COMMUNITY HEALTH NEEDS ASSESSMENT Platte Valley Medical Center
2013
Table of Contents Overview of Key Findings ........................................................................................................4 Introduction ...............................................................................................................................10 Background and Purpose...................................................................................................10 Service Area ......................................................................................................................10 Map of the Service Area.....................................................................................................11 Consultant..........................................................................................................................11 Methods ....................................................................................................................................12 Identification of Community Health Needs..........................................................................12 Input from Persons who Represent the Community ...........................................................12 Information Gaps ...............................................................................................................12 Health Care Facilities and Community Resources .............................................................13 Identification and Prioritization of Health Needs ........................................................................14 Prioritization Process .........................................................................................................14 Demographics ...........................................................................................................................16 Population ..........................................................................................................................16 Race/Ethnicity ....................................................................................................................17 Citizenship .........................................................................................................................17 Language ...........................................................................................................................18 Social and Economic Factors ....................................................................................................19 Social and Economic Factors Rankings .............................................................................19 Unemployment ...................................................................................................................19 Poverty ..............................................................................................................................19 Free or Reduced Price Meals.............................................................................................20 Households ........................................................................................................................20 Households by Type ..........................................................................................................21 Educational Attainment ......................................................................................................21 High School Graduation Rates ...........................................................................................22 Homelessness ...................................................................................................................22 Birth Indicators ..........................................................................................................................23 Births .................................................................................................................................23 Teen Births ........................................................................................................................23 Prenatal Care.....................................................................................................................23 1
Low Birth Weight ................................................................................................................24 Infant Mortality ...................................................................................................................24 Leading Causes of Death ..........................................................................................................25 Age-Adjusted Death Rate ..................................................................................................25 Leading Causes of Death...................................................................................................26 Cancer Mortality .................................................................................................................26 Heart Disease Mortality ......................................................................................................27 Unintentional Injury Mortality Rate .....................................................................................28 Diabetes Mortality ..............................................................................................................28 Pneumonia Mortality ..........................................................................................................28 Suicide ...............................................................................................................................29 Drug Dependence and Abuse Mortality..............................................................................29 Alcoholic Liver Disease ......................................................................................................30 HIV/AIDS Mortality .............................................................................................................30 Access to Health Care ..............................................................................................................31 Health Insurance ................................................................................................................31 Unmet Medical Need .........................................................................................................32 Primary Care Physicians ....................................................................................................32 Dental Care........................................................................................................................32 Access to Primary Care Community Clinics .......................................................................33 Mental Health Providers .....................................................................................................33 Hospital Access .................................................................................................................34 Chronic and Communicable Disease ........................................................................................36 Fair or Poor Health.............................................................................................................36 Diabetes ............................................................................................................................36 Asthma ..............................................................................................................................36 Colorectal and Breast Cancer ............................................................................................37 Tuberculosis ......................................................................................................................37 Sexually Transmitted Diseases ..........................................................................................37 HIV/AIDS ...........................................................................................................................38 Health Behaviors.......................................................................................................................39 Health Behaviors Rankings ................................................................................................39 Adults Overweight and Obese............................................................................................39 2
Adults Physical Activity ......................................................................................................40 Youth Physical Activity .......................................................................................................40 Recreational Facilities ........................................................................................................40 Access to Parks .................................................................................................................41 Fast Food...........................................................................................................................41 Fresh Fruits and Vegetables ..............................................................................................41 Smoking .............................................................................................................................42 Physical or Mental Unhealthy Days ....................................................................................42 Inadequate Social Support .................................................................................................42 Frequent Mental Distress, Adult, 5-Year Average ..............................................................42 Adult Alcohol Use...............................................................................................................42 Flu Shots ...........................................................................................................................43 Pneumonia Vaccination .....................................................................................................43 Pap Smears .......................................................................................................................43 Mammograms ....................................................................................................................44 Colorectal Cancer Screening .............................................................................................44 Interview Results.......................................................................................................................45 Attachment 1. Benchmark Comparisons ..................................................................................56 Attachment 2. Platte Valley Medical Center Interview Respondents .........................................57 Attachment 3. Health Facilities and Other Community Resources ............................................58
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Overview of Key Findings The Community Health Needs Assessment is a primary tool that identifies unmet community health needs. The assessment incorporates components of existing data analysis and input from the community that focus on the health needs of the service area. The Platte Valley Medical Center service area includes the communities of Brighton, Commerce City, and Henderson in Adams County, and Ft. Lupton, Hudson and Keenesburg in Weld County, Colorado. This overview summarizes significant findings for the hospital service area drawn from an analysis of the 2013 Community Health Needs Assessment data. A detailed narrative that examines the data sets, findings, and data sources follows in the report. Demographics
The population of the Platte Valley Medical Center service area is 152,137. Children and youth, ages 0-17, make up 30.6% of the population; 62.1% are adults, ages 18-64; and 7.3% of the population are seniors, ages 65 and over. In the Platte Valley Medical Center service area, 55.9% of the population is White; 37.6% of the population is Hispanic/Latino; 2.3% are Asian; 1.6% are African American; and 2.6% are American Indian/Alaskan Native or other race/ethnicity. English is spoken in the home among 74.4% of the service area population. Spanish is spoken at home among 22.5% of the population; 1.4% of the population speak and Asian language; and 1.3% of the population speaks an Indo-European language at home.
Social and Economic Factors
The unemployment rate in the hospital service area averaged over 5 years was 7.5%. Among the residents in the Platte Valley Medical Center service area, 10.3% are at or below 100% of the federal poverty level (FPL) and 27.0% are at 200% of FPL or below. In Adams County 42% of the student population is eligible for the free and reduced price meal program. And 38% are eligible for the program in Weld County. These rates are higher than the state rate of 33%. In the Platte Valley Medical Center service area there are 45,826 households. The median household income ranges from $53,634 in Commerce City to $96,409 in Brighton 80602.
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Educational attainment is a key driver of health. In the hospital service area, 18.0% of adults lack a high school diploma. Over one quarter the population (29.2%), ages 25 and older, have a college degree.
Birth Indicators
In 2011, the number of births in the Platte Valley Medical Center service area was 2,216. The number of births has shown a steady decline over the past five years. 2.7% of live births in Adams County were to teens, ages 15-17. In Weld County, 2.4% of the births were to teens. Pregnant women in Adams County entered prenatal care late - after the first trimester - at a rate of 238.0 per 1,000 live births, and in Weld County the rate of late prenatal care was 220.6. This rate of late entry into prenatal care translates to 76.2% of women in Adams County and 78% in Weld County entering prenatal care within the first trimester. The Adams County rate of low birth weight babies is 8.4% (84.2 per 1,000 live births), and in Weld County it is 8.3% (82.6 per 1,000 live births). This is lower than the state rate of 8.7% (87.0 per 1,000 live births). The infant mortality rate in Adams County was 6 deaths per 1,000 live births and in Weld County it was 7.5 deaths per 1,000 live births. In comparison, the infant death rate in the state was 5.6 deaths per 1,000 live births.
Leading Causes of Death
When adjusted for age, the death rate in Adams County was 787.2 and in Weld County 688.5. These rates of death were higher than found in Colorado (680.6). The top causes of death in the service area are cancer and heart disease, respiratory disease and unintentional injuries. Adams County has an age-adjusted rate of death due to heart disease of 146.3 per 100,000 persons. In Weld County the heart disease age-adjusted death rate is 151.7. These rates exceed the Healthy People 2020 objective of 100.8 deaths per 100,000 persons. In Adams County the death rate for unintentional injuries is 45.8 per 100,000 persons. In Weld County the rate is 49.9. These exceed the Healthy People 2020 objective for unintentional injury deaths of 36.0 per 100,000 persons.
Access to Health Care
Health insurance coverage is considered a key component to accessing health care. Among the adult population, 72.9% of the adult population in Adams
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County and 79.6% in Weld County have health insurance, a lower rate than the state (79.8%). Among children in Adams County, 14.3% are uninsured (85.7% insured), compared to 9.1% who are uninsured (90.9% insured) in Weld County. The ratio of the population to primary care physicians in Adams County is 2,073:1, and in Weld County it is 2,118:1. The measure represents the population to one provider. The national benchmark for this indicator is 631:1. Over a third of adults in Adams County (36.9%) and Weld County (37.6%) did not visit a dentist within the past year. This is a higher rate than found in the state (31.8%). In Adams County, the ratio of the population to mental health providers is 5,916:1. In Weld County the ratio is 4,797:1. In the state the ratio is 1,807:1.
Chronic and Communicable Disease
17% of adults in Adams County and 15% in Weld County indicated they were in fair or poor health. These rates are higher than found in the state (13%). The percent of adults, 18 and older, diagnosed with diabetes was 5.9% in Adams County and 5% in Weld County. 5.4% of adults have been diagnosed with diabetes in Colorado. 8.5% of children, ages 1-14, and 9.8% of adults in Adams County have been diagnosed with asthma. 8.8% of children, ages 1-14, and 7.7% of adults in Weld County have been diagnosed with asthma. The incidence of colorectal cancer was 45.2 per 100,000 persons in Adams County and 37.7 in Weld County. The rate of colorectal cancer was higher than the state rate of 36.4 per 100,000 persons. Breast cancer rates occur among females at a rate of 124.6 per 100,000 persons in Adams County and 114.0 in Weld County. These rates are lower than the state rate of 129.8 per 100,000 persons. Chlamydia occurs at a rate of 448.3 per 100,000 persons in Adams County, which is higher than the rate of Chlamydia in Weld County (378.5 per 100,000 persons) and Colorado (426.3 per 100,000 persons).
Health Behaviors
Among adults in Adams County, 40% are overweight. In Weld County, 37.2% of adults are overweight. Approximately one-fourth of the adult population is obese in Adams County (24.2%) and Weld County (24.7%). 22.3% of adults in Adams County are sedentary and do not participate in any leisure time physical activity. 19.2% of adults in Weld County are sedentary. 6
The CDC recommendation for youth physical activity is 60 minutes or more each day. 34.4% of Adams County youth ages 5 to 14 met this activity recommendation on 7 of the past 7 days, just slightly higher than the state rate of 33.8%, which was slightly higher than Weld County's achievement of 33.3%. The percentage of restaurants in Adams County that are fast food restaurants is 56%. 49% of Weld County restaurants are fast food restaurants. In the state, 45% are fast food restaurants. The percentage of adults, 18 and over, in Adams County who smoke cigarettes is 20.4%, and in Weld County it is 19%. These rates of smoking are higher than found in the state (16.2%). The average number of physically unhealthy days experienced by adults in Adams County in the last 30 days was 3.3 days. Adams County adults experienced 3.5 mentally unhealthy days a month. In Weld County, adults experienced an average of 3.1 physically unhealthy days and 3.3 mentally unhealthy days a month. Binge drinking is defined as consuming five or more drinks on one occasion for men and four or more for women. 17.5% of adults in Adams County and 16.2% in Weld County engaged in binge drinking in the past month. Over three-quarters (78.6%) of seniors have obtained a recommended flu shot in Adams County and 73% in Weld County. Among women 18 years and older, 89.6% in Adams County and 94.4% in Weld County had a Pap smear. 55.5% of women over 40 years old in Adams County and 64.2% in Weld County had a screening mammogram in the last two years. This is below the state rate (67%) and the Healthy People 2020 objective of 81.1%. In Adams County, 60.9% of adults 50 years and older have been screened for colorectal cancer. In Weld County, 64% of adults 50 years and older have been screened for colorectal cancer. This rate is below the state rate (66.1%) and the Healthy People 2020 objective of 70.5%.
Interview Results Community issues/concerns that were identified included issues that cut across all population groups as well as some issues of greatest concern within specific communities or sub-populations. The community-wide issue most frequently mentioned was the declining economy and its impact on the community, including:
Large numbers of low-income children/youth, adults and seniors Unemployment, layoffs, and concern about jobs and wages Loss of housing due to the high foreclosure rate, resulting in increased homelessness and transience among families 7
Difficulty accessing basic needs, such as food, clothing and housing, and a doubling of requests for food and income assistance requests to the Adams County Human Services Department Substance abuse and mental health issues, including depression, stress, marital/relationship problems, family issues, trauma, and PTSD Difficulty accessing legal assistance for low-income and immigrant populations
Regarding access to health care, several of the concerns were related to the economy/income/ employment status of people in the area, while others extended to the insured population as well. Concerns related to health care access included:
Lack of or loss of health insurance, impacting ability to access health care Inability to afford co-pays or deductibles, resulting in delays in seeking medical care and avoidance of dental care Lack of access to specialty care for the uninsured (though access to primary care was identified by several interviewees through Salud Family Health Care Centers) People who are undocumented will be left uninsured under Health Care Reform as there will be no provision for them to access health insurance Limited access to sub-specialties at PVMC Limited selection of primary care providers for people with insurance
Needs among the senior/aging population were identified
Rapid growth of the low-income, senior population Lack of affordable services to support keeping frail elderly in their homes, despite this being the preferred and least expensive place for them to be Lack of access to affordable housing or assisted living facilities Lack of access to food and proper nutrition, resulting from minimal financial resources and/or lack of transportation to purchase healthy food as well as difficulty preparing healthy meals Loneliness and social isolation as seniors lose friends, family and others in their cohort Decline in general health status, including vision and hearing loss, arthritis, mobility issues, etc.
Some specific concerns regarding lower-income children/youth were identified
Eating habits and nutrition. Many kids are on the free and reduced meal program, and the only nutritious meal they eat is lunch at school, and possibly dinner if they also attend the Boys & Girls Club 8
Homelessness and transient living, as parents struggle with financial losses Lack of access to health care, including routine physicals Health care issues, such as asthma and allergies (including food allergies and life-threatening allergies). There are a lot of medically fragile children in the area due to the proximity to Children’s Hospital in Denver Childhood obesity Increased tobacco use among youth, resulting from advertising campaigns
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Introduction Background and Purpose Platte Valley Medical Center is a community-owned, nonprofit hospital governed by a community board of directors where decisions are made at the local level. The mission of Platte Valley Medical Center is to foster optimal health for all. Platte Valley Medical Center (PVMC) became the first private general medical-surgical hospital in Adams and Southern Weld Counties in 1960. For 47 years, Platte Valley Medical Center was located on seven acres at 18th and Bridge Street in Brighton. In 2007, Platte Valley Medical Center moved to a 50-acre campus at I-76 and 144th Avenue. Currently, the PVMC hospital campus includes a 78-bed patient tower, a diagnostics and treatment building, and a 58,319 square foot medical office building for physician offices and specialty services. The Affordable Care Act and IRS section 501(r)(3) direct tax exempt hospitals to conduct a Community Health Needs Assessment and develop an Implementation Strategy every three years. The Community Health Needs Assessment is a primary tool that identifies unmet community health needs. The assessment incorporates existing data analysis and input from the community that focus on the health needs of the service area. Service Area Platte Valley Medical Center is located at 1600 Prairie Center Parkway Brighton, Colorado 80601. The primary service area includes six communities in Adams County and Weld County, Colorado. Overall, these cities/zip codes make up 84.4% of the 2012 patient admissions at Platte Valley Medical Center. Platte Valley Medical Center Service Area City Zip Code County Brighton 80601*, 80602, 80603 Adams Commerce City 80022 Adams Ft. Lupton 80621 Weld Henderson 80640 Adams Hudson 80642 Weld Keenesburg 80643 Weld *Lochbuie is a statutory town that is located within zip code 80601
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Map of the Service Area
Consultant Melissa Biel of Biel Consulting conducted the Community Health Needs Assessment. Biel Consulting is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. Dr. Biel has over 10 years of experience conducting hospital Community Health Needs Assessments and is a specialist in the field of community benefit for nonprofit hospitals
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Methods Identification of Community Health Needs Secondary data are existing sources of data that were collected from a variety of local, county, and state sources to present community demographics, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, and health behaviors. Analyses were conducted at the most local level possible for the hospital service area, given the availability of the data. For example, some demographic data are based on zip codes or communities. Most of the Community Health Needs Assessment data are available by county. Sources of data include the 2010 U.S. Census, American Community Survey, Colorado Department of Public Health and Environment, Colorado Behavioral Risk Factor Survey, County Health Rankings, Uniform Data Set, and others. When pertinent, these data sets are presented in the context of Colorado State, framing the scope of an issue as it relates to the broader community. The report includes benchmark comparison data that measures PVMC community data findings with Healthy People 2020 objectives (Attachment 1). Healthy People 2020 objectives are a national initiative to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels. Input from Persons who Represent the Community Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by PVMC. Sixteen interviews were completed during September and October, 2012. For the interviews, community stakeholders identified by PVMC were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations, or regional, State or local health or other departments or agencies that have “current data or other information relevant to the health needs of the community served by the hospital facility”. A list of the stakeholder interview respondents, their titles, organizations and leadership roles can be found in Attachment 2. Information Gaps Information gaps that impact the ability to assess the PVMC service area health needs were identified. Most notably, there are limited sources for County level data. Some of the results of the Behavioral Risk Factor Survey and most of the Youth Risk Behavior Survey results are not available for Adams and Weld Counties as the sample size was 12
too small, which limits available data on chronic diseases and preventive health behaviors. Health Care Facilities and Community Resources A list of existing facilities and resources within the community that are available to meet identified community health needs are outlined in Attachment 3.
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Identification and Prioritization of Health Needs The health needs were identified from issues supported by primary and secondary data sources gathered for the Community Health Needs Assessment. Each health need was confirmed by more than one indicator or data source (i.e., the health need was suggested by more than one source of secondary or primary data). In addition, the health needs were based on the size of the problem (relative portion of population afflicted by the problem); or the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of a problem, the health need indicators identified in the secondary data were measured against benchmark data, specifically California state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. Additionally, primary data sources were asked to identify community and health issues based on the perceived size or seriousness of a problem. The identified health needs include: Access to health care Birth indicators (prenatal care, low birth weight) Cancer Cardiovascular disease Housing / homelessness Mental health Overweight and obesity Preventive care (immunizations, screenings) Smoking Transportation Unintentional injuries Prioritization Process Priority setting is a required step in the community benefit planning process. The IRS regulations indicate that the Community Health Needs Assessment must provide a prioritized description of the community health needs identified through the CHNA, and include a description of the process and criteria used in prioritizing the health needs. For the health needs prioritization process, Platte Valley Medical Center engaged a hospital leadership team to review the health needs using the following criteria: o Current area of hospital focus.
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o Established relationships with community partners to address the health need. o Organizational capacity and existing infrastructure to address the health need. Based on the criteria outlined above, the leadership team ranked each of the health needs using a “high/low” scale. Those health needs that were ranked “high” met the criteria. As a result of the priority setting process the identified priority health needs for PVMC are:
Access to care Cardiovascular disease Cancer
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Demographics Population The population of the Platte Valley Medical Center service area is 152,137. Total Population Platte Valley Service Area 152,137
Population Total population
Adams County
Weld County
434,295
248,441
Source: U.S. Census Bureau, American Community Survey, 2007-2011
Of the area population, 47% are male and 53% are female. Population by Gender Platte Valley Service Area 47.0% 53.0%
Gender Male Female
Adams County
Weld County
50.2% 49.8%
50.1% 49.9%
Source: U.S. Census Bureau, American Community Survey, 2007-2011
Children and youth, ages 0-17, make up 30.6% of the population; 62.1% are adults, ages 18-64; and 7.3% of the population are seniors, ages 65 and over. Population by Age Platte Valley Service Area 9.9% 20.7% 7.9% 31.5% 22.7% 7.3%
Age Ranges 0–4 5 – 17 18 – 24 25 – 44 45 – 64 65 and older
Adams County 8.8% 19.9% 9.4% 31.2% 22.4% 8.3%
Weld County 8.1% 19.9% 10.9% 27.8% 23.9% 9.4%
Source: U.S. Census Bureau, American Community Survey, 2007-2011
When the hospital service area is examined by community, Henderson has the highest percentage of youth, ages 0-17, at 34.1% and the smallest percentage of seniors (4.2%). Hudson has the smallest percentage of youth (23.6%). Ft. Lupton has the largest percentage of seniors (10.5%) in the service area. Population by Youth, Ages 0-17, Seniors, Ages 65+, and Median Age Geographic Area Brighton Brighton Brighton Commerce City Ft. Lupton Henderson Hudson
Zip Code 80601 80602 80603 80022 80621 80640 80642
Youth Ages 0 – 17 28.7% 32.7% 29.6% 32.0% 27.7% 34.1% 23.6%
Seniors Ages 65+ 8.5% 4.8% 7.6% 7.8% 10.5% 4.2% 6.3%
Median Age 32.4 32.6 34.1 30.3 33.0 29.5 41.5
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Geographic Area
Zip Code
Keenesburg Platte Valley Service Area Adams County Weld County
80643
Youth Ages 0 – 17 28.3% 30.6% 28.7% 28.0%
Seniors Ages 65+
Median Age 7.6% 7.3% 8.3% 9.4%
39.1 32.8 32.2 32.9
Source: U.S. Census Bureau, American Community Survey, 2007-2011
Race/Ethnicity In the PVMC service area, 55.9% of the population is White; 37.6% of the population is Hispanic/Latino; 2.3% are Asian; 1.6% is African American; and 2.6% are American Indian/Alaskan Native or other race/ethnicity. The PVMC service area has a smaller percentage of Whites (55.9%) and larger percentage of Hispanics or Latinos (37.6%) than are found in the state. Race/Ethnicity Platte Valley Service Area 55.9% 37.6% 2.3% 1.6% 0.7% 1.9%
Race/Ethnicity White Hispanic/Latino Asian Black/African American American Indian/Alaska Native Other
Adams County 53.2% 38.0% 3.5% 2.8% 0.6% 1.9%
Weld County
Colorado
67.6% 28.4% 1.1% 0.8% 0.6% 1.5%
70.0% 20.7% 2.7% 3.8% 0.6% 2.5%
Source: U.S. Census Bureau, 2010
When race and ethnicity are examined by place, the majority of the population in Commerce City is Hispanic or Latino (52%). In Keenesburg, 85.8% of the population is White, the highest in the service area. 6.5% of the population in Brighton 80602 is Asian. Race/Ethnicity by Place Geographic Area Brighton Brighton Brighton Commerce City Ft. Lupton Henderson Hudson Keenesburg
ZCTA 80601 80602 80603 80022 80621 80640 80642 80643
White 55.2% 72.0% 66.9% 41.4% 50.2% 54.5% 68.6% 85.8%
Hispanic Latino 40.2% 17.5% 28.6% 52.0% 46.7% 38.9% 17.7% 11.2%
Asian 1.3% 6.5% 1.3% 1.6% 0.9% 2.4% 0.8% 0.6%
Black 1.1% 1.3% 1.1% 2.8% 0.5% 1.7% 2.3% 0.3%
Source: Source: U.S. Census Bureau, 2010
Citizenship 8.5% of the population in the Platte Valley service area is not a U.S. citizen. This is a lower percentage than found in Adams County (10.8%) but higher than in Weld County (6.4%). 17
Citizenship Citizenship
Platte Valley Service Area
Not a Citizen
Adams County 8.5%
Weld County
10.8%
6.4%
Source: U.S. Census Bureau, American Community Survey, 2007-2011
Language The languages spoken at home by area residents mirror the racial/ethnic make-up of the Platte Valley Medical Center service area communities. English is spoken in the home among 74.4% of the service area population. Spanish is spoken at home among 22.5% of the population;1.3% of the population speaks an Indo-European language; and 1.4% of the population speak an Asian language at home. Language Spoken at Home for the Population 5 Years and Over Platte Valley Service Area Population 5 years and older 127,860 English only 74.4% Speaks Spanish 22.5% Speaks other Indo-European languages 1.3% Speaks Asian and Pacific Islander languages 1.4% Speaks other languages 0.4% Language
Adams County 396,285 72.4% 22.1% 2.3% 2.8% 0.5%
Weld County 228,321 81.8% 16.3% 1.0% 0.7% 0.2%
Colorado 4,624,055 83.3% 11.8% 2.4% 1.9% 0.6%
Source: U.S. Census Bureau, American Community Survey, 2007-2011
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Social and Economic Factors Social and Economic Factors Rankings The County Health Rankings ranks counties according to health factors data. Social and economic indicators are examined as a contributor to the health of a county’s residents. Colorado’s 64 counties are ranked according to social and economic factors with 1 being the county with the best factors to 64 for that county with the poorest factors. This Ranking examines: high school graduation rates, unemployment, children in poverty, social support, and others. Adams County is ranked 50, in the bottom quartile of all Colorado counties according to social and economic factors. Weld County is ranked as 34, placing it in the bottom half of all Colorado counties. Social and Economic Factors Rankings County Adams County Weld County
County Rankings (out of 64) 50 34
Source: County Health Rankings, 2013
Unemployment The unemployment rate in the hospital service area averaged over 5 years was 7.5%, which is slightly lower than the state rate of 7.6%. Employment Status for the Population 16 and Over, 2007-2011 Unemployed
Unemployment Rate
73,419
5,473
7.5%
Adams County
231,794
21,106
9.1%
Weld County
128,072
8,561
6.7%
2,679,446
203,279
7.6%
Geographic Area Platte Valley Service Area
Colorado
Civilian Labor Force
Source: U.S. Census Bureau, American Community Survey, 2007-2011
Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2011, the federal poverty level (FPL) for one person was $10,890 and for a family of four $22,350. Among the residents in the Platte Valley Medical Center service area, 10.3% are at or below 100% of the federal poverty level (FPL) and 27.0% are at 200% of FPL or below. These rates of poverty are lower than found in the state where 12.5% of residents are at poverty level and 29% are at 200% of FPL or below.
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Poverty Levels Platte Valley Adams County Service Area 10.3% 14.0% 27.0% 33.4%
Poverty Level 30), 2009-2010 Geographic Area
Percent
Adams County
24.2%
Weld County
24.7%
Colorado
19.9%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
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Adults Physical Activity The CDC recommendation for adult physical activity is moderate activity equal to or greater than 150 minutes in a week or vigorous activity equal to or greater than 60 minutes a week. In Adams County, 51.8% of adults meet the physical activity recommendation. 49.9% of adults are moderately active in Weld County. Moderately Physically Active, Adults, 2007 & 2009 Geographic Area
Percent
Adams County
51.8%
Weld County
49.9%
Colorado
55.9%
Source: Colorado Department of Public Health and Environment, Colorado Health Indicators, 2007 and 2009
22.3% of adults in Adams County are sedentary and do not participate in any leisure time physical activity. 19.2% of adults in Weld County are sedentary. Sedentary Adults, 2008-2010 Geographic Area Adams County
Percent 22.3%
Weld County
19.2%
Colorado
18.3%
Source: Colorado Department of Public Health and Environment, Colorado Health Indicators, 2008-2010
Youth Physical Activity The CDC recommendation for youth physical activity is 60 minutes or more each day. 34.4% of Adams County youth ages 5 to 14 met this activity recommendation on 7 of the past 7 days, just slightly higher than the state rate of 33.8%, which was slightly higher than Weld County's achievement of 33.3%. Youth Physical Activity, Ages 5-14, 2009-2010 Geographic Area
Percent
Adams County
34.4%
Weld County
33.3%
Colorado State
33.8%
Source: Colorado Department of Public Health and Environment, Colorado Health Indicators, 2009-2010
Recreational Facilities Proximity to recreational facilities can increase physical activity in a community. The number of recreational facilities per 100,000 residents in Adams County is 4.5 and in Weld County it is 9.4. The state has 11 recreational facilities per 100,000 persons. 40
Access to Recreational Facilities, per 100,000 Persons, 2010 Geographic Area
Rate
Adams County Weld County Colorado
4.5 9.4 11
Source: County Health Rankings, 2013
Access to Parks The percentage of people living within one-half mile of a park in Adams County is 66%. In Weld County, 52% of the population lives within one-half mile of a park. Access to Parks, 2010 Geographic Area
Percent
Adams County Weld County Colorado
66% 52% 60%
Source: County Health Rankings, 2013
Fast Food The percentage of restaurants in Adams County that are fast food restaurants is 56%. 49% of Weld County restaurants are fast food restaurants. In the state, 45% are fast food restaurants. Fast Food Restaurants, 2010 Geographic Area
Percent 56% 49% 45%
Adams County Weld County Colorado Source: County Health Rankings, 2013
Fresh Fruits and Vegetables The CDC recommends eating five servings of fruits and vegetables a day. 22.8% of adults in Adams County and 26.5% in Weld County ate the recommended daily amount of fruits and vegetables. Consumption of Fruits and Vegetables, Adults, 2009-2010 Geographic Area
Percent
Adams County Weld County Colorado
22.8% 26.5% 24.9%
Source: Colorado Department of Public Health and Environment, Colorado Health Indicators, 2009-2010
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Smoking The percentage of adults, 18 and over, in Adams County who smoke cigarettes is 20.4%, and in Weld County it is 19%. These rates are higher than the state (16.2%). Adult Smokers, 2009-2010 Geographic Area
Percent
Adams County
20.4%
Weld County
19.0%
Colorado
16.2%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
Physical or Mental Unhealthy Days The average number of physically unhealthy days experienced by adults in Adams County in the last 30 days was 3.3 days. Adams County adults experienced 3.5 mentally unhealthy days a month. In Weld County, adults experienced an average of 3.1 physically unhealthy days and 3.3 mentally unhealthy days a month. Physical or Mental Unhealthy Days in Previous 30 Days, Adults, 3-Year Average Geographic Area
Physically Unhealthy Days
Mentally Unhealthy Days
Adams County
3.3
3.5
Weld County
3.1
3.3
Colorado
3.1
3.2
Source: Colorado Department of Public Health and Environment, Colorado Health Indicators, 2008-2010
Inadequate Social Support The percentage of the adult population that indicated they have no social or emotional support was 19% in Adams County and 17% in Weld County. Frequent Mental Distress, Adult, 5-Year Average Geographic Area
Percent
Adams County
19%
Weld County
17%
Colorado
17%
Source: County Health Rankings, 2013
Adult Alcohol Use Binge drinking is defined as consuming five or more drinks on one occasion for men and four or more for women. 17.5% of adults in Adams County and 16.2% in Weld County engaged in binge drinking in the past month.
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Binge Drinking, Adults, 2009-2010 Geographic Area Adams County
Percent 17.5%
Weld County
16.2%
Colorado
16.2%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
Flu Shots Over three-quarters (78.6%) of seniors have obtained a recommended flu shot in Adams County and 73% in Weld County. This is lower than the Healthy People objective of 90%. Flu Shots, Adults 65+, received in the past 12 months Geographic Area
Percent
Adams County
78.6%
Weld County
73.0%
Colorado
76.5%
Source: Colorado Department of Public Health and Environment, 2008-2010
Pneumonia Vaccination The pneumonia vaccination rate among seniors in Adams County is 74.7% and 74.2% in Weld County. These rates of vaccination are higher than the state (73.2%) but less than the recommended Healthy People 2020 objective of 90%. Pneumonia Vaccine, Adults 65+ Geographic Area
Percent
Adams County
74.7%
Weld County
74.2%
Colorado
73.2%
Source: Colorado Department of Public Health and Environment, 2008-2010
Pap Smears Among women 18 years and older, 89.6% in Adams County and 94.4% in Weld County had a Pap smear. The rate in Adams County is lower than the recommended Healthy People 2020 objective of 93%. Pap Smears, Women 18+, 2009-2010 Geographic Area
Percent
Adams County
89.6%
Weld County
94.4%
Colorado
92.3%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
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Mammograms 55.5% of women over 40 years old in Adams County and 64.2% in Weld County had a screening mammogram in the last two years. This is below the state rate (67%) and the Healthy People 2020 objective of 81.1%. Mammogram in Last Two Years, Women 50+, 2009-2010 Geographic Area
Percent
Adams County
55.5%
Weld County
64.2%
Colorado
67.0%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
Colorectal Cancer Screening In Adams County, 60.9% of adults 50 years and older have been screened for colorectal cancer. In Weld County, 64% of adults 50 years and older have been screened for colorectal cancer. This rate is below the state rate (66.1%) and the Healthy People 2020 objective of 70.5%. Colorectal Cancer Screening, Adults 50+ Geographic Area
Percent
Adams County
60.9%
Weld County
64.0%
Colorado
66.1%
Source: Colorado Department of Public Health and Environment, CoHiD; Behavioral Risk Factor Surveillance System - BRFSS, 2009-2010
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Interview Results Sixteen telephone interviews were completed for the Platte Valley Medical Center (PVMC) Community Health Needs Assessment, conducted during September-October, 2012. Interview participants included representatives from the City of Brighton and Brighton School District; health organizations such as a Federally Qualified Health Center (FQHC), local health departments, private practice providers and PVMC; mental health provider organizations; a local community college; and organizations that address a wide range of needs, including services for seniors/aging, youth, and homeless. The interviewees spoke to issues and needs in the PVMC service area. Attachment 2 lists the interview participants and their organizational affiliations. Interview Topics Interview participants were asked to share their perspectives on a number of topics, including:
Biggest issues or concerns facing the community and causes of these issues Existing and needed actions/activities to address community issues Recent shifts in population demographics Impact of the economy on organizational budgets and/or services Challenges people face in obtaining health care and/or social services and suggested strategies to facilitate access Barriers to care for chronic disease prevention and treatment Preventive measures used to manage chronic disease and services/resources used for care and education Needed services for women’s health
Biggest Issues or Concerns in the Community Community issues/concerns that were identified included issues that cut across all population groups as well as some issues of greatest concern within specific communities or sub-populations. The community-wide issue most frequently mentioned was the declining economy and its impact on the community, including:
Large numbers of low-income children/youth, adults and seniors Unemployment, layoffs, and concern about jobs and wages Loss of housing due to the high foreclosure rate, resulting in increased homelessness and transience among families Difficulty accessing basic needs, such as food, clothing and housing, and a doubling of requests for food and income assistance requests to the Adams County Human Services Department 45
Substance abuse and mental health issues, including depression, stress, marital/relationship problems, family issues, trauma, and PTSD Difficulty accessing legal assistance for low-income and immigrant populations
Regarding access to health care, several of the concerns were related to the economy/income/ employment status of people in the area, while others extended to the insured population as well. Concerns related to health care access included:
Lack of or loss of health insurance, impacting ability to access health care Inability to afford co-pays or deductibles, resulting in delays in seeking medical care and avoidance of dental care Lack of access to specialty care for the uninsured (though access to primary care was identified by several interviewees through Salud Family Health Care Centers) People who are undocumented will be left uninsured under Health Care Reform as there will be no provision for them to access health insurance Limited selection of primary care providers for people with insurance
Needs among the senior/aging population were identified
Rapid growth of the low-income, senior population Lack of affordable services to support keeping frail elderly in their homes, despite this being the preferred and least expensive place for them to be Lack of access to affordable housing or assisted living facilities Lack of access to food and proper nutrition, resulting from minimal financial resources and/or lack of transportation to purchase healthy food as well as difficulty preparing healthy meals Loneliness and social isolation as seniors lose friends, family and others in their cohort Decline in general health status, including vision and hearing loss, arthritis, mobility issues, etc.
Some specific concerns regarding lower-income children/youth were identified
Eating habits and nutrition. Many kids are on the free and reduced meal program, and the only nutritious meal they eat is lunch at school, and possibly dinner if they also attend the Boys & Girls Club Homelessness and transient living situations, as parents struggle with financial losses Lack of access to health care, including routine physicals
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Health care issues, such as asthma and allergies (including food allergies and life-threatening allergies). There are a lot of medically fragile children in the area due to the proximity to Children’s Hospital in Denver Childhood obesity Increased tobacco use among youth, resulting from strategic advertising campaigns
Causes of these issues were identified
Economy and economic recession resulting in job losses and huge foreclosure rates in the community Harder for people with challenges (e.g., felony background or a disability) to find work due to decrease in job availability overall Lack of education or limited educational background among some in the community Not knowing what services and resources are available or how to find them Fear/discomfort of asking for help due to shame about having needs Cuts in grant funding for seniors Insufficient assisted living facilities that accept Medicaid Societal changes where both parents are working, leaving children to fend for themselves, make their own food choices or treat their medical problems
Existing and Needed Actions/Activities to Address Community Issues The interview participants identified a number of strategies that are being employed by local organizations to help address the community’s increased needs
Boys & Girls Club of Brighton is educating and engaging with families to let them know about available services and resources, and working to increase their comfort levels about asking for help City, college community, private sector, hospitals and government agencies are reaching out to citizens more than in the past, providing better information about local resources and services Pennock Center for Counseling is providing counseling services to uninsured people, regardless of ability to pay City of Brighton is providing more information to the public on issues related to foreclosures in partnership with the Chamber Weld County Health Department is participating in the North Colorado Health Alliance, which has prioritized obesity and social/emotional wellness through its Community Health Improvement Plan
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Brighton School District 27J has developed a Wellness Policy and Wellness Committee for students. They changed the lunch program to reduce fat and sodium as strategies to reduce obesity. The School District is also providing more physical education and an annual health fair for students Community Reach Center has expanded services beyond their focus on mental health to include more case management for clients, including assistance with linkages to resources and government programs (e.g., food stamps and Medicaid applications) Career fairs (led by Chamber) Health Fairs (led by Nine News) Nonprofits and health clinics, including Salud Family Health Center and Almost Home, are providing low-income people with assistance on various needs, including food, clothing, health care and housing (Section 8) Tri-County Health Department is working with cities to increase walking and cycling, as well as to promote community gardens Private providers (e.g., Premiere Pediatrics) offering sliding fee scales and prompt-pay discounts
Several interviewees noted outreach that PVMC has engaged in to better serve the community
Publicizing services via newspaper and emails, so community organizations/institutions are better able to link residents to PVMC services Reaching out to the City of Brighton with education and prevention information Helping rural areas and outlying clinics to set up their offices and also offering grant writing assistance Offering flu clinics and classes at no cost to the public Offering discounts to seniors in the hospital cafeteria/restaurant Serving people in their emergency room with non-emergency issues
In response to the question of what else needs to be done, or what some possible solutions to the issues/concerns facing the community might be, interviewees suggested the following:
Keep listening to community needs and reaching out Better support is needed from governmental organizations for senior services to support people being cared for in their homes versus in more costly, institutional settings Create more access to specialty care for the uninsured, perhaps through econsult or phone consults 48
We need the economy and job market to turn around Provide a comprehensive health education program for students in Brighton School District 27J, which is currently fragmented and only minimally effective, to meet the State’s recently adopted health education standards Provide workshops to help prepare people with less than a high school education for jobs Work at the policy, systems and environmental levels to create sustainable changes to the community that support healthy lifestyles (i.e., the Adams County Open Space Plan seeks to designate more open space for places to play and be outdoors) Build an integrated model at PVMC that includes the primary care providers and encourages coordination among them Agencies should take their services out to the community; this can be challenging from a staffing perspective, but is a community need Help link people to services by making personal connections for referrals
This question also led some participants to identify additional community needs that need to be addressed
Substance abuse treatment services Inpatient and outpatient psychiatric services (there is no psychiatrist in Brighton) Bilingual therapists/counselors (Spanish speaking) Affordable housing
Recent Shifts in Population Demographics The most frequently mentioned shifts in population demographics were:
Growing older adult population, including a segment of very low-income older adults. Large and growing Latino population, including a segment of very low-income, monolingual Spanish-speaking group with low education levels Growing numbers of people who are economically unstable o Increase in uninsured, working poor o Increased risk of losing home and homelessness o Decrease in number of insured patients in private practice settings, and more who are self-pay or Medicaid o Increased number of uninsured patients in the emergency room o Larger numbers of homeless children in the school district o Increased numbers of children on free and reduced lunch program
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o Doubling of people seeking assistance for basic needs from Adams County Other population shifts that were identified included:
Decrease in migrant seasonal farm workers, as there is less agricultural work in the area Increased population as a result of recent past housing boom Addition of seven new schools over eight years in Brighton School District 27J due to population increases Significant increase in numbers of children in the School District with a diagnosed health condition and in numbers of children taking medications or with “delegated procedures” that occur during the school day (e.g., taking insulin) and that require nurse supervision Increase in number of children referred for mental health services due to disruptive behaviors from schools and probation departments High rates of childhood obesity
Impact of the Economy on Organizational Budget and/or Services While a number of organizations reported no layoffs, they also reported that vacated positions were not being filled, leaving the remaining employees to do the work of several people. This was particularly difficult when the demand for services also increased, such as at the Adams County Human Services Department, or Brighton School District 27J. The Brighton School District student census has increased dramatically, but there has been no concurrent increase in the number of teachers or school health staff. As a result, student to teacher ratios have increased and health services have become more global and less individualized. Several interviewees said they “felt fortunate” because they had not had to reduce services in a noticeable way. Others, however, have suffered from cuts from government-funded programs and have reduced programs and services accordingly, while seeking other resources to replace the losses. This was particularly the case for the FQHC (Salud Family Health Center) and the two health departments. Salud said it is challenging to fund prevention and education programs. Weld County Health Department noted that their policy is that as funding goes away, so does the program, and they will offer fewer low-cost immunizations as the State reduces the vaccine it provides. Almost Home, a human services organization that runs a shelter for homeless families and affordable housing units as well as provides rent and utility assistance, reflected that demand has greatly exceeded their capacity. People needing rent and utility 50
assistance has “gone through the roof.” There have been cuts in state, county and federal programs along with reduced charitable giving within the community. The result is that they are only able to assist one in 12 families that contact them. Challenges in Obtaining Services and Suggested Strategies to Facilitate Access Stakeholders were asked to identify problems or challenges that the people in their community and/or are served by their agency face in obtaining health care and/or social services. Several interviewees mentioned they were grateful for the availability of the local FQHC, Salud Family Health Center. Some barriers to primary care were still noted, including:
Transportation Payment still required Can be difficult to get in
Other barriers that were identified
Cost and lack of insurance, resulting in people neglecting preventive care and seeking care only when sick or very sick, both for themselves and their children High deductibles and co-pays that can be prohibitive for those with insurance Lack of affordable dental care for people of all ages, including children and seniors Lack of affordable mental health services, noted particularly for seniors Lack of specialty care services for the uninsured Language, including primarily Spanish but also some growing need for Asian languages and Somali Difficulty understanding billing processes and insurance statements. It is sometimes hard for people to distinguish what is a bill and when a payment is required Difficulty navigating the bureaucracy of application processes for social services and Medicaid, resulting in people sometimes getting frustrated and giving up. This was identified particularly as a concern for seniors Transportation, particularly for seniors who may need intensive services (e.g., radiation therapy) but do not have family or friends available who can provide transportation Working poor are ineligible for Medicaid, but are often living paycheck to paycheck and do not make enough money to purchase health insurance, and so have to prioritize among paying for health care or for food. It was noted that some people use 60-70% of their income for housing, leaving very little for any other needs 51
Although the hospital offers a discounted rate for low-income, uninsured people who seek services in the emergency room, the discounted rates may still be a struggle for them financially and they are accountable for payment
When asked what would make it easier for people to obtain services, several interview participants mentioned that implementation of the Affordable Care Act will facilitate access to health care insurance for many who are currently uninsured. Suggestions for addressing barriers to care also included:
Bring services to places where people feel comfortable (e.g., trusted nonprofits, schools, churches) Encourage specialty care providers to offer sliding fee scales to facilitate access to specialty care for the uninsured Transportation assistance Centralize information and referrals, so people could call or access one location to help steer/guide them to appropriate services and all services are available in a centralized resource directory Provide a “medical friend/advocate” to people who have barriers to accessing services (e.g., seniors, people who lack education or speak other languages) to help explain things and support people in keeping their appointments Offer a nurse advice line for people to call with medical questions Facilitate access to Medicaid enrollment by offering it at schools and WIC offices Support a school-based health center to offer primary care, mental health and Medicaid enrollment for students Increase number of nurses at Brighton School District and increase hours of health aides to one full-time aide per school to better support the growing and complicated health needs of students Extend hours of health care providers to evenings and weekends so families can access more affordable services without having to miss work, or use the emergency department
Chronic Health Conditions: Barriers to Prevention, Treatment and Management The reported barriers to care, treatment and management of chronic health conditions included:
Lack of health insurance Cost of services and medications for the uninsured Cost of co-pays for people with insurance (an example was provided where a copay of $35 was prohibitive for a family whose son needed care)
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Economic barriers associated with missing work to attend doctor’s appointments or prioritizing between care/medications and other basic needs (e.g., housing, food). A participant from a private practice medical group said, “People are just trying to avoid the cost of a medical visit.” Transportation within the somewhat rural area where distances can be a barrier Lack of orientation to prevention services Language barriers Difficulty in finding funding for meaningful education to help people understand and manage their chronic disease(s), including development of self-management goals through individual or group contacts/sessions. These are not billable services at this time, though there is hope that the Affordable Care Act may include sustainable reimbursement for this kind of prevention/management education Lack of knowledge regarding the services that are available Lack of access to healthy food or physical activity opportunities Lack of education/knowledge about the proper nutrition and diet needed for diabetics beyond the simple “don’t eat sugar” Lack of coordination or integration within the medical community, and lack of medical homes
What People Do to Prevent/Manage Chronic Health Conditions Several interview participants said that many people do not do anything to help prevent/manage their chronic health condition(s) until there is a consequence or complication, and then they visit the emergency room. Several interviewees also expressed skepticism about whether people with chronic conditions see a doctor regularly and follow-through with their recommendations, including medications. In the case of seniors who may have cognitive impairment, they may get confused with so many medications to take, and if they don’t have a family member to help them manage their health, they likely do not comply with physician recommendations. The Salud Family Health Center offers health educators at the clinic to help patients learn more about and manage their chronic conditions (e.g., how to read food labels). They are also able to offer lower-cost medications through their pharmacy program for their patients and encourage patients to return to their providers to monitor their health status indicators. One interview participant said that people try to be active and make changes to their diet, while another said that it’s, “personal choice… some people embrace it and go to nutrition classes, watch what they eat, and talk with their friends about it, while others just don’t.” 53
Chronic Disease Health Care Services, Education Programs and Materials Several of the health care providers said they provide health education, including:
The FQHC provides health education and is looking to use Electronic Health Record “Meaningful Use” goals to focus on patient education through a recommended software program in Spanish and English Weld County Health Department has a health education team that includes Registered Dieticians for diabetes education classes, and also offers screenings for cholesterol and to identify risk factors. The community’s interest in the free screenings and classes has exceeded their capacity for service PVMC provides diabetes education for the community, and physicians provide education to their patients Premiere Pediatrics offers information about disease management for patients on their website and through pamphlets as a way to reach and accommodate some of their patients who have difficulty affording visits to the doctor
Other mechanisms by which people are getting information to help them learn more about and manage their chronic diseases included:
Presentations at organizations (e.g., Eagle View Adult Center), provided by PVMC staff Brochures and pamphlets offered at a number of locations Information provided through the PVMC email distribution list, which is then shared with clients Internet/web-based resources Employee Wellness Program at City of Brighton Educational programs that promote healthy lifestyles offered at local organizations, including the YMCA and WIC
Women’s Health Services Needed Interview participants were asked what services are needed in the community to better serve the health needs of women. Several people noted the high-level resources available for insured women at PVMC as well as the development of the Women’s Services Program at the hospital and outreach PVMC is doing through events such as Ladies Nights. Women’s health needs identified included:
Availability/accessibility of cancer screening resources (mammograms, Pap smears) for low-income, uninsured women as well as follow-up services if a problem is detected. This was also mentioned as big concern for college-age
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women and Latina women. Funding for this resource is capped and not sufficient to meet community need Obesity prevention to reduce heart disease and diabetes, including education for women on how to shop, read labels, and cook healthfully for themselves and their families as well as physical activity opportunities that are safe for women and children Sex education and family planning services for teens and young adults Support for new mothers, including lactation/breastfeeding support and education about post-partum issues. The Nurse-Family Partnership model was identified as a successful program that includes home visits and support for new families
Comments/Other At the close of the interview, participants were given an opportunity to share any final thoughts or comments. Several participants requested a copy of the final Community Health Needs Assessment report. A number of people expressed appreciation for PVMC and its services:
PVMC is a great resource for the community and doing the 9 Health Fair has been a great way to link people to services PVMC is always willing to come out to community organizations and present on health topics and they also help by teaching exercise classes and offering flu clinics PVMC is doing a great job of offering a variety of different services, particularly in Brighton Hospital employees are accessible and helpful
Some suggestions for improvements included:
Bring services out to community locations, where families tend to congregate Educate community organizations more about PVMC services, so they can better refer their families Doctors often refer pediatric patients to Children’s Hospital because PVMC does not have any certified pediatric nurses, whereas providers and families would prefer to keep them in the community and refer them to PVMC
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Attachment 1. Benchmark Comparisons Where data are available, health and social indicators in Adams County and Weld County are compared to the Healthy People 2020 objectives. The bolded items are indicators in the counties that do not meet established benchmarks; non-bolded items meet or exceed benchmarks. Service Area County Data
Healthy People 2020 Objectives
High School graduation rate Adams - 65%; Weld - 77% Child health insurance rate Adams - 85.7%; Weld - 90.9% Adult health insurance rate Adams - 72.9%; Weld - 79.6% Heart disease deaths Adams - 146.3 per 100,000; Weld - 151.7 per 100,000 Cancer deaths Adams - 163.5 per 100,000; Weld - 152.7 per 100,000 Breast cancer deaths Adams - 12.7 per 100,000; Weld - 11.6 per 100,000 Colorectal cancer deaths Adams - 13.0 per 100,000; Weld - 9.7 per 100,000 Stroke deaths Adams - 39.5 per 100,000; Weld - 32.7 per 100,000 Diabetes deaths Adams - 21.7 per 100,000; Weld - 19.7 per 100,000 Unintentional injury deaths Adams - 45.8 per 100,000; Weld - 49.9 per 100,000 Suicides Adams -14.6 per 100,000; Weld - 14.2 per 100,000 Drug-related deaths Adams - 20.2 per 100,000; Weld - 13.5 per 100,000 HIV/AIDS deaths Adams - 1.3 per 100,000; Weld - 1.8 per 100,000 Early prenatal care Adams - 76.2% of women; Weld – 77.9% of women Low birth weight infants Adams - 8.4% of live births; Weld - 8.3% of live births Infant death rate Adams - 6.0 per 1,000 live births; Weld - 7.5 per 1,000 live births Persons unable to obtain medical care Adams - 16%; Weld - 16% Adult obese Adams - 24.2%; Weld - 24.7% Adults who are sedentary Adams - 22.3%; Weld - 19.2% Adults 50+ who receive colorectal cancer screening Adams - 60.9%; Weld - 64% Women mammogram in the last two years Adams - 55.5%; Weld - 64.2% Seniors who received pneumococcal vaccination Adams - 74.7%; Weld - 74.2% Adults engaging in binge drinking Adams - 17.5%; Weld - 16.2% Cigarette smoking by adults Adams - 20.4%; Weld - 19%
High School graduation rate 84% Child health insurance rate 100% Adult health insurance rate 100% Heart disease deaths 100.8 per 100,000 Cancer deaths 160.6 per 100,000 Breast cancer deaths 20.6 per 100,000 Colorectal cancer deaths 14.5 per 100,000 Stroke deaths 33.8 per 100,000 Diabetes deaths 65.8 per 100,000 Unintentional injury deaths 36.0 per 100,000 Suicides 10.2 per 100,000 Drug-related deaths 11.3 per 100,000 persons HIV/AIDS deaths 1.6 per 100,000 persons Early prenatal care 78% of women Low birth weight infants 7.8% of live births Infant death rate 6.0 per 1,000 live births Persons unable to obtain medical care 4.2% Adult obese 30.6% Adults who are sedentary 32.6% Adults 50+ who receive colorectal cancer screening 70.5% Women who had a mammogram based on guidelines - 81.1% Seniors who received pneumococcal vaccination 90% Adults engaging in binge drinking 24.3% Cigarette smoking by adults 12%
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Attachment 2. Platte Valley Medical Center Interview Respondents Name 1 Karen Borkowski 2 Patty Boyd 3 4 5 6
7 8 9 10 11
Elizabeth Clark Sue Corbett Kathryn Hoch, MD Cindy Kronauge & Deborah Drew
Human Resources Director Program Manager, Communities Putting Prevention to Work School Nurse Supervisor Manager OB/GYN Data Analyst & Director of Public Health Services
Diana Long
Program Assistant
Terry Moore Jennifer Morse
Executive Director Development Director
Jody Pierce
Executive Director
Kirk Quackenbush, MD
12 Monica Roers 13 14 15 16
Title
Dan Ruybal Sharon Saba Matthew Shirley Howard Yeoman
Director of Emergency Department & Chief of Staff Director of SelfSufficiency and Adult Services Branch Director Practice Administrator Program Manager Executive Director
Organization City of Brighton Human Resources Department Tri-County Health Department (Adams, Arapahoe and Douglas Counties) Brighton School District 27J Eagle View Adult Center Alcott Women’s Center Weld County Health Department Front Range Community College Almost Home Salud Family Health Center Pennock Center for Counseling Platte Valley Medical Center Adams County Human Services Department Boys & Girls Club of Brighton Premiere Pediatrics Community Reach Center The Senior Hub
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Attachment 3. Health Facilities and Other Community Resources A partial listing of community assets Health Facilities
Hospitals o Anschutz Cancer Pavilion o Children’s Hospital of Colorado o Good Samaritan Medical Center o North Suburban Medical Center o Platte Valley Medical Center o Saint Anthony North Hospital o University of Colorado Hospital Clinics o Clinica Campesina o Commerce City Community Health Services o Metro Community Provider Network o Salud Family Health Center Public Health Facilities o Tri-County Health Department o Weld County Health Department
Other Community Resources Additional resources can be accessed at: https://211colorado.communityos.org/cms/home and http://www.unitedway-weld.org/ o o o o o o o o o o o o o o
A Woman’s Place Almost Home Alternatives to Family Violence Boys & Girls Club of Brighton CASA Community Reach Center Eagle View Adult Center Educational Opportunity Center Front Range Community College Pennock Center for Counseling Project Safeguard St. Augustine Community Food Pantry The Senior Hub Via Mobility
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