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TRANSCRIPT
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Pocahontas Memorial Hospital
Community Health Needs
Assessment
2013
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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 (