[PPT] - Cowley County, Kansas: Community Health Needs Assessment Jacqueline PowerPoint Presentation

SLIDE 1

Cowley County, Kansas: Community Health Needs Assessment

Jacqueline Hill, MPH, CHES & Lori Timmons, MA Ray & Associates, LLC July 2012

SLIDE 2

Agenda

Cowley County Overview
Planning Grant Purpose and R&A Role
Data Collection Methods
Findings
Summary

Ray & Associates, LLC | July 2012 | 2

SLIDE 3

Statistic Cowley County State of Kansas Total population1 36,311 2,853,118 Caucasian race1 89.8% 87.4% 65+ years old1 16.1% 13.3% Has bachelor’s degree or higher1 19.5% 29.3% Median household income1 $40,749 $49,424 Lives at or below 200% FPL2 37.6% 14.6% Has children in single-parent households3 33.0% 28.0% Qualifies for free/reduced lunches4 61.0% 47.4%

FPL = federal poverty level; In 2011, FPL = $10,980 for an individual or $22,350 for a family of four.5

Ray & Associates, LLC | July 2012 | 3

Cowley County Population Statistics

SLIDE 4

Cowley County Population Statistics

0% 4% 8% 12% 16% 20% 2010 2011 2012

Percent of Uninsured Adults3

Cowley County Kansas National Benchmark

Ray & Associates, LLC | July 2012 | 4

SLIDE 5

Statistic5 National Benchmark Severe Benchmark Cowley County Age-adjusted diabetes rate 6.5% 7.8% 8.0% High blood pressure diagnoses 24.8% 27.7% 35.8% Cigarette use during pregnancy 10.7% 14.3% 26.2% Age-adjusted death rate 870/ 1,000,000 n/a 1,056/ 1,000,000

Ray & Associates, LLC | July 2012 | 5

Cowley County Population Statistics

Cowley County ranks in the bottom 20% of ranked Kansas counties
n summary health scores:5
Health outcomes (82 of 99 counties)
Health behaviors (86 of 99 counties)

SLIDE 6

Federal Planning Grant

Vision 20/20 Strategic Plan
Planning grant from Health Services Resources

Administration (HRSA) in August 2011

Purpose of grant is to support development of

community heath centers (CHCs)6

Before applying for additional federal funding,

Ray & Associates, LLC conducted a needs assessment7 to determine:

Consumer health care needs
Resident access to care
Community receptivity to health center

Ray & Associates, LLC | July 2012 | 6

SLIDE 7

Data Collection Methods

Collected quantitative and qualitative data8
Guided by input from Steering Committee
Gathered information on perceived health

needs and barriers to care access in county:

Provider Surveys
Stakeholder Interviews
Community Surveys
Focus Groups
Used to formally establish priorities and

community support7

Ray & Associates, LLC | July 2012 | 7

SLIDE 8

Provider Survey

20 practice-level telephone surveys performed by nurse

volunteers in April 2012

Surveys encompassed 58 providers:
21 physicians
10 physician assistants/nurse practitioners
1 midwife
12 dentists
14 hygienists

Ray & Associates, LLC | July 2012 | 8

SLIDE 9

Provider Survey Findings

Appointments for Medicaid patients:
20% dedicate specific slots to Medicaid patients
65% of providers, 40% of dentists accept Medicaid
Of those who accept Medicaid patients:
30% accept children (ages 0-21)
69% have the same wait times as other patients
31% have to wait more than 2 weeks for an appointment
Providers receive daily (40%) and weekly (25%) requests to

accept new Medicaid patients

Ray & Associates, LLC | July 2012 | 9

SLIDE 10

Provider Survey Findings

80% have had to turn patients away:
25% for payment issues or being Medicaid patient
15% for prescription drug abuse or full schedules
45% have patients who have been unable to pay, primarily

because of high deductibles or no insurance

Provider accommodations for patient payments:
15% have a sliding-fee scale for patients
25% make payment arrangements with patients
80% have difficulty collecting patient payments

Ray & Associates, LLC | July 2012 | 10

SLIDE 11

Stakeholder Interviews

Ray & Associates, LLC | July 2012 | 11

12 semi-structured individual interviews conducted with

key stakeholder representatives in March 2012

Interviewees included:
Physicians and hospital administrators
Education officials and community organization

representatives

Local business owners and city managers

SLIDE 12

Common Interview Threads

Ray & Associates, LLC | July 2012 | 12

Emergency rooms are used a source of primary medical care
Those with insurance often have high deductibles that

prevent them from seeking care

Transportation concerns, taking time off work, and low health

literacy levels are barriers to seeking care

After hours and weekend care would help working families
Affordable primary care, dental care, mental health, and case

management services are needed

Agreement that CHC would 1) not be threat to busy provider

community, 2) reduce inappropriate ED use, and 3) provide medical home for under/uninsured

SLIDE 13

2,700 paper surveys printed
12 questions
English or Spanish
Distributed throughout county
1,872 valid surveys returned (69%)
1,845 in English (99%)
32 web-based surveys

completed (2%)

Short Survey

Two point-in-time surveys conducted in March/April 2012
495 paper surveys printed
31 questions
English or Spanish
Distributed via volunteers
252 valid surveys returned (51%)
226 in English (89%)

Long Survey

Ray & Associates, LLC | July 2012 | 13

Community Surveys

SLIDE 14

Survey Respondent Location (n = 2,214)

Winfield 62% Ark City 27% Burden 2% Udall 3% Other Zip Codes 6%

15 total zip codes
9 city zip codes (82%)
6 partial zip codes (18%)

Ray & Associates, LLC | July 2012 | 14

Community Survey Demographics

SLIDE 15

Females (68%) responded

to surveys more often than males (32%)

Majority of respondents (42%)

were 36-64 years old

Surveys for those under 18

years of age were typically completed by parents

Ray & Associates, LLC | July 2012 | 15

Gender & Age Race/Ethnicity & Language Family & Household Size Education & Income

Community Survey Demographics

Age Group (n = 2,091)

Under 18 12% 36-64 42% 18-35 29% 65+ 17%

SLIDE 16

Majority of respondents were

Caucasian (86%)

18% of respondents were of

Hispanic ethnicity

Respondents reported

primarily speaking English (91%), Spanish (8%), and Laotian (1%) at home

Ray & Associates, LLC | July 2012 | 16

Gender & Age Race/Ethnicity & Language Family & Household Size Education & Income

Community Survey Demographics

Self-Reported Race (n = 227)

Caucasian 86% Other 10% African American 4%

SLIDE 17

Respondents’ family sizes

ranged from 1 to 11, with most common family size being 2 people

Majority of respondents were

married (37%) or single (33%)

Ray & Associates, LLC | July 2012 | 17

Household Status (n = 250)

Married 37% Live-In Partner 13% Single 33% Separated 17% Gender & Age Race/Ethnicity & Language Family & Household Size Education & Income

Community Survey Demographics

SLIDE 18

Majority of respondents

finished high school/have GED (37%) or completed some college (38%)

Most respondents’

households earn less than $2,000 per month (65%)

Ray & Associates, LLC | July 2012 | 18

Monthly Household Income (n = 209)

>$1,000 28% $3,000-3,999 4% $1,000-1,999 37% $2,000-2,999 18% $4,000+ 13% Gender & Age Race/Ethnicity & Language Family & Household Size Education & Income

Community Survey Demographics

SLIDE 19

Ray & Associates, LLC | July 2012 | 19

Insurance Health Status Providers ER Use Appointments

* Some respondents had both Medicare and Medicaid.

74% of respondents had

health insurance and 45% had dental insurance

75% of respondents stated

they would use fee-based health and dental clinics

Community Survey Findings

Health Insurance Type (n = 1,859)*

0% 10% 20% 30% 40% 50% Medicaid Medicare Private Insurance No Insurance

SLIDE 20

Ray & Associates, LLC | July 2012 | 20

Insurance Health Status Providers ER Use Appointments

Respondents identified the

following needed services to improve their health:

Family doctor (55%)
Dentist (51%)
Eye doctor (43%)
Women’s doctor (36%)
Children’s doctor (27%)

Community Survey Findings

Self-Rated Health Status (n = 246)

0% 10% 20% 30% 40% 50% Very Good Good Fair Poor Very Poor

SLIDE 21

Ray & Associates, LLC | July 2012 | 21

Insurance Health Status Providers ER Use Appointments

Majority of respondents

(50%) reported going to the doctor only when they are very sick or hurt

37% of respondents go to

the doctor for regular check-ups

* Some respondents listed more than one provider location.

Community Survey Findings

Primary Health Providers (n = 252)*

0% 15% 30% 45% 60% 75% Doctor's Office Hospital ER Health Dept None Other Clinic

SLIDE 22

Ray & Associates, LLC | July 2012 | 22

Insurance Health Status Providers ER Use Appointments

* Some respondents listed more than one reason.

Cost Concerns:
out-of-pocket costs (52%)
expensive medication (36%)
no health insurance (32%)
inadequate insurance (20%)
Appointment Concerns:
availability of times (24%)
wait times (11%)

Community Survey Findings

0% 15% 30% 45% 60% Can't Afford Appt Time Don't Know Where Other

Appointment Difficulties*

Immediate Concern (n = 1,343) Regular Check-Up (n = 1,223)

SLIDE 23

Ray & Associates, LLC | July 2012 | 23

Insurance Health Status Providers ER Use Appointments

ER use among respondents

varied from 0 to 20 visits last year

Majority of respondents

(38%) visited the ER 1 or 2 times last year, while 35% had no ER visits

Community Survey Findings

ER Visits in Last 12 Months (n = 232)

0% 10% 20% 30% 40% 1 2 3 4+

SLIDE 24

Focus Groups

8 focus groups conducted by trained researcher in March

2012 with individuals representing:

Social workers
School nurses
Behavioral health clients
Elderly individuals
Teachers
WIC clients
Laotian community
Hispanic community

Ray & Associates, LLC | July 2012 | 24

SLIDE 25

Focus Group Common Threads

Care seeking behavior:
Primary locations are family physicians and emergency rooms
Care is postponed due to costs and appointment times
Payment difficulties:
High copays and deductibles (out-of-pocket costs)
Unpaid past bills
Earn too much for HealthWave, but can’t afford private insurance
Income-based fee health and dental clinics:
Community members want them
Feel it is reasonable to pay something for care

Ray & Associates, LLC | July 2012 | 25

SLIDE 26

Focus Group Common Threads

Ways to improve access to health services:
Appointment times (evenings, weekends)
Affordable services
Transportation
Assistance finding appropriate services, completing forms
Bilingual providers (Spanish, Laotian)
Health care services needed locally:
Dental
Vision
Health education (asthma, diabetes, antibiotics)

Ray & Associates, LLC | July 2012 | 26

Obstetrics
Pediatrics

SLIDE 27

Summary

Cowley County has:
Higher than average rates of health care needs,

particularly for chronic conditions

Lower than average levels of personal resources

(e.g., income, insurance)

Major barriers to accessing care include:
Out-of-pocket costs (high deductibles, inadequate
r no insurance, unpaid bills)
Appointment availability (wait times, taking time
ff work during business hours)
Emergency rooms are utilized as a source of

regular health care

Ray & Associates, LLC | July 2012 | 27

SLIDE 28

Summary

Services community wants locally:
Dental
Vision
Assistance finding appropriate services,

completing forms

Findings demonstrate support for community

health center:

Health care needs
Care access barriers
Community desire and willingness to pay

Ray & Associates, LLC | July 2012 | 28

Obstetrics
Pediatrics

SLIDE 29

References

1.

U.S. Census Bureau. (2012). State and County QuickFacts. Accessed July 2012 from http:// quickfacts.census.gov/qfd/states/20/20035.html.

2.

Cowley County Planning Grant Narrative. (2011). Data accessed July 2012 from Health Services and Resources Administration submission.

3.

Robert Wood Johnson Foundation. (2012). County health rankings and roadmaps. Accessed July 2012 from http://www.countyhealthrankings.org/app/kansas/2012.

4.

Institute for Policy & Social Research. University of Kansas. (2011). Free or Reduced Price Lunch Program Enrollment in Kansas by County. Accessed July 2012 from http://www.ipsr.ku.edu/ksdata/ ksah/education/6ed21.pdf .

5.

Vision 20/20. (2011). Accessible health care: Data for Cowley County, Kansas. Data accessed July 2012 from Health Services and Resources Administration planning grant submission.

6.

Health Services and Resources Administration. (2012). Health center planning grants technical

assistance. Accessed July 2012 from http://www.hrsa.gov/grants/apply/assistance/planning/.

7.

Centers for Disease Control and Prevention. (2007). General considerations regarding health education and risk reduction activities. Accessed July 2012 from http://www.cdc.gov/hiv/resources/guidelines/ herrg/gen-con_community.htm.

8.

National Institutes of Health. (2010). Best practices for mixed methods research in the health sciences. Accessed July 2012 from http://obssr.od.nih.gov/mixed_methods_research/pdf/ Best_Practices_for_Mixed_Methods_Research.pdf. Ray & Associates, LLC | July 2012 | 29