Summit Healthcare Regional Medical Center
Community Health Needs Assessment
May 10, 2013
Prepared with consulting assistance from:
May 10, 2013
Dear Residents of our White Mountain communities,
I am pleased to share with you the results from the hospital’s first Community Health Needs Assessment, which was
completed in May of this year. Undertaken in part to make sure we meet new IRS requirements for maintaining our tax
exempt status, this project has also helped us to better understand the people that we serve – how healthy is our
population, and how well are your health needs being met?
Based on our data findings, plus results from a community survey and input from community leaders, we have identified
mental health and substance abuse services as the leading area of unmet health needs in our region.
Summit Healthcare leaders are committed to helping to address the issues that have been identified. During this process
we learned that other groups and organizations in our area are also concerned about gaps in mental health and substance
abuse services and want to work with us to find effective and sustainable solutions. By pooling our ideas and resources,
we believe that we can make real progress that has a positive impact in our local communities.
We are in the early stages of working with our community partners to develop action plans going forward. If you would
like more information about the status of these projects or would like to be involved as a community partner, please feel
free to contact me.
Best regards,
Ron McArthur, FACHE
Chief Executive Officer
Table of Contents
Introduction & Project Overview
4
Needs Assessment Methodology
10
Needs Assessment Key Findings
16
Process to Establish Health Improvement Priorities
30
Appendices
35
Appendix A: Community Definition and Profile
36
Appendix B: County Health Rankings
41
Appendix C: Mortality and Morbidity
47
Appendix D: Personal Health Behaviors
56
Appendix E: Clinical Care
59
Appendix F: Physical Environment and Public Safety
62
Appendix G: Community Survey Results
65
Appendix H: Community Leader Meeting Attendees
74
Appendix I: Additional Information
77
4
5
Introduction & Project Overview
Project Goals
The Community Health Needs Assessment project completed by Summit Healthcare Regional Medical Center
(“Summit”) in early 2013 was designed to meet five major goals:
1.
Better understand the community we serve – how healthy is our population, and how well are their health
needs being met?
2.
Gain focus for the hospital’s community health outreach efforts – how can we best use our resources to
address the most pressing needs?
3.
Strengthen the community health component of the hospital’s strategic plan – how can we better align our
community health activities with the overall goals and priorities of the organization?
4.
Create synergies with other organizations working to address health issues – what are the opportunities to
work with other groups in the community to achieve shared goals?
5.
Comply with requirements outlined in the Affordable Care Act (ACA) for non-profit 501(c)(3) hospitals to
conduct a community health needs assessment and implement strategies to address identified needs.
Additional information about ACA requirements can be found in Appendix I.
Consulting Assistance
Summit engaged Strategy Connections, a health care consulting company based in Fort Collins, Colorado, to provide
consulting assistance for completing the CHNA project. Carol Davis, Owner and Principal Consultant, served as
project leader and primary consultant throughout the project. A summary of Ms. Davis’ qualifications and experience
is included in Appendix I.
6
Introduction & Project Overview
Community Health Improvement Model
Summit’s model for community health improvement as shown below considers health status data, community survey
results and community leader perspectives in determining priority health needs that the hospital will help to address
over the next three years. On an annual basis as part of the budget development process, Summit Healthcare will
identify specific initiatives to be undertaken during the year that will help to address highest priority community
health needs.
Health Status Data
Community Survey
Leader Perspectives
Priority
Needs for
Summit
Healthcare
to Address
Action Plan &
Implementation
7
Introduction & Project Overview
Project Timeline
The CHNA project kicked off in May 2012 and concluded in May 2013, with timing of the various components as
follows:
Project Kick Off
Meetings
May
2012
Community
Survey
Jun-Aug
2012
Health Status
Data Collection
& Analysis
Sep-Oct
2012
Planning Meeting with
Community Leaders
Dec 2012Jan 2013
Survey Analysis;
Prliminary
Health Needs
Development
Feb 2013
May 2013
Board Approval
of Community
Health Priorities
8
Introduction & Project Overview
Definition of Community
Area A:
 85901 Show Low
 85902 Show Low
 85912 White Mountain Lake
 85923 Clay Springs
 85928 Heber
 85929 Lakeside
 85933 Overgaard
 85934 Pinedale
 85935 Pinetop
 85937 Snowflake
 85939 Taylor
 85924 Concho
 85940 Vernon
Area B:
 85911 Cibecue
 85930 McNary
 85926 Fort Apache
 85941 Whiteriver
9
Introduction & Project Overview
Demographic Overview
Area A
Population Size
Area B
51,676
11,250
43.0
24.8
Percent of Population 0-17
25.1%
36.9%
Percent of Population 18-44
26.5%
38.1%
Percent of Population 45-64
28.6%
19.0%
Percent of Population 65+
19.9%
6.1%
$46,845
$31,806
81.8%
12.8%
2.9%
0.5%
0.3%
1.6%
1.5%
2.4%
94.2%
0.8%
0.1%
1.1%
Median Age
Median Household Income
Racial & Ethnic Diversity
•
•
•
•
•
•
White Non-Hispanic
Hispanic of Any Race
American Indian Non-Hispanic
Asian Non-Hispanic
African American Non-Hispanic
Other or Multi-Racial
Source: The Nielsen Company (data retrieved 10/31/2012)
10
11
Needs Assessment Methodology
Secondary Data
Summit analyzed both secondary and primary data in the CHNA process .
Secondary data analysis uses data that was collected by others and is already in existence. A reference list of
secondary data sources used in the needs assessment can be found on page 12. In addition, all statistics used in the
report are fully referenced.
The availability of credible and objective measures of health status is essential to understanding overall health of the
population. Without such data, the ability to prioritize health needs would be severely limited and based solely on
small scale observations, anecdotal information, and personal opinions and agendas. This data, although critical to
the integrity of the process, has important limitations that need to be acknowledged:

Most health status data is collected and reported only at the county level. Summit’s primary service area
encompasses only the southern half of Navajo County. The characteristics of the population served by Summit
could be quite different from the overall county profile.
 Data is not current. Most of the data used in this report is based on 2010 statistics. Although changes in specific
indicators tend to be small from year to year, the lag time makes it especially difficult to identify potential trends
in a timely manner or to determine whether targeted interventions are having the intended impact and should be
continued, modified or discontinued.
12
Needs Assessment Methodology
Secondary Data Sources
 County Health Rankings 2012
 Arizona Health Status & Vital Statistics 2010
 Behavioral Risk Factor Surveys 2009, 2010
 Dartmouth Atlas
Data from above-listed sources allowed
for easy comparison of Navajo County
with other counties in Arizona.
Additional sources of data
 Arizona Cancer Registry
 Centers for Disease Control
 Crime in Arizona Report 2010
 The Nielsen Company
13
Needs Assessment Methodology
Primary Data
Primary data is new data that was collected by Summit via a community survey to gain additional insight into health
status and perception of health needs.
The survey, designed and tabulated by Strategy Connections, utilized a convenience sampling methodology, which
means that respondents self-selected to participate. It was available both on-line and in hard copy. The survey was
advertised via e-mail distribution lists and newsletters of a wide variety of local organizations, including school
districts, businesses, public health, health care organizations and county/city/town governments.
The survey was completed by 164 individuals. A profile of survey respondents is depicted on page 14, and detailed
survey results can be reviewed in Appendix G.
Community input received from the survey was invaluable to the needs assessment process, and Summit appreciates
those who took the time to share their opinions. It is, however, important to be cautious in reviewing and interpreting
the results due to these limitations:

Convenience sampling, while economical and helpful, does not produce statistically valid results that can be
generalized to the overall target population. In other words, we can’t say that results from this survey are
representative of the entire population of the community, only that the findings are representative of those
individuals who chose to participate.
 The profile of those who responded to the survey does not reflect overall demographics of the community. Most
respondents were Caucasian females from the Show Low–Pinetop–Lakeside area. Elderly individuals, males and
minority populations, especially American Indians, were underrepresented in survey participation.
14
Needs Assessment Methodology
Community Survey:164 Respondents
No Answer: 21%
No Answer: 22%
No Answer: 21%
Male: 20%
65+: 7%
>4: 12%
45-64: 44%
3-4: 26%
Female: 59%
2: 34%
18-44: 27%
Sex
Age
No Answer: 22%
Other Apache: 5%
Other Navajo: 9%
Vernon: 4%
Snowflake/Taylor: 10%
Lakeside/Pinetop: 23%
1: 7%
# in Household
No Answer: 22%
Asian: <1%
American Indian: 3%
Hispanic: 6%
No Answer: 22%
Don’t Live Here: 4%
Part Time/Seasonal: 0%
White: 69%
Full Time: 74%
Show Low: 27%
Zip Code
Diversity
Residency
Needs Assessment Methodology
Health Needs Assessment Process for Area B – Fort
Apache Reservation
For purposes of the health needs assessment, Summit Healthcare defined its community as the southern 1/3 of Navajo
County, which corresponds to the geographic area where 80% of the hospital’s inpatients reside. Due to significant
differences in demographics and governance, this large area was subdivided into two regions – Area A and Area B as
shown on the map on page 8.
The process of identifying health needs described in this report pertains primarily to Area A, although county-wide
health status data includes Area B as well. With significantly different demographic characteristics (summarized on
page 9 – younger, less household income, 94% American Indian, higher unemployment), the Area B population likely
has unique community health needs as well.
Area B lies within the Fort Apache Indian Reservation, which is governed by the White Mountain Apache Tribe. The
Indian Health Service (IHA) is responsible for providing health care services to this population. Summit leaders work
closely with IHS leaders to identify health needs on an ongoing basis and provide certain specialty services not available
through local IHS providers, including high risk obstetrics, surgery, oncology, urology and wound care. In addition,
Summit has a mutual aid agreement with Whiteriver Indian Hospital for supplies and disaster-planning. Summit is
currently working with IHS leaders on ways to address the need for transportation when residents require health care
services at Summit. Summit leaders also meet periodically with tribal leaders to discuss specific programs (e.g. First
Things First) and other topics of mutual interest.
Summit Healthcare is committed to working collaboratively with tribal and IHS leaders to address community health
needs for residents of the Fort Apache Reservation. We support their ongoing processes to identify and prioritize the
issues and will continue to assist with providing solutions whenever possible.
15
16
17
Needs Assessment Key Findings
10 Highest Survey Scores for Needs Being Met
Top 10 Highest Scores for Needs Being Met
1.
Chiropractic care
2.
Prescription drugs
3.
Medical equipment
4.
Ambulance & emergency transport services
5.
Hospice care
6.
Outpatient testing services
7.
Dental care
8.
Hospital care – ER & inpatient
9.
Kidney dialysis
10. Assisted living
Needs Assessment Key Findings
6 Lowest Survey Scores for Needs Being Met
(“Poor” or “Fair”)
Six Lowest Scores for Needs Being Met
1.
Mental health services
2.
Substance abuse treatment
3.
Obesity treatment
4.
Specialty physicians
5.
Services for people without health insurance
6.
Alzheimer’s disease & other dementias
18
Needs Assessment Key Findings
10 Highest Survey Scores for Importance in
Improving Overall Community Health
Ten Highest Scores for Improving Health
1. Get prenatal care
2. Decrease substance abuse
3. Increase exercise & physical fitness
4. Get recommended screening exams
5. Achieve a healthy weight
6. Decrease tobacco use
7. Improve diet & nutrition
8. Get routine physicals & lab work
9. Get recommended immunizations
10. Get regular dental checkups
19
20
Needs Assessment Key Findings
8 Areas of Potential Community Need (Data +
Survey Results
Category
Availability of Services
Potential Area for Improvement
• Mental health and substance abuse services
• Specialty physicians
• Obesity treatment
• Services for individuals without health
insurance
Compliance with
Prevention & Treatment
Guidelines
• Cancer screening exams
Healthy Lifestyle
• Exercise and physical fitness
• Management of chronic diseases
• Prenatal care
21
Needs Assessment Key Findings
Mental Health & Substance Abuse Services
How important for improving
health of community?
How well are needs being met?
10
Excellent
Decreasing substance abuse
Decreasing suicides
Improving stress management skills
9
8
Very Good
Good
Fair
X
X
8
7
6
6
5
5
4
4
2
Substance abuse services
Mental health services
0
0
Suicide (7th Alcohol-induced
leading cause)
17
Drug-induced
Note: Arizona counties ranked from #1 (best) to #15 (worst)
Very
Important
Moderately
Important
Somewhat
Important
2
1
49
X
X
X
3
1
Navajo County Deaths (2010)
33
9
7
3
Poor
10
Additional Data Findings
Not At All
Important
County Rank
3.6 poor mental health days (per person average)
past 30 days
#10
11.3% binge drinking (adults) past 30 days
#2
9.8 mental health providers per 100,000 population
#8
22
Needs Assessment Key Findings
Specialty Physicians
How well are needs being met?
Survey Comments – Perceived
Specialty Needs
10
Excellent
#
Mentions
9
Neurology
22
7
Pediatric specialties
12
6
Psychiatry/other mental health
11
Endocrinology
6
Rheumatology
6
Cardiology
4
8
Very Good
Good
5
X
Fair
4
3
2
1
Poor
0
Specialty physicians
23
Needs Assessment Key Findings
Obesity Treatment
How well are needs being met?
How important for improving
health of community?
10
Excellent
10
Achieving a healthy weight
9
8
Very Good
7
6
Fair
6
5
X
4
Moderately
Important
5
Obesity treatment services
4
3
3
2
Somewhat
Important
2
1
Poor
X
8
7
Good
9
Very
Important
1
0
0
Data Findings
29% obese (adults)
Note: Arizona counties ranked from #1 (best) to #15 (worst)
County
Rank
#8
Not At All
Important
24
Needs Assessment Key Findings
No Health Insurance
How well are needs being met?
10
Excellent
CHR Data Findings
9
8
Very Good
7
County
Rank
22% lack health insurance
#12
17% couldn’t afford to see doctor past
year
#12
6
Good
5
X
Fair
Community Survey Findings
4
3
No health insurance
2
1
Poor
0
Note: Arizona counties ranked from #1 (best) to #15 (worst)
Of the 32% who did not received needed services in
past 12 months:
• 35% could not afford to pay for care
• 25% had no health insurance
Respondents could select multiple answers.
25
Needs Assessment Key Findings
Cancer Screening Exams
Data Findings
County
Rank
90% ever had mammogram (women 40+)
#11
86% ever had Pap test (women 18+)
#15
84% ever had PSA test (men 40+)
#1
50% ever had colonoscopy (50+)
#13
How important for improving
health of community?
Getting recommended
screening exams
10
9
8
7
6
24
Cancer Deaths – Navajo County (2010)
5
148 total deaths - #2 cause of death
4
22
3
19
13
Lung
Colorectal
Lymph/blood
Breast
10
10
Prostate
Kidney/renal
New Cancer Cases – Navajo County (2009)
394 total new cancer cases
Breast
55
Prostate
46
Lung
34
Colorectal
Note: Arizona counties ranked from #1 (best) to #15 (worst)
20
19
Kidney/renal
Melanoma
14
Urinary/bladder
Moderately
Important
Somewhat
Important
2
1
0
58
X
Very
Important
Not At All
Important
26
Needs Assessment Key Findings
Management of Chronic Diseases
How well are needs being met?
Additional Data Findings (adults)
10
Excellent
9
County
Rank
34% high cholesterol
#5
21% high blood pressure
#1
13% asthma
#5
11% diabetes
#10
8
Very Good
Good
7
X
X
X
X
X
X
Fair
6
5
4
3
Asthma/COPD/respiratory
Dialysis
Heart disease
Diabetes
Chronic pain
Stroke/neurological
4% heart attack
2
1
Poor
0
4% stroke
#8
43% blood sugar tests
(Medicare patients with diabetes)
#14
Navajo County Deaths (2010)
182
Cardiovascular (#1
cause of death)
#4 (tie)
41
41
31
Lower respiratory (#4
cause of death)
Diabetes (#5 cause of
death)
Stroke (#8 cause of
death)
Note: Arizona counties ranked from #1 (best) to #15 (worst)
12
Renal failure (#12
cause of death)
27
Needs Assessment Key Findings
Prenatal Care
How important for improving
health of community?
How well are needs being met?
10
Excellent
Very Good
X
Good
Fair
Poor
Getting prenatal care
10
9
9
8
8
7
7
Pregnancy-related care
6
6
5
5
4
4
3
3
2
2
1
1
0
0
Data Findings
68% of women giving birth received
prenatal care in 1st trimester
Note: Arizona counties ranked from #1 (best) to #15 (worst)
County
Rank
#12
X
Very
Important
Moderately
Important
Somewhat
Important
Not At All
Important
28
Needs Assessment Key Findings
Exercise & Physical Fitness
How important for improving
health of community?
10
Increase exercise & physical fitness
9
X
Very
Important
8
Data Findings
County
Rank
56% with moderate/vigorous exercise past
30 days
#12
2.7 fitness/recreational facilities per
100,000 population
7
6
5
4
#12
3
Somewhat
Important
2
1
0
Note: Arizona counties ranked from #1 (best) to #15 (worst)
Moderately
Important
Not At All
Important
29
Needs Assessment Key Findings
Survey Results: One Thing to Most Improve Health?
Topic
# of Mentions
1.
More community education & personal
responsibility for health
17
2.
More exercise
10
3.
Better access to medical care
8
4.
More affordable care
6
5.
More trails for safe walking/bicycling
6
6.
Better access to healthy food – restaurants &
grocery stores
5
7.
Better diet/nutrition
5
30
31
Process to Establish Health Improvement Priorities
Community Leader Meeting

Summit Healthcare leaders hosted a meeting of invited community representatives to share key findings from the
health needs assessment and to seek input on which health needs are the most important to address. The prioritysetting meeting was held on Wednesday, February 6, 2013 from 6:00-7:30 p.m. at a local restaurant.

Thirty-five individuals representing 18 organizations participated in the meeting. A complete list of attendees,
including job title and organization, is located in Appendix H.

The agenda consisted of the following segments:
•
•
•
•
•
Welcome and introductory remarks by Ron McArthur, CEO of Summit Healthcare
Presentation of key findings from health needs assessment
Audience discussion and voting on perceived priority of eight community health needs
Additional discussion
Next steps and concluding remarks
32
Process to Establish Health Improvement Priorities
Health Needs Presented for Community Leader Input
 Availability of Services
•
•
•
•
Mental health and substance abuse services
Specialty physicians
Obesity treatment
Services for individuals without health insurance
 Compliance with Prevention and Treatment Guidelines
• Cancer screening exams
• Management of chronic diseases
• Prenatal care
 Healthy Lifestyle
• Exercise and physical fitness
33
Process to Establish Health Improvement Priorities
Results of Community Leader Voting
After the list of 8 community health needs was presented, attendees had an opportunity for questions and
large group discussion. Then 26 voting participants (Summit representatives did not vote) were asked to rate
the importance of each issue on a scale from 1 (“less important”) to 5 (“very important) using Turning Point
audience response technology and based on the following criteria:
 Does this issue affect a large number of individuals and families?
 Does the community have (or can we acquire) the necessary skills and resources to make a difference?
Results from the voting exercise were as follows:
Topic
Mean Score
Frequency Distribution
5
4
3
2
1
1.
Mental health and substance abuse
services
4.46
15
8
3
0
0
2.
Prenatal care
4.00
12
6
4
4
0
3.
Services for individuals without health
insurance
3.85
11
6
4
4
1
4.
Exercise and physical fitness
3.81
11
5
6
2
2
5.
Cancer screening exams
3.80
9
4
11
0
1
6.
Management of chronic diseases
3.65
6
8
10
1
1
7.
Specialty physicians
3.35
3
9
9
4
1
8.
Obesity treatment services
3.15
4
5
10
5
2
34
Process to Establish Health Improvement Priorities
Summit Healthcare Board Decision and Next Steps
At its monthly meeting on May 10, 2013, the Summit Healthcare Board of Directors reviewed key findings from the
health needs assessment process, including results from the community leader meeting that was held on February 6.
The Board then considered and passed the following motion:
a) To adopt mental health and substance abuse services as the leading community health need
that Summit will help to address by working with other community groups to find collaborative
and sustainable solutions, and b) to adopt the seven other improvement areas as priorities to
consider for Summit’s various community outreach programs and services.
Initial implementation activities include the following projects to be completed by December 31, 2013:

Mental health and substance abuse
i.
ii.

Continue efforts to recruit a psychiatrist and/or develop a telemedicine option for psychiatry.
Convene community partners to more clearly identify and prioritize gaps in services.
Seven other improvement areas
i.
Review current services provided by Summit that focus on these areas (listed on page 33), and identify opportunities to
improve effectiveness or potentially expand services to address unmet needs.
Implementation plans with specific projects and resource requirements for subsequent years will be developed
annually during Summit’s budget planning process for the next fiscal year. An action plan for FY2014 will be adopted
by the board no later than December 31, 2013.
35
36
37
Community Definition and Profile
Map of Defined Community
Sources: Intellimed for patient origin, Microsoft MapPoint 2011 for map boundaries
For purposes of the community health needs
assessment, Summit Healthcare defined its community
as the southern 1/3 of Navajo County, which
corresponds to the geographic area where 80% of the
hospital’s inpatients reside. Due to significant
differences in demographics and governance, this large
area was subdivided into two regions as follows:
 Residents of Area A accounted for 69.7% of
Summit’s inpatient discharges between July 1,
2011 and June 30, 2012. Area A encompasses 11
zip codes:
• 85901 Show Low
• 85902 Show Low
• 85912 White Mountain Lake
• 85923 Clay Springs
• 85924 Concho
• 85928 Heber
• 85929 Lakeside
• 85933 Overgaard
• 85934 Pinedale
• 85935 Pinetop
• 85937 Snowflake
• 85939 Taylor
• 85940 Vernon
 Area B lies within the Fort Apache Indian
Reservation. Residents of Area B accounted for
10.3% of Summit’s inpatient discharges during the
same 12-month period. Area B includes 4 zip
codes:
• 85911 Cibecue
• 85930 McNary
• 85926 Fort Apache
• 85941 Whiteriver
38
Community Definition and Profile
Summit Healthcare Inpatient Origin (7/1/2011-6/30/2012)
As % of Total Summit Inpatient
Discharges
Inpatient Discharges
Show Low
974
27.65%
Lakeside
405
11.08%
Snowflake
347
9.49%
Whiteriver
264
7.22%
Pinetop
204
5.58%
Taylor
195
5.34%
Concho
129
3.53%
Saint Johns
116
3.17%
Overgaard
104
2.85%
Eagar
97
2.65%
Holbrook
78
2.13%
Vernon
69
1.89%
Springerville
62
1.70%
Heber
57
1.56%
Cibecue
53
1.45%
Fort Apache
39
1.07%
Clay Springs
29
0.79%
McNary
20
0.55%
White Mountain Lake
20
0.55%
Pinedale
16
0.44%
All Others
378
10.34%
3,655
100.00%
Total Discharges
Source: Intellimed; excludes newborns
39
Community Definition and Profile
Demographic Overview: Area A
2013
Estimated
2018
Projected
5 Year
Change
5 Year
Change %
51,676
54,127
+2,451
+4.7%
43.0
41.3
-1.7
-4.0%
Percent of Population 0-17
25.1%
25.1%
+619
+4.8%
Percent of Population 18-44
26.5%
28.0%
+1,503
+11.0%
Percent of Population 45-64
28.6%
25.0%
-1,285
-8.7%
Percent of Population 65+
19.9%
21.9%
+1,614
+15.7%
Median Household Income
$46,845
$49,584
+$739
+5.9%
White Non-Hispanic
Hispanic of Any Race
81.8%
12.8%
81.9%
13.3%
+2,067
+594
+4.9%
+9.0%
•
American Indian Non-Hispanic
Asian Non-Hispanic
African American Non-Hispanic
2.9%
0.5%
0.3%
2.5%
0.5%
0.3%
-188
+14
-17
-12.4%
+5.0%
-11.0%
•
Other or Multi-Racial
1.6%
1.5%
-19
-2.3%
Population Size
Median Age
Racial & Ethnic Diversity
•
•
•
•
Source: The Nielsen Company (data retrieved 10/31/2012)
40
Community Definition and Profile
Demographic Overview: Area B
2013
Estimated
2018
Projected
5 Year
Change
5 Year
Change %
11,250
11,528
+278
+2.5%
24.8
26.1
+1.3
+5.2%
Percent of Population 0-17
36.9%
35.7%
-34
-0.8%
Percent of Population 18-44
38.1%
38.3%
+136
+3.2%
Percent of Population 45-64
19.0%
18.8%
+28
+1.3%
Percent of Population 65+
6.1%
7.2%
+148
+21.7%
Median Household Income
$31,806
$34,031
+$2,225
+7.0%
White Non-Hispanic
Hispanic of Any Race
1.5%
2.4%
1.5%
2.8%
+11
+54
+6.7%
+20.4%
94.2%
0.8%
0.1%
93.3%
1.1%
0.1%
+153
+42
+3
+48.8%
•
American Indian Non-Hispanic
Asian Non-Hispanic
African American Non-Hispanic
•
Other or Multi-Racial
1.1%
1.2%
+15
+12.1%
Population Size
Median Age
Racial & Ethnic Diversity
•
•
•
•
Source: The Nielsen Company (data retrieved 10/31/2012)
+1.4%
+37.5%
41
42
County Health Rankings
Introduction to County Health Rankings

County Health Rankings is a collaboration between the University of Wisconsin Population Health Institute and
the Robert Wood Johnson Foundation. The project publishes an annual report that assesses the overall health of
nearly every county in all 50 states, using a standard way to measure how healthy people are and how long they
live.

Results are aggregated into two overall categories: 1) health outcomes, and 2) health factors.
•
Ranking for health outcomes is based on mortality and morbidity data.
•
Ranking for health factors considers data on health behaviors, clinical care, social and economic factors, and
physical environment.
43
County Health Rankings
Arizona Maps for Health Outcomes and Health Factors
Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 4/10/2012.
44
County Health Rankings
Navajo County Data
Navajo
County
Error Margin
National
Benchmark
Arizona
Navajo County
Rank 1-15
(1=most
favorable)
Health Outcomes
12
Mortality
13
Premature death (years of potential life lost per 100,000 population)
11,875
11,12512,625
5,466
7,213
Morbidity
Poor or fair health (percent of adults)
11
17%
14-19%
10%
15%
Poor physical health days in past month
3.4
2.9-3.9
2.6
3.4
Poor mental health days in past month
3.6
3.0-4.1
2.3
3.3
7.9%
7.4-8.3%
6.0%
7.0%
Low birthweight babies (percent of total live births)
Health Factors
13
Health Behaviors
10
Smoking (percent of total adults)
18%
15-21%
14%
18%
Obesity (percent of total adults)
32%
28-35%
25%
25%
Physical inactivity (percent of total adults)
25%
22-29%
21%
20%
Excessive drinking (percent of total adults)
12%
10-15%
8%
17%
Motor vehicle crash death rate per 100,000 population
53
48-58
12
19
Sexually transmitted infections per 100,000 population (chlamydia)
572
84
400
Teen births per 1,000 females ages 15-19
63
22
60
61-66
Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data.
Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
45
County Health Rankings
Navajo County Data
Navajo
County
Error Margin
National
Benchmark
Arizona
Clinical Care
Uninsured (% of total population)
Population per primary care physician
Preventable hospital stays per 1,000 Medicare enrollees
10
20%
18-21%
1,170:1
11%
20%
631:1
1,118:1
66
60-71
49
52
Diabetic testing of blood sugar levels (% of people with diabetes)
43%
40-46%
89%
76%
Mammography screening (% of women ages 40+)
47%
42-51%
74%
68%
Social & Economic Factors
13
High school graduation (% of population ages 25+)
72%
Some college (% of population ages 25+)
49%
Unemployment (% of total workforce)
Navajo County
Rank 1-15
(1=most
favorable)
76%
45-53%
15.7%
68%
60%
5.4%
10.0%
Children in poverty (% of total children)
36%
29-44%
13%
25%
Inadequate social support (% of total adults)
24%
20-27%
14%
20%
Children in single-parent households (% of total children)
39%
35-43%
20%
33%
Violent crimes per 100,000 population
354
73
466
Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data.
Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
46
County Health Rankings
Navajo County Data
Navajo
County
Error Margin
National
Benchmark
Arizona
Physical Environment
Navajo County
Rank 1-15
(1=most
favorable)
9
Air pollution – particulate matter days in a year
0
0
1
Air pollution – ozone days in a year
1
0
29
Recreational facilities (total number)
3
16
7
Limited access to healthy foods (% of population based on formula
that considers poverty level and geographic isolation)
22%
0%
9%
Fast food restaurants (% of total restaurants)
42%
25%
52%
Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data.
Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
47
48
Mortality and Morbidity
Age-Adjusted Mortality Rates for 10 Leading Causes of Death
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Cardiovascular disease
202.8
188.6
12
2. Malignant neoplasms (cancer)
134.6
150.5
6
3. Unintentional injury
78.1
43.8
13
4. Chronic lower respiratory diseases
41.7
42.6
6
5. Diabetes
38.7
20.1
13
6. Chronic liver disease & cirrhosis
37.1
12.3
14
7. Suicide
33.1
16.7
14
8. Cerebrovascular disease (stroke)
32.0
30.7
8
9. Influenza & pneumonia
18.3
10.9
12
10. Alzheimer’s disease
17.8
35.1
6
808.9
679.9
12
11. Total, all causes
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation from
state number) but not necessarily statistically significant
Note: All rates per 100,000 population and age-adjusted.
Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
49
Mortality and Morbidity
Additional Mortality Measures
Navajo County
Arizona
Navajo County Rank
1-15
(1=most favorable)
1. Perinatal deaths (per 1,000 live births +
4.6
5.5
5
16.3
17.6
8
51.5
14.1
13
4. Average age at death
64.3
72.1
14
5. Median age at death
69.0
77.0
14
11,875
7,213
13
fetal losses at 28+ weeks gestation)
2. Drug-induced deaths (per 100,000
population)
3. Alcohol-induced deaths (per 100,000
population)
6. Years of potential life lost due to
premature death (per 100,000
population)
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation from
state number) but not necessarily statistically significant
Source for #1, 2, 3, 4, 5: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #6: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
50
Mortality and Morbidity
Overall Health Status and Limitations
Navajo County
Arizona
Navajo County Rank
1-15
(1=most favorable)
1. Percent of adults satisfied or very
satisfied with life
2. Percent of adults reporting fair to poor
general health
3. Poor physical health days in past 30
days
4. Poor mental health days in past 30
days
5. Percent of adults with activity
limitations due to health issues
6. Percent of adults who need special
equipment for health reasons
7. Percent of live births with low
birthweight (<2,500 grams)
93.2%
93.7%
12 (tie)
16.5%
15.4%
5 (out of 14)
3.4
3.4
4
3.6
3.3
9
20.9%
20.4%
6
8.6%
7.1%
8
7.9%
7.0%
13
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation from
state number) but not necessarily statistically significant
Source for #1, 5, 6: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #2, 3, 4, 7: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012..
51
Mortality and Morbidity
Health Conditions
Navajo County
Arizona
Navajo County Rank
1-15
(1=most favorable)
1. Percent of adults diagnosed with
asthma
2. Percent of adults who have had a
heart attack
3. Percent of adults who have high blood
pressure
4. Percent of adults who have high
cholesterol
5. Percent of adults who are obese
6. Percent of adults diagnosed with
diabetes
7. Percent of adults who have had a
stroke
12.8%
15.6%
5
4.0%
4.5%
4 (tie)
21.2%
26.6%
1
34.0%
40.9%
5
29.3%
25.1%
8
10.7%
8.9%
10
3.8%
2.9%
8
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation from
state number) but not necessarily statistically significant
Source for #1, 2, 5, 6, 7: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #3, 4: Behavioral Risk Factor Survey 2009; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
52
Mortality and Morbidity
Age-Adjusted Rates of New Cancer Cases
Navajo County
Arizona
388.7
391.2
90.2 (females only)
109.6 (females only)
Lung and Bronchus
40.0
54.1
Colorectal
17.2
35.5
16.9 (females only)
21.1
11.4
17.8
10.5 (females only)
21.1 (females only)
Thyroid
12.9
14.5
Prostate
100.5 (males only)
99.5 (males only)
Kidney and Renal Pelvis
15.4
14.5
Melanomas of the Skin
14.6
14.0
Stomach
13.3
5.1
12.6 (males only)
5.2 (males only)
All Invasive Cancers
Female Breast
Corpus and Uterus, Not Otherwise Specified
Urinary Bladder
Ovary
Testis
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation from
state number) but not necessarily statistically significant
Note: All rates per 100,000 population and age-adjusted based on new cancer cases reported for 2009.
Source: Arizona Cancer Registry Query Module; data retrieved from http://healthdata.azgov on 8/17/2012.
53
Mortality and Morbidity
Rates of Reported Cases of Selected Notifiable Diseases
Navajo County
Arizona
Navajo County Rank
1-15
(1=most favorable)
Gonorrhea
33.5
50.8
10
Coccidioidomycosis (Valley Fever)
29.8
175.9
5
Genital herpes
21.4
29.0
9
Methicillin resistant S. aureus (invasive)
11.2
17.6
7
Pertussis
4.7
6.4
11 (tie)
Syphilis (total)
1.9
14.1
2 (tie)
Hepatitis B (acute)
1.9
2.3
7 (tie)
Giardiasis
1.9
2.4
9
Aseptic meningitis
0.9
9.0
6
West Nile virus
0.9
2.6
7
E. Coli 0157:H7
0.9
1.5
6
Hepatitis A
0.9
1.1
5 (tie)
Tuberculosis (total)
4.7
4.4
9
Chlamydia
559.3
420.2
14
Campylobacteriosis
42.8
14.7
14
Salmonellosis
31.6
14.3
15
Streptococcus pneumoniae (invasive)
29.8
11.9
14
Shigellosis
16.8
6.8
13
Streptococcal Group A (invasive)
10.2
2.8
15
County number is
FAVORABLE (>10%
positive variation from state
number) but not
necessarily statistically
significant
County number is
UNFAVORABLE (>10%
negative variation from
state number) but not
necessarily statistically
significant
Note: All rates per 100,000 population.
Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 8/17/2012.
54
Mortality and Morbidity
Leading Reasons for Hospitalization among Navajo County Residents
2010
Discharges
% of Total
Navajo
County
% of Total
Arizona
Total hospital discharges
9,657
Circulatory system
1,268
13.1%
14.5%
Digestive system
1,170
12.1%
11.3%
Injury and poisoning
1,148
11.9%
9.9%
Respiratory system
1,103
11.4%
9.0%
Musculoskeletal system
624
6.5%
6.3%
Genitourinary system
469
4.9%
5.7%
Infectious and parasitic diseases
442
4.6%
4.1%
Endocrine/nutritional/metabolic/immunity disorders
374
3.9%
3.8%
Symptoms/signs/ill-defined conditions
351
3.6%
5.3%
Neoplasms (cancer)
319
3.3%
4.0%
Skin and subcutaneous tissue
242
2.5%
2.5%
Mental disorders
195
2.0%
2.8%
Nervous system
188
1.9%
2.3%
Conditions originating in perinatal period
110
1.1%
0.5%
Blood and blood-forming organs
83
0.9%
1.0%
Certain congenital anomalies
61
0.6%
0.4%
1,510
15.6%
16.7%
All other diagnoses
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
55
Mortality and Morbidity
Leading Reasons for ER Visits among Navajo County Residents
2010
Visits
% of Total
Navajo
County
% of Total
Arizona
Total ER visits
26,859
Injury and poisoning
6,998
26.1%
22.7%
Symptoms/signs/ill-defined conditions
4,877
18.2%
23.8%
Respiratory system
2,686
10.0%
9.9%
Musculoskeletal system
1,351
5.0%
6.9%
Genitourinary system
1,424
5.3%
6.1%
Digestive system
1,751
6.5%
5.8%
Nervous system
1,448
5.4%
6.0%
Skin and subcutaneous tissue
1,162
4.3%
3.8%
Mental disorders
1,272
4.7%
3.5%
Circulatory system
865
3.2%
2.3%
Infectious and parasitic diseases
760
2.8%
2.1%
Endocrine/nutritional/metabolic/immunity disorders
573
2.1%
1.4%
Neoplasms (cancer)
54
0.2%
0.1%
All other diagnoses
1,638
6.1%
5.5%
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
56
57
Personal Health Behaviors
Lifestyle Measures
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Binge drinking (5 or more drinks on a single
11.3%
14.5%
2
2. Consume 5+ fruits and vegetables daily
30.5%
24.7%
3
3. Always use seat belts
80.5%
87.0%
7
4. Moderate/vigorous exercise in past 30 days
55.7%
52.3%
6
63.1
59.9
8
19.2%
15.6%
9
occasion) in past 30 days
5. Teen birth rate (per 1,000 females ages 15-
19)
6. Currently smoke
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source for #1, 2, 4, 6: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #3: Behavioral Risk Factor Survey 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #5: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
58
Personal Health Behaviors
Prevention and Wellness Measures
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Ever had a mammogram (women ages
89.8%
91.3%
11
2. Ever had a PSA test (men ages 40+)
83.9%
76.8%
1
3. Flu shot in past year (ages 65+)
70.4%
67.0%
2
4. Checkup in past year
69.0%
65.8%
4
5. Ever had a Pap test (women ages 18+)
85.6%
95.3%
15
6. Ever had a colonoscopy (ages 50+)
50.0%
61.0%
13
43.0%
75.6%
14
6.0%
9.1%
12
24.1%
57.3%
15
40+)
7. HbA1c screening for Medicare enrollees
with diabetes
8. Shingles vaccination in past 5 years
(ages 50+)
9. Awareness of folic acid to prevent birth
defects (women ages 18-44)
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source for #1, 4, 8: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #2, 3, 5, 6, 9: Behavioral Risk Factor Survey 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #7: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
59
60
Clinical Care
Availability and Accessibility of Care
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Primary care physicians per 100,000 population
2. Has a personal doctor or health care provider
3. Mental health providers per 100,000 population
4. Dentists per 100,000 population
5. Doesn’t have health insurance
6. Needed to see a doctor but couldn’t afford it
during past year
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
85.4
89.4
5
74.1%
79.2%
9
9.8
28.7
8
32.7
42.9
6
21.6%
14.2%
12
16.7%
13.2%
12
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source for #1, 3, 4: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.
Source for #2, 5, 6: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
61
Clinical Care
Effectiveness of Care
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Total health care spending per Medicare
enrollee
2. Medical patients readmitted to hospital within 30
days of discharge (Medicare only)
3. Surgical patients readmitted to hospital within
30 days of discharge (Medicare only)
4. Preventable hospital admissions per 1,000
Medicare enrollees
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
$7,438
$8,413
4
14.7%
15.8%
4 (out of 14)
14.2%
12.2%
12 (out of 13)
65.7
51.7
9
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source for #1, 2, 3: Dartmouth Atlas; data retrieved from www.dartmouthatlas.org on 6/11/2012.
Source for #4: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
62
63
Physical Environment and Public Safety
Physical Environment
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Percent of all restaurants that are fast food
2. Air pollution: average number of days per year of
unhealthy air due to ozone
3. Air pollution: average number of days per year of
unhealthy air due to particulates
4. Percent of population with limited access to
healthy foods
5. Number of fitness and recreational facilities per
100,000 population
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
41.7%
51.7%
7
1
29
7 (tie)
0
1
N/A
22.2%
8.8%
12
2.7
7.3
12
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
64
Physical Environment and Public Safety
Crime Rates
Navajo County
Arizona
Navajo County
Rank 1-15
(1=most favorable)
1. Violent crimes per 100,000 population
353.7
466.4
6
2. Larceny – thefts per 1,000 population
13.5
24.5
N/A
3. Burglaries per 1,000 population
8.0
7.5
N/A
4. Aggravated assaults per 1,000 population
3.5
2.4
N/A
5. Motor vehicle thefts per 1,000 population
1.3
3.2
N/A
6. Robberies per 1,000 population
0.3
1.1
N/A
7. Forcible rapes per 1,000 population
0.1
0.2
N/A
8. Arsons per 1,000 population
0.1
0.2
N/A
0.06
0.10
N/A
9. Murders per 1,000 population
County number is FAVORABLE (>10% positive variation from
state number) but not necessarily statistically significant
County number is UNFAVORABLE (>10% negative variation
from state number) but not necessarily statistically significant
Source for #1: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.
Source for #2-9: Crime in Arizona Report 2010; Arizona Department of Public Safety; data retrieved from www.azdps.gov on 8/17/2012.
65
66
Community Survey Results
How well are needs for health care services being met in White
Mountains?
Excellent
None
Very Good
Score
Good
(0=low,
10=high)
Score
(0=low,
10=high)
Fair
Score
(0=low,
10=high)
Chiropractic
6.51
Dialysis
5.71
Specialty
physicians
3.62
Prescription drugs
6.43
Assisted living
5.55
Substance abuse
2.77
Medical equipment
6.38
Outpatient rehabilitation
5.53
Mental health
2.37
Ambulance/emergency
transport
6.33
Home health care
5.12
Hospice
6.23
Urgent care
4.98
Outpatient testing
6.20
Primary care
4.89
Dental
6.15
Alternative medicine
4.79
Hospital care - ER &
inpatient
6.03
Nursing home
4.67
Communication & coordination
4.59
Poor
None
Note: Excludes “no opinion” responses.
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
67
Community Survey Results
How well are health care needs being met for specific populations?
Excellent
None
Very Good
None
Good
Score
(0=low,
10=high)
Visitors & seasonal residents
5.87
Racial & ethnic minorities
5.74
Children
5.29
Young families
5.29
Seniors
5.24
Persons with disabilities
4.91
Low income
4.66
Fair
People without health insurance
Score
(0=low,
10=high)
3.45
Poor
None
Note: Excludes “no opinion” responses.
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
68
Community Survey Results
How well are health care needs being met for patients & families
with specific health conditions?
Excellent
None
Very Good
Pregnancy
Score
Good
(0=low,
10=high)
6.71
Score
Fair
(0=low,
10=high)
Score
(0=low,
10=high)
Asthma, COPD,
respiratory diseases
5.85
Alzheimer's disease &
other dementias
3.87
Cancer
5.44
Obesity
3.58
Heart disease
5.21
Mental health conditions
3.11
Diabetes
5.11
Substance abuse &
addictions
2.95
Chronic pain
4.19
Stroke & other
neurological disorders
4.04
Poor
None
Note: Excludes “no opinion” responses.
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
69
Community Survey Results
Health Care Obstacles
A. In the past 12 months, did anyone in your household go without health care services that they needed?
Yes
No
Did Not Answer
Total
# of Responses
52
91
21
164
% of Total
31.7%
55.5%
12.8%
100.0%
B. Please identify the issues that caused you or a member of your household NOT to get the care they
needed during the past 12 months. (Respondents could select more than one answer.)
# of Responses
% of Total
Too expensive
35
35%
Didn’t have health insurance
25
25%
Not satisfied with choice of providers
12
12%
Service wasn’t available locally
11
11%
Couldn’t get a convenient appointment time
5
5%
Didn’t know who to call
3
3%
Didn’t have transportation
1
1%
Language barriers
1
1%
Other
7
7%
Total
100
100.0%
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
70
Community Survey Results
Health Care Obstacles (continued)
C.
What types of health care services were needed but not obtained?
# of Responses
Primary care
20
Specialty care
10
Dental care
8
Diagnostic testing
6
Vision care
2
Prescriptions
2
Surgery/other treatment
2
Mental health services
2
Emergency services
1
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
71
Community Survey Results
How important are these goals & activities to improving overall
health of the population?
Top Quartile
Score
(0=low,
10=high)
2nd Quartile
Score
Score
(0=low,
10=high)
3rd Quartile
(0=low,
10=high
4th Quartile
Score
(0=low,
10=high)
Get prenatal care
9.60
Decrease tobacco use
9.05
Decrease teen pregnancy
8.80
Develop streets & trails
to promote
walking/bicycling
8.04
Decrease substance
abuse
9.38
Improve diet & nutrition
9.04
Get regular eye exams
8.46
Improve access to
healthy foods
7.87
Increase exercise &
physical fitness
9.17
Get routine physicals &
lab work
8.95
Use seat belts & car seats
8.33
Improve access to
recreational facilities
7.67
Get recommended
screening exams
9.15
Get recommended
immunizations
8.89
Improve stress
management skills
8.13
Improve connections
with spiritual care
7.59
Achieve a healthy weight
9.14
Get regular dental
checkups
8.84
Decrease motor vehicle
accidents
8.11
Improve water quality
6.48
Decrease suicides
8.81
Improve community
safety
8.10
Improve air quality
6.08
Note: Excludes “no opinion” responses.
Source: Based on results from online and paper survey advertised by Summit Healthcare and completed by 164 respondents between 9/1/2012 and
11/7/2012. Survey administered by Strategy Connections.
72
Community Survey Results
Demographic Profile of Survey Respondents (n=164)
Sex
# of Responses
% of Total
Zip Code
# of Responses
% of Total
Male
32
19.5%
Show Low
44
26.8%
Female
97
59.2%
Lakeside
22
13.4%
Did Not Answer
35
21.3%
Pinetop
15
9.2%
Total
164
100.0%
Snowflake
11
6.7%
Vernon
7
4.3%
Taylor
6
3.7%
Other Navajo County
14
8.5%
Other Apache County
8
4.9%
Did Not Answer
37
22.5%
Total
164
100.0%
Age
# of Responses
% of Total
Under 18
0
0.0%
18-44
45
27.4%
45-64
72
43.9%
65+
11
6.7%
Did Not Answer
36
22.0%
Total
164
100.0%
Residency
# in Household
# of Responses
% of Total
Full Time Resident
# of Responses
% of Total
121
73.8%
Part Time or Seasonal Resident
0
0%
7
4.3%
1
11
6.7%
2
56
34.2%
Don’t Live Here At All
3-4
43
26.2%
Did Not Answer
36
21.9%
More than 4
19
11.6%
Total
164
100.0%
Did Not Answer
35
21.3%
Total
164
100.0%
73
Community Survey Results
Demographic Profile of Survey Respondents (n=164)
Diversity
# of Responses
% of Total
White non-Hispanic
113
68.9%
Hispanic of any race
10
6.1%
American Indian/Alaska
Native non-Hispanic
4
2.4%
Asian non-Hispanic
1
0.6%
Black non-Hispanic
0
0%
Multi-racial
0
0%
Did Not Answer
36
22.0%
Total
164
100.0%
Health Plans
Group insurance
# of Responses
% of Total
108
57.8%
No coverage
18
9.6%
Individual insurance
8
4.3%
Medicare HMO/PPO
5
2.7%
Traditional Medicare
3
1.6%
AHCCCS/Medicaid
3
1.6%
Indian Health Service
2
1.1%
KidsCare
0
0%
Other coverage
5
2.7%
Did Not Answer
35
18.6%
Total
187
100.0%
Note: Respondents could select multiple answers.
74
75
Appendix H: Community Leader Meeting Attendees
Participant List
Name
Title
Organization
Bowman, Greg
Pastor
Life Church
Bowman, Kassie
Pastor
Life Church
Bradley, Bart
Director of Nursing
Tall Pines Care and Rehab
Bruce, Barbara
President
Summit Healthcare Foundation/White Mountain Radio
Carlyon, Brad
Attorney
Navajo County
Ebert, Thia
Chief Nursing Officer
Summit Healthcare
Forney, Julie
Director
Summit Healthcare Cancer Center
Garrett, Steve
Member
Summit Healthcare Governing Board
Grugel, Kirk
Director
CASA of Navajo County
Head, Brad
Director of Special Operations
Community Counseling Centers
Jacobs, Carolyn
Chief Quality Officer
Summit Healthcare
Jeffries, Nadine
Community Member
Jeffries, Mark
Director
Frontier Communications
Kartchner, Wade
Director
Navajo County Public Health
Kolling, Angie
Chief Marketing & Communications Officer
Summit Healthcare
Lanner, Mary Anne
Branch Manager
Pioneer Title Agency
Lewis, Sandra
Executive Director
Tall Pines Care and Rehab
Loveless, Kurt
Chief Financial Officer
Summit Healthcare
Macedo, Sharon
Community Development Specialist
Matyas, Samuel
Chief Operating Officer
Snowflake Carriage House
76
Appendix H: Community Leader Meeting Attendees
Participant List
(continued)
Name
Title
Organization
McArthur, Ron
Chief Executive Officer
Summit Healthcare
Moore, Hunter
Government Relations Administrator
Navajo County
Nicks, Laura
Director of Care Resources
Summit Healthcare
Northup, Jeff
Chief Medical Officer
Summit Healthcare
Oakes, Jeffrey
Chief Executive Officer
Community Counseling Center
O’Donnell, Crystal
Executive Director
Pinetop-Lakeside Chamber of Commerce
Orth, Susan
Office Manager
Silversword Asset Management
Sandoval, Kathy
Bank Manager
National Bank of Arizona
Smith, Carol
Owner
Bannon Springs Assisted Living Center
Stoner, Julie
Administrative Assistant
Summit Healthcare
Szoke, Jana
Program Manager
NCOG
Tegmeyer, Susan
Executive Director
Show Low Chamber of Commerce
Thompson, Neal
Chairman
Summit Healthcare Governing Board
Tyler, Mary
Assistant Health Director
Navajo County Public Health
Wright, Doug
ER Physician, Chief of Staff
Summit Healthcare
77
78
Appendix I: Additional Information
Health Care Services Available to Meet
Community Health Needs (Area A)
Type of Service(s)
Acute Care Hospital w/ 24 hour ER
Physicians – Primary Care
# of Facilities or
Providers
1
• 16 primary care physicians have active staff privileges at Summit
– family medicine, general internal medicine & pediatrics.
• There are additional primary care physicians (and nonphysicians) who practice in the area but don’t have active staff
privileges at Summit.
15+
• 15 medical subspecialists have active staff privileges at Summit,
including cardiology, oncology, pulmonary medicine and
nephrology.
• There may be additional medical subspecialists who practice in
the area but don’t have active staff privileges at Summit.
20+
• 20 surgeons have active staff privileges at Summit, including
obstetrics & gynecology, general surgery, orthopedics, urology,
vascular surgery, plastic surgery, ENT & pain management.
• There may be additional surgeons who practice in the area but
don’t have active staff privileges at Summit.
Source: Summit Healthcare (3/13/2013)
Physicians – Surgery
Source: Summit Healthcare (3/13/2013)
Federally Qualified Health Center
Source: www.northcountryhealthcare.org
VA Outpatient Clinic
Source: www.phoenix.va.gov
• Summit Healthcare Regional Medical Center
16+
Source: Summit Healthcare (3/13/2013)
Physicians – Medical Subspecialties
Additional Information
1 clinic location
(Show Low) in
Area A
1
• North Country HealthCare
• Show Low VA Health Care Clinic
79
Appendix I: Additional Information
Health Care Services Available to Meet
Community Health Needs (Area A)
Type of Service(s)
Public Health Services
Source: www.navajocountyaz.gov/pubhealth
Urgent Care Centers
# of Facilities
or Providers
Satellites in
Show Low &
Snowflake
1
Additional Information
• Navajo County Public Health Services District
• StatClinix
Source: Google search
Home Health Agencies – Medicare Certified
3
• Summit Healthcare Home Health
• KC’s Home Health Care, LLC
• Focus Care of Arizona, LLC
1
• Show Low Dialysis
2
• Tall Pines Care and Rehab
• Sierra Blanca
1
• Hospice Compassus
Source: www.medicare.gov
Dialysis
Source: www.medicare.gov
Nursing Homes
Source: Navajo County Health Assessment (2012)
Hospice and Palliative Care
Source: Navajo County Health Assessment (2012)
Dentists
≈11
• Several dental clinics in Show Low area
Source: Navajo County Health Assessment (2010)
Mental Health & Substance Abuse
Source: www.samhsa.org
2
• Community Counseling Centers Outpatient
Unit
• Community Counseling Centers at PineView
Psychiatric Hospital
80
Appendix I: Additional Information
Summit’s Role in Addressing Other Identified Needs
Other Community Health Needs
1.
2.
3.
4.
5.
6.
7.
Prenatal care
Services for individuals without health insurance
Exercise and physical fitness
Cancer screening exams
Management of chronic diseases
Specialty physicians
Obesity treatment services
Mean Score (see p. 33
for details)
4.00
3.85
3.81
3.80
3.65
3.35
3.15
During the next three years, Summit will focus on helping to address the top health needs as identified by community
leaders – mental health and substance abuse services. This effort will require a significant commitment of time and
resources to be successful. For the other seven areas listed above, Summit will continue to collaborate with local
physicians as well as other groups and organizations to monitor the issues and assist with resources when it is
consistent with our mission and within our capabilities to do so. We will also consider these community health needs
as we plan various community outreach programs and services.
Summit already plays an active role in monitoring community needs for primary and specialty medical care and in
helping to address gaps as appropriate. We provide discounted care for individuals who qualify. We work with our
physicians and other community organizations to provide and promote screening exams for cancer. We provide
community outreach programs to help people better manage chronic health conditions and maintain a healthy
lifestyle. Can we do more? No doubt. During the next three years, we will continue to evaluate our activities related
to these community health needs and identify opportunities to improve and expand our efforts.
81
Appendix I: Additional Information
Consulting Assistance
Carol Davis offers 22 years of health care consulting and management experience. She engages clients in understanding
their critical strategic issues and implementing collaborative solutions with measurable results. Carol has been recognized
by clients for excellence in customer service, group facilitation, physician relations, board development and project
management.
Community Health Experience
Carol has assisted a number of hospitals with conducting a community health needs assessment and developing a strategic
plan to address identified needs as required for 501(c)(3) hospitals under national health care reform legislation passed in
March 2010. These projects require strong analytic as well as group facilitation skills, along with the ability to customize
each engagement to reflect the organization’s unique mission, capabilities and resources.
Carol’s interest and experience with community health projects is long standing. As a health system executive in 1992, she
persuaded the organization to designate community health improvement as a strategic priority. She championed
community health initiatives both internally as well as across the community to address pressing needs. In 1998, she was
recognized as a Public Health Hero for “efforts to assure primary health care access to low income and uninsured members
of the community.”
Selected community health activities:
 Member of Leadership Council for community-wide initiative for prevention of substance abuse
 Co-founder and President of non-profit organization that successfully expanded access to primary care services
 Co-founder of coalition that completed inaugural community health assessment and improvement plan
 Member of Community Benefit Steering Committee for VHA regional initiative
Strategy Consulting Experience
With experience as an independent consultant as well as with a national health care consulting company, Carol has served
as project leader for over 250 strategy engagements with 85 hospitals and health systems located in 23 states. Areas of
expertise include organizational strategy, hospital-physician integration strategy and community health strategy.
82
Appendix I: Additional Information
Consulting Assistance
Selected consulting engagements:
 Led efforts by a community hospital to implement an integration strategy with independent physicians
 Assessed market potential of building an acute care hospital in an underserved community
 Evaluated market potential of reopening an acute care hospital that had closed due to bankruptcy
 Developed patient volume projections to support building replacement hospitals in rural markets
 Worked with two competing hospitals to explore a potential merger
 Worked with an American Indian tribe to resolve funding issues with the Indian Health Service under a SelfGovernance Compact
Health System Experience
As executive leader for strategic services in a 220 bed regional referral hospital for seven years, Carol was responsible for
strategic planning, business development, marketing, community health improvement and information technology.
Education
Carol earned an M.S. in Health Administration from the University of Colorado at Denver, and a B.M.E. in Music Therapy
from the University of Kansas.
Professional Memberships





American College of Healthcare Executives
Society for Healthcare Strategy and Market Development
Healthcare Financial Management Association
Association for Community Health Improvement
Colorado Health Administration Alumni Association
Additional Information
 Company website: www.strategy-connect.com
 Linked In profile: www.linkedin.com/pub/carol-davis/6/76a/78a/
83
Appendix I: Additional Information
Schedule H References
The Affordable Care Act was passed by Congress and signed into law in March 2010. The legislation contains a new community
health needs assessment (CHNA) standard that a non-profit hospital must meet in order to retain its status as a tax-exempt
charitable organization under Section 501(c)(3) of the Internal Revenue Code. Final regulations for complying with the CHNA
requirement have not yet been issued; the IRS, however, issued draft reporting regulations in December 2011.
IRS Schedule H, Form 990
Reference
Topic
Report Location and/or Suggested Response
Part V, Sec B, Line 1a
Definition of community served by hospital
• Pages 8, 15, 37-38
Part V, Sec B, Line 1b
Demographics of the community
• Pages 9, 39-40
Part V, Sec B, Line 1c
Existing health care facilities and resources within the
community that are available to respond to the health
needs of the community
• Pages 78-79
Part V, Sec B, Line 1d
How data was obtained
• Pages 11-15
Part V, Sec B, Line 1e
Health needs of the community
• Health needs identified in community survey page 18
• Health needs identified from survey + data pages 20, 32
• Health needs prioritized by community leaders page 33
Part V, Sec B, Line 1f
Primary and chronic disease needs and other health
issues of uninsured persons, low income persons and
minority groups
• Health needs identified in community survey page 18
• Health needs identified from survey + data pages 20, 32
• Health needs prioritized by community leaders page 33
Part V, Sec B, Line 1g
Process for identifying and prioritizing community
health needs and services to meet the community
health needs
• Pages 31-34
Appendix I: Additional Information
Schedule H References
IRS Schedule H, Form 990
Reference
Topic
Report Location and/or Suggested Response
Part V, Sec B, Line 1h
Process for consulting with persons representing the
community’s interests
• Community survey page 13
• Community leader meeting page 31
Part V, Sec B, Line 1i
Information gaps that limit the hospital facility’s ability
to assess the community’s health needs
• Secondary data limitations page 11
• Primary data limitations page 13
• Information gaps Area B page 15
Part V, Sec B, Line 2
Tax year the hospital facility last conducted a Needs
Assessment
• FYE December 31, 2013
Part V, Sec B, Line 3
In conducting its most recent Needs Assessment, did
the hospital facility take into account input from public
health experts and persons who represent the
community served by the hospital facility? If yes,
describe in Part VI how the hospital facility took into
account input from persons who represent the
community, and identify the persons the hospital facility
consulted.
• Consulted with Mary Tyler, Assistant Director, Navajo County
Public Health Services District in May 2012 during project
kick-off meetings and again in January 2013 to share
findings. Ms. Tyler also participated in community leader
meeting in February 2013, along with Dr. Wade Kartchner,
Director of Navajo County Public Health Services District.
• Invited broad cross-section of community leaders to
participate in a priority-setting meeting in February 2013.
• Thirty-five people representing 18 organizations participated
in the February 2013 priority-setting meeting. Individuals are
listed by name, title and organization on pages 75-76..
Part V, Sec B, Line 4
Was the hospital facility’s Needs Assessment
conducted with one or more other hospital facilities?
• No
Part V, Sec B, Line 5
Did the hospital facility make its Needs Assessment
widely available to the public? If yes, indicate how.
• Available on hospital website: www.summithealthcare.net
• Available by request from Summit Healthcare administration:
928.537.6399
Appendix I: Additional Information
Schedule H References
IRS Schedule H, Form 990
Reference
Topic
Report Location and/or Suggested Response
Part V, Sec B, Line 6a
Adoption of an implementation strategy to address the
health needs of the hospital facility’s community
• Implementation plan for FY2014 to be developed and
adopted by the end of FY2013 (December 31, 2013)
Part V, Sec B, Line 6f
Adoption of a budget for provision of services that
address the needs identified in the Needs
Assessment
• Budget to support implementation plan for FY2014 to be
developed and adopted by the end of FY2013 (December
31, 2013)
Part V, Sec B, Line 6g
Prioritization of health needs in community
• Pages 31-34
Part V, Sec B, Line 7
Did the hospital facility address all of the needs
identified in its most recently conducted Needs
Assessment? If no, explain in Part VI which needs it
has not addressed and the reasons why it has not
addressed such needs.
• Page 80