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Hospital for Special Care
COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA)
Triennial Report for FY ending 3/31/2016
3/24/2016
As a requirement of the Affordable Care Act (ACA), not-for-profit hospitals in the United States must complete a
Community Health Needs Assessment (CHNA) every three years. Once needs are identified, the hospitals create an
implementation strategy to outline programs to meet those needs and to track the outcomes of the programs. This
process was created to assure that, as tax-exempt organizations, hospitals are working with their communities to
meet the health needs of residents. Hospital for Special Care (HSC) performed its first required assessment in 2013
and has been working to impact the stated needs for three years. Program updates and progress are included in this
report.
The main focus of this report is the results of our 2016 CHNA. The data collected will impact HSC’s decisions on
programs and services for 2016 – 2019. Acute care hospitals usually consider their “community” to be a geographic
area surrounding their facilities. At HSC, we define our community as individuals living with chronic conditions or
physical disabilities, statewide. This definition impacts the population we survey, the comparative data we collect,
and the services we offer.
Community members and “key informants” (representatives of organizations that serve or support HSC’s
community) were surveyed regarding health status, services needed, and barriers to care. Results of surveys and
research on state and national data are presented here, with identified health needs prioritized. Following approval of
this report by the HSC Board of Directors, an implementation strategy will be developed toward impacting those
needs in the next three years.
1
Table of Contents
Introduction ........................................................................................................................ Page 2
Results of 2013 CHNA Implementation Strategy ........................................................... Page 5
2016 CHNA Methodology ................................................................................................. Page 9
Assessment Summary: Identified Health Needs ........................................................... Page 12
Prioritized Community Health Needs ............................................................................ Page 46
Next Steps ......................................................................................................................... Page 49
Attachment ....................................................................................................................... Page 50
2
INTRODUCTION
Hospital for Special Care
Hospital for Special Care (HSC) is one of the 10 largest, free-standing long-term acute care
hospitals (LTACH) in the United States and the nation’s only LTACH serving adults and
children. Established in 1941 as The New Britain Memorial Hospital, it was a municipal hospital
for “the medical and surgical treatment of all persons suffering from chronic or other diseases.”
Over the years the hospital changed its name to Hospital for Special Care, has grown to 228
beds, and is celebrating its 75th
anniversary in 2016.
As an LTACH, HSC provides a full spectrum of medical rehabilitation services for both
inpatient and outpatient care for complex rehabilitation and chronic diseases for both children
and adults. HSC is recognized for advanced care and rehabilitation in:
Pulmonary (including ventilator weaning and management)
Brain injury
Medically-complex pediatrics
Neuromuscular disorders
Spinal cord injury
Cardiac (including CHF1 and LVAD
2)
Autism spectrum disorders
Located in New Britain and Hartford, HSC operates inpatient and outpatient facilities serving
Connecticut and beyond on a not-for-profit basis. An important regional resource HSC prides
itself on being the answer to solving difficult healthcare problems for other hospitals, for state
and federal government agencies, and most importantly, for the community.
The hospital is set amid a beautiful campus of walking paths and flower gardens designed to
enhance the patient experience. For people with disabilities, HSC has made a special
commitment to assure that they may strive to achieve their fullest physical and recreational
potential.
Mission Statement
We will ensure exemplary care within our continuum, with the active involvement of
those we serve, so that they can achieve enduring improvements in their quality of life.
We will anticipate and be responsive to changing needs of our communities and a
changing healthcare environment by creating an innovative, fiscally sound, cost effective
system of care.
We will support the practice of rehabilitation and continuing medical care through
research and education.
We will create a work environment and climate where employees are supported to
provide excellent care, and find opportunities for personal and professional growth.
1 Congestive Heart Failure
2 Left Ventricular Assist Device
3
We will be, in all of the above, responsive and accountable to our communities, for
whose benefit we exist.
Demographics of HSC’s Community and Connecticut
Catastrophic illnesses and accidents occur regardless of personal demographics, income levels,
insurance coverage, or ability to pay for care. Because of the unique inpatient and outpatient
services we offer, people statewide choose HSC for their care. In the past two years our
clinicians and medical staff cared for:
outpatients from 95% of Connecticut’s 169 towns
children with autism spectrum disorder (ASD) from 71% of CT towns
inpatients admitted from 74% of CT towns
as well as patients from outside Connecticut
For these reasons, we consider Connecticut’s demographics to represent persons served by
HSC’s inpatient, outpatient, and community programs. Connecticut demographics are detailed in
a chart, Attachment 1.
While most of our newly admitted inpatients have healthcare coverage, many become Medicaid-
eligible during their stay. Our social workers and case managers support patient and family
efforts through the Title XIX application process. All of our programs accept Medicaid patients.
Community-based programs have free services or sliding scale services. Special Care Dental
Services, operating since 1997, was specifically designed to provide oral health care to uninsured
and underinsured children, with no geographic restriction. The program now dedicates some
clinic days to children with ASD, so they can receive care in a quiet environment, from
experienced staff.
Previous Community Health Needs Assessments
In 2007 and 2013 HSC partnered with The Hospital of Central Connecticut (HOCC), a
neighboring not-for-profit acute care hospital, to complete health needs assessments for residents
of the greater New Britain area. Both assessments included household telephone surveys and key
informant interviews. The findings from each assessment were utilized by HSC and HOCC to
prioritize public health issues and develop a community health implementation plan focused on
meeting the needs of that geographic community.
Questions asked in past CHNA data collection included a broad range of health issues of interest
to acute care providers. Many of these topics are not relevant to services offered by an LTACH
(e.g. obstetrics, surgical care, emergency department, and many acute illnesses). Additionally,
we were not afforded an opportunity to ask detailed questions on chronic diseases, limitations
posed by disabilities, and challenges facing caregivers of our typical populations. Responses to
such questions would provide useful data to help HSC address the needs of our patients and
program participants.
4
2016 Community Health Needs Assessment
To improve upon the defined community served by HSC and to ask more specific questions of
that community, the 2016 CHNA was conducted independently. HSC provides care to inpatients
and outpatients from nearly every town in Connecticut, not to a small geographic area typically
defined by community-based healthcare systems.
When partnering with an acute care system, the focus is on more and broader groups of patients
(e.g. individuals with diabetes or cancer) commonly treated in such systems. At HSC, our
“community” is defined as individuals living with chronic conditions or physical disabilities,
statewide. An independent CHNA provided the opportunity to gather details on those conditions
and disabilities, gathering data that will be used to refine our implementation strategies. The
2016 assessment has been completed without a consulting service.
5
Results of 2013 CHNA Implementation Strategy
The goal of the 2013 CHNA Implementation Strategy was to improve individuals’ abilities to
manage chronic conditions and physical disabilities through coordination of care.
Objectives and the results of HSC’s efforts are summarized here. No written comments were
offered in response to HSC’s 2013 CHNA report. Individuals researching community health
needs and students have called to inquire and verbally offered positive comments on the report
and Implementation Strategy.
Objectives Action Steps/Result
1: Improve access to primary care for persons with chronic conditions and physical
disabilities Establish a medical home for
specific groups Research and implement medical
homes for populations in need
The Autism Center at Hospital for Special Care was certified by the
NCQA (National Committee for Quality Assurance) as a PCSP
(Patient-Centered Specialty Practice): in February, 2015. It is the only
Autism PCSP in the USA.
In response to the need demonstrated in the outpatient Center, HSC
opened the only inpatient autism unit in Connecticut in December
2015.
COPD Disease Management program was formally launched in May,
2013 and has provided services to 122 patients. 33 new patients were
admitted to the program in 2015, with 79 patients actively participating
in March, 2016.
Although not NCQA certified, it functions as a PCSP.
Coordination of care for
persons with chronic
conditions Expand HSC’s role in
coordinating healthcare needs of
persons with chronic conditions
The Neuromuscular Center offers a model for coordination of care for
individuals with ALS, Muscular Dystrophy, and other neuromuscular
conditions. Evaluation of the Center toward PCSP certification in 2015.
2: Reduce obesity and overweight by increasing physical activity levels of persons with
chronic conditions and physical disabilities Promote community
membership in the Aquatic
Rehabilitation and Fitness
Center (ARC)
Membership is offered to community residents, with no geographic or
ability restrictions.
New ARC members 2013 = 313, 2014 = 370, 2015 = 433
There is no membership charge for members of the Adaptive Sports
program or for HSC inpatients. A fund is available to supplement
membership charges for those with economic need. Reduced rates are
offered for students, family membership, seniors, senior couples, group
home membership, and HSC employees and their families. The Silver
Sneakers program (www.silversneakers.com ) reimburses the Center by
member visits.
Metrics: A survey was conducted in 2014 and 2015, measuring the
improvement in fitness levels among members.
6
Objectives Action Steps/Result
Offer Pulmonary Exercise
Program (PEP)
A growing number of patients enroll in PEP following their pulmonary
rehabilitation program. In 2014, 20 of 36 individuals continued to
exercise in the community; in 2015, 26 of 39 continued. 13 participants
reduced their BMI in 2014, as did 19 in 2015.
Increase participation in the
HSC Adaptive Sports Program
HSC uses Foundation funds to allow our Adaptive Sports program to be
free-of-charge.
HSC Ivan Lendl Adaptive Sports Camp continues to attract new
campers. (2013 = 7, 2014 = 11, 2015 = 14)
An Inclusive Recreation program for families of youths living with
physical disabilities was launched in 2013 with 3 programs.
In 2014 it was expanded to serve youths with autism (2014 = 6, 2015 =
14)
As “Team Special Care”, HSC’s involvement in the Hartford Marathon
event:
2013, 7 athletes with disabilities competed in the 5K
2014, 11 athletes with disabilities competed in the 5K the half
marathon
2015, 12 athletes with disabilities competed in the 5K
HSC hosted Gateway to Gold event (May, 2015), free to the public to
introduce people living with physical disabilities to the opportunities in
track and field (11 participants), and swimming (7 participants).
Support Parkinson’s Exercise
Program
HSC provides a New Britain location for a statewide twice-weekly
exercise program open to community members. (May 2014)
Program expanded to three day/week. (in Autumn 2014)
The trainer reports a consistent number of participants and measures
improvements in balance and ambulation.
Offer Special Care Equipment
Exchange
Donated durable medical equipment is given to community members
enabling them to increase their independence and physical activity
levels. 2013 = 477 items distributed, 2014 = 660 2015 = 667
The program is possible thanks to the 500-600 annual hours of
volunteers’ work.
3: Enhancing the ability of like groups to communicate and share aspects of their
conditions Promote existing support
groups
HSC-based support group meetings are posted on website calendars and
submitted to local print and internet media. (May 2013)
Future: Trial social media posts for effectiveness.
Develop new venues for
support groups through
technology
Explored on-line potentials to reach consumers unable to attend the
traditional meeting-style groups and expand the geographic reach.
Conference call-in numbers and webinar options made available; no
interest demonstrated. (March 2014)
SCI Committee considering teleconferencing/webinar equipment so
group members may attend meeting remotely. Exploring funding. (June
2015)
7
Objectives Action Steps/Result
New support group topics Explored emerging subjects for new support groups to meet the
interests of our target populations.
2013 – 2015 New support groups established for:
Alpha One Antitrypsin
Stroke
Parkinson’s
Balance/Dizziness
HSC requested the assistance of Hanger, Inc., a recognized prosthetic
and orthotic company, in establishing an Amputee Support Group.
(Spring 2014)
Hanger offers a peer mentors, work with inpatients. Rather than
duplicate services HSC refers inpatients, outpatients, and sports
participants to the Hanger program. Education was provided to
HSC clinicians on the Hanger program.
In-patients informed of HSC’s adaptive sports programs for
seamless transition and supports.
Hanger sponsored motivational speaker Cameron Clapp twice,
to audiences of 50-100 people. Cameron, a triple amputee, is the
Honorary Team Captain for Team Special Care at the Hartford
Marathon.
Program support for Camp No Limits, for individuals with limb
loss. National program, in CT 2015.
Future: Explore Siblings Support Group/mentorship for siblings of
children with chronic conditions
4: Provide education and support to encourage people to make healthy lifestyle choices Reduce smoking through
smoking cessation program
Participants increased from 8 in 2014 to 25 in 2015, with 40%
remaining smoke-free at a three- month survey.
Reduce overweight/obesity
through promotion of healthy
food choices
When contacted (June 2014) about offering a community site at HSC,
Weight Watchers declined. HSC convinced them to restart an employee
program in 2015.
While the data suggests a need in this area, despite the many weight
loss and healthy food choice programs in the community, individuals
do not express interest in participating. This strategy will not be
pursued in the new plan.
Increase health literacy
through healthcare
information/resources
Health Sciences Library services are now promoted to the community.
(Nov 2013)
Update and reorganize the Consumer Health Resources webpage,
http://hfsc.org/resources/overview . (Dec 2013)
HSC website adds a link to access consumer online database Health
Library. (April 2014) FY15: 2081 visitor hits; average of 5 page views
per day, with each visitor visiting an average of 1.69 pages.
8
Objectives Action Steps/Result
Addressing mental health and
substance abuse issues
HSC does not offer mental health or substance abuse treatment
programs. Patients are screened and referred to existing community
resources.
Aware of the risk for the population with chronic conditions and
physical disabilities, clinicians include key questions (using a suicide
protocol grid) in inpatient and outpatient evaluations. Inpatients receive
appropriate services while at HSC, beginning with a psychology
consult. Outpatient therapists refer patients to community mental health
services. Outpatient therapists’ referrals.
2013 = 3, 2014 = 6, 2015 = 4
5: Improve access to resources for caregivers
Providing resources to
caregivers Expanding availability of
resource information from family
members of HSC patients to
caregivers of individuals in the
community
Inpatient social workers provided their resources to the HSC website.
(Jan. 2014) See objective 4 on health literacy.
Future: Exploring community support for a Caregivers health fair
sponsored by HSC. If well-attended, HSC can offer similar fairs at local
Senior Centers.
Develop a caregiver support
group
Monthly support group for parents of chronically ill children on HSC’s
Pediatrics Unit. It is open to parents of inpatients and discharged
patients’ parents. Attendance is 2-5 persons monthly.
Feasibility study: HSC social worker experience was that it is difficult
for caregivers to get away to attend a support group. They recommend
on line blogs (www.thecaregiverspace.org).
Future: continue to research options to create an online caregiver
support group; see objective 3.
9
METHODOLOGY
2016 CHNA Methodology
Data included in this assessment was obtained through surveys and interviews of community
members and key informants, research, and statistics from related organizations (government and
healthcare) and Connecticut acute care hospitals. Most data was collected from November 2015 -
March 2016. We solicited and obtained input from individuals across the state and a variety of
organizations. HSC appreciates the time and information shared by everyone who completed a
survey.
Collection processes
We used a community member survey to identify the significant health needs. This survey
offered insight directly from individuals within HSC’s community. A key informant survey
targeted organizations that work with individuals within our statewide community.
Research returned some very useful data, but there are gaps in data collection regarding several
of the challenges faced by individuals living with chronic conditions or physical disabilities.
Primary sources of data included:
United States Census Bureau
State of Connecticut
DataHaven (New Haven, CT)
American Lung Association
National Cancer Institute
Centers for Disease Control and Prevention (CDC)
The Henry J. Kaiser Family Foundation (Kaiser Family Foundation)
National Council on Disability (NCD)
United Health Foundation
National Coalition Against Domestic Violence (NCADV)
Community member survey
An important component of the CHNA is the data provided by community members. The
traditional method for gathering this data is a Behavioral Risk Factor Surveillance System
(BRFSS), a telephone survey conducted with randomly-selected community residents. BRFSS
was used in our previous assessments (2007 and 2013). In preparing for the 2016 assessment,
HSC concluded that a BRFSS survey would not adequately reach our defined community. It
would be unlikely that the survey could reach a sufficient number of individuals living with
chronic conditions or physical disabilities within a geographic area as large as a state.
For this assessment, we created an online survey, using typical questions posed on past health
needs surveys, with added questions specific to our targeted population. Telephone surveys and
paper surveys were offered as alternatives to the on-line survey.
The survey was distributed widely throughout the state using a variety of methods:
10
Mailings, both email and postal mail, to 823 participants in HSC programs including
dental services, aquatic fitness center members, therapeutic horseback riding, inclusive
recreation, and volunteers
Paper surveys and the link to the online survey were available in outpatient service
waiting areas
Paper surveys and the link to the online survey were distributed at seven HSC support
groups
Social media postings on HSC sites. These posts were shared by organizations and
individuals familiar with HSC. Initial posts reached 674 people on Twitter and 1,114 on
Facebook. The Facebook post was boosted, resulting in 11,500 individuals reached.
Collaborative organizations (Spinal Cord Injury Association-CT, Brain Injury Alliance-
CT, Autism Families CONNECTicut, Muscular Dystrophy Association-CT, ALS
Association-CT) used email, social media, and newsletters to ask members to complete
HSC surveys
Key informant survey
A second component of the CHNA is data collected from organizations across the state that
represent underserved groups and serve our community members. HSC regularly works with
facilities, organizations and associations that support our community. An online key informant
survey was created and distributed to 73 individuals across 56 organizations, asking each to
explain the priority health needs of individuals served by their organization. Those contacted
included acute care hospitals, state departments, community-based human services agencies, not-
for-profit organizations and advocates representing individuals within HSC’s community. Public
health and healthcare professionals shared knowledge and expertise about health issues, and
leaders and representatives of community-based organizations provided insight on the
populations they serve, including medically underserved, low income, and minority populations.
For example, Community Health Centers offer services to otherwise underserved, low-income,
and minority populations. The Hispanic Health Council and Pathways Senderos serve a minority
population. New Britain Housing Authority, Opportunities Industrialization Center, and Billings
Forge Community Works serve low income families. A LinkedIn post was also used to reach key
informants. The post was seen by over a thousand people, although it is not possible to determine
how many are be key informants in Connecticut.
Organizations on Key Informant List
Advanced Physical Therapy
Aetna: Product Strategy & Insights
ALS Association - CT
American Lung Association-CT
Andrew House Health Care
Autism Families CONNECTicut
Berlin Mosque
Billings Forge Community Works
Brain Injury Alliance of CT
Bristol Hospital
CCARC
Coginchaug Regional High School
Community Health Centers (Middletown,
New Britain, New London, other
locations)
Connecticut Interscholastic Athletic
Conference
Corporation for Independent Living
CT Society for Respiratory Care
CW Resources
Dentist, private practice, Kensington
Gorzoch Associates
Grove Hill Medical Center (Starling
Physicians)
11
Hanger Prosthetics
Hartford Behavioral Health
Hartford Healthcare Rehabilitation Network
Hartford Hospital
Hartford Neighborhood Centers, Inc.
Harvest Development Group
Hispanic Health Council
Hospital of Central CT
Journey Found, Inc.
KeepMeHome, LLC
LeadingAge Connecticut
MidState Medical Center
Money Follows the Person
Muscular Dystrophy Association-CT
Neighborhood Housing Services of New
Britain
New Britain Board of Education
New Britain EMS
New Britain Health Department
New Britain Housing Authority
Opportunities Industrialization Center of
New Britain
Pathways Senderos
Patient Advocate for You
Saint Francis Hospital and Medical Center
School Street Apartments Wellness Center
Seabury Retirement Community
Small Miracles Natural Health Center
Spinal Cord Injury Association-CT
The Edward & Mary Lord Family Health
Center
United Community and Family Services,
The Edward & Mary Lord Family
Health Center
University of Connecticut, Hartford campus
University of Saint Joseph
Wheeler Clinic
Women's Health USA
YWCA of New Britain
Because the survey was anonymous, we cannot confirm exactly which organizations responded,
however, the demographic data collected reflects a wide variety of organizations representing
healthcare, public health, mental/behavioral health, not-for-profit, government, and other service
groups. Following the CHNA report in 2013, we hosted a meeting of key informants to discuss
potential programs to meet community health needs. A similar meeting will be held in the spring
of 2016 and will provide the opportunity to confirm and enhance information submitted in the
surveys.
Survey Results
The results of both key informant and community member surveys are presented in this report in
separate sections.
Community member survey
Online, paper, or telephone surveys were completed by over 180 Connecticut residents. Common
adult health needs reported include overweight, chronic illness (especially asthma, arthritis, and
depressive disorder), and a limited ability to participate in activities. Many respondents function
as caregivers. Children in the household were generally reported as healthy. The few reports of
chronic conditions in children were primarily asthma and autism.
Key informant survey
Online or telephone surveys were completed by 46 key informants, allowing us to obtain input
on the health needs of the group(s) they represent. In addition to medically underserved, low
income, and minority populations, data on individuals with chronic conditions or physical
disabilities was provided by organizations representing these specific groups.
12
ASSESSMENT SUMMARY: IDENTIFIED HEALTH NEEDS
Community Member Survey
The 89 questions in the survey of Connecticut residents (HSC Survey) have been grouped by
topic. Available state and/or national statistics are included in the survey results section to serve
as a comparison to data collected from the HSC Survey.
General Health
HSC community members rate their health somewhat lower than state and national data, but
most report few days of poor/fair health. 70% report their weight is higher than desired.
1. Would you say that in general your health is: 3
Answer
Options HSC Survey
Number
HSC Survey
Percent CT Percent
National Percent
Excellent 23 13% 27% 12.6%
Very Good 49 27% 35% 34.4%
Good 73 40% 23% 38.0%
Fair 32 17% 10% 10.8%
Poor 7 4% 4% 2.0%
Responses 184
2. For how many days during the past 30 days would you rate your physical health as poor or
fair? 4
Answer
Options
HSC Survey
Number
HSC Survey
Percent CT Average National Average
0 days 62 34%
3.30 days
3.90 days
1-2 days 50 27%
3-5 days 19 10%
6-9 days 10 5%
10 or more
days 43 23%
Responses 184
3 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey , http://hints.cancer.gov/question-
details.aspx?PK_Cycle=7&qid=744 4 http://www.americashealthrankings.org/CT
13
7. How would you describe your weight? 5
Answer Options HSC Survey
Number
HSC Survey
Percent CT (BMI)
Underweight 4 2% 2%
At your desired weight 51 28% 37%
10-25 pounds over your
desired weight 70 39% 36%
More than 25 pounds over
your desired weight 55 31% 26%
Responses 180
Access to Healthcare
Less than 3% of HSC community members do not have healthcare coverage and just 5% do not
have a personal physician. 80% have been able to see a doctor when they wished and 81% have
had a checkup within 12 months. 84% receive care at a doctor’s office and visits to emergency
departments are fewer than the state average.
8. Do you have any kind of health care coverage, including health insurance, prepaid plans
such as HMOs, or government plans such as Medicare? 6
Answer Options HSC Survey
Number
HSC Survey
Percent
CT Percent
age 19-64
National Percent
age 19-64
No 5 2.8% 10.0% 14%
Yes 171 97.2%
Employer 67.0% 59%
Non-Group 8.0% 8%
Medicaid 12.0% 14%
Other Public 3.0% 5%
Responses 176
9. Do you have one person you think of as your personal doctor or health care provider? 7
Answer
Options HSC Survey Number HSC Survey Percent CT Percent
No 9 5.1% 14.0%
Yes, only one 80 45.5% 86%
More than one 87 49.4% n/a
Responses 176
5 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
6 http://kff.org/other/state-indicator/adults-19-64/ , http://kff.org/other/state-indicator/adults-19-64/ 7 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
14
10. Was there a time in the past 12 months when you needed to see a doctor but could not? 8
Answer Options HSC Survey Number HSC Survey Percent CT Percent
No 141 80.6% 79% Yes 34 19.4% 21% Responses 175
13. About how long has it been since you last visited a doctor for a routine checkup? 9
Answer Options HSC Survey Number HSC Survey Percent
Never 3 2%
0-12 month 141 81%
1-2 years 19 11%
2-5 years 5 3%
5 years or more 6 3%
Responses 174
14. In general, where do you go when you are in need of medical care? (please choose one)
Answer Options HSC Survey Number HSC Survey Percent
Doctor’s Office 147 84.5%
Health Clinic 6 3.4%
Emergency
Department 6
3.4%
Walk-in/Urgent Care
Center 16
9.2%
Responses 174
15. In the past 12 months, did you receive care in an emergency room? 10
Answer
Options HSC Survey
Number
HSC Survey
Percent CT Percent National Percent
No 136 77.3% 73% 10%
Yes 40 22.7% 26%
Responses 176
8http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
9 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
10 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
15
Oral Health
HSC respondents match the statewide figures for visiting a dentist within the last 12 months.
This figure is considerably higher than national numbers. Of the 19.5% that do not have regular
dental services, over half state cost or lack of insurance coverage as a reason. Six individuals
avoid dental care due to fear or aversion to pain.
Special Care Dental Services provides oral health care to children who are uninsured or
underinsured, including those on the autism spectrum. As the schedule allows, both Special Care
Dental Services and our hospital-based clinic treat adults who find receiving care at community
practices to be challenging. Education in overcoming fear of dental care is a small, but identified
need.
16. How long has it been since you last visited a dentist or dental clinic for any reason?
Answer Options HSC
Survey
Number
HSC
Survey
Percent
CT-1 %
2014-
2015
CT-2 %
2012 (within
12 months,
No/Yes)
National-1
Percent
2012 (within
12 months)
National-2
Percent 2013
(within 12
months)
Never 0 0.0% 1.0% 23.9% 34.6%
0-12 months 135 77.6% 76.0% 76.1% 65.4%
Age 18-64:
61.7%
Age 65+:
60.6%
1-2 years 23 13.2% 10.0%
3-5 years 6 3.4% 11.0%
5 years or more 10 5.7%
Responses 174
17. Do you visit a dentist or dental clinic for regular check-ups?
Answer Options HSC Survey Number HSC Survey Percent
No 34 19.5%
Yes 140 80.5%
Responses 174
18. Why don't you visit a dentist or dental clinic for regular check-ups? (please choose all that
apply)
Answer Options HSC Survey Number HSC Survey Percent
Cost 18 52.9%
Lack of transportation 3 8.8%
Provider would not
accept your insurance 4 11.8%
Other (see next page) 17 50.0%
Responses 150
16
Other Reasons:
Need partials but price is too much.
My state insurance only covers cleaning
When I turned 65 last year, I no longer could afford dental insurance.
Fear
Having troubles w anxiety
Have dentures
Rough with me and it hurts me
No teeth. MD Does oral exam
Fear and co pay costs
Just haven't made the time
Fear
False Teeth
No dental insurance
Have dentures
No dental insurance
I'm afraid of pain
Exercise / Activities
HSC community members are less active for fitness purposes than statewide numbers, likely due
in part to physical or emotional problems limiting their ability to participate in such activities.
Over 30% rely on DME (durable medical equipment) for ambulation or daily care. 25% report
recent falls (40 total), some requiring a decrease in activity level for at least a day.
Increasing physical activity and preventing falls are identified needs in our community.
6. During the past month, other than during your regular job, did you participate in any
fitness activities or exercises? (Examples: running, walking, calisthenics, golf, gardening) 11
Answer Options HSC Survey CT
Number Percent Percent
No 57 32% 17%
Yes (how many days) 123 68% 83%
Responses 180
11
http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
17
32. Are you limited in any way in any activities because of physical problems? 12
Answer
Options
HSC Survey
Number
HSC Survey
Percent
National % age <65, with
disability
No 83 51.6%
Yes 78 48.4% 8.5%
Responses 161
33. Do you have any health problems that require you to use special equipment? (Examples:
cane, crutches, walker, wheelchair, special bed, special telephone)
Answer
Options HSC Survey Number HSC Survey Percent
No 111 68.5%
Yes 51 31.5%
Responses 162
34. Are you limited in any way in any activities because of mental or emotional problems?
Answer
Options HSC Survey Number HSC Survey Percent
No 152 93.8%
Yes 10 6.2%
Responses 162
35. Does a physical disability prevent you from visiting a health care provider?
Answer
Options HSC Survey Number HSC Survey Percent
No 156 96.3%
Yes 6 3.7%
Responses 162
36. In the past 3 months, how many times have you fallen?
Answer
Options HSC Survey
Number
HSC Survey
Percent Total Yes
None 122 75%
1-2 28 17.3%
25% 3-5 9 5.6%
6-9 2 1.2%
10 or more 1 0.6%
Responses 162
12
https://www.census.gov/quickfacts/table/PST045215/00
18
37. How many of these falls caused an injury (caused you to limit your regular activities for
at least a day or to go see a doctor)?
Answer Options HSC Survey Number HSC Survey Percent Total Yes
None 103 87%
1-2 13 11.0%
13% 3-5 1 0.8%
6-9 0 0.0%
10 or more 1 0.8%
Responses 118
Lifestyle
HSC survey respondents demonstrate a much higher rate of receiving influenza vaccinations than
state or national averages. The average age of individuals who completed the survey is under age
65, so it is expected that state and national data show higher rates of pneumonia vaccinations.
42. During the past 12 months, have you had a seasonal flu shot? 13
Answer
Options No Yes Responses
Response
Percent NO Response Percent YES
HSC Survey 42 119 161 26.09% 73.91%
State, 2014 41.00%
National, 2014 43.70%
43. Have you ever had a pneumonia shot? 14
Answer Options No Yes Responses Response
Percent NO
Response Percent
YES
HSC Survey 94 68 162 58.02% 41.98%
State, age 65+, 2014 70.60%
National, age 65+,
2014
58.70%
Prevalence of cigarette smoking among HSC respondents is about half that of state and national
averages. A number of individuals who responded in the negative to question 39 also responded
to question 40, making the number not quitting higher than it might otherwise be. As an LTACH,
many of HSC inpatients and outpatients have pulmonary diseases, making smoking cessation an
essential component of many programs. It is not surprising that people that choose HSC for
healthcare or community programs are non-smokers.
13
http://www.lung.org/assets/documents/research/pi-trend-report.pdf 14
http://www.lung.org/assets/documents/research/pi-trend-report.pdf
19
38. Have you smoked at least 100 cigarettes in your entire life?
Answer
Options HSC Survey HSC Percent
No 92 57.14%
Yes 69 42.86%
Responses 161
39. Do you now smoke cigarettes every day, some days, or not at all? 15
Answer
Options
HSC
Survey HSC Percent CT, use rate National, use rate
Every day 11 7.24% 15.40% 16.80%
Some days 2 1.32%
Not at all 139 91.45%
Responses 152
40. During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit smoking?
Answer
Options HSC Survey HSC Percent
No 92 85.98%
Yes 15 14.02%
Responses 107
The percentage of community survey respondents who have felt the need to decrease use of
alcohol or drugs is slightly higher than the statewide figure. We will seek additional data from
our community so we may address these topics in support groups, other community programs,
and in resources for caregivers.
41. During the past 12 months, have you ever felt the need to cut down on your drinking or
drug use? 16
Answer
Options HSC Survey Number HSC Survey Percent CT Percent
No 135 87.66% 91%
Yes 19 12.34% 8%
Responses 154
Individuals living with physical disabilities may be vulnerable to violence at home or in the
public, making this an important question to pose to our community.
15
http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/state-grades/highlights.html,
http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/federal-grades/highlights.html 16
http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
20
4. In the past 12 months, have you felt unsafe or physically threatened in your home? 17
Answer Options HSC Survey
Number
HSC Survey
Percent National
No 179
1 in 3 women and 1 in 4 men have been
victims of (some form of) physical
violence by their intimate partner within
their lifetime Yes 4
Responses 183
Chronic Illnesses and Conditions
HSC offers a wide range of inpatient and outpatient services and community programs for
individuals with chronic conditions. Questions posed in the survey will provide details on the
challenges these individuals experience within their community. Items of concern include the
number of individuals reporting chronic conditions, and the specific data on asthma, COPD,
arthritis-related conditions, and depressive disorders. 87% of respondents are receiving treatment
for the condition on a regular basis; some that responded negatively are not currently
symptomatic.
19. Has a doctor, nurse, or other health professional ever told you that you have a chronic
illness?
Answer Options HSC Survey Number HSC Survey Percent
No 82 49.7%
Yes 83 50.3%
Responses 165
20. Has a doctor, nurse, or other health professional ever told you that you had a heart attack,
also called a myocardial infarction?18
Answer Options HSC Survey Number HSC Survey Percent CT Percent
No 160 96.4% 93%
Yes 6 3.6% 5%
Responses 166
17
http://www.ncadv.org/learn/statistics 18
http://www.ctdatahaven.org/sites/ctdatahaven/files/DataHaven2015%20Greater%20New%20Britain%20Pub.pd
f
21
21. Has a doctor, nurse, or other health professional ever told you that you have angina or
coronary heart disease?
Answer Options HSC Survey Number HSC Survey Percent
No 156 94.5%
Yes 9 5.5%
Responses 165
22. Has a doctor, nurse, or other health professional ever told you that you had a stroke?
Answer Options HSC Survey Number HSC Survey Percent
No 160 96.4%
Yes 6 3.6%
Responses 166
23. Has a doctor, nurse, or other health professional ever told you that you have asthma?
Answer Options HSC Survey Number HSC Survey Percent
No 131 79.9%
Yes 33 20.1%
Responses 164
22
24. Has a doctor, nurse, or other health professional ever told you that you have COPD (chronic
obstructive pulmonary disease), emphysema, or chronic bronchitis? 19
Answer
Options HSC Survey Number HSC Survey Percent CT Percent National Percent
No 142 85.5%
Yes 24 14.5% 5.7% 6.3%
Responses 166
25. Has a doctor, nurse, or other health professional ever told you that you have some form of
arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
Answer Options HSC Survey Number HSC Survey Percent
No 94 57.3%
Yes 70 42.7%
Responses 164
26. Has a doctor, nurse, or other health professional ever told you that you have some form of
neuromuscular disease? (Examples: ALS, Lou Gehrig’s Disease, Muscular Dystrophy,
Parkinson's Disease)
Answer Options HSC Survey Number HSC Survey Percent
No 154 95.1%
Yes 8 4.9%
Responses 162
19
http://www.copdfoundation.org/What-is-COPD/COPD-Facts/Statistics.aspx ,
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm?s_cid=mm6146a2_w
23
27. Has a doctor, nurse, or other health professional ever told you that you have a depressive
disorder?
Answer Options HSC Survey Number HSC Survey Percent
No 123 75.5%
Yes 40 24.5%
Responses 163
28. Has a doctor, nurse, or other health professional ever told you that you have kidney disease?
Answer Options HSC Survey Number HSC Survey Percent
No 159 97.0%
Yes 5 3.0%
Responses 164
29. Has a doctor, nurse, or other health professional ever told you that you have diabetes?
Answer Options HSC Survey Number HSC Survey Percent
No 144 86.7%
Yes 22 13.3%
Responses 166
24
30. If you answered "yes" to any of questions 19-29, are you:
Answer Options HSC Survey
Number
HSC Survey
Percent
Seeing a primary care/family doctor for follow up
treatment and monitoring
22 21%
Seeing a specialist for follow up treatment and monitoring 23 22%
Seeing both your primary care/family doctor and a
specialist for follow up treatment and monitoring
46 44%
Not receiving any follow up treatment or monitoring
(Reason?)
13 13%
Responses 104
30. If you answered "yes" to any of questions 19-29, are you:
Answer Options HSC Survey Number HSC Survey Percent
Seeing a primary care/family
doctor for follow up treatment
and monitoring
22
21%
Seeing a specialist for follow up
treatment and monitoring 23
22%
Seeing both your primary
care/family doctor and a
specialist for follow up treatment
and monitoring
46
44%
Responses 104
31. About how many times in the past 12 months have you seen a doctor, nurse, or other
health professional for any condition listed in questions 19-29?
Answer
Options HSC Survey Number HSC Survey Percent
None 59 38%
1-2 40 26%
3-5 25 16%
6-9 9 6%
10 or more 23 15%
Responses 156
Emotional Health
25
HSC respondents report few days of “feeling down” than the state average. However, when
caregiver responses to a combination of questions are studied, numbers suggest the need for
further study of that group.
3. During the past 30 days, have you been bothered by feeling down, depressed, or hopeless? 20
Answer Options HSC Survey Number HSC Survey Percent CT Percent
No 113 66.9% 46%
Yes 56 33.1% 52%
Responses 169
5. How often do you get the social and emotional support you need? 21
Answer Options HSC Survey CT
Percent Number Percent
Always 50 27%
93% Usually 73 40%
Sometimes 37 20%
Rarely 17 9%
Never 7 4% 6%
Responses 184
27. Has a doctor, nurse, or other health professional ever told you that you have a
depressive disorder?
Answer Options HSC Survey Number HSC Survey Percent
No 123 75.5%
Yes 40 24.5%
Responses 163
34. Are you limited in any way in any activities because of mental or emotional problems?
Answer Options HSC Survey Number HSC Survey Percent
No 152 93.8%
Yes 10 6.2%
Responses 162
34. Are you limited in any way in any activities because of mental or emotional problems?
20
http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey 21
http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey
26
Answer Options HSC Survey Number HSC Survey Percent
No 152 93.8%
Yes 10 6.2%
Responses 162
Caregivers
A much higher number of HSC respondents serve as caregivers to family or friends than the
national average. While tasks performed are varied, maintaining the home and providing
transportation are the top two tasks. Caregivers report a number of serious difficulties as a result
of the responsibility, including stress and the impact on time for themselves, family, and work.
Studying individual answers shows many of the caregivers have emotional problems and impacts
on their lifestyle (smoking, use of alcohol or other substances).
44. During the past month, did you provide regular care or assistance to a friend or family
member?22
Answer
Options
HSC Survey
Number
HSC Survey
Percent National % (care for an adult >65)
No 95 59.01% 24% of adults age 45-64, and 17% of
those >65, care for an aging adult. Yes 66 40.99%
Responses 161
45. What age is the person to whom you are providing care?
6 individuals under age 20
4 individuals age 21-40
average age (41-96) is 79
46. What is the person's gender?
Answer Options HSC Survey Number HSC Survey Percent
Male 28 45.2%
Female 33 53.2%
Other 1 1.6%
Responses 62
47. What is the person's relationship to you? 23
22
http://www.bls.gov/news.release/elcare.nr0.htm 23
http://www.pewresearch.org/fact-tank/2015/11/18/5-facts-about-family-caregivers/
27
Answer Options HSC Survey
Number
HSC Survey
Percent
National %
(care for parent, >65)
Parent 23 37% approx. 44%
Parent-in-law 8 13%
Child 10 16%
Spouse 5 8%
Sibling 1 2%
Grandparent 3 5%
Grandchild 2 3%
Other relative 3 5%
Non-relative 7 11%
Responses 62
48. In which of the following areas does the person you care for need your help? (please
choose all that apply) 24
Answer Options
HSC
Survey
Number
HSC
Survey
Percent
National %
(care for
parent, >65)
Personal care 27 44% 14%
Taking medications 25 40%
Wound care, injections, or other medical
treatments 10 16%
Maintaining household 37 60% 58%
Communicating with others 23 37%
Learning or remembering 15 24%
Seeing or hearing 9 15%
Moving around within the home 21 34%
Transportation outside of the home 42 68%
Relieving/decreasing anxiety or depression 14 23%
Other (please specify)
8 13%
Financially
28%
Responses 62
49. Please indicate which of the following difficulties you have faced as a caregiver.(please
choose all that apply) 25
24
http://www.pewresearch.org/fact-tank/2015/11/18/5-facts-about-family-caregivers/ 25
http://www.pewresearch.org/fact-tank/2015/11/18/5-facts-about-family-caregivers/
28
Answer Options HSC Survey
Number
HSC
Survey
Percent
National %
(care for parent,
>65)
No difficulty 18 30%
Creates a financial burden 13 21%
Doesn't leave enough time for yourself 20 33%
Doesn't leave enough time for your family 12 20%
Interferes with your work 13 21%
Creates stress 30 49% 32%
Creates or aggravates your health problems 12 20%
Affects family relationships 19 31%
Other difficulty (please specify) 6 10%
Responses 61
Children
The demographics on children provided by the respondents are comparable to state averages.
However, comparison stats were not available for each segment in contrast to the adult section.
50. Do you have children under the age of 18 living in your household?
Answer Options HSC Survey Number HSC Survey Percent
No 121 77%
Yes 36 23%
Responses 157
51. What is the age of the child in your household?
Average is 10.7 years of age.
52. What is the child's gender?
Answer Options HSC Survey Number HSC Survey Percent
Boy 20 54%
Girl 16 43%
Other 1 3%
Responses 37
53. Which one of these groups would you say best represents the child’s race?
Answer Options HSC Survey Number HSC Survey Percent
Caucasian/White 26 74%
29
Black or African American 3 9%
Asian 1 3%
Native Hawaiian or Pacific Islander 0 0%
Native American, Alaskan Native 0 0%
Hispanic 0 0%
Other (2 or more races) 5 14%
Responses 35
54. How are you related to the child?
Answer Options HSC Survey Number HSC Survey Percent
Not related in any way 0 0%
Parent (biological, step, adoptive) 29 81%
Grandparent 6 17%
Foster parent or guardian 0 0%
Sibling (biological, step, adoptive) 1 3%
Other relative 0 0%
Responses 36
Child Health
The majority of HSC community members report the child’s health as being good or better, with
49% reporting zero days of poor or fair physical health.17% report the child being underweight
and 9% report the child being at least 10 pounds over the respondent’s desired weight for the
child.
55. Would you say that in general the child's health is:
Answer Options HSC Survey Number HSC Survey Percent
Excellent 13 35%
Very Good 16 43%
Good 7 19%
Fair 1 3%
Poor 0 0%
Responses 37
56. For how many days during the past 30 days would you rate the child's physical health as
poor or fair?
Answer Options HSC Survey Number HSC Survey Percent
0 days 18 49%
1-2 days 9 24%
30
3-5 days 5 14%
6-9 days 3 8%
10 or more days 2 5%
Responses 37
57. For how many days during the past 30 days would you rate the child’s mental health as
poor or fair?
Answer Options HSC Survey Number HSC Survey Percent
0 days 22 59%
1-2 days 5 14%
3-5 days 4 11%
6-9 days 1 3%
10 or more days 5 14%
Responses 37
68. How would you describe the child's weight?
Answer Options HSC Survey Number HSC Survey Percent
Underweight 6 17%
At your desired weight 27 75%
10-25 pounds over desired weight 2 6%
More than 25 pounds over desired weight 1 3%
Responses 36
Access to Healthcare for Child
Less than 3% of HSC community members report the child as not having healthcare coverage
and just 2.8% as not having a personal physician. 94.6% report the child as having been able to
see a doctor when needed and 92% report the child having a checkup within the past 12 months.
58. Does the child have any kind of health care coverage, including health insurance, prepaid
plans such as HMOs, or government plans such as Medicare? 26
Answer
Options HSC Survey
Number
HSC Survey
Percent CT Percent National Percent
No 5 2.8% 3.0% 6%
Yes 171 97.2%
Employer 62.0% 47%
26
http://kff.org/other/state-indicator/children-0-18/
31
Non-Group 4.0% 5%
Medicaid 29.0% 39%
Other Public n/a 2%
Responses 176
59. Do you have one person you think of as the child’s personal doctor or health care
provider?
Answer
Options HSC Survey Number HSC Survey Percent
No 1 2.8%
Yes, only one 27 75.0%
More than one 8 22.2%
Responses 36
60. Was there a time in the past 12 months when the child needed to see a doctor but could
not?
Answer
Options HSC Survey Number HSC Survey Percent
No 35 94.6%
Yes 2 5.4%
Responses 37
61. What was the reason? (please choose all that apply)
Answer Options HSC Survey Number Reason
Cost 0
Lack of transportation 0
Provider would not accept your insurance 1
Other 1 "Out of state"
Responses 2
62. What type of doctor?
Answer Options HSC Survey Number HSC Survey Percent
Primary care physician 24 85.7%
Specialist 2 7.1%
Other (please specify) 2 7.1%
Responses 28
63. About how long has it been since the child last visited a doctor for a routine checkup?
Answer Options HSC Survey Number HSC Survey Percent
Never 1 3%
0-12 month 34 92%
1-2 years 2 5%
2-5 years 0 0%
5 years or more 0 0%
Responses 37
32
Oral Health – Child
HSC respondents match the national figures for children visiting a dentist within the last 12
months, falling only slightly under the Northeast region’s figures with 81.1%. It is important to
note that the 8.1% that were cited as never having been to a dentist or dental clinic were reported
as being too young to receive the service. While the other 10.8%reported as having not received
care in over a year cite cost and the difficulty associated with obtaining care for a special needs
child as the reasoning.
64. How long has it been since the child last visited a dentist or dental clinic for any reason? 27
Answer Options HSC Survey
Number
HSC Survey
Percent
Northeast Region
% 2013 (within 12
months, No/Yes)
National % 2013
(within 12 months)
Never 3 8.1%
0-12 months 30 81.1% 86.9% 83.0%
1-2 years 4 10.8%
3-5 years 0 0.0%
5 years or more 0 0.0%
Responses 37
65. Does the child visit a dentist or dental clinic for regular check-ups?
Answer
Options HSC Survey Number HSC Survey Percent
No 3 8.1%
Yes 34 91.9%
Responses 37
66. Why doesn't the child visit a dentist or dental clinic for regular check-ups? (please choose
all that apply)
Answer Options HSC Survey Number HSC Survey Percent
Cost 2 33.3%
Lack of transportation 0 0.0%
Provider would not accept
your insurance 0 0.0%
Other* 4 66.7%
Responses 6
*Other responses: "Having trouble with special care needs"
“child too young”
27
http://www.cdc.gov/nchs/data/hus/hus14.pdf#084 , http://www.cdc.gov/nchs/fastats/dental.html
33
Chronic Illnesses and Conditions – Child
HSC offers a wide range of inpatient and outpatient services and community programs for
children with chronic conditions. Questions posed in the survey will provide details on the
challenges these children experience within their community. Items of concern include the
number of children being reported as having chronic conditions, and the specific data on asthma
and autism spectrum disorders.
69. Has a doctor, nurse, or other health professional ever told you the child has a chronic
illness?
Answer Options HSC Survey Number HSC Survey Percent
No 28 78%
Yes 8 22%
Responses 36
70. Regarding that chronic illness. Is the child:
Answer Options HSC Survey Number HSC Survey Percent
Seeing a primary care/family doctor for
follow up treatment and monitoring 22 21%
Seeing a specialist for follow up treatment
and monitoring 23
22%
Seeing both your primary care/family
doctor and a specialist for follow up
treatment and monitoring
46
44%
Responses 104
71. About how many times in the past 12 months has the child seen a doctor, nurse, or other
health professional for the chronic illness?
Answer Options HSC Survey Number HSC Survey Percent
0 days 15 56%
1-2 days 7 26%
3-5 days 2 7%
6-9 days 1 4%
10 or more days 2 7%
Responses 27
72. Has a doctor, nurse, or other health professional ever said that the child has asthma? 28
28
http://www.lung.org/assets/documents/research/estimated-prevalence.pdf
34
Answer
Options
HSC Survey
Number
HSC Survey
Percent CT Percent National Percent
No 29 83%
Yes 6 17% 3% 9%
Responses 35
73. Has a doctor, nurse, or other health professional ever said that the child has autism,
Asperger syndrome, or a related developmental disorder?
Answer
Options HSC Survey Number HSC Survey Percent
No 32 89%
Yes 4 11%
Responses 36
74. Has a doctor, nurse, or other health professional ever told you the child has diabetes?
Answer
Options HSC Survey Number HSC Survey Percent
No 36 100%
Yes 0 0%
Responses 36
Exercise / Activities – Child
94% of respondents reported the child as having participated in a fitness activity or exercise in
the past month; however, 6% reported that the child was limited in some way due to a physical
problem. Continuing or even expanding HSC’s programs that promote physical activity,
especially for those children with disabilities and chronic illnesses should be a priority.
67. During the past month, has the child participated in any fitness activities or exercises?
(Examples: running, walking, calisthenics, sports, games)
Answer
Options HSC Survey Number HSC Survey Percent
No 4 11%
Yes 32 89%
Responses 36
75. Is the child limited in any way in any activities because of physical problems? 29
Answer
Options
HSC Survey
Number
HSC Survey
Percent
CT % with
disability 2010
National % with
disability 2010
No 34 94%
29
https://www.census.gov/prod/2011pubs/acsbr10-12.pdf , https://www.census.gov/prod/2011pubs/acsbr10-12.pdf
35
Yes 2 6% 4.3-4.5% 5.2%
Responses 36
76. Does the child have any health problems that require use of special equipment?
Examples: cane, crutches, walker, wheelchair, special bed, special telephone.
Answer Options HSC Survey Number HSC Survey Percent
No 1 3%
Yes 5 14%
Responses 36
Emotional Health – Child
While 60% of children are reported as having no days affected by mental health issues, 40% are
affected and the activities of 14% are impacted by the problem.
57. For how many days during the past 30 days would you rate the child’s mental health as
poor or fair?
Answer Options HSC Survey Number HSC Survey Percent
0 days 22 59%
1-2 days 5 14%
3-5 days 4 11%
6-9 days 1 3%
10 or more days 5 14%
Responses 37
77. Is the child limited in any way in any activities because of mental or emotional problems?
Answer Options HSC Survey Number HSC Survey Percent
No 31 86%
Yes 5 14%
Responses 36
Demographics of Those Surveyed
Demographic details pertinent to identified health needs are discussed here. 153 of the 184
respondents completed the demographic section, including individuals from 51 towns.
A number of respondents do not drive as their primary means of transportation. 42% of
individuals who serve as caregivers provide transportation services. Downtown sections of most
state cities have readily available buses, but sections of these cities may not have an adequate
schedule and connection link to make public buses an efficient option for transportation.
36
Suburban towns in Connecticut may have a commuter bus that runs on “drive time” schedules, to
specific cities. Other towns offer no public transit options. Some public systems have limited
equipment to accommodate individuals living with disabilities. HSC’s “Amazing Journey”
demonstrates the challenges to travel within Connecticut. At this annual event, teams of
individuals living with disabilities are given destinations to which they must travel via public
transit.
88. What is your primary means of transportation?
Answer Options HSC Survey Number HSC Survey Percent
Drive Myself 128 84%
Get a Ride with family or
friends 15 10%
Public Bus system 3 2%
Walk 1 1%
Bicycle 0 0%
Taxi 0 0%
Paratransit (wheelchair,
accessible van) 5 3%
Other (please specify) 1 1%
Responses 153
An interesting and helpful response shows that most survey respondents have internet access and
chose to complete the questions online. Support groups and other educational programs and
mailings may now be offered using technology to reach the majority of our patients, program
participants, and new contacts.
89. Which of these devices do you have? (please choose all that apply)
Answer Options HSC Survey Number HSC Survey Percent
Computer or Tablet with
Internet Access
140 93%
Smartphone 105 70%
Cell phone with text and
calling (no internet)
44 29%
None of the above 3 2%
Response Count 151
Survey Completion Number Percent
Online 168 91%
Paper/phone 16 9%
Total surveys 184
37
38
Key Informant Survey
The key informants provided a range of health concerns in their community, with several issues
receiving more focus than others.
What are the top three health issues you see in your community? (CHOOSE 3)
0 5 10 15 20 25 30
Other
Uninsured/Underinsured
Tobacco
Suicide
Substance Abuse/Alcohol Abuse
Stroke
Obesity/Overweight
Mental health
Maternal/Infant/Child Health
Heart Disease
Diabetes
Dental Health
Cancer
Access to Care
Other:
Lack of physical activity
Dementia
MND/ ALS
Affordable care
Limb Loss
Housing
Access to affordable healthy food
Geriatrics/Aging Population
Disabilities
39
Of those mentioned, which one is the most significant? (CHOOSE 1)
0 5 10 15 20
Other (please specify)
Uninsured/Underinsured
Tobacco
Suicide
Substance Abuse/Alcohol…
Stroke
Obesity/Overweight
Mental health
Maternal/Infant/Child Health
Heart Disease
Diabetes
Dental Health
Cancer
Access to Care
Access to Care
The key informants reported having varying opinions on the availability and accessibility of
healthcare in their communities.
Answe r Op tio nsStro ng ly
D isa g re eDisa g re e Ag re e Stro ng ly Ag re e
Re sp o nse
Co unt
Number of Individuals 3 12 21 0 36
Percentage 8.33% 33.33% 58.33% 0.00%
Number of Individuals 3 14 19 0 36
Percentage 8.33% 38.89% 52.78% 0.00%
Number of Individuals 3 19 12 2 36
Percentage 8.33% 52.78% 33.33% 5.56%
Number of Individuals 5 21 10 0 36
Percentage 13.89% 58.33% 27.78% 0.00%
Number of Individuals 9 18 9 36
Percentage 25.00% 50.00% 25.00% 0.00%
Number of Individuals 5 22 8 0 36
Percentage 13.89% 61.11% 22.22% 0.00%
Number of Individuals 12 16 8 0 36
Percentage 33.33% 44.44% 22.22% 0.00%
9. T he re is a suffic ie nt numb e r o f me nta l/b e ha v io ra l he a lth p ro v id e rs in Co nne cticut.
3. Co mmunity me mb e rs a re a b le to a cce ss a p rima ry ca re p ro v id e r whe n ne e d e d .
(Fa mily Do cto r, Pe d ia tric ia n, Ge ne ra l Pra ctitio ne r)
4. Co mmunity me mb e rs a re a b le to a cce ss a me d ica l sp e c ia lis t whe n ne e d e d .
(Ca rd io lo g is t, De rma to lo g is t, Ne uro lo g is t, e tc .)
5. Co mmunity me mb e rs a re a b le to a cce ss a d e ntis t whe n ne e d e d .
6. T he re is a suffic ie nt numb e r o f b il ing ua l p ro v id e rs in Co nne cticut.
7. T he re is a suffic ie nt numb e r o f p ro v id e rs a cce p ting Me d ica id a nd Me d ica l
Ass is ta nce in Co nne cticut.
8. T ra nsp o rta tio n fo r me d ica l a p p o intme nts is a va ila b le whe n ne e d e d .
40
Significant Barriers to Access
According to the key informants, significant barriers affect the accessibility of healthcare in their
communities. These barriers affect health disparity rates among different populations.
Underserved Populations
41
Uninsured/Underinsured Programs
In the United States, the percentage of people with health insurance coverage has increased since
2013. Specifically, Connecticut’s uninsured rate fell from 12.3% in 2013 to 6.4% in 2015. This
5.9% change represents an increase in both private and government coverage. Furthermore, the
ACA will help many currently uninsured people from the state gain health coverage by providing
coverage options across the income spectrum for low and moderate-income people. The recent
Medicaid expansion established coverage provisions for low-income individuals, while premium
tax credits help individuals with moderate income purchase insurance directly through new
Health Insurance Marketplaces (Figure 1).
Due to Connecticut’s recent Medicaid expansion, over six in ten (63%) uninsured nonelderly
people in the state are eligible for financial assistance to gain coverage through either Medicaid
or the Marketplaces (Figure 2).30
As a result of these changes, the focus now shifts to outreach and enrollment efforts, as well as
education about navigating the new health care system in order to further decrease the state’s
uninsured rate, as well as help the underinsured gain access to better coverage.
Adults and Children Living with Disabilities
The health care system in the United States is complex, highly fragmented, and restrictive in
terms of program eligibility. As a result, people with disabilities are often left uninsured or with
cost-sharing obligations and limits on benefits. These barriers to care prevent adults and children
living with disabilities from obtaining health-preserving prescription medications, medical
equipment, specialty care, dental and vision care, long-term care, and care coordination, leading
to a significant increase in health disparities compared with people who do not have
disabilities.31
30
http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-connecticut/
31 https://www.ncd.gov/publications/2009/Sept302009#Health Coverage and Benefits
42
Location for Healthcare Services
Emergency care departments serve as the safety net for the entire national health care system,
providing care to everyone, regardless of ability to pay or insurance status. As a result, newly
employed individuals and uninsured/underinsured individuals are turning to emergency
departments for primary care. Furthermore, one key informant cited the following as rational for
using emergency departments for primary care in her survey response:
“Simplicity. It’s a known location, big building, locally situated. It’s easy to get to and it
resembles retail services. It’s known and trusted because it is familiar.”
- Key Informant32
Needed Services and Resources
14. Related to health and quality of life, what services or
resources do you think are missing in the community?
Response
Free/Low Cost Medical Care 50.0%
Free/Low Cost Dental Care 58.3%
Primary Care Providers 22.2%
Medical Specialists 8.3%
Mental Health Services 61.1%
Substance Abuse Services 25.0%
Multilingual Services 22.2%
Transportation 44.4%
Prescription Assistance 19.4%
Health Education/Information/Outreach 38.9%
Health Screenings 13.9%
Other (see next page) 11.1%
32
http://kff.org/medicaid/issue-brief/safety-net-emergency-departments-a-look-at-current-experiences-and-
challenges
43
Other:
Long term services and supports - information on how to access is often difficult
Smoking Cessation Programming is absent in this Community.
Lack of capacity for free med. PCP could develop better capacity for Medicaid.
Providers specializing in disabled populations
Multilingual
Healthcare in the United States is currently one of the top industries in need of multilingual
workers. Recent studies have shown that a majority of hospitals lack multilingual physicians and
healthcare support staff, leading to increased miscommunication and malpractice. Moreover,
many non-English speakers have mistrust of the healthcare system, as well as difficulty
navigating the system. This leads to the misuse of emergency care departments and other
resources. 33
Dental
“Dental care now represents the number one health care issue among people with
neurodevelopmental disorders.” – Dr. Steve Perlman, Global Clinical Director for the US Special
Olympics/Special Smiles Program
Research links poor oral health with increased risks for systematic conditions such as heart
disease, diabetes and aspiration associated with chronic obstructive pulmonary disorder (COPD).
Furthermore, people with disabilities are at a greater risk for health issues related to the lack of
dental care. As such, “oral health and general health should not be interpreted as separate
entities,” according to Surgeon General David Satcher who noted, “You cannot be healthy
without oral health.” For this reason, it is imperative that dental providers increase the care they
provide to persons with disabilities and implement systems for care for those persons requiring
individualized care.34
Smoking Cessation
Tobacco related diseases are the nation’s single most preventable cause of death, yet according
to DPH statistics, tobacco use continues to kill more people in Connecticut annually than
alcohol, AIDS, car crashes, illegal drugs, accidents, murders and suicides combined. Fortunately,
70% of Connecticut’s smoker’s indicate they want to quit; however, only 40% attempt to quit
each year, and only 5% are successful. These statistics show the need for tobacco use prevention
and cessation programs. Not only would these programs cut annual tobacco related health care
costs, they would also decrease tobacco related deaths, including those due to second-hand
smoke. 35
33
http://www.jointcommission.org/assets/1/6/hlc_paper.pdf 34
https://www.achieva.info/files/PDFs/Access%20to%20dental%20care%20for%20people%20with%20disabilities
%20-%20challenges%20and%20solutions%20includes%20policy%20recommendations.pdf 35
https://www.cga.ct.gov/ph/related%5C20141222_Public%20Health%20and%20Appropriation%20Committees%2
0Public%20Hearing%20re%20THTF%20Board%202014%20Report/Testimony%20-
%20American%20Cancer%20Society.pdf
44
Providers for Disabled Population
According to the World Health Organization (WHO), people with disabilities have less access to
health care services and therefore experience unmet health care needs. This is because people
with disabilities encounter a range of barriers when they attempt to access health care, including
the following: prohibitive costs such as affordability of health services and transportation; a
limited availability of appropriate services; and physical barriers including uneven access to
buildings and inaccessible medical equipment. Moreover, many healthcare workers lack
adequate skills and knowledge to provide care to those living with disabilities. These barriers
cause people with disabilities to be particularly vulnerable to deficiencies in health care services.
Depending on the group and setting, persons with disabilities may therefore experience greater
vulnerability to secondary conditions, co-morbid conditions, age-related conditions, engaging in
health risk behaviors and higher rates of premature death. For these reasons, physicians need to
provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate
access to health care services to disabled individuals, as well as ensure their staff possesses
adequate skills and knowledge for providing the necessary care. 36
Challenges to Maintaining Healthy Lifestyles
Maintaining a healthy lifestyle can be challenging in today’s environment, especially for those
individuals with acute or chronic illnesses or disabilities. The stress of being diagnosed with said
ailments can lead to an increase in dangerous life style behaviors such as smoking, unhealthy
diet, and physical inactivity. These behaviors increase the risk factors for developing additional
chronic diseases, specifically heart disease, stroke, diabetes, obesity, metabolic syndrome,
chronic obstructive pulmonary disease, and some types of cancer.37
What Is Being Done Well? (regarding health and quality of life)
According to our key informants who participated in the survey, Hospital for Special Care has
made strides in increasing health and quality of life, including having a strong understanding of
the needs of the community and the patients it serves. Great effort has been made to
communicate and fulfill said needs through new and continuing services and programming, such
as support groups, recreation services, advocacy for healthy lifestyles, and web based resources.
Outside HSC, there have also been several community initiatives to help improve health and
quality of life, such as MyPlate education, after school programming and recreational
programming for children and adults offered by the Park and Recreation Department, and free
flu shots at local pharmacies.
36
http://www.who.int/mediacentre/factsheets/fs352/en/ 37
http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf
https://www.health.ny.gov/diseases/cardiovascular/heart_disease/risk_factors.htm
45
Recommendations to Improve Health and Quality of Life (for persons living with chronic
conditions and physical disabilities)
According to our key informants who participated in the survey, there are several areas Hospital
for Special Care should focus on to improve the health and quality of life of individuals with
disabilities and chronic conditions. Those areas that key informants focused on most include:
improved transportation to medical services, increased mental health services, and increased
education about healthy lifestyle choices for the whole family.
Education about Services and Navigating Healthcare System
With the abundance of changes and additions being made to the state’s healthcare system, effort
needs to be made to increase education about available resources, as well as how to successfully
navigate the system as a whole. This includes helping individuals better understand the insurance
landscape in order to increase coverage across the state.
Transportation
Transportation serves as a prohibitive cost of healthcare and is therefore a barrier to care for
many adults and children living with disabilities and chronic illnesses. Increasing the availability
of free or low-cost transportation would increase the utilization of healthcare resources,
including those services that help decrease the health disparities experienced by individuals
living with disabilities.
Increase Awareness/Incentives Healthy Lifestyles and Public Health Initiatives
Increased awareness should be established about the importance of living a healthy lifestyle,
including: the impact of preventative care, the importance of maintaining a healthy diet and
exercise, eliminating dangerous life style behaviors, and increasing focus on the importance of
dental care. Similarly, programming should be implemented to make healthy lifestyle choices
easier. Developing ways to incentivize these behaviors would be especially valuable.
Key Informant Demographics
46
47
PRIORITIZED COMMUNITY HEALTH NEEDS
The health needs stated or implied by the community member survey—targeted groups like those
served by HSC—differ from the priorities measured by the key informant group. Most key
informants serve a much broader range of the general population than our LTACH facility, which
impacts their priorities. Our hospital does not provide all of the types of services requested, but
we do have the ability to impact several important needs. When comparing our community
member survey to state and national statistics differences are noticeable. Many of those currently
served by HSC’s programs demonstrate good choices (healthcare coverage, not smoking, regular
medical checkups and treatment of chronic conditions), but increased needs for assistance and
education in special areas (frequency of falls, and transportation challenges).
Needs documented in the 2013 CHNA have been successfully addressed by new or expanded
HSC programs, but more work can be done in most of these areas. The data collected in the 2016
assessment provides details on our community that will allow us to better design program
content to meet needs.
The HSC community health needs team and clinical operations leadership examined the data,
selected needs, and prioritized the projects to meet those needs using a simple but effective tool
employed regularly by our Lean process teams to rank projects by the level of impact (high or
low) and the ability of HSC to implement the project (hard or easy).
Prioritization Matrix Source: Rocky Hill, CT www.connstep.org
Using this method, HSC prioritized the following identified needs:
1. Reduce obesity and overweight by increasing physical activity levels of persons with
chronic conditions and physical disabilities. Continue to promote community
membership in the Aquatic Rehabilitation and Fitness Center, targeting special
populations. Expand services of Special Care Equipment Exchange.
Rated as high impact, easy to implement
48
2. Enhancing the ability of like groups to communicate and share aspects of their conditions
Promote existing support groups and new groups, with an emphasis on new venues.
Improve access to resources for caregivers; explore opportunities to help caregivers
communicate as a group. Rated as high impact, easy to implement
3. Offer education on prevention of slips, trips and fall to individuals who report falls and
challenges with ambulation. Rated as high impact, easy to implement
4. Improve access to primary care for persons with chronic conditions and physical
disabilities. Continue working to establish medical homes for specific groups and
coordinate care for persons with chronic conditions. Programs will include our
Neuromuscular Center, Autism Center, and Dental Services.
Rated as high impact, hard to implement
5. Issues from transportation to medical services, are identified as a challenge by
individuals, caregivers, and key informants. Public transportation, especially accessible
vehicles, is a statewide challenge could benefit from a collaborative effort.
Rated as high impact, hard to implement
6. Provide education and support to encourage people to make healthy lifestyle choices.
HSC’s smoking cessation program has demonstrated effectiveness and should be
continued. Many community members rely on HSC for reliable healthcare information
and resources. Rated as low impact, hard to implement
7. HSC does not offer services in the areas of mental health, substance abuse, or weight loss
and healthy food choice programs, but will explore collaborative options to promote
existing community services. Rated as low impact, hard to implement
Existing Community Resources
Connecticut has many acute care hospitals that work to meet the healthcare needs of their
community members. HSC is part of the continuum of care for these hospitals statewide:
The William W. Backus Hospital, Norwich
Bridgeport Hospital, Bridgeport
Bristol Hospital, Bristol
The Hospital of Central Connecticut, New
Britain
Connecticut Children's Medical Center,
Hartford
Danbury Hospital, Danbury
Day Kimball Hospital, Putnam
Greenwich Hospital, Greenwich
Griffin Hospital, Derby
Hartford Hospital, Hartford
The Charlotte Hungerford Hospital,
Torrington
Johnson Memorial Hospital, Stafford
Springs
Lawrence + Memorial Hospital, New
London
Manchester Memorial Hospital, Manchester
Middlesex Hospital, Middletown
MidState Medical Center, Meriden
Milford Hospital, Milford
New Milford Hospital, New Milford
Norwalk Hospital, Norwalk
Rockville General Hospital, Vernon
49
Saint Francis Hospital and Medical Center,
Hartford
Saint Mary's Hospital, Waterbury
St. Vincent's Medical Center, Bridgeport
Stamford Hospital, Stamford
UConn John Dempsey Hospital, Farmington
Waterbury Hospital, Waterbury
Windham Hospital, Willimantic
Yale-New Haven Hospital, New Haven
The state of Connecticut has a number of departments and programs that address specific needs
of special populations. HSC often refers patients and program participants to programs that can
help them to access services:
Department of Public Health
Department of Mental Health and Addiction
Services
Department of Children and Families
Department of Developmental Services
Department of Housing
Department of Rehabilitation Services
Department of Social Services
Money Follows the Person
Department on Aging
Council of Developmental Disabilities
Office of Early Childhood
Office of the Healthcare Advocate
Office of Protection and Advocacy for
Persons with Disabilities
A number of valuable not-for-profit organizations advocate for special groups and provide
services. Those working with members of HSC’s community include:
ALS Association – CT (Amyotrophic lateral
sclerosis)
American Heart Association, CT Affiliate
American Lung Association in CT
Autism Speaks
Autism Families CONNECTicut
Brain Injury Alliance – CT
Food Share (CT)
Muscular Dystrophy Association, CT office
National Stroke Association
Spinal Cord Injury Association – CT
Community Health Needs Not Addressed
All of the needs demonstrated in the assessment are genuine. However, based on the variety of
those needs and HSC’s core competencies in certain specialized areas, HSC will continue to
focus on the needs of individuals living with chronic conditions or physical disabilities.
Therefore, HSC is not in a position to address all of the needs. Identified needs that will not be
directly addressed are explained here.
Healthcare coverage / Access to care / Navigation of healthcare systems
The reasons individuals do not seek care or are unable to obtain care are many and varied. The
survey responses indicate that these reasons are often intertwined.
In the United States, the percentage of people with health insurance coverage has increased since
2013. Specifically, Connecticut’s uninsured rate fell from 12.3% in 2013 to 6.4% in 2015. This
5.9% change represents an increase in both private and government coverage. While there are
48
some individuals who remain uninsured, this number also includes those individuals who have
chosen to pay the annual fine rather than pay for insurance.
All of HSC’s inpatient and outpatient services access a wide variety of coverage products
including Medicare and Medicaid. Some services specifically target uninsured and underinsured
individuals.
Some of the exchanges offered to individuals without other health coverage options may actually
complicate access to care. Some products have few approved providers which may limit access.
Most plans require co-pay or have high deductibles that may be unaffordable for some people.
HSC supports and encourages patients and program participants to enroll in programs that will
best meet their needs. Advice and education on navigating healthcare systems is offered to
patients and to program participants. Clinicians at HSC often function as advocates for our
community members.
Mental health services / Substance abuse treatment
As an LTACH, HSC’s programs address physical rehabilitation and respiratory care; we are not
a provider of mental health services or substance abuse treatment as primary diagnoses. Staff
psychologists and psychiatrists address such issues with our inpatients and outpatients when the
issues are secondary to a patient’s medical diagnoses.
49
NEXT STEPS
Approval of CHNA Report by the Governing Body
The Hospital for Special Care Board of Directors met on March 24, 2016 to review the findings
of the CHNA. The report was approved.
Public Access to the 2016 CHNA
This report can be found on the HSC website at: http://hfsc.org/about-us/community-health-needs-
assessment . A paper copy is available in the HSC Health Sciences Library.
Implementation Strategy
Data collection will be ongoing throughout the three-year cycle of this CHNA.
Design Implantation Strategy to address prioritized needs, with participation of the HSC
program managers
Meetings with key informants and service providers to discuss implementation strategy
and collaborative efforts.
Board of Directors will adopt the Implementation Strategy before August 15, 2016.
Implementation from the month of adoption through 2019.
50
ATTACHMENT SECTION FOLLOWS
Age
Gro
upM
FM
FM
FM
FM
FM
FM
FM
FTo
tal
<1 y
rs10
,329
9,80
92,
511
2,42
252
521,
062
1,04
727
,284
3,82
03,
693
816
765
121
117
7184
9,48
736
,771
1-4
yrs
43,5
3841
,331
10,1
649,
786
320
356
4,47
94,
540
114,
514
16,2
2415
,918
2,44
12,
388
355
362
227
237
38,1
5215
2,66
65-
9 yr
s62
,180
59,3
3013
,479
12,9
5331
631
35,
997
6,08
516
0,65
320
,433
19,7
323,
845
3,72
456
151
635
434
849
,513
210,
166
10-1
4 yr
s73
,515
69,2
7314
,141
13,7
0033
234
95,
705
5,91
118
2,92
619
,634
18,8
203,
515
3,22
656
350
231
532
146
,896
229,
822
15-1
9 yr
s82
,870
79,4
0715
,893
14,9
1435
337
15,
308
5,73
320
4,84
920
,236
18,9
333,
401
3,12
352
255
333
132
347
,422
252,
271
All
272,
432
259,
150
56,1
8853
,775
1,37
31,
441
22,5
5123
,316
690,
226
80,3
4777
,096
14,0
1813
,226
2,12
22,
050
1,29
81,
313
191,
470
881,
696
Sug
gest
ed C
itatio
n: B
acku
s, K
, Mue
ller,
LM (2
015)
Sta
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Est
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, 201
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Sta
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Sur
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Estim
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for t
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Con
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by
Age
Gro
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and
His
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Rac
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(His
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Whi
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ndia
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Non
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Whi
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lack
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/ PI
His
pani
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ll R
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Not
es:
Rac
e ca
tego
ries
in th
is ta
ble
are
cons
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ith th
e th
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ur ra
ce c
ateg
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s sp
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y th
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of M
anag
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(OM
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15, “
Rac
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thni
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tand
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for F
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Sta
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s an
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dmin
istra
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Rep
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g”: W
hite
, Bla
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can
Am
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an, A
mer
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Indi
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Nat
ive,
Asi
an o
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ific
Isla
nder
. P
leas
e se
e N
CH
S' d
ocum
enta
tion
for m
ore
info
rmat
ion:
ftp
://ftp
.cdc
.gov
/pub
/Hea
lth_S
tatis
tics/
NC
HS
/Dat
aset
s/N
VS
S/b
ridge
pop/
2014
/Doc
umen
tatio
nBrid
gedP
ostc
enV
2014
Sour
ce: N
atio
nal C
ente
r for
Hea
lth S
tatis
tics.
Vin
tage
201
4 po
stce
nsal
est
imat
es o
f the
resi
dent
pop
ulat
ion
of th
e U
nite
d S
tate
s (A
pril
1, 2
010,
Jul
y 1,
201
0-Ju
ly 1
, 201
4, b
y ye
ar, c
ount
y,si
ngle
-yea
r of a
ge, b
ridge
d ra
ce, H
ispa
nic
orig
in, a
nd s
ex. P
repa
red
unde
r a c
olla
bora
tive
arra
ngem
ent w
ith th
e U
.S. C
ensu
s B
urea
u; re
leas
ed J
une
30, 2
015.
Ava
ilabl
e fro
m: h
ttp://
ww
w.c
dc.g
ov/n
chs/
nvss
/brid
ged_
race
.htm
as
of J
une
30, 2
015.
Attachment 1