community health needs assessment - mercyone · community health needs assessment . june 27, 2016...

Community Health Needs Assessment

June 27, 2016

An assessment of Chickasaw County conducted by Mercy Medical Center – New Hampton

Mission: We serve together at Mercy Medical Center - New Hampton with

Trinity Health in the spirit of the Gospel, to heal body, mind and spirit, to improve

the health of our communities and to steward the resources entrusted to us.

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Amended November 11, 2016

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Introduction Summary of Previous CHNA Mercy's previous community health needs assessment was adopted by the Board of Directors in December of 2012. Mercy-New Hampton performed the CHNA in adherence with certain federal requirements for not-for-profit hospitals set forth in the Affordable Care Act and by the Internal Revenue Service. The assessment took into account input from representatives of the community, community members, and various community organizations. The CHNA conducted in June and July 2012 identified 5 significant health needs within the Mercy – New Hampton community. The Planning Team members agreed on a set of criteria to use in evaluating the list of High-Potential Opportunities identified through the fact-finding process. The criteria included:

• The Prevalence or degree of customer need throughout the identified service area, measured by the number of people affected.

• The Threat or degree to which not addressing the need jeopardizes vital community health needs or organizational capabilities.

• Trends in the identified service area, i.e. is the situation worsening over time? • The estimated Degree of Difficulty of addressing the need, i.e. does MMC-NH possess

demonstrated skills and capabilities in this area? If not, are there community partners who do? • The estimated community Health Reward or Return on Investment of a successful outcome. • Other issues as noted.

Mercy – New Hampton's resources and overall alignment with the hospital’s mission, goals and strategic priorities were taken into consideration of the significant health needs identified through the most recent CHNA process. Mercy focused on developing and/or supporting initiatives and measure their effectiveness, to improve the following health needs. Below each health need listed is a summary of the progress that has been made over the past three years.

• Improve Community Health o Medventive patient health registry, was implemented in February 2014 which enables the family

clinic to track patients by disease conditions. In addition, a health coach was hired to track patients by disease conditions, and to make phone calls to all patients due for a physical, mammogram or colonoscopy. Mercy's Wellness Coordinator/ATC is working with school for athletic trainer responsibilities. The wellness coordinator serves on our area Food and Fitness Coalition, Chickasaw Connections (underage drinking coalition) and the Chickasaw County Board of Health.

• Access to Family Clinic o At the time the focus groups were being held, there was limited access for acute patients. An

open access initiative now in place sets a goal of having 25% of all appointments available open at start of clinic hours each day. Mercy Family Clinic made process improvement changes to the weekly INR appointments to maximize provider availability. Mercy saw an increase in patient and provider satisfaction since more openings are available, they were double-booking less and staying on schedule with appointments.

• Awareness of Services o In response to our CHNA, Mercy strategically set out to communicate to communities,

organizations and individuals about the services of Mercy - New Hampton. Mercy wanted to create "top of mind awareness" so Mercy was the first healthcare provider that came to mind

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when someone faced a healthcare concern. An annual report presentation was developed and presented to civic groups & local government (board of supervisors, NH city council, NH Lions, Fredericksburg Lions). The presentation also emphasizes Mercy's role in promoting community health. Mercy developed a postcard mailer campaign with CRM (Consumer Relationship Management) to target consumers for mammograms and colonoscopies. Mercy worked with area industries to choose Mercy – New Hampton for their pre-employment physicals and hearing testing.

• Increase Access to Mental Health Services o Mercy determined it was important to establish relationships with area providers in order to

enhance communication with primary providers and determine future needs of mental health services. A meeting of local BHS providers was held to gain their assessment of the need for increasing local access and possible solutions. A crisis intervention processes was created that is now utilized by the clinic and emergency room.

Executive Summary During 2015-16, a Community Health Needs Assessment (CHNA) was conducted by Mercy Medical Center – New Hampton (MMC-NH) for the 12,246 residents of Chickasaw County, IA. Chickasaw County includes its county seat, New Hampton, a town of 3,564 residents located in the midst of the rolling farmland of north-east Iowa. MMC-NH, an 18-bed Critical Access Hospital, serves New Hampton and essentially all the surrounding rural areas in Chickasaw County. The assessment process was initiated by MMC-NH. A planning team was formed consisting of representatives from hospital governance, leadership and medical staff, area employers, school districts and area health professionals. (Names and roles can be found in Attachment A.) The following report will demonstrate how our CHNA resulted in the following significant health needs being identified: primary care access (including continuity of care); behavioral health / chemical dependency; area pharmacy demand exceeds availability; and maintain / increase specialty services. CHNA Report Table of Contents Page • Community Served 2

o Geographic Area 3 o Population Identification 3 o Demographics 4 o Services Provided 5

• Process & Methods Used 5 o Data & Sources 5 + Attachments o County Health Rankings 6 o Methods Used to Collect & Analyze Data 13 o Description of any parties collaborated with 5

• Collaborative Partners 12 • Community Input 5 & 13 • Significant Community Health Needs 14 _________________________________________________________________________________________

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Communities Served by Mercy – New Hampton & Population Identification

Chickasaw County is predominately rural and heavily dependent on agriculture. The county’s population dropped 1.4% from 2010 to 2014; by comparison, Iowa’s population grew 2% over the same time period. As an indicator, population trends are relevant because a shrinking population base affects healthcare providers and the utilization of community resources. In general, rural populations are older, poorer and less educated than their urban counterparts, with higher prevalence of chronic diseases. Chickasaw County is no exception. The county’s population is predominately white (98.3%). And, though median household income of $43,971 is only 85% of the Iowa state

average, the 10.3% of persons below the poverty level is better than the Iowa average of 12.4%. 19.4% of the population is 65 years and over, compared to 15.8% in Iowa. Only 13.8% of the population has a Bachelor’s degree or higher, compared to 25.7% in Iowa. Mercy Medical Center – New Hampton serves patients in bordering counties as well. Due to over 80% of Mercy's market share coming from patients in Chickasaw County and for accuracy in data collection, Chickasaw County was the focus of the assessment.

Patient Home Address County Percent Market

Share New Hampton (all 50659 zip codes) Chickasaw 61.4%

Lawler Chickasaw 6% Elma Howard 6%

Fredericksburg Chickasaw 5% Ionia Chickasaw 4.7% Other Other 4%

Alta Vista Chickasaw 3% Waucoma Fayette 3%

Charles City Floyd 2% Nashua Chickasaw 2% Cresco Howard <1%

Ft. Atkinson Winneshiek <1% Sumner Bremer <1%

Frederika Breamer <1% Calmar Winneshiek <1%

Hawkeye Fayette <1%

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Chickasaw County, Iowa Demographics

People QuickFacts Chickasaw County Iowa

Population, 2014 estimate 12,264 3,107,126 Population, 2010 (April 1) estimates base 12,439 3,046,869 Population, percent change - April 1, 2010 to July 1, 2014 -1.4% 2.0% Population, 2010 12,439 3,046,355 Persons under 5 years, percent, 2014 6.1% 6.3% Persons under 18 years, percent, 2014 23.8% 23.4% Persons 65 years and over, percent, 2014 19.4% 15.8% Female persons, percent, 2014 50.0% 50.3% White alone, percent, 2014 (a) 98.3% 92.1% Black or African American alone, percent, 2014 (a) 0.6% 3.4% American Indian and Alaska Native alone, percent, 2014 (a) 0.1% 0.5% Asian alone, percent, 2014 (a) 0.3% 2.2% Native Hawaiian and Other Pacific Islander alone, percent, 2014 (a) 0.0% 0.1% Two or More Races, percent, 2014 0.7% 1.7% Hispanic or Latino, percent, 2014 (b) 2.3% 5.6% White alone, not Hispanic or Latino, percent, 2014 96.2% 87.1% Living in same house 1 year & over, percent, 2009-2013 91.6% 84.8% Foreign born persons, percent, 2009-2013 1.8% 4.5% Language other than English spoken at home, pct age 5+, 2009-2013 4.2% 7.2% High school graduate or higher, percent of persons age 25+, 2009-2013 88.8% 91.0% Bachelor's degree or higher, percent of persons age 25+, 2009-2013 13.8% 25.7% Veterans, 2009-2013 1,116 226,175 Mean travel time to work (minutes), workers age 16+, 2009-2013 21.3 18.8 Housing units, 2014 5,664 1,362,124 Homeownership rate, 2009-2013 80.1% 72.2% Housing units in multi-unit structures, percent, 2009-2013 10.0% 18.4% Median value of owner-occupied housing units, 2009-2013 $95,900 $124,300 Households, 2009-2013 5,364 1,226,547 Persons per household, 2009-2013 2.27 2.42 Per capita money income in past 12 months (2013 dollars), 2009-2013 $24,139 $27,027

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Median household income, 2009-2013 $43,971 $51,843 Persons below poverty level, percent, 2009-2013 10.3% 12.4% Source U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, American Community Survey, Census of Population and Housing, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits Last Revised: Wednesday, 02-Dec-2015 09:55:17 EST __________________________________________________________________________________________ Services Provided Mercy Medical Center-New Hampton, a member of Mercy Health Network, is a faith-based, not-for-profit community health care system that offers comprehensive health care services. Mercy is licensed for 18 beds and has 20,000 outpatient visits each year. Located in New Hampton, Iowa, Mercy serves 17,000 residents in and around Chickasaw County. Mercy Medical Center-New Hampton offers a full range of services in an inpatient and outpatient setting as well as 24 hour emergency care, surgical services, obstetrics and family health, therapy and rehabilitation, diagnostic services, health education and wellness promotion. Mercy also offers convenient access to 17 different specialties from a 55 member medical staff. Mercy Family Clinic – New Hampton is a department of Mercy. No other facilities are owned or operated by Mercy – New Hampton. __________________________________________________________________________________________ Process & Methods Used Data Sources Community Commons: Chickasaw County, Iowa, Quantitative Data, Outliers. Report ran on October 23, 2015. http://www.communitycommons.org/ . See Attachment B. Resources cited within the report include:

• National Institutes of Health • National Cancer Institute • Surveillance, Epidemiology • End Results Program. • State Cancer Profiles • Centers for Disease Control and Prevention • National Vital Statistics System • Behavioral Risk Factor Surveillance System • Health Indicators Warehouse • US Department of Health & Human Services • Health Indicators Warehouse • Dartmouth College Institute for Health Policy & Clinical Practice • Dartmouth Atlas of Health Care • US Census Bureau • American Community Survey.

Chickasaw County Public Health CHNA-HIP Survey (September – December 2015)

• Chickasaw County Public Health collected 531 surveys from residents who came to a flu shot clinic. While we found some of the data useful, it became evident that many people had only completed the first 6-8 questions and the response rate dropped significantly as the survey progressed. We also learned post survey evaluation that all New Hampton High School students were administered the

http://www.communitycommons.org/

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survey which we felt skewed the results drastically. Mercy decided to not weigh the results of this survey heavily in our CHNA decisions. See Attachment C.

Focus Groups

• Three groups held on December 10. A full report of the focus groups begins on page 7. County Health Rankings Rank of 2 (99 counties in state)

Measures Chickasaw State US 90th Percentile Health Outcomes 2 Length of Life 10

Premature death /100,000 4524 5911 5200 Quality of Life 1

% Adults reporting fair or poor health 7% 11% 10% Avg. physically unhealthy days/month 1.3 2.8 2.5 Avg. mentally unhealthy days/month 1.9 2.6 2.3 % Live births with low birth weight <2500g 4.30% 6.80% 5.90%

Health Factors 39 Health Behaviors 23

% Adults report currently smoking cigarettes 15% 18% 14% % Adults reporting BMI >= 30 30% 30% 25% Food environment index 8.1 7.8 8.4 % Adults 20+ reporting no leisure-time physical

activity 27% 24% 20% % Pop. with adequate access to locations for

physical activity 66% 79% 92% % Adults reporting binge drinking 30% 20% 10% % Alcohol-impaired driving deaths 0% 23% 14% Chlamydia rate /100,000 130 370 138 Teen birth rate /1,000 female pop., ages 15-19 19 30 20

Clinical Care 49

% Pop. under age 65 without health insurance 11% 10% 11% Ratio of pop. to primary care physicians 2,455:1 1,375:1 1,045:1 Ratio of pop. to dentists 2,464:1 1,670:1 1,377:1 Ratio of pop. to mental health providers 1,760:1 904:01:00 386:01:00 Preventable hospital stays /1,000 Medicare

enrollees 56 56 41 % Diabetic Medicare enrollees receiving HbA1c

test 89% 89% 90% % Female Medicare enrollees receiving

mammography 73.30% 66.40% 70.70% Social & Economic Factors 50

% Students who graduate HS in 4 years 93% 89% % Adults, age 25-44 with some college

education 53.90% 69.10% 71%

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% Pop. age 16+ unemployed but seeking work 4.70% 4.60% 4% % Under age 18 in poverty 15% 16% 13% % Adults without social/emotional support 22% 15.60% 22% % Children in single parent households 30% 29% 20% Violent crime /100,000 64 263 59 Injury mortality /100,000 60 50 59

Physical Environment 76

Avg. daily fine particulate matter in

micrograms/cubic meter (PM2.5) 11.7 10.9 9.5 % Pop. potentially exposed to water exceeding a

violation limit /yr 0% 7% 0% % Households with severe housing problems 11% 12% 9% % Workforce driving alone to work 79% 80% 71% % Commuting 30+ mins to work, driving alone 26% 19% 15%

_________________________________________________________________________________________ Focus Group Report Facilitated by Deb Lassise, an outside consultant, three separate discussion groups were held on December 10 at The Pub in New Hampton. The groups represented varying sectors in the community: social service partners, patients and community/business representatives. Forty-three letters of invitation were sent; 31 attended (72% participation.) The patient group was pulled randomly from a patient listing over the last 6 months, social service partners were a cross-section of the agencies Mercy works closely with, and community leaders/business owners were selected for their knowledge of the community. The three groups are outlined in the table below:

Seven participants were from outside New Hampton (Fredericksburg, Lawler, Elma and Alta Vista); all others were from New Hampton. It is important to note, Holy Family Catholic Church is the center of our Hispanic community The outside consultant collated and analyzed the focus group results with support from Mercy Medical Center – North Iowa’s (MMC-NI) Strategy & Planning in Mason City. Methodology for Conducting the Assessment Strategic planning to meet the needs of a community requires quantitative and qualitative data. MMC-NH has several mechanisms to gather community input on services: surveys, patient feedback, and service utilization data. Data sources included County Health Rankings, the Iowa Hospital Association, the Advisory Board and the Department of Health & Human Services.

Group Number of Participants

Gender Additional Group Information

#1 Social service partners 10 8F/2M Health and community service providers including the area Hispanic Minister

#2 Patients 12 8F/4M Older adults (65‐70+)

#3 Community/Business 9 5F/4M Adults (35 – 60) Total 31 21F/10M

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In addition, focus groups provide a valuable tool to gather qualitative data for strategic planning. There is great value in having community representatives participate in a guided discussion about the health status of the community, the organization’s strengths, and opportunities for improvement. These data provide direction for strategic planning as MMC-NH works to become a trusted healthcare partner for life. Information from these focus group listening sessions was collated and presented to the Planning Team, and with the assistance of an MMC-NI facilitator, was distilled into a list of opportunities estimated to have the greatest positive impact on the identified community health needs. Through a series of facilitated meetings, Planning Team members rankings of opportunities were shared and discussed. Team members were then given the opportunity to revise and/or amend their rankings. The prioritization process identified 4 priority issues for the community: 1. Primary care access (including continuity of care) 2. Behavioral health / chemical dependency 3. Area pharmacy demand exceeds availability 5. Maintain / increase specialty services _________________________________________________________________________________________ Health Needs Identified Though residents of New Hampton and rural Chickasaw County take great pride in their community as a place to live, work and raise families, health status data collected from various sources show that, compared to state of Iowa benchmarks, the area has significant opportunities for improvement. Information from County Health Rankings & Roadmaps identifies the following areas of opportunity for Chickasaw County: • Adult smoking • Adult obesity • Percentage of adults ages 25-44 with some post-secondary education • Excessive drinking Armed with that information and the results of Chickasaw County Public Health's community needs survey, Mercy – New Hampton gathered three separate discussion groups on December 10, 2015 at The Pub in New Hampton. Jenny Monteith, MMC-NH, identified groups representing varying sectors in the community; recruitment and attendance details are provided by MMC-NH. The Community Health Needs Assessment (CHNA) survey completed by Chickasaw County Public Health served as a basis for focus group discussions. Using the survey as a starting point, community members were asked to answer the first four questions of the survey:

• Q1 - Overall, on a scale of 1 to 5, how would you rate the health of the community with 5 being “very healthy” and 1 being “very unhealthy?

• Q2 - What are the three (3) most important factors for a "Healthy Community" (those factors which most improve the quality of life in a community)?

• Q3 - Of this list of health care issues, what do you think are the 3 top health problems? • Q4 - What do you think are the three (3) most "risky behaviors" in your community?

Focus group participant results were reviewed and compared to CHNA survey results. The discussion proceeded with a focus on MMC-NH being a trusted healthcare partner for life. Considering the group’s

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perspective on these four questions and referencing full survey results, participants were asked how MMC-NH could work to improve community health (referencing Q1). Also, given the identified important factors (Q2), top health care issues (Q3), and risky behaviors (Q4), what does MMC-NH do best to contribute to a healthy community? Participants were asked to consider primary care, outpatient and inpatient services; also youth, growing families, and the elderly: where are the hospital’s strengths? Recognizing strengths exist as a base for change and growth, participants were asked to identify opportunities for MMC-NH to improve in their role as trusted healthcare partner for life. In addition, what support exists to develop opportunity, what partnerships are involved, what barriers exist to change? Given discussion, where should MMC-NH focus their effort and what goals should they set? The chart below compares focus group participant results with CHNA HIP survey results. Obviously, the focus group results represent a much smaller number of responses, but this group was also older (55% of CHNA HIP respondents were 0-18 years of age) and more involved with health care issues, either by profession or willingness/interest to participate.

Overall Health

Important Factors for a Healthy Community

Health Problems Risky Behaviors

Focus Group Participants

84% somewhat healthy

26% access 22% behaviors 15% jobs

23% aging 20% obesity 17% mental health 15% cancer

25% alcohol abuse 25% physical inactivity

CHNA HIP Survey

67% very healthy/healthy

24% access 15% jobs 13% environment, 12% behaviors

19% heart disease/ high blood pressure 18% cancer 16% aging 14% obesity

20% alcohol abuse 17% illegal drug use 14% texting/phone while driving

Focus group participants rated overall health lower than the CHNA HIP community responses. While focus group participants view the overall health of the community as “somewhat healthy”, CHNA HIP survey participants see the community as “very healthy/healthy”. This baseline perception will skew responses and explain variation in additional survey inconsistencies between the two groups. Access to care and behaviors, followed by jobs were the most important factors for a healthy community by focus group participants. CHNA HIP Survey results identified access to health care as the most important factor for a healthy community; good jobs/healthy economy, clean environment, and healthy behaviors received relatively equal responses. Of note here is the replication of access, behaviors and jobs as important factors for a healthy community. Aging, obesity, mental health, and cancer represented 75% of top health problems for focus group participants. These responses – aging, obesity, cancer -- mirrored CHNA HIP results. Of interest, mental health was not listed on the survey and was added by focus group participants. Also of interest is the strength of the focus group response re: top issues. The top four CHNA HIP responses represent only 67% of top health problems (this is combining heart disease/stroke and high blood pressure). Alcohol and physical inactivity were the top two risky behaviors, representing half of responses. Texting while driving and illegal drug use account for another quarter of responses. CHNA HIP results identified alcohol abuse, illegal drug use, texting while driving as top three risky behaviors.

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Discussions about nutrition and activity dominated discussions about overall community health. The hospital has clearly met a community need with the Wellness Coordinator role. That position was first mentioned in this part of the discussion, and is brought up numerous times in discussions with all groups. With the exception of that role, participants are not sure of the hospital’s role in prevention/healthy lifestyle issues. However, it was noted that leadership, participation, and the education done by primary care physicians are an important contribution by the hospital to these community health issues. Partnerships within the community were highlighted as participants discussed strengths. It is clear that MMC-NH contribution to supporting and providing services with other health care agencies and services is valued. These partnerships include public health, mental health, CWC/parks, Chickasaw Connections and Chickasaw Coalition. Services and providers were also listed as top strengths for MMC-NH. Service comments highlighted availability and convenience, including visiting specialists, hospice, emergency room, ob/gyn, physical therapy and in particular, the wellness coordinator. Clearly, the primary care providers are appreciated. They are recognized for their follow-up, ease with youth, ability to look at the whole person, ability to model behavior, and commitment to community. Communication and keeping hospital resources in the public eye is seen as a strength at MMC-NH. The CEO was recognized for having good connections, as was marketing for the work in communicating with the community. Education with support groups, nutrition, and community outreach is another hospital asset. Also mentioned as strengths were the facility, the staff, and the auxiliary/philanthropic presence. There were three primary issues for improvement: access to care, continuity of care, and mental health care/substance abuse. In all groups, expanded clinic hours – the need for primary care/urgent care services during evening and weekend hours was articulated. Participants talked about going to Waverly for care and the difficulty of getting in to see a provider, especially after school. Another piece of the care/services discussion was around the importance of provider consistency – continuity of care - for those with chronic issues and for obstetrics. Participants felt somehow this could be managed better by making introductions, developing a second relationship, sharing schedule and rotation information. Having patients only comfortable with one doctor sometimes conflicts with access. Switching doctors is problematic for those with complicated health histories. Improvements in this area will also better serve obstetrics patients. Mental health/substance abuse is seen as an important issue in the community and an opportunity for improvement, both in prevention and acute care. Specific suggestions include adaptations in the ER to accommodate mental health patients. Providers, programming, community outreach, and screening for substance abuse were also mentioned. Participants acknowledge the importance of healthy behaviors: parenting, health promotion, and healthy lifestyles. A specific suggestion was for the hospital to provide space for meetings to connect healthy behaviors with the hospital. Connections in the community was identified as a strength, but also recognized as an area for improvement. This work is ongoing: community outreach, connecting with other providers and community resources, continuing work on partnerships, and visibility. Staff shortages, and attracting young people to health careers is another opportunity. The need is great – what role can the hospital play to encourage the health professions?

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To summarize, it is clear that community residents value MMC-NH. Their identification of the community as “somewhat healthy” suggests they have a realistic perception and objective knowledge of issues. With great ease, focus group participants identified numerous strengths of this organization in their community. Partnerships, services, providers, communication, and education are strong assets. MMC-NH is viewed as the leader and expectations are high in their role in improving community health. Being a trusted health care partner for life means involvement in issues and concerns that reach beyond the traditional realm of health care services. It is from their strengths that MMC-NH is challenged to develop and grow. Using the Chickasaw County CHNA HIP Survey as a basis for discussion, focus group participants discussed concerns about access to care, continuity of care, community health issues, and communication/awareness efforts. There is no debate about the importance of primary care when considering a healthy community. MMC-NH is without a doubt the point of primary care access in this community. A strong message was delivered regarding the need for expanded hours or urgent care services. This is applicable particularly for working families who are caring for children and/or the elderly. Several times it was mentioned that people were traveling to receive evening/weekend care. Primary care also involves continuity of care. For those with chronic conditions, the importance of developing a physician relationship – someone who understands a complicated, lengthy history – is paramount. These people want to see their provider, not someone else who doesn’t know their story or their journey. Focus group participants suggest that MMC-NH continue to develop provider rotation protocols for patient continuity. The community values their providers and recognizes their scheduling patterns, but wonder if dual relationships can’t be developed and strengthened to minimize problems with continuity of care: making introductions and sharing schedules/rotations would be helpful. When discussing community health issues, the success with the Wellness Coordinator is evident. There were many references to the visibility and benefit of this position. MMC-NH is encouraged to look for parallels with other lifestyle issues and programming partnerships to enhance community health. This type of position demonstrates MMC-NH desire to be a healthcare partner for life. MMC-NH needs to be present as a partner as the community addresses mental health and substance abuse issues. It is clear services are needed in this arena, but in addition to that, their presence, partnership, support in other preventive services is needed and expected. The issue of substance abuse/mental health were pervasive throughout discussions. Concern is shown in its listing as “risky behaviors” and in its addition to the discussion under top health problems. Participants suggest ongoing community partnerships, screening, and provider support for mental health/substance abuse issues. Current efforts made by primary care physicians – willingness to discuss the issues – is appreciated. Communication and awareness efforts are applauded; clearly that work is ongoing. Enhance awareness whenever possible – keeping MMC-NH the “top of mind” resource for health and wellness information and resource connections. Invite more groups into the hospital so it remains a hub for community health. Explore models for developing health careers in youth. MMC-NH is the health leader in Chickasaw County. It is recognized for its services, leadership, staff, and community involvement. The organization needs to keep doing what it does so well, constantly striving to improve services, communications and partnerships to continue its role as “Your Trust Healthcare Partner for Life.” _________________________________________________________________________________________

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Next Steps The Planning Team established five teams to develop implementation strategies for each priority. Each team’s leader, who is a member of MMC-NH's administrative team, is responsible for: • Determining what other community organizations are doing regarding the priority. • Organizing a team, including both field professionals and representative community members. • Guiding the team’s work, including development of a work plan in the format of a Strategy A3 to mirror

Mercy Health Network’s lean-inspired strategic planning format. A3 is, simply, structured scientific problem solving to:

o Meet the CHNA goals o Develop/coach all employees to be better problem solvers as part of the CHNA implementation

process. o Develop managers to be effective CHNA problem solving coaches and to become creators of more

managers with the same capability. Together these goals ensure that Mercy – New Hampton will continually improve its capability to deploy strategies, meet goals, respond to changes in the marketplace, and to solve performance problems.

• Establishing metrics, including measurable outcomes indicators. • Assuring work is coordinated with other implementation teams, and • Communicating appropriately with the community at-large. The Planning Team also charged the organization with attempting to fill the information gaps and with developing a better understanding of the social determinants of the health issues identified in order to better understand and address the community’s health needs going forward. _________________________________________________________________________________________ Collaborative Partners Through the assessment process, a number of strong community assets were identified, including the hospital and its many community benefit programs and collaborative partners.

Collaborative Partner Type/Assistance Organization Name/ Contact Person Phone

United Way Human Service Information Kathy Beckman 641-394-3021

School Districts Education Jay Jurrens 641-394-5858

Hospital Auxiliary Volunteers Dee Larkin 563-380-0336

Salvation Army Poverty / Needs Kris Markham 641-229-0113

Northeast Iowa Community Action Poverty / Needs Pat Ipsen 641-394-2007 Volunteer Organizations Lions Club Randy Gorres 641-394-1639

Service Organizations Rotary Lynne Kuethe 563-599-0548

Pastoral Committee Community Input Paston Kevin Frey 641-394-2552 Hispanic Community Minority Health Needs Pastor Gustavo Jimenez 641-394-2105

Chamber of Commerce Community Information Jason Speltz 641-394-2021

Public Health Needs Data/Wellness Kathy Babcock 641-394-4053

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Mental Health & Targeted Services Mental Health Needs/Poverty Shelia Kobliska 641-394-3426 Housing & Urban Development Economic Development Tammy Robinson 641-394-2437

Community College (NICC) Community Education/Training Dianne Diiro 641-229-0931

Chickasaw Wellness Center Community Wellness Emily Kleiss 641-394-5433 Pathways Behavioral Services Mental Health Erika Coleman 563-237-5300

_________________________________________________________________________________________ Community Input Input Received From: Lead

Person or Community

Partner

Input Type Sample Size

Method Where When (see examples

below) (Hand, mail,

phone, web)

(Public, Media,

Business, Event)

(Approx. time

period)

Local/ regional agencies or other health department (public health, Central Point of Coordination, County Board of Supervisors, City Council)

Jennifer Monteith, Mercy Interviews 9 In-person Event

December 2015 - January 2016

Members or representatives of medically underserved, low-income, and minority populations and who they represent & Broad Community

Chickasaw County Public Health

Questionnaires/ Surveys 531 Hand

Flu Shot Clinics

September - October 2015

Comments received on most recently conducted CHNA & Imp. Strat.

Aaron Flugum CEO

Hospital Board Meeting 8 In-person Meetings

July - December 2015

Businesses & Community Health Partners & Broad Community

Jennifer Monteith, Mercy Focus Groups 31 In-person Event

December - January 2015

_________________________________________________________________________________________ Significant Community Health Needs Planning Team members committed to focus on the affirmed priorities (See attachment D for brainstorming notes). In summary, priority needs identified were:

• Needs From Data Review: o Adult smoking o Adult obesity o Percentage of adults ages 25-44 with some post-secondary education o Excessive drinking

• Needs From Focus Groups & Interviews:

o Access to primary care o Continuity of care o Mental health care/substance abuse

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• Needs From Planning Team & Board Members:

o Chemical dependency / excessive drinking o Local pharmacy demand o Increase specialty services

Through a series of facilitated meetings, Planning Team members rankings of opportunities were shared and discussed. Team members were then given the opportunity to revise and/or amend their rankings. The prioritization process identified 4 priority issues for the community: 1. Primary care access (including continuity of care) 2. Behavioral health / chemical dependency 3. Area pharmacy demand exceeds availability 5. Maintain / increase specialty services Of the four significant needs identified, three issues were also listed on the prior CHNA: primary care access, behavior health and maintain/increase specialty services. Primary care access did see an improvement over the past three years however when Mercy collected information from the community in the Fall of 2015, Mercy Family Clinic has recently implemented an electronic health record which significantly reduced capacity for 4-5 months. While the clinic continues to improve their access, it is still a concern for our patients as we will have four providers leaving in 2016 and three new providers joining the practice which is why continuity of care was added to this CHNA's needs list. Behavioral health is an ongoing problem in Chickasaw County. Relationships with our area mental health providers have flourished since our prior CHNA yet work continues on access, especially for our high risk groups like inmates at the Chickasaw County jail. Tele-mental health is a new service Mercy is offering to the inmates. Focus on this year's CHNA will be targeted on safe/secure care of mental health patients in our facility and educating the community about early signs of mental health issues. Having specialty care available to our patients is important in a rural area. Since the prior CHNA, Mercy has seen specialists come and go. Mercy and the community felt a big impact with Mayo Health stopped sending specialists to New Hampton for endocrinology and cardiology. It is an ongoing concern of our community to continue to maintain and grow our specialty services.

Mercy Medical Center – New Hampton's Community Health Needs Assessment (CHNA) is available at: Mercy Public Relations Department, 308 North Maple Ave., New Hampton, IA 50659. The report can also be accessed online at http://www.mercynewhampton.com/community-health-needs-assessment. Mercy would appreciate written comments regarding our CHNA. Please submit written comments by email, [email protected] or mail to: Mercy Public Relations Department, 308 North Maple Ave., New Hampton, IA 50659.

http://www.mercynewhampton.com/community-health-needs-assessment

mailto:[email protected]

15

ATTACHMENT A

Name Affiliation/Title Sector/Population Representative For:

John Anderson Retired NHHS principal, Chickasaw County Supervisor, Board of Health

Government, Low-income & underserved

John Cuvelier Local business owner (insurance agency); MMC-NH board member Business

Aaron Flugum Current CEO, MMC-NH Health provider, Community based organizations, education

Jennifer Monteith Manager of Public Relations & Development, MMC-NH

Health provider, Community based organizations, education

Dr. Mary Sharon Peraud

Retired family physician, past MMC-NH board chair, current MMC-NI board member, community volunteer

Health Provider, chronic conditions, underserved

Scott Perkins

Senior VP, Tri-Mark (manufacturer in New Hampton), member, New Hampton City Council, former MMC-NH board member

Business, organized labor, low-income & underserved

Laura Reicks

Community volunteer and philanthropist, local business owner (restaurant), member, auxiliary board Business, minorities, elderly

Jennifer Schwickerath Attorney, current MMC-NH board chair Business

Dr. Sarah Updegraff Principal, NHHS Community based organizations, education

Jason Speltz New Horizons-Chamber Director Community based organizations

Tammy Robinson Economic Development Director Government

Callie Weigel Former board member, community volunteer, Elma B.R.I.D.G.E. committee Community based organizations

Jordan Anderson Athletic Trainer & Wellness Coordinator for Mercy - NH

Health provider, community education

Jessica Flanscha

Mercy Family Clinic – NH Manager, BSN, former Health Coach/Population Health Management

Health provider, community education, chronic conditions

Father Mark Osterhaus

Priest at Holy Family Parish, community volunteer

Faith based organizations, minorities, low-income & underserved

Jason Monarch Planning Team facilitator, Executive Director, Strategy for Mercy Medical Center – North Iowa Health providers

Dr. Paul McQuillen Family physician Health providers, chronic conditions

Andrew Fox Mercy – North Iowa Administrative Fellow, co-facilitator Health providers

16

ATTACHMENT B

Chickasaw County, Iowa Quantitative Data Outliers Report

Report generated on October 23, 2015

Topic-based Reports

Health Indicator Report-Lower-than-IOWA

Report Area

Chickasaw County, IA

Data CategoryDemographics | Clinical Care | Health Behaviors | Health Outcomes

Demographics

Current population demographics and changes in demographic composition over time play a determining role in the types of healthand social services needed by communities.

Data Indicators

Population with Any Disability

Population with Any Disability

Population with Any Disability by Gender

Report Area Total Male Total Female Percent Male Percent Female

Chickasaw County, IA 805 754 13.02% 12.45%

Iowa 171,444 171,980 11.49% 11.28%

United States 17,813,338 19,355,542 11.91% 12.34%

This indicator reports the percentage of the total civilian non-institutionalized population with a disability. This indicator is relevantbecause disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.

Report AreaTotal Population

(For Whom DisabilityStatus Is Determined)

Total Population with aDisability

Percent Population witha Disability

Chickasaw County, IA 12,238 1,559 12.74%

Iowa 3,016,863 343,424 11.38%

United States 306,448,480 37,168,876 12.13%Note: This indicator is compared with the state average.Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Percent Population witha Disability

Chickasaw County, IA(12.74%) Iowa (11.38%) United States (12.13%)

Disabled Population, Percent by Tract, ACS 2009-13

Over 18.0% 15.1 - 18.0% 12.1 - 15.0% Under 12.1% No Data or Data Suppressed

Report Area

Page 1 / 15

http://www.census.gov/acs/www/

Population with Any Disability by Age Group, Percent

Report Area Under Age 18 Age 18 - 64 Age 65

Chickasaw County, IA 3.56% 10.61% 31.37%

Iowa 3.87% 9.28% 32.7%

United States 4.03% 10.1% 36.48%

Population with Any Disability by Age Group, Total

Report Area Under Age 18 Age 18 - 64 Age 65

Chickasaw County, IA 105 746 708

Iowa 27,977 172,330 143,117

United States 2,972,823 19,403,946 14,792,111

Page 2 / 15

Population with Any Disability by Ethnicity Alone

Report Area Total Hispanic / LatinoTotal Not Hispanic /

LatinoPercent Hispanic /

LatinoPercent Not Hispanic /

Latino

Chickasaw County, IA 15 1,544 5.47% 12.91%

Iowa 10,325 333,099 0.68% 11.64%

United States 4,293,944 32,874,932 2.74% 12.87%

Population with Any Disability by Race Alone, Percent

Report Area WhiteBlack orAfrican

American

NativeAmerican /

Alaska NativeAsian

NativeHawaiian /

PacificIslander

Some OtherRace

Multiple Race

Chickasaw County,IA

12.84% 0% 5.5% 8.33% no data 0% 18.84%

Iowa 11.55% 12.11% 16.09% 5.12% 5.27% 6.37% 11.32%

United States 12.52% 13.78% 16.18% 6.47% 9.52% 7.66% 10.97%

Page 3 / 15

Population with Any Disability by Race Alone, Total

Report Area WhiteBlack orAfrican

American

NativeAmerican /

Alaska NativeAsian

NativeHawaiian /

PacificIslander

Some OtherRace

Multiple Race

Chickasaw County,IA

1,535 0 6 5 0 0 13

Iowa 319,267 10,609 1,415 2,852 73 2,711 6,497

United States 28,465,424 5,216,936 400,799 980,900 48,807 1,114,143 941,871

Page 4 / 15

Clinical Care

A lack of access to care presents barriers to good health. The supply and accessibility of facilities and physicians, the rate ofuninsurance, financial hardship, transportation barriers, cultural competency, and coverage limitations affect access.

Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community residents access services such as healthscreenings, routine tests, and vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding oneor more health issues and can inform program interventions.

Access to Primary Care

Access to Primary Care, Rate (Per 100,000 Pop.) by Year, 2002 through 2011

This indicator reports the rate of primary care physicians per 100,000 population by year. This figure represents all primary carephysicians practicing patient care, including hospital residents. In counties with teaching hospitals, this figure may differ from therate reported above.

Report Area 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

ChickasawCounty, IA

38.79 39.36 39.58 31.84 32.23 32.75 33 24.96 8.04 24.1 40.73

Iowa 60.34 61.24 61.13 59.64 59.86 60.31 60.55 72.11 82.72 81.77 82.56

United States 79.41 80.99 80.76 80.94 80.54 80.38 80.16 82.22 84.57 85.83 86.66

This indicator reports the number of primary care physicians per 100,000 population. Doctors classified as "primary care physicians"by the AMA include: General Family Medicine MDs and DOs, General Practice MDs and DOs, General Internal Medicine MDs andGeneral Pediatrics MDs. Physicians age 75 and over and physicians practicing sub-specialties within the listed specialties areexcluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues.

Report Area Total Population, 2012Primary Care

Physicians, 2012

Primary CarePhysicians, Rate per

100,000 Pop.

Chickasaw County, IA 12,276 5 40.7

Iowa 3,074,186 2,236 72.7

United States 313,914,040 233,862 74.5Note: This indicator is compared with the state average.Data Source: US Department of Health & Human Services, Health Resources and Services Administration, Area HealthResource File. 2012. Source geography: County

Primary Care Physicians,Rate per 100,000 Pop.

Chickasaw County, IA(40.7) Iowa (72.7) United States (74.5)

Access to Primary Care Physicians, Rate per 100,000 Pop. by County, AHRF2012

Over 80.0 60.1 - 80.0 40.1 - 60.0 Under 40.1 No Primary Care Physicians or No Data

Report Area

Page 5 / 15

http://arf.hrsa.gov/

Colon Cancer Screening (Sigmoid/Colonoscopy)

Diabetes Management (Hemoglobin A1c Test)

This indicator reports the percentage of adults 50 and older who self-report that they have ever had a sigmoidoscopy orcolonoscopy. This indicator is relevant because engaging in preventive behaviors allows for early detection and treatment of healthproblems. This indicator can also highlight a lack of access to preventive care, a lack of health knowledge, insufficient provideroutreach, and/or social barriers preventing utilization of services.


Age 50

EstimatedPopulation Ever

Screened forColon Cancer

Crude PercentageAge-AdjustedPercentage

Chickasaw County,IA

4,052 1,904 47% 42.4%

Iowa 812,983 517,870 63.7% 60%

United States 75,116,406 48,549,269 64.6% 61.3%Note: This indicator is compared with the state average.Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Accessed via theHealth Indicators Warehouse. US Department of Health & Human Services, Health Indicators Warehouse. 2006-12. Sourcegeography: County

Percent Adults Screenedfor Colon Cancer

(Age-Adjusted)

Chickasaw County, IA(42.4%) Iowa (60%) United States (61.3%)

Colon Cancer Screening (Ever), Percent of Adults Age 50 by County, BRFSS2006-12


Report Area

This indicator reports the percentage of diabetic Medicare patients who have had a hemoglobin A1c (hA1c) test, a blood test whichmeasures blood sugar levels, administered by a health care professional in the past year. In the report area, 195 Medicare enrolleeswith diabetes have had an annual exam out of 220 Medicare enrollees in the report area with diabetes, or 89.1%. This indicator isrelevant because engaging in preventive behaviors allows for early detection and treatment of health problems. This indicator can

Page 6 / 15

http://www.cdc.gov/brfss/

http://healthindicators.gov

http://healthindicators.gov/

Diabetes Management by Year, 2008 through 2012

Percent of Medicare Beneficiaries with Diabetes with Annual Hemoglobin A1c Test

Report Area 2008 2009 2010 2011 2012

Chickasaw County,IA

85.64 89.1 87.21 87.39 89.09

Iowa 88.3 89.26 89.22 89.45 89.43

United States 82.71 83.52 83.81 84.18 84.57

Health Professional Shortage Areas - Primary Care

also highlight a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach, and/or social barrierspreventing utilization of services.

Report AreaTotal Medicare

EnrolleesMedicare Enrollees

with Diabetes

Medicare Enrolleeswith Diabetes with

Annual Exam

Percent MedicareEnrollees withDiabetes withAnnual Exam

Chickasaw County,IA

2,170 220 195 89.1%

Iowa 366,817 39,069 34,940 89.4%

United States 53,131,712 6,517,150 5,511,632 84.6%Note: This indicator is compared with the state average.Data Source: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care. 2012. Sourcegeography: County

Percent MedicareEnrollees with Diabetes

with Annual Exam


Patients with Annual HA1C Test (Diabetes), Percent of Medicare Enrolleeswith Diabetes by County, DA 2012


Report Area

Page 7 / 15

http://www.dartmouthatlas.org/

Preventable Hospital Events

This indicator reports the percentage of the population that is living in a geographic area designated as a "Health ProfessionalShortage Area" (HPSA), defined as having a shortage of primary medical care, dental or mental health professionals. This indicator isrelevent because a shortage of health professionals contributes to access and health status issues.

Report Area Total Area PopulationPopulation Living in a

HPSA

Percentage ofPopulation Living in a

HPSA

Chickasaw County, IA 12,439 12,439 100%

Iowa 3,046,355 1,075,510 35.3%

United States 308,745,538 105,203,742 34.07%Note: This indicator is compared with the state average.Data Source: US Department of Health & Human Services, Health Resources and Services Administration, Health Resourcesand Services Administration. March 2015. Source geography: HPSA

Percentage of PopulationLiving in a HPSA

Chickasaw County, IA(100%) Iowa (35.3%) United States (34.07%)

Primary Care HPSA Components, Type and Degree of Shortage by Tract /County, HRSA HPSA Database March 2015

Population Group; Over 20.0 FTE Needed Population Group; 1.1 - 20.0 FTE Needed Population Group; Under 1.1 FTE Needed Geographic Area; Over 20.0 FTE Needed Geographic Area; 1.1 - 20.0 FTE Needed Geographic Area; Under 1.1 FTE Needed

Report Area

This indicator reports the discharge rate (per 1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACSconditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequateprimary care resources were available and accessed by those patients. This indicator is relevant because analysis of ACS dischargesallows demonstrating a possible “return on investment” from interventions that reduce admissions (for example, for uninsured orMedicaid patients) through better access to primary care resources.

Report AreaTotal Medicare Part A

Enrollees

Ambulatory CareSensitive ConditionHospital Discharges

Ambulatory CareSensitive Condition

Discharge Rate


Iowa 395,880 22,060 55.7

United States 58,209,898 3,448,111 59.2Note: This indicator is compared with the state average.Data Source: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care. 2012. Sourcegeography: County

Preventable HospitalEvents, Age-Adjusted

Discharge Rate(Per 1,000 Medicare

Enrollees)


Page 8 / 15

http://hpsafind.hrsa.gov/

http://www.dartmouthatlas.org/

Preventable Hospital Events by Year, 2008 through 2012

Rate of Ambulatory Care Sensitive Condition Discharges (per 1,000 Medicare Part A Beneficiaries)

Report Area 2008 2009 2010 2011 2012

Chickasaw County,IA

82.77 56.91 64.99 69.42 56.6

Iowa 68.55 63.38 60.37 60.5 55.72

United States 70.5 68.16 66.58 64.92 59.29

Ambulatory Care Sensitive Conditions, Rate (Per 1,000 Medicare Enrollees)by County, DA 2012

Over 100.0 80.1 - 100.0 60.1 - 80.0 Under 60.1 No Data or Data Suppressed

Report Area

Page 9 / 15

Health Behaviors

Health behaviors such as poor diet, a lack of exercise, and substance abuse contribute to poor health status.

Heavy Alcohol Consumption

This indicator reports the percentage of adults aged 18 and older who self-report heavy alcohol consumption (defined as more thantwo drinks per day on average for men and one drink per day on average for women). This indicator is relevant because currentbehaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as cirrhosis,cancers, and untreated mental and behavioral health needs.


Age 18

Estimated AdultsDrinking

Excessively


Excessively(Crude

Percentage)


Excessively(Age-AdjustedPercentage)

Chickasaw County,IA

9,486 2,798 29.5% 31.3%

Iowa 2,307,562 463,820 20.1% 21.4%

United States 232,556,016 38,248,349 16.4% 16.9%Note: This indicator is compared with the state average.Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Accessed via theHealth Indicators Warehouse. US Department of Health & Human Services, Health Indicators Warehouse. 2006-12. Sourcegeography: County

Estimated AdultsDrinking Excessively

(Age-AdjustedPercentage)


Excessive Drinking, Percent of Adults Age 18 by County, BRFSS 2006-12


Report Area

Page 10 / 15

http://www.cdc.gov/brfss/

http://healthindicators.gov

http://healthindicators.gov/

Health Outcomes

Measuring morbidity and mortality rates allows assessing linkages between social determinants of health and outcomes. Bycomparing, for example, the prevalence of certain chronic diseases to indicators in other categories (e.g., poor diet and exercise)with outcomes (e.g., high rates of obesity and diabetes), various causal relationship may emerge, allowing a better understanding ofhow certain community health needs may be addressed.

Heart Disease Mortality

Coronary Heart Disease Mortality, Age-Adjusted Rate (Per 100,000 Pop.) by Gender

Report Area Male Female

Chickasaw County, IA 188.2 115.7

Iowa 165.9 89.4

United States 146.2 81.3

Within the report area the rate of death due to coronary heart disease per 100,000 population is 148. This rate is greater than thanthe Healthy People 2020 target of less than or equal to 103.4. Figures are reported as crude rates, and as rates age-adjusted to year2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator isrelevant because heart disease is a leading cause of death in the United States.

Report Area Total PopulationAverage Annual

Deaths, 2007-2011

Crude Death Rate (Per 100,000 Pop.)

Age-AdjustedDeath Rate

(Per 100,000 Pop.)

Chickasaw County,IA

12,390 31 248.6 148

Iowa 3,061,227 4,935 161.2 122.6

United States 311,430,373 376,572 120.9 109.5

HP 2020 Target <= 103.4Note: This indicator is compared with the state average.Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2009-13. Source geography: County

Coronary Heart DiseaseMortality, Age-Adjusted

Death Rate(Per 100,000 Pop.)

Chickasaw County, IA(148) Iowa (122.6) United States (109.5)

Ischaemic Heart Disease Mortality, Age Adj. Rate (Per 100,000 Pop.) byCounty, NVSS 2009-13

Over 150.0 120.1 - 150.0 100.1 - 120.0 Under 100.1 Data Suppressed (<20 Deaths)

Report Area

Page 11 / 15

http://www.healthypeople.gov/2020/about/default.aspx

http://www.cdc.gov/nchs/nvss.htm/

http://wonder.cdc.gov

Coronary Heart Disease Mortality, Age-Adjusted Rate (Per 100,000 Pop.) by Race / Ethnicity

Report Area Non-Hispanic White Non-Hispanic BlackAsian or Pacific

IslanderAmerican Indian /

Alaskan NativeHispanic or Latino

Chickasaw County,IA

148.8 no data no data no data no data

Iowa 123.2 149.7 63.7 75.1 54.6

United States 111.3 128.6 64.1 81.7 86

Coronary Heart Disease Mortality, Age-Adjusted Rate (Per 100,000 Pop.) by Year, 2002 through 2011

Report Area 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Iowa 173.1 165 149.9 150.1 143 134.3 139.3 132 126.5 118.7 119.3 117

United States 173.5 165.6 153.2 148.2 138.3 129.2 126.1 117.7 113.7 109.2 105.4 102.6

Page 12 / 15

Pedestrian Motor Vehicle Death

Prostate Cancer Incidence

This indicator reports the crude rate of pedestrians killed by motor vehicles per 100,000 population. This indicator is relevantbecause pedestrian-motor vehicle crash deaths are preventable and they are a cause of premature death.

Report Area Total Population (2010)Total Pedestrian

Deaths, 2011-2013Average Annual Deaths,Rate per 100,000 Pop.


Iowa 3,046,355 68 0.7

United States 312,732,537 15,591 1.7

HP 2020 Target <= 1.3Note: This indicator is compared with the state average.Data Source: US Department of Transportation, National Highway Traffic Safety Administration, Fatality Analysis ReportingSystem. 2011-13. Source geography: County

Pedestrian Motor VehicleMortality, Age-Adjusted

Death Rate(Per 100,000 Pop.)


Pedestrian Motor Vehicle Crash Mortality, Rate (Per 100,000 Pop.) byCounty, NHTSA 2011-13

Over 3.0 2.1 - 3.0 1.1 - 2.0 0.1 - 1.0 No Deaths

Report Area

This indicator reports the age adjusted incidence rate (cases per 100,000 population per year) of males with prostate canceradjusted to 2000 U.S. standard population age groups (Under age 1, 1-4, 5-9, ..., 80-84, 85 and older). This indicator is relevantbecause cancer is a leading cause of death and it is important to identify cancers separately to better target interventions.

Page 13 / 15

http://www.healthypeople.gov/2020/about/default.aspx

http://www.nhtsa.gov/FARS

Prostate Cancer Incidence Rate (Per 100,000 Pop.) by Race / Ethnicity

Report Area White BlackAsian / Pacific


Alaskan NativeHispanic or Latino

Chickasaw County,IA

161.7 no data no data no data no data

Iowa 132.4 184.7 80.4 no data 77.5

United States 133.3 217.9 73.8 75.8 123.6

Population by Race / Ethnicity, New Prostate Cancer Incidence (Count)

Report Area White BlackAsian / Pacific


Alaskan NativeHispanic / Latino

Report Area Male PopulationAverage New Cases per

YearAnnual Incidence Rate

(Per 100,000 Pop.)


Iowa 1,498,400 2,224 133.3

United States 150,740,224 220,000 142.3Note: This indicator is compared with the state average.Data Source: National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and End Results Program.State Cancer Profiles. 2007-11. Source geography: County

Annual Prostate CancerIncidence Rate

(Per 100,000 Pop.)


Prostate Cancer, Incidence Rate (Per 100,000 Pop.) by County, STCANPRO2007-11

Over 160.0 140.1 - 160.0 120.1 - 140.0 Under 120.1 No Data or Data Suppressed

Report Area

Page 14 / 15

http://seer.cancer.gov/

http://statecancerprofiles.cancer.gov/

Chickasaw County,IA

14 no data no data no data no data

Iowa 2,111 41 8 no data 16

United States 171,991 30,367 4,018 778 13,248

Please see Health Indicator Report footnotes for information about the data background, analysis methodologies and other relatednotes.

Report prepared by Community Commons, October 23, 2015.

Page 15 / 15

http://assessment.communitycommons.org/CHNA/footnotes?reporttype=HEALTH&areatype=county&areaid=19037

http://www.communitycommons.org

17

ATTACHMENT C

Chickasaw County Public Health CHNA-HIP Survey

Surveys distributed to 531 area residents including in the Fall of 2015 to members or representatives of the broad community, medically underserved, low-income,

and minority (specifically Hispanic) populations. The report was provided by the Iowa Department of Public Health on November 23, 2015.

7.91% 42

59.13% 314

29.76% 158

2.82% 15

0.38% 2

Q1 How would you rate the overall health ofyour community?

Answered: 531 Skipped: 5

Total 531

Very healthy

Healthy

Somewhathealthy

Unhealthy

Very unhealthy

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Very healthy

Healthy

Somewhat healthy

Unhealthy

Very unhealthy

1 / 31

CHNA HIP Survey - Chickasaw County

Q2 What are the three (3) most importantfactors for a "Healthy Community" (thosefactors which most improve the quality of

life in a community)?Answered: 532 Skipped: 4

Access tohealth care...

Affordablehousing

Arts andcultural events

Cleanenvironment

Excellent racerelations

Good jobs andhealthy economy

Good place toraise children

Good schools

Healthybehaviors an...

Low adultdeath and...

Low crime/safe...

Low infantdeaths

Low level ofchild abuse

Parks andrecreation

Religious orspiritual...

Strong familylife

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2 / 31


71.62% 381

15.79% 84

2.07% 11

38.16% 203

2.44% 13

43.80% 233

20.68% 110

27.63% 147

34.77% 185

3.20% 17

21.43% 114

1.88% 10

4.32% 23

6.77% 36

7.52% 40

11.84% 63

Total Respondents: 532


Access to health care (example: family doctor, hospital, other health services)

Affordable housing

Arts and cultural events

Clean environment

Excellent race relations

Good jobs and healthy economy

Good place to raise children

Good schools

Healthy behaviors and lifestyles

Low adult death and disease rates

Low crime/ safe neighborhoods

Low infant deaths

Low level of child abuse

Parks and recreation

Religious or spiritual values

Strong family life

3 / 31


49.04% 255

6.35% 33

Q3 What do you think are the top three (3)health problems in your community?


Aging(arthritis,...

Asthma

Cancer

Diabetes

Heartdisease/stroke

High bloodpressure

Infectiousdisease

Injuries(falls, car...

Limited or noaccess to a...

Limited or noaccess to...

Limited or noaccess to...

Obesity

Poor nutrition

Sexuallytransmitted...

Teenagepregnancy

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Aging (arthritis, hearing/vision loss, dementia, etc.)

Asthma

4 / 31


54.81% 285

26.54% 138

30.19% 157

26.35% 137

2.50% 13

14.23% 74

4.23% 22

3.08% 16

10.00% 52

42.88% 223

17.69% 92

2.50% 13

2.50% 13


Cancer

Diabetes

Heart disease/stroke

High blood pressure

Infectious disease

Injuries (falls, car accidents, drowning)

Limited or no access to a doctor

Limited or no access to dental care

Limited or no access to mental health services

Obesity

Poor nutrition

Sexually transmitted disease

Teenage pregnancy

5 / 31


59.50% 307

32.56% 168

6.40% 33

50.19% 259

10.27% 53

14.92% 77

6.98% 36

Q4 What do you think are the three (3) most"risky behaviors" in your community?


Alcohol abuse

Driving whiledrunk or high

Dropping outof school

Illegal druguse

Not gettingshots to...

Not wearing ahelmet on a...

Not wearing aseatbelt/ us...

Physicalinactivity

Prescriptiondrug abuse

Texting orusing a cell...

Unsafe sex

Using tobacco

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Alcohol abuse

Driving while drunk or high

Dropping out of school

Illegal drug use

Not getting shots to prevent disease

Not wearing a helmet on a bike or motorcycle

Not wearing a seatbelt/ using child safety seats

6 / 31


29.26% 151

9.69% 50

44.77% 231

5.43% 28

21.12% 109


Physical inactivity

Prescription drug abuse

Texting or using a cell phone while driving

Unsafe sex

Using tobacco

7 / 31


21.26% 108

15.55% 79

12.80% 65

Q5 What do you think are the top three (3)health concerns relative to children's health

in your community?Answered: 508 Skipped: 28

Access tohealth care

Access tomental healt...

Access toimmunizations

Affordablefresh foods

Affordablehealth...

Bullying

Child care/daycare...

Healthy diets

Nutritiousschool lunch

Physicalactivity...

Responsiblesexual behavior

Screen time

Structured,safe, or...

Substance abuse

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Access to health care

Access to mental health services

Access to immunizations

8 / 31


19.29% 98

30.71% 156

48.43% 246

13.39% 68

39.76% 202

15.55% 79

22.05% 112

11.22% 57

12.01% 61

12.80% 65

17.52% 89


Affordable fresh foods

Affordable health insurance

Bullying

Child care/day care availability

Healthy diets

Nutritious school lunch

Physical activity opportunities

Responsible sexual behavior

Screen time

Structured, safe, or supportive living environment

Substance abuse

9 / 31


25.11% 56

54.26% 121

18.39% 41

1.35% 3

0.90% 2

Q6 How would you rate your personalhealth?


Total 223

Very healthy

Healthy

Somewhathealthy

Unhealthy

Very unhealthy

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Very healthy

Healthy

Somewhat healthy

Unhealthy

Very unhealthy

10 / 31


93.15% 204

1.37% 3

1.37% 3

6.39% 14

Q7 Where do you go for routine (regular)health care? Select all that apply:



Medicalprovider/Doc...

Urgent care

Emergency room

I don'treceive rout...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Medical provider/Doctor's office

Urgent care

Emergency room

I don't receive routine care

11 / 31


54.09% 119

48.18% 106

38.64% 85

43.18% 95

2.27% 5

5.00% 11

1.36% 3

3.64% 8

4.09% 9

4.09% 9

Q8 What two (2) healthy behaviors wouldyou like to start or improve?


Drinking morewater

Decreasingstress

Eating morefruits or...

Getting morephysical...

Gettingshots/vaccines

Quit smoking

Reducingalcohol intake

Routine cancerscreenings

Routine dentalcare

Routinephysicals

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Drinking more water

Decreasing stress

Eating more fruits or vegetables

Getting more physical activity

Getting shots/vaccines

Quit smoking

Reducing alcohol intake

Routine cancer screenings

Routine dental care

Routine physicals

12 / 31



13 / 31


2.36% 5

55.66% 118

4.25% 9

61.79% 131

4.25% 9

46.70% 99

0.47% 1

16.98% 36

1.89% 4

Q9 What do you feel prevents you frombeing healthier? Select all that apply:



Lack of accessto getting...

Lack ofmotivation

Need moreeducation ab...

Not enough time

Nowhere toexercise

Otherpriorities

Physicalhealth is to...

Too expensiveto buy healt...

Unemployment

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Lack of access to getting shots (vaccines and medications) to prevent sickness

Lack of motivation

Need more education about healthy choices

Not enough time

Nowhere to exercise

Other priorities

Physical health is too poor

Too expensive to buy healthy foods

Unemployment

14 / 31


37.89% 72

33.68% 64

22.11% 42

22.63% 43

13.68% 26

14.21% 27

46.84% 89

3.16% 6

Q10 What would help you start or maintain ahealthy lifestyle?Select all that apply:



Additionalrecreational...

Affordablewellness and...

Communityphysical...

Employeewellness...

Healtheducation...

Local schoolwellness...

More freshfood and...

Transportationto local...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Additional recreational paths, trails, sidewalks

Affordable wellness and fitness facilities

Community physical activity programs (water aerobics, volleyball/basketball league, fitness class)

Employee wellness programs

Health education classes (Diabetes prevention/management, Heart Disease, Arthritis, Cooking etc.)

Local school wellness programs

More fresh food and produce available

Transportation to local fitness or food markets

15 / 31


14.55% 32

30.00% 66

39.09% 86

14.09% 31

2.27% 5

Q11 How would you rate the socialenvironment (friendly people, willingness to

help others) in your community?Answered: 220 Skipped: 316

Total 220

Excellent

Very Good

Good

Fair

Poor

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Excellent

Very Good

Good

Fair

Poor

16 / 31


25.23% 54

15.42% 33

11.21% 24

20.09% 43

18.69% 40

69.63% 149

28.97% 62

56.07% 120

33.64% 72

Q12 What are the top three (3) social issuesfacing people in your community?



Childabuse/neglect

Crime andviolence

Domestic abuse

Lack oftransportati...

Lack of healthinsurance...

Poor parentingskills

Poverty

Single parentfamilies

Unemployment

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Child abuse/neglect

Crime and violence

Domestic abuse

Lack of transportation services

Lack of health insurance coverage

Poor parenting skills

Poverty

Single parent families

Unemployment

17 / 31


18.82% 32

19.41% 33

22.35% 38

22.35% 38

37.06% 63

42.94% 73

25.29% 43

41.76% 71

29.41% 50

10.00% 17

Q13 What do you think are the top three (3)environmental health issues in your

community?Answered: 170 Skipped: 366

Abandonedprivate wells

Contaminatedfood supply

Lack offluoride in...

Lead exposure

Old septicsystems

Outdoor airquality (ast...

Radon exposure

Safe housing

Unsafedrinking water

Un-seweredcommunities

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Abandoned private wells

Contaminated food supply

Lack of fluoride in drinking water

Lead exposure

Old septic systems

Outdoor air quality (asthma triggers)

Radon exposure

Safe housing

Unsafe drinking water

Un-sewered communities

18 / 31



19 / 31


60.54% 135

39.46% 88

Q14 Do you feel you/your family areprepared for a natural or man-made

disaster?Answered: 223 Skipped: 313

Total 223

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Yes

No

20 / 31


90.41% 198

75.80% 166

43.84% 96

56.62% 124

24.66% 54

30.59% 67

65.30% 143

49.77% 109

38.81% 85

Q15 Which of the following emergencypreparedness statements are true for you/

your family?Select all that apply:Answered: 219 Skipped: 317


My family hasa cell phone...

My family hasa first aid kit

My family hasdiscussed a...

My family hasmade a conta...

My family haspracticed a...

My family haspracticed a...

My family hasa weather...

My familykeeps a supp...

My familykeeps a list...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


My family has a cell phone with a charger

My family has a first aid kit

My family has discussed a central meeting place

My family has made a contact list for emergencies (kids know howl to call another family member and how to use 911)

My family has practiced a fire drill at home

My family has practiced a tornado drill at home

My family has a weather radio, flashlight, and batteries in our home

My family keeps a supply of bottled water and extra non-perishable food items on hand

My family keeps a list of current medications and important paperwork for each family member

21 / 31


8.59% 17

23.23% 46

41.41% 82

33.33% 66

18.69% 37

28.28% 56

Q16 What prevents you from beingprepared for an emergency? Select all that

apply:Answered: 198 Skipped: 338


Access tosupplies (no...

Need moreinformation...

Not a priority

Not enough time

Too expensiveto purchase...

Not applicable- my family ...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Access to supplies (no transportation, no place to purchase supplies)

Need more information about how to prepare for an emergency

Not a priority

Not enough time

Too expensive to purchase supplies

Not applicable - my family is prepared for an emergency

22 / 31


Q17 What public health services would youlike to see available in your community?


23 / 31


4.21% 4

3.16% 3

0.00% 0

2.11% 2

2.11% 2

1.05% 1

7.37% 7

28.42% 27

61.05% 58

Q18 Where/how did you hear about thissurvey? Select all that apply:



Church

Communitymeeting

Grocery store/shopping mall

Mail

Newspaper

Newsletter

PersonalContact

Website

Workplace

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Church

Community meeting

Grocery store/ shopping mall

Mail

Newspaper

Newsletter

Personal Contact

Website

Workplace

24 / 31


54.59% 119

8.72% 19

11.01% 24

10.09% 22

8.72% 19

5.50% 12

0.00% 0

1.38% 3

Q19 What is your age?Answered: 218 Skipped: 318

Total 218

0-18

19-29

30-39

40-49

50-59

60-69

70-79

80+

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


0-18

19-29

30-39

40-49

50-59

60-69

70-79

80+

25 / 31


58.88% 126

41.12% 88

Q20 What is your gender?Answered: 214 Skipped: 322

Total 214

Female

Male

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Female

Male

26 / 31


Q21 What county do you live in?Answered: 520 Skipped: 16

Allamakee

Bremer

Butler

Cerro Gordo

Chickasaw

Fayette

Floyd

Franklin

Hancock

Howard

Humboldt

Kossuth

Mitchell

Winnebago

Winneshiek

Worth

Wright

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


27 / 31


0.00% 0

0.19% 1

0.00% 0

0.00% 0

97.31% 506

0.38% 2

0.38% 2

0.00% 0

0.00% 0

1.35% 7

0.00% 0

0.00% 0

0.19% 1

0.00% 0

0.00% 0

0.19% 1

0.00% 0

Total 520

Allamakee

Bremer

Butler

Cerro Gordo

Chickasaw

Fayette

Floyd

Franklin

Hancock

Howard

Humboldt

Kossuth

Mitchell

Winnebago

Winneshiek

Worth

Wright

28 / 31


0.47% 1

0.47% 1

1.42% 3

1.89% 4

0.00% 0

93.87% 199

1.89% 4

Q22 What is your race/ethnicity?Answered: 212 Skipped: 324

Total 212

AmericanIndian or...

Asian

Black orAfrican...

Hispanic orLatino

NativeHawaiian or...

White orCaucasian

Two or moreraces

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White or Caucasian

Two or more races

29 / 31


52.13% 110

7.11% 15

5.21% 11

27.01% 57

8.53% 18

Q23 What is the highest level of educationyou have completed?


Total 211

Some highschool

High schoolgraduate

Some college

Collegegraduate

Advanced degree

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Some high school

High school graduate

Some college

College graduate

Advanced degree

30 / 31


96.71% 206

33.33% 71

24.88% 53

0.94% 2

Q24 Are you/your family members coveredby health insurance? Select all that apply:



Yes - I'mcovered by...

Yes - Myspouse is...

Yes - Mychild(ren) i...

No - No one inmy family is...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Yes - I'm covered by health insurance

Yes - My spouse is covered by health insurance

Yes - My child(ren) is covered by health insurance

No - No one in my family is covered by health insurance

31 / 31


18

ATTATCHMENT D

Planning Team members committed to focus on the affirmed. Through a series of facilitated meetings, Planning Team members rankings of opportunities were shared and discussed. Team members were then given the opportunity to revise and/or amend their rankings. The prioritization process identified 5 priority issues for the community.

community health needs assessment - mercyone · community health needs assessment . june 27, 2016...

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