1. COMMUNITY HEALTH ASSESSMENT Tracy Hill, Anna Marshall, Patricia Neis Miriam Slaugh, Allison Veeder March 4, 2010

2. Douglas County, Kansas

3. Statistical Data: Lawrence/ Douglas County Kansas Douglas County Kansas is comprised of 4 towns: Lawrence, Baldwin, Eudora, Lecompton. Douglas County is one of the fastest growing counties in the state of Kansas. *5 th largest; 4 th healthiest Lawrence population: 81,604 in 2007

4. Statistical Data Top 6 Employers in Douglas County: The University of Kansas (9,872)The University of Kansas (9,872) Lawrence Public Schools (1,831)Lawrence Public Schools (1,831) Vangent (1,500)Vangent (1,500) City of Lawrence (1,431)City of Lawrence (1,431) Lawrence Memorial Hospital (1,251)Lawrence Memorial Hospital (1,251) Hallmark Cards (814)Hallmark Cards (814)

5. Primary/Tertiary care Existing healthcare services Physicians/APRN care available: family practice, internal medicine, pediatrics, obstetrics/gynecological, urology, allergy & asthma, dermatology, rheumatology, ophthalmology, neurology, general surgery, plastic surgery, otolaryngology (EENT), psychiatry, oncology, gastroenterology, endocrinology, nephrology, infectious disease, cardiology, and occupational medicine family practice, internal medicine, pediatrics, obstetrics/gynecological, urology, allergy & asthma, dermatology, rheumatology, ophthalmology, neurology, general surgery, plastic surgery, otolaryngology (EENT), psychiatry, oncology, gastroenterology, endocrinology, nephrology, infectious disease, cardiology, and occupational medicine Dental care: Douglas county dental clinic, 64 Dentists Dental care: Douglas county dental clinic, 64 Dentists Eye care: 31 Optometrist/Opthamologists Eye care: 31 Optometrist/Opthamologists

6. Primary/Tertiary care Douglas County Health Department 3 Safety net clinics: Healthcare Access Healthcare Access Heartland/Leo Center Heartland/Leo Center Douglas County Dental Clinic Douglas County Dental Clinic Lawrence Memorial Hospital Community owned; not for profit. Community owned; not for profit. Bert Nash Mental Health outpatient day clinics, counseling (limited medication management) outpatient day clinics, counseling (limited medication management) Home Healthcare Services: 8 agencies

7. Primary/Tertiary care Hospice: 3 agencies 3 agencies Lawrence Douglas County Fire and Medical: 6 stations with Paramedic, EMT’s, and Fire specialist. (they provide public education on fire safety, bike safety/helmets, basic first aid). 6 stations with Paramedic, EMT’s, and Fire specialist. (they provide public education on fire safety, bike safety/helmets, basic first aid). Tertiary care: Lawrence is located within 30-45 minutes from Topeka and Kansas City which provides further Tertiary care for services not available at Lawrence Memorial Hospital (Cardiac, Midwifery, Neurology, Trauma, High-Risk OB/Peds) Lawrence is located within 30-45 minutes from Topeka and Kansas City which provides further Tertiary care for services not available at Lawrence Memorial Hospital (Cardiac, Midwifery, Neurology, Trauma, High-Risk OB/Peds)

8. Sociodemographics

9. What are the sociodemographics of the population being served? DG County High School graduation86% 4-yr College Degree43% Unemployment 4% Children in Poverty13% Single-Parent Households 7% Homicide Rate (per 100,000) 3 Adult Smoking18% Adult Obesity25% Teen Birth Rate14 Uninsured Adults19% Primary Care Provider Rate110 Access to Healthy Foods86% Kansas 78%26% 4% 4%15% 8% 8% 519%28%4312% 115 11535% U.S. 84.5%27.4%10.6%22%26%16,69220.6%26.1%41.9/1,00018.5%51%

10. Douglas County Demographic Estimates EstimatePercentU.S. Total population113,569 Male56,66649.9%49.3% Female56,90350.1%50.7% Median age (years) 28.636.7 Under 5 years6,2905.5%6.9% 18 years and over91,86180.9%75.5% 65 years and over10,0538.9%12.6% Source: U.S. Census Bureau, 2006-2008 American Community Survey at http://factfinder.census.gov

11. Douglas County Population Characteristics: Race/Ethnicity White 87.5% Black 4.1% American Indian 2.1% Asian/Pacific Islander 3.8% Hispanic origin 3.6% Source: U.S. Census Bureau, 2006-2008 American Community Survey at http://factfinder.census.gov

12. Douglas County Vulnerable Population Douglas County: > 22,000 individuals Vulnerable Populations Include People Who: Have no high school diploma (among adults age 25 and older) 4,409 Are unemployed2,517 Are severely work disabled1,071 Have major depression6,723 Are recent drug users (within past month) 7,285 Source: http://communityhealth.hhs.gov/

13. Douglas County Adult Preventative Services Use Source: http://communityhealth.hhs.gov/

14. What are Douglas County’s primary health issues? Adult Smoking (smoking ban) Adult Obesity Breast Cancer - women PovertyUninsured Binge Drinking (college town) STD’s (chlamydia) Ozone

15. Macrosystem Factors Insurance coverage:  11,344 individuals in Douglas County are uninsured (~10% of the population)  102,144 individuals in Douglas County are insured (~ 90% of the population)

16. Macrosystem Factors Insurance coverage: Types of payors for Insured Individuals AND Percentages of payors for population:Types of payors for Insured Individuals AND Percentages of payors for population: Private/Non-government InsurancePrivate/Non-government Insurance Employment-based 72.8% Direct purchase 11.7% Government-sponsored Insurance Medicare8.4%Government-sponsored Insurance Medicare8.4% Medicaid/SCHIP7.5% Military health care2.2% Indian/other gov’t health services2.5%

17. Macrosystem Factors Political Forces:  Douglas County is in Congressional District 2  In 2008 general election, Congressional District 2 (and Douglas County) voted Democrat in House, Senate, and Presidential races. 34,398 votes - Obama/Biden 17,929 votes - McCain/Palin

18. Macrosystem Factors: Social Forces either Contribute to OR Detract from The health of individuals and communities

19. Macrosystem Factors Social Forces Socioeconomic factors FoodEducation Environmental Conditions  Income  Education  Occupation  Transportation  Sanitation  Housing  Access to Services  Resources linked to health discrimination, social support, environmental hazards -Source: MLC

20. Macrosystem Factors Vulnerable Populations IncomeEducationOccupationTransportationSanitationHousing

21. Macrosystem Factors Access to Care Primary care physicians per 100,000 population – 74.8Primary care physicians per 100,000 population – 74.8 Dentists per 100,000 population – 42.8Dentists per 100,000 population – 42.8 Services in Douglas County Dg Co Dental Clinic, Visiting Nurses, Rehab and Hospice care Senior Services, Inc. Dg Co Health Dept United Way AIDS Project LINK Health Care Access DCCCA, Inc. GaDuGi Safe Center Headquarters Counseling Center Community Living Opportunities

22. Safety-Net Clinics and LMH Safety-Net Clinics and LMH In 2009, 7.6% of patients served by Lawrence Memorial Hospital had no insurance. In 2008, the 4 safety net clinics served Total: 5,077 Total: 5,077 3,554 uninsured (70%) 1,338 Medicaid/Healthwave (26.4%) 3,766 (74.2% earned less than federal poverty level) 1,257 (24.8% earned between 101-200% of poverty level)

23. Gap analysis What health problems are not being sufficiently addressed? What services are lacking 1.Primary health care 2.Mental health services 3.Dental

24. Solution/Strategies Provide your solutions and suggested strategies to accomplish these goals

25. References Britt, K. (2010, January 21). Douglas county dental clinic changes income guidelines. Lawrence Journal World, retrieved on February 27, 2010 from http://www2.ljworld.com/news/2010/jan/21/douglas-county-dental-clinic-changes-income-guidel/. http://www2.ljworld.com/news/2010/jan/21/douglas-county-dental-clinic-changes-income- Britt, K. (2010, February 13). A day at Lawrence’s health care access clinic reveals need for affordable medical care. Lawrence Journal World, retrieved on February 27, 2010 from http://www2.ljworld.com/news/2010/feb/13/day-lawrences-health-care-access-reveals-need- affo/. http://www2.ljworld.com/news/2010/feb/13/day-lawrences-health-care-access-reveals- Community care. (2009, Septmber 28). Lawrence Journal World, retrieved on February 27, 2010 from http://www.2.ljworld.com/news/2009/sep/28/community-care/?print. DeNavas-Walt, C., Proctor, B.D., & Smith, J.C. (2009). Income, poverty, and insurance coverage in the U.S.: 2008. Retrieved from US Census Bureau: http://www.census.gov/hhes/www/hlthins/hlthin08/hlthtables08.html Duncan, R.P., Porter, C.K., & Garvan, C.W. (2001). The Kansas health insurance study. Finding and filling the gaps: Developing a strategic plan to cover all Kansans. Retrieved from: http://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdf Haskell Indian Health Center: Service area profile (2005). Retrieved from Division of Facilities Planning & Construction, Indian Health Service: http://www.dfpc.ihs.gov. Kansas Department of Health and Environment. (2010). Kansas Department of Health and Environment: Annual Report 2009 (Annual Report). Retrieved from Kansas Department of Health and Environment: http://www.kdheks.gov/

26. References Kansas Insurance Department. (2001). Finding and Filling the Gaps: Developing a Strategic Plan to Cover all Kansans: The Kansas Health Insurance Study. Retrieved from Kansas Insurance Commissioner website: http://www.ksinsurance.org/about/archive/hrsa/KHIS_2001.pdf Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (Eds.). (2007). Policy & Politics in Nursing and Health Care (5th ed.). St. Louis, MO: Saunders Elsevier. Robert Wood Johnson Foundation. (2010). Snapshot 2010: Douglas County Health Rankings. Retrieved from http://www.countyhealthrankings.org/kansas/douglas U.S. Census Bureau. (2006-2008). http://factfinder.census.gov U.S. Department of Health & Human Services website. (2007). http://www.cms.hhs.gov/MedicareEnrpts/ U.S. Department of Health & Human Services. (2008). http://communityhealth.hhs.gov U.S. Department of Health & Human Services: Indian Health Services website. (n.d.). http://www.dfpc.ihs.gov/

28. Conclusion