Texas Health Presbyterian Hospital Denton · HCI Project Team & Report Authors Project Manager •...

Texas Health Presbyterian Hospital

Denton2016 Community Health Needs Assessment

2Community Health Needs Assessment Outline

Report Contents• Background

– About the Organizations– CHNA Overview & Executive

Summary

• Service Area Demographics• Data Analysis

– Secondary Data– Key Informant Interviews & Focus

Groups– Online Community Survey

• Data Synthesis– Community Health Needs– Community Health Disparities– Community Health Barriers

• Prioritization– Methodology– 2016 Priority Health Topics

Appendix ContentsI. County Level Data ScoringII. Secondary Data SourcesIII. Community Resources Cited in

Primary DataIV. Organizations Represented in

Focus Group & Key Informant Interviews

V. Prioritization ParticipantsVI. Evaluation of Actions Taken

Since Preceding CHNAVII. Service Area Zip CodesVIII. CHNA Project Team & Hospital

LeadershipIX. IRS Checklist

Background

4About Texas Health Resources

Your feedback on this report is welcomed and encouraged. Please direct any questions or feedback to:

Texas Health Resources System ServicesCommunity Health Improvement612 E. Lamar Blvd., Suite 1400 | Arlington, TX 76011Email: [email protected]: 682-236-7990

Texas Health Resources is one of the largest faith-based, nonprofit health care

delivery systems in the United States and the largest in North Texas in terms of

patients served. The system's primary service area consists of 16 counties in north

central Texas, home to more than 6.8 million people. Texas Health was formed in

1997 with the assets of Fort Worth-based Harris Methodist Health System and

Dallas-based Presbyterian Healthcare Resources. Later that year, Arlington

Memorial Hospital joined the Texas Health system. Texas Health has 24 acute-care

and short-stay hospitals that are owned, operated, joint-ventured or affiliated with

the system. It has more than 3,800 licensed beds, more than 20,500 employees of

fully-owned/operated facilities plus 2,100 employees of consolidated joint

ventures, and counts more than 5,500 physicians with active staff privileges at its

hospitals.

5About Healthy Communities Institute

Healthy Communities Institute, a Xerox Corporation, was contracted by Texas Health Resources to conduct the 2016 Community Health Needs Assessment and to author the CHNA reports. Based in Berkeley, California, HCI provides customizable, web-based information systems that offer a full range of tools and content to improve community health, and developed the Healthy North Texas Platform. To learn more about Healthy Communities Institute please visit: www.HealthyCommunitiesInstitute.com

HCI’s mission is to improve the health, vitality, and environmental

sustainability of communities, counties, and states

HCI Project Team & Report Authors

Project Manager• Heather Cobb, MPHSecondary Data Lead• Rebecca YaePrimary Data Lead• Mari Rasmussen, MPH

Project Support:• Muniba Ahmad• Nicolia Eldred-Skemp, MPH• Claire Lindsay, MPH

http://www.healthyntexas.org

http://www.HealthyCommunitiesInstitute.com

6About Texas Health Presbyterian DentonTexas Health Presbyterian Hospital Denton serves the communities of Denton, Gainesville, Lake Dallas, Little Elm, Aubrey, Argyle, Corinth, Pilot Point and others across Cooke and Denton Counties with advanced medical treatments and an experienced staff that provides compassionate care. With a mission of improving the health of the people in the communities we serve, Texas Health Denton and the physicians on its medical staff are committed to your well-being and the health and wellness of your family.

Texas Health Denton offers:Bariatric SurgeryCancer CareDigestive HealthEmergency DepartmentHeart and VascularOrthopedics Pediatrics Physical TherapySleep Medicine Sports Medicine Stroke CenterWomen and Infants CareWound Care

Texas Health Denton is certified as a chest pain center by the Joint Commission and is an accredited member of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. It serves as a Primary Stroke Center as certified by the Joint Commission and the American Heart Association and designated by the Texas Department of State Health Services. The hospital offers advanced neonatal care and houses Denton’s only designated Level III NICU.

Texas Health Denton is a 255-bed hospital conveniently located on the east side of Interstate 35, immediately north of the I-35E and I-35W split.

https://www.texashealth.org/denton/Pages/Services/Bariatric-Surgery.aspx

https://www.texashealth.org/denton/Pages/Services/Cancer-Care.aspx

https://www.texashealth.org/denton/Pages/Services/Digestive-Health.aspx

https://www.texashealth.org/denton/Pages/Services/Emergency-Services.aspx

https://www.texashealth.org/denton/Pages/Services/Heart-and-Vascular.aspx

https://www.texashealth.org/denton/Pages/Services/Orthopedics.aspx

https://www.texashealth.org/denton/Pages/Services/Pediatrics.aspx

https://www.texashealth.org/denton/Pages/Services/Physical-Therapy.aspx

https://www.texashealth.org/denton/Pages/Services/Sleep-Medicine.aspx

https://www.texashealth.org/sports-medicine/Pages/default.aspx

https://www.texashealth.org/denton/Pages/Services/Stroke-Center.aspx

https://www.texashealth.org/denton/Pages/Services/Women-and-Infant-Services.aspx

https://www.texashealth.org/denton/Pages/Services/Wound-Care.aspx

7Community Health Needs Assessment Overview

Analyze Data & Gather

Community Input

Prioritize Health Needs to be Addressed

CHNA ReportImplementation

Strategy

Evaluate Actions Taken

• Mandated by the Affordable Care Act

• Allows Hospitals to Maintain 501c3 Status

The GoalTo improve the health of each hospital’s service area by using a data-based approach to address real community health needs and target resources where they are needed most.

CHNA 3-Year Cycle

8CHNA Process Overview & Executive Summary

Community Input Collection

• In depth interviews and focus groups were conducted with individuals with public health expertise who were able to speak to the broad interests of the community and/or the needs of low-income/underservedpopulations. An online community survey was also distributed to collect input on community health needs, assets, and barriers from community members.

Primary Data Analysis

• The primary data gathered in the community input collection phase was analyzed by the two categories of “Key Informant/Focus Group” findings and “Online Community Survey” findings. Significant health needs, barriers, and assets/resources were identified by leveraging qualitative data analysis software from Dedoose© and Survey Monkey©.

Secondary Data Analysis

• The Healthy North Texas platform, which includes data on over 100 health indicators from vetted national and state sources, was leveraged along with Prevention Quality Indicator data from The DFW Hospital Council. HCI’s data scoring methodology was used to compare indicator values at national, state, and county levels as well as trends over time and Healthy People 2020 targets.

Data Synthesis & Significant Health

Needs

• The qualitative (community input/primary data) and quantitative (secondary data) analysis findings were synthesized to identify significant community health needs. Health needs were considered “significant” if at least two of the following data types cited the topic as a pressing health concern: Key Informant/Focus Group Findings, Survey Findings, Secondary Data Findings.

Prioritization of Significant Health

Needs

• Key hospital staff and community stakeholders utilized the data analysis and synthesis findings to vote on which significant health needs will be prioritized for implementation strategy development consideration. Participants engaged in multiple rounds of voting and discussion and considered specific system-wide criteria for prioritizing significant health needs.

Texas Health Denton’s Priority Health Needs for 2016 CHNA

Mental Health, Mental Disorders, & Substance Abuse

Access to Health Services

Exercise, Nutrition & Weight

Diabetes

Service Area Demographics

10Service Area Demographics Summary

The demographics of a community significantly impact its health profile. Different race/ethnic, age, and socioeconomic groups may have unique needs and require varied approaches to health improvement efforts. This section explores the demographic profile of Texas Health Denton’s service area.

*All demographic estimates are sourced from the U.S. Census Bureau’s 2010-2014 American Community Survey unless otherwise indicated.

11Service Area Population Count

Total Population Count: 268,701

12Service Area Population by Age

6.3%

18.5%

14.5%

27.9%

23.0%

9.7%

7.4%

19.4%

10.3%

28.1%

24.0%

10.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

<5 5-17 18-24 25-44 45-64 65+

In Texas Health Denton’s service area, there are more people between the ages of 18-24 and fewer people above the age of 45 when compared to the state of Texas overall.

Texas Health Denton Texas

13Service Area Population by Race/Ethnicity

84.0%

7.0%

0.5%2.5%

0.1%2.5% 3.4%

18.8%

74.7%

11.9%

0.5%

4.1%

0.1%

6.4%

2.4%

38.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

White Black AmericanIndian orAlaskanNative

Asian NativeHawaiian or

PacificIslander

Other Two or MoreRaces

Hispanic

When compared to the state of Texas, Texas Health Denton’s service area has a larger White population, and smaller Black, Asian, and Hispanic populations.

Texas Health Denton Texas

14Service Area’s Social and Economic Characteristics

Overall, Texas Health Denton’s service area is doing better than Texas across social and economic metrics.

Texas Health Presbyterian Denton

Texas

United States

33.6%

27.1%29.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

People 25+ with a Bachelor'sDegree or Higher

8.3%7.7%

9.2%

0.0%

5.0%

10.0%

15.0%

20.0%

Unemployment Rate

$63,660

$52,576 $53,482

$0

$20,000

$40,000

$60,000

$80,000

$100,000

Median Household Income

14.0%

17.7%

15.6%

0.0%

5.0%

10.0%

15.0%

20.0%

People Living Below Poverty Level

15People Living Below Poverty Level by Race/Ethnicity

9.7%

26.4%

11.1%

38.6%

0.6%

14.1%

19.4%

21.8%

14.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

White, non-Hispanic

Black orAfrican

American

AmericanIndian or

Alaska Native

Asian NativeHawaiian or

Other PacificIslander

Other Two or moreraces

Hispanic orLatino

Black, Asian, Hispanic/Latino, and those who identify as other racial/ethnic subpopulations have a high percentage of people living below the poverty line. Overall, 14.0% of people in Texas Health Denton’s service area are living below the poverty level.

Texas Health Denton - - - Overall Value

16Service Area Population Living Below Poverty Line

Zip Codes with Highest Percentage of Population Living Below Poverty Level: 76201 & 76205

17Service Area Households with No Vehicle

Zip Codes with Highest Percentage of Households with No Vehicle: 76259 & 76201

18

Income

Poverty

Unemployment

Occupation

Education

Language

Index Value

QQQQQQQQQQQQ

HCI’s SocioNeeds Index

This index incorporates estimates for six different social and economic determinants ofhealth that are associated with poor health outcomes. The indicators were standardized andaveraged to create one composite index value for each zip code. Zip codes with highervalues are estimated to have higher socioeconomic need, which is correlated with poorerhealth. More information can be found by clicking on the SocioNeeds Index tab atwww.HealthyNTexas.org.


19Service Area SocioNeeds Index

Zip Codes with Highest Socioeconomic Need: 76240, 76201, 76209 & 76205

Data Analysis

21Data Analysis Overview

Significant Health Needs

Interviews & Focus Groups

Secondary Data

Online Community

Survey

In order to determine the significant health needs for Texas Health Denton’s service area population, multiple sources of data were analyzed:

• Secondary data, or numerical health indicators, from the Healthy North Texas web platform were analyzed and scored based on their values.

• Interviews and focus groups were conducted with community members who have a fundamental understanding of public health and represent the broad interests of the community.

• An English-language community surveywas distributed to people who live and work in the area. Hard copy surveys for 1-on-1 literacy assistance and Spanish translation were also utilized.

Each data source listed above has its own set of strengths and limitations, so the findings from all three data sets were compared and studied together. If a health need appeared in more than one of the data sources, then that health need was considered to be significant for the community.

Data Analysis Secondary Data

23Secondary Data Analysis Overview

This section describes how secondary data was collected and analyzed using the Healthy North Texas web platform, and HCI’s “Secondary Data Scoring” technique to rank and identify which health topics have the greatest room for improvement.

Secondary data refers to data that has been collected from vetted local, state, and national sources. Examining secondary data allows us to compare numerical values for specific health indicators.



Secondary Data

Online Community

Survey

24Secondary Data Analysis – Healthy North Texas Platform

Healthy North Texas (www.HealthyNTexas.org) is a publicly available data platform that was leveraged to conduct this assessment. The platform contains a dashboard of over 100 health and quality of life indicators from public state and national secondary data sources and is maintained by the Healthy Communities Institute.


25Secondary Data Analysis – County-Level Secondary Data Scoring

Comparisons

• Quantitatively score all possible comparisons

Indicators

• Summarize comparison scores for each indicator

Topics

• Summarize indicator scores by topic area

Data scoring is a tool developed by HCI to systematically score and rank health indicators and topics. Data scoring summarizes the many types of comparisons for each indicator, which are then summarized by broader health topics.

Each indicator score factors in how each county compares to other counties in Texas, other counties in the U.S., the Texas state value, the U.S. value, Healthy People 2020 targets, and the trend over the four most recent time periods of measure.

26County Level Analysis – Secondary Data Scoring

Texas Counties

US Counties

Texas State

US Value

HP 2020

Trend

Indicator Score

Topic Score

QQQQQQQQQQQQ

All indicators on the Healthy North Texas platform, along with PQI data provided by Texas Health, were analyzed and scored based on the comparisons to the right. Health indicators are grouped into topic areas for a higher level ranking of community health needs.

27County Level Analysis – Secondary Data Scoring

0 1 2 3

Score range:

Good Bad

Cancer Topic Score:1.50

Data Scoring Example: Calculating the topic score for Cancer

The overall topic score represents the average of all health indicators relevant to the topic of cancer.

28Multi-County Secondary Data Scoring Methods

Since Texas Health Denton’s service area spans both Denton and Cooke Counties, the data scoring results are weighed by the percent breakdown of each county’s population to arrive at one overall data score for the facility’s service area. The percentage breakdown by county for Texas Health Denton’s service area is highlighted in the table below:

County 1 County 2County 1

PopulationCounty 2

PopulationTotal

PopulationCounty 1 Weight

County 2 Weight

Denton Cooke 753,363 38,437 791,800 95.1% 4.9%

29Multi-County Secondary Data Scoring Methods

Cooke (Weight: 4.9%)Denton (Weight: 95.1%)

30Denton & Cooke County Level Analysis – Secondary Data Scoring

0 1 2 3

Score range:

Good Bad

The results below represent the combined data scoring for all health and quality of life topics

for which data was available on the Healthy North Texas platform for Denton & Cooke Counties:

Data Analysis Interviews & Focus Groups

32Interview & Focus Group Analysis Overview

This section describes how interviews and focus groups with people who live and work in the community were conducted and analyzed to determine significant health needs. The interviews and focus groups captured valuable community input and provide additional insight into the community’s significant health needs.

Persons with public health expertise, the ability to speak on the needs of low-income, underserved, or minority populations, and the ability to speak on



Secondary Data

Online Community

Survey

the broad interests of the community were asked to act as key informants for interviews and as focus group participants.

33Interview & Focus Group Analysis

Three interviews were conducted between 11/20/15-2/4/16, and two focus group discussions took place - one on 11/3/15 with 17 attendees and another on 1/5/16 with 20 attendees – for a total of 30 unique individuals representing 20 organizations. Interview and focus group discussion questions were organized around the following themes and questions shown below:

• Community Health Status: How would you rate the health status of the community?

• Health Needs/Issues: What are the major health needs/issues you see in the community?• Data gaps: Could you help us fill in data gaps by telling me a little about how [topic area] is

impacting the community?• Barriers: What are barriers to receiving care and for building a healthy community?• Impact by population: Who in your community appears to struggle most with these issues

you’ve identified and how does it impact their lives?

• Community Resources: Could you tell me about some of the strengths and resources in your community that address these issues, such as groups, initiatives, services, or programs?

• The Role of the Hospital: How can Texas Health better partner with you to improve the health of the communities we serve together?

• Vision of the Community: What is your vision for a healthy community?

34Interview & Focus Group Analysis

Source: Wordle.com

Notes from the interviews and the focus group discussion were transcribed and uploaded to the web-based qualitative data analysis tool, Dedoose©. The transcriptions were coded by relevant health topic areas and themes. The frequency with which a health topic was discussed was used to assess the relative importance of that health and/or social need and determine the most pressing health needs of the community. The word cloud below illustrates the most

prominent themes in the interviews and focus group discussions for Texas Health Denton. Themes mentioned more frequently are displayed in larger font.

35Interview & Focus Group Analysis - Results

Top Community Health Needs

1. Mental Health & Mental Disorders

2. Access to Health Services

3. Environment

4. Exercise, Nutrition, & Weight

5. Substance Abuse

6. Older Adults & Aging

7. Education & Prevention

Top Barriers to Community Health

1. Transportation

2. Healthcare Navigation & Literacy

3. Language & Cultural Barriers

Most Negatively Impacted Populations• Low-Income/Underserved

• Homeless

• Hispanic/Latino

• African-American

• Asian

The results below represent the most frequently cited community health needs, barriers to community health, and populations most negatively affected by poor health outcomes according to the community members who were interviewed and focus group participants.

Data Analysis Online Community Survey

37Online Community Survey Analysis Overview

An online survey was developed using Survey Monkey© in order to gain additional insight into community health needs. The link was distributed widely across Texas Health’s service area, and the results in this report are based on the cities and towns that comprise Texas Health Denton’s service area.



Secondary Data

Online Community Survey

This was a convenience sample survey which means results may be vulnerable to selection bias and make the findings less generalizable. Some surveys were distributed in person to assist with literacy and language barriers, however the online survey was conducted only in English, therefore the demographics of respondents may not mirror the actual demographics of the service area. A total of 173 people from Texas Health Denton’s service area responded to the survey between 12/1/15 – 2/12/16. The results of the online community survey are highlighted on the following slides.

38Online Community Survey Results – Respondent Demographics

• Gender: 21% Male, 79% Female

• 17% of respondents were Healthcare Professionals

• 69% have Bachelor’s Degree or higher

**Note: Convenience Sample Survey, demographics of respondents do not mirror the actual demographics of the service area

White, 82%

Race

White

Black or AfricanAmerican

American Indian orAlaska Native

Asian

Native Hawaiian andOther Pacific Islander

Two or more races

Other (please specify)

7%8%

16%

14%

17% 17% 17%

5%

0%2%4%6%8%

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

Annual Household Income

0%

5%

32%

36%

28%

0%

5%

10%

15%

20%

25%

30%

35%

40%

<18 18-24 25-44 45-64 65+

Age

39Online Community Survey Results – Community Health Needs

Results below pertain to what respondents feel are the greatest community health needs.

9%

12%

13%

14%

15%

17%

21%

31%

37%

39%

42%

47%

56%

0% 10% 20% 30% 40% 50% 60%

Reproductive Health (family planning)

Immunization & Infectious Diseases

Sexual Health (HIV, STD/I, etc.)

Injury, Violence & Safety

Respiratory/Lung Diseases (asthma, COPD, etc.)

Oral Health

Clinical Prevention Services

Cancer

Heart Disease & Stroke

Substance Abuse (alcohol, tobacco, e-cigs, drugs, etc.)

Diabetes

Mental Health & Mental Disorders

Obesity/Overweight

Community Health Needs

40Online Community Survey Results – Community Health Social Determinants

Social determinants are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The results below show which social determinants respondents feel have the most significant impact on the health of their community.

13%

14%

26%

29%

31%

35%

45%

50%

53%

53%

0% 10% 20% 30% 40% 50% 60%

Social Environment (faith, friendship, family, etc.)

Environmental Quality (exposure to secondhand smoke,etc.)

Language Barriers I Cultural Diversity

Transportation

Physical Activity and Exercise

Education

Employment (jobs, etc.)

Diet, Food and Nutrition


Economy (housing, etc.)

Social Determinants of Health

41Online Community Survey Results – Community Assets & Barriers to Health

Results below pertain to respondents’ views on community assets and barriers to health.

Agree

Agree

Agree

Agree

Agree

Neutral

Neutral

Neutral

Neutral

Neutral

Disagree

Disagree

Disagree

Disagree

Disagree

0% 20% 40% 60% 80% 100%

My community is knowledgeable of the health resourcesavailable to them.

Infrastructure in my community supports a healthy lifestyle.

I and members of my community feel we have a voice in ourcommunity.

Public transportation and other transit opportunities makeaccessing health services manageable.

I consider my community to be safe.

Community Assets

Agree

Agree

Agree

Agree

Neutral

Neutral

Neutral

Neutral

Disagree

Disagree

Disagree

Disagree

0% 20% 40% 60% 80% 100%

I, or someone I know, have had difficulty understanding a healthprofessional because of a language barrier in the last 12 months.

There is a lack of resources related to health improvement in thiscommunity.

I, or someone I know, have delayed seeking health care due towait times or limited appointment opportunity.

I, or someone I know, have delayed seeking health care due tocost in the last 12 months.

Community Barriers

42Online Community Survey Results – Community Health Disparities

Results to the right pertain to which racial/ethnic groups and specific populations respondents view as being most negatively impacted by poor health outcomes.

6%

9%

9%

11%

12%

17%

30%

30%

32%

56%

76%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Maternal, Fetal, and Infant

Refugees

Men

Lesbian, Gay, Bisexual, and Transgender

Teen and Adolescent

Women

Racial or Ethnic Populations

Children

Persons with Disabilities

Older Adults

Low income

Populations Highly Impacted by Poor Health Outcomes

1%

2%

5%

6%

32%

43%

0% 10% 20% 30% 40% 50%

Asian

American Indian or Alaska Native

Two or More Races

Other

Black or African American

HIspanic/Latino

Highly Impacted Race/Ethnic Groups

Data Synthesis Identifying Significant Community

Health Needs

44Data Synthesis Overview

As mentioned in the data analysis overview of this report, each data source listed to the right has its own set of strengths and limitations. In order to gain a comprehensive understanding of the significant health needs for Texas Health Denton’s service area, the findings from all three data sets were compared and studied together. This will be illustrated using a Venn diagram on the following slides.



Secondary Data

Online Community

Survey

45Data Synthesis Overview

Top Needs in Online Community Survey

Top Needs in Secondary Data

Top Needs in Interviews & Focus Group

Significant Health Needs Significant

Health Needs



The secondary data, interviews and focus group, and the online community survey were treated as three separate sources of data. The top five to seven health needs identified by each data source were analyzed for areas of overlap with the other two data sources. Health needs were determined to be significant if they were cited as a top need in at least two of the three data sources.

46Data Synthesis Results for Texas Health Denton

Secondary Data

Interviews and Focus Group

Online Community

Survey

Community Input

• Diabetes• Heart Disease &

Stroke

• Children’s Health• Other Chronic Diseases*

• Education• Environment• Exercise,

Nutrition, Weight (Obesity)

• Mental Health & Mental Disorders

*Topic Includes Indicators for:Kidney Disease, Osteoporosis, & Arthritis

• Access to Health Services

• Older Adults & Aging

• Substance Abuse

47Texas Health Denton Significant Community Health Needs Summary

Access to Health Services• Improved access to comprehensive, quality health care services is one of the HP2020 goals, and an important

concern in order to improve health equity and quality of life.

• Topic area includes indicators of or directly related to health care provider rate, health insurance status, usual source of health care, and difficulties obtaining health care

Exercise, Nutrition, & Weight• Nutritious diets, regular physical activity, and healthy weight maintenance are all important aspects of chronic

disease prevention. The HP2020 goal is to improve health and quality of life through these behaviors.• Topic area includes indicators of or directly related to physical activity, obesity/overweight, and nutrition

Mental Health & Mental Disorders• Mental disorders are among the most common forms of disability. The HP2020 goal is to improve mental

health through prevention and by ensuring access to appropriate, quality mental health services.• Topic area includes indicators of or directly related to access to mental health care, prevalence of mental

illness, and general mental health status

Older Adults & Aging• Older adults are among the fastest growing age group and are at high risk for developing chronic illness and

related disabilities. The HP2020 goal is to improve the health, function, and quality of life of older adults.• Topic area includes indicators of or directly related to health issues specific or especially pertinent to older

adults (usually age 65+)

Substance Abuse• Substance use and abuse impact individuals, families, and entire communities. HP2020’s goal is to reduce

substance abuse in order to protect the health, safety, and quality of life for all, especially children• Topic area includes indicators of or directly related to alcohol abuse, tobacco use, illegal substance use, and

abuse of prescription drugs

Significant Community Health Needs

49

Key Informant Interviews & Focus Group Discussions

Survey

Exploring Significant Health Needs - Overview Slide

Secondary Data

Major themes from key informant interviews and

focus groups

How the community health need ranked in

online community survey

Quote from Key Informant or Focus Group Participant

Topic Score:

Warning Indicators for health topic from secondary data

scoring and comparison values

Data analysis findings relevant to the significant health needs identified in the data synthesis will be outlined on the following slides using the format below:

50


Survey


Secondary Data

• Lack of resources to meet mental health needs Negative stigma attached to mental health issues

• Co-occurring mental health & substance abuse issues

most pressing health need in

Community Survey

17.2% and 16.4% of the Medicare pop. in Denton & Cooke had Depression

(US: 15.4%)

11.0% and 10.5% of the Medicare pop. in Denton & Cooke had Alzheimer’s Disease or Dementia

(US: 9.8%)

Veterans with PTSD do not want to drive to appointments

especially if they require driving on the interstate

highway (I-35); some veterans ride with a volunteer from Denton County Veterans Coalition to navigate the

transit system connections to get to VA.

Topic Score:

2nd

1.88

10.0 and 19.4 suicide deaths/100,000 populationin Denton and Cooke

(TX: 11.6)

51


Survey


Secondary Data

• Need for better coordination & awareness of services that accept Medicare

• Jails are a major healthcare provider

• Low-income pops. have difficulty accessing/navigating system

• Language & cultural barriers are prevalent


Community Survey(Clinical Prevention

Services)

90.9% of children in Denton had health insurance

(US: 94.0%)

Topic Score:

7th

1.50

63 & 26 primary care providers in Denton and Cooke per 100,000 persons

(TX: 59 providers/100,000 persons)

Low income, English as second language, those not as familiar

with insurance resources, or not knowing where to get care

or best manage their illnesses—those people often progress to a point where it’s hard to make a turn for the best, it’s too late to benefit

from medical care.

52


Survey

Exercise, Nutrition, & Weight

Secondary Data

• Food insecurity makes it difficult for all to access healthy foods

• Sedentary lifestyle & prevalence of unhealthy food options contributes to obesity in children and adults

• Need for more recreation & fitness opportunities in built environment


Community Survey

16.8% & 17.5% of residents in Denton & Cooke experienced food insecurity

(US: 15.8%)

56.7% of residents in Cooke & 95.9% in Denton had access to exercise opportunities

(TX: 84.3%)

Topic Score:

1st

1.44

It seems like saying “don’t smoke, don’t eat this, get

exercise” isn’t as helpful as showing them HOW to have

healthy habits. People may not know how easy it can be to change. There needs to be more visibility of farmers

markets to encourage healthy eating.

(Obesity/Overweight)

14.2% & 16.6% of low-income pre-school students in Denton & Cooke are obese

53


Survey

Older Adults & Aging

Secondary Data

• Fixed income makes it difficult for seniors to afford necessities

• Lack of transportation options hinders accessibility

7.7% and 8.4% of Medicare pop. in Denton and Cooke had Atrial Fibrillation

(TX: 7.0%)

8.1% and 7.5% of Medicare pop. in Denton and Cooke had Cancer

(TX: 7.1)

Topic Score:

2nd

1.67 Seniors especially, and low income persons in general, may be forced to choose

between paying rent or eating full meals. Seniors have to

choose between paying for rent, medical care,

prescriptions or eating.4.1% of Medicare pop. in both Denton & Cooke

suffered from Stroke(US: 3.8%)

most impacted population by poor health outcomes in Community Survey

54


Survey

Substance Abuse

Secondary Data

• Limited services for detox/rehabilitation/harm reduction

• High rates of methamphetamine use

• High rates of tobacco use• Co-occurrence with

mental health issues


Community Survey

7.5 & 15.6 deaths in Denton & Cooke due to drug

poisoning/100,000 persons(TX: 9.4)

33.0% & 40.5% of deaths in automobile accidents in Denton and Cooke were due to

alcohol-impaired driving (TX: 32.8%)

Topic Score:

4th

1.24

Alcoholism is a continuous struggle and meth use has grown significantly. Most

people who have an addiction have mental health issues that need to be addressed as well.

Significant Community Health Disparities & Barriers

56Investigating Health Disparities & Barriers

Secondary Data:Index of Disparity: Identifies large disparities based on how far each subgroup (by race/ethnicity) is from the overall county value

SocioNeeds Index: Identifies socioeconomic disparities by zip code

Primary Data: Key Informants and Focus Group Participants were asked which racial, ethnic, or special population groups were most negatively impacted with respect to community health concerns, and what barriers to health exist in their communities

An important goal of the CHNA process is identifying unmet health needs in underserved populations. Health disparities and barriers were identified using the 3-pronged approach described to the right.

57Texas Health Denton Significant Health Disparities

Comments from Key Informants:

Zip Codes w/ Greatest Socioeconomic Need:

• 76240• 76201• 76209• 76205

Disparity Findings in Secondary Data• Families & persons 65+ living below poverty

level in Black & Hispanic pops.• High school drop out rate in Black, Asian &

Hispanic pops.• Infants born to mothers with <12yrs.

Education in Hispanic pop.

Disparity Findings in Primary Data• Some programs not inclusive of all genders

or LGBT• Low income populations struggle most with

affordability and transportation• English as a Second Language populations

have more difficulty navigating health system

We have a large Hispanicpopulation, other Asian minority populations, homeless, LGBT, and

veteran populations – any program being planned must be

prepared to help all of those groups.

There are underemployed populations (i.e. refugees) who

are working for wages and at jobs “below their ability,” and not by choice. Large growth in Chinese

population in Lewisville and Burmese refugees fleeing persecution in Myanmar.

58Texas Health Denton Significant Community Health Barriers

We need a low cost transportation program. Viable transportation

services were eliminated. What we have now at $6/day is too

expensive for some. We need a trolley system from the train service to take us elsewhere.

There is a need for reliable access to post discharge appointments, barrier

identification and mitigation, interagency coordination and

funding. We also need a better way to help people know what resources

are available to them.

Many services in the community are religiously based, so some services

may not be offered to those who are LGBT or have other specific

characteristics. We need more services available to smaller minority

populations and which are not religiously based.

Top 3 Barriers Cited by Key Informants & Focus Group Participants

Transportation- Public transit & biking options are limited- Low Income & Seniors are especially affected

Healthcare Navigation- Need for more coordination of & education on resources- Difficulty navigating system

Language/Cultural Barriers- Need for cultural diversity with respect to religion - Language barriers for whom English is a second language

Agree

Agree

Agree

Agree

Neutral

Neutral

Neutral

Neutral

Disagree

Disagree

Disagree

Disagree

0% 20% 40% 60% 80% 100%

I, or someone I know, have had difficulty understanding a healthprofessional because of a language barrier in the last 12 months.

There is a lack of resources related to health improvement in thiscommunity.

I, or someone I know, have delayed seeking health care due towait times or limited appointment opportunity.

I, or someone I know, have delayed seeking health care due tocost in the last 12 months.

Community Barriers

59Texas Health Denton Significant Health Topics & Barriers - Summary

Significant Health Topics


Exercise, Nutrition, & Weight (Obesity)


Older Adults & Aging

Substance Abuse

Significant Health Barriers

Healthcare Navigation & Literacy

Language/Cultural Barriers

Transportation

Data synthesis revealed these significant health topics and barriers for Texas Health Denton’s service area. The health topics and barriers on the left represent the full list of significant community health needs that were considered for prioritization.

Prioritization of Significant Community Health Needs

61Prioritization Process & Criteria

To prioritize the significant health topics and barriers for Texas Health Denton’s service area, key hospital staff and the Community Health Council engaged in multiple rounds of voting and discussion on 6/7/16. The meeting was a combined effort between Texas Health Denton and Texas Health Flower Mound. For each round, prioritization participants were allowed a set number of votes. After each round of voting, participants discussed results and eliminated health topics with the lowest number of votes. Prior to the voting and discussion, prioritization participants were asked to consider how each significant health need applied to the following criteria:

• Alignment w/National, State, or Local Initiatives: Does the health issue align with larger public health improvement efforts?

• Magnitude: Does the issue affect a large percentage of your community’s population?

• Economic Burden on Community: Does the health issue cause financial strain on individuals or the community as a whole?

• Severity: Is there a high probability of complications (morbidity & mortality) associated with health issue?

• Opportunity to Intervene at Prevention Level: Can we address the health issue before it gets exacerbated?

62

Texas Health Denton’s Priority Health Topics for 2016 CHNA

Votes from Hospital Staff &

Community Health Council

Texas Health Prioritization

Criteria

Significant Health Topics &

Barriers

Texas Health Denton Priority Health Topics for 2016 CHNA

Mental Health, Mental Disorders, & Substance

Abuse


Exercise, Nutrition & Weight

Diabetes

These priority health topics will subsequently be considered for implementation planning.

63Appendices

The following information can be found in the Appendices:

I. Data Scoring Outputs

II. Secondary Data Sources

III. Resources Cited from Community Input

IV. Organizations Represented in Focus Groups & Key Informant Interviews

V. Prioritization Session Participants

VI. Evaluation of Actions Taken Since Preceding CHNA

VII. Service Area Zip Codes

VIII. CHNA Project Team & Hospital Leadership

IX. IRS Checklist

Appendices

65Appendix I. Denton County Data Scoring Appendix

* AIAN = American Indian/AK Native, NH = Native Hawaiian, PI = Pacific Islander, API = Asian or Pacific Islander, NHPI = Native Hawaiian/Pacific islander, Mult = Multiracial, Hisp = Hispanic/Latino

SCORE ACCESSTOHEALTHSERVICES UNITS

DENTON

COUNTY HP2020 TEXAS U.S.

MEASUREMENT

PERIOD HIGHRACEDISPARITY*

1.92 ChildrenwithHealthInsurance percent 90.9 100.0 89.0 94.0 2014

1.75 Non-PhysicianPrimaryCareProviderRate providers/100,000population 45 53 2014

1.47 AdultswithHealthInsurance percent 82.9 100.0 74.3 83.7 2014

1.25 DentistRate dentists/100,000population 51 52 2013

1.08 PrimaryCareProviderRate providers/100,000population 63 59 2012

SCORE CANCER UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*2.67 Cancer:MedicarePopulation percent 8.1 7.1 7.9 2012

2.17 BreastCancerIncidenceRate cases/100,000females 126.4 113.1 123.0 2008-2012

1.67 ProstateCancerIncidenceRate cases/100,000males 129.9 115.7 131.7 2008-2012

1.19Age-AdjustedDeathRateduetoProstateCancer deaths/100,000males 20.4 21.8 19.6 19.6 2008-2012

1.17 AllCancerIncidenceRate cases/100,000population 424.3 417.8 453.8 2008-2012

0.92

Age-AdjustedDeathRateduetoBreast

Cancer deaths/100,000females 19.5 20.7 21.0 21.3 2008-2012 Black(38.9)White(19.1)

0.75

OralCavityandPharynxCancerIncidence

Rate cases/100,000population 9.3 10.6 11.3 2008-2012

0.47 CervicalCancerIncidenceRate cases/100,000females 5.1 7.1 9.2 7.7 2008-2012

0.33

Age-AdjustedDeathRateduetoColorectal

Cancer deaths/100,000population 13.2 14.5 15.4 14.7 2008-2012

0.33 LungandBronchusCancerIncidenceRate cases/100,000population 53.7 58.1 63.7 2008-2012

0.28 Age-AdjustedDeathRateduetoCancer deaths/100,000population 148.2 161.4 164.6 166.4 2008-2012

0.28 ColorectalCancerIncidenceRate cases/100,000population 36.4 38.6 40.2 41.9 2008-2012

0.17 Age-AdjustedDeathRateduetoLungCancer deaths/100,000population 39.4 45.5 43.5 45.0 2008-2012

SCORE CHILDREN'SHEALTH UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*1.92 ChildrenwithHealthInsurance percent 90.9 100.0 89.0 94.0 2014

1.67 ChildrenwithLowAccesstoaGroceryStore percent 6.3 2010

1.61 Low-IncomePreschoolObesity percent 14.2 2009-2011

1.00 ChildFoodInsecurityRate percent 22.2 27.4 21.4 2013



SCORE DIABETES UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*1.49 DiabetesShort-TermComplication hospitalizations/100,000 43.3 62.5 2013

1.39 UncontrolledDiabetes hospitalizations/100,000 11.5 12.6 2013

1.28 RateofLower-ExtremityAmputation hospitalizations/100,000 13.3 22.0 2013

1.11 Diabetes:MedicarePopulation percent 24.9 28.6 27.0 2012

0.84 DiabetesLong-TermComplication hospitalizations/100,000 74.0 119.1 2013

0.42 Age-AdjustedDeathRateduetoDiabetes deaths/100,000population 18.0 22.0 21.2 2009-2013

SCORE ECONOMY UNITS

DENTON


MEASUREMENT


1.89 SNAPCertifiedStores stores/1,000population 0.3 2012

1.83

Low-IncomePersonswhoareSNAP

Participants percent 20.7 2007

1.67 FoodInsecurityRate percent 16.8 17.6 15.8 20131.61 Low-IncomePreschoolObesity percent 14.2 2009-2011

1.28 Homeownership percent 61.0 55.8 56.9 2009-2013

1.17

Low-IncomeandLowAccesstoaGrocery

Store percent 4.4 2010

1.08 SevereHousingProblems percent 13.3 18.3 2007-2011

1.08 StudentsEligiblefortheFreeLunchProgram percent 27.3 53.1 2013-2014

1.06

RentersSpending30%orMoreofHousehold

IncomeonRent percent 45.7 49.1 52.3 2009-20131.00 ChildFoodInsecurityRate percent 22.2 27.4 21.4 2013

0.94

HouseholdswithCashPublicAssistance

Income percent 1.4 1.8 2.8 2009-2013

0.83 ChildrenLivingBelowPovertyLevel percent 10.2 25.3 21.6 2009-2013

Black(17.7)White(4.3)Asian(7.3)

AIAN(1.1)NHPI(0)Mult(16.9)

Other(24.2)Hisp(19.7)

0.83 PeopleLiving200%AbovePovertyLevel percent 77.7 61.2 65.8 2009-2013

0.61 FamiliesLivingBelowPovertyLevel percent 5.6 13.7 11.3 2009-2013

Black(11.2)White(2.7)Asian(5.8)AIAN(4.9)NHPI(8.4)Mult(12.4)


0.61 PeopleLivingBelowPovertyLevel percent 8.7 17.6 15.4 2009-2013


AIAN(6.9)NHPI(1.6)Mult(14)

Other(17.6)Hisp(15.8)0.61 UnemployedWorkersinCivilianLaborForce percent 3.4 4.4 5.2 Aug-150.17 MedianHouseholdIncome dollars 74155 51900 53046 2009-2013

0.17 People65+LivingBelowPovertyLevel percent 5.0 11.3 9.4 2009-2013

Black(18.4)White(3.8)Asian(9.5)AIAN(12.7)NHPI(0)Mult(9.6)Other(24.3)Hisp(7.7)

0.17 PerCapitaIncome dollars 33855 26019 28155 2009-2013



SCORE EDUCATION UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*1.92 Student-to-TeacherRatio students/teacher 15.5 15.4 2013-2014

1.06 HighSchoolDropOutRate percent 3.4 6.6 2014


AIAN(6.3)PI(0)Mult(1.1)Hisp

(5.6)

0.64

InfantsBorntoMotherswith<12Years

Education percent 12.9 21.6 15.9 2013

Black(4.9)White(3.6)Other(8.7)

Hisp(37.4)

0.17 People25+withaBachelor'sDegreeorHigher percent 40.5 26.7 28.8 2009-2013

SCORE ENVIRONMENT UNITS

DENTON


MEASUREMENT


2.00 GroceryStoreDensity stores/1,000population 0.1 2012

1.89 SNAPCertifiedStores stores/1,000population 0.3 20121.75 AnnualOzoneAirQuality grade F 2011-2013


1.67 FastFoodRestaurantDensity restaurants/1,000population 0.7 2012

1.61 PBTReleased pounds 2824 2013

1.61 RecognizedCarcinogensReleasedintoAir pounds 7 2013

1.58 DrinkingWaterViolations percent 6.5 6.6 FY2013-14

1.58 FarmersMarketDensity markets/1,000population 0.01 0.03 2013

1.33 RecreationandFitnessFacilities facilities/1,000population 0.1 20121.25 FoodEnvironmentIndex 7.2 6.4 2015

1.17



1.17

People65+withLowAccesstoaGrocery



1.00

HouseholdswithNoCarandLowAccesstoa

GroceryStore percent 0.7 20100.94 LiquorStoreDensity stores/100,000population 6.2 7.0 10.4 2013

0.75 AccesstoExerciseOpportunities percent 95.9 84.3 2015

SCORE EXERCISE,NUTRITION,&WEIGHT UNITS

DENTON


MEASUREMENT




1.83Low-IncomePersonswhoareSNAPParticipants percent 20.7 2007





SCORE EXERCISE,NUTRITION,&WEIGHT(cont'd) UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*1.67 FoodInsecurityRate percent 16.8 17.6 15.8 2013



1.33 RecreationandFitnessFacilities facilities/1,000population 0.1 2012

1.25 FoodEnvironmentIndex 7.2 6.4 2015

1.17



1.17




1.00


GroceryStore percent 0.7 2010


SCORE HEARTDISEASE&STROKE UNITS

DENTON


MEASUREMENT


2.50 Hyperlipidemia:MedicarePopulation percent 48.1 45.4 44.8 2012

1.83 AtrialFibrillation:MedicarePopulation percent 7.7 7.0 7.8 2012

1.78 Hypertension hospitalizations/100,000 60.4 56.3 2013

1.72 Stroke:MedicarePopulation percent 4.1 4.2 3.8 2012

1.61 Hypertension:MedicarePopulation percent 55.7 57.8 55.5 20121.17 AnginaWithoutProcedure hospitalizations/100,000 4.8 9.0 2013

1.06 HeartFailure:MedicarePopulation percent 14.7 16.5 14.6 2012

0.84 HeartFailure hospitalizations/100,000 248.0 317.0 2013

0.64

Age-AdjustedDeathRatedueto

CerebrovascularDisease(Stroke) deaths/100,000population 35.0 34.8 42.6 37.9 2009-2013

0.50 IschemicHeartDisease:MedicarePopulation percent 27.7 30.9 28.6 2012

0.42

Age-AdjustedDeathRateduetoHeart

Disease deaths/100,000population 148.5 175.5 175.0 2009-2013

SCORE IMMUNIZATIONS&INFECTIOUSDISEASES UNITS

DENTON


MEASUREMENT


1.89

Age-AdjustedDeathRateduetoInfluenzaand

Pneumonia deaths/100,000population 22.6 14.6 15.5 2009-20131.83 SyphilisIncidenceRate cases/100,000population 2.4 5.9 20141.56 BacterialPneumonia hospitalizations/100,000 256.4 236.4 20131.39 TuberculosisIncidenceRate cases/100,000population 2.1 1.0 4.9 2010-20141.28 ChlamydiaIncidenceRate cases/100,000population 275.8 475.0 20141.28 GonorrheaIncidenceRate cases/100,000population 57.1 127.7 20141.22 HIVDiagnosisRate cases/100,000population 8.2 16.3 2014



SCORE MATERNAL,FETAL&INFANTHEALTH UNITS

DENTON


MEASUREMENT


1.58 MotherswhoReceivedEarlyPrenatalCare percent 66.2 77.9 59.2 74.2 2013

0.86 BabieswithLowBirthWeight percent 7.0 7.8 8.3 8.0 2013

0.83 BabieswithVeryLowBirthWeight percent 1.0 1.4 1.4 1.4 2013

0.64



Black(4.9)White(3.6)Other(8.7)

Hisp(37.4)

0.47 InfantMortalityRate deaths/1,000livebirths 3.6 6.0 5.8 6.0 20130.47 PretermBirths percent 9.5 11.4 12.0 11.4 2013

0.42 TeenBirths percent 1.7 3.2 4.8 2013 Black(1.2)White(0.8)Hisp(4)

SCORE MEN'SHEALTH UNITSDENTONCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHRACEDISPARITY*


1.19

Age-AdjustedDeathRateduetoProstate

Cancer deaths/100,000males 20.4 21.8 19.6 19.6 2008-2012

0.50 LifeExpectancyforMales years 78.4 75.8 76.1 2010

SCORE MENTALHEALTH&MENTALDISORDERS UNITS

DENTON


MEASUREMENT


2.67 Depression:MedicarePopulation percent 17.2 16.2 15.4 2012

1.89

Alzheimer'sDiseaseorDementia:Medicare

Population percent 11.0 11.5 9.8 2012

1.06 Age-AdjustedDeathRateduetoSuicide deaths/100,000population 10.0 10.2 11.6 12.3 2009-2013

SCORE OLDERADULTS&AGING UNITS

DENTON


MEASUREMENT


2.67 Cancer:MedicarePopulation percent 8.1 7.1 7.9 2012


2.61 Asthma:MedicarePopulation percent 5.6 5.0 4.9 2012

2.50 Hyperlipidemia:MedicarePopulation percent 48.1 45.4 44.8 20122.17 ChronicKidneyDisease:MedicarePopulation percent 16.2 16.6 15.5 20122.00 Osteoporosis:MedicarePopulation percent 6.9 7.0 6.4 2012


1.83RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 29.3 30.8 29.0 2012

1.72 Stroke:MedicarePopulation percent 4.1 4.2 3.8 20121.61 Hypertension:MedicarePopulation percent 55.7 57.8 55.5 2012



SCORE OLDERADULTS&AGING(cont'd) UNITS

DENTON


MEASUREMENT


1.17




1.06 COPD:MedicarePopulation percent 11.1 11.3 11.3 2012




Black(18.4)White(3.8)Asian(9.5)AIAN(12.7)NHPI(0)Mult(9.6)


SCORE OTHERCHRONICDISEASES UNITS

DENTON


MEASUREMENT


2.17 ChronicKidneyDisease:MedicarePopulation percent 16.2 16.6 15.5 2012

2.00 Osteoporosis:MedicarePopulation percent 6.9 7.0 6.4 2012

1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.0 11.5 9.8 2012

1.83

RheumatoidArthritisorOsteoarthritis:

MedicarePopulation percent 29.3 30.8 29.0 2012

SCORE OTHERCONDITIONS UNITS

DENTON


MEASUREMENT


1.44 PerforatedAppendix per100discharges 31.1 33.0 2013

1.39 Dehydration hospitalizations/100,000 126.2 128.8 2013

1.34 UrinaryTractInfection hospitalizations/100,000 191.1 180.8 2013

SCORE PREVENTION&SAFETY UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*1.39 DeathsduetoMotorVehicleCollisions deaths 40 2013


1.03 PedestrianDeathRate deaths/100,000population 0.3 1.4 1.8 1.5 2013

0.92 DeathRateduetoDrugPoisoning deaths/100,000population 7.5 9.4 2006-2012

0.47


UnintentionalInjuries deaths/100,000population 25.7 36.4 38.1 38.6 2009-2013

SCORE PUBLICSAFETY UNITSDENTONCOUNTY HP2020 TEXAS U.S.


1.75 Alcohol-ImpairedDrivingDeaths percent 33.0 32.8 2009-2013

1.39 DeathsduetoMotorVehicleCollisions deaths 40 2013




SCORE RESPIRATORYDISEASES UNITS

DENTON


MEASUREMENT

PERIOD HIGHRACEDISPARITY*2.61 Asthma:MedicarePopulation percent 5.6 5.0 4.9 2012

1.89


Pneumonia deaths/100,000population 22.6 14.6 15.5 2009-2013

1.61 AsthmainYoungerAdults(Ages18-39) hospitalizations/100,000 25.5 27.1 2013

1.56 BacterialPneumonia hospitalizations/100,000 256.4 236.4 2013

1.51 COPDinOlderAdults(Ages40+) hospitalizations/100,000 471.4 406.5 2013

1.39 TuberculosisIncidenceRate cases/100,000population 2.1 1.0 4.9 2010-2014




SCORE SOCIALENVIRONMENT UNITS

DENTON


MEASUREMENT


1.39 LinguisticIsolation percent 4.6 8.0 4.6 2009-2013

1.14 VoterTurnout percent 62.1 58.6 61.8 2012


Black(17.7)White(4.3)Asian(7.3)AIAN(1.1)NHPI(0)Mult(16.9)


0.83 Single-ParentHouseholds percent 22.8 33.2 33.3 2009-2013

SCORE SUBSTANCEABUSE UNITS

DENTON


MEASUREMENT



0.94 LiquorStoreDensity stores/100,000population 6.2 7.0 10.4 2013


SCORE TRANSPORTATION UNITSDENTONCOUNTY HP2020 TEXAS U.S.


2.25 SoloDriverswithaLongCommute percent 44.5 35.1 2009-20132.06 MeanTravelTimetoWork minutes 27.4 25.0 25.5 2009-20131.72 WorkerswhoDriveAlonetoWork percent 81.0 79.9 76.3 2009-20131.56 WorkersCommutingbyPublicTransportation percent 0.9 5.5 1.6 5.0 2009-2013

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.7 2010



SCORE WOMEN'SHEALTH UNITS

DENTON


MEASUREMENT



0.92


Cancer deaths/100,000females 19.5 20.7 21.0 21.3 2008-2012 Black(38.9)White(19.1)0.72 LifeExpectancyforFemales years 81.9 80.4 80.8 2010

0.47 CervicalCancerIncidenceRate cases/100,000females 5.1 7.1 9.2 7.7 2008-2012

73Appendix I. Cooke County Data Scoring Appendix


SCORE ACCESSTOHEALTHSERVICES UNITS

COOKE


MEASUREMENT


2.08 PrimaryCareProviderRate providers/100,000population 26 59 2012

1.42 DentistRate dentists/100,000population 44 52 2013

1.08 Non-PhysicianPrimaryCareProviderRate providers/100,000population 57 53 2014

SCORE CANCER UNITS

COOKE


MEASUREMENT



2.33 ColorectalCancerIncidenceRate cases/100,000population 47.0 38.6 40.2 41.9 2008-2012

2.22






1.17 AllCancerIncidenceRate cases/100,000population 428.1 417.8 453.8 2008-2012

0.75OralCavityandPharynxCancerIncidenceRate cases/100,000population 9.3 10.6 11.3 2008-2012


0.69


Cancer deaths/100,000females 19.3 20.7 21.0 21.3 2008-2012

0.58




SCORE CHILDREN'SHEALTH UNITS

COOKE


MEASUREMENT





SCORE DIABETES UNITS

COOKE


MEASUREMENT



1.11 RateofLower-ExtremityAmputation hospitalizations/100,000 8.9 22.0 2013

1.06 DiabetesShort-TermComplication hospitalizations/100,000 22.0 62.5 2013

1.06 UncontrolledDiabetes hospitalizations/100,000 6.5 12.6 2013

0.68 DiabetesLong-TermComplication hospitalizations/100,000 31.3 119.1 2013




SCORE ECONOMY UNITS

COOKE


MEASUREMENT


2.00 FoodInsecurityRate percent 17.5 17.6 15.8 2013


1.92 SevereHousingProblems percent 17.4 18.3 2007-20111.89 SNAPCertifiedStores stores/1,000population 0.5 2012


1.67



1.56 PerCapitaIncome dollars 25186 26019 28155 2009-2013

1.53 StudentsEligiblefortheFreeLunchProgram percent 49.0 53.1 2013-2014

1.39 MedianHouseholdIncome dollars 50067 51900 53046 2009-2013

1.28 Homeownership percent 60.6 55.8 56.9 2009-2013

1.22 FamiliesLivingBelowPovertyLevel percent 11.8 13.7 11.3 2009-2013


AIAN(15.7)NHPI(0)Mult(29.5)


1.22 PeopleLiving200%AbovePovertyLevel percent 63.6 61.2 65.8 2009-20131.11 ChildrenLivingBelowPovertyLevel percent 21.6 25.3 21.6 2009-2013

1.11 PeopleLivingBelowPovertyLevel percent 14.8 17.6 15.4 2009-2013

1.00



0.78 UnemployedWorkersinCivilianLaborForce percent 3.6 4.4 5.2 Aug-15

0.67

HouseholdswithCashPublicAssistance

Income percent 0.9 1.8 2.8 2009-2013


Black(23.1)White(6.8)Asian(0)AIAN(16.7)Mult(0)Other(57.1)

Hisp(4.4)

0.50

RentersSpending30%orMoreofHousehold

IncomeonRent percent 43.2 49.1 52.3 2009-2013

SCORE EDUCATION UNITS

COOKE


MEASUREMENT


1.97



1.94 People25+withaBachelor'sDegreeorHigher percent 19.5 26.7 28.8 2009-2013

1.42 Student-to-TeacherRatio students/teacher 14.2 15.4 2013-2014

1.00 HighSchoolDropOutRate percent 1.6 6.6 2014

Black(8.3)White(1.9)Asian(0)

AIAN(0)Mult(0)Hisp(0)



SCORE ENVIRONMENT UNITS

COOKE


MEASUREMENT




1.92 SevereHousingProblems percent 17.4 18.3 2007-20111.89 SNAPCertifiedStores stores/1,000population 0.5 2012



1.61 RecognizedCarcinogensReleasedintoAir pounds 30779 2013

1.33





1.08 DrinkingWaterViolations percent 0.8 6.6 FY2013-14


1.00



1.00





COOKE


MEASUREMENT



2.00 FoodInsecurityRate percent 17.5 17.6 15.8 20131.94 Low-IncomePreschoolObesity percent 16.6 2009-2011





1.67



1.33






1.00






COOKE


MEASUREMENT


1.00




SCORE HEARTDISEASE&STROKE UNITS

COOKE


MEASUREMENT



2.53





1.97



1.94 AnginaWithoutProcedure hospitalizations/100,000 12.3 9.0 2013

1.72 Hypertension:MedicarePopulation percent 57.9 57.8 55.5 2012

1.72 Stroke:MedicarePopulation percent 4.1 4.2 3.8 2012


1.17 Hypertension hospitalizations/100,000 31.5 56.3 2013

0.68 HeartFailure hospitalizations/100,000 158.5 317.0 2013

SCORE IMMUNIZATIONS&INFECTIOUSDISEASES UNITS

COOKE


MEASUREMENT


2.33



1.67 ChlamydiaIncidenceRate cases/100,000population 332.8 475.0 2014

1.33 GonorrheaIncidenceRate cases/100,000population 87.7 127.7 2014

1.33 SyphilisIncidenceRate cases/100,000population 0.0 5.9 2014

1.17 HIVDiagnosisRate cases/100,000population 2.6 16.3 20141.06 BacterialPneumonia hospitalizations/100,000 147.1 236.4 2013



COOKE


MEASUREMENT


2.36 InfantMortalityRate deaths/1,000livebirths 7.6 6.0 5.8 6.0 2013

2.17 BabieswithVeryLowBirthWeight percent 2.1 1.4 1.5 1.5 2009

1.97



1.97 MotherswhoReceivedEarlyPrenatalCare percent 56.5 77.9 59.2 74.2 2013




COOKE


MEASUREMENT


1.86 TeenBirths percent 4.7 3.2 4.8 2013

1.14 PretermBirths percent 10.8 11.4 12.0 11.4 2013

0.58 BabieswithLowBirthWeight percent 6.6 7.8 8.3 8.0 2013

SCORE MEN'SHEALTH UNITS

COOKE


MEASUREMENT


1.94 LifeExpectancyforMales years 74.4 75.8 76.1 2010


0.58



SCORE MENTALHEALTH&MENTALDISORDERS UNITS

COOKE


MEASUREMENT




1.56



SCORE MORTALITYDATA UNITS

COOKE


MEASUREMENT


2.53





2.36 InfantMortalityRate deaths/1,000livebirths 7.6 6.0 5.8 6.0 2013

2.33




2.22



2.14




1.97








SCORE MORTALITYDATA UNITS

COOKE


MEASUREMENT


0.69




0.58



SCORE OLDERADULTS&AGING UNITS

COOKE


MEASUREMENT








1.72 Hypertension:MedicarePopulation percent 57.9 57.8 55.5 20121.72 Stroke:MedicarePopulation percent 4.1 4.2 3.8 2012



1.61





1.00People65+withLowAccesstoaGroceryStore percent 1.4 2010

0.94 Asthma:MedicarePopulation percent 3.9 5.0 4.9 2012


Black(23.1)White(6.8)Asian(0)

AIAN(16.7)Mult(0)Other(57.1)

Hisp(4.4)

SCORE OTHERCHRONICDISEASES UNITS

COOKE


MEASUREMENT



1.61



1.56






SCORE OTHERCONDITIONS UNITS

COOKE


MEASUREMENT


1.28 PerforatedAppendix per100discharges 28.8 33.0 2013

1.06 Dehydration hospitalizations/100,000 66.5 128.8 2013

0.84 UrinaryTractInfection hospitalizations/100,000 70.8 180.8 2013

SCORE PREVENTION&SAFETY UNITS

COOKE


MEASUREMENT


2.14





1.39 DeathsduetoMotorVehicleCollisions deaths 3 20130.81 PedestrianDeathRate deaths/100,000population 0.0 1.4 1.8 1.5 2013

SCORE PUBLICSAFETY UNITS

COOKE


MEASUREMENT





SCORE RESPIRATORYDISEASES UNITSCOOKECOUNTY HP2020 TEXAS U.S.



2.33





1.06 AsthmainYoungerAdults(Ages18-39) hospitalizations/100,000 0.0 27.1 2013

1.06 BacterialPneumonia hospitalizations/100,000 147.1 236.4 20130.94 Asthma:MedicarePopulation percent 3.9 5.0 4.9 2012


0.84 COPDinOlderAdults(Ages40+) hospitalizations/100,000 305.4 406.5 2013

SCORE SOCIALENVIRONMENT UNITS

COOKE


MEASUREMENT


1.17 Single-ParentHouseholds percent 29.5 33.2 33.3 2009-2013


1.08 VoterTurnout percent 61.1 58.6 61.8 2012

1.06 LinguisticIsolation percent 3.3 8.0 4.6 2009-2013



SCORE SUBSTANCEABUSE UNITS

COOKE


MEASUREMENT

PERIOD HIGHRACEDISPARITY*2.25 Alcohol-ImpairedDrivingDeaths percent 40.5 32.8 2009-2013



SCORE TRANSPORTATION UNITS

COOKE


MEASUREMENT


2.44 WorkersCommutingbyPublicTransportation percent 0.2 5.5 1.6 5.0 2009-2013

Black(0)White(0.2)Asian(0)AIAN

(0)NHPI(0)Mult(0)Other(0)Hisp

(0.5)

1.33



1.28 WorkerswhoDriveAlonetoWork percent 76.5 79.9 76.3 2009-2013

1.25 SoloDriverswithaLongCommute percent 28.5 35.1 2009-2013

1.17 MeanTravelTimetoWork minutes 24.3 25.0 25.5 2009-2013

SCORE WOMEN'SHEALTH UNITS

COOKE


MEASUREMENT


1.78 LifeExpectancyforFemales years 79.8 80.4 80.8 2010

0.69




81Appendix II: Sources for Secondary Data

• American Community Survey • American Lung Association • Behavioral Risk Factor Surveillance System • Centers for Medicare & Medicaid Services • County Health Rankings • Fatality Analysis Reporting System • Feeding America • Institute for Health Metrics and Evaluation • National Cancer Institute • National Center for Education Statistics • PQI Data from Dallas-Fort Worth Hospital Council• Texas Department of State Health Services • Texas Education Agency • Texas Secretary of State • U.S. Bureau of Labor Statistics • U.S. Census - County Business Patterns • U.S. Department of Agriculture - Food Environment Atlas • U.S. Environmental Protection Agency

82Appendix III: Resources – Community Input

Resources that were mentioned by key informants or focus group participants:

Texas Health Resource’s Community Connect database is an online tool to connect our patients and community members to free and reduced-cost services:https://texashealth.org/communityconnect

• Texas Christian University partnership with the homeless community

• Texas Health Denton• Texas Health Denton Caring Clinic• Texas Health Resources• Texas Women’s University• University of North Texas• United Way• U Prevent of Tarrant County

• Age Well Live Well Denton• Denton Chamber of Commerce • Denton Community Food Center• Denton County Healthy Communities

Coalition• Denton County Public Health Department• Denton County Transit Authority• Denton County Veterans Coalition• Denton Independent School District• Denton Regional Medical Center• Health Services of North Texas• Interfaith Ministries• Meals on Wheels• Medicare and Medicaid• Medical Reserve Corps• Our Daily Bread• Senior Paws• Serve Denton• Singing Oaks Church of Christ• Tarrant County Academy of Nutrition and

Dietetics• Tarrant County Food Bank

https://texashealthcommunityconnect.org/v1

83Appendix IV: Community Input Participants

Organizations represented in focus groups and key informant interviews:

• City of Denton• Denton County Public Health • Denton County Transit Authority• Denton Independent School District• Denton Public Library• Denton Senior Center• First Refuge Ministries• Health Services of North Texas• Interfaith Ministries of Denton• Our Daily Bread• Meals on Wheels of Denton County• North Central Texas Council of Governments• Seniors in Motion• Special Programs for Aging Needs Transport (SPAN) - Denton• Texas Health Denton Staff• Texas Hunger Initiative• United Way of Denton County• University of North Texas, Student Health & Wellness Center• Women, Infants, & Children (WIC) of Denton County

84Appendix V: Prioritization Session Participants

The following individuals participated in the prioritization session:

• Pamela Barnes, Health Services of North Texas• Laura Behrens, Denton Fire Department• Max Calder, SPAN, Inc.• Cindy Carter, Texas Health Denton• Crystal Collins, Denton County Transportation Authority• Jennifer Deel, Texas Health Flower Mound• Darrell Druery, Lucent Home Health• Alyson Duplantis, Intern, United Way of Denton County• Robin Fox, City of Denton/Denton Black Chamber of Commerce• Jeff Gilbert, Denton Senior Center• Ashley Gould, Denton County Health Department• Haley Hackler, Intern, United Way of Denton County• Kerol Harrod, City of Denton North Branch Library• Kamilah Hasan, Denton County Public Health• Lisa Henry, University of North Texas• Brenda Jackson, Our Daily Bread• Ginger Johnson, Child Advocacy Center of Cooke County/Abigail’s Arms• Teri Johnson, Health Services of North Texas• Bupe Kapansa, Intern, United Way of Denton County• Kristen Keeth, SPAN, Inc./Meals on Wheels of Denton County• Dana Kennedy, Texas Health Denton• Meghan Maloney, Intern, United Way of Denton County• Chris Martin, Denton County Veterans Coalition• Ernestina Lopez, Intern, United Way of Denton County• Michelle Obuong, Intern, United Way of Denton County• Marty Otero, Texas Hunger Initiative/Denton Hunger Coalition• Pam Petrides, Texas Health Flower Mound

• Brett Pollard, Texas Health Flower Mound• Matt Richardson, Denton County Public Health• Deborah Robertson, SPAN, Inc./Meals on Wheels of Denton County• Norma Y. Rodriguez, Texas Health Denton• Doreen Rue, Health Services of North Texas• Danielle Shaw, City of Denton/Denton Homeless Coalition• Justin Silk, United Way of Cooke County• Kathy Srokosz, Texas Health Denton• Kayla Stewart, United Way of Denton County• Beth Tellez, Mental Health Mental Rehabilitation (MHMR)• Shelley Tobey, Texas Health Flower Mound• Laura Valentino, Texas Women’s University• Joseph Walker, University of North Texas• Debra Warrington, Texas Health Flower Mound

85Appendix VI: Evaluation of Actions Taken Since Preceding CHNA

86Appendix VII: Service Area Zip Codes

• 76201 • 76205 • 76207 • 76209 • 76210 • 76266 • 76208 • 76226 • 76227 • 76240 • 76247 • 76249 • 76258 • 76259• 76272

For the purposes of this CHNA, the service area for Texas Health Denton consists of Cooke and Denton Counties, and is inclusive of the following zip codes:

87Appendix VIII: CHNA Project Team & Hospital Leadership

Laurie Long, PhD, Community Health Program Manager, Texas Health DentonMina Kini, MS, MSW, Director of Multicultural & Community Health Improvement, Texas Health ResourcesCatherine McMains, MPH, CPH, Community Benefit & Impact Specialist, Texas Health ResourcesMarjeta Daja, MBA, MHA, Multicultural Health Specialist, Texas Health ResourcesJeff Reecer, FACHE, President, Texas Health DentonTimothy Harris, MD, Chief Medical Officer, Texas Health DentonMelissa Winans, MBA-HCM, MSN, RN, NEA-BC, Chief Nursing Officer, Texas Health Denton

88Appendix IX: IRS Checklist

The following checklist outlines the components necessary for a successful Community Health Needs Assessment as required by the IRS*:

*These are summarized guidelines and should not be substituted for legal advice. For full information on IRS requirements please consult your attorney and visit: IRS Community Health Needs Assessment Rule 12/31/14

A definition of the community served by the hospital facility and a description of how the

community was determined

A description of the process and methods used to conduct the CHNA

A description of how the hospital facility solicited and took into account input received

from persons who represent the broad interests of the community it serves

A prioritized description of the significant health needs of the community identified

through the CHNA, along with a description of the process and criteria used in identifying

certain health needs as significant and prioritizing those significant health needs

A description of the resources potentially available to address the significant health

needs identified through the CHNA

An evaluation of the impact of any actions that were taken since the hospital facility

finished conducting its immediately preceding CHNA to address the significant health

needs identified in the hospital facility’s prior CHNAs

https://www.federalregister.gov/articles/2013/04/05/2013-07959/community-health-needs-assessments-for-charitable-hospitals

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