SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

8/21/2019 SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

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A Community Health Needs AssessmentPrepared for Fauquier Health and Fauquier Health Foundation

By Community Health SolutionsMay 2014


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Table of Contents

Section Page

Executive Summary 1

Part I. Community Interview Results 4

Part II. Community Survey Results 9

1. Survey Respondents 9

2. Community Health Concerns 10

3. Community Service Gaps 12

4. Vulnerable/At-Risk Populations in the Community 14

5. Vulnerable/At-Risk Regions in the Community 17

6. Additional Ideas and Suggestions 18

Part III. Community Indicators 19

1. Health Demographic Trend Profile 20

2. Health Demographic Snapshot Profile 21

3. Mortality Profile 22

4. Maternal and Infant Health Profile 23

5. Preventable Hospitalization Discharge Profile 24

6. Behavioral Health Hospitalization Discharge Profile 25

7. Adult Health Risk Factor Profile 26

8. Youth Health Risk Factor Profile 27

9. Uninsured Profile 28

10. Medically Underserved Profile 29

Appendix A. Zip Code-Level Maps 30

Appendix B. Community Interview Guide and List of Participants 47

Appendix C. Community Survey: Additional Ideas and Suggestions for ImprovingCommunity Health

49

Appendix D. Defining a “Healthy Community” 53

Appendix E. Data Sources 55


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Executive Summary

Page " 1 Community Health Needs Assessment

Executive Summary

This report presents the results of a community health needs assessment commissioned by Fauquier Health andFauquier Health Foundation. The study is focused on the geographic region encompassed by Fauquier County andRappahannock County. The study results are presented in three parts, including the results of CommunityInterviews with selected community leaders; a Community Survey of a broader group of community stakeholders;and Community Indicators containing dozens of community health status indicator profiles. This ExecutiveSummary outlines the major findings of the study. Details are provided in the body of the report, and the data

sources and methods are described in Appendix E .

The Study Region

Part I. Community Interviews

In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21community leaders from diverse organizations (see participant list in Appendix B ). The purpose of these interviewswas to obtain participant insights about the characteristics of a healthy community, as well as vulnerablepopulations, emerging health issues, community assets, and opportunities for community collaboration. Theinterview participants expressed diverse perspectives on these topics, as presented in detail in Part I of the report.

Part II. Community Survey

In an effort to expand the range of community input for the study, a Community Survey was conducted with abroad-based group of community stakeholders identified by Fauquier Health and Fauquier Health Foundation. Thesurvey participants were asked to provide their viewpoints on:

Important health concerns in the community; Significant service gaps in the community;

Vulnerable/at-risk populations in the community; Vulnerable/at-risk geographic regions in the community; and

Additional ideas or suggestions for improving community health.The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted aresponse (although not every respondent answered every question). The respondents provided rich insights aboutcommunity health in the study region, as summarized below.

Health Concerns. The respondents identified over 20 important health concerns including obesity, mentalhealth conditions, diabetes, substance abuse and other concerns.


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Executive Summary


Service Gaps. The respondents identified more than two dozen specific community services in need ofstrengthening. Identified services included behavioral health services, aging services, transportation andother services.

Vulnerable or At-Risk Populations. The respondents reported a number of vulnerable/at-risk populationsin the community. Identified populations included the elderly, low income residents and persons withbehavioral health needs, and other populations with particular health concerns.

Vulnerable or At-Risk Regions. The respondents reported a number of vulnerable/at-risk neighborhoodsor geographic regions in the community, including rural areas; areas with a large population of seniors; andareas in central, northern, and southern Fauquier County. (See Appendix A for zip-code level maps ofselected demographic and health indicators for the region).

Ideas and Suggestions. Forty-three respondents offered open-ended responses with additional ideas andsuggestions for improving community health. These responses are listed in Appendix C .

Part III. Community Indicators

The community indicators in Part III present a wide array of quantitative community health indicators for the studyregion. To produce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the

analysis does not include every possible indicator of community health. The analysis is focused on a set ofindicators that provide broad insight into community health, and for which there were readily available data sources.To summarize:

Demographic Profile. As of 2013, the study region included an estimated 74,567 people. The population isexpected to increase to 79,035 by 2018. It is projected that population growth will occur in all demographicgroups, including a 22% increase in seniors age 65+; a 21% increase in the Asian population; and a 22%increase in the Hispanic ethnicity population. Compared to Virginia as a whole, the study region is more rural,older, and less racially/ethnically diverse. The study region also has higher income levels than Virginia as awhole.

Mortality Profile. In 2012, the study region had 553 total deaths. The leading causes of death were malignantneoplasms (cancer), heart disease, and cerebrovascular disease (stroke). The age-adjusted rate for stroke

deaths in the study region was higher than the Virginia statewide rate.

Maternal and Infant Health Profile. In 2012, the study region had 925 pregnancies, 731 total live births andfour infant deaths. Compared to Virginia as a whole, the study region had a higher rate of births without earlyprenatal care.

Preventable Hospitalization Discharge Profile. The Agency for Healthcare Research and Quality (AHRQ)defines a set of conditions (called Prevention Quality Indicators, or ‘PQIs’) for which hospitalization should beavoidable with proper outpatient health care. High rates of hospitalization for these conditions indicate potentialgaps in access to quality outpatient services for community residents. In 2011, residents of the study regionhad 871 PQI hospital discharges. The leading diagnoses for these discharges were chronic obstructivepulmonary disease (COPD) and asthma in older adults, bacterial pneumonia, and congestive heart failure. Theage-adjusted PQI discharge rates for the study region were higher than the Virginia statewide rates for mostPQI diagnoses.

Behavioral Health Hospitalization Discharge Profile. Behavioral health hospitalizations provide anotherimportant indicator of community health status. In 2012, residents of the study region had 260 hospitaldischarges from Virginia community hospitals for behavioral health conditions.1 The leading diagnoses forthese discharges were affective psychoses, alcoholic psychoses and schizophrenic disorders. The age-adjusted discharge rates for the study region were lower than the statewide rates.

1 Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do notinclude discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.


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Executive Summary


Adult Health Risk Profile. Local estimates indicate that substantial numbers of adults (age 18+) in the studyregion have health risks related to nutrition, weight, physical inactivity, tobacco and alcohol. In addition,substantial numbers of adults have chronic conditions such as high cholesterol, high blood pressure, arthritis,diabetes and asthma.

Youth Health Risk Profile. Local estimates indicate that substantial numbers of youth (age 14-19) in the studyregion have health risks related to nutrition, weight, alcohol, mental health, tobacco, and physical inactivity.

Uninsured Profile. An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at agiven point in time in 2013. This included an estimated 1,188 children and 6,903 adults.

Medically Underserved Profile. Medically Underserved Areas (MUAs) and Medically Underserved

Populations (MUPs) are designated by the U.S. Health Resources and Services Administration as being at-risk

for health care access problems. The designations are based on several factors including primary care provider

supply, infant mortality, prevalence of poverty, and the prevalence of seniors age 65+. All of Rappahannock

County is designated as medically underserved. Part of Fauquier County is designated as medically

underserved. Part of Fauquier County is designated as medically underserved; two county subdivisions (minor

civil divisions or MCDs) meet the designation criteria. These MCDs are 94215 Lee District and 94511 Marshall

District.

Additional Information Additional information on study results and methods is provided as follows.

Accompanying File of Community Indicators. A separate Microsoft Excel file contains all quantitativeindicators used in the report.

Appendix A. Zip Code-Level Maps. Appendix A provides a set of thematically colored maps displayingvariation in selected community health indicators by zip code. The underlying data for these maps areprovided in a separate Microsoft Excel file. Please read the important note about zip code-level data inAppendix A.

Appendix B. Community Interview Guide and List of Participants. Appendix B provides a copy of theguide used to conduct the community interviews for this study along with a list of participants.

Appendix C. Community Survey: Additional Ideas and Suggestions for Improving CommunityHealth. Forty-three survey respondents offered open-ended responses with additional ideas andsuggestions for improving community health. These responses are listed in Appendix C .

Appendix D. Defining a “Healthy Community”. On May 7, 2014, Community Health Solutions facilitated

a town hall meeting of community stakeholders on behalf of Fauquier Health and Fauquier HealthFoundation. As part of the meeting, participants were invited to share their vision of a healthy community.Twenty-four responses were submitted. These responses are listed in Appendix D .

Appendix E. Data Sources. Appendix E provides a list of the data sources used in the analysis of thisreport.


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Part I. Community Interview Results


Part I. Community Interviews

In March of 2014, Fauquier Health and Fauquier Health Foundation hosted three group interviews with a total of 21community leaders from diverse organizations (see participant list in Appendix B ). The purpose of these interviewswas to obtain participant insights about the characteristics of a healthy community, vulnerable populations,emerging health issues, community assets, and opportunities for community collaboration. The interviewparticipants expressed diverse perspectives which are summarized below and listed in detail in Exhibit I-1. ( Pleasenote that responses are paraphrased in

Exhibit I-1.)

Q1. In your own words, how would you define the idea of a “healthy community”?

Interview participants used a variety of descriptors to define the idea of a healthy community. Summarizinggeneral themes, participants described a healthy community as a place where people have an expectationof health; are engaged in health improvement; focus on both physical and behavioral health; have accessto services; are informed about existing services; are empowered to make healthy choices; practice healthyliving; and live in a physical environment that supports health.

Q2. From your perspective, who are the population segments within the community that are especiallyvulnerable/at-risk for health problems?

Interview participants identified multiple population segments that are especially vulnerable/at-risk.Participants identified subgroups of children, adolescents, adults, and seniors with specific healthconditions as well as socioeconomic and environmental risk factors. Specific health conditions identified byinterview participants include chronic disease and disability, various mental health conditions, andaddiction. Behavioral risk factors include smoking, sedentary lifestyle, poor nutrition, and substance abuseincluding abuse of prescription drugs. Socioeconomic and environmental risk factors include low income,lack of health insurance, and geographic isolation.

Q3. Are there health issues on the horizon that few people know about, but could cause serious harm todayor in the future?

Interview participants identified multiple emerging issues of concern, including perceived increases inpopulations with health challenges due to aging; chronic disease, pain, and disability; mental health needs;

substance abuse problems; human papilloma virus and risk for cervical cancer; and sexually transmitteddisease. Associated socioeconomic concerns include a growing number of working poor, and increases inthe uninsured population.

Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or naturalresources that promote a culture of health. In your view, what are the most important health assets withinthe community?

Interview participants identified a variety of community health assets, including caring and engagedresidents; good community programs and services; committed healthcare providers; an attractive physicalenvironment; growing support for active living and healthy eating; existing community coalitions; andindividuals willing to invest their intellectual and financial capital in the community.

Q5. Thinking of a healthy community as everyone’s responsibility, please share one creative way thatpeople could work together to promote better health in the community.

Interview participants identified a range of creative ways that residents could collaborate to promote betterhealth in the community including setting community-wide goals; developing regional strategies; sharinginformation across organizations; collaborating on community information campaigns; collaborating onfundraising and interventions; and building on current collaboration efforts.


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Exhibit I-1 Community Interview Results: Detailed Responses

Q1. In your own words, how would you define the idea of a “healthy community”?

1. Community efforts enforce physical and mental health.

2. Community members are engaged in improving health.

3. Health promotion activities are present.

4. It's easy for people to make good and healthy choices.

5. People are empowered to make choices to have a healthy lifestyle.

6. People are physically active and exercise.

7. People eat nutritionally sound diets.

8. People have access to good care (hospitals, mental health, dental).

9. People have access to education (e.g. schools, health information, health care services, and health resources).

10. People have access to transportation.

11. People have an expectation of health in the community.

12. People receive education regarding available services.

13. People's basic needs are met.

14. Services are available for everyone, regardless of risk or need.15. The environment is healthy.

16. There are adequate resources available across the age span.

17. There are opportunities and access to resources and activities that help people be healthy.

18. There is a plan for an active community.

19. There is an awareness of resources and needs of the population.

20. There is intellectual stimulation for both children and adults.

Q2. From your perspective, who are the population segments within the community that are especially

vulnerable or at-risk for health problems?

1. Adolescents who will suffer from the impact of bad habits, poor health choices, social pressures and social media

2. Caregivers

3. Children and adolescents with increasing levels of anxiety, attention deficit hyperactivity disorder, depression,overweight and who lack good nutrition

4. Children in foster care

5. Children who lack medicines

6. Children with undiagnosed mental health issues

7. Employees with absenteeism issues

8. Employees with exhaustion due to outside responsibilities or activities

9. Geographically isolated persons

10. Immobile persons

11. Issues related to the role of businesses providing health insurance

12. Lack of mental and physical breaks

13. Long commutes lead to sedentary lifestyles and contribute to poor nutrition.14. Older adults with disabilities

15. People functioning outside the mainstream of communications

16. People in need of dental care, especially children and low-income families

17. People with mental health issues (e.g. depression, anxiety, suicide)

18. People with mental illness who are put in jail because it is more easily available than a mental health facility

19. People who are non-native English speakers

20. People who can't speak for themselves

21. People who lack transportation to services (e.g. veterans)

22. People with chronic diseases (e.g. diabetes, obesity)


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23. People with disabilities

24. People with a family history of disease

25. Persons with lower socio-economic status (e.g. uninsured, working poor)

26. Prisoners who are released without a follow-up plan

27. Seniors with economic or social barriers, lack of healthcare and local venues (e.g. food stores)

28. Smoking and physical exhaustion in the healthcare workforce

29. Substance users

30. The disabled

31. The elderly

32. The very young

33. There's no separation between work and home and mobile devices keep people engaged 24/7.

34. Individuals without education

Q3. Are there health issues on the horizon that few people know about, but could cause serious harm today or in thefuture?

1. Alzheimer’s and Dementia

2. Children are being left out of accessing care because few providers see Medicaid patients.

3. Chronic disease (e.g. cancer, diabetes, hypertension and obesity in both children and adults)

4. Dental care needs

5. Eating disorders

6. Effects of drug mixing

7. Environmental health

8. Healthcare messaging is often overwhelming and is negatively skewed.

9. If people are not served at the free clinic, then they use the emergency room for health care.

10. In 15-20 years, we will see the unexpected outcomes of long term prescription and over the counter drug use.

11. In the aging population, there are changes in reactions to drugs over time and with substance abuse.

12. Palliative care options

13. Persons with unmanaged chronic pain

14. Population distrust of corporate medicine will have effects on health behavior.

15. Population growth is slowing in both counties.

16. Quality telephone service for people without cell phones or access to cell service

17. Sexually transmitted diseases (e.g. human immunodeficiency virus, human papilloma virus)

18.Since the recession, there has been an increase in people needing social services. Now there is a backlog becauseVirginia has changed its eligibility system.

19. Substance abuse (especially heroin, methamphetamine )

20. The ability of people with disabilities or mental health issues to navigate their life and health care system

21. The long term impact of anxiety and depression on the population

22. The outcome of long term use of recreational drugs

23. The population age mix will result in a gap between the young and older adults.

24. There are growing needs for people with serious disabilities. There is especially a need for infrastructure.

25.There is an increase in children with anxiety and mental health issues which, unless treated early, will lead to teensand adults with these same issues.

26. There is an increase in the elderly.

27. There is an increase in the working poor.

28. There will probably be an increase in uninsured patients at the free clinic in the coming year.

29. There's a gap between the need and the bed space available for mental health patients.


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Q4. Think of health assets as people, institutions, programs, built resources (e.g. parks), or natural resources thatpromote a culture of health. In your view, what are the most important health assets within the community?

1. Some Rappahannock schools have farm to table programs.

2. Banks3. County Health Fair

4. Faith-based organizations

5. Fire and Rescue

6. Hospital and caring providers

7. Infrastructure

8. The community is getting more active.

9. The community is a beautiful place to live.

10. Local nonprofits

11. Many influential people

12. Medical professionals are responsible.

13. New community members can be useful.

14. Old Town Festival

15. Park and Recreation

16. People are generous with time and money.

17. People are hard-working and caring.

18. People are playing sports, walking, using trails and riding bikes.

19. Providers use evidence-based care.

20. Schools

21. The community is moving towards consuming more fresh food and is willing to pay for it.

22. The community and nature are pretty.

23. The county is appealing to medical professionals.

24. The food bank

25. The free clinic is expanding to provide dental and behavioral health services.

26. The hospital is progressive and engaged.

27.There are a number of health and mental health-related community services such as: Community Service Board,

Adult and Child Protective Services, Home Instead, Department of Social Services, the Free Clinic, the Food pantry,Warrenton shelters, Virginia Department of Health and the Healthy Families Program and the Red Cross.

28. There are lots of smart people in the community.

29. There are many resources in the nearby Washington, D.C. metro area.

30. There are opportunities to be active at the Warrenton Aquatic and Recreation Facility.

31. There are retired baby boomers who want to be useful.

32. There are three community collaboratives that focus on aging, children and community resources.

33. There is an interest in community well-being.

34. There is social capital and the community is helpful, compassionate, capable and committed.

35. Wealthy people


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Q5. Thinking of a healthy community as everyone’s responsibility, please share one creative way that people couldwork together to promote better health in the community.

1. Assist people with needs to find resources.

2.Use a Care Medicine Approach and create a multi-disciplinary team (nurse, Emergency Medical Services, education,nonprofit) to staff a mobile health care service to provide outreach services in high need communities.

3. Develop a five county strategy.4. Develop a packet of information for Emergency Medical Services to use to locate services and resources.

5. Distribute the Department of Social Services' resource list.

6. Emergency Medical Services could set up education tables at the town fair.

7. Every patient discharged should receive a booklet listing services and receive assistance in setting up appointments.

8.Free clinics have received 'bonus bucks' that can be used at farmers markets. This program could expand across thearea.

9. Guidance counselors from schools could share resources.

10. Identify the gaps in services and resources.

11. Improve health literacy.

12. Look beyond political boundaries.

13. Make sure everyone knows the issues and people will fill the need.14. Nonprofits could collaborate on fundraising and interventions.

15. Organize a "health season" launch.

16. Organize a health fair with stations for screenings and education on health topics.

17. Organize a service-oriented fair for county government employees to volunteer for other organizations.

18. Organize Mental Health First Aid trainings for community members.

19. Other organizations can participate in Emergency Medical Services monthly meeting.

20. People need to spend time in someone else's shoes to get out of working in silos.

21. People need to work together even if there is no crisis.

22. Provide educational information about resources.

23. Provide follow-up care after discharge from hospital.

24. Set community goals related to community health and engage the community to achieve those goals.

25. Sometimes the government needs to get out of the way.

26. Start early with health education for children.

27. The collaborative on aging crosses barriers, is broad based and focuses on planning.

28. The community needs to do something like Michelle Obama's healthy food and habits initiative.

29. There is a request for the hospital to consider medical practice support.


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Part II. Community Survey Results


Part II. Community Survey

In an effort to expand the range of community input for the study, a Community Survey was conducted with a groupof community stakeholders identified by Fauquier Health and Fauquier Health Foundation. The survey participantswere asked to provide their viewpoints on:

Important health concerns in the community; Significant service gaps in the community; Vulnerable/at-risk populations in the community; Vulnerable/at-risk geographic regions in the community; and Additional ideas and suggestions for improving community health.

The survey was sent to a group of 172 community stakeholders. A total of 80 (47%) stakeholders submitted aresponse (although not every respondent answered every question). The respondents provided rich insights aboutcommunity health in the study region. The results are summarized in the remainder of this section.

1. Survey Respondents

Exhibit II-1 below lists the organizational affiliations of the survey respondents.

Exhibit II-1

Reported Organization Affiliation of Survey Respondents2

2 A count is provided for organizations with multiple survey respondents.

Aging Together Lifepoint Fauquier Hospital

Bealeton Baptist Church Marianne Clyde, Licensed Marriage and Family Therapist

Boys and Girls Club of Fauquier Marshall Volunteer Fire Department, Inc.

Branch Banking and Trust Company Mental Health Association of Fauquier County

Capital Caring Oak Springs of Warrenton

Christian Science Reading Room People Helping People of Fauquier County

Chrysalis Counseling Centers, Inc. Piedmont Dispute Resolution Center

Community Touch, Inc. Piedmont Family Practice

County of Rappahannock Piedmont Internal Medicine (2)

Fauquier Bridges Piedmont Pediatrics

Fauquier CADRE Piedmont Press and Graphics

Fauquier County Department of Social Services Piedmont United Way

Fauquier Community Child Care, Inc. Advanced Practice Psychiatric NurseFauquier County Rappahannock County Department of Social Services

Fauquier County Government Rappahannock County Public Schools (2)

Fauquier County Government and Public Schools Rappahannock Food Pantry

Fauquier County Parks and Recreation Rappahannock Historical Society

Fauquier County Public Schools Rappahannock Office of Emergency Management

Fauquier County Sheriff's Office Rappahannock Rapidan Community Services (3)

Fauquier Domestic Violence Services Rappahannock-Rapidan Regional Commission

Fauquier County Fire Rescue & Emergency Management Saint James' Episcopal Church

Fauquier FISH (For Immediate Sympathetic Help) School Health Advisory Board

Fauquier Free Clinic Sperryville Volunteer Rescue Squad

Fauquier Health (3) The Villa at Suffield Meadows

Fauquier Health Home Care Services Town of Washington

Fauquier Health Wellness Center Trinity Episcopal Church

Fauquier Hospital (2) Virginia Department of Health, Rappahannock-Rapidan District

Fauquier Sheriff’s Office Virginia Cooperative Extension (2)

Fauquier Trails Coalition, Inc. VOLTRAN

FCAC Head Start/Bright Stars Program Wakefield School

Fauquier Health Physician Services (2) Walgreens #9383

Flint Hill Volunteer Fire and Rescue Company Warrenton Volunteer Fire Company

Highland School Women of Wonder (WOW)

Hospice of the Rapidan Unknown Organization (3)

Hottle and Associates


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2. Community Health Concerns

Survey respondents were asked to review a list of common community health issues. The list of issues draws fromthe topics in Healthy People 2020 with some refinements. The survey asked respondents to identify from the listwhat they view as important health concerns in the community. Respondents were also invited to identify additionalissues not already defined on the list. Exhibit II-2 summarizes the results, including open-ended responses.

Exhibit II-2.

Important Community Health Concerns Identified by Survey Respondents

Answer Options Response Percent Response Count

Adult Obesity 69% 54

Depression 55% 43

Mental Health Conditions (other than depression) 54% 42

Diabetes 53% 41

Childhood Obesity 51% 40

Substance Abuse - Illegal Drugs 50% 39

Substance Abuse - Prescription Drugs 50% 39

High Blood Pressure 42% 33

Alcohol Use 36% 28

Heart Disease 36% 28

Alzheimer's Disease 35% 27

Cancer 30% 23

Chronic Pain 30% 23

Tobacco Use 27% 21

Domestic Violence 26% 20

Dental Care/Oral Health-Adult 22% 17

Autism 21% 16

Arthritis 18% 14

Dental Care/Oral Health-Pediatric 18% 14

Infant and Child Health 18% 14

Teen Pregnancy 17% 13

Asthma 15% 12

Physical Disabilities 15% 12

Stroke 15% 12

Orthopedic Problems 14% 11

Intellectual/Developmental Disabilities 13% 10

Respiratory Diseases (other than asthma) 13% 10

Injuries 12% 9

Infectious Diseases 10% 8

Sexually Transmitted Diseases 8% 6

Renal (kidney) Disease 6% 5

Prenatal & Pregnancy Care 5% 4Environmental Quality 4% 3

Neurological Disorders (seizures, multiple sclerosis) 4% 3

HIV/AIDS 3% 2

Other Health Problems (see next page) 15% 12

" Seventy-eight (78) of the 80 survey respondents answered this question.

Note: Wheninterpreting thesurvey results,please notethat althoughthe relativenumber ofresponsesreceived foreach item is

instructive, it isnot a definitivemeasure of therelativeimportance ofone issuecompared toanother.


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Exhibit II-2.Important Community Health Concerns Identified by Survey Respondents (continued)

Other Important Community Health Concerns Identified by Survey Respondents

Response # Reponses

1. Attention deficit hyperactivity disorder Other school difficulties

2. Attention deficit hyperactivity disorder Anxiety

3. Affordable health insurance Access to care for the elderly Inactivity leading to other community health concerns for adults and pediatric

4.

All of the above-mentioned community health concerns are important in our community.

Some of the least served issues would be in the area of mental health and substance abuse. Social issues with access to health care remain due to lack of transportation in many areas of our county

and there is little access to inter-county transportation for services. There is also very little in the way of assistance for dental treatment for the indigent in our community.

5.

All of the above-listed community health concerns are concerns within our community. The items I checked[Alzheimer's disease, mental health conditions (other than depression), substance abuse-illegal drugs andsubstance abuse-prescription drugs] represent issues that I often address and have found room forimprovement as far as services available.

6. Chronic diseases (multiple) Specific to injuries - those caused by falls

7. Eating disorders

8.From the emergency response side, we are typically not aware of these issues as we handle their post effects.However, [we] do get training and are aware of current trends so we can stay up to date on possible issues.

9.I believe that [lack of] access to mental health and substance abuse services is a major health problem in ourarea.

10. I don't have direct experience or information on health concerns in the community.

11. I feel that physicians over-prescribe medications to the elderly.

12. We are dangerously deficient in mental health access.


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3. Community Service Gaps

Survey respondents were asked to review a list of community services that are typically important for addressingthe health needs of a community. Respondents were asked to identify from the list any services they think needstrengthening in terms of availability, access, or quality. Respondents were also invited to identify additional servicegaps not already defined on the list. Exhibit II-3 summarizes the results, including open-ended responses.

Exhibit II-3.

Important Community Service Gaps Identified by Survey Respondents

Answer Options Response Percent Response Count

Behavioral Health Services (including mental health, substanceuse and intellectual disability)

71% 55

Aging Services 49% 38

Transportation 44% 34

Health Care Insurance Coverage (private and government) 31% 24

Health Care Services for the Uninsured and Underinsured 31% 24

Health Promotion and Prevention Services 30% 23

Early Intervention Services for Children 27% 21

Homeless Services 27% 21

Chronic Pain Management Services 26% 20

Home Health Services 24% 19Job/Vocational Retraining 24% 19

Lon Term Care Services 23% 18Patient Self-Management Services(e.g. nutrition, exercise,taking medications)

23% 18

Social Services 23% 18

Dental Care/Oral Health Services-Pediatric 21% 16

Dental Care/Oral Health Services-Adult 19% 15

Food Safety Net (food bank, community gardens) 18% 14

Cancer Services (screening, diagnosis, treatment) 17% 13

Hospice Services 17% 13

Primary Health Care Services 17% 13

Specialty Medical Care (e.g. cardiologists, oncologists, etc.) 17% 13

Family Planning Services 15% 12

Domestic Violence Services 14% 11Public Health Services 14% 11

Chronic Disease Services (including screening and earlydetection)

13% 10

School Health Services 12% 9

Pharmacy Services 8% 6

Maternal, Infant & Child Health Services 6% 5

Hospital Services (including emergency, inpatient and outpatient) 5% 4

Physical Rehabilitation 3% 2

Workplace Health and Safety Services 3% 2

Environmental Health Services 1% 1

Other Health Problems (see next page) 17% 13

4 Seventy-eight (78) of the 80 survey respondents answered this question.

Note: Wheninterpretingthe surveyresults,please notethat althoughthe relativenumber ofresponsesreceived foreach item isinstructive, itis not adefinitivemeasure ofthe relativeimportance ofone issuecompared toanother.


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Exhibit II-3.Important Community Service Gaps Identified by Survey Respondents (continued)

Other Important Community Health Services Gaps Identified by Survey Respondents

Response # Responses

1.

Affordable medications and outpatient medical treatments Affordable Herpes Zoster vaccine for adults

We need access to [a] safe haven for victims of domestic violence, such as a women's shelter.Other communities our size have this.

2. The county has no urgent care clinic, no pharmacy, no hospital, little home care and no public

transportation; all of which are critical to an aging population profile. The county is "no country for old men" (or women).

3.Dental care is an issue for adults without insurance coverage for dental services and for children with nocoverage or with Medicaid coverage (since the health department ended its pediatric dental services).

4. Integrated, all inclusive care offered in single locations Emergency mental health care and evaluations

5. Orthopedic services

6. Palliative care

7.[There is a need for] safe and healthful housing for very low-income and extremely low-income, includingseniors living only on Social Security. There is no source of assistance for these households to findaffordable safe housing.

8. Teaching children and parents the value and importance of eating healthy and buying local.

9. There are few primary care physicians who accept Medicaid and access for Medicare recipients is

becoming more limited. We have some problems with access to certain specialties such as psychiatry and neurology.

10. There is a huge need for a good psychiatrist.

11. Under specialty medical care, I think we need more oncology, and neurology services.

12. We need more endocrinology, neurology, psychiatry and urology physicians.

13.We need more psychiatry, chronic pain [services], orthopedic [services], gastrointestinal [services] andpharmacies.


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4. Vulnerable/At-Risk Populations in the Community

Survey respondents were asked if there are particular populations within the community who are vulnerable/at-riskfor health concerns or difficulties obtaining health services. Exhibit II-4 summarizes the results, includingrepresentative comments.5

Exhibit II-4.Vulnerable/At-Risk Populations Identified by Survey Respondents

Vulnerable/At-RiskPopulation Category

Representative Comments6

Elderly

1. An aging population demographic in need of services now delivered in Culpeper, Warrenton andFront Royal

2. Elderly and low income

3. If [an individual is] fortunate to have Medicaid, not all health care providers are willing to acceptit. This can result in clients having to travel some distance to receive medical services. Theproblem is then compounded by inadequate transportation.

4. Elderly eligible for Medicare but unable to afford medicines or recommended vaccines

5. Elderly living in rural areas

6. Elderly patients with underserved needs such as caregiver assistance and transportation needs

7. Older adults who are isolated and don't have family support

8. Rappahannock is aging and graying. It has relatively few children, relatively few young familieswith growing children, and an enlarging population of senior citizens. [These are] trends that areprojected to continue for the next couple of decades. Seniors with chronic health conditions havelittle choice but to move away, as we did last year, to be convenient to medical care, seniorservices, appropriate housing, transportation and services.

9. Resources for seniors with behavioral health issues

10. The elderly need constant supervision. If they want to maintain their independence, they needhelp in doing so.

11. The elderly, especially CTC residents [are vulnerable or at-risk]. It is hard to find services forresidents already in CTC setting, especially with Medicaid.

12. We often see frail elderly and disabled trying to continue living in their homes without adequatecare resources. We coordinate with Social Services [staff] who provide what help they can, buttheir resources are very limited.

Low Income

1. Fixed income adults, age range 25-59, who have medical issues and can't afford all theirmedications and living expenses [are vulnerable or at-risk].

2. I feel that all low income residents, and even middle class families of the community, are at-riskfor health problems due to poor preventative care (due to the inability to afford the same[prevention care]). That same group has difficulties obtaining health services, preventative andaffordable services for economic reasons.

3. In my short experience, the working poor struggle mightily in this county due to the limitedaffordable housing and basic high cost of living.

4. Lack of adequate housing and basic needs like food, clean water, and indoor plumbing

5. Low income families and those on Medicaid would be included in this group.

6. Low income or indigent persons who do not have a category for Medicaid.

7. Persons who are working but do not earn enough to pay for insurance.

5 Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at -risk populations.6 Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in theExhibit represent the range of populations identified.


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Vulnerable/At-Risk Population

Category7


Behavioral Health

1. Availability of inpatient behavioral health services

2. Children, adolescents and adults who have symptoms of mental illness but who can'taccess services because of stigma, wait times to get into care or lack of resources.

3. [There is] difficulty obtaining mental health and substance abuse intervention forthose with limited financial resources.

4. Doctors familiar or experienced with individuals with cognitive and physicaldisabilities

5. Community Services Board is unable to keep up with the needs of dual diagnosedmental health and substance abusers.

6. The elderly population will not seek medical attention due to not having medicalinsurance. Most of our elderly population has an extensive medical history.

7. Individuals with developmental and intellectual disabilities

8. The mentally ill have problems accessing mental health and physical health services.The mental health population is much more [at-risk for] chronic diseases due to theirlack of access to health care.

9. There is a lack of dependable, holistic psychiatry.

10. Those [individuals] needing behavioral medicine have few choices.

11. Those [individuals] with mental health issues, including substance abuse, have fewservices available to them; especially on an immediate need basis.

Uninsured

1. The uninsured who fall into [the] gap due to Virginia not expanding Medicaid.

2. Women age 50+who have separated or become divorced and do not have any typeof health insurance

3. Yes, children who don't qualify for Medicaid [are vulnerable or at-risk] because theirparent, or parents, work and are over the guidelines but no insurance is offered onthe job.

Residents withoutTransportation

1. Anyone dependent on public transportation not living in Warrenton City proper

2. Older adults without transportation

3. We have a large aging population and our area is very rural with no publictransportation.

Children

1. If we lose dental service from the county or state health services many of ourchildren will be without dental care.

2. Our rural students, without access to local food banks, may not have access tosufficient food and nutritional services when school is not in session.

3. We have children in the schools who do not have access to healthy and regular foodchoices.

4. Young children from single parent homes

Immigrant Community

1. Folks coming from outside the U.S.

2. People who speak a language other than English

3. The Latino community [is vulnerable or at-risk] because they may not be aware ofexisting services or because of language, cultural barriers or legal implications, theydo not or cannot seek services.

4. Undocumented migrant workers

5. Undocumented workers

7 Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at -risk populations.8 Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in theExhibit represent the range of populations identified.

Exhibit II-4.Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)


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Vulnerable/At-Risk Population

Category9


Other

1. Dental

2. Caregivers

3. Families in crisis

4. Homeless

5. No internet access or understanding

6. People who are nonwhite

7. People who have religious traditions other than Christian

8. Persons re-entering the community after incarceration

9. Prescription drug abuse is a substantial, but largely hidden, health problem in ourcommunity.

10. Rappahannock County is underserved by health professionals. [There are] twodoctors, one of whom is retiring.

11. Single mothers with children

12. Single males

13. Those families who are geographically isolated.

14. Those with "pre-diabetes" are often in need of "healthy living" information; such aswhat is provided in our diabetes services. However, most commercial insurances andMedicare do not cover any sort of health or nutrition counseling for those with adiagnosis of pre-diabetes. Those services, unfortunately, are only paid for oncesomeone has diabetes. Some people referred here will pay out of pocket for a one onone visit with our Registered Dietician, but some won't do it if their insurance doesn'tcover. Often, one visit isn't enough to learn about an entire lifestyle change over time.

15. Those with advanced stage diseases

16. Victims of domestic violence

17. Victims of sexual violence

18. We need primary care services.

19. Working with Fauquier Social Services and the Virginia Health Department will alsoprovide us this information.

9 Sixty-four (64) of the 80 survey respondents answered this question. Most responses included multiple at -risk populations.10 Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed inthe Exhibit represent the range of populations identified.

Exhibit II-4.Vulnerable/At-Risk Populations Identified by Survey Respondents (continued)


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5. Vulnerable/At-Risk Geographic Regions

Survey respondents were asked if there are particular neighborhoods or geographic regions within the communitywhere residents may be vulnerable/at-risk for health problems or difficulties obtaining health services. Exhibit II-5 summarizes the results, including representative comments.

11

Exhibit II-5.

Vulnerable/At-Risk Neighborhoods or Geographic Regions Identified by Survey Respondents

Vulnerable/At-RiskNeighborhood/Geographic

RegionRepresentative Comments

12

Rural/Remote Areas In General

1. Outlying areas of the county [are at-risk] because transportation to health careservices may be a significant problem.

2. Remote mountain areas and hollows

3. Rural uninsured or underinsured with rabies exposure

4. Rural, low income areas

5. Those [individuals] whose geographic location (rural, isolated) makes it difficult toaccess health care.

Central, Northern, and SouthernFauquier County

1. The southern end of Fauquier County including Bealeton, Midland, Goldvein, etc.

2. The central and southern regions of our county have a higher population and,therefore, require more services.

3. Bealeton area and Northern area

4. Central and southern areas of the county [have] poor access and transportation.

5. Southern and Northern Fauquier do not have adequate transportation for patients toobtain needed services in Warrenton.

6. It is more difficult for residents of Marshall to access health care resources.

7. Marsh Run Mobile Home Community

Areas with a large Senior

Population

1. In outlying areas, seniors have particularly difficult times getting to medical services.

2. One of our areas that we see an issue with is the local nursing homes. There seemsto be a lack of education on when and when not to call 911. We have had incidenceswhere we have [been] called to a nursing home at 2 am and transported them

[nursing home residents] to the emergency room because the blood labs came backabnormal. The Medic unit had to wake the resident up from a comfortable sleep totake them to the emergency department.

3. Housing designed for aging seniors with mobility problems is also badly needed.

4. Our community is a retirement community.

Other

1. Homeless people who do not meet the Family Shelter's rigid requirements

2. People who are in treatment

3. None I am aware of. Geography is not the issue, economics is, I believe.

4. The whole county is one under-served community bypassed by modern medicalcare. We desperately need an urgent care clinic and pharmacy at a minimum.

5. I am only familiar with the health problems in Rappahannock County. The problemsappear to be county wide.

11 Thirty-nine (39) of the 80 survey respondents answered this question. Most responses included multiple at-risk populations.12 Many respondents identified the same types of geographic regions (e.g. southern Fauquier), although with slightly different language. Thepopulations listed in the Exhibit represent the range of populations identified.


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6. Additional Ideas and Suggestions

Forty-three respondents offered open-ended responses with additional ideas and suggestions for improvingcommunity health. These responses are listed in Appendix C .


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This section of the report provides a quantitative analysis on a wide array of community health indicators. Toproduce the profiles, Community Health Solutions analyzed data from multiple sources. By design, the analysisdoes not include every possible indicator of community health. The analysis is focused on a set of indicators thatprovide broad insight into community health, and for which there were readily available data sources.

The results of this profile can be used to evaluate community health status compared to Virginia overall. The resultscan also be helpful for determining the number of people affected by specific health concerns. In addition, theresults can be used alongside the Community Interview and Community Survey results, as well as the zip code-level maps in Appendix A to help inform action plans for community health improvement. This section includes tenprofiles as follows:

1. Health Demographic Trend Profile2. Health Demographic Snapshot Profile3. Mortality Profile4. Maternal and Infant Health Profile5. Preventable Hospitalization Discharge Profile6. Behavioral Health Hospitalization Discharge Profile7. Adult Health Risk Factor Profile8. Youth Health Risk Factor Profile9. Uninsured Profile10. Medically Underserved Profile


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1. Health Demographic Trend Profile

Trends in health-related demographics are instructive for anticipating changes in community health status.Changes in the size, age and racial/ethnic mix of the population can have a significant impact on overall healthstatus, health needs and demand for local services.

As shown in Exhibit III-1, as of 2013, the study region included an estimated 74,567 people. The population isexpected to increase to 79,035 by 2018. It is projected that population growth will occur in all age groups, including

a 22% increase in seniors age 65+. Focusing on racial background, growth is projected for all populations, includinga 21% increase in the Asian population. The Hispanic ethnicity population is also expected to grow by 22%.

Exhibit III-1.Health Demographic Trend Profile for the Study Region, 2010-2018

Indicator 2010 Census2013

Estimate2018

Projection% Change2013-2018

Total Population 72,576 74,567 79,035 6%

Population Density (per Sq. Mile) 79.0 81.2 86.1 6%

Total Households 25,909 27,544 29,440 7%

Population by Age

Children Age 0-17 17,512 17,977 18,311 2%

Adults Age 18-29 8,853 9,021 9,876 9%

Adults Age 30-44 13,463 13,414 13,516 1%

Adults Age 45-64 23,051 23,833 24,734 4%

Seniors Age 65+ 9,697 10,322 12,598 22%

Population by Race/Ethnicity

Asian 875 1,015 1,226 21%

Black/African American 5,642 6,400 7,232 13%

White 62,441 63,299 66,102 4%

Other or Multi-Race 3,618 3,853 4,475 16%

Hispanic Ethnicity13

4,406 4,685 5,698 22%

Source: Community Health Solutions analysis of US Census data and estimates from Alteryx, Inc. See Appendix E.Data Sources for details.

13 Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories.


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2. Health Demographic Snapshot Profile

Community health is driven in part by community demographics. The age, sex, race, ethnicity, income andeducation status of a population are strong predictors of community health status and community health needs.

Exhibit III-2 presents a snapshot of key health-related demographics of the study region. As of 2013, the studyregion included an estimated 74,567 people. Focusing on population rates in the lower part of the Exhibit,compared to Virginia as a whole, the study region is more rural, older, and less racially/ethnically diverse. The study

region also has higher income levels than Virginia as a whole. Note: Maps 1-13 in Appendix A show the geographicdistribution of the population by zip code.

Exhibit III-2.Health Demographic Snapshot Profile, 2013

IndicatorStudy

RegionFauquierCounty

RappahannockCounty

Virginia

Population Counts

TotalPopulation

Population 74,567 67,137 7,430 8,246,990

Age

Children Age 0-17 17,977 16,525 1,452 1,889,997

Adults Age 18-29 9,021 8,214 807 1,411,537

Adults Age 30-44 13,414 12,281 1,133 1,673,982

Adults Age 45-64 23,833 21,252 2,581 2,244,242Seniors Age 65+ 10,322 8,865 1,457 1,027,232

SexFemale 37,741 34,025 3,716 4,197,377Male 36,826 33,112 3,714 4,049,613

Race

Asian 1,015 970 45 478,144Black/African American 6,400 6,015 385 1,607,903White 63,299 56,519 6,780 5,606,007Other or Multi-Race 3,853 3,633 220 554,936

Ethnicity Hispanic Ethnicity14 4,685 4,429 256 696,403

Income Low Income Households (Households with Income < $25,000) 3,160 2,605 555 581,266

Education Population Age 25+ Without a High School Diploma 5,376 4,317 1,059 668,407

Population Rates

Total

Population Population Density (pop. per sq. mile) 81.2 103.1 27.8 204.5

Age

Children Age 0-17 pct. of Total Pop. 24% 25% 20% 23%

Adults Age 18-29 pct. of Total Pop. 12% 12% 11% 17%



Seniors Age 65+ pct. of Total Pop. 14% 13% 20% 12%

SexFemale pct. of Total Pop. 51% 51% 50% 51%

Male pct. of Total Pop. 49% 49% 50% 49%

Race

Asian pct. of Total Pop. 1% 1% 1% 6%

Black/African American pct. of Total Pop. 9% 9% 5% 19%

White pct. of Total Pop. 85% 84% 91% 68%

Other or Multi-Race pct. of Total Pop. 5% 5% 3% 7%

Ethnicity Hispanic Ethnicity pct. of Total Pop. 6% 7% 3% 8%

Income

Per Capita Income $42,467 $43,103 $36,716 $34,707

Median Household Income $85,784 $89,397 $60,802 $63,146

Low Income Households (Households with Income


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3. Mortality Profile

Mortality is one of the most commonly cited community health indicators. As shown in Exhibit III-3 , in 2012, thestudy region had 553 total deaths in 2012. The leading causes of death were malignant neoplasms (cancer) (125),heart disease (117), and cerebrovascular disease (stroke) (36). The age-adjusted rate for stroke deaths in the studyregion was higher than the Virginia statewide rate. Note: Maps 14-17 in Appendix A show the geographicdistribution of deaths by zip code.

Exhibit III-3.Mortality Profile, 2012

Indicator Study RegionFauquierCounty

RappahannockCounty

Virginia

Total Deaths

Deaths by All Causes 553 469 84 61,101

Deaths by Top 14 Causes

Malignant Neoplasms Deaths 125 106 19 14,209

Heart Disease Deaths 117 92 25 13,289

Cerebrovascular Diseases Deaths 36 28 8 3,390

Unintentional Injury Deaths 28 24 4 2,779

Chronic Lower Respiratory Diseases Deaths 27 23 4 3,046

Nephritis and Nephrosis Deaths 18 17 1 1,518

Septicemia Deaths 18 18 0 1,308

Suicide Deaths 14 11 3 1,056

Alzheimer's Disease Deaths 12 9 3 1,708

Influenza and Pneumonia Deaths 11 10 1 1,302

Chronic Liver Disease Deaths 10 9 1 809

Diabetes Mellitus Deaths 8 7 1 1,589

Parkinson’s Disease Deaths 6 5 1 561

Primary Hypertension and Renal Disease Deaths 3 3 0 639

Age Adjusted Death Rates per 100,000Population

15

Total Deaths 686.0 676.0 778.1 724.9

Malignant Neoplasms Deaths 143.2 142.5 -- 164.1

Heart Disease Deaths 143.9 131.6 -- 157.4

Cerebrovascular Diseases Deaths 46.4 -- -- 40.7

Unintentional Injury Deaths -- -- -- 33.3

Chronic Lower Respiratory Diseases Deaths -- -- -- 36.6

Nephritis and Nephrosis Deaths -- -- -- 18.2

Septicemia Deaths -- -- -- 15.6

Suicide Deaths -- -- -- 12.5

Alzheimer's Disease Deaths -- -- -- 21.1

Influenza and Pneumonia Deaths -- -- -- 15.8Chronic Liver Disease Deaths -- -- -- 8.8

Diabetes Mellitus Deaths -- -- -- 18.5

Parkinson’s Disease Deaths -- -- -- 7.1

Primary Hypertension and Renal Disease Deaths -- -- -- 7.6

Source: Community Health Solutions analysis of mortality data from the Virginia Department of Health. See Appendix E. DataSources for details.

15 -- Age adjusted rates are not calculated where the number of deaths is less than 30.


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4. Maternal and Infant Health Profile

Maternal and infant health indicators are another widely cited category of community health. As shown in Exhibit III- 4, the study region had 925 pregnancies, 731 total live births and four infant deaths in 2012. Compared to Virginiaas a whole, the study region had a higher rate of births without early prenatal care. Note: Maps 18-21 in Appendix Ashow the geographic distribution of births by zip code.

Exhibit III-4

Maternal and Infant Health Profile, 2012Indicator StudyRegion

FauquierCounty

RappahannockCounty

Virginia

Counts

Total Pregnancies 925 844 81 129,787

Induced Terminations of Pregnancy 118 106 12 21,438

Natural Fetal Deaths 76 63 13 5,538

Total Live Births 731 675 56 102,811

Low Weight Births (under 2,500 grams / 5 lb. 8 oz.) 51 48 3 8,391

Births Without Early Prenatal Care (No Prenatal

Care in First 13 Weeks)

152 138 14 13,368

Non-Marital Births 225 208 17 36,271

Total Teenage (age 10-19) Pregnancies 65 59 6 8,651

Live Births to Teens Age 10-19 45 41 4 6,134



Live Births to Teens Age


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5. Preventable Hospitalization Discharge Profile

The Agency for Healthcare Research and Quality (AHRQ) identifies a defined set of conditions (called PreventionQuality Indicators, or ‘PQIs’) for which hospitalization should be avoidable with proper outpatient health care.

16 Highrates of hospitalization for these conditions indicate potential gaps in access to quality outpatient services forcommunity residents.

As shown in Exhibit III-5 , residents of the study region had 871 PQI hospital discharges in 2011.17 The leading

diagnoses for these discharges were chronic obstructive pulmonary disease (COPD) and asthma in older adults(213), bacterial pneumonia (183), and congestive heart failure (156). The age-adjusted PQI discharge rates for thestudy region were generally higher than the Virginia statewide rates for most PQI diagnoses. Note: Map 22 inAppendix A shows the geographic distribution of PQI discharges by zip code.

Exhibit III-5.Prevention Quality Indicator (PQI) Hospital Discharge Profile, 2011

Indicator StudyRegion

FauquierCounty

RappahannockCounty

Virginia

Total PQI Discharges

Total PQI Discharges by All Diagnoses 871 793 78 88,544

PQI Discharges by Diagnosis

Chronic Obstructive Pulmonary Disease (COPD) and Asthma in

Older Adults PQI Discharges

213 197 16 16,007

Bacterial Pneumonia PQI Discharges 183 170 13 15,720

Congestive Heart Failure PQI Discharges 156 138 18 20,006

Urinary Tract Infection PQI Discharges 108 97 11 10,826

Diabetes PQI Discharges 76 64 12 12,200

Dehydration PQI Discharges 58 54 4 7,422

Hypertension PQI Discharges 42 40 2 3,299

Perforated Appendix PQI Discharges 15 14 1 1,282

Asthma in Younger Adults PQI Discharges 14 13 1 1,121

Angina PQI Discharges 6 6 0 661

Age Adjusted PQI Discharge Rates per 100,000 Population18

All Diagnoses 947.5 967.7 828.1 1,068.1Chronic Obstructive Pulmonary Disease (COPD) and Asthma inOlder Adults

238.2 187.8 -- 134.2

Bacterial Pneumonia 236.4 281.3 -- 197.4

Congestive Heart Failure 193.8 275.5 -- 233.0

Urinary Tract Infection 140.6 150.5 -- 131.0

Diabetes 85.1 79.7 -- 133.2

Dehydration 70.4 35.7 -- 41.4

Hypertension 47.4 57.7 -- 34.8

Perforated Appendix -- -- -- 18.1

Asthma in Younger Adults -- -- -- 75.3

Angina -- -- -- 8.3Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and localdemographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

16 The PQI definitions are detailed in their specification of ICD-9 diagnosis codes and procedure codes. Not every hospital admission forcongestive heart failure, bacterial pneumonia, etc. is included in the PQI definition; only those meeting the detailed specifications. Low birthweight is one of the PQI indicators, but for the purpose of this report, low birth weight is included in the Maternal and Infant Health Profile. Also,there are four diabetes-related PQI indicators which have been combined into one for the report. For more information, visit the AHRQ websiteat www.qualityindicators.ahrq.gov/pqi_overview.htm 17 Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data donot include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.18 -- Age adjusted rates are not calculated where the number of PQI discharges is less than 30.


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6. Behavioral Health Hospitalization Discharge Profile

Behavioral health (BH) hospitalizations provide another important indicator of community health status. As shownin Exhibit III-6, residents of the study region had 260 hospital discharges from Virginia community hospitals forbehavioral health conditions in 2012.19 The leading diagnoses for these discharges were affective psychoses (133),alcoholic psychoses (21) and schizophrenic disorders (20). The age-adjusted BH discharge rates for the studyregion were lower than the statewide rates. Note: Map 23 in Appendix A shows the geographic distribution of BHdischarges by zip code.

Exhibit III-6.Behavioral Health Hospital Discharge Profile, 2012


RappahannockCounty

Virginia

BH Discharges

Total BH Discharges by All Diagnoses 260 232 28 55,372

BH Discharges by Diagnosis

Affective Psychoses Discharges20 133 123 10 27,038

Alcoholic Psychoses Discharges 21 19 2 3,623

Schizophrenic Disorders 20 19 1 8,142

Depressive Disorder, Not Elsewhere Classified 16 14 2 3,410Drug Psychoses 15 12 3 1,532

Adjustment Reaction Discharges 9 6 3 2,346

Neurotic Disorders 9 8 1 1,374

Other Nonorganic Psychoses 9 8 1 2,147

Alcohol Dependence Syndrome Discharges 6 6 0 2,162

Drug Dependence 5 4 1 649

Other Organic Psychotic Conditions-Chronic 4 3 1 773

Non Dependent Abuse of Drugs 3 2 1 626

Age Adjusted BH Discharge Rates per 100,000Population

21

All Diagnoses 384.8 378.5 -- 674.0

Affective Psychoses Discharges 199.4 201.3 -- 332.3

Alcoholic Psychoses Discharges -- -- -- 42.2

Schizophrenic Disorders -- -- -- 96.4

Depressive Disorder, Not Elsewhere Classified -- -- -- 42.3

Drug Psychoses -- -- -- 18.5

Adjustment Reaction Discharges -- -- -- 29.0

Neurotic Disorders -- -- -- 16.9

Other Nonorganic Psychoses -- -- -- 26.0

Alcohol Dependence Syndrome Discharges -- -- -- 25.5

Drug Dependence -- -- -- 8.0

Other Organic Psychotic Conditions-Chronic -- -- -- 9.1

Non Dependent Abuse of Drugs -- -- -- 7.6

Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and localdemographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

19 Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data donot include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis.20 Includes major depressive, bipolar affective and manic depressive disorders.21 -- -- Age adjusted rates are not calculated where the number of discharges is less than 30.


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7. Adult Health Risk Factor Profile

This section examines health risks for adults age 18+. Prevalence estimates of health risks, chronic disease andhealth status can be useful in developing prevention and improvement efforts. Exhibit III-7 shows estimatesindicating that substantial numbers of adults in the study region have health risks related to nutrition, weight,physical inactivity, tobacco and alcohol. In addition, substantial numbers of adults have chronic conditions such ashigh cholesterol, high blood pressure, arthritis, diabetes and asthma. Note: Maps 24-27 in Appendix A show thegeographic distribution of selected adult health risks by zip code.

Exhibit III-7.Adult Health Risk Factor Profile (Estimates), 2013

IndicatorStudy

RegionFauquierCounty

RappahannockCounty

Estimates-Counts

Estimated Adults age 18+ 56,590 50,612 5,978

RiskFactors

Less than Five Servings of Fruits and Vegetables Per Day 45,152 40,490 4,663

Overweight or Obese 33,747 29,861 3,886

Not Meeting Recommendations for Physical Activity in the Past 30Days

26,597 23,788 2,810

Smoker 11,645 10,629 1,016

At-risk for Binge Drinking (males having five or more drinks on oneoccasion, females having four or more drinks on one occasion)

11,079 10,122 956

ChronicConditions

High Cholesterol (was checked, and told by a doctor or other healthprofessional it was high)

19,866 17,714 2,152

High Blood Pressure (told by a doctor or other health professional) 16,471 14,677 1,793

Arthritis (told by a doctor or other health professional) 13,195 11,641 1,554

Diabetes (told by a doctor or other health professional) 6,165 5,567 598

GeneralHealthStatus

Limited in any Activities because of Physical, Mental or EmotionalProblems

10,306 9,110 1,196

Fair or Poor Health Status 9,620 8,604 1,016

Estimates-Percent of Adults Age 18+

Risk

Factors

Less than Five Servings of Fruits and Vegetables Per Day 80% 80% 78%

Overweight or Obese 60% 59% 65%

Not Meeting Recommendations for Physical Activity in the Past 30Days

47% 47% 47%

Smoker 21% 21% 17%

At-risk for Binge Drinking (males having five or more drinks on oneoccasion, females having four or more drinks on one occasion)

20% 20% 16%

ChronicConditions

High Cholesterol (was checked, and told by a doctor or other healthprofessional it was high)

35% 35% 36%

High Blood Pressure (told by a doctor or other health professional) 29% 29% 30%

Arthritis (told by a doctor or other health professional) 23% 23% 26%

Diabetes (told by a doctor or other health professional) 11% 11% 10%

GeneralHealthStatus

Limited in any Activities because of Physical, Mental or EmotionalProblems

18% 18% 20%

Fair or Poor Health Status 17% 17% 17%

Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data

and local demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

22 According to the CDC, for adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for allages and for both men and women. Overweight is defined as a BMI between 25.0 and 29.9. Obesity is defined as a BMI 30.0 and above. Formore information: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Interpreted


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8. Youth Health Risk Factor Profile

This section examines selected health risks for youth age 14-19. These risks have received increasing attention asthe population of American children have become more sedentary, more prone to unhealthy eating and more likelyto develop unhealthy body weight. The long-term implications of these trends are serious, as these factors placechildren at higher risk for chronic disease both now and in adulthood.

Exhibit III-8 shows estimates indicating that substantial numbers of youth in the study region have health risks

related to nutrition, weight, alcohol, mental health, tobacco, and physical activity. Note: Maps 28-29 in Appendix Ashows the geographic distribution of selected youth health risks by zip code.

Exhibit III-8.Youth Health Risk Factor Profile (Estimates), 2013


RappahannockCounty

Estimates-Counts

Estimated Youth Age 14-19 6,150 5,617 533

RiskFactors

Less than the Recommended Intake of Vegetables 5,414 4,944 470

Less than the Recommended Intake of Fruit 5,356 4,891 465

Overweight or Obese23

1,585 1,455 131Not Meeting Recommendations for Physical Activity inthe Past Week

883 810 74

Used Tobacco in the Past 30 Days 1,382 1,258 124

Have at least One Drink of Alcohol at least One Day inthe Past 30 Days

2,008 1,829 179

GeneralHealthStatus

Feel Sad or Hopeless (almost every day for two or moreweeks in a row so that they stopped doing some usualactivities)

1,537 1,407 130

Estimates-Percent of Youth Age 14-19

RiskFactors

Less than the Recommended Intake of Vegetables 88% 88% 88%

Less than the Recommended Intake of Fruit 87% 87% 87%

Overweight or Obese 26% 26% 25%Not Meeting Recommendations for Physical Activity inthe Past Week

14% 14% 14%

Used Tobacco in the Past 30 Days 22% 22% 23%

Have at least One Drink of Alcohol at least One Day inthe Past 30 Days

33% 33% 34%

GeneralHealthStatus

Feel Sad or Hopeless (almost every day for two or moreweeks in a row so that they stopped doing some usualactivities)

25% 25% 24%

Source: Estimates produced by Community Health Solutions using Virginia Youth Risk Behavioral Surveillance System data andlocal demographic estimates from Alteryx, Inc. See Appendix E. Data Sources for details.

23 For children and adolescents (aged 2 –19 years), the BMI value is plotted on the CDC growth charts to determine the corresponding BMI-for-age percentile. Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile. Obesity is defined as a BMIat or above the 95th percentile for children of the same age and sex. For more information:http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.html


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9. Uninsured Profile

Decades of research show that health coverage matters when it comes to overall health status, access to healthcare, quality of life, school and work productivity, and even mortality. Exhibit III-9 shows the estimated number ofuninsured individuals, by income as a percent of the federal poverty level (FPL), in the study region as of 2013.24 An estimated 8,090 (13%) nonelderly residents of the study region were uninsured at a given point in time in 2013.This included an estimated 1,188 children and 6,903 adults. Note: Maps 30-31 in Appendix A show the geographicdistribution of the uninsured population by zip code.

Exhibit III-9.Uninsured Profile (Estimates), 2013

Indicator

StudyRegion

FauquierCounty

RappahannockCounty

Estimated Uninsured Counts*

Uninsured Nonelderly Age 0-64 8,090 7,094 996

Uninsured Children Age 0-18 1,188 1,044 144

Uninsured Children Age 0-18


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10. Medically Underserved Profile

Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the U.S.Health Resources and Services Administration as being at-risk for health care access problems. The designationsare based on several factors including primary care provider supply, infant mortality, prevalence of poverty and theprevalence of seniors age 65+.

As shown in Exhibit III-10 , All of Rappahannock County is designated as medically underserved. Part of Fauquier

County is designated as medically underserved; two county subdivisions (minor civil divisions or MCDs) meet thedesignation criteria:

94215 Lee district 94511 Marshall district

For a more detailed description, visit the U.S. Health Resources and Service Administration designation webpageat http://muafind.hrsa.gov/.

Exhibit III-10.Medically Underserved Area/Populations Profile

Locality MUA/MUP Designation Census Tracts

Fauquier County Partial 2 MCDs of 17 Census Tracts

Rappahannock County Full 2 of 2 Census Tracts

Source: Community Health Solutions analysis of U.S. Health Resources and Services Administration data.


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Appendix A


APPENDIX A. Zip Code-Level Maps for the Study Region

The maps in this section illustrate the geographic distribution of the zip code-level study region population on keydemographic and health indicators. The results can also be used alongside the Community Interview Results,Community Survey Results and the Community Indicators to help inform plans for community health initiatives. Theunderlying data for these maps are provided in a separate Microsoft Excel file. The maps in this section include thefollowing:

1. Total Population, 2013 17. Cerebrovascular Disease (Stroke) Deaths, 2012

2. Population Density, 2013 18. Total Live Births, 2012

3. Child Population Age 0-17, 2013 19. Low Weight Births, 2012

4. Senior Population Age 65+, 201320. Births Without Early Prenatal Care (No Prenatal Care

in the First 13 Weeks), 2012

5. Asian Population, 2013 21. Births to Teen Mothers Under Age 18, 2012

6. Black/African American Population, 201322. Prevention Quality Indicator (PQI) Hospital

Discharges, 2011

7. White Population, 2013 23. Behavioral Health (BH) Hospital Discharges, 2012

8. Other or Multi-Race Population, 201324. Estimated Adults Age 18+ Overweight or Obese,

2013

9. Hispanic Ethnicity Population, 2013 25. Estimated Adult Age 18+ Smokers, 2013

10. Per Capita Income, 2013 26. Estimated Adults Age 18+ with Diabetes, 2013

11. Median Household Income, 201327. Estimated Adults Age 18+ with High Blood Pressure,

201312. Low Income Households (Households with Income


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Appendix A


Map 1: Total Population, 2013

Map 2: Population Density (population per square mile), 2013

Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix E. Data Sources for details.


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Appendix A


Map 3: Child Population Age 0-17, 2013

Map 4: Senior Population Age 65+, 2013



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Appendix A


Map 5: Asian Population, 2013

Map 6: Black/African American Population, 2013



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Appendix A


Map 7: White Population, 2013

Map 8: Other or Multi-Race Population, 2013



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Appendix A


Map 9: Hispanic Ethnicity Population, 2013



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Appendix A


Map 10: Per Capita Income, 2013

Map 11: Median Household Income, 2013



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Appendix A

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SUP 15-01 Staff Report With Attachments - Updated 6-12-2015

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