Jefferson County, WARural Health Initiative

Matthew Helbert RN, BSNUniversity of Washington

UCONJ 501

Table of Contents

• 1- Objectives

• 2- County Data

- Geography

- Demographics

- Socioeconomic Data

•3- Current Health System

- Health Facilities

- Distance to Care

- Telehealth/Broadband Capability

- Positive Health Indicators

- Areas of Disparity

•4- Health Priorities- Questions for Stakeholders: Insurance

- Questions for Stakeholders: Access

•5- Health Initiative Focus- Selection Justification

- Intervention Overview

- Intervention Models

- Intervention Detail

- Intervention Resources

- Proposed Community Engagement

•6- Summary and Conclusion- References

•Questions

Objectives

Assess and synthesize county demographic and health data

Identify current health assets and resource levels

Identify health strengths and disparities

Seek input and collaboration from community and stakeholders

Present evidenced-based interventions for identified areas of health disparity

Propose a community engagement strategy to secure community buy-in

County Data

• Jefferson County, Washington is a sparsely populated area of the Olympic Peninsula with a total population of just under 30,000

• Jefferson County is ranked 27 out of 39 for population in Washington State.

Geography

Jefferson County is divided into three sections that are dictated by its landforms. • East county- This area is the most

populated portion of the county due to it’s rich farm land, vicinity to major waterways and roads, and weather patterns

• Central county- Mount Olympus lies in the center of the county and the Olympic National Forest; limited population due to the park

• West county- This area is geographically remote, bordered by the Pacific Ocean and the Olympic National Forest; population consists of small villages and logging communities

Demographics

• Total population for 2009 was 29,000

• 59% of the population was age 45 and older

• 19% of the population was age 19 and younger

• 92% of the population is reported to be Caucasian, 2.7% is reported to be Hispanic, and 2.5% is reported to be American Indian or Alaskan Native

Demographics

• The county seat and most densely populated town is Port Townsend with 8,895 residents

• Population density per square mile is 16.0; Jefferson County ranks 29 out of 39 in Washington State for this measure

• 92% of the population has a high school diploma or completion certificate (WA state 87%)

• 28.4% of the population has a Bachelor’s degree or higher (WA state 27.7%)

Socioeconomic Data• Reported unemployment figures through

October, 2009 was 7.6% (WA state 8.7%)

• 12.4% of adult residents are reported to live below the federal poverty level (WA state 11.3%)

• 18.8% of child residents are reported to live below the federal poverty level (WA state 16%)

• The largest employers in the county are in the construction, paper manufacturing, food service and accommodation, health care, public administration, and education fields

• 20.4% (5800) of the county population is eligible for state Medicaid coverage according to income and disease/injury related conditions

• Rough estimates identify that 24% of the county population is medically uninsured (WA state 16%)

• Further estimates suggest that as high as 45% of the county population is medically under-insured

Socioeconomic Data

Current Health System

The health system in Jefferson County currently consists of a single acute care and OB hospital-Jefferson Healthcare Hospital

RUCA classification: small town and isolated rural

The Primary Care Provider to patient ratio is 2300:1

The Mental Health Provider to patient ratio is 30,000:1

There have been 2 free clinics identified to be operating within the county

There are no county or state subsidized primary care community health clinics operating in Jefferson County

The Jefferson County Public Health Department operates several robust disease prevention programs and outreach services

Health Facilities

• Jefferson Healthcare Hospital is a hospital district owned 25 bed critical access facility

• Trauma designation Level 4 facility• OB/GYN designation Basic facility• 5 primary care clinics including a

ARNP run clinic in Quilcene, WA

• JC-MASH operates 2 free physician and ARNP staffed clinics a week

• Located in Port Townsend and Port Hadlock, WA

Distance to Care

• The only county facility designated for OB care is located in Port Townsend, WA

• Approximately 80% of the county area is more than 30 minutes from a facility that provides OB care

• The only county facility designated for emergency/ trauma care is located in Port Townsend, WA

• Approximately 80% of the county area is more than 30 minutes from definitive emergency care

Telehealth/Broadband Capability

• Populated areas of Jefferson County are well equipped for telehealth

• Broadband access has enabled a single vendor electronic medical records (EMR) system to be adopted in the east county area

• Jefferson Healthcare participates in a telehealth program for Parkinson’s disease patients and families

Positive Health Indicators

Health Indicator Jefferson County WA State

Teen Physical Activity1 57% 44%

Adult Overweight or Obese1 56% 61%

Adults with Diabetes1 4% 7%

Adult Poor Mental Health1 <5% 10%

Food Service Safety1, 2 100% 93%

1 Washington State Department of Health (2009) 2 Encompasses all food safety metrics, including shellfish; Washington State DOH (2010)

Areas of Disparity

Health Indicator Jefferson County WA State

Reported Child Immunizations1 38% 42%

Children with Health Insurance1 88% 95%

Adults with Health Insurance1 76% 84%

Adults with Unmet Medical Need1 16% 12%

Adult Cigarette Smoking1 31% 16%

1 Washington State Department of Health (2009)

County Health Priorities

Insurance Access• Includes private, state, and federally funded insurance

products

Access to Care• Includes provider access, financial access, and

resource identification

Questions for Stakeholders: Insurance

• What organizations exist (if any) that provide outreach for the uninsured and assistance in obtaining basic health coverage?

• Are there any charitable organizations in the county that may provide safety net insurance coverage to qualified individuals or families?

• Are there any current plans for the public health department to secure funding for a subsidized community health clinic?

• Is there community support to provide neighborhood identification of at risk groups, i.e. low socioeconomic status, high incidence of substance abuse, etc?

• What resources are available in the current health system for under-insured cohorts that may be adversely affected by prohibitive health costs, i.e. charity programs, sliding scale fee providers?

Questions for Stakeholders: Access

• Are there any paramedic, PA, or ARNP level providers in the county that operate remote clinics?

• Are there any physician level providers willing to train physician extenders to operate remote clinics via telehealth?

• What infrastructure exists for telehealth programs both for in-county care and for out of county referrals?

• Are there any telehealth agreements in place for specialty care?• Are plans being made for the establishment of government funded

primary care community health clinics that will provide acute care and primary care visits?

• Are there grants available for rural health expansion now and under the new Patient Protection and Affordable Care Act?

Health Initiative Focus

Expand access to care

Evidenced-based Interventions Expand, empower, and advocate

Expand access to insurance

Evidenced-based Interventions Outreach, inform, and advocate

Selection Justification

INSURANCE DEFICIT

Lack of appropriate medical insurance

increases cost burden for entire community

Lack of insurance results in emergency services being

utilized for primary care and limits vital resources

Financial outcomes spill over into all aspects of the

economy at every level

LIMITED ACCESS

Lack of access to basic health services increases the health care burden for other

communities

Lack of primary medical care results in amplification of

costly emergency services and in-patient stays

Inability to receive definitive treatment

results in higher mortality

Intervention Overview

Insurance• Establish outreach to link the

uninsured to available and appropriate resources

• Inform uninsured and under-insured populations that affordable or free insurance and financial resources are available

• Advocate for the uninsured and under-insured through the local community, state government, and federal government

Access• Expand current systems to

accommodate the needs of the entire community; build if needed

• Empower physician extenders, rural providers, and the community to play a more active role in innovation of the county health care system

• Advocate for medical home initiatives, community health clinics, and expanded EMS services

Intervention Models

Insurance• The CHOICE program provides

funding, insurance resources, and Medical Home placement for uninsured and underinsured in 5 central-western Washington counties

• The Inland Northwest in Charge (INIC) program based in Spokane, WA provides 11 counties many services including outreach and enrollment for insurance programs for the underserved and uninsured, specialty care and primary care referral and placement, affordable insurance product design for low income working populations, and health resources

Access• The development of a training program

for volunteer firefighters and EMT-Basic trained personnel to obtain paramedic certification

• Develop partnerships with other available assets in the county such the U.S. Coast Guard for coastal regions, and DIA/ Indian Health Services to collaborate in providing dedicated EMS coverage for the entire county

• The Red River (New Mexico) project allowed paramedics an expanded scope of practice under telephonic supervision of a dedicated physician

Intervention Detail

Insurance

• Provide insurance counseling and resources

• Expand sliding scale and charity programs

• Establish outreach to inform the uninsured and under-insured of available programs

• Provide primary care and specialty care coordination and referral

• Develop safety net insurance for interim time period prior to full implementation of the PPACA legislation

Access

• Establish funding and plans for community health clinics as safety net providers

• Expand the roles of EMS providers and physician extenders in remote areas via telehealth and advanced practice development

• Establish partnerships with out of county resources including federal health assets to cover specialty needs or emergency transports (flight resources)

Intervention Resources

• The CHOICE Regional Health Network Regional Access program- Olympia, WA

• The Inland Northwest in Charge program- Spokane, WA• The Red River Project of the Taos Health Outreach Program- Taos, NM• Western Regional Medical Command- Joint Base Lewis-McChord, WA• Washington State Department of Health- Tumwater, WA• National Association of Emergency Medical Technicians (NAEMT)- Clinton,

MS• Northwest Region EMS and Trauma Care Council- Bremerton, WA• Washington Academy of Physician Assistants (WAPA)- Seattle, WA• Washington State Nurses Association (WSNA)- Seattle, WA• ARNP’s United of Washington State- Kent, WA• Washington State Medical Association- Seattle, WA

Proposed Community Engagement

The Jefferson County community must be involved in and informed of all data analysis and proposed interventions. Community buy-in is essential for any program success. A plan would include:

Community outreach about prevalence of issues and outreach services available- can be accomplished with media partnerships

Community forum involvement, i.e. town halls, county council sessions, health fairs, community events

Community assessment for local champions and key stakeholders

Explanation of benefits and risks associated with all interventions and accurate public reporting of results

Summary and Conclusion• Jefferson County is a vibrant

community ready for improvement in the existing health system

• The health priorities identified are problems that have evidenced-based intervention programs available for modeling

• Disparity in insurance coverage and access to care affects the local economy

• The human, social, and financial burden associated with these disparities can be eliminated with careful planning and innovative action

References

Capoccia, L., & Baumgarten, D. (2010). Models for Practice: Inland Northwest in Charge. Spokane: Rural Healthy People 2010.

Jefferson County Public Health Department. (2010). JCPH Home Page. Retrieved July 17, 2010, from Jefferson County Public Health: http://www.jeffersoncountypublichealth.org/index.php

Jefferson County Washington. (2010, May 1). Welcome to Jefferson County. Retrieved June 25, 2010, from Jefferson County Home Page: http://www.co.jefferson.wa.us/Default.htm

Northwest Parkinson's Foundation. (2010). Parkinson's Telehealth Program. Retrieved July 7, 2010, from Northwest Parkinson's Foundation Home Page: http://www.nwpf.org/TeleHealthNet.aspx

Onboard Informatics. (2010). Jefferson County, Washington. Retrieved July 3, 2010, from City-Data.com: http://www.city-data.com/county/Jefferson_County-WA.html

Rural Healthy People 2010. (2010). Models for Practice: Red River Project of the Taos Health Outreach Program. Taos: Rural Healthy People 2010.

U.S. Census Bureau. (2010). Jefferson County, Washington. Retrieved July 3, 2010, from State & County QuickFacts: http://quickfacts.census.gov/qfd/states/53/53031.html

Washington State Department of Health. (2010). Rural Health Program. Retrieved July 14, 2010, from Washington State Department of Health Home Page: http://www.doh.wa.gov/hsqa/ocrh/Default.htm

Washington State Office of Financial Management. (2010). Jefferson County Main Page. Retrieved August 9, 2010, from Washington State Office of Financial Management Home Page: http://www.ofm.wa.gov/localdata/jeff.asp

West, K. (2010). Models for Practice: CHOICE Regional Health Network Regional Access. Olympia: Rural Healthy People 2010.

Questions?