Community Health Needs Assessment Western Maryland Health System In collaboration with Allegany County Health Department 2011

Background The Patient Protection & Affordable Care Act and the Health Care Education Reconciliation Act (known together as the Affordable Care Act) mandated… Development of a National Prevention & Health Promotion Strategy Community Health Needs Assessment by Non-Profit Hospitals in conjunction with public health entities (Section 9007)

National Prevention Strategy Vision: Working together to improve the health and quality of life for individuals, families and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness. Goal: Increase the number of Americans who are healthy at every stage of life. Strongest Predictors of health & well-being fall outside of the healthcare setting- social, economic and environmental factors all influence health. Encourages Partnerships among State & Local Government, Businesses, Community organizations and everyday Americans.

Maryland Health Care Reform Coordinating Council Established to proactively plan for pending changes at federal level Directed State Health Department to develop State Health Improvement Plan in coordination with hospitals under Health Services Cost Review Commission Recommended development of interconnected state and local strategic plans to achieve improved health outcomes Maryland’s Health Improvement Plan 2011-2014 will provide a framework to support improvements in the health of Marylanders and their communities. Improving the health of all Marylanders through population planning requires commitment of local partnerships such as the hospital, local health department, private sector, etc.

Community Health Needs Assessment Expands Community Benefit Report to Health Services Cost Review Commission (HSCRC) Required by Internal Revenue Service 990-Schedule H to justify non-profit status Guides decision making for community and allows us to engage effectively with State and Federal Initiatives Leads to development of Local Health Improvement Plan in partnership between the hospital and the local health department

National Priorities Tobacco-Free Living Preventing Drug Abuse & Excessive Alcohol Use Healthy Eating Active Living Injury & Violence Free Living Reproductive & Sexual Health Mental & Emotional Well-Being Maryland Vision Areas Reproductive Health Care & Birth Outcomes Social Environments that are Safe & Support Health Physical Environments that are Safe & Support Health Prevent & Control Infectious Disease Prevent & Control Chronic Disease All Marylanders Receive Needed Health Care

National & State Plans Include: Engagement of Partners Alignment of Policies and Programs Utilization of Evidence Based Research & Best Practices Accountability

WMHS Community Health Needs Assessment FY11 FY12 FY13 FY14 Tasks Jan-Mar‘11 Apr-Jun’11 July-Spt 2011 Oct-Dec ‘11 Jan-Mar’12 Apr-Jun’12 2012 Oct-Dec ‘12 Jan-Mar’13 Apr-Jun’13 2013 and beyond Data Collection & Analysis Presentations & Priorities Service Line Coordination Summary of Needs, Gaps & Resources 5 Priorities, Best Practices & Partners Approve Action Plan & Metrics Community Benefit Report Report to Public Implement Plan & Report Quarterly Update Timeline for Next 3 yr. cycle Community Presentations July-Oct WMHS Board of Directors Board of Health Workgroup on Access to Care Community Wellness Coalition Local Management Board Drug and Alcohol Council Mental Health Advisory Board School Health Council Cumberland Ministerial Ass WMHS Service Line Managers, Care Mgmt., Home Care Western Maryland AHEC Board Community Forum (open to public) How it will be used- next steps- identify best practices & partnerships for top priorities by Dec 2011 Reports to WMHS Board and Community Advisory Committee.Periodic Develop Local Health Improvement Plan Approve action plan to address priorities with identified metrics – March 2012 Quarterly internal progress report on activities and outcomes – Quarterly FY 12-14 Written documentation to HSCRC, IRS, Board, website and partners – Community Benefit December 2011,IRS November 2011, Public July 2012 Updated timeline & process revisions for next assessment - December 2013 Complete Remaining

WMHS Service Area The service area encompasses the majority of Allegany and Garrett Counties in Maryland, Mineral County and selected zip codes in Hampshire County in West Virginia, and Bedford and Somerset Counties in Pennsylvania.

Patient Residence 72.51% of WMHS patients resided in Allegany County. In FY10, 76.47% of WMHS patients came from the two MD counties, 16.02% from the two counties in WV and 3.5% from the two counties in PA. July 2009-June 2010

Demographics of Community Poverty Less Educated (Fewer college graduate and illiteracy) Limited Diversity Elderly Population Single Parents and Responsible Grandparents Economic Characteristics Median income-The median household income in all six counties is below the US median income of $51,425. Hampshire County is the lowest at $34,571 followed by Allegany ($36810) and Mineral ($37681). Garrett is the highest at (43,802) Poverty- Mineral (14.5) & Hampshire (16) are joined by Allegany(14.2) and Bedford (14.2)with a higher percentage of individuals living below poverty compared to the US(13.5). The percentage of children living in poverty is above the US benchmark (11%) in all six counties ranging from 19-23%, which is reflected in the free lunch program rates. (2011 Poverty level for 1-$10,890, 3p-$18,530, 4-$22,350) Education High school graduation: Allegany(85.2) and Mineral (88.1) have a higher percent of high school graduates compared to the US (84.6) while Garrett (16), Hampshire (22), Bedford (17) and Somerset (18) all have a higher percent of drop outs than the US (15). College: However, the percentage of those with a bachelors or higher in the six counties ranges from 10.3 in Hampshire, 15.2 in Allegany, to 17.3 in Garrett, all below the target. 27.5% of US has a bachelor’s degree or higher and in Maryland it increases to 35.2%. Illiterate: Both Allegany & Garrett counties as well as the state have about 11% of the population age 16 and over who are illiterate and the percentage increases from 13.4 in Mineral to 15 in Hampshire and Somerset. Population Gender, Age, Race: In all six counties, there is much less diversity compared to Maryland or the US, with over 95% of the population being white except in Allegany County where only 91.4% is white, 6.2% is black, 1.1% is Hispanic or Latino, and 1.1% is two or more races. a larger percent of the population is 65 years and over (14.8-18.6%) Allegany 18.1 compared to Maryland(11.8) or the US (12.6) According to FY10 WMHS inpatient admission data, 44.97% are over 65. In FY11 YTD, the age of the inpatient seems to be increasing with the 65 years and over group increasing in percentage. Households Allegany & Mineral have a larger percentage of single parent household(33 & 31%)compared to MD & US (32 & 20) and all six counties have more single parent household than the US benchmark (20). Of the grandparents living with their own grandchildren under 18 years old, there is a higher percentage responsible for their grandchildren in all six counties(44-77.5%- Allegany 54.2) compared to MD & US (36.7 & 33.4). American Community Survey 2010

5= Greater Community Need Community Needs Index 5= Greater Community Need Based on socio-economic barriers including income, culture, education, insurance & housing. Comparison of CNI scores to hospital utilization shows a strong correlation between high need and high use. Greatest Need Lowest Need 21502- Cumberland - 3.8 26726 - Keyser - 3.8 26757- Romney– 3.8 21562 – Westernport – 3.6 21539 – Lonaconing- 3.6 21531 – Friendsville- 3.6 21536 – Grantsville – 3.6 21532 – Frostburg -3.6 21557 –Rawlings – 2.2 26753 – Ridgeley – 1.8 26710 – Burlington – 2.2 15539 – Fishertown – 1.2 15559 – Schellsburg – 2 15535 – Clearville - 2 Catholic Healthcare West and Thomson Reuters developed the nation’s first standardized Community Needs Index (CNI). It identifies the severity of health disparity in every zip code in the US and demonstrates a link between community need, access to care, and preventable hospitalizations. CNI gathers data about the community’s socio-economy including barriers related to income, culture/language, education, insurance and housing. A score of 1.0 indicates a zip code with the lowest socio-economic barriers and 5.0 represents a zip code with the most socio-economic barriers. The closer to 5 the more community need there is in a zip code. A comparison of CNI scores to hospital utilization shows a strong correlation between high need and high use. In fact admission rates for the most highly needy communities (red in the online maps) are over 60% higher than communities with the lowest need. Catholic Healthcare West and Thomson Reuters

Lifestyle & Environment Unhealthy Behaviors Tobacco Use Substance Abuse Limited Fruits and Vegetables No Physical Activity Poor Access to Healthy Food Lack of Emotional and Social Support

Tobacco & Alcohol Use Garrett MD Mineral WV Hampshire WV Bedford PA Tobacco use-The HP 2020 target is 12% or less of adults report smoking. The six counties range from 20% to 28%, with Allegany at 26%. Alcohol use-The US benchmark for excessive drinking is 8%. Bedford is closest at 9% and Somerset the most off target at 23%. Mineral (11), Hampshire (12) and Garrett (14) are all below Maryland at 15,but Allegany is at 16. Allegany and Somerset also have the highest percentage of adults reporting binge drinking in the past 30 days. Substance Abuse- With 903 hospital discharges per 100,000 (2001-2005) for substance abuse, Allegany was ranked the 7th highest in Maryland. Garrett MD Mineral WV Hampshire WV Bedford PA Somerset, PA % Adults Smoking 20 23 28 22 % Adults Excessive Drinking 14 11 12 9 County Health Ranking 2011 (U of Wisconsin)

Food Choices and Access Fruits & Vegetables-Between 71.4 and 82.3 % of the adults in this area report eating fewer than 5 fruits & vegetables per day. Allegany (76.3) Access to food, recreation and liquor stores-The US benchmark is for 92% of the population to have access to healthy food. Allegany and Somerset come closest at 46, followed by Mineral and Bedford at 38, Garrett at 33 and Hampshire at 13. When examining access to recreational facilities per 100,000 population, the US benchmark is 17. Only Allegany has more at 19. Garret is next at 13 and the others are all below 10. There is no target for liquor store density per 100,000,however all six counties are below Maryland at 20, and all have more liquor stores per 100,000 population than recreation facilities except Allegany (and the difference there is 1). Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Adults eating <5 fruits & vegetables a day 78.3 82.3 71.4 77.1 79.5 % Adults with access to healthy food 33 38 13 46 County Health Ranking 2011 (U of Wisconsin) and Health Indicator Warehouse

Physical Activity & Social Support Physical Activity-30-31% of the adults in Allegany, Garrett, Mineral and Hampshire counties report no leisure time physical activity. Bedford and Somerset are a bit lower at 24 and 25% Emotional and social support-The US benchmark for % of adults without social and emotional support is 14. Mineral and Hampshire are closest with 15 followed by Bedford (17), Garrett (19), Allegany (20) and Somerset (24) Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Adults no leisure time physical activity 30 31 24 25 % Adults without emotional & social support 19 15 17 County Health Ranking 2011 (U of Wisconsin)

Ranking of 436 Congressional Districts 2010 Well Being Index Ranking of 436 Congressional Districts 2010 MD 6 WV 1 WV 2 PA 9 Overall Rank 99 364 390 218 Life Evaluation 132 402 396 313 Emotional Health 264 401 399 276 Physical Health 206 403 426 320 Healthy Behavior 200 307 384 249 Work Environment 42 85 78 Basic Access 93 318 336 166 Well Being Index33 The Gallup-Healthways Well Being Index and Congressional District Reports are based on the World Health Organization of health which is, “not only the absence of infirmity and disease but also a state of physical, mental and social wellbeing.” Based on interviews from 1000 US adults a day, excluding major holidays, communities receive an overall well-being composite score and a score for each of six sub-indices including: life evaluation-present life situation and anticipated life situation five years from now emotional health-daily experiences of smiling or laughter, being treated with respect, enjoyment, happiness, worry, sadness, anger, stress, learning or doing something interesting and depression physical health-sick days in past month, disease burden, health problems that got in way of normal activities, obesity, feeling well rested, energy, colds, flu, and headaches healthy behavior-lifestyle habits that have established relationships to health outcomes, smoking, eating healthy, weekly consumption of fruits and vegetables, weekly exercise frequency work environment –perceptions of work environment, job satisfaction, ability to use one’s strengths at work, supervisor’s treatment, and supervisor creates an open and trusting work environment basic access-access to necessities crucial to high well being including satisfaction with community or area, area getting better as a place to live, clean water, medicine, safe place to exercise, affordable fruits and vegetables, feel safe walking alone at night, enough money for food, enough money for shelter, enough money for healthcare, visited a dentist recently, access to a doctor, and access to health insurance. Annually, Congressional Districts are then ranked based on their scores. www.well-beingindex.com

Health Needs & Disease Status Birth Measures Health Status Death Rates Incidence Usage

Birth Factors Garrett MD Mineral WV Hampshire WV Bedford PA Mother : The teen birth rate is above the US benchmark (22 per 1000) in all six counties, ranging from 35 in Allegany to 46.9 in Hampshire. 42.7% of births in Allegany are to unmarried women. Prenatal care: All of the counties have a higher percent of mothers not receiving care in the first trimester than the target of <12. Hampshire is at 12.6 followed by Bedford 16.7, Somerset 17.9, Allegany 19, Garrett 19.6 and Mi Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA Teen Birth Rate per 1000 39.4 40.2 46.9 (9.4%) (7.2%) % No Care in First Trimester 19.6 25.3 12.6 16.7 17.9 Kids Count 2005-2011 & Vital Statistics

Tobacco & Drug Use During Pregnancy Mothers behavior during pregnancy- Of the Medicaid eligible pregnant women in Allegany 8.7% reported using illicit drugs within the past 6 months, 18.1% reported current or past mental health issues, and 41.3% used tobacco during pregnancy. These are above the targets of 0 for illicit drugs and <9 for tobacco use. All the other counties (except Garrett for which data is unavailable) are above the target for tobacco use. Drug Exposed & Drug Addicted Infants41 In CY2010, of the 1058 deliveries at WMHS, 102 infants (9.6%) were drug exposed and 25 (2.4%) were drug addicted. Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA %Tobacco use during pregnancy 17.0 22.6 23.4 22.9 20.4 MD Prenatal Risk Assessment FY10 & WV/PA Vital Statistics

Birth Weight & Infant Mortality Birth weights When comparing the counties to the target percentage of low birth weight babies (7.8) and very low birth weight (1.4), Garrett and Mineral have a high percent of both low (8.5 &9.8) and very low birth weights(1.8 &2.1), while Allegany (1.9)only has a higher percentage of very low birth weights. Infant Mortality-Allegany (8.4), Garrett (10.8), Mineral (8.4) and Hampshire (8.2) have a higher rate of infant mortality than the target of 6. This is based on deaths per 1000 live births. Neonatal infant mortality or those under 28 days has a target of 4.1. Allegany (6), Mineral (12.2) and Hampshire (5.3) are above the target. Post neonatal infant mortality’s target is 2. Both Allegany and Bedford are at 3.4 and Garrett is at 4.5. Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Low Birth Wt. <2500 g 8.5 9.8 6.2 6.3 7.6 % Very Low Birth Wt. <1500 g 1.8 2.1 1.3 1.5 1.2 Infant Mortality (deaths per 1000 live births) 10.8 8.4 8.2 No data Kids Count 2005-2011 & Vital Statistics

Health Factors Garrett MD Mineral WV Hampshire WV Bedford PA BMI>30: All six counties had a higher percentage of adults report a BMI of 30 or more compared to the US benchmark of 25. Diabetes: Four counties had a higher percentage of adults diagnosed with diabetes (age adj) than the 8.5 target. Allegany (12.3), Garrett (10.3), Mineral (10.4) and Hampshire (10.2). Bedford and Somerset were below the target. Hypertension: Allegany (32.9), Mineral (32.5) and Hampshire (31.2) had a higher percentage of adults with high blood pressure compared to the 26.9 target. Age- Adjusted-statistical process applied to rates of disease, death, injuries, or other health outcomes that allows communities with different age structures to be compared. Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Adults with Body Mass Index >30 29 34 33 27 32 % Adults with high blood pressure 25.9 32.5 31.2 NA 24.8 % Adults diagnosed with diabetes 10.3 10.4 10.2 7.6 8.3 County Health Ranking, 2008 CDC Trends, & Community Health Status Indicators

Self-Reported Health Status Poor or Fair Rated; 17.1 of the US adult population reported a poor or fair health status (age adjusted). Somerset and Garrett had less report poor or fair health status and the remaining counties were higher ranging from 18-20. Allegany is at 20. Poor physical and mental days; All six counties had a higher average number of poor physical and poor mental health days reported in the last 30 days (age adjusted) than the US benchmarks (2.6 physical) and (2.3 mental). Allegany is 4.5 physical and 4.2 mental. Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Adults reporting poor or fair health 17 18 19 14 Avg. # poor physical days in past 30 3.4 4.9 3.7 3.6 3.5 Avg. # poor mental days in past 30 3.3 County Health Ranking 2011 (U of Wisconsin)

Mental Health Prevalence In Allegany County, there is a 6% prevalence of mental disorders in adults and 13% prevalence among children ages 13-18 During the first three quarters of fiscal year 2011, mental disorders have grown to be the fourth largest category of admissions at 8.01%. Severe depression was the 6th most prevalent reason for hospital admission in past year. Source: NIMH & NCHS 2009 Prevalence and WMHS Mental Health Prevalence In Allegany there is a 6% prevalence of mental health disorders and 13% prevalence among children ages 13-18. Aging Trends7-People who report depressive symptoms often experience higher rates of physical illness and higher health care resource utilization. In 2006 18% of women 65and over and 10% of men reported depressive symptoms. Reasons for Hospital Admissions and ED use15,34-WMHS Admission data for FY10 and FY11 YTD-4/15 has been collected by primary diagnosis upon admission and grouped by ICD9 Categories. In FY10, Diseases of the Circulatory System (390-459) accounted for the largest percentage of admissions (19.01%) and this continues in FY11 with 18.71% of admissions being in this category. Disease of the Respiratory System is the second largest percent of admissions with 10.52% in FY10 and 10.91 in FY11YTD. The third highest admission category was supplementary classification of factors influencing health status (V01-V89) with 9.3 in both years. The fourth highest in Fy10 was Diseases of the Digestive System (8.4%) and in FY11 YTD it is Mental Disorders (8.01%).

Death Rates Death Rates- Burden of Chronic Disease43-In Allegany County, heart disease, cancer and stroke account for 58% of deaths. MD Vital Statistics & BRFSS 2009

Death Rates Death Rates- In review of the age adjusted death measures per 100,000 population, the leading causes of death in the region are heart disease, cancer, stroke and chronic respiratory disease. All six counties have a higher death rate compared to MD and the target. The heart disease target is 169 and all the counties are over 200. The cancer target is 160.6 and the closest is Garrett at 176. Stroke’s target is 33.8 and the counties range from 47.2-71.5. (PIE CHART) Other death rates above the US rate are: Accidents (all but Garrett), Diabetes (all but Allegany & Garrett), Flu & pneumonia (Bedford), Septicemia (Allegany), Nephritis (Mineral, Hampshire and Somerset), Substance Abuse (Allegany). All counties except Somerset have a suicide rate above the target of 8.4. Motor vehicle crash deaths are higher than the 12.4 target, ranging from 15 in Allegany to 45 in Hampshire. Death rates for Septicemia and Substance Abuse are higher in Allegany County than MD and/or the target. Vital Statistics 2007-2009

Cancer Death Rates & Incidence Death Rate/Trend Comparison by State/County, Death Years through 2007 Allegany County, Maryland versus Maryland All Races, Both Sexes   Above State Rate Similar to State Rate Below State Rate Rising Trend Priority 1: rising and above [none]  Priority 2: rising and similar Lung & Bronchus (Females) Non-Hodgkin Lymphoma (Males)  Priority 3: rising and below [none]  Stable Trend Priority 4: stable and above Lung & Bronchus (Males)  Priority 6: stable and similar Non-Hodgkin Lymphoma (Females) Prostate (Males)  Priority 7: stable and below [none]  Falling Trend Priority 5: falling and above [none]  Priority 8: falling and similar Breast (Females) Colon & Rectum (Females) Colon & Rectum (Males)  Priority 9: falling and below [none]  Created by statecancerprofiles.cancer.gov on 06/14/2011 12:46 pm. State Cancer Profiles creates priority indices by ordering rates that are rising and above the comparison rate to rates that are falling and below the comparison rate. According to the death rate/trend comparison for all cancer sites, all races and both sexes, Garrett rates are similar to the US Rate and on a stable trend (priority 6). Allegany rates are also similar to the US rate but in a falling trend (priority 8). Cancer Incidence: The cancer incidence rate for all cancer cases per 100,000 population per year is 464.5 in US. Garrett and Bedford are below that level. Allegany is slightly higher at 470.6, and Mineral (521.5), Hampshire (590.9) and Somerset (501.8) are higher. The incidence rate for ages <20 is below the US rate in all of the counties except Somerset.   When looking at the death rate (2007) and trend comparison of county to state and US for all races and both sexes, Allegany County has similar rates of lung& bronchus (females) and non-Hodgkin lymphoma (males) compared to US and Maryland and there is a rising trend, classifying it as priority 2 by NCI. Lung & bronchus rates in Allegany County males is above the state and US, however the trend is stable, lowering the priority to 4. Non-Hodgkin lymphoma in females and prostate cancer are similar to US and MD and stable (priority 6). Breast (female), colon & rectum (both sexes) are similar to MD and US with a falling trend (priority 8). The data for brain cancer is too sparse to provide stable estimates of annual rates needed to calculate trend.

Injuries Injuries- HP 2020 target for injury related ED visits per 100,000 is 7533.4. Allegany is at 14,361. The target for injury related hospital discharges is 555.8 and Allegany is at 1866. DHMH Injuries 2005-2008

2010 WMHS Emergency Department Top 10 Diagnoses 2010 WMHS Emergency Department Chest Pain Abdominal Pain Urinary Tract Infections Acute Bronchitis Sprain of Ankle Noninfectious Gastroenteritis Head Injury Otitis Media (Ear Infection) Sprain of Neck Headache

Most Prevalent Diagnoses for WMHS Admissions Natural Birth Coronary Atherosclerosis Pneumonia Rehabilitation Process Obstructive Chronic Bronchitis Recurring Depressive Disorder Osteoarthritis Cesarean Birth Chest Pain Atrial Fibrillation Acute Chronic Systolic Heart Failure Septicemia July 2010-April 2011 WMHS Admission data for FY10 and FY11 YTD-4/15 has been collected by primary diagnosis upon admission and grouped by ICD9 Categories. In FY10, Diseases of the Circulatory System (390-459) accounted for the largest percentage of admissions (19.01%) and this continues in FY11 with 18.71% of admissions being in this category. Disease of the Respiratory System is the second largest percent of admissions with 10.52% in FY10 and 10.91 in FY11YTD. The third highest admission category was supplementary classification of factors influencing health status (V01-V89) with 9.3 in both years. The fourth highest in Fy10 was Diseases of the Digestive System (8.4%) and in FY11 YTD it is Mental Disorders (8.01%).

Access to Care Payor Mix Providers Barriers

Payor Mix Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA % Uninsured under age 65 22 21 25 16 % receiving Medical Assistance 23.9 16.5 17.1 17.5 16.8 % Medicare Beneficiaries 19.1 20.7 18.8 21.5 21.2 % Other-Commercial Insurance, Private Pay, etc. 35 41.8 39.1 45 46 Uninsured: The desire is to have no one uninsured and the US benchmark is 13% of individuals under age 65. All six counties have 15% uninsured or over. Hampshire is the highest at 25%. The percentage of uninsured children is less in each county except Bedford, where the percent of uninsured under age 65 is about the same as the percent of uninsured children. Types of Coverage: The percentage receiving Medical Assistance ranges from 16.5% in Mineral, Allegany 22.3%, to 23.9 in Garrett. 2011 County Health Ranking & Community Health Status Indicators

Payor Mix WMHS Payor Mix16,37 For CY10 inpatient and outpatients combined the payor mix was as follows:Medicare (38.51%), MPC (10.22) and Carefirst (8.82). For CY10 Emergency Department visits the payor mix was as follows:Medicare (25.87), MPC (17.99, Private Pay (9.47) and Carefirst (6.69) When sorted by insurance groups, the ED payors are as follows: Medicare (26.02), HMO Medical Asst (22.41), Commercial (13.94), Blue Cross (13.84) and Private Pay (9.47).

Payor Mix Based on data collected by the PharmaCare Network in CY 2010 and a total of 237,095 prescriptions, coverage types broke down as follows: 8.43% retail/no insurance or discounted plan, 5.54% Medicaid, and 86.01% were third party insurance. ACHD Mental Health Clinic Report 2010 PharmaCare Network 2010

Providers Needed Top Needs: Primary Care Psychiatry Other needs: Medical Oncology Gastroenterology Vascular Surgery Urology Supply: A summary report done by WMHS. The average net need is based on the current supply and calculated demand based on population needs, causes of death, age of physicians and more. The WMHS must recruit within Stark guidelines. The top needs seem to be primary care, OB/GYN, and psychiatry.(Summarize highlights) Gaps- Based on the emergency call schedule, GI was the only area identified as not having good coverage. Outmigration of Patients by Service Line39- The service line with the lowest percentage of patients from the primary service area is orthopedics at 56.5%. Psych/Drug Abuse has the largest percentage of patients from the secondary service area at 15.2%. Dental: According to the 2008 BRFSS 12.4% of Allegany county residents have had all their permanent teeth extracted ranking us #1 in MD. Have never seen a dentist or 15.8% of residents without dental visit in past 5 years. HPSA- Allegany Primary-Low Income and correctional institutions Dental-Low Income and correctional institutions, MA pending Mental-correctional institutions and MA Other counties have varying types of HPSA designations, only areas with none-Hampshire-primary care and Mineral-dental. Though many limits to type. Dentists to provide care for adults with no insurance or Medical Assistance. WMHS Foundation 2011

Continuum of Care & Utilization Issues related to access and changes that could be made to impact entry point to care. Preventable stays: The US benchmark for hospitalization rate for ambulatory care sensitive conditions per 1000 Medicare enrollees is 52. All six counties were above this mark with Allegany (108) and Mineral (111) the highest. The others ranged from 76-91. chart Flu & Pneumonia vaccines: The target is to get 80%of those 65 and over vaccinated for the flu within the past 12 months. None of the counties were above 70. Ambulatory care sensitive conditions-age standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital (per 100,000 population under age 75 years) -measure of access to appropriate primary health care -includes angina, asthma, COPD, diabetes, epileptic convulsions, heart failure and pulmonary edema, hypertension Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA Preventable Stays-hospitalization rate for ambulatory care sensitive conditions per 1000 Medicare enrollees 86 111 91 79 76 % 65 and over getting flu vaccine within year 61.4 68 65.5 NA 63.9 County Health Ranking 2011

Barriers Transportation 11% of Allegany households are without vehicles Allegany County Transit does not run on weekends or major holidays. Health Literacy US Department of Education claims only 12% of English speaking adults in the US have proficient health literacy skills Health literacy disproportionately impacts lower socioeconomic groups Other? Transportation29-Allegany County Transit offers fixed route and demand response services. Half fares are available for those with Medicare, disabled or senior citizen cards. Demand Response is an ADA service. There is no service on Saturdays, Sundays and major holidays. ADA Service limited to individuals with disabilities who are unable to ride accessible, fixed route bus service because of disability. Seniors age 65 and older are provided with curb to curb transportation within service area. To be eligible for ADA service one must live less than ¾ miles from a bus route. ADA service seems to be offered Mon-Friday 7am-4pm and the fixed routes appear to run from 7am-5pm. Homes without vehicle: Allegany has 11% households without vehicles compared to 9% US. Health Literacy40 According to the National Action Plan to Improve Health Literacy, nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in health care facilities and in the community. Research from the US Department of Education claims only 12% of English speaking adults in the US have proficient health literacy skills, and is disproportionately impacts lower socioeconomic groups. American Community Survey 2010

Overall Needs to Consider Economy Education Level Elderly Population Lifestyle Choices Emotional & Mental Health Lack of Insurance Transportation Provider Shortages Chronic Diseases & Risk Factors Healthy Pregnancy & Birth Criteria to identify the most significant health issues Magnitude % or # Severity- degree to which is worse than target or US norm High Need for vulnerable population  

Current Strategies Slide under development. Will include what is currently being done to address the needs. Community Health & Wellness Programs-tobacco cessation, screening Community Partnerships to Address Obesity, Uninsured Needs Heart Center- Cardiac Rehab Diabetes Self Mgmt Program Pulmonary Rehab Other….

Top Community Health Priorities to Address Tobacco Cessation (especially during pregnancy) Emotional & Mental Health (suicide rate and self diagnosed depression) Prenatal Care – Healthy Start Access to Care & Providers Health Literacy Screening & Prevention-Diabetes, Hypertension, Cancer Substance Abuse (alcohol & drugs) Obesity Immunization (flu) Heart disease & Stroke Cancer (narrow types?) Chronic Respiratory Disease Dental Criteria to evaluate which issues to prioritize Community capacity to act on issue ($, politics, culture) Feasibility of having measurable impact on issue Community resources already focused on issue? Issue is root cause of other problems (WMHS capacity & resources)

WMHS Community Health & Wellness Allegany County Health Department Thank you! For more information: Nancy Forlifer WMHS Community Health & Wellness 240-964-8422 Dr. Sue Raver Allegany County Health Department 301-759-5000