Mercy Medical Center Dubuque Community Health Needs ...€¦ · Mercy Medical Center - Dubuque and Mercy Health Network serves with fidelity to the Gospel as a ... weight loss, and

Mercy Medical Center Dubuque

Community Health Needs Assessment

Conducted in Fiscal Year 2018

For Fiscal Years 2019, 2020, and 2021

Mercy Medical Center – Dubuque Community Health Needs Assessment

Contents Mercy Medical Center – Dubuque....................................................................................................2

Community Health Needs Assessment..............................................................................................2

Introduction......................................................................................................................................4

Our Vision, Mission and Values Ground Us ...................................................................................4

Mission Statement......................................................................................................................4

Our Vision Calls Us....................................................................................................................4

Our Values Guide Us .................................................................................................................4

Executive Summary ......................................................................................................................4

CHNA Approval ............................................................................................................................5

Review of Previous CHNA .............................................................................................................5

Comments from previous CHNA ...................................................................................................8

Community Description....................................................................................................................9

Geographic Area Served ..............................................................................................................9

How Population Served Was Identified .........................................................................................9

Demographics of Population .......................................................................................................10

Health Facilities...........................................................................................................................11

Services Provided .......................................................................................................................11

Process and Methods......................................................................................................................12

Steering Committee Members.................................................................................................12

Steering Committee Meetings .................................................................................................13

Taskforce Membership............................................................................................................13

County Health Rankings ..............................................................................................................13

Health Outcomes .....................................................................................................................13

Health Factors..........................................................................................................................14

Community Input............................................................................................................................15

Methods used to solicit input.......................................................................................................15

Health Department Input..........................................................................................................15

Representation of medically underserved, low-income, and minority populations ..................15

Community Input Survey Results.................................................................................................15

Mercy Dubuque CHNA 2019-21 Page 2 of 28

Select Key Findings from Data Review............................................................................................21

Dubuque County and Iowa Health Data from County Health Rankings .....................................21

Dubuque County Health Portrait 2017, from Community Commons .........................................21

Iowa Department of Public Health core measures: ...................................................................22

Dubuque County cancer incidence rates: (Iowa Cancer Registry) ...........................................25

2017 Cancer In Iowa, University of Iowa College of Public Health............................................25

Significant Community Health Needs..............................................................................................26

Ranking of significant community health needs and brief description: ........................................26

Conclusion .....................................................................................................................................27

Implementation Strategy .............................................................................................................27

How to obtain copies...................................................................................................................27

Contact Information ....................................................................................................................27

Next CHNA Due Date ..................................................................................................................28


Introduction For the third time, Mercy Medical Center - Dubuque joined the Dubuque County Community Health

Needs Assessment – Health Improvement Plan (CHNA-HIP) coalition. This assured broad involvement from many key organizations across our service area. For that reason, some of the

processes, data and findings reported here are identical to those detailed in the Dubuque County

Community Health Needs Assessment. Mercy participated in all aspects of steering, coordinating

and completing the process.

Our Vision, Mission and Values Ground Us

Mission Statement

Mercy Medical Center - Dubuque and Mercy Health Network serves with fidelity to the Gospel as a

compassionate, healing ministry of Jesus Christ to transform the health of our communities.

Our Vision Calls Us

Mercy Health Network will set the standard for a personalized and radically convenient system of

health services.

Our Values Guide Us Reverence: We honor the sacredness and dignity of every person.

Integrity: We are faithful to who we say we are.

Commitment to the Poor: We stand with and serve those who are poor, especially the most

vulnerable.

Compassion: Solidarity with one another, capacity to enter into another’s joy or sorrow Excellence: Preeminent performance, becoming the benchmark, putting forth our personal and

professional best.

Justice: We foster right relationships to promote the common good, including sustainability of the

Earth.

Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and

natural resources entrusted to our care.

Executive Summary This Community Health Needs Assessment was developed collaboratively between Mercy Medical

Center—Dyersville, Mercy Medical Center—Dubuque, Unity Point Health Finley Hospital, Dubuque

County Health Department, City of Dubuque Health Services, and Crescent Community Health

Center. Mercy Medical Center – Dubuque is a community medical-surgical hospital serving the Tri-State area of eastern Iowa, southwest Wisconsin, and northwest Illinois. Also located in Dubuque

County are Mercy Medical Center – Dyersville, a critical access hospital, and Unity Point Health Finley Hospital, another community medical-surgical hospital. The service area is relatively

homogenous, with a white non-Hispanic population of 93% and very low overall population growth.

This process began by convening the steering committee, comprised of representatives from

organizations representing a broad variety of community organizations with an interest in health

and wellness. The Steering Committee collected primary and secondary data and organized

taskforces of content experts from the community to analyze and identify priority health needs in


the community. The task forces reviewed secondary research consisting of statistical information

about disease occurrence, mortality, and behavioral patterns of Dubuque County residents

compared to Iowans in general or to previous periods of time. Some of the data sources used for

this research were Community Commons, County Health Rankings, and Iowa Vital Statistics, and a

community input survey updated and designed for this process.

Based on the secondary research as well as the survey findings, the steering committee reviewed

the taskforce recommendations and identified and prioritized, through discussion and consensus,

fourteen significant health needs:

1. Opioid Use and Abuse

2. Obesity & Overweight

3. Alcohol Use and Abuse

4. Mental Health Access

5. Influenza Immunizations

6. Healthy Homes

7. Primary Care Access

8. Emergency/Disaster Planning

9. Drinking Water Protection

10. Dental Care Access

11. Specialty Care Access

12. Elder Care Access

13. HIV/AIDS Screening and Prevalence

14. STD/STI Screening and Prevalence

These are further addressed in the hospital's forthcoming Implementation Strategy.

CHNA Approval On May 24, 2018, the Board of Trustees for Mercy Medical Center – Dubuque met to discuss the Fiscal Years 2019, 2020, and 2021 Community Health Needs Assessment conducted during

Fiscal Year 2018. Upon review, the Board approved this Community Health Needs Assessment.

Review of Previous CHNA In 2016, Mercy's CHNA identified several high priority health needs, including:

1. Reducing obesity

2. Reduction in alcohol abuse in particular and substance abuse in general

3. Diabetes screening and management

4. Not taking prescribed medication for high blood pressure

5. Increased screening for prostate cancer

6. Community concerns about insufficient access to mental health providers

7. Insufficient bilingual health care providers in the community

From these high priority health needs, Mercy collaborated with Mercy Medical Center – Dyersville, Dubuque County Health Department, and the Dubuque County Wellness Coalition to focus on

addressing the goal of reducing obesity in our communities.


Mercy, in partnership with many community partners, supported and implemented numerous

interventions to address obesity in our community, and we continue to look for and implement new

and innovative opportunities to respond to our community needs. Our goal from the previous

CHNA-HIP was to reduce obesity among Dubuque County adults from 29% to 27% by June 30,

2018. The data source used, countyhealthrankings.org does not have this data point up to date.

Thus, it is difficult to say with certitude that this goal has been achieved. However, the data

available from that measure does indicate we have stabilized the percentage, and we believe the

initiatives listed below will result in the desired impact as updated data becomes available. The list

below highlights actions taken since implementation of the 2015 CHNA-HIP we believe have made

an impact on the health of our community, towards the goal of reduced incidence of adult obesity.

- Broaden the scope of the Dubuque County Wellness Coalition to include organizational

representation capable of carrying strategic policies back to their organizations, and

organizations that better represent the cultural and economic diversity of the community

and all geographic areas of the county.

o The Dubuque Wellness Coalition consists of community members and organizations working to impact policy and infrastructure identify gaps and duplication of efforts

and utilize data to influence individual and community health. Members consist of

City Health , Leisure Service Department, Dubuque County Health Department,

IDPH, Dubuque Community & Holy Family Schools, Live Health Dubuque, Hy-Vee,

Multi-Cultural FC, Mercy, Finley, Hillcrest, Iowa State University Extension, VNA,

Crescent CHC, Tri-State Trail Vision, St. Stephen's Food Bank, Dubuque Community

Y, Helping Services, and other local business.

o Although membership has expanded and represents more sectors and organizations, cultural diversity has not changed.

- Involve the Local Food Systems Working Group and other community-based organizations

that have a specific interest in nutrition, weight loss, and physical activity in the process.

o Dubuque Eats Well is a network of community members and organizations working together to transform the local food system.

o Local food systems group representative is a member of the Coalition and reported out/received coalition input on local foods assessment, local food activities etc.

o Established Double Up Food Bucks (DUFB) program which distributed $4,100 DUFB dollars to SNAP recipients attending the Dubuque Farmers Market (DFM). Over 50

vendors were engaged redeeming DUFB in 2016, and recorded over 200 NEW SNAP

market goers.

o Weekly offerings of Snap-Ed friendly recipes are through #MealMonday social media series, as well as a recipe on the back of the DFM Market Map.

o The Agricultural Urbanism Toolkit is a three year (2015-2017), three phase process through which stakeholders in the greater Dubuque area are coming together to

evaluate the local food system, identify assets and gaps, and create a shared vision

and goals, leading towards the implementation of tactics to move the local food

system forward. Current projects addressing the social determents include The ,

Double Up Food Bucks and Sinsinawa Collaborative Farms.

o In addition, there is progressive work around numerous community gardens including Dubuque Rescue Mission, Washington Neighborhood, Four Mounds, Dr.

Viner, Jaycees, St. Luke's, West Minster Presbyterian. Other projects include Farm to


http:countyhealthrankings.org

Institution, Convivium Urban Farmstead, Kids at Market, Chefs at Market, 3rd Annual

Tristate Local Food Summit, Bee Branch Project, 2016 Driftless Farm and Food Fest,

Community Supported Agriculture connecting with businesses.

- Secure commitments from participating partner organizations and coalition members to assist in implementing and supporting environmental change.

o Mercy collaborated with the Iowa SNAP Incentive Project proposed by the Iowa's Healthiest State Initiative to increase fresh fruits and vegetable access to low income

residents.

o Mercy expanded our Community Benefit Ministry Grant program to invite community organizations to request grant funding for programs addressing priority health

needs. During Fiscal Years 2016-2018 (July 2015 – June 2018) Mercy awarded $86,000 to the community organizations and programs targeting healthy behaviors, exercise,

nutritious foods and obesity reduction listed below. Mercy also plans to distribute

nearly $40,000 during Fiscal Year 2019 to similar community programs.

Organization Program Grants

Distributed

FY 2016-2018

Crescent Community Community Gardening $28,800 Health Center for a Healthier Life

Clarke University Geriatric Wellness Falls $10,000

Prevention Program

Northeast Iowa Scouting for Food $7,000 Council, Boy Scouts of

America

Sinsinawa Sinsinawa Mound $10,000 Dominicans Collaborative Farm

Dubuque Rescue Mission School of $15,000 Mission Preservation

St. Stephen Food Bank Growing and Giving $10,200

Dubuque Main Street Double Up Food Bucks $5,000

Total $86,000.00

The current year's CHNA Community Input Survey responses highlight community perspectives on

the progress made over the past CHNA cycle. The survey asked, "Over the past 3-5 years, what

would you say are the most significant improvements in our community that have improved health

and well-being? Over 569 responses to this question were submitted. The following sample

comments highlight progress made regarding this focus area.

- "Organic food selection has really improved!"

- "Access to outdoor activities"

- "Working to clean up river area, walking, hiking areas."

- "Increased community efforts to grow food and make it available to those living with food insecurity."

- "Improved access to physical activity opportunities – parks, trails, fitness facilities, a variety of exercise classes. Robust farmers market and focus on local healthy foods."

- "Better dietary information at stores. Weight loss programs"


- "YMCA is starting new health programs to fight diabetes, high blood pressures, and

arthritis. Insurances started paying gym memberships."

- "Nutrition information through classes and publications"

- "Increased social gathering places that incorporate additional activities to foster wellbeing and health."

- "Maintaining bike trails and parks, and encouraging people to get out and use them more."

Comments from previous CHNA Mercy did not receive any comments from the public on this CHNA.


Community Description

Geographic Area Served Mercy Medical Center Dubuque serves people residing within a 50-mile radius of Dubuque, Iowa.

The major service area is Dubuque, County, but also includes Jackson, Clayton, Lafayette, and

Delaware Counties in Iowa, Grant County, Wisconsin, and JoDaviess County, Illinois. For the

purposes of this community assessment, Mercy's CHNA committee reviewed information from all

seven communities above, but decided to primarily focus on Dubuque County as it accounts for the

majority of our discharges and allows for closer collaboration with the Dubuque County Community

Health Needs Assessment Steering Committee.

How Population Served Was Identified This definition of the community is based on the primary residence of Mercy Medical Center

Dubuque's patients: over calendar years 2012-2016, 62.84% of inpatient discharges and 76.56%

Emergency Department discharges were patients from Dubuque County, Iowa.

Mercy Dubuque Inpatient Discharges by County, Calendar Years 2011-2016

County 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY Total

Dubuque 61.87% 62.81% 62.00% 62.92% 63.56% 63.82% 62.84%

Grant (WI) 11.01% 10.82% 10.68% 9.96% 10.09% 10.28% 10.46%

Jo Daviess (IL) 9.42% 8.69% 9.02% 9.12% 9.78% 9.74% 9.30%

Jackson 6.89% 6.82% 6.99% 7.28% 6.75% 6.40% 6.85%

Clayton 3.48% 2.79% 3.35% 3.19% 2.88% 2.91% 3.10%

Lafayette 1.82% 1.70% 1.70% 1.57% 1.45% 1.68% 1.65%

Delaware 1.32% 1.41% 1.39% 1.34% 1.06% 0.84% 1.22%

Other* 4.19% 4.97% 4.87% 4.64% 4.42% 4.34% 4.57%

Totals 100% 100% 100% 100% 100% 100% 100%

*253 Counties accounting for

Mercy Dubuque Emergency Department Discharges by County, Calendar Years 2011-2016

County 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY Total

Dubuque 75.60% 76.19% 77.27% 76.42% 76.71% 77.05% 76.56%

Jo Daviess 6.79% 6.49% 6.30% 6.23% 6.75% 6.35% 6.48%

Grant 6.18% 6.16% 5.74% 5.96% 5.36% 5.33% 5.77%

Jackson 4.61% 4.39% 4.30% 4.70% 4.85% 4.65% 4.59%

Lafayette 0.96% 0.88% 0.75% 0.79% 0.85% 0.95% 0.86%

Clayton 0.89% 0.74% 0.81% 1.02% 0.95% 0.72% 0.85%

Delaware 0.72% 0.72% 0.70% 0.58% 0.57% 0.59% 0.64%

Other* 4.24% 4.42% 4.12% 4.30% 3.96% 4.36% 4.23%

Totals 100% 100% 100% 100% 100% 100% 100%

*175 Counties accounting for

Persons without health insurance, under age 65 years 4.1% 5.0% 10.1%

In civilian labor force, total, percent of population age 69.0% 67.6% 63.1%

16 years+, 2012-2016

In civilian labor force, female, percent of population 64.6% 63.3% 58.3%

age 16 years+, 2012-2016

Mean travel time to work (minutes), workers age 16 16.5 18.9 26.1

years+, 2012-2016

Median household income (in 2016 dollars), 2012-2016 $56,154 $54,570 $55,322

Per capita income in past 12 months (in 2016 dollars), $28,526 $28,872 $29,829

2012-2016

Persons in poverty 10.5% 11.8% 12.7%

Source: US Census Bureau QuickFacts, www.census.gov

Health Facilities Three hospitals are located in Dubuque County:

Mercy Medical Center—Dyersville

Mercy Medical Center—Dubuque

Unity Point Health Finley Hospital

Services Provided In 1879, the Sisters of Mercy arrived in Dubuque at the request of Bishop John Hennessy to launch a

healing ministry now known as Mercy Medical Center. Today, Mercy is the leading hospital in the

tri-states, with the most comprehensive cardiology center in the area and the only level II regional

neonatal intensive care unit. Other services include a trauma center, a CARF-accredited inpatient

rehabilitation unit, home health care, orthopedics, cancer care, retail pharmacies, palliative care,

and a wide range of outpatient and community services. Mercy operates two hospital-based skilled

nursing units and a 40-bed nursing home.

In recognition of the strength of its nursing service and the overall quality of patient care, Mercy

was the 134th hospital in the country to be designated a Magnet® hospital, the nation's most

prestigious award for nursing excellence. Also accredited by The Joint Commission, Mercy is a

member of Mercy Health Network of DesMoines, Iowa and Trinity Health of Livonia, Michigan.


http:www.census.gov

Process and Methods This CHNA was conducted in partnership with Dubuque County, City of Dubuque, Crescent

Community Health Center and Mercy Medical Center Dyersville and Unity Point Finley Hospital,

herein "steering committee".

The steering committee collected information from primary and secondary data sources. Data was

also collected through a community input survey in Dubuque County. Surveys were gathered

between January 11 and January 22, 2018. The survey was offered on-line via "Survey Monkey" and

was available in English and Spanish languages. The steering committee developed a

communications plan to spread the word around the community and ultimately 1052 completed

responses were collected. Summary results are available upon request.

When the steering committee first met in November 2017, they reviewed the previous CHNA/HIP

documents for Mercy and for the County of Dubuque. In the previous CHNA-HIP Mercy focused on

results from the "Healthy Behaviors and Lifestyles" section of the Dubuque County CHNA-HIP

process. However, we determined that including the full scope of the Dubuque County CHNA-HIP

into Mercy's CHNA better represents the continuum of health needs across our county and

communities. Previous years' county CHNA-HIP have used general categories of Healthy Behaviors,

Disease Infection Control, Healthcare Access, and Environmental Health. The steering committee

determined to continue utilizing this framework as it best positioned us to assess the community

health needs more comprehensively than focusing on just one as we had in the past.

The data collection process progressed simultaneously collecting available data and developing

and executing the community-wide survey related to these four broad categories. The steering

committee reviewed, revised and improved upon the survey from in the previous CHNA-HIP cycle.

In the review process, the steering committee also collected and reviewed community input

surveys from other hospitals and communities as a comparison for improving the

comprehensiveness of our tool.

The steering committee then reviewed and compared the survey results to the collected data. The

results and data were consistent with each other, validating both findings. The steering committee

then began forming taskforces of community experts to evaluate the data, including survey results,

and to identify the priority needs for each of the four categories.

The steering committee identified and invited community members, experts and leaders from

across the community to participate on the taskforces. Each taskforce reviewed the data, conducted

a SWOT analysis, and made recommendations to the steering committee regarding priority needs

and focus areas for our health improvement plans. The steering committee then convened to review

and adopt the recommendations from the steering committees.

Steering Committee Members

Joseph Norris, Mercy Medical Center Dubuque & Dyersville

Patrice Lambert, Dubuque County Health Department (CHAIR)

Stacey Killian, Unity Point Finley Hospital, Visiting Nurse Association

Jonathan Wilke, Unity Point Finley Hospital

Mary Rose Corrigan, City of Dubuque

Travis Schrobilgen, City of Dubuque

Angela Petsche, Crescent Community Health Center


Steering Committee Meetings

November 2, 2017 January 24, 2018 April 13, 2018

November 14, 2017 February 6, 2018 April 19, 2018

November 28, 2017 February 21, 2018 April 25, 2018

December 13, 2017 February 28, 2018 May 2, 2018

January 3, 2018 March 8, 2018 May 17, 2018

January 17, 2018 April 6, 2018

Taskforce Membership The steering committee invited the following community organizations to participate and share their expertise on each taskforce:

Healthy Behaviors: City of Dubuque, Dubuque County Health Department, Dubuque

School District, Dubuque YMCA, Grand River Medical Group, Helping Services, Hy-

Vee, Iowa State Extension, Mercy Dubuque & Dyersville, Unity Point Health System,

Western Dubuque School District

Healthcare Access: Crescent Community Health Center, Dubuque County, Dubuque

County Board of Health, Dubuque County Early Childhood, Dubuque County

Emergency Management, Grand River Medical Group, Hillcrest Family Services,

Medical Associates, Mercy Dubuque & Dyersville, Unity Point Health System

Disease Infection Control: City of Dubuque, Dubuque County Health Department,

Dubuque School District, Iowa Department of Public Health, Medical Associates,

Mercy Dubuque & Dyersville, Unity Point Health System

Environmental Health: City of Dubuque, Clarke University, Dubuque County Health

Department, Dubuque Soil & Water Conservation, Loras College, Unity Point Health

System

County Health Rankings County Health Rankings (www.CountyHealthRankings.org), provides comparative rankings

and data for a variety of different health factors and health outcomes. These rankings are an

effort to highlight the importance of many different factors in determining the health of a

population. County Health Rankings is a project supported by Robert Wood Johnson

foundation and University of Wisconsin Population Health Institute.

Health Outcomes

Health outcomes represent how healthy counties are within the state. The healthiest

county in the state is ranked #1. The ranks are based on two types of measures: how

long people live and how healthy people feel while alive. According to County Health

Rankings 2018, Dubuque County ranks 41 out of 99 counties in Iowa in health outcomes.


http://www.countyhealthrankings.org/

Health Factors

Health factors represent what influences the health of a county. They are an estimate of

the future health of counties as compared to other counties within a state. The ranks are

based on four types of measures: health behaviors, clinical care, social and economic,

and physical environment factors. According to County Health Rankings 2018, Dubuque

County Ranks 27 out of 99 counties in Iowa in health factors.


Community Input

Methods used to solicit input The primary methods for community wide input included: steering committee,

taskforces, and the community-wide survey. Results of this input follow. In addition to

soliciting community wide input, the steering committee also invited broad

representation for the taskforces and welcomed involvement throughout the process.

The steering committee reviewed the survey responses and overall felt the community

input supported and validated the collected data. The steering committee presented

these results and the collected data to the taskforces. The taskforces used the compiled

data to further assess and prioritize our community needs.

Health Department Input

The steering committee obtained input from multiple departments of health throughout

this process. First, Patrice Lambert of the Dubuque County Health Department and Mary

Rose Corrigan from City of Dubuque Public Health were members of the steering

committee. Second, we reviewed the Community Health Needs Assessment and

Community Health Improvement Plans for Grant County, Wisconsin and Jo Daviess

County, Illinois to assure we were taking into consideration other priority needs in our

region though they are beyond our primary service area for the purposes of our needs

assessment process. We found the priority needs identified in this CHNA overlap and

align well with the priority needs of the secondary service area.

Representation of medically underserved, low-income, and minority

populations

The steering committee sought and considered the needs, input, and concerns of

underrepresented persons and populations throughout this process. Serving on the

steering committee, Angela Petsche from Crescent Community Health Center and

Stacey Killian from Unity Point Finley Hospital – Dubuque Visiting Nurse Association represented the populations their organizations serve. The primary makeup of these

populations are those who are underrepresented in the community: those who are

medically underserved, in poverty; and/or from minority populations. In addition,

representatives from Dubuque School District, Western Dubuque School District, and

Dubuque Early Childhood participated on the taskforces and represented the needs and

best interests of the youth population that comprises 23% of our community. The

steering committee reviewed reported demographic information of those who

completed the survey and found that distribution by ethnicity, age, income and zip code

were consistent with the community's demographic profile.

Community Input Survey Results Community Input Survey results were taken into consideration when prioritizing which

needs to focus on for the term of this CHNA-HIP. Summary responses are included

below; please contact us if you would like to review the full results.


The survey tool was originally designed for the previous CHNA-HIP process. The

steering committee consulted various community input surveys when revising the

survey tool for this cycle. Most questions were revised, though to varying degrees.

The steering committee had two primary goals for the community input survey. First, to

identify which community health needs, identified through the data collection process,

were of highest priorities to the community to address. Second, we aimed to solicit

community input regarding any needs that we had missed that community members

believed needed to be addressed in the coming 3-5 years.

The steering committee also had the survey translated into Spanish language to make

the survey more accessible. Only two responses were received using the Spanish

translation. In the next cycle, the steering committee will look to expand language

availability to meet the needs of the community.


Question: From the list below, please check

THREE items that you think are the most

important health concerns for our community

to address in the next 3-5 years. (Check exactly

3 below)

Answer Choices

Mental health/mental illness/suicide

Obesity/overweight

Illegal drug use

Cancer

Prescription drug abuse

Heart disease and stroke

Alcohol abuse

Diabetes

Chronic pain

Pregnancy/infant health

Dental health

Respiratory and lung problems

Sexually transmitted diseases

High blood pressure

Unintentional injuries

Responses

73.21%

47.91%

41.30%

28.65%

25.95%

17.67%

16.28%

14.14%

9.21%

8.19%

5.12%

4.28%

4.00%

3.07%

1.02%

Answered

787

515

444

308

279

190

175

152

99

88

55

46

43

33

11

1075

Question: From the list below, please check

THREE behaviors that you think have the

greatest impact on overall community

health. (Check exactly 3 below)

Answer Choices Responses

Drug abuse 63.63% 684

Being overweight 50.05% 538

Poor diet 42.14% 453

Lack of exercise 41.12% 442

Alcohol Abuse 40.09% 431

Tobacco use 20.19% 217

Dropping out of school 16.09% 173

Unprotected sex 11.72% 126

Not getting flu shots or 11.26% 121 other vaccinations

Not wearing a helmet 2.33% 25

Not using seat belts 1.40% 15

Answered 1075


Question: From the list below, please check THREE environmental hazards

that you feel are needs that should be addressed in our community in the

next 3-5 years. (Check exactly 3 below)


Healthy homes 44.19% 475

Drinking water protection 40.00% 430

Disaster preparedness 32.37% 348

Water pollution 30.79% 331

Food safety 27.53% 296

Food waste 21.30% 229

Air Pollution 19.44% 209

Hazardous waste 17.12% 184

Hazardous materials 15.63% 168

Radon 15.35% 165

Lead poisoning 11.26% 121

Vector (disease-carrying animals and insects) control 11.07% 119

Soil Erosion 9.49% 102

Radiological health 4.47% 48

Answered 1075

Question: Using a scale from Strongly Disagree to Strongly Agree, please rate these

statements about Health Care Access in our community:

Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree

Disagree

Most residents in my community are able to access a primary care provider (family doctor, pediatrician, general

2.60% 17.30% 12.84% 57.86% 9.40%

practitioner) when needed.

Most residents in my community are able to access a medical specialist (cardiologist, dermatologist,

7.63% 27.35% 20.28% 39.53% 5.21%

neurologist, etc.) when needed.

Most residents in my community are able to access a dentist when needed.

5.86% 19.81% 17.21% 46.14% 10.98%

Most residents in my community are able to obtain prescription medications 2.88% 16.93% 20.37% 51.07% 8.74% when needed.

People new to my community know how to get health care.

3.63% 19.81% 38.60% 33.58% 4.37%

There are enough health care providers who accept Medicaid or other forms of 19.72% 27.72% 31.44% 16.74% 4.37% medical assistance in my community.

There are enough bilingual health care providers in my community.

15.16% 30.79% 44.56% 6.98% 2.51%


Question: Please select up to THREE of the most important barriers that you

believe keep people in our community from accessing health care. (You may

check 1-3 options below)


Not able to pay out-of-pocket expenses (co-pays, 80.09% 861 prescriptions, etc.)

Lack of health insurance 64.47% 693

Not able to navigate the health care system 39.16% 421

Not enough providers; hard to get an appointment 35.35% 380

Lack of transportation 18.88% 203

Language or cultural barriers 16.74% 180

Time limitations 10.88% 117

Lack of trust 6.88% 74

Lack of child care 6.79% 73

Other (please describe) 5.95% 64

In addition to the questions with fixed responses, three questions offered free-text response

for comments. One question was retrospective and so is not included here, the other two are

summarized below. All responses were categorized as follows:

Question: Please describe any other health needs that

were not mentioned in the previous questions that you feel

should be addressed in the next 3-5 years in our

community. 698 responses were received and categorized:

Category

Mental Health

N/A

Specialty Care

Access

Substance Abuse

Provider Shortage

Affordability

Environment

Insurance

Cancer

Aging

Public Safety

Nutrition

Count of Category Response

99 Dental

74 Sexual Health

68 Crescent

58 Transportation

53 Childcare

36 Obesity

30 Dyersville

28 Mercy

26 Pharmacy

18 Cultural

17 Marijuana

17 Individual Responsibility

16 Language

Count of Response

8

7

7

6

5

3

3

3

2

2

2

2

2


Political 15 Provider Shortage 1

General 14 Veterans 1

Health Education 13 Pain 1

Children 13 Men's Health 1

Education 13 Pediatrics 1

Exercise 11 Finley 1

Public Health 10 Communication 1

Women's Health 9 Marshall Islands 1

Total: 698

Question: What do you see as barriers that prevent our community from

becoming healthier? 830 responses were received and categorized:

Category

Money

Individual Responsibility

Access - Insurance

Political

Access - Nutrition

Substance Abuse

Education

Education - Health Literacy

Access - Exercise

N/A

Culture

Access - Providers

Access - Mental

Access - Care

Education - Nutrition/Cooking

Count of Response

153

92

76

57

52

44

42

32

30

28

28

26

26

25

20

Category

Access - General

Obesity

Access - Transportation

Pharmacy

Dental

Environment - Chemicals

Children

Access - Housing

Aging

Access - Affordability

Jobs

Marshall Islands

Quality Care

Cancer

Crime

Count of Response

17

15

13

11

8

8

6

4

4

3

3

2

2

2

1

Total: 830


Select Key Findings from Data Review Dubuque County and Iowa Health Data from County Health Rankings

(countyhealthrankings.org), for each year 2013 through 2017.

22% of adults in Dubuque County report physical inactivity, compared to 24% throughout Iowa.

The sexually transmitted infection rate (412.8) is higher than the statewide rate (382). 6% of adults in Dubuque County are uninsured compared to a statewide average of 7%. The per capita ratio of primary care physicians to population is higher than the statewide

average (1,380:1 for Dubuque compared to 1350:1 for Iowa).

Dubuque County is ranked eighth best of Iowa's 99 counties in Clinical Care. Dubuque County (10.2) reported a higher rate of air pollution – air particulate matter than the

state (9.6).

Dubuque County (12%) had a lower percentage of the population driving longer commutes alone than the statewide percentage (20%).

Dubuque County reported drinking water violations.

Dubuque County Health Portrait 2017, from Community Commons (communitycommons.org/chna).

9.55% of Dubuque County households receive SNAP benefits compared to 11.73% for Iowa.

42% of Dubuque County Adults are reported overweight compared to 35% for Iowa.

28.7% of Dubuque County adults are not taking blood pressure medication when needed compared to 19.1% in Iowa.

Dubuque County (51.21%) has a higher percentage of Medicare Beneficiaries with high blood pressure than the Iowa average (50.98%).

77.4% Dubuque County female Medicare enrollees with mammogram in past 2 years compared to 68.5% for the statewide average.

82.6% Dubuque County adult females, age 18+, with regular pap test (age-adjusted) compared to 79.5% for the statewide average.

69.4% Dubuque County adults, age adjusted screened for colon cancer compared to the statewide average of 60%.

10.1% of adults in Dubuque County smoke cigarettes, compared to 18.1% for Iowa. Dubuque County has 31.5% age-adjusted estimated adult excessive drinking

compared to the Iowa average of 21.4%.

Percent of adults never screened for HIV/AIDS is higher (78.7%) than the Iowa average (73.82%).

Dubuque County age-adjusted percent of population age 65+ with pneumonia vaccination (68.5%) is slightly below the Iowa average (69.9%).

Chlamydia infection rate per 100,000 pop. in Dubuque County (412.76) is higher than the statewide average (382).

Gonorrhea infection rate per 100,000 pop. in Dubuque County (86.73) is higher than the statewide average (53.1).


http:countyhealthrankings.org

Dubuque County has a lower percentage of the insured population receiving Medicaid (15.24%) than the Iowa average (17.96%)

Dubuque County (140) has more mental health providers per 100,000 than the Iowa rate (125.1) but well below the national average rate of 202.8.

19.99% of Dubuque County adults are without a regular doctor compared to 17.93% in Iowa.

Dubuque County has a lower percentage of uninsured population (5.46%) than the Iowa average (6.82%)

Dubuque County has a lower percentage of uninsured population under 19 years old (2.79%) than the Iowa average (3.63%).

Dubuque County has 72.07 dentists per 100,000 population compared to the state rate of 62.6.

Dubuque County (74.74) has a higher percentage of fast food establishments per 100,000 population than the state average (63.19).

Dubuque County (25.23) has a higher percentage of population with low food access than the statewide average (21.41%).

Dubuque County (16.02) has a lower rate of grocery stores per 100,000 population than Iowa (20.06).

Dubuque County (24.7%) has a comparable percentage of substandard housing units to the Iowa average (24.44%).

Iowa Department of Public Health core measures: (https://www.pht.idph.state.ia.us)

Age adjusted heart attacks per 10,000 population.


https://www.pht.idph.state.ia.us/

Emergency visits due to heat related illness per 10,000 population.


Dubuque County cancer incidence rates: (Iowa Cancer Registry)

Rate Count Pop

IA: Dubuque County (19061) 2010 498.9 559 93,924






Malignant cancer frequency and incidence age-adjusted rates by year in

Dubuque County, 2010-2015

Rates are per 100,000 and age-adjusted to the 2000 US Std Population

(19 age groups - Census P25-1130) standard.

Rate Count Pop

2010 480.2 17,179 3,050,694

2011 475.8 17,217 3,065,389

2012 460.8 16,910 3,076,636

2013 457 16,952 3,092,224

2014 469.9 17,604 3,109,481

2015 462.1 17,603 3,123,899

Malignant cancer frequency and incidence age-adjusted rates

by year in state of Iowa, 2010-2015

Rates are per 100,000 and age-adjusted to the 2000 US Std

Population (19 age groups - Census P25-1130) standard.

2017 Cancer In Iowa, University of Iowa College of Public Health.


Significant Community Health Needs This CHNA identified the top needs within Dubuque County using the expertise of the

steering committee, community taskforces, and community wide survey. Those needs

fall into four categories of need within Dubuque County. The committee examined the

specific needs from each category and prioritized each of the 14 identified needs based

on magnitude of persons affected, impact on quality of life, feasibility and community

resources, and the consequences of inaction.

Work is underway to identify community partners and potential resources available for

addressing the significant health needs below. This information will be utilized in the

development of the implementation strategy.

Ranking of significant community health needs and brief description: 1. Opioid Use and Abuse – Our county has been particularly impacted by the opioid

crisis and lack of treatment and resources available across the community.

2. Obesity & Overweight – Over 40% adults in the community report being overweight.

3. Alcohol Use & Abuse – The age-adjusted percentage of adults who drink excessively in Dubuque County is 31.5%

4. Mental Health Access – We have many mental health resources in the community, but there are significant access challenges related back to awareness of services,

provider availability, and insurance coverages.

5. Influenza Immunizations – Our community continues to see high incidence of influenza-associated hospitalizations year over year.

6. Healthy Homes – Data indicates particular concerns with childhood lead poisoning rates, household moisture and gas challenges, and general safety

issues impact the overall health and safety of the community.

7. Primary Care Access – Though uninsured rates are low, many surveyed, indicated challenges with accessing primary care related to insurance,

transportation, and availability.

8. Emergency/Disaster Planning – Community preparedness is the ability of communities to prepare for, withstand, and recover – in both the short and long terms – from public health incidents.

9. Drinking Water Protection – Data indicates private water supplies for those not served by public water systems are negatively impacted by inadequate

wastewater treatment in un-sewered communities.

10. Dental Care Access

11. Specialty Care Access

12. Elder Care Access

13. HIV/AIDS Screening and Prevalence – Dubuque County has a high incidence of known positive HIV/AIDS diagnoses and data indicates 14% of Iowans living with

HIV are undiagnosed.

14. STD/STI Screening and Prevalence – Gonorrhea and Chlamydia infection rates are higher than the state averages.


Conclusion This assessment is an effort to analyze the current state of health and socioeconomic

factors in the Mercy Medical Center-Dubuque service area.

Limitations and inconsistencies in available data can make it challenging to accurately

compare indicator performance between the local communities, the state and the nation

as a whole. As areas of concern are selected for further conversation about community

collaboration and community benefit planning, additional data may be sought if needed.

There are some indicators where local-level data was not available and this assessment

may point out areas for future data collection.

Implementation Strategy The identified priority needs will be incorporated into a Mercy Medical Center – Dubuque Community Benefit Implementation Strategy that will inventory current

programs in place and recommend additional services and collaborative efforts to

target priority needs. Once drafted, the Community Benefit Implementation Plan will be

presented to the Mercy Medical Center – Dubuque Board of Trustees for input and approval, after which objectives and targets will be established to integrate into the

hospital's operating plan and budget.

How to obtain copies This Community Health Needs Assessment will be posted to the Mercy website:

http://www.mercydubuque.com/community-health-needs-assessment . Paper copies of

this document are available upon request by visiting the Information Desk at either

Mercy Dyersville or Mercy Dubuque. You can also write or call the Office of the

President to request a copy of the document.

Office of the President

Mercy Medical Center Dubuque & Dyersville

250 Mercy Drive

Dubuque, Iowa 52001

Phone: 563-589-8037

Contact Information Mercy invites your feedback regarding this Community Health Needs Assessment. If

you would like to share your feedback with us, please contact the Office of the President

for Mercy Dubuque and Dyersville by phone or by mail (below).

Office of the President

Mercy Medical Center Dubuque & Dyersville

250 Mercy Drive

Dubuque, Iowa 52001

Phone: 563-589-8037


http://www.mercydubuque.com/community-health-needs-assessment

Next CHNA Due Date The next Community Health Needs Assessment will be scheduled for completion by

June 30, 2021.


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