3. Community Health Needs Assessment Flashcards
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
health NHANES nutritional physical US population health programs
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
effectiveness formative achieved process/implementation time line outcome/effectivness prevalence impact disparities
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
systematic
multisector
shared
community
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 \_\_\_\_
basis needs assessment self-report representative nationally
end
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
systematic existing gaps data grants
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
request for proposal (RFP) verifiable methodology work plan evaluation organizational capacity budget narrative
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/
needs
seven
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
individual
community
systematic
efficient
epidemiological
comparative
practical
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 \_\_\_\_
US census NHANES CDC population step population
• 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
cluster
oral health
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 )
instinct input us census poverty medicaid
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
web site
capacity
maternal and child
medicaid
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
female
hispanic or latinos
wealthy
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.
91.9
82.9
18-64
males
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
92.8
48.5
southern
• 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
potter
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)
medicaid
medicaid
partially
not
Workforce capacity
* PA is 28% * Chester is \_\_\_\_
15%
Dental coverage participation, PA and Chester County, 2013
• \_\_\_\_ county is taking fewer medicaid and medicare ○ Less than half
Chester
Dentists enrolled in medicaid accepting patients, June 2015
• All \_\_\_\_ dentists take medicaid ○ No \_\_\_\_ were taking ○ And no \_\_\_\_ were taking • GD 35%, ortho was 33%
pediatric
perio
OS
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
transportation
public
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
knowledge
smoking
far
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
educational
uninsured
medicaid
dental services
capital
operational
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
enhanced
100
medicare economic index
- Red - more dentists that took medicaid closer to the ____
- Pockets where dentists do not take medicaid
○ Below ____ poverty level
border
0.5
- CVIM is located ____ in chester county
* LCH is close to delaware border and mushroom farms
centrally
• Most of township is not \_\_\_\_ • Longwood gardens - multiple wells on the property • Fluoridation is in more \_\_\_\_ levels ○ But spotty at best ○ Needs political advocacy
fluoridated
low-income
• Red hotspots are philly/suburbs, harrisburg and pittsburgh
• Clustered around major ____
• LCH
○ ____ dentists in the county
highways
6-9
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)
people
- ____ 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
poorest
87
children
lower-income
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
20
poverty line
income
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
premature death coronary heart diabetes obese HIV/AIDS five
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
health insurance
dentist
cost
98
- Geographic maldistribution, although on average have enough dentitsts, but concentrated in ____ areas
- Many counties are rural
urban
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
28 dentist shortages medicaid dentists 1:2000
Community Strengths
Locke School & Belmont Community • \_\_\_\_ Agencies • Sources of \_\_\_\_ • \_\_\_\_ Based Resources • \_\_\_\_ Programs
social service
health care
faith
educational
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
dental decay
dental emergency
• Philly has 45%
○ Found it was actually ____
72%
• NHANES information
○ Dental decay - DMFT - in general, 21%
○ Belmont is much higher than ____ or ____ average
state
national
Pennsylvania Oral Health Assessment & State Health Plan
- ____ & Monitoring of Oral Diseases
- ____ Barriers
- Prevention of ____
- Oral Health ____
- ____ Populations
- Water ____
assessment financial oral disease workforce special fluoridation
