Transcript Select Reproductive Health Indicators

St. Louis County Missouri
Community Health Needs Assessment Findings
Public Health Summit
December 12, 2011
Ron Deprez, Ph.D., MPH
Executive Director
The Center for Community and Public Health
University of New England
Agenda
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CHNA Objectives
Overview of Health Planning Process
Study Methods
Selected Findings
Priority Health Services
Next Steps
St Louis County 2011 CHNA
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Objectives of the Study
• Develop comprehensive profile of health status, quality of
care and care management indicators for residents of St.
Louis County overall and by sub-county.
• Identify priority health issues from the profile
• Assessing existing services in the county on the issues
identified
• Provide recommendations on services and programs to
address the priority issues identified in the study
St Louis County 2011 CHNA
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What we want to find out?
St Louis County 2011 CHNA
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CHNA Methods
Health Status
Risk Factors
Disease Prevalence/incidence
Utilization
Morbidity/Mortality
Services Preference
Birth Records
Provider Survey
Quantitative Assessment-Key Health
Indicators
Access and Quality Indicators
Prevalence of Mental Health/Substance
Abuse Conditions
Inpatient/ER/Outpatient Use Indicators
Related Chronic Conditions
Mortality Indicators
Risks Factors for Mental Health/
Substance Abuse
Identify Priority
Health Service Issues/Gaps
St Louis County 2011 CHNA
Region Level Data
Hospital Utilization Data
Mortality Data
ER/Outpatient data
Program Specific Data
Benchmarking
National Benchmarks
Clinical Standards
Best Practice Guidelines
5
Methods
Discussions with Key
Stakeholders
Key Clinical Providers
Other Service Providers
Service Needs:
Prevention
Detection
Treatment
Follow-up
Qualitative Analysis
of Services and
Delivery System
Needs
Summary Planning
Report
Major Findings
Service Delivery Issues/Options
Model
Community
Programs and Delivery
System Options
Transformation
Barriers
and
Opportunities
Dissemination of Results
Publications
Meetings
St Louis County 2011 CHNA
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Methods
Assessment and Analysis
I.
Data Acquisition
– Community Household Survey
– Public Data (e.g., birth and mortality records)
– Other Data (e.g., from existing studies and reports or databases)
II.
Analysis of Health Status, Outcome & Medical Service Indicators for the
Community to Identify Priority Health Issues
-
III.
Key Population & Demographic Indicators
Epidemiological Indicators (risk, prevalence, etc.)
Care Management and Utilization Indicators
Outcome Indicators
Assessment of Specific Local Healthcare Service
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Health Leaders and Stakeholder Interviews
Recommendations and Strategies
IV. Health Planning Report and Recommendations
St Louis County 2011 CHNA
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Methods
How does the assessment process identify service needs?
• Analyze health service issues/disparities indicators
(prevention, access, detection, treatment, care
management,)
• Determine priority issues—where follow-up is needed
• Conduct interviews and/or focus groups to identify service
access, capacity, organizational and related issues
• Develop specific planning and health services
recommendations
St Louis County 2011 CHNA
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Methods
Analysis of Indicators for Health Services Planning
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Burden of disease
Pattern analysis (risk factor, disease prevalence, health
condition care management, outcomes)
Comparisons to External Standards/Benchmarks
(State, US, Healthy People 2010)
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
Age, gender, and race specific
Clinical vs. Statistical Significance
County and sub-county level
St Louis County 2011 CHNA
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Data
Primary Data for St. Louis County CHNA
• 2011 Community Status, Utilization & Preference Survey
• Key Provider and Stakeholder Interviews
Secondary Data for the St. Louis County CHNA
• Population and Demographics (Census & ACS)(2009 Est, 2005-2009)
• Birth & Mortality Records (2007-2009)
• Hospital Inpatient and Emergency Department (ED) Data - (2008-2009)
• Cancer Registry (2006-2008)
• Infectious disease data (2007-2009)
• Unintentional Injury data (2007-2009)
• Missouri Youth Risk Behavior Surveillance System (YRBSS) (2010)
• Missouri BRFSS (2008-2009)
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CHNA Data Methods
Household Health Survey (N=2,149)
• Household health survey: January – March 2011
• Random digit dial selection of households in each of the four subcounties in St. Lois County
• Both land lines and cell phone only households
• Survey Domains include:
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Health Services Access and Utilization
Functional Health/Chronic Conditions
Chronic Disease Management
Youth Health
Physical Activity/Lifestyle
Biometrics
Primary Care
Dental Care
Mental Health
St Louis County 2011 CHNA
 Drug use/Substance Abuse
 Behavioral Risk Factors
 Health Insurance
 Health Care Barriers
 Community Health Needs
 Emergency Preparedness
 Sexual Behavior
 Wellness Activities and Programs
 Demographics
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Methods
Special Considerations
• Analyzing indicators for a county the size of St.
Louis County doesn't tell the whole story
• Population of St. Louis County: (992,412)
• Each sub-county has specific needs
• Additional geographic break down can be helpful
Methods
Sub-Counties
• Four sub-county regions: Mid, North, South, and West—
defined based on municipalities within the regions and their
associated zip codes. Unincorporated areas of the county
were assigned to a region based on proximity.
• Data obtained from secondary sources by zip code. [If data
could not be pulled by zip code, census tracts within each
region were used.]
St Louis County 2011 CHNA
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Methods
Sub-Counties
St Louis County 2011 CHNA
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St. Louis County
Demographics
Indicator
2007-2009 Population Estimate
2005-2009 Median Household Income
Resident under the age of 18
Population age 65+
Race
Education: population (age 25+) without H.S.
Diploma
St Louis County 2011 CHNA
St. Louis
County
992,412
$57,502
23%
15%
White:76%
Black: 20%
Other: 4%
9.6%
Missouri
5,951,247
$46,005
24%
13%
White: 83%
Black: 12%
Other: 5%
14%
15
St. Louis County
Functional Health Status
St Louis County 2011 CHNA
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St. Louis County
Wellness Categories
St Louis County 2011 CHNA
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St. Louis County
Access to Care
St Louis County 2011 CHNA
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St. Louis County
Access to/ Quality of Care for Primary Care Services
Ambulatory Care Sensitive (ACS) Conditions
• ACS conditions are illnesses that can often be managed
effectively on an outpatient basis and generally do not result
in hospitalization if managed properly (e.g. diabetes, asthma,
etc).
St Louis County 2011 CHNA
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St. Louis County
Access to/ Quality of Care for Primary Care Services
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Access to/ Quality of Care for Primary Care Services
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Chronic Disease Behavioral Risk Factors
St Louis County 2011 CHNA
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St. Louis County
Chronic Disease Behavioral Risk Factors
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Cardiovascular Medical Conditions
St Louis County 2011 CHNA
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St. Louis County
Selected Cardiovascular Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Cardiovascular Health Indicators
300
250
200
Heart Disease, Mortality
Rate
150
AMI, Mortality Rate
100
50
0
St. Louis County
Missouri State
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Diabetes Health Indicators
St Louis County 2011 CHNA
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St. Louis County
Selected Diabetes Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Diabetes Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Reproductive Health Indicators
12.0
11
10.0
8.5
8.0
6.0
% Inadequate Prenatal
Care (of Live Births)
4.0
2.0
0.0
St. Louis County
St Louis County 2011 CHNA
Missouri State
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St. Louis County
Selected Reproductive Health Indicators
St Louis County 2011 CHNA
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St. Louis County
Selected Reproductive Health Indicators
St Louis County 2011 CHNA
32
St. Louis County
Selected Reproductive Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
33
St. Louis County
Selected Reproductive Health Indicators
9.0
8.0
8.0
7.4
7.0
5.7
6.0
4.7
5.0
4.0
Infant Mortality Rate
(Deaths to Infants from
Birth through 364 Days of
Age) per 1,000 Live Births
Neonatal Mortality Rate
(Deaths to Infants under
28 Days) per 1,000 Live
Births
3.0
2.0
1.0
0.0
St. Louis County
St Louis County 2011 CHNA
Missouri State
34
St. Louis County
Selected Infectious Disease Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
35
St. Louis County
Selected Substance Abuse Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Substance Abuse Indicators
40
36
35
30
30
29
20
Acute Alcohol-Related Mental
Disorders, Hospital Admission
Rate
15
Acute Alcohol-Related Mental
Disorders, ED Rate
25
21
10
5
0
St. Louis County
Missouri State
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Mental Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
38
St. Louis County
Selected Mental Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Selected Mental Health Indicators
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
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St. Louis County
Recommendations-overall
• Increase awareness about the scope of health
disparities in St. Louis County overall and by region
• Engage in an ongoing county-wide planning process
to better identify and rationally address health
service needs indicated by the information contained
in this report.
St Louis County 2011 CHNA
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St. Louis County
Priority Health Issues
Access to Care:
– Conclusion: SLC population has relatively good access as measured by
health insurance coverage and having a source of care but quality of
care as measured by high ACS hospital admission rates needs followup.
– Recommendation: Explore how access can be expanded and review
quality. The implementation of ACA offers and opportunity to expand
access to insure high levels of access (ACOs, PCMH, Innovations, public
private health partnerships, technology innovations)
St Louis County 2011 CHNA
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St. Louis County
Overall Priority Health Issues
Chronic Disease Issues and Barriers to Care:
– Conclusions: Rates of disease/health conditions likely very similar to
the state if social determinants such as income and education are
taken into account. Levels of wellness already similar. This is resulting
in higher use of the hospital for the population with chronic health
conditions.
– Recommendations: Continue to engage in prevention/promotion
programs for smoking, weight, activity levels. Determine which
populations are at risk for hospitalization due to levels of primary care
quality, access, self management skills, etc.; collaborate with the
private health system to address with system level changes.
St Louis County 2011 CHNA
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St. Louis County
Priority Health Issues
Cancer Incidence
– Conclusions: Cancer incidence levels are relatively high in SLC. The
differences, while not alarming, are likely due to specific cancer sites—
i.e. breast and prostate.
– Recommendation: Work with the state health department and the
academic community to conduct a study in order to determine if the
differences in rates especially in some regions and for specific sites
warrant interventions.
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St. Louis County
Priority Health Issues
Reproductive Health:
– Conclusions: The levels of women at high risk for a poor birth outcome
is high and may be due to a number of factors. This results in levels of
complications at birth, hospitalizations and neonatal mortality. Levels
of C-sections deliveries are high overall.
– Recommendations: Determine if care for high risk women is adequate
throughout the county. Determine if anything can be done to lower
the C-sections rates in the county.
St Louis County 2011 CHNA
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St. Louis County
Priority Health Issues
Mental Health and Substance Abuse Services
– Conclusions: There may be a significant population in the county with
both substance abuse (including alcohol) and mental health issues.
– Recommendations: Assess the capacity of the current system to treat
this population (dual programs); develop/implement a plan to improve
these services.
Infectious Disease:
– Conclusion/Recommendation: The levels of sexually transmitted
diseases need to be addressed on the county with education and
other types of evidence based programs.
St Louis County 2011 CHNA
46
Sub-Counties
Access to Care
18
17
16
16
14
12
10
8.8
% Uninsured Non-Elderly Adults
(18-65)
8
6
4.5
4
2
0
Mid
St Louis County 2011 CHNA
North
South
West
47
Sub-Counties
Wellness Categories
20
18
18
16
16
14
12
12
% 11+ Days Lost due to Poor
Mental or Physical Health
10
10
8
% 3+ Chronic Conditions
7.5
7.6
6.4
6
6.3
6.2
5.0
4
4.5
% Health Fair to Poor
3.6
2
0
Mid
St Louis County 2011 CHNA
North
South
West
48
Sub-Counties
Functional Health Status
100%
90%
21
20
14
12
80%
70%
60%
40
37
% Some Health Problems
4.8
7.1
6.7
% At Risk for Future Medical
Problems
9.0
% Well
30%
20%
% Not Well
37
50%
40%
37
35
36
38
Mid
North
South
46
10%
0%
St Louis County 2011 CHNA
West
49
Sub-Counties
Access to Care
ED Visits
80,000
70,000
60,000
Overall
50,000
Ages <18
40,000
Ages 18-44
30,000
Ages 45-64
20,000
Ages 65+
10,000
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
50
Sub-Counties
Access to Care
ACS Conditions: Hospital Admissions & ED Rates
ACS Conditions, Hospital Admission Rate (Overall PQI)
ACS Conditions, ED Rate (Overall PQI)
5,149
2,841
2,903
2,168
1,673
Mid
North
1,485
South
1,194
918
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
51
Sub-Counties
Cardiovascular Health: Risk Factors
40
36
35
30
29
27
25
25
21
20
18
% Current Smokers (Age 18+)
20 20
19
17
14
15
12
% Sedentary Lifestyle (measured
by no pysical activity)
% Obesity (Ages 18+)
10
5
0
Mid
St Louis County 2011 CHNA
North
South
West
52
Sub-Counties
Chronic Conditions
Cardiovascular Health: Prevalence
40
38
35
30
28
30
30
28
27
26
25
25
20
15
10
4.0
3.9
3.2
5
3.2
0
Mid
North
% High Cholesterol
St Louis County 2011 CHNA
South
% High Blood Pressure
West
% Heart Disease
53
Sub-Counties
CVD related Hospital Admission Rates Per 100,000
600
500
Congestive Heart Failure, Hospital
Admissions
400
AMI, Hospital Admission Rate
300
Cerebrovascular Disease (stroke),
Hospital Admission Rate
200
CABG, Hospital Admission Rate
100
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
54
Sub-Counties
350
321
300
260
250
238
Heart Disease, Mortality Rate
188
200
AMI, Mortality Rate
150
100
Cerebrovascular Disease (stroke),
Mortality Rate
101
68
78
58
60
58
50
52 47
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
55
Sub-Counties
14
12
12
11
10
8
6.6
6
% Current Asthma (Ages 18+)
5.3
4
2
0
Mid
St Louis County 2011 CHNA
North
South
West
56
Sub-Counties
Chronic Conditions
% Diagnosed Diabetes
30.0
25
24
25.0
22
20.0
16
15.0
15
12
10
10.0
6.8
5.0
3.9
3.6
1.0
0.2
0.0
Mid
North
Ages 18-44
St Louis County 2011 CHNA
South
Ages 45-64
West
Ages 65+
57
Sub-Counties
Chronic Conditions
Diabetes Management
120
100
97
91
92
88
83
82
80
66
62
63
68
67
60
41
40
20
0
Mid
North
South
West
% Reported hemoglobin A1c measurement (at least once) in past year (Age 18+)
% Reported foot examination in past year (Age 18+)
% Reported retinal eye exam in past year (Age 18+)
St Louis County 2011 CHNA
58
Sub-Counties
Cancer Incidence
620
602
600
580
560
557
541
540
All Cancers, Incidence Rate
527
520
500
480
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
59
Sub-Counties
Cancer Incidence
Select Cancer Incidence Rates
Female Breast Cancer, Incidence Rate
Male Prostate, Incidence Rate
187
171
167
174
174
184
166
146
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
60
Sub-Counties
Select Mental Health Indicators
20
19
18
18
16
15
14
14
12
13
11
11
10
10
% Diagnosed Depression (ever,
18+)
% Diagnosed Other Psychiatric
Disorder (ever, 18+)
8
6
4
2
0
Mid
St Louis County 2011 CHNA
North
South
West
61
Sub-Counties
Select Mental Health Indicators
1400
1248
1200
1000
916
800
666
Schizophrenia, Hospital Admission Rate
Psychoses Hospital Admission Rate
600
429
363
400
257
200
113
62
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
62
Sub-Counties
Select Mental Health Indicators
400
336
350
300
250
324
267
238
214
Major Depressive Disorder,
Hospital Admission Rate
195
200
160
150
Anxiety, Hospital Admission Rate
115
100
50
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
63
Sub-Counties
Select Substance Abuse Indicators
70
60
50
Alcohol-Related Psychoses,
Hospital Admission Rate
40
Drug-Related Psychoses, Hospital
Admission Rate
30
Alcohol-Related Psychoses, ED
Rate
20
Drug-Related Psychoses, ED Rate
10
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
64
Sub-Counties
Select Infectious Disease Indicators
Sexually Transmitted Disease Incidence Rate
1,400
1,194
1,200
1,000
800
683
Gonorrhea Incidence Rate
600
Chlamydia Incidence Rate
370
400
231
139
200
22
12
86
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
65
Sub-Counties
Select Reproductive Health Indicators
100
90
94
93
87
82
80
70
60
50
% Adequate Prenatal Care (of live
births)
40
% Inadequate Prenatal Care (of
live births)
30
20
10
9.3
13.6
3.9
3.7
0
Mid
St Louis County 2011 CHNA
North
South
West
66
Sub-Counties
Select Reproductive Health Indicators
1200
980
1000
800
629
High Risk Pregancy, Hospital
Admission Rate (10-44 year old
females)
600
349
400
240
200
0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
67
Sub-Counties
Select Reproductive Health Indicators
20.0
18.0
17
16.0
14
14.0
10.0
12
11.4
12.0
12
% Low Birthweight (<2500 grams)
9.3
8.0
7.0
7.0
% Prematurity (< 37 weeks)
6.0
4.0
2.0
0.0
Mid
North
South
West
Note: Rates are per 100,000 unless otherwise stated
St Louis County 2011 CHNA
68
Sub-Counties
Select Reproductive Health Indicators
14.0
12
12.0
10.0
9.0
8.0
6.0
Infant Mortality Rate (Deaths to
Infants from Birth through 364 Days
of Age) per 1,000 Live Births
7.9
5.8
4.3
3.5
4.0
Neonatal Mortality Rate (Deaths to
Infants under 28 Days) per 1,000
Live Births
3.7
2.8
2.0
0.0
Mid
St Louis County 2011 CHNA
North
South
West
69
Sub-Counties
Select Reproductive Health Indicators
Teen Birth Rate (10-17yrs) Per 1,000 Females
12.0
10
10.0
8.0
6.5
6.0
Teen Birth Rate (10-17yrs) Per
1,000 Females
4.0
2.0
2.0
1.3
0.0
Mid
St Louis County 2011 CHNA
North
South
West
70
Mid-County
Priority Health Issues
Access to Care:
– Conclusion: Access issues apparent in this region (poorer insurance coverage
despite older population, high use of ED especially for the younger
population).
– Recommendation: Determine where gaps in access especially for primary
care.
Chronic Disease Issues and Barriers to Care
– Conclusions: Levels of risk relatively low except for respiratory disease
especially for 0-17 age group and for diabetes. This results in higher hospital
use and poorer health status.
– Recommendations: Improve Care Coordination at all levels: use of evidence
based protocols for diagnosis and treatment; patient education and self
management; school based programs and exposure to triggers in home and at
work.
St Louis County 2011 CHNA
71
Mid-County
Priority Health Issues
Cancer Incidence:
– Conclusion: Higher than expected levels of cancer incidence for breast
and prostrate cancer despite good screening and early detection.
– Recommendation: Determine the need for improvement of prevention
and treatment services for breast and prostrate cancer.
Reproductive Health:
– Conclusion: High risk pregnancies higher in this region and high Csection rates.
– Recommendation: Follow-up on access to preventive education and
care management. Determine what can be done to reduce C-section
rates in this region.
St Louis County 2011 CHNA
72
Mid-County
Priority Health Issues
Mental Health and Substance Abuse Services
– Conclusion: Higher than expected proportion of the population at risk
for serious mental health problems and for both mental health and
substance abuse problems. Both youths and adults
– Recommendation: Determine levels and types of care available and
whether outpatient and mid-level services can be improved for each
population.
Infectious Disease
– Conclusion: Levels of sexual transmitted disease an issue in this
community.
– Recommendation: Follow-up is needed to
develop/implement/promote education and other types of evidence
based programs.
St Louis County 2011 CHNA
73
North-County
Priority Health Issues
Access to Care:
– Conclusions: Large population without a regular source of care resulting in
over use of the hospital (ED and Inpatient) , especially among the 44 and
younger population.
– Recommendations: Determine where there are gaps in access especially for
primary care.
Chronic Disease Issues and Barriers to Care
– Conclusions: Levels of risk relatively low except for high blood pressure and
diabetes resulting in higher hospital use and early deaths.
– Recommendations: Follow up at all levels of care—primary and specialty.
Need to connect patients at risk with higher quality care and patient self
management system. Use of evidence based protocols for diagnosis and
treatment.; patient education and self management; community care teams,
and school based programs.
St Louis County 2011 CHNA
74
North-County
Priority Health Issues
Cancer Incidence:
– Conclusion: Higher than expected levels of cancer incidence for breast,
cervical, colorectal, prostrate and lung cancer. Screening and early detection
mixed depending on the cancer site.
– Recommendation: Determine what is driving the higher rates of these cancers
(not evident from the data) and how to improve prevention and treatment
services for these cancer sites.
Reproductive Health:
– Conclusion: High risk pregnancies elevated and adequate prenatal care low
resulting in poorer birth outcomes. C-section rate is high.
– Recommendation: Work with the hospitals to plan/provide better prenatal
care and to improve care for high risk pregnant women. Follow-up on access
to preventive education and care management. Determine what can be done
to reduce C-section rates in this region.
St Louis County 2011 CHNA
75
North-County
Priority Health Issues
Mental Health and Substance Abuse Services
– Conclusion: Higher than expected proportion of the population at risk
for serious mental health problems and for both mental health and
substance abuse problems. Both youths and adults
– Recommendation: Determine levels and types of care available and
whether outpatient and mid-level services can be improved for each
population.
Infectious Disease
– Conclusion: Levels of sexual transmitted disease an issue in this region.
– Recommendation: Follow-up is needed to develop/implement/
promote education and other types of evidence based programs.
St Louis County 2011 CHNA
76
South-County
Priority Health Issues
Access to Care:
– Conclusions: Access issues are relatively good in this region (insurance
coverage is high and use of the ED is low).
– Recommendations: Work to improve insurance coverage for the uninsured
and underinsured.
Chronic Disease Issues and Barriers to Care
– Conclusions: Levels of risk relatively for weight (overweight/obesity), physical
activity not as good as would be expected given the demographics of the
region. This results in somewhat higher hospital use for some chronic diseases
(CHF and diabetes in 65+ pop).
– Recommendations: Follow up access prevention, care coordination and self
management programs for those at risk for those with CHF and diabetes
[patient centered medical home and community care team].
St Louis County 2011 CHNA
77
South-County
Priority Health Issues
Cancer Incidence:
– Conclusion: Higher than expected levels of cancer incidence for
prostrate cancer—good screening and early detection.
– Recommendation: Focus on prevention services for prostrate cancer.
Reproductive Health:
– Conclusion: Care at expected levels and good outcomes. C-section
rates high in this region.
– Recommendation: Determine what can be done to reduce C-section
rates in this region.
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West-County
Priority Health Issues
Access to Care:
– Conclusions: Access overall very good due to high income and education,
larger working age population, insurance coverage and good health.
– Recommendations: Determine where gaps in access for those without
insurance coverage and means especially safety net care.
Chronic Disease Issues and Barriers to Care
– Conclusions: Levels of risk relatively low except for overweight/obesity levels
(still high despite better than other parts of the county) and activity levels.
Higher hospital use in the 65+ (diabetes and bronchitis/asthma).
– Recommendations: Follow up on prevention services and care management of
the elderly with chronic conditions.
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West-County
Priority Health Issues
Cancer Incidence:
– Conclusion: Higher than expected levels of cancer incidence for breast
and prostrate cancer despite good screening and early detection
– Recommendation: Determine the need for improvement of prevention
and treatment services for breast and prostrate cancer
Reproductive Health:
– Conclusion: C-section rates high in this area
– Recommendation: Determine what can be done to reduce C-section
rates in this region.
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80
West-County
Priority Health Issues
Mental Health and Substance Abuse Services
– Conclusion: Higher than expected proportion of the elderly population
at risk for serious mental health problems and for both mental health
and substance abuse problems.
– Recommendation: Determine levels and types of care available and
whether outpatient and mid-level services can be improved for this
population.
St Louis County 2011 CHNA
81
Next Steps
Rational Planning Model Phase 1: Assessment
Cycle
• Phase 1 is the Assessment Cycle (CIAP) that
identifies critical health issues and service
needs.
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82
Rational Planning Model Phase 1:
Assessment Cycle
Analysis of
Community
Health Profile
(CCPH)
Identification
of Critical
Health Issues
and Service
Needs
St Louis County 2011 CHNA
Oversight
Committee
83
Next Steps
Planning and Implementation Phase 2:
• Phase 2 is the Planning and Implementation Cycle for
prioritizing, planning and implementing interventions
that address healthy issues and service needs.
• The St. Louis County Community Health Needs
assessment is currently in between Phases 1 and 2 of
implementing community wide health services
improvement.
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84
Rational Planning Model Phase 2: Planning
and Implementation Cycle
Planning and
Steering
Subcommittee
Priority Healthy
Issue
St Louis County 2011 CHNA
Priority Health
Issue
Priority Health
Issue
85
Rational Planning Model Phase 2:
Planning and Implementation Cycle
Identify
Infrastructural
Capacity and
Stakeholders
Monitor
Processes and
Outcomes
Implementati
on Strategy
St Louis County 2011 CHNA
Priority Health
Issue Planning
and
Implementation
Subcommittees
Develop
Implementati
on Goals and
Indicator Set
Develop
Implementati
on Strategy
86
Next Steps
Planning and Implementation Phase 2:
• The Planning and Implementation Steering
Committee must prioritize which health issues need
further intervention.
• The priority health issue sub-committees convened
should be representative of interested parties as well
as public health agency representatives.
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87
Next Steps
Planning and Implementation Phase 2:
Step 1: Identify infrastructural capacity and stakeholders
• Examine health service gaps in order to identify contributing factors of health service
shortages.
•
Identify available community resources as well as points of entry for health service
improvement interventions.
Step 2: Develop implementation goals and key indicator sets
• Identifying key quantitative performance indicator sets that can be used to monitor health
service improvements;
• Identify long and short term goals.
Step 3: Develop implementation strategy
• Stages and timeline of implementation are delineated clearly.
• Assess how available resources inventoried might be most effectively utilized
• Specify how long and short term goals will be achieved?
• Engage relevant health care constituents in the conversation.
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88