Monongalia County

Community Health Needs Assessment

 

January 2011

 

Sponsored by:

Monongalia Health System and

West Virginia University Hospitals

 

January 14, 2011

Darryl Duncan, FACHE

President

Monongalia General Hospital

1200 J.D. Anderson Drive

Morgantown, West Virginia 26505

 

Bruce McClymonds

President

West Virginia University Hospitals

Medical Center Drive

Morgantown, West Virginia 26505

 

Messrs. Duncan and McClymonds:

On behalf of Douglas Rich, managing director of ASR Planning, and Lifton Associates, LLC, I am pleased to submit this report of the Monongalia County Community Health Needs Assessment which was sponsored by your two organizations.

Your hospitals are subject to the West Virginia Health Care Authority whose “goals are to control health care costs, improve the quality and efficiency of the health care system, encourage collaboration and develop a system of health care delivery which makes health services available to all residents of the State.” This Assessment was a collaborative effort and implementation could eventually strengthen the health care delivery system and expand the services available to area residents.

In addition, the Patient Protection and Affordable Care Act requires that all not for profit hospitals conduct a community health needs assessment every three years. While the regulations for such assessments have not yet been written, this assessment was undertaken as a good faith effort in anticipation of those regulations. The Affordable Care Act requires that in conjunction with the assessment hospitals also “adopt an implementation plan” and that the assessment be “made widely available to the public.”

Consistent with those provisions of the Act, we recommend that you structure a process for developing an implementation plan and make provision for making the Assessment publicly available.

With regard to implementation, we recommend that a core group of committed individuals from the county be identified and given responsibility for further assessment of community health needs and development of an action/implementation plan. The core group should include representative of your two organizations, the County Health Department, United Way leadership and citizens review board, Health Right, the City of Morgantown and Monongalia County. This core group would identify others to join the committee.

Agenda items for first meeting of the group should include: 1) review and discussion of this report; 2) discussion of identified needs, areas for further study, and initial priorities for action; 3) committee structure and logistics, including recruitment of additional committee members.

While the group will be free to make their own interpretation of findings in the Assessment, and establish priorities for action, we strongly recommend that they consider ways to address the lifestyle and resulting health issues (e.g., obesity and diabetes) that were identified, as well as substance abuse and drug-seeking behaviors.

Mr. Rich or I would be pleased to attend the first meeting of this group.

Thank you for the opportunity to work with your organizations and on behalf of your community.

Sincerely,

James Lifton

James G. Lifton, FACHE

Principal

 

 

TABLE OF CONTENTS

 

1. Introduction and Summary . . . . . . . 1

 

2. Population and Demographics . . . . . . . 4

Chart 1: Population of Monongalia County, West Virginia and the U.S.,

2000 – 2015

Chart 2: Age Distribution of Monongalia County as Compared to the U.S., 2010

Chart 3: Racial Characteristics of the Population, U.S., 2010

Chart 4: Racial Characteristics of the Population, Monongalia County, 2010

Chart 5: High School Graduation Rates in West Virginia and Monongalia County,

2005 – 2010

 

3. Health Status . . . . . . . . . 12

Chart 6: Crude Death Rates, 2007

Chart 7: Death Rates by Age Cohort, 2007

Chart 8: Death Rates for Selected Causes of Death

Chart 9: Cancer Mortality Rates by Site, 2007

Chart 10: Traffic Fatalities per 100,000 Population, 1994 – 2008

Chart 11: Reported Chronic Diseases, 2008

Chart 12: Lifestyle Factors that Contribute to Premature Death, 2008

Chart 13: Infant Mortality Rates, 2003 – 2007

Chart 14: Low Birth Weight Rates, 2007

Chart 15: Teen Pregnancy Rates, by Age of the Mother, 2007

Chart 16: Behavioral and Birth Factors in Pregnancy Risk, 2007

 

4. Interview and Focus Group Summary . . . . . . 22

 

 

Appendices

 

1. Licensed Non-Acute Healthcare Providers in Monongalia County . . 28

 

2. Unlicensed Health and Social Service Agencies in Monongalia County . . 30

 

3. Actively Licensed Doctors of Medicine and Osteopathy Practicing in

West Virginia and Monongalia County . . . . . 32

 

1. INTRODUCTION AND SUMMARY

 

Introduction

This community health needs assessment was undertaken jointly by Monongalia General Hospital and West Virginia University Hospitals during the summer and fall of 2010.

Impetus for the Assessment

Both hospitals are subject to rules and regulations of the West Virginia Health Care Authority, whose “goals are to control health care costs, improve the quality and efficiency of the health care system, encourage collaboration and develop a system of health care delivery which makes health services available to all residents of the State.” Development of this assessment represents a collaborative effort and implementation could eventually strengthen the health care delivery system and expand the services available to area residents.

Also, the Patient Protection and Affordable Care Act (“health reform”) passed earlier this year includes a requirement for non-profit hospitals to conduct a community needs assessment every three years. While the regulations for this part of the Affordable Care Act have not yet been written, this assessment was undertaken as a good faith effort in anticipation of those regulations and requirements.

Process

Consultants from Lifton Associates, LLC and ASR Planning, Inc. were retained to support the assessment. They performed the analyses, conducted the interviews and focus groups, and developed the findings and observations included in this assessment. Hospital executive staff provided general direction and orientation, identified data sources, and facilitated scheduling of interviews, focus groups, and other meetings. A total of 37 persons were interviewed and 38 individuals participated in the focus groups.

All data used in the assessment came from public sources, and these sources are footnoted or otherwise identified in the body of this report. Other input came from persons interviewed or who were part of a focus group. No comments made during interviews or focus group sessions have been attributed to an individual.

Preliminary findings and observations were presented to a meeting of the joint executive committees of the two hospitals in October. Discussion included general comments and questions regarding the data, analyses, findings and observations.

At no point during the process was any non-public data or other information shared by either hospital, including charges for goods or services, costs, managed care contract terms, market shares, or planned changes in facilities or programs. Further, there was no discussion of how either or both organizations might respond to needs identified in the assessment.

 

Summary of Major Findings and Observations

 

Quantitative findings based on the population, demographic, socioeconomic, health status, and behavioral data (presented in section 2 & 3) were consistent in almost every respect with the qualitative findings from the interviews and focus group sessions (which are summarized in section 4).

 

1. Monongalia County is different than the rest of West Virginia. For almost all characteristics profiled in the tables and charts in this assessment, Monongalia County had a higher/better status or performance than West Virginia as a whole. For some characteristics, however, Monongalia County performed below/worse than the U.S.

 

This difference was mentioned in several of the interviews and focus group sessions, leading to comments prefaced by words such as “We’re better off than the rest of the state, but could still improve by…”

 

The relatively strong economy and good availability of health and human services was also identified as a factor (both cause and result) in the county’s historic population growth and, more recently, a perceived increase in the number of homeless as people migrate from poorer, surrounding counties.

 

Lifestyle and cultural issues have a major impact on health status. In particular, poor diet, lack of exercise, obesity, smoking, alcohol consumption, diabetes, and heart disease and cancer were always mentioned in some combination during interviews and focus groups. Further, there was broad recognition that until underlying causes (e.g., diet and exercise) are addressed the full benefit of resources devoted to dealing with outcomes (e.g., diabetes) will not be realized.

 

Thus, improving health status will require changing behavior patterns that are part of the culture and, in the case of intervention with children, patterns that may not be exhibited or even supported in the home environment.

 

Mental health is a concern, both as a primary condition and as a complicating factor in other conditions. As a result, mental health services are inadequate to meet the needs of Monongalia County residents. Particular concerns were expressed about: the shortage of psychiatrists and non-physician therapists, due in part to low reimbursement for services; timely diagnosis and disposition of patients coming to the emergency department; and, an inadequate number of residential beds (psych and substance abuse) for adolescents, resulting in young people being sent to facilities in other states

 

2. Lack of coordination reduces the benefit and impact of available health and social service resources. This concern was expressed about a range of programs and facilities, including acute care (e.g., patients visiting both emergency departments in dealing with a single condition or episode), ambulatory care, and programs offered in schools and by social service agencies.

 

3. Drug use and abuse are significant and growing concerns. The assessment suggests problems related to: alcohol uses/abuse, especially among the student population; “drug seeking” (mainly in the hospitals’ emergency departments) and prescription drug abuse; and an emerging pattern of heroin use.

 

4. Other comments on health status and/or needs topics: Dental health, post-acute care, transportation, homelessness and the homeless, and developing interventions to instill health awareness and healthy behavior in children.

 

2. POPULATION AND DEMOGRAPHICS

 

Population demographic and socioeconomic characteristics play determining roles in the types of health and social services needed by a community. In the case of Monongalia County, these factors are also important in identifying how the county is similar or different from the rest of West Virginia.

 

Population

The population of Monongalia County has increased 9.1 percent since the 2000 census. During the same time period, the state of West Virginia is estimated to have grown only 0.5 percent. U.S. population grew 9.8 percent over the decade. Over the next five years, Monongalia County is expected to grow by 3.2 percent. By contrast, the state of West Virginia is expected to decline in population by 0.3 percent. The U.S. as a whole is expected to grow by 4.1 percent by 2015. Monongalia County has about 5 percent of the total West Virginia population.

 

Chart 1: Population of Monongalia County, West Virginia and the U.S., 2000 – 2015

 

 

 

 

 

 

These population estimates and projections are the first indicators of the difference between Monongalia County and West Virginia. The growing county population suggests that the need for health and social services will probably grow over time, as well.

 

Age

Monongalia County is the sixth most densely populated county in West Virginia, with most of that population concentrated in the Morgantown area, which accounts for about one quarter of the county’s area. The remaining three quarters of the county are very lightly populated and are considered rural. Furthermore the population of Morgantown is influenced by the presence of the student population of West Virginia University. West Virginia University currently reports an undergraduate and graduate population of approximately 30,000 students. Some, but not all, of these students are counted in the census as residents of Monongalia County. As a result, the age groups represented by university students (18 – 20 years, 21 – 24 years and 25 – 34 years) are significantly larger than is true in the state or nation as a whole.

 

The large number of university students in Monongalia County tends to understate other cohorts of the County’s population. For example, the 9,448 residents of Monongalia County age 65 and older represent only 10.6 percent of the population. If the age cohorts that include university students were more normally sized (based on the national averages), that same number of senior citizens would represent 12.3 percent of the population, which is much closer to the national average of 13.2 percent. In West Virginia, 16.3 percent of the population is age 65 and older. In Monongalia County, West Virginia and the U.S. the percentage of seniors will continue to grow over the next five years. These seniors consume health services at a rate nearly five time that of the younger population, so increases in this segment of the population will also increase health service consumption.

 

Chart 2: Age Distribution of Monongalia County as Compared to the U.S., 2010

 

 

The presence of West Virginia University students also influences the number of women of child-bearing age. Women between the ages of 15 and 44 years currently represent 24.4 percent of the total population of Monongalia County. In West Virginia, women of child-bearing age represent 18.8 percent of the total population. In the U.S., women of child-bearing age represent 20.1 percent of the population. While this higher-than-average proportion of women in the child-bearing years would typically also result in a higher than average birth rate, such is not the case in Monongalia County. Women who are seeking undergraduate or graduate degrees, or spouses of students or junior faculty, tend to delay starting their families, so the fertility rates (births per women of child-bearing age) in university communities also tend to be lower than average.

 

It should be noted that the population characteristics of Monongalia County are very similar to other counties throughout the nation that host significant-sized universities.

 

Race and Ethnicity

Monongalia County’s racial and ethnic characteristics are fairly homogenous as compared to the nation as a whole. Over 90 percent of the county’s population is White. Blacks/African Americans make up 3.8 percent of the population, Asians represent 2.2 percent and Hispanics/Latinos make up 1.4 percent.

 

Chart 3: Racial Characteristics of the Population, U.S., 2010

 

 

 

 

 

 

 

 

Chart 4: Racial Characteristics of the Population, Monongalia County, 2010

 

 

 

Over the next five years, the percentages of the population that are White or Asian are expected to drop slightly while the percentages of Black/African American or Hispanic/Latino are expected to increase slightly. The percentages of Blacks/African Americans and Hispanics/Latinos in Monongalia County in 2015 will continue to remain significantly below the national averages of 12.1 percent and 17.5 percent, respectively. The lower-than-average percentages of minorities in the County will also reduce the types of morbidity and mortality that are specific to, or more prevalent in, these groups.

 

Education

In Monongalia County, 49.6 percent of the adult population (age 25 and older) holds at least a high school diploma while 17.1 percent hold at least a bachelor’s degree. In West Virginia, 51.5 percent of the adult population holds at least a high school diploma, but only 10.4 percent have bachelor’s degrees. The favorable variance to the State averages is assumed to be because of the presence of West Virginia University. This situation was commented on by several individuals in the interview process (see Section 4 of this report). The County also compares favorably to the U.S as a whole where 46.4 percent have high school diplomas and 17.4 percent have bachelor’s degrees.

 

Overall, Monongalia County had a high school graduation rate of 84.2 percent for the 2009 – 2010 school year. The definition of graduation rate is the number of students who graduate from a public high school with a regular diploma in the standard number of years. The County average is equivalent to the state average of 84.3 percent. However, the graduation rate in the County has been declining over the last six years while the state average has remained relatively stable.

 

Chart 5: High School Graduation Rates in West Virginia and Monongalia County, 2005 – 2010

 

 

 

 

Income and Employment

Monongalia County has a higher median household income than the state of West Virginia, but lower than the U.S. as a whole. Monongalia County’s estimated median household income in 2010 is $40,800. In West Virginia the estimated median household income is $38,900, while in the U.S. it is $52,800. The median household income in Monongalia County has been increasing more rapidly than the national rate over the last ten years and is expected to continue to outgrow the U.S. rate through 2015. In spite of this faster growth rate, Monongalia County will continue to lag behind the national median household income through the five-year horizon.

 

Monongalia County’s current estimated civilian labor force is 48,450. Unemployment in Monongalia County remains low. As of September 2010, the unemployment rate in the County had reached 5.7 percent, up from 4.7 percent a year earlier. This rate is still significantly below the state unemployment rate of 8.6 percent, and 9.2 percent nationally, in the same month. Both income and unemployment impact utilization of health services. Low income and/or high unemployment tend to cause delays in the seeking of health services and the over-utilization of emergency services.

 

Poverty

In 2008, 16.3 percent of the population in Monongalia County was below the federal poverty level ($21,200 for a family of four) according to the U.S. Census Bureau. This was lower than the West Virginia rate of 17.4 percent but higher than the national rate of 13.2 percent. Although state and local poverty rates are not available, the U.S. Census Bureau reports that the national poverty rate increased to 14.2 percent in 2009. The Nielsen Company estimates that there are currently 20,416 family households in Monongalia County. Of these families, 1,395, or 6.8 percent of families in Monongalia County were below the federal poverty level, as compared to 12.5 percent in the state and 9.7 percent in the U.S. as a whole. This apparent disparity between individual and family poverty levels is probably due to the large number of West Virginia University students who live in non-family households.

 

 

Health Insurance Status

Health insurance is an important factor in an individual’s ability to access healthcare when needed. The U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE) Program indicated that 23.9 percent of Monongalia County residents under the age of 65 were uninsured in 2007. The estimated percent of the population that is uninsured in West Virginia for that year was 16.7 percent. Nationally, the uninsured represented 15.0 percent of the population in 2007. The U.S. Census Bureau reports that the national rate increased to 15.4 percent in 2008 and 16.7 percent in 2009. Health insurance was commented on by many individuals during the interview process (see Section 4 of this report). The low rates were attributed to the prevalence of uninsured West Virginia University students, especially foreign students and their families.

 

Special Populations

Whenever possible, it is relevant to determine the size of population groups that have special needs. Among these groups are migrant/farm workers, the homeless and linguistically isolated groups.

 

Migrant/Farm Workers

It is assumed that the migrant/farm worker population in Monongalia County is very small. In 2010, only 56 Monongalia County residents are identified as farm or forestry workers by the Nielsen Company. This represents 0.14 percent of the employed population of the County, as compared to 0.56 percent in West Virginia and 0.69 in the U.S as a whole. In 2007, according to the U.S. Department of Agriculture, there were 23,618 farms in West Virginia. Of those farms, only 85 reported using migrant workers. Most of the migrant workers were used in the apple farms of the eastern panhandle of the state. Migrant workers, by definition, do not have access to regular medical care and often access medical services only in emergency or crisis situations. The very lower percentage of migrant workers in the County will tend to reduce these problems

 

Homeless

The homeless in Monongalia County are difficult to count, primarily due to the transient and complicated lives of people who are temporarily or chronically homeless. The National Alliance to End Homelessness estimated that there were 2,409 homeless persons in West Virginia in 2007. The homelessness rate in West Virginia in 2007 was 13 per 10,000 population. In the states surrounding West Virginia, only Kentucky and Maryland have higher homelessness rates. The national homelessness rate in 2007 was 22 per 10,000 population. Using the West Virginia homelessness rate, there would currently be 116 homeless persons in Monongalia County. However, there are a number of factors that could influence that number. The general state of the U.S. economy and the problems in the real estate mortgage market are presumed to have increased the rate of homelessness since 2007. The generally strong economy in Monongalia County, as measured by lower unemployment, could make Morgantown attractive to homeless persons who are seeking employment. It is possible that some homeless persons have migrated to Monongalia County seeking work. In fiscal year 2009 – 2010 Bartlett House, a homeless shelter in Morgantown, served 420 adults and children. The homeless population is less likely to have health insurance and access to medical care. As a result, homeless people are likely to delay medical care and access medical services through the most expensive venues. Homelessness is also both a cause and result of serious health issues including addiction, psychological disorders and HIV/AIDS. Although homelessness is not a major issue in Monongalia County, several individuals who participated in the interview process (see Section 4 of this report.

 

Linguistically Isolated Populations

The Census Bureau defines a linguistically isolated household as one in which no one 14 years old and over speaks only English or speaks a non-English language and speaks English "very well." In other words, all members of the household 14 years old and over have at least some difficulty with English. Currently, 95.6 percent of the population in Monongalia County speaks English at home. Of the remaining 4.4 percent, residents of Monongalia County predominantly speak IndoEuropean, Asian and Spanish languages at home. In West Virginia, 97.8 percent of the population speaks English at home while 80.3 percent of the population in the U.S. speaks English at home.

 

The ability to communicate is critical between patients and health providers. Health providers who do not speak the language of the patient or lack an interpreter’s assistance are unable to deliver quality health care that meets the need of the patient. A patient will have difficulty telling the provider the reason for the visit, thereby impacting the provider’s delivery of care. As a result, the potential outcomes for patients with limited English-speaking ability include reduced provider order compliancy, missed follow-up visits, and medication mistakes. Although linguistic isolation is not a major issue in Monongalia County, several individuals contacted during the interview process (see Section 4 of this report) noted that there is an issue particularly among the families of foreign students at West Virginia University.

 

3. HEALTH STATUS

 

Knowledge of the current health status of the residents of Monongalia County is a critical element in this Community Health Needs Assessment. The health issues, prevalence of chronic diseases and overall mortality are measures of the health and well-being of Monongalia County, as well as indicators of potential health service needs.

 

Morbidity and Mortality

Monongalia County was ranked as the healthiest county in the West Virginia County Health Rankings 2009. This ranking is based on a combination of health outcomes, mortality, low birth weight, general health status, health determinants, health care, health behaviors, socioeconomic factors and physical environment. Monongalia County ranked first in five of these ten factors. This finding, while encouraging, should not be taken as an indicator that the health status of Monongalia County is perfect.

 

Monongalia County has a crude death rate (7.2 deaths per 1,000 population per year) that is significantly lower than West Virginia and slightly lower than the nation as a whole.

 

Chart 6: Crude Death Rates, 2007

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

To some extent the crude death rate is likely impacted by the high percentage of younger adults (ages 18 – 34 years) present in Monongalia County as a result of the student population at West Virginia University. However, even when the death rates are examined by age cohort, Monongalia County is consistently lower than the state of West Virginia.

 

Chart 7: Death Rates by Age Cohort, 2007

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

Heart disease and cancer are the two leading causes of death in Monongalia County as they are in West Virginia and the U.S. However, chronic lower respiratory diseases in Monongalia County and West Virginia replace stroke as the third most frequent cause of death.

 

Chart 8: Death Rates for Selected Causes of Death

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

Of the causes of death profiled, only diabetes has a higher death rate in Monongalia County than in the U.S. as a whole. In all of the causes of death profiled, Monongalia County has a lower death rate than the state of West Virginia.

 

In spite of having lower overall cancer mortality rates in Monongalia County than in West Virginia as a whole, there are some disparities by cancer site. Some of these variances can be attributed to the “youthful” population and demographic characteristics of the County caused by the presence of West Virginia University. Others, such as pancreatic cancer, remain unexplained by population variances and may require further research to explain.

 

Chart 9: Cancer Mortality Rates by Site, 2007

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

In 2007 there were only 3 firearms deaths in Monongalia County, all ruled as suicides. There were no firearms deaths from assault, accidents or legal intervention. Statewide there were 267 firearms deaths that year, with the majority ruled as suicides.

 

The most frequent cause of accidental deaths in Monongalia County (28) was motor vehicle injuries (10). Other accidental deaths resulted from falls (9), poisoning (6), drowning (1), and unspecified causes (2).

 

 

Chart 10: Traffic Fatalities per 100,000 Population, 1994 - 2008

 

Source: NHTSA, National Center for Statistical Analysis, Fatality Analysis Reporting System, October 2010.

 

Although there are wide fluctuations in traffic fatalities from year to year, it appears that the fatality rates in Monongalia County have been increasing over time. About three quarters of the traffic fatalities in Monongalia County occur on major arteries other than the Interstates. Only about 15 percent occurred on the Interstates while about 10 percent occurred on local and other types of roads. This distribution was similar to the state and national patterns. In Monongalia County 48 percent of all traffic fatalities involved blood alcohol levels of 0.8 or greater. This rate was much higher than in West Virginia as a whole (37 percent) or the U.S. as a whole (34 percent)

 

Chronic Disease and Behavioral Factors

Chronic diseases and lifestyle factors contribute to the overall health of Monongalia County residents. Important indicators of health status include the percentage of residents reporting having ever been told they have high cholesterol (30.9 percent), high blood pressure (22.5 percent), arthritis (19.7 percent), asthma (10.4 percent) and diabetes (8.3 percent). With the exception of asthma, the reported rates of chronic diseases in Monongalia County are lower than the rates in West Virginia and the U.S. as a whole.

 

 

Chart 11: Reported Chronic Diseases, 2008

 

Source: West Virginia Behavioral Risk Factor Surveillance System, WV Health Statistics Center, 2010

 

The West Virginia Behavioral Risk Surveillance System also allows for the identification of lifestyle factors that impact health and well-being. In 2008 nearly 15 percent of Monongalia County residents reported that they were in poor to fair health. Residents also reported that they were obese (27.9 percent), smokers (22.8 percent), not exercising (15.0 percent), binge drinking (14.9 percent), and/or using smokeless tobacco (7.3 percent). Only in the case of binge drinking was Monongalia County higher than the reported West Virginia rates. In the cases of obesity, smoking, and smokeless tobacco use, Monongalia County was higher than the reported U.S. rates.

 

 

Chart 12: Lifestyle Factors that Contribute to Premature Death, 2008

 

Source: West Virginia Behavioral Risk Factor Surveillance System, WV Health Statistics Center, 2010

 

The National Immunization Survey (NIS) estimates vaccination coverage for children ages 19 to 35 months. Healthy People 2010 (a comprehensive set of national disease prevention and health promotion goals initiated by the U.S. Department of Health and Human Services) established a target of 90 percent for each of the vaccines routinely given to children and 80 percent vaccination coverage for the typical series of vaccines. In the U.S. vaccination coverage for the typical series was 66.5 percent in 2007. In West Virginia the rate was 64.9 percent. Although no statistics or estimates are available for Monongalia County, several sources imply that the vaccination rates may be lower than the state or national rates. The West Virginia Behavioral Risk Factor Surveillance System indicated that Monongalia County residents reported lower immunization rates for influenza and pneumonia than the state as a whole. Several participants in the interview process (see Section 4 of this report) indicated that these lower rates were caused by fear, particularly among young parents, of serious side effects of certain vaccines (the side effects feared are, in fact, undocumented).

 

Infant Health

Between 2003 and 2007 the number of births to Monongalia County residents ranged from 883 to 929 annually. There was no apparent trend in the birth rate for the county. In 2007, the birth rate in Monongalia County was 10.4 births per 1,000 population. In West Virginia the rate was 12.2 and the U.S. rate was 14.3 births per 1,000 population. This lower birth rate is, at least in part, attributable to the West Virginia University student population who are intentionally delaying the start of their families.

 

Infant mortality has long been used as an indicator of the general health and well-being of a community. The West Virginia Healthy People 2010 goal is to reduce infant mortality to seven deaths per 1,000 live births. Between 2003 and 2007, the infant mortality rate has been below the goal twice and above the goal three times. Straight line trending over the five years suggests that infant mortality rates are declining in Monongalia County. The five-year average infant mortality rate in Monongalia County was 6.4 deaths per 1,000 live births. In West Virginia the average rate was 7.6 deaths per 1,000 live births.

 

Chart 13: Infant Mortality Rates, 2003 – 2007

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

Monongalia County’s percentage of low birth weight infants is below both the state and national average. Again, this rate is probably attributable to the favorable health status of the County population as a whole, and the higher-than-average educational attainment of the mothers in the County.

 

 

 

 

 

 

 

 

 

 

 

Chart 14: Low Birth Weight Rates, 2007

 

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

Another indicator of community health is the rate of teen pregnancies. In 2007, Monongalia County had a lower teen pregnancy rate than either West Virginia or the U.S. as a whole.

 

Chart 15: Teen Pregnancy Rates, by Age of the Mother, 2007

 

 

Source: West Virginia Vital Statistics 2007, WV Health Statistics Center, 2009

 

The West Virginia Behavioral Risk Surveillance System also tracks lifestyle and birth factors that influence infant health. Mothers in Monongalia County are more likely to have primary cesarean sections than are West Virginia mothers in general. Monongalia County mothers are also twice as likely to use alcohol during pregnancy as West Virginia mothers in general.

 

Chart 16: Behavioral and Birth Factors in Pregnancy Risk, 2007

 

 

Source: West Virginia Behavioral Risk Factor Surveillance System, WV Health Statistics Center, 2010

 

Infant health is often determined by the timing and frequency of prenatal care. In Monongalia County, 77.0 percent of mothers in 2007 received prenatal care during their first trimester of pregnancy. In West Virginia, the rate was 80.1 percent and the Healthy People 2010 goal is for 90 percent of mothers to receive prenatal care in the first trimester of pregnancy.

 

Oral and Dental Health

Monongalia County currently has 104 dentists or about 116 dentists per 1,000 population. This is the highest rate in West Virginia, which has 46.7 dentists per 1,000 population. In spite of this high ratio of dentists, the western part of Monongalia County is still considered a Health Professional Shortage Area for Dental Care. According to the national fluoridation study 75 to 100 percent of the water in Monongalia County is treated with fluoride. In spite of these advances, oral health continues to be an issue throughout West Virginia. According to the Center for Disease Control, 38.5 percent of all senior citizens in West Virginia have lost all of their teeth and 65.6 percent of seniors have lost six or more teeth.

 

The West Virginia Oral Health Plan 2010 – 2015 was published earlier this year by the West Virginia Bureau of Public Health. The Plan has set seven objectives to improve the oral health status of West Virginia by providing a structured approach to meeting the oral health needs of all residents of the state.

4. INTERVIEW AND FOCUS GROUP SUMMARY

 

Interviewees

 

The following individuals were interviewed to explore issues related to health status, needs and resources in Monongalia County.

 

Name Affiliation/Organization

Macall Allen Reporter, WBOY television

James Arbogast, M.D. Chair, WVU Dept. of Family Practice

C. Brian Arthurs, M.D. Family practice, Wedgewood Family Practice and Psychiatry

Martin Boone, PhD Psychologist, Wedgewood Family Practice and Psychiatry

Bill Byrne Mayor, City of Morgantown

 

Tori Christian Director of Benefits Administration, WVU

Vicki Conner Literacy Volunteers

Heather Cross American Heart Association

Chris Dyer Lead Captain, Mon EMS

Kerri Hall, M.D. Obstetrician/gynecologist

 

Mike Hicks Executive Director, Sundale Nursing Home

Linda Holmstrand Tobacco Policy Coordinator, Wellness Council of WV

Charlene Horan, M.D. Internal medicine

Laura Jones Executive Director, Milan Puskar Health Right

Asel Kennedy Monongalia County Commissioner

 

K. A. Kisner Sheriff, Monogalia County

Boyce McCoy Director of Human Resources, Swanson Industries

Richard Meckstroth, D.D.S. Chair, WVU Dept. of Dentistry and Rural Health

Tammy Minton Vice President, Patient Care Services, Mon General

Stacy Moniot Reporter, WBOY television

 

Linda Moore Executive Director, WV Family Grief Center

Kim Mosby Associate Dean of Student Affairs, WVU

Bob Myers Director of Corporate Human Resources, Centra Bank

Georgia Narsavage, PhD Dean and Professor, WVU School of Nursing

Dottie Oakes Vice President of Nursing, WVUH

 

Ward Paine, M.D. Internal medicine

Cheryl Perone CEO, Valley Healthcare Systems

Bob Pirner Director of Development, PACE Industries

Leesa Prendergast Associate Director, WVU Prevention Research Center

Pam Queen Managing Editor, Dominion Post

 

Linda Rudy Executive Director, Mon EMS

Tom Sloane, PhD Senior Associate Dean of Student Affairs, WVU

M. D. Starsick Patrolman, Westover Police Department

Ryan Thorne Executive Director, MECCA

Chris Whetsell Director of Case Management, WVUH

 

Lisa Wood, M.D. Pediatrician, Cardinal Pediatrics

Cathy Yura Assistant Vice President, Well WVU

 

Focus Groups and Participants

 

The following focus groups were convened to explore specific issues related to health status, needs and resources in Monongalia County.

 

Monongalia County Health Department

Brenda Fisher WIC Program Director

Cindy Graham Director of Public Health Nursing

Jason Nguyen Nutrition Specialist

James Strosnider Executive Director

Jon Welch Director of Environmental Health

Bob White Regional Epidemiologist

 

Educators

Maxine Arbogast Health teacher, Morgantown High School

Susan Haslebacher Supervisor, Mon County School Health

Sandra Nelms Elementary school guidance counselor

Suzanne Smart Community Liaison, Early Head Start

Joe Statler Member, Mon County Board of Education

 

Emergency Departments

Todd Crocco, M.D. Emergency physician, Ruby Memorial Hospital

Charmaine Egidi Nurse, Mon General emergency department

Mike Ferrebee, M.D. Emergency physician, Mon General

Leaetta Logan Nurse, Mon General emergency department

Roxanne Porter Nurse mgr., Ruby Memorial Hospital emergency department

Paula Sago Nurse, Mon General emergency department

 

Juvenile Justice and Advocacy Groups

Laura Capage Mon County Child Advocacy Center

Sharon Jackson The SHACK

Katrina Liddle-Futrill Child Advocate, Rape and Domestic Violence Info. Ctr.

Denny Poluga Boys and Girls Club

Stephanie Utt Prevention Educator, Rape and Domestic Violence Info. Ctr.

 

Mon General Care Coordinators

Kaye Bartrug; Susan Dalton; Melissa Demaske; Michelle Keith, Director; Pat Tederick; Texisha Wadell

 

Religious Congregations and Groups

Brian Bennett Pastor, St. Paul Lutheran Church

Ed Horvat Chaplain, Mon General

Ellesa High Native American community

Bill Miller Baha’i community

Julie Murdoch Rector, St. Thomas a’ Becket (Episcopal)

Bill Walker Associate Pastor, Chestnut Ridge Church

 

United Way Citizens Review Committee

Bobbie Hawkins; Pam Kaehler; Denise Myers; Janet Scarcelli

 

Comments

 

Issues

1. Obesity; both childhood and adult. Worse in the southern part of the state, but still a problem in Mon County. Caused in large part by poor diet/nutrition and lack of exercise.

2. Diabetes; direct consequence of obesity. Only two endocrinologists (1.5 FTE) in the area.

3. Heart and cancer

a. Heart disease; aggravated by lifestyle and diet

b. Cancer; particular WV problems include late detection and lifestyle issues (e.g., lung cancer patients who don’t stop smoking)

4. Mental health services; inadequate overall, problems on several fronts

a. Few psychiatrists or therapists (e.g., clinical psychologists, social workers)

b. Low reimbursement for services

c. Chestnut Ridge, the WVUH psych/substance abuse facility; not enough capacity, won’t take uninsured

d. EDs have problems getting consults, placing patients; often face delays in getting mental hygiene hearings

e. Not enough adolescent residential (psych and substance abuse) beds in WV, so adolescents are sent to facilities in other states

5. Health insurance; low unemployment, but many jobs in service sector without health insurance. Also many students lack health insurance (estimated to be 20% of the student body). Foreign students and their families are a particular problem.

6. Drug abuse; growing problem, not fully recognized by the public. Heroin and prescription drug abuse cited as the biggest problems.

a. Heroin use growing among WVU drop outs and poor residents.

b. Prescription drug abuse a problem for primary care physicians who are beset by patients with chronic pain complaints. WV reportedly has a big problem (“worst in the nation”) with physicians writing bogus prescriptions. Both emergency departments have problems with “drug seekers.”

7. Alcohol abuse; binge drinking, primarily among WVU students. Alumni are bad role models for students; have beer at tailgate parties and give it out to students. Fraternity system also encourages use/abuse (both alcohol and drugs).

8. Tobacco use; smoking and smokeless. Cultural issue; use growing among young adults. Hospitals going tobacco-free a big step. Efforts underway to make entire WVU campus tobacco-free.

9. Non-supportive home environments; kids may get info at school on stopping tobacco use and drug and alcohol abuse, but it’s going on at home. So, the lessons don’t stick. Also, often no follow-up after initial intervention.

10. Affordable housing; rental market is driven by the student population and little is available for low income non-student population.

11. Homelessness; growing problem caused by economy, lack of low income housing. Mon County has better services than surrounding counties, so poor migrate. Chronic poverty in rural areas.

12. Dental care; especially for low income population. Preventive services not readily available and/or used. ED used for pain control, often until extraction is only option.

13. Immunization compliance; small but persistent issue especially with young families. Unnecessary, inappropriate fears of side effects outweigh benefit of preventing communicable diseases.

14. Disabilities; high percentage of residents with disabilities (“both our jobs and our recreational choices are dangerous”) in WV, and presumably in Mon County. Estimated at 20% of the population but no statistics to verify.

15. Transportation, for some sectors of the population; e.g., getting WVU students back to campus from the hospitals, getting residents to appointments with doctors or other healthcare services.

16. Patients routinely go to inappropriate places for care, mainly the ED for non-emergencies. Leads to overuse and overcrowding. Complicated by some patients going to both EDs over time; difficult to coordinate care; results in duplication of services.

17. Medicaid/public aid recipients need assistance in navigating the system. They often cannot read doctors’ orders or understand diagnoses and treatment recommendations.

 

Resources

1. Not enough primary care physicians, especially in the western part of the county. Nurses doing some primary care; likely to have an expanded role.

2. Almost all physician specialties available.

3. Abundance of urgent care facilities in Morgantown, but some concerns expressed about the quality of care provided. Some insurance issues between the urgent care centers and local employers.

4. Milan Puskar Health Right is a free clinic serving the uninsured and under-insured; provides patient care through volunteer physicians, dentists, pharmacists, and therapists; also provides screening, medication assistance, and educational services. Health Right depends on grants and state funding, both can be inconsistent. Many Health Right programs have waiting lists due to financial limitations, facility constraints.

5. American Heart Association’s WV branch is based in Morgantown. AHA focuses on educational/support programs to prevent heart disease and stroke. Most AHA funding goes to research.

6. Both WVUH and Mon General were cited as being excellent hospitals with good services and facilities. WVUH characterized as the teaching/trauma hospital while Mon General is the community hospital. Some interviewees believe there is too much overlap, due to competition between the systems and resulting in high costs.

7. Four nursing homes and two assisted living facilities in the county. No long term acute care (LTAC) beds/facilities. No certified hospice beds; Sundale Nursing Home is constructing 15 palliative care beds. According to state regulatory standards, Monongalia County may be over-bedded. Sundale is the only not-for-profit entity.

8. Limited options for wellness/fitness/exercise other than WVU. Hilly terrain is a disincentive to get even normal exercise from walking. WVU just got approval for a new student health center and fitness park. Public access to the new facility not yet determined.

9. The WV Family Grief Center is a peer support service for children to age 18. Well regarded, but underfunded and in danger of being forced to reduce, eliminate services.

 

See appendices 1, 2 & 3 for information on selected health care and social service resources in Monongalia County.

 

Potential Solutions

1. A recreation center or YMCA was identified as a way to address obesity and unhealthy lifestyles. WVU has an excellent recreation center but it is only available to students, faculty, and their families. WVU has also just constructed a large wellness center. (Some interviewees suggested that this solution will not be effective because it is just an excuse. The “beer and wings” crowd will not exercise even if resources are available.)

2. Biking/walking trails for the western part of the county also recommended. There is a railroad right-of-way that could be used if support could be mustered.

3. Better sidewalks in Morgantown and throughout the county were cited as an opportunity. Walking is often unsafe; pedestrian conflicts with traffic, discourages walking.

4. The Affordable Care Act (“health reform”) may improve insurance coverage in Mon County. Parents will be able to extend coverage to their children up to age 26, which is expected to resolve some of the problem with uninsured WVU students.

5. Fund the school system to provide preventive dental services.

6. Better coordination and promotion of educational services available in the community. More programs needed for health management, diet and food preparation education.

7. County Board of Health was charged with creating a smoking ban at restaurants, bars, etc., but so far has failed to do so. Significant resistance to smoking ban from some segments of the population.

8. WVU dental school offers a total care program for a limited number of children, but cannot meet the requests for care. Some additional services (e.g., extractions and dentures) are available in its public clinics, but there is significant unmet demand. Health Right offers preventive and treatment dental programs but has a long waiting list for these services. The County Health Department has one dentist.

9. The concept of the “medical home” should be implemented and expanded to incorporate a multi-disciplinary team for the management of chronic diseases. The cost of management would be much lower than the cost of treatment.

10. Outreach needed to extend smoking cessation programs to rural parts of the county.

11. The local drug court provides an alternative to prison for drug abusers. The program has only been operating in Monongalia County for about a year so there are few statistics (e.g., recidivism rate). If successful, the program could be expanded.

12. “Safe zones” would allow teenagers to be with their friends, protected from alcohol and drugs. Morgantown had a roller rink and a dance hall for teenagers; both are now gone.

 

Appendix 1

Licensed Non-Acute Healthcare Providers in Monongalia County

 

 

Behavioral Health Centers

 

Chestnut Ridge Day Hospital, 930 Chestnut Ridge Road

 

Coordinating Council, 1097 Greenbag Road

 

Monongalia County Youth Service Center, 440 Elmer Prince Drive

 

Odyssey House, 305 Fayette Street

 

PACE Enterprises, 889 Mylan Park Lane

 

REM Community Options, 72 Distributor Drive

 

Rescare North Central, 5000 Greenbag Road

 

Richwood, 90 School Street

 

Valley Healthcare System and Valley-Alliance Treatment Services, both located at 301 Scott Avenue

 

Home Health Agencies

 

Amedisys Home Health Care, 246 Cheat Road

 

Care Partners Home Health, 4000 Hampton Center

 

Interim Health Care of Morgantown, 1111 Van Voorhis Road

 

Monongalia County Health Department Home Health, 453 Van Voorhis Road

 

Hospices

 

Amedisys Hospice Care, 246 Cheat Road

 

Morgantown Hospice, P.O. Box 4222

 

 

 

 

Long Term Care (SNF/NF)

 

Golden Living Center, 1379 Van Voorhis Road (100 beds)

 

The Madison, 161 Bakers Ridge Road (62 beds)

 

Mapleshire Nursing and Rehabilitation Center, 30 Vandervort Drive (120 beds)

 

Sundale Nursing Home, 800 J. D. Anderson Drive (115 beds)

 

Other Providers

 

Ambulatory Surgery Center

Surgical Eye Care Center of Morgantown, 1299 Pineview Drive

 

Assisted Living Residence

Assisted Living at Evergreen, 3705 Collins Ferry Road (48 beds)

 

End Stage Renal Dialysis Center

FMC, 11 Commerce Drive

 

Federally-Qualified Health Center

Clay-Barrelle Health Service Association, Blacksville

 

Intermediate Care Facilities/Mental Retardation

REM, 843 Brookhaven Road (8 beds), 904 Curtis Avenue (8 beds), 1040 White Avenue (7 beds)

 

Physical/Speech Therapist

Therapy Services, 1052 Maple Drive

 

Rehabilitation Hospital

Healthsouth MountainView Regional Rehab Hospital, 1160 Van Voorhis Road (2 campuses, 96 beds)

 

Residential Care Community

Suites at Heritage Point, One Heritage Point (44 beds)

 

Note: Excludes facilities licensed by WVU Hospitals

 

Source: State of West Virginia Department of Health and Human Resources, Office of Health Facility Licensure and Certification; www.wvdhhr.org/ohflac/FacilityLookup ; accessed November 19, 2010

Appendix 2

Unlicensed Health and Social Service Agencies in Monongalia County

 

 

American Red Cross, River Valley Chapter Disaster services program; armed forces emergency services program

 

Bartlett House Resident shelter program

 

Big Brothers Big Sisters One-on-one mentoring program

 

Caritas House Prevention education program; volunteer program

 

CASA for Kids Child advocacy program

 

Christian Help Emergency financial assistance; women’s and men’s career closets

 

Criss Cross Credit counseling program

 

Girl Scouts of Black Diamond Council New Girl Scout leadership experience program

 

In Touch and Concerned Telephone reassurance; transportation services

 

Literacy Volunteers Adult tutoring

 

Mental Health America Friendship room

 

Milan Puskar Health Right Community medical and dental partners program; medication assistance program; counseling program

 

Monongalia County Child Advocacy Center Child advocacy center program

 

Morgantown Area Youth Services Project Delinquency intervention program; youth transitions program

 

Mountaineer Area Council, Boy Scouts of America Cub Scouting; Boy Scouting; Scoutreach program

 

Mountaineer Boys and Girls Club Educational enhancement program; teen services program

 

PACE Enterprises New vocational training programs; on the job training, job creation and retention

 

Rape and Domestic Violence Information Center Children’s program; volunteer program

 

Raymond Wolfe Center Wellness works; food pantry

 

Rock Forge Neighborhood House Emergency assistance; before and after school program

 

Salvation Army Feeding program for Monongalia County; social services program for Preston County

Scott’s Run Settlement House Child development center

 

The Connecting Link Emergency assistance program; information and referral program

The Shack Youth, family and happy school program; summer junior volunteer program; home repair and rehabilitation program

Visiting Homemakers Home health aide program

 

West Virginia Family Grief Center

Peer support for children, education and outreach

 

Source: teamunitedway.org/our-partners

 

Appendix 3

Actively Licensed Doctors of Medicine and Osteopathy

Practicing in West Virginia and Monongalia County