Question;Application: Case Exercise: Community Health Assessment forPitt County, North CarolinaApplication: Case Exercise: Community Health Assessment forPitt County, North CarolinaThis Application Assignment asks you to consider the kinds of data you would use, and how you would obtain the data, for a community health assessment.Read through the case exercise on Community Health Assessment, linked below, and complete all the questions. All the information you will need to complete this assessment exercise is provided in the Appendix at the end of the document. Save this Word document to your computer before you begin to fill out the form.Community Health Assessment ExerciseNote:Assessment is a very involved process, and you could easily spend many hours exploring this case exercise alone. However, for the purposes of this assignment, you should limit yourself to spendingno more than two hoursto complete this Application.This Application Assignment is due byDay 7of this week.You have completed Week 4. The course now shifts in focus to performance management. Please proceed to Week 5.Your name;Date;Week 4 Application: Community Health;Assessment for Pitt County, North Carolina[*];Community;health assessment is key to understanding the health problems and priorities of;a population. This Application Assignment outlines a process by which you can;complete a health assessment of a community using indicator-based methods. You;will construct a set of health indicators from a variety of domains, evaluate;problems, and report on the health priorities for a community.;Sections A?C ask questions about assessment;in general. Section D involves assessment of a particular county in North Carolina;information on which is provided in that section and in the Appendix.;Instructions;Save this document to;your computer and complete all questions in Sections A?D below. Submit by the;end of Week 4 following the submission instructions in the Week 4 Application;section.;Section;A: Community Health Assessment;The goal of public health is to improve the;health of a population. Public health interventions such as safe water sources;immunization programs, and improved motor vehicle safety regulations account;for the majority of years of life expectancy gained in the United States;over the last 100 years.;A community health assessment involves obtaining;and interpreting information to determine the health status of a specific;community. Once community health needs are identified, public health;interventions can be developed and their effectiveness evaluated using a;similar approach. Information necessary;for performing a community health assessment, for example data on mortality;rates or behavioral risk factors such as smoking, is available from various;sources.;Questions;1.;How do you define community?;2.;What stakeholders (groups/organizations);would you want to consult with for a community assessment?;3.;What types and sources of data would you use;for a community assessment?;Section B;Healthy People 2010;The Healthy People 2020 initiative is a;national approach that identifies high priority health issues and establishes;objectives to reduce the impact of these public health threats. To understand;the significance of data on your own community, you have to be able to compare;it to another standard. The questions in this section ask you about other;standards that can be used.;Questions;1.;How are Healthy;People 2020 standards used? What are advantages and disadvantages to;applying them at a local community level?;(Note: you may use the Healthy People 2010 standards if the 2020;standards are not reported.);2.;What other standards (national, state, or;local) can be used?;Section C: Health Indicators;For this exercise, you will use;an indicator approach to develop a community health assessment. A community;health assessment involves three-step feedback loop.;The first step in such an;assessment involves identifying important health indicators. The second step;involves matching those indicators with available data. In the third step;standards such as those explored in Section B are applied to the data gathered;in the first two steps to transform it into useful information about health;needs of the population.;Health indicators are measurable;health outcomes, such as death rate, insurance coverage measures, immunization;rates, or other data items that are relevant to the health of a community.Indicators are thoughtfully selected data;points that provide useful information about the health of a community.;Note;that each indicator should be;An;important health problem.Prevalent;or common in the community of interest.Measurable;on a community or population basis. There should be population data on a;local level that is easily available?this cannot be collected from health;facilities or providers because these data sources do not apply to the;entire community.Ideally;because we want to use a limited number of indicators, the indicator;should not be redundant?not measure the same thing?as another chosen;indicator.;To organize indicators, it is;helpful to identify major areas of focus. For this case, we will refer to these;broad categories of public health concerns asdomains. Please refer to Table 1 below for examples;of domains. For each domain, an example of an indicator is provided.;Table 1: List of Domains to Assist Developing;a Community Health Assessment;Domain;Example of an Indicator;Communicable Diseases;(including Sexually Transmitted Diseases);Incidence;of Gonorrhea;Chronic;Diseases (including Cancer);Incidence;of Diabetes;Injury;and Violence;Homicide;rate;Maternal;and Child Health;Childhood;immunization rate;Environmental;Health;Rates;of Lead Poisoning;Access;to Health Care;Rates;of Uninsured;Question;1. How you would obtain data for these indicators. What sources might you;use? Select 2 of the indicators above and provide specific sources of;information on them (including URLs) for your own community or state.;Section D;Performing a Community Health Assessment;As a consultant to Pitt County Health;Department, you are asked to perform a community health assessment for the;county. Below is information about the county;Pitt County is located in eastern North Carolina and has a population of;138,690 residents (2005 Census). Pitt County;has been classified as urban for the first time in 2006. It and the surrounding;counties are largely rural with a history of dependence on tobacco farming. Caucasians;make up about 62.8% of the population, African Americans 33.6%, Hispanics 3.2%;Asians 1.1% and American Indians 0.3%. There are an estimated 6,606 migrant and;seasonal workers or 5.4% of the population. About 18% or 26,000 adults in Pitt County;adults have household incomes below the federal poverty level with a median per;capita income of $18,243 (2000). The child poverty rate is estimated to be;21.8%. Approximately 20% of adult lack health insurance.;Pitt County contains Greenville;the largest city in eastern North Carolina;with a population of 67,525 (2005). Greenville;is considered the hub of eastern North;Carolina. The major employers are Pitt County;Memorial Hospital (PCMH), Brody School of Medicine and East Carolina;University. If a state;was created of all the land in North;Carolina east of Interstate 95, it would be the;poorest of all 50 states. In addition, it would rate 48th in terms of;premature mortality. Consider these factors when evaluating populations at risk;and targeting resources for public health activities.;You now embark on the steps needed to;perform your assessment.;?;STEP ONE;IDENTIFYING HEALTH INDICATORS;As;noted earlier, the first step in a community health assessment is identifying;health indicators. Develop a list of 18-20;indicators you would want to use in your assessment, identifying 3-4 indicators;per domain.;Complete the column on the right in this table;Domain;Indicator: (provide 3-4 per domain;Communicable Diseases;(including Sexually Transmitted Diseases);Chronic;Diseases (including Cancer);Injury;and Violence;Maternal;and Child Health;Environmental;Health;Access;to Health Care;? STEP TWO: MATCHING THE INDICATORS;Now;that you have chosen indicators to use for a community health assessment, use;the information provided in the tables below (Appendix) to match available data;to your chosen indicators. In this example, residents of Pitt County;constitute the community. If the Appendix does not give you the data for your;indicator, you should choose another indicator (alternatively, you may seek out;the data elsewhere that you need for your proposed indicator).;Question;1. Have you matched each of your indicators to the data available in the;Appendix?If not, explain how and where you got the data;needed for your proposed indicator.;? STEP THREE;SETTING HEALTH PRIORITIES;Using;the information gathered in the first two steps, please answer the following;questions. Note: Keep in mind that in order to;plan an effective intervention program in real life, you must communicate with;other constituents and stakeholders and see what they perceive to be priority;health issues. Collaboration with community stakeholders in program design is;critical to the success of an intervention plan. For this purposes of this;assignment, however, you are reviewing the data on your own, without the input;from other stakeholders.;Questions;1.;Looking at this data only, what would you conclude are three priority health;issues for this population? (Can be picked by how the indicator compares);2. Choose;three of your indicators. Compare them;to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page;from Healthy People to the specific;indicator.;3.;How do you explain;the health disparities of these indicators? (i.e., as shown by this comparison with HP?];You have completed;this Application on assessment. Submit this completed form in the Dropbox;following the submission instructions in the Week 5 Application area.;APPENDIX 1: DATA;TABLES;Community Health;Assessment Indicators;Pitt County (NC);North;Carolina, and;the United States;Domain;Maternal and Child Health (2004);Indicator;Pitt County;North Carolina;United;States;Infant mortality;rate per 1,000 live births;(2004);7.1;8.8;6.9;Black infant mortality per 1,000 live;births;8.1;15.6;14.1;White infant mortality per 1,000 live;births;7.0;6.2;5.8;Neonatal infant;mortality rate per 1,000 live births(<28 days of age) (2000-2004);5.7;6.0;4.6;Black neonatal infant mortality rate;8.9;11.2;7.3;White neonatal infant mortality rate;3.3;4.1;3.8;Low birth weight;(<2,500 g) per 100 births;(2004);11.6;9.1;7.9;Minority births <2500 g;15.9;13.4;13.0;White births <2500 g;8.3;7.4;6.5;Very low birth;weight (<1500 g) per 100 births;(2000-2004);2.8;1.9;1.4;Minority births 25 years of age with <9th grade education;7.6;7.8;7.5;Median;Household income $;33,734;46,335;50,046;Median;per capita income $;18,243;26,882;32,937;Migrant;and seasonal workers number;6,606;(5.4%);155,888;(2.1%);13;million;(4.4%);APPENDIX 2: Healthy;People 2020;What;Is Healthy People?;Healthy People 2020 provides science-based;10-year national objectives for improving the health of all Americans..For 3;decades, Healthy People has established benchmarks and monitored progress over;time in order to;?;Encourage collaborations across communities;and sectors.;?;Empower individuals toward making informed;health decisions.;?;Measure the impact of prevention activities;It;can be used by many different people, states, communities, professional;organizations, and others to help them develop programs to improve;health.;Healthy;People 2020 continues in this tradition with the launch on December 2, 2010 of;its ambitious, yet achievable, 10-year agenda for improving the Nation?s;health. Healthy People 2020 is the result of a multiyear process that reflects;input from a diverse group of individuals and organizations.;What;Are the Leading Health Indicators?;Healthy;People 2020 provides a comprehensive set of 10-year, national goals and;objectives for improving the health of all Americans. Healthy People 2020;contains 42 topic areas with nearly 600 objectives (with others still;evolving), which encompass 1,200 measures. A smaller set of Healthy People 2020;objectives, called Leading Health Indicators, has been selected to communicate;high-priority health issues and actions that can be taken to address them.;The Leading Health Indicators are composed of 26 indicators organized under 12;topics. The Healthy People 2020 Leading Health Indicators are;Access;to Health Services 7. Nutrition, Physical Activity, and;Obesity;Clinical;Preventive Services;8. Oral Health;Environmental;Quality 9. Reproductive and Sexual Health;Injury;and Violence 10. Social Determinants;Maternal;Infant, and Child Health 11.;Substance Abuse;Mental;Health. 12.;Tobacco;http://www.healthypeople.gov/2020/about/default.aspx;Pitt;County Municipalities Data;Municipality;Child;<5;yrs;Pop.;Persons/;square;mile;White;Non-Hispanic%;African-;America%;Amer.;Indian%;Hispanic;(#) %;Asian%;Ayden;282;4,622;1992;47.6;49.5;0.2;(102);2.2;0.2;Bethel;116;1,681;1618;40.2;58.1;0.0;(13);0.8;0.1;Falkland;11;112;15;yrs of age);Ayden;34,808;30%;21%;53.1%;X;45%;Bethel;35,278;40%;18.5%;49.2%;25;42.5%;Falkland;43,750;40%;5.0;57.4%;18;36%;Farmville;38,918;27.4%;14.6;57.5%;18.7;44.6%;Fountain;26,042;41%;35.6;51.6%;20.4;48%;Greenville;44,491;14%;9.0;66.3%;17.9;35.9%;Grifton;40,875;27%;12.2;55.9%;23.4;58.3%;Grimesland;36,250;40%;12.3;58.3%;22.9;53.5%;Simpson;47,500;23.6%;14.2;63.6%;17;56.6%;Winterville;47,167;16.6%;10.3;71.2%;25.5;56.7%;Pitt County;43,971;20%;13.5;65.8%;X;47%;North Carolina;46,335;22%;9.0;65.7%;X;56.3;U.S.;50,046;19.6%;9.2;63.9%;25.5;54.4;http://factfinder.census.gov http://www.city-data.com/city;Disclaimer regarding;interpretation of data in this Community Assessment;Various sources of;data have been used in the development of this teaching case including but not limited to vital statistics;the 2004 BRFSS survey, N.C. Communicable Disease Control Branch reports, N.C.;County Health Data Book, U.S. Census;American Fact Finder, N.C. Child Advocacy Institute, N.C. Child Fatality;Task Force.;The data in this;report is not to be relied on for actual assessment activities because of;various limitations including: different time periods for data collections and;a small number of events during the reported time period. These factors subject;the results to chance variation. Longer time periods of data collection are;required before inferences can be made. For a full discussion of the issues and;up-to-date data, refer to the report of the North Carolina State Center of;Health Statistics, http://www.schs.state.nc.us/SCHS/.;Resources for;Community Assessment;Advocates;for Youth;http://www.advocatesforyouth.org;Cecil G. Sheps Center for Health Services Research ? University of North Carolina, Chapel Hill;http://www.shepscenter.unc.edu/Data.html;http://www.shepscenter.unc.edu/hp/prof04.htm;Center;for Disease Control and Prevention ? STD Surveillance 2004;http://www.cdc.gov/std/stats/toc2004.htm;Center;for Health Services Research and Development, East Carolina;University;http://www.chsrd.med.ecu.edu;CLIKS;community-Level Information for Kids;http://www.aecf.org/cgi-bin/cliks.cgi;Employment;Security commission of North Carolina;? Labor & Wage Unit, Labor Market Information Division;http://eslmi23.esc.state.nc.us/ew/;Environmental;Defense Fund;http://www.scorecard.org/;Geographic.org;http://www.geographic.org;Guttmacher Institute;http://www.guttmacher.org/pubs/fb_teens.html;Institute of Research in Social Science at University;of North Carolina, Chapel;Hill;http://unc.edu/depts/irss/;Log;into North Carolina;(LINK);http://data.osbm.state.nc.us/pis/linc/dyn_linc_main.show;North;Carolina Child Advocacy Institute;http://www.ncchild.org;North Carolina Child;Fatality Task Force;www.preventchildabusenc.org/publications/press_releases/cftf;North Carolina;Communicable Disease Control;http://www.epi.state.nc.us/epi/gcdc.html;North Carolina Crime;Statistics;http://sbi2.jus.state.nc.us/crp/public/default.htm;North;Carolina Department of Agriculture;http://www.agr.state.nc.us/stats/;North;Carolina Department of Commerce;http://www.commerce.state.nc.us;North;Carolina Department of Health and Human Services ? Division of Medical;Assistance;http://www.dhhs.state.nc.us.dma/;North;Carolina Department of Health and Human Services ? HIV/STD Prevention;Care Branch;http://www.epi.state.nc.us.epi/hiv/surveillance.html;North;Carolina Department of Public Instruction;http://www.dpi.state.nc.us;North;Carolina Department of Transportation Public Transportation Division;http://www.dot.state.nc.us/transit/transitnet/;North Carolina Division;of Public Health ? Oral Health Section;http://www.communityhealth.dhhs.state.nc.us/dental/;North Carolina Division;of Public Health ? Women?s and Children?s Health Section;http://wch.dhhs.state.nc.us/;North Carolina;Employment Security Commission;http://esc.state.nc.us;North Carolina Office of;State Planning;http://www/ospi.state.nc.us;North;Carolina State Bureau of;Investigation;http://sbi.jus.state.nc.us;North;Carolina State;Center for;Health Statistics (NC-SCHS);http://www.schs.state.nc.us/SCHS/index.html;North;Carolina Rural Data Bank (by county);http://www.ncruralcenter.org/databank/profile;Public;Schools of North Carolina;http://www.ncpublicschools.org/accountability/reporting/sat/2005;State;of North Carolina;http://www.state.nc.us;University;of North Carolina;Highway Safety;Research Center;http://www.hsrc.unc.edu;[*]This case study exercise;adapted by Lloyd F. Novick, MD, MPH and Jorg Westermann, PhD, from Cibula, D. A;Novick, L. F., Morrow, C. B., & Sutphen, S. M. (2003). Community health assessment.;American Journal of Preventive Medicine, 24(4S);118?123.
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