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Obici Healthcare Foundation Community Health Assessment
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  1. Obici Healthcare Foundation Community Health Assessment Community Health Solutions, Inc. May 23, 2007

  2. Table of Contents Executive Summary (Slide 3) • Health Demographic Indicators (Slide 13) • Community Survey Indicators (Slide 19) • Mortality Indicators (Slide 26) • Birth Indicators (Slide 31) • Adult Health Status Indicators (Slide 37) • Health Care Access Indicators (Slide 42) Appendix A: Gates County, NC Indicators (Slide 53) Appendix B: Table of Charts (Slide 68) Unofficial Discussion Draft Subject to Change

  3. Executive Summary • Executive Summary Outline • Study Purpose, Scope, and Limitations • Study Methods • The Study Region • The Mission Statement as Organizing Principle • Demographics of the Study Region • Mission Focus 1: Addressing Unmet Needs of the Medically Indigent & Uninsured • Mission Focus 2: Preventing or Reducing Illness or Disease • Additional Issues • Organization of the Report Unofficial Discussion Draft Subject to Change

  4. Study Purpose, Scope, and Limitations • Purpose • The purpose of the study is to provide information on community health status to the Obici Healthcare Foundation • Scope • The study includes: • Seven cities and counties in Virginia and North Carolina • Six categories of health indicators from existing data • Original survey data from Survey of Local Health Professionals and Community Leaders • Limitations • The study was: • Not designed or budgeted to identify or detail every conceivable health issue • Designed to be a starting point to support Foundation planning rather than a comprehensive assessment of every issue Unofficial Discussion Draft Subject to Change

  5. Study Methods • The study was conducted by Community Health Resource Center of Richmond, VA during December-May 2007 • Demographic data were obtained from SRC, Inc., a commercial data vendor • Death and Birth data were obtained from Virginia Department of Health and the North Carolina Department of Health • Hospital Discharge data were obtained from Virginia Health Information, Inc. • Adult health status data were obtained from the National Behavioral Risk Factor Surveillance Survey • Community Survey data were obtained from a sample of local health professionals and community leaders. The survey was limited to Virginia. • Gates County, NC data are presented separately (in Appendix A) because data were not available for some indicators, and other data were in different formats than Virginia data. Unofficial Discussion Draft Subject to Change

  6. The Study Region The Obici Healthcare Foundation Service Region includes most of seven cities and counties, including Gates County, NC. Surry Sussex Isle of Wight Suffolk Southampton Gates Franklin Unofficial Discussion Draft Subject to Change

  7. The Mission Statement as Organizing Principle • The mission of the Obici Healthcare Foundation is to improve the health status of people living in the service area by: • 1) addressing the unmet needs of the medically indigent and uninsured; and • 2) supporting programs which have the primary purpose of preventing or reducing illness and disease. • Study results are summarized in terms of the two mission focus areas. Unofficial Discussion Draft Subject to Change

  8. Demographics of the Service Area • Major Findings from Virginia Service Region: • More than 156,000 people in the Virginia service region • Expected to reach 178,000+ by 2011 • Growing twice as fast as Virginia • Growth driven by Suffolk and Isle of Wight • 42 percent African American compared to 19 percent for Virginia • 22% of adults age 25+ without high school diploma compared to 14% for state • Poorer than state as a whole on most economic measures, including low-income children In addition, Gates County, NC has a population of 11,500+.and a roughly similar profile in terms of age, race, and income. See Appendix A for detail. Unofficial Discussion Draft Subject to Change

  9. Mission Focus 1: Addressing the Needs of the Medically Indigent & Uninsured • Major Findings in the Virginia Service Region: • ‘Access to quality health services’ identified as immediate & significant health concern by 39 of 63 respondents to Survey of Local Health Professionals and Community Leaders • In the Virginia Study Region for 2005: • An estimated 22,500+ uninsured in the region, including 3,000-4000 children • An estimated 12,700+ uninsured with income below 200 percent of poverty • An estimated 17,000+ adults could not see a doctor due to cost • An estimated 22,300+ adults had no dental visit in previous 2 years • 3,584 hospital discharges for potentially preventable conditions • Rates for all of the above were near or above the Virginia statewide rate In addition, Gates County, NC had an estimated 1,600+ uninsured in 2005. See Appendix A for detail. Unofficial Discussion Draft Subject to Change

  10. Mission Focus 2: Preventing or Reducing Illness and Disease • Major Findings in the Virginia Service Region • Survey of Local Health Professionals and Community Leaders identified the following as leading community health concerns: • Overweight, Obesity, & Nutrition • Heart Disease & Stroke • Diabetes • Physical Activity & Fitness • Cancer • Substance abuse • Oral health • Mental health & mental disorders • Sexually transmitted diseases • Injury & violence • Tobacco • Additional issues are noted in the report Unofficial Discussion Draft Subject to Change

  11. Mission Focus 2: Preventing or Reducing Illness and Disease • Major Findings in the Virginia Service Region • By the numbers: • Leading causes of death = heart disease, cancer, stroke, chronic lower respiratory disease, injury, and diabetes • Among adults, an estimated: • 73,000+ overweight or obese • 30,000+ no exercise in past 30 days • 91,000+ not consuming 5 or more fruits & vegetables per day • 26,000+ smoke • 15,900+ at risk for binge drinking • 37,000+ with high blood pressure • 35,700+ with high cholesterol • 15,700+ with asthma • 11,000+ with diabetes • National rates of childhood overweight range from 10-16 percent, suggesting 3,700-6,000 children in the Virginia service region may be overweight. • Rates in the Virginia Study Region were near or above Virginia statewide rates on most indicators. Rates in Gates County, NC are similar to the Virginia Service Region rates. See Appendix A for detail. Unofficial Discussion Draft Subject to Change

  12. Additional Issues • Community Survey Responses • Community Survey Respondents were asked to identify local health concerns expected to emerge in the Virginia Service Region over next 1-3 years • Most frequently mentioned emerging local health issues: • Medical Product Safety • Public Health Infrastructure • Occupational Safety & Health • Vision & Hearing • Food Safety Unofficial Discussion Draft Subject to Change

  13. Part 1. Health Demographic Indicators • Purpose • Health status is highly influenced by a person’s age, sex, race, ethnicity, education, and income. • Content • Chart 1.1-1.5 provide a demographic profile of the Virginia Service Region. • Source • CHRC analysis of data from SRC Corporation, a commercial vendor of demographic data. Unofficial Discussion Draft Subject to Change

  14. Chart 1.1 Population Change 2000-2011 The Virginia Service Region population is expected to grow by 29 percent from 2000 to 2011, with Suffolk and Isle of Wight driving the increase. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  15. Chart 1.2 Population by Age 2005 The Virginia Service Region includes more than 37,000 children and more than 19,800 seniors. The region is slightly older than Virginia as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  16. Chart 1.3 Population by Race & Ethnicity 2005 The Virginia Service Region includes a significantly higher proportion of Black or African American residents than the state as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  17. Chart 1.4 Adult Population by Education Status 2005 The Virginia Service Region has lower educational attainment (among adults) than Virginia as a whole. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  18. Chart 1.5 Population by Income Status 2005 The Virginia Service Region includes higher rates of poverty and near-poverty than Virginia as a whole. Rates are high for both children and adults. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  19. Part 2. Community Survey Indicators • Purpose • Community officials and professionals have valuable insight into community health concerns • Content • Charts 2.1-2.6 summarize responses to the survey • Results are for Virginia Service Region only • Source • The survey was sent to 180+ community officials and health professionals from a list provided by Obici Healthcare Foundation • 63 valid responses were received • Analysis is by CHRC Unofficial Discussion Draft Subject to Change

  20. Chart 2.1 Top Local Health Concerns from Community Survey Overweight, Obesity, & Nutrition was the most frequently named top local health concern in the Virginia Service Region Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’ Unofficial Discussion Draft Subject to Change

  21. Chart 2.2 Top Local Health Concerns from Community Survey (continued) Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’ Unofficial Discussion Draft Subject to Change

  22. Chart 2.3 Immediate & Significant Local Health Concerns from Community Survey Overweight, Obesity, & Nutrition was the most frequently named ‘immediate significant local health concern’ in the Virginia Service Region. Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’ Unofficial Discussion Draft Subject to Change

  23. Chart 2.4 Immediate & Significant Local Health Concerns from Community Survey (continued) Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’ Unofficial Discussion Draft Subject to Change

  24. Chart 2.5 Emerging Local Health Concerns from Community Survey Medical Product Safety, Public Health Infrastructure, Occupational Safety & Health, Vision & Hearing, and Food Safety were the most frequently identified emerging local health issues in the Virginia Service Region. Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’ Unofficial Discussion Draft Subject to Change

  25. Chart 2.6 Emerging Local Health Concerns from Community Survey (continued) Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’ Unofficial Discussion Draft Subject to Change

  26. Part 3. Mortality Indicators • Purpose • Leading causes of death provide important insights into the health and concerns of a population • Content • Charts 3.1-3.4 show the leading causes of death in terms of counts, deaths per 100,000 population, and age-adjusted deaths per 100,000 population. • Source • CHRC analysis of 2004 data from the Virginia Department of Health Unofficial Discussion Draft Subject to Change

  27. Chart 3.1 Leading Causes of Death In 2004, multiple localities had age-adjusted death rates above the statewide rate for overall deaths, heart disease deaths, and cancer deaths. Suffolk had a higher rate for cerebrovascular disease deaths. Unofficial Discussion Draft Subject to Change Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

  28. Chart 3.2 Leading Causes of Death In 2004, multiple localities had age-adjusted death rates above the statewide rate for chronic lower respiratory disease, unintentional injury, diabetes, and Alzheimer’s. Unofficial Discussion Draft Subject to Change Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

  29. Chart 3.3 Leading Causes of Death In 2004, multiple localities had age-adjusted death rates above the statewide rate for Pneumonia & Influenza, Nephritis & Nephrosis, Septicemia, and Suicide. Unofficial Discussion Draft Subject to Change Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

  30. Chart 3.4 Leading Causes of Death In 2004, multiple localities had age-adjusted death rates above the statewide rate for pneumonitis, chronic liver disease, and homicide/legal intervention. Unofficial Discussion Draft Subject to Change Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

  31. Part 4. Birth Indicators • Purpose • Birth indicators provide insight into maternal and child health and health care access • Content • Charts 4.1-4.5 show counts and rates for several common birth indicators. • Source • CHRC analysis of 2004 data from the Virginia Department of Health Unofficial Discussion Draft Subject to Change

  32. Chart 4.1 Total Pregnancies In 2004, the region had 2,760 pregnancies resulting in 2,054 live births. Franklin, Suffolk, and the region as a whole had birth rates above the statewide rate. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  33. Chart 4.2 Low Birth Weight and Late Prenatal Care Births In 2004 there were 195 low weight births and 226 late or no prenatal care births. The low birth weight rate was higher than the statewide rate in three localities and the region as a whole. The late/no prenatal care rate was above the state rate in Franklin. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  34. Chart 4.3 Non-marital Births In 2004 there were 773 non-marital births. The non-marital birth rate exceeded the statewide rate throughout the region. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  35. Chart 4.4 Teen Pregnancies In 2004 there were 336 teenage pregnancies, including 128 to teens under 18. Teen pregnancy rates were above the statewide rate in multiple localities. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  36. Chart 4.5 Infant Deaths In 2004 there were 24 infant deaths. Over the period 200-2004, the infant death rate was higher than the statewide rate in every locality except Isle of Wight. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  37. Part 5. Adult Health Status Estimates • Purpose • Adult health status estimates paint a picture of community health beyond death rates, birth rates, and hospitalization rates. • Content • Charts 5.1-5.4 contain local estimates of adult health status. • The figures are ‘synthetic estimates’ based on application of statewide and national survey data to local demographics. They are for planning purposes only, and are not guaranteed for accuracy. • Source • CHRC analysis of data from the National Behavioral Risk Factor Surveillance Survey and demographic data from SRC, Inc. Unofficial Discussion Draft Subject to Change

  38. Chart 5.1 Adult Health Limitation Estimates In 2005 there were an estimated 20,000+ adults in fair or poor health status. Estimated rates were above the statewide average. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  39. Chart 5.2 Adult Overweight, Obesity, Exercise, and Nutrition Estimates In 2005 there were an estimated 73,000+ adults who could be classified as overweight or obese. Overweight/obesity rates were estimated to be above the statewide average throughout the region. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  40. Chart 5.3 Adult Smoking and Alcohol Consumption Estimates In 2005 there were an estimated 26,000+ adult smokers and an estimated 15,900+ adults at risk for binge drinking. Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  41. Chart 5.4 Adult Chronic Disease Estimates In 2005 there were an estimated 11,500+ adults with diabetes, 37,000+ adults with high blood pressure, 35,700+ with high cholesterol, 15,200+ with asthma, and 34,600+ with arthritis. These estimates assume a diagnosis of the specified disease, and do not include those not yet diagnosed. Unofficial Discussion Draft Subject to Change Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data

  42. Part 6. Health Care Access Indicators • Purpose • Access to health care is a fundamental prerequisite for community health. • Content • Charts 6.1-6.9 provide various measures of health care access in the Virginia Service Region. • Source • Uninsured estimates and adult health care access estimates were produced by CHRC using ‘synthetic estimation techniques’ in which national and state-level survey data are applied to local demographic profiles. • Underserved area designations were obtained from the U.S. Health Resources and Services Administration. • Ambulatory Care Sensitive Condition indicators were produced by CHRC using discharge data from Virginia Health Information, Inc. and population data from SRC, Inc. Unofficial Discussion Draft Subject to Change

  43. Chart 6.1 Uninsured Estimates Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Among the uninsured are an estimated 3,000-5,000 children under 18, and17,500-19,500 adults. Unofficial Discussion Draft Subject to Change

  44. Chart 6.2 Adult Health Care Access Estimates Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data Unofficial Discussion Draft Subject to Change

  45. Chart 6.3 Underserved Area Designations Access to health care is closely tied to availability of health care providers. Every locality in the region except for Southampton and Franklin have been designated as health professional shortage areas (HPSAs), meaning they may have a shortage of health professionals to meet population need. In addition, Surry County, Sussex County, Gates County are designated as ‘medically underserved areas’ (MUA), indicating they have additional risk factors related to poverty, infant mortality, or both. Designations are made by the Federal Bureau of Primary Health Care in coordination with the Virginia Department of Health. MUA/ HPSA HPSA MUA/ HPSA HPSA MUA/ HPSA Unofficial Discussion Draft Subject to Change

  46. Charts 6.4-6.9Ambulatory Care Sensitive Condition Discharges • Ambulatory Care Sensitive Conditions are health conditions for which inpatient hospitalization may be avoided with proper ambulatory care. • A region with high rates of ACSC discharges may have barriers to ambulatory care utilization. • Technical Note: • Virginia Health Information, Inc. requires the following notice to accompany any use of its data: • “VHI has provided non-confidential patient level information used in this report which it has compiled in accordance with Virginia law, but which it has no authority to independently verify. By using this report, the user agrees to assume all risks that may be associated with or arise from the use of inaccurate data. VHI cannot and does not represent that the use of VHI’s data was appropriate for this report, or endorse or support any conclusions of inferences that may be drawn from the use of VHI’s data.” Unofficial Discussion Draft Subject to Change

  47. Chart 6.4 Ambulatory Care Sensitive Condition Discharges In 2005, residents of the Virginia Service Region had 3,548 ACSC discharges from Virginia hospitals. The rate of hospitalization was above the statewide rate in Franklin, Southampton, Sussex, and the region as a whole. Charts 6.5-6.8 show detailed breakouts of ACSC discharges by condition. Chart 6.9 shows separate data on discharges for psychosis, which some researchers also identify as an ambulatory care sensitive condition. Unofficial Discussion Draft Subject to Change

  48. Chart 6.5 Ambulatory Care Sensitive Condition Discharges Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges. Unofficial Discussion Draft Subject to Change

  49. Chart 6.6 Ambulatory Care Sensitive Condition Discharges Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges. Unofficial Discussion Draft Subject to Change

  50. Chart 6.7 Ambulatory Care Sensitive Condition Discharges Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges. Unofficial Discussion Draft Subject to Change