Conducting a Community Needs Assessment Handouts

2010 CHAMPS/NWRPCA ANNUAL
PRIMARY CARE CONFERENCE
Conducting a Community
Needs Assessment
Monday, October 25th 1:30-3:00P
Dana Abbey, MLS
Consumer Health Coordinator
National Network of Libraries of Medicine
University of Colorado Health Sciences Center
NATIONAL SNAPSHOT
Served 18.8 million patients
• 92% below 200% poverty
• 71% below 100% poverty
• 38% uninsured
• 1,018,000 homeless individuals
• 865,000 migrant/seasonal farm workers
• 165,000 residents of public housing
Provided 74 million patient visits
• 1,131 grantees - half of which are located in rural
areas
• 7,900+ service sites
• Employed more than 123,000 staff
9,100 physicians
5,800 nurse practitioners, physicians
assistants, and certified nurse midwives
WHY CONDUCT A COMMUNITY
ASSESSMENT
Community health centers are:
• required to assess the health needs of the population to be
served and the resources
• required to work closely with other safety net providers in
defining and revising an appropriate role for the health
center
Improve health center performance and operations
Identify trends over time
Establish or expand targeted programs
Identify effective services and interventions
Baseline to track overall program accomplishments
$
FRAMEWORK
New Access Points Funding
• up to $250 million
• 350 NAP grant awards in FY 2011
• Existing grantees or new organizations that do not
currently receive section 330 grant funds
• HRSA-11-017 application http://goo.gl/8QRM
This session will address data sources that may
be helpful when completing this, or similar
applications
Example sites
• Dove Creek, CO
• Butte, MT
• Provo, UT
DOVE CREEK, COLORADO
BUTTE, MONTANA
Dolores County Population 1,894
Silver Bow County Population: 32, 682
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PROVO, UTAH
FOCUSING ON THE TAIL, NOT THE
DOG
Provo-Orem metropolitan area 555,551
Photo: Jeremiah Owyang
EXTRAPOLATING DATA
It may be difficult to find data specific to the
proposed service area or target population.
Key demographic information about the service
area or target population may permit an
extrapolation of data from a more aggregate
level, such as the State or county.
Use the experience of one population (the
“standard” population) to project the data for the
target population.
CORE BARRIERS: POPULATION TO
ONE FTE PRIMARY PHYSICIAN
Community Fact Sheets –
http://datawarehouse.hrsa.gov/HGDWReports/Commu
nity_Fact_Sheet.aspx
• County-level profile
Health Resources County Comparison Tool:
http://arf.hrsa.gov/arfwebtool/Counties_search.asp
• Peer counties, multiple county comparison
Health Center Data: http://www.hrsa.gov/datastatistics/health-center-data/index.html
• National and state data covering 2006-2009
Shortage Areas: HPSA by State & County:
http://hpsafind.hrsa.gov/
• State and county data, updated 10/2010
EXAMPLE: POPULATION TO ONE
FTE PRIMARY PHYSICIAN
EXAMPLE: POPULATION TO ONE
FTE PRIMARY PHYSICIAN
Determine Service Area
Zip Code Analysis
Geographical Barriers
Weather
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EXAMPLE: POPULATION TO ONE
FTE PRIMARY PHYSICIAN
CORE BARRIERS: % OF POPULATION
AT OR BELOW 200% OF POVERTY
Community Fact Sheets –
http://datawarehouse.hrsa.gov/HGDWReports/Com
munity_Fact_Sheet.aspx
• County-level profile
State & County QuickFacts:
http://quickfacts.census.gov/qfd/index.html
• For cities and towns with more than 25,000
CORE BARRIERS: PERCENT OF
POPULATION UNINSURED
By state
• Current Population Survey (State and age):
http://www.census.gov/hhes/www/cpstables/032010/health/h05
_000.htm
• Kaiser Foundation State Health Facts:
http://www.statehealthfacts.org/profile.jsp (Health coverage
and the uninsured)
By county
• Community Health Status Indicators (CHSI)
http://www.communityhealth.hhs.gov/HomePage.aspx
• Community Fact Sheets –
http://datawarehouse.hrsa.gov/HGDWReports/Community_Fa
ct_Sheet.aspx
CORE BARRIERS: DISTANCE OR
TRAVEL TIME
Community Fact Sheets –
http://datawarehouse.hrsa.gov/HGDWReports/Community_Fact_Shee
t.aspx
• County-level data on Medicare patients, PCP
What Congestion Means to Your Town, 2007 Urban Area Totals
http://mobility.tamu.edu/ums/congestion_data/tables/national/table_2.
pdf
Agricultural Workers Distance to Work and Transportation Table
5.15
http://www.doleta.gov/agworker/report9/chapter5.cfm#basis_for_pay
Transportation and Worst Case Needs (pg. 18)
http://www.huduser.org/Publications/pdf/worstcase_HsgNeeds07.pdf
What other data might be
used in this narrative
CORE HEALTH INDICATORS:
DIABETES
Resources
• Short term complication Hospital Admission Rate
http://www.cdc.gov/diabetes/statistics/complications_national.htm
• Long term Complications Hospital Admission Rate
http://www.cdc.gov/diabetes/statistics/complications_national.htm
• Uncontrolled Diabetes Hospital Admission Rate
Healthy People 2010
http://www.healthypeople.gov/data/2010prog/focus01/ (program review)
• Rate of Lower-extremity Amputation Among Patients with
Diabetes
http://www.cdc.gov/diabetes/statistics/lealevel/fig9.htm (United States
2005)
MT http://www.dphhs.mt.gov/PHSD/MTHDDS/index.shtml
• Age adjusted Diabetes Prevalence
http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetesPrevalenceEstim
ates.aspx (county level estimates 2004-2007)
http://www.cdc.gov/diabetes/statistics/prev/national/figageadult.htm
(national 1980-2008)
CORE HEALTH INDICATORS:
DIABETES
Additional Resources
Chronic Disease Indicator
http://apps.nccd.cdc.gov/cdi/Default.aspx
• Adult prevalence (national, state, select counties)
• Mortality rate
• Age-adjusted prevalence
http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetesPrevalence
Estimates.aspx (national, state, county)
Diabetes Indicators and Data Sources Internet Tool (DIDIT)
http://apps.nccd.cdc.gov/DDTSTRS/DIDIT.aspx
• Must submit form for access to program
Kaiser Family Foundation State Health Facts:
http://www.statehealthfacts.org/profile.jsp (health status)
National Health Statistics Reports, Number 5, July 30, 2008
(Table 2) http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf
• Diabetes mellitus (national - number of discharges from shortstay
hospitals by first-listed diagnosis and age: United States,
2006 )
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EXAMPLE: RATE OF LOWER-
EXTREMITY AMPUTATION
EXAMPLE: RATE OF LOWER-
EXTREMITY AMPUTATION
CORE HEALTH INDICATORS:
CARDIOVASCULAR DISEASE
Hypertension Hospital Admission Rate
• http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf (discharge survey
2006)
• State Hospital “Report Cards”
Example: Colorado http://goo.gl/1opY
Congestive Heart Failure Hospital Admission Rate
• http://www.americanheart.org/downloadable/heart/1265665152970DS-
3241%20HeartStrokeUpdate_2010.pdf
• http://www.cdc.gov/nchs/data/nhds/nhds071stlisteddiagnoses.pdf
• http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf (discharge survey
2006)
Angina without Procedure Hospital Admission Rate
• http://www.americanheart.org/downloadable/heart/1265665152970DS-
3241%20HeartStrokeUpdate_2010.pdf
Mortality from Diseases of the Heart
• http://www.americanheart.org/downloadable/heart/1265665152970DS-
3241%20HeartStrokeUpdate_2010.pdf
Proportion of Adults Reporting Diagnosis of High Blood
Pressure
CORE HEALTH INDICATORS:
CANCER
Cancer Screening – % of women 18 and older with No
Pap test in the last 3 years
• http://www.meps.ahrq.gov/mepsweb/data_files/publications
/st173/stat173.pdf (national data)
• http://statecancerprofiles.cancer.gov/risk/index.php (state
data for those who had a Pap in the last 3 years)
Cancer Screening - % of women 40 and older with No
Mammogram in the past 3 years
• http://statecancerprofiles.cancer.gov/risk/index.php (state
data of those who had mammogram in the past 2 years)
Cancer Screening - % of adults 50 and older with No
Fecal Occult Blood Test Within the past 2 years
• http://statecancerprofiles.cancer.gov/risk/index.php (home
blood stool test used in the past 2 years)
CORE HEALTH INDICATORS:
PRENATAL/PERINATAL HEALTH
Low Birth Weight Rate (5 year average)
• http://www.statehealthfacts.org/children.jsp
Infant Mortality Rate (5 year average)
• http://www.statehealthfacts.org/children.jsp
• http://datawarehouse.hrsa.gov/HGDWReports/Community_Fact_Shee
t.aspx (County-level birth and infant deaths)
Births to Teenage Mothers (ages 15-19; % of all births)
• http://www.statehealthfacts.org/children.jsp
• http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_24.pdf (Stat
Late entry into prenatal care
• http://www.statehealthfacts.org/children.jsp
• http://apps.nccd.cdc.gov/cPONDER/ (from dropdown box, select
“prenatal care initiation”)
Cigarette use during pregnancy
• http://apps.nccd.cdc.gov/cPONDER/ (from dropdown box, select
“tobacco use”)
CORE HEALTH INDICATORS: CHILD
HEALTH
Pediatric Asthma Hospital Admission Rate
• Summary Health Statistics for U.S. Children: National Health Interview
Survey, 2008 http://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf
(Ever told have asthma, still have asthma (national/region)
Percent of Children not tested for elevated blood lead blood levels by 30
months
• http://www.cdc.gov/nceh/lead/data/state.htm (most states, 2006-2008)
• http://www.cdc.gov/nceh/lead/data/national.htm (national data for most
states 1997-2007)
Percent of children not receiving recommended immunizations
• Kaiser Family State Health Facts:
http://www.statehealthfacts.org/index.jsp (Immunizations children age
19-35 months)
• http://www.cdc.gov/nchs/data/hus/hus09.pdf#082 (National data on
vaccination coverage 19-35 months)
National Health Statistics Reports, Number 5, July 30,2008 (Table 2)
http://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf
• Under 15 years , 15-44 years (national)
Community Fact Sheets –
http://datawarehouse.hrsa.gov/HGDWReports/Community_Fact_Sheet.aspx
-
• County-level birth and infant deaths
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EXAMPLE: % OF CHILDREN TESTED
LEAD
EXAMPLE: % OF CHILDREN TESTED
LEAD
CDC does not have state data for Colorado,
Montana, or Utah
EXAMPLE: % OF CHILDREN TESTED
LEAD
EXAMPLE: % OF CHILDREN TESTED
LEAD
CORE HEALTH INDICATORS:
BEHAVIORAL AND ORAL HEALTH
Depression Prevalence
• http://oas.samhsa.gov/2k7/states/depression.htm (state estimates
2004-2005)
• http://oas.samhsa.gov/statesList.cfm (links to state level data)
• http://oas.samhsa.gov/2k6/suicide/suicide.htm (prevalence of MDE)
Suicide Rate
• http://webappa.cdc.gov/cgi-bin/broker.exe (national, by age group)
• http://www.afsp.org/index.cfmfuseaction=home.viewPage&page_id=0
5114FBE-E445-7831-F0C1494E2FADB8EA (state level data)
Youth Suicide Attempts Requiring Medical Attention
• http://oas.samhsa.gov/2k6/suicide/suicide.htm (drug-related suicide
attempts)
Percent of Adults with Mental Disorders Not Receiving
Treatment
• http://oas.samhsa.gov/NSDUH/2k6nsduh/tabs/Sect6peTabs1to41.htm#
Tab6.17A (unmet need for treatment 2005-2006)
CORE HEALTH INDICATORS:
BEHAVIORAL AND ORAL HEALTH
Any Illicit Drug Use in the Past Month
• http://oas.samhsa.gov/statesList.cfm (links to state level data)
Heavy Alcohol Use (12 and over)
• http://apps.nccd.cdc.gov/brfss/page.aspyr=2008&state=All&cat=AC#AC
Homeless with Severe Mental Illness (% of all Homeless)
• http://www.nationalhomeless.org/publications/facts/Mental_Illness.pdf
(national data)
• http://www.nami.org/Content/NavigationMenu/State_Advocacy/About_the_
Issue/Homelessness.pdf (national data)
• http://www.huduser.org/publications/pdf/5thHomelessAssessmentReport.p
df (national homelessness data)
• http://www.nationalhomeless.org/factsheets/rural.html (rural
homelessness)
• http://www.usmayors.org/pressreleases/documents/hungerhomelessnessrep
ort_121208.pdf (select cities)
Oral Health (% without dental visit in the last year)
• BRFSS
http://apps.nccd.cdc.gov/brfss/page.aspyr=2008&state=All&cat=OH#OH
(visited dentist in the past year)
• CDC Oral Health Resources by State
http://apps.nccd.cdc.gov/synopses/StateDataV.aspStateID=AL&Year=2009
• Kaiser State Health Facts – Health Status – Oral Health
http://statehealthfacts.org
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EXAMPLE: % WITHOUT DENTAL
VISIT IN LAST YEAR
EXAMPLE: % WITHOUT DENTAL
VISIT IN LAST YEAR
EXAMPLE: % WITHOUT DENTAL
VISIT IN LAST YEAR
OTHER HEALTH INDICATORS
Age-adjusted death rate
• CDC Wonder http://wonder.cdc.gov/mcd-icd10.html (age-adjusted, national, state,
metro/micopolitan, through 2006)
HIV infection prevalence
• National Center for HIV/AIDS, Viral Hep., STD, and TB Prevention
http://www.cdc.gov/nchhstp/stateprofiles/usmap.htm ( state profiles )
• CDC: HIV in the United States Fact Sheet
http://www.cdc.gov/hiv/resources/factsheets/us.htm (national)
• HIV Surveillance Report 2008
http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/pdf/2008Surveillance
Report.pdf (national, state, links for state/local surveillance reports)
Percent Elderly (65+)
• U.S. Census Bureau State and County Quick Facts
http://quickfacts.census.gov/qfd/index.html
• U.S. Census Population Estimates http://www.census.gov/popest/counties/CO-
EST2009-01.html (county-level all ages)
Adult Asthma Hospital Admission Rate
• CDC Fast Facts: Asthma http://www.cdc.gov/nchs/fastats/asthma.htm
Bacterial Pneumonia Hospital Admission Rate
• State Hospital Association’s “Report Card”
Example CO - http://www.cohospitalquality.org/index.php
Three Year Average Pneumonia Death Rate
State Hospital Association Data
See above
EXAMPLE: THREE YEAR AVERAGE
PNEUMONIA DEATH RATE
OTHER HEALTH INDICATORS
Adult Current Asthma Prevalence
• CDC 2008 Adult Asthma Data http://www.cdc.gov/asthma/brfss/08/brfssdata.htm
Adult Ever Told Had Asthma
• SMART: BRFSS City and County Data http://apps.nccd.cdc.gov/brfsssmart/ListMMSAQuest.aspyr2=2009&MMSA=All&cat=AS&qkey=4417&grp=0
(selected local prevalence data through 2009)
Unintentional death
• National Center for Injury Prevention and Control
http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html (national, region and state
data through 2007)
Linguistically isolated (% over age 5 speaking language other than English)
• U.S. Census Bureau State and County Quick Facts http://quickfacts.census.gov/qfd/
(state data)
• U.S. Census Bureau American Fact Finder http://factfinder.census.gov (city, town,
county-level data for 2000, some for 2006-2008)
Waiting time for public housing
• A Picture of Subsidized Households 2008
http://www.huduser.org/portal/picture2008/form_1s4.odb (naitonal, state, city level)
• Contact state HUD office http://portal.hud.gov/portal/page/portal/HUD/states
• 2009 annual Homelessness Assessment Report to Congress
http://www.huduser.org/publications/pdf/5thHomelessAssessmentReport.pdf
• Worst Case Housing Needs 2007: A Report to Congress
http://www.huduser.org/Publications/pdf/worstcase_HsgNeeds07.pdf
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GENERAL RESOURCES
American Fact Finder (