St. Louis County Missouri Community Health Needs Assessment Findings

1. St. Louis County MissouriCommunity Health Needs Assessment Findings Public Health Summit December 12, 2011 Ron Deprez, Ph.D., MPH Executive Director The Center for Community and Public Health University of New England

2. Agenda • CHNA Objectives • Overview of Health Planning Process • Study Methods • Selected Findings • Priority Health Services • Next Steps

3. Objectives of the Study • Develop comprehensive profile of health status, quality of care and care management indicators for residents of St. Louis County overall and by sub-county. • Identify priority health issues from the profile • Assessing existing services in the county on the issues identified • Provide recommendations on services and programs to address the priority issues identified in the study

4. What we want to find out?

5. CHNA Methods Quantitative Assessment-Key Health Indicators Access and Quality Indicators Prevalence of Mental Health/Substance Abuse Conditions Inpatient/ER/Outpatient Use Indicators Related Chronic Conditions Mortality Indicators Risks Factors for Mental Health/ Substance Abuse Health Status Risk Factors Disease Prevalence/incidence Utilization Morbidity/Mortality Services Preference Birth Records Provider Survey Region Level Data Hospital Utilization Data Mortality Data ER/Outpatient data Program Specific Data Identify Priority Health Service Issues/Gaps Benchmarking National Benchmarks Clinical Standards Best Practice Guidelines

6. Methods Model Community Programs and Delivery System Options Discussions with Key Stakeholders Key Clinical Providers Other Service Providers Qualitative Analysis of Services and Delivery System Needs Service Needs: Prevention Detection Treatment Follow-up Transformation Barriers and Opportunities Summary Planning Report Major Findings Service Delivery Issues/Options Dissemination of Results Publications Meetings

7. Methods Assessment and Analysis I.Data Acquisition • Community Household Survey • Public Data (e.g., birth and mortality records) • Other Data (e.g., from existing studies and reports or databases) II. Analysis of Health Status, Outcome & Medical Service Indicators for the Community to Identify Priority Health Issues - Key Population & Demographic Indicators - Epidemiological Indicators (risk, prevalence, etc.) - Care Management and Utilization Indicators - Outcome Indicators • Assessment of Specific Local Healthcare Service - Health Leaders and Stakeholder Interviews Recommendations and Strategies IV. Health Planning Report and Recommendations

8. MethodsHow does the assessment process identify service needs? • Analyze health service issues/disparities indicators (prevention, access, detection, treatment, care management,) • Determine priority issues—where follow-up is needed • Conduct interviews and/or focus groups to identify service access, capacity, organizational and related issues • Develop specific planning and health services recommendations

9. MethodsAnalysis of Indicators for Health Services Planning • Burden of disease • Pattern analysis (risk factor, disease prevalence, health condition care management, outcomes) • Comparisons to External Standards/Benchmarks • (State, US, Healthy People 2010) • Age, gender, and race specific • Clinical vs. Statistical Significance • County and sub-county level

10. Data Primary Data for St. Louis County CHNA • 2011 Community Status, Utilization & Preference Survey • Key Provider and Stakeholder Interviews Secondary Data for the St. Louis County CHNA • Population and Demographics (Census & ACS)(2009 Est, 2005-2009) • Birth & Mortality Records (2007-2009) • Hospital Inpatient and Emergency Department (ED) Data - (2008-2009) • Cancer Registry (2006-2008) • Infectious disease data (2007-2009) • Unintentional Injury data (2007-2009) • Missouri Youth Risk Behavior Surveillance System (YRBSS) (2010) • Missouri BRFSS (2008-2009)

11. CHNA Data MethodsHousehold Health Survey (N=2,149) • Household health survey: January – March 2011 • Random digit dial selection of households in each of the four sub-counties in St. Lois County • Both land lines and cell phone only households • Survey Domains include: • Health Services Access and Utilization • Functional Health/Chronic Conditions • Chronic Disease Management • Youth Health • Physical Activity/Lifestyle • Biometrics • Primary Care • Dental Care • Mental Health • Drug use/Substance Abuse • Behavioral Risk Factors • Health Insurance • Health Care Barriers • Community Health Needs • Emergency Preparedness • Sexual Behavior • Wellness Activities and Programs • Demographics

12. MethodsSpecial Considerations Analyzing indicators for a county the size of St. Louis County doesn't tell the whole story Population of St. Louis County: (992,412) Each sub-county has specific needs Additional geographic break down can be helpful

13. MethodsSub-Counties • Four sub-county regions: Mid, North, South, and West—defined based on municipalities within the regions and their associated zip codes. Unincorporated areas of the county were assigned to a region based on proximity. • Data obtained from secondary sources by zip code. [If data could not be pulled by zip code, census tracts within each region were used.]

14. MethodsSub-Counties

15. St. Louis CountyDemographics

16. St. Louis CountyFunctional Health Status

17. St. Louis CountyWellness Categories

18. St. Louis CountyAccess to Care

19. St. Louis CountyAccess to/ Quality of Care for Primary Care Services Ambulatory Care Sensitive (ACS) Conditions • ACS conditions are illnesses that can often be managed effectively on an outpatient basis and generally do not result in hospitalization if managed properly (e.g. diabetes, asthma, etc).

20. St. Louis CountyAccess to/ Quality of Care for Primary Care Services Note: Rates are per 100,000 unless otherwise stated

21. St. Louis CountyAccess to/ Quality of Care for Primary Care Services Note: Rates are per 100,000 unless otherwise stated

22. St. Louis CountyChronic Disease Behavioral Risk Factors

23. St. Louis CountyChronic Disease Behavioral Risk Factors Note: Rates are per 100,000 unless otherwise stated

24. St. Louis CountyCardiovascular Medical Conditions

25. St. Louis CountySelected Cardiovascular Health Indicators Note: Rates are per 100,000 unless otherwise stated

26. St. Louis CountySelected Cardiovascular Health Indicators Note: Rates are per 100,000 unless otherwise stated

27. St. Louis CountySelected Diabetes Health Indicators

28. St. Louis CountySelected Diabetes Health Indicators Note: Rates are per 100,000 unless otherwise stated

29. St. Louis CountySelected Diabetes Health Indicators Note: Rates are per 100,000 unless otherwise stated

30. St. Louis CountySelected Reproductive Health Indicators

31. St. Louis CountySelected Reproductive Health Indicators

32. St. Louis CountySelected Reproductive Health Indicators

33. St. Louis CountySelected Reproductive Health Indicators Note: Rates are per 100,000 unless otherwise stated

34. St. Louis CountySelected Reproductive Health Indicators

35. St. Louis CountySelected Infectious Disease Indicators Note: Rates are per 100,000 unless otherwise stated

36. St. Louis CountySelected Substance Abuse Indicators Note: Rates are per 100,000 unless otherwise stated

37. St. Louis CountySelected Substance Abuse Indicators Note: Rates are per 100,000 unless otherwise stated

38. St. Louis CountySelected Mental Health Indicators Note: Rates are per 100,000 unless otherwise stated

39. St. Louis CountySelected Mental Health Indicators Note: Rates are per 100,000 unless otherwise stated

40. St. Louis CountySelected Mental Health Indicators Note: Rates are per 100,000 unless otherwise stated

41. St. Louis CountyRecommendations-overall • Increase awareness about the scope of health disparities in St. Louis County overall and by region • Engage in an ongoing county-wide planning process to better identify and rationally address health service needs indicated by the information contained in this report.

42. St. Louis CountyPriority Health Issues Access to Care: • Conclusion: SLC population has relatively good access as measured by health insurance coverage and having a source of care but quality of care as measured by high ACS hospital admission rates needs follow-up. • Recommendation: Explore how access can be expanded and review quality. The implementation of ACA offers and opportunity to expand access to insure high levels of access (ACOs, PCMH, Innovations, public private health partnerships, technology innovations)

43. St. Louis CountyOverall Priority Health Issues Chronic Disease Issues and Barriers to Care: • Conclusions: Rates of disease/health conditions likely very similar to the state if social determinants such as income and education are taken into account. Levels of wellness already similar. This is resulting in higher use of the hospital for the population with chronic health conditions. • Recommendations: Continue to engage in prevention/promotion programs for smoking, weight, activity levels. Determine which populations are at risk for hospitalization due to levels of primary care quality, access, self management skills, etc.; collaborate with the private health system to address with system level changes.

44. St. Louis CountyPriority Health Issues Cancer Incidence • Conclusions: Cancer incidence levels are relatively high in SLC. The differences, while not alarming, are likely due to specific cancer sites—i.e. breast and prostate. • Recommendation: Work with the state health department and the academic community to conduct a study in order to determine if the differences in rates especially in some regions and for specific sites warrant interventions.

45. St. Louis CountyPriority Health Issues Reproductive Health: • Conclusions: The levels of women at high risk for a poor birth outcome is high and may be due to a number of factors. This results in levels of complications at birth, hospitalizations and neonatal mortality. Levels of C-sections deliveries are high overall. • Recommendations: Determine if care for high risk women is adequate throughout the county. Determine if anything can be done to lower the C-sections rates in the county.

46. St. Louis County Priority Health Issues Mental Health and Substance Abuse Services • Conclusions: There may be a significant population in the county with both substance abuse (including alcohol) and mental health issues. • Recommendations: Assess the capacity of the current system to treat this population (dual programs); develop/implement a plan to improve these services. Infectious Disease: • Conclusion/Recommendation: The levels of sexually transmitted diseases need to be addressed on the county with education and other types of evidence based programs.

47. Sub-CountiesAccess to Care

48. Sub-CountiesWellness Categories

49. Sub-CountiesFunctional Health Status

50. Sub-CountiesAccess to Care Note: Rates are per 100,000 unless otherwise stated