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ETMCRHS Community Health Needs Assessment
Executive Summary
As a part of the mission of care of the East Texas Medical Center Regional Healthcare System,
each ETMC hospital conducted a Community Health Needs Assessment (CHNA) in 2012-13,
with the goal of advancing community benefits planning and better meeting the needs of
specific populations.
Definition of the Community Served
ETMC Tyler is an inpatient tertiary hospital serving the needs East Texas, beginning with
Smith County (population 209,714). The flagship facility and the ETMC affiliate hospitals
serve a combined population of 826,319 East Texans, many living in highly rural areas.
Approximately 38% of the patients admitted to ETMC Tyler come from Smith County, with
the remainder primarily from contiguous and ETMC affiliate counties. This contrasts with the
ETMC affiliate hospitals, which draw the great majority of inpatients from their home county.
Key demographic statistics include:
• Approximately 16% of ETMC service area residents are age 65 and older, significantly
higher than the state average of 11%.
• Median household income for the ETMC service area was $37,867 in 2010, below the
Texas average of $49,646.
• The unemployment rate in the ETMC service area in 2011 was 8.4%, higher than the
state average of 7.9%. A total of 27% of residents are uninsured, and 17% live in
poverty.
The CHNA: Process and Methods
Each ETMC hospital undertakes a major Community Health Needs Assessment every three
years. The most recent process began in early 2012, as representatives from the home
communities were identified for personal interviews based on specific roles/expertise, such
as family health, mental health, seniors’ services and outreach to special populations. While
some of these agencies were county specific, others were selected based on their East Texas
footprint, thereby providing a regional perspective to health-related needs in the area served
by the ETMC system. The interview task force included ETMC administrators and members
of the ETMC Regional Healthcare System’s CHNA team.
The CHNA interviews involved representatives from public health, education, economic
development, faith-based organizations, human service agencies and law enforcement. For
example, the following organizations were represented in the interviews held at ETMC Tyler
on July 24, 25 and 26, 2012:
• Bethesda Health Clinic
● East Texas Crisis Center
● East Texas Medical Center EMS
• East Texas Food Bank
• Literacy Council
● Tyler Area Chamber of Commerce
• PATH
● Tyler Police Department
• Hispanic Business Alliance
● ETCOG – Agency on Aging
● NE Texas Public Health District
• AgriLife (extension service)
• Texas Dept. of State Health Services
Selection of Interviewees
The interview planning process involved consideration of persons/organizations that could
best represent the ETMC communities, including minority populations and those segments
that are medically-underserved. The variety of organizations interviewed was instrumental
to the depth of information gathered and the success of the project.
Significant Health Needs Identified
Each person interviewed was asked a series of standard questions, with further discussion on
areas and populations specific to their community role and perspective. From their
responses – as well as substantial data from state and local resources – the following health
needs were identified:
Areas of greatest concern:
• Lack of mental health resources; prescription and illegal drug abuse, problems with
caring for these patients in the emergency department setting
• Aging populations across East Texas, and the resulting increased healthcare needs
• Seniors’ access to healthcare in rural areas
• Family and lifestyle issues: shorter life expectancy in East Texas due to a perfect
storm of smoking, poverty, low education, lower rates of exercise, poor nutrition and
lack of healthcare access
• Lack of life skills among teens/young adults
Specific areas of healthcare concern specific for Tyler/Smith County include:
• Healthcare safety net: not enough providers, lack of insurance, no check-ups
• Patient navigation: navigating the whole caregiver process
• Culture of care: moving from current wellness on sick care to wellness care
• ED issues: inappropriate use of the ED and need for discharge planning
• Care for the elderly: including falls prevention
• Other areas of concern: Hepatitis C, dental care, specialty care for the working poor,
tuberculosis, STDs (now less access to treatment), clients with bed bugs and lice
A study of Smith County health data identified the following areas of concern, based on
rankings worse than Texas averages: prenatal care in the first trimester; communicable
diseases (gonorrhea, Chlamydia and varicella); and mortality from all cancer, chronic lower
respiratory disease, accidents/MVAs, Alzheimer’s disease and infant death.
In addition to healthcare needs, the CHNA process revealed areas of concern in East Texas
regarding other community issues. These included: family violence, youth issues, nutrition
and hunger, illiteracy, economics/poverty, homelessness and chronic agency clients.
Addressing Significant Health Needs
The CHNA process employed by ETMC hospitals is of great importance in identifying each
communities’ need to better understand the resources available through the hospital, its
clinics and related services. This includes greater collaboration with the agencies and
organizations that participated in the interview process, as well as others. In 2013, the ETMC
hospitals will begin a series of dialogue meetings that continue the CHNA process and
provide organizations with a platform for distributing information, aligning goals and
ultimately better meeting the health and community needs identified. In addition, the
hospitals are acting on the information gleaned through the CHNA process by evaluating
programs and piloting new projects as part of ongoing community benefits planning.
ETMC Tyler - Community Health Needs Assessment 2012-13
INTERVIEW GUIDE
1. Background information about your organization, your roles within the community
and your connection (if any) with ETMC.
2. What do you think are the greatest areas of healthcare need or concern in Smith
County? In surrounding counties? What community needs has your own
organization identified?
• Healthcare needs
● How identified
• Greatest priority
Availability of other needs assessments
3. What do you think are the biggest obstacles to obtaining care within Smith
County? Within surrounding counties?
4. How would you rate the availability/accessibility of hospital services in Smith
County? In surrounding counties? What additional services to you think are
needed?
5. How would you rate the availability/accessibility of primary care physician services
in Smith County? In surrounding counties? Are additional primary care physicians
needed?
6. How would you rate the availability/accessibility of specialist physician services in
Smith County and the region? Are additional specialists needed?
7. What are the greatest needs in terms of healthcare and access to healthcare
among:
• Seniors population?
• Minority populations?
• The poor and working poor?
8. What do you think are the greatest lifestyle concerns among residents of the East
Texas service area? Examples: obesity, smoking, diabetes, teen pregnancy, etc.
9. Aside from healthcare-specific needs, what other challenges currently face your
community and county? Examples: lack of public transportation, school system
issues, growing poverty rate, illiteracy, lack of public parks and recreation, etc.
10. What is your perception of ETMC’s current efforts to address community health
care needs?
11. How can/should ETMC work with the community to help address needs identified?
ETMC Tyler Community Health Needs Assessment
Data Analysis Summary
Community Profile
Smith County alone composes the ETMC Central Region. Counties included in the other
regions served by ETMC facilities are listed below:
•
•
•
•
North Region – Camp, Franklin, Hopkins, Morris, Rains, Red River, Titus, Upshur,
Woods
South Region – Anderson, Cherokee, Houston, Trinity
East Region – Panola, Rusk, Shelby
West Region – Freestone, Henderson, Van Zandt
Approximately 14% of the 209,714 Smith County residents are age 65 and older, higher
than the state average of 11%.
Per capita household income for Smith County was $25,374 in 2010, close to the Texas
average of $24,870 and higher than the North, South, East and West regions.
The unemployment rate in Smith County in 2011 was 7.8%, again comparable to the state
average of 7.9% and significantly lower than the average reported by surrounding regions.
Almost 25% of Smith County residents are uninsured and 15% live in poverty. Counties that
compose the ETMC South Region are the poorest in the broader service area.
Smith County
Community Profile
Smith/
Indicator
Smith
County
Texas
Texas Ratio
North
Region
Region/Texas Ratio
South
Region
East Region
West
Region
Demographic Indicators
% Increase 2012-2017
7.8%
10.0%
0.78
5.1%
3.4%
3.8%
4.6%
% 65 and Older
14.4%
11.2%
1.29
14.5%
15.4%
14.8%
17.5%
% Hispanic
18.4%
38.1%
0.48
15.8%
16.3%
14.7%
11.2%
% African American
17.5%
12.2%
1.43
8.7%
18.1%
17.3%
5.7%
Socioeconomic Indicators
% Poverty
Per Capita Income
% Unemployment
% High School Education
15.0%
16.8%
0.89
1.09
1.74
0.99
1.09
$25,374
$24,870
1.02
0.83
0.72
0.88
0.87
7.8%
7.9%
0.99
84.2%
80.0%
1.05
1.03
NA
1.16
NA
0.91
NA
0.99
NA
English Not Spoken at Home
15.3%
34.2%
0.45
0.37
0.35
0.33
0.26
% Medicaid
12.8%
13.9%
0.92
1.07
1.06
0.99
0.96
% Uninsured <65
25.1%
26.3%
0.95
1.04
1.11
0.98
1.03
Better than Average
About Average
Poorer than Average
Maternal, Infant and Child Health
There were 2,992 babies delivered by Smith County mothers in 2010.
The rate of Smith County mothers who secure prenatal care in the first trimester declined
over the last six years and falls well below the state average and the average reported in the
surrounding ETMC regions.
Although not as high as the surrounding regions, the rate of women in Smith County who
report smoking during pregnancy is still almost double the state average.
Smith County reports lower rates of teen pregnancy, low birth weight (LBW) babies and
confirmed cases of child abuse/neglect than the Texas average.
Smith County
Maternal, Infant, Child Health
Smith County
2010
Indicator
Timely Prenatal Care
Smoking During Pregnancy
Smith/
Region/Texas Ratio
6-Year
Texas
Texas
North
South
East
West
Trend
2010
Texas Ratio
Region
Region
Region
Region
39.0%
56.9%
0.69
1.02
0.93
1.02
0.95
8.8%
4.9%
1.80
3.10
3.27
2.96
3.71
Teen Pregnancy/1,000 Teens
17.8
21.4
0.83
0.87
1.13
0.92
0.73
LBW
7.5%
8.5%
0.88
0.95
1.00
0.99
0.78
9.1
9.9
0.92
1.12
1.25
1.17
1.45
Child Abuse Neglect/1,000 - 2011
NA
Improved
Better than Average
Eroded
About Average
Neutral
Poorer than Average
Personal Responsibility
Based on the ongoing Behavioral Risk Factor Surveillance Survey (BRFSS), Smith County
residents generally reported rates of behavioral risk factors, use of preventive services and
rates of drug abuse and depression that were about average or better than average for the
state as a whole.
Two exceptions include a higher rate of high blood pressure and a lower rate of women that
obtained a pap smear within the last three years.
Residents of East Texas (Public Health Region 4/5N encompassing the ETMC Service Area,
but excluding Smith County) have significantly higher rates of smoking, exercise less and are
more likely to have high blood pressure and high blood cholesterol levels.
The rate of women age 40 and older in East Texas who did not obtain a mammogram in the
last two years is 1.2 times the state average.
Smith County
Personal Responsibility
Smith
Smith
County
Indicator
Texas
PHR 4/5N PHR 4/5N
2011 w/o
Smith
Texas Ratio
Texas Ratio
Behavioral Risk Factors
Current Smoker
16%
19.2%
0.82
27.1%
1.41
Heavy Drinking
3%
7.0%
0.46
5.4%
0.77
29%
27.2%
1.05
36.5%
1.34
1.04
No Leisure Time Exercise
Overweight/Obese
67%
65.8%
1.01
68.5%
High Blood Pressure
35%
31.3%
1.13
37.8%
1.21
High Cholesterol
45%
41.7%
1.07
46.6%
1.12
0.92
59.4%
0.93
Use of Preventive Services
No Flu Shot (Age 18+)
59%
64.1%
No Mammogram within 2 years (Age
40+) - 2010
22%
30.0%
0.72
36.3%
1.21
No Pap Smear within 3 years - 2010
26%
20.6%
1.24
18.7%
0.91
25%
38.5%
0.64
33.6%
0.87
No Sigmoidoscopy/ Colonoscopy (Age
50+) - 2010
Mental Health
Recent Drug User
5.1%
6.7%
0.77
7.0%
1.05
Major Depression
5.1%
6.6%
0.77
7.0%
1.06
Better than Average
About Average
Poorer than Average
Incidence/Prevalence of Disease
The BRFSS also indicates that Smith County residents have significantly higher rates of
cardiovascular and cerebrovascular disease.
There are an estimated 18,544 adults in Smith County living with diagnosed diabetes.
Another 54,571 adults are estimated to have pre-diabetes.
Smith County
Incidence/Prevalence of Disease
Smith
Indicator
Texas
County
Diagnosed Diabetes, Age 18+
Smith
PHR 4/5N
Texas
w/o Smith
PHR 4/5N
Texas
Ratio
2010
Texas Ratio
8.9%
10.2%
0.87
12.3%
10.9%
7.5%
1.45
13.2%
1.76
Had a Stroke
3.3%
2.7%
1.22
3.5%
1.30
Asthma
7.8%
7.4%
1.05
11.2%
1.51
Cardiovascular Disease
1.21
Better than Average
About Average
Poorer than Average
Injury/Illness
The rate of hospital admissions due to motor vehicles among Smith County residents
exceeds the state average. Significantly higher rates of injury admissions are apparent in the
ETMC Regions.
Smith County residents also have rates of hospital admission for CHF, pneumonia and
urinary tract infections that are 20% to 40% higher than the state average, but lower than
admission rates in the surrounding areas.
Smith County
Injury/Illness
Smith County
2010
Indicator
Smith/
Region/Texas Ratio
6-Year
Texas
Texas
North
South
East
West
Trend
2010
Ratio
Region
Region
Region
Region
Unintentional Falls/100,000
123.0
NA
155.0
0.79
1.21
1.68
1.55
1.69
Motor Vehicle Accidents/100,000
103.0
NA
75.4
1.37
1.08
1.38
1.53
1.27
Potentially Preventable
Hospitalizations/1,000
Congestive Heart Failure
16.5
13.0
1.27
1.36
1.79
1.63
1.88
4.1
2.9
1.41
1.52
1.83
1.83
1.76
Bacterial Pneumonia
3.6
2.5
1.44
1.60
2.00
1.96
2.12
COPD
1.8
1.7
1.06
1.65
2.24
2.12
2.71
UTI
2.3
1.9
1.21
1.42
1.63
1.47
1.47
Improved
Better than Average
Eroded
About Average
Neutral
Poorer than Average
Mortality
Smith County mortality rates for all causes, cardiovascular disease and cancer approximate
the state averages. The rate of deaths due to cerebrovascular disease is significantly below
the Texas average; however, the rate of cancer deaths may be increasing.
Mortality rates in the ETMC South Region appear to be the highest in the area.
Smith County
Age-Adjusted Mortality
Smith County
Smith/
6-Year
2010
Indicator
Trend
Texas
Region/Texas Ratio
Texas
North
South
East
West
Texas Ratio
Region
Region
Region
Region
All Causes
781.1
781.2
1.00
1.11
1.22
1.15
1.18
Cardiovascular Disease/100,000
184.0
186.7
0.99
1.17
1.24
1.18
1.25
Cancer/100,000
179.7
167.6
1.07
0.98
1.27
1.03
1.13
33.2
45.8
0.72
0.91
1.22
1.07
0.99
Cerebrovascular/100,000
Improved
Better than Average
Eroded
About Average
Neutral
Poorer than Average
Availability of Healthcare Services
The ratios of health care providers in Smith County are relatively high, underscoring the role
of Smith County in the provision of health care to residents of the broader service area.
Smith County
Availability of Healthcare Services
Indicator
Primary Care Physicians/100,000
Physician Assistants/100.000
Smith
Smith/
County
Texas
North
South
East
West
Texas Ratio
Region
Region
Region
Region
2011
Texas
Region/Texas Ratio
104.0
69.5
1.50
0.68
0.82
0.58
0.58
25.1
19.5
1.29
0.48
0.73
0.50
0.33
Nurse Practitioners/100,000
36.3
24.3
1.49
0.44
0.59
0.79
0.55
Dentists/100,000
49.3
44.5
1.11
0.54
0.52
0.47
0.48
102.5
80.5
1.27
0.60
0.69
0.52
0.61
Pharmacists/100,000
Better than Average
About Average
Poorer than Average