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2018 Community Health Assessment Report Scott County & Muscatine County, Iowa Rock Island County, Illinois Study Sponsored by: Community Health Care, Inc. Genesis Health System Muscatine County Board of Health Quad City Health Initiative Rock Island County Health Department Scott County Health Department UnityPoint Health – Trinity Funded by: Genesis Health System UnityPoint Health – Trinity Prepared by: Professional Research Consultants, Inc. 11326 P Street Omaha, NE 68137-2316 www.PRCCustomResearch.com FINAL 2017-0858-02 © September 2018 COMMUNITY HEALTH ASSESSMENT Table of Contents Introduction 9 Preface 10 Project Goals 10 Acknowledgments 11 Methodology 13 Qualitative Community Health Assessment Methodology 19 Summary of Findings 20 Significant Health Needs of the Community 20 Summary of Qualitative Community Health Assessment Findings 22 Summary Tables 23 Public Comment & Feedback 44 Community Description 45 Population Characteristics 46 Total Population 46 Urban/Rural Population 48 Age 49 Race & Ethnicity 51 Linguistic Isolation 54 Social Determinants of Health 56 Poverty 56 Education 59 Employment 60 Housing Issues 61 Food Insecurity 67 Social Services 69 Health Literacy 71 Problems Facing Families in the Community 74 Health Disparities 75 Social Determinant Risk & Health 75 Income & Health 76 General Health Status 77 Overall Health Status 78 Mental Health 80 Evaluation of Mental Health Status 81 Depression 82 Stress 84 2 COMMUNITY HEALTH ASSESSMENT Suicide 86 Mental Health Treatment 89 Perceived Ease of Obtaining Mental Health Services 93 Death, Disease, & Chronic Conditions 95 Leading Causes of Hospital Visits 96 Inpatient Hospitalizations 96 Emergency Department Visits 98 Hospital Readmissions 100 Leading Causes of Death 102 Distribution of Deaths by Cause 102 Age-Adjusted Death Rates for Selected Causes 102 Cardiovascular Disease 104 Age-Adjusted Heart Disease & Stroke Deaths 104 Prevalence of Heart Disease & Stroke 107 Cardiovascular Risk Factors 109 Cancer 115 Age-Adjusted Cancer Deaths 115 Cancer Incidence 117 Prevalence of Cancer 119 Cancer Screenings 122 Respiratory Disease 127 Age-Adjusted Respiratory Disease Deaths 128 Prevalence of Respiratory Disease 130 Injury & Violence 134 Unintentional Injury 134 Intentional Injury (Violence) 140 Diabetes 145 Age-Adjusted Diabetes Deaths 145 Prevalence of Diabetes 147 Alzheimer’s Disease 149 Age-Adjusted Alzheimer’s Disease Deaths 149 Kidney Disease 151 Age-Adjusted Kidney Disease Deaths 151 Prevalence of Kidney Disease 152 Infectious Disease 154 Influenza & Pneumonia Vaccination 155 Flu Vaccination 155 Pneumonia Vaccination 156 3 COMMUNITY HEALTH ASSESSMENT HIV 157 HIV Prevalence 158 Sexually Transmitted Diseases 160 Chlamydia & Gonorrhea 160 Births 162 Prenatal Care 163 Lack of Timely Prenatal Care 163 Perceived Ease of Obtaining Prenatal/Postnatal Care 164 Birth Outcomes & Risks 166 Low-Weight Births 166 Infant Mortality 167 Perceptions of Childhood Vaccinations 168 Family Planning 170 Births to Teen Mothers 170 Modifiable Health Risks 172 Nutrition 173 Daily Recommendation of Fruits/Vegetables 174 Access to Fresh Produce 176 Physical Activity 178 Leisure-Time Physical Activity 178 Activity Levels 180 Access to Physical Activity 183 Use of Local Trails for Exercise 184 Weight Status 186 Adult Weight Status 186 Children’s Weight Status 190 Substance Abuse 193 Age-Adjusted Cirrhosis/Liver Disease Deaths 193 Alcohol Use 195 Age-Adjusted Unintentional Drug-Related Deaths 196 Illicit Drug Use 198 Negative Effects of Substance Abuse 199 Perceived Ease of Obtaining Substance Abuse Services 202 Tobacco Use 204 Cigarette Smoking 204 Other Tobacco Use 207 4 COMMUNITY HEALTH ASSESSMENT Access to Health Services 210 Health Insurance Coverage 211 Type of Healthcare Coverage 211 Lack of Health Insurance Coverage 211 Difficulties Accessing Healthcare 213 Difficulties Accessing Services 213 Barriers to Healthcare Access 214 Perceived Ease of Accessing Local Healthcare Services 218 Outmigration for Care 223 Primary Care Services 225 Access to Primary Care 225 Specific Source of Ongoing Care 226 Utilization of Primary Care Services 230 Emergency Room Utilization 232 Oral Health 234 Particular Place Used for Dental Care 234 Dental Insurance 236 Dental Care 238 Perceived Ease of Accessing Local Dental Services 240 Local Resources 243 Number-One Health Concern in the Area 244 Perceptions of Local Healthcare Services 245 Healthcare Resources & Facilities 247 Hospitals & Federally Qualified Health Centers (FQHCs) 247 Health Professional Shortage Areas (HPSAs) 248 Appendices 249 Appendix A: Quad Cities Qualitative Community Health Assessment 250 Introduction 251 Quad Cities Community Themes and Strengths Assessment 253 Community Themes and Strengths Assessment 254 Introduction 254 Purpose 254 Methods 254 Results 255 Themes 255 Acknowledgements 255 Table 1: Community Themes and Strengths Participants 256 Exhibits 257 Exhibit 1: Focus Group Questions and Responses 257 Figure 1: Health Related Phrases 258 5 COMMUNITY HEALTH ASSESSMENT Figure 2: Sex/Gender of Target Population 258 Figure 3: Race/Ethnicity of Participants 259 Figure 4: Race/Ethnicity as Percentage 259 Table 2: Average Age and Number of Participants by Target Focus Group 260 Table 3: What Is Your Favorite Aspect About Living in the Community? 260 Table 4: What Do You See as the Biggest Health Concern in Your Community? 261 Table 5: What Do You Think Could Address Your Health Concerns? 263 Table 6: What Barriers Exist That Might Keep This From Happening? 264 Table 7: What Could Address Those Barriers? 266 Table 8: What Are Some Assets In Your Community That Support Improved Health? 267 Table 9: What Would You Like to See In Our Community In The Next 5-10 Years? 268 Table 10: Is There Anything Else You’d Like To Say About What Could Make Your Community Healthier? 269 Table 11: What Are The Top Three Daily Living Stresses In YOUR Life? 269 Table 12: What Are The Top Three Daily Things That Bring YOU Joy? 271 Exhibit 2: Survey Questions and Responses 274 Figure 5: Zip Code of Residence (n=274) 274 Figure 6: Proportion of Respondents by Gender (n=201) 275 Figure 7: Proportion of Respondents by Age (n=195) 276 Figure 8: Proportion of Respondents by Race/Ethnicity (n=210) 277 Figure 9: Proportion of Respondents by Annual Household Income (n=162) 278 Figure 10: Proportion of Respondents by Number of People in Household (n = 186) 279 Figure 11: Proportion of Respondents by Highest Education Level (n=217) 280 Figure 12: Level of Community Health (n=237) 281 Figure 13. Factors that Contribute to a Healthy Community (n=237) 282 Figure 14: Leading Health Problems (n=237) 283 Figure 15: Leading Safety Problems (n=237) 284 Figure 16: Level of Personal Health (n=237) 285 Figure 17: Number of Days Unable to Work or Perform Daily Activities Due to Illness (n=237) 286 Figure 18: Community Assets (n=237) 287 Figure 19: Method of Payment for Health Care Services (n=237) 288 Figure 20: Ability to Access Health Care Services (n=237) 289 Figure 21: Type of Health Care Services Received Outside of Community (n=237) 289 Figure 22: Reasons for Receiving Health Care Services Outside of Community (n=237) 290 Figure 23: Mental Health Services Needed by Individual or Family Members (n=237) 291 Figure 24: Social Service Benefits Needed by Individual or Family Members (n=237) 292 Figure 25: Ability to Access Services in Community (n=144) 292 Figure 26: Ability to Receive Benefits in Community (n=166) 293 Figure 27: Top Three Daily Things that Bring You Joy (n=237) 294 Figure 28: Top Three Daily Stressors (n=237) 294 Quad Cities Local Public Health System Assessment 296 Local Public Health System Assessment 297 Introduction 297 Purpose 297 Methods 297 Table 13: Essential Public Health Services 298 Results 300 Themes 300 Table 14: Suggested Focus Areas 302 Acknowledgements 302 Table 15: Local Public Health System Assessment Participants 303 6 COMMUNITY HEALTH ASSESSMENT Exhibits 304 Exhibit 3: LPHS - Jelly Bean Diagram 304 Exhibit 4: LPHSA Subcommittee Meeting Agendas 305 Exhibit 5: Essential Service Ratings 307 Table 16: Combined Essential Service Activity Levels 307 Figure 29: Essential Services Activity Level Comparison 307 Table 17: Essential Services Overall Consensus Results - Subcommittee Meeting 308 Exhibit 6: SWOT Analysis Discussion Results 310 Table 18: Essential Services 1 & 2 SWOT Analysis 310 Table 19: Essential Services 3 & 4 SWOT Analysis 311 Table 20: Essential Services 5 & 6 SWOT Analysis 312 Table 21: Essential Services 7 & 8 SWOT Analysis 313 Table 22: Essential Services 9 & 10 SWOT Analysis 314 Quad Cities Forces of Change Assessment 315 Forces of Change Assessment 316 Introduction 316 Purpose 316 Methods 316 Results 318 Table 23: Identified Forces of Change 318 Table 24: Rankings of Forces Categories 326 Table 25: Forces of Change Ranked as a “Top 3” Force 327 Themes 328 Acknowledgements 328 Table 26: Forces of Change Assessment Participants 328 Exhibits 329 Exhibit 7: Forces of Change Meeting Agenda 329 Exhibit 8: Forces of Change Note Sheet 330 Exhibit 9: Forces of Change Follow-Up Survey 331 Appendix B: Muscatine Community Health Assessment 332 Introduction 333 Muscatine Community Themes and Strengths Assessment 335 Community Themes and Strengths Assessment 336 Purpose 336 Method 336 Results 336 Muscatine Local Public Health System Assessment 338 Local Public Health System Assessment 339 Purpose 339 Table 1: Essential Public Health Services 339 Method 339 Results 340 Muscatine Forces of Change Assessment 341 Forces of Change Assessment
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