columbia gorge regional community health … central/2017.01.23...jan 23, 2017 · the columbia...
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CommunityClinicsHospitals PublicHealth CommunityPartners
COLUMBIAGORGEREGIONALCOMMUNITYHEALTHASSESSMENT:SUMMARY-2016CollaboratingforOptimumHealthandOptimizedHealthcare
A summary of the needs for improved health for the residents of the Columbia Gorge Region including Hood River, Wasco, Sherman, Gilliam, Wheeler counties in Oregon and Skamania and Klickitat counties in Washington – Fall 2016
NorthCentralPublicHealthDepartment
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The2ndColumbiaGorgeRegionalCommunityHealthAssessment ThisdocumentrepresentsthesecondversionofourregionalapproachtotheColumbiaGorge
CommunityHealthAssessment.Buildingonthepartnershipsstartedwiththefirstiterationin2013,thisregionalassessmentnowincludes7adjacentcountiesintheColumbiaGorgeRegion.Thecohortlistedonthecoverpagerepresentstheprimarysupportingorganizationsinthiseffort.
AcknowledgementtoKeyCommunityContributorsConductingathoroughhealthassessmentwaspossiblebythetirelesssupportofthesegroups.
Forgatheringhand-fieldedsurveys
DHS,Mid-ColumbiaHousingAuthority,HoodRiverCountyHealthDepartment,HoodRiverCountySeniorCenter,RevellCoyInsurance,OregonChildDevelopmentCoalition,MealsonWheels:TheDalles,Mid-ColumbiaCenterForLiving,NorthCentralPublicHealthDistrict,OneCommunityHealth,Wings,TheNextDoorInc,ProvidenceHoodRiverMemorialHospital,AgingintheGorgeAlliance,KlickitatValleyHealth,SkylineHospital,SkamaniaCountyHealthDepartment,KlickitatCountyHealthDepartment
Providingaugmenteddata
OregonPublicHealthDivision,WashingtonStateDepartmentofHealth,OregonHealthAuthority,Mid-ColumbiaEconomicDevelopmentDistrict-CoordinatedHumanServicesTransportationPlanData
CollectiveMedicalTechnologies(CMT):(CMT)usesreal-timedata,riskanalytics,notifications,andsharedcareguidelinestopromptandguideproviderdecisionmakinginawaythatdrivesdifferentialoutcomesintermsofreducedEDutilizationandinpatientreadmissions.CMTwasabletoprovideuswithaccurateuptodateinformationaboutEmergencyDepartmentUtilizationbasedonEmergencyDepartmentInformationExchange(EDIE).
Executionofthemail-basedsurveyanddataanalysis
ProvidenceCenterforOutcomeResearchandEducation(CORE)
AcknowledgmenttotheCommunityAdvisoryCouncil(CAC)TheCommunityAdvisoryCouncil,orCAC,iscomprisedofMedicaidconsumers,communitymembers,
andlocalorganizations.Theirmissionistogivethecommunityavoicesothattheconsumerandcommunityhealthneedsareheard.Theywereinstrumentalinreviewingandadjustingthesurveyitselftoensureourlocalneedsweremet.
AresultthatisrewardingInaruralcommunity,workingtogetherisparamountforsuccess.Theformationof
theColumbiaGorgeCoordinatedCareOrganizationwithPacificSourceCommunitySolutionsaidedustoturnanordinaryrequirementfromOregonlawmakersintoanextraordinaryopportunitytoimprovethehealthandwellnessofallresidents.WeareproudofouraccomplishmentsanddelightedthattheRobertWoodJohnsonFoundationrecognizedourwork.
Weinvitethecommunitytousethismaterialinthepursuitofbetterhealthforall.
***ForthefulldocumentlookontheColumbiaGorgeHealthCouncilwebsiteatcghealthcouncil.org
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20162013
QUESTIONS
COUNTY
COHORT
SOCIAL
DETERMINANTS
HEALTHCARE
CONNECTED
VS
6Counties:4Oregon+
2Washington
7Counties:5Oregon+
2Washington
65QuestionsincludingFood,
HousingandTransportation
72QuestionsincludingTrauma
andSupportforCaregivers
4hospitals;4HealthDeparts;
OneCommunityHealth;
CountyMentalHealth
ColumbiaGorgeCCO
2013cohort+UnitedWay;Four
RiversEarlyLearningHub
Housing&Food;
Transportation;Jobs
AdultDentalAccess;Physical
andMentalhealthtogether;
MentalHealthaccessfor
Children&Youth
Coordinationwithhealthcare&social
services;Healthinsurancere-
enrollment;SupportingDevelopmental
andHealthyGrowthintheEarlyYears
Employmentratebetter;
otherareasremainaconcern
DentalAccessremains#1gap;
ProgressonMentalHealthAccess;
PCPAccessharder
Coordinationwithprimarycareand
mentalhealth=good;Morepeopleare
insured;Familieswithchildren0-5more
likelytogowithoutbasicneeds
ColumbiaGorgeRegional
CommunityHealthAssessment
Hospitals:ProvidenceHoodRiver,Mid-ColumbiaMedicalCenter,KlickitatValleyHealth,SkylinePublicHealth:HoodRiverCounty,KlickitatValley,NorthCentral,Skamania
OneCommunityHealth,Mid-ColumbiaCenterforLiving,PacificSourceCommunitySolutionsUnitedWayoftheColumbiaGorge,4RiversEarlyLearningHubInpartnershipwith:
SURVEYS
Mail=457
Hand-fielded=691
Mail=674*statisticalsignificance
Hand-fielded=694
DEMOGRAPHICS
Non-HispanicWhite=827
Hispanic/Latino/Other=290
LowIncome=668
Non-HispanicWhite=1043
Hispanic/Latino/Other=301
LowIncome=631
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ColumbiaGorgeRegionalHealthAssessment-2016
GeneralPopulation
BasicNeeds
IncomeSecurity
FoodSecurityandHealthyEating
TransportationAccess
HousingSecurity
HealthInsurance
SocialCohesion
SupportforCaregivers
1in3hadtroublepayingforbasicneeds
7%hadtogowithoutstablehousing
25%areworriedabouttheirhousingsituation
morethan1in10hadtogowithoutfood
1in4hadtogowithoutabasicneedAND1in4hadtogowithoutahealthcareneed
13%hadtogowithouttransportation
8%areuninsured
1in3areworriedaboutrunningoutoffood*
oftheuninsured,21%liveinWashingtonand69%liveinOregon
21%donothavesomeonetomakethemfeellovedorwanted
22%donohavesomeonetogivethemgoodadvice
29%donohavesomeonetorelaxwith
26%donothavesomeonetotalktoaboutproblems
29%donothavesomeonetohelpiftheywereconfinedtoabed
1in5arecaregivers
6outof10caregiversdon'tfeelthattheyhaveadequatesupport
13%thinkpeopleintheircommunityareunwillingtohelp
25%feeltheycannottrustpeopleintheircommunity
20%cannotcountonadultsintheircommunity
10%donotfeelsafeintheircommunity
SocialSupport
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BasicNee
dsCom
mun
ityand
Soc
ialE
nviro
nmen
t
*GorgeWideFoodSurvey
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ColumbiaGorgeRegionalHealthAssessment-2016
Populationswithdisparitiesbyrace/ethnicity,income,orinsurance
BasicNeeds
IncomeSecurity
FoodSecurityandHealthyEating
TransportationAccess
HousingSecurity
HealthInsurance
SocialCohesion
SupportforCaregivers
MorethanhalfoftheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtroublepayingforbasicneeds
16%ofthesepopulationshadtogowithoutstablehousing
About40%inHispanic/Latino/Other,Uninsured,andMedicaidpopulationsareworriedabouttheirhousingsituation
1in4intheHispanic/Latino/Other,Uninsured,andMedicaidpopulationshadtogowithoutfood
4in10intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithoutabasicneedandhealthcareneed
Hispanic/Latino/OtherandLowincomepopulationsareabouttwiceaslikelytobeuninsuredthanthegeneralpopulation
Lowincomewaslesslikelytofeelliketheyhadthesesocialsupportsthanhigherincomes
UninsuredandMedicaidpopulationswerelesslikelytofeelliketheyhadthesesocialsupportsthanthePrivateandMedicarepopulations.
6outof10caregiversdonotfeelliketheyhaveadequatesupport
25%oftheUninsuredthinkpeopleintheircommunityareunwillingtohelp
35%ofLowincome,Uninsured,andMedicaidpopulationsfeeltheycannottrustpeopleintheircommunity
25%ofHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationscannotcountonadultsintheircommunity
20%oftheUninsureddonotfeelsafeintheircommunity
SocialSupport
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BasicNee
dsCom
mun
ityand
Soc
ialE
nviro
nmen
t
About1in4intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithouttransportation
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Adults(ages18-98)
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
Specialists
1in4ratedtheirhealthasfairorpoor
Highbloodpressureisthemostcommonchroniccondition
Depressionisthemostdiagnosedmentalhealthcondition
3outof4experiencedoneormoretraumaticevent
21%havethreeormoredrinksonthedaystheydrink19%usetobacco
1in5donothaveaprimarycareproviderandaregoingwithoutneededcare
Greatestunmethealthcareneed:344peoplearegoingwithoutcare
Accessgreatlyimprovedfrom2013
7%neededsubstanceusecare,ofthose68%arereceivingtreatment
1in10cannotgetalltheirmedications
Neurology,substanceusetreatment,andcancertreatmenthadhighestunmetneed
2outof3areoverweightorobese
Morethanhalfhaveachronicmedicalcondition
About4outof10hadsomeonedosomethingharmfultothem
Mostpeopleuselocalservices
ColumbiaGorgeRegionalHealthAssessment-2016
46%gotcarefromprimarycareprovider30%gotcarefromcountymentalhealthclinics
1in3haveamentalhealthcondition
1in4aregoingwithoutneededcare
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15%usemarijuana7%useotherdrugs
Hea
lthStatus
Hea
lthca
reAcc
ess
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Adultswithdisparitiesbyrace/ethnicity,income,orinsurance(ages18-98)
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
Specialists
35%ofLowincomeandMedicaidpopulationsratedtheirhealthasfairorpoor
AnxietyisthemostdiagnosedmentalconditionforLowincomeandMedicaid
TheUninsuredandMedicaidpopulationweremorelikelytohavethreeormoredrinks,usetobacco,anduseotherdrugsthangeneralpopulation
HalfoftheMedicaidpopulationhasexperienced3ormoretraumaticevents
1in4oftheUninsuredandMedicaidpopulationsaregoingwithoutneededcare
15%ofMedicaidrecipientsneededsubstanceusecare
Nosignificantdisparities
Lowincomehadmoreunmetorthopedicneedsthanthegeneralpopulation
Privateinsurancehadmoreunmetcardiologyneedsthanthegeneralpopulation
Medicaidhadmoreunmetskinconditionneedsthanthegeneralpopulation
3outof4onMedicarehaveachronicmedicalcondition
Lowincomewasmorelikelytousetobaccothanthegeneralpopulation
ColumbiaGorgeRegionalHealthAssessment-2016
NearlytwiceasmanyMedicaidrecipientsaregoingwithoutneededcarethanthegeneralpopulation
2of5oftheLowincomepopulationhaveamentalhealthcondition
About37%oftheLowincome,Uninsured,andMedicaidpopulationsaregoingwithoutneededcare
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HealthStatus
HealthcareAccess
HalfofMedicaidrecipientshaveamentalcondition
MorethanhalfoftheUninsureddonothaveaprimarycareprovider
Highincome,Uninsured,andPrivateinsurancepopulationsweretwiceaslikelytogowithoutneededcarethanthegeneralpopulation
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Youth
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
1in10ratedtheirhealthasfairorpoor*
Asthmaisthemostcommonchronicmedicalcondition
Anxietyisthemostdiagnosedmentalhealthcondition
Nearly1outof4hadanadulthurtthemonpurpose*
20%havehadalcohol*14%haveusedtobacco*
1in5youthfeeltheyarenotgettingallneededcare*
1in5teenshaven'tbeentothedentistinthepast12months
7%neededsubstanceusecare,ofthose22%arereceivingtreatment^
1in20teenshaveusedprescriptiondrugswithoutadoctor'sorders*
1outof3areoverweightorobese*
ColumbiaGorgeRegionalHealthAssessment-2016
1in10parentssaidtheirchildrenarenotgettingallneededcare
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1in10parentssaidtheirchildrenarenotgettingallneededcare
8%parentssaidtheirchildrenarenotgettingallneededcare
15%youthfeeltheyarenotgettingallneededcare*
1in4haveamentalhealthcondition
15%haveusedmarijuana*5%haveusedotherdrugs*
VS
VS
Health
Status
Health
careAccess
(ages0-17)
VS
*ThisinformationisfromtheOregonandWashingtonHealthyTeenSurvey^ThisinformationcamefromtheOregonHealthAuthority(OHA)BehavioralProfilesAllotherinformationisfromthe2016CommunityHealthSurvey
Columbia Gorge Regional Community Health Assessment
2016 ResultsNext Steps towards Community Health Improvement Plan
Coco Yackley/John Huffman
Using the Coordinated Care Organization
structure we… • …..“turned an ordinary requirement from Oregon lawmakers into an extraordinary opportunity to improve the health and wellness of all residents.”
-RWJF Culture Of Health Prize
• Columbia Gorge CCO = • PacificSource (Health Plan)• Columbia Gorge Health Council (501c3)• Medicaid (low income) client• ~25% of residents; +50% of kids• Hood River & Wasco Counties
• Community Health Assessment for 7 counties
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A Collaborative Approach …
• Yields a better; more accurate and actionable as community providers agree on the needs within our region and communities and will support our ability to address those needs together.• Maximizes collective resources available for improving population health.
• Requires commitments of cash or in-kind resources from all participants who would use it to satisfy a regulatory requirement.
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Where have we been? Timeline of the Regional Process
2013 Community Health Assessment•First Collaborative Assessment•Broad survey to identify needs•Oregon & WA
2014 Community Health Improvement Plan (CHIP)•Identified 10 Focus Areas•Housing, Food, Transportation, Jobs•Dental for Adults, Physical & Mental Health Integration, Services for Youth, Health Insurance•Collaboration within Healthcare and with Social Services•Healthy Development in the Early Years
2014-2016 Regional Focus brings results•>$3M in additional grant funds•Regional approach to issues•Synergy in Programs across counties
2016 RWJF Culture of Health Prize Winner•Collaborative CHA/CHIP one of the cornerstone reasons
2016 Community Health Assessment•Expanded Cohort•Expanded surveys, included other sources•Incorporated new questions
2017 CHIP•Review/adjust CHIP topics•Community Advisory Council is convener
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Summary points from the 2016 CHA
• Food and housing security are still high concern areas• The number of insured grew; the number of people who got services grew
some• While those receiving dental care did improve, it’s still the largest unmet
healthcare need• Transportation continues to be a barrier • Parents underestimate the needs that their teens face• Households with children 0-5 are more likely to go without basic needs
than those without children 0-5• Most of our community has experienced at least one form of Trauma
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Trauma
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• Haven, Mid-Columbia Center for Living and Sanctuary Institute Instructor partnered to create a single ‘Trauma’ question.
• 3 out of 4 experienced one or more traumatic event
• About 4 out of 10 had someone do something harmful to them
Aging Population
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• 22% say Yes – they are a caregiver
• Of those, only 40% have all the support they need
About 1 in 7 Adults overall are struggling with care giving support to loved ones
Updating the CHIP priorities
Reflection 2017 CHIP List
2014 CHIP
CAC Voices
CHA 2016
Emerging data
Listening Sessions
Final Focus areas
Community Needs
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Regional Solutions Participation
• 2014 CHIP Topics will be refreshed but many are likely to stay• Housing, Food, Transportation, Jobs are outside the expertise of
Healthcare• What active role can Regional Solutions play in leading these efforts?
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