redington-fairview general hospital community assessmentassessment+2016.pdf · redington-fairview...

Redington-Fairview General Hospital

2016 Community Health Annual Needs

Assessment Report

&

Community Health Work-plan Original Community Needs Assessment: November 2007 Updated: January 2010; April 2012, September 2013; August 2015; July 2016 Approved by RFGH Board of Directors September 27, 2016

2 Redington-Fairview General Hospital Community Health Needs Assessment, 2016

Table of Contents Executive Summary Page 3 Background / History / Surveys Page 3 - 10 Health Rankings Page 11 Population and Demographics Page 12 Socioeconomic Factors Page 13 - 15 Access to Healthcare / Healthcare Quality Page 16 - 17 Chronic Disease Page 18 - 23 Environmental Health 4 Immunization Page 25 Injuries Page 26 Tobacco Use Page 26 Substance and Alcohol Abuse Page 27 – 28 Pregnancy and Birth Outcomes Page 28 Attachment 1 Redington-Fairview General Hospital Community Health Improvement Plan Attachment 2 Redington-Fairview General Hospital Community Health Workplan


EXECUTIVE SUMMARY

RFGH Mission – to develop, provide, and facilitate high quality, comprehensive, cost-effective health services for the people we serve. We affirm a commitment to maintain our unique community hospital identity, offering personalized services.

RFGH Community Engagement Strategies Community Health Improvement – Directly, or in collaboration with others, identify and provide health, prevention and education services throughout the community.

Offer community education, disease prevention and wellness initiatives based on community need. Public Health Infrastructure Development – As a member and fiscal agent for Somerset Public Health, RFGH works collaboratively with regional health and wellness providers to deliver public health services.

The intent of the community health assessment is to use it as a planning tool to assist in initiating strategic initiatives to meet the needs of citizens whose health need are at risk in our community. Community health outreach strives to promote healthy behaviors through the services provided.

RFGH works in collaboration with numerous organizations and community partners to work on preventative health services in our community.

BRIEF HISTORY

Assessments and / or updates to assessments were completed in 2007, 2010, 2012, and 2013.

A completed Community Health work-plan with identified Healthy 2020 National Goals, Maine Goals, and

RFGH Goals and strategies to meet goals with each assessment and / or update as above.

In addition, Somerset Public Health, previously known as Somerset Heart Health and later as Greater

Somerset Public Health Collaborative, as part of their Healthy Maine Partnership work, completed a Mobilizing

for Action through Planning and Partnerships (MAPP) assessment process in 2011 as part of the strategic

approach to community health improvement. “Bearing the Fruits of Our Labor” is an evaluation Framework for

Somerset Public Health was completed in 2013.

A Somerset County Community Health Needs Assessment was completed in August 2014 (EMHS) with RFGH

as partnering / collaborating hospital.

2014 - 2015 RFGH Healthy Community Goals strategized (listed below):

a. to promote healthy behaviors (promote nutrition and weight status, promote physical activity and fitness, reduce

tobacco use and reduce use of alcohol and other drugs)

b. to promote healthy and safe communities (improve environmental health, increase vaccinations, prevent injuries,

and promote educational and community based programs)

c. to improve systems (access to primary care, specialty care and emergency care) improve maternal, infant and child

care, improve health communication and technology, improve public health infrastructure)

d. to prevent; reduce; and manage diseases and disorders (cancer, cardiovascular/ heart disease and stroke, chronic

diseases, infectious diseases, pulmonary and respiratory health)

August, 2015 annual report and community health work-plan to RFGH Board of Directors


RFGH has collaborated with the Maine Shared Health Needs Assessment & Planning Process (SHNAPP)

Project - a collaborative of Central Maine Healthcare, Eastern Maine Healthcare Systems, MaineGeneral Health,

MaineHealth and the Maine Center for Disease Control and Prevention. The SHNAPP works to improve the

health status of Maine residents and track results. RFGH has had active representation on the Community

Engagement team of the project and has actively participated in identifying forum focuses and developing

feedback opportunities from the forums.

The collaboration of the entities above for the SHNAPP is an expansion on the OneMaine Health Collaborative of

2007 and 2010. The key goal of SHNAPP: to “turn data into action”. RFGH appreciates the “Project” work,

resources, data, and outreach to hospitals. Being involved at this level has aided our community assessment

work and community engagement. People and organizations throughout Maine have been sharing work,

resources, and data and sharing the information from the State of Maine through a universal tool, the SHNAPP

Community Engagement Reporting Form.

As part of the work of the SHNAPP, a qualitative statewide stakeholder survey was conducted in June 2015.

Qualitative data (data that can be arranged into categories which are not numerical, also referred to as

categorical data) was collected from 1,639 individuals representing more than 80 organizations and businesses

across the State of Maine. Out of the 1639, 102 stakeholders were from Somerset County, representing

community leadership and health experts. The survey asked the respondents many questions. The tables below

are summaries of just a few of the questions.

Key results from the statewide survey of stakeholders are listed in the table below (not all inclusive of results)

numerator = 1,639. Stakeholders included medical care providers / hospitals, nonprofit or social service

agencies, public health, business owners and employees, educators, other health care organizations, behavioral

/ mental health providers, local government, other governmental agencies, youth serving organizations, faith

based organization, and other.

Stakeholder Rating of Health Issues

Category of Issue Health Issue and percentage of those rating the health issue as major or critical

Family Health

Chronic Disease

Infectious Disease

Healthy Behaviors

Other Health Issues

▪ childhood obesity – 58% ▪ elder health – 55% ▪ child developmental issues – 34%

▪ adolescent health – 25% ▪ maternal and child health – 23% ▪ infant mortality – 4%

▪ obesity -78% ▪ depression – 67% ▪ cardiovascular disease – 63% ▪ diabetes – 63% ▪ ▪ respiratory

disease – 60% ▪ cancer – 50% ▪ neurological diseases – 35% ▪ musculoskeletal diseases – 28%

▪ infectious diseases – 22% ▪ ▪ sexually transmitted diseases / HIV/ AIDS – 13%

▪ drug and alcohol abuse – 80% ▪ ▪ physical activity and nutrition – 69% ▪ tobacco use – 63%

▪ mental health – 71% ▪ ▪ oral health – 53% ▪ ▪ violence – 38% ▪ suicide and self-harm – 37% ▪

▪ unintentional injury – 34% ▪ ▪ lead poisoning and other environmental health issues – 17%


Stakeholder Rating of Health Issues

Top Health Issues

Identified

Resources available Resources in need

Drug and alcohol abuse Hotlines, OSA and Mental Health Services, AA Greater access to drug/alcohol treatment, and to

substance abuse prevention programs and treatment

providers

Obesity Public gyms, farmers markets, Maine SNAP-ED

program, School Nutrition Program, Public walking

and biking trails, Healthy Maine Partnerships, Let’s

Go! 5-2-1-0

Greater access to affordable and healthy food; more

programs that support low-income families

Mental Health /

Depression

Mental health/counseling providers and programs More mental health professionals; more community-

based services; better funding and support; greater

access to inpatient care; transitional programs

Diabetes National Diabetes Prevention Program, Education

Programs, School nutrition programs, Maine CDC

DPCP, Diabetes Programs

Physical Activity and

Nutrition

Public gyms, farmers markets, Maine SNAP-ED

program, School Nutrition Program, Public walking

and biking trails, Healthy Maine Partnerships, Let’s

Go! 5-2-1-0, Cooking Matters, Worksite wellness

programs

Greater access to affordable and healthy food; more

programs that support low-income families

Cardiovascular Diseases Hospitals, Primary Care Providers, Public gyms,

Education Programs

Health Factor Percentage of stakeholder rating the factor as major or critical problem in their area

Economic Stability

▪ poverty – 78% ▪ employment – 64% ▪ food security– 58% ▪ housing stability – 57%

Education

▪ early childhood education/development – 43% ▪ enrollment in higher education – 35% ▪ language and

literacy – 34% ▪ high school graduation – 31%

Social and Community

Context

▪ adverse childhood experiences – 56% ▪ social support and interactions– 50% ▪ caregiver support– 46%

▪ social attitudes (such as discrimination) – 38% ▪ incarceration or institutionalization – 35%

▪ civic participation– 30%

Health and Health Care ▪ access to behavioral care/mental health care – 67% ▪ health care insurance– 64% ▪ health literacy– 62%

▪ access to oral care – 56% ▪ access to other health care – 41% ▪ access to primary care – 39%

Neighborhood and Built

Environment

▪ transportation – 67% ▪ access to healthy foods – 53% ▪ access to physical activity opportunities – 42%

▪ quality of housing – 32% ▪ crime and violence – 27% ▪ environmental conditions – 12%


In September 2015, Somerset Public Health invited the community to a forum to have conversation about

what is causing Somerset County to have the lowest ranking in Maine, “Moving up the Ranks”. The Director of

the Health Index Initiative (MMC) presented County Health Ranking information (data) and 80+ participants

worked on action planning for changing our health status. At the time the current data and information was

based on the 2015 County Health Rankings by the Robert Wood Johnson Foundation. The 89 individuals

attending were from The United Way, Medical Care Development, local and state public health, Kennebec

Behavioral Health, local elementary educators, multiple municipalities (Madison, Starks, St. Albans, and

Skowhegan), Spectrum Generations, Maine CDC, Maine Parent Federation, seniors, hospitals, a local nursing

home; local business; Hospice; and others.

Action planning focused on prioritizing issues in the data, action steps to take immediately to address identified

issues in a collaborative way, identifying others who need to be brought to the conversation, identifying how to

engage community stakeholders to the conversation, and the next action steps.

In December of 2015 Community members were invited to additional forums across Somerset County as another method of gathering information from the community at large. The goal was that people with diverse backgrounds would have the opportunity to share their perspective about the issues at hand. Three such forums were held to maximize resources in the two counties of Kennebec and Somerset. A summary of the key health issues identified and discussed during these forums are in the table below (may not be all inclusive of all comments). One of these forums was held in the Pittsfield area.

Health Issue Barriers or need Potential solutions Available Resources

Obesity Poverty, transportation,

funding, access to care

Increased programming for and access to

physical activity and weight loss, access to

healthy foods. Fund evidence based

programs, organizations offer space for

activities

Worksite wellness programs, school

education, physical activity opportunities

Tobacco Transportation, poverty,

stigma around substance

abuse

Youth involvement in solutions, increase

access to tobacco cessation, address health

care professional shortage for screening and

referral for services, those in need attend

existing groups / Quit line

Youth, seniors, parents, businesses

Mental Health Lack of behavioral health

professionals, limited social

support

Policy change, collaboration to improve

referral processes, education and provider

protocol

NAMI, support groups, assisted living and

hospice providers, school support staff,

Acadia hospital, 211

Drug and Alcohol

Abuse

Transportation, poverty,

stigma around substance

abuse

Increase prevention education, improve

partnerships among law enforcement and

public safety, provide resources, cultural shift

to reduce stigma, treat disease and engage

youth in prevention/ treatment

Treatment providers, support groups,

school-based education, health care, law

enforcement

Collaboration on the SHNAPP project has been valuable for RFGH. RFGH has access to available data for 160

quantitative indicators for Somerset County within eighteen groupings for reporting at the state level and where

possible, county level. The data are taken from the most current year (s) that is available. Some of the data

available is several years old. Data sources may have changed since the last assessment / report of RFGH.


Health Indicator Data Sources used in the Maine Shared Community Needs Assessment, 2015 are numerous and

include:

Child Maltreatment Report,

Administration on Children Youth and

Families

Maine Behavioral Risk Factor

Surveillance System (BRFSS)

Maine CDC National Electronic Disease

Surveillance System (NEDSS)

MaineCare

Maine Department of Public Safety

Maine Department of Labor

Maine Department of Education

National Center for Health Statistics

US CD WONDER & WISQARS

Maine Cancer Registry

Maine Health Data Organization

(MHDO)

Maine Integrated Youth Health Survey

(MIYHS)

US Census

Maine CDC: Drinking Water Program;

Lead Program, HIV Program; Public

Health Emergency Preparedness; STD

Program, Vital Statistics

National Immunization Survey (NIS)

National Survey of Children w/Special

Health Care Needs

The public is welcome to download or view several county and state reports and datasets

that are available on the Maine CDC website at www.maine.gov/SHNAPP/.

As a means of gathering additional input from the direct community that RFGH serves, a simple qualitative

survey was developed by RFGH and taken to a total of 18 community events / presentations. The survey

purpose or intent was to provide a consistent and structured method for asking questions of community

members. It was an opportunity for members of the community to provide feedback and opinions without the

potential influence that can occur when an individual verbally asks a question. The survey focused on which

health issues impact their overall health. The surveys focused on family health, infectious diseases, chronic

diseases, healthy behaviors and other health issues.

This survey was well received by community members and was easily completed. Between August of 2015 and

June of 2016, 850 respondents completed the live survey. Community members were invited to complete the

survey at the beginning of a community event, support group, presentation, or other event. The opportunities

for these surveys included several worksites, nursing homes, triathlon event, diabetes event, multiple support

groups, weight management groups/classes, a nutrition class, local fair that focused on family and violence

prevention, farmer’s market, local food cupboard, and an event focusing on cancer survival. This method of

gathering community input on how health issues impact them was valuable in reaching many different

populations - medically underserved, poverty or low income, hard to reach groups such as those who rely on

others for transportation (for example; support group individuals or the nursing home environment).

The survey was similar to the survey that community leadership and health experts were asked about but rather

than using a five-point scale, where one was “not at all a problem” and five was “a critical problem”, RFGH asked

participants to use a three-point scale, where one was “not a problem”, 2 was “a moderate problem”, and 3 a

“major problem”. The following are the results from the surveys that RFGH collected.

http://www.maine.gov/SHNAPP/


REDINGTON-FAIRVIEW GENERAL HOSPITAL QUALITATIVE SURVEY RESULTS

N = 850

This chart is the same information, just a different look as on the previous page. The 850 individuals surveyed in the immediate community that RFGH serves indicated the top issues / concerns are physical activity and nutrition, obesity, cardiovascular health, musculoskeletal diseases, and elder health. Cancer, diabetes, and depression were not far behind in those rating a level of concern.

= 0-10% = 11 – 19% = 20 – 25% =26-35% =36-45% =46-61%

As an additional means of gathering input from the community that RFGH serves, a focused follow-up

occurred whereby 40 participants were asked to share their opinions about the topic at hand and to offer

suggestions for action. They were asked about their perception about the following four health issues: drug

abuse/addiction, smoking, obesity and transportation. When asked “what needs to be changed?” – participants

provided their perception of health and social/environmental health outcomes. Responses were as follows:

Drugs / addiction – “places to get help”, “provide education and assistance without stigma”, “parents

using need to be taken from their kids”

Tobacco – “enforce smoking distances”, “increase cost”, “’shock’ ads to prevent them from starting

young”

Obesity: “sidewalks”,” places to walk”,” feed kids better at school”,” start at home”, “parent

responsibility”

Additional comments included: “senior centers as resources”, “additional education needed”,

“leadership”, “free transportation”.

Our youth when surveyed about community assets have had this to say:

Source: MIYHS data (Maine Youth Drug and Alcohol Use Survey) results from Somerset Public Health

Numerator variable between 1250 – 1400; SPHC = Somerset Public Health Community


HEALTH RANKINGS

The Health Rankings, published by the University of Wisconsin Population Health Institute, looks at health outcomes to see how healthy a county is and at health factors which influence the health of a county. Measures used are mortality, morbidity, health behaviors, access to care, quality of care, income, education, community safety, and environment. The indicators for health factors are similar to indicators throughout the Maine Shared Community Health Needs Assessment. An individual’s health status is impacted by disparities such as income, education levels, and access to medical care. According to the 2016 national “Health Rankings” Somerset County currently ranks 14 out of 16 for health outcomes and 15 out of 16 for health factors, a slight improvement over 2015. The flow chart below helps one understand the Health Rankings.

The County Health Rankings also looks at gaps in the State. In 2015, the following gaps were identified within this state: Every year, nearly 1,000 deaths in Maine could be avoided if all residents in the state had a fair chance to be healthy. If residents of all counties in Maine had the same opportunities for health, there could be:

40,000 fewer adult smokers

48,000 fewer adults who are obese

25,000 fewer adults who drink excessively

14,000 fewer people who are uninsured

12,000 more adults, ages 25-44, with some education beyond high school

7,400 fewer people who are unemployed

12,000 fewer children in poverty

15,000 fewer households with severe housing problems Source: University of Wisconsin Population Health Institute. County Health Rankings Health Gaps Report 2015.

Adult Smoking Obesity Physical Inactivity Access to exercise opportunities Excessive drinking Alcohol impaired driving deaths STI – Chlamydia rate Teen Births

% Uninsured Population to provider ratios Preventable hospital stays Diabetic monitoring Mammography screening

High school graduation (in 4 yrs) Some college Unemployment Children in poverty Income inequality Children in single-parent households Social associations Violent crime Injury deaths

Air pollution – particulate matter Drinking water violations Severe housing problems Driving alone to work Long commute – driving alone

Indicators for Health Factors


DEMOGRAPHICS RFGH services most of Somerset County, which is 80% rural. There are 23 towns, small and large, that make up Somerset County. Skowhegan, the largest, has a population of approximately 9100. Some of the towns’ populations run as small as 110. Somerset County

The total population in Somerset County is 51,792, for Maine 1,328,535. The Population in Somerset County grew 2.63% between 2000 and 2010.

Source: Community Commons downloaded May 19, 2016 Source of Data & Charts: US Census Bureau, American Community Survey. 2010-14. Source geography: Tract

Picture Source: 2016 County Rankings

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

SC 2,432 8,218 3,605 5,320 6,580 8,293 8,226 9,088

Maine 66,079 199,299 115,198 148,687 162,191 209,433 201,176 226,472

United States 19,973,712 53,803,944 31,273,296 42,310,184 40,723,040 44,248,184 38,596,760 43,177,960

Source of Charts: Courtesy: Community Commons, downloaded May 19, 2016 http://www.communitycommons.org

ADDITIONAL DEMOGRAPHIC INDICATORS Maine Shared Community Health Needs Assessment Health Indicators

Data Year Somerset County Maine US

Age 65+ living alone 2019-2013 36.3 41.2 37.7

Single parent families 2014 37.7% 34.0% 33.2%

Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml

Race: Somerset County

White 97.01%

Black 0.38%

Asian 0.39%

Native American / Alaska Native 0.45%

Native Hawaiian/Pacific Islander 0.04%

Other 0.07%

Multiple Races 1.66%

SC = SOMERSET COUNTY

Somerset County


SOCIOECONOMIC FACTORS For families and communities to do well, several socioeconomic factors need to be in place. Employment, educational achievement, and having an above poverty level income all affect healthy behavior engagement. INCOME

The average Somerset County weekly wage of $650 -$ 749 is considerably less than the U.S. according to the US bureau of Labor Statistics (2014).

SOCIOECONOMIC INDICATORS

Maine Shared Community Health Needs Assessment Health Indicators


Adults and children living in poverty 2009-2013 17.8% 13.6%^ 15.4%

Single parent families 2014 37.7% 34.0% 33.2%


Somerset County


CHILDREN ELIGIBLE FOR FREE/REDUCED PRICE LUNCH

According to the National Center for Education Statistics, of the 7,325 students enrolled in Somerset County public schools in the 2013-2014 school year, 4,393 were eligible for free or reduced price free lunch. This indicates a vulnerable population.

Community Commons Health Indicators


Percent Free/Reduced Price Lunch Eligible

2013 - 2014 59.97 45.77 52.35

Source: Community Commons downloaded May 19, 2016 Data Source: National Center for Education Statistics, NCES - Common Core of Data. 2013-14. Source geography: Address

Percent Students Eligible for Free or Reduced Price Lunch 2013 2014

SC (59.97%)

Maine (45.77%)

United States (52.35%)

FOOD INSECURITY RATE Food insecurity is the uncertain access or limited access to adequate food in a household. This indicator is an estimated rate of food insecurity in Somerset County in 2013 according to the Feeding America source.



Food insecurity Rate 2013 16.75 15.52 15.21

Source: Community Commons downloaded May 19, 2016 Data Source: Feeding America. 2013. Source geography: County

Percentage of the Population with Food Insecurity 2013

SC (16.75)

Maine (15.52)

United States (15.21)

POPULATION RECEIVING SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS


Data Year Somerset County US

Population receiving SNAP Benefits between July 2012 – July 2013

2013 26.6 18.2 15.8

Source: Community Commons, downloaded May 19, 2016 Data Source: US Census Bureau, Small Area Income Poverty Estimates. 2013. Source

geography: County


HIGH SCHOOL GRADUATION RATE

Another important socioeconomic factor is educational achievement. High School graduation rate is one indicator to look at. Somerset County on-time graduation rate (within four years) reported 85.5% which exceeded the goal of national Healthy People 2020 of 82.4%.



On time graduation rate 2013 85.5 87.2 75.5

Community Commons downloaded May 19, 2016 Data Source: National Center for Education Statistics, NCES - Common Core of Data. 2008-09. Source geography: County

On-Time Graduation Rate 2013

SC (85.5%)

Maine (87.2%)

United States (75.5%)

UNINSURED ADULTS AND UNINSURED CHILDREN

Lack of insurance contributes to poor health status as it can be a major barrier to receiving adequate care. In the 2016 County Health Rankings, it is stated that 17% of Somerset County’s adults are uninsured and 6% of Somerset County children are uninsured. Source: University of Wisconsin Population Health Institute. County Health Rankings Health, 2016 ensuring access to social and economic resources provides a foundation for a healthy community.

UNEMPLOYMENT RATE

Unemployment is one more barrier to access to care, healthy food, and education. According to the US Department of Labor 6.2% of Somerset County are unemployed.



Unemployment Rate 2016 6.2 4.2 5.2

Source: Community Commons Report downloaded May, 19, 2016 Data Source: US Department of Labor, Bureau of Labor Statistics. 2016 - March. Source geography: County

Unemployment Rate 2016

SC (6.2)

Maine (4.2)

United States (5.2)

Summary: According to the Maine Shared Community Health Needs Assessment, 2016, Somerset County “is worse off than the state in many demographic and socioeconomic characteristics, including income, poverty rates and education.” Source: www.maine.gov/SHNAPP/county-reports.shtml


ACCESS TO CARE / HEALTH CARE QUALITY

Access to care contributes to one’s health status. Barriers to access to care may include transportation, cost,

education, lack of usual source of care, lack of insurance, child care, or other barriers may exist.

PRIMARY CARE ACCESS INDICATORS



Adults with usual primary care provider

2011-2013 85.5% 87.7% 76.6%

Individuals who are unable to obtain or delay obtaining necessary medical care due to cost

2011-2013 12.6% 11.0% 15.3%


County Ranking Indicator Data Year Somerset County Maine US

Ratio of adult to Primary care physicians

2015 1290:1 1040:1

Source: University of Wisconsin Population Health Institute. County Health Rankings Health, 2016

DENTAL CARE ACCESS INDICATORS



Adults with visits to a dentist in the past 12 months

2012 59.1% 65.3% 67.2%

MaineCare members under 18 with a visit to the dentist in the past year

2014 54.1% 41.8% 48%


County Rankings Indicators Data Year Somerset County Maine US

Ratio of adults to Dentists 2015 5,120:1 1,720:1 N/A

Source: University of Wisconsin Population Health Institute. County Health Rankings Health, 2016



Dentists, rate per 100,000 population

2013 19.3 56.4 63.2

Source: Community Commons Report downloaded May, 19, 2016 Data Source: US Department of Health Human Services, Health Resources and Services Administration, Area Health Resource File. 2013. Source geography: County



Percent adults (age 18+) who self- report 6 or more permanent teeth removed due to decay, disease or infection

2006-2010 31.1% 19.85% 15.7%

Source: Community Commons Report downloaded, May, 19, 2016 Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Additional data analysis by CARES. 2006-10. Source geography: County

Dentists, Rate per 100,000 Pop. 2013

SC (19.3)

Maine (56.4)


Percent Adults with Poor Dental Health 2006-2010

SC (31.1%)

Maine (19.8%)

US (15.7%)


MENTAL HEALTH ACCESS INDICATORS

This indicator reports the rate of the county population to the number of mental health providers including psychiatrists, psychologists, clinical social workers, and counsellors that specialize in mental health care.



Number of Mental Health Providers 2014 44 3,887 426,991

Ratio of Mental Health Providers to the population

2014 1,196 351.1 745.5

Mental Health Provider Rate per 100,000 population

2014 31.1% 19.85% 15.7%

Source: Community Commons Report downloaded May, 19, 2016 Data Source: University of Wisconsin Population Health Institute, County Health Rankings. 2014. Source geography: County


Data Year Somerset County

Maine US

Adults who have ever had depression

2011-2013 26.5% 23.5% 18.7%

Mental health ED rates per 100,000 population

2011 2,073.6 1972.1 N/A

Seriously considered suicide (HS students)

2013 14.4% 14.6% 17%

Mental Health Care Provider Rate (Per 100,000 Population) 2014

SC (83.6)

Maine (284.8)



GENERAL HEALTH INDICATORS



Adults who rate their health fair to poor

2011-2013 22.1%

15.6% 16.7%

Adults with 14+ days lost due to poor mental health

2011-2013 14.9% 12.4% NA

Adults with 14+ days lost due to poor physical health

2011-2013 17.1% 13.1% NA

Adults with three or more chronic conditions

2011, 2013 32.5% 27.6% NA

Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml Indicates county is significantly worse than state average using a 95% confidence level


Data Year Somerset County

Maine US

Ambulatory care-sensitive condition hospital admission rate per 100,000 population

2011 1665.2 1499.3 1457.5

Ambulatory care-sensitive condition emergency department rate per 100,000 population

2011 7478.6 4258.8 N/A

Percent Adults with Poor or Fair Health (Age-Adjusted) 2011 - 2013

SC (17%)

Maine (12.9%)

United States (15.7%) Source: Community Commons Report downloaded May 19, 2016 Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Accessed via the Health Indicators Warehouse. US Department of Health Human Services, Health Indicators Warehouse. 2006-12. Source geography: County

Summary: Healthy people in communities need access to quality care. Barriers for Somerset County include transportation, poverty, chronic disease, and cost-related barriers such as insurance. One resource the community has brought together is the Somerset Explorer in which in 2015 7,488 riders took advantage of the opportunity to be physically active, commute to work, doctor’s office, obtain needed food or supplies.


CHRONIC DISEASE (S) Chronic diseases include cardiovascular diseases (heart and stroke), cancer, chronic respiratory diseases, diabetes, and bone and joint disorders such as arthritis and osteoporosis.

Causes of chronic diseases may have underlying socioeconomic, cultural, political and environmental determinants. Individuals may have risk factors that place them at increase their likelihood for a particular chronic disease or injury. Very often there are common modifiable risk factors, non-modifiable risk factors, and intermediate risk factors that lead to the main chronic diseases mentioned above. The following chart will clarify those risk factors that one can modify and those one cannot.

Physical inactivity, poor nutrition and tobacco are modifiable risk factors most individuals can adjust in their

daily life and our community health programming can have an impact upon.

Modifiable Risk Factors – those we as individuals we can impact

Non – modifiable risk factors – those as individuals we cannot impact

Intermediate risk factors – those as individuals we can make lifestyle changes that may impact

Unhealthy diet Age Raised blood pressure

Physical inactivity Heredity Raised blood glucose

Tobacco use Abnormal blood lipids (cholesterol)

Overweight / obesity

Tobacco use and exposure to tobacco, poor nutrition, and sedentary lifestyle or physically inactivity are the top three health behavior risk factors affecting people. These risk factors affect all of the chronic diseases: diabetes, cardiovascular health, cancer, chronic lung disease like COPD (chronic obstructive pulmonary disease) and other health issues as well and frequently start in one’s youth. Those with arthritis that are inactive or overweight tend to be more symptomatic (have increased pain and are not as able to move with as much ease). Nutrition /Weight and Physical Activity: sedentary lifestyle, overweight and obesity are risk factors for many of the chronic diseases. Reported in Maine Health Report, Maine’s adult obesity rates have nearly doubled in the past 16 years. Data sources vary slightly source to source, but Mainers and Americans overall are trending to the overweight and obesity ranges. According to the CDC data, the county’s obesity rate (BMI >30) doubled in just ten years from 2003 – 2013. CDC sources have cautioned that changes have been made in an effort to improve the Behavioral Risk Factor Surveillance System that affect the obesity prevalence estimates and therefore data collected for 2010 and prior cannot be compared to later data. PHYSICAL ACTIVITY AND NUTRITION INDICATORS


Somerset County Maine US

Fruit and vegetable consumption (High school students)

16.2% 16.8% n/a

Fruit consumption age 18+ 44.4% 34.0% 39.2%

Met physical Activity 2013 recommendations adults 45.9% 53.4% 50.8%

Met physical activity for at least 60 minutes per day on five of the past seven days (HS students 2013)

41.9% 43.7% 47.3%

Sedentary lifestyle – no leisure – time physical activity in past month (Adults ) 2011 – 2013)

29.3% 22.4 25.3

Soda/sports drink consumption (HS students) (2013) 28.7% 26.2% 27.0%

Vegetable consumption among adults 18+ (less than one serving per day) (2013)

20.1% 7.9% 22.9%



WEIGHT INDICATORS



Obesity Adults 2013 33.8% 28.9 29.4

Overweight Adults 2013 39.0 35.9


Source: Community Commons Report downloaded May 19, 2016 Data source CDC, Behavioral Risk Factor Surveillance System 2012 SOMERSET PUBLIC HEALTH YOUTH DATA

High School Students 2009 2011 2013 2015

Vegetables 3+ times/day during the past week 7% 9% 10% 12%

Fruit 2+ times/day during the past week 19% 18% 21% 21%

At least one SSB during the past week 85% 89% 86% 82%

Physically active on 5 of 7 days in the past week (60 mins) 38% 45% 41% 42%

SSB = Sugared sweetened beverage

Source MIYHS data (Maine Youth Drug and Alcohol Use Survey) results from Somerset Public Health Note: numerator variable – greater than 1200 and less than 1500 HS students. Note: SSB = Sweetened / sugared beverage


SOMERSET PUBLIC HEALTH YOUTH DATA

19%20%

21%

18%

20%

22%

percent middle schoolersoverweight

Overweight Middle School Students (%)

2009 2011 2013

10%27% 19%

0%

middle school students obese (%)

% Obese Middle School Students

2009 2011 2013

27% 30% 34%

0%

50%

60 min/ day every day for the past 7 days

Middle School Exercise

2009 2011 2013

Summary: Somerset Public Health has worked with the local district schools, child care centers and out of school programs in Somerset County to promote nutrition and physical activity. Walking programs and after school physical activity programs for schools and recreation across Somerset County are in play. Many nutritional education programs have been provided for children of all ages and adults. Although no major gains in adult obesity rates in Somerset County have yet to be obtained, we are starting to see a shift in the middle age students from obese to overweight in our local districts. In 2015 the RFGH weight management class 139 individuals lost an average approximately 5 pounds each over 8 weeks.


Cardiovascular Health Cardiovascular disease refers to a group of diseases and conditions affecting the heart and blood vessels. According to the Maine Cardiovascular Health and Diabetes Plan (2011 – 2020) Heart Disease is the 2nd leading cause of death in Maine with Stroke the 4th leading cause of death. In Somerset County, according to the Maine Shared Health Needs Assessment, Heart disease was the leading cause of death in Somerset County in 2013. Risks of heart disease and stroke are 2-4 times greater in people with diabetes. According to the CDC, About 1 of 3 U.S. adults—or about 70 million people—have high blood pressure. Only about half (52%) of these people have their high blood pressure under control. This common condition increases the risk for heart disease and stroke. CARDIOVASCULAR HEALTH INDICATORS



Hypertension prevalence 39.6% 32.8% 31.4%

High cholesterol 43.3% 40.3% 38.4%


Respiratory Health / Pulmonary Disease Respiratory health includes diseases such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. As with other chronic diseases, risk factors include smoking and sedentary lifestyle. In addition, exposure to noxious particles or gases, recurrent infections, genetic factors and diet may be additional risk factors for COPD. Respiratory health includes diseases such as Chronic Obstructive Pulmonary Disease (COPD), pneumonia and asthma. Asthma is a chronic disease that affects the lungs and airways. There is no cure but it can be controlled. Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. COPD is a disease that is caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Most people with COPD can achieve good symptom control and quality of life with proper management, as well as reduced risk of other associated conditions. RESPIRATORY HEALTH / PULMONARY DISEASE INDICATORS



COPD diagnosed 2011-2013 9.1% 7.6% 6.5%

Asthma emergency department visits per 10,000 population

2009-2011 101.2 67.3 N/A

Current asthma (adults) 2011-2013 14.4 11.07 9.0

Current asthma (youth 0-17) 2011-2013 12.01 9.1 N/A

Pneumonia emergency department rate per 100,000 population

2011 1379.2* 719.9 N/A

Indicates county is significantly worse than state average using a 95% confidence level *and italics indicate a statistically significant difference between SC and Maine



Diabetes Diabetes is a disease that affects the way the body uses food. It is characterized by the inability to produce or properly use insulin, a hormone that helps control blood sugar levels. Every minute a person’s blood sugar is higher than it should be, the disease damages the nervous and circulatory systems, leading to blindness, amputations and increasing disability. The Center for Disease Control reports approximately 29 million people are living with diabetes in the United States. According to the CDC 2014 Diabetes Report Card, about 8.1 people in the nation with diabetes do not know they have diabetes. People may be able to lower their risk just by knowing what the risk factors are and controlling those risk factors. Obesity is one of several risk factors linked to type 2 Diabetes. Both obesity and type 2 diabetes have contributing factors of socioeconomic, lack of physical activity, and an unhealthy diet. In addition, poorly controlled cholesterol, blood pressure, and blood sugar levels are associated in people with obesity in those with type 2 diabetes. The overweight or obese diabetic may experience more severe complications.

Complications of diabetes may include heart disease, kidney disease, eye disease, nerve disease, atherosclerosis, stroke, bone or gum infections, and birth defects in babies born to diabetic mothers. Early prevention, effective management, lifestyle changes, and treatment can often successfully prevent many complications of diabetes. DIABETES INDICATORS

County Health Rankings 2015 Somerset County Maine

Diabetic monitoring 88% 88%



Diabetes prevalence (ever been told) 2011-2013 11.8 9.6 9.7

Pre-diabetes prevalence 2011-2013 8.1% ≠ 6.9 N/A

Adults with diabetes who have received formal diabetes education

2011-2013 N/A 60% 55.8%

Diabetes emergency department visits (principal diagnosis) per 100,000 population

2011 364.7 235.9 N/A

Diabetes long term complication hospitalizations

2011 47.2 59.1 N/A

Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml ≠ result may be statistically unreliable due to small numerator, use caution when interpreting * and italics Indicate a statistically significant difference between SC and Maine

Indicates county is significantly worse than state average using a 95% confidence level

Summary: RFGH currently has two Certified Diabetes Educators and a physician in Endocrinology. See the attached improvement plan for Diabetes as we work to improve our diabetes care.


Cancer Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. Cancer is not just one disease, but many diseases. There are more than 100 kinds of cancer. Early detection through screening (finding cancer or pre-cancerous changes before it can grow and spread into late-stage disease) makes a difference in health outcomes for many cancers. Not only does it save lives, provide quality of life, it also saves billions of dollars of healthcare treatment costs.

CANCER INDICATORS



Incidence – all cancers per 100,000 population

2007-2011 472.0 500.1 453.4

Mortality – all cancers per 100,000 population

2007-2011 204.9* 185.5 168.7

Colorectal screening 2012 70.1% 72.2% N/A

Mammograms female age 50+ in past 2 yrs

2012 82.8% 82.1% 77%

* italics indicate a statistically significant difference between SC and Maine Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml

Arthritis

Arthritis is no longer an indicator that the State of Maine has chosen to follow. Musculoskeletal topics (for example, arthritis) are of key concern for this community, therefore this assessment will include the topic.

Osteoarthritis is characterized by the breakdown of the joint’s cartilage. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. Rheumatoid arthritis) is a chronic disease, mainly characterized by inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability.

In December of 2014 the CDC estimated that an estimated 52.5 million US adults reported that their doctor told them they had arthritis. As our nation’s population ages, the prevalence is expected to increase. In addition, 294,000 U.S. children under age 18 (or 1 in 250 children) have been diagnosed with arthritis or another rheumatologic condition. Prior estimates ranged from 80,000 to 290,000, depending on the definition of arthritis, age range and methods used to find cases. Many afflicted with arthritis have limitations in their ability to do physical activity, have work limitations, and have social participation limitations.

Source: Data Source: BRFSS 2013; CDC unpublished data

Summary: Extremely popular community topic was “Hand Arthritis” offered by Occupational Therapy in 2015.

Summary: RFGH continues to support our oncology patients through the oncology clinic, offer mammogram screening and colorectal screening .


ENVIRONMENTAL HEALTH Prevention and / or minimizing exposures to those environmental things that may have adverse health effects are important to the health of our community.

Lead exposure: the reference level for lead for which the CDC recommends Public Health actions be taken are blood levels for > 5 micrograms per deciliter. Lead exposure can affect nearly every system in the human body. It often goes without symptoms, therefore is not easily recognized. The importance of testing is crucial for early intervention, especially in children ages 1-5 when they are rapidly growing physically and mentally. It is equally important to protect children from exposure to lead for their lifelong good health, academic achievement, IQ, and their ability to pay attention in school and in social settings.

High arsenic levels in private wells may come from certain arsenic fertilizers used in the past or industrial waste. It also may indicate improper well construction or overuse of chemical fertilizers or herbicides in the waste. Heating or boiling water does not remove arsenic, nor does chlorine (bleach) use. One should test well water at least once a year and contact your state certification officer for a list of laboratories that will perform tests on your drinking water. There is a fee for this service.

ENVIRONMENTAL HEALTH INDICATORS



Children with confirmed elevated blood lead levels (% among those screened)

2009-2013 2.4% 2.5% N/A

Children with unconfirmed elevated blood level (% among those screened)

2009-2013 9.1% 4.2% N/A

Homes with private wells tested for arsenic

2009-2013 45.4% 43.3% N/A

Lead screening among children age 12-23 months

2009-2013 41.1% 49.2% N/A

Lead screening among children age 24-35 months

2009-2013 40.7% 27.6% N/A

Data Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml

Summary: Redington Fairview General Hospital and KVCAP collaboratively screen children in local preschool programs for lead. KVCAP works with state Lead Program for education, lead dust kit for the home, lead education materials. Parents and physicians are engaged in results, education and follow up. A barrier for testing well water for arsenic may be the fee for the kit and laboratory fees.


IMMUNIZATION The influenza (flu) virus is a serious disease that can lead to hospitalization or even death. The best way

to reduce the chance of getting the seasonal flu and spreading the flu to others is by getting the annual flu shot. When more people are vaccinated each year, less flu can spread throughout the community.

Pneumonia may be caused by bacteria, fungi, or viruses. There are several vaccines that prevent infections that cause pneumonia. You can also help prevent pneumonia and other infections by washing your hands regularly. Pneumonia vaccines are generally recommended for specific age groups.

IMMUNIZATION INDICATORS



Adults immunized annually for influenza

2011-2013 37.6% 41.5% N/A

Adults immunized for pneumococcal pneumonia – ages 65 +

2011-2013 73.1% 72.4% 69.5%

Immunization exemptions among kindergarteners for philosophical reasons

2015 3.9 3.7 N/A

Data Source: Maine Shared Community Health Needs Assessment www/maine.gov/SHNAPP/county-reports.shtml

INFECTIOUS DISEASE / SEXUALLY TRANSITTED DISEASE Lyme disease is caused by a bacteria transmitted to humans through the bite of infected blacklegged

ticks. Prevention: use insect repellent, remove ticks promptly, remove leaves and other habitat that ticks like to live in from your yard.

Tuberculosis (TB) is caused by a bacterium which attacks the lungs most generally. If not treated, the disease can be fatal. In some people the disease can be asymptomatic for a long time. Maine has a very low incidence rate.

Hepatitis C is a liver infection caused by the Hepatitis C virus, a bloodborne virus. Many individuals infected may not know of their illness because they do not feel ill.

INFECTIOUS DISEASE INDICATORS



Lyme disease incidence per 1000,000 population

2014 33.2 105.3 10.5

TB incidence per 100,000 population 2014 0≠ 1.1 3.0

Hep C (acute incidence per 100,000 2014 2.0 2.3 N/A


Summary: Redington Fairview General Hospital reaches four school districts and three community schools in its efforts to vaccinate school age children against influenza (flu). In addition it holds many community based clinics for flu, pneumonia, and whooping cough. Somerset County does above Maine and US rate for immunization for pneumonia ages 65 and above.

Summary: Lyme, TB, and Hepatitis C rates in Somerset County are lower than in the rates in Maine. The RFGH Infection Control Practitioner has done many education prevention programs throughout the community and at worksites to inform the public about Lyme disease.


INJURIES

INJURY INDICATORS



Intentional Injury

Domestic assaults reports to police per 100,000 population

2013 774.0 413 N/A

Reported rape per 100,000 population

2013 46.4 27.0 25.2

Suicide deaths per 100,000 population

2009-2013 17.7 15.2 N/A

Violent crime per 100,000 population

2013 108.4 125 368

Unintentional Injury

Always wear seatbelt (adults) 2013 79.8% 85.2% N/A

Always wear seatbelt (HS students) 2013 52.4% 61.6% 54.7%

Unintentional fall related injury emergency department visits per 10,000 population

2011 470.7 361.3 N/A


TOBACCO USE

According to the CDC, cigarette smoking causes nearly one in five deaths in the United States. According to this source, smoking causes about 90% of all lung cancer deaths and 80% of all deaths from Chronic Obstructive Pulmonary Disease (COPD). Smoking is estimated to increase the risk of coronary heart disease by 2-4 times, for stroke 2-4 times, of men developing lung cancer by 25 times, and of women developing lung cancer by 25.7%. In addition, smoking is a cause of type 2 diabetes and can make it harder to control. It is a cause of rheumatoid arthritis and can affect bone health. Smoking can make it more difficult for women to become pregnant and can affect the baby’s health before and after birth. It can lead to pre-term labor, stillbirth, low-birth weight, sudden infant death syndrome, and orofacial clefts in infants. Smoking causes diminished overall health, increased absenteeism from work and increased health care cost and utilization. By quitting smoking one can reduce cardiovascular risks. Just one year after quitting your risk for heart attack drops sharply. Within 2-5 years, one’s risk for stroke could fall to that of a non-smoker. If one quits smoking, the risk for cancer of the mouth, throat, esophagus and bladder drop by half in 5 years. And in 10 years after one quits smoking, the risk for lung cancer drops in half. TOBACCO USE INDICATORS



Current adult smoking 2011-2013 26.1% 20.2% 19.0%

Current High School smoking 2013 14.9% 12.9% 15.7%


County Health Rankings Data Year Somerset County Maine

Current adult smoking 2014 21% 19%

NOTE: County Health Rankings state the above data should not be compared with prior years due to changes in definition/methods Source: University of Wisconsin Population Health Institute. County Health Rankings Health, 2016

Summary: Unintentional fall related injury emergency department visits are higher in SC than in Maine overall, we know that SC has an older population than other areas in Maine. Broken bones such as hips, arms or ankles or even head injuries may occur in one out of five falls making it hard to be independent. Balance screening and encouraging sites to remain open for winter walking are two major initiatives that RFGH and Somerset Public Health undertook in 2015 to address this topic.


SUBSTANCE AND ALCOHOL ABUSE

SUBSTANCE AND ALCOHOL ABUSE INDICATORS



Drug affected baby referrals received as a percentage of all live births

2014 12.3% 7.8% N/A

Emergency medical service overdose response per 100,000 population

2014 281.5 391.5 NA

Opiate poisoning (ED visits) per 100,000 population

2009-2011 22.7 25.1 NA


HIGH SCHOOL INDICATORS

Source: Maine Integrated Youth Health Survey (MIYHS) 2015; High School Asset Indicators: Somerset Public Health, Somerset County and Maine




PREGNANCY AND BIRTH OUTCOMES Prenatal care helps to keep the pregnant woman and baby healthy. According to womenshealth.gov, babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care. Health problems may be prevented or treated. PREGNANCY AND BIRTH INDICATORS Maine Shared Community Health Needs Assessment Health Indicators


Live births for which the mother received early and adequate prenatal care

2010-2012 75.5% 86.4% 84.8%

Live births to 15-19 year olds per 1.000 population

2010-2012 27.8 20.5 26.5

Low birth weight (<2500grams) 2010-2012 6.1% 6.6% 8.0%


The indicators above are not all inclusive. The public is welcome to download or view

both state and county level reports on the Maine CDC website at www.maine.gov/SHNAPP/.

Please review the attached RFGH work-plan to review the specific topic areas that Community Health focuses

on, goals / objectives, and accomplishments or outcomes for 2015.

ATOD = Alcohol, Tobacco or Other Drug

Summary: In 2003 the rate of adult smoking in Somerset County was 31% and with the initiatives of RFGH, Somerset Public Health (SPH), and others, the smoking rate dropped to 26% in 2010. According to 2014 reported by County Health Rankings, the County has dropped to 21%; however do caution method collection of data has changed so data may not be compared. same rate today. We continue to work to decrease this rate with tobacco free policies implemented in municipalities and worksites, education in the school systems, other support programs at RFGH and Somerset Public Health, as well as additional initiatives with retailers through the work of SPH and RFGH’s Tobacco Specialist. Our high school local charts indicate that the efforts on substance abuse prevention are working:

Past month usage of cigarette, alcohol, binge alcohol, marijuana, prescription drugs have declined each 2 year measurement period since 2009

Lifetime use of alcohol, marijuana, prescription drugs, and inhalants have declined since 2009

http://www.maine.gov/SHNAPP/

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