Ringgold County IA Community Health Needs Assessment On behalf of Ringgold County Hospital
September 2013
VVV Research & Development LLC Olathe, KS Community Health Needs Assessment Table of Contents
I Executive Summary II Methodology
a) CHNA Scope & Purpose
b) Local Collaborating CHNA parties…the identity of any and all organizations with which the organization collaborated and third parties that engaged to assist with the CHNA.
c) CHNA & Town Hall Research Process… a description of the process & methods used to conduct the CHNA, a description of how the organization considered the input of persons representing the community, and an explanation of the process/criteria used in prioritizing such needs.
d) Community Profile (Demographics/Economics)… a description of the community served by the facility and how the community was determined. TABS 1-2
III Community Health Status
a) Town Hall CHNA Findings: Areas of Strengths & Areas to Change and/or Improve.”
b) County Health Area of Future Focus… a prioritized description of all of the community needs identified by the CHNA.
c) Historical Health Statistics – TAB 3-10
IV Inventory of Existing County Health Resources
a) Physician Manpower, Health Service Offerings, Detail Inventory of HC providers and Detail Listing local DOH…. a description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA.
V Detail Exhibits
a) Patient Origin & Access to Care
b) Town Hall Attendees, Notes & Feedback… who those persons are (with qualifications)
c) Public Notice & News Shaded lines note IRS requirements
Prepared by VVV Research & Development INC YR 2013
1 I. Executive Summary
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2 I. Executive Summary
The following report is the Community Health Needs Assessment (CHNA) prepared on behalf of Ringgold County Hospital (Primary Service Area) for Ringgold County IA. Creating healthy communities requires a high level of mutual understanding and collaboration with community individuals and partner groups. The development of this assessment brings together community health leaders and providers, along with local residents, to research, prioritize county health needs and to document community health delivery successes. This health assessment will serve as the foundation for community health improvement efforts for the next three years. The Patient Protection and Affordable Care Act (ACA) require non- profit hospitals to conduct a CHNA every three years and adopt an implementation strategy to meet the needs identified by the CHNA.
Year 2013 CHNA brings together a variety of health status information. This assessment was coordinated and produced by VVV Research & Development INC. from Olathe, Kansas under the direction of Vince Vandehaar, MBA. Important CHNA benefits for the sponsoring local hospital and health department, as well as for the community, are as follows: 1) Increases knowledge of community health needs and resources, 2) Creates a common understanding of the priorities of the community's health needs, 3) Enhances relationships and mutual understanding between and among stakeholders, 4) Provides a basis upon which community stakeholders can make decisions about how they can contribute to improving the health of the community, 5) Provides rationale for current and potential funders to support efforts to improve the health of the community, 6) Creates opportunities for collaboration in delivery of services to the community and 7) Provides guidance to the hospital and local health department for how they can align their services and community benefit programs to best meet needs.
Town Hall Community Health Strengths Cited – Ringgold County Hospital Primary Service Area (PSA) Ringgold County, IA
Health Delivery Strengths - Ringgold County IA Town Hall Attendees (N=25) 1 Antismoking campaign 11 New hospital 2 Community support for families 12 Nursing homes 3 Doctors 13 Outdoor activities 4 Good school support 14 Public health initiatives for kids & adults 5 Health screenings 15 Quality of life Healthier concession offerings RCH, PHN, HCI dedicated to healthcare 6 16 7 Healthy lifestyles (biking walking) 17 Ringgold County Public Health services 8 Immunization rates 18 Rural water system 9 Low smoking percentage 19 School screenings and health teaching 10 Nature trails 20 Weight program, physical fitness
3 CHNA “Health Priorities” Cited – Ringgold County Hospital PSA Ringgold County, IA:
Ringgold County IA on behalf of RCH Town Hall Community Health Needs Priorities N = 25 # HCTopicscitedtoeitherchangeorimprove Votes % Accum Total Town Hall Votes 91 100%
Lack of Visiting Physicians i.e. Oncology, 1 Geriatric, Pediatric, Neurology. 14 15.4% 15.4% Aging of Ringgold County Medical Staff. 2 Surgeon to retire soon. 12 13.2% 28.6% 3 Further County Economic development 11 12.1% 40.7%
4 Provide local Dentistry services 8 8.8% 49.5% Poor HC Insurance coverage (High deductible 5 resulting in hospital bad debt) 8 8.8% 58.2%
6 Lack of personal responsibility for health care 7 7.7% 65.9%
7 Develop Senior Care / Elderly support 6 6.6% 72.5%
County wide technology backbone to support 8 healthcare 5 5.5% 78.0% 9 Provide local optical services (Eye doctor) 4 4.4% 82.4%
Other items receiving votes: Young mother support, Diabetes, Expand hours of Note: service to support workers, nutritional education age < 21, awareness of HC services, abuse and children in poverty.
Key Community Health Needs Assessment Conclusions (Secondary Research)
IA HEALTH RANKINGS: According to the 2013 RWJ County Health Rankings study, Ringgold County’s highest State of Iowa ranking (of 99 counties) was in Environmental Quality (4th). Ringgold’s lowest ranking was in Access to Clinical Care/Quality of Care (81st).
TAB 1: Ringgold County’s population has remained steady for the last three years slightly declining by -.6% (Years 2010-2012). Ringgold County’s median household income is $42,213, which is lower than state comparison norms and other Critical Access Hospital (rural) counties.
TAB 2: Ringgold County has an unemployment rate of 5.1%, lower than the state norm and other rural counties. The number of children living below the poverty level is higher than the state norm and other rural counties (27%).
TAB 3: Ringgold County has about the same amount of high school graduates as other Iowa and rural county communities (89.5%) and a higher number of bachelor degrees versus rural (21.1% vs. 17.9%) and about the same as the state (21.1%.)
4 TAB 4: Ringgold County’s percentage of mothers who have prenatal care in the first trimester is much lower than the state norm and other rural counties (70.7% for Ringgold versus 94% and 83.7% for the state and comparable counties, respectively).
TAB 5: Total hospital inpatient discharges in Ringgold County have declined over past 3 years. Ringgold County Hospital discharges have fallen by more than half from 892 to 358 from 2010 to 2012.
TAB 6: The amount of money spent in Ringgold County by the state on mental health has decreased significantly from $38,813 in 2010 to $2,779 in 2012.
TAB 7: Adult obesity is on par with the state average (around 29%). The physical inactivity (29%) is slightly higher than the state and percentage of adults who smoke is much lower than both the state and comparable counties at 5% versus 19% for the state and 19.2% for counties.
TAB 8: Miami County has a higher rate of uninsured at 16% than the state norm and other rural counties (10.8% and 12.4%, respectively).
TAB 9: Mortality rates for Ringgold County are higher than rural comparison for malignant neoplasms.
TAB 10: The percentage of infants fully immunized at 24 months is much higher than the state and other counties at 87%. Diabetic (88%) are about the same and mammography (72%) screenings are slightly higher than the norms.
5 II. Methodology
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6 II. Methodology a. CHNA Scope and Purpose
The new federal Patient Protection and Affordable Care Act requires that each registered 501(c)3 hospital conduct a Community Health Needs Assessment (CHNA) at least once every three years and adopt a strategy to meet community health needs. Any hospital who has filed a 990 is required to conduct a CHNA. IRS Notice 2011-52 was released in late fall of 2011 to give notice and request comments.
JOB #1: Meet/Report IRS 990 Required Documentation
1. a description of the community served by the facility and how the community was determined; 2. a description of the process and methods used to conduct the CHNA; 3. the identity of any and all organizations with which the organization collaborated and third parties that it engaged to assist with the CHNA; 4. a description of how the organization considered the input of persons representing the community (e.g., through meetings, focus groups, interviews, etc.), who those persons are, and their qualifications; 5. a prioritized description of all of the community needs identified by the CHNA and an explanation of the process and criteria used in prioritizing such needs; and 6. a description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA.
Section 501(r) provides that a CHNA must take into account input from persons who represent the broad interests of the community served by the hospital facility, including individuals with special knowledge of or expertise in public health. Under the Notice, the persons consulted must also include: Government agencies with current information relevant to the health needs of the community and representatives or members in the community that are medically underserved, low- income, minority populations, and populations with chronic disease needs. In addition, a hospital organization may seek input from other individuals and organizations located in or serving the hospital facility’s defined community (e.g., health care consumer advocates, academic experts, private businesses, health insurance and managed care organizations, etc.).
JOB #2: Making a CHNA Widely Available to the Public
The Notice provides that a CHNA will be considered to be “conducted” in the taxable year that the written report of the CHNA findings is made widely available to the public. The Notice also indicates that the IRS intends to pattern its rules for making a CHNA “widely available to the public” after the rules currently in effect for Form 990. Accordingly, an organization would make a facility’s written report widely available by posting the final report on its website either in the form of (1) the report itself, in a readily accessible format, or (2) a link to another organization’s website, along with instructions for accessing the report on that website. The Notice clarifies that an organization must post the CHNA for each facility until the date on which its subsequent CHNA for that facility is posted.
7 JOB #3: Adopt an Implementation Strategy by Hospital
Section 501(r) requires a hospital organization to adopt an implementation strategy to meet the needs identified through each CHNA. The Notice defines an “implementation strategy” as a written plan that addresses each of the needs identified in a CHNA by either (1) describing how the facility plans to meet the health need, or (2) identifying the health need as one that the facility does not intend to meet and explaining why the facility does not intend to meet it. A hospital organization may develop an implementation strategy in collaboration with other organizations, which must be identified in the implementation strategy. As with the CHNA, a hospital organization that operates multiple hospital facilities must have a separate written implementation strategy for each of its facilities.
Great emphasis has been given to work hand-in-hand with leaders from both hospitals and the local county health department. A common approach has been adopted to create the CHNA, leading to aligned implementation plans and community reporting.
8 IRS Notice 2011-52 Overview
Applicability of CHNA Requirements to “Hospital Organizations” The CHNA requirements apply to “hospital organizations,” which are defined in Section 501(r) to include (1) organizations that operate one or more state-licensed hospital facilities, and (2) any other organization that the Treasury Secretary determines is providing hospital care as its principal function or basis for exemption. Under Section 501(r), a hospital organization is required to conduct a CHNA for each of its hospital facilities once every three taxable years. The CHNA must take into account input from persons representing the community served by the hospital facility and must be made widely available to the public. The CHNA requirements are effective for taxable years beginning after March 23, 2012 . As a result, a hospital organization with a June 30 fiscal year end must conduct an initial CHNA for each of its hospital facilities by June 30, 2013, either during the fiscal year ending June 30, 2013 or during either of the two previous fiscal years. Determining the Community Served A CHNA must identify and assess the health needs of the community served by the hospital facility. Although the Notice suggests that geographic location should be the primary basis for defining the community served, it provides that the organization may also take into account the target populations served by the facility (e.g., children, women, or the aged) and/or the facility’s principal functions (e.g., specialty area or targeted disease). A hospital organization, however, will not be permitted to define the community served in a way that would effectively circumvent the CHNA requirements (e.g., by excluding medically underserved populations, low-income persons, minority groups, or those with chronic disease needs).
Persons Representing the Community Served Section 501(r) provides that a CHNA must take into account input from persons who represent the broad interests of the community served by the hospital facility, including individuals with special knowledge of or expertise in public health. Under the Notice, the persons consulted must also include: (1) government agencies with current information relevant to the health needs of the community and (2) representatives or members of medically underserved, low-income, and minority populations, and populations with chronic disease needs, in the community. In addition, a hospital organization may seek input from other individuals and organizations located in or serving the hospital facility’s defined community (e.g., health care consumer advocates, academic experts, private businesses, health insurance and managed care organizations, etc.).
Required Documentation The Notice provides that a hospital organization will be required to separately document the CHNA for each of its hospital facilities in a written report that includes the following information: a description of the community served by the facility and how the community was determined; a description of the process and methods used to conduct the CHNA; the identity of any and all organizations with which the organization collaborated and third parties that it engaged to assist with the CHNA; a description of how the organization considered the input of persons representing the community (e.g., through meetings, focus groups, interviews, etc.), who those persons are, and their qualifications; a prioritized description of all of the community needs identified by the CHNA and an explanation of the process and criteria used in prioritizing such needs; and a description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA.
9 Making a CHNA Widely Available to the Public The Notice provides that a CHNA will be considered to be “conducted” in the taxable year that the written report of the CHNA findings is made widely available to the public. The Notice also indicates that the IRS intends to pattern its rules for making a CHNA “widely available to the public” after the rules currently in effect for Forms 990. Accordingly, an organization would make a facility’s written report widely available by posting on its website either (1) the report itself, in a readily accessible format, or (2) a link to another organization’s website, along with instructions for accessing the report on that website. The Notice clarifies that an organization must post the CHNA for each facility until the date on which its subsequent CHNA for that facility is posted.
How and When to Adopt an Implementation Strategy Section 501(r) requires a hospital organization to adopt an implementation strategy to meet the needs identified through each CHNA. The Notice defines an “implementation strategy” as a written plan that addresses each of the needs identified in a CHNA by either (1) describing how the facility plans to meet the health need, or (2) identifying the health need as one that the facility does not intend to meet and explaining why the facility does not intend to meet it. A hospital organization may develop an implementation strategy in collaboration with other organizations, which must be identified in the implementation strategy. As with the CHNA, a hospital organization that operates multiple hospital facilities must have a separate written implementation strategy for each of its facilities.
Under the Notice, an implementation strategy is considered to be “adopted” on the date the strategy is approved by the organization’s board of directors or by a committee of the board or other parties legally authorized by the board to act on its behalf. Further, the formal adoption of the implementation strategy must occur by the end of the same taxable year in which the written report of the CHNA findings was made available to the public. For hospital organizations with a June 30 fiscal year end, that effectively means that the organization must complete and appropriately post its first CHNA no later than its fiscal year ending June 30, 2013, and formally adopt a related implementation strategy by the end of the same tax year. This final requirement may come as a surprise to many charitable hospitals, considering Section 501(r) contains no deadline for the adoption of the implementation strategy.
10 II. Methodology b. Collaborating CHNA Parties (continue)
Consultant Qualifications
VVV Research & Development, Inc. Company Profile: 601 N. Mahaffie, Olathe, KS 66061-6431 (913) 302-7264
VINCE VANDEHAAR, MBA Principal Consultant & Owner of VVV Research & Development, Inc. VVV Research & Development, Inc. was incorporated on May 28th 2009. With over 30 years of business & faculty experience in helping both providers, payors, and financial service firms obtain their strategic planning, research & development needs, Vince brings in-depth health industry knowledge, research aptitude, planning expertise, and energy. VVV Research & Development services are organized, formal processes of listening to the voice of the customer. Vince started his consulting business in May of 2009, after working for Saint Luke’s Health System (SLHS) of Kansas City for 16 years. Note: Saint Luke’s Hospital of Kansas City, SLHS’s largest hospital, won the Malcolm Baldrige National Quality Award in March of 2003. The Baldrige examiners cited Vince’s department as “Best Practice” in the areas of customer satisfaction, market research, and evaluation efforts (Kansas City Star 3/10/04).
VVV Research & Development, INC. (Olathe, KS) consultants have in-depth experience helping hospitals work with local Health Departments to engage community residents & leaders to identify gaps between existing health community resources & needs, and construct detailed strategies to meet those needs - while still adhering to the hospital’s mission and budget. Over the past 20 years, Vandehaar has completed 8 comprehensive Baldrige aligned Community Health Needs Assessments for Saint Luke’s of Kansas City System facilities (3 campuses) and was contracted to conduct 2 additional independent Dept. of Health consulting projects (prior to IRS 990 regs). Currently in 2012, VVV has 12 CHNA IRS aligned assessments underway for Kansas hospitals & Health Departments.
Vince Vandehaar, MBA is actively involved in the Kansas City community. He is a member the Greater Kansas City Employee Benefits Association, the Society for Healthcare Strategy & Market Development, the American Marketing Association Kansas City Chapter, and Co-Chair of the AMA Kansas City Healthcare Special Interest Group. In addition to these roles, from 2000 to 2008, Vince served as the state chairman for MHA’s Data Committee and was a member of KHA’s Data Taskforce.
Collaborating Consultants
Sarah Legg VVV Research & Development, Inc. Lead Project Coordinator & Planning Analyst
VVV Research & Development INC
11 II. Methodology c. CHNA & Town Hall Research Process
Ringgold County Hospital (RCH) Community Health Needs Assessment process began in January of 2013. At that time an inquiry was made by Jim Fitzpatrick, SVP Mercy Health Network Central Iowa to VVV Research & Development to explore the possibility of conducting a comprehensive IRS aligned CHNA for hospital members. On February 15th of 2013 a meeting was held to learn more about Mercy Network Central CHNA’s collaborative options. On that date VVV Research & Development INC reviewed: VVV Research & Development CHNA experience, CHNA requirements (in-depth regulations), CHNA development steps / options to meet IRS requirements, and next steps after option approval. After this review, Ringgold County Hospital elected to move forward with VVV CHNA support.
VVV CHNA Deliverables:
Confirm Ringgold County Hospital primary service area meets patient origin rule, Uncover/Document Basic Secondary Research – Health of County. Organized by 10 TABS, Conduct Town Hall Meeting to discuss secondary data and uncover/prioritize county health needs, and Prepare and publish IRS-aligned CHNA report to meet requirements.
(NOTE: To ensure proper Town Hall representation, the following patient origin 3 years summary was generated.
Historical Inpatient Origin Trends Age 75+ Ringgold Totals PSA % Time County Age 75+ 75+ only FFY 12 231 136 58.9% FFY 11 255 179 70.2% FFY 10 269 198 73.6% Source: IHA Patient Destination Reports
Historical Outpatient (OP/ER) Origin Trends Ringgold Time Totals County PSA % only CY 2012 2337 1462 62.6% CY 2011 2492 1693 67.9% CY 2010 2571 1781 69.3% RCH Casemix
The following chart (calendar of events) outlines approved CHNA roles & responsibilities:
12 Ringgold County Hospital IA - CHNA Work Plan Project Timeline & Roles 2013 as of 5/17/2013 Step Date (Start-Finish) LEAD Task 1 Dec 2012 VVV Sent CHNA Overview material outlining options to CEO. Approval VVV CHNA project quote basic plus - CEO signed 2 2/18/2013 RCH pdf CHNA Overview Conf call with RCH/Public Health leaders. Request FFY 12, 11, and 10 IHA patient origin data reports 3 5/13/2013 VVV / RCH to document service area. (2 runs) Send out REQCoimmInvite Excel file plus SchoolHealthdata 4 5/13/2013 VVV Excel file for RCH input. Prepare/send out PR story to local media announcing 5 5/20/2013 VVV / RCH upcoming CHNA work (general story) Complete Community Town Hall Required invite list. 6 6/15/2013 DCH Send file to VVV to review. Prepare/send out Community TOWN HALL invite letter. (Use Hosp PSA Required data file - joint 7 6/28/2013 DCH signature (2). Use VVV letter sample format.)
Conduct CHNA conference call. Review Town Hall 8 7/11/2013 VVV / RCH Secondary Research data (10 TABS) + Town Hall ppt. Conduct CHNA Town Hall. Lunch 5:30-7pm XXX Conf Room) Review Basic plus CHNA info and uncover 9 THURS 7/18/2013 VVV community needs. Complete Analysis - Release Draft 1- seek feedback 10 on or before 8/31/13 VVV from County Leaders (Hospital & Health Dept.) Produce & Release final CHNA report. Post CHNA 11 on or before 9/15/13 VVV online. Hold Board Meetings discuss CHNA needs, create & adopt an implementation plan/strategy and 12 after 11/1/13 RCH communicate CHNA plan to community.
SecII_c1b_RinggoldCOIA_CHNADatesRoles_v1
13 To meet IRS aligned CHNA requirements, a four-phase methodology was reviewed and approved as follows:
Phase I – Discovery: Conduct a 30 minute conference call with CHNA hospital client and County Health Department. Review / confirm CHNA calendar of events, explain / coach client to complete required participants database and schedule / organize all Phase II activities.
Phase II – QUALIFY Community Need:
A) Conduct secondary research to uncover the following historical community health status for PSA. Use Iowa Hospital Association (IHA), Vital Statistics, Robert Woods Johnson County Health Rankings, etc. to document “current state” of county health organized as follows:
TAB 1. Demographic Profile TAB 2. Economic/Business Profile TAB 3. Educational Profile TAB 4. Maternal and Infant Health Profile TAB 5. Hospitalization / Providers Profile TAB 6. Behavioral Health Profile TAB 7. Risk Indicators & Factors TAB 8. Uninsured Profile TAB 9. Mortality Profile TAB 10. Preventative Quality Measures
B) Gather historical primary research to uncover public health needs, practices and perceptions for hospital primary service areas.
Phase III – QUANTIFY Community Need: Conduct 90 minute Town Hall meeting with required county PSA residents. (Note: At each Town Hall meeting, CHNA secondary data will be reviewed, facilitated group discussion will occur, and a group ranking activity to determine the most important community health needs will be administered.
Phase IV - Complete data analysis & create comprehensive Community Health Needs Assessment. Post CHNA report findings to meet IRS CHNA criteria.
After consideration of CHNA stakeholders (sponsoring hospital & local health department) the CHNA Basic option was selected with the following project schedule: Phase I: Discovery…………………………………………………………….. December 2012 Phase II: Secondary Research …………………………………….….. April – June 2013 Phase III: Town Hall Meeting.……………………………………..…….. July 18, 2013 Phase IV: Prepare / Release CHNA report………………………..….. June-August 2013
14 Detail CHNA development steps include:
Suggested Development Steps Step # 1 Determine interest level of area healthcare leaders (Hospital, Health Commitment Dept, Schools, Churches, Physicians etc), hold community meeting.
Prepare brief Community Health Needs Assessment Plan - list goals, Step # 2 objectives, purpose, outcome, roles, community involvement, etc. Hold Planning Community Kick-off meeting.
Step # 3 Collect & Report Community Health Published Facts. Gather data Secondary health practice data from published secondary research sources i.e. Research census, county health records, behavioral risk factors surveillance, etc.
Step # 4a Conduct Community Roundtable (Qualitative Research). Review Primary Secondary Research (Step3) with Community Stakeholders. Gather Research current opinions and identify health needs.
Step # 4b Collect Community Opinions. (Quantitative Research). Gather current Primary opinions (Valid sample size) regarding community health needs and Research healthcare practices. If appropriate, conduct Physician Manpower
Prepare/Present comprehensive Community Health Needs Assessment Steps # 5 report (to community leaders) with Recommended Actions to improve Reporting health . < Note: Formal report will follow IRS Notice 2011-52 regs > VVV Research & Development INC 913 302-7264
15 Overview of Town Hall Community Priority Setting Process
Each community has a wealth of expertise to be tapped for CHNA development. For this reason, a town hall is the perfect forum to gather community insight and provide an atmosphere to objectively consensus build and prioritize county health issues.
All Town Hall priority-setting and scoring processes involve the input of key stakeholders in attendance. Individuals and organizations attending the Town Halls were critically important to the success of the CHNA. The following list outlines partners invited to Town Hall: local hospital, public health community, mental health community, free clinics, community- based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups.
Ringgold County’s IA Town Hall was held over dinner on Thursday July 18th, 2013, at the REC Community Room (Mount Ayr IA). Vince Vandehaar and Sarah Legg facilitated this 1 ½ hour session with twenty five community attendees. (Note: a detail roster of Town Hall attendees is listed in Section V a.)
The following Town Hall agenda was conducted: 1. Welcome & Introductions 2. Review purpose for the CHNA Town Hall and roles in the process 3. Present / Review of historical County Health Indicators (10 TABS) 4. Facilitate Town Hall participant discussion of data (probe health strengths / concerns). Reflect on size and seriousness of any health concerns sited and discuss current community health strengths. 5. Engage Town Hall participants to rank health needs (using 4 dots to cast votes on priority issues). Tally & rank top community health concerns cited. 6. Close meeting by reflecting on the health needs / community voting results. Inform participants on “next steps”. At the end of each Town Hall session, VVV encouraged all community members to continue to contribute ideas to both hospital and health department leaders via email or personal conversations.
< NOTE: To review detail Town Hall discussion content, please turn to Section V for detail notes of session and activity card content reporting of open end comments.>
16 17 18 19 20 II. Methodology d. Community Profile (a description of community served)
Ringgold County IA Community Profile
Demographics
The population of Ringgold County was estimated to be 5,119 in 2011, and had a -0.2% change in population from 2010–2011.1
The county covers 535.5 square miles and this area is home to Ringgold County Conservation, Ringgold County Pioneer and Rural Life Museum and Diagonal Printing Museum and Genealogy Center.2 The county has an overall population density of 9.6 persons per square mile, compared to the State average of 54.5 persons per square mile.3
The county is located in south central Iowa and its economy is based on Educational,health and social services (27.2%), Agriculture,forestry,fishing and hunting, and mining (14.0%), Manufacturing (12.1%), Retail trade (10.4%).4 The county was founded in 1847 and the county seat is Mount Ayr.5
Population by Race 20116
1 http://quickfacts.census.gov/qfd/maps/iowa_map.html 2 http://www.southerniowatourism.com/index.php/ringgold-county-iowa.html 3 http://quickfacts.census.gov/qfd/maps/iowa_map.html 4 http://www.city-data.com/county/Ringgold_County-IA.html#ixzz2PtwMzXYp
5 https://en.wikipedia.org/wiki/XXXX_County,_Iowa 6 http://quickfacts.census.gov/qfd/maps/iowa_map.html
21 The major highway transportation in Ringgold County is U.S. Highway 169, Iowa Highway 2, Iowa Highway 25.7
Homeownership in Ringgold County is 79.6% and is higher than the state average of 73.0%. Median price of an owner-occupied home in Ringgold County is $85,600 as compared to than the state median value of $121,300.8
Employment in Ringgold County resulted in a median household income of $42,213 from 2007-2011 versus the state median household income of $50,451.9
As of December 2012 the average unemployment rate in Ringgold County was 5.30%.10
7 https://en.wikipedia.org/wiki/XXXX_County,_Iowa 8 http://quickfacts.census.gov/qfd/maps/iowa_map.html 9 http://quickfacts.census.gov/qfd/maps/iowa_map.html 10 www.google.com/publicdata
22 Detail Demographic Profile - Ringgold County IA Population: Households Per Capita ZIP NAME County Yr2011 Yr2016 Chg Yr2011 Yr2016 Avg Size Income 11 50074 ELLSTON RINGGOLD 350 341 163 158 2.2 $22,203 50133 KELLERTON RINGGOLD 581 617 232 247 2.5 $15,814 50835 BENTON RINGGOLD 182 164 72 63 2.4 $17,911 50845 DIAGONAL RINGGOLD 819 744 297 264 2.6 $16,667 50854 MOUNT AYR RINGGOLD 2319 2218 975 929 2.3 $19,337 50860 REDDING RINGGOLD 441 427 130 124 3.4 $13,510 50863 TINGLEY RINGGOLD 336 327 136 131 2.5 $19,209 Totals 5,028 4,838 -3.8% 2,005 1,916 2.5 $17,807 Population 2011: Females ZIP NAME County Yr2011 POP65p % GenX MALES FEMALES Age20_35 50074 ELLSTON RINGGOLD 350 103 63 171 179 28 50133 KELLERTON RINGGOLD 581 102 132 307 274 61 50835 BENTON RINGGOLD 182 39 37 90 92 17 50845 DIAGONAL RINGGOLD 819 166 167 408 411 78 50854 MOUNT AYR RINGGOLD 2319 628 441 1072 1247 201 50860 REDDING RINGGOLD 441 68 83 227 214 32 50863 TINGLEY RINGGOLD 336 94 62 164 172 28 Totals 5,028 1,200 23.9% 985 2,439 2,589 445 Population 2011: Average Hholds #HH $50+ ZIP NAME County White Black Hisp Amer IN HH Inc11 Yr2011 Income 50074 ELLSTON RINGGOLD 347 0 1 0 $47,675 163 56 50133 KELLERTON RINGGOLD 554 8 7 5 $39,597 232 74 50835 BENTON RINGGOLD 177 1 6 1 $43,951 72 21 50845 DIAGONAL RINGGOLD 795 3 27 5 $44,581 297 93 50854 MOUNT AYR RINGGOLD 2272 3 37 2 $45,056 975 319 50860 REDDING RINGGOLD 427 2 7 0 $45,630 130 47 50863 TINGLEY RINGGOLD 333 0 2 0 $47,456 136 47 Totals 4,905 17 87 13 $44,849 2,005 657 Source: ERSA Demographics
ERSA2011 Demo_PopCHNAmodel 23 III. Community Health Status
[VVV Research & Development INC]
24 II. Community Health Status a. Historical Health Statistics Health Status Profile – Ringgold County, IA
This section of the CHNA reviews published quantitative community health indicators and results of our recent CHNA Town Hall. To produce this profile, VVV Research & Development staff analyzed data from multiple sources. This analysis focuses on a set of published health indicators organized by ten areas of focus (10 TABS), results from the 2013 County Health Rankings and conversations from Town Hall primary research. (Note: The Robert Wood Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to release annual County Health Rankings. As seen below in model, these rankings are based on a number of health factors.)
The County Health
25 2012 State Health Rankings
IA Rank of 99 Ringgold IA Rural # counties Definitions Co Trend Norm N=13 1 Physical Environment Environmental quality 4 44.2 2 HealthFactors 27 58.4 Access to care / Quality 69.8 2a Clinical Care of Care 81 Education, Employment, Income, Family/Social 57.4 support, Community 2b Social & Economic Factors Safety 50 3 Health Outcomes 27 56.8 Tobacco Use, Diet/Exercise, Alcohol 47.5 3a Health Behaviors Use, Sexual Activitiy 6 3b Morbidity Quality of life 13 60.1 3c Mortality Length of life 39 53.2 http://www.countyhealthrankings.org, released 2013
Note : Iowa Rural Norm N=13 Includes the following counties: Page, Fremont, Ida, Sac, Davis, Decatur, Appanoose, Marion, Poweshiek, Tama, Madison, Ringgold, and Lee
Secondary Research
When considering the state of community health, it’s important to review published health data by topic area. Below is a summary of key TABS of information collected:
Tab 1 Demographic Profile
% Change YR 2010 YR 2011 YR 2012 # Population History Vital Statistics 2006-10 1 Ringgold County Population 5,128 5,107 5,096 -0.6% Source: Census.gov
State of IA Rural # People QuickFacts Ringgold Co Trend IA Norm N=13 1 Population, 2012 estimate 5096 3,062,309 8,133.8 2 Population, 2010 5131 3,046,355 9,222.1 3 Persons under 5 years, percent, 2011 6.2% 6.5% 6.3% 4 Persons under 18 years, percent, 2011 24.0% 23.70% 23.70% 5 Persons 65 years and over, percent, 2011 23.6% 14.90% 18.7% 6 Persons per square mile, 2010 9.6 54.5 27.8 7 Living in same house 1 year & over-2010 89.2% 83.80% 83.7% 8 Foreign born persons, percent-2010 1.8% 4.10% 1.8% Ringgold IA Rural countyhealthrankings.org County Trend State of IA Norm N=13 1 Children in single-parent households 23.0% 27.0% 26.6%
26 Tab 1 Demographic Profile (con’t)
State of IA Rural # People QuickFacts Ringgold Co Trend IA Norm N=13 1 Veterans, 2006-2010 464 245,537 1322 Mean travel time to work (minutes), 2 workers age 16+, 2006-2010 17.6 18.5 19.9 3 Housing units, 2010 2,576.0 1,336,417 6869.2 4 Homeownership rate, 2006-2010 79.6% 73.20% 76.0% Housing units in multi-unit structures, 5 percent, 2006-2010 7.4% 18.60% 10.8% Median value of owner-occupied housing 6 units, 2006-2010 $85,600 $119,200 $94,615
State of IA Rural # People QuickFacts Ringgold Co Trend IA Norm N=13 1 Households, 2007-2011 2,056.0 1,215,954 6,018.5 2 Persons per household, 2007-2011 2.5 2.4 2.4 3 Per capita income past 12 months (2010) $22,620 $25,335 $23,119 4 Median household income 2006-2010 $42,213 $48,872 $45,257
Tab 2 Economic Profile
IA Rural # Business QuickFacts Ringgold Co Trend State of IA Norm N=13 1 Private nonfarm establishments, 2011 141 80,971 390.3 2 Private nonfarm employment, 2011 975 1,283,769 4919.8 Private nonfarm employment, percent change 2010- -7.7% 3 2011 -2.0% 1.5% 4 Nonemployer establishments, 2010 488 195,410 1050.8 5 Total number of firms, 2007 553 259,931 957.3
Ringgold IA Rural # http://www.countyhealthrankings.org County Trend Iowa NORM N=13 1 Children in poverty 27.0% 16.0% 20.0% 2 Fast food restaurants 17.0% 44.0% 34.7% 3 Unemployment 5.1% 6.1% 6.3%
27 Tab 3 Public Schools Health Delivery Profile. Currently school districts are providing on site primary health screenings and basic care.
# School District Indicators Diagonal Mount Ayr 1 Total # Public School Nurses 1 1 2 School Nurse is part of the IEP team no yes 3 School Wellness Plan in place (Active) yes yes all screened but 399/ 15/ data not 4 VISION: # Screened / Referred to Prof / Seen by Professional data not provided to school available 275/ 25 data not 5 HEARING: # Screened / Referred to Prof / Seen by Professional no provided to school 7 out of 13 48/ 13/ data not 6 ORAL HEALTH: # Screened / Referred to Prof / Seen by Professional screened provided to school 7 SCOLIOSIS: # Screened / Referred to Prof / Seen by Professional no 0 8 # of Students served with no identified chronic health concerns not monitored 600 9 School has a suicide prevention program yes plan, not program 10 Compliance on required vaccinations (%) 100% 100%
Ringgold Iowa Norm Trend State of IA # People QuickFacts County N=13 1 33% 33.3% 29.9% Students Eligible for the Free Lunch Program (%) High school graduates, percent of persons age 25+, 2005- 89.5% 90.3% 90.4% 2 2009 Bachelor's degree or higher, pct of persons age 25+, 2005- 21.1% 21.2% 17.9% 3 2009
TAB 4 Maternal and Infant Health Profile. Tracking maternal & infant care patterns are vital in understanding the foundation of family health.
Ringgold IA Rural # Indicators Co Trend State of IA Norm N=13 1 Total Live Births, 2007 60 40,592 182.9 2 Total Live Births, 2008 63 40,835 186.1 3 Total Live Births, 2009 64 40,221 186.9 4 Total Live Births, 2010 54 39,662 181.0 5 Total Live Births, 2011 51 38,514 173.0 Births Occurring to Teens 11 3,137 16.2 Number of Births Occuring to Unmarried Women 11 13,418 35.9 Low Weight Births (under 2,500 grams / 5 lb. 8 oz) 6 2,536 46.6
Ringgold IA Rural # Indicators Co Trend State of IA Norm N=13 1 Births with Prenatal Care in First 3 Months 70.70% 94.0% 83.7% 2 Percentage of Mothers Who Initiate Breastfeeding NA 76.0% 61.3% Percentage of Mothers who Smoke Any Time 3 During Pregnancy NA 14.0% 25.0% 4 Percent of Births Occurring to Unmarried Women 21.6% 34.8% 33.5% 5 Children Receiving WIC (Percent) – 2010 27.3% 28.2% 30.2% Ringgold IA Rural Indicator http://www.countyhealthrankings.org Co Trend State of IA Norm N=13 1 Low birthweight 5.5% 6.6% 6.7%
28 TAB 5 Hospitalization/Provider Profile Understanding provider access and disease patterns are fundamental in healthcare delivery. Listed below are several vital county statistics.
Ringgold County - TOTALS # IA Hospital Association FY2010 FY1011 FY2012 Trend 1 Total Discharges 690 633 606 2 Total IP Discharges-Age <18 68 59 67 3 Total IP Discharges-Age 18-44 102 93 91 4 Total IP Discharges-Age 45-64 117 123 108 5 Total IP Discharges-Age 65-74 134 103 109 6 Total IP Discharges-Age 75+ 269 255 231 Ringgold Hospital # IA Hospital Association FY2010 FY1011 FY2012 Trend 1 Total Discharges 350 281 230 Marketshare % ALL IP 50.7% 44.4% 38.0% 2 Total IP Discharges-Age <18 4 1 2 3 Total IP Discharges-Age 18-44 23 15 8 4 Total IP Discharges-Age 45-64 52 44 34 5 Total IP Discharges-Age 65-74 73 42 50 6 Total IP Discharges-Age 75+ 198 179 136 Marketshare % IP Age 65 plus 77.4% 78.6% 80.9%
Source: RCH Internal Records # Total Patients YR2010 YR2011 YR2012 Trend 1 Total Inpatient discharges (All zips) 892 409 358 2 Total Emergency Visits 1,724 1,732 1,789 3 Total Outpatient Visits 9,741 9,325 9,676 4 Total Clinic (Employed Physician) visits 12,595 12,821 12,085
TAB 6 Social & Rehab Services Profile. Behavioral health and rehabilitation care provide another important indicator of community health status. Below is a summary of the previous 3 years assistance:
29 TAB 7 Health Risk Profiles. Knowing community health risk factors and disease patterns can aid in the understanding “next steps” to improve health. Being overweight/obese; smoking, drinking in excess, not exercising etc can lead to poor health.
State of IA Rural countyhealthrankings.org Ringgold Co Trend IA Norm N=13 1 Adult obesity 29% 29.0% 29.9% 2 Adult smoking 5% 19.0% 19.2% 3 Excessive drinking NA 20.0% 18.9% 4 Inadequate social support NA 12.0% 17.0% 5 Physical inactivity 29% 25.0% 28.2% 6 Poor physical health days 1.2 2.8 3.2
State of IA Rural # IA Health Categories Ringgold Co Trend IA Norm N=13 Percent of housing units with a high 1 risk of lead hazards NA 4% NA 2 Air Pollution Particulate Matter Days 0 1 NA 3 Air Pollution Ozone Days 0 0 NA Number of people in population with 4 poor drinking water 0 636.2 ngs, IA 2011, http://www.countyhealthrankings.org/IA/downloads-and-linIA Source: County Health Ranki
TAB 8 Uninsured Profiles. Based on synthetic estimations, the number of insured is documented below. Also, the amount of charity care (last 3 years of free care) from area providers is trended below.
State of IA Rural # Uninsured Population (2007) Ringgold Co Trend IA Norm N=13 Number of Unisured (<65) 598 180,032 1,391 % Uninsured (<65) 16.0% 10.8% 12.4% Source: 2011 Iowa Health Fact Book
Ringgold County Hospital $ (000) YR10 YR11 YR12 Trend
1 Bad Debt.. Have Insurance Cant' Pay Bill $575,405 $538,770 $547,277
2 Charity Care .. Free Care given $70,148 $41,896 $174,731
30 TAB 9 Mortality Profile. The leading causes of county deaths are listed below. Areas of higher than expected are so noted.
Vital Statistics Causes of Death by County of Residence, IA 2010 Selected Causes of Death (ICD-10) Ringgold Co Trend Iowa TOTAL 1796 61,907 1 Major Cardiovascular Diseases 235 9,090 Malignant Neoplasms, Including 2 Neoplasms of Lymphatic and 217 6,394 Hematopoietic Tissues 3 Diseases of Heart 182 6,851 4 All Other Diseases 144 4,014 5 Ischemic Heart Disease 130 5,026 Other Forms of Chronic Ischemic 6 97 3,515 Heart Disease All Other Forms of Chronic Ischemic 7 71 2,466 Heart Disease Malignant Neoplasms of 8 Respiratory and Intrathoracic 70 1,784 Organ Malignant Neoplasms of Digestive 9 62 1,615 Organs and Peritoneum Chronic Lower Respiratory 10 61 1,692 Diseases Other Chronic Lower Respiratory 11 55 1,559 Diseases 12 Alzheimer’s Disease 45 1,421 13 Other Heart Diseases 42 1,481 14 Diabetes Mellitus 39 742 15 Unintentional Injuries 38 1,292
IA Rural Norm # IA Health Categories Ringgold Co Trend N=13 Age-adjusted Suicide Mortality 1 Rate per 100,000 population 15.4 13.4 Age-adjusted Traffic Injury 2 Mortality Rate per 100,000 population 7.7 22.5 Age-adjusted Unintentional 3 Injuries Mortality Rate per 100,000 population 25.1 42.3 Indicator IA Rural Norm http://www.idph.state.ia.us Ringgold Co Trend N=13 1 Premature death per 100,000 2.5 2.9
31 TAB 10 Preventive Health Profile. The following table reflects future health of county. This information also is an indicator of community awareness of preventative measures.
Ringgold State IA Rural http://www.countyhealthrankings.org Co Trend of IA Norm N=13 1 Diabetic screening 88% 88% 86.2% 3 Mammography screening 72% 71% 68.3% 2 Limited access to healthy foods 3% 6% 5.4% 4 Poor or fair health (Self Assess) 13% 12% 13.0% Indicators: Immunization program annual Ringgold State IA Rural # report 2012 Co Trend of IA Norm N=13 1 Adolescent Immunization Rate 59% 23% 28.5% Percent of Infants Fully immunized at 24 2 months 87% 64% 67.4% 3 Annual check-up visit to PCP (past year) NA NA NA Annual check-up visit to Eye Doctor (past 4 year) NA NA NA 5 Annual check-up visit to Dentist (past year) NA NA NA
32 IV. Inventory of Community Health Resources
[VVV Research & Development INC]
33 Inventory of Health Services Ringgold County IA Cat HC Services Offered in county: Yes / No Hospital HLTH Dept Other Clinic Primary Care
Hosp Alzheimer Center No Yes Hosp Ambulatory Surgery Centers No Hosp Arthritis Treatment Center No Hosp Bariatric/weight control services No Hosp Birthing/LDR/LDRP Room No Hosp Breast Cancer No Hosp Burn Care No Hosp Cardiac Rehabilitation Yes Hosp Cardiac Surgery No Hosp Cardiology services Yes Hosp Case Management No Hosp Chaplaincy/pastoral care services No Yes Hosp Chemotherapy Yes Hosp Colonoscopy Yes Hosp Crisis Prevention No Yes Hosp CTScanner Yes Hosp Diagnostic Radioisotope Facility No Hosp Diagnostic/Invasive Catheterization No Hosp Electron Beam Computed Tomography (EBCT) No Hosp Enrollment Assistance Services Yes Hosp Extracorporeal Shock Wave Lithotripter (ESWL) No Hosp Fertility Clinic No Hosp FullField Digital Mammography (FFDM) Yes Hosp Genetic Testing/Counseling No Hosp Geriatric Services Yes Hosp Heart Yes Hosp Hemodialysis Yes Hosp HIV/AIDSServices No Hosp Image-Guided Radiation Therapy (IGRT) No Hosp Inpatient Acute Care - Hospital services Yes Hosp Intensity-Modulated Radiation Therapy (IMRT) 161 No Hosp Intensive Care Unit No Hosp Intermediate Care Unit No Hosp Interventional Cardiac Catherterization No Hosp Isolation room Yes Hosp Kidney Yes Hosp Liver Yes Hosp Lung Yes Hosp MagneticResonance Imaging (MRI) Yes Hosp Mammograms Yes Hosp Mobile Health Services No Hosp Multislice Spiral Computed Tomography (<64 slice CT) Yes Hosp Multislice Spiral Computed Tomography (<64+ slice CT) No Hosp Neonatal No Hosp Neurological services No Hosp Obstetrics No Hosp Occupational Health Services Yes Hosp Oncology Services No Hosp Orthopedic services Yes Hosp Outpatient Surgery Yes Hosp Pain Management No Hosp Palliative Care Program Yes Yes Hosp Pediatric Yes Hosp Physical Rehabilitation Yes Hosp Positron Emission Tomography (PET) No Hosp Positron Emission Tomography/CT (PET/CT) No
1_HCServiceOfferings_Ringgold
34 Inventory of Health Services Ringgold County IA Cat HC Services Offered in county: Yes / No Hospital HLTH Dept Other Hosp Psychiatric Services No Yes Hosp Radiology, Diagnostic Yes Hosp Radiology, Therapeutic No Hosp Reproductive Health Yes Hosp Robotic Surgery No Hosp Shaped Beam Radiation System 161 No Hosp Single Photon Emission Computerized Tomography No Hosp Sleep Center Yes Hosp Social Work Services No Yes Hosp Sports Medicine Yes Hosp Stereotactic Radiosurgery No Hosp Swing Bed Services Yes Hosp Transplant Services No Hosp Trauma Center -Level IV Yes Hosp Ultrasound Yes Hosp Women's Health Services Yes Hosp Wound Care Yes SR Adult Day Care Program No Yes SR Assisted Living No Yes SR Home Health Services No Yes SR Hospice No Yes SR LongTerm Care No Yes SR Nursing Home Services No Yes SR Retirement Housing No Yes SR Skilled Nursing Care No Yes ER Emergency Services Yes ER Urgent Care Center No ER Ambulance Services Yes SERV Alcoholism-Drug Abuse No Yes SERV Blood Donor Center No Yes SERV Chiropractic Services No Yes SERV Complementary Medicine Services No Yes SERV Dental Services No Yes SERV Fitness Center No Yes SERV Health Education Classes Yes Yes SERV Health Fair (Annual) Yes SERV Health Information Center No SERV Health Screenings Yes Yes Yes SERV Meals on Wheels No Yes SERV Nutrition Programs No Yes SERV Patient Education Center No SERV Support Groups No Yes SERV Teen Outreach Services No Yes SERV Tobacco Treatment/Cessation Program No Yes SERV Transportation to Health Facilities No Yes SERV Wellness Program No Yes
1_HCServiceOfferings_Ringgold
35 Providers Delivering Care in Ringgold Co Hospital IA Primary Service Area FTE Physicians FTE Allied Staff PSA Based Visting PSA Based # of FTE Providers working in county DRs DRs * PA / NP Primary Care: Family Practice 3.50 3.00 Internal Medicine / Geriatrician Obstetrics/Gynecology Pediatrics
Medicine Specialists: Allergy/Immunology Cardiology 0.14 0.14 Dermatology 0.02 Endocrinology Gastroenterology Oncology/RADO Infectious Diseases Nephrology 0.05 Neurology Psychiatry Pulmonary Rheumatology
Surgery Specialists: General Surgery / Colon / Oral 1.00 Neurosurgery Ophthalmology Orthopedics 0.18 Otolaryngology (ENT) 0.05 Plastic/Reconstructive Thoracic/Cardiovascular/Vasc 0.05 Urology
Hospital Based: Anesthesia/Pain 0.60 Emergency 1.80 1.20 0.70 Radiology 0.28 Pathology 0.05 Hospitalist Neonatal/Perinatal Physical Medicine/Rehab Occ Medicine Podiatry 0.05 Chiropractor 3.00 Optometrist OD 0.55 Dentists 1.50 TOTALS 10.80 2.60 4.46 * Total # of FTE Specialists serving community who office outside PSA.
2_PhysicianManpower_Ringgold
36 Visiting Specialists to Ringgold County IA Office Location Annual LOCATION OF SPECIALTY Physician Name/Group SCHEDULE (City/State) Days OUTREACH CLINIC
Cardiology - Iowa Heart Center Des Moines, IA 2nd/4th Wed. 24 VPC - RCH
Dermatology - Anne Nelson, PA-C Des Moines, IA 3rd Wed. 12 VPC - RCH
ENT Iowa Head & Neck, P. C. Des Moines, IA Twice Monthly (Wed.) 24 VPC - RCH Twice Monthly ( Fri Nephrology Associates in Kidney Care Des Moines, IA /Wed.) 24 VPC - RCH
Twice Wkly. Mon./Thur. 96 VPC - RCH General Surgeon - Dane Johnson, D. O. Mt. Ayr, IA
Orthopedic - Southern Iowa Orthopedics Corydon, IA Wkly. Tues. 48 VPC - RCH
Pod (Foot) Capital Orthopedics Clive, IA Monthly 4th Tues. 12
Vascular - Iowa Heart Center West Des Moines, IA Monthly (Wed.) 12 VPC - RCH
Heartland Vascular Vascular - Medicine & Surgery Des Moines, IA Twice Monthly (Tues.) 20 VPC - RCH
3_VistingSpecialist_Samplefile.xls 37 Ringgold County Iowa Health Care Area Service Directory
Emergency Numbers
Police/Sheriff 911
Fire 911
Ambulance 911
Non-Emergency Numbers
Ringgold County Sheriff (641) 464-3921 Ringgold County Hospital EMS (641) 464-4402
38 QUICK REFERENCE PHONE GUIDE
Action Now 1-800-622-5168 Al-Anon “Free to Be Me” (515) 462-4253 Alcoholics Anonymous (515) 282-8550 Alzheimer’s Disease Helpline 1-800-272-3900 American Cancer Society 1-800-227-2345 American Red Cross 1-800-887-2988 Arthritis Foundation 1-866-378-0636 Battered Women 1-800-433-SAFE Child Abuse Hotline 1-800-795-9606 Dependent Adult Abuse Hotline 1-800-362-2178 Dependent Adult and Child Abuse 1-800-652-9516 Domestic Abuse Hotline 1-800-942-0333 First Call for Help (515) 246-6555 Foundation Through Crisis 1-800-332-4224 Gambling Hotline 1-800-238-7633 Iowa Arson/Crime Hotline 1-800-532-1459 Iowa Child Abuse Reporting Hotline 1-800-362-2178 Iowa State Patrol Emergency 1-800-525-5555 Lifeline of Southern Iowa (641) 342-2395 1-800- Medicare MEDICARE Mental Health Information and Referral 1-800-562-4944 National Alcohol Hotline 1-800-252-6465 National Center for Missing & Exploited Children 1-800-THE LOST National Institute on Drugs 1-800-662-4537 Poison Control 1-800-222-1222 Senior Health Ins Info Program (SHIIP) 1-800-351-4664 Substance Abuse Information & Treatment 1-800-662-HELP Suicide Prevention Hotline 1-800-SUICIDE Teen Line (Red Cross) 1-800-443-8336
39 Child Abuse Prevention Services Mike Magers, D. O. Iowa Department of Human Services Mount Ayr Medical Clinic 109 S. Main 504 N. Cleveland Mount Osceola, IA 50213 Ayr, IA 50854 800-362-2178 641-464-4470
Bikers against Child Abuse (BACA) Ron Schafer, P.A. Central Iowa Chapter Mount Ayr Medical Clinic P.O. Box 41605 504 N. Cleveland Des Moines, Iowa 50311-3100 Mount Ayr, IA 50854 515-789-0101 641-464-4470
Child Care Resource & Referral Jerald Phipps, D. O. West Central Community Action Agency Mount Ayr Medical Clinic 800-945-9778 504 N. Cleveland www.swiowachildcare.org Mount Ayr, IA 50854 641-464-4470 Chiropractor Dennis Hemann, DC Dentists 201 W South St Terry B Lesan DDS Mount Ayr, IA 50854 1330 E Main St 641-464-2000 Lamoni, IA 50140 6417846059
Clinics C Collus Lawhead DDS Dwain Crain, D. O. 104 South Taylor Crain Medical Clinic Mount Ayr, IA 50854 207 North Taylor 6414642320 Mount Ayr, IA 50854 641-464-3911 Domestic Violence Crisis Centers Crisis Intervention & Advocacy Center Family Health Clinic P.O. Box 40 1332 E Main St Adel, IA 50003 Lamoni IA 50140 24 Hour Crisis Line 641-784-7526 800-400-4884
Bruce W. Ricker, D. O. Employment Assistance Mount Ayr Medical Clinic Iowa Workforce Development & Workforce 504 N. Cleveland Investment Act Mount Ayr, IA 50854 215 N. Elm 641-464-4470 Creston, IA 50801 www.iowaworkforce.org Marcy Gregg, ARNP 641-782-2119 Mount Ayr Medical Clinic 504 N. Cleveland Vocational Rehabilitation Mount Ayr, IA 50854 1501 W. Townline 641-464-4470 Creston, IA 50801 641-782-8538
40 Food Assistance General Assistance Kellerton Food Pantry (Serving Ringgold, Ringgold County Courthouse Decatur, Clarke & Union Counties) 109 W. Madison Former Great Western Bank Bldg Mount Ayr, IA 50854 Kellerton, IA 50133 641-464-0647 641-783-2583 3rd Wednesday of each month Open Closet Emergency food call 641-414-5243 Mount Ayr Assembly of God 1605 W. South Street Women, Infants, and Children (WIC) Mount Ayr, IA 50854 MATURA Free clothes, shoes, house ware, linens, etc. 210 Russell St. First Saturday of each month Creston, IA 50801 Emergency call 641-464-3113 www.maturacommunityaction.com 641-782-8431 Veterans Assistance Ringgold County Courthouse MATURA Outreach Center—Food Pantry 109 W. Madison 202 N. Taylor St. Mount Ayr, IA 50854 Mount Ayr, IA 50854 641-464-2397 641-464-2401 Government Fitness SIRF (Southern Iowa Resources For The Workout Place Families) 700 E. South Street 109 N. Elm Mount Ayr, IA 50854 Creston, IA 50801 515-782-0629 641-782-4170
Foster Care and Adoptive Services Department Of Human Services Children and Families of Iowa (CFI) 109 S Main St 115 W. McLane St. Osceola, IA 50213 Osceola, IA 50213 8773941439 www.cfiowa.org 641-342-3444 Health, Dental, and Maternal Health (Children 0-18 & pregnant women Iowa Kids Net only) www.iowakidsnet.com Iowa Department of Human Services 800-243-0756 109 S. Main Osceola, IA 50213 General Assistance *Medicaid Iowa Department of Human Services *Hawk-i 109 S. Main 641-342-6516 Osceola, IA 50213 641-342-6516 Community Health Centers of Southern Iowa MATURA Outreach Center 302 NE 14th St. 202 N. Taylor St. Leon, IA 50144 Mount Ayr, IA 50854 www.chcsi.org 641-464-2401 641-446-2383
41 MATURA Nancy Ford 203 W. Adams St. Heritage Park Creston, IA 50801 306 E. Monrie www.maturacommunityaction.com Mount Ayr, IA 50854 641-782-8431 641-464-3832 *WIC *I-Smile Helen Schardein *Maternal health Mount Ayr Manors 400 N. Fillmore Health Department Mount Ayr, IA 50854 Becky Fletchall 641-464-3115 Ringgold County Public Health 119 S Fillmore St Shawn Cameron Mount Ayr, IA 50854 Clearview Estates 6414640691 500 W Columbus St Mount Ayr, IA 50854 Home Health and Hospice 6414640651 Amy Mobley, RN, CHPN HCI Care Services Robin Bickel , DON 107 S Fillmore St Clearview Nursing Home Mount Ayr, IA 50854 406 W. Washington 6414642088 Mount Ayr, IA 50854 641-464-2240 Hospital Gordon Winkler, Administrator/CEO Nancy Ford Ringgold County Hospital Tingley Apartments 504 N. Cleveland 301 E. Main Street Mount Ayr, IA 50854 Tingley, IA 50863 641-464-3226 641-464-3832
Housing Housing Assistance John Worthington Iowa Department of Human Services Kellerton Apartments 109 S. Main 100 W. 6Th Avenue Osceola, IA 50213 Kellerton, IA 50133 641-342-6516 641-783-2343 Southern Iowa Council of Governments Kelsey Allen, Don (SICOG) Maple Ridge Estates 101 E. Montgomery St. 1500 E. South Street Creston, IA 50801 Mount Ayr, IA 50854 www.sicog.com 641-464-3204 641-782-8491
Kelsey Allen, DON Southern Iowa Regional Housing Authority Mt. Ayr Health Care 219 N. Pine St. 1500 E. South Street Creston, IA 50801 Mount Ayr, IA 50854 www.sirha-ia.org 641-464-3204 641-782-8585
42 MATURA Rural Family Therapy Services 202 N. Taylor St. 505 E. Taylor St. Mount Ayr, IA 50854 Creston, IA 50801 641-464-3107 641-782-7212 *Low Income Heat Energy Assistance *All Ages Program (LIHEAP) *Weatherization Assistance Optometrists *Utility Assistance Joel Weis, OD *Homeless prevention/crisis programs Family Vision Center *Homeless Prevention and Rapid Re- 102 N. Fillmore housing Mount Ayr, IA 50854 641-464-2813 Legal Assistance Iowa Legal Aid Parent Education 800-342-9229 Head Start 302 N. Lincoln St. Iowa Concern Hotline Mount Ayr, IA 50854 800-447-1985 641-464-3107
Child Support Recovery Parents as Teachers 215 W. Adams St. Robin McDonnell, RN Creston, IA 50801 Ringgold County Public Health 888-229-9223 119 S. Fillmore St. Mount Ayr, IA 50854 Iowa Mediation Service www.rcph.net 228 N. Pine St. 641-464-0691 Creston, IA 50801 641-782-7329 Preschool Tuition Assistance Quad Counties 4 Kids Early Childhood Area Juvenile Court Services Vicki Sickels, Director 211 N. Elm St. 641-464-3186 Creston, IA 50801 641-782-2519 Physicians, Surgeons and Providers Dwain Crain, DO Mental Health Services Crain Medical Clinic Community Health Centers of Southern 207 N. Taylor S Iowa Mount Ayr, IA 50854 302 NE 14th St. 641-464-3911 Leon, IA 50144 www.chcsi.org Mary Gregg, ARNP 641-446-2383 Mount Ayr Medical Clinic 504 N. Cleveland Children and Families of Iowa (CFI) Mount Ayr, IA 50854 115 W. McLane St. 641-464-4470 Osceola, IA 50213 www.cfiowa.org 641-342-3444 *All ages
43 Bruce Ricker, DO Public Health and Home Care Services Mount Ayr Medical Clinic Ringgold County Public Health 504 N. Cleveland 119 S. Fillmore St. Mount Ayr, IA 50854 Mount Ayr, IA 50854 641-464-4470 www.rcph.net 641-464-0691 Ron Scharer, PA Mount Ayr Medical Clinic Seniors 504 N. Cleveland Joe Routh Mount Ayr, IA 50854 Clearview Nursing Home 641-464-4470 406 W. Washington Mount Ayr, IA 50854 Raydeen Derscheid, ARNP 641-464-2240 Crain Medical Clinic 207 N. Taylor S Bob Hinz Mount Ayr, IA 50854 Mt. Ayr Health Care Center 641-464-3911 1500 E. South Street Mount Ayr, IA 50854 Dane Johnson DO 641-464-3204 Mount Ayr Medical Clinic 504 N. Cleveland Hogue, Janet Mount Ayr, IA 50854 Mt Ayr Senior Center 6414644433 30604 Pvt 105th Dr Hatfield MO 64458 Jerald Phipps, D. O. Mount Ayr Medical Clinic Special Needs Assistance 504 N. Cleveland Southern Iowa Resources for Families Mount Ayr, IA 50854 (SIRF) 641-464-4470 109 N. Elm St. Creston, IA 50801 Mike Magers, DO 641-782-4170 Mount Ayr Medical Clinic 504 N. Cleveland Specialized Support Services Mount Ayr, IA 50854 119 N. Elm St. 641-464-4470 Creston, IA 50801 641-782-4119 Shehada Homedan MD Southern Iowa Orthopedic Svc Innovative Industries 504 N. Cleveland 215 N. Walnut St. Mount Ayr, IA 50854 Creston, IA 50801 641-464-4409 641-782-8495
Podiatrist Iowa Focus Jill Frerich, DPM 105 W. Adams St., Suite B 12499 University Avenue # 210 Creston, IA 50801 Clive, IA 50263 641-782-4478 515-440-2676
44 Child Health Specialty Clinics Community Health Centers Of Southern 860 Wyoming Ave. Iowa Creston, IA 50801 302 NE 14th Street 641-782-9500 Leon, IA 50144 641-446-2383 Iowa COMPASS www.iowacompass.org Aging Advocates 800-779-2001 100 E. Euclid, Ste. 113 Des Moines, IA 50310 Iowa Protection and Advocacy 515-244-3070 www.ipna.org 800-779-2502 Cedar Valley Mobility 8832 Swanson Blvd. Ringgold County Supportive Services Des Moines, IA 50310 507 S. Henderson St. 877-529-8734 Mount Ayr, IA 50854 641-464-2067 Office Aides Corp Substance Abuse Treatment and 105 N Pierce St Prevention Mount Ayr, IA 50854 Action Now 6414640776 1003 Cottonwood Creston, IA 50801 Neighborhood Center 641-782-8457 202 N. Taylor Mount Ayr, IA 50854 Support 641-464-2401 Geist, Jodie Mt Ayr Community Schools Polk Villa 305 W Kneedler HOME ADDRESS 202 S. Polk Mount Ayr, IA 50854 Mount Ayr, IA 50854 641-782-8585 Jody Martin USDA Rural Devolopment (Grant Program) Ronnie Leonard 909 E. 2Nd Avenue Suite C Circle Of Life Rehabilitation Services Indianola, IA 50125 ??? W. Madison 515-961-7473 Mount Ayr, IA 50854 641-344-8568 Kathy Johnston Kellerton Food Pantry 1 Connections Area Agency On Aging 00 W. 6Th Avenue 300 Broadway, Suite 240 Kellerton, IA 50133 Council Bluffs IA 51503 641-783-2583 712-328-2540
Decatur County Community Services Hammer Medical Supply 201 NE Idaho Street 609 W. Taylor Leon, IA 50144 Creston, IA 50801 641-446-7178 641-782-7995
45 Apria Healthcare 701 W. Townline Creston, IA 50801 1-800-813-3351
Transportation Southern Iowa Trolley 215 E. Montgomery Creston IA 50801: 641-782-6571
Volunteer Services Volunteer Center of Southern Iowa 1 University Place Lamoni, IA 50140 [email protected] 641-784-5401
46 General Online Healthcare Resources
Doctors and Dentists--General AMA Physician Select: Online Doctor Finder (American Medical Association) DocFinder (Administrators in Medicine) Find a Dentist (Academy of General Dentistry) Find a Dentist: ADA Member Directory (American Dental Association) Physician Compare (Centers for Medicare & Medicaid Services)
Hospitals and Clinics--General Find a Health Center (Health Resources and Services Administration) Find a Provider: TRICARE Provider Directories (TRICARE Management Activity) Hospital Quality Compare (Centers for Medicare & Medicaid Services)
Doctors and Dentists--Specialists ACOG's Physician Directory (American College of Obstetricians and Gynecologists) ACR: Geographic Membership Directory (American College of Rheumatology) American College of Surgeons Membership Directory (American College of Surgeons) American Osteopathic Association D.O. Database (American Osteopathic Association) ASGE: Find a Doctor (American Society for Gastrointestinal Endoscopy) Cancer Genetics Services Directory (National Cancer Institute) Child and Adolescent Psychiatrist Finder (American Academy of Child and Adolescent Psychiatry) Dystonia: Find a Health Care Professional (Dystonia Medical Research Foundation) Expert Locator: Immunologists (Jeffrey Modell Foundation) Find a Dermatologic Surgeon (American Society for Dermatologic Surgery) Find a Dermatologist (American Academy of Dermatology) Find a Gastroenterologist (American College of Gastroenterology) Find a Gynecologic Oncologist (Society of Gynecologic Oncologists) Find a Hand Surgeon (American Society for Surgery of the Hand) Find a Hematologist (American Society of Hematology) Find a Neurologist (American Academy of Neurology) Find a Pediatric Dentist (American Academy of Pediatric Dentistry) Find a Pediatrician or Pediatric Specialist (American Academy of Pediatrics) Find a Periodontist (American Academy of Periodontology) Find a Physical Medicine & Rehabilitation Physician (American Academy of Physical Medicine and Rehabilitation) Find a Plastic Surgeon (American Society of Plastic Surgeons) Find a Podiatrist (American Podiatric Medical Association) Find a Thyroid Specialist (American Thyroid Association) Find a Urologist (American Urological Association) Find an ACFAS Physician (American College of Foot and Ankle Surgeons) Find an Allergist/Immunologist: Search (American Academy of Allergy, Asthma, and Immunology) Find an Endocrinologist (Hormone Health Network) Find an Eye M.D. (American Academy of Ophthalmology) Find an Interventional Radiologist (Society of Interventional Radiology) Find an Oncologist (American Society of Clinical Oncology) Find an Oral and Maxillofacial Surgeon (American Association of Oral and Maxillofacial Surgeons) Find an Orthopaedic Foot and Ankle MD (American Orthopaedic Foot and Ankle Society) Find an Otolaryngologist (ENT) (American Academy of Otolaryngology--Head and Neck Surgery) Finding an Eye Care Professional (National Eye Institute) GI Locator Service (American Gastroenterological Association)
Other Healthcare Providers AMTA's Find a Massage Therapist (American Massage Therapy Association) Cancer Genetics Services Directory (National Cancer Institute) Find a Diabetes Educator (American Association of Diabetes Educators) Find a Genetic Counselor (National Society of Genetic Counselors) Find a Midwife (American College of Nurse-Midwives) Find a Nurse Practitioner (American Academy of Nurse Practitioners) Find a Physical Therapist (American Physical Therapy Association) Find a Professional: Online Directory of Audiology and Speech-Language Pathology Programs (American Speech-Language-Hearing Association) Find a Registered Dietitian (Academy of Nutrition and Dietetics) Find a Therapist (Anxiety Disorders Association of America) Find an Audiologist (American Academy of Audiology) Manual Lymphatic Drainage Therapists (National Lymphedema Network) National Register of Health Service Providers in Psychology (National Register of Health Service Providers in Psychology) NCCAOM: Find Nationally Certified Practitioners (National Certification Commission for Acupuncture and Oriental Medicine) Search for an Emergency Contraception Provider in the United States (Princeton University, Office of Population Research)
47 Hospitals and Clinics--Specialized Accredited Birth Centers (Commission for the Accreditation of Birth Centers) Alzheimer's Disease Research Centers (National Institute on Aging) Cystic Fibrosis Foundation: Find a Chapter (Cystic Fibrosis Foundation) Cystic Fibrosis Foundation: Find an Accredited Care Center (Cystic Fibrosis Foundation) Dialysis Facility Compare (Centers for Medicare & Medicaid Services) FDA Certified Mammography Facilities (Food and Drug Administration) Find a Free Clinic (National Association of Free Clinics) Find an Indian Health Service Facility (Indian Health Service) Find Treatment Centers (American Cancer Society) Genetics Clinic Directory Search (University of Washington) Locate a Sleep Center in the United States by Zip Code (American Academy of Sleep Medicine) MDA ALS Centers (Muscular Dystrophy Association) Mental Health Services Locator (Substance Abuse and Mental Health Services Administration) NCI Designated Cancer Centers (National Cancer Institute) Neurofibromatosis Specialists (Children's Tumor Foundation) Post-Polio Directory 2011: Post-Polio Clinics, Health Professionals, Support Groups (Post-Polio Health International including International Ventilator Users Network) Spina Bifida Clinic Directory (Spina Bifida Association of America) Substance Abuse Treatment Facility Locator (Substance Abuse and Mental Health Services Administration) Transplant Center Search Form (BMT InfoNet) U.S. NMDP Transplant Centers (National Marrow Donor Program) VA Health Care Facilities Locator & Directory (Veterans Health Administration) Where to Donate Blood (AABB) Where to Donate Cord Blood (National Marrow Donor Program) Other Healthcare Facilities and Services Alzheimer's Disease Resource Locator (Fisher Center for Alzheimer's Research Foundation) American College of Radiology Accredited Facility Search (American College of Radiology) APA District Branch / State Association Directory (American Psychiatric Association) Directory of Organizations (Deafness and Communication Disorders) (National Institute on Deafness and Other Communication Disorders) Dog Guide Schools in the United States (American Foundation for the Blind) Eldercare Locator (Dept. of Health and Human Services) Find a Hospice or Palliative Care Program (National Hospice and Palliative Care Organization) Find Services (for People with Vision Loss) (American Foundation for the Blind) Find Urgent Care Centers by State (Urgent Care Association of America) Genetic Testing Laboratory Directory (University of Washington) Home Health Compare (Centers for Medicare & Medicaid Services) Medicare: Helpful Contacts (Centers for Medicare & Medicaid Services) Muscular Dystrophy Association Clinics and Services (Muscular Dystrophy Association) National Foster Care and Adoption Directory Search (Children's Bureau) Nursing Home Compare (Centers for Medicare & Medicaid Services) Organizations That Offer Support Services (National Cancer Institute) Poison Control Centers (American Association of Poison Control Centers) Resources and Information for Parents about Braille (American Foundation for the Blind) State-Based Physical Activity Program Directory (Centers for Disease Control and Prevention) TSA Chapters in the USA (Tourette Syndrome Association) Violence against Women: Resources by State (Dept. of Health and Human Services, Office on Women's Health) Where to Find Hair Loss Accessories and Breast Cancer Products (American Cancer Society) SOURCE: MedlinePlus provides links to directories to help you find libraries, health professionals, services and facilities. NLM does not endorse or recommend the organizations that produce these directories, nor the individuals or organizations that are included in the directories.
48 V. Detail Exhibits
[VVV Research & Development INC]
49 Patient Origin & Access
[VVV Research & Development INC]
50 51 52 53 Town Hall Attendees Notes & Feedback
[VVV Research & Development INC]
54 Ringgold County - CHNA Town Hall Attendees - July 18, 2013 # Name Company/Agency St. Address City St Zip 1 BRABY JANICE Board RCH 2434 125TH AVENUE MALOY IA 50836 2 CARLSON, JIM HOSPITAL MARKETING CONS 504 North Cleveland Street MOUNT AYR IA 50854 3 FLETCHALL, BECKY Public Health Dept. 1869 240TH AVE MOUNT AYR IA 50854 4 GEIST, JODIE Mt Ayr Community Schools 305 W KNEEDLER MOUNT AYR IA 50854 5 HARTMAN, LINDA Community member 1000 W COLUMBUS MOUNT AYR IA 50854 6 HAVER, LORRAINE Retired RCH 503 N HAYES MOUNT AYR IA 50854 7 HOGUE, JANET Mt Ayr Senior Center 30604 PVT 105TH DR HATFIELD MO 64458 8 HUTTON, BARBARA Community member 1951 260TH ST MOUNT AYR IA 50854 5 HYMBAUGH, MITZI ADMIN RCH 504 North Cleveland Street MOUNT AYR IA 50854 6 HYNEK, ANGELA KSOI Radio 3228 130TH ST ELLSTON IA 50074 7 JACKSON, CAMILLE Community member 2125 CO HWY P68 KELLERTON IA 50134 8 JACKSON, RICHARD Retired RCH Board / Farmer 2124 CO HWY P68 KELLERTON IA 50133 9 KLEJCH, CRAIG Small business owner 1939 COUNTY HIGHWAY P33 DIAGONAL IA 50845 10 KLEJCH, DORIS Small business owner 601 W. MADISON MOUNT AYR IA 50855 11 KLEJCH, NORMAN Small business owner 600 W. MADISON MOUNT AYR IA 50854 12 MCDONNELL, RANDALL & RUTH Retired - Small business owner 305 N HAYES STREET MOUNT AYR IA 50854 13 MCDONNELL, ROBIN Public Health Dept. 200 EAST JEFFERSON ST MOUNT AYR IA 50854 14 PERRY, MARGE Community member MOUNT AYR IA 50854 15 ROBERTS, TERESA CFO RCH 504 North Cleveland Street MOUNT AYR IA 50854 16 SCHUSTER, KATHY CNO RCH 504 North Cleveland Street MOUNT AYR IA 50854 17 SICKELS, VICKI RCH Board, Public Health Dept. 807 W COLUMBUS MOUNT AYR IA 50854 18 SMITH, RENDA HCI Care Services 100 S GARFIELD MOUNT AYR IA 50854 19 SWANK, MALINDA DIETARY DIR RCH 504 North Cleveland Street MOUNT AYR IA 50854 20 WINKLER, GORDON CEO RCH 504 North Cleveland Street MOUNT AYR IA 50854 21 WINKLER, LINDA PT RCH 504 North Cleveland Street MOUNT AYR IA 50854
55 Ringgold County IA on behalf of RCH Town Hall Community Health Needs Priorities N = 25 # HC Topics cited to either change or improve Votes % Accum Total Town Hall Votes 91 100%
Lack of Visiting Physicians i.e. Oncology, 1 Geriatric, Pediatric, Neurology. 14 15.4% 15.4% Aging of Ringgold County Medical Staff. 2 Surgeon to retire soon. 12 13.2% 28.6% 3 Further County Economic development 11 12.1% 40.7%
4 Provide local Dentistry services 8 8.8% 49.5% Poor HC Insurance coverage (High deductible 5 resulting in hospital bad debt) 8 8.8% 58.2%
6 Lack of personal responsibility for health care 7 7.7% 65.9%
7 Develop Senior Care / Elderly support 6 6.6% 72.5%
County wide technology backbone to support 8 healthcare 5 5.5% 78.0% 9 Provide local optical services (Eye doctor) 4 4.4% 82.4%
Other items receiving votes: Young mother support, Diabetes, Expand hours of service Note: to support workers, nutritional education age < 21, awareness of HC services, abuse and children in poverty.
RinggoldCoVotingResults_v1 56 Ringgold County Hospital, Mt Ayr, Iowa Town Hall Notes July 18, 2013 5:30 - 7 p.m.
In Attendance – Introductions by Gordon Winkler, CEO Ringgold County Hospital and Becky Fletchall, Public Health Administrator.
In Attendance total 25:
Providers Nurses Physicians Social workers Parents Primary care Caregivers Farmers Small Business Owners Home Care/Hospice Schools
REVIEW OF TABS:
Food system assessment: 1. What FOOD system issues have the most ‘significant impact on health’ of Ringgold County residents? Higher food costs for healthier foods. Consuming the bad foods with poor food choices. Marketing.
2. To what extent does food insecurity impact the health of Ringgold County residents, especially children and seniors? It is happening more often than one would think –once a week or possibly daily. Sending 30 backpacks home with food each week from school. May feed kids before selves. Eat better than the kids even. Elderly may have to decide between buying food, and buying medicine due to fixed income.
3. What are the primary places in which Ringgold County residents purchase food? Give order. Grocery Store (CGI, Hy-Vee), Wal-Mart, Full Service Restaurant, Convenience Store
MY NOTES: WHITE CARD
Tab 1 – Demographic Trends Limited speaking other languages.
Tab 2 – Economic/Business Trends Stable unemployment numbers.
Tab 3 – Education Profile
57 Elementary school free lunch is 52% per school rep.
Tab 4 – Maternal and Infant Population
Tab 5 – Hospitalization / Providers
Tab 6 - Behavior Health Profiles County tax health dollars.
Tab 7 – Risk Indicators & Factors
Tab 8 – Uninsured
Tab 9 – Mortality Profile
Tab 10 – Preventative Quality Measures
COMMUNITY PERSPECTIVE QUESTIONS: Strengths: 1. Hospital with access to providers, nursing and EMS 2. Public health initiatives with tobacco coalition, wellness, healthy lifestyles, immunizations, walking trails, bicycling. 3. Quality of life 4. Health screenings at hospital, public health, schools - proactive 5. Hospice care 6. Scope of healthcare delivery 7. Environment – air, water 8. Gardens 9. Wellness events in community by hospital, county – coordinated; like health fair, walk to school, etc. 10.Low smoking rate 11.Hospital and school proactive on healthier foods
Needs Improvement:
News / Trends
58 Community Health Needs Assessment Ringgold County, IA Strengths (Color cards) N=25 Today: What are the strengths of our community that CODE1 CODE2 contribute to health ? ACC OTHR Caregivers education, availability, delivery DIAL Dialysis unit DOCS Doctors DOCS Dr Ricker DOCS Practitioners DOCS Practitioners DOH Medical care and public health DOH Public health initiatives for kids & adults DOH Ringgold County public health services FAC Hospital FAC Hospital FAC New hospital FIT Exercise FIT REC Healthy lifestyles (biking walking) FIT REC Weight program, physical fitness H2O Rural water system NH Nursing homes OTHR Community pulls together OTHR Community support for families OTHR Environment OTHR Family time OTHR Food lines OTHR Good school support OTHR Healthier concession offerings OTHR Healthy environment OTHR Personalized medical care OTHR Quality of life OTHR RCH, PHN, HCI dedicated to healthcare OTHR School initiatives OTHR School lunch OTHR SNUR School screenings and health teaching OTHR School system OTHR Schools OTHR Support in community OTHR Welcoming hospital people aren't afraid of PREV Health screenings REC Nature trails REC Outdoor activities
RinggoldTownHall_Cards_STRENGTHS 59 Community Health Needs Assessment Ringgold County, IA Weakness (White cards) N=25 Today: What are the weaknesses of our community CODE1 CODE2 CODE3 that contribute to health ? ACC Access to healthcare Increase health access, increase hours of mammograms ACC CANC PREV offered ACC INSU More free access for uninsured ACC More health services for working population BH Mental health BH Mental Health BH Mental Health BH Mental health services CANC PREV Cancer screening and education CANC DIAB MAMO Colon cancer screenings, mammograms, diabetes screenings COMM OTHR Knowledge of services DENT Dentist DENT Dentist who will take medicaid DENT OPTH ONC Dentist, optometrist, oncologist ECON Economy - unisured, less jobs Get people off welfare and into jobs - develop pride and ECON caring about their childrens' health Physical activity (could affect diabetes, cancer, heart disease, FIT mental health) FIT OTHR Sidewalks & walking trails for safer exercise FOOT Podiatry FP Family practice docs HOSP COMM OTHR More education on hospice services INSU Better insurance on vision and dental for employees INSU Uninsured IP OTHR Use hospital for more acute care OBES Obesity OPTH ONC Specialists - Ophthalmologist, hematologist OTHR Age of medical staff OTHR Average age of physicians Citizen involvement and responsibility toward own health OTHR Condom machine in hospital & doctors office bathrooms to OTHR show it is a healthy behavior OTHR Easily accessible education, easy to understand OTHR Expand food bank OTHR Farmers market OTHR Healthy food options at school, work, play OTHR Improved school lunches
60 Community Health Needs Assessment Ringgold County, IA Weakness (White cards) N=25 Today: What are the weaknesses of our community CODE1 CODE2 CODE3 that contribute to health ? OTHR More food for families OTHR More individuals taking responsibility for their health OTHR RCH financial health OTHR Technology training OTHR Women's shelter PEDS Pediatrician in area PNEO OB - early prenatal care PNEO Prenatal care 1st trimester PNEO Prenatal care first three months POV Children in poverty POV Decrease children in poverty SMOK Smoking SPEC Need specialty physcians SS AGE Inadequate social support-elderly SS Social Support TPRG Decrease single, teen moms
61 KEY - CHNA Open End Comments Code HC Themes CODE PhysicianSpecialty ACC Access to Care Primary Care: AGE Aging (Senior Care / Assistance) FP Family Practice AIR Air Quality IM Internal Medicine ALC Alcohol OBG Obstetrics/Gynecology ALCU Underage Drinking PEDS Pediatrics ALT Alternative Medicine ALZ Alzheimers Medicine Specialists: AMB Ambulance Service ALL Allergy/Immunology AUD Auditory CARD Cardiology BACK Back / Spine DERM Dermatology BD Blood Drive ENDO Endocrinology ** BH Mental Health Services GAS Gastroenterology BIRT Low Birth Weight ONC Oncology/RADO BRST Breastfeeding IFD Infectious Diseases CANC Cancer NEP Nephrology ** CHEM Chemotherapy NEU Neurology CHIR Chiropractor PSY Psychiatry CHRON Chronic Diseases PUL Pulmonary COMM Communication RHE Rheumatology DENT Dentists DIAB Diabetes Surgery Specialists: DIAL Dialysis SUR General Surgery DOCS Physicians NEUS Neurosurgery DOH Public Health Department OPTH Ophthalmology DRUG Substance Abuse (Drugs / Rx) ORTH Orthopedics ECON Economic Development ENT Otolaryngology (ENT) EMRM Emergency Room PLAS Plastic/Reconstructive EMS EMS VAST Thoracic/Cardiovascular/Vascular EYE Eye Doctor / Optometrist URL Urology FAC Facility FAM Family Planning Services Hospital Based: FINA Financial Aid AES Anesthesia/Pain FIT Fitness / Exercise EMER Emergency FLU Pneumonia / Flu RAD Radiology FOOT Podiatrist PATA Pathology GEN General Practioner NEO Neonatal/Perinatal * ABP 06 GOV Government PHY Physical Medicine/Rehab H2O Water Quality HEM Hemotologist Ad'l Codes: HH Home Health PRIM Primary Care HIV HIV/AIDS PROS Prostate HOSP Hospice REC Recreation HRT Heart Care RESP Respiratory Disease INSU Uninsured/Underinsured SMOK Smoking IP Inpatient Services SNUR School Nurse KID Child Care SPEC Specialist Physician care LEAD Lead Exposure SS Social Services MAMO Mammogram STD Sexually Transmitted Diseases NEG Neglect STFF Medical Staff NH Nursing Home STRK Stroke NUTR Nutrition SUIC Suicide OBES Obesity THY Thyroid OP Outpatient Services TOB Tobacco Use ORAL Oral Surgery TPRG Teen Pregnancy OTHR Other TRAN Transportation OZON Ozone TRAU Trauma PAIN Pain Management VACC Vaccinations PHAR Pharmacy VIO Abuse / Violence PNEO Prenatal WAIT Wait Times POV Poverty WELL Wellness Education PREV Preventative Healthcare WIC WIC Progam
CHNACodes 62 Public Notice & Invitation
[VVV Research & Development INC]
63 Ringgold County Hospital to Assess Community Health Needs
Date: May 22, 2013
For Immediate Release
Over the next three months Ringgold County Hospital and Ringgold County Public Health Office will be conducting a community health needs assessment. Vince Vandehaar MBA from VVV Research & Development INC, an independent health research and consulting firm from Olathe KS, has been retained to conduct and complete this assessment.
“We hope that the community will take advantage of this opportunity to provide input into the future of healthcare and services we offer”, comments Gordon Winkler, CEO.
All assessment information obtained can assist local health care and related service providers, community organizations, policymakers, and residents in making informed decisions on improving access and minimizing barriers to care, creating efficiencies in the delivery of care, and participating in the development of local health care improvement strategies.
On Thursday evening July 18th (from 5:30-7pm) a CHNA Ringgold County Town Hall meeting will be held at the REC Meeting Room to review published health information and discuss current community health needs. That night a light dinner will be provided, with all Ringgold County residents invited to attend. For more information about this assessment and the upcoming town hall meeting, contact Mitzi Hymbaugh at 641-464- 3226, Extension 235.
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MOUNT AYR — Over the next three months Ringgold County Hospital and Ringgold County Public Health will be conducting a community health needs assessment. Vince Vandehaar, MBA from VVV Research & Development INC, an independent health research and consulting firm of Olathe, Kan., has been retained to conduct and complete this assessment.
“We hope that the community will take advantage of this opportunity to provide input into the future of health care and services we offer,” said Gordon Winkler, CEO.
All assessment information obtained can assist local health care and related service providers, community organizations, policymakers and residents in making informed decisions on improving access and minimizing barriers to care, creating efficiencies in the delivery of care and participating in the development of local health care improvement strategies.
A CHNA Ringgold County town hall meeting will be held 5:30 to 7 p.m. July 18 at the REC meeting room to review published health information and discuss current community health needs. That night a light dinner will be provided with all Ringgold County residents invited to attend.
For more information about this assessment and the upcoming town hall meeting, contact Mitzi Hymbaugh at 641-464-3226, ext. 235.
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*Password: Forgot Your Password? Login 6765 66 CHNA Report contact :
Vince Vandehaar, MBA VVV Marketing & Development INC. Adjunct Professor / Professional Healthcare Marketing & Strategic Planning Consulting Services
601 N Mahaffie, Olathe, KS 66061 (913) 302-7264 (C) [email protected]
LinkedIn: vandehaar Website: VandehaarMarketing.com
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