Community Health Assessment for Pitt County - Case Study Example

 Community health assessment is key to understanding the health problems and priorities of a population. This Application Assignment outlines a process by which you can complete a health assessment of a community using indicator-based methods. You will construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community. Sections A–C ask questions about assessment in general. Section D involves assessment of a particular county in North Carolina, information on which is provided in that section and in the Appendix. Instructions: Save this document to your computer and complete all questions in Sections A–D below. Submit by the end of Week 5 following the submission instructions in the Week 5 Application section. Section A: Community Health Assessment The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years. A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach. Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources. Questions: 1. How do you define community? Community is a system that depends on totality of interactions of all subsystems. The subsystems include health, education, religion, family, economy, religion and communication. It can also be defined as a set of population living in same geographical area with shared cultural cohesion, common resources and consider themselves as belong to a common social group. 2. What stakeholders (groups/organizations) would you want to consult with for a community assessment? The information for this assessment can be gotten by consulting various stakeholders. The stakeholders to be consulted include health organizations to provide disease records and medical data, insurance providers so as to provide data needed to enable identification of indicators, intelligence institutions or department that will provide data involving the violence, injury and accident related information among the past surveys done by them nationally, research institutions to provide information such as past research concerning the community being assessed, law enforcers and local authorities to provide data involving accidents, local census data and information involving injury and violation. 3. What types and sources of data would you use for a community assessment? Type of data to be used in this assessment include; social and economic activities of the community, mortality, healthcare utilization and services, population data and social behaviors. The sources of data include; hospital data, community’s past surveys, information from census, hospital disease records, records from accident scenes, police registry, non-governmental organization’s data and any other essential records concerning the community on assessment. Section B: Healthy People 2010 The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. To understand the significance of data on your own community, you have to be able to compare it to another standard. The questions in this section ask you about other standards that can be used. Questions: 1. How are Healthy People 2020 standards used? What are advantages and disadvantages to applying them at a local community level? (Note: you may use the Healthy People 2010 standards if the 2020 standards are not reported.) Healthy People 2020 standards are used by different people, states, communities and professional organizations to develop programs to improve health. They are also used to identify health priorities and sets mechanisms to ensure objectives of reducing public health threats. The advantages of applying them at a local community level include; it is a product of national process hence, the benefits are nationally felt and process is tried and tested. The other advantage is that the standards are all-inclusive and wide-spread, finally they are extensively available. The disadvantages of applying these standards in a local community include the difficulty to apply actions used on a local setting, they can not be compared; for example from one local community to another or their applicability in one state to another. Another disadvantage is the state of different standards cutting across various communal needs; they are not specific and straightforward. 2. What other standards (national, state, or local) can be used? Other standards include; sexual and reproductive health; that includes information on STDS, maternal mortality and nutrition related health issues, drug and substance abuse standards; to provide standards that is associated drug related ailment like lung cancer, and some time violations due to substance use, HIV & STDs national or local standards; to provide standards governing infections and management or care for the infected persons, national educational standards; provides information on the available educational related standards and records on the quality of education that is supposed to be provided to the residents of this community, regional standards and child care related standards; that provides information on the way children and minors should be looked after to avoid child related mortality. Section C: Health Indicators For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop. The first step in such an assessment involves identifying important health indicators. The second step involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population. Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community. Note that each indicator should be: 1. An important health problem. 2. Prevalent or common in the community of interest. 3. Measurable on a community or population basis. There should be population data on a local level that is easily available—this cannot be collected from health facilities or providers because these data sources do not apply to the entire community. 4. Ideally, because we want to use a limited number of indicators, the indicator should not be redundant—not measure the same thing—as another chosen indicator. To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided. Table 1: List of Domains to Assist Developing a Community Health Assessment Domain: Example of an Indicator: Communicable Diseases (including Sexually Transmitted Diseases) Incidence of Gonorrhea Chronic Diseases (including Cancer) Incidence of Diabetes Injury and Violence Homicide rate Maternal and Child Health Childhood immunization rate Environmental Health Rates of Lead Poisoning Access to Health Care Rates of Uninsured Question: 1. How you would obtain data for these indicators. What sources might you use? Select 2 of the indicators above and provide specific sources of information on them (including URLs) for your own community or state. The data for incidence of Gonorrhea will be obtained from hospital patient admission and discharge data or from local health registry data as indicated in the disease records. Specific URLs include; http://www.cdc.gov/std/stats/. The data for childhood immunization rates will be obtain from local childcare centers and health surveys’ records that may have been carried in the past Specific URLs include; http://datacenter.kidscount.org/. Section D: Performing a Community Health Assessment As a consultant to Pitt County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county: Pitt County is located in eastern North Carolina and has a population of 138,690 residents (2005 Census). Pitt County has been classified as urban for the first time in 2006. It and the surrounding counties are largely rural with a history of dependence on tobacco farming. Caucasians make up about 62.8% of the population, African Americans 33.6%, Hispanics 3.2%, Asians 1.1% and American Indians 0.3%. There are an estimated 6,606 migrant and seasonal workers or 5.4% of the population. About 18% or 26,000 adults in Pitt County adults have household incomes below the federal poverty level with a median per capita income of $18,243 (2000). The child poverty rate is estimated to be 21.8%. Approximately 20% of adult lack health insurance. Pitt County contains Greenville, the largest city in eastern North Carolina with a population of 67,525 (2005). Greenville is considered the hub of eastern North Carolina. The major employers are Pitt County Memorial Hospital (PCMH), Brody School of Medicine and East Carolina University. If a state was created of all the land in North Carolina east of Interstate 95, it would be the poorest of all 50 states. In addition, it would rate 48th in terms of premature mortality. Consider these factors when evaluating populations at risk and targeting resources for public health activities. You now embark on the steps needed to perform your assessment. STEP ONE: IDENTIFYING HEALTH INDICATORS As noted earlier, the first step in a community health assessment is identifying health indicators. Develop a list of 18-20 indicators you would want to use in your assessment, identifying 3-4 indicators per domain. Complete the column on the right in this table: Domain: Indicator: (provide 3-4 per domain Communicable Diseases (including Sexually Transmitted Diseases) Incidence of TB Incidence of Hepatitis A Incidence of Hepatitis B Chronic Diseases (including Cancer) Incidence of Stroke Incidence of heart diseases Incidence of diabetes Injury and Violence Admission to juvenile justice Incidence of suicide mortality Incidence of motor vehicle accidents Maternal and Child Health Incidence of post-neonatal infant mortality. Incidence of teen pregnancy. Incidence of low birth weight/very low birth weight. Environmental Health Incidence of lead poisoning. Incidence of sunburns and skin cancer. Incidence of indoor deaths as a result of poor ventilations and contaminated air. Access to Health Care Low access to dentist. Low access to children health insurance. Low access to medical insurance. STEP TWO: MATCHING THE INDICATORS Now that you have chosen indicators to use for a community health assessment, use the information provided in the tables below (Appendix) to match available data to your chosen indicators. In this example, residents of Pitt County constitute the community. If the Appendix does not give you the data for your indicator, you should choose another indicator (alternatively, you may seek out the data elsewhere that you need for your proposed indicator). Question: 1. Have you matched each of your indicators to the data available in the Appendix? If not, explain how and where you got the data needed for your proposed indicator. Yes. The indicators matched perfectly as those provided in the appendix. For example, in the Communicable Diseases domain, the indicators filled include TB, hepatitis A and B, that matches with those provided in the appendix. STEP THREE: SETTING HEALTH PRIORITIES Using the information gathered in the first two steps, please answer the following questions. Note: Keep in mind that in order to plan an effective intervention program in real life, you must communicate with other constituents and stakeholders and see what they perceive to be priority health issues. Collaboration with community stakeholders in program design is critical to the success of an intervention plan. For this purposes of this assignment, however, you are reviewing the data on your own, without the input from other stakeholders. Questions: 1. Looking at this data only, what would you conclude are three priority health issues for this population? (Can be picked by how the indicator compares) The three main priorities health issues for this community include communicable diseases; which has the rates of 5.0 which indicates that if not contained, other community residents are exposed, thus the possibility of having new infections. The second priority is , access to health care that rates at 12.1, this indicates that the community is not adequately covered and access to health care is minimal, to reduce cases of mortality priority must be given to this indicator, the third priority is maternal and child healthcare, the mothers and children should be given the care they require, priority should be given to their health and centers to attend to their needs set up. 2. Choose three of your indicators. Compare them to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page from Healthy People to the specific indicator. The three indicators are; Incidence of teen pregnancy, admission to juvenile justice and low access to medical insurance. These are comparable to the Healthy People 2020 standards that include Injury and Violence, maternal and Child Health and access to Health Services. Though, the priorities and implementation differ in a big manner. The community needs strict adherence and urgent implementation for the community to be safe http://www.healthypeople.gov/2020/LHI/default.aspx. 3. How do you explain the health disparities of these indicators? (i.e., as shown by this comparison with HP? This community’s indicators need more attention as the high rate of disparities has led to poor health standards and mortality; below the proposed HP’s recommendations. Thus, the need to urgently prioritize these indicators and quick solutions implemented to reduce the effects immediately. The disparities show that the community is at danger as it is exposed to risks of infections, poor health and incidences of insecurity or violation. This are issues that can be minimized if the standards as set out in HP are strictly implemented and followed as required. You have completed this Application on assessment. Submit this completed form in the Dropbox following the submission instructions in the Week 5 Application area. BRFSS for 2004 Age adjusted rates Pitt County North Carolina Adult disability 28.3 25.0 Current asthma 7.1 6.4 Smoking: women of childbearing age 30.4 24.4 Smoking everyday: men 32.9 37.6 Obesity 26.1 22.7 Binge drinking (childbearing age) 9.5 6.8 Binge Drinking (all) 12.0 8.4 Men 19.8 Women 3.1 No leisure time physical activity 26.4 26.3 Are any firearms kept in your home 39.6 40.9 Domain: Access to Care Indicator Pitt County North Carolina United States % No medical insurance 20.8 17.5 16.5 % Children with no health insurance 14.3 12.5 9.8 % Children enrolled in Medicaid 36.7 32.6 26.0 % Children enrolled in NC Health Choice 5.2 5.9 NA Primary Care Physicians/100,000 population 149 83.5 Dentists/100,000 population 37.8 40.5 58.4 Kindergarten Tooth Decay Rates 27.7% 22% 26% whites 36% A-A 43% Hispanic BRFSS 2001 Eastern NC North Carolina Cost as barrier to health insurance 16.5 11.5 No usual place of care 24.0 22.1 No dental insurance 52.7 45.3 Domain: Communicable Diseases Indicator Pitt County North Carolina United States TB rate per 100,000 population (2004) 5.0 4.5 4.9 Hepatitis A rate per 100,000 population 2004: 17 cases 12.1 (2004) 3.65 (2003) 2.6 (2003) Hepatitis B rate per 100,000 population 2004: 11 cases 7.0 (2004) 1.9 2.6 Hepatitis C rate per 100,000 population 2004: 4 cases 2.9 0.2 0.4 Domain:Sexually Transmitted Diseases Indicator Pitt County North Carolina United States Gonorrhea rate per 100,000 population 347.8 181.3 113.5 Black rate 848.3 673.8 629.6 White rate 52.6 38.4 33.3 Chlamydia rate per 100,000 population 645.9 313.3 319.6 Black rate 1206.4 929.7 1209.4 White rate 216.2 116.3 143.6 Syphilis rate per 100,000 population 3.2 8.9 2.7 Black rate 8.0 15.3 9.0 White rate 1.3 1.1 1.6 HIV rate per 100,000 population 18.0 25.2 20.7 Black rate 38.8 76.6 76.3 White rate 7.2 9.6 9.0 Domain: Cancer (2000) Indicator Pitt County North Carolina United States Lung Cancer Mortality rate per 100,000 population 68.7 61.6 54.2 Incidence rate per 100,000 78.8 69.7 67.5 Breast Cancer (Female) Mortality rate per 100,000 females 27.7 26.5 14.4 Female incidence per 100,000 females 167.5 149.5 132.2 Colon/Rectum Cancer Mortality rate per 100,000 population 22.7 20.0 19.1 Incidence rate per 100,000 males 64.7 48.4 52.0 Prostate Cancer Mortality rate per 100,000 males 36.7 36.9 31.5 Incidence rate per 100,000 males 154.5 152.5 166.7 Incidence All Cancer 494.3 445.3 Domain: Chronic Diseases Indicator Pitt County N.C. (1999-2002) United States (2003) Heart disease Mortality rate per 100,000 population 248.5 246.6 235.4 Stroke Mortality rate per 100,000 population 82.1 72.0 54.3 Diabetes Mortality rate per 100,000 population 34.3 27.4 25.4 COPD Mortality rate per 100,000 population 38.4 46.5 43.4 Youth death rates (Ages 0-17)/100,000 100.6 79.9 Domain: Environmental Health Indicator Pitt County North Carolina United States Lead (2004) 2.8 1.3 >1100 infants 56% tested Have you had an illness in the past 12 months that you think was caused by outdoor air pollutants? 9.1 12.0 Have you had an illness in the past 12 months that you think was caused by poor indoor air quality? 15.0 16.4 Domain: Injury and Violence Indicator Pitt County North Carolina 1999–2002 United States 2003 Motor vehicle accidents Mortality rate per 100,000 population 19.6 19.2 15.2 Mortality Homicide rate per 100,000 population 11.2 7.6 5.9 Suicide rate per 100,000 population(10-24 yr) 10.82 11.36 10.5 Violent Crime rate per 100,000 population (2004) 617.2 446.9 Accidents Unintentional injuries Mortality rate per 100,000 population 40.0 42.7 36.3 Child Maltreatment substantiated 18.1 14.5 12.3 Admissions to Juvenile Justice 38.6 34.1 Domain: Economic and Education Indicator Pitt County North Carolina United States Premature mortality rate per 100,000 population under 75 956 years 903 years 799 years Percent below poverty level 17.5 15.2 12.4 Percent of children below poverty level 21.8 21.9 16.9 Unemployment rate 5.2 5.0 4.7 Percent children receiving food stamps 24.9 18.2 10.6 million (14%) Percent children receiving free or reduced lunch 48.4 44.3 41.9 Public school dropout rate (9-12th grade)2004-5 6.95 4.86 10.3% High School completion (%) 56 86.1 85% Percent >25 years of age with Read More