Unit 6 Health Care Delivery Project

DN713 Epidemiology and Social Determinants of Population Health

Community Health Assessment

Conducting a Community Health Assessment is the first step when evaluating your community and highlighting the stark differences in health that stem from injustices and barriers to health opportunities in communities such as the rural Texas community of Wheeler, Texas, located in Wheeler County. Wheeler is in the Panhandle of Texas and has a population of 1,481 according to the latest Census of 2019 (Congress, 2017). We can uncover the barriers to healthcare in Wheeler by conducting Community Health Assessment. The assessment facilitates the development of policies and interventions that are necessary to mitigate healthcare disparities. By completing this research, the goal is to improve the overall population health in that community. It is difficult to identify what measures are needed to enhance a community’s health care services without comparing it to other similar communities in population and location. Community Health Needs Assessment (CHNA) is a website used to reach that data. (Growing community power to improve health equity, n.d.) The gathering of the collaborative data, analyzing, and evaluating the data is necessary when determining the health care needs in a community and then designing policies for mitigating the identified problems (Alfano-Sobsey et al., 2014). To evaluate issues faced in this community, I used information from Healthy People 2020 (“Global Environment Outlook Geo-6 Healthy Planet, Healthy People,” 2019)as a guide. I used the Healthy People data as a guide on what to search for when conducting my research.

I also utilized the CHNA website (Panhandle Community Services [PCS], 2019), which has the State of Texas Community Needs Assessment data. From the review, the majority of the population in this area are uninsured or underinsured. There is also limited availability of first aid providers, and the ratio of first aid providers to the general population was starkly deficient. The data that is collected can also be used to examine how to maximize cost-effective health care delivery to this community of uninsured or underinsured patients. Evaluating the quality of care in the community can also give data on what interventions are needed to provide high-quality healthcare to this community. Ideally, residents should access primary care, public health services and prompt care in the ER, and behavioral health. Healthy People 2020 state that access to healthcare is essential for:

Mental, physical and social health

Prevention of diseases

Diagnosis, Treatment, evaluation of illness

Avoiding preventable death

Life quality

Life expectancy

Residents in Rural areas encounter barriers to healthcare that cause delays in care. This includes the basic care that they need. Rural residents have the right to have sufficient access, necessary and appropriate healthcare services that are available and obtainable promptly. Other factors can influence healthcare accesseven when an adequate servicesfor healthcare services exists in the community, (Fahs, 2020). For example, the healthcare literacy of the patient can be a barrier to healthcare if the patient does not understand the education that is needed to care for themselves. This could be related to a language barrier or the education level of the patient.

Method of Data Collection

The health assessment was started by determining the demographics of Wheeler County, Texas. I utilized the Panhandle Community Services(PCS) 2019 Community Needs Assessment (CNA) report (Panhandle Community Services [PCS], 2019). I was able to see the demographic and social determinants, including multicultural and how diverse the community is in Wheeler County, Texas. The economic status of the Wheeler County, Texas, was determined using the following indicators- household income, home ownership, unemployment rate, educational opportunities, and average income, in comparison with the state of Texas and the United States (USA). For example, the average pay for a household is $51,114 (Panhandle Community Services [PCS], 2019). The report shows clearly that the income level for Wheeler County is below the average for Texas (Texas $55,668) and even for the United States ($55,775). (PCS, 2019).

According to Panhandle Community Services [PCS], 2019, is 18.80% of people in the Panhandle of Texas did not graduate from high school. Additionally, eleven (42%) counties have more than 20% youth with less than a high school diploma. The number of residents that receive a high school diploma, some college, and a degree is higher than the state of Texas and equal to or slightly lower than the United States (Panhandle Community Services [PCS], 2019)however, the Panhandle has fewer people with bachelors and graduate/professional degrees than the United States. Lower education has a significant impact on economic development in the Panhandle. The percentage of residents that do not have a high school education in Wheeler County, TX is 18.7%, and the 13.35% in the United States. Wheeler County has a significantly higher number than most of the USA for high school dropouts. Except for retail stores and processing plants, the employment opportunities in the entire Panhandle are primarily small and family businesses such as farming and ranching offer employment opportunities for most residents.

Some of the findings of the community need assessment are employment, education, healthcare access, insurance, safe housing, and food availability. Employment is a factor because of the low educated workforce, the bulk of jobs do not pay well, and the variable of small/family businesses, coupled with the low education attainment that has no focus on future areas, and limited access to trade schools are barriers for Wheeler Residents regarding education and employment. The lack of dental care and affordability even with Medicaid or Medicare insurance, or the lack of health insurance altogether is a significant barrier to care. Most residents are not eligible for Medicaid and the lack of mental health services are also a factor for many withunderinsured patient when it comes to their healthcare. Safe housing to rent or buy due to lack of quality housing stock is a huge concern in this area. Access and transportation causing food desertscoupled with limited food pantry availability, is a major concern. The findings show that 17.2% of the population in Wheeler County lives in poverty. The uninsured population of Wheeler County with 5,618 residents is 1,056, which is 22.7% of residents by data from 2015 (PCS, 2019)

Data from the focus groups are utilized to discuss perceived healthcare issues in a community’s future more prominent and intimate setting. During the presentation, the community can talk about the available local healthcare. The encouragement to participate allows for the discussion of the perception of the public regarding general healthcare. The data obtained will enable us to better understand and take advantage of the group effect of shared experiences by showing how people perceive things differently (Becker, 2014). When conducting the interviews, the goal is to include community leaders in the assessment. Involving community leaders in the process can show the community that these activities are taken to improve the community; Therefore, creating validation of the research and the need for the evaluation to be as inclusive as possible.

Involving the community is the goal of the focus group. The focus group provides validity to the survey. Focus groups also improve the quality and provision of data that is obtained during the session(Becker, 2014). When gathering other secondary data for data related to the community, we would use resources from the 2018 County Health Ranking, which measures associated health factors (County Health Rankings, n.d.). Truven Health is a company that has supported a transformational change in the delivery of quality care. Truven Health advocates for better outcomes for all, better use of resources by companies, and better experiences for individual patients and the persons delivering that healthcare. (“Improving Decision-Making Using Health Data Analytics,” 2020). This database is a search engine that discovers clinical shortages and outpatient statistics, called MarketScan. The MarketScan databases are a family of administrative claims databases that contain data on inpatient and outpatient claims, outpatient prescription claims, clinical utilization records, and healthcare expenditures(Stewart, 2018).

Factors that impact the health and wellness

When assessing the community, itis essential to understand the factors that influence community health and wellness. Barriers commonly found within the communities include transportation, assesses of behavioral health addiction and dental care services, uninsured and underinsured patients, availability of providers, lack of knowledge about health conditions, language barriers, and fear of the healthcare system. The data collected was obtained from portions of the assessment through the survey, interviews, and focus groups. The research allows us to narrow down to a significant problem that needs to be addressed. This is how new programs can be created and funding secured to support them.

Evaluating the data collected

After collecting and analyzing the data, we identify the health priorities: medical conditions, health behavior, and community conditions. During the process, we can also look for the causes of these health issues and thus will lead us to the necessary implementations and strategies that can be put in place to address these priorities. The plan will also include ways to measure the effectiveness of the health improvement strategies and health outcomes with the development of obtainable goals (Pennel etal., 2016). In the Wheeler County assessment, the most significant concerns discovered were the lack of insurance, lack of trust in the local health facility, lack of an excellent preventative health system such as providing care to underinsured and uninsured patients focus on preventive healthcare programs.

Screening Tool

The screening tool I selected to discuss is the INTERMED Self-Assessment questionnaire (IM-SA). This questionnaire was developed as an alternative to the INTERMED Complexity Assessment Grid interview (IM-CAG) to assess biopsychosocial complexity and health care needs to optimize care(Burrus et al., 2020). The self-assessment INTERMED questionnaire is one of the most reliable screening tools available to detect patients with complex medical care needs. It is valuable and dependable when identifying patients who are high utilizers of healthcare services with complex medical conditions. To the best of our knowledge, there is no research addressing the association of biopsychosocial complexity and healthcare costs(Burrus et al., 2020). The questionnaire is efficiently utilized and can be given to participates at the focus group gathering. The results are easily tallied and reliable. This allows the information to be evaluated and applied to the formation of programs and policies needed to care for residents in the community.

Conclusion

Community Health Assessments are valuable tools for the reason of evaluating the lives of residents in a community. The data obtained is used to create community health improvement plans. The community health improvement plan is a systematic effort that is long term used to address public health issues and concerns. The findings are based on the results of community health assessment activities. The results are then used to formulatethe community health improvement process.A community health assessment gives a comprehensive look into community’s current health status, the needs, and any issues that exist. The information is used to help develop the community health improvement plan using the information from the study to show where and how resources should best be used and allocated to meet community needs (Alfano-Sobsey et al., 2014). These assessments and the finding discussed in this paper can be used to promote change in community and can help engage stakeholders to address community needs, creating better lives for all the residents in Wheeler County, Texas.

References

Alfano-Sobsey, E., Ledford, S., Decosimo, K., & Horney, J. A. (2014). Community health needs assessment in wake county, north carolina. North Carolina Medical Journal, 75(6), 376–383. https://doi.org/10.18043/ncm.75.6.376

Becker, K. L. (2014). Conducting community health needs assessments in rural communities. Health Promotion Practice, 16(1), 15–19. https://doi.org/10.1177/1524839914555887

Burrus, C., Vuistiner, P., Léger, B., Stiefel, F., Rivier, G., & Luthi, F. (2020). The self-assessment intermed predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments. Clinical Rehabilitation, 35(1), 135–144. https://doi.org/10.1177/0269215520949170

Congress, U. S. (2017). Census 2020. Createspace Independent Publishing Platform.

Fahs, P. (2020). Covid – 19 and rural health care: Editorial. Online Journal of Rural Nursing and Health Care, 20(1), 1–5. Retrieved October 7, 2021, from https://doi.org/10.14574/ojrnhc.v20i1.626

Global environment outlook geo-6 healthy planet, healthy people. (2019). In Global environment outlook – geo-6: Healthy planet, healthy people (pp. iii–v). Cambridge University Press. https://doi.org/10.1017/9781108627146.001

Growing community power to improve health equity. (n.d.). How healthy is your county? | county health rankings. County Health Rankings & Roadmaps. https://www.countyhealthrankings.org/

Improving decision-making using health data analytics. (2020). In Big data and health analytics (pp. 316–339). Auerbach Publications. https://doi.org/10.1201/b17945-19

Panhandle Community Services. (2019). Changing Lives Leading Change. Community Needs Assessment Report 2018 (Panhandle Texas CNA, January and May 2018) [Report]. Panhandle Community Services 2019 Community Needs Assessment. https://www.pcsvcs.org/images/uploads/documents/pcs-cna-report-2018.pdf

Stewart, E. (2018). Rural mental health policy and parity. In Mental health in rural america (pp. 8–27). Routledge. https://doi.org/10.4324/9781315189857-2