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St. Joseph County
Community Health
Needs Assessment
2016
Why a Community Health Assessment?
What We Know….
• Michigan Accreditation Program for Local Public Health requires evidence that a community health assessment has occurred.
• New IRS rules effective on tax years beginning after March 23, 2012, requires each 501(c) (3) hospital facility to conduct a community health needs assessment at least once every three taxable years.
• Community Health Center Grant (FQHC) requires a community health assessment. …. [it] looks outside of the performance
of an individual organization serving
a specific segment of a community
to the way in which the activities
of many organizations contribute
to community health improvement .
Why a Community Health Assessment?
What We Did….• Surveyed St. Joseph residents to
identify their most pressing health needs:
• 478 people responded.
• 43 local experts assisted.
• Five issues were identified:
• Obesity/Physical Inactivity
• Mental Health/Suicide
• Physician Services
• Education/Prevention
• Diabetes
…. [it] looks outside of the performance
of an individual organization serving
a specific segment of a community
to the way in which the activities
of many organizations contribute
to community health improvement .
What We Know….Obesity/Physical Inactivity….
Healthy WeightWhat We Know…Obesity/Physical Inactivity• Obesity/Physical Inactivity was ranked as the #1 health
issue among public health experts and #2 issue by the community (48% of respondents).
• St. Joseph ranked 64th among 83 counties for adult obesity.
• 34% of St. Joseph County adults are obese and an additional 37% adults are overweight.
• Between 2001 and 2009, percentages of obesity have grown for both St. Joseph County men and women.
• Percentages have grown by 4.7 points for St. Joseph County men
• Percentages have grown by 11.4 points for St. Joseph County women
• St. Joseph ranked 77th among 83 Counties for Adults who reported no leisure time activity (29%)
• In addition to its serious health consequences, (i.e., high blood pressure, diabetes, coronary heart disease, stroke, gallbladder disease, high cholesterol, and some cancers) obesity has real economic costs. The estimated annual health care costs of obesity-related illness are a staggering $190.2 billion or nearly 21% of annual medical spending in the United States
Only 1 out of 4 St. Joseph County Adults
maintains a Healthy Weight
What We Know…Obesity/Physical Inactivity• 20.4% of St. Joseph County High School Students are
obese and 14.1% are overweight.
• 11th graders were more likely to be obese than 9th
graders.
• Males were more likely to be obese then females.
• African Americans and Hispanics were more likely to be obese than Whites.
• 60% of female students were trying to lose weight even though only 33.3% were overweight/obese.
• More than 1 in 5 (22.5%) watched 3 or more hours of TV on an average school day.
• More than 1 in 3 (34.7%) played video games or used a computer for something that is not school work 3 or more hours per day on an average school day.
• Overweight adolescents have a 70% chance of becoming overweight adults.
Childhood Obesity
Worksite WellnessWhat’s Been Done…Sturgis
• Co-sponsor “biggest loser” contests open to community as well annual internal “biggest loser” contest
• “Create your Weight” weight-loss program run by registered dietician that is open and advertised to the community and subsidized by the Hospital; scholarships also available to help cover costs
Three Rivers
• Sponsor of annual Color Run
• Sponsor of Correy Lake triathlon
• HealthTRAC Fitness Center serves community
Collaborations/Shared Initiatives
• Occupational Wellness programs in business
• Step Up St. Joseph County
• Evidenced-based education through School-linked clinics
Worksite wellness programs that include nutrition and physical activity components have claimed to improve morale, improve productivity, increase energy and decrease
sick time among employees. Programs often aim to assist employees with smoking
cessation, maintaining a healthy weight and preventative screenings for
cholesterol, blood pressure, cancer and other conditions.
Worksite WellnessWhat’s Being Done…Sturgis
• Partnering with Senior Enrichment Center for free health assessments, lunch ‘n’ learns with registered dietician
• Hispanic obesity programs and seeking grant funding
Three Rivers
• Start senior annual wellness visits at primary care clinic (Accountable Care Organization)
• Walking trail connecting parks for exercise opportunities (non-motorized trail)
Collaborations/Shared Initiatives
• Collaboration with Step Up St. Joseph promoting local resources and opportunities for physical activity reaching the community through Facebook with healthcare challenges, website with listing of local events, and monthly radio and newspaper topics (includes representatives from local gyms, chamber of commerce, parks and recreation, etc.)
• Ongoing monitoring of efforts and indicators
Step Up to a Healthier You!
1 Mile = 2,000 steps and 100 calories burned
1 Pound = 3,500 calories
1 Pound weight loss per week = 500 calorie deficit per day
To lose 1 pound per week you need to add 10,000 steps to your day.
What We Know….Mental Health/Suicide….
2. Diagnose & investigate
health problems & health
hazards.
St. Joseph High School Students
Prevent and control epidemics and
contain diseases/injuries. Examples
include:
• Investigate foodborne outbreaks
• Communicate serious health threats
to community in timely manner
• Develop emergency response plans
for public health emergencies
• Respond to public health
emergencies including disease
outbreaks or terrorism
• Ensure access to laboratory with
capacity for sampling
- Adults
35.4%Felt sad or
hopeless for 2 ore more
weeks in a row
11.6%attempted
suicide 26.4%Bullied on
school property in
last year
8.2% Threated or
injured with
weapon on school prop.
11.4% receive
Special Ed. Svcs.
Mental disorders are common….
Approximately 1 in 4 of adults are diagnosed
for one or more disorders.
About 1 in 17 suffer from a seriously
debilitating mental illness.
12.9% Pressured
into unwanted
sex by person they were dating
Mental Health / Suicide
2. Diagnose & investigate
health problems & health
hazards.
Mental Health / SuicideCommunity Concerns
Prevent and control epidemics and
contain diseases/injuries. Examples
include:
• Investigate foodborne outbreaks
• Communicate serious health threats
to community in timely manner
• Develop emergency response plans
for public health emergencies
• Respond to public health
emergencies including disease
outbreaks or terrorism
• Ensure access to laboratory with
capacity for sampling
What We Know…Depression• On average, St. Joseph County adults
reported 3.8 mentally unhealthy days reported in past 30 days
• Between 2010-2014, St. Joseph County’s age-adjusted suicide rate was 16.3 compared to 12.3 for Michigan.
Substance Abuse
• In 2015, St. Joseph County reported 89alcohol-related vehicle crashes.
• 347 St. Joseph County under the age of 18 years confirmed victims of child abuse and/or neglect. 1/3rd to 2/3rds of these cases more than likely involved some degree of substance abuse.
Methamphetamine
• Between Jan. 2012 and March 2013, about 6.5days' worth of cold medicine per person, was sold in St. Joseph County making it #1 in the state for pseudoephedrine sales.
62%
53%
52%
46%
44%
26%
20%
Mental Health
Adult Substance Abuse
Youth Drug Use
Youth Alcohol Use
Meth Lab Site Clean Up
Household Issue -Anxiety/Stress
Household Issue -Depression
Major Issues
2. Diagnose & investigate
health problems & health
hazards.
Prevent and control epidemics and
contain diseases/injuries. Examples
include:
• Investigate foodborne outbreaks
• Communicate serious health threats
to community in timely manner
• Develop emergency response plans
for public health emergencies
• Respond to public health
emergencies including disease
outbreaks or terrorism
• Ensure access to laboratory with
capacity for sampling
What’s Been Done…Sturgis
• Established school-linked clinic which includes an adolescent behavioral health counselor
• Expanded behavioral health services throughout primary care practices and into the pain clinic (only in one location before)
Three Rivers
• Three Rivers PAWS Clinic provides mental health services and counseling to youth (18 or under); also provides substance abuse counseling
• Collaborate with CMH to assess patients presenting at ER with mental health issues, as well as to link women with substance abuse issues to primary care providers
• Collaborating with CHM and other partners to provide trauma-informed services
Others
• ISD has been working with its partners to develop trauma training and to train all providers and their staff within the county
Current Initiatives
2. Diagnose & investigate
health problems & health
hazards.
Counseling
Prevent and control epidemics and
contain diseases/injuries. Examples
include:
• Investigate foodborne outbreaks
• Communicate serious health threats
to community in timely manner
• Develop emergency response plans
for public health emergencies
• Respond to public health
emergencies including disease
outbreaks or terrorism
• Ensure access to laboratory with
capacity for sampling
What’s Being Done…Sturgis
• Collaborating to develop FQHC, which includes behavioral health services
• Counselor with school-linked clinic will be providing education to teachers to help identify and address mental health issues in students
• Research ways to expand mental health services through primary care practices
• Working geriatric-psych inpatient unit
Three Rivers
• Expand behavioral health services throughout primary care practices
• Partnering with CMH to place Recovery Coaches in the facility to provide outreach
• Participating in training provided by CMH to help primary care providers identify substance abuse
What We Know….Physician Services
Population to Physicians/Medical
ProfessionalsRatios
What We Know…Lack of Health Professionals• St. Joseph ranked 65th among 82 counties in its
population to primary care physician ratio.
• St. Joseph ranked 61st among 82 counties in its population to dentists.
• St. Joseph ranked 29th among 81 counties in its population to mental health provider ratio.
• St. Joseph County has been designated Health Professional Shortage Areas (HPSA) for primary care and mental health and has received a partial county designation for being medically underserved.
• St. Joseph ranked 77th out of 83 counties for the number of hospital stays for ambulatory-care sensitive conditions per 1,000 Medicare
• From survey respondents, 26% had three or more problems accessing healthcare due to cost; 33% had issues with medical bills or medical debt in the last year and 42% have left the county in the last two years in search of health care.
Physician 2,903:1 1,240:1 1,040:1
Dentist 2,770:1 1,450:1 1,340:1
Mental Health Professional
592:1 450:1 370:1
Other Primary Care Providers
2,344:1 1342:1 n/a
2016 County Health Rankings
1.Monitor Health Status
Monitor health status to identify
community health problems. Collect,
manage, and analyze health related
data for knowledge-based decisions.
Examples include:
• Conduct community health
assessment to identify public
health risks and inform public
health planning
• Develop community health profile
to educate community and community
leaders about public health
promotion
• Establish website to provide
community information about
persistent health problems within
community and how to prevent these
problems
What’s Been Done…Sturgis
• Added one urgent care center including additional providers
• Recruited 3 full-time midlevel providers
• Established Student Help & Healing Center –Gesundheit – school-linked clinic
Three Rivers
• Recruited new providers at Three Rivers Health, including ENT
• Added nurse midwives to improve appointments
• Revised Community Wellness Programs
Others
• Federally Qualified Health Center established
• Health Department became Navigator Organization and a DHHS Community Partner to help with health insurance enrollment.
School-Linked Clinics
Located at:Three Rivers Family Care Clinic
721 Sixth Ave.Three Rivers, MI 49093
Located at:Sturgis Hospital Medical Commons II
1555 East Chicago Road, Sturgis, MI 49091
1.Monitor Health Status
Monitor health status to
identify community health
problems. Collect, manage,
and analyze health related
data for knowledge-based
decisions. Examples
include:
Conduct community health
assessment to identify
public health risks and
inform public health
planning
Develop community health
profile to educate community
and community leaders about
What’s Being Done…Sturgis
• 2 Urgent Care centers and Fast Care Clinic at Meijer's
• Part-time Physician Recruiter hired to bring in new providers
• Qualified Choice Site so veteran’s who live greater than 40 miles from VA facility can receive services locally
Three Rivers
• Open scheduling at Family Clinic
• Promote new providers through quarterly newsletter.
Collaborations/Shared Initiatives
• Telestroke Programs – using technology to maximize access
• Care Coordinators hired for ACO Project
• Partnering with Covered Bridges
• Increased specialty providers/clinics
• Dental Clinic expansion in Sturgis.
Telestroke Initiative
What We Know….Diabetes
Age-Adjusted Death Rates* - Diabetes Mellitus,
St. Joseph County, Michigan & US, 2010 -2014
35.7% 33.4%35.5% 36.1%
43.9%
23.9% 24.2% 23.0% 23.7% 23.6%
20.8% 21.6% 21.2% 21.2% 20.9%
2010 2011 2012 2013 2014
St. Joseph County Michigan U.S.
*per 100,000 population
Diagnosed Diabetes Age-Adjusted Percentage,
St. Joseph County, Michigan and US, 2013
9.2%
10.2%
8.4%9.2%
10.2%
8.5%8.7%
6.9%6.1%
All Male Female
St. Joseph County Michigan U.S.
What We Know…Diabetes• Diabetes is the 5th leading cause of death in St.
Joseph County and claimed the lives of 32 people in 2014.
• More than 1 out of 11 of St. Joseph County have diabetes.
• Prediabetes, an underreported condition, impacts one out of three people, yet only 11% are aware of their condition.
• Diabetes was the 6th leading cause of preventable hospitalizations in St. Joseph County in 2014.
• St. Joseph ranked 73rd among 83 Michigan counties for its diabetes death rate (crude rate) per 100,000 population (2014).
• St. Joseph ranked 54th among 65 peer counties nationwide
• Diabetes lowers life expectancy by up to 15 years and increases the risk of heart disease by 2 to 4 times.
• Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.
Diabetes Education
Diabetes ScreeningWhat’s Been Done…Sturgis
• Certified Diabetes Educator for patients and provides scholarships to help with program costs.
• Keys to Managing Diabetes – annual public event that includes: speakers, food demonstrations, screenings, educational materials
• Offers free or reduced-cost community health screenings for: healthy eating habits, activity, risk assessment BMI, cholesterol and glucose.
Three Rivers
• Provide A1C screenings at reduced costs at health fairs.
• Dieticians that provide diabetes education/counseling
Others
• MSUE offers several diabetes and nutrition programs to the community.
• AAA offers evidence-based PATH program for trainers and the community.
What Can You Do? Diabetes EducationWhat’s Being Done…Sturgis
• Collaborate with MSU Extension to offer Dining with Diabetes class in Spanish
• Initiation of Diabetes Care Teams to work with providers to help patients manage their diabetes.
Three Rivers
• Implement outpatient diabetes education program
Collaborations/Shared Initiatives
• Work with ACO coordinator to monitor Medicare population with Diabetes
• Working through Step Up St. Joseph County, initiate educational campaigns during National Diabetes Month (November)
Education and Prevention
Social Vulnerability – St. Joseph County
What We Know…• The median income in St. Joseph County in 2014
was $44,145 compared Michigan and U.S. incomes of $49,087 and $53,482, respectively.
• 2 out of 5 county residents live below 200% of poverty.
• Nearly 3 out 5 children (58.4%) attending St. Joseph County School Districts are economically disadvantaged.
• 16,475 (27%) of county residents have Medicaid and/or Healthy Michigan (Medicaid expansion) coverage and 11,767 (19%) are on Medicare.
• St. Joseph County population is represented by the following racial/ethnic groups:
• White: 94.8%
• African/American: 3.6%
• Hispanic: 7.3%
• Amish: 2.1% (proxy indicator)
Socioeconomic Characteristics - 2014
5.7%
11.7%
17.8%
27.3%
40.2%
7.3%
10.1%
16.9%
23.7%
34.7%
Unemployment
Uninsured
% Below Poverty
Children <18years Below
Poverty
Below 200% ofPoverty
Michigan St. Joseph Co.
What We Know…• In St. Joseph County, less than ½ the population
(46.1%) has attended college which is considerably lower than Michigan’s percentage.
• 22.4% of St. Joseph infants born were to mothers without a high school diploma, compared to Michigan where only 12.3% were born to mothers without a high school diploma.
• Identified needs of priority population include: transportation for low-income groups and residents in rural areas; and the need for bilingual health providers, translators, and health information in Spanish.
• In addition:• Adult Smoking –22% of St. Joseph Co. residents smoke,
compared to MI (20%) and US best (14%) and 36% of respondents reported living with someone who used tobacco products.
• 56% of respondents perceive that there are problems with living healthy lifestyles.
• More than 40% of respondents identified Poverty, Bullying, Low Educational levels as major community issues.
Educational Attainment
3.3% 5.5%7.4%
9.8%
30.2%
38.6%
23.9%
23.2%8.8%
7.9%16.1%
9.3%
10.3%5.7%
MI St. JosephCo.
Grad/Prof.
Bachelor
Associate
SomeCollege
H.S. Grad.
9th to 12th,no diploma
<9th Grade
What’s Been Done…Sturgis & Three Rivers
• Published /presented 2012 Community Needs Assessment to the community /various groups to educate them on the community ‘s needs
• Worked with community partners, (schools,Chambers of Commerce, United Way, Health Department, CMH and others) to establish the Step Up St. Joseph County website, Facebook and promotional activities
• Offer free/low cost screenings, health fairs, educational offerings
• Evidence-based curriculum offered through student-linked clinics
Others
• Target promotion o local resources/programs for various health /human service providers (i.e., Project Connect, Community Baby Showers, Back to School events)
• Maternal Smoking Cessation program being developed by Certified Tobacco Specialist (Health Department) and Matter of Balance (AAA)
CliniciansCurrent Initiatives
Community Health Needs Assessment of St. Joseph County
What’s Being Done…
Sturgis
• Continue existing activities
• Expand health and wellnessofferings/online marketing initiatives
Three Rivers
• Continue existing activities
• Grow and develop social mediapresence
• Increase community education
Others
• Increase use of social media efforts
• Senior Reach Project
• Expand Step Up St. Joseph Countyefforts to include community challenges, worksites, etc.
CliniciansCurrent Initiatives
Check us out @Stepupsjc.net
Or like us at Facebook@www.facebook.com/StepUpSt.JosephCounty
What’s Next?For More Information, go to…
• You can visit one of the following websites and click on the Community Health Needs Assessment button to learn more:
• www.bhsj.org
• www.sturgishospital.com
• www.threerivershealth.org
• www.stjoecmh.org
We want to hear from you!
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