Community Health Needs
Assessment
2013
Community Health Needs Assessment 2013
Contents
Introduction ...........................................................................................................................1
Executive Summary .................................................................................................................... 2
Organization Description ........................................................................................................... 3
How the Assessment was Conducted...................................................................................5
Our Community ....................................................................................................................6
Identification and Description of Geographical Community .................................................. 6
Defined Community or Service Area......................................................................................... 6
Community Population and Demographics ............................................................................ 10
Socioeconomic Characteristics of the Community ................................................................. 13
Income and Poverty Characteristics of the Community ...................................................... 13
Employment Status of the Community ............................................................................... 17
Uninsured Status of the Community Education .................................................................. 17
Socio-Economic Characteristics of the Community ........................................................... 18
Educational Status of the Community ................................................................................. 18
Lifestyle Choices of the Community .................................................................................. 19
Violence in the Community ................................................................................................ 20
Summary of Findings ................................................................................................................ 21
Our Community Resources ................................................................................................22
Community Health Care Resources ........................................................................................ 22
Hospitals.............................................................................................................................. 22
Other Licensed Facilities..................................................................................................... 24
Physicians............................................................................................................................ 25
Primary Care Physicians and Family Clinics ...................................................................... 26
Health Department .............................................................................................................. 27
Summary of Findings ................................................................................................................ 27
Our Community Health Status ..........................................................................................28
Primary Health Conditions Responsible for Inpatient Hospitalization ............................... 28
Leading Causes of Death .......................................................................................................... 29
Community Health Needs Assessment 2013
Contents (continued)
Premature Births ....................................................................................................................... 30
Summary of Findings ................................................................................................................ 31
Our Community Mental Health and Substance Abuse ...................................................32
Community Mental Health Care and Substance Abuse Disorder Resources ...................... 33
Leading Risk Factors for Mental Health Disorders ............................................................... 33
Primary Mental Health and Substance Abuse Conditions Responsible for
Inpatient Hospitalization ...................................................................................................... 34
Summary of Findings ................................................................................................................ 35
Our Community’s Voice.....................................................................................................36
General Public Survey Responses ............................................................................................ 37
Physician/Community Leader Survey Responses .................................................................. 38
Summary of Findings ................................................................................................................ 40
Our Community’s Health Outcomes ................................................................................41
Health Statistics and Rankings ................................................................................................ 41
Summary of Findings ................................................................................................................ 43
Our Community’s Health Priorities..................................................................................44
Priority Community Health Needs Identified......................................................................... 44
Community Health Needs Assessment 2013
Introduction
During 2012, a community health needs assessment was conducted by University of Louisville Hospital |
James Graham Brown Cancer Center (ULH | JGBCC) to support its mission to enhance the health of people in the communities it serves, to comply with the Patient Protection and Affordable Care Act of 2010
and federal tax-exemption requirements, and to identify health needs of the community to help prioritize
the allocation of hospital resources to meet those needs. Based on current literature and other guidance
from the Treasury and IRS, the following steps were completed as part of the community health needs assessment:
The “community” served was defined utilizing inpatient data on patient origin. This process is
further described in Community Served by the Hospital.
Population demographics and socioeconomic characteristics of the community were gathered and
reported using various sources (see references in Appendices). The health status of the community
was then reviewed. Information on the leading causes of death and morbidity was analyzed in
conjunction with health outcomes and factors reported for the community by
CountyHealthrankings.org. Health factors with significant opportunity for improvement were
noted.
An inventory of health care facilities and resources was prepared.
Through a collaborative process conducted by the Louisville Metro Department of Public Health
& Wellness, the Kentucky Hospital Association and Louisville area hospitals, community input
was obtained through a series of four public forums held across the county, one forum for community leaders and medical professionals, and through an online survey.
Information gathered in the steps above was analyzed and reviewed to identify health issues of uninsured
persons, low-income persons, minority groups and the community as a whole. Health needs were prioritized utilizing a method that weighs: 1) the size of the problem; 2) the seriousness of the problem;
3) the impact of the problem on vulnerable populations; 4) how important the problem is to the community; 5) prevalence of common themes; 6) how closely the need aligns with the strategies and strengths of the
hospital and KentuckyOne Health; and 7) an evaluation of existing hospital programs responding to the
identified need. Information gaps were identified during the prioritization process and reported.
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Community Health Needs Assessment 2013
Executive Summary
Louisville is conterminous with Jefferson County in the Bluegrass region of Kentucky. As the largest
urban area, Louisville faces many challenges that are unique in a largely rural state. ULH | JGBCC, located
in downtown Louisville, serves a population that faces challenges that no other provider in Kentucky experiences. The ULH | JGBCC CHNA population is Jefferson County, but the areas that provide the most inpatient discharges are located in the downtown, western and southern parts of the county. These areas have
more African-Americans, increased poverty and unemployment, increased drinking, violence and sexually
transmitted infections which are characteristics that serve to separate it from not only the rest of Kentucky,
but also the remainder of the county. With these structural challenges the population that ULH|JGBCC
serves is more likely to have poorer outcomes and a greater likelihood that they will not have the financial
means to properly utilize the healthcare services provided in their community.
Jefferson County ostensibly meets the healthcare needs of its population. However, the resources provided
within the county also serve a much larger region that includes not only the surrounding counties but many
areas further out in the states of Kentucky, Indiana and even into Tennessee, Ohio, Illinois and beyond.
However, the primary area which ULH | JGBCC serves does not have adequate health care resources with
a lack of primary care physicians, health clinics, emergency care and other vital implements needed to
promote and ensure the health of the community. Moving forward to the era of primary care will only exacerbate these disparities as those in our community who need the services the most will have limited or no
access to preventative or maintenance care.
Louisville and Jefferson County have higher rates of preterm birth, diabetes, heart disease, malignant neoplasms, cerebrovascular disease and substance abuse disorders than the national rates which can put further
strains upon the health care delivery system both in costs, utilization of services and the detrimental impact
on community health. These health factors have been identified as needs to be managed and focused upon
by the health care providers in Louisville and Jefferson County. Managing these will benefit the overall
health of the community through increased productivity, attendance and participation.
Though we know that there are health care needs that are not adequately being addressed in Louisville and
Jefferson County one primary concern is the health literacy of the community and providing it with the
knowledge to effectively use the resources that are available - both in care providance and financial assistance.
The efforts of ULH | JGBCC will be focused primarily on meeting the needs of our CHNA Community
through focusing on Access and Health Care Disparities, Access to Primary Care, Chronic Diseases,
Leading Causes of Death, Risky Lifestyles, Psychiatric, Emotional & Substance Abuse Disorders and
Prematurity & Low Birth Weight.
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Community Health Needs Assessment 2013
Organization Description
University of Louisville Hospital, a 404-licensed-bed facility, is
the leading academic medical center in the area and offers the
benefits of the latest research, equipment and expertise. It is also
home to the region’s only Level 1 Adult Trauma Center and adult
burn unit. The hospital is also the first nationally accredited
Comprehensive Stroke Center in Kentucky.
Rooted in nearly two centuries of service to the community, University Hospital has a rich history of providing extraordinary patient care and conducting leading-edge research. Today, the organization’s direct tie to the UofL Health Sciences Center attracts
millions of research dollars to improve health care and educate
physicians. This high level of achievement offers patients unmatched access to innovative and specialized treatment options
that are unavailable elsewhere in the region.
The James Graham Brown Cancer Center opened in 1981 with the purpose of addressing the exceptionally
high cancer rates experienced by the people of Kentucky. Its mission is to relieve Kentuckians’ disproportionate burden of pain and suffering caused by this disease, through state-of-the-art clinical, research, education and outreach programs. During the past 30 years, the Brown Cancer Center has also become home
to some of the best cancer scientists and physicians in the world.
The James Graham Brown Cancer Center is a national leader in the provision of multidisciplinary cancer
care, in which patients benefit (medically and practically) from a team of physicians and caregivers from
every applicable field working together to plan, coordinate and provide care.
ULH | JGBCC has long been on the leading edge of developments and accolades in key service areas:
First Trauma Center in the Nation
First Certified Primary Stroke Center in Kentucky
First to achieve American Heart Association “Stroke Honor Roll” in Kentucky
First Nationally Accredited Comprehensive Stroke Center in Kentucky
First Level IV Epilepsy Center in Kentucky
First Nationally Accredited Breast Center in Kentucky
First Nationally Accredited Radiation Oncology Program in Louisville
First to provide true multidisciplinary cancer care in Kentucky
First and only Blood and Marrow Transplantation Program in Louisville
First and only statewide education leader in Kangaroo Care
ULH | JGBCC is committed to the provision of the highest quality patient- and family-centered care regardless of economic status. The hospital and cancer center provided more than $91 million of charity care
in 2011, representing just part of $158 million in community benefit programs that year. ULH | JGBCC is
the largest provider of charity care in Kentucky.
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Community Health Needs Assessment 2013
On March 1, 2013, ULH | JGBCC became a part of KentuckyOne Health through a Joint Operating
Agreement announced in November 2012. KentuckyOne Health is committed to improving the health of
Kentuckians by integrating medical research, education, technology and health care services wherever patients receive care. KentuckyOne Health has nearly 200 locations including hospitals, physician groups,
clinics, primary care centers, specialty institutes and home health agencies, with more than 15,000 employees across Kentucky and southern Indiana.
We bring hope, improve health and change lives.
Inspired by our Catholic and Jewish faith heritage, we:
- Serve with a spirit of innovation and collaboration
- Transform health care delivery
- Partner to create healthy communities
- Advocate for a just health system
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Community Health Needs Assessment 2013
How the Assessment was Conducted
ULH | JGBCC is part of KentuckyOne Health which collaborated with the Louisville Metro Department of
Public Health and Wellness (LMDPHW), the Kentucky Hospital Association and other Louisville area
hospitals to conduct the Community Health Needs Assessment. Other hospital systems that participated
included: Baptist Hospital East, Norton Healthcare and Jewish Hospital.
Four community forums were held in March 2012 at sites in each quadrant of Jefferson County. Members
of the general public were asked to complete a survey on their perceptions of the city’s health care needs.
The data gained from these forums was utilized to inform the entire process.
A fifth forum was conducted by LMDPHW Director Dr. LaQuandra Nesbitt on March 29, 2012 at the
Greater Louisville Medical Society tailored to gather input from community leaders, physicians and other
health professionals. It was attended by 40 individuals representing a wide array of expertise including
Bill Wagner, Executive Director of the Family Health Centers, Inc., Jay Davidson, Executive Director of
The Healing Place, and leaders from an array of health and human service agencies that serve low-income
and minority populations.
In addition, secondary data was compiled from demographic and socioeconomic sources as well as national, state and local sources of information on disease prevalence, health indicators, health equity and mortality.
Page 5
Community Health Needs Assessment 2013
Our Community
Identification and Description of Geographical Community
Louisville is a major city—the largest in the state of Kentucky and the county seat of Jefferson County. As
of 2010, the Louisville metropolitan statistical area (MSA) had a population of 1,307,647 ranking it 42nd
in size nationally. The metro area includes Louisville-Jefferson County and 12 surrounding counties, eight
in Kentucky and four in Southern Indiana. Louisville is southeasterly situated along the border between
Kentucky and Indiana, the Ohio River, in north-central Kentucky at the Falls of the Ohio. The Louisville
metropolitan area is often referred to as Kentuckiana because it includes counties in Southern Indiana.
Defined Community or Service Area
For the purposes of this document, a community is defined as the geographic area from which 60 percent
of the patients utilizing hospital services reside. While the community health needs assessment considers
other types of health care providers, hospitals are the single largest provider of acute care services. For
this reason, the utilization of hospital services provides the clearest definition of the community.
Because almost 65 percent of ULH | JGBCC inpatient discharges originate in Jefferson County, it
collaborated with the Louisville Metro Department of Public Health & Wellness (LMDPHW) in
conducting its community health needs assessment. Though ULH | JGBCC has a nominal presence in
other counties such as Bullitt and Clark (IN), we consider Jefferson County to be our primary service
area and the CHNA Community.
ULH | JGBCC defines its service area for this community health needs assessment based on where the
majority of its inpatients reside. Based on the patient origin of inpatient discharges from January 1, 2011
to December 31, 2011, management has identified the community as listed on Exhibit 1. It is followed by
a map Exhibit 1A showing ULH | JGBCC’s geographic location and the footprint of the community
identified in Exhibit 1 which includes Jefferson, Bullitt and Clark (IN) counties. The map displays the
hospital’s defined community, identifies the zip codes that comprise this community, and illustrates its
geographic relationship to surrounding counties, significant roads and highways. A demographic snapshot
for Jefferson County is provided in Exhibit 2. Exhibits 3 through 8 show additional corresponding
demographic information for the top zip codes identified as the ULH | JGBCC CHNA Community.
When specific information is not available by zip code, this community health needs assessment relies on
county-level data.
Though the ULH | JGBCC CHNA Community covers the majority of Jefferson County, there are eight zip
codes in particular that represent 34 percent of total inpatient admissions for 2011 where ULH | JGBCC
feels it can make the most impact. They are shaded in Exhibit 1 and in the map in Exhibit 1B.
Page 6
Community Health Needs Assessment 2013
Exhibit 1
University of Louisville Hospital CHNA Community
Summary of Inpatient Discharges by Zip Code (Descending Order)
1/1/11- 12/31/11
Percent
of Total
Zip Code
City
County
40203
40211
40212
40214
40216
40210
40218
40202
40219
40215
40272
40208
40258
40229
47130
40213
40206
40204
40165
40220
40291
40299
40217
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Jeffersonville, IN
Louisville, KY
Louisville, KY
Louisville, KY
Shepherdsville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Louisville, KY
Other Jefferson
Other Bullitt
All Other
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Clark
Jefferson
Jefferson
Jefferson
Bullitt
Jefferson
Jefferson
Jefferson
Jefferson
Discharges
1,259
960
822
778
690
665
597
595
566
561
490
358
320
305
287
286
269
261
249
249
243
227
225
1,387
156
5,880
18,685
Discharges
6.7%
5.1%
4.4%
4.2%
3.7%
3.6%
3.2%
3.2%
3.0%
3.0%
2.6%
1.9%
1.7%
1.6%
1.5%
1.5%
1.4%
1.4%
1.3%
1.3%
1.3%
1.2%
1.2%
7.4%
0.8%
31.5%
100.0%
Page 7
Community Health Needs Assessment 2013
Exhibit 1A
Page 8
Community Health Needs Assessment 2013
Exhibit 1B (Top Eight Key Zip Codes are shaded)
Page 9
Community Health Needs Assessment 2013
Community Population and Demographics
The Community Population and Demographics snaphot is displayed in Exhibit 2. The demographic data
for Jefferson County has lower income overall when compared to the United States average for income
distribution with a higher percentage of households making less than $50,000 a year (27.43% versus
23.20%) and a lower percentage of households making more than $75,000 a year (26.37% versus 34.30%).
Additionally, the racial mix for the community is much different than the United States as a whole with a
larger white non-hispanic population and black non-hispanic population. However, the Hispanic population is much smaller (2.67% versus 16.34%) than the overall United States.
The U.S. Census Bureau has compiled population and demographic data based on the 2010 census. SRC
Demographics, a firm specializing in the analysis of demographic data, has extrapolated this data to
estimate population trends from 2011 through 2016.
Exhibit 2
2011 Demographic Snapshot
University of Louisville Hospital CHNA Community
DEMOGRAPHIC CHARACTERISTICS
Selected
Area
USA
779,931 311,591,919
834,559 314,793,000
7.00%
1.03%
2011 Total Population
2016 Total Population (est)
% Change 2011 - 2016
POPULATION DISTRIBUTION
Age Distribution
% of
% of
Total
2016
Total
23.30% 194,785 23.34%
36.18% 302,402 36.23%
27.26% 227,123 27.21%
13.25% 110,249 13.21%
Age Group
0 -17
18 - 44
45 - 64
Over 65
2011
181,735
282,196
212,639
103,361
Total
779,931 100.00%
834,559 100.00%
USA 2011
% of Total
24.00%
36.50%
26.40%
13.10%
100.00%
2011
2016 % Change
Total Male Population
374,973 401,294
7.02%
Total Female Population 404,958 433,265
6.99%
HOUSEHOLD INCOME DISTRIBUTION
Income Distribution
% of USA 2011
2011 Household Income HH Count Total % of Total
<$10K
29,346
9.13%
7.10%
$10 - 25K
58,815 18.30%
16.10%
$25 - 50K
88,762 27.61%
24.20%
$50 - 75K
59,780 18.60%
18.30%
$75 - 100K
34,645 10.78%
12.40%
Over $100k
50,098 15.59%
21.90%
Total
321,446 100.00% 100.00%
RACE/ETHNICITY
Race/Ethnicity
White Non-Hispanic
Black Non-Hispanic
Hispanic
Asian
All Others
Total
Race/Ethnicity Distribution
% of
USA
2011 Pop. Total
% of Total
573,070 73.48%
65.07%
156,974 20.13%
12.60%
20,858
2.67%
16.34%
17,009
2.18%
4.96%
11990
1.54%
1.03%
779,901 100.00%
100.00%
Includes: Jefferson county, KY
Source: SRC Demographics
Page 10
Community Health Needs Assessment 2013
Exhibit 3 illustrates that the overall population is projected to increase over a five-year period from
548,704 in 2011 to 588,220 (from Exhibit 3A), or 7.2 percent. The cohort of people who utilize health care
services the most, those ages 65 years and over, are projected to increase 7.1 percent, from 68,860 to
73,738. The projected change to the composition of the total community of males and females is projected
to remain approximately the same.
However, for the top eight zip codes that ULH | JGBCC serves, the overall population is projected to see
an 8.1 percent increase. For these eight zip codes, the over 65 cohort is projected to increase 7.6 percent.
Both of these increases are larger than the general ULH | JGBCC CHNA Community.
Exhibit 3
University of Louisville Hospital CHNA Community
Estimated 2011 Population
Zip Code
City
40203
Louisville, KY
40211
Louisville, KY
40212
Louisville, KY
40214
Louisville, KY
40216
Louisville, KY
40210
Louisville, KY
40218
Louisville, KY
40202
Louisville, KY
40219
Louisville, KY
40215
Louisville, KY
40272
Louisville, KY
40208
Louisville, KY
40258
Louisville, KY
40229
Louisville, KY
40213
Louisville, KY
40206
Louisville, KY
40204
Louisville, KY
40220
Louisville, KY
40291
Louisville, KY
40299
Louisville, KY
40217
Louisville, KY
PROVIDER SERVICE AREA
County
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
PROVIDER SERVICE AREA
(Projected 2016 Population)
Source: SRC Demographics
Under
17 years
18-44
years
45-64
years
65 years
and over
Total
Male
Female
5,115
6,631
4,837
11,298
9,855
4,226
7,740
756
8,787
6,208
9,053
2,558
6,628
9,546
3,840
3,127
2,010
6,610
8,736
9,467
2,094
129,122
8,536
7,446
5,929
17,994
13,924
5,361
11,940
2,441
13,506
8,430
12,567
7,885
9,253
13,921
6,335
8,196
6,928
12,008
13,251
13,165
5,678
204,694
5,011
6,152
4,902
12,492
11,859
3,981
7,905
1,739
9,380
5,918
10,009
2,972
7,193
8,610
4,581
5,458
3,932
9,283
10,066
11,147
3,438
146,028
2,330
2,957
1,987
5,836
5,873
1,800
3,913
421
5,285
2,183
5,094
855
3,710
3,412
2,290
2,569
1,663
5,700
4,537
4,932
1,513
68,860
20,992
23,186
17,655
47,620
41,511
15,368
31,498
5,357
36,958
22,739
36,723
14,270
26,784
35,489
17,046
19,350
14,533
33,601
36,590
38,711
12,723
548,704
10,560
10,080
8,149
23,815
19,730
6,936
14,344
3,057
17,211
10,844
18,038
7,288
13,125
17,182
8,317
9,192
7,101
16,125
17,929
18,672
6,397
264,092
10,432
13,106
9,506
23,805
21,781
8,432
17,154
2,300
19,747
11,895
18,685
6,982
13,659
18,307
8,729
10,158
7,432
17,476
18,661
20,039
6,326
284,612
138,620
219,650
156,212
73,738
588,220
283,148
305,072
Page 11
Community Health Needs Assessment 2013
Exhibit 3A
University of Louisville Hospital CHNA Community
Projected 2016 Population
Zip Code
City
40203 Louisville, KY
40211 Louisville, KY
40212 Louisville, KY
40214 Louisville, KY
40216 Louisville, KY
40210 Louisville, KY
40218 Louisville, KY
40202 Louisville, KY
40219 Louisville, KY
40215 Louisville, KY
40272 Louisville, KY
40208 Louisville, KY
40258 Louisville, KY
40229 Louisville, KY
40213 Louisville, KY
40206 Louisville, KY
40204 Louisville, KY
40220 Louisville, KY
40291 Louisville, KY
40299 Louisville, KY
40217 Louisville, KY
PROVIDER SERVICE AREA
County
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Under
17 years
5,520
7,172
5,168
12,206
10,486
4,725
8,632
899
9,419
6,659
9,713
2,880
6,942
10,064
4,027
3,307
2,203
6,937
9,283
10,125
2,253
138,620
18-44
years
9,320
7,987
6,311
19,327
14,784
6,007
13,261
2,667
14,485
9,039
13,457
9,018
9,695
14,643
6,638
8,653
7,507
12,532
14,118
14,107
6,094
219,650
45-64
years
5,487
6,613
5,233
13,433
12,521
4,372
8,714
1,877
10,062
6,347
10,743
3,313
7,545
9,031
4,814
5,754
4,277
9,723
10,768
11,930
3,655
156,212
65 years
and over
2,560
3,184
2,130
6,279
6,199
1,941
4,270
459
5,722
2,346
5,514
932
3,911
3,605
2,402
2,728
1,798
5,919
4,893
5,350
1,596
73,738
Total
22,887
24,956
18,842
51,245
43,990
17,045
34,877
5,902
39,688
24,391
39,427
16,143
28,093
37,343
17,881
20,442
15,785
35,111
39,062
41,512
13,598
588,220
Male
11,515
10,850
8,714
25,637
20,927
7,712
15,867
3,319
18,475
11,635
19,348
8,326
13,767
18,093
8,727
9,702
7,694
16,866
19,110
20,021
6,843
283,148
Female
11,372
14,106
10,128
25,608
23,063
9,333
19,010
2,583
21,213
12,756
20,079
7,817
14,326
19,250
9,154
10,740
8,091
18,245
19,952
21,491
6,755
305,072
Source: SRC Demographics
Page 12
Community Health Needs Assessment 2013
Exhibit 4 shows the population of the community by race by illustrating three different categories: white,
black and other residents. This table does not examine ethnicity. In total, the population breakdown for the
community shows a higher percentage of black residents compared to the state of Kentucky and the United
States. The top eight zip codes for our community have a racial mix of 46.9 percent white and 46.5
percent black for 2011 changing to 48.0 percent white and 45.5 percent black in 2016 as projected by SRC
Demographics.
Exhibit 4
University of Louisville Hospital CHNA Community
Estimated 2011 Population vs Projected 2016 Population With Percent Difference
Zip Code
City
White
Estimated 2011
Black
Other
Total
White
Projected 2016
Black
Other
Total
Percent Total
(based on Projected)
White Black Other
40203
Louisville, KY
40211
Louisville, KY
40212
Louisville, KY
40214
Louisville, KY
40216
Louisville, KY
40210
Louisville, KY
40218
Louisville, KY
40202
Louisville, KY
40219
Louisville, KY
40215
Louisville, KY
40272
Louisville, KY
40208
Louisville, KY
40258
Louisville, KY
40229
Louisville, KY
40213
Louisville, KY
40206
Louisville, KY
40204
Louisville, KY
40220
Louisville, KY
40291
Louisville, KY
40299
Louisville, KY
40217
Louisville, KY
PROVIDER SERVICE AREA
7,417
960
6,540
35,170
25,073
1,883
16,482
1,803
25,619
13,723
33,708
8,406
22,902
31,619
12,562
16,376
12,306
26,287
30,869
33,451
11,019
374,175
12,659
21,633
10,590
6,888
14,505
12,966
12,049
3,215
7,845
7,145
1,508
4,835
2,864
2,240
3,181
1,884
1,615
4,876
3,765
3,173
959
140,395
913
598
527
5,562
1,943
516
2,971
338
3,494
1,866
1,505
1,031
1,016
1,627
1,301
1,085
613
2,432
1,958
2,077
740
34,113
20,989
23,191
17,657
47,620
41,521
15,365
31,502
5,356
36,958
22,734
36,721
14,272
26,782
35,486
17,044
19,345
14,534
33,595
36,592
38,701
12,718
548,683
8,532
1,585
7,104
38,252
26,852
2,524
18,553
2,019
27,601
15,016
36,253
9,660
24,131
33,331
13,296
17,395
13,287
27,661
33,064
35,966
11,791
403,873
13,345
22,677
11,162
7,200
15,086
13,913
13,007
3,515
8,392
7,396
1,586
5,347
2,916
2,324
3,253
1,914
1,839
4,970
3,949
3,354
1,011
148,156
1,009
695
577
5,791
2,057
601
3,314
365
3,695
1,978
1,588
1,143
1,046
1,686
1,333
1,126
662
2,483
2,051
2,187
794
36,181
22,886
24,957
18,843
51,243
43,995
17,038
34,874
5,899
39,688
24,390
39,427
16,150
28,093
37,341
17,882
20,435
15,788
35,114
39,064
41,507
13,596
588,210
37.3%
6.4%
37.7%
74.6%
61.0%
14.8%
53.2%
34.2%
69.5%
61.6%
91.9%
59.8%
85.9%
89.3%
74.4%
85.1%
84.2%
78.8%
84.6%
86.7%
86.7%
68.7%
58.3%
90.9%
59.2%
14.1%
34.3%
81.7%
37.3%
59.6%
21.1%
30.3%
4.0%
33.1%
10.4%
6.2%
18.2%
9.4%
11.6%
14.2%
10.1%
8.1%
7.4%
25.2%
4.4%
2.8%
3.1%
11.3%
4.7%
3.5%
9.5%
6.2%
9.3%
8.1%
4.0%
7.1%
3.7%
4.5%
7.5%
5.5%
4.2%
7.1%
5.3%
5.3%
5.8%
6.2%
Kentucky (1,000s)
U.S. (1,000s)
3,769
196,201
342
38,662
293
79,999
4,404
314,862
3,815
195,933
354
40,292
342
89,098
4,511
325,322
84.6% 7.8% 7.6%
60.2% 12.4% 27.4%
Source: SRC Demographics
Socioeconomic Characteristics of the Community
The socioeconomic characteristics of a geographic area influence the way residents access health care
services and perceive the need for them. The economic status of an area may be assessed by examining
multiple variables within the community. The following exhibits are a compilation of data that includes
household income, poverty, unemployment rates and educational attainment for the community served by
the hospital. These standard measures will be used to compare the socioeconomic status of the counties
served internally as well as to the state.
Income and Poverty Characteristics of the Community
Exhibit 5 presents the median household income poverty rate and unemployment rate in each zip code.
Median household incomes range from $15,809 to $71,310. Shaded zip codes have median household
income below the federal poverty level for a family of four. These zip codes are among the top eight
sources for inpatient admissions. The zip codes that comprise the ULH | JGBCC CHNA Community have
percentages of population in poverty that is lower than the state average, though higher than the national
Page 13
Community Health Needs Assessment 2013
average and unemployment rates that are unfavorable compared to both state and national averages. The
top eight zip codes that ULH | JGBCC serves had a median household income of just $31,330 with 28.1
percent of the population in poverty and 15.6 percent of the population unemployed. These factors are
significantly worse than for the CHNA Community as a whole and for Kentucky and the United States.
Zip Code
Exhibit 5
University of Louisville Hospital CHNA Community
Median Household Income, Poverty and Unemployment Rates of Community
2011
Median
Population
Household
in
City
State
County
Income
Poverty
40203
Louisville
40211
Louisville
40212
Louisville
40214
Louisville
40216
Louisville
40210
Louisville
40218
Louisville
40202
Louisville
40219
Louisville
40215
Louisville
40272
Louisville
40208
Louisville
40258
Louisville
40229
Louisville
40213
Louisville
40206
Louisville
40204
Louisville
40220
Louisville
40291
Louisville
40299
Louisville
40217
Louisville
PROVIDER SERVICE AREA
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
KY
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Kentucky
United States
Unemployment
Rate
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
15,809
23,289
26,712
40,359
39,513
18,490
34,177
18,584
39,586
25,313
46,955
25,641
47,854
51,169
38,475
44,433
44,833
52,170
61,266
71,310
41,204
51.30%
37.70%
34.30%
18.30%
17.40%
43.90%
20.60%
43.40%
18.30%
35.80%
13.30%
39.00%
9.40%
9.70%
22.00%
13.20%
15.30%
7.20%
7.90%
5.50%
18.30%
23.00%
22.20%
21.90%
11.50%
12.00%
24.20%
10.40%
6.60%
11.60%
23.50%
10.40%
11.60%
7.90%
9.90%
10.00%
7.10%
6.60%
5.80%
7.10%
5.00%
8.90%
$
41,988
19.44%
11.67%
$
$
41,141
52,762
19.10%
14.30%
10.40%
8.70%
Median household income below 2012 Federal Poverty Level for a family of tw o adults and tw o children.
Source: US Census (Amercian Community Survey 1-Year Estimate)
To assess health issues impacting those people in the community who are low-income, uninsured or from
minority groups, ULH | JGBCC reviewed the Louisville Metro Health Equity Report issued in 2011 by the
LMDPHW and its Center for Health Equity. According to the report:
Louisvillians in the lower-income neighborhoods have lower life expectancies, sometimes by as
much as 10 years shorter than the overall Louisville Metro life expectancy.
Page 14
Community Health Needs Assessment 2013
Louisville residents ages 40-65 who earn less than $20,000 annually are significantly more likely
to report that they have had a heart attack.
The following charts are excerpted from the LMDPHW 2011 Health Equity Report:
Page 15
Community Health Needs Assessment 2013
The map below shows percentage of families earning less than $15,000 a year by neighborhood for Jefferson County. The neighborhoods of California-Parkland, Russell, Phoenix Hill-Smoketown-Shelby Park,
Algonquin-Park Hill-Park Duvalle, Portland, Downtown-Old Louisville-University, South Central Louisville, Chickasaw-Shawnee and Buechel-Newburg-Indian Trail all have percentages at 20 percent or more
and all fall within not only the ULH | JGBCC CHNA Community, but largely within the top eight priority
zip codes that were identified.
Page 16
Community Health Needs Assessment 2013
Employment Status of the Community
Exhibit 6 presents the average annual resident unemployment rates for Jefferson county. Jefferson County
has seen increasing unemployment over the past 5 years and has a higher unemployment rate than Kentucky and national rates.
Unemployment Rate (%)
Unemployment Rates (%)
14.0%
12.0%
10.0%
8.0%
Jefferson, KY
Kentucky
6.0%
United States
Exhibit 6
University of Louisville Hospital CHNA Community
Unemployment Rates (%)
2007-2011
County
2007
2008
2009
2010
2011
4.0%
Jefferson, KY
Kentucky
United States
2.0%
0.0%
2007
2008
2009
2010
6.8%
6.6%
6.3%
7.0%
6.9%
6.4%
10.4%
10.1%
9.9%
11.4%
11.2%
10.8%
11.8%
10.4%
10.3%
2011
Source : US Census
Uninsured Status of the Community
Exhibit 7 presents health insurance coverage status by age (under 65 years) and income (at or below 400
percent of poverty) for each county compared to the state of Kentucky. According to the U.S. Census,
Small Area Health Insurance Estimates (SAHIE), an additional 91,745 patients (or 90 percent of the total
uninsured population) in the ULH | JGBCC CHNA Community who now do not qualify for insurance will
soon be able to participate due to the expansion of coverage as outlined by the Patient Protection and
Affordable Care Act (PPACA) of 2010.
Exhibit 7
University of Louisville Hospital CHNA Community
Health Insurance Coverage Status by Age (Under 65 years) and Income (At or Below 400%) of Poverty
2010
All Incom e Levels
Under 65
Area
Jefferson, KY
Kentucky
Percent
Uninsured Uninsured
101,366
640,974
16.1%
17.5%
At or Below 400% of FPL
Under 65
Percent
Insured
Insured
529,450
3,012,207
83.9%
82.5%
Under 65
Percent
Uninsured Uninsured
91,745
585,339
22.1%
22.4%
Under 65
Percent
Insured
Insured
323,697
2,032,203
77.9%
77.6%
Source: US Census, SAHIE
Page 17
Community Health Needs Assessment 2013
Socio-Economic Characteristics of the Community
Other areas to examine with regards to socio-economic factors are listed in the table below. Jefferson
County fared comparably to the state average for citizens without adequate social support as well as the
percent of population that live close to healthy food stores and with regards to access to recreational
facilities. Jefferson County had a larger percent of children in single-parent households than the state
average and is more than double the national benchmark (41 percent versus 20 percent) and has a higher
percentage of fast food restaurants than the state average and are much higher than the national
benchmark.
Exhibit 8
University of Louisville Hospital CHNA Community
Health Factors (2012)
Jefferson
County
Social & Economic Factors
Inadequate social support - Percent of adults without
social/emotional support
19.0%
Children in single-parent households - Percent of children that
live in household headed by single parent
Limited access to healthy foods - Percent of population who
are low-income and do not live close to a grocery store
Access to recreational facilities - Rate of recreational
facilities per 100,000 population
Fast food restaurants - Percent of all restaurants that are fastfood establishments
Violent crime rate - Deaths due to homicide per 100,000
population (age-adjusted)
National
Benchmark
KY
20.0%
14.0%
41.0%
32.0%
20.0%
5.0%
7.0%
0.0%
10
8
55.0%
54.0%
646
288
16
25.0%
73
Source: Countyhealthrankings.org
Educational Status of the Community
The educational attainment of community residents typically impacts the local economy. Higher levels of
education generally lead to higher wages, less unemployment and job stability. These factors may
indirectly influence community health. Exhibit 9 indicates Jefferson County residents obtain a bachelor’s
degree or higher at rates greater than state and national averages. This information is based upon Jefferson
County and is not based upon zip code.
Exhibit 9
University of Louisville Hospital CHNA Community
Educational Attainment by County - Ages 25 and Over
High School
Bachelor's Degree
County/State
Graduates
or Higher
Jefferson, KY
Kentucky
United States
86.90%
81.00%
85.00%
28.50%
20.30%
27.90%
Source: U.S. Census Bureau, Current Population Survey
Page 18
Community Health Needs Assessment 2013
Lifestyle Choices of the Community
Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior, human
biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health
care and medical services. Studies by the American Society of Internal Medicine conclude that up to 70
percent of an individual’s health status is directly attributable to personal lifestyle decisions and attitudes.
People who do not smoke, who drink in moderation (if at all), use automobile seat belts (car seats for
infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily
living and exercise regularly have a significantly greater potential of avoiding debilitating diseases,
infirmities and premature death.
Unfortunately, for most lifestyle choices that are considered risky, Jefferson County fares poorly when
compared to the national benchmarks. Jefferson County notably fares poorly for Excessive Drinking and
Sexually Transmitted Infections when compared to the state average and the national benchmarks. One
positive is that the Motor Vehicle Crash Death Rate for Jefferson County is well below the state average
and is very near to the national benchmark even with the large network of interstate highways.
Additionally, the Teen Birth Rate for Jefferson County is similar to the state average, but is more than
twice the national benchmark.
Exhibit 10
University of Louisville Hospital CHNA Community
Health Factors (2012)
Jefferson
County
Health Behaviors
Adult smoking - Percent of adults that report smoking at least
100 cigarettes and that they currently smoke
Adult obesity - Percent of adults that report a BMI >= 30
Physical inactivity - Percent of adults aged 20 and over
reporting no leisure time physical activity
Excessive drinking - Percent of adults that report excessive
drinking in the past 30 days
Motor vehicle crash death rate - Motor vehicle deaths per
100K population
Sexually transmitted infections - Chlamydia rate per 100K
population
Teen birth rate - Per 1,000 female population, ages 15-19
National
Benchmark
KY
24.0%
34.0%
27.0%
33.0%
14.0%
25.0%
29.0%
31.0%
21.0%
14.0%
10.7%
8.0%
13
22
12
568
51
311
52
84
22
Source: Countyhealthrankings.org
Page 19
Community Health Needs Assessment 2013
Violence in the Community
With a violent crime rate of 504 per 100,000 residents, Jefferson County has one of the highest crime rates
in America compared to all communities of all sizes—from the smallest towns to the very largest cities.
This Violent Crime Rate is more than twice the state average. Areas of particular concern include Aggravated Assault, Burglary, Larceny and Theft, Motor Vehicle Theft, Murder and Robbery which all
have rates much higher than the state average and national averages.
Exhibit 11
University of Louisville Hospital CHNA Community
Incidents
2010 Crime (Actual Data)* per 100,000
Louisville Metro
Kentucky
Aggravated Assault
Arson
Burglary
Forcible Rape
Larceny and Theft
Motor Vehicle Theft
Murder and Manslaughter
Robbery
Crime Rate (Total Incidents)
Property Crime
Violent Crime
249.6
30.1
1,021.6
30.9
2,699.4
266.5
7.0
216.3
4,426.4
3,987.5
503.9
120.1
N/A
698.5
31.8
1,709.7
143.1
4.3
86.4
2,793.9
2,551.3
242.6
USA
243.5
18.2
703.2
26.8
1976.9
229.6
4.7
117.1
3243.37
2851.17
392.2
Source: CityRating.com http://www.cityrating.com/crime-statistics
Page 20
Community Health Needs Assessment 2013
Summary of Findings
As part of the largest urban area in a largely rural state, ULH | JGBCC CHNA Community has several
characteristics that serve to separate it from not only the rest of Kentucky, but also the remainder of
Jefferson County. Specifically, the ULH | JGBCC CHNA Community has more African-Americans,
increased poverty and unemployment, increased drinking, violence and sexually transmitted infections. As
such, the CHNA Community faces many structural demographic and socioeconomic challenges that will
need to be kept in consideration during the construction of the implementation plan. It is understood that
little can be done to change these factors, but their impact cannot be underestimated and will serve as the
underlying foundation for the work to come.
Page 21
Community Health Needs Assessment 2013
Our Community Resources
Community Health Care Resources
The availability of health care resources is critical to the health of a county’s residents and a measure of
the soundness of the area’s health care delivery system. An adequate number of health care facilities and
health care providers is vital to sustain a community’s health status as fewer health care facilities and
health care providers can impact the timely delivery of services. A limited supply of health resources,
especially providers, results in the limited capacity of the health care delivery system to absorb charity and
indigent care as there are fewer providers upon which to distribute the burden of indigent care. The next
section addresses the availability of health care resources to the residents of ULH | JGBCC service area.
Hospitals
There are a large number of hospitals in ULH | JGBCC service area with 2,656 acute care beds, 491
psychiatric beds, 164 physical rehabilitation beds, 47 long-term care beds, 165 neo-natal beds and 24
chemical dependency beds that are staffed. Exhibit 12 summarizes hospital services available to the
residents of our service area. For this assessment, we will not be considering government-run facilities
such as Central State Hospital and VA Hospital – Louisville. Following the table is a map showing the
location of each Hospital within Jefferson County.
According to the 2010 – 2012 State Health Plan (Kentucky), the Jefferson County area has sufficient
Acute Care, Psychiatric, Long-term, Physical Rehabilitation, and Neo-Natal beds to meet the health care
needs of the community as granted by the licensing aspect of the Certificate of Need process.
Facility
Baptist Hospital East
Jewish Hospital & St Mary's Healthcare (KentuckyOne)
Frazier Rehab (KentuckyOne)
Kindred Hospital - Louisville
Norton Audubon Hospital
Norton Brownsboro Hospital
Norton Hospital / Kosair Children's Hospital
Norton Suburban Hospital
Our Lady of Peace (KentuckyOne)
Saints Mary and Elizabeth Hospital (KentuckyOne)
The Brook Hospital
The Brook Hospital Dupont
University of Louisville Hospital (KentuckyOne)
Exhibit 12
University of Louisville Hospital CHNA Community
Summary of Area Hospitals
Staffed
Staffed
Staffed
Acute
Psychiatric
Long-Term
Facility Type
Beds
Beds
Beds
Short Term Acute Care
Short Term Acute Care
Physical Rehabilitation
Long Term
Short Term Acute Care
Short Term Acute Care
Short Term Acute Care
Short Term Acute Care
Psychiatric
Short Term Acute Care
Psychiatric
Psychiatric
Short Term Acute Care
Staffed
Staffed
Staffed
Physical Rehab Neo-Natal Chemical Dep.
Beds
Beds
Beds
468
412
262
98
579
364
164
309
22
20
24
243
86
76
20
30
117
-
29
79
-
4
97
40
24
2,656
491
147
108
165
-
12
12
-
24
Source: http://chfs.ky.gov
Page 22
Community Health Needs Assessment 2013
Page 23
Community Health Needs Assessment 2013
Other Licensed Facilities
There are licensed facilities other than hospitals in Jefferson County. These facilities include home
health, hospice, adult day care, ambulatory surgery centers, rehabilitation agencies and private duty
nursing providers. A complete inventory may be obtained through the Kentucky Cabinet for Health and
Family Services at http://chfs.ky.gov/ohp/con/inventory.htm and an overview is in Exhibit 13.
Exhibit 13
University of Louisville Hospital CHNA Community
Summary of Ambulatory Care Clinics
Facility Type
Short-Term Acute Care Hospitals
Long-Term Acute Care Hospitals
Physical Rehabilitation Hospitals
Psychiatric Hospitals
Long Term Care Facilities
Home Health Services
Hospice Services
Adult Day Health Programs
Ambulatory Surgery Centers
Ambulatory Care Centers
Rehabilitation Agencies
Private Duty Nursing
Limited Service Clinics
Psychiatric Residential Treatment Facilities
County
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
Jefferson
# of
Facilities
8
2
3
7
67
9
1
24
11
9
87
2
19
11
Source:http://chfs.ky.gov
Page 24
Community Health Needs Assessment 2013
Physicians
ULH | JGBCC conducted an analysis that compared physician supply and estimated physician demand
utilizing Truven Health Analytics. Jefferson County has an over-supply of physicians in every specialty
except General/Family Practice and Psychiatry. Overall, the supply of physicians in Jefferson County
exceeds demand by 864.4 FTEs for 2012. As Louisville serves as a regional hub for medical services, the
use rates for these physicians is higher than in a typical community. Overall, Kentucky is experiencing a
shortfall of almost 900 physicians with 414 of this total being Psychiatrists.
Exhibit 14
Summary of Inpatient Discharges by Zip Code (Descending Order)
Physician Demand Estimates & Supply (Jefferson County)
2017 FTE
2012 FTE
Demand
Difference 2012
Physician Specialty
Demand
(Proj)
2012 Supply Supply/Demand
Allergy/Immunology
13.31
15.45
22.9
9.59
Cardio/Thoracic Surgery
10.19
12.19
26.65
16.46
Cardiology
69.66
84.47
92.99
23.33
3.32
3.90
6.2
2.88
Dermatology
32.24
37.40
57.25
25.01
Emergency/Critical Care
121.19
143.34
129.39
8.20
Endocrinology
11.82
13.68
22.66
10.84
Gastroenterology
34.91
41.09
46.6
11.69
General Surgery
62.11
73.89
104.49
42.38
General/Family Practice
282.26
335.18
245.1
(37.16)
Hematology/Oncology
46.81
55.63
68.97
22.16
Infectious Disease
12.42
14.68
20.13
7.71
Internal Medicine
242.91
288.97
368.04
125.13
Nephrology
18.39
22.09
45.99
27.60
Neurology
35.12
42.39
54.92
19.80
9.83
11.54
22.16
12.33
Obstetrics/Gynecology
99.14
119.74
162.01
62.87
Ophthalmology
40.82
48.61
60.22
19.41
Orthopedic Surgery
68.43
81.70
128.17
59.74
Other Pediatric Subspecialties
13.38
15.82
26
12.62
Otolaryngology
24.27
28.75
38.16
13.89
Pain Management
6.94
8.19
10.5
3.56
Pediatric Cardiology
2.31
2.74
13.37
11.06
Pediatric EMCC
4.54
5.33
33
28.46
Pediatric Endocrinology
2.91
3.43
5
2.09
Pediatric Pulmonology
1.22
1.44
3
1.78
Pediatrics
118.58
139.35
207.06
88.48
Physical Medicine/Rehab
29.10
34.10
30.16
1.06
Plastic Surgery
20.21
23.60
36.66
16.45
Psychiatry
167.62
188.63
160.68
(6.94)
Pulmonology
22.19
26.37
51.06
28.87
-
-
175.71
-
10.74
27.87
5.97
1,672.74
12.54
33.35
7.22
1,976.79
12.5
30.67
18.74
2,537.11
1.76
2.80
12.77
864.37
Colorectal Surgery
Neurosurgery
Radiology
Rheumatology
Urology
Vascular
Totals
Source: Truvan Health
Page 25
Community Health Needs Assessment 2013
The table below shows the primary care physician rate for Jefferson County. Additionally, it shows the
preventable hospital stays for which Jefferson County is below the state average, yet above the national
benchmark. Another aspect of physician impact on clinical care is represented by the screenings that are
performed within the community. For these metrics Jefferson County exceeds the state average and are
nearer to the national benchmarks.
Exhibit 15
University of Louisville Hospital CHNA Community
Health Factors (2012)
Jefferson
County
Clinical Care
Primary care physicians - Ratio of population to primary care
physicians
Preventable hospital stays - Hospitalization rate for
ambulatory-care sensitive conditions per 1,000 Medicare
enrolleesscreening - Percent of diabetic Medicare enrollees
Diabetic
that receive HbA1c screening
Mammography screening - Percent of female Medicare
enrollees that receive mammorgraphy screening
740:1
70
National
Benchmark
KY
1232:1
631:1
104
49
85.0%
82.0%
89.0%
70.0%
63.0%
74.0%
Source: Countyhealthrankings.org
Primary Care Physicians and Family
Clinics
There are 34 Primary Care Physician
practices located in Jefferson County.
Of these, there are only eight located
within the top eight zip codes of the
ULH | JGBCC CHNA Community a
population of 203,187. Of these eight,
three of them are located in the Buechal
zip code in Eastern Jefferson County.
Additionally, there are seven Family
Health Centers within Jefferson
County, three of which are located
within the key zip codes for ULH |
JGBCC. These facilities are shown on
the map to the right. There is a large
section of Western Louisville with no
Primary Care Practices or any Family
Health Centers. This area is one of
ULH | JGBCC’s key locations for inpatient admissions.
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Community Health Needs Assessment 2013
Health Department
The health department located within ULH | JGBCC CHNA Community is the Louisville Metro Public
Health & Wellness (LMDPHW). As stated earlier, ULH | JGBCC collaborated with the LMDPHW to
conduct its community health needs assessment as the majority of patients originate in Jefferson County.
LMDPHW has 350 highly-trained employees providing a wide range of services to the people of Louisville, including: health clinics; health information; health inspections; and child wellness. LMDPHW operates multiple preventive health clinics and educational programs throughout Louisville Metro to
community members regardless of their residency status or ability to pay. Additionally, LMDPHW partners with Family Health Centers, Inc., University of Louisville and Park DuValle Community Health Center for the provision of direct primary and prenatal care.
Services provided by LMDPHW include: dental care, WIC, immunizations, family planning, pregnancy
tests, head lice checks, cancer screens, sexually transmitted infection testing, tuberculosis testing,
diagnosis and treatment and well child exams. The department also operates some mobile preventive
clinics that can be deployed for mass vaccination, infectious disease outbreaks or service delivery to
underserved areas.
Summary of Findings
Jefferson County ostensibly meets the healthcare needs of its population. However, the resources provided
within the county also serve a much larger region that includes not only the surrounding counties but also
many areas further out in the states of Kentucky, Indiana and even into Tennessee, Ohio, Illinois and
beyond. Therefore there are definite challenges facing the health care providers within the county. Not
only do they serve the local community, but the larger community as well. However, the health care
providers within Jefferson County are not evenly distributed throughout the county. There are
concentrations of facilities in three distinct locations: Downtown; Dutchman’s Lane; and Northeast
Jefferson. The heavily populated areas of Western and Southern Jefferson County have limited access to
services. These areas are within the ULH | JGBCC CHNA Community and in particular the eight key zip
codes that were identified earlier. This is illustrated in the map above where Southern and Jefferson
County could be described as “Physician Deserts.”
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Community Health Needs Assessment 2013
Our Community Health Status
This section of the assessment reviews the health status of Jefferson County residents. As in the previous
section, comparisons are provided with the state of Kentucky and the United States. This in-depth
assessment of the mortality and morbidity data, health outcomes, health factors and mental health
indicators of Jefferson County residents that make up the community will enable ULH | JGBCC to
identify priority health issues related to the health status of its residents.
Good health can be defined as a state of physical, mental, and social well-being, rather than the absence of
disease or infirmity. According to Healthy People 2010, the national health objectives released by the U.S.
Department of Health and Human Services, individual health is closely linked to community health.
Community health, which includes both the physical and social environment in which individuals live,
work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who
lives in the community. Healthy people are among a community’s most essential resources.
Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as
the incidence of illness or injury and mortality is defined as the incidence of death.
Louisville Metro/Jefferson County fares bettter than the rest of the state of Kentucky for most key health
indicators listed below except for the percent of population that is obese. However, Louisville has higher
rates than the national average for arthritis, asthma, and hypertension. Louisville has a lower percentage of
its population with diabetes than the national average. This information was pulled from the CDC BFRSS
and is largely based on self-reported answers to a national survey.
Exhibit 16
University of Louisville Hospital CHNA Community
Health Factors (2012)
Morbidity for Key Health Indicators
Arthritis
Asthma
Heart Disease
Cerebrovascular Disease
Diabetes
Hypertension
Louisville
KY
United
States
29.0%
9.8%
31.9%
10.5%
22.0%
8.2%
4.2%
2.4%
6.9%
33.6%
6.1%
3.9%
10.8%
38.0%
6.0%
2.3%
8.3%
25.5%
Source: CDC
Primary Health Conditions Responsible for Inpatient Hospitalization
The 2012 Louisville Metro Health Status Report noted the top four health conditions responsible for
inpatient hospitalizations are heart disease, mental or emotional diagnosis, chronic obstructive pulmonary
disease (COPD) and cancer.
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Community Health Needs Assessment 2013
Leading Causes of Death
This health assessment relies heavily on death and death rate statistics for leading causes of death. Such
information provides useful indicators of health status trends and permits an assessment of the impact of
changes in health services on a resident population during an established period of time. Community
attention and health care resources may then be directed to those areas of greatest impact and concern.
According to the 2012 Louisville Metro Health Status Report, malignant neoplasm, commonly known as
cancer, was the number one cause of death in Louisville Metro during 2009 (the latest year for which mortality data is available), accounting for 23 percent of all deaths. In addition to cancer, the other top causes
of death are heart disease, chronic lower respiratory disease (including COPD), stroke/cerebrovascular disease and unintentional injuries.
Source: 2012 Louisville Metro Health Status Report, LMDPHW
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Community Health Needs Assessment 2013
The mortality rates for Jefferson County are generally better than the rates of the state of Kentucky and
compares favorably to most national averages. The only area in which Jefferson County has a negative
rate as compared to the rest of the state is infectious disease mortality rate which is double than the rest of
the state yet it is still less than the national rate. Jefferson County has significantly better rates than
Kentucky for motor vehicle deaths, occupational fatalities, premature deaths, and heart disease deaths.
However, Jefferson County has higher rates for death due to stroke, heart disease, and asthma than the
national rates.
Cancer deaths in Jefferson County are similar to the rates for the state overall with lower lung cancer rates,
yet higher breast and prostate cancer rates. However, cancer rates in Jefferson County exceed the national
rates for all cancers and all modalities.
Jefferson
Rate
Cause of Death - All Ages (Rate)
Infectious Disease (per 100,000 population)
Motor Vehicle Deaths (per 100,000,000 miles driven)
Occupational Fatalities (per 100,000 workers)
Premature Death (years lost per 100,000 population)
Less than Good Health (percent adults)
Physically Unhealthy Days (per month)
Mentally Unhealthy Days (per month)
Prevalence of Asthma (percent adults)
Prevalence of Diabetes (percent adults)
Prevalence of Hypertension (percent adults)
Heart Disease Deaths (per 100,000 population)
Stroke Deaths (per 100,000 population)
KY
Rate
USA
Rate
16.2
0.5
5.1
8,159.5
17%
3
4
13%
8%
30%
206.9
48.0
8.0
2.1
8.0
9,111.0
23%
5
4
13%
8%
38%
224.0
47.0
23.0
1.5
5.0
7,562.0
17%
9%
9%
31%
190.9
42.2
Cancer Deaths (age-adjusted rate per 100,000 population)
All Cancers
212
Lung and Bronchus
71
Colorectal
20
Breast
26
Prostate
26
212
75
20
23
25
181
52
17
24
24
Source: Jefferson county and Kentucky - kentuckyhealthfacts.org
Source: USA - CDC (Behavioral Risk Factor Surveillance System)
Premature Births
Prematurity is defined by the World Health Organization as delivery of an infant prior to 37 completed
weeks gestation. Infants born prematurely are classified as either preterm (34 weeks gestation), or late preterm (34 – 36 6/7 wks) by American College of Obstetrics and Gynecology. According to the March of
Dimes, Kentucky has a preterm birth rate of 13.4 percent which is one of the highest in the country and is
significantly worse for the uninsured (21.7 percent) and those who smoke during pregnancy (32.2 percent).
The preterm birth rate for Louisville was 13.9 percent, though for black infants the rate was 18.6 percent.
The national Healthy People 2020 goal is to reduce the number of preterm births to no more than 11.4 percent of all live births. According to the March of Dimes, the United States rate for 2011 was 11.7 percent.
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Community Health Needs Assessment 2013
Known risks of preterm birth that affect the population of Kentucky include smoking, substance abuse,
exposure to second hand smoke, intimate partner violence, and infection. Kentucky has one of the highest
rates in the nation of women who smoke during pregnancy. March of Dimes reports that one out of four
pregnant women in the state smoke during pregnancy, and one out of every seven babies is born prematurely. In 2007, the financial cost of prematurity was over $200 million dollars in hospital charges. Furthermore, the initial cost of hospitalization is just the beginning. Long-term, premature infants have more
health problems than full term infants, including cerebral palsy, blindness, hearing loss, physical disabilities and other chronic conditions.
Summary of Findings
In general, the health of the population of Jefferson County compares very favorably with the rest of
Kentucky though poorly when compared to the national rates. Health conditions such as preterm birth,
diabetes, heart disease, malignant neoplasms and cerebrovascular disease can create multiple strains upon
the health care delivery system both in costs, utilization of services and the detrimental impact on
community health. In order for the overall health of Jefferson County to improve, there must be increased
focus on managing these chronic diseases and the improvement of outcomes for those afflicted. The
attainment of this goal will reduce strains upon the health care delivery system through decreased
utilization and costs and will benefit the overall health of the community through increased productivity,
attendance and participation.
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Community Health Needs Assessment 2013
Our Community Mental Health and Substance Abuse
Status
This section of the assessment reviews the mental health status of Jefferson County residents who utilize
ULH | JGBCC. As in the previous section, comparisons are provided with the state of Kentucky and the
United States. This assessment, which focuses on the mental health and substance abuse disorders of Jefferson County residents that make up the community, will enable ULH | JGBCC to identify priority
health issues related to the mental health status of its residents.
Good mental health can be defined as a state of successful performance of mental function. This includes
fulfilling relationships with people, ability to adapt to change and contributing in a positive matter to the
community. According to Healthy People 2010, the national health objectives released by the U.S. Department of Health and Human Services, individual health is closely linked to community health. Community health, which includes both the physical and social environment in which individuals live, work
and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who lives in
the community. Healthy people are among a community’s most essential resources.
Numerous factors have a significant impact on an individual’s mental health status. According to Healthy
People 2020, mental health and physical health are closely related. Mental illness is a medical problem
that directly impacts physical health and the person’s ability to participate in healthy behaviors particularly
when only 17 percent of US adults are considered to be in a state of optimal mental health according to the
CDC and that 26 percent of adults are living with a mental health disorder at any time in a given year.
However, problems with physical health can have a direct impact on one’s mental health and ability to participate in healthy behaviors and can affect people of all ages.
The relationship between lifestyle/behavior, illness management and overall good health is gaining recognition and understanding by both the general public and health care providers. The prevention of mental,
emotional, behavioral and substance abuse disorders can come from a variety of strategies and can decrease the development of chronic diseases due to poor mental health. Moreover people with brain disorders or mental illness can and do recover.
According to the Robert Wood Johnson Foundation, more than 68 percent of adults with mental health
disorders have at least one physical health condition. Consequently, 29 percent of adults with a physical
health condition also deal with mental health disorders. People with mental health disorders are more likely to have diabetes, asthma, migraines, heart disease, cancer or obesity while those with physical health
conditions are likely to suffer from distress and/or mental health disorders. Additionally, according to the
Substance Abuse and Mental Health Services Administration (SAMHSA) in 2011, there were approximately 20 million people who needed substance abuse treatment who did not receive it, and 10.6 million
adults who had an unmet need for mental health care. These adults largely must rely on public safety net
programs as the current health care system is not able to meet their needs.
According to the National Council for Community Behavioral Healthcare, 15 percent of total state
spending (nationwide) on criminal justice, Medicaid, transportation and public safety results “from the
failure to prevent and treat addiction disorders.” Additionally, they note that each incremental dollar
invested in addiction treatment saves taxpayers over seven dollars in future societal costs.
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Community Health Needs Assessment 2013
Community Mental Health Care and Substance Abuse Disorder Resources
There are seven facilities in Jefferson County which have staffed inpatient Psychiatric beds totaling 491.
The largest provider is Our Lady of Peace, a KentuckyOne Health facility with 243 staffed beds. In
addition to Our Lady of Peace, KentuckyOne Health has staffed Psychiatric Beds at Jewish Hospital
(Downtown) and University of Louisville Hospital making it the largest provider of Inpatient Psychiatric
services in the region. There are only 24 staffed Chemical Dependency beds in the ULH|JGBCC CHNA
Community area.
Exhibit 20
University of Louisville Hospital CHNA Community
Summary of Area Psychiatric Hospitals
Facility
Baptist Hospital East
Jewish Hospital & St Mary's Healthcare (KentuckyOne)
Norton Hospital / Kosair Children's Hospital
Our Lady of Peace (KentuckyOne)
The Brook Hospital
The Brook Hospital Dupont
University of Louisville Hospital (KentuckyOne)
Facility Type
Short Term
Short Term
Short Term
Psychiatric
Psychiatric
Psychiatric
Short Term
Acute Care
Acute Care
Acute Care
Acute Care
Staffed
Psychiatric
Beds
Staffed
Chemical Dep.
Beds
22
20
24
243
86
76
20
491
12
12
24
Source: http://chfs.ky.gov
Leading Risk Factors of Mental Health Disorders
According to the national Center for Chronic Disease Prevention and Health Promotion, there is no single
factor that leads to individuals developing a mental illness. However, there are certain factors that increase
the likelihood of mental health disorders, many of which can be considered chronic diseases. Exhibit 21
below lists common risk factors for mental health disorders as delineated by Healthy People 2020. This
strengthens the bond between mental health disorders and substance abuse disorders as alcohol consumptions and drug use are leading risk factors.
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Community Health Needs Assessment 2013
Exhibit 21
University of Louisville Hospital CHNA Community
Risk Factors for Mental Health Disorders
Risk Factor
Smoking
Alcohol consumption
Poor nutrition/obesity
Lack of exercise
"Unsafe" sexual behavior
IV drug use
Residence in group care facilities and homeless shelters
(exposure to tuberculosis and other infectious disease)
Source: www.dsamh.utah.gov/docs/mortality-morbidity_nasmhpd.pdf
Primary Mental Health and Substance Abuse Conditions Responsible for Inpatient
Hospitalization
There were almost 6,000 inpatient admissions for Jefferson County residents based upon Mental
Diseases/Disorders in 2012. By far the most common mental health condition for inpatient admission was
psychoses with over 75 percent of the total.
Additionally, there were over 2,000 admissions for substance abuse in Jefferson County for 2011.
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Community Health Needs Assessment 2013
Summary of Findings
The Mental Health and Substance Abuse issues of the community are extraordinarily important in
consideration for the overall health of the community. One of the key concerns for any community is how
these patients are cared for as these problems tend to exacerbate overall health issues and can impact the
community at large in very negative ways. There is a strong correlation between physical well-being and
mental well-being. In order to generate positive outcomes for the physical well-being of the ULH | JGBCC
CHNA Community, then the mental well-being of this community must be addressed in tandem. Ignoring
Mental Health and Substance Abuse Disorders leads to serious socioeconomic costs according to
SAMHSA, as nearly 30 percent of all state health spending relates to substance abuse disorders, while
mental health disorders lead to increased rates of incarceration, emergency room usage and lowered
private income. The fact that “Psychiatrist” is one of the very few physician specialties in Jefferson County
for which there is an actual shortage, only serves to limit the effectiveness of the resources available within
the community.
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Community Health Needs Assessment 2013
Our Community’s Voice
General Public Survey Responses
As previously stated, to obtain feedback from the general public, surveys were conducted by the
LMDPHW in collaboration with a consortium of area hospitals. The survey was available in English and
Spanish and covered a broad range of topics from access to health care to perception about the most pressing health care needs. After the forums, the same survey was made available online at the LMDPHW
website from March 18 to June 1, again both in English and Spanish. A total of 1,871 individuals completed the survey with demographics that closely correspond to that of Jefferson County: 80 percent of respondents were white, 16 percent were African-American and the remainder were Asian, Native Hawaiian,
Pacific Islander and American Indiana, Alaskan Native or other. Three percent were ages 18-24, 18 percent were 25-34, 22 percent were 35-44, 28 percent were 45-54, 24 percent were 55-64 and 5 percent were
age 65 or older. Respondents came from each of the city’s zip codes, with most responses from southwest
Louisville. The number of participants exceeded 1,800.
The survey identified what the community perceives are major barriers to health care. The overwhelming
majority of respondents strongly agreed or agreed that cost/expense (89 percent) and insurance issues (86
percent) are considerable barriers to health care. Other barriers include health knowledge, health beliefs
and knowing where to go in a health facility. Ninety-five percent of respondents felt they had access to
preventive care and 72 percent believe that health providers give them needed education and resources.
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Community Health Needs Assessment 2013
The survey solicited input from participants regarding health problems of the community. Addiction,
chronic diseases, including diabetes/high blood pressure, heart disease and stroke, and emerging issues,
primarily obesity, were identified as the biggest health problems in the community.
The majority (74 percent) said there were people in their community who need care but cannot get it; yet
84 percent said they had seen a primary care provider in the last 12 months and 95 percent said they had
access to preventive services. Respondents identified low income families and the elderly as the groups in
need of the most help with access to health care.
Respondents’ Opinion
on a Group Needing the
Most Help with Access
to Health Care
The majority of respondents considered lowering the cost of health care and prescription drugs and increasing access to primary care doctors as the best ways to address health needs of people in their commu-
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Community Health Needs Assessment 2013
nity. Furthermore, respondents recommended that wellness goals could be met through increased funding
or free services and providing more education and prevention programs.
Best Ways to Address the
Health Needs of People in
Their Community
Physician/Community Leader Survey Responses
The perceptions of forty physician/community leader survey participants reflected slightly different priorities. Ninety-five percent said they thought there were medically underserved areas of the community.
Seventy-nine percent said that various organizations in the community they served were not meeting health
and wellness needs. Only 14 percent felt Louisville was doing a good or very good job on preventive care,
while 53 percent thought the city was doing a poor or very poor job. The verdict was not any better when
it came to providing mental health services; 54 percent said Louisville was a doing a poor or very poor job.
Sixty-nine percent of the physician/community leader respondents said that Louisville was doing a good or
very good job providing immunizations, but only 16 percent said the city was doing a good job providing
oral health services. Additionally, only 25 percent said the city was doing a good or very good job of drug
and alcohol treatment, while 34 percent thought providers in the city were doing a poor or very poor job.
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Community Health Needs Assessment 2013
The physician/community leader group also identified the following priority health issues. Sixty-four percent identified obesity as the most prevalent emerging health issue.
This group felt the best way to address the needs of medically underserved areas was to increase access to
primary care physicians (40 percent), lower the cost of health care and prescription drugs (15 percent) and
improve availability to health screenings (15 percent).
When asked how leaders and health care organizations could collaborate to meet the health care needs of
the communities they serve, most pointed to easier access to services (25 percent), advocating for better
health policy (18 percent), increased support for free or income-based services (17 percent) and more education and prevention programs (17 percent).
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Community Health Needs Assessment 2013
Summary of Findings
“We can screen—provide information—but if people are uninsured they need ACCESS for not just
emergency care…most clinics are so busy and burdened they are not always able to spend time on
education.”
Though many of the respondents reported that they had seen a physician in the last twelve months, the majority also reported that they knew someone in their community who needed care but could not get it. Additionally access to primary care was listed as a primary concern. Another issue to consider when
contemplating access is the ability to pay as a majority of respondents mentioned the cost of care as a barrier and lowering the costs as a way to best meet the health needs of the community.
“The young children and adults need to be taught in school about health care because they are learning from their parents and the parents have no idea how to handle the health care problems…”
Many people in our community feel that there is a lack of knowledge and a lack of educational resources
available to teach the community how best to live healthy lives. Intergenerational knowledge transfer only
highlights the pervasiveness and longevity of the problems that we face. The health care systems have
trained the community to act in very specific ways with regards to their health, primarily through Emergency Room care and/or the absence of care. The system that we offer to the community is complex and
frightening and often does not put the needs of the patient and the community first.
“My clients struggle to navigate an extremely poorly devised system that presents limited resources.”
It is not easy to know what options are available to the public when health care needs arise. More often
than not, the Emergency Room is used for basic or primary care rather than more appropriate and cost effective venues. Much of this is due to need/convenience, but there is a large segment that uses the ER because they lack the knowledge about the alternatives such as clinics, urgent treatment and primary care
physicians as well as services that are provided by the health department.
“Provide clear/precise information for expected cost/coverage of health care not covered by insurance benefits – current policy very confusing”
Health care is one of the few industries in which most of its’ customers do very little shopping around
based on cost. Due to the third-party payer system utilized in the United States, most users of the system
have little to no understanding of the costs of the system and how to use the system in a cost-effective
manner. Consequently, the patients are ill-informed about the health care decisions that they make and are
often quite surprised at the bills that they receive for what they may consider even basic care. Insured or
not, very few patients go into a health care facility knowing exactly what their financial obligations are
going to be. This lack of financial transparency only serves to drive up costs and inefficiencies in the system and create a larger financial burden upon the community.
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Community Health Needs Assessment 2013
Our Community’s Health Outcomes
Health Statistics and Rankings
An analysis of various health outcomes for a particular community can, if improved, help make that
community a healthier place to live, learn, work, and play. This portion of the community health needs
assessment utilizes information from County Health Rankings, a key component of the Mobilizing Action
Toward Community Health (MATCH) project, a collaboration between the Robert Wood Johnson
Foundation and the University of Wisconsin Population Health Institute.
The County Health Rankings model is grounded in the belief that programs and policies implemented at
the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health
outcomes for communities across the nation. The model evaluates all 50 states and the counties within
each state based on two types of health outcomes—how long people live (mortality) and how healthy
people feel (morbidity). For these rankings (listed in Exhibit 32 below), Jefferson County ranked 33
overall out of 120 counties in Kentucky. Jefferson County compared favorably to the Kentucky averages
for premature death and percent reporting poor or fair health as well as the number of poor physical and
poor mental health days. Unfortunately, Jefferson County had a higher percent of live births with lower
birthweights than the rest of the state of Kentucky. All indicators were significantly higher than the
national benchmark.
Exhibit 32
University of Louisville Hospital CHNA Community
Health Outcomes (2012)
Jefferson
County
KY
Mortality
Premature death - Years of potential life lost before
age 75 per 100,000 population (age-adjusted)
Morbidity
Poor or fair health - Percent of adults reporting fair
or poor heatlh (age-adjusted)
Poor physical health days - Average number of
physically unhealthy days reported in past 30 days
(age-adjusted)
Poor mental health days - Average number of
mentally unhealthy days reported in past 30 days
(age-adjusted)
Low birthweight - Percent of live births with low
birthweight (<2500 grams)
8,405
National
Benchmark
8,781
5,466
17%
22%
10%
4.0
4.7
2.6
3.8
4.3
2.3
9.4%
9.0%
6%
Source: Countyhealthrankings.org
Exhibit 33 shows the progress that Louisville Metro/Jefferson County made towards the health indicators
for the Healthy People 2010 initiative. Louisville Metro/Jefferson County only met one of the objectives
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Community Health Needs Assessment 2013
for Healthy People 2010 and that was for diabetes death rate. Many of the other indicators were significantly higher than the objectives such as unintentional injury death rate, suicide, homicide, cancer, heart
disease and sexually transmitted diseases. As seen previously in Exhibit 10 (page 20), Louisville Metro/Jefferson County has high rates of teen pregnancy and chlamydia infections. So even though these indicators are not part of the Healthy People initiative, the LMDPHW includes them on their scorecard.
Exhibit 33: Trends for Louisville Metro Key Health Indicators
Health Indicator
HP 2010
Objective
Compared
Louisville
to HP 2010
Metro
Objective
Compared to
Previous Year
(2009)
Injury
Motor Vehicle Crash Death Rate
9.2
16
Unintentional Injury Death Rate
17
56
Suicide Death Rate
4.8
14
3
11
All Cancers Death Rate
160
256
Lung Cancer Death Rate
44.9
79
Female Breast Cancer Death Rate
22.3
34
Prostate Cancer
28.8
31
Disease of Heart
166
237
Stroke Death Rate
48
67
Diabetes Death Rate
45
35
Homicide
Chronic Disease
Maternal and Child Health
Infant Death Rate
4.5
6.7
NRG
50.6
5
9.1
AIDS Incidence Rate
1
18.2
Tuberculosis Incidence Rate
1
3.5
Primary or Secondary Syphilis
0.2
5.7
Gonorrhea
19
259
Chlamydia
NRG
561
-
Pertussis
NRG= No Related Goal
NRG
3.9
-
Birth Rate to Teens Aged 15-19
Percentage Low Birth Weight Infants
-
Communicable Disease
Source: Louisville Metro Health Department
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Community Health Needs Assessment 2013
Summary of Findings
While Jefferson County largely compares favorably with the rest of the state of Kentucky, it does not near
many national benchmarks. An additional concern is that the information on health indicators and rankings
is based upon the county as a whole and does not take into account the very real differences in
demographics and health indicators that occur throughout the different areas of the county. As the ULH |
JGBCC CHNA Community is comprised of the lower income areas of the county, it can be assumed with
some certainty given the information presented previously, that their overall health outcomes will likely be
poorer than those that have better access to care and the financial means to meet their health obligations.
Given this, even though Jefferson County fares moderately well when compared to the state, the
community that ULH | JGBCC serves faces more challenges and have more health care issues than those
seen in the more affluent areas of the county.
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Community Health Needs Assessment 2013
Our Community’s Health Priorities
Priority Community Health Needs Identified
Using findings obtained through the community survey and collection of primary and secondary data
enabled ULH | JGBCC to complete an analysis of these inputs to identify community health needs. The
following data was analyzed to identify health needs for the community:
Leading Causes of Death: Leading causes of death for the community were reviewed and the death rates
for the leading causes of death for each county within the ULH | JGBCC CHNA community were
compared to U.S. adjusted death rates. Causes of death in which the county rate compared unfavorably to
the U.S. Adjusted death rate resulted in a health need for ULH | JGBCC CHNA community.
Primary Causes for Inpatient Hospitalization: The primary causes for inpatient hospitalization resulted in
an identified health need for the community.
Health Outcomes and Factors: An analysis of the County Health Rankings health outcomes and factors
data was prepared for each county within the ULH | JGBCC CHNA community. County rates and
measurements for health behaviors, clinical care, social and economic factors and the physical
environment were compared to national benchmarks. County rankings in which the county rate compared
unfavorably (by greater than 30 percent of the national benchmark) resulted in an identified health need.
Primary Data: Health needs identified through community surveys, focus groups and key informant
interviews (if applicable) were included as health needs. Needs for vulnerable populations were separately
reported on the analysis in order to facilitate the prioritization process.
As a result, the following summary list of needs was identified:
Access and Health Care Disparties is very broad in that it addresses characteristics such as insurance status, income/poverty, educational attainment, crime rates, location of health care services
and providers, etc. all of which impact the health status of a community. Our assessment of the
community identified that all of these factors are present negatively compared to national standards in the community we serve and warrants consideration under our Community Health Needs
Assessment.
Access to Primary Care impacts the health status of the community through lack of management of
chronic conditions and lack of efficient and effective access to preventive care. Our assessment
identified a shortage of primary care physicians in our community and an even greater shortage of
primary care practices in the areas of Jefferson County served by ULH | JGBCC.
Chronic Diseases impact the health and health care cost of our community because lack of appropriate management leads to preventable deaths, preventable hospitalizations and increased health
care costs.
Leading Causes of Death in our community include heart disease, lower respiratory disease, cancer,
chronic lower respiratory disease,unintentional /trauma related injuries, etc. . This is important to
the health of our community because if these conditions can be prevented and/or managed we
have the ability to save the lives of these individuals in our community. Our assessment of our
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Community Health Needs Assessment 2013
community clearly demonstrates that Jefferson County has significant opportunity for improvement in these areas as we fall above benchmark in many of these areas.
Risky Lifestyles was identified as an issue in our assessment of the community. Jefferson County
has very high rates of alcohol and drug abuse, tobacco use, obesity, concentration of fast food
resturants, etc. . These issues not only drive up health care costs, but they also impact the overall
health and wellbeing of the individuals in our community.
Psychiatric, Emotional and Substance Abuse Disorders were identified as issues for our CHNA
Community due to the lack of resources available to this community and the high socioeconomic
impact from untreated populations.
Prematurity and Low Birth Weight babies was identified in our report as issues. Jefferson County
has a higher percentage of babies born below 2500 grams than the rest of the state and the nation
and has a higher preterm pregnancy rate as well. This is an issue because prematurity and low
birth weight are linked to long-term health and developmental issues throughout the individual’s
life.
To facilitate prioritization of identified health needs, a ranking and prioritization process was used. Health
needs were ranked based on the following seven factors. Each factor received a score between 0
and 4.
1) How many people are affected by the issue or size of the issue? For this factor ratings were
based on the percentage of the community who are impacted by the identified need. The
following scale was utilized for health outcomes and factors: >20% of the community
population=4; >10% and <20%=3; >5% and <10%=2 and <5%=1. Chronic diseases were rated
based on state ranking for incidence of the disease. A factor of 1-4 was assigned based on which
quartile the state was reported.
2) What are the consequences of not addressing this problem? Identified health needs which have
a high death rate or have a high impact on chronic diseases received a higher rating for this factor.
3) The impact of the problem on vulnerable populations. Needs associated with vulnerable
populations identified through the community health needs assessment process were rated for this
factor.
4) How important the problem is to the community. Needs identified through community surveys
and/or focus groups.
5) Prevalence of common themes. Determined by how many sources of data (Leading Causes of
Death, Primary Causes for Inpatient Hospitalization, Health Outcomes and Factors and Primary
Data) identified the need.
6) How closely does the need align with KentuckyOne Health strategies?
7) Does the hospital have existing programs which respond to the identified need?
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Community Health Needs Assessment 2013
Each need was then ranked based on these seven prioritization metrics:
University of Louisville Hospital
Prioritization of Health Needs
Access to Care/Health Disparities and Health Needs
Access to Primary Care
Chronic Diseases
Leading Causes of Death (cancer, heart disease, lower respiratory disease,
unintentional injuries/trauma, etc.)
Risky Lifestyles (Smoking, Obesity, STDs)
Psychiatry/Mental Disorders/Substance Use Disorders
Low Birthweight/Premature birth
How many
people are
affected by the
issue?
3
3
4
What are the
consequences What is the
How many
of not
impact on
How important
sources
addressing
vulnerable
is it to the
identified the
this problem? populations? community?
need?
4
4
4
3
4
4
3
3
4
4
4
3
4
3
3
2
4
4
4
3
4
3
4
3
3
3
3
3
3
3
3
2
How closely
does the need Does the hospital
align with
have existing
KentuckyOne
programs which
Health
respond to the
strategies?
identified need?
4
2
4
2
4
3
4
3
3
2
3
2
3
2
Total
Score*
23
24
24
24
21
22
17
*Highest potential score = 28
PLEASE SCORE EACH BOX ON A SCALE OF 0 to 4, WITH 4 BEING THE HIGHEST POSSIBLE MARK
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Community Health Needs Assessment 2012
APPENDICES - Sources
1. University of Louisville Invision system
2. Kentucky Health Association InfoSuite System – SRS Demographics
3. US Census – American Community Survey, SAHIE
4. Louisville Metro Health & Wellness (LMDPHW) - 2011 Health Equity Report
5. 2012 Louisville Metro Health Status Report, LMDPHW
6. County Health Rankings – www.countyhealthrankings.org
7. City Rating – www.cityrating.com/crime-statistics
8. Kentucky Hospital Utilization Report – http://chfs.ky.gov
9. Truven Health – Physician Supply and Demand
10. Centers for Disease Control – www.cdc.gov
11. Kentucky Health Facts – www.kentuckyhealthfacts.org
12. 2012 Community Health Needs Assessment Survey Results (General Public Survey &
Community Leaders Survey)
13. Louisville Metro Health Department
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