Mercy Regional Medical Center - Centura Health

Mercy Regional Medical Center - Community Health Needs Assessment 2012 1

Mercy Regional Medical Center 2012 Community Health Needs Assessment


CONTENTS

1 INTRODUCTION.............................................................................................................................................. 3

1a Brief description of hospital, history and services provided.................................................................. 3

1b Mission statement, vision and values .................................................................................................... 4

1c Organizational commitment to community benefit .............................................................................. 5

1d Commitment statement to the uninsured and underinsured ............................................................... 6

2 COMMUNITY HEALTH NEEDS ASSESSMENT .................................................................................................. 7

2a Community ............................................................................................................................................ 7

2a i Definition of community served by the hospital ............................................................................... 7

2a ii Demographics of the community ...................................................................................................... 8

2a iii Uninsured persons, low-income persons, and minority groups .................................................. 10

2b Data collection ..................................................................................................................................... 10

2b i Process used to gather data ............................................................................................................ 10

2b ii Information gaps .............................................................................................................................. 12

2c Health needs of the community .......................................................................................................... 12

2c i Process to identify and prioritize needs .......................................................................................... 12

2c ii Prioritized list and description of community health needs ............................................................ 13

2c iii Healthcare resources available in the community to meet the needs ............................................ 14

3 CONTACT INFORMATION ............................................................................................................................. 17

Attachment A- Stakeholder Meeting Attendees ............................................................................................. 18

Attachment B- Capacity Assessment Results ................................................................................................... 23

Attachment C- Summary of Risk Questionnaire Results .................................................................................. 27


1 INTRODUCTION

This Community Health and Capacity Needs Assessment was a result of a partnership between San Juan Basin Health Department, Mercy Regional Medical Center, and Pagosa Springs Medical Center.

A Community Health and Capacity Needs Assessment Planning Committee was staffed by an epidemiologist, Emily Burns, MD/MPH under contract with San Juan Basin Health. Joe Theine, Executive Director of San Juan Basin Health, oversaw the needs assessment process while Brad Cochennet, CEO of Pagosa Mountain Hospital, and Bill Willson, Consultant for Mercy Regional Medical Center provided input and support. The Planning Committee was involved in the initial definition of project scope, review of progress during the project, as well as providing suggestions leading to finalization of the Community Health and Capacity Needs Assessment.

1A BRIEF DESCRIPTION OF HOSPITAL, HISTORY AND SERVICES PROVIDED

Mercy Regional Medical Center, a hospital within the Centura Health system, was the first hospital in the Four Corners region and was originally called Mercy Hospital of the San Juans. The original six-bed hospital, which was attached to a boarding school, was founded by the Sisters of Mercy on September 1, 1882.

In 1884, a new building, often referred to as the "stone hospital" because of its native sandstone construction, replaced the original building. Subsequent major additions took place in 1892, 1931, and 1952. Over the next 50 years, the building went through various additions and remodels, while older sections of the facility were demolished to make room for the new. By the late 1990s, Mercy Medical Center was operating at capacity, but unable to expand because

downtown Durango had literally grown up around it. Plans were drawn for a brand new facility, to be built in the newly annexed Grandview area of Durango. In June of 2006, Mercy Regional Medical Center opened. The state-of-the-art, 212,000-square-foot, 82-bed, acute-care facility features the latest medical technologies. It is attached to a 153,000-square-foot medical office building and ambulatory surgical center. Mercy has a medical staff of over 190 physicians who represent over 40 different specialties and subspecialties. Major services include emergency care; cardiac care; diagnostic imaging; women’s services, including obstetrics; orthopedic, spine, and general surgery; laboratory services; intensive care; and more. Mercy has earned special distinctions in many areas, including recently receiving the HealthGrades Patient Safety Excellence Awardtm 2012, which places Mercy among the top five percent of the nation’s hospitals for overall patient safety records. HealthGrades also recognized Mercy with the Outstanding Patient Experience Awardtm 2012, which ranks Mercy in the top ten percent of hospitals in the nation for outstanding patient experience. Mercy has received this distinction for the last four years. It is one of only 47 hospitals in the nation to be recognized for both patient-centric HealthGrades distinctions.


In 2012, Mercy was rated third among 38 Colorado hospitals for patient safety by Consumer Reports, an independent and non-profit consumer protection organization. The rating was based on quality data in six categories: infections, readmissions, communication, CT scanning, complications, and mortality. The data used in the rating came from government and independent sources, inspection and investigation reviews, and interviews of patients, physicians, hospital administrators, and safety experts.

In addition to overall quality recognition and accreditation, several specific areas within the hospital have earned accreditation and received recognition for quality. Mercy clinics Southwest Oncology and Durango Cancer Center, now part of the statewide Centura Health Cancer Network, are accredited by the American College of Surgeons (ACoS) Commission on Cancer, which places these programs in the top 20 percent of cancer programs in the nation. To receive accreditation, facilities must demonstrate a commitment to quality care, ongoing improvement, and public accountability for the care and services they provide.

Southwest Oncology is also the only oncology practice in the state of Colorado to achieve national recognition with the American Society of Clinical Oncology’s Quality Oncology Project Initiative (QOPI) award. The award certifies oncology practices that meet rigorous standards for high-quality cancer care. It recognizes oncology practices that meet or exceed QOPI standards for more than 24 selected measures for cancer care, and additionally, show evidence of meeting 17 specific chemotherapy safety standards.

Other service lines at Mercy are notable for the exceptional patient satisfaction scores. Patients receiving joint replacement or spine surgery through Mercy’s Orthopedic & Spine Center of Excellence, for example, consistently rate the hospital in the top decile or quartile in terms of overall satisfaction and likelihood to recommend the hospital. Clinical quality outcomes are also well above national averages. Other accreditations and designations Mercy has earned include:

• Accreditation by The Joint Commission • Designation as a Level III trauma center in the state of Colorado • Accreditation by the American College of Radiology for magnetic resonance imaging (MRI);

ultrasound (including vascular ultrasound); and mammography (Mammography Quality Standards Act (MQSA) compliance through FDA survey)

For more information about Mercy Regional Medical Center, visit www.mercydurango.org.

1B MISSION STATEMENT, VISION AND VALUES

Our Mission: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.

Our Vision: To fulfill a covenant of caring for our communities to become their partner for life.

Our Core Values:

Compassion- In serving our customers, their families and each other, we will: o Honor the individuality of each person; o Treat each person with dignity, taking the time to be present, to listen, to explain and to

understand; o Create a caring environment that exudes humanity, humility, grace and love.

Respect- In working with each other, we will:


o Encourage and value the contributions of each person, and make each feel supported, reassured and empowered;

o Listen well, communicate openly and honestly, and encourage others to do the same; o Treat others as we would like to be treated ourselves, relating so well with them that they actively

seek to associate with us. Integrity- In all of our interactions, we will:

o Foster trust by being truthful, empathetic and consistent; o Be authentic and courageous, aligning what we are thinking, saying, feeling, and doing; o Be responsible for and follow through on the commitments we make.

Spirituality- In honoring the missions, ministries, and heritages of our Catholic and our Adventist sponsors, we will:

o Add meaning and purpose to the lives of our associates, physicians, and partners; o Celebrate the role of spirituality in healing for each individual; o Serve each other and our communities in harmony with the inclusiveness, wholeness and touch

that characterized Christ's healing ministry. Stewardship- In managing the natural, human, and financial resources to which we have been entrusted, we will:

o Seek ways to appropriately utilize resources, allowing us to become more effective and productive; o Act responsibly, taking only those actions that align with our mission; o Be accountable to the organization and to each other for our actions and the outcomes they

produce. Imagination- In seeking to grow our ministry, we will:

o Look beyond the challenges of the present and envision what is possible; o Cultivate and reward innovation and risk taking; o Embrace continuous learning and positive technological advancement.

Excellence- In all we do, we will:

o Put forth our personal and professional best, providing the highest quality of care of which we are capable;

o Commit ourselves to continuous improvement, seeking to set the recognized performance standards within our industry;

o Deliver a superior experience for all of our customers, sensing their needs and exceeding their expectations.

1C ORGANIZATIONAL COMMITMENT TO COMMUNITY BENEFIT

Colorado’s needs are growing. To live our mission in an economy that challenges more people than ever before, Centura Health continues to lead the way in helping Coloradans access quality health care. The connected network of facilities, entities and foundations that form the Centura Health family are serving community needs through education, preventive care, safety initiatives, health advocacy, counseling and support groups.

Our work in our communities is born out of the second part of our mission, which compels us to serve others “…by nurturing the health of our communities.” From access for the uninsured, to serving as a voice for health care in the state legislature, to community classes and education to build strong, healthy communities, Centura Health is a partner for life. We are more committed than ever before to making our world a better place, and we seek to make the most impact in every community we touch.


Mercy’s work in the community is born out of the second part of the mission statement, which compels the hospital to serve others “…by nurturing the health of our communities.” Caring for the community has been an integral part of Mercy Regional Medical Center. Much of the cost of care provided at Mercy is not reimbursed. In fiscal year 2012, Mercy provided:

• Unreimbursed cost of charity care equal to $2,977,000 • Unreimbursed cost of care for indigent patients and patients with Medicaid at $5,008,000 • Non-billed health services to the broader community valued at $260,000

Total Quantifiable Community Benefit at $8,245,000 Mercy also provided care for thousands of patients covered by Medicare. The total cost to Mercy of providing that care exceeded the payment Mercy received from Medicare. Unreimbursed cost of providing care for patients with Medicare in fiscal year 2012 equaled $13,935,000.

1D COMMITMENT STATEMENT TO THE UNINSURED AND UNDERINSURED

According to Centura.org, more than 700,000 Coloradans are without health insurance and, as a result, growing numbers are facing difficulties paying for medical care. Centura Health believes that hospitals should have the ability to offer discounts to those who are unable to obtain insurance and do not meet charity care criteria. It is the policy of Centura Health to provide uninsured patients with discounted rates for all hospital bills. The discount is applied to all hospital inpatient, outpatient and Emergency Room bills that have been screened and do not have third-party insurance, Medicare, Medicaid, Champus, or other governmental payer programs and do not meet the Centura charity guidelines. Centura Health strives to compassionately serve uninsured patients with an understanding of the financial burdens they may face. Centura supports and advocates for meaningful and appropriate changes in legislation that improve access to affordable, quality medical care for the uninsured.

Centura Health will treat uninsured patients in the following manner:

Uninsured patients will be treated fairly and with respect during and after treatment, regardless of their ability to pay.

Uninsured patients will be provided with financial counseling, including assistance applying for local, state and federal health care programs such as Medicare, Medicaid and the Colorado Indigent Care Program.

Uninsured patients will be informed of and assisted in applying for charity care available through Centura Health as appropriate.

Centura Health utilizes a charity discount schedule that takes into account state or federal poverty guidelines to aid in the qualification of patients seeking assistance in meeting their financial obligations.

Financial counselors will attempt to meet with all uninsured patients prior to discharge from the hospital.

Financial counselors will use best efforts to personally contact uninsured patients before any collection activities are initiated.

Uninsured patients that do not qualify for assistance will receive a 30 percent discount off billed charges. This will automatically be adjusted during the billing process, so that all statements and collection efforts will be based on the discounted amount.


Centura will also offer an additional 15 percent Prompt Pay Discount for accounts paid in full within 60 days of receiving the first statement of patient liability.

If at any point an alternative payment source is identified, all discounts stated in this policy will be reversed.

A call center is available so that patients may speak to an individual who can help them with questions on their bills; the call center phone number is prominently displayed on all billing correspondence.

Hospital-based physicians and related entities will be encouraged to follow the Centura Health Principles Regarding Uninsured Patients but this is done at their discretion.

Centura Health will not engage in the following activities:

Centura Health will not pursue legal action for nonpayment of hospital bills against any patient who has worked with Centura to demonstrate his or her inability to pay and who is unemployed or otherwise financially unable to pay.

Centura Health will not pursue legal action for nonpayment if the only way to collect payment would be to place a lien on the patient's home.

Centura Health always has distinguished itself from other hospitals and systems in its treatment of the uninsured:

Centura Health hospitals will continue to treat patients in their emergency rooms without regard to the patient's ability to pay. All patients will continue to be triaged and treated as appropriate.

Centura Health has provided numerous outreach programs to the community in its pursuit of healthy communities and constantly seeks opportunities to advance its health care ministry.

It is not the practice of Centura Health to place a lien on a patient's home when it is the patient's only asset.

Centura Health will continue to work for increased access and coverage for the uninsured through legislative and community activity.

It is the practice of Centura Health not to pursue legal action for nonpayment unless it has first examined the patient's eligibility for other assistance or charity care.

2 COMMUNITY HEALTH NEEDS ASSESSMENT

2A COMMUNITY

2A I DEFINITION OF COMMUNITY SERVED BY THE HOSPITAL

To ensure alignment with publicly available Colorado Department of Public Health and Environment (CDPHE) data, Centura Health leaders decided that Colorado counties would comprise the geographic area for the 2012 Community Health Needs Assessment (CHNA). Individual Centura hospital facilities then examined their primary market areas and identified Colorado counties where at least 10% of their patient population resided.


The counties identified by each facility comprise the “Primary Service Area” used in the data reports. The Primary Service Area for Mercy Regional Medical Center includes La Plata and Archuleta Counties. These two counties account for 76% of inpatient discharges from Mercy and coincide with the service area of San Juan Basin Health Department – facilitating collaboration between Mercy Regional Medical Center, Pagosa Springs Medical Center, and San Juan Basin Health Department.

2A I I DEMOGRAPHICS OF THE COMMUNITY

Table 1 shows population characteristics of Archuleta and La Plata counties and Colorado. Both counties are somewhat older, more educated, and less often Hispanic compared to the state.

Archuleta has a higher percentage of Hispanic residents than La Plata but fewer report speaking a language other than English or being foreign-born. Household incomes are similar across both counties and the state but housing costs are much higher in both counties. Homeownership rates are similar to the state in La Plata and higher in Archuleta. Poverty rates (see Appendix C) are slightly lower than the state in both counties while unemployment is higher in Archuleta. Veterans number more than 5,000 between the two counties. One way to get a sense of the amount of income that residents of the counties have to spend on health costs is to analyze the amount of income spent on rent. In both counties during 2006-2010, approximately one-third of both renters and home-owners with mortgages spent 35% or more of their household income on mortgage costs.1

1 American Community Survey, 2006-2010. Retrieved on May 13, 2012 at http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk.


The population growth of different age groups is shown in the Figures 1 and 2. In Figure 1, in Archuleta, the 50-64 age group is the fastest growing and largest age group by 2010. The 65+ age group also grew steadily over the ten-year period.

In Figure 2, in La Plata, the younger 18-34 age group is the largest by 2010, followed closely by those aged 50-64. As in Archuleta, the 50-64 age group grew the most during the ten-year period, with growth also among the 65+ age group. Both counties experienced growth of approximately one-fifth increase from the 2000 population size during the ten-year period (22.1% growth in Archuleta and 6.8% in La Plata during 2000-2010).2

As shown in Figure 3, most of the population in both counties is white, with a somewhat higher proportion of Archuleta residents being Hispanic (17.8% in Archuleta and 11.8% in La Plata) and lower proportion being American Indian/Alaska Native compared to La Plata. Among the Latino population, Archuleta experienced a 29.5% increase and La Plata a 32.5% increase during 2000-2010.3 Figure 4 shows the breakdown by age groups of the Hispanic population in both counties. Archuleta has a slightly higher proportion of under 18 and

2 Colorado State Demography Office, Department of Local Affairs, US Census Bureau Data. Accessed at http://dola.colorado.gov/dlg/demog/2010censusdata.html on May 7, 2012.

3 Colorado State Demography Office, Department of Local Affairs, US Census Bureau Data. Accessed at http://dola.colorado.gov/dlg/demog/2010censusdata.html on May 7, 2012.

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

0

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10,000

15,000

20,000

25,000

30,000

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45,000

white Hispanic or Latino American Indian andAlaska Native

other

Figure 3: Race/ethnicity of total population, by county in 2010

La Plata

Archuleta

Source: Colorado State Demography Office, US Census Bureau data

1,941 1,730 1,495 450 440

682

492541

230 203

0100200300400500600700800

0

500

1,000

1,500

2,000

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Less than 18 18-34 35-54 55-64 65+

Figure 4: Hispanic population, by county and age, 2010

La Plata

Archuleta

Source: Colorado State Demography Office, US Census Bureau data

1000

1500

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3500

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Figure 1: Archuleta County, population trends by age, 2000-2010

age 0-17 age 18-34 age 35-49age 50-64 age 65+

Source: Colorado State Demography Office, Department of Local Affairs via Colorado

2000

4000

6000

8000

10000

12000

14000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Figure 2: La Plata County, population trends by age, 2000-2010

age 0-17 age 18-34 age 35-49age 50-64 age 65+

Source: Colorado State Demography Office, Department of Local Affairs via Colorado Health Institute

http://dola.colorado.gov/dlg/demog/2010censusdata.html

http://dola.colorado.gov/dlg/demog/2010censusdata.html


older Hispanics than La Plata.

Poverty and health are closely connected. Figure 5 shows that in 2010, those below the federal poverty level had risen to more than 5,700 in La Plata County, with one-fourth being children under age 18. The increase of residents below the federal poverty level in Archuleta was smaller during this ten-year period; in 2010, one-third of those below the federal poverty level were children below age 18.

2A I II UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS

As described previously, 18.9% of the population in both Archuleta and La Plata Counties are uninsured – one of the highest rates of uninsured in Colorado. Those without health insurance are less likely to obtain necessary preventive or curative services and have higher rates of death and disease.4

The burden of the uninsured is experienced most directly by the low income and Hispanic populations in our community. The Center for Health Administration at the University of Colorado Denver points out the strong correlation between low income and the lack of health insurance for Coloradoans. Further, the Hispanic population has the lowest rate of health insurance coverage of any racial or ethnic group in the state. Even if the Patient Protection and Affordable Care Act is fully implemented, a significant number of the low income and Hispanic population are expected to remain uninsured.

Obesity, mental health access and oral health care are the key health issues of the Hispanic populations as listed in number 7 above. This determination was based upon interviews of key stakeholders as well morbidity and mortality statistics. The chronic and interrelated nature of these conditions point toward the need for a comprehensive and integrated health care service targeted at the low income uninsured population with a particular focus on the Hispanic population

2B DATA COLLECTION

2B I PROCESS USED TO GATHER DATA

4 Center for Health Administration, University of Colorado Denver, Custom Study for Centura Health Mercy Regional Medical Center, “Access”, April 2012.

1,565

5,705

547

1465

0

1000

2000

3000

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6000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Figure 5: Population below 100% federal poverty level, by county and age, 2000-2010

Archuleta all ages

La Plata all ages

Archuleta age 0-17

La Plata age 0-17

Source: U.S. Census Bureau, State Area Income and Poverty Estimates, via Colorado Health Institute


The Center for Health Administration at the University of Colorado Denver was retained to conduct the data collection for the Centura Health system and its respective hospital facilities.

PUBLIC HEALTH DATA

Data for the Community Health Needs Assessment (CHNA) was predominantly collected from the Colorado Department of Public Health and Environment (CDPHE). The CDPHE’s Colorado Behavioral Risk Factor Surveillance System Survey (2003-2010) was used to determine information about adult behaviors that impact health, such as substance abuse, eating and exercise habits, and smoking. The national Youth Risk Behavior Survey (2003-2010) was queried to determine behaviors that impact the health of students from 9th through 12th grades. The CDPHE’s database was also probed for information on mortality rates for a variety of health indicators.

Many other sources were used to provide information relevant to each health area. They are noted in graphs or cited via footnotes in the text. The sources of data include:

• Colorado Department of Public Health and Environment, Colorado Health Indicators (developed specifically for the Colorado Health Assessment and Planning System (CHAPS) process to analyze down to county-level data for multiple health, environmental, and demographic indicators)

• San Juan Basin Health Department

• Colorado State Demography Office; United States Census Bureau; American Community Survey

• Maternal and Child Health County datasets

• Colorado Healthy Kids Survey; Colorado Child Health Survey

• Colorado Health Institute; Colorado Health Access Survey; Colorado Hospital Association; Mercy Regional Medical Center; Dartmouth Atlas

• Colorado Environmental Public Health Tracking

• Colorado State Patrol

County-level data was used whenever possible; regional or state data was added to supplement the county-level findings or substitute when county-level data was not available. Regional data most often applied in this assessment is referred to as ‘HSR9,’ or Health Statistics Region 9. Health Statistics Regions were defined by the Colorado Department of Public Health and Environment as 21 divisions of counties across the state by demographic and geographic criteria. Included in HSR9 are Archuleta, Dolores, La Plata, Montezuma, and San Juan counties.

In some cases multiple years were combined by the data source or by the epidemiologist preparing the report in order to present a stable estimate for the counties. In many cases, Colorado state-level values are not presented in charts if there was not a statistically significant difference between the state and county level estimates. Since county level data is often based on a small sample size, there still might be important differences between the counties and the state but that cannot be determined from available data.

COMMUNITY LEADER INTERVIEWS

Data was also collected from a series of two community stakeholder meetings in each county during January 2012-April 2012. Two meetings each in La Plata County and Archuleta County were well publicized through newspaper notices, individual mailings, and personal contacts. Attendees included a broad cross-section of the public including local and regional public health representatives, Southern Ute Indian Health and


Community Action Program, a variety of low-income consumer advocates, non-profit organizations, academic experts, local government officials, community-based organizations such as Citizens Healthcare Alliance, and health care providers including those focusing on patients with chronic disease and private businesses. A list of meeting attendees can be found in Attachment A.

Capacity Assessment

A capacity assessment was conducted during the second set of community stakeholder meetings around the chosen topics to determine what resources already exist in the counties to address the topic areas. The capacity questions were answered via an audience real-time polling system and consisted of the following questions about each topic:

• <County> currently has the right amount of organizations and/or people to address <issue>.

• Existing organizations address <issue> effectively among all necessary populations in <County>.

• Existing organizations and/or people are likely to continue to address <issue> in the next five years in <County>.

• I think <issue> can be improved in <County> during the next five years.

Results of the capacity assessment can be found in Attachment B.

Ranking Questionnaire

A written ranking questionnaire was used to help prioritize the health care needs in the community. Each participant who attended the stakeholder meetings was also asked to rank health issues on a five point scale ranging from strongly agree to strongly disagree. The results of the surveys were averaged to provide a quantitative measure. Results of the questionnaire can be found in Attachment C.

2B I I INFORMATION GAPS

The data used to assess the community’s health needs was exhaustive and up to date. No identifiable gaps exist and this report offers an accurate representation of the health needs of Archuleta and La Plata counties.

2C HEALTH NEEDS OF THE COMMUNITY

2C I PROCESS TO IDENTIFY AND PRIORITIZE NEEDS

The first step for Mercy’s Community Benefit Advisory Committee (CBAC) in its prioritization of health needs was the review and analysis of the Archuleta and La Plata County public health data, capacity assessment and ranking questionnaire results. The data provided a comprehensive, fact-based summary of health needs as well as the key stakeholder’s perception of need.

The second step of the process entailed an assessment of opportunities for improvement concerning the following health issues:

• Access • Cancer • Communicable diseases • Diabetes • Heart and cerebrovascular disease


• Injury • Mental health • Obesity, nutrition, and physical activity • Oral health • Sexual health

A profile of the disease burden associated with above-listed health issues was provided along with consideration of the unique challenges of the medically-underserved populations. Potential interventions were identified as well a summary of the evidence concerning efficacy. Finally, organizational/resource considerations were discussed as well as potential Mercy Regional Medical Center responses. Each health issue was assigned an “A, B, or C” priority.

The third step of the priority process was one of refinement and review. Access was broken down into three parts: eligibility outreach, community clinic support, and primary care expansion/improvement. Mental and oral health were each elevated to a high priority issue in recognition of their high importance to the stakeholders as well as the ability to integrate both into an effective primary care/community clinic model.

The final step of the priority process was to take into account the professional judgment of the Community Health and Capacity Needs Assessment Planning Committee that served San Juan Basin Health Department, Mercy Regional Medical Center, and Pagosa Springs Medical Center. The Committee’s judgment, in turn, was informed by the high rates of mortality, years of life lost, as well as areas in which county measures of health were lower than Colorado.

2C II PRIORITIZED LIST AND DESCRIPTION OF COMMUNITY HEALTH NEEDS

1. Access to health care - Identified as the number one priority in both counties and strongly linked to improved health status. Multiple factors are negatively impacting access to care in both counties:

a. Lack of a usual source of care b. Lower insurance rates for those aged 19-54 and those with lower incomes, especially 200% of

the federal poverty level and below. c. Lack of a community clinic, particularly in La Plata County

2. Mental health and substance abuse - Identified as the number two priority in both counties and an opportunity for closer integration with primary care has been noted.

3. Oral health- Third highest priority identified by La Plata County stakeholders and of particular concern for large number of people without dental insurance.

4. Obesity- Strongly linked to cardiovascular disease as the prevalence has increase dramatically over the past 15 years.

5. Tobacco use- Measures are not worse than Colorado in the service area but remain as a significant risk factor for cardiovascular disease and cancer.

6. Primary care access for the elderly- Health problems of older adults naturally increase with time as do needs for health care.

7. Obesity, mental health access and oral health care for Hispanic populations - Important areas with disparate outcomes for Hispanic populations.

8. Motor vehicle accidents- Hospitalization and death rates are among the few measures that are significantly worse in both counties compared to the state. Unintentional injuries comprise the third leading cause of death in both counties but the leading cause of years of potential life lost.


9. Colorectal and breast cancer- Screening measures are not worse, in general, among both counties but may be important areas for improving cancer outcomes, the leading cause of death in Archuleta and a close second in La Plata

2C III HEALTHCARE RESOURCES AVAILABLE IN THE COMMUNITY TO MEET THE NEEDS

Acute Care Hospitals:

Service area residents have access to three acute care hospitals. Mercy Regional Medical Center is a not-for-profit 82 bed general acute care hospital (52% occupancy rate). Animas Surgical Hospital is a for-profit 12 bed surgical specialty hospital, (22% occupancy rate). – both located in Durango in Plata County.

Pagosa Springs Medical Center is a not-for-profit 11 bed critical access hospital offering basic hospital services plus a range of rotating specialty services and is located in Archuleta County. The residents of La Plata and Archuleta County enjoy ready access to acute care hospital services.

Access to Health Care

Primary care - There are 23 full-time equivalent physicians in La Plata County compared with a demand for 26.5 The unmet need is especially severe for adult care – the county has 17 non-pediatric primary care physicians compared with an estimated demand for 22 FTEs in La Plata County, meeting only 77% of projected demand. This unmet need is especially significant for the Medicare-aged population, Medicaid adults, and the low-income uninsured population.

Archuleta County is served by 5 full-time equivalent primary care physicians compared with an estimated demand for approximately 7 primary care physicians. While three mid-level providers in Pagosa make a significant contribution to meeting the community need, unmet need is especially significant for the Medicare-aged population, Medicaid adults, and the low-income uninsured population.

Recent surveys show that residents of both counties combined report the following related to seeking health care:6

• 15.3% were told by a doctor’s office that no appointments were available for new patients.

• 26.0% of those with any healthcare visit in the past year report visiting the emergency room at least once.

• 38.0% of those who visited the emergency room report their last visit to the emergency room was for a non-emergency.

Health Insurance - The uninsured rate in the two counties of Archuleta and La Plata at 18.9% is among the highest in Colorado (ave. 16.3%).7 Additionally, Archuleta and La Plata County have a higher rate of residents likely to be eligible but not enrolled in Medicaid or CHP+.

5 Thomson Reuters, Physician Demand 2011

6 Chambers, G. Capstone project: Determinants of Health Care Access in Archuleta and La Plata Counties. Data combined from Colorado Health Access Survey (2011) and Colorado Household Survey (2008-2009).


Community Health Center - La Plata County is almost twice as large as the next rural county without a community health center, meaning that La Plata has a relatively large uninsured and low income population without access to a community health center safety net system.

Oral Health

In 2010 68.0% of Colorado adults visited the dentist in the past year, with one-third (35.4%) ever having any permanent teeth extracted.8 Significant disparities exist between Hispanic and whites in Colorado where indicators for Hispanics are all significantly worse than for whites in Colorado.

Dental visit rates in Colorado have been stable during past 10 years. Extraction rates of any permanent teeth have been stable during the past six years while extraction of all natural teeth has decreased by about one-fourth over the past 10 years (down to 13.4% of Colorado adults in 2010 who reported all natural teeth extracted).9

For the most recent year available, half of third-graders in both counties have a history of cavities, one-third have sealants, and one in five have untreated tooth decay.

Having dental insurance is an important factor in accessing dental care. According to recent surveys, only about half of residents of both counties have dental insurance (45.9%). Approximately one-fourth across both counties (25.5%) report not receiving necessary oral care in the past year because of cost.10

A slightly increasing percent of Medicaid recipients over four years have accessed dental care. Still, just slightly more than one-third of Medicaid recipients are accessing dental care; this is below the Colorado 2010 target of 44.0%.11

Mental Health

Colorado ranks 32nd in the nation in public sector mental health spending while substance abuse disorder spending is one-third the national average.12 In 2009, Colorado spent an average of $2,256 per estimated person in need of public mental health treatment (up from $1,665 in 2002). Per capita substance abuse treatment funding in Colorado in 2009 was $9.44. More than $53 million was spent on prevention of

7 Colorado Health Institute, County Profiles, June 2012

8 Colorado Behavioral Risk Factor Surveillance System.

9 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2010.

10 Chambers, G. Capstone project: Determinants of Health Care Access in Archuleta and La Plata Counties. Data combined from Colorado Health Access Survey (2011) and Colorado Household Survey (2008-2009).

11 San Juan Basin Trend Analysis, 2011. Epidemiology, Planning and Evaluation Branch, Colorado Department of Public Health and Environment.

12 TriWest Group. (2011). The status of behavioral health care in Colorado—2011 update. Advancing Colorado’s Mental Health Care: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, and The Denver Foundation: Denver, CO.


substance abuse disorder by the Department of Behavioral Health in 2010. Average Medicaid spending in Colorado is 124% higher per person for those with any health mental health diagnosis compared to those without; the majority of the difference is due to increased physical and prescription costs.

Table 2 applies national prevalence estimate ranges for substance use and behavioral health disorders13 to the adult population in Archuleta and La Plata counties to determine estimated number of people needing services.

In fiscal year 2011, Axis Health System, the largest regional Medicaid mental health provider, served approximately 2,400 people in La Plata and approximately 400 in Archuleta.14 Although there are additional private providers providing services in both counties, these numbers indicate that capacity to serve even those with the most serious mental health disorders may currently be insufficient. Nationally, approximately half of those seeking behavioral health care receive it in primary care settings. Access to care may be lower for certain populations; national data shows that the Hispanic population is 60% as likely to receive mental health care compared to other populations.15

Diagnostic Screening – Cancer screening rates for cervical (with Pap test), breast (with mammograms), and colon cancer (with colonoscopy, sigmoidoscopy, or fecal occult blood testing) are not different than the state in either county. Mercy and Digestive Health Associates both offer colonoscopy services. Mercy also provides breast cancer screening services. Pap tests are generally performed by primary care providers and their relative scarcity has been described earlier.

Obesity, Nutrition, and Physical Activity – Healthy Lifestyle La Plata is a local organization dedicated to improving wellness in our community and has achieved a number of local successes including the transit building reconfiguration for safer bicycle access, bike path expansion, encouraging eating local and healthy foods, as well as coordinating with schools in improving their offering of healthy food options and adopting policies to prevent obesity. Future funding for this organization is uncertain.

Tobacco - San Juan Basin Health Department has an active tobacco prevention initiative including community outreach and advocacy activities. San Juan Basin Health Department has also recently applied for a major five year smoking cessation grant and is waiting to hear whether it receives the award.

13 Ibid

14 Personal communication, Pam Wise-Romero, March 13, 2012.

15 TriWest Group. (2011). The status of behavioral health care in Colorado—2011 update. Advancing Colorado’s Mental Health Care: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, and The Denver Foundation: Denver, CO.

Type of disorder national %* La Plata estimate Archuleta estimatesubstance use disorder 11.5% 4,693 1,113

mild 10.8-13.8% 4,408-5,632 1,045-1,336moderate 7-13.5% 2,857-5,509 678-1,307

serious 6.3-8.2% 2,571-3,346 610-794

behavioral health (mental health and substance abuse disorder)

Table 2: Estimated numbers of adults who need behavioral health services in La Plata and Archuleta counties


Health Disparities - San Juan Basin Health Department has also applied for a health disparities grant with CDPHE which is intended to work with existing providers to reduce barriers to care for the Spanish speaking population. Mercy has pledged cooperation and support in this endeavor.

Motor Vehicle Accidents - Injury hospitalizations from motor vehicle accidents (MVAs) were higher than the state in La Plata and similar in Archuleta. In both counties death rates from MVAs were higher than the state. In both Archuleta and La Plata counties, excessive speed was the leading cause of injuries. Archuleta experienced more injuries from animals but no fatalities from that cause. Of note in both counties alcohol and drugs caused the most bodily injury and in La Plata caused the most fatalities.

3 CONTACT INFORMATION

Jane Strobel, Chief Financial Officer Mercy Regional Medical Center 1010 Three Springs Blvd Durango, CO 81301 970-247-4311 www.mercydurango.org

http://www.mercydurango.org/


ATTACHMENT A- STAKEHOLDER MEETING ATTENDEES

Attendees, organizations, and positions of the first La Plata County community stakeholder meeting,

January 17, 2012

Toni Abbey, Southwest Oncology & Blueprints of Hope, Survivorship Nurse Navigator & Founder Ed Aber, LPCO SO, Lt. Jim Abramonitz, Dentist Pattie Adler, San Juan Basin Health Department Michelle Appenzeller, Mercy Hospice HomeCare & PallitativePalliative Care, Director Angela Atkinson, Early Childhood Revival Barbara Bacon, Alpine Home Health, Director Marianne Ball, CCC, RN Enid Brodsky, League of Women Voters, Rachel Camer, La Plata Family Centers Coalition, ED Ann Camp, City of Durango Parks & Recreation, Facility Supervisor, Durango Rec Center Bob Cox, Community, MD Tracy Davis, San Juan Basin Health Department, Nurse Navigator Deanne Deveneaux, RPD Julie Dreyfuss, CCI, CEO Valerie Dyar, Medical Reserve Corps and Community RN, Volunteer RN Wanda Ellingson, University of Denver, Social Work Professor Nora Flucke, Southwest CO Community College, Department Coordinator Jaynee Fontecchio, Citizens Health Advisory Council, RN Patsy Ford, San Juan Basin Health Department Karen Forest, San Juan Basin Health Department- Promoviendo La Salud, RN Richard Grossman Bern Heath, Axis Health, CEO Christine Imming, United Way, Finance Director Martha Johnson, La Plata County Human Services, Assistant Director Helen Joline, San Juan Basin Health Department, Nurse Navigator Josh Joswick, San Juan Citizens Alliance Karen Kelley, Personal Assistance Services of Colorado/SW , Branch Manager Roseana Kutzhes, San Juan Basin Health Department, Lasso Tobacco Program Coordination Will Lacey, San Juan Basin Dental Society, President Bob Ledger, San Juan Basin Health Department, Board President Paul Lee, Osteopathic Center, Physician Lauren Loftis, La Plata Family Med, Physician Jane Looney, San Juan Basin Health Department, Communications Director Jenn Lopez, Regional Housing Alliance, Executive Director Sue M., La Plata Family Medicine, MD Jennifer Matthews, CCI, RN Mike Meschke, San Juan Basin Health Department, Environmental Health Director Tami Miller, Housing Solutions Yonna Moore, Personal Assistance Services of Colorado SW Home Health, Marketing Director Amita Nathvani, Healthy Lifestyles La Plata/Ayurveda Center, Director, Practitioner Virginia Newman, Fort Lewis College Student Health Center, Director, Physicians Assistant Lyn Patrick, Private Medical Practice Lauren Patterson, San Juan Basin Health Department/PLS Children Youth Family Master Plan, Program Evaluator Charlotte Pirnat, Tri County Head Start, Executive Director


Eve Presler, Advocacy for La Plata, Program Director Danny Quinlon, La Plata Unity Project, Certified Medical Interpreter -Spanish Suzan Renger, Tri County Head Start, Nurse Wendy Rice, CSU Extension Andy Rizzo, VA Retired Cheryl Roberts-Lee, Public Health, Director Dale Rodebaugh, Durango Herald Missy Rodey, Citizens Health Advisory Council/Mercy Regional Medical Center Paul Schmitz, Consultant Nicole Schnee, San Juan Basin Health Department, Community Health Educator Jack Scott, San Juan Citizens Alliance Mariel Sholes, San Juan Basin Health Department, Promotora Yvette Tanner, Personal Assistance Services of Colorado SW Home Health, Director Susan Turner, Southern Ute Health, DPHN, RN Lynn Urban, Southwest CO Community College, Campus Dean Tamara Volz, Early Childhood Council, La Plata County, Director Rita Warfield, Durango Police, Sergeant Eileen Wasserbach, SUCAP, Executive Director Audrey Werner, Manna Soup Kitchen Lynn Westberg, San Juan County Partnership, RN, contract Doug Wiersma, Colorado State Patrol, Trooper Pat Wilson, San Juan Basin Health Department, Human Resources Bill Wilson, Mercy Regional Medical Center/San Juan Basin Health Department, Consultant Jenny Wrenn, Healthy Lifestyle La Plata Roger Zalneraitis, La Plata Economic Development Alliance, Executive Director


Attendees, organizations, and positions of the second La Plata County community stakeholder meeting, April 4, 2012

Jim Abramonitz, Dentist

Suzanne Arme, Birthing the Future, Director

Donna Blasdell Ann Camp, City of Durango Parks & Recreation, Facility Supervisor, Durango Rec Center

Sheila Casey, La Plata County Senior Services

Judy Clarke

Lori Cooper, Montezuma County Public Health, Director Nora Flucke, Southwest CO Community College, Department Coordinator

Jaynee Fontecchio, Citizens Health Advisory Council, RN

Rita Fowler, San Juan Basin Health Department, RN, HCBS

Richard Grossman Bern Heath, Axis Health, CEO

Rich Hoehlein, La Plata County Senior Program Advisory Council

Paul Lee, Osteopathic Center, Physician

Lauren Loftis, La Plata Family Med, Physician Danny Quinlon, La Plata Unity Project, Certified Medical Interpreter -Spanish

Lauren Rardin, Durango Senior Center, Administrator

Missy Rodey, Citizens Health Advisory Council/Mercy Regional Medical Center

Tyler VanGemert, Durango Community Acupuncture, Licensed Acupuncturist/Owner


Attendees, organizations, and positions of the first Archuleta County community stakeholder meeting, January 10, 2012

Dick Basillis, Blue Skies Community USJHSD, Fin. Comm. Dori Blauert, Pagosa Springs Medical Center, HR Manager

Diane Bower, Pagosa Fire, Fire Chief

Lindsey Bright, Pagosa Sun, Reporter

Kathleen Douglas, Pagosa Springs Medical Center, Director ED, MS Services Vickie Fahrenkrug, Restoration Fellowship Office Manage, Justice Ministries

Don Ford, Community United Methodist Church, Pastor

Maria Kolpin, RN

Kathie Lattin, Town Council Rich Lindblad, Community Development

Clifford Lucero, Archuleta County, Commissioner

Don Lundergan

Brian MacNeill, Archuleta County DHS, Caseworker Supervisor Maureen Margiotta, Archuleta School District, 50 Joint, School Head Nurse

Michael McCrudden, Retired Resident

Lynne McCrudden, St. Patrick's Episcopal Church, Jr. Warden

Jan Miller, Pagosa Springs Medical Center, Quality Improvement Risk Management Director Jim Saunders, Archuleta County Sheriff's Office, Under Sheriff

Chris Smith, Visiting Angels, Director

Todd Starr, Archuleta County, County Attorney

Randy Stueve, Pagosa Springs Medical Center, Director of Pharmacy MaryJo Valentine, Archuleta School District, 50 Joint, RN, BSN, School Nurse

Steve Wadley, Archuleta County, Commissioner

Janell Wood, Archuleta School District, 50 Joint


Attendees, organizations, and positions of the second Archuleta County community stakeholder meeting, April 23, 2012

Dick Babillis, USJHSDDori Blauert, Pagosa Springs Medical Center, HR ManagerDiane Bower, Pagosa Fire, ChiefLindsey Bright, Pagosa Sun, ReporterBrad Cochennet, USJHSD, CEOLarry Escude, Pagosa Springs Medical Center, IT ManagerVickie Fahrenkrug, Restoration Fellowship, Office ManagerMark Floyd, USJHSD, Board MemberKarin Kohade, San Juan Basin Health Department, Board MemberMaria Kolpin, , RNSusan Kuhns, Pagosa Womens Health and Wellness, Owner-business/CANPRich Lindblad, PSCDC, Executive DirectorClifford Lucero, Archuleta County Commissioner, CommissionerDon Lundergan, P.S. Health Ctr. Maureen Margiotta, Archuleta School District, School District NurseElizabeth Moran, Pregnancy Center/Hospital, R.N.Nancy Rea, Justice Ministries, DirectorJim Saunders, Arch. Co. S.O., UndersheriffGreg Schulte, Archuleta County, County AdministratorT. Searle, OTM/JMChris Smith, Visiting Angels, DirectorTodd Starr, Archuleta County, County AttorneyMaryJo Valentine, School Archuleta 50 Joint, R.N. Steve Wadley, County Commissioner, Archuleta CountyLanell Wood, Archuleta School District, Finance Director


ATTACHMENT B- CAPACITY ASSESSMENT RESULTS

La Plata County Summary of Results:

↑ = at least 50% in two agree/strongly or two disagree/strongly categories;

↑↑= at least 75%; neutral=at least 50% in neutral or not 50% in other category

Actual capacity polling questions: <County> currently has the right amount of organizations and/or people to address <issue>.

Existing organizations address <issue> effectively among all necessary populations in <County>.

Existing organizations and/or people are likely to continue to address <issue> in the next five years in <County>.

I think <issue> can be improved in <County> during the next five years.

Access to care- La Plata County Right number of organizations ↓ Existing organizations effectively addressing ↓↓ Existing organizations will continue ↑ Optimistic about improvement ↑↑

Mental health- La Plata County Right number of organizations ↓ Existing organizations effectively addressing ↓ Existing organizations will continue ↔ Optimistic about improvement ↑↑

Obesity- La Plata County Right number of organizations ↓ Existing organizations effectively addressing ↓↓ Existing organizations will continue ↑ Optimistic about improvement ↑↑

Oral health- La Plata County Right number of organizations ↓↓ Existing organizations effectively addressing ↓↓ Existing organizations will continue ↔ Optimistic about improvement ↑

Tobacco- La Plata County

Right number of organizations ↔ Existing organizations effectively addressing ↔ Existing organizations will continue ↑


Optimistic about improvement ↑

Unintended pregnancy- La Plata County Right number of organizations ↔ Existing organizations effectively addressing ↑ Existing organizations will continue ↑ Optimistic about improvement ↑↑

Injury prevention- La Plata County Right number of organizations ↔ Existing organizations effectively addressing ↑ Existing organizations will continue ↔ Optimistic about improvement ↑↑

Cancer- La Plata County Right number of organizations ↔ Existing organizations effectively addressing ↓ Existing organizations will continue ↑ Optimistic about improvement ↑↑

Clean air and water- La Plata County Right number of organizations ↔ Existing organizations effectively addressing ↓ Existing organizations will continue ↔ Optimistic about improvement ↑


Archuleta County Summary of Results:

↑ = at least 50% in two agree/strongly or two disagree/strongly categories;

↑↑ = at least 75%; neutral=at least 50% in neutral or not 50% in other category

Actual capacity polling questions: <County> currently has the right amount of organizations and/or people to address <issue>.

Existing organizations address <issue> effectively among all necessary populations in <County>.

Existing organizations and/or people are likely to continue to address <issue> in the next five years in <County>. I think <issue> can be improved in <County> during the next five years. Access to care- Archuleta County

Right number of organizations ↓

Existing organizations effectively addressing ↓

Existing organizations will continue ↑↑

Optimistic about improvement ↑↑

Mental health- Archuleta County

Right number of organizations ↓↓

Existing organizations effectively addressing ↓↓

Existing organizations will continue ↑


Obesity- Archuleta County


Existing organizations effectively addressing ↓↓



Oral health- Archuleta County

Right number of organizations ↔




Tobacco- Archuleta County


Existing organizations effectively addressing ↔



Unintended pregnancy- Archuleta County





Optimistic about improvement ↔

Injury prevention- Archuleta County



Existing organizations will continue ↔


Cancer- Archuleta County



Existing organizations will continue ↑↑


Clean air and water- Archuleta County






ATTACHMENT C- SUMMARY OF RISK QUESTIONNAIRE RESULTS

La Plata County Summary of Results by Question

1.) Vote for your top 3 priorities: (priority ranking)

Responses

(percent) (count)

Access to care

29.31% 175

Cancer

4.52% 27 Clean air and water

10.89% 65

Infectious disease

0% 0

Injury prevention

3.18% 19

Mental health

19.10% 114

Obesity

12.90% 77 Oral health

15.58% 93

Tobacco

1.51% 9 Unintended pregnancy

3.02% 18

Totals 100% 597

2.) Which county do you work in? (multiple choice)

Responses

(percent) (count)

La Plata

76.19% 16 Archuleta

4.76% 1

both

9.52% 2 other

9.52% 2

Totals 100% 21

3.) What field do you work in? (multiple choice)

Responses

(percent) (count)

Public health

19.05% 4 Health care

42.86% 9

Government

14.29% 3 Business

0% 0

Education

9.52% 2 Law enforcement

0% 0

Fire dept.

0% 0 other

14.29% 3

Totals 100% 21


4.) La Plata County currently has the right amount of organizations and/or people to address access to care. (multiple choice)

Responses

(percent) (count)

Strongly Agree

4.76% 1

Agree

14.29% 3 Neutral

19.05% 4

Disagree

28.57% 6 Strongly Disagree

33.33% 7

Totals 100% 21

5.) Existing organizations address access to care effectively among all necessary populations in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

4.76% 1 Neutral

9.52% 2

Disagree


42.86% 9

Totals 100% 21

6.) Existing organizations and/or people are likely to continue to address access to care in the next five years in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

22.73% 5

Agree

40.91% 9 Neutral

18.18% 4

Disagree


9.09% 2

Totals 100% 22


7.) I think access to care can be improved in La Plata County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

45.45% 10

Agree

31.82% 7 Neutral

13.64% 3

Disagree


0% 0

Totals 100% 22

8.) La Plata County currently has the right amount of organizations and/or people to address mental health. (multiple choice)

Responses

(percent) (count)

Strongly Agree

8.70% 2

Agree

8.70% 2 Neutral

26.09% 6

Disagree


17.39% 4

Totals 100% 23

9.) Existing organizations address mental health effectively among all necessary populations in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

13.64% 3 Neutral

13.64% 3

Disagree

50% 11 Strongly Disagree

22.73% 5

Totals 100% 22

10.) Existing organizations and/or people are likely to continue to address mental health in the next


five years in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

9.52% 2

Agree

23.81% 5 Neutral

42.86% 9

Disagree


0% 0

Totals 100% 21

11.) I think mental health can be improved in La Plata County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

36.36% 8

Agree

45.45% 10 Neutral

18.18% 4

Disagree


0% 0

Totals 100% 22

12.) La Plata County currently has the right amount of organizations and/or people to address obesity. (multiple choice)

Responses

(percent) (count)

Strongly Agree

9.52% 2

Agree

14.29% 3 Neutral

23.81% 5

Disagree


23.81% 5

Totals 100% 21

13.) Existing organizations address obesity effectively among all necessary populations in La Plata


County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

4.76% 1

Agree

0% 0 Neutral

14.29% 3

Disagree


38.10% 8

Totals 100% 21

14.) Existing organizations and/or people are likely to continue to address obesity in the next five years in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

14.29% 3

Agree

38.10% 8 Neutral

28.57% 6

Disagree


9.52% 2

Totals 100% 21

15.) I think obesity can be improved in La Plata County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

15% 3

Agree

65% 13 Neutral

10% 2

Disagree


0% 0

Totals 100% 20


16.) La Plata County currently has the right amount of organizations and/or people to address oral health. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

23.53% 4 Neutral

0% 0

Disagree


23.53% 4

Totals 100% 17

17.) Existing organizations address oral health effectively among all necessary populations in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

0% 0 Neutral

11.11% 2

Disagree


55.56% 10

Totals 100% 18

18.) Existing organizations and/or people are likely to continue to address oral health in the next five years in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

29.41% 5 Neutral

29.41% 5

Disagree


11.76% 2

Totals 100% 17


19.) I think oral health can be improved in La Plata County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

22.22% 4

Agree

50% 9 Neutral

22.22% 4

Disagree


5.56% 1

Totals 100% 18

20.) La Plata County currently has the right amount of organizations and/or people to address clean air and water. (multiple choice)

Responses

(percent) (count)

Strongly Agree

6.67% 1

Agree

6.67% 1 Neutral

40% 6

Disagree


26.67% 4

Totals 100% 15

21.) Existing organizations address clean air and water effectively among all necessary populations in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

14.29% 2 Neutral

28.57% 4

Disagree


28.57% 4

Totals 100% 14


22.) Existing organizations and/or people are likely to continue to address clean air and water in the next five years in La Plata County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

11.76% 2

Agree

29.41% 5 Neutral

41.18% 7

Disagree


5.88% 1

Totals 100% 17

23.) I think clean air and water can be improved in La Plata County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

27.78% 5

Agree

22.22% 4 Neutral

22.22% 4

Disagree


0% 0

Totals 100% 18


Archuleta County Summary of Results by Question

1.) Vote for your top 3 priorities: (priority ranking)

Responses

(percent) (count)

Access to care

23.12% 123

Cancer

10.15% 54 Clean air and water

1.69% 9

Infectious disease

3.20% 17

Injury prevention

5.45% 29

Mental health

21.43% 114

Obesity

14.85% 79 Oral health

8.08% 43

Tobacco

0% 0 Unintended pregnancy

12.03% 64

Totals 100% 532

2.) Which county do you work in? (multiple choice)

Responses

(percent) (count)

La Plata

0% 0 Archuleta

93.75% 15

both

6.25% 1 other

0% 0

Totals 100% 16

3.) What field do you work in? (multiple choice)

Responses

(percent) (count)

Public health

0% 0 Health care

46.67% 7

Government

6.67% 1 Business

13.33% 2

Education

6.67% 1 Law enforcement

6.67% 1

Fire dept.

6.67% 1 other

13.33% 2

Totals 100% 15

4.) Archuleta County currently has the right amount of organizations and/or people to address access


to care. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

33.33% 5 Neutral

13.33% 2

Disagree


0% 0

Totals 100% 15

5.) Existing organizations address access to care effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

6.25% 1 Neutral

25% 4

Disagree


0% 0

Totals 100% 16

6.) Existing organizations and/or people are likely to continue to address access to care in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

18.75% 3

Agree

56.25% 9 Neutral

18.75% 3

Disagree


0% 0

Totals 100% 16


7.) I think access to care can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

47.06% 8

Agree

52.94% 9 Neutral

0% 0

Disagree


0% 0

Totals 100% 17

8.) Archuleta County currently has the right amount of organizations and/or people to address mental health. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

0% 0 Neutral

11.76% 2

Disagree


17.65% 3

Totals 100% 17

9.) Existing organizations address mental health effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

0% 0 Neutral

20% 4

Disagree


25% 5

Totals 100% 20


10.) Existing organizations and/or people are likely to continue to address mental health in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

11.11% 2

Agree

44.44% 8 Neutral

22.22% 4

Disagree


5.56% 1

Totals 100% 18

11.) I think mental health can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

38.89% 7

Agree

38.89% 7 Neutral

11.11% 2

Disagree


5.56% 1

Totals 100% 18

12.) Archuleta County currently has the right amount of organizations and/or people to address obesity. (multiple choice)

Responses

(percent) (count)

Strongly Agree

5.56% 1

Agree

16.67% 3 Neutral

22.22% 4

Disagree


27.78% 5

Totals 100% 18


13.) Existing organizations address obesity effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

5.56% 1 Neutral

16.67% 3

Disagree


22.22% 4

Totals 100% 18

14.) Existing organizations and/or people are likely to continue to address obesity in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

5.88% 1

Agree

58.82% 10 Neutral

0% 0

Disagree


0% 0

Totals 100% 17

15.) I think obesity can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

23.53% 4

Agree

47.06% 8 Neutral

11.76% 2

Disagree


0% 0


Totals 100% 17

16.) Archuleta County currently has the right amount of organizations and/or people to address unintended pregnancy. (multiple choice)

Responses

(percent) (count)

Strongly Agree

18.75% 3

Agree

18.75% 3 Neutral

37.50% 6

Disagree


12.50% 2

Totals 100% 16

17.) Existing organizations address unintended pregnancy effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

6.67% 1

Agree

26.67% 4 Neutral

46.67% 7

Disagree


0% 0

Totals 100% 15

18.) Existing organizations and/or people are likely to continue to address unintended pregnancy in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

11.76% 2

Agree

47.06% 8


Neutral

23.53% 4 Disagree

17.65% 3

Strongly Disagree

0% 0

Totals 100% 17

19.) I think unintended pregnancy can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

40% 6 Neutral

26.67% 4

Disagree


0% 0

Totals 100% 15

20.) Archuleta County currently has the right amount of organizations and/or people to address cancer. (multiple choice)

Responses

(percent) (count)

Strongly Agree

5.88% 1

Agree

17.65% 3 Neutral

11.76% 2

Disagree


23.53% 4

Totals 100% 17

21.) Existing organizations address cancer effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

12.50% 2 Neutral

25% 4


Disagree


12.50% 2

Totals 100% 16

22.) Existing organizations and/or people are likely to continue to address cancer in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

81.25% 13 Neutral

0% 0

Disagree


12.50% 2

Totals 100% 16

23.) I think cancer can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly Agree

14.29% 2

Agree

57.14% 8 Neutral

21.43% 3

Disagree


0% 0

Totals 100% 14

24.) Archuleta County currently has the right amount of organizations and/or people to address oral care. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0


Agree

27.78% 5 Neutral

33.33% 6

Disagree


11.11% 2

Totals 100% 18

25.) Existing organizations address oral care effectively among all necessary populations in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

0% 0 Neutral

26.67% 4

Disagree


0% 0

Totals 100% 15

26.) Existing organizations and/or people are likely to continue to address oral care in the next five years in Archuleta County. (multiple choice)

Responses

(percent) (count)

Strongly Agree

0% 0

Agree

56.25% 9 Neutral

31.25% 5

Disagree


0% 0

Totals 100% 16

27.) I think oral care can be improved in Archuleta County during the next five years. (multiple choice)

Responses

(percent) (count)

Strongly

13.33% 2


Agree Agree

66.67% 10

Neutral

6.67% 1 Disagree

13.33% 2

Strongly Disagree

0% 0

Totals 100% 15

Documents

Mercy Regional Medical Center - Centura Health