FY2019 Welcome! Joseph P. Ross, President & CEO Meritus - - PowerPoint PPT Presentation

Community Health Needs Assessment FY2019

Welcome!

Joseph P. Ross, President & CEO Meritus Medical Center, Inc. Earl Stoner, Washington County Health Officer Maryland Department of Health

• R. Lynn Rushing, CEO

Brook Lane Health Services, Inc.

Allen Twigg, Meritus Medical Center - Chair Joelle Butler, Meritus Medical Center Shelby DeHaven, YMCA of Hagerstown Susan Delauter, Community member Diana Gaviria MD, Maryland Department of Health Adam Roberson, Community Free Clinic Erin Hershey, Meritus Health Board of Directors Susan Lopp, John R. Marsh Cancer Center Rod MacRae, Washington County Health Department Curt Miller, Brook Lane Health Services Jon Noyes, Meritus Medical Center Kathy Powderly, Hagerstown Area Religious Council Rick Rock, Washington County Mental Health Authority Guinn Rogers, United Way of Washington County Douglas Spotts MD, Meritus Health Shelley Steiner, Hospice of Washington County Cynthia Terl, Wells House Susan Walter, Tristate Community Health Center Melissa Minotti, Johns Hopkins Comstock Center Douglas Brown, Frostburg State University Brad Sell, Community Foundation of Washington County

CHNA Steering Committee

A public and private collaboration to help people living in our community understand their personal health status and how to make healthy lifestyle changes

Today’s goal

To identify and prioritize needs to improve the health of people in our community

• Public policy
• Support for grant writing
• Strategic planning
• Not for profit hospitals
• Local Health Improvement Coalition (LHIC)
• MD State Health Improvement Planning (SHIP)

Prioritized Community Health Needs 2009 - 2018

2009 Mental health, senior services, obesity, oral care 2012 Obesity, diabetes, heart disease, cancer, mental health, teen pregnancy 2015 Obesity & physical inactivity, mental health, diabetes, healthy lifestyles, substance abuse, heart disease & hypertension 2018 ?

Methodology

• Community Health Steering Committee January, 2018
• Collection and Review of Secondary Data February – May 2018
• Behavioral Risk Factor Surveillance BRFSS (Centers for Disease Control)
• Community Health Rankings (Robert Wood Johnson)
• Maryland State Health Improvement Project (SHIP)
• Conducted Community Health Needs Survey

Sample Size = 1,514; data collected June 25, 2018 to September 14, 2018

• Online, YMCA, Community Free Clinic, WCDSS, Farmer’s Markets
• Complimentary Community Health Focus Groups & Interviews (n= 112)

– Senior’s Focus Group August 28, 2018 – Men’s Focus Group, September 6, 2018 – Physician Focused Interviews October 2 – 19, 2018 – Hispanic Focused Interviews, September 23, 2018 – African American Focus Group October 9, 2018 – Behavioral Health Focus Group October 29, 2018 – Care Management Focused Interviews October 18 - November 2, 2018

• Data Analysis October – November, 2018
• Prioritization of Needs November 20, 2018

DASHBOARDS

County Health Rankings Dashboard (RWJ)

Source: Robert Wood Johnson Foundation 2018

Community Health Rankings MARYLAND

2012 vs. 2018

Rank

Health Outcomes

Rank

Health Factors

2012 2018 2012 2018 1 Howard Montgomery 1 Howard Howard 2 Montgomery Howard 2 Montgomery Montgomery 3 Queen Anne's Carroll 3 Frederick Carroll 4 Frederick Calvert 4 Talbot Frederick 5 Carroll Frederick 5 Carroll Calvert 6 Calvert

• St. Mary's

6 Calvert Queen Anne's 7 St Mary's Anne Arrundel 7 Anne Arundel Talbot 8 Talbot Harford 8 Harford Harford 9 Harford Queen Anne's 9 Queen Anne's Anne Arrundel 10 Anne Arrundel Talbot 10 Baltimore St Mary's 11 Charles Charles 11 Charles Baltimore

12 Washington

Worcester 12 St Mary's Charles 13 Baltimore Baltimore 13 Kent Kent 14 Worcester Prince George's 14 Garrett Garrett 15 Prince George's Garrett 15 Worcester Worcester 16 Garrett Kent

16 Washington

Prince George's 17 Kent Cecil 17 Prince George's

Washington

• 1

18 Cecil

Washington

• 6

18 Allegany Allegany 19 Wicomico Wicomico 19 Wicomico Wicomico 20 Caroline Allegany 20 Cecil Cecil 21 Somerset Dorchester 21 Caroline Caroline 22 Dorchester Caroline 22 Dorchester Dorchester 23 Allegany Somerset 23 Somerset Somerset 24 Baltimore City Baltimore City 24 Baltimore City Baltimore City

Source: Robert Wood Johnson Foundation Community Health Rankings 2018

79.5 77.5 76 76.5 77 77.5 78 78.5 79 79.5 80 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016 YEARS

Life Expectancy

MD Goal Maryland Washington

79.8 Source: Maryland State Health Improvement Process (SHIP) Healthy Living Data, 2008 - 2016

77.5 74 75 76 77 78 79 80 81 82 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Life Expectancy County Comparison

MD Goal Washington Allegany Frederick Carroll

79.8

YEARS

Source: Maryland State Health Improvement Process (SHIP) Healthy Living Data, 2008 - 2016

COMMUNITY SURVEY

1,514 responses

Who took the survey?

Source: The Maryland Department of Planning https://planning.maryland.gov/MSDC/Documents/zipcode_map/2013/washzc13.pdf

WEST SOUTH EAST CENTRAL

Source: U.S. Census Bureau, Population Estimates Program (PEP), July 1, 2017 and CHNA FY2019

41.1% 29.7% 22.3% 6.9% 37.5% 33.6% 18.8% 10.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% Central/City East South West

• Q1. Geographic Population vs. Survey Sample

Population Survey Sample

Source: CHNA FY2019 0.3% 11.6% 16.5% 16.9% 24.1% 21.7% 6.8% 2.0% 0.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

• Q36. What is your age?

Source: U.S. Census Bureau, Population Estimates Program (PEP), July 1, 2017 and CHNA FY2019

1.1% 0.9% 5.3% 2.1% 0.4% 86.2% 0.3% 1.9% 9.7% 4.3% 0.1% 83.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% American Indian Asian Black / African American Hispanic / Latino Hawaiian Native White/ Caucasian

• Q40. What is your race / ethnicity?

Census Survey

Source: CHNA FY2019

29.2% 31.4% 17.8% 8.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% $0 – 49,000 $50,000 - $99,000 $100,000 - $149,000 $150,000 +

• Q39. How much total Combined money did all

members of your HOUSEHOLD earn last year?

Source: CHNA FY2019

19% 80% 1%

• Q35. What is your

gender?

Male Female Other

53.7% 21.8% 5.10% 19.20%

• Q37. What is your highest

level of education?

College Graduate Some College GED / Tech School High School or less

Economic Status

Kathy Saxman, Washington County United Way

AFFORDABLE HOUSING

Allen Twigg, Meritus Medical Center

Housing and Living Arrangements

Housing Housing units, July 1, 2017, (V2017) 61,488 Owner-occupied housing unit rate, 2012-2016 64.50% Median value of owner-occupied housing units, 2012-2016 $198,900 Median monthly owner costs -with a mortgage, 2012-2016 $1,498 Median monthly owner costs -without a mortgage, 2012-2016 $429 Median gross rent, 2012-2016 $869 Building permits, 2017 308 Families & Living Arrangements Households, 2012-2016 56,094 Persons per household, 2012-2016 2.51 Living in same house 1 year ago, percent of persons age 1 year+, 2012-2016 85.80% Language other than English spoken at home, percent of persons age 5 years+, 2012-2016 7.30%

Source: U.S Census QuickFacts https://www.census.gov/quickfacts/fact/table/washingtoncountymaryland/PST045217

76.1% 10 20 30 40 50 60 70 80 90 100 2010 2011 2012 2013 2014 2015

% of Affordable Housing Units Sold County Comparison

MD Goal Washington Allegany Frederick Carroll

Source: Maryland SHIP 2018

Housing & Shelter Requests 2017 - 2018

Source: Washington County 211 https://md-dc.211counts.org/ accessed 10/25/2018

HEALTH ACCESS

Allen Twigg, Meritus Medical Center

Source: Healthy Washington County CHNA Survey FY2013 - FY2019 15.4% 32.4% 32.4% 14.0% 5.6% 14.3% 38.9% 34.5% 10.7% 1.6% 11.4% 35.6% 40.9% 11.1% 1.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% Excellent Very Good Good Fair Poor

• Q2. In general, how would you rate your overall

health?

2012 2015 2018

Source: CHNA FY19, Healthy Washington County Survey FY2016, CHNA FY2013 7.2% 6.7% 42.3% 34.6% 9.1% 1.4% 7.7% 38.2% 43.3% 9.4% 1.4% 5.6% 33.3% 45.6% 14.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

Excellent Very Good Good Fair Poor

• Q4. Overall, how would you rate the health status of

the community?

2012 2015 2018

Source: CHNA FY2019 2.6% 0.9% 1.1% 1.8% 3.3% 8.0% 82.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Other Tri-State Community Health Center Family HealthCare

• f Hagerstown

Urgent Care I do not receive routine health care Community Free Clinic Doctor's

• ffice
• Q5. Where do you go for routine health care?

90.1 85.9 89 86.9 87 83.3

74 76 78 80 82 84 86 88 90 92 2011 2012 2013 2014 2015 2016 Percentage

Persons with a Usual Primary Care Provider

MD Goal Maryland Washington

Source: Maryland SHIP 2018

Source: CHNA FY19 Healthy Washington County Survey FY2016, CHNA Survey FY2013 6.6% 7.9% 9.1%

2012 2015 2018

No personal health care provider

Source: CHNA FY2019 46.40% 34.70% 15.30% 3.60% 49.0% 33.9% 11.9% 5.2%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% Urgent Care Emergency Room Doctor's Office Other

• Q6. If you experienced an immediate medical need,

where would you go?

FY16 FY19

Source: MMC 2018 64,000 66,000 68,000 70,000 72,000 74,000 76,000 78,000 80,000 82,000

FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

Total ED Visits

14.4% 13.0%

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0

FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

ER Admitted to Inpatient

PERCENTAGE

Source: CHNA FY2019 1.9% 2.3% 3.3% 3.7% 4.6% 6.1% 6.7% 7.1% 7.3% 8.0% 12.1% 12.4% 13.4% 21.4% 55.7% 81.8% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Radio Church group Library School or college Health Department Other Other social media Worksite TV Facebook or Twitter Hospital Newspaper / magazines Pharmacy Family or friends Internet Doctor / health professional

• Q15. Where do you get MOST of your health

information?

Source: CHNA FY2019 0.2% 0.4% 0.8% 1.6% 2.1% 2.2% 4.3% 4.8% 9.8% 10.0% 13.3% 14.5% 27.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Cultural / religious beliefs Language barriers Don't know how to find a doctor Transportation The doctor I need is not taking new patients Fear of doctors Don't have a family doctor Other No insurance Can't get an appointment Can’t afford the co-pay

• r deductible

Doctor office not open evenings or weekends Cost

• Q7. Are there any issues that stop you from getting

care when you need it?

Source: CHNA FY2013 - 2019 12% 79% 10%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Yes No I don’t take medicine

• Q8. In the past 12 months, have

you gone without medicine, or not taken medicine as prescribed because you could not afford it?

10.5% 12.2% 11.5%

2012 2015 2018

• Q. Gone without Meds –

Can't Afford TREND

211 Service Requests

Source: Washington County 211 https://md-dc.211counts.org/ accessed 10/25/2018

HEALTH COVERAGE

Nefertiti Guillaume, Maryland Health Connection

Source: CHNA FY2019

88.5% 11.2% 0.3%

• Q29. Do you currently have health insurance?

Yes No Don't know

Source: CHNA FY2019 59.6% 19.1% 17.2% 7.3% 4.3% 1.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Employer Government (Medicare, Medicaid or ACA Exchange) Family member's insurance I pay for 100%

• f expense

Other Group other than employer

• Q30. Who helps pay for your health insurance?

Source: RJW County Health Factors 2018 12% 12% 11% 8% 7%

0% 2% 4% 6% 8% 10% 12% 14% 2014 2015 2016 2017 2018

Washington County Uninsured Rate

Maryland Washington Allegheny Frederick Carroll

25.2 22.2 17.9 15.5 15.1 15.3 9.7 9.8 7.3

5 10 15 20 25 30 2008 2009 2010 2011 2012 2013 2014 2015 2016 Percentage

Uninsured ED Visits

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

Source: CHNA FY2019 0.0% 0.8% 0.8% 0.8% 1.7% 1.7% 7.5% 9.2% 17.5% 25.0% 60.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Prefer not to participate in government insurance Dissatisfied with previous insurance plan or provider Prefer not to participate in private insurance Do not believe in insurance Insurance company refused coverage for health reasons Do not need insurance Do not know how to

• btain health insurance

Not eligible for employer- paid insurance Lost or changed jobs Employer does not pay for insurance Cannot afford insurance

• Q31. Why do you currently not have health

insurance?

Source: CHNA FY2013 – 2019 34.0% 1.9% 1.9% 35.8% 83.3% 28.8% 8.3% 15.9% 60.0% 25.0% 9.2% 17.5%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Cannot afford insurance Employer does not pay for insurance Not eligible for employer paid insurance Lost or changed jobs

Q: Why do you not have health insurance?

2012 2015 2018

HEALTHY LIFESTYLE

Deb Lehr, BA, RN, BSN, CCRN, CRN Meritus Community Health & Wellness

Source: CHNA FY2019 4.7% 5.8% 6.8% 6.9% 10.8% 10.8% 11.2% 13.2% 18.6% 19.7% 21.4% 25.4% 31.6% 35.1% 48.2%

COPD Cancer Heart disease Smoking Asthma Dental Other I do not have any… Mental health (ADHD,… Diabetes or Pre-diabetes Sleep problems High cholesterol Joint or Back Pain High Blood Pressure Overweight

• Q3. Please select all health concerns that you face.

Source: CHNA FY2019 32.3% 35.4% 49.0% 57.6% 66.7% 0.9% 0.9% 0.9% 1.4% 2.6% 4.2% 4.5% 8.7% 13.4% 31.1%

I use smokeless tobacco. I take other people's prescription medication. I mis-use drugs, legal or illegal I use medical marijuana I use electronic cigarettes. I have more than 2 alcoholic drinks (if female) or 3 (if male)… None of the above applies to me I smoke cigarettes. I drink 2 or more sodas or energy drinks per day. I eat fast food more than once per week. I eat at least 5 servings of fruits and vegetables each day I have a wellness program at work. I drink at least 6-8 glasses of water per day. I use sunscreen or protective clothing for planned time in the… I receive a flu shot each year.

• Q23. Please choose ALL statements below that apply to you.

Non-Healthy Behaviors Response Percent Healthy Behaviors Response Percent

Source: CHNA FY2019 4.0% 4.5% 7.6% 12.0% 12.8% 13.2% 16.7% 17.4% 41.5% 41.7% 51.4% 55.2% 57.4% 60.5% 61.3% 66.1% 81.6%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

None of the above Prostate cancer screening Bone density test Cardiovascular screening Hearing screening Colon / rectal exam Depression screening Skin cancer screening Mammogram Pap smear Cholesterol screening Blood sugar check Vision screening Dental cleaning / X-rays Physical exam Flu shot Blood pressure check

• Q24. Which of the following preventive procedures

have you had in the past 12 months?

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.

Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018

Obesity Percentage

32% 33% 33% 34% 34% 24% 26% 28% 30% 32% 34% 36% 2014 2015 2016 2017 2018

Washington County Adult Obesity BMI > 30

Maryland Washington Allegheny Frederick Carroll

Adult Obesity: Percentage of adults that report a BMI of 30 or more. Source: RWJ County Health Rankings 2018

36.6 34.1 32.9 27.9 32.2 31.6 31.5 20 22 24 26 28 30 32 34 36 38 2011 2012 2013 2014 2015 2016

Adults Who Are Not Overweight or Obese

MD Goal Maryland Washington

Adult Obesity: This indicator shows the percentage of adults who are not overweight or obese. Source: SHIP 2018

Source: CHNA FY2019

13.4% 27.5% 37.7% 16.0% 5.5% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Extremely important Very important Moderately important Slightly important Not at all important

• Q25. How important is exercise to you?

26.6% 16.1% 34.7% 12.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% I don't regularly exercise Once a week 2 to 4 days a week 5 to 7 days a week

• Q26. In a typical week, how many days do you

exercise?

Source: CHNA FY2019

30.0% 31.0% 32.0% 33.0% 34.0% 35.0% 36.0% 2012 2015 2018

Washington Co. CHNA Trend - Adult Weight 2012 - 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

32% 27% 27% 26% 26% 15% 17% 19% 21% 23% 25% 27% 29% 31% 33% 2014 2015 2016 2017 2018

Physical Inactivity

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

77% 82% 81% 81% 77%

70% 75% 80% 85% 90% 95% 100%

2014 2015 2016 2017 2018

Access to Exercise Opportunities

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

Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018

Heart Disease Mortality

208.4 195.4 187.7 184.1 196.1 202.5 202.5 193.5

100 120 140 160 180 200 220 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Age-Adjusted Mortality Rate From Heart Disease

MD Goal Maryland Washington

Source: Maryland SHIP 2018

100 120 140 160 180 200 220 240 260 280 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Age-Adjusted Mortality Rate From Heart Disease County Comparison

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

34.4% 31% 35.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 2012 2015 2018

Q: Have you ever been told that you have hypertension?

2012 2015 2018

Source: CHNA FY2013 - 2019

Hypertension Mortality

Source: CDC https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MD accessed 10.23.2018

126.9 126.7 152.7 131.2 172.1 154.4 182.4

50 100 150 200 250 300 2008 2009 2010 2011 2012 2013 2014

ED Visit Rate Due to Hypertension

MD Goal Maryland Washington

Source: MD SHIP 2018

Source: Meritus Medical Center 2018

79.4% 72.3% 72.2% 74.1% 77.8% 80.0%

17.7% 23.4% 22.9% 21.5% 17.0% 14.8%

0.6% 1.4% 1.3% 1.5% 1.8% 1.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 2013 2014 2015 2016 2017 2018

Hypertension in ED

White Black Latin American

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

25% 18% 20% 22% 22% 18% 16% 0% 5% 10% 15% 20% 25% 30% 2011 2012 2013 2014 2015 2016

Adults Who Currently Smoke Rate

Maryland Washington MD Goal

Source: MD SHIP 2018

21% 21% 17% 16% 17% 10% 12% 14% 16% 18% 20% 22% 24% 2014 2015 2016 2017 2018

Adult Smoking Rate County Comparison

Maryland Washington Allegheny Frederick Carroll

Percentage of adults who are current smokers. Source: RWJ County Health Rankings 2018

33% 25% 24%

0% 5% 10% 15% 20% 25% 30% 35% 2010 2013 2014

Adolescents Who Used Tobacco Products Past 30 Days

MD Goal Maryland Washington

Source: RWJ County Health Rankings 2018

33% 25% 24%

0% 5% 10% 15% 20% 25% 30% 35% 2010 2013 2014

Adolescents Who Used Tobacco Products Past 30 Days County Comparison

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

Source: CDC https://www.cdc.gov/diabetes/atlas/obesityrisk/24/atlas.html 10.23.2018

Diabetes Prevalence

37.4 34.8 35.9 21.7 20.7 22.6 5 10 15 20 25 30 35 40 2014 2015 2016

Diabetes Mortality Rate

(per 100,000 people) Washington County Maryland

Source: Maryland Vital Statistics 2016

17% 83%

• Q11. Have you ever been told

by a doctor or health professional that you have diabetes?

Yes No

Diabetes Morbidity

29% 71%

• Q13. Are you interested in

learning how to prevent diabetes?

Yes No

Source: CHNA FY2019

1.8% 1.8% 3.2% 9.7% 17.1% 30.4% 42.4% 51.2% 72.8% 77.4%

0.2 0.4 0.6 0.8 1

Support group None of the above I am not managing my symptoms I had gestational diabetes Endocrinologist Diabetes education program Family doctor Exercise Diet Medication

• Q12. If YES for diabetes, how are you managing your

symptoms? (check ALL that apply)

2018 2015 2012

Source: CHNA FY2019

Source: MMC 2018

100 200 300 400 500 600 700 800 900 2010 2011 2012 2013 2014 2015 2016 2017 2018

Diabetes Visits in ED – Raw Data

16.2% 16.5% 15.0% 19.6% 18.1% 15.8%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 2013 2014 2015 2016 2017 2018

Diabetes Visit Rate in ED

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

68.9 62.8 76.5 31.9 33.9 34.5

10 20 30 40 50 60 70 80 90 2014 2015 2016

Chronic Lower Resiratory Disease Mortality (per 100,000 lives)

Washington County Maryland

Source: Maryland Vital Statistics 2016

80.0% 77.0% 75.6% 87.6% 88.5% 86.7% 15.4% 16.7% 18.5% 10.6% 9.3% 11.4%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2013 2014 2015 2016 2017 2018

COPD Visit Rate in ED

White Black Latin American

Source: MMC 2018

Source: MMC 2018 72.1% 67.3% 65.3% 58.9% 58.6% 57.6% 21.4% 23.1% 25.7% 32.8% 30.3% 30.4% 2.8% 5.1% 3.0% 1.9% 4.2% 4.4%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 2013 2014 2015 2016 2017 2018

Asthma Visit Rate in ED

White Black Latin American

CANCER

Susan Lopp, Meritus Medical Center

216 201.2 209.6 179.3 175.9 181.5

50 100 150 200 250 2014 2015 2016

Malignant Neoplasms Mortality (per 100,000 lives)

Washington County Maryland

Source: Maryland Vital Statistics 2016

Source: MD SHIP 2018 185.4 184.3 178.5 179.4 178 180.2 174.3 165.2

120 130 140 150 160 170 180 190 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Cancer Mortality Rate

MD Goal Maryland Washington

185.4 184.3 178.5 179.4 178 180.2 174.3 165.2 120 130 140 150 160 170 180 190 200 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015 2014-2016

Cancer Mortality Rate County Comparison

MD Goal Washington Allegany Frederick Carroll

243 1312 823 608 827 295 494

200 400 600 800 1000 1200 1400 1600

Stage 0 Stage I Stage II Stage III Stage IV Unknown N/A

MMC Cancer Cases

2006-2010 2010-2014 2013-2017

5.3% 28.5% 17.9% 13.2% 17.9% 6.4% 10.7%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Stage 0 Stage I Stage II Stage III Stage IV Unknown N/A

MMC Cancer Cases - %

2006-2010 2010-2014 2013-2017

Source: Meritus JRM data 2006 - 2017

656 293 88 64 56 92 56

475 136 101 67 31 30 30

100 200 300 400 500 600 700 Bronchus & Lung Colon Breast Pancreas Ovary Rectum Esophagus

MMC - Cancer Cases with Higher Than Average Percentages of Stage 3 or 4

2006-2010 2010-2014 2013-2017

Source: Meritus JRM data 2006 - 2017

MENTAL HEALTH

• F. Marshall Rock, Washington County

Core Service Agency Curt Miller, Brook Lane Health Services

Source: Healthy Washington County Survey FY2019 17.5% 34.8% 34.0% 11.8% 2.0%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Excellent Very good Good Fair Poor

• Q16. In general, how would you rate your overall

mental or emotional health?

Source: Healthy Washington County Survey FY2019 7.1% 6.2%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

0 - less than 1 day 1 - 5 days 6 - 10 days more than 10 days

• Q17. During the past month

have you often been bothered by feeling down, depressed or hopeless?

29% 71%

• Q18. In the past month have you
• ften been bothered by little

interest or pleasure in doing things?

Yes No

11.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Prefer not to answer Yes Have not needed care No

• Q19. Have you ever needed mental health treatment and

couldn't get it?

5.3% 5.9% 11.7%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 2012 2015 2018

Needed mental health treatment and couldn't get it

Source: CHNA FY2019

Source: RWJ County Health Rankings 2018

765 560 530 500 480 100 200 300 400 500 600 700 800 900 2014 2015 2016 2017 2018

Mental Health Providers

(number of people per provider) Maryland Washington

Source: Maryland DHMH Vital Statistics Administration 2780.8 3211.2 3500.6 3318.5 3442.6 6731 7318 7472 7168 5785 5827 5973 5603 5321

1000 2000 3000 4000 5000 6000 7000 8000 2010 2011 2012 2013 2014 2015 2016 2017 2018

Behavioral Health ED Visits – Raw Data

Maryland Washington Co. MD Goal

5171.8 4968.9 6730.6 7318.2 7472.1 7168.4 5785.3

1000 2000 3000 4000 5000 6000 7000 8000 2008 2009 2010 2011 2012 2013 2014

ED Visits Related to Behavioral Health Conditions County Comparison

MD Goal Washington Allegany Frederick Carroll

Source: Maryland DHMH Vital Statistics Administration

Source: MMC 2018 80.4% 81.1% 80.2% 13.0% 11.9% 12.0% 2.3% 2.4% 2.9%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 2016 2017 2018

Mental Health in ED

White Black Latin American

12.5 10.6 11.2 11.8 14.5 14.1 14.1 14.7

9

2 4 6 8 10 12 14 16 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Suicide Rate

(per 100,000 people) Maryland Washington MD Goal

Source: MD SHIP 2018

Focus Group Themes

Why?

• Stigma and denial
• Treatment not always available when “ready”
• Depression symptoms are minimized

Barriers

• Cost; uninsured, high deductibles, co-pays
• Federal rules around confidentiality
• Can be a long wait for new patient intake
• Shortage of psychiatry providers

SUBSTANCE USE DISORDER

Cynthia Terl, Wells House Victoria Sterling, Local Addictions Authority

1263.6 1084.5 1255.7 1509.6 1591.5 1745.8 1833 800 1000 1200 1400 1600 1800 2000 2008 2009 2010 2011 2012 2013 2014

ED Visits for Addictions-Related Conditions

MD Goal Maryland Washington

Source: State Health Improvement Plan 2018

200 400 600 800 1000 1200 1400 1600 1800 2000 2008 2009 2010 2011 2012 2013 2014

ED Visits for Addictions-Related Conditions County Comparison

MD Goal Washington Allegany Frederick Carroll

Source: MD SHIP 2018

100 200 300 400 500 600 700

2016 2017 2018

Drug Overdoses in ED Raw data 3 years

86.3% 82.5% 85.4% 9.4% 12.2% 10.5% 1.2% 1.9% 1.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

2016 2017 2018

Drug Overdose in ED

White Black Latin American

Source: MMC 2018 * 2018 data for partial calendar year through Sept. 2018

11 21 14 13 16 20 26 34 57 63 51

10 20 30 40 50 60 70 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Deaths

Total Opioid Overdose Deaths Washington County

Source: Maryland Department of Health Sept. 2018

1.1% 3.0% 42.0% 53.9%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Prefer not to answer Yes No Have not needed care

• Q20. Have you ever needed substance use treatment

and couldn't get it?

Source: CHNA FY2019

Focus Groups Themes

Why?

• Drugs are readily available
• Pain management
• Stigma; sometimes viewed as a moral problem,
• r “weakness”
• Associated with crime
• Socioeconomic factors contribute

Barriers

• Can’t always enter treatment when “ready”
• Location of services / transportation

DENTAL

Kim Murdaugh, Family Healthcare of Hagerstown

Source: CHNA FY2019 27.70% 26.59% 26.8%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 2012 2015 2018

• Q21. In the past 12 months did you receive dental

care - NO

Source: CHNA FY2019 0.3% 0.9% 1.2% 5.2% 10.8% 14.2% 20.6% 20.6% 40.3% 45.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

Language barriers Transportation The dentist I need is not taking new patients Don't know how to find a dentist Other Can’t afford the co-pay

• r deductible

Fear of dentists I didn't need dental care in the past 12 months No insurance Cost

• Q22. If NO, why have you not received dental care?

Source: MMC 2018 1366 1108 968 1153 1298 1180 899 1040 1007

200 400 600 800 1000 1200 1400 1600 2010 2011 2012 2013 2014 2015 2016 2017 2018

Dental Conditions Seen in ED - Raw Data

1037.3 1155 1123 955.3 847.1 836.5 888.1

600 700 800 900 1000 1100 1200 2008 2009 2010 2011 2012 2013 2014

ED Visit Rate for Dental Care

(per 100,000 people) MD Goal Maryland Washington

Source: MD SHIP 2018

49.7% 60.9% 60.9% 59.7% 58.8% 56.5% 58.6% 58.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Children Receiving Dental Care in the Last Year

MD 2017 Goal Maryland Washington

Source: MD SHIP 2018

Focus Groups Why?

• Forgo preventative care due to cost
• Tooth extractions are painful and people can’t

afford it or know where to go Barriers

• Cost, lack of insurance
• Funding
• Capacity

CHILD HEALTH

Dianna Gaviria, Deputy Health Officer MD Dept. of Health

6.2 4 5.3 7.7 7.1 7.1

1 2 3 4 5 6 7 8 9

2010 2011 2012 2013 2014 2015 2016

Infant Death Rate

MD Goal Maryland Washington

Source: MD SHIP 2018

9.1 7.7 8.8 6.8 9 9.5 9.4 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10

2010 2011 2012 2013 2014 2015 2016

Low Birth Weight

MD Goal Maryland Washington Source: MD SHIP 2018

11.4 24.5 29.3 20.4 13.6 11.1 10.5

5 10 15 20 25 30 35 2010 2011 2012 2013 2014 2015 2016

Child Maltreatment Rate

Maryland Washington

Source: Maryland SHIP 2018

Source: Maryland SHIP 2018 11.4 24.5 29.3 20.4 13.6 11.1 10.5

5 10 15 20 25 30 35 40 2010 2011 2012 2013 2014 2015 2016

Child Maltreatment Rate County Comparison

Washington Allegany Frederick Carroll

33.1 24.6 23.7

5 10 15 20 25 30 35 2010 2013 2014

Adolescents Who Use Tobacco Products County Comparison

MD Goal Washington Allegany Frederick Carroll

Source: Maryland SHIP 2018

Source: Maryland SHIP 2018

0.3 0.4 0.4 0.3 0.2 0.2 0.3 0.1 0.2 0.3 0.4 0.5 0.6 2009 2010 2011 2012 2013 2014 2015 2016

Children with Elevated Blood Lead Levels

MD Goal Maryland Washington

36 38.1 36.2 28.2 30.4 24.7 25.8 17.8 5 10 15 20 25 30 35 40 45 2010 2011 2012 2013 2014 2015 2016

Teen Birth Rate

Maryland Washington MD Goal Linear (Washington)

Rate of births to teens ages 15-19 years (per 1,000 population). Source: MD SHIP 2018

89.8 90.4 89.8 91.5 91.1 91.2 91.1

75 80 85 90 95 100 2010 2011 2012 2013 2014 2015 2016

High School Graduation Rate

MD Goal Maryland Washington

Source: MD SHIP 2018

ADVERSE CHILDHOOD EXPERIENCES (A.C.E.s)

Kathy Powderly,

Hagerstown Association Religious Council

Source: CHNA 2019 5.3% 6.2% 8.8% 13.9% 18.5% 19.3% 20.4% 20.6% 20.7% 30.2% 35.7% 42.2%

Incarcerated Household Member Physical Neglect Intimate Partner Violence Mother Treated Violently Sexual Abuse Prefer Not to Say Substance Misuse within the Household Emotional Neglect Physical Abuse Household Mental Illness Parental Separation

• r Divorce

Emotional Abuse

• Q34. Studies show that sometimes childhood trauma affects adult
• health. In your childhood, were you exposed to any of the following?

37.6% of survey participants answered at least 1

Maryland Original Study CHNA Survey

161 121 60 42 24 27 16 6 5 3 1 20 40 60 80 100 120 140 160 180 1 2 3 4 5 6 7 8 9 10 11

Number of Respondents reporting 1 or more A.C.E.s

Source: CHNA 2019 161 121 60 124 20 40 60 80 100 120 140 160 180 1 2 3 4+

Number of A.C.E.S.

4+ A.C.E.s Highlights

• 92.7%, reported at least one health issue (from Q2)
• 63%, reported 3 or more health issues (from Q2)
• 39.5%, reported 4 or more health issues (from Q2)
• 42.7%, reported mental health issues
• 31.5%, reported being down or depressed at least 6 days in the prior month; 18%,

reported 10+ days down or depressed

• 51%, reported they have been bothered with little interest or pleasure in doing things

in the past month

• 9%, reported alcohol or drug abuse (lower than expected)
• 36% had an income of $0-$49K
• 12% male vs. 88% female

Of all people who responded with 1 or more ACE:

• 53% answered “no exercise” or “once in past week” (significantly higher than overall)

Source: FY2019 CHNA

SENIOR HEALTH

Amy Olack, Commission on Aging

Source: Projection Based on Maryland Department of Planning Assessment

28,820 29,610 30,730 32,060 33,000 38,072 43,582 47,406

5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000

2015 2020 2025 2030

Age Cohort Comparison

Ages 5-19 Ages 60+

Number of Older Adults (60+) in Washington County

Statistically similar results to

• ther cohorts

*Only notable difference is the decreased reporting of illicit drug use.

Senior Focus Group (65+)

• Held August 28, 2018 at the

Williamsport Fire Hall & facilitated by Cindy Earle, MPH, RN

• 65 participants (all Caucasian with

majority making $20,000- $25,000/year)

• All participants indicated that they

have a regular healthcare provider and health insurance.

• What they/their family do to stay

healthy…

– Walk – Swim – Stay Busy – Drink water – Drink wine – Read – Mall Walker’s Group

• Where do they get their

healthcare information? – Doctor’s office – AARP – Internet – 55up – Smart Seniors group – Homewood Nurse – Mayo Clinic Newletter – Church-Parish Nurse – Senior Center – Newspaper – Magazine – Hospital Newsletter – Health Fairs

• What health problems are they

dealing with?

– Diabetes – COPD – High Blood Pressure – Arthritis/joint replacements – Depression – Cancer – Falls – Heart Disease – Dementia

• What they would have done

sooner…

– Stop smoking earlier or not at all – Use more sunscreen – Healthy eating – Different career choice – Take better care of my back – Wear sunglasses

• What keeps them from eating a

well-balanced diet?

– Lack of funds – Don’t want to cook for only one person – Can’t eat salad due to health problems, poor ability to chew

• What keeps them from getting

enough exercise?

– Balance problems – Health/endurance problems – Fatigue – Depression

• What frustrates them about the

health care industry?

– Getting in for an appointment – Seeing a physician assistant instead

• f their physician

– Insurance & pharmaceutical needs and costs- do I eat or purchase my meds?

313.6 241.4 237 205.9 192.1 181.6 159.6

50 100 150 200 250 300 350 400 2008 2009 2010 2011 2012 2013 2014

Hospitalization Rate Related to Alzheimer's or Other Dementias

MD Goal Maryland Washington

Source: MD SHIP 2018

Source: MD SHIP 2018 313.6 241.4 237 205.9 192.1 181.6 159.6

100 200 300 400 500 600 700 800 2008 2009 2010 2011 2012 2013 2014

Hospitalization Rate Related to Alzheimer's or Other Dementias County Comparison

MD Goal Washington Allegany Frederick Carroll

9.8 9.9 8.1 8.5 10.2

2 4 6 8 10 12 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016

Fall-Related Death Rate

MD Goal Maryland Washington

Source: MD SHIP 2018

Malnutrition…leading cause of morbidity & mortality among older adults

• 1. Older adults experiencing

food insecurity suffer from higher rates of chronic disease, including diabetes, heart disease and depression.

• 2. Conversely, good nutrition has

been shown to help support a healthy and active lifestyle, reduce frailty and disability, improve health outcomes, and reduce health disparities and health care costs.

Source: The National Resource Center on Nutrition and Aging, 2018

Food Insecurity in Washington County Seniors

• While food insecurity may seem like it is only

about hunger, it is just as much about having access to healthy, affordable foods. Unsurprisingly, food insecurity can be associated with an increased risk for obesity as “eating less

• r skipping meals to stretch food budgets may

result in overeating when food does become available”. 1

• 10.8% (approx. 16,150) in Washington County are

Food Insecure 2

• Over 50 medically homebound seniors on a

waiting list for Meals on Wheels.

Sources: 1. Food Research & Action Center, 2. Feeding America, 2016 results

Sexually Transmitted Disease

10.7 12.1 10.4 8 6.4 7.1 8.7 4.7

5 10 15 20 25 30 35 40 2009 2010 2011 2012 2013 2014 2015 2016

HIV Incident Rate

(per 100,000 people) MD Goal Maryland Washington

Source: MD SHIP 2018

349.0 329.0 313.7 303.5 331.6

0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0 500.0 2014 2015 2016 2017 2018

Sexually Transmitted Infections

Maryland Washington Allegheny Frederick Carroll

Source: RWJ County Health Rankings 2018

Source: MD SHIP 2018 295.7 290.2 344.6 384.8 360.7 342.8 335.7 370.2

100 200 300 400 500 600 2008 2009 2010 2011 2012 2013 2014 2015

Chlamydia Infection Rate

MD Goal Maryland Washington

What’s needed?

Community perceptions

Source: Healthy Washington County Survey FY2019 1.4% 2.4% 4.0% 4.5% 5.3% 7.8% 9.1% 9.8% 10.6% 11.4% 12.2% 12.5% 13.1% 13.8% 14.7% 16.9% 20.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

Birth control Transportation Substance abuse treatment Quit tobacco use Affordable housing Education Other Financial assistance Dental services Specialty doctors Mental health services Job opportunities Free health screenings Help to pay for medicine Recreation facilities Safe places to walk/play Wellness services

• Q9. What is MOST needed to improve the health of

your family?

Source: Healthy Washington County Survey FY2019 22.8% 22.9% 24.8% 25.8% 28.5% 30.3% 32.1% 39.2% 40.0% 41.9%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% Diabetes Mental health / depression Cholesterol (fats in the blood) Vision Diet / Nutrition Dental Routine wellness checkups Weight-loss help Exercise / physical activity Blood pressure

• Q10. What types of health screenings and/or services

are needed to keep you and your family healthy?

Source: Healthy Washington County Survey FY2019 0.2% 1.7% 2.0% 2.4% 2.9% 3.3% 3.7% 4.4% 4.4% 4.7% 4.9% 5.0% 5.2% 6.0% 7.0% 9.1% 10.0% 10.1% 10.4% 13.1% 14.9% 15.6% 17.7% 18.7% 23.7% 29.8% 38.6% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% HIV / AIDS & STDs Prenatal care Birth control Eating disorders Alcohol abuse Drug abuse Suicide prevention Injury prevention Disease outbreak prevention Hospice or palliative care Vaccination / immunizations Organ donation Quit smoking Falls prevention Medication Cancer Dental health Dementia Heart disease Allergies Diabetes Cholesterol Blood pressure Mental health / depression Living Will / Advanced Directives Exercise / physical activity Diet / nutrition

• Q14. What health issues do you need more information about?

Focus Groups (n= 112) Q: What community services are needed?

• Preventative care and wellness education
• Free health screenings
• Mobile health services
• Reduced cost health services and medications
• Transportation for those who need it
• Guidance with diet and nutrition
• Food security
• Greater support for health issues; addictions, mental

health, cancer

Biggest unmet need?

Community perceptions

Source: Healthy Washington County Survey FY2019 1.0% 1.3% 1.6% 1.8% 1.9% 2.3% 2.7% 2.9% 4.0% 4.2% 4.8% 9.2% 12.4% 18.7% 34.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Poverty Transportation Homeless Wellness Senior/Elderly Care Medication Education Recreation/Exercise Facility Nutrition/Healthy Foods Access to Healthcare/Specialties Dental Affordable Healthcare Obesity/Weightloss Mental Health Substance Use

• Q32. What is the biggest unmet health need in

Washington County?

Focus Groups (n = 112) Q: What is the biggest health need in Washington County?

• Drug and alcohol treatment & support (21%)
• Obesity (14.5%)
• Diabetes (13.3%)
• Mental health treatment & support (12%)
• HTN & cardiovascular disease (10.8%)
• Chronic obstructive pulmonary disorder (8.6%)
• Cancer (6%)
• Poor diet & nutrition (5%)
• Smoking (3.6%)
• Physical inactivity (3.6%)
• Kidney disease (1%)

Prioritization Criteria

Scoring Item Definition Low (1) Medium High (10) Magnitude of the problem The degree to which the problem leads to death, disability or impaired quality of life and/or could be an epidemic based on the rate

• r % of population that is impacted

by the issue Low numbers of people affected; no risk for epidemic Moderate numbers/ % of people affected and/or moderate risk High numbers/ % of people affected and/or risk for epidemic Variance against benchmarks or goals This would include variance with selected benchmarks, state standards or state data, Healthy People 2010 goals and/or other prevention agenda standard or state data Local / regional rates meet or exceed the goal

• r standard

Local/ regional rates are somewhat worse than the goal or standard Local/ regional rates are significantly worse than the goal or standard Impact on other health outcomes The extent to which the issue impacts health outcomes and/or is a driver of other conditions Little impact on health outcomes

• r other

conditions Some impact on health outcomes

• r other

conditions Great impact on health

• utcomes and
• ther conditions

Capacity (systems and resources) and practical ability to change or influence This would include the capacity to implement evidence based solutions There is little or no capacity (systems and resources) to implement evidence based solutions Some capacity (system and resources) exist to implement evidence based solutions There is solid capacity (system and resources) to implement evidence based solutions in this area

FY19 CHNA Health Needs Prioritization Ranking

RANK Topic Weight 1 Substance Abuse 16.1% 2 Mental Health 13.3% 3 Obesity/Weight loss 12.2% 4 Wellness 8.2% 5 Diabetes 6.8% 6 Heart Disease & HTN 5.4% 6 A.C.E. 5.4% 7 Senior/Elderly 5.0% 8 Cancer 4.7% 8 Nutrition/Eating 4.7% 9 Transportation 4.3% 10 Homeless 3.6% 11 Rec/Exercise 2.5% RANK Topic Weight 11 Rec/Exercise 2.5% 12 Access to Healthcare 2.2% 13 Poverty 1.8% 13 Teenage Pregnancy 1.8% 14 Dental 1.0% 14 Education 1.0% 14 Affordable Healthcare 1.0% 14 Smoking 1.0% 14 Medication 1.0% 15 Child health 0.7% 15 Employment 0.7% 16 Crime 0.3% Affordable Housing Vision/Hearing

NEXT STEPS

• Develop action plans; hospitals, community
• Submit report and action plan to the hospital

boards for approval

• Publish written report and make publicly

available, Spring 2019

• Strategically direct community resources to

help meet identified needs

• Measure outcomes and trends over the next

3 years

Community Action Planning January 8, 2019

Washington County Health Dept. 1302 Pennsylvania Avenue 2nd floor auditorium 10:00 am – 12 noon