentifyandprioritizesignificanthealthneedsacrossMemorialHermannHealthSystem’sregionalservicearea(includingMHNortheast),asfederallyrequiredbytheAffordableCareAct.MemorialHermannHealthSystempartneredwithConduentHealthyCommunitiesInstitute(HCI)toconducttheCHNAfor13facilities:

• MemorialHermannKatyHospital• MemorialHermannMemorialCityMedicalCenter• MemorialHermannGreaterHeightsHospital• MemorialHermannNortheastHospital• MemorialHermannSoutheastHospital• MemorialHermannSugarLandHospital• MemorialHermannSouthwestHospital• MemorialHermannTheWoodlandsMedicalCenter• MemorialHermannRehabilitationHospital–Katy• MemorialHermann–TexasMedicalCenter• TIRRMemorialHermann• MemorialHermannSurgicalHospitalKingwood• MemorialHermannSurgicalHospitalFirstColony

ThepurposeofthisCHNAistoofferacomprehensiveunderstandingofthehealthneedsinMHNortheast’sserviceareaandguidethehospital’splanningeffortstoaddressthoseneeds.Specialattentionhasbeengiventotheneedsofvulnerablepopulations,unmethealthneedsorgapsinservices,andinputfromthecommunity.TostandardizeeffortsacrosstheMemorialHermannHealthSystemandincreasethepotentialforimpactingtophealthneedsinthegreaterHoustonregion,communityhealthneedswereassessedandprioritizedataregional/systemlevel.Findingsfromthisreportwillbeusedtoidentifyanddevelopeffortstoimprovethehealthandqualityoflifeofresidentsinthecommunity.

Summary of Findings TheCHNAfindingsinthisreportresultfromtheanalysisofanextensivesetofsecondarydata(over100indicatorsfromnationalandstatedatasources)andprimarydatacollectedfromcommunityleaders,non-healthprofessionals,andorganizationsservingthecommunityatlarge,vulnerablepopulations,and/orpopulationswithunmethealthneeds.Throughanexaminationoftheprimaryandsecondarydata,thefollowingtophealthneedswereidentified:

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Priorit ized Areas InMarch2019,stakeholdersfromthe13hospitalfacilitiesintheMemorialHermannHealthSystemcompletedasurveytoprioritizethesignificanthealthissues,basedoncriteriaincludinghealthimpactandriskaswellasconsiderationofMemorialHermann’sstrategicfocus.Thefollowingfourtopicswereidentifiedasprioritiestoaddress:

MHNortheastwilldevelopstrategiestoaddresstheseprioritiesinits2019ImplementationStrategy.

MemorialHermannHealthSystem’sSignificantHealthNeeds•AccesstoHealthServices•Cancers•Children’sHealth•Diabetes•Economy

•Education•FoodInsecurity•HeartDisease/Stroke•LackofHealthInsurance•Low-Income/Underserved

•MentalHealth•Obesity•OlderAdults/Aging•SubstanceAbuse•Transportation

MemorialHermannHealthSystem’sCHNAPriorities• AccesstoHealthcare• EmotionalWell-Being• FoodasHealth• ExerciseIsMedicine

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Introduction

Memorial Hermann Northeast Hospital A255-bedfacility,MemorialHermannNortheastHospitalhasbeencaringforfamiliesintheLakeHoustonandKingwoodareaformorethan30years,offeringworld-classcareclosetohome.Itsaffiliateddoctorsspanawidevarietyofservicesincludingcancercare,children’semergencyandNICUcare,heartandvascularcare,orthopedics,neurosciences,sleephealth,woundcare,andwomen’scare.ThehospitalistheanchorfortheinnovativeMemorialHermannConvenientCareCenterprovidingone-stop,highlycoordinatedaccesstoanextensivearrayofMemorialHermannservices.Additionally,MemorialHermannNortheastservesastheofficialhealthcareprovidertopassengerstravelingthroughHouston’sGeorgeBushInternationalAirport.

Vision MemorialHermannwillbethepreeminenthealthsystemintheU.S.byadvancingthehealthofthoseweservethroughtrustedpartnershipswithphysicians,employeesandotherstodeliverthebestpossiblehealthsolutionswhilerelentlesslypursuingqualityandvalue.

Mission Statement MemorialHermannisanot-for-profit,community-owned,healthcaresystemwithspiritualvalues,dedicatedtoprovidinghighqualityhealthservicesinordertoimprovethehealthofthepeopleinSoutheastTexas.

Memorial Hermann Health System Oneofthelargestnot-for-profithealthsystemsinthenation,MemorialHermannHealthSystemisanintegratedsystemwithanexceptionalaffiliatedmedicalstaffandmorethan26,000employees.GovernedbyaBoardofcommunitymembers,theSystemservicesSoutheastTexasandtheGreaterHoustoncommunitywithmorethan300caredeliverysitesincluding19hospitals;thecountry’sbusiestLevel1traumacenter;anacademicmedicalcenteraffiliatedwithMcGovernMedicalSchoolatUTHealth;oneofthenation’stoprehabilitationandresearchhospitals;andnumerousspecialtyprogramsandservices.MemorialHermannhasbeenatrustedhealthcareresourceformorethan110yearsandasGreaterHouston’sonlyfull-service,clinicallyintegratedhealthsystem,wecontinuetoidentifyandmeetourregion’shealthcareneeds.AmongourdiverseportfolioisLifeFlight,thelargestandbusiestairambulanceserviceintheUnitedStates;theMemorialHermannPhysicianNetwork,MHMD,oneofthelargest,mostadvanced,andclinicallyintegratedphysicianorganizationsinthecountry;and,theMemorialHermannAccountableCareOrganization,operatingacaredeliverymodelthatgeneratesbetteroutcomesatlowercoststoconsumers,whileprovidingresidentsoftheGreaterHoustonareabroadaccesstohealthinsurancethroughtheMemorialHermannHealthInsuranceCompany.Specialtiesspanburntreatment,cancer,children’shealth,diabetesandendocrinology,digestivehealth,ear,noseandthroat,heartandvascular,lymphedema,neurosurgery,neurology,stroke,nutrition,ophthalmology,orthopedics,physicalandoccupationaltherapy,rehabilitation,roboticsurgery,sleepstudies,transplant,weightloss,women’shealth,maternityandwoundcare.SupportingtheSysteminitsimpacton

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overallpopulationhealthistheCommunityBenefitCorporation.Atamarketshareof26.1%inthe‘expanded’greaterHoustonareaof12counties,ourvisionisthatMemorialHermannwillbeapreeminentintegratedhealthsystemintheU.S.byadvancingthehealthofthoseweserve.

Memorial Hermann Northeast Hospital Service Area TheserviceareaforMHNortheastincludesHarris,LibertyandMontgomerycountiesinTexas.ThegeographicboundariesoftheserviceareaareshowninFigure1.ThezipcodeswithinMHNortheast’sprimaryserviceareaarelistedinTable1andrepresentapproximately75%ofinpatientdischarges(66.6%inHarrisCounty,1.5%inLibertyCounty,and8%inMontgomeryCounty).

Figure1.MHNortheastServiceArea

Table1.ProportionofPatientPopulationServedbyZipCodeZIPCode County PercentofPatient

Population77346 Harris 8.3%77338 Harris 8.2%77396 Harris 7.5%77016 Harris 6.6%77093 Harris 5.8%77039 Harris 5.6%77044 Harris 5.3%77339 Harris 4.2%77365 Montgomery 3.5%

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ZIPCode County PercentofPatientPopulation

77357 Montgomery 3.1%77032 Harris 2.8%77336 Harris 2.6%77373 Harris 2.5%77078 Harris 2.2%77028 Harris 1.8%77345 Harris 1.6%77532 Harris 1.6%77327 Liberty 1.5%77372 Montgomery 1.4%

Consultants MemorialHermannHealthSystemcommissionedConduentHealthyCommunitiesInstitute(HCI)toconductits2019CommunityHealthNeedsAssessment.HCIworkswithclientsacrossthenationtodrivecommunityhealthoutcomesbyassessingneeds,developingfocusedstrategies,identifyingappropriateinterventionprograms,establishingmonitoringsystems,andimplementingperformanceevaluationprocesses.TolearnmoreaboutConduentHealthyCommunitiesInstitute,pleasevisithttps://www.conduent.com/community-population-health.

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Evaluation of Progress Since Prior CHNA TheCHNAprocessshouldbeviewedasathree-yearcycle.AnimportantpartofthatcycleisrevisitingtheprogressmadeonprioritytopicsfrompreviousCHNAs.Byreviewingtheactionstakentoaddresspriorityareasandevaluatingtheimpactoftheseactionsinthecommunity,anorganizationcanbetterfocusandtargetitseffortsduringthenextCHNAcycle.

Priority Health Needs and Impact from Prior CHNA MHNortheast’slastCHNAwasconductedin2016.ThepriorityareasinFY16-18were:

• HealthyLiving:Encourageandfosterhealthylifestylesthrougheducation,awarenessandearlydetectiontopreventillness.

• HealthcareAccess:Improvecommunityknowledgeabouthealthcareaccesspointsandreduceperceivedbarrierstocare.

• BehavioralHealth:Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

EachoftheabovehealthtopicscorrelateswellwiththeprioritiesidentifiedforthecurrentCHNA(detailedbelow);thusMHNortheastwillbebuildinguponeffortsofpreviousyears.A

Figure2.CHNAProcess

AnalyzeData&

CommunityInput

PrioritizeHealthNeeds

CHNAReport&

ImplementationStrategy

Implement

EvaluateActionsTaken 3Year

Cycle

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detailedtabledescribingthestrategies/actionstepsandindicatorsofsuccessforeachoftheprecedingpriorityhealthtopicscanbefoundinAppendixA.MHNortheast’sprecedingCHNAwasmadeavailabletothepublicviathewebsiteandcommunityfeedbackdirectedtoMemorialHermann’sCommunityBenefitDepartment:http://www.memorialhermann.org/locations/northeast/community-health-needs-assessment-northeast/.NocommentsorfeedbackwerereceivedontheprecedingCHNAatthetimethisreportwaswritten.

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Methodology

Overview Twotypesofdatawereusedinthisassessment:primaryandsecondarydata.Primarydataaredatathathavebeencollectedforthepurposesofthiscommunityassessment.Primarydatawereobtainedthroughacommunitysurveyandkeyinformantinterviews.Secondarydataarehealthindicatordatathathavealreadybeencollectedbypublicsourcessuchasgovernmenthealthdepartments.Eachtypeofdatawasanalyzedusingauniquemethodology.FindingswereorganizedbyhealthtopicsandthensynthesizedforacomprehensiveoverviewofthehealthneedsinMHNortheast’sservicearea.

Secondary Data Sources & Analysis SecondarydatausedforthisassessmentwerecollectedandanalyzedfromHCI’scommunityindicatordatabase.Thisdatabase,maintainedbyresearchersandanalystsatHCI,includesover100communityindicatorsfromatleast15stateandnationaldatasources.HCIcarefullyevaluatessourcesbasedonthefollowingthreecriteria:thesourcehasavalidatedmethodologyfordatacollectionandanalysis;thesourcehasscheduled,regularpublicationoffindings;andthesourcehasdatavaluesforsmallgeographicareasorpopulations.

Secondary Data Scoring HCI’sDataScoringTool®wasusedtosystematicallysummarizemultiplecomparisonsinordertorankindicatorsbasedonhighestneed.Foreachindicator,thecommunityvaluewascomparedtoadistributionofTexasandUScounties,stateandnationalvalues,HealthyPeople2020,andsignificanttrendswerenoted.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.Thecomparisonscoresweresummarizedforeachindicator,andindicatorswerethengroupedintotopicareasforasystematicrankingofcommunityhealthneeds.PleaseseeAppendixBforfurtherdetailsonthequantitativedatascoringmethodologyaswellassecondarydatascoringresults.

Figure3.SummaryofTopicScoringAnalysis

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Disparit ies Analysis Whenagivenindicatorhasdataavailableforsubgroupslikerace/ethnicity,ageorgender–andvaluesforthesesubgroupsincludeconfidenceintervals–significantdifferencesbetweenthesubgroups’valueandtheoverallvaluecanbedetermined.Asignificantdifferenceisdefinedastwovalueswithnon-overlappingconfidenceintervals.Onlysignificantdifferencesinwhichthevalueforasubgroupisworsethantheoverallvalueareidentified.Confidenceintervalsarenotavailableforallindicators.Inthesecases,therearenotenoughdatatodetermineiftwovaluesaresignificantlydifferentfromeachother.

Primary Data Methods & Analysis CommunityinputforMemorialHermannHealthSystemwascollectedtoexpandupontheinformationgatheredfromthesecondarydata.PrimarydatausedinthisassessmentconsistedofacommunitysurveyinEnglishandSpanishaswellaskeyinformantinterviews.SeeAppendixCforthesurveyandinterviewquestions.

Community Survey Inputfromcommunityresidentswascollectedthroughanonlinesurvey.Thissurveyconsistedof11questionsrelatedtotophealthneedsinthecommunity,individuals’perceptionoftheiroverallhealth,andweeklyexercisehabits.ThecommunitysurveywasdistributedonlinethroughSurveyMonkey®fromOctober23rdthroughNovember27thof2018.ThesurveywasmadeavailableinbothEnglishandSpanish.PapersurveyswerealsomadeavailableandanswerstothepapersurveywereenteredintotheSurveyMonkeytool.Atotalof285responseswerecollected.ResultsinthisreportarebasedontheserviceareaforMemorialHermannHealthSystem.Thiswasaconveniencesample,whichmeansresultsmaybevulnerabletoselectionbiasandmakethefindingslessgeneralizabletothepopulationasawhole.

Table2.CommunitySurveyOutreachCommunityEvent DescriptionStepHealthEvent–MoodyPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

StepHealthEvent–CastilloPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

MemorialHermannHealthCentersforSchools

10school-basedhealthclinicsin5schooldistricts(74schools)inHarrisandFortBendCounties,providingmedical,mentalhealth,anddentalcare,alongwithnutrition,navigation,andsummerbootcampprogramstouninsuredandunderinsuredchildrenthroughouttheGreaterHoustonarea.

WestOremYMCA,77085

Acommunity-centeredorganizationthatbringspeopletogethertobridgethegapsincommunityneeds(underservedresidents),nurturesresidents’potentialtolearn,grow,andthrive,andmobilizesthelocalcommunitytoeffectlasting,meaningfulchange.

SpringBranchCommunity

AFederallyQualifiedHealthCenter(FQHC)providingquality,affordablehealthcareservicestotheunderservedanduninsuredcommunitiesofSpring

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Therace/ethnicitymake-upofsurveyrespondentsisshowninFigure4.ThelargestproportionofrespondentsidentifiedasHispanic/Latino(47.2%),22.4%asWhite,20.8%asBlack/AfricanAmerican,andtheremaining9.6%ofrespondentsasAsian/PacificIslander,OtherandNativeAmerican.

HealthCenter,77080

BranchandWestHouston.

WesleyCommunityCenter,77009

Amulti-purposesocialserviceagencyprovidingresidentsofHouston:short-termrent,utility,andfoodassistancetopreventhomelessnessandmaintainfamilyfinancialstability;acareerandpersonalfinancialservicecenter;andEarlyHeadStart,achilddevelopmentprogramservinginfantstotoddlerstopromoteschoolreadiness.

CompleteCommunities,Houston

PrograminitiatedbytheMayorofHoustoninfivecommunities-allhistoricallyunder-resourced,eachwithabaselevelofcommunityinvolvementandsupport,andwithdiversepopulations.Theprogramisdesignedtoenhanceaccesstoqualityaffordablehomes,jobs,well-maintainedparksandgreenspace,improvedstreetsandsidewalks,grocerystoresandotherretail,goodschoolsandtransitoptions.Communities:AcresHomes[77018,77088,77091],Gulfton[77056,77057,77081],NearNorthside[77009,77022,77026],SecondWard[77003,77011,77020],andThirdWard[77003,77004,77204].

HealthyLivingMatters

AHouston/HarrisCountyChildhoodObesityCollaborative-Acollaborativeofmulti-sectorleadersthatpromotepolicyaimedatsystem-levelandenvironmentalchangetoreducetheincidenceofchildhoodobesity.Prioritycommunitieswereselectedduetothelackofaccesstohealthyfoodoptionsandopportunitiestoengageinphysicalactivityaswellasfortheircommunityassetsandreadinessforchange.PriorityCommunities:CityofPasadena[77058,77059,77502,77503,77504,77505,77506,77507,77536,77571,77586],NearNorthside[77009,77022,77026],andFifthWard/KashmereGardens[77020,77026,and77028]

GreaterNorthsideHealthCollaborative

Non-profitcollaborativewhosegoalistoexpandactivelivingresourcesandincreaseaccesstoqualityhealthcareandhealthyfoodbypromotingresidentleadershipandcivicparticipation.

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Figure4.SurveyRespondentsbyRace/Ethnicity

Surveyrespondentswereaskedtoselecttopissuesmostaffectingthecommunity’squalityoflife.AsshowninFigure5,themajorityofrespondentsidentifiedDiabetes,Obesity/Overweight,SubstanceAbuse,andMentalHealth&MentalDisordersastopissuesinthecommunity.

Figure5.TopIssuesAffectingQualityofLife(Survey)

Key Informant Interviews Communityinputwasalsocollectedthroughkeyinformantinterviews.

MemorialHermannHealthSystemjoinedwiththeEpiscopalHealthFoundation(EHF)intheirkeyinformantinterviewinitiativesupportingfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsofthisinitiativeincludeMemorialHermann,CHISt.Luke’sHealth,HoustonMethodist,andTexasChildren’s(Table3).Throughthispartnership,atotalof53interviewswereconductedwith

47.20%

22.40%

20.80%

4.80%3.60% 1.20%

Hispanic

White

AfricanAmerican

Asian/PacificIslander

Other

NativeAmerican

10%10%13%13%14%

17%23%26%26%

35%51%54%

64%69%

SexualHealthOralhealth

TeenagePregnancyReproductiveHealth

OtherRespiratory/LungDiseaseInjuries,Violence&Safety

ElderCareHeartDisease&Stroke

CancersMentalHealth&MentalDisorders

SubstanceAbuseObesity/Overweight

Diabetes

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stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Communityleaderswithspecificexperienceworkingwithprioritypopulations,suchaswomen,children,peopleofcolor,thedisabled,andmore,werealsointerviewed.

Table3.MemorialHermannCollaborativePartners

Intotal,64keyinformantinterviewswereconductedbyphonefromAugustthroughNovember2018;53keyinformantinterviewswereconductedthroughthecollaborativeand11interviewswereconductedbyHCI.Intervieweeswhowereaskedtoparticipatewererecognizedashavingexpertiseinpublichealth,specialknowledgeofcommunityhealthneedsand/orrepresentedthebroadinterestofthecommunityservedbythehospital,and/orcouldspeaktotheneedsofmedicallyunderservedorvulnerablepopulations.Effortsweremadetoidentifyintervieweesworkinginand/orknowledgeableaboutthecountiesinMemorialHermannHealthSystem’sservicearea.AsseeninTable4,someintervieweeswereidentifiedwithknowledgeofmultiplecounties.

Table4.KeyInformantsbyCountyCounty KeyInformantsAustin IncludedinMultipleCountiesBrazoria 3Chambers 2

EpiscopalHealthFoundation’smissionistoadvancetheKingdomofGodwithspecificfocusonhumanhealthandwell-beingthroughgrants,research,andinitiativesinsupportoftheworkoftheDiocese,spanning57counties.Throughinformedaction,collaboration,empowerment,stewardship,transparency,andaccountabilitythefoundationstrivesforthetransformationofhumanlivesandorganizationswithcompassionforthepoorandpowerless.

CHISt.Luke’sHealth,apartofCatholicHealthInitiatives(CHI),oneofthenation’slargesthealthsystems,isdedicatedtoamissionofenhancingcommunityhealththroughhigh-quality,cost-effectivecare.Throughpartnershipswithphysiciansandcommunitypartners,CHISt.Luke’sHealthservesGreaterHoustonwithitscommitmenttoexcellenceandcompassionincaringforthewholepersonwhilecreatinghealthiercommunities.

HoustonMethodistisanonprofithealthcareorganizationservingGreaterHouston,dedicatedtoexcellenceinresearch,education,andpatientcare.HoustonMethodistbringscompassionandspiritualitytoallitsendeavorstohelpmeetthehealthneedsofthecommunitythroughthesystem’sICAREvalues:integrity,compassion,accountability,respect,andexcellence.

TexasChildren’sHospitalisanot-for-profitorganizationwhosemissionistocreateahealthierfutureforchildrenandwomenthroughoutGreaterHoustonandtheglobalcommunitybyleadinginpatientcare,education,andresearch.TexasChildren’siscommittedtocreatingahealthycommunityforchildrenbyprovidingthebestpediatriccarepossible,throughgroundbreakingresearchandemphasisoneducation,whilealsoofferingafullcontinuumoffamily-centeredcareforwomen,fromobstetricstowell-womancare.

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County KeyInformantsFortBend 10Galveston 7Harris 28Liberty 1Montgomery 4SanJacinto IncludedinMultipleCountiesWalker IncludedinMultipleCountiesWaller 2Wharton 2MultipleCounties* 5

Total

64

Interviewsweretranscribedandanalyzedusingthequalitativeanalytictool,Dedoose1.Interviewexcerptswerecodedbyrelevanttopicareasandkeyhealththemes.Threeapproacheswereusedtoassesstherelativeimportanceoftheneedsdiscussedintheseinterviews.Theseapproachesincluded:thefrequencybywhichahealthtopicwasdiscussedacrossallinterviews;thefrequencybywhichatopicwasdescribedbythekeyinformantasabarrier/challenge;andthefrequencybywhichatopicwasmentionedperinterviewee.

Data Considerations Severallimitationsofdatashouldbeconsideredwhenreviewingthefindingspresentedinthisreport.Althoughthetopicsbywhichdataareorganizedcoverawiderangeofhealthandhealth-relatedareas,dataavailabilityvariesbyhealthtopic.Sometopicscontainarobustsetofsecondarydataindicators,whileothersmayhavealimitednumberofindicatorsorlimitedsubpopulationscoveredbythosespecificindicators.Datascoresrepresenttherelativecommunityhealthneedaccordingtothesecondarydataforeachtopicandshouldnotbeconsideredtobeacomprehensiveresultontheirown.Inaddition,thesescoresreflectthesecondarydataresultsforthepopulationasawhole,anddonotrepresentthehealthorsocioeconomicneedthatismuchgreaterforsomesubpopulations.Moreover,manyofthesecondarydataindicatorsincludedinthefindingsarecollectedbysurvey,andthoughspecificmethodsareusedtobestrepresentthepopulationatlarge,thesemeasuresaresubjecttoinstability,especiallyforsmallerpopulations.TheIndexofDisparityisalsolimitedbydataavailability,whereindicatordatavariesbasedonthepopulationgroupsandserviceareasbeinganalyzed.

1DedooseVersion8.0.35,webapplicationformanaging,analyzing,andpresentingqualitativeandmixedmethodresearchdata(2018).LosAngeles,CA:SocioCulturalResearchConsultants,LLCwww.dedoose.com

*Five(5)oftheKeyInformantInterviewsrepresented2ormorecounties,including:Austin,Brazoria,Chambers,FortBend,Galveston,Harris,Liberty,Montgomery,SanJacinto,Walker,Waller,andWhartoncounties.

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Race/Ethnic Groupings

Thesecondarydatapresentedinthisreportderivefrommultiplesources,whichmaypresentraceandethnicitydatausingdissimilarnomenclature.Forconsistencywithdatasourcesthroughoutthereport,subpopulationdatamayusedifferenttermstodescribethesameorsimilargroupsofcommunitymembers.

Zip Codes and Zip Code Tabulation Areas

ThisreportpresentsbothZIPCodeandZIPCodeTabulationArea(ZCTA)data.ZIPorZoneImprovementPlanCodeswerecreatedbytheU.S.PostalServicetoimprovemaildeliveryservice.Theyarebasedonpostalroutes,whichfactorindelivery-area,mailvolumeandgeographiclocation.Theyarenotdesignedtobeusedforstatisticalreportingandmaychangefrequently.SomeZIPCodesmayonlyincludeP.O.boxesorcoverlargeunpopulatedareas.ZCTAsorZIPCodeTabulationAreaswerecreatedbytheU.S.CensusBureauandaregeneralizedrepresentationsofZIPCodesthathavebeenassignedtocensusblocks.Therefore,ZCTAsarerepresentativeofgeographiclocationsofpopulatedareas.Inmostcases,theZCTAwillbethesameasitsZIPCode.ZCTAswillnotnecessarilyexistforZIPCodeareaswithonlybusinesses,singleormultipleaddresses,orforlargeunpopulatedareas.SinceZCTAsarebasedonthemostrecentCensusdata,theyaremorestablethanZIPCodesanddonotchangeasfrequently.DemographicsforthisreportaresourcedfromtheUnitedStatesCensusBureau,whichpresentsZCTAestimates.TablesandfiguresintheDemographicssectionofthisreportreferenceZIPCodesintitle(forpurposesoffamiliarity)butshowvaluesofZCTAs.DatafromothersourcesisrepresentativebyZIPCodesandarelabeledassuch.

Priorit ization Inordertofocuseffortsonasmallernumberofthemostsignificantcommunityissues,sixteenrepresentativesfromtheMemorialHermannHealthSystem(oneormorerepresentingeachfacility)participatedinanonlineprioritizationprocesstoprioritizethefifteensignificanthealthneedsidentifiedthroughthesecondaryandprimarydataanalyses.Theprioritizedhealthneedswillbeunderconsiderationforthedevelopmentofanimplementationplanthatwilladdresssomeofthecommunity’smostpressinghealthissues.

Priorit ization Process Toprioritizesignificanthealthneeds,MemorialHermannstakeholdersparticipatedinanonlinewebinaronMarch7,2019toreviewdatasynthesisresultsfollowedbycompletionofaprioritizationmatrixlistingsignificanthealthneedsandfourcriteriabywhichtorateeachneed.Participantsscoredeachneedforeachofthecriteriaonascalefrom1-5,with1meaningtherespondentstronglydisagreesto5meaningtherespondentstronglyagreesthatthehealthneedmeetsthecriterion.Respondentswerealsoabletoselect“Don’tKnow/Unsure”foreachhealthneed.Thecriteriaforprioritizationincludedtowhatextentanissue:

• Impactsmanypeopleinthecommunity• Significantlyimpactssubgroupsinthecommunity(gender,race/ethnicity,LGBTQ,etc.)

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• Hasinadequateexistingresourcesinthecommunity• Hashighriskfordiseaseordeath

CompletionoftheprioritizationmatrixinAppendixDresultedinnumericalscoresforeachhealthneedthatcorrespondedtohowwelleachhealthneedmetthecriteriaforprioritization.Thescoreswererankedfromhighesttolowest(Table5).

Table5.ResultsfromMemorialHermannPrioritizationMatrixSignificantHealthNeed Impacton

CommunityImpactonSubgroups

InadequateResources

HighRisk AverageScore

Obesity(Exercise,NutritionandWeight)

4.69 4.00 3.19 4.50 4.09

MentalHealth 4.44 3.44 4.50 3.75 4.03Diabetes 4.50 4.00 3.25 4.19 3.98LackofHealthInsurance 4.31 4.19 3.38 4.00 3.97Low-Income/Underserved

4.19 4.19 3.44 4.00 3.95

HeartDisease/Stroke 4.44 3.82 2.81 4.44 3.88SubstanceAbuse 3.56 3.88 3.63 4.19 3.81AccesstoHealthServices

4.00 3.94 3.25 3.88 3.77

OlderAdultsandAging 4.38 3.81 3.13 3.75 3.76FoodInsecurity 3.88 4.00 3.44 3.50 3.70Cancers 4.19 3.19 3.00 4.31 3.67Education 3.88 3.81 3.00 3.13 3.45Transportation 4.00 3.88 2.81 3.00 3.42Children'sHealth 4.00 3.50 3.00 3.19 3.42Economy 3.31 3.31 2.69 2.88 3.05Inadditiontoratingeachneedinthematrix,prioritizationparticipantswereaskedtoratethelevelofimportanceofMemorialHermann’s4strategicpillars.

1. ImprovingAccesstoHealthcarethroughprogramming,education,andsocialservicesupport;

2. AddressingEmotionalWell-being(mentalandbehavioralhealth)throughinnovativeaccesspoints;

3. PromotingtheimportanceofahealthydietthroughscreeningandcreatingaccesstonutritiousFoodasHealth;and,

4. FosteringimprovedhealththroughExerciseIsMedicinewithculturallyappropriateactivities.

EachoftheseintersectingpillarsconnecttoeachotherthroughvariouspointsinMemorialHermannprogramsandinitiativesadvancingthehealthofourcommunities(Figure6).

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Figure6.MemorialHermann’sFourPillarsforCommunityHealth

Over93%ofparticipantsrespondedthatthe4pillarswereimportantorveryimportant.TheMemorialHermannCommunityBenefitteamreviewedthesefindings,andtakingintoaccountthealignmentoftopneedswithMemorialHermann’sstrategicfocusareas,adecisionwasmadetointegrate:

• LackofHealthInsurance,Low-Income/Underserved,andAccesstoHealthServicesintoPillar1:AccesstoHealthcare

• MentalHealthandSubstanceAbuseintoPillar2:EmotionalWell-Being• Diabetes,FoodInsecurityandHeartDisease/StrokeintoPillar3:FoodasHealth• Obesity(Exercise,NutritionandWeight)intoPillar4:ExerciseIsMedicine

Throughthissystem-wideprioritizationprocess,thefollowingfourprioritiesforMemorialHermannHealthSystemare:

• AccesstoHealthcare(addressingAccesstoHealthServices,LackofHealthInsurance,andLow-Income/Underserved)

• EmotionalWellbeing(addressingMentalHealthandSubstanceAbuse)• FoodasHealth(addressingDiabetes,FoodInsecurity,andHeartDisease/Stroke)• ExerciseIsMedicine(addressingObesity)

ThesefourhealthtopicswillbeexploredfurtherinordertounderstandhowfindingsfromthesecondaryandprimarydataanalysesresultedineachissuebeingahighpriorityhealthneedforMemorialHermannHealthSystem.

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Demographics ThefollowingsectionexploresthedemographicprofileofMHNortheast’sservicearea,includingHarris,Liberty,andMontgomerycounties.Thedemographicsofacommunitysignificantlyimpactitshealthprofile.Differentrace/ethnic,age,andsocioeconomicgroupshaveuniqueneedsandrequiredifferentapproachestohealthimprovementefforts.AlldemographicestimatesaresourcedfromtheU.S.CensusBureau’s2013-2017AmericanCommunitySurveyunlessotherwiseindicated.Furthermore,tablesinthissectionlistindicatorvaluesforthetop75%ofzipcodeswithinMHNortheast’sserviceareaindescendingorderofinpatientdischargesunlessotherwisenoted.

Population AccordingtotheU.S.CensusBureau’s2013-2017AmericanCommunitySurvey,the3countiesinMHNortheast’sserviceareahadpopulationsof4,652,980(HarrisCounty),83,658(LibertyCounty),and570,934(MontgomeryCounty).Figure7illustratesthepopulationsizebycountyandTable6byzipcode.ThemostpopulouszipcodesinMHNortheast’sserviceareaare77346,77373,and77396(allwithinHarrisCounty).

Figure7.PopulationbyCounty

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Table6.PopulationbyZipCode

ZIPCode County TotalPopulationEstimate

77346 Harris 63,23377338 Harris 40,33577396 Harris 54,35277016 Harris 29,59777093 Harris 44,42877039 Harris 27,97277044 Harris 42,66577339 Harris 41,40377365 Montgomery 31,40677357 Montgomery 24,33477032 Harris 14,44377336 Harris 12,39777373 Harris 58,25577078 Harris 15,82077028 Harris 15,72577345 Harris 29,09077532 Harris 28,32077327 Liberty 22,43077372 Montgomery 12,351

AmericanCommunitySurvey,2013-2017

Age Figure8showsMHNortheast’sserviceareapopulationthatisunder18yearsold.26.9%ofHarrisCounty’spopulation,26.0%ofLibertyCounty’spopulation,and26.5%ofMontgomeryCounty’spopulationisunder18.HarrisandMontgomerycountieshavehigherproportionsofresidentsunder18comparedtothestateandnationalvalues(26%and22.6%,respectively).LibertyCounty’sproportionisequaltothestatevalue.

Figure8.PopulationUnder18

26.9%26.0%

26.5%26.0%

22.6%

20%

21%

22%

23%

24%

25%

26%

27%

28%

Harris Liberty Montgomery Texas U.S.

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AsshowninFigure9,HarrisCountyhasasmallerproportionofolderadults(10.2%)comparedtoTexas(12.3%)andtheU.S.(15.6%).InLibertyCounty,12.8%ofthepopulationisover65yearsold.InMontgomeryCounty,12.9%ofresidentsareover65.

Figure9.PopulationOver65

Figure10showsthatHarrisCountyhasalargerproportionofresidentsunder5yearsold(7.7.%)comparedtobothTexas(7.2%)andtheU.S.(6.1%).Alittleover7%ofLibertyCounty’spopulationisunder5,whileMontgomeryCountyhas6.9%ofitspopulationunder5.

Figure10.PopulationUnder5

Race/Ethnicity Theraceandethnicitycompositionofapopulationisimportantinplanningforfuturecommunityneeds,particularlyforschools,businesses,communitycenters,healthcareandchildcare.Raceandethnicitydataarealsousefulforidentifyingandunderstandingdisparitiesinhousing,employment,income,andpoverty.AlargernumberofresidentsinLibertyandMontgomerycountiesidentifyasWhite,non-HispanicwhileHarrisCountyhasalargernumberofresidentswhoidentifyasHispanicorLatino.Figure11showstheracialcompositionofresidentsinHarrisCountywith42.2%of

10.2%

12.8% 12.9% 12.3%

15.6%

0%2%4%6%8%

10%12%14%16%18%

Harris Liberty Montgomery Texas U.S.

7.7%7.2% 6.9% 7.2%

6.1%

0%1%2%3%4%5%6%7%8%9%

Harris Liberty Montgomery Texas U.S.

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residentsidentifyingasHispanicorLatino(ofanyrace);30.6%asWhite;18.5%asBlackorAfricanAmerican;6.8%asAsian;and1.9%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure11.Race/EthnicityinHarrisCounty

Figure12showstheracialcompositionofresidentsinLibertyCountywith65.8%ofresidentsidentifyingasWhite,non-Hispanic;21.9%asHispanicorLatino(ofanyrace);10.0%asBlackorAfricanAmerican;0.6%asAsian;and1.7%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure12.Race/EthnicityinLibertyCounty

Figure13showstheracialcompositionofresidentsinMontgomeryCountywith67.9%ofresidentsidentifyingasWhite,non-Hispanic;23.0%asHispanicorLatino(ofanyrace);4.5%as

30.6%

18.5%

6.8%

42.2%

1.9%

White,non-Hispanic

BlackorAfricanAmerican

Asian

HispanicorLatino(ofanyrace)

Other

65.8%10.0%

0.6%

21.9%

1.7%

White,non-Hispanic

BlackorAfricanAmerican

Asian

HispanicorLatino(ofanyrace)

Other

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BlackorAfricanAmerican;2.8%asAsian;and1.8%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure13.Race/EthnicityinMontgomeryCounty

Language Languageisanimportantfactortoconsiderforoutreacheffortsinordertoensurethatcommunitymembersareawareofavailableprogramsandservices.

Figure14.LanguageOtherthanEnglishSpokenatHome

Figure14showstheproportionofresidentsinHarris,Liberty,andMontgomerycountieswhospeakalanguageotherthanEnglishathome.Asshown,alargerproportionofresidentsinHarrisCountyspeakalanguageotherthanEnglishathome(43.7%),incomparisontoLibertyandMontgomerycounties(18.9%and21%,respectively).HarrisCounty’sproportionishigherthanthestatevalue(35.3%)andmorethantwicethenationalvalue(21.3%).Thisisan

67.9%4.5%

2.8%

23.0%

1.8%

White,non-Hispanic

BlackorAfricanAmerican

Asian

HispanicorLatino(ofanyrace)

Other

43.7%

18.9% 21.0%

35.3%

21.3%

0%5%

10%15%20%25%30%35%40%45%50%

Harris Liberty Montgomery Texas U.S.

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importantconsiderationfortheeffectivenessofservicesandoutreachefforts,whichmaybemoreeffectiveifconductedinlanguagesotherthanEnglishalone.

Table7.PopulationwithDifficultySpeakingEnglishbyZipCodeZIPCode County DifficultySpeaking

English77346 Harris 4.9%77338 Harris 10.9%77396 Harris 16.0%77016 Harris 14.7%77093 Harris 51.2%77039 Harris 61.0%77044 Harris 17.5%77339 Harris 5.2%77365 Montgomery 9.2%77357 Montgomery 15.2%77032 Harris 27.2%77336 Harris 2.7%77373 Harris 8.1%77078 Harris 16.9%77028 Harris 9.2%77345 Harris 2.2%77532 Harris 7.0%77327 Liberty 9.0%77372 Montgomery 7.6%Harris -- 20.4%Liberty -- 7.4%Montgomery -- 7.8%Texas -- 14.1%

AmericanCommunitySurvey,2013-2017

AsshowninTable7,HarrisCountyhasalargerproportionofresidentswithdifficultyspeakingEnglish(20.4%)comparedtoLibertyCounty(7.4%),MontgomeryCounty(7.8%),andthestateofTexas(14.1%).InHarrisCounty,themajorityofresidentsinzipcodes77093and77039havedifficultyspeakingEnglish(51.2%and61%,respectively).

Social and Economic Determinants of Health Thissectionexplorestheeconomic,environmental,andsocialdeterminantsofhealthinMHFacility’sservicearea.Socialdeterminantsaretheconditionsinwhichpeopleareborn,grow,work,live,andage,andthewidersetofforcesandsystemsshapingtheconditionsofdailylife.

Income Medianhouseholdincomereflectstherelativeaffluenceandprosperityofanarea.Areaswithhighermedianhouseholdincomesarelikelytohaveagreatershareofeducatedresidentsandlowerunemploymentrates.

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Figure15comparesthemedianhouseholdincomevaluesforthe3countiesinMHNortheast’sserviceareatothemedianhouseholdincomevalueforTexasandtheUnitedStates.MontgomeryCounty’smedianhouseholdincomeof$74,323isgreaterthanthatofbothHarrisCounty($57,791)andLibertyCounty($48,344).HarrisCounty’smedianhouseholdincomeissimilartothestateandnationalvalues,whereasLibertyCounty’smedianhouseholdincomeislowerthanthestateandnationalvalues.

Figure15.MedianHouseholdIncome

AsshowninTable8,MHNortheast’stopzipcodesforinpatientdischargesrevealabroadrangeinmedianhouseholdincome.Zipcodes77338,77016,77093,and77039havemedianhouseholdincomeslowerthanthestateofTexas,whereaszipcode77346hasamedianhouseholdincomeof$98,840,whichisabout$40,000greaterthanthestatevalue.

$57,791

$48,344

$74,323

$57,051 $57,652

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

Harris Liberty Montgomery Texas U.S.

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Table8.MedianHouseholdIncomebyZipCode

ZIPCode County MedianHouseholdIncome

77346 Harris $98,84077338 Harris $50,26377396 Harris $64,19577016 Harris $32,30277093 Harris $30,83777039 Harris $34,60877044 Harris $76,38777339 Harris $73,46677365 Montgomery $72,62377357 Montgomery $47,80577032 Harris $30,45177336 Harris $67,56377373 Harris $67,92477078 Harris $35,77077028 Harris $30,23377345 Harris $128,64677532 Harris $62,60677327 Liberty $40,63677372 Montgomery $51,818Harris -- $57,791Liberty -- $48,344Montgomery -- $74,323Texas -- $57,051

AmericanCommunitySurvey,2013-2017

Poverty FederalpovertythresholdsareseteveryyearbytheCensusBureauandvarybysizeoffamilyandagesoffamilymembers.Ahighpovertyrateisbothacauseandaconsequenceofpooreconomicconditions.Figure16showstheproportionofresidentslivingbelowthepovertylevelinHarris,Liberty,andMontgomerycountiescomparedtothestateofTexasandtheU.S.ThepercentagesofresidentslivingbelowthepovertylevelinbothHarrisCounty(16.8%)andLibertyCounty(16.2%)arehigherthanthenationalvalue(14.6%)andslightlyhigherthanthestatevalue(16.0%).AsmallerproportionofresidentsinMontgomeryCountylivebelowthepovertyvalue(10.3%),comparedtothestate(16%)andtheU.S.(14.6%)aswellasHarrisandLibertycounties.

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Figure16.PeopleLivingBelowPovertyLevel

Figure17showstheproportionofresidentslivingbelowthepovertylevelbyrace/ethnicity.InHarrisCounty,22.6%ofHispanicorLatinoresidentsand21.8%ofBlackorAfricanAmericanresidentslivebelowthepovertylevel,comparedto7.0%Whiteand11.4%Asianresidents.ThepercentageofBlackandAsianresidentslivingbelowthepovertylevelinHarrisCountyishigherthanthestatevaluesforBlackandAsianresidents.Notably,theproportionofAsianresidentslivingbelowthepovertylevelinLibertyCounty(33.8%)isalmostthreetimesthestateandnationalvalues(10.6%and11.9%,respectively).Forallrace/ethnicitygroupsinMontgomeryCounty,thepercentageofresidentslivingbelowthepovertylevelislowerthanthevaluesforTexasandtheU.S.

16.8%16.2%

10.3%

16.0%

14.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Harris Liberty Montgomery Texas U.S.

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Figure17.PeopleLivingBelowPovertyLevelbyRace/Ethnicity

Figure18.PeopleLivingBelowPovertyLevelbyZipCode

7.0%

21.8%

11.4%

22.6%

12.4%15.5%

33.8%

27.2%

6.7%

13.1%

5.6%

21.5%

8.8%

21.4%

10.6%

23.0%

10.3%

25.2%

11.9%

22.2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

White,non-Hispanic BlackorAfricanAmerican Asian HispanicorLatino

Harris Liberty Montgomery Texas U.S.

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PovertyratesarehigherinHarrisCounty(16.8%)andLibertyCounty(16.2%)comparedtoMontgomeryCounty(10.3%).AsshowninFigure18andTable9,withinMHNortheast’sservicearea,6.6%ofresidentsinzipcode77346and14.7%ofresidentsinzipcode77338arelivingbelowthepovertylevel,comparedto16%inTexas.However,therearehigherproportionsofpeoplelivingbelowthepovertylevelinotherzipcodeswithMHNortheast’sservicearea,suchas77016,77093,77039,and77032(thelatterzipcodewithover40%ofpeoplelivingbelowthepovertylevel).

Table9.PeopleLivingBelowPovertyLevelbyZipCodeZIPCode County PeopleLivingBelow

PovertyLevel77346 Harris 6.6%77338 Harris 14.7%77396 Harris 12.7%77016 Harris 26.1%77093 Harris 36.6%77039 Harris 32.0%77044 Harris 11.9%77339 Harris 8.4%77365 Montgomery 12.1%77357 Montgomery 22.1%77032 Harris 40.1%77336 Harris 8.8%77373 Harris 12.2%77078 Harris 21.9%77028 Harris 28.0%77345 Harris 3.2%77532 Harris 14.2%77327 Liberty 21.9%77372 Montgomery 20.0%Harris -- 16.8%Liberty -- 16.2%Montgomery -- 10.3%Texas -- 16.0%

AmericanCommunitySurvey,2013-2017

Food Insecurity TheSupplementalNutritionAssistanceProgram(SNAP)isafederalassistanceprogramthatprovideslow-incomefamilieswithelectronicbenefittransfers(EBTs)thatcanbeusedtopurchasefood.Thegoaloftheprogramistoincreasefoodsecurityandreducehungerbyincreasingaccesstonutritiousfood.Table10showsthepercentofhouseholdswithchildrenthatparticipateinSNAPinthezipcodeswithinMHNortheast’sservicearea.HarrisCountyhasahigherproportionofhouseholdswithchildrenreceivingSNAP(67.7%)comparedtoTexas(64.3%);ontheotherhand,LibertyandMontgomerycountieshavelowerproportions(57.4%and61.7%,respectively)compared

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tothestatevalue.Inparticular,zipcodes77346and77396inHarrisCountystandout,astheyareMHNortheast’stopzipcodesforinpatientdischargesandalsohavemorethan80%ofhouseholdswithchildrenreceivingSNAP.

Table10.HouseholdswithChildrenReceivingSNAPbyZipCode

ZIPCode County HouseholdswithChildrenReceivingSNAP

77346 Harris 84.4%77338 Harris 60.6%77396 Harris 83.2%77016 Harris 57.4%77093 Harris 71.6%77039 Harris 77.9%77044 Harris 76.9%77339 Harris 64.8%77365 Montgomery 51.1%77357 Montgomery 70.9%77032 Harris 68.0%77336 Harris 73.0%77373 Harris 75.3%77078 Harris 74.0%77028 Harris 41.6%77345 Harris 79.1%77532 Harris 65.7%77327 Liberty 60.4%77372 Montgomery 73.9%Harris -- 67.7%Liberty -- 57.4%Montgomery -- 61.7%Texas -- 64.3%

AmericanCommunitySurvey,2013-2017

Unemployment Theunemploymentrateisakeyindicatorofthelocaleconomy.Unemploymentoccurswhenlocalbusinessesarenotabletosupplyenoughappropriatejobsforlocalemployeesand/orwhenthelaborforceisnotabletosupplyappropriateskillstoemployers.Ahighrateofunemploymenthaspersonalandsocietaleffects.Duringperiodsofunemployment,individualsarelikelytofeelsevereeconomicstrainandmentalstress.Unemploymentisalsorelatedtoaccesstohealthcare,asmanyindividualsreceivehealthinsurancethroughtheiremployer.Ahighunemploymentrateplacesstrainonfinancialsupportsystems,asunemployedpersonsqualifyforunemploymentbenefitsandfoodstampprograms.Figure19displaystherateofunemploymentinHarris,Liberty,andMontgomerycountiesbetweenMay2017andNovember2018.Inallthreecounties,theunemploymentratehasexhibitedadecrease.Nevertheless,LibertyCounty’sunemploymentrateremainedhigherthan

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theratesinHarrisandMontgomerycountiesaswellasTexasandtheU.SInNovember2018,theMontgomeryCountyrate(3.4%)wasalmostequivalenttothestateandnationalrates(3.5%).However,theunemploymentratesinHarrisCounty(3.8%)andLibertyCounty(5.0%)remainedhigherthanTexasandtheU.S.

Figure19.UnemploymentRateperCounty(U.S.BureauofLaborStatistics,2017-2018)

Education Graduatingfromhighschoolisanimportantpersonalachievementandisessentialforanindividual’ssocialandeconomicadvancement.Graduationratescanalsobeanimportantindicatoroftheperformanceofaneducationalsystem.Havingabachelor’sdegreeopensupcareeropportunitiesinavarietyoffieldsandisoftenaprerequisiteforhigher-payingjobs.Figure20displaystheproportionofresidentsinHarris,Liberty,andMontgomerycountieswhoare25yearsandolderwithatleastahighschooldegree.Nearly90%ofresidents25yearsandolderinMontgomeryCountyhaveatleastahighschooldegreecomparedto80.5%inHarrisCountyand77.1%inLibertyCounty.LibertyCounty’svalueislowerthantheU.S.(87.3%)andTexas(82.8%)whileMontgomeryCounty’svalueishigher.

5.1%

4.3% 4.3%3.8%

7.3%

6.0%5.7%

5.0%4.6%

3.7% 3.6%3.4%

4.4% 3.7% 3.7%3.5%

4.1% 3.9%3.6% 3.5%

0%

1%

2%

3%

4%

5%

6%

7%

8%

May2017 November2017 May2018 November2018

Harris Liberty Montgomery Texas UnitedStates

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Figure20.People25+withaHighSchoolDegreeorHigher

Figure21showstheproportionofresidentsinHarris,Liberty,andMontgomerycountieswhoare25yearsandolderwithabachelor’sdegreeorhigher.Withover30%ofresidents25andolderhavingabachelor’sdegreeinHarrisandMontgomerycounties,thesecountieshaveaneconomicadvantagecomparedtoLibertyCounty(9.3%).Theproportionofresidents25andolderwithabachelor’sdegreeinMontgomeryCounty(33.7%)issomewhatbetterthanbothTexas(28.7%)andtheU.S.(30.9%).

Figure21.People25+withaBachelor'sDegreeorHigher

Table11displaystheeducationalattainmentindicatorsforresidents25yearsandolderbyzipcodeinMHNortheast’sservicearea.Forhighschooldegreeattainment,thezipcodewiththehighestrateis77345(97.4%)andthezipcodewiththelowestrateis77039(48.1%).Forattainmentofabachelor’sdegree,thezipcodewiththehighestrateis77345(62.9%)andthezipcodewiththelowestrateis77093(3.2%).ThezipcodeswithhighestproportionsofMHNortheast’sinpatientdischarges,zipcodes77346and77338,havemorethan85%ofpeople25yearsandolderwithahighschooldegree.Inzipcode77338,however,onlyapproximately17%ofresidents25yearsandolderhaveabachelor’sdegreeorhigher.

80.5%

77.1%

87.6%

82.8%

87.3%

70%72%74%76%78%80%82%84%86%88%90%

Harris Liberty Montgomery Texas U.S.

30.5%

9.3%

33.7%

28.7%30.9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Harris Liberty Montgomery Texas U.S.

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Table11.People25+withaHighSchoolDegreeandPeople25+withaBachelor'sDegreebyZipCode

ZIPCode County HighSchoolDegreeorHigher

Bachelor’sDegreeorHigher

77346 Harris 93.6% 40.2%77338 Harris 85.7% 16.6%77396 Harris 83.5% 25.1%77016 Harris 71.9% 9.3%77093 Harris 48.7% 3.2%77039 Harris 48.1% 3.5%77044 Harris 83.6% 29.4%77339 Harris 95.7% 41.4%77365 Montgomery 81.1% 21.3%77357 Montgomery 72.0% 11.3%77032 Harris 62.2% 8.5%77336 Harris 87.1% 16.0%77373 Harris 91.6% 23.5%77078 Harris 69.6% 9.7%77028 Harris 74.5% 7.7%77345 Harris 97.4% 62.9%77532 Harris 85.0% 16.3%77327 Liberty 74.9% 9.7%77372 Montgomery 76.3% 6.3%Harris -- 80.5% 30.5%Liberty -- 77.1% 9.3%Montgomery -- 87.6% 33.7%Texas -- 82.8% 28.7%

AmericanCommunitySurvey,2013-2017

Transportation Therearenumerouswaysinwhichtransportationmayinfluencecommunityhealth.Publictransportationoffersmobility,particularlytopeoplewithoutcars.Transitcanhelpbridgethespatialdividebetweenpeopleandjobs,services,andtrainingopportunities.Publictransportationalsoreducesfuelconsumption,minimizesairpollution,andrelievestrafficcongestion.Walkingtoworkhelpsprotecttheenvironment,whilealsoprovidingthebenefitofdailyexercise.

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Figure22.HouseholdsWithoutaVehiclebyZipCode

Figure22showsthepercentageofhouseholdswithoutavehicle.Asshown,zipcodes77078,77028,77032,and77016havethehighestpercentagesofhouseholdsthatdonothaveavehicle.

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Table12.ModesofCommutingbyZipCode

ZIPCode County CommutebyWalking

CommuteByBiking

CommutebyDrivingAlone

CommutebyPublicTransportation

77346 Harris 0.4% 0.0% 86.7% 1.6%77338 Harris 2.4% 0.2% 80.9% 1.3%77396 Harris 0.9% 0.1% 81.6% 2.0%77016 Harris 1.4% 0.0% 80.1% 4.0%77093 Harris 0.9% 0.2% 76.5% 2.1%77039 Harris 1.2% 0.1% 79.5% 0.9%77044 Harris 0.4% 0.0% 85.8% 0.6%77339 Harris 0.8% 0.5% 83.2% 2.6%77365 Montgomery 1.6% 0.0% 84.0% 0.2%77357 Montgomery 1.1% 0.0% 83.9% 0.5%77032 Harris 0.6% 0.5% 76.6% 1.8%77336 Harris 4.2% 0.0% 81.2% 1.1%77373 Harris 1.0% 0.3% 80.7% 1.3%77078 Harris 0.2% 0.0% 78.4% 6.0%77028 Harris 0.9% 0.0% 78.3% 4.8%77345 Harris 0.9% 0.3% 81.6% 3.5%77532 Harris 1.4% 0.0% 85.0% 0.1%77327 Liberty 1.6% 0.3% 88.3% 0.3%77372 Montgomery 0.8% 1.0% 84.8% 1.2%Harris -- 1.5% 0.3% 79.3% 2.7%Liberty -- 1.0% 0.3% 88.9% 0.3%Montgomery -- 0.9% 0.2% 82.1% 1.2%Texas -- 1.6% 0.3% 80.5% 1.5%

AmericanCommunitySurvey,2013-2017

Table12displaysthedifferentmodesofcommutingusedbyresidentsofHarris,Liberty,andMontgomerycounties.InMontgomeryCounty,lessthan1%ofthepopulationcommutesbywalkingorbiking.InHarrisCounty,slightlymoreresidentscommutebywalking(1.5%)andbiking(0.3%).Inallthreecounties,themajorityofresidentscommutebydrivingalone;with79.3%inHarrisCounty,88.9%inLibertyCounty,and82.1%inMontgomeryCounty,comparedtothestatevalue(80.5%).PublictransportationisusedbyHarrisCountyresidents(2.7%),moresothanLibertyCountyresidents(1.6%)andMontgomeryCountyresidents(1.2%),perhapsindicativeofdifferencesinpublictransportationinfrastructure.InHarrisCounty,6.0%ofresidentslivinginzipcode77078commutebypublictransportation.ConsideringthetoptenzipcodesforinpatientdischargeswithinMHNortheast’sservicearea,zipcodes77396,77016,77093,and77339havethehighestproportionsofresidentscommutingbypublictransportation.

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SocioNeeds Index® ConduentHealthyCommunitiesInstitutedevelopedtheSocioNeedsIndex®toeasilycomparemultiplesocioeconomicfactorsacrossgeographies.Thisindexincorporatesestimatesforsixdifferentsocialandeconomicdeterminantsofhealth–income,poverty,unemployment,occupation,educationalattainment,andlinguisticbarriers–thatareassociatedwithpoorhealthoutcomesincludingpreventablehospitalizationsandprematuredeath.Zipcodeswithineachcountyareassignedanindexvaluefrom0(lowneed)to100(highneed),basedonhowthosezipcodescomparetoothersintheU.S.Withineachcounty,thezipcodesarethenrankedfrom1(lowneed)to5(highneed)toidentifytherelativelevelofneed.Zipcodeswithpopulationsunder300personsareexcluded.

Figure23.SocioNeedsIndexbyZipCode

AsshowninFigure23andTable13,thetenzipcodeswithinMHNortheast’sserviceareathathavethehighestSocioNeedsIndexvaluesarewithinHarrisCounty;zipcodes77093,77039,77032,77028,77078,77016allhavevaluesgreaterthan95.ThezipcodeswithlargestproportionofinpatientdischargesatMHNortheast,zipcodes77346and77338,haveSocioNeedsIndexvaluesof11and71.9,respectively.

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Table13.SocioNeedsIndexbyZipCode(InOrderofSocioNeedsIndexValue)

ZIPCode County SocioNeedsIndexValue

77093 Harris 99.377039 Harris 99.277032 Harris 98.877028 Harris 96.977078 Harris 96.677016 Harris 96.377357 Montgomery 8977327 Liberty 88.677372 Montgomery 83.277338 Harris 71.977365 Montgomery 56.377532 Harris 49.277396 Harris 47.677044 Harris 46.277373 Harris 4277336 Harris 2677339 Harris 23.977346 Harris 1177345 Harris 2.3

ConduentSocioNeedsIndex,2019

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Data Synthesis Allformsofdatahavetheirownstrengthsandlimitations.TogainacomprehensiveunderstandingofthesignificanthealthneedsforMemorialHermannHealthSystem,thefindingsfromboththeprimarydataandthesecondarydatawerecomparedandstudiedtogether.Thesecondarydata,keyinformantinterviewsandcommunitysurveyweretreatedasthreeseparatesourcesofdata.Thesecondarydatawereanalyzedusingdatascoring,whichidentifiedhealthareasofneedbasedonthevaluesofindicatorsforeachtopicarea.(AppendixB).ThefollowingtablesdisplaythedatascoresforHealthandQualityofLifeTopicsforHarris,LibertyandMontgomerycounties.

Table14.HarrisCountyTopicScoresTopic ScoreTransportation 1.82Women'sHealth 1.81Immunizations&InfectiousDiseases 1.78OtherChronicDiseases 1.78PublicSafety 1.65Maternal,Fetal&InfantHealth 1.64Prevention&Safety 1.58SocialEnvironment 1.58Education 1.56Economy 1.55HeartDisease&Stroke 1.54Children'sHealth 1.52OlderAdults&Aging 1.50AccesstoHealthServices 1.48Exercise,Nutrition,&Weight 1.48Wellness&Lifestyle 1.42Men'sHealth 1.38Diabetes 1.34Environment 1.34SubstanceAbuse 1.33Cancer 1.31MortalityData 1.29MentalHealth&MentalDisorders 1.26RespiratoryDiseases 0.99

Table15.LibertyCountyTopicScores

Topic ScoreTransportation 2.28RespiratoryDiseases 2.25AccesstoHealthServices 2.08HeartDisease&Stroke 2.08

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Topic ScoreMentalHealth&MentalDisorders 1.98OlderAdults&Aging 1.95Women'sHealth 1.89Education 1.88OtherChronicDiseases 1.85MortalityData 1.83Exercise,Nutrition,&Weight 1.81Prevention&Safety 1.76Wellness&Lifestyle 1.76Cancer 1.75Economy 1.75Maternal,Fetal&InfantHealth 1.71Children'sHealth 1.70SocialEnvironment 1.66Immunizations&InfectiousDiseases 1.56Environment 1.46PublicSafety 1.46Men'sHealth 1.32SubstanceAbuse 1.08

Table16.MontgomeryCountyTopicScores

Topic ScoreTransportation 1.93HeartDisease&Stroke 1.65AccesstoHealthServices 1.56OtherChronicDiseases 1.52Exercise,Nutrition,&Weight 1.50SubstanceAbuse 1.49Children'sHealth 1.37OlderAdults&Aging 1.36Women'sHealth 1.35PublicSafety 1.33Environment 1.32Immunizations&InfectiousDiseases 1.32MentalHealth&MentalDisorders 1.31Education 1.11SocialEnvironment 1.10RespiratoryDiseases 1.08Cancer 1.06Economy 1.04MortalityData 1.00Men'sHealth 0.95Wellness&Lifestyle 0.93Prevention&Safety 0.85

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Topic ScoreMaternal,Fetal&InfantHealth 0.83

Thismethodologywasappliedtoeachofthe12countieswithinMemorialHermannHealthSystem’sprimaryserviceareaandthendatascorescalculatedfortheregioninordertodeterminesignificanthealthneedsacrossthesystem.Table17liststheresultingdatascoresforHealth&QualityofLifeTopicAreas.

Table17.MemorialHermannRegionTopicScoresTopic ScoreTransportation 1.84HeartDisease&Stroke 1.82AccesstoHealthServices 1.79OlderAdults&Aging 1.60Exercise,Nutrition,&Weight 1.56OtherChronicDiseases 1.52MentalHealth&MentalDisorders 1.50Children'sHealth 1.47Immunizations&InfectiousDiseases 1.43Education 1.43Women'sHealth 1.42SocialEnvironment 1.42Wellness&Lifestyle 1.41Maternal,Fetal&InfantHealth 1.41RespiratoryDiseases 1.41Economy 1.41Environment 1.40PublicSafety 1.36Cancer 1.31Prevention&Safety 1.26SubstanceAbuse 1.23Men'sHealth 1.21

Theanalysisofkeyinformantinterviewsoccurredusingthequalitativesoftware:Dedoose1.Forthecommunitysurvey,HCIperformedasimplereviewandanalysistoidentifytophealthneeds.Overall,eachmethodproducedindividualresultsthatrepresentthecommunityinputinthisreport.Thisconsolidatedinputleadstotheprioritizedheathneedsinthisreport.ThistriangulatedapproachisshowninFigure24.

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Figure24.VisualofDataSynthesisApproach

TheteamusedthetriangulatedapproachtoidentifysignificanthealthneedsforMemorialHermannHealthSystem.Figure25displaystheresultsofthissynthesis.Formanyofthehealthtopicsevidenceofneedwaspresentacrossmultipledatasources,includingObesity,MentalHealth,AccesstoHealthServices,Transportation,andUninsured.Forotherhealthtopicstheevidencewaspresentinjustonesourceofdata,howeveritshouldbenotedthatthismaybereflectiveofthestrengthandlimitationsofeachtypeofdatathatwasconsideredinthisprocess.

SignificantHealthNeeds

HealthIndicatorData

(DataScoringAnalysis)

KeyInformantInterviews(Thematic

CodingAnalysis)CommunitySurvey

(ThematicAnalysis)

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Figure25.DataSynthesisResults

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Priorit ized Signif icant Health Needs

Priorit ization Results Uponcompletionoftheonlineprioritizationsurvey,fourhealthareaswereidentifiedforsubsequentimplementationplanningbyMemorialHermannHealthSystem.Thesefourhealthprioritiesare:AccesstoCare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.ThefollowingsectionwilldivedeeperintoeachofthesehealthtopicsinordertounderstandhowfindingsfromthesecondaryandprimarydataledtoeachhealthtopicbecomingapriorityhealthissueforMemorialHermannHealthSystem.Foreachprioritizedhealthneed,keyissuesaresummarized;secondarydatascoresarenotedforindicatorsofconcern;andcommunityinputisdescribed.

Access to Healthcare

Secondary Data AccesstoHealthServices,LackofInsuranceandLow-Income/UnderservedwereidentifiedassignificantneedsforMemorialHermannHealthSystem.AsshowninTable17,severalindicatorsreceivedscoresof1.75orabovethroughthesecondarydatascoringprocess:AdultsUnabletoSeeaDoctor(HarrisCounty);AdultswithHealthInsurance(HarrisandLibertycounties);ChildrenwithHealthInsurance(HarrisandLibertycounties);DentistRate(LibertyCounty);MentalHealthProviderRate(LibertyandMontgomerycounties);Non-PhysicianPrimaryCareProviderRate(LibertyCounty);PersonswithHealthInsurance(HarrisandLibertycounties);andPrimaryCareProviderRate(LibertyCounty).

Table18.SecondaryDataScoringResults:AccesstoHealthServices

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

AdultsUnableto Liberty --- --- --- --- --- ---

KeyIssues:• Rangeofbarriers,includingtransportation,accesstospecialtycare,lackofawareness,and

fearorstigma• Lackofhealthinsurance• Lowincomeandvulnerablegroups

SecondaryDataScoringMethodologyForeachindicator,eachcountyinMHNortheast’sserviceareawasassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariedbyindicatorandwasdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.PleaseseeAppendixBforfurtherinformationonHCIDataScoringmethodology.

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AffordtoSeeaDoctor[10](2015)

Montgomery

--- --- --- --- --- ---

Harris22.1

2 1.5 3 3 1.5 1.5percent

[10]TexasBehavioralRiskFactorSurveillanceSystem

AdultswithHealthInsurance:18-64[9]

(2016)

Liberty75.0

1.75 2 2 1.5 3 0percent

Montgomery79.7

1.47 0 1 1.5 3 1percent

Harris74.7

1.75 2 2 1.5 3 0percent

[9]SmallAreaHealthInsuranceEstimates

ChildrenwithHealthInsurance[9](2016)

Liberty88.7

1.81 1 2 1.5 3 1percent

Montgomery90.2

1.53 0 2 1.5 2 1percent

Harris89.4

1.81 1 2 1.5 3 1percent

[9]SmallAreaHealthInsuranceEstimates

DentistRate[4](2016)

Liberty26.9

1.83 2 3 3 1.5 0dentists/100,000population

Montgomery45.5

1.56 0 3 3 1.5 1dentists/100,000population

Harris66.3

0.5 0 0 2 1.5 0dentists/100,000population

[4]CountyHealthRankings

MentalHealthProviderRate[4]

(2017)

Liberty14.7

2.61 3 3 3 1.5 2providers/100,000population

Montgomery69.4

2 1 3 3 1.5 1.5providers/100,000population

Harris103.7

1.44 0 1 3 1.5 2providers/100,000population

[4]CountyHealthRankings

Non-Physician Liberty 39.2 2 2 3 3 1.5 0

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PrimaryCareProviderRate[4]

(2017)

providers/100,000population

Montgomery55

1.67 1 3 3 1.5 0providers/100,000population

Harris72.2

1 0 1 3 1.5 0providers/100,000population

[4]CountyHealthRankings

PersonswithHealthInsurance[9](2016)

Liberty79.4

1.75 2 2 1.5 3 0percent

Montgomery83.1

1.47 0 1 1.5 3 1percent

Harris79.3

1.75 2 2 1.5 3 0percent

[9]SmallAreaHealthInsuranceEstimates

PrimaryCareProviderRate[4]

(2015)

Liberty23.9

2.83 3 3 3 1.5 3providers/100,000population

Montgomery61.8

1.22 0 1 3 1.5 1providers/100,000population

Harris57.2

1.61 0 2 3 1.5 2providers/100,000population

[4]CountyHealthRankings

WhenconsideringAccesstoHealthServices,itisimportanttotakeintoaccounttheeconomyandhowfinancialbarriersimpactcommunityresidents’abilitytoaccesscare.AsshowninTable19,allthreecountieshaveindicatorsofconcern,including:ChildFoodInsecurityRate(LibertyCounty);FamiliesLivingBelowPovertyLevel(HarrisandLibertycounties);FemalePopulation16+inCivilianLaborForce(LibertyandMontgomerycounties);FoodInsecurityRate(HarrisandLibertycounties);Homeownership(HarrisCounty);MedianHouseholdGrossRent(HarrisandMontgomerycounties);MedianHousingUnitValue(LibertyCounty);MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage(HarrisandMontgomerycounties);MortgagedOwnersMedianMonthlyHouseholdCosts(MontgomeryCounty);People65+LivingBelowPovertyLevel(HarrisandLibertycounties);PerCapitaIncome(LibertyCounty);PersonswithDisabilityLivinginPoverty(LibertyCounty);PersonswithDisabilityLivinginPoverty(5-year)(LibertyCounty);Population16+inCivilianLaborForce(LibertyCounty);SevereHousingProblems(HarrisandLibertycounties);SNAPCertifiedStores(Harris,LibertyandMontgomerycounties);StudentsEligiblefortheFreeLunchProgram(HarrisandLibertycounties);TotalEmploymentChange(LibertyCounty);andUnemployedWorkersinCivilianLaborForce(HarrisandLibertycounties).Outofthislist,HarrisandLibertycountieseachhaveeighteconomic

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indicatorswithsecondarydatascoresabove2comparedtoMontgomeryCountywithfourindicatorsequaltoorabove2,indicatingpotentiallygreatereconomicneedinthosetwocounties.

Table19.SecondaryDataScoringResults:Economy

County CountyValueComparedto:

Indicator Name ValueDataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

ChildFoodInsecurityRate[5](2016)

Liberty26.0

2.17 3 3 3 1.5 0percent

Montgomery21.2

1.17 0 1 3 1.5 0percent

Harris23.5

1.67 1 2 3 1.5 0percent

[5]FeedingAmerica

ChildrenLivingBelowPovertyLevel[1](2012-2016)

Liberty23.3

1.39 1 1 2 1.5 1percent

Montgomery14.8

0.17 0 0 0 1.5 0percent

Harris26.0

1.67 2 2 3 1.5 0percent

[1]AmericanCommunitySurvey

FamiliesLivingBelowPovertyLevel[1](2012-2016)

Liberty12.4

1.72 2 1 3 1.5 1percent

Montgomery8.3

0.56 0 0 0 1.5 1percent

Harris14.4

2.06 2 3 3 1.5 1percent

[1]AmericanCommunitySurvey

FemalePopulation16+inCivilianLaborForce[1](2012-2016)

Liberty39.5

2.83 3 3 3 1.5 3percent

Montgomery53.6

2 1 2 2 1.5 3percent

Harris59.8

0.94 0 1 1 1.5 2percent

[1]AmericanCommunitySurvey

FoodInsecurityRate[5](2016)

Liberty18.7

2.39 3 3 3 1.5 1percent

Montgomery 14.6 1.33 1 1 3 1.5 0

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percent

Harris16.6

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

Homeownership[1](2012-2016)

Liberty64.8

0.83 0 0 0 1.5 3percent

Montgomery65.6

0.61 0 0 0 1.5 2percent

Harris49.6

2.44 3 2 3 1.5 2percent

[1]AmericanCommunitySurvey

HouseholdswithCashPublic

AssistanceIncome[1](2012-2016)

Liberty1.9

1.61 2 3 0 1.5 2percent

Montgomery1.1

0.56 1 0 0 1.5 1percent

Harris1.5

0.89 2 1 0 1.5 1percent

[1]AmericanCommunitySurvey

MedianHouseholdGrossRent[1](2012-

2016)

Liberty801

1.42 2 0 0 1.5 3dollars

Montgomery1077

2.58 3 3 3 1.5 3dollars

Harris937

2.08 3 2 1 1.5 3dollars

[1]AmericanCommunitySurvey

MedianHousingUnitValue[1](2012-2016)

Liberty89100

1.75 2 3 3 1.5 0dollars

Montgomery190000

0.58 0 0 1 1.5 0dollars

Harris145600

1.08 0 1 3 1.5 0dollars

[1]AmericanCommunitySurvey

MedianMonthlyOwnerCostsfor

HouseholdswithoutaMortgage[1](2012-

2016)

Liberty414

1.08 2 0 0 1.5 1.5dollars

Montgomery531

2.58 3 3 3 1.5 3dollars

Harris534

2.14 3 3 3 1.5 1dollars

[1]AmericanCommunitySurvey

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MortgagedOwnersMedianMonthly

HouseholdCosts[1](2012-2016)

Liberty1160

0.97 2 0 0 1.5 1dollars

Montgomery1635

2.19 3 3 2 1.5 2dollars

Harris1504

1.81 3 2 2 1.5 1dollars

[1]AmericanCommunitySurvey

People65+LivingBelowPovertyLevel

[1](2012-2016)

Liberty10.6

1.94 2 1 3 1.5 2percent

Montgomery7.7

0.78 0 0 0 1.5 2percent

Harris11.3

1.89 2 2 3 1.5 1percent

[1]AmericanCommunitySurvey

PeopleLiving200%AbovePovertyLevel

[1](2012-2016)

Liberty60.5

1.72 2 2 2 1.5 1percent

Montgomery73.0

0.56 0 0 1 1.5 1percent

Harris61.6

1.33 1 2 2 1.5 0percent

[1]AmericanCommunitySurvey

PeopleLivingBelowPovertyLevel[1](2012-2016)

Liberty17.3

1.67 2 2 3 1.5 0percent

Montgomery11.0

0.17 0 0 0 1.5 0percent

Harris17.4

1.67 2 2 3 1.5 0percent

[1]AmericanCommunitySurvey

PerCapitaIncome[1](2012-2016)

Liberty22065

1.83 2 3 3 1.5 0dollars

Montgomery35912

0.17 0 0 0 1.5 0dollars

Harris29850

0.5 0 1 1 1.5 0dollars

[1]AmericanCommunitySurvey

PersonswithDisabilityLivinginPoverty[1](2016)

Liberty28.0

1.81 1.5 3 2 1.5 1percent

Montgomery17.9

0.86 1.5 0 0 1.5 2percent

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Harris22.9

0.97 1.5 1 0 1.5 1percent

[1]AmericanCommunitySurvey

PersonswithDisabilityLivinginPoverty(5-year)[1]

(2012-2016)

Liberty28.4

1.92 2 3 2 1.5 1.5percent

Montgomery19.1

0.75 0 0 0 1.5 1.5percent

Harris25.4

1.42 1 2 1 1.5 1.5percent

[1]AmericanCommunitySurvey

Population16+inCivilianLaborForce[1](2012-2016)

Liberty51.3

2.83 3 3 3 1.5 3percent

Montgomery63.7

1.5 0 2 1 1.5 3percent

Harris68.3

0.94 0 1 1 1.5 2percent

[1]AmericanCommunitySurvey

SevereHousingProblems[4](2010-

2014)

Liberty18.5

2.11 3 2 1 1.5 2percent

Montgomery16.0

1.28 2 0 0 1.5 2percent

Harris20.9

2.39 3 3 3 1.5 1percent

[4]CountyHealthRankings

SNAPCertifiedStores[17](2016)

Liberty0.8

1.78 2 1.5 1.5 1.5 2stores/1,000population

Montgomery0.5

1.89 3 1.5 1.5 1.5 1stores/1,000population

Harris0.6

2.11 3 1.5 1.5 1.5 2stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

StudentsEligiblefortheFreeLunch

Program[8](2015-2016)

Liberty55.5

2.11 2 2 3 1.5 2percent

Montgomery35.1

0.56 0 0 0 1.5 1percent

Harris58.2

2.22 2 3 3 1.5 1percent

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[8]NationalCenterforEducationStatistics

TotalEmploymentChange[16](2014-

2015)

Liberty-3.7

2.5 3 3 3 1.5 1.5percent

Montgomery3.5

1 1 1 0 1.5 1.5percent

Harris2.4

1.67 1 3 2 1.5 1.5percent

[16]U.S.Census-CountyBusinessPatterns

UnemployedWorkersinCivilianLaborForce[15](July

2018)

Liberty6.1

2.61 3 3 3 1.5 2percent

Montgomery3.8

1.28 1 1 1 1.5 2percent

Harris4.4

1.94 2 2 2 1.5 2percent

[15]U.S.BureauofLaborStatistics

Primary Data Duringthekeyinformantinterviewprocess,AccesstoHealthServiceswasdiscussedover160timesandwasraisedbyparticipantsalmost50timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengeswerelimitationstoprocuringspecialtycareservices,transportationtoservicesandhoursofoperation.Inadditiontotheprimarythemes,twoadditionalbarriersorchallengesstoodoutaskeyfactorsimpactingaccesstohealthcareservices,lackofknowledgeandstigmaorfearpreventingpeoplefromseekingcare.Theissuethatinterviewparticipantsweremostconcernedwithwaspatientsbeingabletoaccessfollowupcarewithspecialtycareproviders.Multipleparticipantsraisedconcernsthatevenifpatientsareabletoaccesspreventativeorprimarycareservices,theymaynotbeabletoaccesstheappropriatefollowupcarewithaspecialtycareprovider.Someparticipantsraisedthisconcernincontextofpatientsnotlivingnearaspecialistandothersraisedincontextofpatientsnotbeingabletoaffordthecostoffollowupcare.“Wecantakecareofhelpingthemcontroltheirdiabetes,andkeeptheirbloodpressureincheck,andwecantreatthemforthatcommoncold,wecanprovidethatannualpapsmearforthewomanandprovidethatmammogram,butit'swhenthepersonexperiencessomethingofamoresignificantissue—saytheyhaveagallbladderattack,ortheyhaveahernia—thatisjustaresourcethatwesimplydon'thave.Orsomeoneneedstoseeanorthopedicsurgeon.Wetrytotakecareofthemthebestthatwecaninthesettingthatwehave,butthatisahugebarrierthatwefacewithourpatients,orthatourpatientsface.So,whathappensisitbecomesanurgentsituation,andtheyendupintheemergencyroom,andthey'regivensurgeryonanemergencybasis.”Anothercommonconcernraisedbyinterviewparticipants,wastransportationtoservicesandhoursofoperationofserviceslimitingpatients’accesstocare.Participantsdescribedhow

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thesefactorsdeterminewhetherpatientsdecidetotakeofffromworkandseekservicesinthefirstplace.Afewparticipantsdescribedthemanyservicesandresourcesthatareavailabletothecommunitybutthatmanymaynotbeawarehowtheycanaccessorbenefitfromthem.Oneparticipantdescribedresourcesbeingconcentratedincertaingeographicareasandmoreremotelocationsnotbeingwellconnectedorknowledgeableabouthowtheymayalsobenefitfromtheseresources.Participantsdescribedthepotentialformorecollaborationandpartnershiptoconnectcommunitiestooneanother.“Iwouldlovetoseesomebodyfromthepublicassistance,andI’lljustcallitMedicaid,orthepublicbenefits,maybehaveanofficeinsidethehospital.Thatwouldbephenomenal.I’veworkedinadifferentstateasahospitalsocialworkerpreviously,andtherewassomeonefromapublicassistance,fromtheDepartmentofHumanHealthandWelfareServicesinthehospital,andthatpersonwasabletoconnectthepeopletherewithemergencyMedicaid,withMedicaid,whichalsohelpsthehospital.Havetheirbillspaidandwhatnot,andmaybeitwouldcutdownonoutsourcingandsomeofthecollectionsandwhatnot.Ithinkthatthatwouldbewonderful,wouldbetohavesomeonefromthestatepublicbenefitsprogramhousedinsidethehospital.”Severalparticipantsdescribedadown-turninpeopleseekingpreventativecareserviceandhypothesizedthatoneofthefactorsmayberelatedtotheimmigrantcommunityintheregionexperiencingfearorstigmarelatedtohavingtoshowidentificationorproofofcitizenship.“EventhoughweattheHealthDistrictdonotaskforproofofimmigrationstatus,peopledon'tunderstandthat,particularlysincewe'reagovernmentagency,andit'sbeenarealchallengetogetsomeofthesefolkstocomeinforservices.”Therewerealmost80referencestotheuninsuredpopulationinthekeyinformantinterviewsandlackofhealthinsurancewasraisedasabarrierorchallengetoachievinghealthinthecommunity19times.Lackofhealthinsurancewasmostoftenbroughtupincontextofpatientshavinglimitedfinancialresourcesandafactortonotaccessinghealthcareservices.Participantsdiscussedpatientsnothavingtheabilitytopayfeesformultipleappointmentco-paysornotseekingcareduetocompetingfinancialpriorities.Whilehealthcareservicesmaybeavailableinthecommunity,forthosewhoarelackinghealthinsurance,accessinghealthcareservicesisnotnecessarilyanoption.Lackofhealthinsurancecreatesaparticularchallengeforthosewhorequirespecialtycareservices.“Ithinkthosearethebiggesttwo—access,again,withthemajorityofouradultpopulationbeinguninsured,havingthemtrytofindaproviderthat,again,willtakeslidingfeescale,orreducedrates.Oncethey'reabletoaccessthoseservices,thenitbecomesamatterofpayingforthethingsthatareneeded.Thepatientcomesinandwediagnosethemwithdiabetes,thencomesthecostofmedications,andifthatpatientisneedingspecialtycareoutsideofthescopeofprimarycare,accesstospecialists.”Participantsbroughtupissuesrelatedtolowincomeorgroupswhomaybeunderservedinthecommunity115timesduringthekeyinformantinterviewprocess.Particulargroupsthatparticipantsfeltmayexperienceaddedchallengesaccessinghealthcareservicesincludedtheimmigrantpopulation,individualswithdisabilities,familieswithyoungchildren,andtheelderly.Severalparticipantsnotedfeesrelatedtoco-paysoroutofpocketexpensesasabarrier

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topatientsseekinginitialpreventativeservicesorongoingtreatmentforchronicconditions.Participantsidentifiedseveralgroupstheyfeltwereunderservedinthecommunity.Multipleparticipantsdiscussedtheuniqueandspecificchallengeswithprovidingculturallyappropriatecareforadiverseandrecentimmigrantpopulationinthecommunity.Participantsfeltthatfamilieswithyoungchildrenandtheelderlypopulationareparticularlyvulnerablegroupsinthecommunitythatexperiencebarriersandchallengesaccessinghealthcareservices.Specifically,participantsdiscussedthesegroupsexperiencinghighlevelsofpovertyplacingthemathigherriskforpoorhealthoutcomes.“Mostofthemareextremelylowincomeandtheyfallinthosecategorieswherewehaveasignificantnumberofelderlydisabled,singlemomsandtheirchildren,sovulnerablefolkshereinHouston.”

Emotional Well-Being

Secondary Data MentalHealthandSubstanceAbusewereidentifiedassignificantneedsforMemorialHermannHealthSystem.MentalHealth&MentalDisordersrankedfifthforLibertyCounty’ssecondarydataresults,whileSubstanceAbuserankedsixthinthetoptopicsforMontgomeryCounty.AsshowninTable20,LibertyCountyhasseveralmentalhealthindicatorsofconcern:MentalHealthProviderRate,Age-AdjustedDeathRateduetoAlzheimer'sDisease,Age-AdjustedDeathRateduetoSuicide,andDepressionintheMedicarePopulation.InMontgomeryCounty,mentalhealthindicatorsofnoteinclude:MentalHealthProviderRateandAge-AdjustedDeathRateduetoSuicide.WhileMentalHealth&MentalDisordersdidnotrankashighforHarrisCounty,anindicatortonoteisAlzheimer'sDiseaseorDementiaintheMedicarePopulation.

Table20.SecondaryDataScoringResults:MentalHealth&MentalDisorders

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

MentalHealthProviderRate[4]

(2017)

Liberty14.7

2.61 3 3 3 1.5 2providers/100,000population

Montgomery69.4

2 1 3 3 1.5 1.5providers/100,000population

Harris 103.7 1.44 0 1 3 1.5 2

KeyIssues:• Mentalhealthaspartofoverallhealth• Needformorebehavioralhealthservicesandproviders• Alcoholandsubstanceabuse• Alzheimer’sanddementia

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providers/100,000population

[4]CountyHealthRankings

Age-AdjustedDeathRatedueto

Alzheimer'sDisease[12](2010-2014)

Liberty38.5

2.36 3 3 3 1.5 2deaths/100,000population

Montgomery18.8

0.64 0 0 0 1.5 1deaths/100,000population

Harris17.9

0.64 0 0 0 1.5 1deaths/100,000population

[12]TexasDepartmentofStateHealthServices

Age-AdjustedDeathRateduetoSuicide[12](2010-2014)

Liberty14

2.28 1.5 3 3 3 2deaths/100,000population

Montgomery14.6

2.28 1.5 3 3 3 2deaths/100,000population

Harris10.3

0.94 1.5 0 0 2 1deaths/100,000population

[12]TexasDepartmentofStateHealthServices

Depression:MedicarePopulation

[3](2015)

Liberty17.5

1.94 2 2 2 1.5 2percent

Montgomery15.9

1.28 1 1 1 1.5 2percent

Harris14.8

0.94 1 0 0 1.5 2percent

[3]CentersforMedicare&MedicaidServices

Alzheimer'sDiseaseorDementia:

MedicarePopulation[3](2015)

Liberty10.9

1.67 1 1 2 1.5 1.5percent

Montgomery10.7

1.67 1 1 2 1.5 1.5percent

Harris11.4

1.89 2 1 3 1.5 1percent

[3]CentersforMedicare&MedicaidServices

PoorMentalHealth:5+Days[10](2016)

Liberty

--- --- --- --- --- ---

Montgomery

--- --- --- --- --- ---

Harris 80 1.53 1.5 1 1.5 1.5 2

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percent

[10]TexasBehavioralRiskFactorSurveillanceSystem

SubstanceAbuseisanothertopicofconcernforMemorialHealthSystem.BothHarrisandMontgomerycountieshaveindicatorswithscoresabove2.Therewereover37%alcohol-impaireddrivingdeathsinHarrisCountyandalmost33%inMontgomeryCounty,comparedto21.8%inLibertyCounty.Moreover,21%ofadultsdrinkexcessivelyinMontgomeryCountyascomparedtothenationalvalueof18%.

Table21.SecondaryDataScoringResults:SubstanceAbuse

County CountyValueComparedto:

Indicator Name ValueDataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

AdultswhoDrinkExcessively[4](2016)

Liberty19.4

1.67 3 1 2 0 1.5percent

Montgomery21.0

2.17 3 2 3 0 1.5percent

Harris18.1

1.5 2 1 2 0 1.5percent

[4]CountyHealthRankings

Alcohol-ImpairedDrivingDeaths[4]

(2012-2016)

Liberty21.8

0.72 1 0 0 1.5 1percent

Montgomery32.9

2.06 2 3 3 1.5 1percent

Harris37.8

2.17 3 3 3 1.5 0percent

[4]CountyHealthRankings

Primary Data Approximately50%ofcommunitysurveyrespondentscitedMentalHealthasoneofthetopissuesmostaffectingthequalityoflifeintheircommunityand52%ofrespondentsnotedSubstanceAbuse.Ininterviewswithkeyinformants,MentalHealthwasdiscussed113timesandwasraisedbyparticipants33timesasaneedsorconcernforthehealthofthecommunity.TheprimarythemesrelatedtoMentalHealthweretreatingmentalhealthaspartofoverallhealth,addressbehavioralhealthinschool,needforbehavioralhealthprovidersandservices,andolderadultswithAlzheimer’sanddementia.Someparticipantsdiscussedarecentshiftincaredeliveryandthecontinuedneedtoaddressmentalhealthaspartofaperson’stotalhealthsimilarlytohowchronicdiseaseismanaged.Oneparticularlyvulnerablepopulationthatwouldbenefitfromabroaderapproachto

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treatment,inclusiveofmentalhealth,isthehomelesspopulation.Severalparticipantsbroughtupissuesregardinganeedformorebehavioralhealthprovidersandservicesinthecommunity.“Wehereseeahugegapinmentalhealth,there’sjustnotalotofsupportiveservicesformentalhealth,andwe’reseeingthattoreallyhitouryoungadults,ouradultswhoareintheir20s.WeseealotofpeoplehavingalotofPTSDorevenhavingapsychoticbreak,andweonlyhaveoneagencythatwouldsupportsomebodymaybewithoutinsurancethat’shavingmentalhealthissues,whichiscausingsomuchtraumaforthemfromthatpointforward.Iwouldsayoneofthehugeindicatorsforuswouldbementalhealth,it’shugeforus.”Oneparticipantobservedrecentincreasesandchangeswithinthelocalpopulation.Fromtheparticipant’sperspective,thereshouldbemoreprogramsorservicestoaddressthegrowingneedforaddressingmentalhealthinthecommunity.Anotherparticipantsuggestedsolutionsforaddressingtheneedformorebehavioralhealthprovidersinthecommunitysuchasexpandingresidencyprogramsforpsychiatristsanddevelopingcomprehensivetelemedicineprogramstoprovideservicesmoreefficiently.Furthermore,participantsrecommendedaddressingbehavioralhealthwithyoungerpopulationsintheschools.Schoolsthatprovidebehavioralhealthservicesthroughtelemedicinehavebeenreceivedwellinthecommunityandtheperceptionisthattheyareeffective.Someparticipantsbelievethattheseprogramsshouldbeexpandedandavailableacrossthecommunity.“There[are]thementalhealthunitsthathavegoneoutintotheschools.They'renotschool-basedbutthat’sthevenuetheywilldrivetowiththeirmobileunits.Theyhaveabigimpact.They'reseeingthousandsofkids.They’vedonesometelemedicinewithmentalhealth,behavioralhealth,withsomeofthehighschools.FromwhatI’veheard,(…)it’sbeenprettyeffectiveandwellreceived.”AchallengethathealthcareprovidersidentifiedforthemedicalcommunityisadequatelyaddressingdementiaandAlzheimer’swithinthegeriatricpopulation.“Dementia’saterminalillness.(…)Muchmoreneedstobedonewithhealthcaresystemsaroundroutinescreeningandidentificationofitasanissue.(…)So,thatisthefirstthingthatneedstohappen.Thenthereneedstobeanunderstandingthattherearethings–therearemedicationsthatcanbehelpfultothesystemsofthedementia.(…)Butyoucanaffectitbyaddressingsomeofthesymptoms.”SubstanceAbusewasdiscussed55timesandwasraisedbyparticipants15timesasaneedorconcernforthehealthofthecommunity.MultipleuniquethemesemergedfromtheinterviewsrelatedtoSubstanceAbuse:fundingfortreatmentprograms,invisibilityofalcoholism,overcomingstigmaofseekingtreatment,andemergingshiftsinoutreachmodels.Participantsidentifiedfundingforprogramsandavailabilityofservicesforthosewhomaynotbeabletoaffordtreatmentout-of-pocketasissuesthecommunityisfacingtoaddresssubstanceabuse.Oneparticipantraisedalcoholabusespecificallyasanissueinthecommunitythatdoesnotgettheamountofattentionofothersubstanceabusetopicsbutmayinfactbeimpactingalargerproportionofthepopulationandconnectedtomanyotherhealthissues.Multipleparticipants

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identifiedculturalstigmaasabarrierforthosewhomaybenefitfromseekingtreatment.Stigmaorfearmaybeuniqueandvaryfrompopulationtopopulationinthecommunity.“Withsubstanceabuse,it’scultureandstigma.Nobodygoestosubstanceabusetreatmentontheirown.Theymaynotbeadjudicatedbutsomeoneisreally,reallypushingthem,familymember,boss.Noonegoestotreatmentifthey’renotunderduress.”Afewparticipantsdescribeduniqueapproachestooutreachandsubstanceabusetreatmentinthecommunitythatwouldsupportremovingbarriersforpeoplehavingtotakethefirststepontheirown.“Forinstance,it’sprettynew,butthere’saninitiativethat’scalledtheHeroesProjectthat’slookingatoverdoses,sowhenanoverdosehappens,they’resendingateamtotheER.So,it’sgotapeersupportspecialist,theEMPisinvolved–buttheyactuallygointotheERandtheydoaninterventiontheretotrytohelpwithlinkagetotreatmentsothatwecanassistthepatients.”

Food as Health

Secondary Data ThetopicsofDiabetesandHeartDisease&StrokeemergedassignificanthealthneedsforMemorialHermannHealthSystem.HeartDisease&StrokerankedasthesecondmostimportanttopicforMontgomeryCountyandwasthefourthhighest-rankingtopicforLibertyCounty.AlthoughthetopicofDiabetesdidnotreceiveahighsecondarydatascoreoverall,DiabetesintheMedicarePopulationisofconcerninLibertyCounty,withavalueof31.4%comparedtotheU.S.valueof26.5%inadditiontoexhibitinganegativetrend(Table22).

Table22.SecondaryDataScoringResults:Diabetes

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

Diabetes:MedicarePopulation[3](2015)

Liberty31.4

2.83 3 3 3 1.5 3percent

Montgomery24.8

0.94 0 0 1 1.5 2percent

Harris28.1

1.67 2 1 2 1.5 1.5percent

[3]CentersforMedicare&MedicaidServices

KeyIssues:• Foodinsecurityandlimitedaccesstohealthyfoods• Diabetesandheartdiseaselinkedtosocioeconomicfactors• Fooddeserts

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AsshowninTable23HeartDisease&StrokeisalsoaconcerningtopicinLibertyCounty.Sixindicatorshavescoresequaltoorabove2,includingAge-AdjustedDeathRateduetoHeartDiseaseaswellasthefollowingindicatorsintheMedicarePopulation:AtrialFibrillation,HeartFailure,Hyperlipidemia,IschemicHeartDisease,andStroke.IndicatorsofconcerninMontgomeryCountyincludeAtrialFibrillation,HyperlipidemiaandStroke(allintheMedicarePopulation).InHarrisCounty,indicatorstoobserveareHeartFailureandStroke(bothintheMedicarePopulation).

Table23.SecondaryDataScoringResults:HeartDisease&Stroke

County CountyValueComparedto:

Indicator Name ValueDataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

Age-AdjustedDeathRatedueto

CerebrovascularDisease(Stroke)[12]

(2010-2014)

Liberty41.1

1.75 1 1 3 3 1.5deaths/100,000population

Montgomery38.5

1.25 1 1 2 3 0deaths/100,000population

Harris41.5

1.42 1 1 3 3 0deaths/100,000population

Age-AdjustedDeathRateduetoHeartDisease[12](2010-

2014)

Liberty257.6

2.14 3 3 3 1.5 1deaths/100,000population

Montgomery173.2

1.25 1 2 2 1.5 0deaths/100,000population

Harris167.6

0.92 1 1 1 1.5 0deaths/100,000population

[12]TexasDepartmentofStateHealthServices

AtrialFibrillation:MedicarePopulation

[3](2015)

Liberty8.2

2 2 3 2 1.5 1.5percent

Montgomery8.8

2.44 3 3 2 1.5 2percent

Harris7.3

1.5 1 1 1 1.5 3percent

HeartFailure:MedicarePopulation

[3](2015)

Liberty20.4

2.39 3 3 3 1.5 1percent

Montgomery14.6

1.22 0 1 2 1.5 1percent

Harris 16.0 1.89 1 2 3 1.5 1

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percent

[3]CentersforMedicare&MedicaidServices

Hyperlipidemia:MedicarePopulation

[3](2015)

Liberty46.0

2 2 1 2 1.5 3percent

Montgomery46.3

1.94 2 2 2 1.5 2percent

Harris43.2

1.44 1 1 1 1.5 2percent

Hypertension:MedicarePopulation

[3](2015)

Liberty60.4

1.83 2 2 2 1.5 1.5percent

Montgomery56.0

1.61 1 1 2 1.5 2percent

Harris55.5

1.22 1 1 2 1.5 1percent

[3]CentersforMedicare&MedicaidServices

IschemicHeartDisease:Medicare

Population[3](2015)

Liberty33.2

2 2 3 3 1.5 0percent

Montgomery28.6

1.17 1 1 2 1.5 0percent

Harris28.8

1.33 1 2 2 1.5 0percent

[3]CentersforMedicare&MedicaidServices

Stroke:MedicarePopulation[3](2015)

Liberty5.8

2.5 3 3 3 1.5 1.5percent

Montgomery4.6

2.28 2 2 3 1.5 2percent

Harris5.2

2.61 3 3 3 1.5 2percent

[3]CentersforMedicare&MedicaidServices

Table24revealsthatLibertyCountyhasseveralnutrition-relatedindicatorsofconcern:FoodInsecurityRate,ChildFoodInsecurityRate,GroceryStoreDensity,andHouseholdswithNoCarandLowAccesstoaGroceryStore.InbothHarrisandMontgomerycounties,SNAPCertifiedStoresareofconcern;additionalindicatorsofnoteincludeFoodInsecurityRateinHarrisCountyandGroceryStoreDensityinMontgomeryCounty.

Table24.SecondaryDataScoringResults:Nutrition

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

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FoodInsecurityRate[5](2016)

Liberty18.7

2.39 3 3 3 1.5 1percent

Montgomery14.6

1.33 1 1 3 1.5 0percent

Harris16.6

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

ChildFoodInsecurityRate[5](2016)

Liberty26.0

2.17 3 3 3 1.5 0percent

Montgomery21.2

1.17 0 1 3 1.5 0percent

Harris23.5

1.67 1 2 3 1.5 0percent

[5]FeedingAmerica

GroceryStoreDensity[17](2014)

Liberty0.1

1.94 2 1.5 1.5 1.5 2stores/1,000population

Montgomery0.1

1.83 2 1.5 1.5 1.5 1.5stores/1,000population

Harris0.2

1.5 1 1.5 1.5 1.5 1.5stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

HouseholdswithNoCarandLowAccesstoaGroceryStore[17]

(2015)

Liberty3.4

1.83 3 1.5 1.5 1.5 1.5percent

Montgomery1.5

1.17 1 1.5 1.5 1.5 1.5percent

Harris0.9

1 0 1.5 1.5 1.5 1.5percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

SNAPCertifiedStores[17](2016)

Liberty0.8

1.78 2 1.5 1.5 1.5 2stores/1,000population

Montgomery0.5

1.89 3 1.5 1.5 1.5 1stores/1,000population

Harris0.6

2.11 3 1.5 1.5 1.5 2stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

FoodEnvironment Liberty 6.6 1.72 2 0 3 1.5 1

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Index[4](2018)

Montgomery7.5

1.22 1 0 2 1.5 1

Harris7.2

1 1 0 2 1.5 0

[4]CountyHealthRankings

ChildrenwithLowAccesstoaGroceryStore[17](2015)

Liberty4.3

1.33 1 1.5 1.5 1.5 1.5percent

Montgomery5.6

1.67 2 1.5 1.5 1.5 1.5percent

Harris5.4

1.5 1 1.5 1.5 1.5 1.5percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

FastFoodRestaurantDensity[17](2014)

Liberty0.5

1.33 1 1.5 1.5 1.5 1.5restaurants/1,000population

Montgomery0.6

1.5 1 1.5 1.5 1.5 1.5restaurants/1,000population

Harris0.7

1.67 2 1.5 1.5 1.5 1.5restaurants/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

Primary Data Food-relatedtopicsemergedinthecommunityinputgatheredthroughthesurveyandkeyinformantinterviews.FoodInsecurity,FoodProgramsandFoodKnowledgeissueswerediscussedover170timesduringthekeyinformantinterviewsandwereraisedbyparticipants34timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengesthatemergedintheinterviewswereaccesstohealthyfoodsandaffordability,knowledgegapsandlimitedfoodfamiliarityandprogramlimitations.Themostcommonissueraisedbykeyinformantparticipantsrelatedtofoodinsecuritywascommunitymembersnotbeingabletoaccesshealthyfoodsintheircommunity.Multipleparticipantsbelievedthatinmanycommunities,healthyfoodoptionswerenotavailabletopeoplewithinafive-mileradiusfromtheirhomeorwork.Participantsdescribed‘fooddeserts’asatopissueaffectinghealthinthecommunityandhowlimitedaccesstohealthyfoodsalsowascloselyassociatedwithpeoplealsobeingnotbeingabletoaffordhealthyfoods.

“Wehaveareallylargecounty.(…)Thewestdoesn’tcatertotheeastveryeasilyandviceversa.(…)Onceyougetoffofthatinterstate,youstartgettingintotheeastcountyandwestcountyyou’llgomilesandmilesandmileswithoutgrocerystores,sotherearefooddesertsinourcommunity.”

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Participantsalsodiscussedtheimbalanceofhealthyfoodoptionsforthosecommunitieswithlowerhousingpricesandingeneral,loweraverageincomes.Oneparticipantdescribedthelinkbetweenpeoplehavingtoworkmultiplejobsandhavingtimetoshopforandpreparehealthyfoods.

“Wehaveagrocerystoreoneverycornerbutnoteverycornerinthepoorneighborhoods.It’sbeenmypersonalexperiencethateatinghealthyisexpensive.Itcostsmoremoneytobuyhealthyfruitsandvegetablesandmorehealthyfood,ingeneralthanitdoestobuyfoodthat’snotsohealthy,that’shighfat,highcarb,highsugar….Itcostsmoremoney.Ittakeslongertoprepare.Whenyouhaveamomandadadoreitherandthey’retryingtohandletwojobs,ifnotthree.They’vegotkidsofvaryingages.Themechanicsofshoppingandpreparingmealsisprobablyanactivitythatgetsletgo.”

Someparticipantshaddirectexperiencewitheducatingthecommunityabouthealthyfoodsandeating.Theseparticipantssharedthatsomecommunitymembershavelimitedknowledgeoffreshfruitsandvegetablesandwouldbenefitfromearlyeducationforparentsandchildreninschools..

“Andthereareplaceswhichwearereallyconcernedabout,whichiseastofI45wherethere’sthisfoodinsecurity,fooddesert,andallotherproblemsthatarehappening,andwe’reseeingincreasingincidenceofchildobesityinthoseareas,andthosezipcodes.Sodefinitelyeducationisthekey.Itstartsfromprobablyprenatalcareofmom,anditgoesontoschool.”

InMemorialHermann’scommunitysurvey,67%ofrespondentsselectedDiabetesasoneofthetopissuesmostaffectingthequalityoflifeintheircommunity.Duringkeyinformantinterviews,Diabeteswasdiscussed64timesandwasraisedbyparticipants32timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedDiabetesasatophealthissueinthecommunity,emergedregardinghowdiabetesisimpactingspecificgroupsinthecommunityandthewayasedentarylifestyleimpactsdiabetes.MultipleparticipantsattributedthesurgeinobesityanddiabetesingeneralintheU.S.toashifttoamoresedentarylifestylewhileothersspecificallyidentifiedthelocalclimateanddrivingcultureaskeyfactorsleadingtoanincreaseinsedentarylifestylesimpactingtheregion.HeartDisease&Strokewasdiscussed34timesduringthekeyinformantinterviewsandwasraisedbyparticipants16timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedHeartDisease&Strokeasatophealthissueinthecommunity,theuniquethemesthatemergedintheinterviewswerechronicdiseaseriskrelatedtosocioeconomicstatusandchallengeswithmanagingheart-relatedconditions.“Youhavesomanycommunitiesthatarefooddesertsso,ofcourse,Ithinkweareallatriskforthingslikediabetesandhypertension,obesity,stroke–but,Ithinkinadditiontothat,thosethataremostarealreadymarginalized.Peoplewhoarelowincome.Lowsocioeconomicstatus.So,education,andallofthoseindicatorsareprobablyevenmoreatriskforchronicdiseasesthansomeone,forexample,whohasaccesstocareandinsurance.So,theyprobablyaredoublyatrisk.”

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Exercise Is Medicine

Secondary Data Exercise,Nutrition&Weightwasthefifthhighest-rankingtopicinthesecondarydatascoringresultsforMemorialHermannHealthSystem.ItreceivedthesametopicrankinginMontgomeryCountyand,althoughitdidnotrankashighinthesecondarydatascoringresultsforLibertyCounty,itreceivedatopicscoreover1.8.Table25displaysindicatorsofconcern,withseveralscoresequaltoorabove2.InMontgomeryCounty,anindicatorspecifictoexerciseisWorkersWhoWalktoWork(withascoreof2.78),whileinLibertyCountythesameindicatoralongwithAccesstoExerciseOpportunitiesscoredabove2.HarrisCountyalsohasoneexercise-relatedindicatorofconcern:WorkersWhoWalktoWork.

Table25.SecondaryDataScoringResults:Exercise,Nutrition&Weight

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

WorkerswhoWalktoWork[1](2012-2016)

Liberty1.0

2.67 3 3 3 3 1.5percent

Montgomery1.0

2.78 3 3 3 3 2percent

Harris1.5

2.17 2 2 3 3 1.5percent

[1]AmericanCommunitySurvey

FoodInsecurityRate[5](2016)

Liberty18.7

2.39 3 3 3 1.5 1percent

Montgomery14.6

1.33 1 1 3 1.5 0percent

Harris16.6

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

AccesstoExerciseOpportunities[4]

(2018)

Liberty59.5

2.17 2 3 3 1.5 1.5percent

Montgomery82.7

1 0 1 2 1.5 1.5percent

KeyIssues:• Obesityandconvenienceoffastfood• Walkabilityofcommunities• Safetyofoutdoorspacesandplacestoexercise

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Harris90.4

0.67 0 0 1 1.5 1.5percent

[4]CountyHealthRankings

ChildFoodInsecurityRate[5](2016)

Liberty26.0

2.17 3 3 3 1.5 0percent

Montgomery21.2

1.17 0 1 3 1.5 0percent

Harris23.5

1.67 1 2 3 1.5 0percent

[5]FeedingAmerica

GroceryStoreDensity[17](2014)

Liberty0.1

1.94 2 1.5 1.5 1.5 2stores/1,000population

Montgomery0.1

1.83 2 1.5 1.5 1.5 1.5stores/1,000population

Harris0.2

1.5 1 1.5 1.5 1.5 1.5stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

HouseholdswithNoCarandLowAccesstoaGroceryStore[17]

(2015)

Liberty3.4

1.83 3 1.5 1.5 1.5 1.5percent

Montgomery1.5

1.17 1 1.5 1.5 1.5 1.5percent

Harris0.9

1 0 1.5 1.5 1.5 1.5percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

SNAPCertifiedStores[17](2016)

Liberty0.8

1.78 2 1.5 1.5 1.5 2stores/1,000population

Montgomery0.5

1.89 3 1.5 1.5 1.5 1stores/1,000population

Harris0.6

2.11 3 1.5 1.5 1.5 2stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

FoodEnvironmentIndex[4](2018)

Liberty6.6

1.72 2 0 3 1.5 1

Montgomery7.5

1.22 1 0 2 1.5 1

Harris 7.2 1 1 0 2 1.5 0

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[4]CountyHealthRankings

RecreationandFitnessFacilities[17]

(2014)

Liberty0

1.67 2 1.5 1.5 1.5 1.5facilities/1,000population

Montgomery0.1

1.33 1 1.5 1.5 1.5 1.5facilities/1,000population

Harris0.1

1.33 1 1.5 1.5 1.5 1.5facilities/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

ChildrenwithLowAccesstoaGroceryStore[17](2015)

Liberty4.3

1.33 1 1.5 1.5 1.5 1.5percent

Montgomery5.6

1.67 2 1.5 1.5 1.5 1.5percent

Harris5.4

1.5 1 1.5 1.5 1.5 1.5percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

Adults(18+Years)WhoAreObese[10]

(2016)

Liberty

--- --- --- --- --- ---

Montgomery

--- --- --- --- --- ---

Harris32.0

1.67 1.5 1 2 2 2percent

[10]TexasBehavioralRiskFactorSurveillanceSystem

FastFoodRestaurantDensity[17](2014)

Liberty0.5

1.33 1 1.5 1.5 1.5 1.5restaurants/1,000population

Montgomery0.6

1.5 1 1.5 1.5 1.5 1.5restaurants/1,000population

Harris0.7

1.67 2 1.5 1.5 1.5 1.5restaurants/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

Primary Data Over60%ofMemorialHermann’scommunitysurveyrespondentsnotedObesityasatopissueaffectingthequalityoflifeintheircommunity.Inkeyinformantinterviews,Exercise,Nutrition&Weightwasdiscussedalmost170timesandwasraisedbyparticipants42timesasaneedorconcernforachievinghealthinthecommunity.TheprimarybarriersrelatedtoExercise,Nutrition&Weightidentifiedbyparticipantswerewalkability,accesstosafeoutdoorspaces,

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programmingthatmaynotmeettheneedsofcommunitiesfacingfinanciallimitations,andtheconvenienceofunhealthyfoods.Severalparticipantsdiscussedbarrierstohealthylifestylechangesanddescribedcommunitieswheresidewalksarelimitedorpedestrianpathwaysarenotavailable.Theabilityforcommunitymemberstomakesmallshiftsintheirdailylives,suchaswalkingregularly,maybemorefeasiblethanundertakinganexerciseregimen.Thelimitationsofpedestrianpathwaysandsaferwalkingspacespreventthoseinsomesectionsofthecommunityfrommakingtheseshifts.Forindividualswhomaynotbeabletoaffordgymmembershipsnorattendclassesduetoworkschedules,outdooractivitiesandfitnessareasofferafreealternative.Participantsfeltthatinmanyneighborhoods,theseoutdoorspacesarenotavailableduetodisrepairorunsafeenvironments.“Ithinkthebuiltenvironmentishuge,too.Ifyouliveoutinaplannedcommunity,theyusuallyhavewalkingtrails,ortheyhaveaprettyfountainareaforyoutowalkaroundit.Theyhavethoselittleexercisethingsthatyoustoponpartwayaroundthetrailandyoudoyourlittlepush-upsandyoursit-upsandyourpull-ups(…)Yougointothesepoorerareasandthere'snosidewalks.There'snolightsatnight.There'sapark—it'sallrustedequipment.”Participantsalsodescribedprogramsandfacilitiesthatareeitherlimitedorlacking.Theseprogramsincludedfreeexerciseprogramswithchildcareoptions,youthsportsleaguesandrecessintheschoolsandfreeorlow-costoptionsforair-conditionedfacilitiesduringtimesoftheyearwhentheweatherdoesnotpermitoutdooractivities.“InpoorareasofHouston,there’sjustnotalotofparks.There'snolittleleague,andthere'snosoccerleagues,andso,there'snotalotofrecessintheschools.There'sjustnot—thecultureamongthekidsisjustnotbeingcreatedaroundphysicalactivity.”Achallengethatseveralparticipantsraisedistheconvenienceandlowcostofunhealthyfoods.Forfamiliesthatmayhavefinancialortimelimitations,theconvenienceofinexpensive,lesshealthyfoodsisdifficulttocontendagainst.“Wehavethebigchaingrocerystoreshereinthecommunity,butalotoftimes,becauseourpopulationislimitedwithfunds,thebadfoodsaretheonesthatarethecheapestandmostaccessible,sotheygoinandbuythecheapest/fastestthingtheycanget.”

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Non-Prioritized Significant Health Needs Thefollowingadditionalsignificanthealthneedsemergedfromareviewoftheprimaryandsecondarydata.Withtheneedtofocusontheprioritizedhealthneedsdescribedabove,thesetopicsarenotspecificallyprioritizedeffortsinthe2019-2022ImplementationStrategy.However,duetotheinterrelationshipsofsocialdeterminantneedsmanyoftheseareasfall,tangentially,withintheprioritizedhealthneedsandwillbeaddressedthroughtheupstreameffortsoftheprioritizedhealthneeds.Additionally,manyofthemareaddressedwithinongoingprogramsandservices.Examplesoftheseeffortsareprovidedbelowbytopicarea.

Older Adults and Aging

Secondary Data OlderAdultsandAgingwasatopicofconcernforHarris,LibertyandMontgomerycounties,withatopicscoreof1.5forHarrisCounty’ssecondarydataresults,atopicscorecloseto2forLibertyCounty,andastheeighthhighest-rankingtopicforMontgomeryCounty.Acrossallthreecounties,StrokeintheMedicarePopulationisanindicatortobeawareof.InHarrisCounty,additionalindicatorsscoringabove2includeChronicKidneyDiseaseintheMedicarePopulationaswelltheAge-AdjustedDeathRateduetoFalls.InLibertyCounty,severalindicatorsareconcerningintheMedicarePopulation(Diabetes,ChronicKidneyDisease,Asthma,COPD,andHeartFailure);anotherindicatorscoringabove2inLibertyCountyistheAge-AdjustedDeathRateduetoAlzheimer’sDisease.InMontgomeryCounty,AtrialFibrillationintheMedicarePopulationisanindicatorwithscoreabove2.

Primary Data KeyinformantsandstakeholdersdiscussedOlderAdultsandAging.Over62%ofparticipantsinMemorialHermannHealthSystem’sprioritizationprocesscitedOlderAdultsasoneofthegroupsmostaffectedbypoorhealthoutcomes.Interviewswithkeyinformantsnotedthegrowingpopulationofolderadultsandneedsrelatedtospecializedcare,financialassistanceandoutreach.“…[W]earegoingtowatchtheliteraldoublingofthenumberofAmericansovertheageof65inthenext25years.Everyday,betweennowand2030,dayafterday,10,000Americanswillturn65,sowearewatchinganextraordinaryexpansionofchallengesofaging.(…)[M]oreandmoreAmericansaregoingtobegettingold,socaringforthismassiveincreaseintheagingpopulationisgoingtobeoneofthegreatchallengesIthink.”

Efforts MemorialHermannHealthSystemincludestwofreestandingRehabilitationHospitals(TIRRandKaty)aswellasaseniorlivingfacility(UniversityPlace),featuringindependentliving,personalassistanceservices,andaseparate,butattached,nursingcenter.Additionalcommunityoutreachincludeshealtheducationon:Alzheimer’sdisease,DiscountedDiabetesEducation,Education/outreachforSeniors,InjuryPrevention,FallPrevention,andsupportgroupsforvariouspopulations,including:Alzheimer’s,Amputees,Cardiacpatients,Chronicdisease,Diabetics,Grief,Parkinson’sdisease,Stroke,Survivorship,andmore.

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Cancers

Secondary Data Cancerisatopicthatreceivedasecondarydatascoreof1.75forLibertyCountywithseveralconcerningindicators:Age-AdjustedDeathRateduetoLungCancer,OralCavityandPharynxCancerIncidenceRate,CervicalCancerIncidenceRate,Age-AdjustedDeathRateduetoCancer,LungandBronchusCancerIncidenceRate,andAge-AdjustedDeathRateduetoColorectalCancer.CancerwasnotatoptopicforHarrisandMontgomerycounties’secondarydataresults.However,thereareacoupleofindicatorstonoteinHarrisCounty(withscoresabove2):CervicalCancerIncidenceRateandAge-AdjustedDeathRateduetoBreastCancer.

Primary Data InMemorialHermann’scommunitysurvey,overonethirdofrespondentsnotedCancerasatopissueaffectingthequalityoflifeintheircommunity.Interviewswithkeyinformantsrevealedtheimportanceofmakingcancerscreeningservicesandspecialtycareavailableandaccessible(e.g.,telehealth,mobilemammography).

Efforts AsleadingprovidersofcancertreatmentinHouston,MemorialHermannCancerCentersarecommittedtocancertreatment,prevention,andresearch.Theirbroadgeographicalcoveragemakescancertreatmentextremelyaccessibleandconvenienttowherepatientsliveorwork.AlleightMemorialHermannCancerCentersareapprovedbytheAmericanCollegeofSurgeonsCommissiononCancer(ACoSCoC);only25percentofhospitalsacrossthecountryhavereceivedthisspecialrecognition.Withguaranteedaccesstocomprehensivecare,collaborativeteamapproachforcoordinatingthebestavailabletreatmentoptions,state-of-the-artequipmentandservices,educationandsupport,andlifelongpatientfollow-upthroughtheCancerRegistry,patientsareabletoaccessafullmenuoftherapiesandtreatmentoptions.Additionaloutreachincludeseducationandsupportgroupsforcancerpatients:Art,Self-guidedArtTherapy,Lymphedema,BrestCancer,OncologyNutritionTherapy,StressRelief,LookGoodFeelBetter,Yoga,Meditation,andHealthyEatingAdvices.

Education

Secondary Data Educationreceivedatopicscoreof1.56inthesecondarydatascoringforHarrisCountyand1.88forLibertyCounty.InLibertyCounty,indicatorsofconcerninclude:People25+withaBachelor’sDegreeorHigher,People25+withaHighSchoolDegreeorHigherandInfantsBorntoMotherswithLessthan12YearsEducation.Thereareseveraleducation-relatedindicatorstoconsiderinHarrisCounty:InfantsBorntoMotherswithLessThan12YearsofEducation(withavalueof27.5%inHarrisCounty,comparedto21.3%inTexasand15.9%intheU.S.),Student-to-TeacherRatio,HighSchoolDropOutRate,andPeople25+withaHighSchoolDegreeorHigher.

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Primary Data Duringkeyinformantinterviews,thetopicofEducationcameupfrequentlyandinrelationtodifferentfocusareasandtargetaudiences,includingchildren,generalcommunitymembersaswellasproviders.Thelinkbetweenindividuals’levelofeducationandqualityoflifewasemphasized.Keyinformantsrecommendedfindingopportunitiestoexpandtheavailabilityofeducation(relatedtohealthandnon-healthtopics)aswellasintegratinghealtheducationintoexistingactivitiesinbothclinicalandnon-clinicalsettings,suchasschoolsandchurches.Opportunitieswerealsopointedouttoeducatehealthcareproviders(andprovidecontinuingeducation)onavailablecommunitylinkagesandresourcesandonhowtoinitiateconversationswithpatientsregardingdifferenthealthtopics.“Ithinkitcomesdowntoeducationbecauseprobably75%ofourdiagnoseddiabetesaretype2diabetes,andthatissomethingthatwithproperdiet,properexercise,andeducationthatmanypatientscanovercome,andsowehaveworked,andwecontinuetoprovide(…)thepropereducation.”“Wewanttogointodifferentgroupsandeducatethemonwhattheyshouldbedoingorshouldn’tbedoing.(…)Ithinkeducationisahugecomponentbutwe’vegottofigureouthowtointegratethat.Theeducation,withouttheintegrationintosomebody’slifestyle,doesn’tdothemanygood.”

Efforts MemorialHermannoperatestenHealthCentersforSchools,establishedin1996,offeringaccesstoprimarymedical,dentalandmentalhealthservicestounderservedchildrenat82schoolsintheGreaterHoustonArea.Researchshowsthatschool-basedhealthcentersincreaseeducationalsuccessbyprovidingmedicalandmentalhealthcarethatallowsstudentstostayinschoolandlearn.Theprimarygoaloftheprogramistokeepchildrenhealthyandfeelingwellsothattheystayinschoolandcanperformwellacademically,creatingafoundationforabrighterfuture.Byprovidingimprovedaccesstohealthcaretoat-riskchildrenacrosstheregion,MemorialHermannhasdemonstratedsuccessincreatinghealthieroutcomesforkids,includingimprovementsintheirphysicalhealth,theirmentalwellbeing,andeventheirattendancerateatschool.

Transportation

Secondary Data ForHarris,LibertyandMontgomerycounties,Transportationrosetothetopofthesecondarydatascoringresults,withatopicscoreof1.82inHarrisCounty,2.28inLibertyCountyand1.93inMontgomeryCounty.Inallthreecounties,indicatorsofconcerninclude:SoloDriverswithaLongCommute,MeanTravelTimetoWork,andWorkerswhoWalktoWork.Inadditiontothese,anotherindicatortonoteforLibertyandMontgomerycountiesisWorkerswhoDriveAlonetoWork.Furthermore,thereexisthighdisparitiesforafewoftheseindicators.

Primary Data ParticipantsraisedthetopicofTransportation59timesinrelationtobarriersorchallengestoachievinghealthinthecommunity–morethananyothertopic.KeyinformantsrepeatedlynotedthattheHoustonregionhassignificanttransportationissues(includingavailability,

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accessibility)thatimpactcommunitymembers’abilitytoaccesshealthprogramsandservices.Inadditiontolimitedoptionsforpublictransportation,travelcostandtimewerebroughtup.Moreover,forcertainpopulations,likeolderadultsorpeoplewithdisabilities,publictransportationisnotafeasibleoption.“Thisremarkablespread-outcity,thesizeofMassachusetts,istheGreaterHoustonMetropolitanArea.(…)Thisisnotacityandasuburbanymore,it’sametropolitanregionwitheighttotencentersofactivitythatarelargerthandowntownSanDiego,spreadoutoverthismassivearea,butgettingfromoneplacetoanotherisanincreasingchallenge.Povertyalsomeansinadequatetransportation,wehavenoreallygoodtransitsystembecauseit’salmostimpossibletodevelopagoodtransitsystemforacitysolackingindensityandsospreadoutasHoustonis.Wehaven’tsolvedthatproblem,andalotofthehealthcareissuescomebecausepeople[are]withoutacartryingtogettoahospital,ortohealthcare…”“Houstonisreallyspreadout(…)anditcangofromcitytoruralveryquickly.Thefamiliesintheruralcommunitiesthatreallyarewithina20-mileradiusofthecity,soreallystillwithintheHoustonaddress,Ithinkthattransportationforthemisahugebarrier.That’satoughone,becauseHoustonissobig,anditcangoquicklytorural,veryquickly,andyourzipcodeisstillreflectingHouston.”

Efforts MemorialHermannprovidesbusandtaxitokensasrequiredfordischargeandcontinuityofcareneeds.OneMemorialHermannstrategicefforttonotonlyprovidetherightcareattherighttimeintherightplace,butalsoprovidetheopportunitytoaccesshelp/careviathetelephoneistheMemorialHermannNurseHealthLine.Establishedin2014,theNurseHealthLineisafreetelephoneserviceforGreaterHoustonresidentswhoareexperiencingahealthconcernandareunsureofwhattodoorwheretogo.Experienced,bilingualnursesusetheirtrainingandexpertisetoconductassessmentsbyphone,andareavailabletoanswercalls24hoursaday,sevendayaweekforanyresidentlivinginHarrisorsurroundingcounties.Theyhelpcallersdecidewhenandwheretogoformedicalcareandassistwithsocialservicereferralsandtransportationneeds.

Children’s Health

Secondary Data

Inthesecondarydataresults,Children’sHealthreceivedatopicscoreof1.52inHarrisCountyand1.70inLibertyCounty.Inbothcounties,theChildFoodInsecurityRateisanindicatorofconcern.HarrisCountyhasotherindicatorstonoteincluding:ChildrenwithHealthInsuranceandChildrenwithLowAccesstoaGroceryStore.Closeto10%ofchildreninHarrisCountydonothavehealthinsurance.

Primary Data WhendiscussingChildren’sHealth,keyinformantspointedoutspecificissuessuchaschildhoodobesity,immunization,accesstoservicesandbeinguninsured.Someparticipantsadvisedeffortstoengagechildren,familiesandcommunitiesmorecomprehensively.

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“AlotofpeoplewontgotoaFQHCtogettheirkidimmunizedbecauseit’sahugedoctorvisitthatrequiresalotofpaperworkandtime/effort.”“Texasranksverylowindollarsspentonhealthforchildren.Weranklowinourranking,generally,inchildren’shealth.We’renotputtingenoughmoneyandresourcesintoit.Ithinkweneedtoshiftourattentionand(…)givemoreattentiontochildren’shealthandhowimportantitisforearlychildhooddevelopmentandforbraindevelopmentandongoinghealthintherestoftheirlives.Iwouldsayputthatasapriority.Putchildren’shealthasapriority.Notjustsayingtheearlyyears,notjustsayingzerotofivebutalsothroughoutearlyadolescence,pre-adolescence,earlyadolescenceandintotheteens.”

Efforts Children'sMemorialHermannHospital,licensedunderMemorialHermannTexasMedicalCenter,wasfoundedin1986andistheprimaryteachinghospitalforthepediatricandobstetrics/gynecologyprogramsatTheUniversityofTexasMedicalSchoolatHouston.Children'sMemorialHermannofferscareinmorethanthirtypediatricandwomen'srelatedspecialtiesincludingthelatestadvancesinmaternal-fetalmedicineandneonatalcriticalcareservices,andrenownedprogramsinpediatrictrauma,neurosciences,pulmonologyandcardiaccare.Morethan37,000childrencometoChildren'sMemorialHermannHospitaleachyear.InadditiontoMemorialHermann’sschool-basedhealtheffortsdescribedabove,MemorialHermannisanon-goingfinancialcollaboratorwithChildrenatRisk,a501non-profitorganizationthatdriveschangeforchildrenthroughresearch,education,andinfluencingpublicpolicy.

Economy

Secondary Data

Inthesecondarydatascoringresults,Economyreceivedatopicscoreof1.55inHarrisCountyand1.75inLibertyCounty.HarrisandLibertycountieseachhaveeighteconomicindicatorswithscoresabove2.InHarrisCounty,indicatorsofconcerninclude:Homeownership,SevereHousingProblems,StudentsEligiblefortheFreeLunchProgram,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,SNAPCertifiedStores,MedianHouseholdGrossRent,FamiliesLivingPovertyLevel,andFoodInsecurityRate.InLibertyCounty,concerningindicatorsare:FemalePopulation16+inCivilianLaborForce,Population16+inCivilianLaborForce,UnemployedWorkersinCivilianLaborForce,TotalEmploymentChange,FoodInsecurityRate,ChildFoodInsecurityRate,SevereHousingProblems,andStudentsEligiblefortheFreeLunchProgram.

Primary Data Keyinformantsdiscussedfoodinsecurityandfooddesertsasfactorsrelatedtopoorhealthoutcomes.Theypointedoutthat,althoughindividualsmightunderstandthateatinghealthyfoodsisrecommended,theymaynothaveaccesstogrocerystoresorbeabletoaffordhealthierfoodoptions.Keyinformantsnotedtheimportanceofaddressingsocioeconomicbarrierstoimprovehealthandwellbeing.

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“Ithinkinsomeofthelowerincomeneighborhoods,theoptionsforbuyingfoodarelimitedanddonotofferalotofhealthychoices,andthatalotoftimehealthierfoodcostsmore.Andsotheabilitytoeasilygetandaffordhealthyfood,whetheryou’reeatingathomeoreatingout,arejustmorelimitedforsomepeopleandinsomeneighborhoods…”

Efforts It’sadauntingtaskinaregionlikeGreaterHouston,whichhasanestimated7millionpeopleandoneofthehighestratesofuninsuredandunderinsuredinthecountry.ButMemorialHermannbelievesthatwecanONLYimpactthehealthofourcommunity,andthehealthofindividuals,byfocusingonthemultipledeterminantsofhealththatplaythegreatestroleininfluencingaperson’soverallhealthandwellbeing.

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Other Findings Criticalcomponentsinassessingtheneedsofacommunityareidentifyingbarriersanddisparitiesinhealthcare.Theidentificationofbarriersanddisparitieshelpsinformandfocusstrategiesforaddressingprioritizedhealthneeds.ThefollowingsectionoutlinesbarriersacrossMemorialHermannHealthSystemanddisparitiesastheypertaintoMHNortheast’sservicearea.

Barriers to Care Communityinputrevealedawiderangeofbarrierstocareandwellbeing.Asdiscussedintheprevioussection,transportationwasthemostfrequentlycitedbarrierinthecommunity,followedbyotherbarrierssuchasaccesstohealthservices,healthyfoodandexerciseoptions,lowincome,andfoodinsecurity.Overall,thesecondaryandprimarydataconfirmedthatsocioeconomicfactorsimpactcommunitymembers’abilitytoachievegoodhealth.“Manythingscomebacktopovertyandlackofdisposableincome.”Keyinformantsdescribedtheinfluenceofsocialdeterminantsofhealth(includingincome,poverty,language,education,employment)onhealthoutcomes.Participantsdiscussedtheimportanceofaddressingsocialandeconomicfactorstogetattherootcausesofpoorhealthandwellbeing.“Ithinkyouhavetounderstandthatalotoffolksworkfrompaychecktopaycheck,soiftheyactuallyendupatoneofthesemedicalcentersandtheyrequireathirtydollarcopayortendollarsorfifteendollars,thenthey’renotgoingtohaveit.So,they’regoingtowalkawayuntiltheydohavethatmoneyandthatcouldbemonthslater.So,iftheyaresick,they’rejustgoingtobecomesicker.So,that’soneofthebigbarriers.”

Disparit ies Significantcommunityhealthdisparitiesareassessedinboththeprimaryandsecondarydatacollectionprocesses.Table26identifiesthenumberofsecondarydatahealthindicatorswithahealthdisparityforMHNortheast’sservicearea.SeeAppendixBforthespecificindicatorswithsignificantdisparities.

Table26.NumberofHealthDisparitiesIdentifiedinSecondaryDataAnalysis

HarrisCounty LibertyCounty MontgomeryCountyBlackorAfricanAmerican(13)White(8)HispanicorLatino(8)OtherRace(7)AmericanIndianorAlaskaNative(6)

HispanicorLatino(5) OtherRace(8)BlackorAfricanAmerican(6)HispanicorLatino(6)AmericanIndianorAlaskaNative(3)TwoorMoreRaces(3)

Male(10)Female(3)

Male(4) Male(5)

<6yearsofage(2) 45-54yearsofage(1) <6yearsofage(1)

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GeographicdisparitieswereidentifiedusingtheSocioNeedsIndex.Zipcodes77093,77039,77032,77028,77078,77016(withvaluesgreaterthan95)inHarrisCountywereidentifiedashavingthehighestsocioeconomicneed,potentiallyindicatingpoorerhealthoutcomesforresidentsinthoseareas.ThezipcodeswithlargestproportionofinpatientdischargesatMHNortheast,zipcodes77346and77338,haveSocioNeedsIndexvaluesof11and71.9,respectively.

25-44yearsofage(2)45-64yearsofage(2)65+yearsofage(2)

65+yearsofage(1)

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Conclusion TheCommunityHealthNeedsAssessmentforMHNortheastutilizedacomprehensivesetofsecondarydataindicatorstomeasurethehealthandqualityoflifeneedsforMHNortheast’sservicearea.Furthermore,thisassessmentwasinformedbyinputfromknowledgeableanddiverseindividualsrepresentingthebroadinterestsofthecommunity.MemorialHermann’ssystem-wideprioritizationprocessresultedinfourfocusareasorpillars:AccesstoHealthcare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.MHNortheastwillreviewtheseprioritiesmorecloselyduringtheImplementationStrategydevelopmentprocessanddesignaplanforaddressingthesepillarsmovingforward.Inaddition,MHNortheastinvitesyourfeedbackonthisCHNAreporttohelpinformthenextCommunityHealthNeedsAssessmentprocess.Ifyouhaveanyfeedbackorremarks,pleasesendthemto:[email protected].

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Appendix

Appendix A: Evaluation Since Prior CHNA

Appendix B. Secondary Data Methodology

Secondary Data Sources

Secondary Data Scoring

Data Scoring Results

Appendix C. Primary Data Methodology

Community Input Participants

Key Informant Interview Questionnaire (Episcopal Health Foundation)

Key Informant Interview Questionnaire (Conduent Healthy Communities Institute)

Community Survey (English)

Community Survey (Spanish)

Appendix D. Priorit ization Tool

Priorit ization Survey

Appendix E. Community Resources

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AppendixA.MHNortheastImpactReport

EvaluationSincePriorCHNAPriority1:HealthyLiving

Priority1: HealthyLiving

Goal1: Preventavoidableinjuryandpreventand/ormanagechronicdiseasestoensureoptimalhealthandsafetyforcommunityresidents.

EarlyDetectionandScreeningObjective1.1:Facilitateearlyidentificationof,andinterventionfor,keyhealthconditionstodecreasemortalityfromtheseconditionsOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofcontactsforscreeningshealthfairs 9,77525contacts

11,650attendees10,765

10,200

• Numberofcancerscreeningevents 2 3 3 3• Numberofschoolsaspartners 15 22 22 15• Numberofstudentsperyearexamined 4,500 6080 11,331 4,725

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.1.1: ConductathleticphysicalsinpublicschoolsinMSandHS(fullphysicalsandEKG);partner

withschoolstoprovideaconcussiontrainedPCPorEDphysicianonsiteatHSgames(See1.4.1)

1,2,3

1.1.2: Hostfreehealthscreenings(1screening/quarterforcommunity)tocover:prostate/skincancer,cholesterol,BP,bloodglucose(See1.2.2)

1,2,3

1.1.3: Facilitateemployerhealthfairs(31/year):provideresourcesforancillaryservicesandprevention,directaccesstoscheduleappointmentsforabnormalscreenings(See1.2.4,strategiesofObjective1.5)

1,2,3

1.1.4: Conducteducationandoutreach“LunchandLearns”byproviderstoseniorgroup,employers,andcommunityontopicsre:nutrition/weightmanagement,strokesupport,cancersupport,etc.(2/mon,24peryear)

1,2,3

1.1.5: ConductBMIscreeningandbodyfatpercentage.(see1.1.3) 1,2,3

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Priority1: HealthyLiving

Goal1: Preventavoidableinjuryandpreventand/ormanagechronicdiseasestoensureoptimalhealthandsafetyforcommunityresidents.

Monitoring/EvaluationApproach:• AthleticPhysicals–Keepalogofnumbersforeachschoolevent• HealthScreenings–Tracknumberofparticipantsregistered• HealthFairs–Documentnumberofgiveawaysgiventoparticipants• LunchandLearns–Keepalogofnumberofparticipantsateachevent

PotentialPartners:• Schooldistricts• Employers• PhysiciansandMid-levelproviders• Staff• FreeStandingEDsandUrgentCares• LakeHoustonArea,KingwoodandEastMontgomeryCountyChambersofCommerce• Media

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ObesityPreventionObjective1.2:Decreaseobesityforallagesasmeasuredbybodyfatpercentageand/orBMIOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofattendeesatlunchandlearn 40 1,235 Xreferenceto1.1.4 45• Numberoflunchandlearnsessions 2 3 Xreferemcetp1.1.4 3• Participationnumberinwellnesscenter 440 762 186 475• Numberofcontactsforscreeningshealthfairs 4,750 11,650 10,765 4,980

Strategies:Year1Notes

Year2Notes Timeline:

Year1,2,31.2.1: Facilitatelunchandlearnsessionswithendocrinologistsforemployersandseniorson

nutritionandweightmanagement(see1.1.4) 1,2,3

1.2.2: Hosthealthscreenings(1screening/quarterforcommunity)tocover:prostate/skincancer,cholesterol,BP,bloodglucose(see1.1.2)

1,2,3

1.2.3: Providesubsidizedhealthandwellnessservicestocommunityaton-siteWellnessCenter(SeniorBalance,yoga,Zumba,etc.)

1,2,3

1.2.4: Hostemployerhealthfairsandprovidescreeningsforbodyfatpercentageand/orBMI 1,2,3 Monitoring/EvaluationApproach:

• LunchandLearns–Keeplogofnumberofattendeesateachfunction• HealthScreenings–Tracknumberofparticipantsregistered• HealthFairs–Documentnumberofgiveawaysgiventoparticipants

PotentialPartners:• Schooldistricts• Employers• PhysiciansandMid-levelproviders• Staff• FreeStandingEDsandUrgentCares• ChamberofCommerce• Media

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AccesstoHealthyFoodObjective1.3:Supportaccesstohealthyfood,especiallyforthosemostinneedOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• NumberofERpatientsscreenedforfoodinsecurityviatheERNavigationprogram

1,786 2208 2528 1,786

• NumberofCHWreferralstocommunityfoodpantriesviatheERNavigationprogram

283 368 715 283

• NumberofERNavigationsupportedcommunityeventshostedbylocalpartners 2

28 4

• Numberofpoundsoffoodraisedinfooddrive 18,000lbs. 7400 20,873 19,000

• Numberoffamiliesinneedimpacted 725HAAMdispersesthe

foodHAAMdispersesthe

food 760

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.3.1: ContinuetoparticipateintheMHERNavigationprograminwhichparticipantsare

screenedforfoodinsecurityandreferredtofoodpantriesifnecessary.(See2.4.2) 1,2,3

1.3.2: Collectfoodtosupportfoodpantriesorspecialeventshostedbycommunitypartners(Conductbiannualfooddrivewithsisteragency–HAAMdispersesthroughFoodBank)

1,2,3

Monitoring/EvaluationApproach:• FoodDrives–Keeplogofpoundsweighed• PatientactivitydocumentedandreportedwithintheERNavigationelectronicrecordsystem

PotentialPartners:• HAAM• Media• Schooldistricts• Staff• FamilyTime• MemorialHermannCommunityBenefitCorporation

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Timefor/SafetyDuringPhysicalActivityObjective1.4: IncreasethenumberofcommunitymembersinformedaboutstrategiesformakingtimeforandensuringsafetyduringphysicalactivityOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofpresentations 3 19 2 4• Numberofattendeesatpresentations 120 2000 1200 126• Numberofhealthfairs(propermechanicsandexercise

demonstrations)4 1 5 5

• Numberofattendeesathealthfairs 2,500 800 3,250 2,625

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.4.1: ProvideliaisontoworkwithAthleticTrainersateachschoolandprovidehotlinebackto

ourphysiciantoaddressissuesofhydration,stretching,etc.Provideathleticphysicalsfortheseschools.(see1.1.1)

1,2,3

1.4.2: AddressissuesofhydrationandbodymechanicsviaEmployerFairs(see1.1.3) 1,2,31.4.3: Conductseniorfairsaddressingseasonally-relevanttopicssuchassunburn,mosquito

bites 1,2,3

1.4.4: DiscusswaystoincludeworkoutactivitiesthroughouttheworkdayatphysicianfacilitatedEmployerLunchandLearns(see1.1.4)

1,2,3

Monitoring/EvaluationApproach:• HealthFairs–Documentnumberofgiveawaysgiventoparticipants• LunchandLearns–Keeplogofnumberofattendeesateachfunction

PotentialPartners:• UniversityofHoustonSchoolofPharmacy• MHHSathletictrainerteam• ChambersofCommerce• Media• PhysiciansandMid-levelProviders• Staff• Employers• CommunitySeniors

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ChronicDiseaseManagementObjective1.5:Increasethenumberofpatientswhoaremaintainingtheircurrenthealthstatusthroughcompliancewithrecommendedand/or

prescribedregimensforchronicdiseasemanagementOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofhealth/employerfairs 18 25 20 19• Numberofattendeesathealth/employerfairs 9,775 11,650 Xrefto1.1.3 10,200• Numberofpresentations 9 8 1 10• Numberofattendeesatpresentations 610 36 35 640• Numberofstrokesupportmeetings 5 6 4 6• Numberofattendeesatstrokesupportmeetings 62 36 15 65• Numberofbreastcancersupportmeetings 5 12 11 6• Numberofattendeesatbreastcancersupportmeetings 52 147 139 55

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.5.1: Providenutritionistsanddieticiansathealthfairsandemployerfairstodiscussspecific

plansforthosewithdiabetesandprovideinformationonchronicpainmanagement(see1.1.3)

1,2,3

1.5.2: Providecarotidarteryscreening(preventionandmanagement)(see1.1.3) 1,2,31.5.3: Conductbonedensityscreening(see1.1.3) 1,2,31.5.4: ConductBMIscreeningandbodyfatpercentage(see1.1.3) 1,2,31.5.5: ConductABIscreeningsforarterydisease(see1.1.3 1,2,31.5.6: Conductpresentationsforsleepdisorders,diabetes,heartconditions(see1.1.4) 1,2,31.5.7: ConductaStrokeSupportGroup 1,2,31.5.8: ConductEKGscreeningsatcommunityandemployerhealthfairs(see1.1.3) 1,2,31.5.9: ConductaBreastCancerSupportGroup. 1,2,3

Monitoring/EvaluationApproach:• HealthFairs–Documentnumberofgiveawaysgiventoparticipants• Presentations–Keeplogofnumberofattendeesateachfunction• Screenings–Keeplogofnumberofattendeesateachfunction• SupportGroups–Loginsheets

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Priority1: HealthyLiving

Goal1: Preventavoidableinjuryandpreventand/ormanagechronicdiseasestoensureoptimalhealthandsafetyforcommunityresidents.

PotentialPartners:• Physicianpractices• Staff• Employers• Media• Communitymembers• ChambersofCommerce

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Priority2:AccesstoHealthCare

Priority2: HealthCareAccess

Goal2: Ensureallpatientshaveaccesstoappropriatecareatthetimeandplacetheyneedit,regardlessofabilitytopay.

AvailabilityofPrimaryCareandSpecialtyProvidersObjective2.1: Connectpatientstoappropriatemedicalhomes,careandbenefits,andreduceinappropriateERuse

OutcomeIndicators:AnnualBaseline Year1 Year2 FY2020

Target• NumberofpatientsenrolledintheERNavigationProgram 1,930 2162 2,479 1,930• NumberofERNavigationpatientencounters 4,532 5712 6,936 4,532• NumberofERNavigationreferralstocommunityresources 4,864 4890 5,481 4,864• NumberofERNavigationscheduledappointments 204 259 246 204• Numberofappointmentsattempted 511 488 242 511• Numberofphysiciansrecruitedannually 9 5 7 10

• Numberofreferralsandcompletedappointmentsmadebyhealthfairs(quarterly)

47

488referralsbasedonnumber

attempted/completedappointmentswere

nottracked

49 50

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,32.1.1: ContinuetoparticipateintheMHERNavigationprograminwhichpatientsarereferredtoamedical

home(See2.4.2)ERnavigatorworkswithERunfundedpatients,facilitatesaccesstocountyclinics,assistswithgoldcard,etc.

1,2,3

2.1.2: RecruitspecialiststhruUT,existingcommunitypractices,MHMedicalGroup,andMNA(MischerNeuroscienceAssociates)toensureadequateemergencycare,acutecareandqualitypostacutecare.

1,2,3

2.1.3: ProvideaPCPCoordinatortoidentifypatientswhodonothaveaPCP,regardlessofabilitytopay;providefactsheets;makefollowupappointmentsforthemwhilestillinpatient;alsorefertoneighborhoodhealthcenterifappropriate.

1,2,3

Monitoring/EvaluationApproach:• DatafromMemorialHermannMedicalGrouponHealthFairs• PatientactivitydocumentedandreportedwithintheERNavigationelectronicrecordsystem

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Priority2: HealthCareAccess

Goal2: Ensureallpatientshaveaccesstoappropriatecareatthetimeandplacetheyneedit,regardlessofabilitytopay.

PotentialPartners:• UniversityofTexas(UT)Physicians• MemorialHermannMedicalGroup• MischerNeurosciencesAssociates• AlignedMHMDPhysicianPractices• MHHS• NeighborhoodHealthCenterNortheast• MemorialHermannCommunityBenefitCorporation

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HealthInsuranceCoverageandCostsObjective2.2: HelppatientsapplyforandsecurecoveragetoaccessappropriatecareOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• NumberofClassDPrescriptionsprovidedtotheNimitzandBurbankSchoolBasedHealthCenters

235 252 628 235

• %ofpatientsscreened,%patientswhocompliedwithapplicationprocess,%patientswhoqualifiedforassistance

92%ofuninsuredscreened84%compliedwithapplication

process84%qualifiedforassistance

PatientsscreenedIP–99%Ou-95%

85%patientscompliedwith

applicationprocess93%patientswho

qualifiedforassistance

Patientsscreened99%IP97%OU

75%compliedwithapplicationprocess,80%qualifiedforassistance

95%ofuninsuredscreened

84%compliedwithapplication

process84%qualifiedfor

assistance

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,32.2.1: ProvideClassDPrescriptionstotheNimitzandBurbankSchoolBasedHealthCentersinsupport

ofprimarymedicalcareprovidedtouninsuredchildrenandteensatnocost

1,2,3

2.2.2: Continuetoscreenpatientsandadviseongovernmentalprogramsforcoverage;stateemployeesreceivebenefitsonsite

1,2,3

2.2.3: ContinuecooperativeagreementwithNortheastHospitalFoundationtoenabletheuninsuredtoaccessscreeningmammographiesandtreatmentasappropriate

1,2,3

Monitoring/EvaluationApproach:• Track%ofpatientsscreenedthroughreportingtool

PotentialPartners:• Third-Partyeligibilityvendors• NortheastHospitalFoundation• MemorialHermannCommunityBenefitCorporation

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TransportationObjective2.3: FacilitatetransportationhomeupondischargeforpatientsinneedOutcomeIndicators:

AnnualBaseline Year1 Year2 FY2020Target

• Numberoftaxivouchers 238 282 238 238

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,32.3.1: Providecabvouchersfortransportbackhomeafterdischarge 1,2,3

Monitoring/EvaluationApproach:• Trackinlogbook

PotentialPartners:• Cabcompanies

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HealthCareNavigationObjective2.4: Assistpatientswitheffectiveutilizationof,andself-directionon,resourcestomeettheirhealthcareneedsOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofhospital'sassociatedcounties'callstoNurseHealthLine(Harris,Liberty,andMontgomeryCounties)

30,323 30,226 31,459 30,323

• NumberoftouchesinER(navigation) 4,532 2162 2479 4,532• Numberoftouches(oncology) 600 500 1111 630• NumberofpatientsassistedinaccessingPatientPortal 1,192 2860 2447 1,192• NumberofPCPreferrals 511 2162 2479 511• Numberofreferralstocommunityresources 4,864 4890 5,481 4,864

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,32.4.1: Providea24/7freeresourceviatheNurseHealthLinethatcommunitymembers(uninsuredand

insured)withintheMHHScommunitycancalltodiscusstheirhealthconcerns,receiverecommendationsontheappropriatesettingforcare,andgetconnectedtoappropriateresources

1,2,3

2.4.2: ContinuetoparticipateintheMHERNavigationprograminwhichpatientsarereferredtoamedicalhome(See1.3.1)

1,2,3

2.4.3: Providenursenavigatorforoncologypatients 1,2,32.4.4: Providemedicalsocialworkerforallpatientstohelpthemconnectwithappropriatecare

settingspostdischarge 1,2,3

2.4.7: Providelocalstafftohelppatientslinktothepatientportalandlearnhowtoaccess/useitontheirsmartdevicessotheycanconnectupondischarge

1,2,3

Monitoring/EvaluationApproach:• TrackpatientsvisitedbyPCPCoordinator• PatientactivitydocumentedandreportedwithintheERNavigationelectronicrecordsystem

PotentialPartners:• NeighborhoodHealthCenterNortheast• MemorialHermannCommunityBenefitCorporation

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Priority3:BehavioralHealthThefollowingtablesprovidestrategiesandoutcomeindicatorsthatreflectanMHHSsystem-wideapproachtoBehavioralHealth.DataisnotspecifictoMHNortheastHospitalbuttothecommunityatlargewiththeexceptionofreductioninERencountersthatresultinapsychiatricinpatientstaythroughlinkageswithanetworkofbehavioralpartners.

Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

Objective3.1: Createnontraditionalaccesspointsaroundthecommunity(crisis/ambulatory,acutecare,andcommunity-basedchroniccaremanagement),andlinkthosewhoneedservicestopermanentprovidersandresourcesinthecommunity

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• DecreaseinnumberofERencountersthatresultinpsychiatricinpatient

stay1,146 1,213 1,135 1,089

5%reductionofbaseline

• DecreaseinnumberofERencountersthatresultinpsychiatricinpatientstay–Northeast

108 134 131 103

• NumberofMemorialHermannCrisisClinictotalvisits 5,400 5,590 5,154 5%overbaseline

• NumberofPsychiatricResponseCareManagementtotalvisits 1,200 1,103 1,259 5%overbaseline

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,33.1.1: Providementalhealthassessment,care,andlinkagetoservicesinanacutecaresetting,24x7

atNortheast.Anuptickinacutecarevolumeoverthepastfiscalyearhascontributedtoahighernumberofpsychiatrictransfersoverall.

Anincreaseinacutecarevolumeandnumberofacutecaresitesoverthepastfiscalyearhavecontributedtoahighernumberof

psychiatrictransfersoverall.

1,2,3

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Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

3.1.2: Createnontraditionalcommunityaccesstopsychiatricprovidersforindividualsexperiencingamentalhealthcrisis.ClinicalSocialWorkersconnectthetargetpopulationtoon-goingbehavioralhealthcare

Recruitingmentalhealthproviders

willingtocommittoanon-traditionalscheduleremainsachallenge.Continuingthisurgentcaremodeloftreatmentremainsapriority,duetolimitedmentalhealth

treatmentaccessinthecommunity.

1,2,3

3.1.3: Engageindividualswithachronicmentalillnessandworktomaintainengagementwithtreatmentandstabilityinthecommunityviaenrollmentincommunity-basedmentalhealthcasemanagementprogram

Staffingissuesimpededyearonetarget.Identifyingappropriatelylicensedclinicianswillingtoconsideracareerthatiscommunity-basedwiththerequirementofmakinghomevisitsandworkingnon–traditionalhoursisanongoingchallenge.

CaseManagerspartnerwiththeirclientstoidentifyspecificrecoverygoalsandutilizeevidence-basedpracticesto

facilitateclientachievement.Wecontinuetopartnerwithcommunity

providerstoaddressthementalhealth

needsoftheGreaterHoustonCommunity.

1,2,3

Monitoring/EvaluationApproach:• EMR/registrationsystem(trackandtrenddaily,weekly,monthly)

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Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

PotentialPartners:• Systemacutecarecampuses• MHMG• Networkofpublicandprivateproviders

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Objective3.2: Reducestigmainordertopromotementalwellnessandimprovecommunityawarenessthatmentalhealthispartofphysicalhealthandoverallwell-being

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• Numberofpresentations/educationalsessionsforhealthcareprofessionals

withinMHHS50sessionsperyear 63 71 5%increase

overbaseline• Numberofpresentations/educationalsessionsforcorporations 5 7 8 5%over

baseline• NEManagementandcommunicationwithdisruptivepatients 1training(4hours)

offeredtwotimesperyear

0 0

1training(4hours)offeredtwotimesper

year• TrainingonAcuteCareConcepts-systemnurseresidentprogram

15trainings(45hourstotal/3hourseach)*

18 9

15trainings(45hours

total/3hourseach)*

• TrainingonCMORoundtable-system-wide 1training(2hours)* 0 4 1training(2hours)*

*Totaltimeincludestrainingmaterialdevelopmentandimplementation 531.6

Strategies: Year1Notes Year2Notes Timeline:Year1,2,3

3.2.1: ProvidementalhealtheducationsessionswithintheMHhealthsystemfornursesandphysicians

1,2,3

3.2.2: WorkwithemployersolutionsgrouptoprovideeducationandtrainingwithcorporationsonMHtopics(stress,PTSD)

1,2,3

Monitoring/EvaluationApproach:Requestsforpresentationsandsessionstrackedviacalendar/excel

PotentialPartners:• Systemacutecarecampuses• SystemMarketingandCommunications• Employersolutionsgroup

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Objective3.3: Qualityofmentalhealthandsubstanceabuseservices:access,link,andpracticeutilizingevidence-basedpracticetopromoteoverallwellness

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• NumberofMemorialHermannCrisisClinicfollow-upspostdischargewith

clinicpatients7,716 6,431 5,154 5%overbaseline

• PsychiatricResponseCaseManagementreductioninsystemERutilization 54.4% 53.0% 50% 5%increaseoverbaseline

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,33.3.1: Socialworkersfollow-upwithdischargedpatientsandtheirfamiliestoassesswell-being

andconnectthemtocommunityresourcesThegoalistocontinuetoeducatethecommunity,includingotherhealthsystems,aboutthecrisiscliniclevelofcaresothatwhensomeoneisexperiencingamentalhealthcrisisorneedsimmediateaccesstoabehavioralhealthprovider,theclinicwillbetheidentifiedreferralsource.

TheSystemhasseenanoverallincreaseinpatientacuitywithcomplexphysicalandbehavioralhealthneedsrequiringhigherlevelsofcare.TheCrisisClinicandPsychResponseCaseManagementProgramscontinuetomeettheneedsofpatientswithbehavioralhealthconditionsbyprovidingimmediateaccesstoamentalhealthprovider.

1,2,3

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Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

3.3.2: PsychiatricResponseCaseManagementProgramutilizesevidence-basedpracticeinterventions(motivationalinterviewing,MHFirstAid,CAMS,etc.)toreduceERutilizationforprogramenrollees

CaseManagerscontinuetopartnerwithcommunity

agenciesinanefforttoconnectprogram

enrolleestoresourcesfor

ongoingwellness.Programclinicianscontinuetouseevidence-based

practiceinterventionsto

reduceERutilizationandimprovequality

oflife.

1,2,3

Monitoring/EvaluationApproach:• Socialworklogs(Excelspreadsheet)

PotentialPartners:• Systemacutecarecampuses• Community-basedclinicalproviders• Networkofpublicandprivateproviders

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AppendixB.SecondaryDataMethodology

SecondaryDataSourcesThemainsourceforthesecondarydata,ordatathathavebeenpreviouslycollected,isthecommunityindicatordatabasemaintainedbyConduentHealthyCommunitiesInstitute.ThefollowingisalistofbothlocalandnationalsourcesusedinMemorialHermannNortheast’sCommunityHealthNeedsAssessment.

HarrisCounty1. AmericanCommunitySurvey2. AmericanLungAssociation3. CentersforMedicare&MedicaidServices4. CountyHealthRankings5. FeedingAmerica6. InstituteforHealthMetricsandEvaluation7. NationalCancerInstitute8. NationalCenterforEducationStatistics9. SmallAreaHealthInsuranceEstimates10. TexasBehavioralRiskFactorSurveillanceSystem11. TexasDepartmentofFamilyandProtectiveServices12. TexasDepartmentofStateHealthServices13. TexasEducationAgency14. TexasSecretaryofState15. U.S.BureauofLaborStatistics16. U.S.Census-CountyBusinessPatterns17. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas18. U.S.EnvironmentalProtectionAgency

LibertyCounty1. AmericanCommunitySurvey2. CentersforMedicare&MedicaidServices3. CountyHealthRankings4. FeedingAmerica5. InstituteforHealthMetricsandEvaluation6. NationalCancerInstitute7. NationalCenterforEducationStatistics8. SmallAreaHealthInsuranceEstimates9. TexasDepartmentofFamilyandProtectiveServices10. TexasDepartmentofStateHealthServices11. TexasEducationAgency12. TexasSecretaryofState13. U.S.BureauofLaborStatistics14. U.S.Census-CountyBusinessPatterns

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15. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas16. U.S.EnvironmentalProtectionAgency

MontgomeryCounty1. AmericanCommunitySurvey2. AmericanLungAssociation3. CentersforMedicare&MedicaidServices4. CountyHealthRankings5. FeedingAmerica6. InstituteforHealthMetricsandEvaluation7. NationalCancerInstitute8. NationalCenterforEducationStatistics9. SmallAreaHealthInsuranceEstimates10. TexasDepartmentofFamilyandProtectiveServices11. TexasDepartmentofStateHealthServices12. TexasEducationAgency13. TexasSecretaryofState14. U.S.BureauofLaborStatistics15. U.S.Census-CountyBusinessPatterns16. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas17. U.S.EnvironmentalProtectionAgency

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SecondaryDataScoring

Datascoringisdoneinthreestages:

Foreachindicator,eachcountyinMemorialHermannNortheast’sserviceareaisassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.

Indicatorsarecategorizedintotopicareasandeachtopicareareceivesascore.Indicatorsmaybecategorizedinmorethanonetopicarea.Topicscoresaredeterminedbythecomparisonsofallindicatorswithinthetopic.

ComparisontoaDistributionofCountyValues:WithinStateandNation

Foreaseofinterpretationandanalysis,indicatordataontheCommunityDashboardisvisuallyrepresentedasagreen-yellow-redgaugeshowinghowthecommunityisfaringagainstadistributionofcountiesinthestateortheUnitedStates.Adistributioniscreatedbytakingallcountyvalueswithinthestateornation,orderingthemfromlowtohigh,anddividingthemintothreegroups(green,yellow,red)basedontheirorder.Indicatorswiththepoorestcomparisons(“inthered”)scoredhigh,whereasindicatorswithgoodcomparisons(“inthegreen”)scoredlow.

Comparisons • Quantitatively

score all possible comparisons

Indicators • Summarize

comparison scores for each indicator

Topics • Summarize

indicator scores by topic area

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ComparisontoValues:State,National,andTargets

Eachcountyiscomparedtothestatevalue,thenationalvalue,andtargetvalues.Targetvaluesincludethenation-wideHealthyPeople2020(HP2020)goals.HealthyPeople2020goalsarenationalobjectivesforimprovingthehealthofthenationsetbytheDepartmentofHealthandHumanServices’(DHHS)HealthyPeopleInitiative.Forallvaluecomparisons,thescoringdependsonwhetherthecountyvalueisbetterorworsethanthecomparisonvalue,aswellashowclosethecountyvalueistothetargetvalue.

TrendOverTime

TheMann-Kendallstatisticaltestfortrendwasusedtoassesswhetherthecountyvalueisincreasingovertimeordecreasingovertime,andwhetherthetrendisstatisticallysignificant.Thetrendcomparisonusesthefourmostrecentcomparablevaluesforthecounty,andstatisticalsignificanceisdeterminedatthe90%confidencelevel.Foreachindicatorwithvaluesavailableforfourtimeperiods,scoringwasdeterminedbydirectionofthetrendandstatisticalsignificance.

MissingValues

Indicatorscoresarecalculatedusingthecomparisonscores,availabilityofwhichdependsonthedatasource.Ifthecomparisontypeispossibleforanadequateproportionofindicatorsonthecommunitydashboard,itwillbeincludedintheindicatorscore.Afterexclusionofcomparisontypeswithinadequateavailability,allmissingcomparisonsaresubstitutedwithaneutralscoreforthepurposesofcalculatingtheindicator’sweightedaverage.Wheninformationisunknownduetolackofcomparabledata,theneutralvalueassumesthatthemissingcomparisonscoreisneithergoodnorbad.

IndicatorScoring

Indicatorscoresarecalculatedasaweightedaverageofallincludedcomparisonscores.Ifnoneoftheincludedcomparisontypesarepossibleforanindicator,noscoreiscalculatedandtheindicatorisexcludedfromthedatascoringresults.

TopicScoring

Indicatorscoresareaveragedbytopicareatocalculatetopicscores.Eachindicatormaybeincludedinuptothreetopicareasifappropriate.Resultingscoresrangefrom0-3,whereahigherscoreindicatesagreaterlevelofneedasevidencedbythedata.Atopicscoreisonlycalculatedifitincludesatleastthreeindicators.

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DataScoringResults Thefollowing tableslisteachindicatorbytopicareaforeachofthecountiesinMemorialHermannNortheast’sservicearea.SecondarydataforthisreportareuptodateasofNovember2,2018.

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HarrisCounty

SCORE ACCESSTOHEALTHSERVICES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.00AdultsUnabletoAffordtoSeeaDoctor percent 22.1 18.3 12.1 2015 10

1.81 ChildrenwithHealthInsurance percent 89.4 100 90.3 2016 9

1.75AdultswithHealthInsurance:18-64 percent 74.7 100 77.4 2016 9

1.75 PersonswithHealthInsurance percent 79.3 100 81.4 2016 9

1.61 PrimaryCareProviderRateproviders/100,000

population 57.2 59.9 75.5 2015 4

1.44 MentalHealthProviderRateproviders/100,000

population 103.7 98.8 214.3 2017 4

1.00Non-PhysicianPrimaryCareProviderRate

providers/100,000population 72.2 66.8 81.2 2017 4

0.50 DentistRatedentists/100,000

population 66.3 55.9 67.4 2016 4

SCORE CANCER UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.53 CervicalCancerIncidenceRatecases/100,000

females 11 7.3 9.2 7.5 2011-2015

7

2.25Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7

1.94 Cancer:MedicarePopulation percent 7.6 7.1 7.8 2015 3

1.58ColonCancerScreening:SigmoidoscopyorColonoscopy percent 57.6 62.3 2016 10

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7

1.39 BreastCancerIncidenceRatecases/100,000

females 113.2 111.7 124.7 2011-2015 7

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1.33 ProstateCancerIncidenceRatecases/100,000

males 102.5 95.4 109 2011-2015 7

1.22Age-AdjustedDeathRateduetoColorectalCancer

deaths/100,000population 14.6 14.5 14.4 14.5 2011-2015 7

1.00 AllCancerIncidenceRatecases/100,000population 402.6 401.3 441.2 2011-2015 7

0.94Age-AdjustedDeathRateduetoCancer

deaths/100,000population 157.8 161.4 156.4 163.5 2011-2015 Black,Male 7

0.94 ColorectalCancerIncidenceRatecases/100,000population 38.8 39.9 38.1 39.2 2011-2015 7

0.89OralCavityandPharynxCancerIncidenceRate

cases/100,000population 10.9 10.9 11.6 2011-2015 7

0.50LungandBronchusCancerIncidenceRate

cases/100,000population 50.9 53.1 60.2 2011-2015 7

0.33Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 37.5 45.5 39 43.4 2011-2015 7

SCORE CHILDREN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.81 ChildrenwithHealthInsurance percent 89.4 100 90.3 2016 9

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016 5

1.50ChildrenwithLowAccesstoaGroceryStore percent 5.4 2015 17

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.4 8.5 2017 11

SCORE DIABETES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.67 Diabetes:MedicarePopulation percent 28.1 28.2 26.5 2015

3

1.44 AdultswithDiabetes percent 10.2 11.2 10.5 2016

10

0.92Age-AdjustedDeathRateduetoDiabetes

deaths/100,000population 20.2 21.7 21.2 2010-2014

Black,Hispanic,Male 12

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SCORE ECONOMY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.44 Homeownership percent 49.6 55 55.9 2012-2016 1

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014 4

2.22StudentsEligiblefortheFreeLunchProgram percent 58.2 52.9 42.6 2015-2016 8

2.14MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 534 467 462 2012-2016 1

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016

17

2.08 MedianHouseholdGrossRent dollars 937 911 949 2012-2016

1

2.06FamiliesLivingBelowPovertyLevel percent 14.4 13 11 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other 1

2.06 FoodInsecurityRate percent 16.6 15.4 12.9 2016 5

1.94UnemployedWorkersinCivilianLaborForce percent 4.4 4 4.1 July2018 15

1.89People65+LivingBelowPovertyLevel percent 11.3 10.8 9.3 2012-2016

Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1

1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016

5

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other,<6 1

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1.67 PeopleLivingBelowPovertyLevel percent 17.4 16.7 15.1 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24 1

1.67 TotalEmploymentChange percent 2.4 3.2 2.5 2014-2015 16

1.50RentersSpending30%orMoreofHouseholdIncomeonRent percent 46.8 48 47.3 2012-2016 1

1.42PersonswithDisabilityLivinginPoverty(5-year) percent 25.4 25.1 27.6 2012-2016 1

1.33Low-IncomeandLowAccesstoaGroceryStore percent 6.3 2015 17

1.33PeopleLiving200%AbovePovertyLevel percent 61.6 62.8 66.4 2012-2016 1

1.08 MedianHousingUnitValue dollars 145600 142700 184700 2012-2016 1

0.97PersonswithDisabilityLivinginPoverty percent 22.9 24.2 26.6 2016 1

0.94FemalePopulation16+inCivilianLaborForce percent 59.8 57.7 58.3 2012-2016 1

0.94Population16+inCivilianLaborForce percent 68.3 64.2 63.1 2012-2016 1

0.89HouseholdswithCashPublicAssistanceIncome percent 1.5 1.6 2.7 2012-2016 1

0.67 HomeownerVacancyRate percent 1.5 1.6 1.8 2012-2016 1

0.50 MedianHouseholdIncome dollars 55584 54727 55322 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other 1

0.50 PerCapitaIncome dollars 29850 27828 29829 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican, 1

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HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Other,Two

orMoreRaces

SCORE EDUCATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.92InfantsBorntoMotherswith<12YearsEducation percent 27.5 21.6 15.9 2013

12

1.89 Student-to-TeacherRatio students/teacher 16.4 15.4 17.7 2015-2016

8

1.67 HighSchoolDropOutRate percent 2.6 2 2016

13

1.67People25+withaHighSchoolDegreeorHigher percent 80.2 82.3 87 2012-2016

Male,35-44,45-64,65+ 1

0.67People25+withaBachelor'sDegreeorHigher percent 30.1 28.1 30.3 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1

SCORE ENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014 4

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016 17

1.75 AnnualOzoneAirQuality grade F 2014-2016 2

1.69 AnnualParticlePollution grade C 2014-2016 2

1.67 FastFoodRestaurantDensityrestaurants/1,000

population 0.7 2014 17

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1.61RecognizedCarcinogensReleasedintoAir pounds 1962916 2017 18

1.50ChildrenwithLowAccesstoaGroceryStore percent 5.4 2015 17

1.50 FarmersMarketDensitymarkets/1,000population 0 2016 17

1.50 GroceryStoreDensitystores/1,000population 0.2 2014 17

1.33Low-IncomeandLowAccesstoaGroceryStore percent 6.3 2015 17

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 17

1.25 DrinkingWaterViolations percent 1.7 6.6 FY2013-14 4

1.17 PBTReleased pounds 210516 2017 18

1.00 FoodEnvironmentIndex 7.2 6 7.7 2018 4

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015 17

1.00People65+withLowAccesstoaGroceryStore percent 1.4 2015 17

0.89 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015 16

0.67 AccesstoExerciseOpportunities percent 90.4 80.6 83.1 2018 4

0.17 HousesBuiltPriorto1950 percent 6.2 7.4 18.2 2012-2016 1

SCORE EXERCISE,NUTRITION,&WEIGHT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016 17

2.06 FoodInsecurityRate percent 16.6 15.4 12.9 2016 5

1.67 Adults(18+Years)WhoAreObese percent 32 30.5 33.6 29.9 2016 10

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1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016 5

1.67 FastFoodRestaurantDensityrestaurants/1,000

population 0.7 2014 17

1.50AdultswhoareOverweightorObese percent 66.7 68.4 65.2 2016 10

1.50ChildrenwithLowAccesstoaGroceryStore percent 5.4 2015 17

1.50 FarmersMarketDensitymarkets/1,000population 0 2016 17

1.50 GroceryStoreDensitystores/1,000population 0.2 2014 17

1.42AdultFruitandVegetableConsumption percent 18.7 17.2 2015 10

1.33Low-IncomeandLowAccesstoaGroceryStore percent 6.3 2015 17

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 17

1.00 FoodEnvironmentIndex 7.2 6 7.7 2018 4

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015 17

1.00People65+withLowAccesstoaGroceryStore percent 1.4 2015 17

0.67 AccesstoExerciseOpportunities percent 90.4 80.6 83.1 2018 4

SCORE HEARTDISEASE&STROKE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.61 Stroke:MedicarePopulation percent 5.2 4.5 4 2015 3

1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3

1.50AtrialFibrillation:MedicarePopulation percent 7.3 7.4 8.1 2015 3

1.44 Hyperlipidemia:Medicare percent 43.2 46.1 44.6 2015 3

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Population

1.42Age-AdjustedDeathRateduetoCerebrovascularDisease(Stroke)

deaths/100,000population 41.5 34.8 42 37.3 2010-2014 Black 12

1.33IschemicHeartDisease:MedicarePopulation percent 28.8 28.8 26.5 2015

3

1.22Hypertension:MedicarePopulation percent 55.5 57.5 55 2015

3

0.92Age-AdjustedDeathRateduetoHeartDisease

deaths/100,000population 167.6 173 171.9 2010-2014 Black,White,Male 12

SCOREIMMUNIZATIONS&INFECTIOUSDISEASES UNITS

HARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.33 GonorrheaIncidenceRatecases/100,000population 182.1 160.2 2017 12

2.33 SyphilisIncidenceRatecases/100,000population 59.3 40.6 2017 12

2.11 ChlamydiaIncidenceRatecases/100,000population 571.4 511.6 2017 12

1.83 TuberculosisIncidenceRatecases/100,000population 6.6 1 4.5 2013-2017 12

1.78Adults65+withInfluenzaVaccination percent 57.2 57.3 58.6 2016 10

1.67 HIVDiagnosisRatecases/100,000population 26.3 16.1 2016

12

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016

10

1.00Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12

SCOREMATERNAL,FETAL&INFANTHEALTH UNITS

HARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.36 InfantMortalityRate deaths/1,000live 6.8 6 5.8 6 2013 12

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births

1.97MotherswhoReceivedEarlyPrenatalCare percent 56.1 77.9 59.2 74.2 2013 12

1.92InfantsBorntoMotherswith<12YearsEducation percent 27.5 21.6 15.9 2013 12

1.81 BabieswithLowBirthWeight percent 8.6 7.8 8.3 8 2013 12

1.61 BabieswithVeryLowBirthWeight percent 1.5 1.4 1.4 1.4 2013 12

1.25 PretermBirths percent 11.8 9.4 12 11.4 2013 12

0.58 TeenBirths percent 2.5 2.8 4.3 2014 12

SCORE MEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7

1.33 ProstateCancerIncidenceRatecases/100,000

males 102.5 95.4 109 2011-2015 7

1.28 LifeExpectancyforMales years 76.4 76.2 76.7 2014 6

SCOREMENTALHEALTH&MENTALDISORDERS UNITS

HARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.4 11.7 9.9 2015

3

1.53 PoorMentalHealth:5+Days percent 80 81.5 2016

10

1.50PoorMentalHealth:AverageNumberofDays days 3.7 3.4 3.8 2016 4

1.44 MentalHealthProviderRateproviders/100,000

population 103.7 98.8 214.3 2017 4

1.17 FrequentMentalDistress percent 11.2 10.6 15 2016 4

0.94Age-AdjustedDeathRateduetoSuicide

deaths/100,000population 10.3 10.2 11.7 12.5 2010-2014 White,Male 12

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0.94 Depression:MedicarePopulation percent 14.8 17 16.7 2015

3

0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

SCORE OLDERADULTS&AGING UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67ChronicKidneyDisease:MedicarePopulation percent 20.9 19.9 18.1 2015

3

2.61 Stroke:MedicarePopulation percent 5.2 4.5 4 2015

3

2.06Age-AdjustedDeathRateduetoFalls

deaths/100,000population 10.4 7.2 7.4 8.3 2010-2014 White,Male 12

1.94 Cancer:MedicarePopulation percent 7.6 7.1 7.8 2015 3

1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.4 11.7 9.9 2015 3

1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3

1.89People65+LivingBelowPovertyLevel percent 11.3 10.8 9.3 2012-2016

Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1

1.78Adults65+withInfluenzaVaccination percent 57.2 57.3 58.6 2016 10

1.72Osteoporosis:MedicarePopulation percent 6.3 6.5 6 2015 3

1.67 Diabetes:MedicarePopulation percent 28.1 28.2 26.5 2015 3

1.50AtrialFibrillation:MedicarePopulation percent 7.3 7.4 8.1 2015 3

1.44Hyperlipidemia:MedicarePopulation percent 43.2 46.1 44.6 2015 3

1.44 People65+LivingAlone percent 24.4 23.9 26.4 2012-2016 1

1.33IschemicHeartDisease:MedicarePopulation percent 28.8 28.8 26.5 2015 3

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1.22Hypertension:MedicarePopulation percent 55.5 57.5 55 2015 3

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10

1.00People65+withLowAccesstoaGroceryStore percent 1.4 2015 17

0.94 Asthma:MedicarePopulation percent 7.3 8.2 8.2 2015 3

0.94 Depression:MedicarePopulation percent 14.8 17 16.7 2015 3

0.94

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 27.8 31.6 30 2015 3

0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

0.39 COPD:MedicarePopulation percent 9.6 11.1 11.2 2015

3

SCORE OTHERCHRONICDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67ChronicKidneyDisease:MedicarePopulation percent 20.9 19.9 18.1 2015 3

1.72Osteoporosis:MedicarePopulation percent 6.3 6.5 6 2015 3

0.94

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 27.8 31.6 30 2015 3

SCORE PREVENTION&SAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014

4

2.06Age-AdjustedDeathRateduetoFalls

deaths/100,000population 10.4 7.2 7.4 8.3 2010-2014 White,Male 12

1.19 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.2 9.8 16.9 2014-2016

4

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0.69Age-AdjustedDeathRateduetoUnintentionalInjuries

deaths/100,000population 36.1 36.4 37.6 39.2 2010-2014 White,Male 12

SCORE PUBLICSAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 Alcohol-ImpairedDrivingDeaths percent 37.8 28.3 29.3 2012-2016 4

1.67 ViolentCrimeRatecrimes/100,000

population 713.7 407.6 2012-2014 4

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.4 8.5 2017 11

SCORE RESPIRATORYDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.83 TuberculosisIncidenceRatecases/100,000population 6.6 1 4.5 2013-2017 12

1.78Adults65+withInfluenzaVaccination percent 57.2 57.3 58.6 2016 10

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10

1.00Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12

0.94 Asthma:MedicarePopulation percent 7.3 8.2 8.2 2015 3

0.50LungandBronchusCancerIncidenceRate

cases/100,000population 50.9 53.1 60.2 2011-2015 7

0.39 COPD:MedicarePopulation percent 9.6 11.1 11.2 2015 3

0.33Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 37.5 45.5 39 43.4 2011-2015 7

SCORE SOCIALENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67 MeanTravelTimetoWork minutes 28.6 25.9 26.1 2012-2016 Male 1

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2.50 LinguisticIsolation percent 11.8 7.9 4.5 2012-2016 1

2.44 Homeownership percent 49.6 55 55.9 2012-2016 1

2.17 Single-ParentHouseholds percent 36.2 33.3 33.6 2012-2016 1

2.14MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 534 467 462 2012-2016 1

2.08 MedianHouseholdGrossRent dollars 937 911 949 2012-2016 1

1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1

1.75 PersonswithHealthInsurance percent 79.3 100 81.4 2016

9

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other,<6 1

1.67People25+withaHighSchoolDegreeorHigher percent 80.2 82.3 87 2012-2016

Male,35-44,45-64,65+ 1

1.67 PeopleLivingBelowPovertyLevel percent 17.4 16.7 15.1 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24 1

1.67 TotalEmploymentChange percent 2.4 3.2 2.5 2014-2015 16

1.67VoterTurnout:PresidentialElection percent 58.4 58.8 2016 14

1.44 People65+LivingAlone percent 24.4 23.9 26.4 2012-2016 1

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.4 8.5 2017 11

1.08 MedianHousingUnitValue dollars 145600 142700 184700 2012-2016 1

0.94FemalePopulation16+inCivilianLaborForce percent 59.8 57.7 58.3 2012-2016 1

0.94 Population16+inCivilianLabor percent 68.3 64.2 63.1 2012-2016 1

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Force

0.67People25+withaBachelor'sDegreeorHigher percent 30.1 28.1 30.3 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1

0.50 MedianHouseholdIncome dollars 55584 54727 55322 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other 1

0.50 PerCapitaIncome dollars 29850 27828 29829 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Other,Two

orMoreRaces 1

SCORE SUBSTANCEABUSE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 Alcohol-ImpairedDrivingDeaths percent 37.8 28.3 29.3 2012-2016 4

1.50 AdultswhoDrinkExcessively percent 18.1 25.4 19.4 18 2016 4

1.28

Adults(18+Years)ReportingBingeDrinkingWithintheLast12months percent 16.6 24.2 17.9 16.9 2016 10

1.19 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.2 9.8 16.9 2014-2016 4

0.94 AdultswhoSmoke percent 12.1 12 14.3 17.1 2016 10

0.89 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015

16

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SCORE TRANSPORTATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.83 SoloDriverswithaLongCommute percent 45.8 36.9 34.7 2012-2016

4

2.67 MeanTravelTimetoWork minutes 28.6 25.9 26.1 2012-2016 Male 1

2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1

1.44 WorkerswhoDriveAlonetoWork percent 79.1 80.3 76.4 2012-2016

White,non-Hispanic,25-44,55-

59 1

1.33 HouseholdswithoutaVehicle percent 6.4 5.6 9 2012-2016

1

1.28WorkersCommutingbyPublicTransportation percent 2.8 5.5 1.5 5.1 2012-2016

HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Twoor

MoreRaces,White,non-Hispanic,Male,

25-44 1

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015

17

SCORE WELLNESS&LIFESTYLE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.83Self-ReportedGeneralHealthAssessment:PoororFair percent 18.2 18.2 16 2016 4

1.75 PoorPhysicalHealth:5+Days percent 80.6 81.5 2016 10

1.67 InsufficientSleep percent 33.9 32.7 38 2016 4

1.28 LifeExpectancyforMales years 76.4 76.2 76.7 2014 6

1.17 FrequentPhysicalDistress percent 11.5 10.8 15 2016

4

1.17PoorPhysicalHealth:AverageNumberofDays days 3.6 3.5 3.7 2016

4

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1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014

6

SCORE WOMEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.53 CervicalCancerIncidenceRatecases/100,000

females 11 7.3 9.2 7.5 2011-2015 7

2.25Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7

1.39 BreastCancerIncidenceRatecases/100,000

females 113.2 111.7 124.7 2011-2015 7

1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014 6

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LibertyCounty

SCORE ACCESSTOHEALTHSERVICES UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.83 PrimaryCareProviderRateproviders/100,000

population 24 60 76 2015 3

2.61 MentalHealthProviderRateproviders/100,000

population 15 99 214 2017 3

2.00Non-PhysicianPrimaryCareProviderRate

providers/100,000population 39 67 81 2017 3

1.83 DentistRatedentists/100,000

population 27 56 67 2016 3

1.81 ChildrenwithHealthInsurance percent 88.7 100.0 90.3 2016 8

1.75AdultswithHealthInsurance:18-64 percent 75.0 100.0 77.4 2016 8

1.75 PersonswithHealthInsurance percent 79.4 100.0 81.4 2016 8

SCORE CANCER UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.56Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 63.8 45.5 39.0 43.4 2011-2015 6

2.44OralCavityandPharynxCancerIncidenceRate

cases/100,000population 14.3 10.9 11.6 2011-2015 6

2.42 CervicalCancerIncidenceRatecases/100,000

females 10.7 7.3 9.2 7.5 2011-2015 6

2.33Age-AdjustedDeathRateduetoCancer

deaths/100,000population 196.1 161.4 156.4 163.5 2011-2015 Male 6

2.22LungandBronchusCancerIncidenceRate

cases/100,000population 78.4 53.1 60.2 2011-2015 6

2.17Age-AdjustedDeathRateduetoColorectalCancer

deaths/100,000population 16.0 14.5 14.4 14.5 2011-2015 6

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1.86Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 22.4 20.7 20.2 20.9 2011-2015 6

1.83 ColorectalCancerIncidenceRatecases/100,000population 41.5 39.9 38.1 39.2 2011-2015 6

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 21.1 21.8 18.1 19.5 2011-2015 6

1.17 AllCancerIncidenceRatecases/100,000population 401.0 401.3 441.2 2011-2015 6

1.06 Cancer:MedicarePopulation percent 6.8 7.1 7.8 2015 2

1.00 BreastCancerIncidenceRatecases/100,000

females 98.4 111.7 124.7 2011-2015 6

0.17 ProstateCancerIncidenceRatecases/100,000

males 75.0 95.4 109.0 2011-2015 6

SCORE CHILDREN'SHEALTH UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 ChildFoodInsecurityRate percent 26.0 23.0 17.9 2016 4

1.81 ChildrenwithHealthInsurance percent 88.7 100.0 90.3 2016 8

1.50 SubstantiatedChildAbuseRatecases/1,000children 13.3 8.5 2017 9

1.33ChildrenwithLowAccesstoaGroceryStore percent 4.3 2015 15

SCORE ECONOMY UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.83FemalePopulation16+inCivilianLaborForce percent 39.5 57.7 58.3 2012-2016 1

2.83Population16+inCivilianLaborForce percent 51.3 64.2 63.1 2012-2016 1

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2.61UnemployedWorkersinCivilianLaborForce percent 6.1 4.0 4.1 July2018 13

2.50 TotalEmploymentChange percent -3.7 3.2 2.5 2014-2015 14

2.39 FoodInsecurityRate percent 18.7 15.4 12.9 2016 4

2.17 ChildFoodInsecurityRate percent 26.0 23.0 17.9 2016 4

2.11 SevereHousingProblems percent 18.5 18.3 18.8 2010-2014 3

2.11StudentsEligiblefortheFreeLunchProgram percent 55.5 52.9 42.6 2015-2016 7

1.94People65+LivingBelowPovertyLevel percent 10.6 10.8 9.3 2012-2016 TwoorMoreRaces 1

1.92PersonswithDisabilityLivinginPoverty(5-year) percent 28.4 25.1 27.6 2012-2016 1

1.83 PerCapitaIncome dollars 22065 27828 29829 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

1.81PersonswithDisabilityLivinginPoverty percent 28.0 24.2 26.6 2016 1

1.78 SNAPCertifiedStoresstores/1,000population 0.8 2016 15

1.75 MedianHousingUnitValue dollars 89100 142700 184700 2012-2016 1

1.72FamiliesLivingBelowPovertyLevel percent 12.4 13.0 11.0 2012-2016 HispanicorLatino 1

1.72PeopleLiving200%AbovePovertyLevel percent 60.5 62.8 66.4 2012-2016 1

1.67 PeopleLivingBelowPovertyLevel percent 17.3 16.7 15.1 2012-2016

HispanicorLatino,NativeHawaiianor

OtherPacificIslander 1

1.61HouseholdswithCashPublicAssistanceIncome percent 1.9 1.6 2.7 2012-2016 1

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1.50Low-IncomeandLowAccesstoaGroceryStore percent 7.7 2015 15

1.42 MedianHouseholdGrossRent dollars 801 911 949 2012-2016 1

1.39ChildrenLivingBelowPovertyLevel percent 23.3 23.9 21.2 2012-2016 HispanicorLatino 1

1.33 MedianHouseholdIncome dollars 49655 54727 55322 2012-2016

BlackorAfricanAmerican,Hispanic

orLatino 1

1.08MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 414 467 462 2012-2016 1

0.97MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1160 1444 1491 2012-2016 1

0.83 Homeownership percent 64.8 55.0 55.9 2012-2016 1

0.72RentersSpending30%orMoreofHouseholdIncomeonRent percent 35.1 48.0 47.3 2012-2016 1

0.61 HomeownerVacancyRate percent 1.2 1.6 1.8 2012-2016 1

SCORE EDUCATION UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.39People25+withaBachelor'sDegreeorHigher percent 10.0 28.1 30.3 2012-2016 1

2.06People25+withaHighSchoolDegreeorHigher percent 76.2 82.3 87.0 2012-2016 Other 1

1.97InfantsBorntoMotherswith<12YearsEducation percent 24.2 21.6 15.9 2013 10

1.78 Student-to-TeacherRatio students/teacher 15.4 15.4 17.7 2015-2016 7

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1.22 HighSchoolDropOutRate percent 1.7 2.0 2016 11

SCORE ENVIRONMENT UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 AccesstoExerciseOpportunities percent 59.5 80.6 83.1 2018 3

2.11 SevereHousingProblems percent 18.5 18.3 18.8 2010-2014 3

1.94 GroceryStoreDensitystores/1,000population 0.1 2014 15

1.83HouseholdswithNoCarandLowAccesstoaGroceryStore percent 3.4 2015 15

1.78 SNAPCertifiedStoresstores/1,000population 0.8 2016 15

1.72 FoodEnvironmentIndex 6.6 6.0 7.7 2018 3

1.67 RecreationandFitnessFacilitiesfacilities/1,000population 0.0 2014 15

1.61RecognizedCarcinogensReleasedintoAir pounds 947 2017 16

1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 15

1.50Low-IncomeandLowAccesstoaGroceryStore percent 7.7 2015 15

1.39 PBTReleased pounds 0 2017 16

1.33ChildrenwithLowAccesstoaGroceryStore percent 4.3 2015 15

1.33 FastFoodRestaurantDensityrestaurants/1,000

population 0.5 2014 15

1.33People65+withLowAccesstoaGroceryStore percent 2.2 2015 15

0.75 DrinkingWaterViolations percent 0.0 6.6 FY2013-14 3

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0.61 LiquorStoreDensitystores/100,000population 3.8 6.8 10.5 2015 14

0.17 HousesBuiltPriorto1950 percent 4.8 7.4 18.2 2012-2016 1

SCOREEXERCISE,NUTRITION,&WEIGHT UNITS

LIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67 WorkerswhoWalktoWork percent 1.0 3.1 1.6 2.8 2012-2016 1

2.39 FoodInsecurityRate percent 18.7 15.4 12.9 2016 4

2.17 AccesstoExerciseOpportunities percent 59.5 80.6 83.1 2018 3

2.17 ChildFoodInsecurityRate percent 26.0 23.0 17.9 2016 4

1.94 GroceryStoreDensitystores/1,000population 0.1 2014 15

1.83HouseholdswithNoCarandLowAccesstoaGroceryStore percent 3.4 2015 15

1.78 SNAPCertifiedStoresstores/1,000population 0.8 2016 15

1.72 FoodEnvironmentIndex 6.6 6.0 7.7 2018 3

1.67 RecreationandFitnessFacilitiesfacilities/1,000population 0.0 2014 15

1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 15

1.50Low-IncomeandLowAccesstoaGroceryStore percent 7.7 2015 15

1.33ChildrenwithLowAccesstoaGroceryStore percent 4.3 2015 15

1.33 FastFoodRestaurantDensityrestaurants/1,000

population 0.5 2014 15

1.33People65+withLowAccesstoaGroceryStore percent 2.2 2015 15

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SCORE HEARTDISEASE&STROKE UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.50 Stroke:MedicarePopulation percent 5.8 4.5 4.0 2015 2

2.39HeartFailure:MedicarePopulation percent 20.4 15.5 13.5 2015 2

2.14Age-AdjustedDeathRateduetoHeartDisease

deaths/100,000population 257.6 173.0 171.9 2010-2014 Male 10

2.00AtrialFibrillation:MedicarePopulation percent 8.2 7.4 8.1 2015 2

2.00Hyperlipidemia:MedicarePopulation percent 46.0 46.1 44.6 2015 2

2.00IschemicHeartDisease:MedicarePopulation percent 33.2 28.8 26.5 2015 2

1.83Hypertension:MedicarePopulation percent 60.4 57.5 55.0 2015 2

1.75Age-AdjustedDeathRateduetoCerebrovascularDisease(Stroke)

deaths/100,000population 41.1 34.8 42.0 37.3 2010-2014 10

SCOREIMMUNIZATIONS&INFECTIOUSDISEASES UNITS

LIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.33Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 20.6 14.2 15.2 2010-2014 10

1.67 SyphilisIncidenceRatecases/100,000population 20.3 40.6 2017 10

1.44 ChlamydiaIncidenceRatecases/100,000population 369.4 511.6 2017 10

1.44 GonorrheaIncidenceRatecases/100,000population 87.3 160.2 2017 10

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1.39 TuberculosisIncidenceRatecases/100,000population 2.0 1.0 4.5 2013-2017 10

1.06 HIVDiagnosisRatecases/100,000population 3.7 16.1 2016 10

SCOREMATERNAL,FETAL&INFANTHEALTH UNITS

LIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.36 PretermBirths percent 13.5 9.4 12.0 11.4 2013 10

2.08MotherswhoReceivedEarlyPrenatalCare percent 52.3 77.9 59.2 74.2 2013 10

1.97InfantsBorntoMotherswith<12YearsEducation percent 24.2 21.6 15.9 2013 10

1.75 BabieswithLowBirthWeight percent 8.2 7.8 8.3 8.0 2013 10

1.72BabieswithVeryLowBirthWeight percent 1.5 1.4 1.4 1.4 2013 10

1.31 InfantMortalityRatedeaths/1,000live

births 5.6 6.0 5.8 6.0 2013 10

0.75 TeenBirths percent 2.8 2.8 4.3 2014 10

SCORE MEN'SHEALTH UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.28 LifeExpectancyforMales years 71.6 76.2 76.7 2014 5

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 21.1 21.8 18.1 19.5 2011-2015 6

0.17 ProstateCancerIncidenceRatecases/100,000

males 75.0 95.4 109.0 2011-2015 6

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SCOREMENTALHEALTH&MENTALDISORDERS UNITS

LIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.61 MentalHealthProviderRateproviders/100,000

population 15 99 214 2017 3

2.36Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 38.5 26.6 24.5 2010-2014 10

2.28Age-AdjustedDeathRateduetoSuicide

deaths/100,000population 14.0 10.2 11.7 12.5 2010-2014 10

1.94 Depression:MedicarePopulation percent 17.5 17.0 16.7 2015 2

1.67Alzheimer'sDiseaseorDementia:MedicarePopulation percent 10.9 11.7 9.9 2015 2

1.50 FrequentMentalDistress percent 11.8 10.6 15.0 2016 3

1.50PoorMentalHealth:AverageNumberofDays days 3.8 3.4 3.8 2016 3

SCORE OLDERADULTS&AGING UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.83 Diabetes:MedicarePopulation percent 31.4 28.2 26.5 2015 2

2.67ChronicKidneyDisease:MedicarePopulation percent 20.1 19.9 18.1 2015 2

2.61 Asthma:MedicarePopulation percent 12.2 8.2 8.2 2015 2

2.50 Stroke:MedicarePopulation percent 5.8 4.5 4.0 2015 2

2.39 COPD:MedicarePopulation percent 19.4 11.1 11.2 2015 2

2.39HeartFailure:MedicarePopulation percent 20.4 15.5 13.5 2015 2

2.36Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 38.5 26.6 24.5 2010-2014 10

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2.00AtrialFibrillation:MedicarePopulation percent 8.2 7.4 8.1 2015 2

2.00Hyperlipidemia:MedicarePopulation percent 46.0 46.1 44.6 2015 2

2.00IschemicHeartDisease:MedicarePopulation percent 33.2 28.8 26.5 2015 2

1.94 Depression:MedicarePopulation percent 17.5 17.0 16.7 2015 2

1.94People65+LivingBelowPovertyLevel percent 10.6 10.8 9.3 2012-2016 TwoorMoreRaces 1

1.83Hypertension:MedicarePopulation percent 60.4 57.5 55.0 2015 2

1.67Alzheimer'sDiseaseorDementia:MedicarePopulation percent 10.9 11.7 9.9 2015 2

1.56Age-AdjustedDeathRateduetoFalls

deaths/100,000population 8.0 7.2 7.4 8.3 2010-2014 10

1.44Osteoporosis:MedicarePopulation percent 5.8 6.5 6.0 2015 2

1.44

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 30.1 31.6 30.0 2015 2

1.33People65+withLowAccesstoaGroceryStore percent 2.2 2015 15

1.06 Cancer:MedicarePopulation percent 6.8 7.1 7.8 2015 2

0.94 People65+LivingAlone percent 23.4 23.9 26.4 2012-2016 1

SCORE OTHERCHRONICDISEASES UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67ChronicKidneyDisease:MedicarePopulation percent 20.1 19.9 18.1 2015 2

1.44Osteoporosis:MedicarePopulation percent 5.8 6.5 6.0 2015 2

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1.44

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 30.1 31.6 30.0 2015 2

SCORE PREVENTION&SAFETY UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.11 SevereHousingProblems percent 18.5 18.3 18.8 2010-2014 3

2.08Age-AdjustedDeathRateduetoUnintentionalInjuries

deaths/100,000population 63.5 36.4 37.6 39.2 2010-2014 Male 10

1.56Age-AdjustedDeathRateduetoFalls

deaths/100,000population 8.0 7.2 7.4 8.3 2010-2014 10

1.31 DeathRateduetoDrugPoisoningdeaths/100,000

population 12.9 9.8 16.9 2014-2016 3

SCORE PUBLICSAFETY UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 ViolentCrimeRatecrimes/100,000

population 433.2 407.6 2012-2014 3

1.50 SubstantiatedChildAbuseRatecases/1,000children 13.3 8.5 2017 9

0.72 Alcohol-ImpairedDrivingDeaths percent 21.8 28.3 29.3 2012-2016 3

SCORE RESPIRATORYDISEASES UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.61 Asthma:MedicarePopulation percent 12.2 8.2 8.2 2015 2

2.56Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 63.8 45.5 39.0 43.4 2011-2015 6

2.39 COPD:MedicarePopulation percent 19.4 11.1 11.2 2015 2

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2.33Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 20.6 14.2 15.2 2010-2014 10

2.22LungandBronchusCancerIncidenceRate

cases/100,000population 78.4 53.1 60.2 2011-2015 6

1.39 TuberculosisIncidenceRatecases/100,000population 2.0 1.0 4.5 2013-2017 10

SCORE SOCIALENVIRONMENT UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.83FemalePopulation16+inCivilianLaborForce percent 39.5 57.7 58.3 2012-2016 1

2.83Population16+inCivilianLaborForce percent 51.3 64.2 63.1 2012-2016 1

2.61 MeanTravelTimetoWork minutes 35.6 25.9 26.1 2012-2016 Male 1

2.50 TotalEmploymentChange percent -3.7 3.2 2.5 2014-2015 14

2.39People25+withaBachelor'sDegreeorHigher percent 10.0 28.1 30.3 2012-2016 1

2.06People25+withaHighSchoolDegreeorHigher percent 76.2 82.3 87.0 2012-2016 Other 1

1.83 PerCapitaIncome dollars 22065 27828 29829 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

1.75 MedianHousingUnitValue dollars 89100 142700 184700 2012-2016 1

1.75 PersonswithHealthInsurance percent 79.4 100.0 81.4 2016 8

1.67 PeopleLivingBelowPovertyLevel percent 17.3 16.7 15.1 2012-2016

HispanicorLatino,NativeHawaiianor

OtherPacificIslander 1

1.50 SubstantiatedChildAbuseRate cases/1,000 13.3 8.5 2017 9

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children

1.42 MedianHouseholdGrossRent dollars 801 911 949 2012-2016 1

1.39ChildrenLivingBelowPovertyLevel percent 23.3 23.9 21.2 2012-2016 HispanicorLatino 1

1.33 MedianHouseholdIncome dollars 49655 54727 55322 2012-2016

BlackorAfricanAmerican,Hispanic

orLatino 1

1.33VoterTurnout:PresidentialElection percent 55.3 58.8 2016 12

1.28 LinguisticIsolation percent 3.3 7.9 4.5 2012-2016 1

1.08MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 414 467 462 2012-2016 1

0.97MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1160 1444 1491 2012-2016 1

0.94 People65+LivingAlone percent 23.4 23.9 26.4 2012-2016 1

0.83 Homeownership percent 64.8 55.0 55.9 2012-2016 1

0.56 Single-ParentHouseholds percent 26.4 33.3 33.6 2012-2016 1

SCORE SUBSTANCEABUSE UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.67 AdultswhoDrinkExcessively percent 19.4 25.4 19.4 18.0 2016 3

1.31 DeathRateduetoDrugPoisoningdeaths/100,000

population 12.9 9.8 16.9 2014-2016 3

0.72 Alcohol-ImpairedDrivingDeaths percent 21.8 28.3 29.3 2012-2016 3

0.61 LiquorStoreDensitystores/100,000population 3.8 6.8 10.5 2015 14

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SCORE TRANSPORTATION UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.67WorkerswhoDriveAlonetoWork percent 87.8 80.3 76.4 2012-2016

45-54AmericanIndianorAlaskaNative,Asian 1

2.67 WorkerswhoWalktoWork percent 1.0 3.1 1.6 2.8 2012-2016 1

2.61 MeanTravelTimetoWork minutes 35.6 25.9 26.1 2012-2016 Male 1

2.61SoloDriverswithaLongCommute percent 58.7 36.9 34.7 2012-2016 3

2.06WorkersCommutingbyPublicTransportation percent 0.2 5.5 1.5 5.1 2012-2016 1

1.83HouseholdswithNoCarandLowAccesstoaGroceryStore percent 3.4 2015 15

1.50 HouseholdswithoutaVehicle percent 5.5 5.6 9.0 2012-2016 1

SCORE WELLNESS&LIFESTYLE UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.28 LifeExpectancyforFemales years 76.8 80.8 81.5 2014 5

2.28 LifeExpectancyforMales years 71.6 76.2 76.7 2014 5

1.83Self-ReportedGeneralHealthAssessment:PoororFair percent 18.2 18.2 16.0 2016 3

1.50 FrequentPhysicalDistress percent 11.8 10.8 15.0 2016 3

1.50PoorPhysicalHealth:AverageNumberofDays days 3.8 3.5 3.7 2016 3

1.17 InsufficientSleep percent 32.7 32.7 38.0 2016 3

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SCORE WOMEN'SHEALTH UNITSLIBERTYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.42 CervicalCancerIncidenceRatecases/100,000

females 10.7 7.3 9.2 7.5 2011-2015 6

2.28 LifeExpectancyforFemales years 76.8 80.8 81.5 2014 5

1.86Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 22.4 20.7 20.2 20.9 2011-2015 6

1.00 BreastCancerIncidenceRatecases/100,000

females 98.4 111.7 124.7 2011-2015 6

MontgomeryCounty

SCORE ACCESSTOHEALTHSERVICES UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.00 MentalHealthProviderRateproviders/100,000

population 69 99 214 2017 4

1.67Non-PhysicianPrimaryCareProviderRate

providers/100,000population 55 67 81 2017 4

1.56 DentistRatedentists/100,000

population 46 56 67 2016 4

1.53 ChildrenwithHealthInsurance percent 90.2 100.0 90.3 2016 9

1.47AdultswithHealthInsurance:18-64 percent 79.7 100.0 77.4 2016 9

1.47 PersonswithHealthInsurance percent 83.1 100.0 81.4 2016 9

1.22 PrimaryCareProviderRateproviders/100,000

population 62 60 76 2015 4

SCORE CANCER UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.72 Cancer:MedicarePopulation percent 7.8 7.1 7.8 2015 3

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1.58 CervicalCancerIncidenceRatecases/100,000

females 8.0 7.3 9.2 7.5 2011-2015 7

1.56OralCavityandPharynxCancerIncidenceRate

cases/100,000population 12.2 10.9 11.6 2011-2015 7

1.33 BreastCancerIncidenceRatecases/100,000

females 117.6 111.7 124.7 2011-2015 7

1.19Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 17.8 21.8 18.1 19.5 2011-2015 7

1.08Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 19.6 20.7 20.2 20.9 2011-2015 7

0.94Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 42.4 45.5 39.0 43.4 2011-2015 7

0.83 AllCancerIncidenceRatecases/100,000population 398.9 401.3 441.2 2011-2015 7

0.83LungandBronchusCancerIncidenceRate

cases/100,000population 56.4 53.1 60.2 2011-2015 7

0.78Age-AdjustedDeathRateduetoColorectalCancer

deaths/100,000population 14.4 14.5 14.4 14.5 2011-2015 7

0.67 ColorectalCancerIncidenceRatecases/100,000population 36.6 39.9 38.1 39.2 2011-2015 7

0.67 ProstateCancerIncidenceRatecases/100,000

males 88.7 95.4 109.0 2011-2015 7

0.61Age-AdjustedDeathRateduetoCancer

deaths/100,000population 156.0 161.4 156.4 163.5 2011-2015 Male 7

SCORE CHILDREN'SHEALTH UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.67ChildrenwithLowAccesstoaGroceryStore percent 5.6 2015 16

1.53 ChildrenwithHealthInsurance percent 90.2 100.0 90.3 2016 9

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1.17 ChildFoodInsecurityRate percent 21.2 23.0 17.9 2016 5

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.5 8.5 2017 10

SCORE ECONOMY UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.58 MedianHouseholdGrossRent dollars 1077 911 949 2012-2016 1

2.58MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 531 467 462 2012-2016 1

2.19MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1635 1444 1491 2012-2016 1

2.00FemalePopulation16+inCivilianLaborForce percent 53.6 57.7 58.3 2012-2016 1

1.89 SNAPCertifiedStoresstores/1,000population 0.5 2016 16

1.50Population16+inCivilianLaborForce percent 63.7 64.2 63.1 2012-2016 1

1.33 FoodInsecurityRate percent 14.6 15.4 12.9 2016 5

1.33Low-IncomeandLowAccesstoaGroceryStore percent 5.9 2015 16

1.28 SevereHousingProblems percent 16.0 18.3 18.8 2010-2014 4

1.28UnemployedWorkersinCivilianLaborForce percent 3.8 4.0 4.1 July2018 14

1.17 ChildFoodInsecurityRate percent 21.2 23.0 17.9 2016 5

1.06RentersSpending30%orMoreofHouseholdIncomeonRent percent 39.4 48.0 47.3 2012-2016 1

1.00 TotalEmploymentChange percent 3.5 3.2 2.5 2014-2015 15

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0.86PersonswithDisabilityLivinginPoverty percent 17.9 24.2 26.6 2016 1

0.78People65+LivingBelowPovertyLevel percent 7.7 10.8 9.3 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

0.75PersonswithDisabilityLivinginPoverty(5-year) percent 19.1 25.1 27.6 2012-2016 1

0.61 Homeownership percent 65.6 55.0 55.9 2012-2016 1

0.58 MedianHousingUnitValue dollars 190000 142700 184700 2012-2016 1

0.56FamiliesLivingBelowPovertyLevel percent 8.3 13.0 11.0 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

0.56HouseholdswithCashPublicAssistanceIncome percent 1.1 1.6 2.7 2012-2016 1

0.56PeopleLiving200%AbovePovertyLevel percent 73.0 62.8 66.4 2012-2016 1

0.56StudentsEligiblefortheFreeLunchProgram percent 35.1 52.9 42.6 2015-2016 8

0.39 MedianHouseholdIncome dollars 70805 54727 55322 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other,

TwoorMoreRaces 1

0.17ChildrenLivingBelowPovertyLevel percent 14.8 23.9 21.2 2012-2016

HispanicorLatino,Other 1

0.17 HomeownerVacancyRate percent 1.2 1.6 1.8 2012-2016 1

0.17 PeopleLivingBelowPovertyLevel percent 11.0 16.7 15.1 2012-2016

12-17,18-24,6-11,<6BlackorAfricanAmerican,HispanicorLatino,Other 1

0.17 PerCapitaIncome dollars 35912 27828 29829 2012-2016

AmericanIndianorAlaskaNative,Black

orAfricanAmerican,Hispanic 1

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orLatino,Other,TwoorMoreRaces

SCORE EDUCATION UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.89 Student-to-TeacherRatio students/teacher 16.2 15.4 17.7 2015-2016 8

1.22People25+withaHighSchoolDegreeorHigher percent 86.8 82.3 87.0 2012-2016

AmericanIndianorAlaskaNative 1

1.08InfantsBorntoMotherswith<12YearsEducation percent 17.6 21.6 15.9 2013 11

1.00 HighSchoolDropOutRate percent 0.9 2.0 2016 12

0.33People25+withaBachelor'sDegreeorHigher percent 33.0 28.1 30.3 2012-2016

25-34,65+AmericanIndianor

AlaskaNative,Other,TwoorMore

Races 1

SCORE ENVIRONMENT UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.89 SNAPCertifiedStoresstores/1,000population 0.5 2016 16

1.83 GroceryStoreDensitystores/1,000population 0.1 2014 16

1.75 AnnualOzoneAirQuality grade F 2014-2016 2

1.67ChildrenwithLowAccesstoaGroceryStore percent 5.6 2015 16

1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 16

1.50 FastFoodRestaurantDensityrestaurants/1,000

population 0.6 2014 16

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1.39RecognizedCarcinogensReleasedintoAir pounds 16762 2017 17

1.33Low-IncomeandLowAccesstoaGroceryStore percent 5.9 2015 16

1.33People65+withLowAccesstoaGroceryStore percent 2.5 2015 16

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 16

1.28 SevereHousingProblems percent 16.0 18.3 18.8 2010-2014 4

1.25 DrinkingWaterViolations percent 1.7 6.6 FY2013-14 4

1.22 FoodEnvironmentIndex 7.5 6.0 7.7 2018 4

1.17HouseholdswithNoCarandLowAccesstoaGroceryStore percent 1.5 2015 16

1.00 AccesstoExerciseOpportunities percent 82.7 80.6 83.1 2018 4

0.67 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015 15

0.39 HousesBuiltPriorto1950 percent 1.2 7.4 18.2 2012-2016 1

SCOREEXERCISE,NUTRITION,&WEIGHT UNITS

MONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.78 WorkerswhoWalktoWork percent 1.0 3.1 1.6 2.8 2012-2016 1

1.89 SNAPCertifiedStoresstores/1,000population 0.5 2016 16

1.83 GroceryStoreDensitystores/1,000population 0.1 2014 16

1.67ChildrenwithLowAccesstoaGroceryStore percent 5.6 2015 16

1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 16

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1.50 FastFoodRestaurantDensityrestaurants/1,000

population 0.6 2014 16

1.33 FoodInsecurityRate percent 14.6 15.4 12.9 2016 5

1.33Low-IncomeandLowAccesstoaGroceryStore percent 5.9 2015 16

1.33People65+withLowAccesstoaGroceryStore percent 2.5 2015 16

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 16

1.22 FoodEnvironmentIndex 7.5 6.0 7.7 2018 4

1.17 ChildFoodInsecurityRate percent 21.2 23.0 17.9 2016 5

1.17HouseholdswithNoCarandLowAccesstoaGroceryStore percent 1.5 2015 16

1.00 AccesstoExerciseOpportunities percent 82.7 80.6 83.1 2018 4

SCORE HEARTDISEASE&STROKE UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.44AtrialFibrillation:MedicarePopulation percent 8.8 7.4 8.1 2015 3

2.28 Stroke:MedicarePopulation percent 4.6 4.5 4.0 2015 3

1.94Hyperlipidemia:MedicarePopulation percent 46.3 46.1 44.6 2015 3

1.61Hypertension:MedicarePopulation percent 56.0 57.5 55.0 2015 3

1.25Age-AdjustedDeathRateduetoCerebrovascularDisease(Stroke)

deaths/100,000population 38.5 34.8 42.0 37.3 2010-2014 11

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1.25Age-AdjustedDeathRateduetoHeartDisease

deaths/100,000population 173.2 173.0 171.9 2010-2014 MaleBlack 11

1.22HeartFailure:MedicarePopulation percent 14.6 15.5 13.5 2015 3

1.17IschemicHeartDisease:MedicarePopulation percent 28.6 28.8 26.5 2015 3

SCOREIMMUNIZATIONS&INFECTIOUSDISEASES UNITS

MONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.67 SyphilisIncidenceRatecases/100,000population 13.1 40.6 2017 11

1.50 ChlamydiaIncidenceRatecases/100,000population 265.4 511.6 2017 11

1.44 HIVDiagnosisRatecases/100,000population 7.7 16.1 2016 11

1.39 TuberculosisIncidenceRatecases/100,000population 1.8 1.0 4.5 2013-2017 11

1.28 GonorrheaIncidenceRatecases/100,000population 52.4 160.2 2017 11

0.67Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 10.8 14.2 15.2 2010-2014 11

SCOREMATERNAL,FETAL&INFANTHEALTH UNITS

MONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.75MotherswhoReceivedEarlyPrenatalCare percent 60.7 77.9 59.2 74.2 2013 11

1.08InfantsBorntoMotherswith<12YearsEducation percent 17.6 21.6 15.9 2013 11

0.83BabieswithVeryLowBirthWeight percent 1.1 1.4 1.4 1.4 2013 11

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0.75 PretermBirths percent 10.4 9.4 12.0 11.4 2013 11

0.47 BabieswithLowBirthWeight percent 6.6 7.8 8.3 8.0 2013 11

0.47 InfantMortalityRatedeaths/1,000live

births 4.5 6.0 5.8 6.0 2013 11

0.42 TeenBirths percent 2.0 2.8 4.3 2014 11

SCORE MEN'SHEALTH UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.19Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 17.8 21.8 18.1 19.5 2011-2015 7

1.00 LifeExpectancyforMales years 76.7 76.2 76.7 2014 6

0.67 ProstateCancerIncidenceRatecases/100,000

males 88.7 95.4 109.0 2011-2015 7

SCOREMENTALHEALTH&MENTALDISORDERS UNITS

MONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.28Age-AdjustedDeathRateduetoSuicide

deaths/100,000population 14.6 10.2 11.7 12.5 2010-2014 Male 11

2.00 MentalHealthProviderRateproviders/100,000

population 69 99 214 2017 4

1.67Alzheimer'sDiseaseorDementia:MedicarePopulation percent 10.7 11.7 9.9 2015 3

1.28 Depression:MedicarePopulation percent 15.9 17.0 16.7 2015 3

0.67 FrequentMentalDistress percent 10.2 10.6 15.0 2016 4

0.67PoorMentalHealth:AverageNumberofDays days 3.3 3.4 3.8 2016 4

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0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 18.8 26.6 24.5 2010-2014 11

SCORE OLDERADULTS&AGING UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.44AtrialFibrillation:MedicarePopulation percent 8.8 7.4 8.1 2015 3

2.28 Stroke:MedicarePopulation percent 4.6 4.5 4.0 2015 3

2.00ChronicKidneyDisease:MedicarePopulation percent 18.3 19.9 18.1 2015 3

1.94Hyperlipidemia:MedicarePopulation percent 46.3 46.1 44.6 2015 3

1.72 Cancer:MedicarePopulation percent 7.8 7.1 7.8 2015 3

1.67Alzheimer'sDiseaseorDementia:MedicarePopulation percent 10.7 11.7 9.9 2015 3

1.61Hypertension:MedicarePopulation percent 56.0 57.5 55.0 2015 3

1.39 COPD:MedicarePopulation percent 11.7 11.1 11.2 2015 3

1.33People65+withLowAccesstoaGroceryStore percent 2.5 2015 16

1.33

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 28.5 31.6 30.0 2015 3

1.28 Asthma:MedicarePopulation percent 7.7 8.2 8.2 2015 3

1.28 Depression:MedicarePopulation percent 15.9 17.0 16.7 2015 3

1.22HeartFailure:MedicarePopulation percent 14.6 15.5 13.5 2015 3

1.22Osteoporosis:MedicarePopulation percent 5.8 6.5 6.0 2015 3

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1.17IschemicHeartDisease:MedicarePopulation percent 28.6 28.8 26.5 2015 3

0.94 Diabetes:MedicarePopulation percent 24.8 28.2 26.5 2015 3

0.78People65+LivingBelowPovertyLevel percent 7.7 10.8 9.3 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 18.8 26.6 24.5 2010-2014 11

0.50Age-AdjustedDeathRateduetoFalls

deaths/100,000population 5.1 7.2 7.4 8.3 2010-2014 11

0.50 People65+LivingAlone percent 21.5 23.9 26.4 2012-2016 1

SCORE OTHERCHRONICDISEASES UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.00ChronicKidneyDisease:MedicarePopulation percent 18.3 19.9 18.1 2015 3

1.33

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 28.5 31.6 30.0 2015 3

1.22Osteoporosis:MedicarePopulation percent 5.8 6.5 6.0 2015 3

SCORE PREVENTION&SAFETY UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.28 SevereHousingProblems percent 16.0 18.3 18.8 2010-2014 4

1.08 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.6 9.8 16.9 2014-2016 4

0.53Age-AdjustedDeathRateduetoUnintentionalInjuries

deaths/100,000population 34.1 36.4 37.6 39.2 2010-2014 Male 11

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0.50Age-AdjustedDeathRateduetoFalls

deaths/100,000population 5.1 7.2 7.4 8.3 2010-2014 11

SCORE PUBLICSAFETY UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.06 Alcohol-ImpairedDrivingDeaths percent 32.9 28.3 29.3 2012-2016 4

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.5 8.5 2017 10

0.83 ViolentCrimeRatecrimes/100,000

population 171.2 407.6 2012-2014 4

SCORE RESPIRATORYDISEASES UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.39 COPD:MedicarePopulation percent 11.7 11.1 11.2 2015 3

1.39 TuberculosisIncidenceRatecases/100,000population 1.8 1.0 4.5 2013-2017 11

1.28 Asthma:MedicarePopulation percent 7.7 8.2 8.2 2015 3

0.94Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 42.4 45.5 39.0 43.4 2011-2015 7

0.83LungandBronchusCancerIncidenceRate

cases/100,000population 56.4 53.1 60.2 2011-2015 7

0.67Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 10.8 14.2 15.2 2010-2014 11

SCORE SOCIALENVIRONMENT UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.61 MeanTravelTimetoWork minutes 32.5 25.9 26.1 2012-2016 Male 1

2.58 MedianHouseholdGrossRent dollars 1077 911 949 2012-2016 1

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2.58MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 531 467 462 2012-2016 1

2.19MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1635 1444 1491 2012-2016 1

2.00FemalePopulation16+inCivilianLaborForce percent 53.6 57.7 58.3 2012-2016 1

1.50Population16+inCivilianLaborForce percent 63.7 64.2 63.1 2012-2016 1

1.47 PersonswithHealthInsurance percent 83.1 100.0 81.4 2016 9

1.22People25+withaHighSchoolDegreeorHigher percent 86.8 82.3 87.0 2012-2016

AmericanIndianorAlaskaNative 1

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.5 8.5 2017 10

1.00 TotalEmploymentChange percent 3.5 3.2 2.5 2014-2015 15

0.83 LinguisticIsolation percent 3.7 7.9 4.5 2012-2016 1

0.67VoterTurnout:PresidentialElection percent 65.5 58.8 2016 13

0.61 Homeownership percent 65.6 55.0 55.9 2012-2016 1

0.58 MedianHousingUnitValue dollars 190000 142700 184700 2012-2016 1

0.50 People65+LivingAlone percent 21.5 23.9 26.4 2012-2016 1

0.39 MedianHouseholdIncome dollars 70805 54727 55322 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other,

TwoorMoreRaces 1

0.39 Single-ParentHouseholds percent 23.8 33.3 33.6 2012-2016 1

0.33People25+withaBachelor'sDegreeorHigher percent 33.0 28.1 30.3 2012-2016

25-34,65+AmericanIndianor

AlaskaNative,Other,TwoorMore 1

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Races

0.17ChildrenLivingBelowPovertyLevel percent 14.8 23.9 21.2 2012-2016

HispanicorLatino,Other 1

0.17 PeopleLivingBelowPovertyLevel percent 11.0 16.7 15.1 2012-2016

12-17,18-24,6-11,<6BlackorAfricanAmerican,HispanicorLatino,Other 1

0.17 PerCapitaIncome dollars 35912 27828 29829 2012-2016

AmericanIndianorAlaskaNative,Black

orAfricanAmerican,HispanicorLatino,Other,

TwoorMoreRaces 1

SCORE SUBSTANCEABUSE UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.17 AdultswhoDrinkExcessively percent 21.0 25.4 19.4 18.0 2016 4

2.06 Alcohol-ImpairedDrivingDeaths percent 32.9 28.3 29.3 2012-2016 4

1.08 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.6 9.8 16.9 2014-2016 4

0.67 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015 15

SCORE TRANSPORTATION UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.78 WorkerswhoWalktoWork percent 1.0 3.1 1.6 2.8 2012-2016 1

2.61 MeanTravelTimetoWork minutes 32.5 25.9 26.1 2012-2016 Male 1

2.61SoloDriverswithaLongCommute percent 49.9 36.9 34.7 2012-2016 4

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2.17WorkerswhoDriveAlonetoWork percent 81.5 80.3 76.4 2012-2016 1

1.67WorkersCommutingbyPublicTransportation percent 1.3 5.5 1.5 5.1 2012-2016 16-19,20-24Other 1

1.17HouseholdswithNoCarandLowAccesstoaGroceryStore percent 1.5 2015 16

0.50 HouseholdswithoutaVehicle percent 3.6 5.6 9.0 2012-2016 1

SCORE WELLNESS&LIFESTYLE UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.39 LifeExpectancyforFemales years 80.7 80.8 81.5 2014 6

1.17 InsufficientSleep percent 31.8 32.7 38.0 2016 4

1.00 LifeExpectancyforMales years 76.7 76.2 76.7 2014 6

0.67 FrequentPhysicalDistress percent 9.9 10.8 15.0 2016 4

0.67PoorPhysicalHealth:AverageNumberofDays days 3.3 3.5 3.7 2016 4

0.67Self-ReportedGeneralHealthAssessment:PoororFair percent 14.1 18.2 16.0 2016 4

SCORE WOMEN'SHEALTH UNITSMONTGOMERYCOUNTY HP2020 Texas U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

1.58 CervicalCancerIncidenceRatecases/100,000

females 8.0 7.3 9.2 7.5 2011-2015 7

1.39 LifeExpectancyforFemales years 80.7 80.8 81.5 2014 6

1.33 BreastCancerIncidenceRatecases/100,000

females 117.6 111.7 124.7 2011-2015 7

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1.08Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 19.6 20.7 20.2 20.9 2011-2015 7

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AppendixC.PrimaryDataMethodology

CommunityInputParticipantsAccessHealth(FQHC)(FortBendFamilyHealthCenter)AIDSFoundationofHoustonAssociationfortheAdvancementofMexicanAmericansAvenueCDCCatholicCharities-ArchdioceseofGalvestonCatholicCharities-FortBendChildAdvocatesofFortBendChildrenatRiskChristClinicCityofHouston,DepartmentofParksandRecreationCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceElCentrodeCorazonEpiscopalHealthFoundationFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerce

GulfCoastMedicalFoundationHarrisCountyPublicHealthHealthcarefortheHomeless-HoustonHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictInterfaithCommunityClinicKinderInstituteLegacyCommunityHealthLibertyCountySheriff'sOfficeLoneStarFamilyHealthCenterMidtownArtsandTheaterCenterHoustonMontgomeryCountyWomen'sCenterBaker-RipleyEarlyHeadStartPatientCareInterventionCenter(PCIC)PrairieViewA&MUniversitySantaMariaHostel,Inc.TheArcofFortBendCountyTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeTri-CountyServicesBehavioralHealthcareUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayofHarrisandMontgomeryCountyWestChambersMedicalCenter(FQHC)YMCAofGreaterHouston

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KeyInformantInterviewQuestionnaire(EpiscopalHealthFoundation)• Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],

andIamwithHealthResourcesinAction,anon-profitpublichealthorganizationbasedinBoston.Thankyouforspeakingwithmetoday.

• Aswementionedinourinterviewinvitation,theEpiscopalHealthFoundationis

coordinatinganinterviewinitiativetosupportfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsincludeCHISt.Luke’s,HoustonMethodistHospital,MemorialHermannHealthSystem,andTexasChildren’sHospital.

• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout70stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthebroaderGreater

Houstoncommunityandthepopulationsyouworkwithasaleaderinyourcommunity.TheFoundationandthefourhospitalswelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,HealthResourcesinActionwillprovideatranscriptofyourinterviewtothefourhospitalsforuseinpreparingtheircommunityhealthneedsassessmentreports.Eachhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.HealthResourcesinActionwillalsobepreparingareportofthegeneralthemesthatemergeacrossalltheinterviewstohelpthehospitalspreparetheirreports.

• TheFoundationhasaskedHealthResourcesinActiontoaskallintervieweeshowtheywish

anyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.

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• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW

INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization/agency?

o Hasyourorganization/agencyeverpartneredwithanyofthefourhospitalsinvolvedinthissharedcommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves/theGreaterHoustonpopulationatlarge?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?

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§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyou

thinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,whichwould

yourankasyourtopissue?Howdoyouseethisissueaffectingcommunitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbybarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o Whatdoyouseeasthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whatdoyouseeasitslimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfaceinaccessinghealthcareand

socialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofinthecommunitythataddressaccess

tohealthcareandsocialservices?

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o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenat

addressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesarecurrentlynotavailablethatyouthinkshouldbe?

IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)• Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercome

oraddressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyaren’tdoingrightnow?Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstothefourhospitals.Eachhospitalwillmaketheircommunityhealthneedsassessmentreportspubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoJenniferMineoattheEpiscopalHealthFoundationwhoiscoordinatingthiseffortonbehalfofthefourhospitals.Thankyouagain.Haveagoodmorning/afternoon.

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KeyInformantInterviewQuestionnaire(ConduentHealthyCommunitiesInstitute)Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],andIamwithConduentHealthyCommunitiesInstitute.Mycolleague[name]isalsoontheline.WeareworkingwithMemorialHermannHealthSystemtoconductaCommunityHealthNeedsAssessment.• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout12stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthecommunityandthe

populationsyouworkwithasaleaderinyourcommunity.MemorialHermannwelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,wewillanalyzeandsummarizealltheinterviewstoincorporateintothecommunityhealthneedsassessmentreports.EachMHhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.

• MemorialHermannhasaskedHCItoaskallintervieweeshowtheywishanyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.

• Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.

• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW

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INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization?

o Hasyourorganization/agencyeverpartneredwithMH’scommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?

§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyou

thinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

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§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,whichwouldyourankasyourtopissue?Howdoyouseethisissueaffectingcommunitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbythesebarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o WhatAREthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whataresomeoftheirlimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfacewhenaccessinghealthcare

andsocialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofthataddressaccesstohealthcare

andsocialservices?

o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenataddressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesnotavailablethatyouthinkshouldbe?

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IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)• Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeor

addressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyarenotdoingrightnow?

o Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstoMemorialHermann.Thecommunityhealthneedsassessmentreportswillbepubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoDeborahGanelinatMemorialHermannwhoiscoordinatingthiseffort.Thankyouagain.Haveagoodmorning/afternoon.

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CommunitySurvey(English)MemorialHermannHealthSystemisconductingaCommunityHealthNeedsAssessmentfortheGreaterHoustonarea.ThisassessmentallowsMemorialHermanntobetterunderstandthehealthstatusandneedsofthecommunityandusetheknowledgegainedtoimplementprogramsthatwillbenefitthecommunity.Wecanbetterunderstandcommunityneedsbygatheringvoicesfromthecommunity.Thissurveyallowscommunitymemberslikeyoutotellusaboutwhatyoufeelareimportantissuesforyourcommunity.Weestimatethatitwilltakeabout5minutestocompletethissurvey.Thankyouverymuchforyourinputandyourtime!1. Pleaselookatthislistofcommunityissues.Inyouropinion,whatarethetop5issuesmost

affectingthequalityoflifeinyourcommunity?o Diabeteso Obesity/Overweighto Respiratory/LungDisease(asthma,COPD,etc.)o Cancerso MentalHealthandMentalDisorderso Injuries,ViolenceandSafetyo SubstanceAbuse(alcohol,tobacco,drugs,etc.)o OralHealtho HeartDiseaseandStrokeo SexualHealth(HIV/AIDS,STDs,etc.)o TeenagePregnancyo ElderCareo ReproductiveHealth(familyplanning)o Other(pleasespecify):______________________________

2. Howwouldyourateyourownpersonalhealth?

o Veryhealthyo Somewhathealthyo Unhealthyo Veryunhealthy

3. Abouthowmanytimesaweekdoyouexerciseorperformaphysicalactivitylikewalking,

running,bicycling,etc.?o Lessthan1timeaweeko 2-3timesaweeko 5ormoretimesaweeko Nevero Other(pleasespecify):______________________________

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4. Whataresomeofthebarriersorchallengestoexercisingonaregularbasisforyou?

o Noplacestoexerciseo Notimetoexerciseo Idon’tlikeexercisingo Feelunsafeexercisinginthecommunityo Noneofmyfriendsorfamilyexerciseo Nochildcareo Lackoffundstopayforgymorclasseso Notransportationo Other(pleasespecify):______________________________

5. Howmuchdoyouagreeordisagreewitheachofthestatementsbelow. Agree

stronglyAgree Disagree Disagree

stronglyTherearegoodparksforchildren,adultsandpeopleofallabilitiestoenjoyinmycommunity

Inthepast12months,IhadaproblemgettingthehealthcareIneededformeorafamilymemberfromanytypeofhealthcareprovider,dentist,pharmacy,orotherfacility

Idon’tknowwheretogetservicesformyselfwhenIamsad,depressedorneedsomeonetotalkto

IamconfidentIcangetanappointmentwhenIneedtoseemydoctorfairlyquickly

Ihaveaplacetoreceivemedicalcareotherthantheemergencyroom

Withinthepast12months,IworriedwhethermyfoodwouldrunoutbeforeIgotmoneytobuymore

Withinthepast12months,thefoodIboughtjustdidn’tlastandIdidn’thavemoneytogetmore

Therearemanyoptionsforhealthyandaffordablefoodinmycommunity

6. Hasyourdoctorevertoldyouthatyouhaveanyofthefollowing?(Markallthatapply)

o Highbloodpressureo Highcholesterolo Cancero Diabeteso Obesityo Asthmao Heartdiseaseo Other(pleasespecify):______________________________

Now,afewquestionssothatwecanseehowdifferenttypesofpeoplefeelaboutthequestionsasked.

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7. Zipcodewhereyoulive:______________________________8. Whatisyourage?______________________________9. Whatisyourrace/ethnicity?

o Whiteo Black/AfricanAmericano Hispanic/Latinoo Asian/PacificIslandero NativeAmericano Other(pleasespecify):______________________________

10. Whataretheagesofchildrenlivinginyourhousehold?

o 11andyoungero 12-18yearsoldo 18andoldero None

11. Whatkindofmedicalinsuranceorcoveragedoyouhave?

o Privateo Employer-sponsoredo Medicaido Medicareo Noneo Other(pleasespecify):______________________________

Thankyouforcompletingthissurvey!

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CommunitySurvey(Spanish)MemorialHermannHealthSystemestárealizandounaEvaluacióndelasNecesidadesdeSaluddelaComunidadeneláreametropolitanadeHouston.EstaevaluaciónpermiteaMemorialHermann

comprendermejorelestadodesaludylasnecesidadesdelacomunidad,asícomousarlainformaciónobtenidaparaponerenprácticaprogramasquebeneficienalacomunidad.

1.Lealalistadeproblemasdelacomunidad.Ensuopinión¿cuálessonlos5problemasquemásafectanlacalidaddevidaensucomunidad?□ Diabetes□ Obesidad/sobrepeso□ Enfermedadesrespiratorias/pulmonares(asma,enfermedadpulmonarobstructivacrónica[EPOC],etc.)

□ Cáncer□ Saludmentalytrastornosmentales□ Lesiones,violenciayseguridad□ Drogodependencia(alcohol,tabaco,drogas,etc.)

□ Saludbucal□ Enfermedadescardíacasyaccidentescerebrovasculares

□ Saludsexual(VIH/sida,enfermedadesdetransmisiónsexual[ETS],etc.)

□ Embarazosdeadolescentes□ Cuidadodeancianos□ Saludreproductiva(planificaciónfamiliar)

□ Otros,(especifique):_________________________________________________________

2.¿Cómocalificaríasupropiasaludpersonal?□ Muybuena□ Bastantebuena

□ Mala□ Muymala

3.¿Aproximadamente,cuántasvecesporsemanahaceejerciciooalgunaactividadfísica,comocaminar,correr,andarenbicicleta,etc.?□ Menosde1vezporsemana□ De2a3vecesporsemana

□ 5omásvecesporsemana□ Nunca

□ Otros,(especifique):_________________________________________________________

4.¿Cuálessonalgunasdelasbarrerasodificultadesqueleimpidenhacerejercicioregularmente?□ Notengounlugardondehacerejercicio.□ Notengotiempoparahacerejercicio.□ Nomegustahacerejercicio.□ Nomesientoseguro/ahaciendoejercicioenmicomunidad.

□ Ningunodemisamigosofamiliareshacenejercicio.

□ Notengoconquiéndejaramishijosmientrashagoejercicio.

□ Notengodineroparapagarungimnasiooclases.

□ Notengoaccesoatransporte.

□ Otros,(especifique):_________________________________________________________

Calculamosqueletomaráunos5minutoscompletarestaencuesta.

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5.¿Lehadichosumédicoalgunadelassiguientesafecciones?(Marquetodaslasopcionesquecorrespondan).□ Presiónarterialalta□ Colesterolalto□ Cáncer□ Diabetes

□ Obesidad□ Asma□ Enfermedadcardíaca

□ Otros,(especifique):_________________________________________________________

6.¿Enquémedidaestádeacuerdooendesacuerdoconcadaunadelassiguientesafirmaciones? Muyde

acuerdoDe

acuerdoEn

desacuerdoMuyen

desacuerdoEnmicomunidad,haybuenosparquesparaniños,adultosypersonascontodotipodecapacidadesparanuestrodisfrute.

Enlosúltimos12meses,tuveunproblemaparaobtenerelcuidadomédicoquenecesitabaparamíoparaunfamiliarporpartedecualquiertipodeproveedordecuidadodelasalud,dentista,farmaciauotrocentrosanitario.

Nosédóndeobtenerserviciosparamícuandoestoytriste,deprimido/a,onecesitohablarconalguien.

Séconseguridadquepuedoobtenerunacitaconmimédicoconciertarapidez.

Tengoamidisposiciónunlugarpararecibircuidadosmédicosquenoseaunasaladeemergencias.

Enlosúltimos12meses,mepreocupédesilacomidaseagotaríaantesdeobtenerdineroparacomprarmásalimentos.

Enlosúltimos12meses,losalimentosquecomprésimplementenoduraronlosuficienteynotuvedineroparacomprarmás.

Enmicomunidadhaymuchasopcionesparacompraralimentossaludablesyasequibles.

7.Códigopostaldesucasa:_________________________8.¿Cuántosañostiene?_________________9.¿Cuálessuraza/origenétnico?□ Blanco/a□ Negro/aoafroamericano/a□ Hispano/aolatino/a

□ Asiático/aoisleño/adelPacífico□ Indígenaamericano/a□ Otro/a,(especifique):______________

10.¿Cuántosañostienenlosniños/asquevivenensucasa?

Ahoraleharemosalgunaspreguntasparapodervercómosesientenlosdistintosgruposdepersonasacercadelaspreguntasquelehemoshecho.

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□ 11ymenos□ Entre12y18años

□ Másde18años□ Ninguno

11.¿Quétipodeseguromédicoocoberturatiene?□ Privado□ Patrocinadoporunempleador□ Medicaid

□ Medicare□ Ninguno□ Otro,(especifique):________

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AppendixD.PrioritizationTool

PrioritizationSurveyThankyouforyourparticipationinthisprioritizationprocess.TheCommunityHealthNeedsAssessment(CHNA)processhasmultiplesteps.Afterthoroughresearchhasbeencompletedtoidentifythesignificanthealthneedsinthecommunity,thesesignificanthealthneedsmustbeprioritizedforfurtherstrategicplanningandimplementation.Prioritizationistheprocessofdeterminingthemostimportantorurgenthealthneedstoaddressincommunities.BelowisadiagramthatshowsthemethodsthatwereusedtoidentifykeyissuesacrossMemorialHermann’sserviceareas.Thesethreemethodsincluded:asecondarydatareview,acommunitysurveyandkeyinformantinterviews.Asyousee,someissuesrevealedthemselvesacrossmultiplemethods.Reviewingthisdiagrammayhelpyoucompletethissurvey.

1. Thefollowinghealthneedsarenotlistedbyorderofimportance.Foreachhealthneed,click

onthearrowonthedropdownboxandselectyouragreementwitheachstatement.Ifyouareonatabletorphone,pleasescrollallthewaytotherightforeachrow.

Theissueimpactsmanypeopleinmycommunity

Thisissuesignificantlyimpacts

Therearenotenoughexistingandadequate

Thisissuehashighriskfordiseaseordeath

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subgroups(subgroupsbyage,gender,race/ethnicity,LGBTQ,etc.)

resourcestoaddressthisissueinmycommunity

AccesstoHealthServices

HeartDiseaseandStroke

OlderAdultsandAging

Obesity(Exercise,NutritionandWeight)

Transportation MentalHealth Diabetes SubstanceAbuse Cancers LackofHealthInsurance

Education FoodInsecurity Low-Income/Underserved

Children’sHealth Economy 2. IndicatethelevelofimportancethatshouldbegiventowardseachofMemorialHermann’s

4Pillars.Keydefinitionsarelistedbelow.

NotImportant

SomewhatImportant

Important VeryImportant

NotSure

Accesstocare(includinghealthcareaccess,healthcareresourceawareness,healthcarenavigation/literacy)

Foodashealth(includingfoodinsecurity,foodprograms,foodknowledge)

Exerciseasmedicine(includingobesity,accesstoparks,safeplacestoexercise)

Emotionalwell-being(includingemotionalhealth,mentalhealth,substanceabuse)

Keydefinitions:

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Healthcarenavigation/literacy:needforeducationinnavigatinghealthsystemsFoodinsecurity:lackingreliableaccesstohealthyfoodoptionsFoodprograms:programs,effortsorservicesdesignedtoaddressfoodissuesFoodknowledge:one’sunderstandingofhealthyfoods3. Whoinyourcommunityismostaffectedbypoorhealthoutcomes?(Selectupto5)

o Lesbian,Gay,Bisexual,Transgender,QueerorQuestioning(LGBTQ)o OlderAdultso PersonswithDisabilities(cognitive,sensoryorphysicaldisability)o Racial/EthnicMinorityPopulationso Veteranso Immigrantsorotherundocumentedpersonso Personsexperiencinghomelessnessorprecariouslyhousedo OtherPopulations(pleasespecify):____________________________

4. Pleaseprovideyourname:__________________________________________

5. Pleaseprovideyouremailaddress:__________________________________________

6. Pleaseselectthename(s)ofthehealthcarefacilityorfacilitiesyourepresent.Youmay

choosemorethanone.o MemorialHermannKatyo MemorialHermannMemorialCityo MemorialHermannGreaterHeightso MemorialHermannNortheasto MemorialHermannSoutheasto MemorialHermannSugarLando MemorialHermannSouthwesto MemorialHermannTheWoodlandso KatyRehabo TexasMedicalCentero TIRRMemorialHermanno MemorialHermannSurgicalHospitalKingwoodo MemorialHermannSurgicalHospitalFirstColonyo MemorialHermannFirstColonyHospital(ER)o MemorialHermannTomballHospital(ER)o Other(pleasespecify):_____________________________

ThankyouforyourinputandparticipationintheCommunityHealthNeedsAssessmentprocess.

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AppendixE.CommunityResourcesThefollowingisalistofcommunityresourcesmentionedbycommunityinputparticipants.2-1-1TexasA.C.TaylorHealthCenterAccessHealthAcresHomeHealthCenterAIDSFoundationHoustonAldineHealthCenterAmericanHeartAssociationAmericanRedCrossAmistadCommunityHealthCenterAreaAgencyonAgingAssociationfortheAdvancementofMexicanAmericansAvenue360Health&WellnessAvenueCDCBaker-RipleyBastropCommunityHealthCenterBaylorTeenHealthClinicBaysideClinicBaytownHealthCenterBeeBusyWellnessCenterBoatPeopleSOSBo'sPlaceBrighterBitesBrownsvilleCommunityHealthCenterBuffaloBayouPartnershipBurlesonFamilyMedicalCenterBVCAA-HealthPointCanDoHoustonCasadeAmigosHealthCenterCasaElBuenSamaritanoCatholicCharitiesoftheArchdioceseofGalveston-Houston-FortBendCentralCareCommunityHealthChambersCommunityHealthCenterCHISt.Luke'sHealthChildAdvocatesofFortBendChildrenatRiskChristClinicChristianCommunityServicesCenter(CCSC)CHRISTUSHealthSystemCitiesChangingDiabetesCityofHouston

CityofHouston,DepartmentofParksandRecreationCityofPasadenaCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceCountyIndigentHealthCareProgramCovenantwithChristCommunityServiceCenterCypressHealthCenterDannyJacksonHealthCenterDentalHygieneClinicE.A."Squatty"LyonsHealthCenterElCentroDeCorazonElFrancoLeeHealthCenterEpiscopalHealthFoundationFamilyServices(GalvestonCounty)FortBendConnectFortBendCountyCollaborativeInformationSystemFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGoHealthyHoustonTaskForceGoodRxGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerceGulfCoastCommunityServicesAssociationGulfCoastMedicalFoundationGulfgateHealthCenterHarmonyHouseRespiteCenterHarrisCenterCrisisLineHarrisCountyPublicHealthandEnvironmentalServices(HCPHES)HarrisCountyRidesHarrisCountySocialServices

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HarrisHealthSystemHarvestGreen(Development)HEALInitiativeHealthCenterofSoutheastTexasHealthcarefortheHomeless-HoustonHealthyLivingMatters(HarrisCounty)HelpingHandsFoodPantryHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictHoustonRyanWhitePlanningCouncilHoustonShifaSynottClinicHuntsvilleMemorialHospitalClinicIbnSinaFoundationIndiaHouseCharityClinicInterfaithCommunityClinicInterfaithMinistriesMealsonWheelsInterfaithofTheWoodlandsKinderInstituteLaNuevaCasaHealthCenterLegacyHealth(FQHC)LeonCountyCommunityHealthCenterLibertyCountySheriff'sOfficeLoneStarFamilyHeathCenter(FQHC)LongBranchHealthCenterLongTermRecoveryGroupLosBarriosUnidosCommunityClinicMagnoliaHealthCenterMamieGeorgeCommunityCenterMartinLutherKingJr.HealthCenterMedicalPlusSuppliesMEHOP-MatagordaEpiscopalHealthOutreachProgramMETHeadStartMethodistHospitalMetroliftMidtownArtsandTheaterCenterHoustonMontgomeryCountyFoodBankMontgomeryCountyWomen’sCenterNeighborhoodHealthCenterNorthwestAssistanceMinistry'sChildren'sClinicNorthwestHealthCenterNuestraClinicadelValle

PatMcWatersHealthClinic-SecondMileMissionPatientCareInterventionCenter(PCIC)PearlandCommunityHealthCenterPediatric&AdolescentHealthCenterPhysiciansatSugarCreekPlannedParenthoodPrairieViewA&MUniversityQuentinMeaseHospitalRegionalAssociationofGrantMakersRegionalMedicalCenterRobertCarrascoHealthClinicRSVPMedSpaSanJoseClinicSantaMariaHostel,Inc.SettegastHealthCenterSevaClinicCharityMedicalFacilityShelteringArmSeniorServicesDivisionofBakerRipleyShifaClinicSmithClinicSocialSecurityAdministrationSpringBranchCommunityHealthCenterSt.HopeFoundationSt.Vincent'sHouseStephenF.AustinCommunityHealthNetworkStrawberryHealthCenterTexanaBehavioralHealthTexasA&MAgriLifeExtensionServiceTexasChildren’sHospitalTexasMedicaidandCHIPMedicalTransportationProgramTheArcofFortBendCountyTheBeaconTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeThomasStreetHealthCenterTOMAGWAClinicTri-CountyServicesBehavioralHealthcareUberHealthUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayProjectBlueprint

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UniversityofHouston-CollegeofOptometryUniversityofTexasHealth-DentalUniversityofTexasHealthServicesUniversityofTexasPhysiciansUrbanHarvestUTMBValbonaHealthCenterVCareClinicVecinoHealthCenterWestChambersMedicalCenter(FQHC)WestHoustonAssistanceMinistries(WHAM)WholeLifeServiceCenterWomen'sCareCenterWorkforceSolutionsYMCAofGreaterHouston