Health System Community Analysis: Jackson County Kansas



Health System Community Analysis: Jackson County Kansas

Roline Campbell, Jill Collins, Brandy Schnacker, Danelle Shaw, and Jessica Shirk

Washburn University

Healthcare Policy, Organization, and Finance

NU 508

Dr. Patzel and Dr. Hornberger

February 28, 2010

Health System Community Analysis: Jackson County Kansas

Community Health Assessment

Jackson County is a small county, approximately 650 square miles, located in northeast Kansas. It has an estimated population of 13,240 and is primarily composed of several small rural communities (Jackson County Quick Facts, 2008). Despite being small and in a rural area, Jackson County offers a variety of healthcare services. Jackson County is served by one hospital, Holton Community Hospital (HCH), which is a twelve bed facility and is also a critical access hospital. HCH is affiliated with Family Practice Associates (FPA) which has clinics in Holton and Hoyt (Holton Community Hospital, 2009). There are also three other clinics which provide access to primary care. These are Holton Family Health Clinic (HFHC) which is owned by Community Health Systems of Onaga, Muddy Creek Family Health Clinic in Soldier, and Prairie Band Potawatomi (PBP) Health Center which serves the Native American community and is located in Mayetta. Below is a brief overview of what each clinic/hospital has to offer to the community.

Holton Community Hospital and Family Practice Associates offer a wide variety of services. FPA has clinics in Holton and Hoyt providing primary care services. There are five physicians, two advanced registered nurse practitioners (ARNP) and one physician assistant (PA) working for FPA. Within the hospital is a twelve bed inpatient unit with swing bed and obstetrical services as well as emergency services. The hospital also offers surgical services, cardiovascular services such as cardiac rehabilitation and cardiac stress testing, women’s services, laboratory services, home health and hospice, radiology and ultrasound, diabetic education, nutrition consults, health and wellness programs, and physical and occupational health services. In addition to these services, HCH also provides many outpatient clinics including podiatry, gastroenterology, ear, nose & throat, urology, orthopedics, pulmonology, cardiology, ophthalmology, pain management, obstetrics and gynecology, audiology and veteran healthcare. The hospital also offers durable medical equipment. HCH recently received a grant to assist people with managing chronic conditions such as diabetes, cardiovascular disease, congestive heart failure, and obesity. The hospital/clinic also does some workman’s compensation contracts (Holton Community Hospital, 2009).

Holton Family Health Clinic provides a number of services as well. Primary care services are offered by two regular physicians, one ARNP and 2 PAs. On site the clinic has radiology and ultrasound, laboratory services, cardiovascular services including EKG’s and stress testing, durable medical equipment, home health, nutritional services, rehabilitation services, respiratory and wound care. In addition to these services, HFHC also owns Lifetime Fitness Center and offers L.E.A.N which is a twelve week weight management educational program (Community HealthCare Systems, 2009).

Prairie Band Potawatomi Health Center serves as primary care coverage for Native American citizens residing in Jackson County. It does not offer services to non-Native Americans. The clinic is staffed by three physicians and one ARNP. The clinic has its own laboratory, radiology services, dental clinic, pharmacy, community health nurse, diabetic education and also has some outpatient clinics. The clinic is also a workman’s compensation provider (Prairie Band Potawatomi Health Center, 2009). The Prairie Band tribe also provides general public transportation for their patrons.

Muddy Creek Family Health Clinic offers basic primary care services and is staffed by one physician. All testing has to be done through other facilities.

There are many other healthcare services offered in Jackson County as well. The Jackson County Health Department offers basic public health services and also acts as a safety net clinic (Jackson County, 2009). There are three dental clinics with four dentists, four chiropractors, and two ophthalmologists. There are two pharmacies. There is one facility to help with outpatient mental health services as well as alcoholics and narcotics anonymous and Al Anon groups. There are three facilities that offer help to patrons with developmental disabilities and one food pantry. There are two crisis pregnancy centers in the county. There are two ambulance services in the county, one in Holton and one in Mayetta. Each town/community has a team of first responders. Lifestar provides air medical transportation when needed; however, this company is based in Lawrence and Junction City.

In regard to the elderly, Jackson County has one large nursing home and 4-5 assisted living/retirement homes. There is also an area agency on aging to assist seniors with needs. The Jackson County Senior Center provides meals on site and meals on wheels as well as providing transportation for seniors for doctor appointments, etc.

Sociodemographic Health Issues

Basic demographic information for Jackson County is as follows: total population as mentioned previously is 13, 240. Of that number, 82% are Caucasian, 4.2% are Hispanic, 1.5% are African-American, 0.15% are Asian, Native Hawaiian or other Pacific Islander and 9% are American Indian or Alaskan Native (KS Kids Count, 2008). The median household income is $47,899 with 15.4% living in poverty (KS Kids Count, 2008). Fifty one percent of residents are female and forty nine percent are male. Eighty eight percent of the population is high school graduates and the average age of persons residing in Jackson County in 37.5 years (Jackson County Quick Facts, 2008). Jackson County is also a large farming/ranching community. Approximately 27% of the population falls into the 25-44 year old range with 23% in the 45-64 range and 23% in the 15 or younger age category. Only 15% of the population falls in the 65+ category (Jackson County Quick Facts, 2008).

The primary health issues in Jackson County are hypertension, cardiovascular disease, mental illness, diabetes, obesity, allergies, chemical dependence, asthma, emphysema, and cancer.

Macro system Factors:

There are several major healthcare payors serving the residents of Jackson County. These payors are: Blue Cross/Blue Shield, Medicare, Medicaid, Humana, Unicare, Tricare, Children’s Mercy, Cigna, United HealthCare, workman’s compensation and auto insurances.

Medicare and Medicaid are what the majority of the population in Jackson County utilizes. Of the persons enrolled in Medicare, 1799 of them were age related and 256 of them were enrolled due to disability (City Data, 2009). Holton Community Hospital estimates that approx 25-30% of their patrons are uninsured and within the county, approx 12% of the population is uninsured (City Data, 2009).

One of the biggest social/politicial forces facing the community is budget cuts to the education systems. The three school districts within the county have been forced to cut spending by $400,000 which is a major impact on small school districts. There is also one small school in the county that was forced to close this year secondary to budget cuts (City Data, 2009). Clincis and the hospital are also forced to “tighten their belts” due to recent budget cuts. With a large number of people falling under medicare and medicaid within the community, there is bound to be a major impact as these services possibly face a big cut in funding with propose healthcare reform. In regard to political forces, in the 2008 election, 57% of the population voted republican and 42% voted democrat and 1% voted other (City Data, 2009). Another large political force within the community is the Prairie Band Potawotami Native American tribe. There is a casino in Mayetta which is run by the tribe and generates large amounts of revenue. Some of these funds are donated to local schools and fund healthcare for tribe members.

Gap Analysis:

As mentioned previously, for such a small community, Jackson County really provides many good resources for its residents. However, there are some areas the commuity could use additional resources. One of the major needs, as with many other communities, is that of acute mental health care. In 2006, Kansas Mental Health Agency spent nearly $2.5 million on mental health care, yet there is still a large need for more (The Kaiser Family Foundation). Current resources are not designed for acute mental health incidences and patients are frequently moved to larger towns for care. Along with mental health, there is also lack of resources for victims of domestic violence such as a battered women’s shelter.

Another area lacking in Jackson County is respite and personal care. There are currently resources that provide these services at low cost or no cost depending on patient finances. There are also options for private pay, but only the businesses are background checked not the individuals providing care. This leaves the patient and their family with the responsibility of making sure the person they hire is safe and trustworthy which is often an impossible task. The private pay option can also be quite pricey ranging form $8 to $18/hour. If the patient qualifies, he/she may be eligible for respite care through hospice but often patients and their families are not ready to take this step.

Currently two of the clinics in Jackson County offer outpatient clinics which host specialty physician. These are limited to a few select specialty groups, however, endocrinology and nephrology are not offered. Given the rate at which diabetes and obesity are rising in this country, these specialties could be utilized in this area. In addition, Jackson County does not offer renal dialysis. An outpatient dialysis unit would be an invaluable service to these people. Patients have to drive to about 30 miles to receive these services and when dialysis is usually done 3 times a week, this adds up quickly. There are also no visiting oncologists to either outpatient clinic. Again, with the rising rates of cancer, this would be beneficial as well as possibly and infusion center for patients to receive chemotherapy. The small community hospital does not keep patients in the hospital that require and major medical treatment, they have to be transferred to a larger facility.

Solutions/Strategies:

One possible solution to the mental health issue would be to add mental health staff at the local hospital and clinics to address patient concerns through primary care avenues. Another solution might be to offer psychiatry in outpatient clinics. Larger mental health hospitals would still be needed for acute stays but may not be needed as much with proper outpatient management. A family nurse practitioner with an emphasis on mental health would be a great addition to the local clinics and hospital. Putting a battered women’s shelter would be an asset to the community.

In regard to the personal care issues, one solution may be to utilize volunteers for respite services. Volunteers would decrease the cost of providing these services and make the service more profitable. One way to ensure patient safety with personal assistants would be to require them to be liscenced similar to how daycare providers are. Their liscensure would require a background check and a way for patients to file grievences should the need arise. The state or governing body would then have a resource list for agencies and patients.

Conclusion

The formulation of solutions and strategies to address health care insufficiencies are dependent on the periodic re-evaluation of community resources, sociodemographic health issues, macrosystem factors and the difference between currently available services and the health care needs of the community. Increasing the adaptability of the local health care system to adjust to the residents’ health needs should be a significant consideration in providing accessible primary health care to all communities. According to Andrulis (2000), agendas for health care improvement should focus on the following three priorities: (a) assessment of population dynamics, (b) assessing the consequences of health professional shortages and (c) using local, state and national influence to educate and guide providers in the direction of responding to the community’s health care needs. A thorough health system community analysis may contribute to the development of a state rural health plan which may serve as a guide to those working to improve rural health in their communities, counties and states (Barnes, Barnett, Wightman, Emge, & Johnson, 2008). The successful implementation of the solutions and strategies proposed by such a plan depends on the combined efforts and involvement of policy makers, health providers, health care leaders, associations, universities and communities. The solutions offered and strategies listed here should be utilized as a call to action to encourage all stakeholders to invest their efforts in the improvement of health in Jackson County Kansas.

References

Andrulis, D. (2000). Community service and policy strategies to improve health care access in

the changing urban environment. American Journal of Public Health , 858-862.

Barnes, J., Barnett, L., Wightman, T., Emge, A., & Johnson, S. (2008). Michigan Strategic

Opportunities for Rural Health Improvement: A State Rural Health Plan 2008-2012.

Michigan Department of Community Health.

City Data. (2009). Retrieved February 15th, 2010, from City Data website:



Community HealthCare Systems. (2009). Retrieved February 28th, 2010, from Community

HealthCare Systems web site:

Holton Community Hospital. (2009). Retrieved February 28th, 2010, from Holton Community

Hospital Website:

Jackson County. (2009). Retrieved February 28th, 2010, from Jackson County website:



Jackson County Quick Facts. (2008). Retrieved Februrary 18th, 2010, from US Census Bureau:



KS Kids Count. (2008). Retrieved February 14th, 2010, from KS Kids Count web site:



Prairie Band Potawatomi Health Center. (2009). Retrieved February 28th, 2010, from Prairie

Band Potawatomi Health Center web site:

The Kaiser Family Foundation. (n.d.). Retrieved February 4th, 2010, from The Kaiser Family

Foundation web site:



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