Pocahontas Memorial Hospital

Community Health Needs

Assessment

2013

2

Pocahontas Memorial Hospital

Community Health Needs Assessment

October 2013

Table of Contents

Executive Summary Page 3

Background:

Hospital Profile Page 4

Community Profile Page 5

Methodology Page 5

Service Area Page 5

Data Sources Page 5

Community Needs Assessment:

Demographic Factors Page 6

Social and Economic Factors Page 7

Physical Environment Page 8

Clinical Care Page 8

Health Behaviors Page 10

Health Outcomes Page 11

Comparison of Pocahontas County to Peer Counties Page 13

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Executive Summary:

In 2013 Pocahontas Memorial Hospital (PMH) conducted a Community Health

Needs Assessment to identify health issues and community needs impacting the health

of Pocahontas County Residents. The results of this Community Health Needs

Assessment were used to inform PMHs board and leadership decision-making with

regard to how the hospital can positively impact the health of residents in its service

area as part of the Hospitals strategic planning process.

To assist PMH with conducting the community health needs assessment, PMH

contracted the Center for Rural Health Development, Inc. In conjunction with the board,

leadership and staff of Pocahontas Memorial Hospital, the needs assessment team

sought the participation of a wider circle of interested Pocahontas County residents

through the conduct of key informant interviews. This Community Health Needs

Assessment used multiple data collection tools and methods, both qualitative and

quantitative, to conduct an epidemiological needs assessment of the factors that impact

the health of Pocahontas County residents. Key points of this report include the

influence that the Countys demographic, geographic, socio-economic, clinical care and

physical environment have on health outcomes of the residents of Pocahontas County.

The needs assessment team ensured data collection efforts were as inclusive as

possible and incorporated the perspectives of diverse members of the community in

terms of age, race/ethnicity, gender, profession, and geographic location. The team

worked to develop meaningful partnerships with local agencies and other key

informants in an effort to identify and mobilize community assets that will be used for the

strategic planning process.

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Hospital Profile:

Marlinton Hospital and Infirmary was first established by the County Court in 1926. It

became known as Pocahontas Memorial Hospital as a tribute to the men and women who

served in the military from Pocahontas County. After nearly seventy years, the hospital was

moved to Buckeye in October 1995. PMH is now a 25 bed critical access hospital with a

federally designated Rural Health Clinic.

The mission of Pocahontas Memorial Hospital is to be the communitys first choice for

integrated health care by hardwiring excellence through continuing education, effective

collaboration and by providing exceptional customer service.

In pursuing its mission, Pocahontas Memorial Hospital strives to:

Be the provider of choice for health care to our communities.

Create an environment that promotes healthy living.

Be a key resource to promote stability in our communities.

Be a leader in patient education, prevention and outreach.

Promote physical, emotional and financial well-being of our communities.

The guiding principles of Pocahontas Memorial Hospital are those principles which form the

foundation on which we perform work and conduct ourselves. Our Nine Guiding Principles are:

Principle 1: Commit to Excellence.

Principle 2: Use Measurement to Diagnose Problems and improve Processes.

Principle 3: Build a Culture around Service

Principle 4: Create and Develop Leaders

Principle 5: Focus on Employee Satisfaction

Principle 6: Build Individual Accountability

Principle 7: Align Behaviors with Goals and Values

Principle 8: Communicate at All Levels

Principle 9: Recognize and Reward Success

Pocahontas Memorial Hospital is a 25 bed Critical Access Hospital that provides a continuum of

services that include:

Acute care Emergency services

Diabetes education Laboratory services

Occupational therapy Physical therapy

Physical therapy X-ray and other imaging services

Respite care for care givers Respiratory therapy

Community outreach services and programs Skilled rehabilitation services

Outpatient services, including physical exams, chronic disease management, family practice, immunizations and womens and childrens services

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Community Profile: Pocahontas Memorial Hospital is located in the county seat of

Marlinton, WV in Pocahontas County. Pocahontas County is the home to the National Radio

Astronomy Observatory Green Bank Telescope and is part of the National Radio Quiet Zone. In

addition, the county is known as the birthplace of rivers as it is the location of the headwaters for

eight rivers: Cherry River, Cranberry River, Elk River, Gauley River, Greenbrier River, Tygart

Valley River, Williams River, and Shavers Fork of the Cheat River. Pocahontas County has the

highest average elevation of any county east of the Mississippi. The county also has the largest

concentration of public lands in West Virginia of which 349,000 acres is either state or federal

property. More than 800 miles of hiking and biking trails are located in the county with more

than 1/3 of the Monongahela National Forest located within the county. Given its natural

landscape, more than one million tourists visit the county each year, although the county is one

of smallest in terms of population in West Virginia.

Methodology: The purpose of the community health needs assessment was to compile

current data on the key health issues faced by residents of Pocahontas County. The community

health needs assessment included both quantitative and qualitative assessments.

Quantitative Assessment: Data was collected to create a profile of the following characteristics

of the county:

Demographic Factors Social and Economic Factors

Physical Environment Clinical Care

Health Behaviors Health Outcomes

Qualitative Assessment: Key informant interviews were conducted with community leaders.

Information from 19 key informants was collected representing a variety of sectors including local

government, agriculture, education, industry and business, civic groups, public health, law enforcement,

service industry, etc.

Service Area: The service area is the geographic area from which a significant number of

people using the hospitals services reside. As hospital utilization data provides the clearest

definition of the service area, based on hospital discharge data for 2012, the bulk of patients

discharged from Pocahontas Memorial Hospital resided in Pocahontas County. Thus,

Pocahontas County was defined as the service area for this Community Health Needs

Assessment.

Data Sources: The following data sources were used in compiling the August 2013

Community Needs Assessment for Pocahontas County, WV:

Community Health Needs Assessment Data Report; Pocahontas County, WV; May 2013.

www.chna.org.

Community Health Status Report; Pocahontas County, WV; 2009;

www.communityhealth.hhs.gov

Key Informant Interviews; conducted June 2013.

http://en.wikipedia.org/wiki/National_Radio_Astronomy_Observatoryhttp://en.wikipedia.org/wiki/National_Radio_Astronomy_Observatoryhttp://en.wikipedia.org/wiki/Green_Bank_Telescopehttp://en.wikipedia.org/wiki/United_States_national_radio_quiet_zonehttp://en.wikipedia.org/wiki/Cherry_Riverhttp://en.wikipedia.org/wiki/Cranberry_River_(West_Virginia)http://en.wikipedia.org/wiki/Elk_River_(West_Virginia)http://en.wikipedia.org/wiki/Gauley_Riverhttp://en.wikipedia.org/wiki/Greenbrier_Riverhttp://en.wikipedia.org/wiki/Tygart_Valley_Riverhttp://en.wikipedia.org/wiki/Tygart_Valley_Riverhttp://en.wikipedia.org/wiki/Williams_River_(West_Virginia)http://en.wikipedia.org/wiki/Shavers_Forkhttp://en.wikipedia.org/wiki/Cheat_River

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Table 1

Change in Total Population

Report Area

Total

Population,

2010 Census

Total

Population,

2000 Census

Percent Change

from 2000-2010

Census

Pocahontas County, West

Virginia

8,719 9,131 - 4.51%

West Virginia 1,852,994 1,808,344 + 2.47%

United States 308,745,538 281,421,906 + 9.71%

Demographic Factors

It is important to examine demographic factors in the service area as current population

demographics and changes in demographic composition over time play a determining role in the

types of health and social services needed by communities. As demonstrated in Table 1,

Pocahontas County has realized a 4.51% loss in population from 2000 to 2010. However,

hospital utilization is greatly impacted by the age groups that make up the total population.

Thus, Table 2 indicates the total population by age groups in Pocahontas County. As indicated

the age group that uses the most health care services, age 65+ years, represents the greatest

proportion of residents in the county.

The majority of Pocahontas County residents are white (99.16%), with the next highest being

Black (0.36%) and multiple races (0.26%). The Asian population was the only race identified as

linguistically isolated. That is, 100% of the Asian population in Pocahontas County aged 5 and

older reported to speaking a language other than English at home and speaking English less

than "very well." This indicator is relevant because an inability to speak English well creates

barriers to healthcare access, provider communications, and health literacy/education.

Key Informant interviews indicated that Pocahontas Countys aging population was a significant

health determinant and as a result transportation and distance were also identified as major

Table 2

Total Population, Percent by Age Groups

Report Area Age 0-

4

Age

5-17

Age

18-24

Age 25-

34

Age 35-

44

Age 45-

54

Age 55-

64 Age 65+

Pocahontas County 4.58% 13.98% 6.57% 10.87% 12.43% 16.84% 16.02% 18.72%

West Virginia 5.64% 15.52% 9.17% 11.94% 13.20% 15.15% 13.57% 15.82%

United States 6.62% 17.73% 9.94% 13.22% 13.89% 14.57% 11.28% 12.75%

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problems in accessing health care services. In addition, a lack of availability for non-emergency

medical transportation was identified as a major barrier to health care services.

Social and Economic Factors

Social and economic factors are examined as part of a community health assessment as

economic and social insecurity often are associated with poor health. Poverty, unemployment,

and lack of educational achievement affect access to care and a communitys ability to engage

in healthy behaviors. Without a network of support and a safe community, families cannot thrive.

Ensuring access to social and economic resources provides a foundation for a healthy

community.

Tables 3 and 4 describe how Pocahontas County relates to West Virginia and the nation

in terms of the social and economic factors indicated. Those statistics highlighted in green

indicate factors in which the population is exceeding state and/or national data; while those

factors highlighted in red indicate areas in which the population is below state and/or national

data.

Table 3 Social and Economic Factors

Report Area

%Adults Reporting Adequate Social or

Emotional Support

%Free/Reduced Price Lunch

Eligible

% Children

in Poverty

On-Time Graduation

Rate

%Population with Income Below 200%

Poverty Level

% Population

with No High

School Diploma

Pocahontas County

83.80% 59.93% 20.59% 82.60 43.59% 20.99%

West Virginia

81.00% 51.48% 23.79% 77 39.09% 18.09%

United States

80.33% 48.34% 19.19% 75.50 31.98% 14.97%

HP 2020 Target

>82.4

Table 4 Social and Economic Factors

Report Area Percent

Population in Poverty

% Population Receiving

SNAP Benefits

Teen Births /1,000 Births

Unemployment Rate

Pocahontas County

15.27% 17.07% 42.50 0

West Virginia 17.35% 18.35% 46.20 7.30 United States 13.82% 12.60% 41.20 7.77

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Physical Environment

A communitys health also is affected by the physical environment. A safe, clean

environment that provides access to healthy food and recreational opportunities is important to

maintaining and improving community health.

Table 5 describes how Pocahontas County relates to West Virginia and the nation in

terms of the availability of healthy foods. Grocery stores are defined as supermarkets and

smaller grocery stores primarily engaged in retailing a general line of food, such as canned and

frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry.

Included are delicatessen-type establishments. Although data indicated that Pocahontas County

did not have problem with access to fresh fruits and vegetables, the key informant interviews

indicated that the population, especially children, used gas stations to purchase meals and that

many did not understand healthy eating concepts and thus were making very unhealthy food

choices.

Clinical Care

A lack of access to care presents barriers to good health. The supply and accessibility of

facilities and physicians, the rate of un-insurance, 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 health screenings, routine tests, and

vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding

one or more health issues and can inform program interventions.

Table 6 describes how Pocahontas County relates to West Virginia and the nation in

terms of the factors impacted by access to clinical care services. Unfortunately, residents of

Pocahontas County indicate that the population is below state and/or national data with regard

to clinical care indicators. Ambulatory Care Sensitive Conditions reports the discharge rate (per

Table 5 Physical Environment

# Fast Food Restaurants

/ 100,000 Pop

# Grocery Stores / 100,000

Pop

# Beer, Wine or Liquor

Stores / 100,000

Pop

%Living in Food Deserts

WIC-Authorized Food Store/

100,000 Pop.

Recreational Facilities /

100,000 Pop.

Pocahontas County

22.94 57.35 0 0% 56.91 no data

WV 68.27 20.67 2.54 8.82% 18.80 7.45

US 69.14 21.81 10.20 9.10% 15.60 9.68

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1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACS

conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could

have been prevented if adequate primary care resources were available and accessed by those

patients. This indicator is relevant because analysis of ACS discharges allows demonstrating a

possible return on investment from interventions that reduce admissions (for example, for

uninsured or Medicaid patients) through better access to primary care resources.

Current Health Care Providers

Pocahontas Memorial Hospitals Rural Health Clinic is designated as being located in a

Health Professions Shortage Area (HPSA). In addition, the northern and southern regions of

Pocahontas County are designated as a Medically Underserved Areas (MUA). Table 7 lists the

providers located in Pocahontas County in October 2013. Key Informants indicated that the

availability of local health care services was a concern. Although many indicated that they were

satisfied with their primary care providers, they were concerned about what would happen if

they left as many felt there were very few alternatives. Several key informants indicated that

lack of specialists was a concern and many indicated that this is why they seek care out of the

county. Although key informants indicated that PMH has made major improvements over the

past few years, several indicated that there was a lingering community perception that the

hospital was there to stabilize patients prior to transfer. Many of the key informants indicated a

desire for the following services to be available in Pocahontas County:

OB/GYN, mammography, PAP tests

MRI

Non-emergency transportation

Dialysis

Pediatrics

Expanded dental care, i.e. crowns and extractions

Colonoscopy

Orthopedics; need to be able to set bones

Ophthalmology

Table 6 Clinical Care

Report Area Primary Care Providers /

100,000 Pop.

% Females ages 67 69 Mammogram

in Past 2 Years

%Medicare Enrollees

with Diabetes receiving

annual Hb A1c test

% Adults w/o

Pneumonia Vaccine

Preventable Hospitalizations (ACS discharge

rate)

Pocahontas County

68.81 57.83% 81.53% no data 106.82

West Virginia

87.80 60.74% 82.86% 53.57% 99.07

United States

84.70 65.37% 83.81% 55.68% 66.54

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Finally, key informants were pleased with the availability of after-hour and weekend care

at the rural health clinic, but indicated that many in the community were unaware that these

services were available. Several key informants indicated that they were well pleased with the

school-based health centers.

Health Behaviors

Health behaviors such as poor diet, a lack of exercise, and substance abuse contribute

to poor health status and thus are important to understand in planning for future health services

in the service area.

Table 8 describes how Pocahontas County relates to West Virginia and the nation in

terms of selected health behaviors. Those statistics highlighted in green indicate factors in

which the population is exceeding state and/or national data; while those factors highlighted in

red indicate areas in which the population is below state and/or national data. Information from

the key informant interviews validated that obesity, as well as lack of physical activity and poor

eating habits were concerns. The key informants were especially concerned about these issues

in children. In addition, substance abuse was also identified as a concern by several key

informants.

Table 7 Providers Located in Pocahontas County

October 2013

Provider Location Services

Frankie Puckett, M.D. General Surgery

Stephen Otto, M.D. PMH Emergency Medicine

Mark Spitzer, M.D. PMH Emergency Medicine

Luke McElwain, PMH Emergency Medicine

Jeffrey Davis, M.D. PMH Emergency Medicine

William Browning, JR, D.O. Northern Greenbrier Health Clinic

Family Practice

Neal Rehberg, D.O. PMH Family Practice

Patricia Browning, D.O. Northern Greenbrier Health Clinic

Family Practice

Sarita Bennett, D.O. Marlinton Family Practice

Terry Thomas, D.O. PMH Family Practice

Dr. Debra Auble, MD Community Care Family Practice

Donna Lidel Burley, NP PMH Nurse Practitioner; Family Practice

Rachel Taylor, PA-C Community Care Physician Assistant; Family Practice

Valarie Monico, PA-C PMH Physician Assistant; Family Practice

Dr. Jennifer Beverage, D.O. Community Care Osteopathic Manipulative Medicine

Dr. John Eilers, D.O. Big Springs Clinic Osteopathic Manipulative Medicine

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Health Outcomes

Measuring morbidity and mortality rates allows assessing linkages between social

determinants of health and outcomes. By comparing, 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 of how certain community health needs may be addressed.

Tables 9, 10, 11 and 12 describe how Pocahontas County relates to West Virginia and

the nation in terms of health outcomes. Unfortunately, residents of Pocahontas County indicate

that the population is below state and/or national data with regard to health outcomes for

several of the health outcome indicators reported. It is important to note that 41.53% of the

suicide deaths are in males in Pocahontas County.

Table 8 Health Behaviors

Report Area % Adult Heavy

Drinkers

% Adults Consuming Few

Fruits or Vegetables

% Adult Physically

Inactive

% Adult Cigarette Smokers

Pocahontas County

17.40% 75.20% 18.70% 32.21%

West Virginia 11% 81.30% 28.30% 26.40%

United States 16.61% 75.92% 24.66% 19.27%

Table 9 Health Outcomes

Report Area Breast Cancer

Incidence/ 100,000 Pop

Cancer Mortality /

100,000 Pop.

Cervical Cancer Incidence /

100,000 Pop.

Colon/rectal Cancer

incidence/ 100,000 Pop.

Pocahontas County

110.40 184.29 no data 39.90

West Virginia 112.20 201.68 9.80 52.60

United States 122 176.66 8 40.20

HP 2020 Target:

< 160.6 < 7.1 < 38.6

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Table 10 Health Outcomes

Report Area Percent Adults with Diabetes

Heart Disease Deaths / 100,000

Pop.

Infant Mortality / 1,000 Births

% Low Birth Weight

Pocahontas County

10.80% 140.28 17.19 9.32%

West Virginia 11.39% 154.65 7.60 9.31%

United States 8.77% 134.65 6.71 8.10%

HP 2020 Target:

< 100.8 < 6.0

Table 11 Health Outcomes

Report Area Lung Cancer

Incidence/ 100,000 Pop

Motor Vehicle Deaths/

100,000 Pop % Adult Obesity

% Adults Reporting Poor General Health

Pocahontas County

84.90 42.05 30.90% 22%

West Virginia 90.40 18.60 32.92% 21.60%

United States 67.20 11.13 27.35% 16.27%

HP 2020 Target:

< 12.4

Table 12 Health Outcomes

Report Area Prostate Cancer

Incidence / 100,000 Pop

Stroke Deaths / 100,000 Pop

Suicide Deaths / 100,000 Pop

Prostate Cancer Incidence

/100,000 Pop

Pocahontas County

91.80 60.37 20.54 91.80

West Virginia 138.40 48.19 14.14 138.40

United States 151.40 41.78 11.57 151.40

HP 2020 Target:

< 33.8 < 10.2

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Peer Counties

The Community Health Needs Assessment also identified counties and county-like

geographic areas were identified as peer counties to Pocahontas County. Peer counties were

stratified on the basis of the following factors: frontier status, population size, poverty, age,

population density. Below are peer county ranges representing the 10th and 90th percentile of

values:

Population size: 4,798 13,625

Population density (people/sq mile): 8 19

Individuals living below poverty level: 16.8 25.4%

Age Distribution:

Under age 19: 20.4 - 25.4%

Age 19- 64: 55.1 - 62.0%

Age 65 84: 12.8 -19.7%

Age 85+: 2.3 - 4.3%

Those counties identified a Peer Counties to Pocahontas County included:

Arkansas:

Bradley County

Fulton County

Montgomery County

Scott County

Searcy County

Stone County

Georgia:

Quitman County

Iowa:

Decatur County

Michigan:

Lake County

Missouri:

Oregon County

Ozark County

Putnam County

Scotland County

St. Clair County

Wayne County

Worth County

Montana:

Deer Lodge County

Oklahoma:

Atoka County

Cotton County

Greer County

Hughes County

Jefferson County

Nowata County

Okfuskee County

Pushmataha County

Texas:

Childress County

Coleman County

Comanche County

Delta County

Hardeman County

Haskell County

Houston County

Mitchell County

Red River County

San Augustine County

Trinity County

Race/Ethnicity:

White: 71.2 - 98.0%

Black: 0.2 - 26.1%

American Indian: 0.2 - 16.4%

Asian/Pacific Islander: 0.1 - 0.8%

Hispanic origin: 0.9 - 23.6%

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Table 13 indicates how Pocahontas County compared to its Peer Counties in terms of

health indicators.

Table 13

Pocahontas Countys Health Indicators Compared to Peer Counties

Co

mp

are

d t

o U

S R

ate

s

Compared to Peer Counties UNFAVORABLE FAVORABLE

UN

FA

VO

RA

BL

E

Low Birth Weight (