The executive summary of a needs assessment summarizes the longer actual needs assessment report. It is a shorter version allowing readers to become more quickly informed about the topic at hand. For this assignment, rather than writing a full-scale needs assessment for your health issue and target population, you will prepare an executive summary.
Your executive summary is to be based on the primary and secondary data you have collected thus far on your health issue and target population in your chosen geographic region. That is, your key informant interview will serve as your primary data, while the statistics and other information from the scholarly literature you collected for your annotated bibliography will serve as your secondary data. This data must be synthesized together to inform the sections of your executive summary.
To give you guidance on how these summaries can be prepared, I have attached three examples of executive summaries of health-based needs assessments. They are all different. Please browse through them to get a sense of what you might want to include in this assignment. You have some flexibility with how you present your information, but you do need meet the following guidelines:
Requirements:
• Content must be 3-4 pages in length (this length requirement does not include the cover or references pages)
• Begin with APA-style cover page
• End with APA-style references page (remember to cite all sources in APA-style within the body of your executive summary!)
• Content sections, at a minimum, must include:
- Introduction
- Community profile (i.e. the geographic region you are focusing on) – including overall priority health need. In addition, status of your specific chosen health issue among your chosen target population (e.g. determinants, severity, social factors, recent history, etc.)
- Community programs/organizations addressing this issue (successes, challenges, what they are doing, etc.)
- Conclusions (be sure your conclusion’s language clearly justifies a need for a health program aimed at your health issue among your target population)
By
VERITÉ HEALTHCARE CONSULTING, LLC
And
COMMUNITY HEALTH ADVISORS, LLC
COMMUNITY HEALTH NEEDS ASSESSMENT
Executive Summary
– 2013 –
CS135507
Prepared for
BAYSTATE FRANKLIN MEDICAL CENTER
1
Executive Summary │ Community Health Needs Assessment 2013
This community health needs assessment
(CHNA) was conducted by Baystate Franklin
Medical Center (Baystate Franklin or the
hospital) because the hospital wants to
understand better community health needs
and to develop an effective implementation
strategy to address priority needs. The
hospital also has assessed community health
needs to respond to community benefit
regulatory requirements.
Baystate Franklin is a member of the
Coalition of Western Massachusetts Hospitals
(Coalition) which also includes Baystate
Medical Center, Mercy Medical Center,
Baystate Franklin Medical Center, Baystate
Mary Lane Hospital, Cooley Dickinson
Hospital, and Wing Memorial Hospital. The
Coalition hospitals collaborated in preparing
their CHNAs along with a “Design Team”
established by the Coalition. Information
about this collaboration is included in this
report.
Federal regulations require that tax‐exempt
hospitals provide and report community
benefits to demonstrate that they merit
exemption from taxation. As specified in the
instructions to IRS Form 990, Schedule H,
community benefits are programs or
activities that provide treatment and/or
promote health and healing as a response to
identified community needs.
Community benefit activities or programs
seek to achieve objectives, including:
improving access to health services,
enhancing public health,
advancing increased general
knowledge, and
relief of a government burden to
improve health.1
To be reported, community need for the
activity or program must be established.
Need can be established by conducting a
community health needs assessment.
The 2010 Patient Protection and Affordable
Care Act (PPACA) requires each tax‐exempt
hospital to “conduct a [CHNA] every three
years and adopt an implementation strategy
to meet the community health needs
identified through such assessment.”
CHNAs seek to identify priority health status
and access issues for particular geographic
areas and populations by focusing on the
following questions:
Who in the community is most
vulnerable in terms of health status or
access to care?
What are the unique health status
and/or access needs for these
populations?
Where do these people live in the
community?
Why are these problems present?
The question of how the organization can
best use its limited charitable resources to
address priority needs will be the subject of
the hospital’s separate Implementation
Strategy.
This assessment considers multiple data
sources, including secondary data (regarding
demographics, health status indicators, and
1Instructions for IRS Form 990, Schedule H, 2012.
measures of health care access), assessments
prepared by other organizations in recent
years, and primary data derived from a
community survey and from interviews with
persons who represent the broad interests of
the community, including those with
expertise in public health. A list of
interviewees is included in Exhibits 69
through 72 of the CHNA report.
The following topics and data are assessed in
this report:
Demographics, e.g., numbers and
locations of vulnerable people;
Economic issues, e.g., poverty and
unemployment rates, and the impact
of healthcare reform in
Massachusetts;
Community issues, e.g.,
homelessness, lack of affordable
housing, environmental concerns,
crime, and availability of social
services;
Health status indicators, e.g.
morbidity rates for various diseases
and conditions, and mortality rates
for leading causes of death;
Health access indicators, e.g.,
uninsurance rates, discharges for
ambulatory care sensitive conditions
(ACSC), and use of emergency
departments for non‐emergent care;
Health disparities indicators; and
Availability of healthcare facilities and
resources.
The assessment identifies a prioritized list of community health needs.Baystate Franklin will be
preparing an Implementation Strategy that describes how the hospital plans to address the
identified needs.
2
Executive Summary │ Community Health Needs Assessment 2013
EXECUTIVE SUMMARY
Baystate Franklin Community By the Numbers
33 ZIP codes in Franklin and Worcester
counties
Population (2012): 87,984
Projected population change (2012‐
2017):
o Growth of 1% overall; 16%
increase in the 65+ population
15% of Baystate Franklin’s discharges for
ambulatory care sensitive conditions
(ACSC)
ACSC discharges most common among
Medicare patients
Disparities for Black and Hispanic (or
Latino) residents:
o More likely to be living in poverty
o Higher rates of chronic disease
mortality (including stroke,
diabetes, and heart disease) in
Worcester County
o Comparatively high rates of infant
mortality in Worcester County
3
Executive Summary │ Community Health Needs Assessment 2013
The Baystate Franklin community, which
contains 33 ZIP codes in 30 towns in Franklin
County and parts of Worcester County,
benchmarks favorably on a number of health
indicators.However, health status and access
problems are present, and this assessment
seeks to identify the most pressing issues.
A person’s health is influenced by complex
(and interconnected) social and economic
factors, including income, education,
race/ethnicity, and local environment. Racial
and ethnic minority groups, children, the
elderly, and those with special needs are
more likely to lack the social and economic
resources necessary to maintain optimal
health. Such inequalities can create barriers
to access (to health services, employment,
quality education, healthy food, housing, and
other necessities and opportunities) and thus
contribute to poor health.
A community survey was conducted as a
major element of the CHNA methodology.
679 responses were received from residents
of Baystate Franklin’s community. Survey
results were post‐stratified to help assure
that they accurately reflect the community’s
demographics. Responses also were assessed
by race, insurance status, and education
status.
Survey results indicate that the community
has difficulty accessing prevention, wellness,
and mental health services. MassHealth
(Medicaid) and Medicare recipients are more
likely to rely on free or low‐cost clinics and
emergency room visits for basic primary care
needs, or they indicate that “no routine
healthcare is received.”
The community perceives top health issues to
include low income/financial challenges,
obesity, mental health, substance
abuse/addiction, and insufficient exercise.
Commonwealth Connector and MassHealth
(Medicaid) recipients identify unemployment
and dental health as additional issues.
Following is a brief summary of health issues
in the community served by Baystate Franklin
Medical Center. The summary is based on an
assessment of all study data sources,
including community interviews, the
community survey, and the wide array of
secondary data – all of which are described
and assessed in the report.
Demographics.
Fifteen percent of the community is 65 years
of older and 94 percent of the community is
White. However, the community is aging and
diversifying, driven by growth in elderly and
in Asian, Black, and Hispanic (or Latino)
populations.
Franklin County reports comparatively high
rates of disability, particularly among youth.
Disability can contribute to poverty, health
care access barriers, and poor health.
Economics.
Financial hardship (particularly in Sunderland,
Montague, and Greenfield) is a concern
throughout the community. Pediatric poverty
and unemployment also are comparatively
high. Unemployment and financial hardship
disparities exist for non‐White populations in
the community.
Lack of access to affordable, healthy food and
housing insecurity also are concerns for
vulnerable populations.
Social Factors.
Social and physical isolation and lack of
adequate transportation create barriers to
accessing care. Many residents must travel
outside the community for specialty care, a
need complicated by a lack of reliable
transportation. Due to the North Quabbin
region’s distance from Greenfield, Worcester,
and Springfield (where many services are
4
Executive Summary │ Community Health Needs Assessment 2013
5
Executive Summary │ Community Health Needs Assessment 2013
located), these residents are especially
impacted by issues of poverty, isolation, and
transportation.
The community would benefit from increased
integration and coordination of healthcare
and related human servicesacross different
programs and providers.
Child abuse also is a concern in the
community; additional early intervention is
needed.
Behavioral Factors.
High rates of smoking during pregnancy and
other infant health risk factors are present in
Franklin County. Low rates of healthy food
consumption and exercise andcomparatively
high rates of obesity also are present.
Prevalent substance abuse (including tobacco,
alcohol, and drugs) across the community is
complicated by resident difficulty in accessing
substance abuse treatment.
Mortality and Morbidity.
Poor mental health and poor access to mental
health care affect many in the community,
particularly vulnerable populations.
Some community residents experience a lack
of access to dental care. Many dentists will
not see MassHealth (Medicaid) patients,
there are long waiting times at local clinics,
and many residents do not have dental
insurance. Asthma and air quality are
community health issues, particularly for
children in Franklin County.
Care Access and Delivery.
Cost and an undersupply of certain healthcare
providers in the communityare resulting in
barriers to accessing primary, mental health,
and dental care.
Community residents also need additional
support in improving health literacy and
knowledge of available community services.
Discharges for Ambulatory Care Sensitive
Conditions (ACSCs, which are potentially
preventable if patients access primary care
resources at optimal rates), were about 15
percent of Baystate Franklin’s discharges.The
top four conditions were: bacterial
pneumonia, congestive heart failure, chronic
obstructive pulmonary disease or asthma,
and urinary tract infection.
The community has a variety of resources
working to address access barriers. There are
5 Federally Qualified Health Centers (FQHC)
located in the community: one community
health center, with three locations, and two
programs for the homeless. All serve
medically underserved areas and populations.
Priority Health Needs
This assessment begins by identifying the
communities served by Baystate Franklin.
Findings are based on various quantitative
analyses regarding health‐related needs in
those areas, a review of health assessments
conducted by other organizations in recent
years, information obtained from
interviews, and findings from a community
survey. Preliminary assessment findings
were discussed with community
stakeholders during a series of “listening
sessions” and feedback from participants
helped validate findings. Finally, Verité
applied a ranking methodology to help
prioritize the community health needs
identified by the assessment.
Including multiple data sources and
stakeholder views is important when
assessing the level of consensus that exists
regarding priority community health needs.
If alternative data sources including
interviews support similar conclusions, then
confidence is increased regarding the most
problematic health needs in a community.
Further information about the analytic
methods and prioritization process and
criteria can be found in the CHNA report.
The table that follows describes the health
needs identified throughout the assessment
as priorities in the community served by
Baystate Franklin Medical Center. These
needs are presented in alphabetical order,
by category. The prioritized list identifies
the 13 most problematic community health
needs found by this assessment. Needs
were determined by synthesizing findings
from multiple data sources; this exhibit also
illustrates the sections of the report on
which each community health need is
primarily based. For example, although the
report assesses a variety of data related to
obesity and its causes, Exhibits 31 and 39,
and findings from other assessments,
interviews, and the survey were key
contributors to identifying high rates of
obesity as a priority need.
6
Executive Summary │ Community Health Needs Assessment 2013
List of Priority Community Health Needs
Access to Care
Lack of Affordable and Accessible Medical Care (52, 53, 56, I, S)
Need for Increased Care Coordination (OA, I)
Health Literacy and Knowledge of Available Services (OA, I, S)
Dental Health
Lack of Access to Dental Care (52, 53, 56, I)
Health Behaviors
High Rates of Alcohol, Tobacco, and Drug Use, and Need for Additional Treatment (31, OA,I, S)
Maternal and Child Health
Smoking During Pregnancy (42, 46)
Child Abuse (I)
Pediatric Disability (Franklin County) (14)
Mental Health
Lack of Access to Mental Health Services and Poor Mental Health Status (52, 53, 56, OA, I, S)
Morbidity and Mortality
High Obesity Rate (31, 39, OA, I, S)
High Rates of Asthma in Schoolchildren (Franklin County) (40)
Social and Economic Factors
Basic Needs Insecurity: Financial Hardship, Housing, and Food Access (15, 17, 23, OA, I, S)
Physical and Social Isolation (OA, I, S)
Key
# (i.e., 2, 33, 54) Full Report Exhibit #
OA Other Assessments
I Interviews
S Survey
7
Executive Summary │ Community Health Needs Assessment 2013
- INTRODUCTION
- EXECUTIVE SUMMARY
Buildinga Healthy Community
Health Assessment & Community Service Plan
S e P t e m b e r
2
0 0 9
S i x C o u n t y r e g i o n o f n e w y o r k S t A t e
Essex, Fulton, Hamilton, Saratoga, Warren, & Washington
Copies of the full report are available online at
www.arhn.org
e x e C u t i v e S u m m A r y
ARHN / Health Assessment & Community Service Plan / September 2009
message to the Community2
Message to the Community
We are proud to present you
with this report of the six-county
Adirondack Region of Upstate New
York—a comprehensive collection
and analysis of data regarding
health issues and needs in Essex,
Fulton, Hamilton, Saratoga, Warren
and Washington counties.
This study was conducted to identify health
issues of primary concern and to provide critical
information to those in a position to make an
impact on the health of our region—governments,
social service agencies, businesses, healthcare
providers and consumers—to name just a few.
The results enable us to more strategically
establish priorities, develop interventions and
commit resources to improve the health of our
communities and the region.
Health is—and must be—an issue of concern and
action for all of us. We hope the information in
this study will encourage collaboration involving
all agencies, across county lines, between usual
competitors, and among funders to address the
complex health needs of our residents.
2
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary
3
Executive Summary
Introduction
Established in 1992 through a New York State
Department of Health Rural Health Network
Development Grant, the Adirondack Rural
Health Network (ARHN) is a community
partnership of public, private and non-profit
organizations in Upstate New York. ARHN links
local public health departments, community
health centers, hospitals, community mental
health programs, emergency medical services,
and other community-based organizations by
creating a collaborative process for developing
strategies and for implementing, monitoring
and evaluating the regional health care
system. The Upper Hudson Primary Care
Consortium, a 501-c-3 corporation licensed
as an Article 28 Central Service Facility, serves
as host organization for ARHN and provides
financial management, human resources, and
information technology support.
Since 2002, the ARHN has been recognized as
the leading sponsor of formal health planning
for Essex, Fulton, Hamilton, Saratoga, Warren
and Washington counties. Together with
community stakeholders, the ARHN has
developed and implemented a sophisticated
process of community health assessment and
planning for the defined region. The first ARHN regional community health assessment report was released five years
ago, in September 2004. Subsequent to the report’s release, the Adirondack Rural Health Network Community Health
Planning Committee (the Committee) has continued to meet on a regular basis. Together, they exchange information,
plan new initiatives, and develop strategies to produce an ever-current picture of the health care landscape that can be
used by stakeholders throughout the region.
The planning for the Adirondack Rural Health Network (ARHN) Community Health Assessment and Community
Service Plan 2009 began in August 2008 and was completed in August 2009. The process was guided by the
Committee, a collaborative team including county public health professionals, hospital and community agency
leadership. The Committee was supported by the work of the ARHN staff and Strategy Solutions and Holmes &
Associates as research consultants.
This study was designed around the Prevention Agenda Toward the Healthiest State rationale that was released in
2008, by New York State Health Commissioner, Richard F. Daines, M.D., In this document Dr. Daines states “The
Prevention Agenda is a call to action to local health departments, health care providers, health plans, schools,
employers and businesses to collaborate at the community level to improve the health status of New Yorkers through
increased emphasis on prevention.”
3
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary4
The Prevention Agenda identifies ten priorities for improving the health of all New Yorkers and asks communities to
work together to address them:
• Access to Quality Health Care
• Chronic Disease
• Community Preparedness
• Healthy Environment
• Healthy Mothers, Healthy Babies, Healthy Children
The ARHN Community Health Assessment and Community Service Plan 2009 is intended to be a tool toward reaching
the Prevention Agenda goals
Methodology
In response to this statewide call to action, the partners in the ARHN region came together in 2008 to evaluate their
past efforts and continue to improve their community health assessment and intervention planning process. In 2009,
the Committee was re-energized with the increased involvement of representatives from each of the hospitals in the
ARHN area. Their active participation allowed the Committee to expand its research and analysis to include hospital
utilization data. The hospitals’ involvement also resulted in an enhanced priority setting process that addressed
both the needs of the county public health departments and their required Community Health Assessment (CHA)
documents, as well as the needs of the hospitals and their required Community Service Plans.
The data collection, analysis and reporting process was managed by the ARHN staff and supported through the efforts
of Strategy Solutions and Holmes & Associates. From August 2008 through August 2009 members of the Committee
convened fourteen times to provide guidance on the components of the six-county study.
The data collection and analysis included six key components:
• The New York State Department of Health conducted an extensive Behavioral Risk Factor Surveillance Survey (BRFSS)
in 2008. The BRFSS was conducted by telephone surveys and collected information on health risk behaviors,
preventive health practices, and health care access primarily related to chronic disease and injury. The data is used
throughout the study.
• The 2004/07 ARHN Household Telephone Survey Data
• County, region and state disease incidence, and Healthy People 2010 goals
• New York State Prevention Quality Indicator data (PQI)
• Hospital utilization data from the Statewide Planning and Research Cooperative System (SPARCS)
• Input regarding barriers to health and ideas/priorities to improve the health of the community gathered from 286
individuals and agency representatives through 24 qualitative focus groups
Demographic & Socio-Economic Data
Population
In 2009, there are an estimated 445,985 people living in the six counties of the ARHN area, with almost one-half of
that population (49%) living in Saratoga County. In the 1960s and 1970s, the area’s population growth exceeded that
of the average for the U.S., in large part due to the population growth in Saratoga and Warren counties. In the 1990s,
• Infectious Disease
• Mental Health and Substance Abuse
• Physical Activity and Nutrition
• Tobacco Use
• Unintentional Injury
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary 5
population growth within the ARHN area fell below the average for the U.S. for the first time in 40 years. From 2000
to 2009 the population growth in the ARHN area was 5.1% as compared to 9.1% for the U.S. as a whole. The area’s
population growth is projected to continue to lag behind that of the U.S.
Age and Gender
The median average age in the
ARHN six-county area is 41
years of age, which is 4 years
older than the overall U.S.
median age of 37. Over 27%
of the area’s population is
within the two age categories
of 25-34 and 35-44, while over
three-quarters of the population
(79%) are 18 or older. About
11% are under age 10 and about
15% are age 65 or older. The
population pyramid illustrates
that the ARHN area has an
aging population.
Household and Household Income
In 2009, there were an estimated 179,596 households in the ARHN six-county area. From 2000 to 2009 the total
number of households grew by 8.4%. The average household income is $60,425. For the U.S. as a whole, the average
household income was $69,376. The per capita personal income in the ARHN area was $31,863 on average, which
was less than the averages for both New York ($46,364) and the U.S. ($38,615). On average, there were 2.48 persons
per household in the ARHN area in 2009, which is slightly less than the national average of 2.67 persons per household.
Ethnicity and Race
The ARHN area’s current estimated Hispanic or Latino population is 2.1%, while the United States current estimated
Hispanic or Latino population is 15.5%. For the ARHN area 94.8% are White, 1.9% are Black or African American,
0.2% are American Indian or Alaska Native, 1.2% are Asian, 0.0% are Native Hawaiian and Other Pacific Islander, 0.6%
are Some Other Race, and 1.2% are Two or More Races. By comparison, for the entire United States 72.5% are White,
12.5% are Black or African American, 0.9% are American Indian or Alaska Native, 4.4% are Asian, 0.2% are Native
Hawaiian and Other Pacific Islander, 6.7% are Some Other Race, and 2.9% are Two or More Races.
Poverty
In 2005, the ARHN region had 10.5% of the population living at or below poverty level. While lower than the overall
state rate of 13.9%, it was higher than the Upstate average of 10.1%. Only Saratoga and Warren counties had rates
better than the regional average. With the exception of Saratoga, all other counties had higher rates of children less
than 18 at or below the poverty level than the Upstate average of 13.5%.
Unemployment
In 2008, the ARHN six-county average unemployment rate was 6% as compared to 5.4% for the state and 5.8% for
the United States. There was an annual increase of 1 to 2% from 2007 to 2008 for each of the counties, as there was
nationally. New York State had a slightly lower increase in unemployment of .9% for the same period. The increase in
unemployment in the ARHN region from January 2008 to January 2009 indicates how much more severe the increase
Population Pyramid: Percent of Population in each Age Group
by Gender, for the 6-County ARHN Area (2009)
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary6
in unemployment will be for 2009 as a whole. In general, the June 2009 unemployment rate of 7.7% in the ARHN
counties was lower than those at the State (8.6%) or national (9.7%) levels. One exception was Fulton County where
the unemployment rate was 1% higher than the State rate. The somewhat lower June unemployment rates in the
ARHN area reflect, in part, the importance of the area’s seasonal construction, hospitality, and service industries.
Key Findings
Based on this study, the ARHN area is comparable in many ways to Upstate NY, as well as the state overall, in terms of
health status, behavioral risk factors and hospital utilization. Demographically, the region consists of a mix of suburbs
and rural small towns, where the population is relatively homogeneous, aging and growing at a slower rate than other
areas of the country. However, economic disparities do exist within the various counties and some sections of the
region face significant distance and transportation barriers to accessing community resources and services. While the
behavioral risk factor surveys indicate that people are becoming more aware of the importance of preventative health
and screenings, there are significant health risk behaviors and chronic diseases present.
Access to Quality Health Care
Overall, the health status of the region
is generally good and the majority of
adults indicate that they have health
insurance and access to primary health
care services. The regional rates are lower
than the Healthy People 2010 goals. The
majority of the region accesses primary
care services on an annual basis and
when appropriate. Those without a
dentist or physician most often cite lack
of insurance or felt they were healthy and
did not need one. A small but significant
percentage (11%) of the population
responded they delayed primary care
services due to cost and lack of insurance.
It is important to note that in some
of the ARHN areas the regional
distribution data indicates as much as
a 5% decline in the number of primary
care physicians per 100,000 population.
Research has shown that prevention is
an effective tool to keep people healthy.
People participating in early screening
programs have increased but the
majority of screenings have not met the
Healthy People 2010 goals. The only
testing indicator reaching the Healthy
People 2010 goal is Pap Testing, with
94% of women indicating in the 2008
NYSDOH survey that they had ever
received a pap test.
Access to Quality Care Utilization
Access to Quality – Preventive Testing
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary 7
Caring for the elderly and disabled persons will continue to grow as a regional issue as the population ages. In
the Adirondack region there are eighteen (18) nursing homes in five-counties with a total of 2,455 available beds
(Hamilton County has no nursing homes). While there are negligible geographic variations in nursing home
occupancy rates in the six-county Adirondack Region, the overall occupancy rate of 94% could indicate a potentially
growing barrier to access. Affordability of long term care is also a concern in the region, where the average cost of care
is estimated at $93,192 per year.
In the 2004/07 ARHN survey, 12% of respondents also indicated that they were the caregiver for a disabled or elderly
person who required special care. While the majority (73%) of respondents who are caregivers are able to have the
necessary care received within their home, this also suggests that additional supports may be needed for the remainder
of the population (27%) who do not. Of those indicating they did not feel the person in their care was receiving the
care they need, 25% indicated they “cannot find the services” and 31% indicated it was because of “cost, no insurance
coverage or only partial coverage.” Additionally, as reported in the Unintentional Injury section of the report, fall
related hospitalizations for persons age 65+ is 203.5 per 10,000 population, higher than the state average of 196.
Chronic Disease
A significant percentage of the population suffers from any one of a number of conditions, and many people suffer from
multiple conditions. There are diseases that do not always provide much warning and when there are warning signs they
are often ignored until it is too late, as evidenced by higher than average rates of premature and pre-transport mortality.
Chronic Disease Incidence – Self Report Chronic Disease Mortality
Chronic Disease Premature Mortality Chronic Disease Pre-Transport Mortality
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary8
In terms of cancer incidence, the averages for the ARHN region are fairly similar to the Upstate averages although there
were three cancers where the incidence was higher than average in four or more counties. The cancers are cervical,
malignant mesothelioma and oral cavity and pharynx cancer. The cancers with the highest incidence for the ARHN region
on average were prostate cancer at 160.3 per 100,000 residents and female breast cancer at 124.9 per 100,000 residents.
In terms of cancer mortality, the ARHN region average was generally at or below the Upstate average with the
exception of cervical cancer, where the ARHN average was 2.8 and the Upstate average was 2.2 per 100,000 residents.
Prostate cancer had the highest ARHN region weighted mortality at 27.3 per 100,000 residents, followed by breast
cancer at 23.5, colorectal at 19.1 and colon and rectum at 17.7.
Hospitalizations were below the Upstate average, especially for the most recent year’s data (2006), which, coupled
with the premature mortality statistics could suggest there is an increasing need for identification and management
of chronic diseases. For those diseases where hospitalizations do occur, Cancer is the most urgent priority with
Respiratory Disease, and Digestive Disease emerging. Although Urinary Disease is increasing, the volume of patients
this represents is relatively small. Heart Disease hospitalizations, although not increasing, still affects a large number
of patients in this region. Of less concern is Skin Disease which represents a small portion of the total patients and
has been decreasing over time.
Community Preparedness
Overall, the data boasts that 100% of the six regional counties, as well as the state, have emergency preparedness
plans, which indicates that the region is prepared for community disasters. However, only one in five (20%)
respondents reported in the 2004/07 ARHN survey that they have received training in First Aid and/or CPR in the
past two years.
Additionally, while the majority (77%) of regional respondents indicated that they were satisfied with the emergency
ambulance service available, transportation in the region continues to be a concern as evidenced by the regional pre-
transport mortality statistics, as well as the discussion regarding the importance of transportation in the focus groups.
Sixteen percent (16%) of regional respondents indicated that someone in their household had received emergency
ambulance services in the past 12 months. When asked what time of day they had utilized the ambulance, the most
frequent response was daytime, working hours, 8am-5pm (43%) followed by evening, 5pm-midnight (34%). Most
regional emergency ambulance services received a satisfaction rating around the average of 65%.
Cancer Incidence Rates Cancer Mortality
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary 9
Healthy Environment
A healthy environment is an important component of community health, and while focus group participants discussed
the importance of Air and Water Quality to the health of the region, local and regional statistics on air and water
quality are not available. Overall, 17% of the survey respondents in the region have been told they had asthma, which
is equivalent to the state rate. A total of 12% of respondents in the 2008 survey also indicated that they currently
have asthma, compared to a state rate of 10%, which is consistent with rates in the earlier (2004/07) survey.
The CHA data indicates that on average
the ARHN region has much better rates
than Upstate New York, New York State,
and the United States. The ARHN
average is well within the New York State
2013 goal for asthma hospitalizations at
12.4 per 10,000 residents and the region
essentially meets the goal for asthma
hospitalizations for age 0-17, at 17.4 per
100,000 residents.
In terms of other healthy environment
indicators in the Community Health
Assessment (CHA) data, the ARHN
region was generally better than Upstate
and state averages, with two exceptions
– elevated lead levels age 16+, and
asbestosis hospitalizations age 15+.
Healthy Mothers, Healthy Babies, Healthy Children
Overall, the health of mothers, babies and young children is generally good in the ARHN region. Wellness, particularly
of children and youth are important to regional residents, who rated this topic as one of the highest priorities in
the focus groups. There are very few indicators of maternal/child health where the weighted average for the ARHN
region exceeded the Upstate average. Exceptions included some of the oral health measures and the gastroenteritis
hospitalization rate for the 0 – 4 age group. There were 22.7 hospitalizations per 10,000 residents on average in the
ARHN region, as compared to a 16.9 hospitalization rate for young children with gastroenteritis in Upstate New York.
There also were two measures of infant mortality where the regional average exceeded the Upstate average. One was
fetal death >20 weeks gestation and the other was post-neonatal death for infants age 1 month to 1 year.
While only about 1% of the women participating in the 2004/07 survey indicated that they were currently pregnant,
most women (93%) indicated that they saw a physician during their first trimester and (72%) of the women with
children indicated that they had breastfed their last child. While these self reported statistics appear positive, the CHA
data indicates that only 77% of regional woman actually received pre-natal care during their first trimester.
Teen pregnancy rates in the ARHN region also compare favorably to Upstate and state rates. When compared to total
live births regardless of age, 1.4% of total live births for the ARHN region were to teenagers compared to 2.1% of
the total number of live births for the state. Teenage pregnancy rates for females age 15-19 per 1,000 females for the
ARHN region were 37.7 compared to 61.3 for the State.
For hospitalization rates within the Healthy Mothers, Healthy Babies and Healthy Children category, Female
Reproductive problems are of highest priority, which relates to the breast and cervical cancer rates highlighted in the
Chronic Disease section. Congenital Anomalies and Complications of Pregnancy are emerging as serious issues due to
the large number of patients affected and increasing occurrences.
Work and Social Environment
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary10
Infectious Disease
Tracking and preventing Infectious Diseases is an important public health priority and in 2009, public health officials
are preparing for the upcoming flu season where H1N1 influenza is expected to be an important issue. In the 2008
survey, almost half (42%) of regional respondents report having had a flu shot in the past 12 months, which is equal
to the state rate. These are also comparable to the rates from the 2004/07 ARHN survey. Almost a third (30%) of
respondents in the ARHN region report having had a pneumonia shot. This is somewhat higher than the state rate of
26%. The majority of respondents (74%) who were adults age 65 and over reported they had a pneumonia shot. This
is higher than the state rate of 64%. The hospital utilization rates for infectious and parasitic diseases has increased
in the region over the past 6 years to almost 30 per 10,000 residents, driven mostly by inpatient utilization rates that
have increased, highlighting the importance of prevention in this area.
Of the 13 CHA indicators for Infectious and Contagious Diseases, four indicators for the ARHN region exceeded the
Upstate average including Pertussis, Pneumoconiosis age 15+, E. Coli, and Hepatitis A. None of those are New York
State Department of Health Prevention Agenda priorities. While sexually transmitted diseases are also tracked and
reported, many compare favorably to upstate and state averages.
Mental Health and Substance Abuse
Mental health and substance abuse-related issues are increasing in importance in the region, as evidenced by
higher than average rates for a number of indicators and the focus group discussions related to the importance of
prevention and treatment programs. The ARHN average exceeded the average for Upstate New York in seven out of
the nine indicators including suicide mortality, adults that binge drink, alcohol-related motor vehicle injuries and
deaths, cirrhosis mortality, self-inflicted injury hospitalizations, cirrhosis hospitalizations and self-inflicted injury
hospitalizations age 15-19. The ARHN suicide mortality rate of 10.3 per 100,000 residents was over twice the New
York State 2013 goal of 4.8. Hospitalization rates for psychoses, other mental health and drug and alcohol-related
conditions have increased over the last few years.
In addition to the incidence statistics, behavioral risk factors also illustrate the importance of prevention and
intervention in this area including:
• In the 2004/07 ARHN survey, about 17% of respondents indicated that they felt sad, blue or depressed for two
consecutive weeks and 12% reported that they have depression or other mental health problems. Thirteen (13%)
of regional respondents indicated that they had sought help from a health professional for stress, depression or
emotional problems in the past 12 months and 13% also indicated that they delayed getting the mental health they
needed. In the 2008 Survey, a slightly higher percentage (12%) of respondents reported having poor mental health
14 or more days within the past month, comparable to the state rate of 10%.
• When looking at either poor physical or mental health, 19% of regional respondents indicated that they had poor
physical or mental health 14 or more days within the past month, compared to a state rate of 18%.
• The majority of respondents (51%) in the 2004/07 ARHN survey indicated that they drank alcohol at least once
in the last 30 days. Almost a quarter (23%) of respondents in the 2008 NYSDOH survey indicated that they have
binge drank in the past month. This is slightly higher than the state average of 20%. About 9% of respondents
indicated that they have participated in heavy drinking in the past month, a statistic that is consistent throughout
the region. The state average is 5%. In the 2004/07 ARHN survey, 12% of respondents indicated that they had
driven a vehicle after drinking in the past 12 months.
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary 11
Physical Activity and Nutrition
The relationship between nutrition, obesity and disease incidence makes physical activity and nutrition an important
priority for the ARHN region, particularly when looking at the regional indicators. Only a little more than a quarter
(28%) of adults in the ARHN region report that they eat 5 or more servings of fruits and vegetables a day, compared to
a state rate of 27%. In the 2004/07 ARHN survey, 36% of respondents indicated that they ate one to two fast food
type meals in the last seven days,
although the majority (55%) had
not eaten any fast food type meals
in the last seven days. The majority
of the respondents (62%) would be
classified as either overweight or
obese, as defined by a Body Mass
Index of 25.0 or greater. This is
slightly higher than the state rate
of 58%. About a fourth (23%) of
regional respondents indicated that
they received advice about their
weight from a health professional,
compared with the state rate of
28%. Of those who were given
advice about their weight, the
majority (88%) were advised to lose
weight which is consistent with the
state average.
The highest number of priority votes for interventions generated from focus group discussions pertained to physical
activity/nutrition and involved recommendations for school districts. Several of these suggestions are for programs
specifically geared toward youth recreation and teaching healthy lifestyles and nutrition. Top themes were also related
to promoting wellness and prevention, as well as food and eating habits.
Tobacco Use
While the majority (77%) of regional
survey respondents indicated that
they prohibit smoking in their
homes, Tobacco Use continues to
be a priority in the ARHN region, as
evidenced by higher than average
smoking rates and higher than
average incidence rates for smoking-
related diseases. About one in five
(22%) ARHN respondents reported
in 2008 that they smoked everyday
or some days, which was higher than
the 17% reported at the state level.
Of the six CHA Indicators for
tobacco-related disease incidence,
hospitalization, and mortality, the
ARHN weighted average exceeded the Upstate average on five of the six indicators, including lung cancer for males and
females, lung and bronchus cancer incidence, CLRD (COPD) mortality, and lung and bronchus cancer mortality.
Physical Activity and Nutrition
Tobacco-Related Conditions
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary12
Hospital utilization rates for Trachea/Lung malignant neoplasms are increasing slightly in the ARHN region from a rate
of 8 per 10,000 residents to 10 over the past 6 years. Inpatient utilization has remained stable, while ambulatory
surgery is increasing somewhat.
Unintentional Injury
Fall-related hospitalizations for persons
65+ is the highest priority related to
unintentional injury of the indicators
listed with a rate (203.5 per 10,000
population) that is higher than the
NYS average of 196, and significantly
higher than the state goal of 155
per 10,000.
In the 2008 NYSDOH survey, 19% of
regional respondents indicated that they
had a fall within the past three months,
compared to a state rate of 14%. A
small percentage of respondents (4%)
at both the regional and state levels
indicated they were injured by a fall.
Additionally, the New York State Department of Health Prevention Agenda priority indicators of concern in the ARHN
region include Unintentional injury mortality and motor vehicle deaths. Motor vehicle deaths for the ARHN region
(13.8 per 100,000) are significantly higher than the Upstate average and over twice the New York State 2013 goal of
5.8 per 100,000 residents.
Hospitalizations for all types of unintentional injuries have been increasing with the general category of Other Injuries
being of highest priority. This category includes a wide range of injuries not included in the other groups. Poisoning
injuries are increasing rapidly and emerging as a priority. The Volume of Fractures remain stable, but is a significant
portion of the injuries reported.
Community Input/Participation
In addition to the five quantitative data sets analyzed, focus groups
were conducted from November 2008 through May 2009. There
were 24 groups convened throughout the six-county region with
a total of 286 participants. When asked to describe their vision for
a healthy community, participants described community health in
its broadest terms, recognizing that many elements are outside of
the traditional public health and health care systems. Education,
transportation and infrastructure, safety, housing and crime
prevention are all integral components of a healthy community in
addition to health insurance, access to care, affordablilty, wellness
and other traditional elements of a health care system.
During the focus groups, participants were asked to identify barriers
to creating a healthy community. As shown above, lack of services
and programs (39%) was suggested to be the greatest barrier, followed by awareness (28%), money (16%), disparity
(6%), workforce (5%), geography (4%), and lastly disease prevalence/risk behaviors (2%).
Unintentional Injuries
ARHN Community Health Assessment Barriers
(369 Total Comments)
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary 13
These barriers were categorized into themes with the top 10 themes illustrated below. Focus group participants were
then asked to discuss and vote on priority items for creating a healthy community. The top suggestions are illustrated
below. The bars are coded based on the theme they belong with. Ideas include creating a free clinic, more funding
for school programs, and improving transportation. Three of the suggestions fall under government, two relate to
school districts, and the other ideas are each related to one of the themes.
Of the prevention agenda indicator areas, the majority of votes generated from focus groups related to physical
activity and nutrition. Recommendations involved school districts followed closely by governments. Among these
recommendations were developing programs and community/policy initiatives that improve access to health and
wellness, as well as food and eating habits.
Additional suggestions included lowering taxes, apply for government grants, increasing funding to support new air
quality and water systems, offering free college, opening a supermarket, collaboration, and program development.
Access to care was another key area of discussion in the focus groups. The theme of Doctors/Providers (95) received
a number of votes, along with ideas related to creating a free clinic, better access/more affordable health care, and
availabilty and location of necessary medical services. The theme of transportation received a high number of priority
votes (66) with the key single ideas noted related to improving transportation, with a focus on accessibility and
affordability. Insurance (44) rounded out the top three, with the highest single item related to universal health care.
Of additional interest were the themes relating to Healthy Mothers, Healthy Babies, Healthy Children, which include
Parenting/Family Education (36), Youth Services (34), and Youth Brain Drain (18). There is a perception that there is a
lack of programs and services available for youth to support positive youth development and to ensure that young
people stay within the ARHN region.
Ideas related to Alcohol/Substance Abuse (20), and Mental Health (13) priorities were also discussed and identified
in the focus groups. Participants highlight the need for increased services and programs to address alcohol and
substance abuse problems and issues.
Top 10 Themes from Focus Groups Top 10 Single Items from Focus Groups
ARHN / Health Assessment & Community Service Plan / September 2009
executive Summary14
Strategic Priority Health Issues
In June 2009, based on the information gathered in this community health assessment, the community service plan,
and the guidelines set forth in the New York State Prevention Agenda and Healthy People 2010, the Committee
convened to discuss and analyze all of the health indicator information contained in the study. They also engaged in a
best practice priority setting process to determine the top priority health issues.
The criteria ranking of the ten health priority areas were very close. In order to be precise in their decision-making the
Committee completed a paired comparison exercise. In this exercise the Committee compared the top six health areas
against each other, determining the higher priority area in each case. The results of all the paired comparisons were
tallied and the scores added to the overall priority ranking to determine the final list of the top six priority health areas
for the ARHN region, with Physical Activity and Nutrition topping the list.
Regional Action Plan
While the Committee members agree to focus on Physical Activity and Nutrition as a regional priority issue, individual
organizations will each have additional priority health issues to focus on over the next few years. It is likely those
priorities will be drawn from the list of the top six regional priorities as presented above; however, any of the ten
Prevention Agenda areas could be selected.
The following physical activity and nutrition outcomes were identified by the Committee as steps to be taken over the
next three years:
Outcome 1: Establish a taskforce of regional representatives whose goal is to select activities, design an
implementation schedule and select a method of evaluation for evidence-based programs focusing on
physical activity and/or nutrition by January 1, 2010 for Year 2 and 3 implementation.
Outcome 2: Develop a workplan with measurable outcomes, implementation schedules and budgets by June 30, 2010.
Outcome 3: Physical activity and/or nutrition interventions are implemented by taskforce members by June 30, 2011.
Outcome 4: Physical activity and/or nutrition interventions are evaluated and results are communicated to
stakeholders by June 30, 2012.
Criteria Ranking Criteria Ranking Plus Paired Comparison
Prevention Agenda Areas Score
Tobacco Use 72.75
Community Preparedness 59.45
Physical Activity & Nutrition 58.78
Chronic Disease 57.05
Infectious Disease 56.12
Access to Quality Health Care 54.72
Healthy Mothers, Healthy Babies
& Healthy Children
50.55
Healthy Environment 47.68
Mental Health & Substance Abuse 44.35
Unintentional Injury 40.87
Prevention Agenda Areas Score
Physical Activity & Nutrition 76.8
Chronic Disease 66.3
Access to Quality Health Care 61.1
Tobacco Use 40.0
Community Preparedness 27.4
Infectious Disease 27.4
Project Direction
15
ARHN / Health Assessment & Community Service Plan / September 2009
Project Direction
15
COMMITTEE
Adirondack Medical Center
Megan Murphy
Adirondack Rural Health Network
Patricia Harrison
Elizabethtown Community Hospital
Kerry Haley & Bonnie Bigelow
Essex County Public Health
Kathryn Abernethy, Kathy Daggett & Jessica Darney Buehler
Fulton County Public Health
Denise Frederick & Christina Akey
Glens Falls Hospital
Colleen Florio
Greater Adirondack Perinatal Network
School Beat Healthy Heart Program
Cathy LaMay
Hamilton County Public Health Nursing Service
Karen Levison
Hudson Mohawk Area Health Education Center
Lottie Jameson
Moses-Ludington Hospital
Barbara Wright
Nathan Littauer Hospital and Nursing Home
Susan Kiernan
Saratoga Hospital
Dot Jones
Saratoga County Public Health Nursing Service
Terry Stortz
Warren County Health Services
Patricia Auer & Dan Durkee
Washington County Public Health
Patty Hunt & Marie Capezzuti
ADIRONDACK RURAL HEALTH
NETWORK STAFF
Gail Danforth, Education Consultant
Phyllis Morreale, Project Consultant
Penny Ruhm, Program Coordinator
Vicky Wheaton-Saraceni, Director
CONSULTANTS
Holmes & Associates, Saranac Lake, New York
Strategy Solutions, Inc., Erie, Pennsylvania
This project was made possible by the generous support
of our financial contributors.
FINANCIAL CONTRIBUTORS
Adirondack Medical Center
Adirondack Rural Health Network
Elizabethtown Community Hospital
Essex County Health Department
Fulton County Public Health
Glens Falls Hospital
Greater Adirondack Perinatal Network
Hamilton County Public Health Nursing Service
Hudson Mohawk Area Health Education Center
Moses-Ludington Hospital
Nathan Littauer Hospital and Nursing Home
Saratoga County Public Health Nursing Service
Saratoga Hospital
School Beat Healthy Heart Program
Sexual Trauma and Recovery Services
The Glens Falls Foundation
Warren County Health Services
Washington County Public Health
Building a Healthy Community: Healthy Assessment and Community Service Plan is a project of the Adirondack Rural
Health Network funded by state and county government, foundations, hospitals, community based organizations and
rural health network grant funding from the New York State Department of Health. We acknowledge the expertise of
Strategy Solutions, Inc. and Holmes & Associates in assisting in conducting the study. We appreciate the support of
the many groups and agencies that responded to our call for data.
This study has been made possible through the collaboration among many organizational leaders from the six-county
region. In acknowledgement of their commitment to the health of community residents and their diligent efforts
for providing financial support, oversight and guidance, the following individuals and organizations comprise the
Adirondack Rural Health Network Community Health Planning Committee (the Committee):
9 Carey road
Queensbury, ny 12804
(518) 761-0300 ext. 210
www.arhn.org