3. Community Health Needs Assessment Flashcards

1
Q

Health Surveys
Monitor the ____ of a nation, state or community.
National Health and Nutrition Examination Survey (____)
* Measures health and ____ status of adults and children in the United States
* Interviews and ____ examinations
* Participants are representative of the current ____
* NHANES data is used to design ____ and services

A
health
NHANES
nutritional
physical
US population
health programs
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2
Q

Evaluation Studies
Determine overall ____ in meeting program goals and objectives.

What are the most common types of evaluation?
____ evaluation ensures that a program or program activity is feasible, appropriate, and acceptable before it is fully implemented, e.g., ____ my goals and objectives?
____evaluation determines whether program activities have been implemented as intended, e.g., ____
____evaluation measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve, e.g., lower ____ of ECC
____ evaluation assesses program effectiveness in achieving its ultimate goals, e.g., reduce ____ in ECC

A
effectiveness
formative
achieved
process/implementation
time line
outcome/effectivness
prevalence
impact
disparities
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3
Q

Needs Assessments
Identifies key health needs and issues through
____, comprehensive data collection and analysis.
* ____ collaborations
* ____ ownership of all
phases of community health improvement
* Involving the ____ to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs
CDC CHA

A

systematic
multisector
shared
community

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4
Q

Definitions

	• Telephone surveys get you a lot of info quickly
		○ Can hire polling groups
	• CDC has additional guidelines
	• Surveys
		○ Form \_\_\_\_
		○ Isn't automatically a \_\_\_\_
		○ NHANES
			§ Interview survey
			§ People \_\_\_\_ better things
				□ 66% people say they go, but the economic data doesn't match up - says there's 37%
			§ Includes a dental portion
				□ Well \_\_\_\_
			§ Use to design programs/services
			§ \_\_\_\_ done
	• Evaluation studies
		○ Look at effect of program
		○ May use as part of activities in NA
		○ Use it to evaluate program and to show what to add
		○ Formative
		○ Process and outcome are at the \_\_\_\_
A
basis
needs assessment
self-report
representative
nationally

end

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5
Q

Rationale - Community Health Needs Assessment

— Learn about community needs in a ____ organized way incorporating multiple perspectives: political leaders, health care organizations, community members
—
Locate ____ needs & services using national and local data mapped via GIS and other computer mapping tools
—
Find ____ in needs & services and Develop community programs to meet needs
—
Use ____ to justify and document need for community programs

— Write competitive ____ applications require justification and documentation about the need for dental services

• Answers why
• Do not want to waste money
	○ Existing needs!
	○ Computer maps with GIS
A
systematic
existing
gaps
data
grants
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6
Q

General anatomy of a health services grant

____
¡ Mission, purpose, and instructions in a grant application

— Problem statement /Needs Assessment
¡ Document the health issue with ____ data

____
¡ Goals and objectives describing the plan to address a health issue.

____
¡ Timeline, activities and staffs’ roles and responsibilities for the project

____
¡ Does it work? Goals and objectives met?

____
¡ Experience and credentials of leadership, key staff, and evaluators
¡ Infrastructure, partnerships, letters of support with specific roles described

____
¡ Describe how funds will be spent, line item, categories for each year of the funding period

A
request for proposal (RFP)
verifiable
methodology
work plan
evaluation
organizational capacity
budget narrative
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7
Q

What is a Needs Assessment (NA)?

— Instrument/tool that helps one to match community ____ with services and resources.
— Different needs assessment models.
— Roadmap for oral health needs assessment
¡ Assessing Oral Health Needs: ASTDD ____-Step Model http://www.astdd.org/oral-health- assessment-7-step-model/

A

needs

seven

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8
Q

NA key principles

— Distinguishing between ____ needs and the wider needs of the ____ is important in the planning and provision of local health services.

— Health needs assessment is the ____ approach to ensuring that the health service uses its resources to improve the health of the population in the most ____ way.

— It involves ____, qualitative, and ____ methods to describe health problems of a population; identify inequalities in health and access to services; and determine priorities for the most effective use of resources.

— Successful health needs assessments require a ____ understanding of what is involved, the time and resources necessary to undertake assessments, and sufficient integration of the results into planning and commissioning of local services

A

individual
community
systematic
efficient

epidemiological
comparative

practical

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9
Q

Examples of variables, measures in oral health needs assessment

• Look at who the people are (1)
	○ From the \_\_\_\_
• Oral health status from \_\_\_\_ (2)
• Risk reduction (state fl data from \_\_\_\_)
• MA - medicaid state office
	○ Who are the dentists that accept medicaid
	○ How can we match patients with best \_\_\_\_
• ASTDD
	○ Takes through each step
	○ Doesn't need every \_\_\_\_
	○ Based on the \_\_\_\_
A
US census
NHANES
CDC
population
step
population
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10
Q

• Poverty (darker is greater number of people below poverty line), and the dots are dentists
• A lot of dentists in the reading area
• Border of berks and montgomery - poverty, but not many dentists
• Dentists often ____
on shopping centers, easy access in roads
• Interview data (patient perception)
○ ____
practice
○ Information that’s local for them

A

cluster

oral health

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11
Q

Toolbox for conducting a Needs Assessment 9

— Follow your ____ (What is really important, why?)
— Advisory committee
— Consumers, providers, stakeholders’ ____ (surveys, interviews)
____, American Fact Finder (population, race/ethnicity, ____3, education, health insurance3, employment)
— Contact your state ____ staff (addresses of participating dental providers – need to Geocode GIS )

A
instinct
input
us census
poverty
medicaid
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12
Q

Toolbox (cont.) 10
— Licensure renewal ____ (#s dentists with active licenses)
— State-wide dental workforce ____ survey
¡ Pulse of Pennsylvania’s Dentist and Dental Hygienist Workforce
— Statewide ____ Health Needs Assessment (every 5 years)
— GIS Maps J , interactive online, desktop licensed software. e.g.. ESRI, ArcMap (fluoridation, population sociodemographic data, dental workforce capacity)

• Every time renew license - take a survey on whether you take \_\_\_\_  patients
	○ Ensures accurate information from dentists
A

web site
capacity
maternal and child
medicaid

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13
Q

Chester County has population of 512,784 individuals
• 87.1% White, 7.0% Hispanic
or Latino, 6.4% Black or
African American, 4.5% Asian
• Wealthiest county in PA:
407,952 at or above the 200% of Federal Poverty Level (FPL), with 33,895 below 100% of the FPL
• Those below the FPL were ____ householders with no husband present
• ____ had the highest percent below the FPL

• Chester county
	○ Shares borders with two other states
	○ Significant black, hispanic and asian population
	○ Significant poverty in this \_\_\_\_ county
• Kennett square
	○ Grow mushrooms
	○ Large agricultural area
A

female
hispanic or latinos
wealthy

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14
Q

Health Insurance 12
____% had health insurance coverage (2009-2013)
____% had private health insurance (2009-2013)
— The majority of uninsured were persons ____ years of age.
— More ____ were uninsured than females.

A

91.9
82.9
18-64
males

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15
Q

Educational attainment 13

____% high school graduates
____% bachelor’s degree or higher
— Persons with less than a high school education resided in ____ Chester County
¡ CT 3080 Oxford
CT 3117 London Grove
CT 3065.04 Central New Garden
CT 3034.01 Southern Kennett Square CT 3049 Honeybrook Township

• Five counties served by la communidad hispana
A

92.8
48.5
southern

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16
Q

• Chester county has enough dentists
• Philly has 40 per 100,000
• Surrounding suburban counties have 60+
• ____ county
○ More bears than dentists
• Philly and Pittsburgh, and not much in between

A

potter

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17
Q

Dental Indicators 15

— Chester County dentists less likely to accept ____ patients
¡ Southern Chester County has no dentists currently enrolled in the ____ program in the following zip codes: 19362, 19363, 19352, 19310, 19330, 19311, 19374, and 19348.
— Fluoridation of water systems
¡ Kennett Square (____ fluoridated)
¡ Avondale, West Grove, London Grove, Kennett townships and Oxford (____ fluoridated)

A

medicaid
medicaid
partially
not

18
Q

Workforce capacity

* PA is 28%
* Chester is \_\_\_\_
A

15%

19
Q

Dental coverage participation, PA and Chester County, 2013

• \_\_\_\_ county is taking fewer medicaid and medicare
	○ Less than half
A

Chester

20
Q

Dentists enrolled in medicaid accepting patients, June 2015

• All \_\_\_\_ dentists take medicaid
	○ No \_\_\_\_ were taking
	○ And no \_\_\_\_ were taking
• GD 35%, ortho was 33%
A

pediatric
perio
OS

21
Q

Driving distance and travel time to safety-net
dental clinic 19

South Pottstown to West Nottingham
Driving Distance: 51.6 mi , Duration: 1 hour 13 min.
Kennett Square to West Chester
Driving Distance: 12.4 mi , Duration: 24 min.
West Nottingham to Coatesville
Driving Distance: 23.6 mi , Duration: 34 min.

• CVIM - central chester county
• \_\_\_\_ was a barrier
	○ Very little \_\_\_\_ transportation
A

transportation

public

22
Q

Average score consumers’ opinions dental care

	• Convenience sample
	• \_\_\_\_ of dental care was high
		○ Everyone agreed \_\_\_\_ caused cancer
		○ First dental visit by 12 mo of age
	• Dentist was too \_\_\_\_ away
A

knowledge
smoking
far

23
Q

Justification for new dental facility in Southern
Chester County 21

— A significant number of individuals living below 50% of the Federal Poverty Level
— 14, 585 below 200% of Federal Poverty Level (So. Chester Co.)
¡ 82,550 below 200% (county-wide)
— Area with low ____ attainment and non-
optimally fluoridate water systems
— Large concentration of ____ persons
— Small number of dentists with active license
— No dentists in the area accepting ____

• Give you money to increase \_\_\_\_, \_\_\_\_ money to purchase equipment, and \_\_\_\_money to hire dentists
A

educational
uninsured
medicaid

dental services
capital
operational

24
Q

Sustainability – new public health clinic 22

____Medicaid dental reimbursement for FQHCs
¡ Prospective Payment System4
÷ Dental services reimbursed for ____% of their reasonable
costs
÷PPS payment rate increased each year by a standard medical inflation factor, known as the ____.
• FQHC 330 grant
• Bureau Health Professions grants

• Enhanced medicaid dental reimbursement
	○ More money than a private dentist would get
• Safety net clinics
A

enhanced
100
medicare economic index

25
Q
  • Red - more dentists that took medicaid closer to the ____
    • Pockets where dentists do not take medicaid
    • Who are the very poor in chester county
    ○ Below ____ poverty level
A

border

0.5

26
Q
  • CVIM is located ____ in chester county

* LCH is close to delaware border and mushroom farms

A

centrally

27
Q
• Most of township is not \_\_\_\_
	• Longwood gardens - multiple wells on the property
	• Fluoridation is in more \_\_\_\_ levels
		○ But spotty at best
		○ Needs political advocacy
A

fluoridated

low-income

28
Q

• Red hotspots are philly/suburbs, harrisburg and pittsburgh
• Clustered around major ____
• LCH
○ ____ dentists in the county

A

highways

6-9

29
Q

West Philadelphia

• 14.2 square miles
• 394,000 people (22%)
• Lenape Indians settled
6,000 years ago
• Brits settled in 1677
• Phila Suburb until 1854
• 3 Golf Courses
• Philadelphia ZOO
• Fairmount Park Innovations in Music, Transportation, Health Care
• West - lancaster county
• Lateral - new york
• Farther south - atlantic ocean
• West philly has the schulkyll river front
	○ Exploded when the bridges were built
• Smaller than chester county, but similar \_\_\_\_ (400 vs 550)
A

people

30
Q
  • ____ urban city, 31% of families with children in poverty, ____% adults employed
  • More adults (67%), less ____ (21%) living in West Philadelphia than Phila or PA• Employed in ____ jobs
A

poorest
87
children
lower-income

31
Q

West Philadelphia: 389,000 individuals

Compared to Phila and PA
• Higher % of adults, fewer children, fewer seniors
• 61% Black, 27% White, 7% Asian, 2% Other
• 87% working at least ____ hours per week
• 31% of population below ____
• Median ____$33,400, less than Phila or PA
• Highest level of education: 50% HS grads, 25% College grads, less than Phila or PA

* Much more black individuals (chester is 87% white)
* Working population
A

20
poverty line
income

32
Q

Health Status in West Philadelphia
• Higher ____ rate (10,759 per 100,000), higher than Philadelphia (9,143) and US average (6,635).
• Higher death rate from ____disease(232) than PA (203). 39% have hypertension, with 49% of poor with hypertension as compared with 33% of those with incomes above poverty level.
• 15% have ____, higher than Phila (12%) and PA 9.5%.
• 32.6% are ____, as compared to 31% in Phila and 28%in PA. 28% of children are obese as compared to 24% in Phila and 18% in PA.
• Four West Phila zip codes have the highest prevalence rate of ____ (1,126), ____ times higher than PA

A
premature death
coronary heart
diabetes
obese
HIV/AIDS
five
33
Q

Health Care Access in West Philadelphia

  • 17.3% adults lack ____, with 24% of poor without insurance, higher than PA at 12.2%
  • 16.1% adults did not visit a physician, and 43.6% did not visit a ____, higher than PA at 31.9%
  • 14.5% did not seek care due to cost, 15% did not fill a prescription due to cost, 26% did not visit a dentist due to ____
  • ____% children have a regular source of care, 13.2% adults did not, higher than PA at 11%.
    • Chester county had higher rates of health insurance
    • Develop community clinics - many patients to see
    • Children unaffected
A

health insurance
dentist
cost
98

34
Q
  • Geographic maldistribution, although on average have enough dentitsts, but concentrated in ____ areas
    • Many counties are rural
A

urban

35
Q

Oral Health Workforce

  • 9,400 DMD; 8,200 RDH; 550 PHDHP
  • Currently providing care: 80% dentists, 82% hygienists, ____% PHDHP
  • 86% in solo dental practice; 24% accept Medicaid
  • 55 of 91 PA counties report ____
  • Per 100,000 population: 55 urban dentists, 36 rural dentists
  • West Philadelphia: 16 private dentists, one non- profit pediatric dental center and one dental school (including CHOP) to serve 389,000• PH hygienists can work without supervisison of dentist, but must refer to a dentist
    ○ Take students and do all the things, and then refer back to dentists
    • Can never get 100% of dentists providing care; can be retired but still have license
    • Of the PHDHP, only 28% say they’re acting - ____ won’t reimburse them directly
    ○ Private insurance would only reimburse ____
    ○ Class action lawsuit is in progress
    • Want ____ patients (1:5000 is a shortage)
    • West philly is shortage - few private dentists
A
28
dentist shortages
medicaid
dentists
1:2000
36
Q

Community Strengths

Locke School & Belmont Community
• \_\_\_\_ Agencies 
• Sources of \_\_\_\_ 
• \_\_\_\_ Based Resources 
• \_\_\_\_ Programs
A

social service
health care
faith
educational

37
Q

Locke School Dental Health Status

• School Census: 320 Children
• 152 Screened for Oral Health Status
– 28% (n=42): No active dental decay
– 72% (n=110): At least area of \_\_\_\_ 
– 16% (n=24): \_\_\_\_
• Comparison with State and National Averages
A

dental decay

dental emergency

38
Q

• Philly has 45%

○ Found it was actually ____

A

72%

39
Q

• NHANES information
○ Dental decay - DMFT - in general, 21%
○ Belmont is much higher than ____ or ____ average

A

state

national

40
Q

Pennsylvania Oral Health Assessment & State Health Plan

  1. ____ & Monitoring of Oral Diseases
  2. ____ Barriers
  3. Prevention of ____
  4. Oral Health ____
  5. ____ Populations
  6. Water ____
A
assessment
financial
oral disease
workforce
special
fluoridation