Q6. If you experienced an immediate medical need, where would you go? 49.0% 50.00% 46.40% 40.00% 34.70% 33.9% 30.00% 20.00% 15.30% 11.9% 10.00% 5.2% 3.60% 0.00% Urgent Emergency Doctor's Other Care Room Office FY16 FY19 Source: CHNA FY2019
Total ED Visits ER Admitted to Inpatient 82,000 18.0 80,000 16.0 14.4% 13.0% 78,000 14.0 76,000 12.0 74,000 10.0 PERCENTAGE 72,000 8.0 70,000 6.0 68,000 4.0 66,000 2.0 64,000 0.0 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 Source: MMC 2018
Q15. Where do you get MOST of your health information? Doctor / health professional 81.8% Internet 55.7% Family or friends 21.4% Pharmacy 13.4% Newspaper / magazines 12.4% Hospital 12.1% Facebook or Twitter 8.0% TV 7.3% Worksite 7.1% Other social media 6.7% Other 6.1% Health Department 4.6% School or college 3.7% Library 3.3% Church group 2.3% Radio 1.9% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Source: CHNA FY2019
Q7. Are there any issues that stop you from getting care when you need it? Cost 27.1% Doctor office not open 14.5% evenings or weekends Can’t afford the co -pay 13.3% or deductible Can't get an appointment 10.0% No insurance 9.8% Other 4.8% Don't have a family doctor 4.3% 2.2% Fear of doctors The doctor I need is 2.1% not taking new patients 1.6% Transportation Don't know how to 0.8% find a doctor 0.4% Language barriers Cultural / religious beliefs 0.2% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Source: CHNA FY2019
Q. Gone without Meds – Q8. In the past 12 months, have Can't Afford TREND you gone without medicine, or not taken medicine as prescribed because you could not afford it? 90% 79% 80% 70% 12.2% 60% 11.5% 10.5% 50% 40% 30% 20% 12% 10% 10% 0% Yes No I don’t take medicine 2012 2015 2018 Source: CHNA FY2013 - 2019
211 Service Requests Source: Washington County 211 https://md-dc.211counts.org/ accessed 10/25/2018
HEALTH COVERAGE Nefertiti Guillaume, Maryland Health Connection
Q29. Do you currently have health insurance? 0.3% 11.2% 88.5% Yes No Don't know Source: CHNA FY2019
Q30. Who helps pay for your health insurance? 70.0% 59.6% 60.0% 50.0% 40.0% 30.0% 17.2% 19.1% 20.0% 7.3% 10.0% 4.3% 1.3% 0.0% Employer Government Family I pay for 100% Other Group other (Medicare, member's of expense than employer Medicaid or insurance ACA Exchange) Source: CHNA FY2019
Washington County Uninsured Rate 14% 12% 12% 12% 11% 10% 8% 8% 7% 6% 4% 2% 0% 2014 2015 2016 2017 2018 Maryland Washington Allegheny Frederick Carroll Source: RJW County Health Factors 2018
Uninsured ED Visits 30 25 25.2 22.2 20 Percentage 17.9 15.5 15.3 15 15.1 10 9.8 9.7 7.3 5 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 MD Goal Maryland Washington Source: Maryland SHIP 2018
Uninsured Washington County Residents Source: Maryland Health Exchange accessed 10/25/2018https://maryland.maps.arcgis.com/apps/MapJournal/index.html?appid=fa0c45fcca2d47b1878b6980eea2db49
Uninsured Hot Spots
Q31. Why do you currently not have health insurance? 60.0% Cannot afford insurance Employer does not 25.0% pay for insurance Lost or changed jobs 17.5% Not eligible for employer- 9.2% paid insurance Do not know how to 7.5% obtain health insurance Do not need insurance 1.7% Insurance company refused 1.7% coverage for health reasons Do not believe in insurance 0.8% Prefer not to participate 0.8% in private insurance Dissatisfied with previous 0.8% insurance plan or provider Prefer not to participate in 0.0% government insurance 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Source: CHNA FY2019
Q: Why do you not have health insurance? 90.0% 83.3% 80.0% 70.0% 60.0% 60.0% 50.0% 35.8% 40.0% 34.0% 28.8% 30.0% 25.0% 17.5% 20.0% 15.9% 9.2% 8.3% 10.0% 1.9% 1.9% 0.0% Cannot afford Employer does not pay Not eligible for Lost or changed jobs insurance for insurance employer paid insurance 2012 2015 2018 Source: CHNA FY2013 – 2019
HEALTHY LIFESTYLE Deb Lehr, BA, RN, BSN, CCRN, CRN Meritus Community Health & Wellness
Q3. Please select all health concerns that you face. Overweight 48.2% High Blood Pressure 35.1% Joint or Back Pain 31.6% High cholesterol 25.4% Sleep problems 21.4% Diabetes or Pre-diabetes 19.7% Mental health (ADHD,… 18.6% I do not have any… 13.2% Other 11.2% Dental 10.8% Asthma 10.8% Smoking 6.9% Heart disease 6.8% Cancer 5.8% COPD 4.7% Source: CHNA FY2019
Q23. Please choose ALL statements below that apply to you. I receive a flu shot each year. 66.7% I use sunscreen or protective 57.6% clothing for planned time in the… I drink at least 6-8 glasses of 49.0% water per day. I have a wellness program at work. 35.4% I eat at least 5 servings of fruits 32.3% and vegetables each day I eat fast food more than once 31.1% per week. I drink 2 or more sodas or 13.4% energy drinks per day. I smoke cigarettes. 8.7% None of the above applies to me 4.5% I have more than 2 alcoholic 4.2% drinks (if female) or 3 (if male)… I use electronic cigarettes. 2.6% 1.4% I use medical marijuana 0.9% I mis-use drugs, legal or illegal I take other people's 0.9% prescription medication. 0.9% I use smokeless tobacco. Non-Healthy Behaviors Response Percent Healthy Behaviors Response Percent Source: CHNA FY2019
Q24. Which of the following preventive procedures have you had in the past 12 months? 81.6% Blood pressure check 66.1% Flu shot 61.3% Physical exam 60.5% Dental cleaning / X-rays Vision screening 57.4% 55.2% Blood sugar check 51.4% Cholesterol screening 41.7% Pap smear 41.5% Mammogram Skin cancer screening 17.4% Depression screening 16.7% 13.2% Colon / rectal exam 12.8% Hearing screening 12.0% Cardiovascular screening 7.6% Bone density test 4.5% Prostate cancer screening 4.0% None of the above 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Source: CHNA FY2019
OVERWEIGHT OBESE Allen Twigg, Meritus Community Health Mary McPherson, MD Dept. of Health
Obesity Trends Among U.S. Adults Source: D. Blumenthal and S. Seervai, "Rising Obesity in the United States Is a Public Health Crisis," To the Point, the Commonwealth Fund, Apr. 23, 2018.
Obesity Percentage Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
Washington County Adult Obesity BMI > 30 36% 34% 34% 34% 33% 33% 32% 32% 30% 28% 26% 24% 2014 2015 2016 2017 2018 Maryland Washington Allegheny Frederick Carroll Adult Obesity: Percentage of adults that report a BMI of 30 or more. Source: RWJ County Health Rankings 2018
Adults Who Are Not Overweight or Obese 38 36.6 36 34 34.1 32.9 32 32.2 31.6 31.5 30 28 27.9 26 24 22 20 2011 2012 2013 2014 2015 2016 MD Goal Maryland Washington Adult Obesity: This indicator shows the percentage of adults who are not overweight or obese. Source: SHIP 2018
Q25. How important is exercise to you? 40.0% 37.7% 35.0% 30.0% 27.5% 25.0% 20.0% 16.0% 15.0% 13.4% 10.0% 5.5% 5.0% 0.0% Extremely Very Moderately Slightly Not at all important important important important important Source: CHNA FY2019
Q26. In a typical week, how many days do you exercise? 40.0% 34.7% 35.0% 30.0% 26.6% 25.0% 20.0% 16.1% 12.6% 15.0% 10.0% 5.0% 0.0% I don't regularly Once a week 2 to 4 days a week 5 to 7 days a week exercise Source: CHNA FY2019
Washington Co. CHNA Trend - Adult Weight 2012 - 2018 36.0% 35.0% 34.0% 33.0% 32.0% 31.0% 30.0% 2012 2015 2018 Obese > 30 Overweight 25.1 - 29.9 Healthy Weight 18.5 - 25 Sources: Maryland SHIP 2018, RWJ County Health Rankings 2018, CDC Surveillance 2018
Physical Inactivity 33% 32% 31% 29% 27% 27% 27% 26% 26% 25% 23% 21% 19% 17% 15% 2014 2015 2016 2017 2018 Maryland Washington Allegheny Frederick Carroll Physical Inactivity: Percentage of adults age 20 and over reporting no leisure-time physical activity. Source: RWJ County Health Rankings 2018
Access to Exercise Opportunities 100% 95% 90% 85% 82% 81% 81% 80% 77% 77% 75% 70% 2014 2015 2016 2017 2018 Maryland Washington Allegheny Frederick Carroll Percentage of population with adequate access to locations for physical activity. Source: RWJ County Health Rankings 2018
Focus Group Themes Why? • Fast food is low cost and unhealthy • Lack of time • Lack of exercise and motivation • Screen time / electronics • Lack of knowledge Barriers • Dietary counseling is not a covered insurance benefit • No medical weight loss services Source: CHNA FY2019 Focus Groups
HEART DISEASE HYPERTENSION James Recabo, RN Paul Frey, Washington County Chamber of Commerce
Heart Disease Prevalence Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
Heart Disease Mortality Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
Age-Adjusted Mortality Rate From Heart Disease 220 208.4 202.5 202.5 196.1 200 195.4 193.5 187.7 184.1 180 160 140 120 100 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2009 2010 2011 2012 2013 2014 2015 2016 MD Goal Maryland Washington Source: Maryland SHIP 2018
Age-Adjusted Mortality Rate From Heart Disease County Comparison 280 260 240 220 200 180 160 140 120 100 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2009 2010 2011 2012 2013 2014 2015 2016 MD Goal Washington Allegany Frederick Carroll Source: Maryland SHIP 2018
Stroke Mortality Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
Q: Have you ever been told that you have hypertension? 40.0% 35.1% 34.4% 35.0% 31% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 2012 2015 2018 2012 2015 2018 Source: CHNA FY2013 - 2019
Hypertension Mortality Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
ED Visit Rate Due to Hypertension 300 250 200 182.4 172.1 152.7 150 154.4 126.9 131.2 126.7 100 50 0 2008 2009 2010 2011 2012 2013 2014 MD Goal Maryland Washington Source: MD SHIP 2018
Hypertension in ED 90.0% 80.0% 80.0% 79.4% 77.8% 74.1% 72.3% 72.2% 70.0% 60.0% 50.0% 40.0% 30.0% 23.4% 22.9% 21.5% 20.0% 17.0% 14.8% 17.7% 10.0% 1.8% 1.7% 1.4% 1.5% 1.3% 0.6% 0.0% 2013 2014 2015 2016 2017 2018 White Black Latin American Source: Meritus Medical Center 2018
Blood Pressure Medication Nonadherence Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018
SMOKING Tobacco / Nicotine Use Mary McPherson, MD Dept. of Health
Adults Who Currently Smoke Rate 30% 25% 25% 22% 22% 20% 20% 18% 18% 16% 15% 10% 5% 0% 2011 2012 2013 2014 2015 2016 Maryland Washington MD Goal Source: MD SHIP 2018
Adult Smoking Rate County Comparison 24% 22% 21% 21% 20% 18% 17% 17% 16% 16% 14% 12% 10% 2014 2015 2016 2017 2018 Maryland Washington Allegheny Frederick Carroll Percentage of adults who are current smokers. Source: RWJ County Health Rankings 2018
Adolescents Who Used Tobacco Products Past 30 Days 35% 33% 30% 25% 25% 24% 20% 15% 10% 5% 0% 2010 2013 2014 MD Goal Maryland Washington Source: RWJ County Health Rankings 2018
Adolescents Who Used Tobacco Products Past 30 Days County Comparison 35% 33% 30% 25% 24% 25% 20% 15% 10% 5% 0% 2010 2013 2014 MD Goal Washington Allegany Frederick Carroll Source: RWJ County Health Rankings 2018
DIABETES Cindy Earle, MPH, RN Meritus Medical Center
Source: CDC https://www.cdc.gov/diabetes/data/center/slides.html accessed 10.23.2018
1994 Source: CDC https://www.cdc.gov/diabetes/data/center/slides.html accessed 10.23.2018
Diabetes Prevalence Source: CDC https://www.cdc.gov/diabetes/atlas/obesityrisk/24/atlas.html 10.23.2018
Diabetes Mortality Rate (per 100,000 people) 40 37.4 35.9 34.8 35 30 25 22.6 21.7 20.7 20 15 10 5 0 2014 2015 2016 Washington County Maryland Source: Maryland Vital Statistics 2016
Diabetes Morbidity Q11. Have you ever been told Q13. Are you interested in by a doctor or health learning how to professional that you have prevent diabetes? diabetes? 17% 29% 71% 83% Yes Yes No No Source: CHNA FY2019
Q12. If YES for diabetes, how are you managing your symptoms? (check ALL that apply) 77.4% Medication 72.8% Diet 51.2% Exercise 42.4% Family doctor Diabetes education 30.4% program 17.1% Endocrinologist I had gestational 9.7% diabetes I am not managing 3.2% my symptoms 1.8% None of the above 1.8% Support group 0 0.2 0.4 0.6 0.8 1 2018 2015 2012 Source: CHNA FY2019
Diabetes Visits in ED – Raw Data 900 800 700 600 500 400 300 200 100 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 Source: MMC 2018
Diabetes Visit Rate in ED 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 19.6% 18.1% 20.0% 16.5% 16.2% 15.8% 15.0% 10.0% 0.0% 2013 2014 2015 2016 2017 2018 White Black Latin American Source: MMC 2018
Focus Group Themes Why? • High rate of obesity and pre-diabetes • Huge need for nutritional information in our community • Socioeconomic considerations; fast food is cheap and easy Barriers • Lack of knowledge of resources available • Lack of motivation, not in “crisis” • Location of health services are not convenient • Cost of care, medication and education
BREAK
RESPIRATORY DISEASE Robert Porter, Meritus Medical Center
Chronic Lower Resiratory Disease Mortality (per 100,000 lives) 90 76.5 80 68.9 70 62.8 60 50 40 34.5 33.9 31.9 30 20 10 0 2014 2015 2016 Washington County Maryland Source: Maryland Vital Statistics 2016
COPD Visit Rate in ED 100.0% 88.5% 87.6% 86.7% 90.0% 80.0% 77.0% 75.6% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 18.5% 15.4% 16.7% 20.0% 11.4% 10.6% 9.3% 10.0% 0.0% 2013 2014 2015 2016 2017 2018 White Black Latin American Source: MMC 2018
Asthma Visit Rate in ED 80.0% 72.1% 67.3% 70.0% 65.3% 58.9% 58.6% 57.6% 60.0% 50.0% 40.0% 32.8% 30.3% 30.4% 25.7% 30.0% 23.1% 21.4% 20.0% 10.0% 4.2% 4.4% 5.1% 3.0% 2.8% 1.9% 0.0% 2013 2014 2015 2016 2017 2018 White Black Latin American Source: MMC 2018
CANCER Susan Lopp, Meritus Medical Center
Malignant Neoplasms Mortality (per 100,000 lives) 250 216 209.6 201.2 200 181.5 179.3 175.9 150 100 50 0 2014 2015 2016 Washington County Maryland Source: Maryland Vital Statistics 2016
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