Mercy Medical Center Dubuque
Community Health Needs Assessment
Conducted in Fiscal Year 2018
For Fiscal Years 2019, 2020, and 2021
Mercy Medical Center – Dubuque Community Health Needs Assessment
Contents Mercy Medical Center – Dubuque....................................................................................................2
Community Health Needs Assessment..............................................................................................2
Introduction......................................................................................................................................4
Our Vision, Mission and Values Ground Us ...................................................................................4
Mission Statement......................................................................................................................4
Our Vision Calls Us....................................................................................................................4
Our Values Guide Us .................................................................................................................4
Executive Summary ......................................................................................................................4
CHNA Approval ............................................................................................................................5
Review of Previous CHNA .............................................................................................................5
Comments from previous CHNA ...................................................................................................8
Community Description....................................................................................................................9
Geographic Area Served ..............................................................................................................9
How Population Served Was Identified .........................................................................................9
Demographics of Population .......................................................................................................10
Health Facilities...........................................................................................................................11
Services Provided .......................................................................................................................11
Process and Methods......................................................................................................................12
Steering Committee Members.................................................................................................12
Steering Committee Meetings .................................................................................................13
Taskforce Membership............................................................................................................13
County Health Rankings ..............................................................................................................13
Health Outcomes .....................................................................................................................13
Health Factors..........................................................................................................................14
Community Input............................................................................................................................15
Methods used to solicit input.......................................................................................................15
Health Department Input..........................................................................................................15
Representation of medically underserved, low-income, and minority populations ..................15
Community Input Survey Results.................................................................................................15
Mercy Dubuque CHNA 2019-21 Page 2 of 28
Select Key Findings from Data Review............................................................................................21
Dubuque County and Iowa Health Data from County Health Rankings .....................................21
Dubuque County Health Portrait 2017, from Community Commons .........................................21
Iowa Department of Public Health core measures: ...................................................................22
Dubuque County cancer incidence rates: (Iowa Cancer Registry) ...........................................25
2017 Cancer In Iowa, University of Iowa College of Public Health............................................25
Significant Community Health Needs..............................................................................................26
Ranking of significant community health needs and brief description: ........................................26
Conclusion .....................................................................................................................................27
Implementation Strategy .............................................................................................................27
How to obtain copies...................................................................................................................27
Contact Information ....................................................................................................................27
Next CHNA Due Date ..................................................................................................................28
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Introduction For the third time, Mercy Medical Center - Dubuque joined the Dubuque County Community Health
Needs Assessment – Health Improvement Plan (CHNA-HIP) coalition. This assured broad involvement from many key organizations across our service area. For that reason, some of the
processes, data and findings reported here are identical to those detailed in the Dubuque County
Community Health Needs Assessment. Mercy participated in all aspects of steering, coordinating
and completing the process.
Our Vision, Mission and Values Ground Us
Mission Statement
Mercy Medical Center - Dubuque and Mercy Health Network serves with fidelity to the Gospel as a
compassionate, healing ministry of Jesus Christ to transform the health of our communities.
Our Vision Calls Us
Mercy Health Network will set the standard for a personalized and radically convenient system of
health services.
Our Values Guide Us Reverence: We honor the sacredness and dignity of every person.
Integrity: We are faithful to who we say we are.
Commitment to the Poor: We stand with and serve those who are poor, especially the most
vulnerable.
Compassion: Solidarity with one another, capacity to enter into another’s joy or sorrow Excellence: Preeminent performance, becoming the benchmark, putting forth our personal and
professional best.
Justice: We foster right relationships to promote the common good, including sustainability of the
Earth.
Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and
natural resources entrusted to our care.
Executive Summary This Community Health Needs Assessment was developed collaboratively between Mercy Medical
Center—Dyersville, Mercy Medical Center—Dubuque, Unity Point Health Finley Hospital, Dubuque
County Health Department, City of Dubuque Health Services, and Crescent Community Health
Center. Mercy Medical Center – Dubuque is a community medical-surgical hospital serving the Tri-State area of eastern Iowa, southwest Wisconsin, and northwest Illinois. Also located in Dubuque
County are Mercy Medical Center – Dyersville, a critical access hospital, and Unity Point Health Finley Hospital, another community medical-surgical hospital. The service area is relatively
homogenous, with a white non-Hispanic population of 93% and very low overall population growth.
This process began by convening the steering committee, comprised of representatives from
organizations representing a broad variety of community organizations with an interest in health
and wellness. The Steering Committee collected primary and secondary data and organized
taskforces of content experts from the community to analyze and identify priority health needs in
Mercy Dubuque CHNA 2019-21 Page 4 of 28
the community. The task forces reviewed secondary research consisting of statistical information
about disease occurrence, mortality, and behavioral patterns of Dubuque County residents
compared to Iowans in general or to previous periods of time. Some of the data sources used for
this research were Community Commons, County Health Rankings, and Iowa Vital Statistics, and a
community input survey updated and designed for this process.
Based on the secondary research as well as the survey findings, the steering committee reviewed
the taskforce recommendations and identified and prioritized, through discussion and consensus,
fourteen significant health needs:
1. Opioid Use and Abuse
2. Obesity & Overweight
3. Alcohol Use and Abuse
4. Mental Health Access
5. Influenza Immunizations
6. Healthy Homes
7. Primary Care Access
8. Emergency/Disaster Planning
9. Drinking Water Protection
10. Dental Care Access
11. Specialty Care Access
12. Elder Care Access
13. HIV/AIDS Screening and Prevalence
14. STD/STI Screening and Prevalence
These are further addressed in the hospital's forthcoming Implementation Strategy.
CHNA Approval On May 24, 2018, the Board of Trustees for Mercy Medical Center – Dubuque met to discuss the Fiscal Years 2019, 2020, and 2021 Community Health Needs Assessment conducted during
Fiscal Year 2018. Upon review, the Board approved this Community Health Needs Assessment.
Review of Previous CHNA In 2016, Mercy's CHNA identified several high priority health needs, including:
1. Reducing obesity
2. Reduction in alcohol abuse in particular and substance abuse in general
3. Diabetes screening and management
4. Not taking prescribed medication for high blood pressure
5. Increased screening for prostate cancer
6. Community concerns about insufficient access to mental health providers
7. Insufficient bilingual health care providers in the community
From these high priority health needs, Mercy collaborated with Mercy Medical Center – Dyersville, Dubuque County Health Department, and the Dubuque County Wellness Coalition to focus on
addressing the goal of reducing obesity in our communities.
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Mercy, in partnership with many community partners, supported and implemented numerous
interventions to address obesity in our community, and we continue to look for and implement new
and innovative opportunities to respond to our community needs. Our goal from the previous
CHNA-HIP was to reduce obesity among Dubuque County adults from 29% to 27% by June 30,
2018. The data source used, countyhealthrankings.org does not have this data point up to date.
Thus, it is difficult to say with certitude that this goal has been achieved. However, the data
available from that measure does indicate we have stabilized the percentage, and we believe the
initiatives listed below will result in the desired impact as updated data becomes available. The list
below highlights actions taken since implementation of the 2015 CHNA-HIP we believe have made
an impact on the health of our community, towards the goal of reduced incidence of adult obesity.
- Broaden the scope of the Dubuque County Wellness Coalition to include organizational
representation capable of carrying strategic policies back to their organizations, and
organizations that better represent the cultural and economic diversity of the community
and all geographic areas of the county.
o The Dubuque Wellness Coalition consists of community members and organizations working to impact policy and infrastructure identify gaps and duplication of efforts
and utilize data to influence individual and community health. Members consist of
City Health , Leisure Service Department, Dubuque County Health Department,
IDPH, Dubuque Community & Holy Family Schools, Live Health Dubuque, Hy-Vee,
Multi-Cultural FC, Mercy, Finley, Hillcrest, Iowa State University Extension, VNA,
Crescent CHC, Tri-State Trail Vision, St. Stephen's Food Bank, Dubuque Community
Y, Helping Services, and other local business.
o Although membership has expanded and represents more sectors and organizations, cultural diversity has not changed.
- Involve the Local Food Systems Working Group and other community-based organizations
that have a specific interest in nutrition, weight loss, and physical activity in the process.
o Dubuque Eats Well is a network of community members and organizations working together to transform the local food system.
o Local food systems group representative is a member of the Coalition and reported out/received coalition input on local foods assessment, local food activities etc.
o Established Double Up Food Bucks (DUFB) program which distributed $4,100 DUFB dollars to SNAP recipients attending the Dubuque Farmers Market (DFM). Over 50
vendors were engaged redeeming DUFB in 2016, and recorded over 200 NEW SNAP
market goers.
o Weekly offerings of Snap-Ed friendly recipes are through #MealMonday social media series, as well as a recipe on the back of the DFM Market Map.
o The Agricultural Urbanism Toolkit is a three year (2015-2017), three phase process through which stakeholders in the greater Dubuque area are coming together to
evaluate the local food system, identify assets and gaps, and create a shared vision
and goals, leading towards the implementation of tactics to move the local food
system forward. Current projects addressing the social determents include The ,
Double Up Food Bucks and Sinsinawa Collaborative Farms.
o In addition, there is progressive work around numerous community gardens including Dubuque Rescue Mission, Washington Neighborhood, Four Mounds, Dr.
Viner, Jaycees, St. Luke's, West Minster Presbyterian. Other projects include Farm to
Mercy Dubuque CHNA 2019-21 Page 6 of 28
http:countyhealthrankings.org
Institution, Convivium Urban Farmstead, Kids at Market, Chefs at Market, 3rd Annual
Tristate Local Food Summit, Bee Branch Project, 2016 Driftless Farm and Food Fest,
Community Supported Agriculture connecting with businesses.
- Secure commitments from participating partner organizations and coalition members to assist in implementing and supporting environmental change.
o Mercy collaborated with the Iowa SNAP Incentive Project proposed by the Iowa's Healthiest State Initiative to increase fresh fruits and vegetable access to low income
residents.
o Mercy expanded our Community Benefit Ministry Grant program to invite community organizations to request grant funding for programs addressing priority health
needs. During Fiscal Years 2016-2018 (July 2015 – June 2018) Mercy awarded $86,000 to the community organizations and programs targeting healthy behaviors, exercise,
nutritious foods and obesity reduction listed below. Mercy also plans to distribute
nearly $40,000 during Fiscal Year 2019 to similar community programs.
Organization Program Grants
Distributed
FY 2016-2018
Crescent Community Community Gardening $28,800 Health Center for a Healthier Life
Clarke University Geriatric Wellness Falls $10,000
Prevention Program
Northeast Iowa Scouting for Food $7,000 Council, Boy Scouts of
America
Sinsinawa Sinsinawa Mound $10,000 Dominicans Collaborative Farm
Dubuque Rescue Mission School of $15,000 Mission Preservation
St. Stephen Food Bank Growing and Giving $10,200
Dubuque Main Street Double Up Food Bucks $5,000
Total $86,000.00
The current year's CHNA Community Input Survey responses highlight community perspectives on
the progress made over the past CHNA cycle. The survey asked, "Over the past 3-5 years, what
would you say are the most significant improvements in our community that have improved health
and well-being? Over 569 responses to this question were submitted. The following sample
comments highlight progress made regarding this focus area.
- "Organic food selection has really improved!"
- "Access to outdoor activities"
- "Working to clean up river area, walking, hiking areas."
- "Increased community efforts to grow food and make it available to those living with food insecurity."
- "Improved access to physical activity opportunities – parks, trails, fitness facilities, a variety of exercise classes. Robust farmers market and focus on local healthy foods."
- "Better dietary information at stores. Weight loss programs"
Mercy Dubuque CHNA 2019-21 Page 7 of 28
- "YMCA is starting new health programs to fight diabetes, high blood pressures, and
arthritis. Insurances started paying gym memberships."
- "Nutrition information through classes and publications"
- "Increased social gathering places that incorporate additional activities to foster wellbeing and health."
- "Maintaining bike trails and parks, and encouraging people to get out and use them more."
Comments from previous CHNA Mercy did not receive any comments from the public on this CHNA.
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Community Description
Geographic Area Served Mercy Medical Center Dubuque serves people residing within a 50-mile radius of Dubuque, Iowa.
The major service area is Dubuque, County, but also includes Jackson, Clayton, Lafayette, and
Delaware Counties in Iowa, Grant County, Wisconsin, and JoDaviess County, Illinois. For the
purposes of this community assessment, Mercy's CHNA committee reviewed information from all
seven communities above, but decided to primarily focus on Dubuque County as it accounts for the
majority of our discharges and allows for closer collaboration with the Dubuque County Community
Health Needs Assessment Steering Committee.
How Population Served Was Identified This definition of the community is based on the primary residence of Mercy Medical Center
Dubuque's patients: over calendar years 2012-2016, 62.84% of inpatient discharges and 76.56%
Emergency Department discharges were patients from Dubuque County, Iowa.
Mercy Dubuque Inpatient Discharges by County, Calendar Years 2011-2016
County 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY Total
Dubuque 61.87% 62.81% 62.00% 62.92% 63.56% 63.82% 62.84%
Grant (WI) 11.01% 10.82% 10.68% 9.96% 10.09% 10.28% 10.46%
Jo Daviess (IL) 9.42% 8.69% 9.02% 9.12% 9.78% 9.74% 9.30%
Jackson 6.89% 6.82% 6.99% 7.28% 6.75% 6.40% 6.85%
Clayton 3.48% 2.79% 3.35% 3.19% 2.88% 2.91% 3.10%
Lafayette 1.82% 1.70% 1.70% 1.57% 1.45% 1.68% 1.65%
Delaware 1.32% 1.41% 1.39% 1.34% 1.06% 0.84% 1.22%
Other* 4.19% 4.97% 4.87% 4.64% 4.42% 4.34% 4.57%
Totals 100% 100% 100% 100% 100% 100% 100%
*253 Counties accounting for
Mercy Dubuque Emergency Department Discharges by County, Calendar Years 2011-2016
County 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY Total
Dubuque 75.60% 76.19% 77.27% 76.42% 76.71% 77.05% 76.56%
Jo Daviess 6.79% 6.49% 6.30% 6.23% 6.75% 6.35% 6.48%
Grant 6.18% 6.16% 5.74% 5.96% 5.36% 5.33% 5.77%
Jackson 4.61% 4.39% 4.30% 4.70% 4.85% 4.65% 4.59%
Lafayette 0.96% 0.88% 0.75% 0.79% 0.85% 0.95% 0.86%
Clayton 0.89% 0.74% 0.81% 1.02% 0.95% 0.72% 0.85%
Delaware 0.72% 0.72% 0.70% 0.58% 0.57% 0.59% 0.64%
Other* 4.24% 4.42% 4.12% 4.30% 3.96% 4.36% 4.23%
Totals 100% 100% 100% 100% 100% 100% 100%
*175 Counties accounting for
Persons without health insurance, under age 65 years 4.1% 5.0% 10.1%
In civilian labor force, total, percent of population age 69.0% 67.6% 63.1%
16 years+, 2012-2016
In civilian labor force, female, percent of population 64.6% 63.3% 58.3%
age 16 years+, 2012-2016
Mean travel time to work (minutes), workers age 16 16.5 18.9 26.1
years+, 2012-2016
Median household income (in 2016 dollars), 2012-2016 $56,154 $54,570 $55,322
Per capita income in past 12 months (in 2016 dollars), $28,526 $28,872 $29,829
2012-2016
Persons in poverty 10.5% 11.8% 12.7%
Source: US Census Bureau QuickFacts, www.census.gov
Health Facilities Three hospitals are located in Dubuque County:
Mercy Medical Center—Dyersville
Mercy Medical Center—Dubuque
Unity Point Health Finley Hospital
Services Provided In 1879, the Sisters of Mercy arrived in Dubuque at the request of Bishop John Hennessy to launch a
healing ministry now known as Mercy Medical Center. Today, Mercy is the leading hospital in the
tri-states, with the most comprehensive cardiology center in the area and the only level II regional
neonatal intensive care unit. Other services include a trauma center, a CARF-accredited inpatient
rehabilitation unit, home health care, orthopedics, cancer care, retail pharmacies, palliative care,
and a wide range of outpatient and community services. Mercy operates two hospital-based skilled
nursing units and a 40-bed nursing home.
In recognition of the strength of its nursing service and the overall quality of patient care, Mercy
was the 134th hospital in the country to be designated a Magnet® hospital, the nation's most
prestigious award for nursing excellence. Also accredited by The Joint Commission, Mercy is a
member of Mercy Health Network of DesMoines, Iowa and Trinity Health of Livonia, Michigan.
Mercy Dubuque CHNA 2019-21 Page 11 of 28
http:www.census.gov
Process and Methods This CHNA was conducted in partnership with Dubuque County, City of Dubuque, Crescent
Community Health Center and Mercy Medical Center Dyersville and Unity Point Finley Hospital,
herein "steering committee".
The steering committee collected information from primary and secondary data sources. Data was
also collected through a community input survey in Dubuque County. Surveys were gathered
between January 11 and January 22, 2018. The survey was offered on-line via "Survey Monkey" and
was available in English and Spanish languages. The steering committee developed a
communications plan to spread the word around the community and ultimately 1052 completed
responses were collected. Summary results are available upon request.
When the steering committee first met in November 2017, they reviewed the previous CHNA/HIP
documents for Mercy and for the County of Dubuque. In the previous CHNA-HIP Mercy focused on
results from the "Healthy Behaviors and Lifestyles" section of the Dubuque County CHNA-HIP
process. However, we determined that including the full scope of the Dubuque County CHNA-HIP
into Mercy's CHNA better represents the continuum of health needs across our county and
communities. Previous years' county CHNA-HIP have used general categories of Healthy Behaviors,
Disease Infection Control, Healthcare Access, and Environmental Health. The steering committee
determined to continue utilizing this framework as it best positioned us to assess the community
health needs more comprehensively than focusing on just one as we had in the past.
The data collection process progressed simultaneously collecting available data and developing
and executing the community-wide survey related to these four broad categories. The steering
committee reviewed, revised and improved upon the survey from in the previous CHNA-HIP cycle.
In the review process, the steering committee also collected and reviewed community input
surveys from other hospitals and communities as a comparison for improving the
comprehensiveness of our tool.
The steering committee then reviewed and compared the survey results to the collected data. The
results and data were consistent with each other, validating both findings. The steering committee
then began forming taskforces of community experts to evaluate the data, including survey results,
and to identify the priority needs for each of the four categories.
The steering committee identified and invited community members, experts and leaders from
across the community to participate on the taskforces. Each taskforce reviewed the data, conducted
a SWOT analysis, and made recommendations to the steering committee regarding priority needs
and focus areas for our health improvement plans. The steering committee then convened to review
and adopt the recommendations from the steering committees.
Steering Committee Members
Joseph Norris, Mercy Medical Center Dubuque & Dyersville
Patrice Lambert, Dubuque County Health Department (CHAIR)
Stacey Killian, Unity Point Finley Hospital, Visiting Nurse Association
Jonathan Wilke, Unity Point Finley Hospital
Mary Rose Corrigan, City of Dubuque
Travis Schrobilgen, City of Dubuque
Angela Petsche, Crescent Community Health Center
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Steering Committee Meetings
November 2, 2017 January 24, 2018 April 13, 2018
November 14, 2017 February 6, 2018 April 19, 2018
November 28, 2017 February 21, 2018 April 25, 2018
December 13, 2017 February 28, 2018 May 2, 2018
January 3, 2018 March 8, 2018 May 17, 2018
January 17, 2018 April 6, 2018
Taskforce Membership The steering committee invited the following community organizations to participate and share their expertise on each taskforce:
Healthy Behaviors: City of Dubuque, Dubuque County Health Department, Dubuque
School District, Dubuque YMCA, Grand River Medical Group, Helping Services, Hy-
Vee, Iowa State Extension, Mercy Dubuque & Dyersville, Unity Point Health System,
Western Dubuque School District
Healthcare Access: Crescent Community Health Center, Dubuque County, Dubuque
County Board of Health, Dubuque County Early Childhood, Dubuque County
Emergency Management, Grand River Medical Group, Hillcrest Family Services,
Medical Associates, Mercy Dubuque & Dyersville, Unity Point Health System
Disease Infection Control: City of Dubuque, Dubuque County Health Department,
Dubuque School District, Iowa Department of Public Health, Medical Associates,
Mercy Dubuque & Dyersville, Unity Point Health System
Environmental Health: City of Dubuque, Clarke University, Dubuque County Health
Department, Dubuque Soil & Water Conservation, Loras College, Unity Point Health
System
County Health Rankings County Health Rankings (www.CountyHealthRankings.org), provides comparative rankings
and data for a variety of different health factors and health outcomes. These rankings are an
effort to highlight the importance of many different factors in determining the health of a
population. County Health Rankings is a project supported by Robert Wood Johnson
foundation and University of Wisconsin Population Health Institute.
Health Outcomes
Health outcomes represent how healthy counties are within the state. The healthiest
county in the state is ranked #1. The ranks are based on two types of measures: how
long people live and how healthy people feel while alive. According to County Health
Rankings 2018, Dubuque County ranks 41 out of 99 counties in Iowa in health outcomes.
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http://www.countyhealthrankings.org/
Health Factors
Health factors represent what influences the health of a county. They are an estimate of
the future health of counties as compared to other counties within a state. The ranks are
based on four types of measures: health behaviors, clinical care, social and economic,
and physical environment factors. According to County Health Rankings 2018, Dubuque
County Ranks 27 out of 99 counties in Iowa in health factors.
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Community Input
Methods used to solicit input The primary methods for community wide input included: steering committee,
taskforces, and the community-wide survey. Results of this input follow. In addition to
soliciting community wide input, the steering committee also invited broad
representation for the taskforces and welcomed involvement throughout the process.
The steering committee reviewed the survey responses and overall felt the community
input supported and validated the collected data. The steering committee presented
these results and the collected data to the taskforces. The taskforces used the compiled
data to further assess and prioritize our community needs.
Health Department Input
The steering committee obtained input from multiple departments of health throughout
this process. First, Patrice Lambert of the Dubuque County Health Department and Mary
Rose Corrigan from City of Dubuque Public Health were members of the steering
committee. Second, we reviewed the Community Health Needs Assessment and
Community Health Improvement Plans for Grant County, Wisconsin and Jo Daviess
County, Illinois to assure we were taking into consideration other priority needs in our
region though they are beyond our primary service area for the purposes of our needs
assessment process. We found the priority needs identified in this CHNA overlap and
align well with the priority needs of the secondary service area.
Representation of medically underserved, low-income, and minority
populations
The steering committee sought and considered the needs, input, and concerns of
underrepresented persons and populations throughout this process. Serving on the
steering committee, Angela Petsche from Crescent Community Health Center and
Stacey Killian from Unity Point Finley Hospital – Dubuque Visiting Nurse Association represented the populations their organizations serve. The primary makeup of these
populations are those who are underrepresented in the community: those who are
medically underserved, in poverty; and/or from minority populations. In addition,
representatives from Dubuque School District, Western Dubuque School District, and
Dubuque Early Childhood participated on the taskforces and represented the needs and
best interests of the youth population that comprises 23% of our community. The
steering committee reviewed reported demographic information of those who
completed the survey and found that distribution by ethnicity, age, income and zip code
were consistent with the community's demographic profile.
Community Input Survey Results Community Input Survey results were taken into consideration when prioritizing which
needs to focus on for the term of this CHNA-HIP. Summary responses are included
below; please contact us if you would like to review the full results.
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The survey tool was originally designed for the previous CHNA-HIP process. The
steering committee consulted various community input surveys when revising the
survey tool for this cycle. Most questions were revised, though to varying degrees.
The steering committee had two primary goals for the community input survey. First, to
identify which community health needs, identified through the data collection process,
were of highest priorities to the community to address. Second, we aimed to solicit
community input regarding any needs that we had missed that community members
believed needed to be addressed in the coming 3-5 years.
The steering committee also had the survey translated into Spanish language to make
the survey more accessible. Only two responses were received using the Spanish
translation. In the next cycle, the steering committee will look to expand language
availability to meet the needs of the community.
Mercy Dubuque CHNA 2019-21 Page 16 of 28
Question: From the list below, please check
THREE items that you think are the most
important health concerns for our community
to address in the next 3-5 years. (Check exactly
3 below)
Answer Choices
Mental health/mental illness/suicide
Obesity/overweight
Illegal drug use
Cancer
Prescription drug abuse
Heart disease and stroke
Alcohol abuse
Diabetes
Chronic pain
Pregnancy/infant health
Dental health
Respiratory and lung problems
Sexually transmitted diseases
High blood pressure
Unintentional injuries
Responses
73.21%
47.91%
41.30%
28.65%
25.95%
17.67%
16.28%
14.14%
9.21%
8.19%
5.12%
4.28%
4.00%
3.07%
1.02%
Answered
787
515
444
308
279
190
175
152
99
88
55
46
43
33
11
1075
Question: From the list below, please check
THREE behaviors that you think have the
greatest impact on overall community
health. (Check exactly 3 below)
Answer Choices Responses
Drug abuse 63.63% 684
Being overweight 50.05% 538
Poor diet 42.14% 453
Lack of exercise 41.12% 442
Alcohol Abuse 40.09% 431
Tobacco use 20.19% 217
Dropping out of school 16.09% 173
Unprotected sex 11.72% 126
Not getting flu shots or 11.26% 121 other vaccinations
Not wearing a helmet 2.33% 25
Not using seat belts 1.40% 15
Answered 1075
Mercy Dubuque CHNA 2019-21 Page 17 of 28
Question: From the list below, please check THREE environmental hazards
that you feel are needs that should be addressed in our community in the
next 3-5 years. (Check exactly 3 below)
Answer Choices Responses
Healthy homes 44.19% 475
Drinking water protection 40.00% 430
Disaster preparedness 32.37% 348
Water pollution 30.79% 331
Food safety 27.53% 296
Food waste 21.30% 229
Air Pollution 19.44% 209
Hazardous waste 17.12% 184
Hazardous materials 15.63% 168
Radon 15.35% 165
Lead poisoning 11.26% 121
Vector (disease-carrying animals and insects) control 11.07% 119
Soil Erosion 9.49% 102
Radiological health 4.47% 48
Answered 1075
Question: Using a scale from Strongly Disagree to Strongly Agree, please rate these
statements about Health Care Access in our community:
Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree
Disagree
Most residents in my community are able to access a primary care provider (family doctor, pediatrician, general
2.60% 17.30% 12.84% 57.86% 9.40%
practitioner) when needed.
Most residents in my community are able to access a medical specialist (cardiologist, dermatologist,
7.63% 27.35% 20.28% 39.53% 5.21%
neurologist, etc.) when needed.
Most residents in my community are able to access a dentist when needed.
5.86% 19.81% 17.21% 46.14% 10.98%
Most residents in my community are able to obtain prescription medications 2.88% 16.93% 20.37% 51.07% 8.74% when needed.
People new to my community know how to get health care.
3.63% 19.81% 38.60% 33.58% 4.37%
There are enough health care providers who accept Medicaid or other forms of 19.72% 27.72% 31.44% 16.74% 4.37% medical assistance in my community.
There are enough bilingual health care providers in my community.
15.16% 30.79% 44.56% 6.98% 2.51%
Mercy Dubuque CHNA 2019-21 Page 18 of 28
Question: Please select up to THREE of the most important barriers that you
believe keep people in our community from accessing health care. (You may
check 1-3 options below)
Answer Choices Responses
Not able to pay out-of-pocket expenses (co-pays, 80.09% 861 prescriptions, etc.)
Lack of health insurance 64.47% 693
Not able to navigate the health care system 39.16% 421
Not enough providers; hard to get an appointment 35.35% 380
Lack of transportation 18.88% 203
Language or cultural barriers 16.74% 180
Time limitations 10.88% 117
Lack of trust 6.88% 74
Lack of child care 6.79% 73
Other (please describe) 5.95% 64
In addition to the questions with fixed responses, three questions offered free-text response
for comments. One question was retrospective and so is not included here, the other two are
summarized below. All responses were categorized as follows:
Question: Please describe any other health needs that
were not mentioned in the previous questions that you feel
should be addressed in the next 3-5 years in our
community. 698 responses were received and categorized:
Category
Mental Health
N/A
Specialty Care
Access
Substance Abuse
Provider Shortage
Affordability
Environment
Insurance
Cancer
Aging
Public Safety
Nutrition
Count of Category Response
99 Dental
74 Sexual Health
68 Crescent
58 Transportation
53 Childcare
36 Obesity
30 Dyersville
28 Mercy
26 Pharmacy
18 Cultural
17 Marijuana
17 Individual Responsibility
16 Language
Count of Response
8
7
7
6
5
3
3
3
2
2
2
2
2
Mercy Dubuque CHNA 2019-21 Page 19 of 28
Political 15 Provider Shortage 1
General 14 Veterans 1
Health Education 13 Pain 1
Children 13 Men's Health 1
Education 13 Pediatrics 1
Exercise 11 Finley 1
Public Health 10 Communication 1
Women's Health 9 Marshall Islands 1
Total: 698
Question: What do you see as barriers that prevent our community from
becoming healthier? 830 responses were received and categorized:
Category
Money
Individual Responsibility
Access - Insurance
Political
Access - Nutrition
Substance Abuse
Education
Education - Health Literacy
Access - Exercise
N/A
Culture
Access - Providers
Access - Mental
Access - Care
Education - Nutrition/Cooking
Count of Response
153
92
76
57
52
44
42
32
30
28
28
26
26
25
20
Category
Access - General
Obesity
Access - Transportation
Pharmacy
Dental
Environment - Chemicals
Children
Access - Housing
Aging
Access - Affordability
Jobs
Marshall Islands
Quality Care
Cancer
Crime
Count of Response
17
15
13
11
8
8
6
4
4
3
3
2
2
2
1
Total: 830
Mercy Dubuque CHNA 2019-21 Page 20 of 28
Select Key Findings from Data Review Dubuque County and Iowa Health Data from County Health Rankings
(countyhealthrankings.org), for each year 2013 through 2017.
22% of adults in Dubuque County report physical inactivity, compared to 24% throughout Iowa.
The sexually transmitted infection rate (412.8) is higher than the statewide rate (382). 6% of adults in Dubuque County are uninsured compared to a statewide average of 7%. The per capita ratio of primary care physicians to population is higher than the statewide
average (1,380:1 for Dubuque compared to 1350:1 for Iowa).
Dubuque County is ranked eighth best of Iowa's 99 counties in Clinical Care. Dubuque County (10.2) reported a higher rate of air pollution – air particulate matter than the
state (9.6).
Dubuque County (12%) had a lower percentage of the population driving longer commutes alone than the statewide percentage (20%).
Dubuque County reported drinking water violations.
Dubuque County Health Portrait 2017, from Community Commons (communitycommons.org/chna).
9.55% of Dubuque County households receive SNAP benefits compared to 11.73% for Iowa.
42% of Dubuque County Adults are reported overweight compared to 35% for Iowa.
28.7% of Dubuque County adults are not taking blood pressure medication when needed compared to 19.1% in Iowa.
Dubuque County (51.21%) has a higher percentage of Medicare Beneficiaries with high blood pressure than the Iowa average (50.98%).
77.4% Dubuque County female Medicare enrollees with mammogram in past 2 years compared to 68.5% for the statewide average.
82.6% Dubuque County adult females, age 18+, with regular pap test (age-adjusted) compared to 79.5% for the statewide average.
69.4% Dubuque County adults, age adjusted screened for colon cancer compared to the statewide average of 60%.
10.1% of adults in Dubuque County smoke cigarettes, compared to 18.1% for Iowa. Dubuque County has 31.5% age-adjusted estimated adult excessive drinking
compared to the Iowa average of 21.4%.
Percent of adults never screened for HIV/AIDS is higher (78.7%) than the Iowa average (73.82%).
Dubuque County age-adjusted percent of population age 65+ with pneumonia vaccination (68.5%) is slightly below the Iowa average (69.9%).
Chlamydia infection rate per 100,000 pop. in Dubuque County (412.76) is higher than the statewide average (382).
Gonorrhea infection rate per 100,000 pop. in Dubuque County (86.73) is higher than the statewide average (53.1).
Mercy Dubuque CHNA 2019-21 Page 21 of 28
http:countyhealthrankings.org
Dubuque County has a lower percentage of the insured population receiving Medicaid (15.24%) than the Iowa average (17.96%)
Dubuque County (140) has more mental health providers per 100,000 than the Iowa rate (125.1) but well below the national average rate of 202.8.
19.99% of Dubuque County adults are without a regular doctor compared to 17.93% in Iowa.
Dubuque County has a lower percentage of uninsured population (5.46%) than the Iowa average (6.82%)
Dubuque County has a lower percentage of uninsured population under 19 years old (2.79%) than the Iowa average (3.63%).
Dubuque County has 72.07 dentists per 100,000 population compared to the state rate of 62.6.
Dubuque County (74.74) has a higher percentage of fast food establishments per 100,000 population than the state average (63.19).
Dubuque County (25.23) has a higher percentage of population with low food access than the statewide average (21.41%).
Dubuque County (16.02) has a lower rate of grocery stores per 100,000 population than Iowa (20.06).
Dubuque County (24.7%) has a comparable percentage of substandard housing units to the Iowa average (24.44%).
Iowa Department of Public Health core measures: (https://www.pht.idph.state.ia.us)
Age adjusted heart attacks per 10,000 population.
Mercy Dubuque CHNA 2019-21 Page 22 of 28
https://www.pht.idph.state.ia.us/
Mercy Dubuque CHNA 2019-21 Page 23 of 28
Emergency visits due to heat related illness per 10,000 population.
Mercy Dubuque CHNA 2019-21 Page 24 of 28
Dubuque County cancer incidence rates: (Iowa Cancer Registry)
Rate Count Pop
IA: Dubuque County (19061) 2010 498.9 559 93,924
IA: Dubuque County (19061) 2011 492.2 558 94,612
IA: Dubuque County (19061) 2012 472.1 540 95,227
IA: Dubuque County (19061) 2013 462.8 541 95,981
IA: Dubuque County (19061) 2014 521.6 622 96,587
IA: Dubuque County (19061) 2015 473.8 572 97,125
Malignant cancer frequency and incidence age-adjusted rates by year in
Dubuque County, 2010-2015
Rates are per 100,000 and age-adjusted to the 2000 US Std Population
(19 age groups - Census P25-1130) standard.
Rate Count Pop
2010 480.2 17,179 3,050,694
2011 475.8 17,217 3,065,389
2012 460.8 16,910 3,076,636
2013 457 16,952 3,092,224
2014 469.9 17,604 3,109,481
2015 462.1 17,603 3,123,899
Malignant cancer frequency and incidence age-adjusted rates
by year in state of Iowa, 2010-2015
Rates are per 100,000 and age-adjusted to the 2000 US Std
Population (19 age groups - Census P25-1130) standard.
2017 Cancer In Iowa, University of Iowa College of Public Health.
Mercy Dubuque CHNA 2019-21 Page 25 of 28
Significant Community Health Needs This CHNA identified the top needs within Dubuque County using the expertise of the
steering committee, community taskforces, and community wide survey. Those needs
fall into four categories of need within Dubuque County. The committee examined the
specific needs from each category and prioritized each of the 14 identified needs based
on magnitude of persons affected, impact on quality of life, feasibility and community
resources, and the consequences of inaction.
Work is underway to identify community partners and potential resources available for
addressing the significant health needs below. This information will be utilized in the
development of the implementation strategy.
Ranking of significant community health needs and brief description: 1. Opioid Use and Abuse – Our county has been particularly impacted by the opioid
crisis and lack of treatment and resources available across the community.
2. Obesity & Overweight – Over 40% adults in the community report being overweight.
3. Alcohol Use & Abuse – The age-adjusted percentage of adults who drink excessively in Dubuque County is 31.5%
4. Mental Health Access – We have many mental health resources in the community, but there are significant access challenges related back to awareness of services,
provider availability, and insurance coverages.
5. Influenza Immunizations – Our community continues to see high incidence of influenza-associated hospitalizations year over year.
6. Healthy Homes – Data indicates particular concerns with childhood lead poisoning rates, household moisture and gas challenges, and general safety
issues impact the overall health and safety of the community.
7. Primary Care Access – Though uninsured rates are low, many surveyed, indicated challenges with accessing primary care related to insurance,
transportation, and availability.
8. Emergency/Disaster Planning – Community preparedness is the ability of communities to prepare for, withstand, and recover – in both the short and long terms – from public health incidents.
9. Drinking Water Protection – Data indicates private water supplies for those not served by public water systems are negatively impacted by inadequate
wastewater treatment in un-sewered communities.
10. Dental Care Access
11. Specialty Care Access
12. Elder Care Access
13. HIV/AIDS Screening and Prevalence – Dubuque County has a high incidence of known positive HIV/AIDS diagnoses and data indicates 14% of Iowans living with
HIV are undiagnosed.
14. STD/STI Screening and Prevalence – Gonorrhea and Chlamydia infection rates are higher than the state averages.
Mercy Dubuque CHNA 2019-21 Page 26 of 28
Conclusion This assessment is an effort to analyze the current state of health and socioeconomic
factors in the Mercy Medical Center-Dubuque service area.
Limitations and inconsistencies in available data can make it challenging to accurately
compare indicator performance between the local communities, the state and the nation
as a whole. As areas of concern are selected for further conversation about community
collaboration and community benefit planning, additional data may be sought if needed.
There are some indicators where local-level data was not available and this assessment
may point out areas for future data collection.
Implementation Strategy The identified priority needs will be incorporated into a Mercy Medical Center – Dubuque Community Benefit Implementation Strategy that will inventory current
programs in place and recommend additional services and collaborative efforts to
target priority needs. Once drafted, the Community Benefit Implementation Plan will be
presented to the Mercy Medical Center – Dubuque Board of Trustees for input and approval, after which objectives and targets will be established to integrate into the
hospital's operating plan and budget.
How to obtain copies This Community Health Needs Assessment will be posted to the Mercy website:
http://www.mercydubuque.com/community-health-needs-assessment . Paper copies of
this document are available upon request by visiting the Information Desk at either
Mercy Dyersville or Mercy Dubuque. You can also write or call the Office of the
President to request a copy of the document.
Office of the President
Mercy Medical Center Dubuque & Dyersville
250 Mercy Drive
Dubuque, Iowa 52001
Phone: 563-589-8037
Contact Information Mercy invites your feedback regarding this Community Health Needs Assessment. If
you would like to share your feedback with us, please contact the Office of the President
for Mercy Dubuque and Dyersville by phone or by mail (below).
Office of the President
Mercy Medical Center Dubuque & Dyersville
250 Mercy Drive
Dubuque, Iowa 52001
Phone: 563-589-8037
Mercy Dubuque CHNA 2019-21 Page 27 of 28
http://www.mercydubuque.com/community-health-needs-assessment
Next CHNA Due Date The next Community Health Needs Assessment will be scheduled for completion by
June 30, 2021.
Mercy Dubuque CHNA 2019-21 Page 28 of 28
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