Tahoe Forest Health System Results of 2014 Household Survey & other Community Health Needs...

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Tahoe Forest Health SystemResults of 2014 Household Survey

& otherCommunity Health Needs Assessment

DataPresented to:

Community Collaborative

Caroline Ford, M.P.H., Ex.Director-Wellness NeighborhoodFebruary 3, 2015

2014 TFHS Community Health Needs Assessment


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Overview of Household Survey

• 402 surveys completed between July 10 and August 4, 2014;

• 68% completed by phone, 32% on-line;

• Final data have been are weighted to adjust for the age, gender, and racial and ethic distribution of the sample versus Census Bureau estimates of population characteristics.

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Overview of Household Survey

• Maximum statistical margin of error for the sample-wide results (N=402) is approximately +/- 4.9% at the 95 percent confidence interval;

• Numerous questions benchmarked against data from the 2011 TFHS household survey (N=457);

• Total percentages for many questions do not equal 100.0% due to rounding and respondents who indicated that they were “not sure” or “prefer to not to answer”.


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Truckee BasinIncline VillageKings BeachTahoe City

2014 Household Survey Responses by Area


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Household SurveyPositive Findings


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Excellent Very Good Good Fair Poor0.0%

10.0%

20.0%

30.0%

40.0%

20.2%

30.5% 30.4%

14.4%

4.6%

34.2%

38.2%

18.2%

6.3%

2.0%

California (2013) TFHS (2014)

Would you say that in general your health is _____ ? (Q8)


Excellent Very Good Good Fair Poor0.0%

10.0%

20.0%

30.0%

40.0%

31.8%33.3%

21.8%

10.7%

2.4%

34.2%

38.2%

18.2%

6.3%

2.0%

2011 2014

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Would you say that in general your health is _____ ? (Q8)


8

Percent reporting 15 to 30 days0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

8.5%

10.9% 10.7%

TFHS (2014) CA (2013) US (2013)

How many days during the past 30 days was your mental health not good? (Q10)


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

17.3%

82.7%

12.9%

86.9%

2011 2014

Percent reporting "Yes"0.0%

5.0%

10.0%

15.0%

20.0%

12.9%

15.6% 15.3%

TFHS (2014) CA (2013) US (2013)

Was there a time in the past 12 months when you needed to see a doctor but could not because of cost? (Q63)


10

Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

23.7%

75.6%

10.7%

89.4%

Hispanic/Latino (N=73) Non Hispanic/Latino (N=328)

Was there a time in the past 12 months when you need to see a doctor but could not because of cost? (Q63)


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2011 & 2014 ComparisonsHousehold SurveyPositive Findings


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None 1 to 7 days 8 to 14 days 15 to 30 days0.0%

20.0%

40.0%

60.0%

80.0%

60.4%

27.8%

2.5%

9.3%

69.5%

19.8%

3.2% 5.7%

2011 2014

How many days during the past 30 days was your physical health not good? (Q9)


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Never 1 to 3 times 4 to 7 times 8 times or more0.0%

20.0%

40.0%

60.0%

80.0%

1.8%5.1%

73.4%

9.6%5.0%

13.2%

62.1%

18.8%

2011 2014

How many times per week do you prepare and eat a family meal in your household? (Q12)


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%90.9%

9.1%

93.7%

6.3%

2011 2014

A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? (Q17)

Females age 40 and Over


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No Yes0.0%

20.0%

40.0%

60.0%

80.0%

39.1%

60.9%

33.6%

66.4%

2011 2014


All females 18 yrs and older


20.0%

40.0%

60.0%

80.0%

66.4% 68.4%

TFHS (2014) US (2013)


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1 to 2 days 3 to 4 days 5 to 7 days0.0%

20.0%

40.0%

60.0%

80.0%

6.3%

28.3%

65.4%

4.3%

23.7%

72.1%

2011 2014

How many days per week do you do these moderate activities? (Q41)

Respondents who do these moderate activities for at least ten minutes at a time


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

77.4%

22.6%

85.7%

14.3%

2011 2014

Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or governmental plans such as Medicare? (Q72)


20.0%

40.0%

60.0%

80.0%

100.0%

85.7% 82.8% 82.3%

TFHS (2014) CA (2013) US (2013)


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Health Status


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Percent reporting 15 to 30 days0.0%

10.0%

20.0%

30.0%

40.0%

3.8%7.0%

35.1%

8.1%11.0%

Employed Self-Employed Unemployed Homemaker Retired

N=388

How many days during the past 30 days was your physical health not good? (Q9)


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Preventive Health Services


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20.0%

40.0%

60.0%

80.0%

100.0%

66.4%

48.5%55.8%

76.6%

Entire Sample High School or Less College 1 to 3 Years College 4+ Years

N = 213 (33) (61) (119)



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Yes No0.0%

20.0%

40.0%

60.0%

80.0% 74.2%

25.8%

70.3%

28.2%

2011 2014

Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health

problems. Have you had either of these exams? (Q19)


20.0%

40.0%

60.0%

80.0%70.3% 69.0%

TFHS (2014) US (2013)


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

57.0%

43.0%

72.0%

26.7%


Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health

problems. Have you had either of these exams? (Q19)


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Alcohol Consumption


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

76.7%

23.3%

81.1%

18.6%

2011 2014

During the past 30 days, have you had at least one drink of any alcoholic beverage, such as beer, wine, a malt beverage, or liquor (Q26)


20.0%

40.0%

60.0%

80.0%

100.0%

81.1%

55.5% 54.5%

TFHS (2014) CA (2013) US (2013)

*2014 vs. 2011 (p=0.096) *TFHS vs. CA(2013): P<.0001 TFHS vs. US(2013): P<.0001


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During the past 30 days, have you had at least one drink of any alcoholic beverage, such as beer, wine, a malt beverage, or liquor (Q26)

Entire Sample Kings Beach IV/CB Tahoe city Truckee Basin0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

81.1%

69.0%

89.4% 89.8%

78.8%

N=402 (66) (91) (56) (190)Community Percent reporting "Yes" 95% C. L

Kings Beach 69.0 54.2 88.4

IV/CB 89.4 82.6 96.2

Tahoe city 89.8 83.2 98.1

Truckee Basin 78.8 72.6 86.0


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20.0%

40.0%

60.0%

80.0%

100.0%

81.1%71.2%

63.2%

92.0%

Entire Sample High School or Less College 1 to 3 Years College 4+ Years

N=402 (60) (106) (215)

During the past 30 days, have you had at least one drink of any alcoholic beverage, such as beer, wine, a malt

beverage, or liquor (Q26)


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

67.2%

32.8%

84.2%

15.4%


During the past 30 days, have you had at least one drink of any alcoholic beverage, such as beer, wine, a malt

beverage, or liquor (Q26)


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None Once Twice 3 or more times0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%70.3%

16.2%

6.7% 6.7%

68.0%

12.0%7.3%

10.9%

2011 2014

Considering all types of alcoholic beverages, how many times during the past 30 days did you have five/four (males/females) drinks? (Q29)

Respondents who drank an alcoholic beverage in the past 30 days


Yes No0.0%

20.0%

40.0%

60.0%

80.0%

33.2%

66.8%

33.7%

65.9%

2011 2014


10.0%

20.0%

30.0%

40.0%

50.0%

33.7% 35.6%

42.3%

TFHS (2014) CA (2013) US (2013)

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Have you smoked at least 100 cigarettes in your lifetime (Q30)


Not at all Some days Every day0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

81.0%

7.9% 11.1%

77.1%

15.4%7.5%

2011 2014

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Do you now smoke cigarettes every day, some days, or not at all? (Q31)

Respondents who have smoked at least 100 cigarettes in their life


Percent reporting "Some days" or "Every day"0.0%

10.0%

20.0%

30.0%

22.9%

12.5%

19.0%

TFHS (2014) CA (2013) US (2013)32

Do you now smoke cigarettes every day, some days, or not at all? (Q31)

Respondents who have smoked at least 100 cigarettes in their life


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Children’s Health Care Utilization and Access


N=402

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How many children less than 18 years of age live in your household? (Q43)

69%

11%

14%6%

None 1 child2 children 3 or more children


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

15.8%

84.2%

23.0%

75.0%

2011 2014

Do you have children in your household who have not all had all of their vaccinations and immunizations? (Q44)

Respondents with children living in the household


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10.0%

20.0%

30.0%

40.0%

50.0%

23.0%

11.0% 12.2%

43.8%

13.4%

Entire Sample Truckee Basin IV/CB Kings Beach Tahoe City

N=127 (63) (25) (31) (9)

Do you have children in your household who have not all had all of their vaccinations and immunizations? (Q44)



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Cost

Religious b

elief

Concern

for s

afety

Lack

of insu

rance

No access

to docto

rs

Other r

eason

0.0%

20.0%

40.0%

60.0%

80.0%

10.2%4.9%

12.2%3.1% 0.0%

69.6%

15.4%

0.0%

38.0%

0.0%7.6%

50.4%

2011 2014 (N=29)

For those children in your household who have not had all of their vaccinations and immunizations, would you explain why not? (Q45)

Respondents with children living in the household who have not had vaccinations and immunizations


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In the past 12 months, have you wanted but not sought help for dental care for your child(ren) because _____? (Q48)


20%

81%

Yes No

A. You could not afford it?


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In the past 12 months, have you wanted but not sought help for dental care for your child(ren) because _____? (Q48)


24%

76%

Yes No

B. You did not have insurance?


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Health Care Utilization and Access


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Yes, one person Yes, more than one person

No0.0%

20.0%

40.0%

60.0%54.3%

13.2%

32.4%

50.9%

14.8%

33.9%

2011 2014

Percent reporting "No"0.0%

10.0%

20.0%

30.0%

40.0%

33.9%

28.8%

22.9%

TFHS (2014) CA (2013) US (2013)

Do you have one person you think of as your personal doctor or health care provider? (Q53)


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

47.5%52.5%

69.7%

29.8%


Do you have one person you think of as your personal doctor or health care provider? (Q53)


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Didn't have to wait - the appointment was the same or

next day

Less than 1 week 1 to 2 weeks 2 to 4 weeks More than a month0.0%

10.0%

20.0%

30.0%

40.0%

33.3%37.3%

18.7%

7.5%

2.0%

N=210

When you scheduled that appointment with a doctor or health care provider, about how long did you have to wait for that appointment? (Q55)

Asked of those respondents who scheduled an appointment in the past 12 months


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Didn't have to wait - the appointment was the same or

next day

Less than 1 week 1 to 2 weeks 2 to 4 weeks More than a month0.0%

10.0%

20.0%

30.0%

40.0%

23.7%

32.5%

21.9%

11.5% 10.4%

N=49

When you scheduled that appointment with a mental or behavioral health services provider, about how long did you have to wait for that appointment? (Q57)

Asked of those respondents who scheduled an appointment in the past 12 months


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N = 402

As I read the following items, please tell me whether there were any instances in the past 12 months where you need

this item but did not receive it due to cost. (Q64)

20%

80%

Yes No

A. See a dentist?


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Yes No0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

68.8%

31.2%

89.4%

10.6%




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Percent reporting "No"

14.3% 14.9% 14.2%

16.7%

9.6%

Entire Sample Truckee Basin IV/CB Kings Beach Tahoe City

N = 402 (190) (91) (66) (56)



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0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

23.0%

4.8% 3.4%1.5%

6.6%

0.0% 0.8% 0.5%

15.3%

42.7%

N=402

In your opinion, what is the main barrier you face in accessing health care in our community? (Q77)

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Open-Ended Questions

• Q81: What do you think is the top health or health care challenge facing our community? (75% of respondents provided comments);

• Q82: What changes in health care services would you like to see in our community, if any? (61% of respondents provided comments);

• Q83: Is there anything else you would like to know? (24% of respondents provided comments).

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Summary ofOpen-Ended Questions

• Hospital costs, prices, affordability and transparency; • Hospital quality and ease of access; • Health workforce, esp. access to medical specialists, dental care, and urgent care; • Insurance coverage gaps and acceptance by hospital and other local providers.


Household SurveyNegative Findings

High rates of alcohol consumption;Prescription drug misuse;Health care costs and affordability;Oral health care access barriers;Adult and children’s deficient vaccination rates;Access to care ethnicity disparities;Financial and insurance barriers to care.


Household Survey Positive Findings

Self-reported general and mental health status are good;

Mammography rates improving;Physical activity prevalence improved;Wait times for access providers, including mental health providers reasonable;Health insurance coverage increasing.


Household Survey Uncertain Findings

Tdap vaccination;Colon cancer screening declining;E-cigarette and chew tobacco use; Length of coverage lapses for those with health insurance coverage.

Where to Find the Data:TFHS Wellness Neighborhood

Website LaunchProjected

March 1, 2015

Website tools: 2014 TFHS Assessment Reports, Community Reports and Links to Regional Sites, Data Indicators,

Benchmarks, Mapping, Evidence-Based Models, Best Practices, Report Generation


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The HCI Platform enables local public health departments, hospitals and community coalitions to measure community health, share best practices, identify new funding sources and drive community health improvement.

Mapping and data visualization tools identify intervention opportunities.

A database of thousands of evidence-based programs filters the most appropriate for community-based strategies.

Collaboration centers align objectives and orchestrate core capabilities within community partnerships.

Customizable trackers and indicators provide a “single source of truth” for measuring success.

http://www.healthycommunitiesinstitute.com/hci-platform-overview-2/

http://www.healthycommunitiesinstitute.com/health-department-solutions/

http://www.healthycommunitiesinstitute.com/hospital-solutions/

http://www.healthycommunitiesinstitute.com/consortiums-and-coalitions-solutions/

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Additional Primary Data Collection Results

Key Informant InterviewsFocus GroupsYouth Health Assessment (TTUSD only)Mental Health Assessment


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TransportationLack of Specialty ProvidersMental and Behavioral HealthDental (especially pediatric)ReproductiveInsurance coverageImmigration StatusCost of care (Borderline MediCal)Language and Cultural barriers

Key Informant and Focus Group BarriersAccess To Care


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TNT* Youth Health Initiative Primary Issues

Behavioral & Mental HealthAlcohol and Drug UseReproductive HealthHealth AccessPhysical Health (Obesity & Nutrition, Vision, Healthy Behaviors, Sports Health)Oral Health

* Truckee/North Tahoe-Network Initiative between TTUSD, Nevada & Placer Counties, TFHS



TFHS Mental/Behavioral Health Provider Needs

Assessment

Assessment Findings Winter 2014

Victoria Mercer, Ph.D.


Assessment Parameters

• Purpose: Identify current range of services, assess service gaps, barriers to access, and disparities in the delivery of services;• Sample: private practitioners, medical providers, key community agency representatives.


Environmental Scan of Services• Vital and diverse private practice community;• What disorders are present?

• Anxiety Disorders • Depressive Disorders • SUD (alcohol, marijuana, meth, prescription meds) • Others: relationships, NSSI (Non-Suicidal, Self-Injury),

parenting, SMI (Serious Mental Illness), transitional issues/phase of life, somatic complaints;

• Discrepancies: • Seniors: depression, cognitive issues, isolation, pain• Youth: stress related problems/SUD, anxiety, depression, NSSI,

disordered eating.


Gaps and Barriers

• Service Gaps:- Lack of practitioners: psychiatrist, clinicians accepting insurance, SUD programs;- Inadequate support services: transitional, crisis, discharge services, ED services;- Deficient community services: long-term programs, senior services, youth services;

• Barriers to Access: fragmented system, cost, motivation, stigma, limited practitioner pool, cultural competence, normalized substance use.


Key Mental/Behavioral Health Key Findings

• Many individual's mental health needs are adequately addressed;• Providers want additional services:

-Possible Solutions: Develop integrated behavioral health services with primary care, recruit psychiatrist and appropriate behavioral health practitioners;

• Providers value (and want more) community collaboration-Possible Solutions: Facilitate the development of resources, education and intervention based programs.

Tahoe Forest Health System Results of 2014 Household Survey & other Community Health Needs...

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