Community Health

For the purpose of this Community Health Needs Assessment (CHNA), SoutheastHEALTH has defined the “community” as its primary service area, which consists of four counties in Missouri: Cape Girardeau, Bollinger, Scott, and Stoddard. The primary service area is based on the number of inpatient discharges and outpatient visits by patients that reside in each of these four counties. For SoutheastHEALTH, 71% of its patients are from these four counties. This information is provided by the Hospital Industry Data Institute (HIDI) that is founded by the Missouri Hospital Association.

The assessment was conducted under the direction of SoutheastHEALTH’s Marketing, Planning, and Research team.

• In collaboration with the Cape Girardeau County Public Health Center
• With review and oversight by the SoutheastHEALTH Board of Directors and the SoutheastHEALTH Regional Board of Directors

Quantitative Analysis

Epidemiologic and socio-demographic analysis, aimed at identifying areas of heightened relative risk through comparisons of county data with state and national data. Some areas that were researched include:

• Demographics
• Socio-Economic Characteristics
• Physical & Built Environment
• Health Behaviors
• Health Outcomes –Mortality & Morbidity
• Health Care Resources & Providers

Qualitative Assessment

Input from communities and agencies located in the Southeast Hospital service area.

• A survey was administered in multiple settings over a period of several weeks that was available online via JotForm as well as in paper format for circumstances where the online format could not be used
• A total of 292 surveys were completed by residents from the 4 primary counties: Bollinger (26), Cape Girardeau (171), Scott (47)& Stoddard (48)
• Eight focus groups were held in the four counties on various dates and in various locations
  • One focus group each was held in Dexter, Sikeston, and Marble Hill
  • Five focus groups were held in Cape Girardeau County; 1 in Jackson, 3 at the Cape Girardeau Public Health Center, and 1 at SoutheastHEALTH with the Transitions of Care and Chronic Disease Self-Management teams

Priority Setting

Starting point for priority setting: the heightened risks and risk factors, unmet needs for care, access barriers, and other findings that affect the health status of the community, as identified in the qualitative and quantitative studies

Selection of a limited number of priorities for action, in light of criteria such as:

• Severity of the issue, as represented by some or all of the following: highly acute, affects a large number of people, has significant economic and/or opportunity cost, growing or worsening over time
• Availability of known, feasible interventions, with measurable impact, that are likely to achieve results and improve community’s quality of life and health in a reasonable time frame
• Unaddressed or under-addressed issue: no/few organizations or (insufficient) resources focusing on it effectively at present
• SoutheastHEALTH synergies: special expertise, strategic priority, and/or programs in place to serve as building blocks

Implementation Strategy or Action Plan

The top priority health needs for the SoutheastHEALTH service area are:

1. Substance Abuse/Mental Health (drug and alcohol, anxiety, depression, and suicide)
2. Healthcare Affordability (cost, uninsured/underinsured)
3. Healthcare Access (wait times, available providers and services, transportation)
4. Smoking and vaping
5. Obesity (diet and exercise)
6. Chronic diseases and chronic disease management:
   • Cancer
   • Heart Disease
   • Diabetes
   • Stroke

Demographics

The overall direction of demographic shifts anticipated in the next 10 years highlights the need for the development and reinforcement of social supports that will help the population remain economically vital and facilitate safe aging in place.

Findings:

• Slow population growth vs. MO or US
• Greater concentration in Cape Girardeau County
• Static or declining population in outlying counties
• Greatest growth segment in senior years, ages 65+
• Fairly low diversity levels (85-97% in each county classified as White)
• Increasing dependency ratio (number of individuals relying on each employment-eligible individual for support), putting greater pressure on the 45-64 segment as it moves toward potential retirement age

Socio-Economic Characteristics

The population of the four-county area faces several challenges that may affect socio-economic self-sufficiency, and therefore lead to both direct and indirect effects on health status.

Findings:

• Higher percentages of the population without a high school diploma and lower percentages of higher education achieved in comparison with the MO and US percentages in all counties except Cape Girardeau.
• Lower median and per capita incomes, and high rates of persons living in poverty, in comparison with the state and national level
• The lack of health insurance and/or the cost of healthcare services are substantial barriers to care in most of the counties.
• Several measures related to hunger and food uncertainty are more prevalent than average in all four counties.
• The lack of public transportation, and limited access to or high cost of personal transportation among some segments in the rural counties, creates barriers to access for healthcare services –further exacerbating the access issue in rural counties with relatively few providers per population.

Physical & Built Environment

More challenges are present in regard to the physical and built environments for the four counties that may have an effect on health status.

Findings:

• High percentages of low food access for Scott and Stoddard counties
• Low rate of recreation and fitness facility access per the population in Cape Girardeau County (all other counties have data that is suppressed)

Healthcare Resources

Findings:

• Provider-to-population ratios for primary care, mental health, and dental services substantially exceed the state average in Bollinger and Stoddard counties, potentially indicating a significant barrier to access for those areas.
• Ratios also exceed the state average for primary care and mental health providers in Scott County.
• In contrast, the better-than-average ratios for all types of providers in Cape Girardeau makes it a destination for the surrounding counties.

Health Behaviors and Preventive Health Measures

Findings:

Data on health behaviors and the use of recommended preventive measures indicate the presence of elevated preventable risks across the market area with respect to:

• Smoking –among adolescents, adults, and pregnant women
• Physical inactivity and adult obesity
• Regular dental care
• Alcohol use among adolescents in all counties, except Stoddard County
• Substance abuse –among adolescents, generally related to a range of substances other than marijuana
• Relatively low use of recommended screenings such as pap tests, mammograms, and colon cancer screening, with varying levels of under-utilization by county
• Late-onset prenatal care in Scott County
• Rates of insufficient weight gain during pregnancy (perhaps related to food insufficiency issues) in all counties except Cape Girardeau County
• Expectant mothers throughout the market area having higher-than-average use of the available support systems (Medicaid, WIC, and food stamps) to mitigate some of the prenatal care risks

Health Outcomes

The data reveal high rates of various sources of morbidity and mortality in the four-county market area.
The main areas of concern include:

• Mental Health –depression and suicidal thoughts
• Heightened rates of negative outcomes around infant health, such as preterm births and neonatal and infant deaths –especially in Scott and Stoddard counties
• High rates of teen pregnancy (ages 15-19) vs. the state, despite a substantial decline in those rates
• High rates of STDs in Cape Girardeau and Scott Counties vs. the state and US norms
• High levels of preventable hospitalizations, especially in Bollinger, Scott, and Stoddard counties
• Elevated mortality rates vs. the state and US for multiple conditions, varying by county. Areas of specific concern include:
  • Heart Disease
  • Cancer
  • Lung Disease
  • Motor vehicle accidents
  • Alzheimer’s Disease
  • Stroke
  • Suicide
  • Kidney Disease
  • Pneumonia and Influenza

Many factors influence health and well-being in the communities we serve, and many entities and individuals in the community have a role to play in responding to community health needs. SoutheastHEALTH and the community partnerships established see the need and requirement for a framework within which our communities can take a comprehensive approach to maintaining and improving health: assessing its health needs, determining its resources and assets for promoting health, developing and implementing a strategy for action, and establishing where responsibility should lie for specific results.

The following document describes the action plan and framework for the SoutheastHEALTH System community health improvement process.

2022 SoutheastHEALTH CHNA Implementation Plan