COMMUNITY HEALTHCOMMUNITY HEALTHASSESSMENTASSESSMENT

Tracy Hill, Anna Marshall, Tracy Hill, Anna Marshall, Patricia NeisPatricia Neis

Miriam Slaugh, Allison VeederMiriam Slaugh, Allison VeederMarch 4, 2010March 4, 2010

Douglas County, KansasDouglas County, Kansas

Statistical Data: Lawrence/Statistical Data: Lawrence/Douglas County KansasDouglas County Kansas

Douglas County Kansas is comprised of 4 Douglas County Kansas is comprised of 4 towns: Lawrence, Baldwin, Eudora, towns: Lawrence, Baldwin, Eudora, Lecompton. Lecompton.

Douglas County is one of the fastest Douglas County is one of the fastest growing counties in the state of Kansas. growing counties in the state of Kansas. *5*5thth largest; 4 largest; 4thth healthiest healthiest

Lawrence population: 81,604 in 2007Lawrence population: 81,604 in 2007

Statistical DataStatistical Data

Top 6 Employers in Douglas County:Top 6 Employers in Douglas County:

• The University of Kansas (9,872)The University of Kansas (9,872)

• Lawrence Public Schools (1,831)Lawrence Public Schools (1,831)

• Vangent (1,500)Vangent (1,500)

• City of Lawrence (1,431)City of Lawrence (1,431)

• Lawrence Memorial Hospital (1,251)Lawrence Memorial Hospital (1,251)

• Hallmark Cards (814)Hallmark Cards (814)

Primary/Tertiary carePrimary/Tertiary care

Existing healthcare servicesExisting healthcare servicesPhysicians/APRN care available: Physicians/APRN care available: family practice, internal medicine, pediatrics, family practice, internal medicine, pediatrics,

obstetrics/gynecological, urology, allergy & asthma, obstetrics/gynecological, urology, allergy & asthma, dermatology, rheumatology, ophthalmology, dermatology, rheumatology, ophthalmology, neurology, general surgery, plastic surgery, neurology, general surgery, plastic surgery, otolaryngology (EENT), psychiatry, oncology, otolaryngology (EENT), psychiatry, oncology, gastroenterology, endocrinology, nephrology, gastroenterology, endocrinology, nephrology, infectious disease, cardiology, and occupational infectious disease, cardiology, and occupational medicine medicine

Dental care: Douglas county dental clinic, 64 DentistsDental care: Douglas county dental clinic, 64 Dentists Eye care: 31 Optometrist/OpthamologistsEye care: 31 Optometrist/Opthamologists

Primary/Tertiary carePrimary/Tertiary care

Douglas County Health DepartmentDouglas County Health Department3 Safety net clinics: 3 Safety net clinics: Healthcare AccessHealthcare Access Heartland/Leo CenterHeartland/Leo Center Douglas County Dental ClinicDouglas County Dental ClinicLawrence Memorial Hospital Lawrence Memorial Hospital Community owned; not for profit.Community owned; not for profit.

Bert Nash Mental HealthBert Nash Mental Health outpatient day clinics, counseling (limited medication outpatient day clinics, counseling (limited medication

management)management)

Home Healthcare Services: 8 agenciesHome Healthcare Services: 8 agencies

Primary/Tertiary carePrimary/Tertiary care

Hospice: Hospice: 3 agencies3 agencies

Lawrence Douglas County Fire and Medical: Lawrence Douglas County Fire and Medical: 6 stations with Paramedic, EMT’s, and Fire specialist. 6 stations with Paramedic, EMT’s, and Fire specialist.

(they provide public education on fire safety, bike (they provide public education on fire safety, bike safety/helmets, basic first aid).safety/helmets, basic first aid).

Tertiary care:Tertiary care: Lawrence is located within 30-45 minutes from Lawrence is located within 30-45 minutes from

Topeka and Kansas City which provides further Topeka and Kansas City which provides further Tertiary care for services not available at Lawrence Tertiary care for services not available at Lawrence Memorial Hospital (Cardiac, Midwifery, Neurology, Memorial Hospital (Cardiac, Midwifery, Neurology, Trauma, High-Risk OB/Peds)Trauma, High-Risk OB/Peds)

SociodemographicsSociodemographics

What are the sociodemographicsWhat are the sociodemographics of the population being served? of the population being served?

DG CountyDG County

High School graduationHigh School graduation 86%86%

4-yr College Degree4-yr College Degree 43%43%

UnemploymentUnemployment 4% 4%

Children in PovertyChildren in Poverty 13%13%

Single-Parent HouseholdsSingle-Parent Households 7% 7%

Homicide Rate (per 100,000)Homicide Rate (per 100,000) 3 3

Adult SmokingAdult Smoking 18%18%

Adult ObesityAdult Obesity 25%25%

Teen Birth RateTeen Birth Rate 1414

Uninsured AdultsUninsured Adults 19%19%

Primary Care Provider RatePrimary Care Provider Rate 110110

Access to Healthy FoodsAccess to Healthy Foods 86%86%

KansasKansas78%78%

26%26%

4%4%

15%15%

8%8%

55

19%19%

28%28%

4343

12%12%

115115

35%35%

U.S.U.S.84.5%84.5%

27.4%27.4%

10.6%10.6%

22%22%

26%26%

16,69216,692

20.6%20.6%

26.1%26.1%

41.9/1,00041.9/1,000

18.5%18.5%

51%51%

Douglas County Douglas County Demographic EstimatesDemographic Estimates

 Estimate Percent U.S.

Total population 113,569    

Male 56,666 49.9% 49.3%

Female 56,903 50.1% 50.7%

Median age (years)

28.6 36.7

Under 5 years 6,290 5.5% 6.9%

18 years and over 91,861 80.9% 75.5%

65 years and over 10,053 8.9% 12.6%

Source: U.S. Census Bureau, 2006-2008 American Community Survey at http://factfinder.census.gov

Douglas County Douglas County Population Characteristics:Population Characteristics:

Race/EthnicityRace/Ethnicity

White White 87.5%87.5%

BlackBlack 4.1% 4.1%

American Indian American Indian 2.1% 2.1%

Asian/Pacific Islander Asian/Pacific Islander 3.8% 3.8%

Hispanic origin Hispanic origin 3.6% 3.6%

Source: U.S. Census Bureau, 2006-2008 American Community Survey at http://factfinder.census.gov

Douglas County Douglas County Vulnerable PopulationVulnerable Population

Douglas County:

> 22,000 individuals

Vulnerable Populations Include People Who:

 

Have no high school diploma (among adults age 25 and older)

4,409

Are unemployed 2,517

Are severely work disabled 1,071

Have major depression 6,723

Are recent drug users (within past month)

7,285

Source: http://communityhealth.hhs.gov/

Douglas County Adult Douglas County Adult Preventative Services UsePreventative Services Use

Source: http://communityhealth.hhs.gov/

What are Douglas County’s What are Douglas County’s primary health issues?primary health issues?

Adult Smoking (smoking ban)Adult Smoking (smoking ban)

Adult Obesity Adult Obesity

Breast Cancer - womenBreast Cancer - women

PovertyPoverty

UninsuredUninsured

Binge Drinking (college town)Binge Drinking (college town)

STD’s (chlamydia)STD’s (chlamydia)

Ozone Ozone

Macrosystem FactorsMacrosystem Factors

Insurance coverage:Insurance coverage: 11,344 individuals in Douglas County are 11,344 individuals in Douglas County are

uninsured (~10% of the population)uninsured (~10% of the population) 102,144 individuals in Douglas County are 102,144 individuals in Douglas County are

insured (~ 90% of the population)insured (~ 90% of the population)

Macrosystem FactorsMacrosystem FactorsInsurance coverage:Insurance coverage:• Types of payors for Insured Individuals AND Types of payors for Insured Individuals AND

Percentages of payors for population:Percentages of payors for population:• Private/Non-government InsurancePrivate/Non-government Insurance

Employment-based Employment-based 72.8%72.8%

Direct purchase Direct purchase 11.7%11.7%

• Government-sponsored Insurance Government-sponsored Insurance MedicareMedicare 8.4%8.4%

Medicaid/SCHIPMedicaid/SCHIP 7.5%7.5%

Military health careMilitary health care 2.2%2.2%

Indian/other gov’t health servicesIndian/other gov’t health services 2.5%2.5%

Macrosystem FactorsMacrosystem Factors

Political Forces:Douglas County is in Congressional District 2

In 2008 general election, Congressional District 2 (and Douglas County) voted Democrat in House, Senate, and Presidential races.

34,398 votes - Obama/Biden 17,929 votes - McCain/Palin

Macrosystem Factors:Macrosystem Factors:

Social Forces eitherSocial Forces either

Contribute to Contribute to

OROR

Detract from Detract from

The health of individuals and communitiesThe health of individuals and communities

Macrosystem FactorsMacrosystem FactorsSocial ForcesSocial Forces

Socioeconomic Socioeconomic factorsfactors

FoodFood

EducationEducation

Environmental Environmental ConditionsConditions

IncomeIncome EducationEducation OccupationOccupation TransportationTransportation SanitationSanitation HousingHousing Access to ServicesAccess to Services Resources linked to health Resources linked to health

discrimination, social support, discrimination, social support, environmental hazardsenvironmental hazards

-Source: MLC-Source: MLC

Macrosystem FactorsMacrosystem Factors

Vulnerable PopulationsVulnerable Populations

IncomeIncome

EducationEducation

OccupationOccupation

TransportationTransportation

SanitationSanitation

HousingHousing

Macrosystem FactorsMacrosystem Factors

Access to CareAccess to Care

• Primary care physicians Primary care physicians per 100,000 population – per 100,000 population – 74.874.8

• Dentists per 100,000 Dentists per 100,000 population – 42.8population – 42.8

Services in Douglas CountyServices in Douglas County

Dg Co Dental Clinic, Dg Co Dental Clinic,

Visiting Nurses, Rehab and Hospice Visiting Nurses, Rehab and Hospice carecare

Senior Services, Inc.Senior Services, Inc.

Dg Co Health DeptDg Co Health Dept

United WayUnited Way

AIDS ProjectAIDS Project

LINKLINK

Health Care AccessHealth Care Access

DCCCA, Inc.DCCCA, Inc.

GaDuGi Safe CenterGaDuGi Safe Center

Headquarters Counseling CenterHeadquarters Counseling Center

Community Living OpportunitiesCommunity Living Opportunities

Safety-Net Clinics and LMHSafety-Net Clinics and LMH

In 2009, 7.6% of patients served by In 2009, 7.6% of patients served by Lawrence Memorial Hospital had no Lawrence Memorial Hospital had no insurance.insurance.

In 2008, the 4 safety net clinics servedIn 2008, the 4 safety net clinics served

Total: 5,077Total: 5,0773,554 uninsured (70%)3,554 uninsured (70%)

1,338 Medicaid/Healthwave (26.4%)1,338 Medicaid/Healthwave (26.4%)

3,766 (74.2% earned less than federal poverty level)3,766 (74.2% earned less than federal poverty level)

1,257 (24.8% earned between 101-200% of poverty level)1,257 (24.8% earned between 101-200% of poverty level)

Gap analysisGap analysis

What health problems are not being What health problems are not being sufficiently addressed?sufficiently addressed?

What services are lackingWhat services are lacking

1.1.Primary health carePrimary health care

2.2.Mental health servicesMental health services

3.3.DentalDental

Solution/StrategiesSolution/Strategies

Provide your solutions and suggested Provide your solutions and suggested strategies to accomplish these goalsstrategies to accomplish these goals

ReferencesReferencesBritt, K. (2010, January 21). Douglas county dental clinic changes income guidelines. Britt, K. (2010, January 21). Douglas county dental clinic changes income guidelines. Lawrence Journal Lawrence Journal

WorldWorld, retrieved on February 27, 2010 from , retrieved on February 27, 2010 from http://www2.ljworld.com/news/2010/jan/21/douglas-county-dental-clinic-changes-income-guidel/.guidel/.

Britt, K. (2010, February 13). A day at Lawrence’s health care access clinic reveals need for affordable Britt, K. (2010, February 13). A day at Lawrence’s health care access clinic reveals need for affordable medical care. medical care. Lawrence Journal WorldLawrence Journal World, retrieved on February 27, 2010 from , retrieved on February 27, 2010 from http://www2.ljworld.com/news/2010/feb/13/day-lawrences-health-care-access-reveals- need-need-affo/.affo/.

Community care. (2009, Septmber 28). Lawrence Journal World, retrieved on February 27, 2010 from Community care. (2009, Septmber 28). Lawrence Journal World, retrieved on February 27, 2010 from http://www.2.ljworld.com/news/2009/sep/28/community-care/?print.http://www.2.ljworld.com/news/2009/sep/28/community-care/?print.

DeNavas-Walt, C., Proctor, B.D., & Smith, J.C. (2009). DeNavas-Walt, C., Proctor, B.D., & Smith, J.C. (2009). Income, poverty, and insurance coverage in the Income, poverty, and insurance coverage in the U.S.: 2008. U.S.: 2008. Retrieved from US Census Bureau: Retrieved from US Census Bureau: http://www.census.gov/hhes/www/hlthins/hlthin08/hlthtables08.htmlhttp://www.census.gov/hhes/www/hlthins/hlthin08/hlthtables08.html

Duncan, R.P., Porter, C.K., & Garvan, C.W. (2001). Duncan, R.P., Porter, C.K., & Garvan, C.W. (2001). The Kansas health insurance study. Finding and filling The Kansas health insurance study. Finding and filling the gaps: Developing a strategic plan to cover all Kansans. the gaps: Developing a strategic plan to cover all Kansans. Retrieved from: Retrieved from: http://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdfhttp://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdf

Haskell Indian Health Center: Service area profile (2005). Retrieved from Division of Facilities Planning & Haskell Indian Health Center: Service area profile (2005). Retrieved from Division of Facilities Planning & Construction, Indian Health Service: http://www.dfpc.ihs.gov. Construction, Indian Health Service: http://www.dfpc.ihs.gov.

Kansas Department of Health and Environment. (2010). Kansas Department of Health and Environment. (2010). Kansas Department of Health and Environment: Kansas Department of Health and Environment: Annual Report 2009 Annual Report 2009 (Annual Report). Retrieved from Kansas Department of Health and Environment: (Annual Report). Retrieved from Kansas Department of Health and Environment: http://www.kdheks.gov/http://www.kdheks.gov/

  

ReferencesReferencesKansas Insurance Department. (2001). Kansas Insurance Department. (2001). Finding and Filling the Gaps: Developing a Strategic Plan to Finding and Filling the Gaps: Developing a Strategic Plan to

Cover all Kansans: The Kansas Health Insurance StudyCover all Kansans: The Kansas Health Insurance Study . Retrieved from Kansas Insurance . Retrieved from Kansas Insurance Commissioner website: http://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdfCommissioner website: http://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdf

Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (Eds.). (2007). Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (Eds.). (2007). Policy & Politics in Nursing and Health Policy & Politics in Nursing and Health Care Care (5th ed.). St. Louis, MO: Saunders Elsevier.(5th ed.). St. Louis, MO: Saunders Elsevier.

Robert Wood Johnson Foundation. (2010). Robert Wood Johnson Foundation. (2010). Snapshot 2010: Douglas County Health RankingsSnapshot 2010: Douglas County Health Rankings. . Retrieved from http://www.countyhealthrankings.org/kansas/douglasRetrieved from http://www.countyhealthrankings.org/kansas/douglas

U.S. Census Bureau. (2006-2008). http://factfinder.census.govU.S. Census Bureau. (2006-2008). http://factfinder.census.gov

U.S. Department of Health & Human Services website. (2007). U.S. Department of Health & Human Services website. (2007). http://www.cms.hhs.gov/MedicareEnrpts/http://www.cms.hhs.gov/MedicareEnrpts/

U.S. Department of Health & Human Services. (2008). http://communityhealth.hhs.govU.S. Department of Health & Human Services. (2008). http://communityhealth.hhs.gov

U.S. Department of Health & Human Services: Indian Health Services website. (n.d.). U.S. Department of Health & Human Services: Indian Health Services website. (n.d.). http://www.dfpc.ihs.gov/http://www.dfpc.ihs.gov/

ConclusionConclusion