MEMORIAL HERMANN REHABILITATION HOSPITAL — KATYMemorial Hermann Rehabilitation Hospital Katy...

2019 Community Health Needs Assessment

MEMORIAL HERMANN REHABILITATION HOSPITAL — KATY

HEALTHINSURANCE

Board Approved June 27, 2019

MemorialHermannRehabilitationHospitalKatyCHNA20192

Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Introduction&Purpose...............................................................................................................................4SummaryofFindings...................................................................................................................................4PrioritizedAreas..........................................................................................................................................5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 MemorialHermannRehabilitationHospitalKaty........................................................................................6

Vision.......................................................................................................................................................6MissionStatement...................................................................................................................................6MemorialHermannHealthSystem.........................................................................................................6MemorialHermannRehabilitationHospitalKatyServiceArea...............................................................7

Consultants..................................................................................................................................................8

Evaluation of Progress Since Prior CHNA .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 PriorityHealthNeedsandImpactfromPriorCHNA....................................................................................9

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Overview....................................................................................................................................................11SecondaryDataSources&Analysis...........................................................................................................11

SecondaryDataScoring.........................................................................................................................11DisparitiesAnalysis................................................................................................................................12

PrimaryDataMethods&Analysis.............................................................................................................12CommunitySurvey.................................................................................................................................12KeyInformantInterviews.......................................................................................................................14

DataConsiderations...................................................................................................................................16Race/EthnicGroupings..........................................................................................................................17ZipCodesandZipCodeTabulationAreas..............................................................................................17

Prioritization..............................................................................................................................................17PrioritizationProcess.............................................................................................................................17

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Population..................................................................................................................................................20Age.............................................................................................................................................................21Language....................................................................................................................................................24SocialandEconomicDeterminantsofHealth............................................................................................26

Income...................................................................................................................................................26Poverty...................................................................................................................................................27FoodInsecurity......................................................................................................................................30Unemployment......................................................................................................................................31Education...............................................................................................................................................32Transportation.......................................................................................................................................34SocioNeedsIndex®.................................................................................................................................36

Data Synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Priorit ized Signif icant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 PrioritizationResults..................................................................................................................................44AccesstoHealthcare..................................................................................................................................44EmotionalWell-Being................................................................................................................................55


FoodasHealth...........................................................................................................................................59ExerciseIsMedicine...................................................................................................................................65

Non-Prioritized Significant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 OlderAdultsandAging..............................................................................................................................71Cancers......................................................................................................................................................72Education...................................................................................................................................................72Transportation...........................................................................................................................................73Children’sHealth.......................................................................................................................................74Economy....................................................................................................................................................75

Other Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 BarrierstoCare..........................................................................................................................................77Disparities..................................................................................................................................................77

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 AppendixA:EvaluationSincePriorCHNA.................................................................................................81AppendixB.SecondaryDataMethodology...............................................................................................89AppendixC.PrimaryDataMethodology.................................................................................................152AppendixD.PrioritizationTool................................................................................................................167AppendixE.CommunityResources.........................................................................................................170


Executive Summary

Introduction & Purpose MemorialHermannRehabilitationHospitalKaty(MHRehabKaty)ispleasedtopresentits2019CommunityHealthNeedsAssessment(CHNA).ThisCHNAreportprovidesanoverviewoftheprocessandmethodsusedtoidentifyandprioritizesignificanthealthneedsacrossMemorialHermannHealthSystem’sregionalservicearea(includingMHRehabKaty),asfederallyrequiredbytheAffordableCareAct.MemorialHermannHealthSystempartneredwithConduentHealthyCommunitiesInstitute(HCI)toconducttheCHNAfor13facilities:

• MemorialHermannKatyHospital• MemorialHermannMemorialCityMedicalCenter• MemorialHermannGreaterHeightsHospital• MemorialHermannNortheastHospital• MemorialHermannSoutheastHospital• MemorialHermannSugarLandHospital• MemorialHermannSouthwestHospital• MemorialHermannTheWoodlandsMedicalCenter• MemorialHermannRehabilitationHospital–Katy• MemorialHermann–TexasMedicalCenter• TIRRMemorialHermann• MemorialHermannSurgicalHospitalKingwood• MemorialHermannSurgicalHospitalFirstColony

ThepurposeofthisCHNAistoofferacomprehensiveunderstandingofthehealthneedsinMHRehabKaty’sserviceareaandguidethehospital’splanningeffortstoaddressthoseneeds.Specialattentionhasbeengiventotheneedsofvulnerablepopulations,unmethealthneedsorgapsinservices,andinputfromthecommunity.TostandardizeeffortsacrosstheMemorialHermannHealthSystemandincreasethepotentialforimpactingtophealthneedsinthegreaterHoustonregion,communityhealthneedswereassessedandprioritizedataregional/systemlevel.Findingsfromthisreportwillbeusedtoidentifyanddevelopeffortstoimprovethehealthandqualityoflifeofresidentsinthecommunity.

Summary of Findings TheCHNAfindingsinthisreportresultfromtheanalysisofanextensivesetofsecondarydata(over100indicatorsfromnationalandstatedatasources)andprimarydatacollectedfromcommunityleaders,non-healthprofessionals,andorganizationsservingthecommunityatlarge,vulnerablepopulations,and/orpopulationswithunmethealthneeds.Throughanexaminationoftheprimaryandsecondarydata,thefollowingtophealthneedswereidentified:


Priorit ized Areas InMarch2019,stakeholdersfromthe13hospitalfacilitiesintheMemorialHermannHealthSystemcompletedasurveytoprioritizethesignificanthealthissues,basedoncriteriaincludinghealthimpactandriskaswellasconsiderationofMemorialHermann’sstrategicfocus.Thefollowingfourtopicswereidentifiedasprioritiestoaddress:

MHRehabKatywilldevelopstrategiestoaddresstheseprioritiesinits2019ImplementationStrategy.

MemorialHermannHealthSystem’sSignificantHealthNeeds• AccesstoHealthServices•Cancers•Children’sHealth•Diabetes•Economy

•Education•FoodInsecurity•HeartDisease/Stroke•LackofHealthInsurance•Low-Income/Underserved

•MentalHealth•Obesity•OlderAdults/Aging•SubstanceAbuse•Transportation

MemorialHermannHealthSystem’sCHNAPriorities• AccesstoHealthcare• EmotionalWell-Being• FoodasHealth• ExerciseIsMedicine


Introduction

Memorial Hermann Rehabil itation Hospital Katy MemorialHermannRehabilitationHospital–Katyoptimizespatientresultsthroughacustomizedapproachatits35-bedfacility.Theteamofaffiliatedphysiciansandcliniciansworkwithpatientsandtheirfamiliestosetgoalstailoredtotheirindividualneeds.TheseadvancedtreatmentserviceshavereceivedaccreditationfromtheCommissiononAccreditationofRehabilitationFacilities(CARF)andarebackedbyanaffiliationwithTIRRMemorialHermann,anationalleaderinrehabilitationmedicineandMcGovernMedicalSchoolatUTHealth.

Vision MemorialHermannwillbethepreeminenthealthsystemintheU.S.byadvancingthehealthofthoseweservethroughtrustedpartnershipswithphysicians,employeesandotherstodeliverthebestpossiblehealthsolutionswhilerelentlesslypursuingqualityandvalue.

Mission Statement MemorialHermannisanot-for-profit,community-owned,healthcaresystemwithspiritualvalues,dedicatedtoprovidinghighqualityhealthservicesinordertoimprovethehealthofthepeopleinSoutheastTexas.

Memorial Hermann Health System Oneofthelargestnot-for-profithealthsystemsinthenation,MemorialHermannHealthSystemisanintegratedsystemwithanexceptionalaffiliatedmedicalstaffandmorethan26,000employees.GovernedbyaBoardofcommunitymembers,theSystemservicesSoutheastTexasandtheGreaterHoustoncommunitywithmorethan300caredeliverysitesincluding19hospitals;thecountry’sbusiestLevel1traumacenter;anacademicmedicalcenteraffiliatedwithMcGovernMedicalSchoolatUTHealth;oneofthenation’stoprehabilitationandresearchhospitals;andnumerousspecialtyprogramsandservices.MemorialHermannhasbeenatrustedhealthcareresourceformorethan110yearsandasGreaterHouston’sonlyfull-service,clinicallyintegratedhealthsystem,wecontinuetoidentifyandmeetourregion’shealthcareneeds.AmongourdiverseportfolioisLifeFlight,thelargestandbusiestairambulanceserviceintheUnitedStates;theMemorialHermannPhysicianNetwork,MHMD,oneofthelargest,mostadvanced,andclinicallyintegratedphysicianorganizationsinthecountry;and,theMemorialHermannAccountableCareOrganization,operatingacaredeliverymodelthatgeneratesbetteroutcomesatlowercoststoconsumers,whileprovidingresidentsoftheGreaterHoustonareabroadaccesstohealthinsurancethroughtheMemorialHermannHealthInsuranceCompany.Specialtiesspanburntreatment,cancer,children’shealth,diabetesandendocrinology,digestivehealth,ear,noseandthroat,heartandvascular,lymphedema,neurosurgery,neurology,stroke,nutrition,ophthalmology,orthopedics,physicalandoccupationaltherapy,rehabilitation,roboticsurgery,sleepstudies,transplant,weightloss,women’shealth,maternityandwoundcare.SupportingtheSysteminitsimpactonoverallpopulationhealthistheCommunityBenefitCorporation.Atamarketshareof26.1%inthe‘expanded’greaterHoustonareaof12counties,ourvisionisthatMemorialHermannwill


beapreeminentintegratedhealthsystemintheU.S.byadvancingthehealthofthoseweserve.

Memorial Hermann Rehabil itation Hospital Katy Service Area TheserviceareaforMHRehabKatyincludesAustin,FortBend,Harris,andWallercountiesinTexas.ThegeographicboundariesoftheserviceareaareshowninFigure1.ThezipcodeswithinMHRehabKaty’sprimaryserviceareaarelistedinTable1andrepresentapproximately75%ofinpatientdischarges(3.2%inAustinCounty,15.8%inFortBendCounty,52.3%inHarrisCounty,and2.4%inWallerCounty).

Figure1.MHRehabKatyServiceArea

Table1.ProportionofPatientPopulationServedbyZipCodeZIPCode County PercentofPatient

Population77450 Harris 11.5%77449 Harris 11.2%77494 FortBend 10.5%77084 Harris 7.3%77493 Harris 5.2%77077 Harris 3.4%


ZIPCode County PercentofPatientPopulation

77474 Austin 3.2%77079 Harris 2.7%77433 Harris 2.7%77423 Waller 2.4%77024 Harris 2.0%77407 FortBend 2.0%77043 Harris 1.9%77080 Harris 1.7%77406 FortBend 1.7%77441 FortBend 1.6%77041 Harris 1.4%77055 Harris 1.3%

Consultants MemorialHermannHealthSystemcommissionedConduentHealthyCommunitiesInstitute(HCI)toconductits2019CommunityHealthNeedsAssessment.HCIworkswithclientsacrossthenationtodrivecommunityhealthoutcomesbyassessingneeds,developingfocusedstrategies,identifyingappropriateinterventionprograms,establishingmonitoringsystems,andimplementingperformanceevaluationprocesses.TolearnmoreaboutConduentHealthyCommunitiesInstitute,pleasevisithttps://www.conduent.com/community-population-health.


Evaluation of Progress Since Prior CHNA TheCHNAprocessshouldbeviewedasathree-yearcycle.AnimportantpartofthatcycleisrevisitingtheprogressmadeonprioritytopicsfrompreviousCHNAs.Byreviewingtheactionstakentoaddresspriorityareasandevaluatingtheimpactoftheseactionsinthecommunity,anorganizationcanbetterfocusandtargetitseffortsduringthenextCHNAcycle.

Priority Health Needs and Impact from Prior CHNA MHRehabKaty’slastCHNAwasconductedin2016.ThepriorityareasinFY16-18were:

• HealthyLiving:Encourageandfosterhealthylifestylesthrougheducation,awarenessandearlydetectiontopreventillness.

• HealthcareAccess:Improvecommunityknowledgeabouthealthcareaccesspointsandreduceperceivedbarrierstocare.

• BehavioralHealth:Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

EachoftheabovehealthtopicscorrelateswellwiththeprioritiesidentifiedforthecurrentCHNA(detailedbelow);thusMHRehabKatywillbebuildinguponeffortsofpreviousyears.A

Figure2.CHNAProcess

AnalyzeData&

CommunityInput

PrioritizeHealthNeeds

CHNAReport&

ImplementationStrategy

Implement

EvaluateActionsTaken 3Year

Cycle


detailedtabledescribingthestrategies/actionstepsandindicatorsofsuccessforeachoftheprecedingpriorityhealthtopicscanbefoundinAppendixA.MHRehabKaty’sprecedingCHNAwasmadeavailabletothepublicviathewebsiteandcommunityfeedbackdirectedtoMemorialHermann’sCommunityBenefitDepartment:http://www.memorialhermann.org/locations/katy/community-health-needs-assessment-katy-rehab/.NocommentsorfeedbackwerereceivedontheprecedingCHNAatthetimethisreportwaswritten.


Methodology

Overview Twotypesofdatawereusedinthisassessment:primaryandsecondarydata.Primarydataaredatathathavebeencollectedforthepurposesofthiscommunityassessment.Primarydatawereobtainedthroughacommunitysurveyandkeyinformantinterviews.Secondarydataarehealthindicatordatathathavealreadybeencollectedbypublicsourcessuchasgovernmenthealthdepartments.Eachtypeofdatawasanalyzedusingauniquemethodology.FindingswereorganizedbyhealthtopicsandthensynthesizedforacomprehensiveoverviewofthehealthneedsinMHRehabKaty’sservicearea.

Secondary Data Sources & Analysis SecondarydatausedforthisassessmentwerecollectedandanalyzedfromHCI’scommunityindicatordatabase.Thisdatabase,maintainedbyresearchersandanalystsatHCI,includesover100communityindicatorsfromatleast15stateandnationaldatasources.HCIcarefullyevaluatessourcesbasedonthefollowingthreecriteria:thesourcehasavalidatedmethodologyfordatacollectionandanalysis;thesourcehasscheduled,regularpublicationoffindings;andthesourcehasdatavaluesforsmallgeographicareasorpopulations.

Secondary Data Scoring HCI’sDataScoringTool®wasusedtosystematicallysummarizemultiplecomparisonsinordertorankindicatorsbasedonhighestneed.Foreachindicator,thecommunityvaluewascomparedtoadistributionofTexasandUScounties,stateandnationalvalues,HealthyPeople2020,andsignificanttrendswerenoted.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.Thecomparisonscoresweresummarizedforeachindicator,andindicatorswerethengroupedintotopicareasforasystematicrankingofcommunityhealthneeds.PleaseseeAppendixBforfurtherdetailsonthequantitativedatascoringmethodologyaswellassecondarydatascoringresults.

Figure3.SummaryofTopicScoringAnalysis


Disparit ies Analysis Whenagivenindicatorhasdataavailableforsubgroupslikerace/ethnicity,ageorgender–andvaluesforthesesubgroupsincludeconfidenceintervals–significantdifferencesbetweenthesubgroups’valueandtheoverallvaluecanbedetermined.Asignificantdifferenceisdefinedastwovalueswithnon-overlappingconfidenceintervals.Onlysignificantdifferencesinwhichthevalueforasubgroupisworsethantheoverallvalueareidentified.Confidenceintervalsarenotavailableforallindicators.Inthesecases,therearenotenoughdatatodetermineiftwovaluesaresignificantlydifferentfromeachother.

Primary Data Methods & Analysis CommunityinputforMemorialHermannHealthSystemwascollectedtoexpandupontheinformationgatheredfromthesecondarydata.PrimarydatausedinthisassessmentconsistedofacommunitysurveyinEnglishandSpanishaswellaskeyinformantinterviews.SeeAppendixCforthesurveyandinterviewquestions.

Community Survey Inputfromcommunityresidentswascollectedthroughanonlinesurvey.Thissurveyconsistedof11questionsrelatedtotophealthneedsinthecommunity,individuals’perceptionoftheiroverallhealth,andweeklyexercisehabits.ThecommunitysurveywasdistributedonlinethroughSurveyMonkey®fromOctober23rdthroughNovember27thof2018.ThesurveywasmadeavailableinbothEnglishandSpanish.PapersurveyswerealsomadeavailableandanswerstothepapersurveywereenteredintotheSurveyMonkeytool.Atotalof285responseswerecollected.ResultsinthisreportarebasedontheserviceareaforMemorialHermannHealthSystem.Thiswasaconveniencesample,whichmeansresultsmaybevulnerabletoselectionbiasandmakethefindingslessgeneralizabletothepopulationasawhole.

Table2.CommunitySurveyOutreachCommunityEvent DescriptionStepHealthEvent–MoodyPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

StepHealthEvent–CastilloPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

MemorialHermannHealthCentersforSchools

10school-basedhealthclinicsin5schooldistricts(74schools)inHarrisandFortBendCounties,providingmedical,mentalhealth,anddentalcare,alongwithnutrition,navigation,andsummerbootcampprogramstouninsuredandunderinsuredchildrenthroughouttheGreaterHoustonarea.

WestOremYMCA,77085

Acommunity-centeredorganizationthatbringspeopletogethertobridgethegapsincommunityneeds(underservedresidents),nurturesresidents’potentialtolearn,grow,andthrive,andmobilizesthelocalcommunitytoeffectlasting,meaningfulchange.

SpringBranchCommunity

AFederallyQualifiedHealthCenter(FQHC)providingquality,affordablehealthcareservicestotheunderservedanduninsuredcommunitiesofSpring


Therace/ethnicitymake-upofsurveyrespondentsisshowninFigure4.ThelargestproportionofrespondentsidentifiedasHispanic/Latino(47.2%),22.8%asWhite,20.4%asBlack/AfricanAmerican,andtheremaining9.6%ofrespondentsasAsian/PacificIslander,OtherandNativeAmerican.

HealthCenter,77080

BranchandWestHouston.

WesleyCommunityCenter,77009

Amulti-purposesocialserviceagencyprovidingresidentsofHouston:short-termrent,utility,andfoodassistancetopreventhomelessnessandmaintainfamilyfinancialstability;acareerandpersonalfinancialservicecenter;andEarlyHeadStart,achilddevelopmentprogramservinginfantstotoddlerstopromoteschoolreadiness.

CompleteCommunities,Houston

PrograminitiatedbytheMayorofHoustoninfivecommunities-allhistoricallyunder-resourced,eachwithabaselevelofcommunityinvolvementandsupport,andwithdiversepopulations.Theprogramisdesignedtoenhanceaccesstoqualityaffordablehomes,jobs,well-maintainedparksandgreenspace,improvedstreetsandsidewalks,grocerystoresandotherretail,goodschoolsandtransitoptions.Communities:AcresHomes[77018,77088,77091],Gulfton[77056,77057,77081],NearNorthside[77009,77022,77026],SecondWard[77003,77011,77020],andThirdWard[77003,77004,77204].

HealthyLivingMatters

AHouston/HarrisCountyChildhoodObesityCollaborative-Acollaborativeofmulti-sectorleadersthatpromotepolicyaimedatsystem-levelandenvironmentalchangetoreducetheincidenceofchildhoodobesity.Prioritycommunitieswereselectedduetothelackofaccesstohealthyfoodoptionsandopportunitiestoengageinphysicalactivityaswellasfortheircommunityassetsandreadinessforchange.PriorityCommunities:CityofPasadena[77058,77059,77502,77503,77504,77505,77506,77507,77536,77571,77586],NearNorthside[77009,77022,77026],andFifthWard/KashmereGardens[77020,77026,and77028]

GreaterNorthsideHealthCollaborative

Non-profitcollaborativewhosegoalistoexpandactivelivingresourcesandincreaseaccesstoqualityhealthcareandhealthyfoodbypromotingresidentleadershipandcivicparticipation.


Figure4.SurveyRespondentsbyRace/Ethnicity

Surveyrespondentswereaskedtoselecttopissuesmostaffectingthecommunity’squalityoflife.AsshowninFigure5,themajorityofrespondentsidentifiedDiabetes,Obesity/Overweight,SubstanceAbuse,andMentalHealth&MentalDisordersastopissuesinthecommunity.

Figure5.TopIssuesAffectingQualityofLife(Survey)

Key Informant Interviews Communityinputwasalsocollectedthroughkeyinformantinterviews.

MemorialHermannHealthSystemjoinedwiththeEpiscopalHealthFoundation(EHF)intheirkeyinformantinterviewinitiativesupportingfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsofthisinitiativeincludeMemorialHermann,CHISt.Luke’sHealth,HoustonMethodist,andTexasChildren’s(Table3).Throughthispartnership,atotalof53interviewswereconductedwith

47.20%

22.40%

20.80%

4.80%3.60% 1.20%

Hispanic

White

AfricanAmerican

Asian/PacificIslander

Other

NativeAmerican

10%10%13%13%14%

17%23%26%26%

35%51%54%

64%69%

SexualHealthOralhealth

TeenagePregnancyReproductiveHealth

OtherRespiratory/LungDiseaseInjuries,Violence&Safety

ElderCareHeartDisease&Stroke

CancersMentalHealth&MentalDisorders

SubstanceAbuseObesity/Overweight

Diabetes


stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Communityleaderswithspecificexperienceworkingwithprioritypopulations,suchaswomen,children,peopleofcolor,thedisabled,andmore,werealsointerviewed.

Table3.MemorialHermannCollaborativePartners

Intotal,64keyinformantinterviewswereconductedbyphonefromAugustthroughNovember2018;53keyinformantinterviewswereconductedthroughthecollaborativeand11interviewswereconductedbyHCI.Intervieweeswhowereaskedtoparticipatewererecognizedashavingexpertiseinpublichealth,specialknowledgeofcommunityhealthneedsand/orrepresentedthebroadinterestofthecommunityservedbythehospital,and/orcouldspeaktotheneedsofmedicallyunderservedorvulnerablepopulations.Effortsweremadetoidentifyintervieweesworkinginand/orknowledgeableaboutthecountiesinMemorialHermannHealthSystem’sservicearea.AsseeninTable4,someintervieweeswereidentifiedwithknowledgeofmultiplecounties.

Table4.KeyInformantsbyCountyCounty KeyInformantsAustin IncludedinMultipleCountiesBrazoria 3Chambers 2

EpiscopalHealthFoundation’smissionistoadvancetheKingdomofGodwithspecificfocusonhumanhealthandwell-beingthroughgrants,research,andinitiativesinsupportoftheworkoftheDiocese,spanning57counties.Throughinformedaction,collaboration,empowerment,stewardship,transparency,andaccountabilitythefoundationstrivesforthetransformationofhumanlivesandorganizationswithcompassionforthepoorandpowerless.

CHISt.Luke’sHealth,apartofCatholicHealthInitiatives(CHI),oneofthenation’slargesthealthsystems,isdedicatedtoamissionofenhancingcommunityhealththroughhigh-quality,cost-effectivecare.Throughpartnershipswithphysiciansandcommunitypartners,CHISt.Luke’sHealthservesGreaterHoustonwithitscommitmenttoexcellenceandcompassionincaringforthewholepersonwhilecreatinghealthiercommunities.

HoustonMethodistisanonprofithealthcareorganizationservingGreaterHouston,dedicatedtoexcellenceinresearch,education,andpatientcare.HoustonMethodistbringscompassionandspiritualitytoallitsendeavorstohelpmeetthehealthneedsofthecommunitythroughthesystem’sICAREvalues:integrity,compassion,accountability,respect,andexcellence.

TexasChildren’sHospitalisanot-for-profitorganizationwhosemissionistocreateahealthierfutureforchildrenandwomenthroughoutGreaterHoustonandtheglobalcommunitybyleadinginpatientcare,education,andresearch.TexasChildren’siscommittedtocreatingahealthycommunityforchildrenbyprovidingthebestpediatriccarepossible,throughgroundbreakingresearchandemphasisoneducation,whilealsoofferingafullcontinuumoffamily-centeredcareforwomen,fromobstetricstowell-womancare.


County KeyInformantsFortBend 10Galveston 7Harris 28Liberty 1Montgomery 4SanJacinto IncludedinMultipleCountiesWalker IncludedinMultipleCountiesWaller 2Wharton 2MultipleCounties* 5Total 64

Interviewsweretranscribedandanalyzedusingthequalitativeanalytictool,Dedoose1.Interviewexcerptswerecodedbyrelevanttopicareasandkeyhealththemes.Threeapproacheswereusedtoassesstherelativeimportanceoftheneedsdiscussedintheseinterviews.Theseapproachesincluded:thefrequencybywhichahealthtopicwasdiscussedacrossallinterviews;thefrequencybywhichatopicwasdescribedbythekeyinformantasabarrier/challenge;andthefrequencybywhichatopicwasmentionedperinterviewee.

Data Considerations Severallimitationsofdatashouldbeconsideredwhenreviewingthefindingspresentedinthisreport.Althoughthetopicsbywhichdataareorganizedcoverawiderangeofhealthandhealth-relatedareas,dataavailabilityvariesbyhealthtopic.Sometopicscontainarobustsetofsecondarydataindicators,whileothersmayhavealimitednumberofindicatorsorlimitedsubpopulationscoveredbythosespecificindicators.Datascoresrepresenttherelativecommunityhealthneedaccordingtothesecondarydataforeachtopicandshouldnotbeconsideredtobeacomprehensiveresultontheirown.Inaddition,thesescoresreflectthesecondarydataresultsforthepopulationasawhole,anddonotrepresentthehealthorsocioeconomicneedthatismuchgreaterforsomesubpopulations.Moreover,manyofthesecondarydataindicatorsincludedinthefindingsarecollectedbysurvey,andthoughspecificmethodsareusedtobestrepresentthepopulationatlarge,thesemeasuresaresubjecttoinstability,especiallyforsmallerpopulations.TheIndexofDisparityisalsolimitedbydataavailability,whereindicatordatavariesbasedonthepopulationgroupsandserviceareasbeinganalyzed.

1DedooseVersion8.0.35,webapplicationformanaging,analyzing,andpresentingqualitativeandmixedmethodresearchdata(2018).LosAngeles,CA:SocioCulturalResearchConsultants,LLCwww.dedoose.com

*Five(5)oftheKeyInformantInterviewsrepresented2ormorecounties,including:Austin,Brazoria,Chambers,FortBend,Galveston,Harris,Liberty,Montgomery,SanJacinto,Walker,Waller,andWhartoncounties.


Race/Ethnic Groupings

Thesecondarydatapresentedinthisreportderivefrommultiplesources,whichmaypresentraceandethnicitydatausingdissimilarnomenclature.Forconsistencywithdatasourcesthroughoutthereport,subpopulationdatamayusedifferenttermstodescribethesameorsimilargroupsofcommunitymembers.

Zip Codes and Zip Code Tabulation Areas

ThisreportpresentsbothZIPCodeandZIPCodeTabulationArea(ZCTA)data.ZIPorZoneImprovementPlanCodeswerecreatedbytheU.S.PostalServicetoimprovemaildeliveryservice.Theyarebasedonpostalroutes,whichfactorindelivery-area,mailvolumeandgeographiclocation.Theyarenotdesignedtobeusedforstatisticalreportingandmaychangefrequently.SomeZIPCodesmayonlyincludeP.O.boxesorcoverlargeunpopulatedareas.ZCTAsorZIPCodeTabulationAreaswerecreatedbytheU.S.CensusBureauandaregeneralizedrepresentationsofZIPCodesthathavebeenassignedtocensusblocks.Therefore,ZCTAsarerepresentativeofgeographiclocationsofpopulatedareas.Inmostcases,theZCTAwillbethesameasitsZIPCode.ZCTAswillnotnecessarilyexistforZIPCodeareaswithonlybusinesses,singleormultipleaddresses,orforlargeunpopulatedareas.SinceZCTAsarebasedonthemostrecentCensusdata,theyaremorestablethanZIPCodesanddonotchangeasfrequently.DemographicsforthisreportaresourcedfromtheUnitedStatesCensusBureau,whichpresentsZCTAestimates.TablesandfiguresintheDemographicssectionofthisreportreferenceZIPCodesintitle(forpurposesoffamiliarity)butshowvaluesofZCTAs.DatafromothersourcesisrepresentativebyZIPCodesandarelabeledassuch.

Priorit ization Inordertofocuseffortsonasmallernumberofthemostsignificantcommunityissues,sixteenrepresentativesfromtheMemorialHermannHealthSystem(oneormorerepresentingeachfacility)participatedinanonlineprioritizationprocesstoprioritizethefifteensignificanthealthneedsidentifiedthroughthesecondaryandprimarydataanalyses.Theprioritizedhealthneedswillbeunderconsiderationforthedevelopmentofanimplementationplanthatwilladdresssomeofthecommunity’smostpressinghealthissues.

Priorit ization Process Toprioritizesignificanthealthneeds,MemorialHermannstakeholdersparticipatedinanonlinewebinaronMarch7,2019toreviewdatasynthesisresultsfollowedbycompletionofaprioritizationmatrixlistingsignificanthealthneedsandfourcriteriabywhichtorateeachneed.Participantsscoredeachneedforeachofthecriteriaonascalefrom1-5,with1meaningtherespondentstronglydisagreesto5meaningtherespondentstronglyagreesthatthehealthneedmeetsthecriterion.Respondentswerealsoabletoselect“Don’tKnow/Unsure”foreachhealthneed.Thecriteriaforprioritizationincludedtowhatextentanissue:

• Impactsmanypeopleinthecommunity• Significantlyimpactssubgroupsinthecommunity(gender,race/ethnicity,LGBTQ,etc.)


• Hasinadequateexistingresourcesinthecommunity• Hashighriskfordiseaseordeath

CompletionoftheprioritizationmatrixinAppendixDresultedinnumericalscoresforeachhealthneedthatcorrespondedtohowwelleachhealthneedmetthecriteriaforprioritization.Thescoreswererankedfromhighesttolowest(Table5).

Table5.ResultsfromMemorialHermannPrioritizationMatrixSignificantHealthNeed Impacton

CommunityImpactonSubgroups

InadequateResources

HighRisk AverageScore

Obesity(Exercise,NutritionandWeight)

4.69 4.00 3.19 4.50 4.09

MentalHealth 4.44 3.44 4.50 3.75 4.03Diabetes 4.50 4.00 3.25 4.19 3.98LackofHealthInsurance 4.31 4.19 3.38 4.00 3.97Low-Income/Underserved

4.19 4.19 3.44 4.00 3.95

HeartDisease/Stroke 4.44 3.82 2.81 4.44 3.88SubstanceAbuse 3.56 3.88 3.63 4.19 3.81AccesstoHealthServices

4.00 3.94 3.25 3.88 3.77

OlderAdultsandAging 4.38 3.81 3.13 3.75 3.76FoodInsecurity 3.88 4.00 3.44 3.50 3.70Cancers 4.19 3.19 3.00 4.31 3.67Education 3.88 3.81 3.00 3.13 3.45Transportation 4.00 3.88 2.81 3.00 3.42Children'sHealth 4.00 3.50 3.00 3.19 3.42Economy 3.31 3.31 2.69 2.88 3.05Inadditiontoratingeachneedinthematrix,prioritizationparticipantswereaskedtoratethelevelofimportanceofMemorialHermann’s4strategicpillars.

1. ImprovingAccesstoHealthcarethroughprogramming,education,andsocialservicesupport;

2. AddressingEmotionalWell-being(mentalandbehavioralhealth)throughinnovativeaccesspoints;

3. PromotingtheimportanceofahealthydietthroughscreeningandcreatingaccesstonutritiousFoodasHealth;and,

4. FosteringimprovedhealththroughExerciseIsMedicinewithculturallyappropriateactivities.

EachoftheseintersectingpillarsconnecttoeachotherthroughvariouspointsinMemorialHermannprogramsandinitiativesadvancingthehealthofourcommunities(Figure6).


Figure6.MemorialHermann’sFourPillarsforCommunityHealth

Over93%ofparticipantsrespondedthatthe4pillarswereimportantorveryimportant.TheMemorialHermannCommunityBenefitteamreviewedthesefindings,andtakingintoaccountthealignmentoftopneedswithMemorialHermann’sstrategicfocusareas,adecisionwasmadetointegrate:

• LackofHealthInsurance,Low-Income/Underserved,andAccesstoHealthServicesintoPillar1:AccesstoHealthcare

• MentalHealthandSubstanceAbuseintoPillar2:EmotionalWell-Being• Diabetes,FoodInsecurityandHeartDisease/StrokeintoPillar3:FoodasHealth• Obesity(Exercise,NutritionandWeight)intoPillar4:ExerciseIsMedicine

Throughthissystem-wideprioritizationprocess,thefollowingfourprioritiesforMemorialHermannHealthSystemare:

• AccesstoHealthcare(addressingAccesstoHealthServices,LackofHealthInsurance,andLow-Income/Underserved)

• EmotionalWellbeing(addressingMentalHealthandSubstanceAbuse)• FoodasHealth(addressingDiabetes,FoodInsecurity,andHeartDisease/Stroke)• ExerciseIsMedicine(addressingObesity)

ThesefourhealthtopicswillbeexploredfurtherinordertounderstandhowfindingsfromthesecondaryandprimarydataanalysesresultedineachissuebeingahighpriorityhealthneedforMemorialHermannHealthSystem.


Demographics ThefollowingsectionexploresthedemographicprofileofMHRehabKaty’sservicearea,includingAustin,FortBend,Harris,andWallercounties.Thedemographicsofacommunitysignificantlyimpactitshealthprofile.Differentrace/ethnic,age,andsocioeconomicgroupshaveuniqueneedsandrequiredifferentapproachestohealthimprovementefforts.AlldemographicestimatesaresourcedfromtheU.S.CensusBureau’s2013-2017AmericanCommunitySurveyunlessotherwiseindicated.Furthermore,tablesinthissectionlistindicatorvaluesforthetop75%ofzipcodeswithinMHRehabKaty’sserviceareaindescendingorderofinpatientdischargesunlessotherwisenoted.

Population AccordingtotheU.S.CensusBureau’s2013-2017AmericanCommunitySurvey,the4countiesinMHRehabKaty’sserviceareahadpopulationsof29,786(AustinCounty),764,828(FortBendCounty),4,652,980(HarrisCounty),and51,307(WallerCounty).Figure7illustratesthepopulationsizebycountyandTable6byzipcode.ThemostpopulouszipcodesinMHRehabKaty’sserviceareaare77449(HarrisCounty),77494(FortBendCounty),and77084(HarrisCounty).

Figure7.PopulationbyCounty

Table6.PopulationbyZipCodeZIPCode County TotalPopulationEstimate77450 Harris 74,631


ZIPCode County TotalPopulationEstimate77449 Harris 119,20477494 FortBend 105,85477084 Harris 104,58277493 Harris 29,98477077 Harris 57,75777474 Austin 12,99377079 Harris 33,57777433 Harris 75,00877423 Waller 11,55177024 Harris 38,11077407 FortBend 48,15777043 Harris 25,83877080 Harris 45,66577406 FortBend 41,00877441 FortBend 9,91977041 Harris 35,37277055 Harris 45,003

AmericanCommunitySurvey,2013-2017

Age Figure8showsMHRehabKaty’sserviceareapopulationthatisunder18yearsold.Asshown,24.1%ofAustinCounty’spopulationisunder18and24.3%ofWallerCounty’spopulationisunder18.FortBendandHarriscountieshavehigherproportionsofresidentsunder18(27.7%and26.9%,respectively)comparedtothestateandnationalvalues.

Figure8.PopulationUnder18

AsshowninFigure9,AustinCountyhasabiggerproportionofolderadultscomparedtoTexasandtheU.S.FortBend,Harris,andWallercountiesallhavesmallerproportionsofolderadultscomparedtoboththestateandnationalvalues.

24.1%

27.7% 26.9%24.3%

26.0%22.6%

0%

5%

10%

15%

20%

25%

30%

Austin FortBend Harris Waller Texas U.S.


Figure9.PopulationOver65

Figure10showsthatHarrisCountyhasalargerproportionofresidentsunder5yearsoldcomparedtobothTexasandtheU.S.AustinCountyhasthelowestpercentage(6.2%)ofthefourcountiesintheservicearea.

Figure10.PopulationUnder5

Race/Ethnicity Theraceandethnicitycompositionofapopulationisimportantinplanningforfuturecommunityneeds,particularlyforschools,businesses,communitycenters,healthcareandchildcare.Raceandethnicitydataarealsousefulforidentifyingandunderstandingdisparitiesinhousing,employment,income,andpoverty.AlargernumberofresidentsinAustin,FortBend,andWallercountiesidentifyasWhite,non-HispanicwhileinHarrisCountytherearealargernumberofresidentswhoidentifyasHispanicorLatino.Figure11showstheracialcompositionofresidentsinAustinCountywith63.3%ofresidentsidentifyingasWhite,non-Hispanic;25.9%asHispanicorLatino(ofanyrace);8.9%as

18.6%

10.6% 10.2%11.8% 12.3%

15.6%

0%2%4%6%8%

10%12%14%16%18%20%


6.2%7.1%

7.7%

6.6%7.2%

6.1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%



BlackorAfricanAmerican;0.2%asAsian;and1.7%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure11.Race/EthnicityinAustinCounty

Figure12showstheracialcompositionofresidentsinFortBendCountywith34.4%ofresidentsidentifyingasWhite,non-Hispanic;24.2%asHispanicorLatino(ofanyrace);20.2%asBlackorAfricanAmerican;19.2%asAsian;and2%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure12.Race/EthnicityinFortBendCounty

Figure13showstheracialcompositionofresidentsinHarrisCountywith42.2%ofresidentsidentifyingasHispanicorLatino(ofanyrace);30.6%asWhite;18.5%asBlackorAfricanAmerican;6.8%asAsian;and1.9%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

63.3%8.9%0.2%

25.9%

1.7%White,non-Hispanic

BlackorAfricanAmerican

Asian

HispanicorLatino(ofanyrace)

Other

34.4%

20.2%

19.2%

24.2%



Asian


Other


Figure13.Race/EthnicityinHarrisCounty

Figure14showstheracialcompositionofresidentsinWallerCountywith43.0%ofresidentsidentifyingasWhite,non-Hispanic;29.4%asHispanicorLatino(ofanyrace);24.9%asBlackorAfricanAmerican;0.7%asAsian;and2%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,and/or“Twoormoreraces”.

Figure14.Race/EthnicityinWallerCounty

Language Languageisanimportantfactortoconsiderforoutreacheffortsinordertoensurethatcommunitymembersareawareofavailableprogramsandservices.

30.6%

18.5%6.8%

42.2%



Asian


Other

43.0%

24.9%0.7%

29.4%



Asian


Other


Figure15.LanguageOtherthanEnglishSpokenatHome

Figure15showstheproportionofresidentsinAustin,FortBend,Harris,andWallercountieswhospeakalanguageotherthanEnglishathome.Asshown,43.7%ofresidentsinHarrisCountyand20.2%ofresidentsinAustinCountyspeakalanguageotherthanEnglishascomparedto35.3%inTexasand21.3%intheU.S.Thisisanimportantconsiderationfortheeffectivenessofservicesandoutreachefforts,whichmaybemoreeffectiveifconductedinlanguagesotherthanEnglishalone.

Table7.PopulationwithDifficultySpeakingEnglishbyZipCodeZIPCode County DifficultySpeaking

English77450 Harris 10.8%77449 Harris 17.2%77494 FortBend 8.9%77084 Harris 18.5%77493 Harris 10.8%77077 Harris 12.5%77474 Austin 10.8%77079 Harris 10.9%77433 Harris 9.8%77423 Waller 18.8%77024 Harris 6.9%77407 FortBend 14.6%77043 Harris 24.8%77080 Harris 37.1%77406 FortBend 3.4%77441 FortBend 2.1%77041 Harris 21.9%77055 Harris 30.2%Austin -- 8.8%

20.2%

38.4%43.7%

26.1%

35.3%

21.3%

0%5%

10%15%20%25%30%35%40%45%50%



FortBend -- 13.0%Harris -- 20.4%Waller -- 12.9%Texas -- 14.1%


AsshowninTable7,HarrisCountyhasalargerproportionofresidentswithdifficultyspeakingEnglish(20.4%)comparedtotheotherthreecountiesandthestateofTexas(14.1%).Inzipcodes77080and77055,overathirdofresidentshavedifficultyspeakingEnglish.

Social and Economic Determinants of Health Thissectionexplorestheeconomic,environmental,andsocialdeterminantsofhealthinMemorialHermannKaty’sservicearea.Socialdeterminantsaretheconditionsinwhichpeopleareborn,grow,work,live,andage,andthewidersetofforcesandsystemsshapingtheconditionsofdailylife.

Income Medianhouseholdincomereflectstherelativeaffluenceandprosperityofanarea.Areaswithhighermedianhouseholdincomesarelikelytohaveagreatershareofeducatedresidentsandlowerunemploymentrates.Figure16comparesthemedianhouseholdincomevaluesforallfourcountiesinMHRehabKaty’sserviceareatothemedianhouseholdincomevalueforTexasandtheUnitedStates.FortBendCounty’smedianhouseholdincomeof$93,645isgreaterthanthatofAustin,Harris,andWallercounties.HarrisCounty’smedianhouseholdincomeissimilartothestateandnationalvalues.

Figure16.MedianHouseholdIncome

AsshowninTable8,MHRehabKaty’sservicearearevealsarangeinmedianhouseholdincome.Nineoutofthetop10zipcodesforinpatientdischargeshaveamedianhousehold

$62,614

$93,645

$57,791$53,506 $57,051 $57,652

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000



incomehigherthanthestateofTexas($57,051);zipcodes77494,77433and77450havevaluesabove$100,000.Ontheotherhand,zipcode77080inHarrisCountyhasamedianhouseholdincomeof$44,386,whichisapproximately$13,000lowerthanthestatevalue.

Table8.MedianHouseholdIncomebyZipCode

ZIPCode County MedianHouseholdIncome

77450 Harris $101,24077449 Harris $72,39777494 FortBend $137,60077084 Harris $65,61777493 Harris $85,86577077 Harris $66,58777474 Austin $63,15277079 Harris $98,77477433 Harris $103,77377423 Waller $52,01977024 Harris $118,56177407 FortBend $96,94777043 Harris $60,04377080 Harris $44,38677406 FortBend $114,69677441 FortBend $160,16277041 Harris $79,50377055 Harris $52,269Austin -- $62,614FortBend -- $93,645Harris -- $57,791Waller -- $53,506Texas -- $57,051


Poverty FederalpovertythresholdsareseteveryyearbytheCensusBureauandvarybysizeoffamilyandagesoffamilymembers.Ahighpovertyrateisbothacauseandaconsequenceofpooreconomicconditions.Figure17showstheproportionofresidentslivingbelowthepovertylevelinAustin,FortBend,Harris,andWallercountiescomparedtothestateofTexasandtheU.S.Thepercentageofresidentslivingbelowthepovertylevelis16.8%forHarrisCountyand18%forWallerCounty,bothhigherthanthenationalvalue(14.6%)andthestatevalue(16%).InFortBendCounty,8.1%ofresidentslivebelowthepovertyvalue,whichislowerthanthestateandnationalvaluesandlessthanhalfthevalueofWallerCounty.


Figure17.PeopleLivingBelowPovertyLevel

Figure18showstheproportionofresidentslivingbelowthepovertylevelbyrace/ethnicity.InFortBendCounty,14.8%ofresidentsidentifyingasHispanicorLatinolivebelowthepovertylevel,comparedto3.8%White,5.9%Asianand9.4%BlackorAfricanAmericanresidents.InHarrisCounty,22.6%ofHispanicorLatinoresidentsand21.8%ofBlackorAfricanAmericanresidentslivebelowthepovertylevel,comparedto7%Whiteand11.4%Asianresidents.ThepercentageofBlackresidentslivingbelowthepovertylevelinAustinandWallercounties(27.2%and35.7%,respectively)ismuchhigherthanthestatevalue(21.4%).InAustinCounty,theproportionofHispanicorLatinoresidentslivingbelowthepovertylevel(27.7%)isgreaterthanthevaluesoftheothercounties,TexasandtheU.S.

13.4%

8.1%

16.8%18.0%

16.0%14.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%



Figure18.PeopleLivingBelowPovertyLevelbyRace/Ethnicity

Figure19.PeopleLivingBelowPovertyLevelbyZipCode

5.9%

27.2%

0.0%

27.7%

3.8%

9.4%

5.9%

14.8%

7.0%

21.8%

11.4%

22.6%

7.3%

35.7%

15.7%

22.1%

8.8%

21.4%

10.6%

23.0%

10.3%

25.2%

11.9%

22.2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

White,non-Hispanic BlackorAfricanAmerican Asian HispanicorLatino



PovertyratesareovertwiceashighinHarrisCounty(16.8%)andWallerCounty(18.0%)comparedtoFortBendCounty(8.1%).AsshowninFigure19andTable9,withinMHRehabKaty’sservicearea,thezipcodeswiththehighestpovertyratesarelocatedinHarrisCounty.Onequarterofresidentsinzipcode77080andalmost23%ofresidentsinzipcode77055arelivingbelowthepovertylevel.Withinthetopzipcodesforinpatientdischarges,zipcode77084hascloseto12%ofresidentslivingbelowthepovertylevel.

Table9.PeopleLivingBelowPovertyLevelbyZipCodeZIPCode County PeopleLivingBelow

PovertyLevel77450 Harris 4.6%77449 Harris 9.5%77494 FortBend 3.9%77084 Harris 11.8%77493 Harris 5.9%77077 Harris 10.4%77474 Austin 15.6%77079 Harris 8.0%77433 Harris 4.4%77423 Waller 14.5%77024 Harris 5.8%77407 FortBend 6.4%77043 Harris 14.6%77080 Harris 25.1%77406 FortBend 3.9%77441 FortBend 4.7%77041 Harris 10.2%77055 Harris 22.8%Austin -- 13.4%FortBend -- 8.1%Harris -- 16.8%Waller -- 18.0%Texas -- 16.0%


Food Insecurity TheSupplementalNutritionAssistanceProgram(SNAP)isafederalassistanceprogramthatprovideslow-incomefamilieswithelectronicbenefittransfers(EBTs)thatcanbeusedtopurchasefood.Thegoaloftheprogramistoincreasefoodsecurityandreducehungerbyincreasingaccesstonutritiousfood.Table10showsthepercentofhouseholdswithchildrenthatparticipateinSNAPinthezipcodeswithinMHRehabKaty’sservicearea.BothFortBendandHarriscountieshavehigherproportionsofhouseholdswithchildrenreceivingSNAP(73.5%and67.7%,respectively)


comparedtothestateofTexas(64.3%).Zipcodes77084,77493and77080(allinHarrisCounty)haveover80%ofhouseholdswithchildrenreceivingSNAP.

Table10.HouseholdswithChildrenReceivingSNAPbyZipCodeZIPCode County HouseholdswithChildren

ReceivingSNAP77450 Harris 73.8%77449 Harris 77.4%77494 FortBend 57.2%77084 Harris 85.6%77493 Harris 84.7%77077 Harris 62.0%77474 Austin 62.7%77079 Harris 79.2%77433 Harris 69.5%77423 Waller 59.7%77024 Harris 71.4%77407 FortBend 73.5%77043 Harris 77.3%77080 Harris 81.3%77406 FortBend 69.2%77441 FortBend 72.2%77041 Harris 60.6%77055 Harris 72.4%Austin -- 58.3%FortBend -- 73.5%Harris -- 67.7%Waller -- 58.7%Texas -- 64.3%


Unemployment Theunemploymentrateisakeyindicatorofthelocaleconomy.Unemploymentoccurswhenlocalbusinessesarenotabletosupplyenoughappropriatejobsforlocalemployeesand/orwhenthelaborforceisnotabletosupplyappropriateskillstoemployers.Ahighrateofunemploymenthaspersonalandsocietaleffects.Duringperiodsofunemployment,individualsarelikelytofeelsevereeconomicstrainandmentalstress.Unemploymentisalsorelatedtoaccesstohealthcare,asmanyindividualsreceivehealthinsurancethroughtheiremployer.Ahighunemploymentrateplacesstrainonfinancialsupportsystems,asunemployedpersonsqualifyforunemploymentbenefitsandfoodstampprograms.Figure20displaystherateofunemploymentinAustin,FortBend,Harris,andWallercountiesbetweenMay2017andNovember2018.Inallfourcounties,theunemploymentratehasexhibitedadecrease.InNovember2018,theFortBendCountyratewasequivalenttothestate


andnationalrate.However,theunemploymentratesinHarrisCounty(3.8%)andWallerCounty(3.8%)remainhigherthanTexasandtheU.S.

Figure20.UnemploymentRateperCounty(U.S.BureauofLaborStatistics,2017-2018)

Education Graduatingfromhighschoolisanimportantpersonalachievementandisessentialforanindividual’ssocialandeconomicadvancement.Graduationratescanalsobeanimportantindicatoroftheperformanceofaneducationalsystem.Havingabachelor’sdegreeopensupcareeropportunitiesinavarietyoffieldsandisoftenaprerequisiteforhigher-payingjobs.Figure21displaystheproportionofresidentsinAustin,FortBend,Harris,andWallercountieswhoare25yearsandolderwithatleastahighschooldegree.Nearly90%ofresidents25yearsandolderinFortBendCountyhaveatleastahighschooldegree.AustinCounty(82.2%),HarrisCounty(80.5%),andWallerCounty(78.3%)allhavelowervaluesthantheU.S.(87.3%)andTexas(82.8%).

4.7%

3.5% 3.5%3.2%

4.8%

4.0% 3.9%3.5%

5.1%

4.3% 4.3%3.8%

5.0%

4.3% 4.0%3.8%

4.4%

3.7%3.7%

3.5%4.1% 3.9%

3.6% 3.5%

0%

1%

2%

3%

4%

5%

6%

May2017 November2017 May2018 November2018

Austin FortBend Harris Waller Texas UnitedStates


Figure21.People25+withaHighSchoolDegreeorHigher

Figure22showstheproportionofresidentsinAustin,FortBend,Harris,andWallercountieswhoare25yearsandolderwithabachelor’sdegreeorhigher.Withnearly46%ofresidents25andolderhavingabachelor’sdegreeinFortBend,thiscountyhasaneconomicadvantagecomparedtotheotherthreecountiesintheservicearea.Theproportionofresidents25andolderwithabachelor’sdegreeinAustinCounty(22.3%)andWallerCounty(19.2%)arebothlowerthanthatofTexas(28.7%)andtheU.S.(30.9%).

Figure22.People25+withaBachelor'sDegreeorHigher

Table11displaystheeducationalattainmentindicatorsforresidents25yearsandolderbyzipcodeinMHRehabKaty’sservicearea.Forhighschooldegreeattainment,thezipcodewiththehighestrateis77024(96.9%)inHarrisCountyandthezipcodewiththelowestrateis77080(67.6%)alsoinHarrisCounty.Forattainmentofabachelor’sdegree,thezipcodewiththehighestrateis77024(75.8%)inHarrisCountyandthezipcodewiththelowestrateis77080(17.3%)inHarrisCounty.ThezipcodeswithhighestproportionsofMHRehabKaty’sinpatient

82.2%

89.7%

80.5%

78.3%

82.8%

87.3%

72%

74%

76%

78%

80%

82%

84%

86%

88%

90%

92%


22.3%

45.7%

30.5%

19.2%

28.7%30.9%

0%5%

10%15%20%25%30%35%40%45%50%



discharges,zipcodes77450and77449,havemorethan84%ofpeople25yearsandolderwithahighschooldegree.However,inzipcode77449,onlyapproximately25%ofresidents25yearsandolderhaveabachelor’sdegreeorhigher.

Table11.People25+withaHighSchoolDegreeandPeople25+withaBachelor'sDegreebyZipCodeZIPCode County HighSchoolDegreeor

HigherBachelor’sDegreeorHigher

77450 Harris 94.3% 52.5%77449 Harris 84.3% 25.8%77494 FortBend 96.4% 61.7%77084 Harris 84.8% 28.8%77493 Harris 87.1% 30.1%77077 Harris 95.6% 54.6%77474 Austin 79.6% 18.2%77079 Harris 93.4% 64.3%77433 Harris 91.7% 47.3%77423 Waller 76.1% 18.6%77024 Harris 96.9% 75.8%77407 FortBend 93.7% 48.7%77043 Harris 79.0% 34.7%77080 Harris 67.6% 17.3%77406 FortBend 94.1% 44.1%77441 FortBend 94.3% 59.2%77041 Harris 83.3% 34.1%77055 Harris 72.5% 33.9%Austin -- 82.2% 22.3%FortBend -- 89.7% 45.7%Harris -- 80.5% 30.5%Waller -- 78.3% 19.2%Texas -- 82.8% 28.7%


Transportation Therearenumerouswaysinwhichtransportationmayinfluencecommunityhealth.Publictransportationoffersmobility,particularlytopeoplewithoutcars.Transitcanhelpbridgethespatialdividebetweenpeopleandjobs,services,andtrainingopportunities.Publictransportationalsoreducesfuelconsumption,minimizesairpollution,andrelievestrafficcongestion.Walkingtoworkhelpsprotecttheenvironment,whilealsoprovidingthebenefitofdailyexercise.


Figure23.HouseholdsWithoutaVehiclebyZipCode

Figure23showsthepercentageofhouseholdswithoutavehicle.Asshown,over6%ofhouseholdsinzipcodes77055and77080donothaveavehicle.

Table12.ModesofCommutingbyZipCodeZIPCode County Commuteby

WalkingCommutebyBiking

CommutebyDrivingAlone

CommutebyPublicTransportation

77450 Harris 0.4% 0.2% 80.4% 2.2%77449 Harris 0.2% 0.2% 81.5% 1.3%77494 FortBend 0.3% 0.1% 78.9% 2.4%77084 Harris 1.5% 0.0% 81.3% 1.6%77493 Harris 0.8% 0.0% 80.8% 1.1%77077 Harris 1.4% 0.6% 83.8% 2.1%77474 Austin 1.3% 0.0% 82.9% 0.1%77079 Harris 1.2% 0.2% 81.9% 3.5%


ZIPCode County CommutebyWalking

CommutebyBiking

CommutebyDrivingAlone

CommutebyPublicTransportation

77433 Harris 0.2% 0.1% 83.7% 1.5%77423 Waller 1.3% 0.4% 81.0% 1.4%77024 Harris 1.8% 0.0% 84.8% 0.7%77407 FortBend 0.3% 0.0% 79.9% 1.5%77043 Harris 1.5% 0.4% 81.7% 1.8%77080 Harris 3.1% 0.7% 71.5% 2.7%77406 FortBend 0.3% 0.0% 82.6% 0.9%77441 FortBend 1.1% 0.0% 75.6% 2.2%77041 Harris 0.7% 0.0% 85.3% 1.1%77055 Harris 2.9% 0.5% 70.4% 4.0%Austin -- 1.9% 0.0% 81.6% 0.1%FortBend -- 0.5% 0.1% 82.0% 1.6%Harris -- 1.5% 0.3% 79.3% 2.7%Waller -- 3.9% 0.2% 78.7% 0.9%Texas -- 1.6% 0.3% 80.5% 1.5%


Table12displaysthedifferentmodesofcommutingusedbyresidentsofAustin,FortBend,Harris,andWallercounties.InFortBendCounty,lessthan1%ofthepopulationcommutesbywalkingorbiking.MoreresidentsinWallerCountycommutebywalking(3.9%)thantheotherthreecounties.Themajorityofresidents(around80%)ineachcountyoftheserviceareacommutebydrivingalone.ConsideringthetopzipcodesforinpatientdischargeswithinMHRehabKaty’sservicearea,zipcodes77494,77450and77077havethehighestproportionsofresidentscommutingbypublictransportation(over2%).Inzipcode77055,4%ofresidentscommutebypublictransportation.PublictransportationisusedbyHarrisCountyresidents(2.7%)moresothantheotherthreecounties,perhapsindicativeofdifferencesinpublictransportationinfrastructure.

SocioNeeds Index® ConduentHealthyCommunitiesInstitutedevelopedtheSocioNeedsIndex®toeasilycomparemultiplesocioeconomicfactorsacrossgeographies.Thisindexincorporatesestimatesforsixdifferentsocialandeconomicdeterminantsofhealth–income,poverty,unemployment,occupation,educationalattainment,andlinguisticbarriers–thatareassociatedwithpoorhealthoutcomesincludingpreventablehospitalizationsandprematuredeath.Zipcodeswithineachcountyareassignedanindexvaluefrom0(lowneed)to100(highneed),basedonhowthosezipcodescomparetoothersintheU.S.Withineachcounty,thezipcodesarethenrankedfrom1(lowneed)to5(highneed)toidentifytherelativelevelofneed.Zipcodeswithpopulationsunder300personsareexcluded.


Figure24.SocioNeedsIndexbyZipCode

AsshowninFigure24andTable13,thezipcodeswithinMHRehabKaty’sserviceareathathavethehighestSocioNeedsIndexvaluesareinHarrisCounty;zipcode77080hasavalueof95.6andzipcode77055hasavalueof82.6.ThezipcodeswithlargestproportionofinpatientdischargesatMHRehabKaty,zipcodes77450and77449,haveSocioNeedsIndexvaluesof9.9and53.4,respectively.

Table13.SocioNeedsIndexbyZipCode(InOrderofSocioNeedsIndexValue)ZIPCode County SocioNeedsIndexValue77080 Harris 95.677055 Harris 82.677423 Waller 71.477043 Harris 70.777474 Austin 66.577449 Harris 53.4


ZIPCode County SocioNeedsIndexValue77084 Harris 49.077041 Harris 29.377493 Harris 26.877407 FortBend 22.377077 Harris 21.477450 Harris 9.977433 Harris 8.477406 FortBend 5.577079 Harris 5.077494 FortBend 2.777441 FortBend 1.877024 Harris 1.3

ConduentSocioNeedsIndex,2019


Data Synthesis Allformsofdatahavetheirownstrengthsandlimitations.TogainacomprehensiveunderstandingofthesignificanthealthneedsforMemorialHermannHealthSystem,thefindingsfromboththeprimarydataandthesecondarydatawerecomparedandstudiedtogether.Thesecondarydata,keyinformantinterviewsandcommunitysurveyweretreatedasthreeseparatesourcesofdata.Thesecondarydatawereanalyzedusingdatascoring,whichidentifiedhealthareasofneedbasedonthevaluesofindicatorsforeachtopicarea(AppendixB).ThefollowingtablesdisplaythedatascoresforHealthandQualityofLifeTopicsforAustin,FortBend,Harris,andWallercounties.

Table14.AustinCountyTopicScoresTopic ScoreAccesstoHealthServices 1.97Transportation 1.77HeartDisease&Stroke 1.69Maternal,Fetal&InfantHealth 1.67Education 1.48MentalHealth&MentalDisorders 1.48Exercise,Nutrition,&Weight 1.45Immunizations&InfectiousDiseases 1.43SocialEnvironment 1.42Children'sHealth 1.40OlderAdults&Aging 1.40Economy 1.32Environment 1.26OtherChronicDiseases 1.26RespiratoryDiseases 1.26Cancer 1.20Wellness&Lifestyle 1.18MortalityData 1.07Prevention&Safety 0.99Women'sHealth 0.94PublicSafety 0.81SubstanceAbuse 0.81

Table15.FortBendCountyTopicScores

Topic ScoreTransportation 1.83Immunizations&InfectiousDiseases 1.47Exercise,Nutrition,&Weight 1.45OtherChronicDiseases 1.44PublicSafety 1.37HeartDisease&Stroke 1.32


Topic ScoreEnvironment 1.27SubstanceAbuse 1.24Maternal,Fetal&InfantHealth 1.23OlderAdults&Aging 1.19AccesstoHealthServices 1.18Children'sHealth 1.15SocialEnvironment 1.03MentalHealth&MentalDisorders 0.95Economy 0.91Education 0.83Prevention&Safety 0.78Men'sHealth 0.75Women'sHealth 0.71Wellness&Lifestyle 0.68RespiratoryDiseases 0.63MortalityData 0.61Cancer 0.53

Table16.HarrisCountyTopicScores

Topic ScoreTransportation 1.82Women'sHealth 1.81Immunizations&InfectiousDiseases 1.78OtherChronicDiseases 1.78PublicSafety 1.65Maternal,Fetal&InfantHealth 1.64Prevention&Safety 1.58SocialEnvironment 1.58Education 1.56Economy 1.55HeartDisease&Stroke 1.54Children'sHealth 1.52OlderAdults&Aging 1.50AccesstoHealthServices 1.48Exercise,Nutrition,&Weight 1.48Wellness&Lifestyle 1.42Men'sHealth 1.38Diabetes 1.34Environment 1.34SubstanceAbuse 1.33Cancer 1.31MortalityData 1.29MentalHealth&MentalDisorders 1.26RespiratoryDiseases 0.99


Table17.WallerCountyTopicScores

Topic ScoreAccesstoHealthServices 2.38HeartDisease&Stroke 2.01Prevention&Safety 1.93Education 1.75Economy 1.71Wellness&Lifestyle 1.69Exercise,Nutrition,&Weight 1.65Environment 1.62OlderAdults&Aging 1.61SocialEnvironment 1.60OtherChronicDiseases 1.54Transportation 1.51Women'sHealth 1.47MentalHealth&MentalDisorders 1.46Children'sHealth 1.42RespiratoryDiseases 1.26MortalityData 1.23Immunizations&InfectiousDiseases 1.19Maternal,Fetal&InfantHealth 1.02SubstanceAbuse 0.99Cancer 0.88PublicSafety 0.80

Thismethodologywasappliedtoeachofthe12countieswithinMemorialHermannHealthSystem’sprimaryserviceareaandthendatascorescalculatedfortheregioninordertodeterminesignificanthealthneedsacrossthesystem.Table18liststheresultingdatascoresforHealth&QualityofLifeTopicAreas.

Table18.MemorialHermannRegionTopicScoresTopic ScoreTransportation 1.84HeartDisease&Stroke 1.82AccesstoHealthServices 1.79OlderAdults&Aging 1.60Exercise,Nutrition,&Weight 1.56OtherChronicDiseases 1.52MentalHealth&MentalDisorders 1.50Children'sHealth 1.47Immunizations&InfectiousDiseases 1.43Education 1.43Women'sHealth 1.42SocialEnvironment 1.42Wellness&Lifestyle 1.41


Topic ScoreMaternal,Fetal&InfantHealth 1.41RespiratoryDiseases 1.41Economy 1.41Environment 1.40PublicSafety 1.36Cancer 1.31Prevention&Safety 1.26SubstanceAbuse 1.23Men'sHealth 1.21

Theanalysisofkeyinformantinterviewsoccurredusingthequalitativesoftware:Dedoose1.Forthecommunitysurvey,HCIperformedasimplereviewandanalysistoidentifytophealthneeds.Overall,eachmethodproducedindividualresultsthatrepresentthecommunityinputinthisreport.Thisconsolidatedinputleadstotheprioritizedheathneedsinthisreport.ThistriangulatedapproachisshowninFigure25.

Figure25.VisualofDataSynthesisApproach

TheteamusedthetriangulatedapproachtoidentifysignificanthealthneedsforMemorialHermannHealthSystem.Figure26displaystheresultsofthissynthesis.Formanyofthehealthtopicsevidenceofneedwaspresentacrossmultipledatasources,includingObesity,MentalHealth,AccesstoHealthServices,Transportation,andUninsured.Forotherhealthtopicstheevidencewaspresentinjustonesourceofdata,howeveritshouldbenotedthatthismaybereflectiveofthestrengthandlimitationsofeachtypeofdatathatwasconsideredinthisprocess.

SignificantHealthNeeds

HealthIndicatorData

(DataScoringAnalysis)

KeyInformantInterviews(Thematic

CodingAnalysis)CommunitySurvey

(ThematicAnalysis)


Figure26.DataSynthesisResults


Priorit ized Signif icant Health Needs

Priorit ization Results Uponcompletionoftheonlineprioritizationsurvey,fourhealthareaswereidentifiedforsubsequentimplementationplanningbyMemorialHermannHealthSystem.Thesefourhealthprioritiesare:AccesstoCare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.ThefollowingsectionwilldivedeeperintoeachofthesehealthtopicsinordertounderstandhowfindingsfromthesecondaryandprimarydataledtoeachhealthtopicbecomingapriorityhealthissueforMemorialHermannHealthSystem.Foreachprioritizedhealthneed,keyissuesaresummarized;secondarydatascoresarenotedforindicatorsofconcern;andcommunityinputisdescribed.

Access to Healthcare

Secondary Data AccesstoHealthServices,LackofInsuranceandLow-Income/UnderservedwereidentifiedassignificantneedsforMemorialHermannHealthSystem.AsshowninTable19,thereareseveralindicatorsrelatedtoAccesstoHealthServiceswithdatascoresequaltoorgreaterthan1.75;withWallerCountyoverallhavingagreaternumberofindicatorsofconcerncomparedtoAustin,FortBend,andHarriscounties.InAustinCounty,concerningindicatorsare:DentistRate,MentalHealthProviderRate,Non-PhysicianPrimaryCareProviderRate,andPrimaryCareProviderRate.InFortBendCounty,MentalHealthProviderRateisanindicatorofconcernwith59.8providersper100,000population(comparedtotheTexasvalueof98.8andU.S.valueof214.3).InHarrisCounty,indicatorsofconcerninclude:AdultsUnabletoAffordtoSeeaDoctor,AdultswithHealthInsurance,ChildrenwithHealthInsurance,andPersonswithHealthInsurance.Over22%ofHarrisCountyadultsareunabletoaffordtoseeadoctor,whichishigherthantheproportioninTexas(18.3%)andtheU.S.(12.1%).Moreover,approximately20%ofresidentsinHarrisCountydonothavehealthinsurance.WallerCountyhassevenaccess-relatedindicatorsofconcern:

KeyIssues:• Rangeofbarriers,includingtransportation,accesstospecialtycare,lackofawareness,and

fearorstigma• Lackofhealthinsurance• Lowincomeandvulnerablegroups

SecondaryDataScoringMethodologyForeachindicator,eachcountyinMHRehabKaty’sserviceareawasassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariedbyindicatorandwasdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.PleaseseeAppendixBforfurtherinformationonHCIDataScoringmethodology.


AdultswithHealthInsurance,ChildrenwithHealthInsurance,DentistRate,MentalHealthProviderRate,Non-PhysicianPrimaryCareProviderRate,PersonswithHealthInsurance,andPrimaryCareProviderRate.Withanindicatorscoreof2.83andexhibitinganegativetrend,theNon-PhysicianPrimaryCareProviderRateinWallerCountyisveryconcerning.

Table19.SecondaryDataScoringResults:AccesstoHealthServices

  County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

AdultsUnabletoAffordtoSeea

Doctor[10](2015)

Austin

--- --- --- --- --- ---

FortBend

--- --- --- --- --- ---

Harris22.1

2 1.5 3 3 1.5 1.5percent

Waller

--- --- --- --- --- ---

 [10]TexasBehavioralRiskFactorSurveillanceSystem

AdultswithHealthInsurance:18-64[9]

(2016)

Austin78.3

1.64 1 1 1.5 3 1percent

FortBend

85.40.92 0 0 1.5 3 0

percent

Harris74.7

1.75 2 2 1.5 3 0percent

Waller71.5

2.14 3 2 1.5 1.5 1percent

[9]SmallAreaHealthInsuranceEstimates 

ChildrenwithHealthInsurance

[9](2016)

Austin89.3

1.58 1 2 1.5 3 0percent

FortBend

93.30.97 0 1 1.5 2 0

percent

Harris89.4

1.81 1 2 1.5 3 1percent

Waller86.6

1.97 2 2 1.5 1.5 1percent


DentistRate[4](2016) Austin

371.89 1 3 3 1.5 1

dentists/100,000


population

FortBend

51.81.17 0 2 3 1.5 0dentists/100,000

population

Harris66.3

0.5 0 0 2 1.5 0dentists/100,000population

Waller16

2.5 3 3 3 3 1.5dentists/100,000population

[4]CountyHealthRankings 

MentalHealthProviderRate[4]

(2017)

Austin26.9

2.44 2 3 3 1.5 2providers/100,000population

FortBend

59.82.11 1 3 3 1.5 2providers/100,000

population

Harris103.7


Waller33.9

2.44 2 3 3 3 2providers/100,000population


Non-PhysicianPrimaryCare

ProviderRate[4](2017)

Austin37


FortBend

52.2

providers/100,000population

1.67 1 3 3 1.5 0

Harris72.2

1 0 1 3 1.5 0providers/100,000population

Waller4



PersonswithHealthInsurance[9]

(2016)

Austin81.7

1.64 1 1 1.5 3 1percent

Fort 88.0 1.08 0 1 1.5 3 0


Bend percent

Harris79.3

1.75 2 2 1.5 3 0percent

Waller76.1

2.14 3 2 1.5 1.5 1percent


PrimaryCareProviderRate[4]

(2015)

Austin23.7


FortBend

80.30.33 0 0 1 1.5 0providers/100,000

population

Harris57.2


Waller10.3



WhenconsideringAccesstoHealthServices,itisimportanttotakeintoaccounttheeconomyandhowfinancialbarriersimpactcommunityresidents’abilitytoaccesscare.AsshowninTable20,thereareseveraleconomicindicatorswithdatascoresgreaterthan2inAustin,FortBend,Harris,andWallercounties.InAustinCounty,thefollowingareindicatorstonote:ChildFoodInsecurityRate,ChildrenLivingBelowPovertyLevel,FoodInsecurityRate,MortgagedOwnersMedianMonthlyHouseholdCosts,andEmploymentChange.InFortBendCounty,indicatorsofconcerninclude:MedianHouseholdGrossRent,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,andMortgagedOwnersMedianMonthlyHouseholdCosts.TheMedianHouseholdGrossRentinFortBendCountyis$1,252comparedto$911inTexasand$949intheU.S.Moreover,thisindicatorisexhibitinganegativetrendovertime.Similarly,theMedianMonthlyOwnerCostsforHouseholdswithoutaMortgageishigherinFortBendCounty($712)thanTexas($467)andtheU.S.($462).ComparedtoAustinandFortBendcounties,HarrisCountyhasabroaderrangeofeconomicindicatorsofconcern,including:Homeownership,SevereHousingProblems,StudentsEligiblefortheFreeLunchProgram,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,SNAPCertifiedStores,MedianHouseholdGrossRent,FamiliesLivingBelowPovertyLevel,andFoodInsecurityRate.Lessthan50%ofHarrisCountyresidentsownahome.Over20%of


residentsinHarrisCountyhaveseverehousingproblems.Andmorethan58%ofstudentsareeligibleforthefreelunchprogramcomparedtothenationalvalueof42.6%.InHarrisCounty,thereareover14%offamilieslivingbelowthepovertylevelcomparedto13%inTexasand11%intheU.S.ComparedtoHarrisCounty,WallerCountyhasagreaternumberofeconomicindicatorsofconcern,including:ChildFoodInsecurityRate,FemalePopulation16+inCivilianLaborForce,FoodInsecurityRate,HomeownerVacancyRate,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,PeopleLivingBelowPovertyLevel,PersonswithDisabilityLivinginPoverty(5-year),SevereHousingProblems,StudentsEligiblefortheFreeLunchProgram,SNAPCertifiedStores,andUnemployedWorkersinCivilianLaborForce.

Table20.SecondaryDataScoringResults:Economy

  County CountyValueComparedto:


TXCounties

TX US HP2020Target

TrendOverTime Value Value

ChildFoodInsecurityRate[5](2016)

Austin 24.2

2.17 2 2 3 1.5 1.5 percent

FortBend

19.1 0.67 0 0 2 1.5 0

percent

Harris 23.5

1.67 1 2 3 1.5 0 percent

Waller 24.0

2.06 2 2 3 3 1 percent

[5]FeedingAmerica 

ChildrenLivingBelowPovertyLevel[1](2012-2016)

Austin 25.3

2.33 2 2 3 1.5 3 percent

FortBend

11.2 0.39 0 0 0 1.5 1

percent

Harris 26.0

1.67 2 2 3 1.5 0 percent

Waller 25.1

1.89 2 2 3 3 1 percent

FamiliesLivingBelowPovertyLevel[1](2012-2016)

Austin 11.2

1.44 1 0 2 1.5 2 percent

FortBend

6.4 0.39 0 0 0 1.5 1

percent

Harris 14.4

2.06 2 3 3 1.5 1 percent


Waller 12

1.17 1 1 2 2 0 percent

[1]AmericanCommunitySurvey 

FemalePopulation16+inCivilianLaborForce[1](2012-2016)

Austin 54.4

1.78 1 2 2 1.5 2 percent

FortBend

59.3 1.17 0 1 1 1.5 3

percent

Harris 59.8

0.94 0 1 1 1.5 2 percent

Waller 50.6

2.06 2 3 3 3 1 percent


FoodInsecurityRate[5](2016)

Austin 15.8

2.06 2 2 3 1.5 1 percent

FortBend

14.8 1.56 1 1 3 1.5 1

percent

Harris 16.6

2.06 2 2 3 1.5 1 percent

Waller 19.2

2.39 3 3 3 3 1 percent

[5]FeedingAmerica

HomeownerVacancyRate[1](2012-2016)

Austin 1.6

0.89 1 1 0 1.5 1 percent

FortBend

1.1 0.17 0 0 0 1.5 0

percent

Harris 1.5

0.67 1 1 0 1.5 0 percent

Waller 2

2.28 2 3 3 3 2 percent

Homeownership[1](2012-2016)

Austin 63.5

0.56 0 0 0 1.5 1 percent

FortBend

74.4 0.39 0 0 0 1.5 1

percent

Harris 49.6

2.44 3 2 3 1.5 2 percent

Waller 59.6

1.06 1 1 1 1 1 percent



Low-IncomeandLowAccesstoaGroceryStore[17](2015)

Austin 3.5

1 0 1.5 1.5 1.5 1.5 percent

FortBend

7.1 1.5 1 1.5 1.5 1.5 1.5

percent

Harris 6.3

1.33 1 1.5 1.5 1.5 1.5 percent

Waller 11.3

1.83 2 1.5 1.5 1.5 1.5 percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas 

MedianHouseholdGrossRent[1](2012-

2016)

Austin 852

1.53 3 1 0 1.5 2 dollars

FortBend

1252 2.58 3 3 3 1.5 3

dollars

Harris 937

2.08 3 2 1 1.5 3 dollars

Waller 825

1.53 3 1 0 0 2 dollars

MedianMonthlyOwnerCostsfor

HouseholdswithoutaMortgage[1](2012-

2016)

Austin 448

1.58 3 1 1 1.5 1.5 dollars

FortBend

712 2.36 3 3 3 1.5 2

dollars

Harris 534

2.14 3 3 3 1.5 1 dollars

Waller 494

2.03 3 2 2 2 2 dollars


MortgagedOwnersMedianMonthly

HouseholdCosts[1](2012-2016)

Austin 1512

2.03 3 2 2 1.5 2 dollars

FortBend

1884 2.25 3 3 3 1.5 1.5

dollars

Harris 1504

1.81 3 2 2 1.5 1 dollars

Waller 1435

1.58 3 1 1 1 1.5 dollars

People65+LivingBelowPovertyLevel Austin

7.6 0.56 0 0 0 1.5 1

percent


[1](2012-2016) FortBend

6.9 0.39 0 0 0 1.5 1

percent

Harris 11.3

1.89 2 2 3 1.5 1 percent

Waller 4.9

0.17 0 0 0 0 0 percent

PeopleLiving200%AbovePovertyLevel[1](2012-2016)

Austin 68.2

1.11 0 1 1 1.5 2 percent

FortBend

79.4 0.17 0 0 0 1.5 0

percent

Harris 61.6

1.33 1 2 2 1.5 0 percent

Waller 59.3

1.67 2 2 3 3 0 percent

[1]AmericanCommunitySurvey

PeopleLivingBelowPovertyLevel[1](2012-2016)

Austin 14.5

1.33 1 0 1 1.5 3 percent

FortBend

8.2 0.39 0 0 0 1.5 1

percent

Harris 17.4

1.67 2 2 3 1.5 0 percent

Waller 19.0

2.06 2 3 3 3 1 percent

PerCapitaIncome[1](2012-2016)

Austin 28351

0.67 0 1 2 1.5 0 dollars

FortBend

37134 0.17 0 0 0 1.5 0

dollars

Harris 29850

0.5 0 1 1 1.5 0 dollars

Waller 23338

1.83 2 3 3 3 0 dollars

PersonswithDisabilityLivinginPoverty(5-year)[1]

(2012-2016)

Austin 24.0

1.08 1 1 0 1.5 1.5 percent

FortBend

15.6 0.75 0 0 0 1.5 1.5

percent

Harris 25.4

1.42 1 2 1 1.5 1.5 percent


Waller 30.5

2.08 2 3 3 3 1.5 percent

RentersSpending30%orMoreofHouseholdIncomeonRent[1]

(2012-2016)

Austin 42.3

1.44 3 0 0 1.5 2 percent

FortBend

40.1 1.06 2 0 0 1.5 1

percent

Harris 46.8

1.5 3 1 1 1.5 0 percent

Waller 46.8

1.83 3 1 1 1 1.5 percent


SevereHousingProblems[4](2010-

2014)

Austin 12.3

0.72 1 0 0 1.5 1 percent

FortBend

14.8 1.06 2 0 0 1.5 1

percent

Harris 20.9

2.39 3 3 3 1.5 1 percent

Waller 22.4

2.61 3 3 3 3 2 percent


SNAPCertifiedStores[17](2016)

Austin 0.9

1.22 1 1.5 1.5 1.5 1 stores/1,000population

FortBend

0.4 1.89 3 1.5 1.5 1.5 1 stores/1,000

population

Harris 0.6


Waller 0.6


[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas 

StudentsEligiblefortheFreeLunch

Program[8](2015-2016)

Austin 42.9

0.83 1 0 2 1.5 0 percent

FortBend

26.7 0.17 0 0 0 1.5 0

percent Harris 58.2 2.22 2 3 3 1.5 1


percent

Waller 65.8

2.39 3 3 3 3 1 percent

[8]NationalCenterforEducationStatistics 

TotalEmploymentChange[16](2014-

2015)

Austin -0.7

2.17 2 3 3 1.5 1.5 percent

FortBend

6.2 0.5 0 0 0 1.5 1.5

percent

Harris 2.4

1.67 1 3 2 1.5 1.5 percent

Waller 3.2

1.17 1 2 0 0 1.5 percent

[16]U.S.Census-CountyBusinessPatterns 

UnemployedWorkersinCivilianLaborForce

[15](July2018)

Austin 3.7

1.28 1 1 1 1.5 2 percent

FortBend

4.1 1.78 2 2 1 1.5 2

percent

Harris 4.4

1.94 2 2 2 1.5 2 percent

Waller 4.8

2.44 3 3 3 3 2 percent

[15]U.S.BureauofLaborStatistics 

Primary Data Duringthekeyinformantinterviewprocess,AccesstoHealthServiceswasdiscussedover160timesandwasraisedbyparticipantsalmost50timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengeswerelimitationstoprocuringspecialtycareservices,transportationtoservicesandhoursofoperation.Inadditiontotheprimarythemes,twoadditionalbarriersorchallengesstoodoutaskeyfactorsimpactingaccesstohealthcareservices,lackofknowledgeandstigmaorfearpreventingpeoplefromseekingcare.Theissuethatinterviewparticipantsweremostconcernedwithwaspatientsbeingabletoaccessfollowupcarewithspecialtycareproviders.Multipleparticipantsraisedconcernsthatevenifpatientsareabletoaccesspreventativeorprimarycareservices,theymaynotbeabletoaccesstheappropriatefollowupcarewithaspecialtycareprovider.Someparticipantsraisedthisconcernincontextofpatientsnotlivingnearaspecialistandothersraisedincontextofpatientsnotbeingabletoaffordthecostoffollowupcare.Aconcernbroughtupbyafew


participants,thatforseriouschronicconditions,patientswouldultimatelyendupseekingcarefromemergencyservicesinstead.Anothercommonconcernraisedbyinterviewparticipants,wastransportationtoservicesandhoursofoperationofserviceslimitingpatients’accesstocare.Participantsdescribedhowthesefactorsdeterminewhetherpatientsdecidetotakeofffromworkandseekservicesinthefirstplace.“Iwouldthinkthatourlower-incomefolks,itdefinitelybecomesmoreofachallengeforthem,whenyoudon’thavefacilitiesthatarelocatedclose-byinproximity.”Afewparticipantsdescribedthemanyservicesandresourcesthatareavailabletothecommunitybutthatmanymaynotbeawarehowtheycanaccessorbenefitfromthem.Oneparticipantdescribedresourcesbeingconcentratedincertaingeographicareasandmoreremotelocationsnotbeingwellconnectedorknowledgeableabouthowtheymayalsobenefitfromtheseresources.Participantsdescribedthepotentialformorecollaborationandpartnershiptoconnectcommunitiestooneanother.Severalparticipantsdescribedadown-turninpeopleseekingpreventativecareserviceandhypothesizedthatoneofthefactorsmayberelatedtotheimmigrantcommunityintheregionexperiencingfearorstigmarelatedtohavingtoshowidentificationorproofofcitizenship.“EventhoughweattheHealthDistrictdonotaskforproofofimmigrationstatus,peopledon'tunderstandthat,particularlysincewe'reagovernmentagency,andit'sbeenarealchallengetogetsomeofthesefolkstocomeinforservices.”Therewerealmost80referencestotheuninsuredpopulationinthekeyinformantinterviewsandlackofhealthinsurancewasraisedasabarrierorchallengetoachievinghealthinthecommunity19times.Lackofhealthinsurancewasmostoftenbroughtupincontextofpatientshavinglimitedfinancialresourcesandafactortonotaccessinghealthcareservices.Participantsdiscussedpatientsnothavingtheabilitytopayfeesformultipleappointmentco-paysornotseekingcareduetocompetingfinancialpriorities.Whilehealthcareservicesmaybeavailableinthecommunity,forthosewhoarelackinghealthinsurance,accessinghealthcareservicesisnotnecessarilyanoption.Lackofhealthinsurancecreatesaparticularchallengeforthosewhorequirespecialtycareservices.“Ithinkthosearethebiggesttwo—access,again,withthemajorityofouradultpopulationbeinguninsured,havingthemtrytofindaproviderthat,again,willtakeslidingfeescale,orreducedrates.Oncethey'reabletoaccessthoseservices,thenitbecomesamatterofpayingforthethingsthatareneeded.Thepatientcomesinandwediagnosethemwithdiabetes,thencomesthecostofmedications,andifthatpatientisneedingspecialtycareoutsideofthescopeofprimarycare,accesstospecialists.”Participantsbroughtupissuesrelatedtolowincomeorgroupswhomaybeunderservedinthecommunity115timesduringthekeyinformantinterviewprocess.Particulargroupsthatparticipantsfeltmayexperienceaddedchallengesaccessinghealthcareservicesincludedtheimmigrantpopulation,individualswithdisabilities,familieswithyoungchildren,andthe


elderly.Severalparticipantsnotedfeesrelatedtoco-paysoroutofpocketexpensesasabarriertopatientsseekinginitialpreventativeservicesorongoingtreatmentforchronicconditions.Participantsidentifiedseveralgroupstheyfeltwereunderservedinthecommunity.Multipleparticipantsdiscussedtheuniqueandspecificchallengeswithprovidingculturallyappropriatecareforadiverseandrecentimmigrantpopulationinthecommunity.Participantsfeltthatfamilieswithyoungchildrenandtheelderlypopulationareparticularlyvulnerablegroupsinthecommunitythatexperiencebarriersandchallengesaccessinghealthcareservices.Specifically,participantsdiscussedthesegroupsexperiencinghighlevelsofpovertyplacingthemathigherriskforpoorhealthoutcomes.“Mostofthemareextremelylowincomeandtheyfallinthosecategorieswherewehaveasignificantnumberofelderlydisabled,singlemomsandtheirchildren,sovulnerablefolkshereinHouston.”

Emotional Well-Being

Secondary Data MentalHealthandSubstanceAbusewereidentifiedassignificantneedsforMemorialHermannHealthSystem.AsshowninTable21,thereareseveralconcerningindicatorsrelatedtoMentalHealth&MentalDisorders.InHarrisCounty,11.4%oftheMedicarePopulationhasAlzheimer’sDiseaseorDementia,whichishigherthantheU.S.value(9.9%).Moreover,80%ofresidentsinHarrisCountyreportedhaving5ormorepoormentalhealthdaysinthepastmonth.InAustin,FortBendandWallercounties,anindicatorofconcernistheMentalHealthProviderRate(withindicatorscoresabove2).Therateof26.9providersper100,000population(inbothAustinandWallercounties)islessthanonethirdofthestatevalue(98.8)andisalmostoneeightofthenationalvalue(214.3).AnadditionalindicatorofconcerninAustinandWallercountiesisAge-AdjustedDeathRateduetoSuicide.

Table21.SecondaryDataScoringResults:MentalHealth&MentalDisorders

County CountyValueComparedto:


TXCounties

TX US HP2020Target


MentalHealthProviderRate[4]

(2017)

Austin26.9


FortBend

59.82.11 1 3 3 1.5 2providers/100,000

populationHarris 103.7 1.44 0 1 3 1.5 2

KeyIssues:• Mentalhealthaspartofoverallhealth• Needformorebehavioralhealthservicesandproviders• Alcoholandsubstanceabuse• Alzheimer’sanddementia


providers/100,000population

Waller33.9


[4]CountyHealthRankings

Age-AdjustedDeathRateduetoSuicide[12](2010-2014)

Austin16.6

2.17 1.5 3 3 3 1.5deaths/100,000population

FortBend

7.30.94 1.5 0 0 0 2deaths/100,000

population

Harris10.3

0.94 1.5 0 0 2 1deaths/100,000population

Waller15.8

2.28 1.5 3 3 3 2deaths/100,000population

[12]TexasDepartmentofStateHealthServices

Alzheimer'sDiseaseorDementia:MedicarePopulation[3](2015)

Austin9.9

1 0 0 1 1.5 1.5percent

FortBend

10.21.33 1 0 2 1.5 1.5

percent

Harris11.4

1.89 2 1 3 1.5 1percent

Waller10.5

1.78 1 1 2 2 2percent

[3]CentersforMedicare&MedicaidServices

PoorMentalHealth:5+Days[10](2016)

Austin

--- --- --- --- --- ---

FortBend

--- --- --- --- --- ---

Harris80.0

1.53 1.5 1 1.5 1.5 2percent

Waller

--- --- --- --- --- ---

[10]TexasBehavioralRiskFactorSurveillanceSystemSubstanceAbuseisatopicofconcerninFortBend,HarrisandWallercounties.InFortBendandHarriscounties,theproportionofalcohol-impaireddrivingdeathsishigherthanthestateandtheU.S.Therewere36%alcohol-impaireddrivingdeathsinFortBendCountyand37.8%inHarrisCounty,comparedto28.3%and29.3%inTexasandtheU.S.,respectively(Table22).InWallerCounty,oneinfiveadultsdrinksexcessively(20.5%).


Table22.SecondaryDataScoringResults:SubstanceAbuse



TXCounties

TX US HP2020Target


Alcohol-ImpairedDrivingDeaths[4]

(2012-2016)

Austin18.2

0.33 1 0 0 1.5 0percent

FortBend

36.02 3 3 3 1.5 0

percent

Harris37.8

2.17 3 3 3 1.5 0percent

Waller21.8

0.5 1 0 0 0 0percent

AdultswhoDrinkExcessively[4](2016)

Austin18.3

1.5 2 1 2 0 1.5percent

FortBend

18.31.5 2 1 2 0 1.5

percent

Harris18.1

1.5 2 1 2 0 1.5percent

Waller20.5

2.17 3 2 3 3 1.5percent


Primary Data Approximately50%ofcommunitysurveyrespondentscitedMentalHealthasoneofthetopissuesmostaffectingthequalityoflifeintheircommunityand52%ofrespondentsnotedSubstanceAbuse.Ininterviewswithkeyinformants,MentalHealthwasdiscussed113timesandwasraisedbyparticipants33timesasaneedsorconcernforthehealthofthecommunity.TheprimarythemesrelatedtoMentalHealthweretreatingmentalhealthaspartofoverallhealth,addressbehavioralhealthinschool,needforbehavioralhealthprovidersandservicesandolderadultswithAlzheimer’sanddementia.Someparticipantsdiscussedarecentshiftincaredeliveryandthecontinuedneedtoaddressmentalhealthaspartofaperson’stotalhealthsimilarlytohowchronicdiseaseismanaged.Oneparticularlyvulnerablepopulationthatwouldbenefitfromabroaderapproachtotreatment,inclusiveofmentalhealth,isthehomelesspopulation.Severalparticipantsbroughtupissuesregardinganeedformorebehavioralhealthprovidersandservicesinthecommunity.


“(…)Ithinkthereneedstobemoreworkaroundfundingforbehavioralhealthbutalsofundingforrecruitingandtrainingtherapistsandbehavioralhealthspecialiststoaddresssubstanceabuse,anxiety,depressionandsuicidality.”Oneparticipantobservedrecentincreasesandchangeswithinthelocalpopulation.Fromtheparticipant’sperspective,thereshouldbemoreprogramsorservicestoaddressthegrowingneedforaddressingmentalhealthinthecommunity.Anotherparticipantsuggestedsolutionsforaddressingtheneedformorebehavioralhealthprovidersinthecommunitysuchasexpandingresidencyprogramsforpsychiatristsanddevelopingcomprehensivetelemedicineprogramstoprovideservicesmoreefficiently.Furthermore,participantsrecommendedaddressingbehavioralhealthwithyoungerpopulationsintheschools.Schoolsthatprovidebehavioralhealthservicesthroughtelemedicinehavebeenreceivedwellinthecommunityandtheperceptionisthattheyareeffective.Someparticipantsbelievethattheseprogramsshouldbeexpandedandavailableacrossthecommunity.“There[are]thementalhealthunitsthathavegoneoutintotheschools.They'renotschool-basedbutthat’sthevenuetheywilldrivetowiththeirmobileunits.Theyhaveabigimpact.They'reseeingthousandsofkids.They’vedonesometelemedicinewithmentalhealth,behavioralhealth,withsomeofthehighschools.FromwhatI’veheard,(…)it’sbeenprettyeffectiveandwellreceived.”AchallengethathealthcareprovidersidentifiedforthemedicalcommunityisadequatelyaddressingdementiaandAlzheimer’swithinthegeriatricpopulation.“Dementia’saterminalillness.(…)Muchmoreneedstobedonewithhealthcaresystemsaroundroutinescreeningandidentificationofitasanissue.(…)So,thatisthefirstthingthatneedstohappen.Thenthereneedstobeanunderstandingthattherearethings–therearemedicationsthatcanbehelpfultothesystemsofthedementia.(…)Butyoucanaffectitbyaddressingsomeofthesymptoms.”SubstanceAbusewasdiscussed55timesandwasraisedbyparticipants15timesasaneedorconcernforthehealthofthecommunity.MultipleuniquethemesemergedfromthekeyinformantinterviewsrelatedtoSubstanceAbuse:fundingfortreatmentprograms,invisibilityofalcoholism,overcomingstigmaofseekingtreatment,andemergingshiftsinoutreachmodels.Participantsidentifiedfundingforprogramsandavailabilityofservicesforthosewhomaynotbeabletoaffordtreatmentout-of-pocketasissuesthecommunityisfacingtoaddresssubstanceabuse.Oneparticipantdiscussedthedifficultyofmakingaconnectionbetweenthejailsystemandthehealthcaresystemforthosestrugglingwithsubstanceabuseissues.“Westilldealdailywithalotofdruguseinourcounty,and(…)alotoffolksthatcometoourjailsystemarebeingarrestedondrugoffenses,andthatcontinuestobeachallengetogetthesepeoplewheretheyneedtobe,fromahealthcarestandpoint,especiallymentalhealth,andIthinkthisgoesforanycountyinthestateofTexas.”


Oneparticipantraisedalcoholabusespecificallyasanissueinthecommunitythatdoesnotgettheamountofattentionofothersubstanceabusetopicsbutmayinfactbeimpactingalargerproportionofthepopulationandconnectedtomanyotherhealthissues.Multipleparticipantsidentifiedculturalstigmaasabarrierforthosewhomaybenefitfromseekingtreatment.Stigmaorfearmaybeuniqueandvaryfrompopulationtopopulationinthecommunity.“Withsubstanceabuse,it’scultureandstigma.Nobodygoestosubstanceabusetreatmentontheirown.Theymaynotbeadjudicatedbutsomeoneisreally,reallypushingthem,familymember,boss.Noonegoestotreatmentifthey’renotunderduress.”Afewparticipantsdescribeduniqueapproachestooutreachandsubstanceabusetreatmentinthecommunitythatwouldsupportremovingbarriersforpeoplehavingtotakethefirststepontheirown.“Forinstance,it’sprettynew,butthere’saninitiativethat’scalledtheHeroesProjectthat’slookingatoverdoses,sowhenanoverdosehappens,they’resendingateamtotheER.So,it’sgotapeersupportspecialist,theEMPisinvolved–buttheyactuallygointotheERandtheydoaninterventiontheretotrytohelpwithlinkagetotreatmentsothatwecanassistthepatients.”

Food as Health

Secondary Data ThetopicsofDiabetesandHeartDisease&Strokeemergedassignificanthealthneeds.HeartDisease&StrokerosetothetopofthesecondarydatascoringresultsforMemorialHermannHealthSystem.AlthoughDiabeteswasnotinthetopresultsoftheindividualcounties’secondarydatascoring,anindicatorofconcernforbothFortBendandWallercountiesistheproportionofDiabetesintheMedicarepopulation,withvaluesof30.8%and29.6%,respectively,comparedto26.5%intheU.S.(Table23).

Table23.SecondaryDataScoringResults:Diabetes



TXCounties

TX US HP2020Target


Diabetes:MedicarePopulation[3](2015)

Austin25.0

0.67 1 0 1 1.5 0percent

FortBend

30.82.22 3 2 3 1.5 1

percent

Harris28.1

1.67 2 1 2 1.5 1.5percent

KeyIssues:• Foodinsecurityandlimitedaccesstohealthyfoods• Diabetesandheartdiseaselinkedtosocioeconomicfactors• Sedentarylifestyleanddrivingculture


Waller29.6

2.06 2 2 3 3 1percent


AsshowninTable24,anotherindicatorofconcernisStrokeintheMedicarePopulationwithscoresabove2forAustin,FortBend,Harris,andWallercounties.Additionalindicatorsscoringabove2(andallwithintheMedicarePopulation)include:AtrialFibrillation(AustinandWallercounties),HeartFailure(WallerCounty),Hyperlipidemia(AustinandFortBendcounties),Hypertension(WallerCounty),andIschemicHeartDisease(WallerCounty).

Table24.SecondaryDataScoringResults:HeartDisease&Stroke


Indicator Name ValueDataScore

TXCounties

TX US HP2020Target


Age-AdjustedDeathRateduetoHeartDisease[12](2010-

2014)

Austin176.7

1.25 1 2 2 1.5 0deaths/100,000population

FortBend

1350.42 0 0 0 1.5 0deaths/100,000

population

Harris167.6

0.92 1 1 1 1.5 0deaths/100,000population

Waller194.8

1.75 2 3 3 3 0deaths/100,000population

[12]TexasDepartmentofStateHealthServices

AtrialFibrillation:MedicarePopulation

[3](2015)

Austin8.7

2.28 3 3 2 1.5 2percent

FortBend

6.90.94 1 1 0 1.5 2

percent

Harris7.3

1.5 1 1 1 1.5 3percent

Waller8.4

2.17 3 3 2 2 1.5percent


HeartFailure:MedicarePopulation

[3](2015)

Austin15.1

1.56 1 1 3 1.5 1percent

FortBend

13.91.06 0 0 2 1.5 1

percent

Harris16.0

1.89 1 2 3 1.5 1percent

Waller 17.5 2.44 2 3 3 3 2


percent[3]CentersforMedicare&MedicaidServices

Hyperlipidemia:MedicarePopulation

[3](2015)

Austin46.8

2.17 2 2 2 1.5 3percent

FortBend

46.62.17 2 2 2 1.5 3

percent

Harris43.2

1.44 1 1 1 1.5 2percent

Waller46.1

1.94 2 2 2 2 2percent

Hypertension:MedicarePopulation

[3](2015)

Austin59.6

1.94 2 2 2 1.5 2percent

FortBend

57.11.61 1 1 2 1.5 2

percent

Harris55.5

1.22 1 1 2 1.5 1percent

Waller61.6

2.06 2 2 3 3 1percent

IschemicHeartDisease:Medicare

Population[3](2015)

Austin26.9

1.22 0 1 2 1.5 1percent

FortBend

28.01.22 0 1 2 1.5 1

percent

Harris28.8

1.33 1 2 2 1.5 0percent

Waller31.0

2.06 2 2 3 3 1percent

Stroke:MedicarePopulation[3](2015)

Austin4.7

2.28 2 2 3 1.5 2percent

FortBend

4.72.5 2 2 3 1.5 3

percent

Harris5.2

2.61 3 3 3 1.5 2percent

Waller6.0

2.61 3 3 3 3 2percent


Table25revealsfood-relatedindicatorsofconcern;thosescoringabove2include:ChildFoodInsecurityRate(AustinandWallercounties),FoodEnvironmentIndex(WallerCounty),FoodInsecurityRate(Austin,HarrisandWallercounties),GroceryStoreDensity(WallerCounty),andSNAPCertifiedStores(HarrisandWallercounties).


Table25.SecondaryDataScoringResults:Nutrition



TXCounties

TX US HP2020Target



Austin24.2

2.17 2 2 3 1.5 1.5

percent

FortBend

19.10.67 0 0 2 1.5 0

percent

Harris23.5

1.67 1 2 3 1.5 0percent

Waller24.0

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

ChildrenwithLowAccesstoaGroceryStore[17](2015)

Austin2.5

1.17 0 1.5 1.5 1.5 1.5percent

FortBend

7.41.83 2 1.5 1.5 1.5 1.5

percent

Harris5.4

1.5 1 1.5 1.5 1.5 1.5percent

Waller1.9

1 0 1.5 1.5 1.5 1.5percent

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

FastFoodRestaurantDensity[17](2014)

Austin0.5

1.22 1 1.5 1.5 1.5 1restaurants/1,000population

FortBend

0.61.33 1 1.5 1.5 1.5 1.5restaurants/1,000

population

Harris0.7

1.67 2 1.5 1.5 1.5 1.5restaurants/1,000population

Waller0.4



FoodEnvironmentIndex[4](2018)

Austin7.7

0.72 0 0 1 1.5 1percent

FortBend

7.41.22 1 0 2 1.5 1

percent

Harris7.2

1 1 0 2 1.5 0percent


Waller6.3

2.11 2 1 3 3 2percent



Austin15.8

2.06 2 2 3 1.5 1percent

FortBend

14.81.56 1 1 3 1.5 1

percent

Harris16.6

2.06 2 2 3 1.5 1percent

Waller19.2

2.39 3 3 3 3 1percent

[5]FeedingAmerica

GroceryStoreDensity[17](2014)

Austin0.2

1.39 1 1.5 1.5 1.5 1stores/1,000population

FortBend

0.11.83 2 1.5 1.5 1.5 1.5stores/1,000

population

Harris0.2

1.5 1 1.5 1.5 1.5 1.5stores/1,000population

Waller0.1

2 3 1.5 1.5 1.5 1.5stores/1,000population


HouseholdswithNoCarandLowAccesstoaGroceryStore[17]

(2015)

Austin2.4

1.5 2 1.5 1.5 1.5 1.5percent

FortBend

1.11 0 1.5 1.5 1.5 1.5

percent

Harris0.9

1 0 1.5 1.5 1.5 1.5percent

Waller2.8

1.67 2 1.5 1.5 1.5 1.5percent



Austin3.5

1 0 1.5 1.5 1.5 1.5percent

FortBend

7.11.5 1 1.5 1.5 1.5 1.5

percent

Harris6.3

1.33 1 1.5 1.5 1.5 1.5percent

Waller11.3

1.83 2 1.5 1.5 1.5 1.5percent




Austin0.9


FortBend

0.41.89 3 1.5 1.5 1.5 1stores/1,000

population

Harris0.6


Waller0.6



Primary Data Food-relatedtopicsemergedinthecommunityinputgatheredthroughthesurveyandkeyinformantinterviews.FoodInsecurity,FoodProgramsandFoodKnowledgeissueswerediscussedover170timesduringthekeyinformantinterviewsandwereraisedbyparticipants34timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengesthatemergedintheinterviewswereaccesstohealthyfoodsandaffordability,knowledgegapsandlimitedfoodfamiliarityandprogramlimitations.Themostcommonissueraisedbykeyinformantparticipantsrelatedtofoodinsecuritywascommunitymembersnotbeingabletoaccesshealthyfoodsintheircommunity.Multipleparticipantsbelievedthatinmanycommunities,healthyfoodoptionswerenotavailabletopeoplewithinafive-mileradiusfromtheirhomeorwork.Participantsdescribed‘fooddeserts’asatopissueaffectinghealthinthecommunityandhowlimitedaccesstohealthyfoodsalsowascloselyassociatedwithpeoplealsobeingnotbeingabletoaffordhealthyfoods.

“Thenwerealizedweneededtodosomethingfortheparents,sowecreatedanexerciseprogramforthemintheeveningaswellasthatRecipeforSuccesstonotonlycomeintotheschoolbutcomeintotheparkandrecreationcentertohelptheparentswithnutritionalmealsandthenwerealizedthattherewasn’tagrocerystorenear.Therewereseveralmom-and-popstores,soweworkedwiththemomandpopstorestodevelopahealthiervarietyoffoodsforthecommunity.”

Participantsalsodiscussedtheimbalanceofhealthyfoodoptionsforthosecommunitieswithlowerhousingpricesandingeneral,loweraverageincomes.Oneparticipantdescribedthelinkbetweenpeoplehavingtoworkmultiplejobsandhavingtimetoshopforandpreparehealthyfoods.

“Wehaveagrocerystoreoneverycornerbutnoteverycornerinthepoorneighborhoods.It’sbeenmypersonalexperiencethateatinghealthyisexpensive.Itcostsmoremoneytobuyhealthyfruitsandvegetablesandmorehealthyfood,ingeneralthanitdoestobuyfoodthat’snotsohealthy,that’shighfat,highcarb,highsugar….Itcostsmoremoney.Ittakeslongertoprepare.Whenyouhaveamomandadadoreitherandthey’retryingtohandletwojobs,ifnotthree.They’vegotkidsofvaryingages.Themechanicsofshoppingandpreparingmealsisprobablyanactivitythatgetsletgo.”


Someparticipantshaddirectexperiencewitheducatingthecommunityabouthealthyfoodsandeating.Theseparticipantssharedthatforsomecommunitymembers,theirknowledgeoffreshfruitsandvegetablesislimitedandwouldbenefitfromearlyeducationforparentsandchildreninschools.InMemorialHermann’scommunitysurvey,67%ofrespondentsselectedDiabetesasoneofthetopissuesmostaffectingthequalityoflifeintheircommunity.Duringkeyinformantinterviews,Diabeteswasdiscussed64timesandwasraisedbyparticipants32timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedDiabetesasatophealthissueinthecommunity,uniquethemesemergedregardinghowdiabetesisimpactingspecificgroupsinthecommunityandthewayasedentarylifestyleimpactsdiabetes.MultipleparticipantsattributedthesurgeinobesityanddiabetesingeneralintheU.S.toashifttoamoresedentarylifestylewhileothersspecificallyidentifiedthelocalclimateanddrivingcultureaskeyfactorsleadingtoanincreaseinsedentarylifestylesimpactingtheregion.HeartDisease&Strokewasdiscussed34timesduringthekeyinformantinterviewsandwasraisedbyparticipants16timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedHeartDisease&Strokeasatophealthissueinthecommunity,theuniquethemesthatemergedintheinterviewswerechronicdiseaseriskrelatedtosocioeconomicstatusandchallengeswithmanagingheart-relatedconditions.“Youhavesomanycommunitiesthatarefooddesertsso,ofcourse,Ithinkweareallatriskforthingslikediabetesandhypertension,obesity,stroke–but,Ithinkinadditiontothat,thosethataremostarealreadymarginalized.Peoplewhoarelowincome.Lowsocioeconomicstatus.So,education,andallofthoseindicatorsareprobablyevenmoreatriskforchronicdiseasesthansomeone,forexample,whohasaccesstocareandinsurance.So,theyprobablyaredoublyatrisk.”

Exercise Is Medicine

Secondary Data Exercise,Nutrition&Weightwasthethirdhighest-rankingtopicinthesecondarydatascoringresultsforFortBendCountyandfifthforMemorialHermannHealthSystem.AlthoughExercise,Nutrition&WeightdidnotrisetothetopofthesecondarydatascoringresultsforAustin,HarrisandWallercounties,thereareindicatorsofconcerntonote(Table26).Exercise-relatedindicatorswithscoresabove2include:AccesstoExerciseOpportunities(AustinandWallercounties)andWorkersWhoWalktoWork(Austin,FortBendandHarriscounties).

KeyIssues:• Obesity• Walkabilityofcommunities• Safetyofoutdoorspacesandplacestoexercise• School-basedprograms


Table26.SecondaryDataScoringResults:Exercise,Nutrition&Weight



TXCounties

TX US HP2020Target



Austin24.2

2.17 2 2 3 1.5 1.5percent

FortBend

19.10.67 0 0 2 1.5 0

percent

Harris23.5

1.67 1 2 3 1.5 0percent

Waller24.0

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

AccesstoExerciseOpportunities[4]

(2018)

Austin66.2

2 1 3 3 1.5 1.5percent

FortBend

83.80.83 0 1 1 1.5 1.5

percent

Harris90.4

0.67 0 0 1 1.5 1.5percent

Waller45.2

2.33 2 3 3 1.5 1.5percent


Adults(18+Years)WhoAreObese[10]

(2018)

Austin

--- --- --- --- --- ---

FortBend

--- --- --- --- --- ---

Harris32.0

1.67 1.5 1 2 2 2percent

Waller

--- --- --- --- --- ---

[10]TexasBehavioralRiskFactorSurveillanceSystem

ChildrenwithLowAccesstoaGroceryStore[17](2015)

Austin2.5

1.17 0 1.5 1.5 1.5 1.5percent

FortBend

7.41.83 2 1.5 1.5 1.5 1.5

percent

Harris5.4

1.5 1 1.5 1.5 1.5 1.5percent

Waller1.9

1 0 1.5 1.5 1.5 1.5percent



FastFoodRestaurantDensity[17](2014)

Austin0.5

1.22 1 1.5 1.5 1.5 1restaurants/1,000population

FortBend

0.61.33 1 1.5 1.5 1.5 1.5restaurants/1,000

population

Harris0.7


Waller0.4



FoodEnvironmentIndex[4](2018)

Austin7.7

0.72 0 0 1 1.5 1percent

FortBend

7.41.22 1 0 2 1.5 1

percent

Harris7.2

1 1 0 2 1.5 0percent

Waller6.3

2.11 2 1 3 3 2percent



Austin15.8

2.06 2 2 3 1.5 1percent

FortBend

14.81.56 1 1 3 1.5 1

percent

Harris16.6

2.06 2 2 3 1.5 1percent

Waller19.2

2.39 3 3 3 3 1percent

[5]FeedingAmerica

GroceryStoreDensity[17](2014)

Austin0.2


FortBend

0.11.83 2 1.5 1.5 1.5 1.5stores/1,000

population

Harris0.2

1.5 1 1.5 1.5 1.5 1.5stores/1,000population

Waller0.1

2 3 1.5 1.5 1.5 1.5stores/1,000population



HouseholdswithNoCarandLowAccesstoaGroceryStore[17]

(2015)

Austin2.4

1.5 2 1.5 1.5 1.5 1.5percent

FortBend

1.11 0 1.5 1.5 1.5 1.5

percent

Harris0.9

1 0 1.5 1.5 1.5 1.5percent

Waller2.8

1.67 2 1.5 1.5 1.5 1.5percent



Austin3.5

1 0 1.5 1.5 1.5 1.5percent

FortBend

7.11.5 1 1.5 1.5 1.5 1.5

percent

Harris6.3

1.33 1 1.5 1.5 1.5 1.5percent

Waller11.3

1.83 2 1.5 1.5 1.5 1.5percent


RecreationandFitnessFacilities[17](2014)

Austin0.1

0.89 0 1.5 1.5 1.5 1facilities/1,000population

FortBend

0.11.33 1 1.5 1.5 1.5 1.5facilities/1,000

population

Harris0.1

1.33 1 1.5 1.5 1.5 1.5facilities/1,000population

Waller0

1.78 2 1.5 1.5 1.5 2facilities/1,000population



Austin0.9


FortBend

0.41.89 3 1.5 1.5 1.5 1stores/1,000

population

Harris0.6


Waller0.6




WorkerswhoWalktoWork[1](2012-2016)

Austin1.7

2.11 2 1 3 3 2percent

FortBend

0.62.67 3 3 3 3 1.5

percent

Harris1.5

2.17 2 2 3 3 1.5percent

Waller4.7

0.22 0 0 0 0 1percent

[1]AmericanCommunitySurvey

Primary Data Over60%ofMemorialHermann’scommunitysurveyrespondentsnotedObesityasatopissueaffectingthequalityoflifeintheircommunity.Inkeyinformantinterviews,Exercise,Nutrition&Weightwasdiscussedalmost170timesandwasraisedbyparticipants42timesasaneedorconcernforachievinghealthinthecommunity.TheprimarybarriersrelatedtoExercise,Nutrition&Weightidentifiedbyparticipantswerewalkability,accesstosafeoutdoorspacesandprogrammingthatmaynotmeettheneedsofcommunitiesfacingfinanciallimitations.Participantsalsodiscussedaneedtodevelopnutritionalprogrammingforyouthintheschools.Severalparticipantsdiscussedbarrierstohealthylifestylechangesanddescribedcommunitieswheresidewalksarelimitedorpedestrianpathwaysarenotavailable.Theabilityforcommunitymemberstomakesmallshiftsintheirdailylives,suchaswalkingregularly,maybemorefeasiblethanundertakinganexerciseregimen.Thelimitationsofpedestrianpathwaysandsaferwalkingspacespreventthoseinsomesectionsofthecommunityfrommakingtheseshifts.Forindividualswhomaynotbeabletoaffordgymmembershipsnorattendclassesduetoworkschedules,outdooractivitiesandfitnessareasofferafreealternative.Participantsfeltthatinmanyneighborhoods,theseoutdoorspacesarenotavailableduetodisrepairorunsafeenvironments.“Ithinkthebuiltenvironmentishuge,too.Ifyouliveoutinaplannedcommunity,theyusuallyhavewalkingtrails,ortheyhaveaprettyfountainareaforyoutowalkaroundit.Theyhavethoselittleexercisethingsthatyoustoponpartwayaroundthetrailandyoudoyourlittlepush-upsandyoursit-upsandyourpull-ups(…)Yougointothesepoorerareasandthere'snosidewalks.There'snolightsatnight.There'sapark—it'sallrustedequipment.”Participantsalsodescribedprogramsandfacilitiesthatareeitherlimitedorlacking.Theseprogramsincludedfreeexerciseprogramswithchildcareoptions,youthsportsleaguesandrecessintheschoolsandfreeorlow-costoptionsforair-conditionedfacilitiesduringtimesoftheyearwhentheweatherdoesnotpermitoutdooractivities.


“InpoorareasofHouston,there’sjustnotalotofparks.There'snolittleleague,andthere'snosoccerleagues,andso,there'snotalotofrecessintheschools.There'sjustnot—thecultureamongthekidsisjustnotbeingcreatedaroundphysicalactivity.”Keyinformantsalsodiscussedtheopportunitytobringexerciseandnutritionprogramsintoschoolstoaddresschildhoodobesityandalsohelpwithstudents’overallperformance.“WhenwelaunchedtheCANDOproject,itwas(…)toaddresschildhoodobesity.Wewerelookingatphysicalactivity,wewerelookingatprovidinghealthyfoodandthenutritionguidelinesandthatsortofthing.Welookedatdoingitthroughschoolsandweactuallyidentifiedthreeschoolsthatwewouldworkwithandactuallyendupwithonethatwecouldreallydosomethingwith.”“…theprincipalandtheleadershipoftheschoolsweresofocusedontestscores.Wecanconvincethemthattestscoreswouldbeimprovediftheirstudentshadahealthydietandphysicalactivity,intermsofconnectingthedots.”


Non-Prioritized Significant Health Needs Thefollowingadditionalsignificanthealthneedsemergedfromareviewoftheprimaryandsecondarydata.Withtheneedtofocusontheprioritizedhealthneedsdescribedabove,thesetopicsarenotspecificallyprioritizedeffortsinthe2019-2022ImplementationStrategy.However,duetotheinterrelationshipsofsocialdeterminantneedsmanyoftheseareasfall,tangentially,withintheprioritizedhealthneedsandwillbeaddressedthroughtheupstreameffortsoftheprioritizedhealthneeds.Additionally,manyofthemareaddressedwithinongoingprogramsandservices.Examplesoftheseeffortsareprovidedbelowbytopicarea.

Older Adults and Aging

Secondary Data ThesecondarydatascoringresultsrevealedthetopicofOlderAdultsandAgingasasignificanthealthneed.OlderAdultsandAgingwasinthetop10topicsforAustin,FortBendandWallercountiesandreceivedatopicscoreof1.5inthesecondarydataresultsforHarrisCounty.InAustinCounty,indicatorstonoteinclude:AtrialFibrillation,Stroke,Hyperlipidemia,andRheumatoidArthritisorOsteoarthritis(allintheMedicarePopulation).InFortBendCounty,indicatorsofconcernincludedStroke,Diabetes,ChronicKidneyDisease,andHyperlipidemia(allintheMedicarePopulation).IndicatorsofnoteinHarrisCountyincluded:ChronicKidneyDiseaseandStrokeintheMedicarePopulationaswellasAge-AdjustedDeathRateduetoFalls.InWallerCounty,concerningindicatorsare:ChronicKidneyDisease,Stroke,HeartFailure,Age-AdjustedDeathRateduetoFalls,AtrialFibrillation,Diabetes,Hypertension,andIschemicHeartDisease(allintheMedicarePopulation).

Primary Data KeyinformantsandstakeholdersdiscussedOlderAdultsandAging.Over62%ofparticipantsinMemorialHermannHealthSystem’sprioritizationprocesscitedOlderAdultsasoneofthegroupsmostaffectedbypoorhealthoutcomes.Interviewswithkeyinformantsnotedthegrowingpopulationofolderadultsandneedsrelatedtospecializedcare,financialassistanceandoutreach.“…[W]earegoingtowatchtheliteraldoublingofthenumberofAmericansovertheageof65inthenext25years.Everyday,betweennowand2030,dayafterday,10,000Americanswillturn65,sowearewatchinganextraordinaryexpansionofchallengesofaging.(…)[M]oreandmoreAmericansaregoingtobegettingold,socaringforthismassiveincreaseintheagingpopulationisgoingtobeoneofthegreatchallengesIthink.”

Efforts MemorialHermannHealthSystemincludestwofreestandingRehabilitationHospitals(TIRRandKaty)aswellasaseniorlivingfacility(UniversityPlace),featuringindependentliving,personalassistanceservices,andaseparate,butattached,nursingcenter.Additionalcommunityoutreachincludeshealtheducationon:Alzheimer’sdisease,DiscountedDiabetesEducation,Education/outreachforSeniors,InjuryPrevention,FallPrevention,and


supportgroupsforvariouspopulations,including:Alzheimer’s,Amputees,Cardiacpatients,Chronicdisease,Diabetics,Grief,Parkinson’sdisease,Stroke,Survivorship,andmore.

Cancers

Secondary Data AlthoughCancerwasnotoneofthetoptentopicsinthesecondarydatascoringresultsforAustin,FortBend,Harris,andWallercounties,therearecertainindicatorstonote.InAustinCounty,thefollowingindicatorsscoredabove1.5inthesecondarydataresults:ProstateCancerIncidenceRate(withascoreabove2),CancerintheMedicarePopulation,ColorectalCancerIncidenceRate,andAge-AdjustedDeathRateduetoColorectalCancer.InFortBendCounty,indicatorswithindicatorscoresequaltoorabove1.5areCancerintheMedicarePopulationandProstateCancerIncidenceRate.InHarrisCounty,severalindicatorsareofconcernincluding:CervicalCancerIncidenceRateandAge-AdjustedDeathRateduetoBreastCancer(bothwithindicatorscoresabove2),CancerintheMedicarePopulation,ColonCancerScreening,andAge-AdjustedDeathRateduetoProstateCancer.InWallerCounty,theAge-AdjustedDeathRateduetoBreastCancerreceivedascoreof1.53.

Primary Data InMemorialHermann’scommunitysurvey,overonethirdofrespondentsnotedCancerasatopissueaffectingthequalityoflifeintheircommunity.Interviewswithkeyinformantsrevealedtheimportanceofearlydetectionandmakingcancerscreeningservicesandspecialtycareavailableandaccessible(e.g.,telehealth,mobilemammography).

Efforts AsleadingprovidersofcancertreatmentinHouston,MemorialHermannCancerCentersarecommittedtocancertreatment,prevention,andresearch.Theirbroadgeographicalcoveragemakescancertreatmentextremelyaccessibleandconvenienttowherepatientsliveorwork.AlleightMemorialHermannCancerCentersareapprovedbytheAmericanCollegeofSurgeonsCommissiononCancer(ACoSCoC);only25percentofhospitalsacrossthecountryhavereceivedthisspecialrecognition.Withguaranteedaccesstocomprehensivecare,collaborativeteamapproachforcoordinatingthebestavailabletreatmentoptions,state-of-the-artequipmentandservices,educationandsupport,andlifelongpatientfollow-upthroughtheCancerRegistry,patientsareabletoaccessafullmenuoftherapiesandtreatmentoptions.Additionaloutreachincludeseducationandsupportgroupsforcancerpatients:Art,Self-guidedArtTherapy,Lymphedema,BrestCancer,OncologyNutritionTherapy,StressRelief,LookGoodFeelBetter,Yoga,Meditation,andHealthyEatingAdvices.

Education

Secondary Data EducationwasthefifthmostimportanttopicinAustinCounty’ssecondarydataresults;InfantsBorntoMotherswithLessthan12YearsEducationandPeople25+withaHighSchoolDegreeorHigherreceivedindicatorscoresabove1.5.Educationreceivedatopicscoreof1.56inthe


secondarydataresultsforHarrisCounty.Thereareseveraleducation-relatedindicatorstoconsider:InfantsBorntoMotherswithLessThan12YearsofEducation(withavalueof27.5%inHarrisCounty,comparedto21.3%inTexasand15.9%intheU.S.),Student-to-TeacherRatio,HighSchoolDropOutRate,andPeople25+withaHighSchoolDegreeorHigher.EducationwasthefourthmostimportanttopicinWallerCounty’ssecondarydataresults;aneducation-relatedindicatorthatscoredabove2isPeople25+withaHighSchoolDegreeorHigher.

Primary Data Duringkeyinformantinterviews,thetopicofEducationcameupfrequentlyandinrelationtodifferentfocusareasandtargetaudiences,includingchildren,generalcommunitymembersaswellasproviders.Thelinkbetweenindividuals’levelofeducationandqualityoflifewasemphasized.Keyinformantsrecommendedfindingopportunitiestoexpandtheavailabilityofeducation(relatedtohealthandnon-healthtopics)aswellasintegratinghealtheducationintoexistingactivitiesinbothclinicalandnon-clinicalsettings,suchasschoolsandchurches.Opportunitieswerealsopointedouttoeducatehealthcareproviders(andprovidecontinuingeducation)onavailablecommunitylinkagesandresourcesandonhowtoinitiateconversationswithpatientsregardingdifferenthealthtopics.“Wewanttogointodifferentgroupsandeducatethemonwhattheyshouldbedoingorshouldn’tbedoing.(…)Ithinkeducationisahugecomponentbutwe’vegottofigureouthowtointegratethat.Theeducation,withouttheintegrationintosomebody’slifestyle,doesn’tdothemanygood.”

Efforts MemorialHermannoperatestenHealthCentersforSchools,establishedin1996,offeringaccesstoprimarymedical,dentalandmentalhealthservicestounderservedchildrenat82schoolsintheGreaterHoustonArea.Researchshowsthatschool-basedhealthcentersincreaseeducationalsuccessbyprovidingmedicalandmentalhealthcarethatallowsstudentstostayinschoolandlearn.Theprimarygoaloftheprogramistokeepchildrenhealthyandfeelingwellsothattheystayinschoolandcanperformwellacademically,creatingafoundationforabrighterfuture.Byprovidingimprovedaccesstohealthcaretoat-riskchildrenacrosstheregion,MemorialHermannhasdemonstratedsuccessincreatinghealthieroutcomesforkids,includingimprovementsintheirphysicalhealth,theirmentalwellbeing,andeventheirattendancerateatschool.

Transportation

Secondary Data ForAustin,FortBendandHarriscounties,Transportationroseto(orwasnear)thetopofthesecondarydatascoringresults,withatopicscoreof1.77inAustinCounty,1.83inFortBendCountyand1.82inHarrisCounty.AustinCountyhasseveralconcerningindicatorsrelatedtoTransportation,including:MeanTravelTimetoWork,SoloDriverswithaLongCommute,WorkersCommutingbyPublicTransportation,andWorkerswhoWalktoWork.InbothFortBendandHarriscounties,indicatorsofconcerninclude:SoloDriverswithaLongCommute,MeanTravelTimetoWork,andWorkerswhoWalktoWork.Furthermore,thereexisthighdisparitiesforafewoftheseindicators.InFortBendCounty,anadditionalindicatortonote


includesWorkerswhoDriveAlonetoWork(withanindicatorscoreof1.94).AlthoughTransportationwasnotahigh-rankingtopicinWallerCounty’ssecondarydataresults,therearetwoconcerningindicators(withscoresgreaterthan2):MeanTravelTimetoWorkandSoloDriverswithaLongCommute.

Primary Data ParticipantsraisedthetopicofTransportation59timesinrelationtobarriersorchallengestoachievinghealthinthecommunity–morethananyothertopic.KeyinformantsrepeatedlynotedthattheHoustonregionhassignificanttransportationissues(includingavailability,accessibility)thatimpactcommunitymembers’abilitytoaccesshealthprogramsandservices.Inadditiontolimitedoptionsforpublictransportation,travelcostandtimewerebroughtup.Moreover,forcertainpopulations,likeolderadultsorpeoplewithdisabilities,publictransportationisnotafeasibleoption.“Forsomeindividualsthatdon’thavetransportation,usuallyit’sahugechallenge.(…)wedopartnerwithColoradoValleyTransitAuthority,andtheycanprovidetransportationservices.Again,thechallengeismakingsurepeopleareevenawareofthat,thattheyknowabouttheprogram,thattheyknowwhotocalltoarrangethattransportation.”“Thisremarkablespread-outcity,thesizeofMassachusetts,istheGreaterHoustonMetropolitanArea.(…)Thisisnotacityandasuburbanymore,it’sametropolitanregionwitheighttotencentersofactivitythatarelargerthandowntownSanDiego,spreadoutoverthismassivearea,butgettingfromoneplacetoanotherisanincreasingchallenge.Povertyalsomeansinadequatetransportation,wehavenoreallygoodtransitsystembecauseit’salmostimpossibletodevelopagoodtransitsystemforacitysolackingindensityandsospreadoutasHoustonis.Wehaven’tsolvedthatproblem,andalotofthehealthcareissuescomebecausepeople[are]withoutacartryingtogettoahospital,ortohealthcare…”

Efforts MemorialHermannprovidesbusandtaxitokensasrequiredfordischargeandcontinuityofcareneeds.OneMemorialHermannstrategicefforttonotonlyprovidetherightcareattherighttimeintherightplace,butalsoprovidetheopportunitytoaccesshelp/careviathetelephoneistheMemorialHermannNurseHealthLine.Establishedin2014,theNurseHealthLineisafreetelephoneserviceforGreaterHoustonresidentswhoareexperiencingahealthconcernandareunsureofwhattodoorwheretogo.Experienced,bilingualnursesusetheirtrainingandexpertisetoconductassessmentsbyphone,andareavailabletoanswercalls24hoursaday,sevendayaweekforanyresidentlivinginHarrisorsurroundingcounties.Theyhelpcallersdecidewhenandwheretogoformedicalcareandassistwithsocialservicereferralsandtransportationneeds.

Children’s Health

Secondary Data InbothAustinandWallercounties,theChildFoodInsecurityRatescoredabove2.Children’sHealthreceivedatopicscoreof1.52inHarrisCounty.Particularindicatorstonoteinclude:


ChildrenwithHealthInsurance,ChildFoodInsecurityRate,andChildrenwithLowAccesstoaGroceryStore.Closeto10%ofchildreninHarrisCountydonothavehealthinsurance.AlthoughChildren’sHealthdidnotreceiveatopicscoreabove1.5inFortBendCounty,anindicatorofconcernis:ChildrenwithLowAccesstoaGroceryStore.

Primary Data WhendiscussingChildren’sHealth,keyinformantspointedoutspecificissuessuchaschildhoodobesity,accesstoservicesandbeinguninsured.Someparticipantsadvisedeffortstoengagechildren,familiesandcommunitiesmorecomprehensively.“Texasranksverylowindollarsspentonhealthforchildren.Weranklowinourranking,generally,inchildren’shealth.We’renotputtingenoughmoneyandresourcesintoit.Ithinkweneedtoshiftourattentionand(…)givemoreattentiontochildren’shealthandhowimportantitisforearlychildhooddevelopmentandforbraindevelopmentandongoinghealthintherestoftheirlives.Iwouldsayputthatasapriority.Putchildren’shealthasapriority.Notjustsayingtheearlyyears,notjustsayingzerotofivebutalsothroughoutearlyadolescence,pre-adolescence,earlyadolescenceandintotheteens.”

Efforts Children'sMemorialHermannHospital,licensedunderMemorialHermannTexasMedicalCenter,wasfoundedin1986andistheprimaryteachinghospitalforthepediatricandobstetrics/gynecologyprogramsatTheUniversityofTexasMedicalSchoolatHouston.Children'sMemorialHermannofferscareinmorethanthirtypediatricandwomen'srelatedspecialtiesincludingthelatestadvancesinmaternal-fetalmedicineandneonatalcriticalcareservices,andrenownedprogramsinpediatrictrauma,neurosciences,pulmonologyandcardiaccare.Morethan37,000childrencometoChildren'sMemorialHermannHospitaleachyear.InadditiontoMemorialHermann’sschool-basedhealtheffortsdescribedabove,MemorialHermannisanon-goingfinancialcollaboratorwithChildrenatRisk,a501non-profitorganizationthatdriveschangeforchildrenthroughresearch,education,andinfluencingpublicpolicy.

Economy

Secondary Data Economywasthefifthhighest-rankingtopicinthesecondarydataresultsforWallerCounty.Witheleveneconomicindicatorsscoringabove2,WallerCountyhasthelargestnumberofconcerningeconomicindicatorsoutofthefourcountiesintheservicearea.Withatopicscoreof1.55,EconomywasoneofthetoptentopicsinthesecondarydatascoringresultsforHarrisCounty;eighteconomicindicatorshadscoresabove2.Economywasnotahigh-rankingtopicforAustinCounty,butseveralindicatorsreceivedscoresgreaterthan2,including:ChildrenLivingBelowPovertyLevel,ChildFoodInsecurityRate,TotalEmploymentChange,FoodInsecurityRate,andMortgagedOwnersMedianMonthlyHouseholdCosts.Similarly,althoughEconomywasalsonotamaintopicforFortBendCounty,thereareseveraleconomicindicatorsscoringabove2:MedianHouseholdGrossRent,MedianMonthly


OwnerCostsforHouseholdswithoutaMortgage,andMortgagedOwnersMedianMonthlyHouseholdCosts.

Primary Data Keyinformantsdiscussedfoodinsecurityandfooddesertsasfactorsrelatedtopoorhealthoutcomes.Theypointedoutthat,althoughindividualsmightunderstandthateatinghealthyfoodsisrecommended,theymaynothaveaccesstogrocerystoresorbeabletoaffordhealthierfoodoptions.Keyinformantsnotedtheimportanceofaddressingsocioeconomicbarrierstoimprovehealthandwellbeing.OneparticipantnotedthatwhilemanyresidentscommutetoHoustonforemployment,someopportunitiesareemergingwithlargeremployersalongUS-290andInterstate-10freeways.“(…)That’samatterofmoney.Youcaneducate[a]womanalldaylong,butifshe’sgotacoupleofkidstofeedandshecanfeedthemallforsevendollarsasopposedto25,she’sgoingtogotoMcDonald’s.”

Efforts It’sadauntingtaskinaregionlikeGreaterHouston,whichhasanestimated7millionpeopleandoneofthehighestratesofuninsuredandunderinsuredinthecountry.ButMemorialHermannbelievesthatwecanONLYimpactthehealthofourcommunity,andthehealthofindividuals,byfocusingonthemultipledeterminantsofhealththatplaythegreatestroleininfluencingaperson’soverallhealthandwellbeing.


Other Findings Criticalcomponentsinassessingtheneedsofacommunityareidentifyingbarriersanddisparitiesinhealthcare.Theidentificationofbarriersanddisparitieshelpsinformandfocusstrategiesforaddressingprioritizedhealthneeds.ThefollowingsectionoutlinesbarriersacrossMemorialHermannHealthSystemanddisparitiesastheypertaintoMHRehabKaty’sservicearea.

Barriers to Care Communityinputrevealedawiderangeofbarrierstocareandwellbeing.Asdiscussedintheprevioussection,transportationwasthemostfrequentlycitedbarrierinthecommunity,followedbyotherbarrierssuchasaccesstohealthservices,healthyfoodandexerciseoptions,lowincome,andfoodinsecurity.Overall,thesecondaryandprimarydataconfirmedthatsocioeconomicfactorsimpactcommunitymembers’abilitytoachievegoodhealth.“Manythingscomebacktopovertyandlackofdisposableincome.”Keyinformantsdescribedtheinfluenceofsocialdeterminantsofhealth(includingincome,poverty,language,education,employment)onhealthoutcomes.Participantsdiscussedtheimportanceofaddressingsocialandeconomicfactorstogetattherootcausesofpoorhealthandwellbeing.“Ithinkyouhavetounderstandthatalotoffolksworkfrompaychecktopaycheck,soiftheyactuallyendupatoneofthesemedicalcentersandtheyrequireathirtydollarcopayortendollarsorfifteendollars,thenthey’renotgoingtohaveit.So,they’regoingtowalkawayuntiltheydohavethatmoneyandthatcouldbemonthslater.So,iftheyaresick,they’rejustgoingtobecomesicker.So,that’soneofthebigbarriers.”

Disparit ies Significantcommunityhealthdisparitiesareassessedinboththeprimaryandsecondarydatacollectionprocesses.Table27identifiesthenumberofsecondarydatahealthindicatorswithahealthdisparityforMHRehabKaty’sservicearea.SeeAppendixBforthespecificindicatorswithsignificantdisparities.

Table27.NumberofHealthDisparitiesIdentifiedinSecondaryDataAnalysis

AustinCounty FortBendCounty HarrisCounty WallerCountyHispanicorLatino(6)BlackorAfricanAmerican(4)OtherRace(4)

HispanicorLatino(7)OtherRace(7)BlackorAfricanAmerican(6)White(4)

BlackorAfricanAmerican(13)White(8)HispanicorLatino(8)OtherRace(7)AmericanIndianorAlaskaNative(6)

BlackorAfricanAmerican(6)OtherRace(3)HispanicorLatino(3)

Male(1) Male(5) Male(10)Female(3)

N/A

<6yearsofage(1) 65+yearsofage(2) <6yearsofage(2) 60-64yearsofage(2)


AustinCounty FortBendCounty HarrisCounty WallerCounty65+yearsofage(1) 25-44yearsofage(2)

45-64yearsofage(2)65+yearsofage(2)

GeographicdisparitieswereidentifiedusingtheSocioNeedsIndex.AsshownpreviouslyinTable13,zipcode77080hasavalueof95.6andzipcode77055hasavalueof82.6.ThezipcodeswithlargestproportionofinpatientdischargesatMHRehabKaty,zipcodes77450and77449,haveSocioNeedsIndexvaluesof9.9and53.4,respectively.


Conclusion TheCommunityHealthNeedsAssessmentforMHRehabKatyutilizedacomprehensivesetofsecondarydataindicatorstomeasurethehealthandqualityoflifeneedsforMHRehabKaty’sservicearea.Furthermore,thisassessmentwasinformedbyinputfromknowledgeableanddiverseindividualsrepresentingthebroadinterestsofthecommunity.MemorialHermann’ssystem-wideprioritizationprocessresultedinfourfocusareasorpillars:AccesstoHealthcare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.MHRehabKatywillreviewtheseprioritiesmorecloselyduringtheImplementationStrategydevelopmentprocessanddesignaplanforaddressingthesepillarsmovingforward.Inaddition,MHRehabKatyinvitesyourfeedbackonthisCHNAreporttohelpinformthenextCommunityHealthNeedsAssessmentprocess.Ifyouhaveanyfeedbackorremarks,pleasesendthemto:[email protected].


Appendix

Appendix A: Evaluation Since Prior CHNA

Appendix B. Secondary Data Methodology

Secondary Data Sources

Secondary Data Scoring

Data Scoring Results

Appendix C. Primary Data Methodology

Community Input Participants

Key Informant Interview Questionnaire (Episcopal Health Foundation)

Key Informant Interview Questionnaire (Conduent Healthy Communities Institute)

Community Survey (English)

Community Survey (Spanish)

Appendix D. Priorit ization Tool

Priorit ization Survey

Appendix E. Community Resources

MemorialHermannRehabilitationHospitalKatyCHNA2019 81

AppendixA.MHRehabKatyImpactReport

EvaluationSincePriorCHNAPriority1:HealthyLiving

Priority1: HealthyLiving

Goal1:Achievelong-termimprovedhealthforpeoplewithchronicandlong-termdisabilities.

ChronicDiseaseManagementObjective1.5:ReduceprogressionorpreventablesideeffectsofchronicdiseasesOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofparticipantsinsupportgroups 10-15participants 89 40 20participants

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.5.1 Conductsupportgroupsforstrokesurvivors 1,2,3

Monitoring/EvaluationApproach:• Supportgroupparticipationrecords

PotentialPartners:• MemorialHermannKatyHospital• MemorialHermannStrokeCoordinators


Priority2:AccesstoHealthCare

Priority2: HealthCareAccess

Goal2:Ensureeaseofaccesstocare,services,andsupportsforpeoplewithchronicandlongtermdisabilities.

AvailabilityofPrimaryCareandSpecialtyProvidersObjective2.1: ReducebarrierstocareforpeoplewithdisabilitiesOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofhospital'sassociatedcounties'callstoNurseHealthLine(MHKatyRehab-Austin,Colorado,FortBend,Harris,Waller) 31,333

29,072 32,89031,333


Year1,2,32.1.1 Providea24/7freeresourceviatheNurseHealthLinethatcommunitymembers(uninsuredand

insured)withintheMHHScommunitycancalltodiscusstheirhealthconcerns,receiverecommendationsontheappropriatesettingforcare,andgetconnectedtoappropriateresources(see2.4.1)

1,2,3

Monitoring/EvaluationApproach:• NurseHealthLinecalllogs

PotentialPartners:• MemorialHermannCommunityBenefitCorporation

HealthCareNavigationObjective2.4:Provideopportunitiesforpatientswithdisabilitiestogettheservicestheyneedwhen,where,andhowtheyneedit

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofhospital'sassociatedcounties'callstoNurseHealthLine(MHKatyRehab-Austin,Colorado,FortBend,Harris,Waller) 31,333 29,072 32,890 31,333


Year1,2,32.4.1 Providea24/7freeresourceviatheNurseHealthLinethatcommunitymembers(uninsuredand

insured)withintheMHHScommunitycancalltodiscusstheirhealthconcerns,receiverecommendationsontheappropriatesettingforcare,andgetconnectedtoappropriateresources(see2.1.1)

1,2,3

Monitoring/EvaluationApproach:• NurseHealthLinecalllogs

PotentialPartners:• MemorialHermannCommunityBenefitCorporation


Priority3:BehavioralHealthThefollowingtablesprovidestrategiesandoutcomeindicatorsthatreflectanMHHSsystem-wideapproachtoBehavioralHealth.DataisnotspecifictoMHRehabilitationHospital-Katybuttothecommunityatlarge.

Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

Objective3.1: Createnontraditionalaccesspointsaroundthecommunity(crisis/ambulatory,acutecare,andcommunity-basedchroniccaremanagement),andlinkthosewhoneedservicestopermanentprovidersandresourcesinthecommunity

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• DecreaseinnumberofERencountersthatresultinpsychiatricinpatient

stay1,146 1,213 1,135 1,089

5%reductionofbaseline

• NumberofMemorialHermannCrisisClinictotalvisits 5,400 5,590 5,154 5%overbaseline• NumberofPsychiatricResponseCareManagementtotalvisits 1,200 1,103 1,259 5%overbaseline


Year1,2,33.1.1: Providementalhealthassessment,care,andlinkagetoservicesinanacutecaresetting,

24x7atKatyRehab.Anuptickinacutecarevolumeoverthepastfiscalyearhascontributedtoahighernumberofpsychiatrictransfersoverall.

Anincreaseinacutecarevolumeandnumberofacutecaresites

overthepastfiscalyearhave

contributedtoahighernumberof

psychiatrictransfersoverall.

1,2,3




3.1.2: Createnontraditionalcommunityaccesstopsychiatricprovidersforindividualsexperiencingamentalhealthcrisis.ClinicalSocialWorkersconnectthetargetpopulationtoon-goingbehavioralhealthcare

Recruitingmentalhealthproviderswillingtocommittoanon-traditionalscheduleremainsachallenge.Continuingthisurgentcaremodeloftreatmentremainsapriority,duetolimitedmentalhealth

treatmentaccessinthecommunity.

1,2,3

3.1.3: Engageindividualswithachronicmentalillnessandworktomaintainengagementwithtreatmentandstabilityinthecommunityviaenrollmentincommunity-basedmentalhealthcasemanagementprogram

Staffingissuesimpededyearonetarget.Identifyingappropriatelylicensedclinicianswillingtoconsideracareerthatiscommunitybasedwiththerequirementofmakinghomevisitsandworkingnon–traditionalhoursisanongoingchallenge.

CaseManagerspartnerwiththeirclientstoidentifyspecificrecoverygoalsandutilizeevidence-basedpracticesto

facilitateclientachievement.Wecontinuetopartnerwithcommunityprovidersto

addressthementalhealthneedsoftheGreaterHoustonCommunity.

1,2,3

Monitoring/EvaluationApproach:• EMR/registrationsystem(trackandtrenddaily,weekly,monthly)




PotentialPartners:• Systemacutecarecampuses• MemorialHermannMedicalGroup• Networkofpublicandprivateproviders


Objective3.2: Reducestigmainordertopromotementalwellnessandimprovecommunityawarenessthatmentalhealthispartofphysicalhealthandoverallwell-being

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• Numberofpresentations/educationalsessionsforhealthcare

professionalswithinMHHS50sessionsper

year63 71 5%increaseover

baseline• Numberofpresentations/educationalsessionsforcorporations 5 7 8 5%overbaseline• TrainingonAcuteCareConcepts-systemnurseresidentprogram 15trainings

(45hourstotal/3hourseach)*

18 915trainings

(45hourstotal/3hourseach)*

• TrainingonCMORoundtable-system-wide 1training(2hours)* 0 4

1training(2hours)*

*Totaltimeincludestrainingmaterialdevelopmentandimplementation 531.6 Strategies: Year1Notes Year2Notes Timeline:

Year1,2,33.2.1: ProvidementalhealtheducationsessionswithintheMHhealthsystemfornursesand

physicians

1,2,3

3.2.2: WorkwithemployersolutionsgrouptoprovideeducationandtrainingwithcorporationsonMHtopics(stress,PTSD)

1,2,3

Monitoring/EvaluationApproach:• Requestsforpresentationsandsessionstrackedviacalendar/excel

PotentialPartners:• Systemacutecarecampuses• SystemMarketingandCommunications• Employersolutionsgroup


Objective3.3: Qualityofmentalhealthandsubstanceabuseservices:access,link,andpracticeutilizingevidence-basedpracticetopromoteoverallwellness

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• NumberofMemorialHermannCrisisClinicfollow-upspostdischarge

withclinicpatients7,716 6,431 5,154 5%overbaseline

• PsychiatricResponseCaseManagementreductioninsystemERutilization

54.4% 53.0% 50% 5%increaseoverbaseline


Year1,2,33.3.1: Socialworkersfollow-upwithdischargedpatientsandtheirfamiliestoassesswell-

beingandconnectthemtocommunityresourcesThegoalistocontinuetoeducatethecommunity,includingotherhealthsystems,aboutthecrisiscliniclevelofcaresothatwhensomeoneisexperiencingamentalhealthcrisisorneedsimmediateaccesstoabehavioralhealthprovider,theclinicwillbetheidentifiedreferralsource.

TheSystemhasseenanoverallincreaseinpatientacuitywithcomplexphysicalandbehavioralhealthneedsrequiringhigherlevelsofcare.TheCrisisClinicandPsychResponseCaseManagementProgramscontinuetomeettheneedsofpatientswithbehavioralhealthconditionsbyprovidingimmediateaccesstoamentalhealthprovider.

1,2,3




3.3.2: PsychiatricResponseCaseManagementProgramutilizesevidence-basedpracticeinterventions(motivationalinterviewing,MHFirstAid,CAMS,etc.)toreduceERutilizationforprogramenrollees

Thelackofcrisishousingresourcesandthetargetpopulation’sover-relianceontheacutecaresystemproducesanongoingchallengeinreducingERutilizationofprogramenrollees.

CaseManagerscontinuetopartnerwithcommunityagenciesinan

efforttoconnectprogramenrolleestoresourcesforongoingwellness.Programclinicianscontinuetouseevidence-based

practiceinterventionsto

reduceERutilizationand

improvequalityoflife.

1,2,3

Monitoring/EvaluationApproach:• Socialworklogs(Excelspreadsheet)

PotentialPartners:• Systemacutecarecampuses• Community-basedclinicalproviders• Networkofpublicandprivateproviders


AppendixB.SecondaryDataMethodology

SecondaryDataSourcesThemainsourceforthesecondarydata,ordatathathavebeenpreviouslycollected,isthecommunityindicatordatabasemaintainedbyConduentHealthyCommunitiesInstitute.ThefollowingisalistofbothlocalandnationalsourcesusedinMemorialHermannRehabilitationHospital–Katy’sCommunityHealthNeedsAssessment.

AustinCounty1. AmericanCommunitySurvey2. CentersforMedicare&MedicaidServices3. CountyHealthRankings4. FeedingAmerica5. InstituteforHealthMetricsandEvaluation6. NationalCancerInstitute7. NationalCenterforEducationStatistics8. SmallAreaHealthInsuranceEstimates9. TexasDepartmentofFamilyandProtectiveServices10. TexasDepartmentofStateHealthServices11. TexasEducationAgency12. TexasSecretaryofState13. U.S.BureauofLaborStatistics14. U.S.Census-CountyBusinessPatterns15. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas16. U.S.EnvironmentalProtectionAgency

FortBendCounty1. AmericanCommunitySurvey2. CentersforMedicare&MedicaidServices3. CountyHealthRankings4. FeedingAmerica5. InstituteforHealthMetricsandEvaluation6. NationalCancerInstitute7. NationalCenterforEducationStatistics8. SmallAreaHealthInsuranceEstimates9. TexasDepartmentofFamilyandProtectiveServices10. TexasDepartmentofStateHealthServices11. TexasEducationAgency12. TexasSecretaryofState13. U.S.BureauofLaborStatistics14. U.S.Census-CountyBusinessPatterns15. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas16. U.S.EnvironmentalProtectionAgency


HarrisCounty1. AmericanCommunitySurvey2. AmericanLungAssociation3. CentersforMedicare&MedicaidServices4. CountyHealthRankings5. FeedingAmerica6. InstituteforHealthMetricsandEvaluation7. NationalCancerInstitute8. NationalCenterforEducationStatistics9. SmallAreaHealthInsuranceEstimates10. TexasBehavioralRiskFactorSurveillanceSystem11. TexasDepartmentofFamilyandProtectiveServices12. TexasDepartmentofStateHealthServices13. TexasEducationAgency14. TexasSecretaryofState15. U.S.BureauofLaborStatistics16. U.S.Census-CountyBusinessPatterns17. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas18. U.S.EnvironmentalProtectionAgency

WallerCounty1. AmericanCommunitySurvey2. CentersforMedicare&MedicaidServices3. CountyHealthRankings4. FeedingAmerica5. InstituteforHealthMetricsandEvaluation6. NationalCancerInstitute7. NationalCenterforEducationStatistics8. SmallAreaHealthInsuranceEstimates9. TexasDepartmentofFamilyandProtectiveServices10. TexasDepartmentofStateHealthServices11. TexasEducationAgency12. TexasSecretaryofState13. U.S.BureauofLaborStatistics14. U.S.Census-CountyBusinessPatterns15. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas16. U.S.EnvironmentalProtectionAgency


SecondaryDataScoring

Datascoringisdoneinthreestages:

Foreachindicator,eachcountyinMemorialHermannRehabilitationHospital–Katy’sserviceareaisassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.

Indicatorsarecategorizedintotopicareasandeachtopicareareceivesascore.Indicatorsmaybecategorizedinmorethanonetopicarea.Topicscoresaredeterminedbythecomparisonsofallindicatorswithinthetopic.

ComparisontoaDistributionofCountyValues:WithinStateandNation

Foreaseofinterpretationandanalysis,indicatordataontheCommunityDashboardisvisuallyrepresentedasagreen-yellow-redgaugeshowinghowthecommunityisfaringagainstadistributionofcountiesinthestateortheUnitedStates.Adistributioniscreatedbytakingallcountyvalueswithinthestateornation,orderingthemfromlowtohigh,anddividingthemintothreegroups(green,yellow,red)basedontheirorder.Indicatorswiththepoorestcomparisons(“inthered”)scoredhigh,whereasindicatorswithgoodcomparisons(“inthegreen”)scoredlow.

Comparisons • Quantitatively

score all possible comparisons

Indicators • Summarize

comparison scores for each indicator

Topics • Summarize

indicator scores by topic area


ComparisontoValues:State,National,andTargets

Eachcountyiscomparedtothestatevalue,thenationalvalue,andtargetvalues.Targetvaluesincludethenation-wideHealthyPeople2020(HP2020)goals.HealthyPeople2020goalsarenationalobjectivesforimprovingthehealthofthenationsetbytheDepartmentofHealthandHumanServices’(DHHS)HealthyPeopleInitiative.Forallvaluecomparisons,thescoringdependsonwhetherthecountyvalueisbetterorworsethanthecomparisonvalue,aswellashowclosethecountyvalueistothetargetvalue.

TrendOverTime

TheMann-Kendallstatisticaltestfortrendwasusedtoassesswhetherthecountyvalueisincreasingovertimeordecreasingovertime,andwhetherthetrendisstatisticallysignificant.Thetrendcomparisonusesthefourmostrecentcomparablevaluesforthecounty,andstatisticalsignificanceisdeterminedatthe90%confidencelevel.Foreachindicatorwithvaluesavailableforfourtimeperiods,scoringwasdeterminedbydirectionofthetrendandstatisticalsignificance.

MissingValues

Indicatorscoresarecalculatedusingthecomparisonscores,availabilityofwhichdependsonthedatasource.Ifthecomparisontypeispossibleforanadequateproportionofindicatorsonthecommunitydashboard,itwillbeincludedintheindicatorscore.Afterexclusionofcomparisontypeswithinadequateavailability,allmissingcomparisonsaresubstitutedwithaneutralscoreforthepurposesofcalculatingtheindicator’sweightedaverage.Wheninformationisunknownduetolackofcomparabledata,theneutralvalueassumesthatthemissingcomparisonscoreisneithergoodnorbad.

IndicatorScoring

Indicatorscoresarecalculatedasaweightedaverageofallincludedcomparisonscores.Ifnoneoftheincludedcomparisontypesarepossibleforanindicator,noscoreiscalculatedandtheindicatorisexcludedfromthedatascoringresults.

TopicScoring

Indicatorscoresareaveragedbytopicareatocalculatetopicscores.Eachindicatormaybeincludedinuptothreetopicareasifappropriate.Resultingscoresrangefrom0-3,whereahigherscoreindicatesagreaterlevelofneedasevidencedbythedata.Atopicscoreisonlycalculatedifitincludesatleastthreeindicators.


DataScoringResults Thefollowing tableslisteachindicatorbytopicareaforeachofthecountiesinMemorialHermannRehabilitationHospital–Katy’sservicearea.SecondarydataforthisreportareuptodateasofNovember2,2018.


AustinCounty

SCORE ACCESSTOHEALTHSERVICES UNITSAUSTINCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.44 MentalHealthProviderRateproviders/100,000

population 26.9 98.8 214.3 2017 3

2.39 PrimaryCareProviderRateproviders/100,000

population 23.7 59.9 75.5 2015 3

2.22Non-PhysicianPrimaryCareProviderRate

providers/100,000population 37 66.8 81.2 2017 3

1.89 DentistRatedentists/100,000

population 37 55.9 67.4 2016 3

1.64AdultswithHealthInsurance:18-64 percent 78.3 100 77.4 2016 8

1.64 PersonswithHealthInsurance percent 81.7 100 81.4 2016 8

1.58 ChildrenwithHealthInsurance percent 89.3 100 90.3 2016 8

SCORE CANCER UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.06 ProstateCancerIncidenceRatecases/100,000

males 114.1 95.4 109 2011-2015 6

1.94 Cancer:MedicarePopulation percent 7.6 7.1 7.8 2015 2

1.94 ColorectalCancerIncidenceRatecases/100,000population 42.1 39.9 38.1 39.2 2011-2015 6

1.67Age-AdjustedDeathRateduetoColorectalCancer

deaths/100,000population 15.3 14.5 14.4 14.5 2011-2015 6

1.22OralCavityandPharynxCancerIncidenceRate

cases/100,000population 11.3 10.9 11.6 2011-2015 6

1.00Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 39.9 45.5 39 43.4 2011-2015 6


0.75Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 18.3 20.7 20.2 20.9 2011-2015 6

0.72 AllCancerIncidenceRatecases/100,000population 377.7 401.3 441.2 2011-2015 6

0.67Age-AdjustedDeathRateduetoCancer


0.67LungandBronchusCancerIncidenceRate


0.56 BreastCancerIncidenceRatecases/100,000

females 94 111.7 124.7 2011-2015 6

SCORE CHILDREN'SHEALTH UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.17 ChildFoodInsecurityRate percent 24.2 23 17.9 2016 4


1.17ChildrenwithLowAccesstoaGroceryStore percent 2.5 2015 15

0.67 SubstantiatedChildAbuseRatecases/1,000children 2.1 8.5 2017 9

SCORE ECONOMY UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.33ChildrenLivingBelowPovertyLevel percent 25.3 23.9 21.2 2012-2016

HispanicorLatino,Other 1


2.17 TotalEmploymentChange percent -0.7 3.2 2.5 2014-2015 14

2.06 FoodInsecurityRate percent 15.8 15.4 12.9 2016 4

2.03MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1512 1444 1491 2012-2016 1


1.78FemalePopulation16+inCivilianLaborForce percent 54.4 57.7 58.3 2012-2016 1

1.58MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 448 467 462 2012-2016 1

1.53 MedianHouseholdGrossRent dollars 852 911 949 2012-2016 1

1.44FamiliesLivingBelowPovertyLevel percent 11.2 13 11 2012-2016


1.44Population16+inCivilianLaborForce percent 62.1 64.2 63.1 2012-2016 1

1.44RentersSpending30%orMoreofHouseholdIncomeonRent percent 42.3 48 47.3 2012-2016 1

1.33 PeopleLivingBelowPovertyLevel percent 14.5 16.7 15.1 2012-2016

<6BlackorAfricanAmerican,HispanicorLatino,Other 1

1.28UnemployedWorkersinCivilianLaborForce percent 3.7 4 4.1 July2018 13

1.22 SNAPCertifiedStoresstores/1,000population 0.9 2016 15

1.14 MedianHousingUnitValue dollars 164300 142700 184700 2012-2016 1

1.11HouseholdswithCashPublicAssistanceIncome percent 1.5 1.6 2.7 2012-2016 1

1.11PeopleLiving200%AbovePovertyLevel percent 68.2 62.8 66.4 2012-2016 1

1.08PersonswithDisabilityLivinginPoverty(5-year) percent 24 25.1 27.6 2012-2016 1

1.00Low-IncomeandLowAccesstoaGroceryStore percent 3.5 2015 15

0.89 HomeownerVacancyRate percent 1.6 1.6 1.8 2012-2016 1


0.83StudentsEligiblefortheFreeLunchProgram percent 42.9 52.9 42.6 2015-2016 7

0.72 MedianHouseholdIncome dollars 56681 54727 55322 2012-2016BlackorAfrican

American 1

0.72 SevereHousingProblems percent 12.3 18.3 18.8 2010-2014 3

0.67 PerCapitaIncome dollars 28351 27828 29829 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other,

TwoorMoreRaces 1

0.56 Homeownership percent 63.5 55 55.9 2012-2016 1

0.56People65+LivingBelowPovertyLevel percent 7.6 10.8 9.3 2012-2016 1

SCORE EDUCATION UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


1.81InfantsBorntoMotherswith<12YearsEducation percent 22.1 21.6 15.9 2013 10

1.61People25+withaHighSchoolDegreeorHigher percent 82.4 82.3 87 2012-2016

65+HispanicorLatino 1

1.50People25+withaBachelor'sDegreeorHigher percent 21 28.1 30.3 2012-2016

BlackorAfricanAmerican,Hispanic

orLatino 1

1.28 Student-to-TeacherRatio students/teacher 14 15.4 17.7 2015-2016 7

1.22 HighSchoolDropOutRate percent 0.9 2 2016 11

SCORE ENVIRONMENT UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.17 HousesBuiltPriorto1950 percent 17.6 7.4 18.2 2012-2016 1


2.00 AccesstoExerciseOpportunities percent 66.2 80.6 83.1 2018 3

1.61RecognizedCarcinogensReleasedintoAir pounds 21 2017 16

1.50 FarmersMarketDensitymarkets/1,000population 0 2016 15

1.50HouseholdswithNoCarandLowAccesstoaGroceryStore percent 2.4 2015 15

1.39 GroceryStoreDensitystores/1,000population 0.2 2014 15

1.39 PBTReleased pounds 21 2017 16

1.33People65+withLowAccesstoaGroceryStore percent 2.4 2015 15

1.22 FastFoodRestaurantDensityrestaurants/1,000

population 0.5 2014 15




0.89 LiquorStoreDensitystores/100,000population 6.8 6.8 10.5 2015 14

0.89 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 15

0.75 DrinkingWaterViolations percent 0 6.6 FY2013-14 3

0.72 FoodEnvironmentIndex 7.7 6 7.7 2018 3


SCOREEXERCISE,NUTRITION,&WEIGHT UNITS

AUSTINCOUNTY HP2020 TEXAS U.S.




2.11 WorkerswhoWalktoWork percent 1.7 3.1 1.6 2.8 2012-2016 1














SCORE HEARTDISEASE&STROKE UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.28AtrialFibrillation:MedicarePopulation percent 8.7 7.4 8.1 2015 2

2.28 Stroke:MedicarePopulation percent 4.7 4.5 4 2015 2


2.17Hyperlipidemia:MedicarePopulation percent 46.8 46.1 44.6 2015 2

1.94Hypertension:MedicarePopulation percent 59.6 57.5 55 2015 2

1.56HeartFailure:MedicarePopulation percent 15.1 15.5 13.5 2015 2

1.25Age-AdjustedDeathRateduetoHeartDisease

deaths/100,000population 176.7 173 171.9 2010-2014 10

1.22IschemicHeartDisease:MedicarePopulation percent 26.9 28.8 26.5 2015 2

0.86Age-AdjustedDeathRateduetoCerebrovascularDisease(Stroke)


SCOREIMMUNIZATIONS&INFECTIOUSDISEASES UNITS



1.83Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 16.1 14.2 15.2 2010-2014 10

1.61 TuberculosisIncidenceRatecases/100,000population 2.1 1 4.5 2013-2017 10

1.39 HIVDiagnosisRatecases/100,000population 10.1 16.1 2016 10

1.28 ChlamydiaIncidenceRatecases/100,000population 238.4 511.6 2017 10

1.28 SyphilisIncidenceRatecases/100,000population 3.4 40.6 2017 10

1.17 GonorrheaIncidenceRatecases/100,000population 73.9 160.2 2017 10

SCOREMATERNAL,FETAL&INFANTHEALTH UNITS




2.31 PretermBirths percent 14.8 9.4 12 11.4 2013 10

1.97MotherswhoReceivedEarlyPrenatalCare percent 55.2 77.9 59.2 74.2 2013 10


1.75 BabieswithLowBirthWeight percent 8.2 7.8 8.3 8 2013 10

1.69 TeenBirths percent 3.6 2.8 4.3 2014 10

0.47 InfantMortalityRatedeaths/1,000live

births 3 6 5.8 6 2013 10

SCOREMENTALHEALTH&MENTALDISORDERS UNITS




population 26.9 98.8 214.3 2017 3

2.17Age-AdjustedDeathRateduetoSuicide


1.33PoorMentalHealth:AverageNumberofDays days 3.6 3.4 3.8 2016 3

1.25Age-AdjustedDeathRateduetoAlzheimer'sDisease


1.17 FrequentMentalDistress percent 10.9 10.6 15 2016 3

1.00Alzheimer'sDiseaseorDementia:MedicarePopulation percent 9.9 11.7 9.9 2015 2

1.00 Depression:MedicarePopulation percent 14.4 17 16.7 2015 2

SCORE OLDERADULTS&AGING UNITSAUSTINCOUNTY HP2020 TEXAS U.S.






2.00

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 32.2 31.6 30 2015 2





1.28 COPD:MedicarePopulation percent 10.5 11.1 11.2 2015 2




1.17 Asthma:MedicarePopulation percent 7.3 8.2 8.2 2015 2

1.17 People65+LivingAlone percent 25.2 23.9 26.4 2012-2016 1


1.00ChronicKidneyDisease:MedicarePopulation percent 15.2 19.9 18.1 2015 2


0.78Osteoporosis:MedicarePopulation percent 4.7 6.5 6 2015 2


0.67 Diabetes:MedicarePopulation percent 25 28.2 26.5 2015 2

0.56People65+LivingBelowPovertyLevel percent 7.6 10.8 9.3 2012-2016 1

SCORE OTHERCHRONICDISEASES UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.00




SCORE PREVENTION&SAFETY UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


1.75Age-AdjustedDeathRateduetoUnintentionalInjuries



0.50 DeathRateduetoDrugPoisoningdeaths/100,000

population 5.6 9.4 12.4 2006-2012 3

SCORE PUBLICSAFETY UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


1.44 ViolentCrimeRatecrimes/100,000

population 240.1 407.6 2012-2014 3


0.33 Alcohol-ImpairedDrivingDeaths percent 18.2 28.3 29.3 2012-2016 3


SCORE RESPIRATORYDISEASES UNITSAUSTINCOUNTY HP2020 TEXAS U.S.











SCORE SOCIALENVIRONMENT UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


2.61 MeanTravelTimetoWork minutes 30.3 25.9 26.1 2012-2016 Male 1



2.17 TotalEmploymentChange percent -0.7 3.2 2.5 2014-2015 14





65+HispanicorLatino 1




1.50People25+withaBachelor'sDegreeorHigher percent 21 28.1 30.3 2012-2016

BlackorAfricanAmerican,Hispanic

orLatino 1



<6BlackorAfricanAmerican,HispanicorLatino,Other 1

1.33VoterTurnout:PresidentialElection percent 63.7 58.8 2016 12

1.17 LinguisticIsolation percent 3.5 7.9 4.5 2012-2016 1



0.83 Single-ParentHouseholds percent 29 33.3 33.6 2012-2016 1

0.72 MedianHouseholdIncome dollars 56681 54727 55322 2012-2016BlackorAfrican

American 1



TwoorMoreRaces 1



SCORE SUBSTANCEABUSE UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


1.50 AdultswhoDrinkExcessively percent 18.3 25.4 19.4 18 2016 3




population 5.6 9.4 12.4 2006-2012 3


SCORE TRANSPORTATION UNITSAUSTINCOUNTY HP2020 TEXAS U.S.



2.44SoloDriverswithaLongCommute percent 39.6 36.9 34.7 2012-2016 3

2.17WorkersCommutingbyPublicTransportation percent 0.1 5.5 1.5 5.1 2012-2016 1

2.11 WorkerswhoWalktoWork percent 1.7 3.1 1.6 2.8 2012-2016 1


1.00WorkerswhoDriveAlonetoWork percent 79.5 80.3 76.4 2012-2016 1

0.56 HouseholdswithoutaVehicle percent 4 5.6 9 2012-2016 1

SCORE WELLNESS&LIFESTYLE UNITSAUSTINCOUNTY HP2020 TEXAS U.S.


1.50 LifeExpectancyforFemales years 80.4 80.8 81.5 2014 5

1.50Self-ReportedGeneralHealthAssessment:PoororFair percent 16.9 18.2 16 2016 3

1.39 LifeExpectancyforMales years 76 76.2 76.7 2014 5


1.00PoorPhysicalHealth:AverageNumberofDays days 3.4 3.5 3.7 2016 3

0.83 FrequentPhysicalDistress percent 10.6 10.8 15 2016 3

0.83 InsufficientSleep percent 30.2 32.7 38 2016 3

SCORE WOMEN'SHEALTH UNITSAUSTINCOUNTY HP2020 TEXAS U.S.




deaths/100,000females 18.3 20.7 20.2 20.9 2011-2015 6


females 94 111.7 124.7 2011-2015 6


FortBendCounty

SCORE ACCESSTOHEALTHSERVICES UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.



population 59.8 98.8 214.3 2017 3


providers/100,000population 52.2 66.8 81.2 2017 3


population 51.8 55.9 67.4 2016 3

1.08 PersonswithHealthInsurance percent 88 100 81.4 2016 8




population 80.3 59.9 75.5 2015 3

SCORE CANCER UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.




males 103.8 95.4 109 2011-2015 6


females 114.7 111.7 124.7 2011-2015 6


cases/100,000population 10 10.9 11.6 2011-2015 6



deaths/100,000females 18.1 20.7 20.2 20.9 2011-2015 6

0.47 CervicalCancerIncidenceRatecases/100,000

females 6.4 7.3 9.2 7.5 2011-2015 6


0.25Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 14.6 21.8 18.1 19.5 2011-2015 6






deaths/100,000population 126.2 161.4 156.4 163.5 2011-2015 Male 6



0.00 ColorectalCancerIncidenceRatecases/100,000population 34 39.9 38.1 39.2 2011-2015 6

SCORE CHILDREN'SHEALTH UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.






SCORE ECONOMY UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.














0.75PersonswithDisabilityLivinginPoverty(5-year) percent 15.6 25.1 27.6 2012-2016 1


0.64PersonswithDisabilityLivinginPoverty percent 16.2 24.2 26.6 2016 1


0.50 TotalEmploymentChange percent 6.2 3.2 2.5 2014-2015 14






0.39 Homeownership percent 74.4 55 55.9 2012-2016

1

0.39People65+LivingBelowPovertyLevel percent 6.9 10.8 9.3 2012-2016



HispanicorLatino,Other,<6,6-11,12-

17,18-24 1

0.17 HomeownerVacancyRate percent 1.1 1.6 1.8 2012-2016

1


0.17 MedianHouseholdIncome dollars 91152 54727 55322 2012-2016

BlackorAfricanAmerican,HispanicorLatino,Other 1

0.17PeopleLiving200%AbovePovertyLevel percent 79.4 62.8 66.4 2012-2016

1



TwoorMoreRaces 1

0.17StudentsEligiblefortheFreeLunchProgram percent 26.7 52.9 42.6 2015-2016

7

SCORE EDUCATION UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


1.67 Student-to-TeacherRatio students/teacher 16.5 15.4 17.7 2015-2016

7

1.00 HighSchoolDropOutRate percent 1.1 2 2016

11

0.89People25+withaHighSchoolDegreeorHigher percent 89.2 82.3 87 2012-2016 65+ 1

0.42InfantsBorntoMotherswith<12YearsEducation percent 9.2 21.6 15.9 2013

10

0.17People25+withaBachelor'sDegreeorHigher percent 44.6 28.1 30.3 2012-2016

BlackorAfricanAmerican,Other,TwoorMore

Races,Female,65+ 1

SCORE ENVIRONMENT UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.















1.08 DrinkingWaterViolations percent 0.9 6.6 FY2013-14 3






SCORE EXERCISE,NUTRITION,&WEIGHT UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


2.67 WorkerswhoWalktoWork percent 0.6 3.1 1.6 2.8 2012-2016 25-44 1



1.83 GroceryStoreDensity stores/1,000 0.1 2014 15


population












SCORE HEARTDISEASE&STROKE UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.





1.22IschemicHeartDisease:MedicarePopulation percent 28 28.8 26.5 2015 2







deaths/100,000population 135 173 171.9 2010-2014 Black,White,Male 10


FORTBENDCOUNTY HP2020 TEXAS U.S.


1.67 ChlamydiaIncidenceRatecases/100,000population 373.5 511.6 2017

10

1.67 GonorrheaIncidenceRatecases/100,000population 93 160.2 2017

10

1.67 SyphilisIncidenceRatecases/100,000population 19 40.6 2017

10

1.56 TuberculosisIncidenceRatecases/100,000population 3.7 1 4.5 2013-2017

10

1.22 HIVDiagnosisRatecases/100,000population 9.2 16.1 2016

10


deaths/100,000population 13.6 14.2 15.2 2010-2014

10







1.39BabieswithVeryLowBirthWeight percent 1.4 1.4 1.4 1.4 2013 10


births 4.3 6 5.8 6 2013 10



0.42 TeenBirths percent 1 2.8 4.3 2014 10

SCORE MEN'SHEALTH UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.



males 103.8 95.4 109 2011-2015

6

0.50 LifeExpectancyforMales years 80.1 76.2 76.7 2014

5


deaths/100,000males 14.6 21.8 18.1 19.5 2011-2015

6





population 59.8 98.8 214.3 2017

3

1.33Alzheimer'sDiseaseorDementia:MedicarePopulation percent 10.2 11.7 9.9 2015

2


deaths/100,000population 7.3 10.2 11.7 12.5 2010-2014 White,Male 10


deaths/100,000population 20.6 26.6 24.5 2010-2014 White 10


0.50 FrequentMentalDistress percent 9 10.6 15 2016 3

0.50PoorMentalHealth:AverageNumberofDays days 3 3.4 3.8 2016 3

SCORE OLDERADULTS&AGING UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.



2.50 Stroke:MedicarePopulation percent 4.7 4.5 4 2015

2

2.22 Diabetes:MedicarePopulation percent 30.8 28.2 26.5 2015 2





1.56Osteoporosis:MedicarePopulation percent 6 6.5 6 2015 2


1.22IschemicHeartDisease:MedicarePopulation percent 28 28.8 26.5 2015 2




0.72Age-AdjustedDeathRateduetoFalls

deaths/100,000population 6 7.2 7.4 8.3 2010-2014 10


deaths/100,000population 20.6 26.6 24.5 2010-2014 White 10



0.61







SCORE OTHERCHRONICDISEASES UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


2.17ChronicKidneyDisease:MedicarePopulation percent 19.2 19.9 18.1 2015

2

1.56Osteoporosis:MedicarePopulation percent 6 6.5 6 2015

2

0.61

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 26.1 31.6 30 2015

2

SCORE PREVENTION&SAFETY UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


1.06 SevereHousingProblems percent 14.8 18.3 18.8 2010-2014

3


population 5.6 9.8 16.9 2014-2016

3


deaths/100,000population 6 7.2 7.4 8.3 2010-2014

10



SCORE PUBLICSAFETY UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


2.00 Alcohol-ImpairedDrivingDeaths percent 36 28.3 29.3 2012-2016 3



population 261.5 407.6 2012-2014 3


SCORE RESPIRATORYDISEASES UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.











SCORE SOCIALENVIRONMENT UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.










1.08 PersonswithHealthInsurance percent 88 100 81.4 2016 8


0.89People25+withaHighSchoolDegreeorHigher percent 89.2 82.3 87 2012-2016 65+ 1


0.61 Single-ParentHouseholds percent 22.4 33.3 33.6 2012-2016 1





0.39 Homeownership percent 74.4 55 55.9 2012-2016

1

0.39 People65+LivingAlone percent 15.2 23.9 26.4 2012-2016

1


HispanicorLatino,Other,<6,6-11,12-

17,18-24 1


BlackorAfricanAmerican,HispanicorLatino,Other 1


BlackorAfricanAmerican,Other,TwoorMore

Races,Female,65+ 1



TwoorMoreRaces 1

SCORE SUBSTANCEABUSE UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.


2.00 Alcohol-ImpairedDrivingDeaths percent 36 28.3 29.3 2012-2016 3



population 5.6 9.8 16.9 2014-2016 3



SCORE TRANSPORTATION UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.



2.83SoloDriverswithaLongCommute percent 57.5 36.9 34.7 2012-2016

3

2.67 WorkerswhoWalktoWork percent 0.6 3.1 1.6 2.8 2012-2016 25-44 1

1.94 WorkerswhoDriveAlonetoWork percent 82.3 80.3 76.4 2012-2016BlackorAfricanAmerican,20-44 1

1.06WorkersCommutingbyPublicTransportation percent 1.7 5.5 1.5 5.1 2012-2016 HispanicorLatino 1

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 1.1 2015

15

0.50 HouseholdswithoutaVehicle percent 2.7 5.6 9 2012-2016

1

SCORE WELLNESS&LIFESTYLE UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.





0.50 FrequentPhysicalDistress percent 8.7 10.8 15 2016 3

0.50 LifeExpectancyforMales years 80.1 76.2 76.7 2014

5

0.50PoorPhysicalHealth:AverageNumberofDays days 2.9 3.5 3.7 2016

3


SCORE WOMEN'SHEALTH UNITSFORTBENDCOUNTY HP2020 TEXAS U.S.



females 114.7 111.7 124.7 2011-2015 6



deaths/100,000females 18.1 20.7 20.2 20.9 2011-2015 6


females 6.4 7.3 9.2 7.5 2011-2015 6


HarrisCounty

SCORE ACCESSTOHEALTHSERVICES UNITSHARRISCOUNTY HP2020 TEXAS U.S.


2.00AdultsUnabletoAffordtoSeeaDoctor percent 22.1 18.3 12.1 2015 10





population 57.2 59.9 75.5 2015 4


population 103.7 98.8 214.3 2017 4


providers/100,000population 72.2 66.8 81.2 2017 4


population 66.3 55.9 67.4 2016 4

SCORE CANCER UNITSHARRISCOUNTY HP2020 TEXAS U.S.



females 11 7.3 9.2 7.5 2011-2015

7


deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7


1.58ColonCancerScreening:SigmoidoscopyorColonoscopy percent 57.6 62.3 2016 10


deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7


females 113.2 111.7 124.7 2011-2015 7



males 102.5 95.4 109 2011-2015 7





deaths/100,000population 157.8 161.4 156.4 163.5 2011-2015 Black,Male 7








SCORE CHILDREN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.






SCORE DIABETES UNITSHARRISCOUNTY HP2020 TEXAS U.S.


1.67 Diabetes:MedicarePopulation percent 28.1 28.2 26.5 2015

3

1.44 AdultswithDiabetes percent 10.2 11.2 10.5 2016

10

0.92Age-AdjustedDeathRateduetoDiabetes

deaths/100,000population 20.2 21.7 21.2 2010-2014

Black,Hispanic,Male 12


SCORE ECONOMY UNITSHARRISCOUNTY HP2020 TEXAS U.S.






2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016

17

2.08 MedianHouseholdGrossRent dollars 937 911 949 2012-2016

1


AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other 1




Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1

1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016

5

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016


Other,<6 1



AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24 1







0.97PersonswithDisabilityLivinginPoverty percent 22.9 24.2 26.6 2016 1







Other 1


AmericanIndianorAlaskaNative,BlackorAfricanAmerican, 1


HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Other,Two

orMoreRaces

SCORE EDUCATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.


1.92InfantsBorntoMotherswith<12YearsEducation percent 27.5 21.6 15.9 2013

12

1.89 Student-to-TeacherRatio students/teacher 16.4 15.4 17.7 2015-2016

8

1.67 HighSchoolDropOutRate percent 2.6 2 2016

13


Male,35-44,45-64,65+ 1


AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1

SCORE ENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.




1.75 AnnualOzoneAirQuality grade F 2014-2016 2

1.69 AnnualParticlePollution grade C 2014-2016 2


















SCORE EXERCISE,NUTRITION,&WEIGHT UNITSHARRISCOUNTY HP2020 TEXAS U.S.


2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1



1.67 Adults(18+Years)WhoAreObese percent 32 30.5 33.6 29.9 2016 10





1.50AdultswhoareOverweightorObese percent 66.7 68.4 65.2 2016 10




1.42AdultFruitandVegetableConsumption percent 18.7 17.2 2015 10







SCORE HEARTDISEASE&STROKE UNITSHARRISCOUNTY HP2020 TEXAS U.S.



1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3


1.44 Hyperlipidemia:Medicare percent 43.2 46.1 44.6 2015 3


Population


deaths/100,000population 41.5 34.8 42 37.3 2010-2014 Black 12

1.33IschemicHeartDisease:MedicarePopulation percent 28.8 28.8 26.5 2015

3

1.22Hypertension:MedicarePopulation percent 55.5 57.5 55 2015

3


deaths/100,000population 167.6 173 171.9 2010-2014 Black,White,Male 12


HARRISCOUNTY HP2020 TEXAS U.S.






1.78Adults65+withInfluenzaVaccination percent 57.2 57.3 58.6 2016 10

1.67 HIVDiagnosisRatecases/100,000population 26.3 16.1 2016

12

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016

10


deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12




2.36 InfantMortalityRate deaths/1,000live 6.8 6 5.8 6 2013 12


births




1.61 BabieswithVeryLowBirthWeight percent 1.5 1.4 1.4 1.4 2013 12



SCORE MEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.



deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7


males 102.5 95.4 109 2011-2015 7

1.28 LifeExpectancyforMales years 76.4 76.2 76.7 2014 6




1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.4 11.7 9.9 2015

3

1.53 PoorMentalHealth:5+Days percent 80 81.5 2016

10



population 103.7 98.8 214.3 2017 4

1.17 FrequentMentalDistress percent 11.2 10.6 15 2016 4




0.94 Depression:MedicarePopulation percent 14.8 17 16.7 2015

3


deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

SCORE OLDERADULTS&AGING UNITSHARRISCOUNTY HP2020 TEXAS U.S.


2.67ChronicKidneyDisease:MedicarePopulation percent 20.9 19.9 18.1 2015

3

2.61 Stroke:MedicarePopulation percent 5.2 4.5 4 2015

3





1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3


Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1










1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10




0.94



deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

0.39 COPD:MedicarePopulation percent 9.6 11.1 11.2 2015

3

SCORE OTHERCHRONICDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.




0.94


SCORE PREVENTION&SAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.


2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014

4




population 10.2 9.8 16.9 2014-2016

4




SCORE PUBLICSAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.




population 713.7 407.6 2012-2014 4


SCORE RESPIRATORYDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.




1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10


deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12







SCORE SOCIALENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.









1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1

1.75 PersonswithHealthInsurance percent 79.3 100 81.4 2016

9

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016


Other,<6 1


Male,35-44,45-64,65+ 1


AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24 1







0.94 Population16+inCivilianLabor percent 68.3 64.2 63.1 2012-2016 1


Force


AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1



Other 1


AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Other,Two

orMoreRaces 1

SCORE SUBSTANCEABUSE UNITSHARRISCOUNTY HP2020 TEXAS U.S.




1.28

Adults(18+Years)ReportingBingeDrinkingWithintheLast12months percent 16.6 24.2 17.9 16.9 2016 10


population 10.2 9.8 16.9 2014-2016 4

0.94 AdultswhoSmoke percent 12.1 12 14.3 17.1 2016 10

0.89 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015

16


SCORE TRANSPORTATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.


2.83 SoloDriverswithaLongCommute percent 45.8 36.9 34.7 2012-2016

4


2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1

1.44 WorkerswhoDriveAlonetoWork percent 79.1 80.3 76.4 2012-2016

White,non-Hispanic,25-44,55-

59 1

1.33 HouseholdswithoutaVehicle percent 6.4 5.6 9 2012-2016

1

1.28WorkersCommutingbyPublicTransportation percent 2.8 5.5 1.5 5.1 2012-2016

HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Twoor

MoreRaces,White,non-Hispanic,Male,

25-44 1

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015

17

SCORE WELLNESS&LIFESTYLE UNITSHARRISCOUNTY HP2020 TEXAS U.S.



1.75 PoorPhysicalHealth:5+Days percent 80.6 81.5 2016 10



1.17 FrequentPhysicalDistress percent 11.5 10.8 15 2016

4

1.17PoorPhysicalHealth:AverageNumberofDays days 3.6 3.5 3.7 2016

4


1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014

6

SCORE WOMEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.



females 11 7.3 9.2 7.5 2011-2015 7


deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7


females 113.2 111.7 124.7 2011-2015 7

1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014 6

WallerCounty

SCORE ACCESSTOHEALTHSERVICES UNITSWALLERCOUNTY HP2020 Texas U.S.



providers/100,000population 4 67 81 2017 3


population 10 60 76 2015 3


population 16 56 67 2016 3


population 34 99 214 2017 3

2.14AdultswithHealthInsurance:18-64 percent 71.5 100.0 77.4 2016 8

2.14 PersonswithHealthInsurance percent 76.1 100.0 81.4 2016 8

1.97 ChildrenwithHealthInsurance percent 86.6 100.0 90.3 2016 8

SCORE CANCER UNITSWALLERCOUNTY HP2020 Texas U.S.




deaths/100,000females 21.2 20.7 20.2 20.9 2011-2015 6


females 109.8 111.7 124.7 2011-2015 6














males 85.5 95.4 109.0 2011-2015 6


SCORE CHILDREN'SHEALTH UNITSWALLERCOUNTY HP2020 Texas U.S.


2.06 ChildFoodInsecurityRate percent 24.0 23.0 17.9 2016 4

1.97 ChildrenwithHealthInsurance percent 86.6 100.0 90.3 2016 8




SCORE ECONOMY UNITSWALLERCOUNTY HP2020 Texas U.S.



2.44UnemployedWorkersinCivilianLaborForce percent 4.8 4.0 4.1 July2018 13








2.06 PeopleLivingBelowPovertyLevel percent 19.0 16.7 15.1 2012-201618-24,6-11BlackorAfricanAmerican 1


1.89ChildrenLivingBelowPovertyLevel percent 25.1 23.9 21.2 2012-2016 HispanicorLatino 1




TwoorMoreRaces 1


1.83RentersSpending30%orMoreofHouseholdIncomeonRent percent 46.8 48.0 47.3 2012-2016 1





1.17FamiliesLivingBelowPovertyLevel percent 12.0 13.0 11.0 2012-2016 1


AmericanIndianorAlaskaNative,Black

orAfricanAmerican,Hispanic

orLatino 1



1.06 Homeownership percent 59.6 55.0 55.9 2012-2016 1



BlackorAfricanAmerican 1

SCORE EDUCATION UNITSWALLERCOUNTY HP2020 Texas U.S.


2.11People25+withaHighSchoolDegreeorHigher percent 78.4 82.3 87.0 2012-2016 Other 1



BlackorAfricanAmerican,Other 1


1.61 Student-to-TeacherRatio students/teacher 14.7 15.4 17.7 2015-2016 7

1.17 HighSchoolDropOutRate percent 0.8 2.0 2016 11

SCORE ENVIRONMENT UNITSWALLERCOUNTY HP2020 Texas U.S.




2.11 FoodEnvironmentIndex 6.3 6.0 7.7 2018 3







1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 15


1.39 RecognizedCarcinogensReleased pounds 40 2017 16


intoAir







SCOREEXERCISE,NUTRITION,&WEIGHT UNITS

WALLERCOUNTY HP2020 Texas U.S.




2.11 FoodEnvironmentIndex 6.3 6.0 7.7 2018 3







1.50 FarmersMarketDensitymarkets/1,000population 0.0 2016 15






0.22 WorkerswhoWalktoWork percent 4.7 3.1 1.6 2.8 2012-2016 45-54,55-59,60-64 1

SCORE HEARTDISEASE&STROKE UNITSWALLERCOUNTY HP2020 Texas U.S.


2.61 Stroke:MedicarePopulation percent 6.0 4.5 4.0 2015 2



2.06Hypertension:MedicarePopulation percent 61.6 57.5 55.0 2015 2




deaths/100,000population 194.8 173.0 171.9 2010-2014 Black 10








1.39 TuberculosisIncidenceRatecases/100,000population 2.9 1.0 4.5 2013-2017 10



1.00 HIVDiagnosisRatecases/100,000population 8.0 16.1 2016 10









0.75 BabieswithLowBirthWeight percent 7.2 7.8 8.3 8.0 2013 10


births 5.1 6.0 5.8 6.0 2013 10

0.36 PretermBirths percent 9.1 9.4 12.0 11.4 2013 10





population 34 99 214 2017 3

2.28 Age-AdjustedDeathRatedueto deaths/100,000 15.8 10.2 11.7 12.5 2010-2014 10


Suicide population


1.17 FrequentMentalDistress percent 11.3 10.6 15.0 2016 3


0.94 Depression:MedicarePopulation percent 14.6 17.0 16.7 2015 2



SCORE OLDERADULTS&AGING UNITSWALLERCOUNTY HP2020 Texas U.S.



2.61 Stroke:MedicarePopulation percent 6.0 4.5 4.0 2015 2






2.06Hypertension:MedicarePopulation percent 61.6 57.5 55.0 2015 2








1.06

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 30.0 31.6 30.0 2015 2


0.94 Depression:MedicarePopulation percent 14.6 17.0 16.7 2015 2

0.89Osteoporosis:MedicarePopulation percent 5.1 6.5 6.0 2015 2





BlackorAfricanAmerican 1

SCORE OTHERCHRONICDISEASES UNITSWALLERCOUNTY HP2020 Texas U.S.



1.06

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 30.0 31.6 30.0 2015 2

0.89Osteoporosis:MedicarePopulation percent 5.1 6.5 6.0 2015 2


SCORE PREVENTION&SAFETY UNITSWALLERCOUNTY HP2020 Texas U.S.








population 8.9 9.8 16.9 2014-2016 3

SCORE PUBLICSAFETY UNITSWALLERCOUNTY HP2020 Texas U.S.



population 273.0 407.6 2012-2014 3



SCORE RESPIRATORYDISEASES UNITSWALLERCOUNTY HP2020 Texas U.S.




1.39 TuberculosisIncidenceRatecases/100,000population 2.9 1.0 4.5 2013-2017 10








SCORE SOCIALENVIRONMENT UNITSWALLERCOUNTY HP2020 Texas U.S.


2.61 MeanTravelTimetoWork minutes 31.6 25.9 26.1 2012-2016 1


2.14 PersonswithHealthInsurance percent 76.1 100.0 81.4 2016 8

2.11People25+withaHighSchoolDegreeorHigher percent 78.4 82.3 87.0 2012-2016 Other 1


2.06 PeopleLivingBelowPovertyLevel percent 19.0 16.7 15.1 2012-201618-24,6-11BlackorAfricanAmerican 1



BlackorAfricanAmerican,Other 1

1.89ChildrenLivingBelowPovertyLevel percent 25.1 23.9 21.2 2012-2016 HispanicorLatino 1



TwoorMoreRaces 1







AmericanIndianorAlaskaNative,Black

orAfricanAmerican,Hispanic

orLatino 1



1.06 Homeownership percent 59.6 55.0 55.9 2012-2016 1




SCORE SUBSTANCEABUSE UNITSWALLERCOUNTY HP2020 Texas U.S.


2.17 AdultswhoDrinkExcessively percent 20.5 25.4 19.4 18.0 2016 3


population 8.9 9.8 16.9 2014-2016 3



SCORE TRANSPORTATION UNITSWALLERCOUNTY HP2020 Texas U.S.


2.61 MeanTravelTimetoWork minutes 31.6 25.9 26.1 2012-2016 1


2.39SoloDriverswithaLongCommute percent 51.0 36.9 34.7 2012-2016 3

1.72WorkersCommutingbyPublicTransportation percent 0.6 5.5 1.5 5.1 2012-2016 1


1.22WorkerswhoDriveAlonetoWork percent 78.1 80.3 76.4 2012-2016 60-64 1

0.72 HouseholdswithoutaVehicle percent 4.7 5.6 9.0 2012-2016 1

0.22 WorkerswhoWalktoWork percent 4.7 3.1 1.6 2.8 2012-2016 45-54,55-59,60-64 1

SCORE WELLNESS&LIFESTYLE UNITSWALLERCOUNTY HP2020 Texas U.S.


2.00Self-ReportedGeneralHealthAssessment:PoororFair percent 19.3 18.2 16.0 2016 3

1.83 InsufficientSleep percent 34.5 32.7 38.0 2016 3

1.67 FrequentPhysicalDistress percent 12.0 10.8 15.0 2016 3

1.67PoorPhysicalHealth:AverageNumberofDays days 3.8 3.5 3.7 2016 3



SCORE WOMEN'SHEALTH UNITSWALLERCOUNTY HP2020 Texas U.S.




deaths/100,000females 21.2 20.7 20.2 20.9 2011-2015 6


females 109.8 111.7 124.7 2011-2015 6



AppendixC.PrimaryDataMethodology

CommunityInputParticipantsAccessHealth(FQHC)(FortBendFamilyHealthCenter)AIDSFoundationofHoustonAssociationfortheAdvancementofMexicanAmericansAvenueCDCCatholicCharities-ArchdioceseofGalvestonCatholicCharities-FortBendChildAdvocatesofFortBendChildrenatRiskChristClinicCityofHouston,DepartmentofParksandRecreationCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceElCentrodeCorazonEpiscopalHealthFoundationFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerce

GulfCoastMedicalFoundationHarrisCountyPublicHealthHealthcarefortheHomeless-HoustonHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictInterfaithCommunityClinicKinderInstituteLegacyCommunityHealthLibertyCountySheriff'sOfficeLoneStarFamilyHealthCenterMidtownArtsandTheaterCenterHoustonMontgomeryCountyWomen'sCenterBaker-RipleyEarlyHeadStartPatientCareInterventionCenter(PCIC)PrairieViewA&MUniversitySantaMariaHostel,Inc.TheArcofFortBendCountyTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeTri-CountyServicesBehavioralHealthcareUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayofHarrisandMontgomeryCountyWestChambersMedicalCenter(FQHC)YMCAofGreaterHouston


KeyInformantInterviewQuestionnaire(EpiscopalHealthFoundation)• Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],

andIamwithHealthResourcesinAction,anon-profitpublichealthorganizationbasedinBoston.Thankyouforspeakingwithmetoday.

• Aswementionedinourinterviewinvitation,theEpiscopalHealthFoundationis

coordinatinganinterviewinitiativetosupportfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsincludeCHISt.Luke’s,HoustonMethodistHospital,MemorialHermannHealthSystem,andTexasChildren’sHospital.

• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout70stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthebroaderGreater

Houstoncommunityandthepopulationsyouworkwithasaleaderinyourcommunity.TheFoundationandthefourhospitalswelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,HealthResourcesinActionwillprovideatranscriptofyourinterviewtothefourhospitalsforuseinpreparingtheircommunityhealthneedsassessmentreports.Eachhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.HealthResourcesinActionwillalsobepreparingareportofthegeneralthemesthatemergeacrossalltheinterviewstohelpthehospitalspreparetheirreports.

• TheFoundationhasaskedHealthResourcesinActiontoaskallintervieweeshowtheywish

anyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.


• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW

INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization/agency?

o Hasyourorganization/agencyeverpartneredwithanyofthefourhospitalsinvolvedinthissharedcommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves/theGreaterHoustonpopulationatlarge?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?


§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyou

thinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,whichwould

yourankasyourtopissue?Howdoyouseethisissueaffectingcommunitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbybarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o Whatdoyouseeasthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whatdoyouseeasitslimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfaceinaccessinghealthcareand

socialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofinthecommunitythataddressaccess

tohealthcareandsocialservices?


o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenataddressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesarecurrentlynotavailablethatyouthinkshouldbe?

IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)• Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercome

oraddressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyaren’tdoingrightnow?Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstothefourhospitals.Eachhospitalwillmaketheircommunityhealthneedsassessmentreportspubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoJenniferMineoattheEpiscopalHealthFoundationwhoiscoordinatingthiseffortonbehalfofthefourhospitals.Thankyouagain.Haveagoodmorning/afternoon.


KeyInformantInterviewQuestionnaire(ConduentHealthyCommunitiesInstitute)Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],andIamwithConduentHealthyCommunitiesInstitute.Mycolleague[name]isalsoontheline.WeareworkingwithMemorialHermannHealthSystemtoconductaCommunityHealthNeedsAssessment.• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout12stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthecommunityandthe

populationsyouworkwithasaleaderinyourcommunity.MemorialHermannwelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,wewillanalyzeandsummarizealltheinterviewstoincorporateintothecommunityhealthneedsassessmentreports.EachMHhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.

• MemorialHermannhasaskedHCItoaskallintervieweeshowtheywishanyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.

• Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.

• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW


INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization?

o Hasyourorganization/agencyeverpartneredwithMH’scommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?

§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyou

thinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,which

wouldyourankasyourtopissue?Howdoyouseethisissueaffecting


communitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbythesebarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o WhatAREthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whataresomeoftheirlimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfacewhenaccessinghealthcare

andsocialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofthataddressaccesstohealthcare

andsocialservices?

o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenataddressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesnotavailablethatyouthinkshouldbe?

IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)


• Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeor

addressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyarenotdoingrightnow?

o Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstoMemorialHermann.Thecommunityhealthneedsassessmentreportswillbepubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoDeborahGanelinatMemorialHermannwhoiscoordinatingthiseffort.Thankyouagain.Haveagoodmorning/afternoon.


CommunitySurvey(English)MemorialHermannHealthSystemisconductingaCommunityHealthNeedsAssessmentfortheGreaterHoustonarea.ThisassessmentallowsMemorialHermanntobetterunderstandthehealthstatusandneedsofthecommunityandusetheknowledgegainedtoimplementprogramsthatwillbenefitthecommunity.Wecanbetterunderstandcommunityneedsbygatheringvoicesfromthecommunity.Thissurveyallowscommunitymemberslikeyoutotellusaboutwhatyoufeelareimportantissuesforyourcommunity.Weestimatethatitwilltakeabout5minutestocompletethissurvey.Thankyouverymuchforyourinputandyourtime!1. Pleaselookatthislistofcommunityissues.Inyouropinion,whatarethetop5issuesmost

affectingthequalityoflifeinyourcommunity?o Diabeteso Obesity/Overweighto Respiratory/LungDisease(asthma,COPD,etc.)o Cancerso MentalHealthandMentalDisorderso Injuries,ViolenceandSafetyo SubstanceAbuse(alcohol,tobacco,drugs,etc.)o OralHealtho HeartDiseaseandStrokeo SexualHealth(HIV/AIDS,STDs,etc.)o TeenagePregnancyo ElderCareo ReproductiveHealth(familyplanning)o Other(pleasespecify):______________________________

2. Howwouldyourateyourownpersonalhealth?

o Veryhealthyo Somewhathealthyo Unhealthyo Veryunhealthy

3. Abouthowmanytimesaweekdoyouexerciseorperformaphysicalactivitylikewalking,

running,bicycling,etc.?o Lessthan1timeaweeko 2-3timesaweeko 5ormoretimesaweeko Nevero Other(pleasespecify):______________________________


4. Whataresomeofthebarriersorchallengestoexercisingonaregularbasisforyou?o Noplacestoexerciseo Notimetoexerciseo Idon’tlikeexercisingo Feelunsafeexercisinginthecommunityo Noneofmyfriendsorfamilyexerciseo Nochildcareo Lackoffundstopayforgymorclasseso Notransportationo Other(pleasespecify):______________________________

5. Howmuchdoyouagreeordisagreewitheachofthestatementsbelow. Agree

stronglyAgree Disagree Disagree

stronglyTherearegoodparksforchildren,adultsandpeopleofallabilitiestoenjoyinmycommunity

Inthepast12months,IhadaproblemgettingthehealthcareIneededformeorafamilymemberfromanytypeofhealthcareprovider,dentist,pharmacy,orotherfacility

Idon’tknowwheretogetservicesformyselfwhenIamsad,depressedorneedsomeonetotalkto

IamconfidentIcangetanappointmentwhenIneedtoseemydoctorfairlyquickly

Ihaveaplacetoreceivemedicalcareotherthantheemergencyroom

Withinthepast12months,IworriedwhethermyfoodwouldrunoutbeforeIgotmoneytobuymore

Withinthepast12months,thefoodIboughtjustdidn’tlastandIdidn’thavemoneytogetmore

Therearemanyoptionsforhealthyandaffordablefoodinmycommunity

6. Hasyourdoctorevertoldyouthatyouhaveanyofthefollowing?(Markallthatapply)

o Highbloodpressureo Highcholesterolo Cancero Diabeteso Obesityo Asthmao Heartdiseaseo Other(pleasespecify):______________________________

Now,afewquestionssothatwecanseehowdifferenttypesofpeoplefeelaboutthequestionsasked.7. Zipcodewhereyoulive:______________________________


8. Whatisyourage?______________________________9. Whatisyourrace/ethnicity?

o Whiteo Black/AfricanAmericano Hispanic/Latinoo Asian/PacificIslandero NativeAmericano Other(pleasespecify):______________________________

10. Whataretheagesofchildrenlivinginyourhousehold?

o 11andyoungero 12-18yearsoldo 18andoldero None

11. Whatkindofmedicalinsuranceorcoveragedoyouhave?

o Privateo Employer-sponsoredo Medicaido Medicareo Noneo Other(pleasespecify):______________________________

Thankyouforcompletingthissurvey!


CommunitySurvey(Spanish)MemorialHermannHealthSystemestárealizandounaEvaluacióndelasNecesidadesdeSaluddelaComunidadeneláreametropolitanadeHouston.EstaevaluaciónpermiteaMemorialHermann

comprendermejorelestadodesaludylasnecesidadesdelacomunidad,asícomousarlainformaciónobtenidaparaponerenprácticaprogramasquebeneficienalacomunidad.

1.Lealalistadeproblemasdelacomunidad.Ensuopinión¿cuálessonlos5problemasquemásafectanlacalidaddevidaensucomunidad?□ Diabetes□ Obesidad/sobrepeso□ Enfermedadesrespiratorias/pulmonares(asma,enfermedadpulmonarobstructivacrónica[EPOC],etc.)

□ Cáncer□ Saludmentalytrastornosmentales□ Lesiones,violenciayseguridad□ Drogodependencia(alcohol,tabaco,drogas,etc.)

□ Saludbucal□ Enfermedadescardíacasyaccidentescerebrovasculares

□ Saludsexual(VIH/sida,enfermedadesdetransmisiónsexual[ETS],etc.)

□ Embarazosdeadolescentes□ Cuidadodeancianos□ Saludreproductiva(planificaciónfamiliar)

□ Otros,(especifique):_________________________________________________________

2.¿Cómocalificaríasupropiasaludpersonal?□ Muybuena□ Bastantebuena

□ Mala□ Muymala

3.¿Aproximadamente,cuántasvecesporsemanahaceejerciciooalgunaactividadfísica,comocaminar,correr,andarenbicicleta,etc.?□ Menosde1vezporsemana□ De2a3vecesporsemana

□ 5omásvecesporsemana□ Nunca


4.¿Cuálessonalgunasdelasbarrerasodificultadesqueleimpidenhacerejercicioregularmente?□ Notengounlugardondehacerejercicio.□ Notengotiempoparahacerejercicio.□ Nomegustahacerejercicio.□ Nomesientoseguro/ahaciendoejercicioenmicomunidad.

□ Ningunodemisamigosofamiliareshacenejercicio.

□ Notengoconquiéndejaramishijosmientrashagoejercicio.

□ Notengodineroparapagarungimnasiooclases.

□ Notengoaccesoatransporte.


Calculamosqueletomaráunos5minutoscompletarestaencuesta.


5.¿Lehadichosumédicoalgunadelassiguientesafecciones?(Marquetodaslasopcionesquecorrespondan).□ Presiónarterialalta□ Colesterolalto□ Cáncer□ Diabetes

□ Obesidad□ Asma□ Enfermedadcardíaca


6.¿Enquémedidaestádeacuerdooendesacuerdoconcadaunadelassiguientesafirmaciones? Muyde

acuerdoDe

acuerdoEn

desacuerdoMuyen

desacuerdoEnmicomunidad,haybuenosparquesparaniños,adultosypersonascontodotipodecapacidadesparanuestrodisfrute.

Enlosúltimos12meses,tuveunproblemaparaobtenerelcuidadomédicoquenecesitabaparamíoparaunfamiliarporpartedecualquiertipodeproveedordecuidadodelasalud,dentista,farmaciauotrocentrosanitario.

Nosédóndeobtenerserviciosparamícuandoestoytriste,deprimido/a,onecesitohablarconalguien.

Séconseguridadquepuedoobtenerunacitaconmimédicoconciertarapidez.

Tengoamidisposiciónunlugarpararecibircuidadosmédicosquenoseaunasaladeemergencias.

Enlosúltimos12meses,mepreocupédesilacomidaseagotaríaantesdeobtenerdineroparacomprarmásalimentos.

Enlosúltimos12meses,losalimentosquecomprésimplementenoduraronlosuficienteynotuvedineroparacomprarmás.

Enmicomunidadhaymuchasopcionesparacompraralimentossaludablesyasequibles.

7.Códigopostaldesucasa:_________________________8.¿Cuántosañostiene?_________________9.¿Cuálessuraza/origenétnico?□ Blanco/a□ Negro/aoafroamericano/a□ Hispano/aolatino/a

□ Asiático/aoisleño/adelPacífico□ Indígenaamericano/a□ Otro/a,(especifique):______________

10.¿Cuántosañostienenlosniños/asquevivenensucasa?□ 11ymenos □ Entre12y18años

Ahoraleharemosalgunaspreguntasparapodervercómosesientenlosdistintosgruposdepersonasacercadelaspreguntasquelehemoshecho.


□ Másde18años □ Ninguno

11.¿Quétipodeseguromédicoocoberturatiene?□ Privado□ Patrocinadoporunempleador□ Medicaid

□ Medicare□ Ninguno□ Otro,(especifique):________


AppendixD.PrioritizationTool

PrioritizationSurveyThankyouforyourparticipationinthisprioritizationprocess.TheCommunityHealthNeedsAssessment(CHNA)processhasmultiplesteps.Afterthoroughresearchhasbeencompletedtoidentifythesignificanthealthneedsinthecommunity,thesesignificanthealthneedsmustbeprioritizedforfurtherstrategicplanningandimplementation.Prioritizationistheprocessofdeterminingthemostimportantorurgenthealthneedstoaddressincommunities.BelowisadiagramthatshowsthemethodsthatwereusedtoidentifykeyissuesacrossMemorialHermann’sserviceareas.Thesethreemethodsincluded:asecondarydatareview,acommunitysurveyandkeyinformantinterviews.Asyousee,someissuesrevealedthemselvesacrossmultiplemethods.Reviewingthisdiagrammayhelpyoucompletethissurvey.

1. Thefollowinghealthneedsarenotlistedbyorderofimportance.Foreachhealthneed,click

onthearrowonthedropdownboxandselectyouragreementwitheachstatement.Ifyouareonatabletorphone,pleasescrollallthewaytotherightforeachrow.

Theissueimpactsmanypeopleinmycommunity

Thisissuesignificantlyimpacts

Therearenotenoughexistingandadequate

Thisissuehashighriskfordiseaseordeath


subgroups(subgroupsbyage,gender,race/ethnicity,LGBTQ,etc.)

resourcestoaddressthisissueinmycommunity

AccesstoHealthServices

HeartDiseaseandStroke

OlderAdultsandAging

Obesity(Exercise,NutritionandWeight)

Transportation MentalHealth Diabetes SubstanceAbuse Cancers LackofHealthInsurance

Education FoodInsecurity Low-Income/Underserved

Children’sHealth Economy 2. IndicatethelevelofimportancethatshouldbegiventowardseachofMemorialHermann’s

4Pillars.Keydefinitionsarelistedbelow.

NotImportant

SomewhatImportant

Important VeryImportant

NotSure

Accesstocare(includinghealthcareaccess,healthcareresourceawareness,healthcarenavigation/literacy)

Foodashealth(includingfoodinsecurity,foodprograms,foodknowledge)

Exerciseasmedicine(includingobesity,accesstoparks,safeplacestoexercise)

Emotionalwell-being(includingemotionalhealth,mentalhealth,substanceabuse)

Keydefinitions:


Healthcarenavigation/literacy:needforeducationinnavigatinghealthsystemsFoodinsecurity:lackingreliableaccesstohealthyfoodoptionsFoodprograms:programs,effortsorservicesdesignedtoaddressfoodissuesFoodknowledge:one’sunderstandingofhealthyfoods3. Whoinyourcommunityismostaffectedbypoorhealthoutcomes?(Selectupto5)

o Lesbian,Gay,Bisexual,Transgender,QueerorQuestioning(LGBTQ)o OlderAdultso PersonswithDisabilities(cognitive,sensoryorphysicaldisability)o Racial/EthnicMinorityPopulationso Veteranso Immigrantsorotherundocumentedpersonso Personsexperiencinghomelessnessorprecariouslyhousedo OtherPopulations(pleasespecify):____________________________

4. Pleaseprovideyourname:__________________________________________

5. Pleaseprovideyouremailaddress:__________________________________________

6. Pleaseselectthename(s)ofthehealthcarefacilityorfacilitiesyourepresent.Youmay

choosemorethanone.o MemorialHermannKatyo MemorialHermannMemorialCityo MemorialHermannGreaterHeightso MemorialHermannNortheasto MemorialHermannSoutheasto MemorialHermannSugarLando MemorialHermannSouthwesto MemorialHermannTheWoodlandso KatyRehabo TexasMedicalCentero TIRRMemorialHermanno MemorialHermannSurgicalHospitalKingwoodo MemorialHermannSurgicalHospitalFirstColonyo MemorialHermannFirstColonyHospital(ER)o MemorialHermannTomballHospital(ER)o Other(pleasespecify):_____________________________

ThankyouforyourinputandparticipationintheCommunityHealthNeedsAssessmentprocess.


AppendixE.CommunityResourcesThefollowingisalistofcommunityresourcesmentionedbycommunityinputparticipants.2-1-1TexasA.C.TaylorHealthCenterAccessHealthAcresHomeHealthCenterAIDSFoundationHoustonAldineHealthCenterAmericanHeartAssociationAmericanRedCrossAmistadCommunityHealthCenterAreaAgencyonAgingAssociationfortheAdvancementofMexicanAmericansAvenue360Health&WellnessAvenueCDCBaker-RipleyBastropCommunityHealthCenterBaylorTeenHealthClinicBaysideClinicBaytownHealthCenterBeeBusyWellnessCenterBoatPeopleSOSBo'sPlaceBrighterBitesBrownsvilleCommunityHealthCenterBuffaloBayouPartnershipBurlesonFamilyMedicalCenterBVCAA-HealthPointCanDoHoustonCasadeAmigosHealthCenterCasaElBuenSamaritanoCatholicCharitiesoftheArchdioceseofGalveston-Houston-FortBendCentralCareCommunityHealthChambersCommunityHealthCenterCHISt.Luke'sHealthChildAdvocatesofFortBendChildrenatRiskChristClinicChristianCommunityServicesCenter(CCSC)CHRISTUSHealthSystemCitiesChangingDiabetesCityofHouston

CityofHouston,DepartmentofParksandRecreationCityofPasadenaCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceCountyIndigentHealthCareProgramCovenantwithChristCommunityServiceCenterCypressHealthCenterDannyJacksonHealthCenterDentalHygieneClinicE.A."Squatty"LyonsHealthCenterElCentroDeCorazonElFrancoLeeHealthCenterEpiscopalHealthFoundationFamilyServices(GalvestonCounty)FortBendConnectFortBendCountyCollaborativeInformationSystemFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGoHealthyHoustonTaskForceGoodRxGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerceGulfCoastCommunityServicesAssociationGulfCoastMedicalFoundationGulfgateHealthCenterHarmonyHouseRespiteCenterHarrisCenterCrisisLineHarrisCountyPublicHealthandEnvironmentalServices(HCPHES)HarrisCountyRidesHarrisCountySocialServices


HarrisHealthSystemHarvestGreen(Development)HEALInitiativeHealthCenterofSoutheastTexasHealthcarefortheHomeless-HoustonHealthyLivingMatters(HarrisCounty)HelpingHandsFoodPantryHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictHoustonRyanWhitePlanningCouncilHoustonShifaSynottClinicHuntsvilleMemorialHospitalClinicIbnSinaFoundationIndiaHouseCharityClinicInterfaithCommunityClinicInterfaithMinistriesMealsonWheelsInterfaithofTheWoodlandsKinderInstituteLaNuevaCasaHealthCenterLegacyHealth(FQHC)LeonCountyCommunityHealthCenterLibertyCountySheriff'sOfficeLoneStarFamilyHeathCenter(FQHC)LongBranchHealthCenterLongTermRecoveryGroupLosBarriosUnidosCommunityClinicMagnoliaHealthCenterMamieGeorgeCommunityCenterMartinLutherKingJr.HealthCenterMedicalPlusSuppliesMEHOP-MatagordaEpiscopalHealthOutreachProgramMETHeadStartMethodistHospitalMetroliftMidtownArtsandTheaterCenterHoustonMontgomeryCountyFoodBankMontgomeryCountyWomen’sCenterNeighborhoodHealthCenterNorthwestAssistanceMinistry'sChildren'sClinicNorthwestHealthCenterNuestraClinicadelVallePatMcWatersHealthClinic-SecondMileMission

PatientCareInterventionCenter(PCIC)PearlandCommunityHealthCenterPediatric&AdolescentHealthCenterPhysiciansatSugarCreekPlannedParenthoodPrairieViewA&MUniversityQuentinMeaseHospitalRegionalAssociationofGrantMakersRegionalMedicalCenterRobertCarrascoHealthClinicRSVPMedSpaSanJoseClinicSantaMariaHostel,Inc.SettegastHealthCenterSevaClinicCharityMedicalFacilityShelteringArmSeniorServicesDivisionofBakerRipleyShifaClinicSmithClinicSocialSecurityAdministrationSpringBranchCommunityHealthCenterSt.HopeFoundationSt.Vincent'sHouseStephenF.AustinCommunityHealthNetworkStrawberryHealthCenterTexanaBehavioralHealthTexasA&MAgriLifeExtensionServiceTexasChildren’sHospitalTexasMedicaidandCHIPMedicalTransportationProgramTheArcofFortBendCountyTheBeaconTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeThomasStreetHealthCenterTOMAGWAClinicTri-CountyServicesBehavioralHealthcareUberHealthUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayProjectBlueprintUniversityofHouston-CollegeofOptometryUniversityofTexasHealth-DentalUniversityofTexasHealthServices


UniversityofTexasPhysiciansUrbanHarvestUTMBValbonaHealthCenterVCareClinicVecinoHealthCenterWestChambersMedicalCenter(FQHC)WestHoustonAssistanceMinistries(WHAM)WholeLifeServiceCenterWomen'sCareCenterWorkforceSolutionsYMCAofGreaterHouston

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