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Toward a Population Health Delivery System:

First Steps in Performance Measurement

James Studnicki, Frank V. Murphy, Donna Malvey, Robert A. Costello, Stephen L. Luther, and Dennis C. Werner

In spite of the technological sophistication and clinical excellence of the U.S. health care industry and annual health expenditures in excess of a trillion dollars, the overall health status of the American population is comparatively poor. The BCHS in west central Florida sought to improve the health status of the communities that it serves. Known by the acronym CHAPIR, an information-driven health status decision support system was developed, pilot tested, and is now fully implemented throughout the BCHS. The methodological approach, quantitative indicators, report format components, and management implications of the system are described.

Health Care Manage Rev, 2002, 27(1), 76–95 © 2002 Aspen Publishers, Inc.

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Managing health care organizations has never been more challenging. The continued growth of managed care, recent changes in Medicare reimbursement, and increased public access to detailed financial and clini- cal information are making it more difficult for health care executives to meet performance expectations re- lated to the quality of service, market share, and prof- itability. An even more difficult challenge, however, may lie ahead for this country’s health care leader- ship: to demonstrate that the health status of commu- nities and populations can be improved. Although the U.S. spends a larger percentage of its wealth for health expenditures and has, without question, the most technologically advanced medical care system in the world, our health status as a nation is persistently sub- par, even when compared to some less economically developed nations. This gap between our wealth and our health, long a subject of some debate among re- searchers, is now being more widely acknowledged by politicians and the public at large. Increasingly, managers of our health care institutions and agencies will be expected to close this gap. Improving the health status of populations repre- sents a new management challenge to a health care

Key words: community health status assessment, defined popu- lations, integrated delivery systems, multihospital systems

James Studnicki, Sc.D., is Professor of Health Policy and Man- agement and Director, Center for Health Outcomes Research, University of South Florida, Health Sciences Center, Tampa and St. Petersburg, Florida.

Frank V. Murphy, M.H.A., is President and CEO, BayCare Health System, Clearwater, Florida.

Donna Malvey, Ph.D., is Assistant Professor, Health Policy and Management, University of South Florida, College of Public Health, Tampa and St. Petersburg, Florida.

Robert A. Costello, M.B.A., is Director of Quality Planning, BayCare Health System, Clearwater, Florida.

Stephen L. Luther, Ph.D., is Research Assistant Professor, Cen- ter for Health Outcomes Research, University of South Florida, Tampa and St. Petersburg, Florida.

Dennis C. Werner, M.H.A., is Senior Research Coordinator, Cen- ter for Health Outcomes Research, University of South Florida, Health Sciences Center, Tampa and St. Petersburg, Florida.

This work was supported in part by grants from the U.S. Department of Commerce (Telecommunications and Information Infrastructure Assistance Program) and the BayCare Health System.

system primarily oriented toward providing insur- ance coverage and medical and hospital services to sick people. Our organizational structures, priorities, values, and financial incentives are seemingly incon- gruent with an emphasis on the health of populations and on coordinated and focused efforts to identify health risks and prevent illness. Especially for private sector organizations in the U.S., these management objectives are unfamiliar territory. This article reviews the experience of a hospital-based integrated delivery system (IDS) taking its first steps toward managing the health status of defined communities.

THE AMERICAN DILEMMA

This fundamental, peculiarly American dilemma has been so well documented over such a long period of time and with such profound implications for our society, it is surprising that it is not widely acknowl- edged as a national disgrace: While our health care system consumes the massive amount of resources represented by the more than one trillion plus dollars expended annually, the health status of our nation as characterized by multiple measures is alarmingly low. At least a dozen nations with a population greater than one million persons have lower infant mortality rates. 1 Immunization rates for measles by age 12 are higher in nearly 60 countries, including many that would be considered economically under- developed or distressed. 2 Nearly 20 nations have male and female life expectancy at birth longer than the U.S. The World Bank has cited the United States as the nation with the worst health outcomes in relation to expenditures. 3

MULTIPLE DETERMINANTS OF HEALTH

Since the medical care system consumes such a large percentage of total U.S. health expenditures, many investigators expressing a public health per- spective have challenged the extent to which these in- vestments have improved population health status, 4,5 generally concluding that medical interventions have a relatively minor impact on population mortality. Explanatory models have emerged that differentiate the concepts of disease, health, and well being. 6 Mul- tiple factors identified as impacting disease, health, and function include the social environment, physical environment, and genetic endowment. 7 For example, extensive research evidence exists that higher levels

Toward a Population Health Delivery System

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of socioeconomic status are persistently associated with lower mortality and morbidity. 8,9 Related factors such as employment, income, social support systems, marital status, and race have been found to have independent effects on mortality rates. 1012 Environ- mental hazards and toxic agents have been deter- mined to have measurable impacts on the health of populations in the form of occupational hazards, food and water contaminants, and components of commercial products. Personal behaviors such as smoking habits, diet, exercise, alcohol use, motor ve- hicle use, sexual activity, and violent and abusive be- havior contribute significantly to health outcomes. 13 Therefore, since there are multiple determinants of population health, it is unlikely that even a lavishly funded medical care system alone will deliver sub- stantial improvements in health status. Traditional public health agencies have defined as core functions the assessment of the health of popula- tions, policy formulation appropriate to the problems identified, and assurance that relevant environmental, behavioral, or medical care interventions are applied and sustained. 14 However, most Americans have no experience with public health agencies, which are chronically handicapped by a paucity of resources, and in many areas, relegated to the role of the health care provider of last resort to especially vulnerable popula- tions. Many health policy experts have come to believe that improvements in population health status are likely to come only from the type of organization de- scribed by Alfred Sommer, Dean of the Johns Hopkins School of Hygiene and Public Health as “a complex, diverse, integrated, and dynamic enterprise, com- posed of many disciplines, whose primary goal is im- proving and protecting the health of the public.” 15 (p.657) No such organization presently exists in the U.S.

NEW ORGANIZATIONAL MODELS, BARRIERS, AND INFORMATION

Currently, our health care system, despite an in- creasing awareness of the importance of both clinical and population outcomes, is neither organized nor in- centivized to address population health. Considera- tions of profitability and market share continue to dominate management decisions in private sector organizations. 16 Public health agencies and organ- izations are largely focused upon designated pop- ulations of interest (e.g., poor mothers and children, patients with AIDS) supported by categorical funding. The challenge of being able to affect both medical and

78 HEALTH CARE MANAGEMENT REVIEW/WINTER 2002

nonmedical determinants of health through some type of vertically integrated delivery system has been addressed by a few researchers. It has been suggested that hospital integrated delivery systems may have the potential to incrementally develop the vertically integrated services (e.g., screening, health education) necessary to address additional determinants of pop- ulation health. 17 Barriers to the evolution of hospital- based integrated delivery systems into “integrated population health delivery systems” are formidable. Implementing appropriate financial incentives is probably the most essential task in the creation of the new paradigm. Shortell has described the health pro- motion accountability region (HPAR), a type of inte- grated delivery system, at the state or regional level whose reimbursement would be tied to improve- ments in population health status. 18 More recently, Kindig has suggested a financial mechanism that re- wards integrated delivery systems and health plans for improvements in an index of health adjusted life expectancy (HALE) but also proposes the establish- ment of a Health Outcomes Trust that would have re- sponsibility for coordinating the medical care sector and other sectors (e.g., social services, education, envi- ronment, public health) in order to maintain and im- prove the health of the public. 19 It should be noted that other European nations have already incorpo- rated improvements in population health as a means to evaluate the performance of health care managers. As exciting as these theoretical concepts and inno- vative organizational schemes may be to some re- searchers and policy analysts, the first few necessary steps must be taken on the messy turf of the real world. In the most fundamental terms, there are two practical requirements necessary for any organization wishing to impact on community health status: pur- pose and performance measurement. First, an explicit recognition of improved population health status as an enterprise objective is a prerequisite for success. Second, there must be a valid performance measure- ment system, which makes the powerful connection among the health of the community, information- driven decision support systems, and management decisions. 20

BAYCARE HEALTH SYSTEM

In the summer of 1997, the signing of a joint operat- ing agreement involving some of the largest and most influential not-for-profit community hospitals in west central Florida formed the BayCare Health System

(BCHS). The hospitals forming BCHS collectively rep- resent 2,756 beds, 3,400 medical staff members, and 10,989 employees. In fiscal 1999, BCHS hospitals ac- counted for approximately 88,000 admissions, 14,000 births, and 269,000 emergency department visits. The system is moving toward vertical integration of ser- vices and provides a wide range of nonacute services in addition to hospital care including screening and pre- ventive services, primary care, and postacute services. The system is organized into a regional structure of three community health alliances (CHAs) that are named after the system hospitals located in each of the geographically defined population areas (see Figure 1). Bayfront–St. Anthony’s Health Care is lo- cated in southernmost part of Pinellas County, in the city of St. Petersburg. (Note: As of December 31, 2000, Bayfront Medical Center is no longer a BCHS member.) Morton Plant Mease Health Care repre- sents the areas of Pinellas County, including the city of Clearwater, and the western area of Pasco County. St. Joseph’s–Baptist Health Care incorporates all of Hillsborough County, including the city of Tampa, and the eastern area of Pasco County. The total three- county area is home to approximately 2.4 million resi- dents. Each of the three CHAs represents considerable geographic, demographic, and socioeconomic hetero- geneity. Pinellas County, for example, is the least rural county in all of Florida, but both Pasco and Hillsbor- ough Counties have expansive rural areas. As is true of many Florida places, older and wealthier coastal com- munities lie adjacent to inland pockets of relative poverty. This diversity represents a formidable chal- lenge to the BCHS management team in assessing the needs and health status of the communities residing inside their population areas, as well as evaluating the impact of the services being delivered. All three CHAs share the same mission of BCHS, “to improve the health of all we serve through community-owned health care services that set the standard for high qual- ity, compassionate care.” Each CHA operationalizes its commitment to improving the communities’ health status through their Quality Planning Process, which

The hospitals forming BCHS collectively represent 2,756 beds, 3,400 medical staff members, and 10,989 employees.

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FIGURE 1

BAYCARE COMMUNITY HEALTH ALLIANCES POPULATION AREAS

BAYCARE HEALTH SYSTEM COMMUNITY HEALTH ALLIANCES’ POPULATION AREAS

1 BAYCARE COMMUNITY HEALTH ALLIANCES POPULATION AREAS BAYCARE HEALTH SYSTEM COMMUNITY HEALTH ALLIANCES’ POPULATION AREAS

80 HEALTH CARE MANAGEMENT REVIEW/WINTER 2002

defines multiyear Strategic Directions and annual Action Steps and Quality Improvement Goals. Com- munity health priority areas for these benchmarks are selected based on findings from research methodolo- gies discussed in this article. Progress on accomplish- ments (i.e., Quality Reporting) is shared on a quar- terly basis with each CHA’s senior and middle management teams, Community Affairs Board Com- mittee, and the health system Board.

PROJECT OBJECTIVES

The rationale for the creation of BCHS was formed in the competitive hospital service market of the 1990s, and there was undoubtedly some reaction to the growth of the proprietary Columbia/HCA system in the Tampa–St. Petersburg area during that period. The goals of the new enterprise reflected the typical antici- pated benefits of service integration: cost efficiencies and economies of scale derived from consolidation of duplicated administrative services; improvements in the quality of clinical care by standardizing on best practices inside the system; and enhanced attractiveness to managed care organizations by providing a network of coordinated hospital and physician services through a “single signature contract.” 21 These objectives are con- sistent themes inside the developing literature on the organization and operation of hospital-based integrated delivery systems. 22,23 However, from the very beginning, the BayCare leadership underscored the system’s promise for im- proving the health of the community. A decision was made to develop an information-driven, community health status decision support system. With consulta- tion assistance from the Center for Health Outcomes Research at the University of South Florida Health Sciences Center, the development of this system was initiated. Known by the acronym CHAPIR (Commu- nity Health Alliance Performance Impact Report), it was determined that the community health status monitoring system would need to meet the following specifications:

Comprehensiveness. Following the recommenda- tions of the Institute of Medicine (IOM) of the National Academy of Sciences, the CHAPIR would establish and maintain a broad strategic view of the health status of the community and the various factors that influence it. 24

Operational Integratability. The indicators used to monitor health status of communities inside the CHAs must, at least to some extent, be related to

the programs and services planned or imple- mented by the CHAs.

Feasibility and Continuity. Data elements utilized in the CHAPIR must be drawn from available extant public databases, or existing sources of internal information. Information requiring original, primary data collection such as surveys would be less desirable on the assumption of the decreased likelihood that these special efforts would be sustained over time.

Community-Level Granularity. County- and CHA- specific information, while valuable for compar- ative purposes, is insufficient in identifying the health status variability of the communities inside the CHA service areas. Therefore, the CHAPIR system must aggregate data to the com- munity level as defined by groups of postal zip codes.

Parsimonious Presentation. Intended primarily for senior corporate managers, clinical leadership, and board members, the CHAPIR reports must capture and present the important and valid in- dicators and findings without resorting to lengthy narrative or complicated statistical treat- ment.

Measurement and Monitoring of Results. The CHAPIR report must include interim “process” indicators to measure progress on recommenda- tions, goals, and action plans initiated to address priority problem areas. Process indicators can be reported on a more frequent basis than ultimate outcome indicators such as morbidity and mor- tality, which are typically updated on an annual basis.

THE METHODOLOGICAL APPROACH

An existing methodology for assessing the health status of communities, under development for nearly 8 years, served as the starting point for CHAPIR. Known as CATCH (Comprehensive Assessment for Tracking Community Health), the method draws 250 indicators from multiple sources and uses a compara- tive framework and weighted evaluation criteria to produce a rank-ordered community problem list. The indicators are organized into 10 categories: demo- graphic characteristics; socioeconomic characteristics; maternal and child health indicators; infectious disease indicators; physical and environmental health in- dicators; health status indicators (mortality and morbidity); social and mental health indicators; sentinel

events (immunizable diseases and avoidable hospi-

talizations); health resource availability indicators; and, behavioral risk factors. 25 Comprehensive CATCH assessments have been completed in 13 Florida coun- ties including all three of the counties composing the BCHS–CHA areas. The CHAPIR reports draw much of their data from the same sources, but the format specifies a three-level indicator selection process:

1. Generic Health Status Indicators, which are in- tended to provide a baseline profile of the impor- tant dimensions of community health status. This indicator list will be identical for each of the three CHAs, allowing comparison between the CHAs with statewide, regional, and national norms.

2. CHA-Specific Health Status Indicators are in- tended to profile those diseases or conditions that can be identified as a priority area of con- cern for each CHA. The assignment of priority for any indicator may be the result of each CHA’s internal strategic analysis, a previous county-level CATCH assessment, an evaluation of zip code level community cluster analyses, or some other source of information.

3. Programmatic Indicators are determined largely by the nature of service programs and monitor- ing systems that have been implemented by the CHA operating units. These indicators would tend to be more “operational,” focusing on pro- gram utilization or intermediate outcome tar- gets rather than morbidity and mortality indi- cators. Although these indicators are drawn largely from existing sources of external and in- ternal information, some may require a primary data collection effort such as a periodic tele- phone survey.

GENERIC HEALTH STATUS INDICATORS

The first level of Generic Health Status Indicators was identified through a comprehensive review and statistical analysis of the unique CATCH database. These indicators are intended to represent major disease groups and/or leading causes of death, the relevant CATCH category indicators, and a smaller subset of CATCH indicators that would explain most of the statistical variation in mortality accounted for by all of the CATCH indicators. Researchers refer to the subset as the “parsimonious model,” that is, a smaller group of indicators, which accounts for a large

Toward a Population Health Delivery System

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percentage of the total variation represented by all of the indicators. A principal components analysis (PCA) was se- lected as the statistical technique to derive the par- simonious model. The PCA is applied to a set of variables where there is interest in discovering which variables inside the set or the group of indicators form coherent subsets that are relatively independent of one another. Variables that are correlated with one an- other but are largely independent of other subsets are combined into the principal components. The major goal of the PCA is to reduce the number of variables down to a few factors. For example, the total number of variables in the original CATCH socioeconomic indicators category was reduced to two factors:

poverty and education/employment. The 14 factors created by the PCA and the individual variables com- prising each are found in Table 1.

CHA-SPECIFIC HEALTH STATUS INDICATORS

Since comprehensive assessments were completed in each of the three counties composing the BCHS service area, the priority problems or issues identified in those projects were an important source of infor- mation in determining CHA priorities. Table 2 is a summary of the major categories and indicators iden- tifying health challenges in each county. Subsets of the indicators utilized in the comprehen- sive community assessments are available at the postal zip code level. This presents the opportunity to focus down on identified “communities” inside each of the CHAs that are composed of groups of zip codes. This capability considerably enhances the process of describing the characteristics and health status of population groups inside the boundaries of each CHA. In order to provide these new dimensions to the CHAPIR report, the following analytical steps were completed:

Each of the three CHAs was subdivided into communities based upon groups of zip codes. This process generally attempts to define com- munities that are relatively homogeneous in- ternally, but acknowledged by residents to be different from other communities. While there tends to be some disagreement over the assign- ment of some boundary zip codes to one com- munity versus another, there is usually high agreement regarding the core cluster of zip codes. Often these communities correspond very closely to old neighborhood boundaries.

TABLE 1

PRINCIPAL COMPONENT ANALYSIS OF COMMUNITY HEALTH STATUS: RESULTING FACTORS

Factor

Indicators

Poverty

Education/Employment

Demography

Rurality Community Violence

Maternal and Child Health

Avoidable Hospitalizations Resources

Infection Morbidity Chronic Morbidity Site-specific Mortality (adult)

Unintentional Injury Infant Deaths (white) Infant Deaths (non-white)

% of families below federal poverty level, per capita income % of unemployed persons, % of high school dropouts % of population 15, % of population 65, % of populations non-white % of population living in rural areas simple assault rate, aggravated assault rate, domestic violence birth to mothers 15, birth to mothers 15–17, birth to mothers 18–19 congestive heart failure, pneumonia, asthma physicians/100k population, dentists/100k population, LPNs/100k population enteric diseases colorectal cancer morbidity, breast cancer morbidity lung cancer AAM, cardiovascular diseases AAM, pneumonia AAM, prostate cancer AAM, AIDS AAM unintentional injury AAM infant mortality (white), neonatal mortality (white) infant mortality (non-white), neonatal mortality (non-white)

AAM - age adjusted mortality

TABLE 2

MAJOR HEALTH PRIORITIES RESULTING FROM THREE COUNTY LEVEL ASSESSMENTS

County Priority Area

Indicators

Maternal and Child Health

Community Violence and Safety Issues

Preventable Cancers Other

Maternal and Child Health Social Issues Lung/Respiratory Diseases

Other

Maternal and Child Health

Lung/Respiratory Diseases Preventable Cancers Infectious Diseases Other

Hillsborough County

infant, neonatal and post neonatal mortality mortality due to perinatal conditions, birth defects domestic violence, simple and aggravated assaults, suicide, homicide and unintentional injuries breast, cervical, colorectal; smoking related stroke, COPD

Pinellas County

infant and child mortality, birth defect mortality births to mothers 15, repeat births to teenagers smoking related cancers, lung and bronchus cancers, pneumonia and influenza, chronic obstructive lung diesease Years of Productive Life Lost (YPLL)

Pasco County

low and very low birthweight babies, births to mothers 15, perinatal conditions neonatal, post neonatal and infant mortality pneumonia and influenza breast, cervical; melanoma, lung, and smoking related syphilis, gonorrhea, meningitis stroke

Figure 2 illustrates the nine communities created by postal zip code aggregation within the St. Joseph’s–Baptist Health Care CHA.

A comprehensive list of indicators from the CATCH database, available at the zip code level, was then aggregated into CHA, county, and community (i.e., zip code groups) mean values.

Finally, eliminating those indicators that re- flected volumes so low that many zip codes would have three or fewer observations in 1 year reduced the list. The remaining indicators would then represent a relatively large volume of cases, and would be suitable for validly iden- tifying indicators which had relatively large dif- ferences between the CHA mean value and one or more of the community values.

PROGRAMMATIC INDICATORS

A major source of information that was used to identify CHA-specific priority issues and problems is the internal strategic analysis conducted by the CHAs and/or their various operating units. Presumably, a set of organizational objectives serves as the guide for allocating resources and development of programs. Many of these decisions will be based upon the growth of new clinical programs, the strengthening of existing ones and even, occasionally, the termination of others. In a few instances, those objectives are congruent with improvement in community health status outcomes. In an effort to include this type of strategic thinking in the CHA-specific indicators, meetings were scheduled with key staff and management at each of the three CHAs. A loosely structured questionnaire was devel- oped that elicited information for three domains: the health care needs that have been identified inside each CHA and its communities; the services or programs implemented or planned to address these identified needs; and the measures or quantifiable indicators currently utilized or planned that could monitor the implementation of the programs and anticipated out- comes that would be impacted by these programs. The responses were organized in the same categories uti- lized by the CATCH methodology so as to improve the internal consistency of both the reporting and the presentation. BCHS has also implemented a framework for iden- tifying basic quality improvement goals, which were developed by each of the three CHAs and organized into three categories: service, outcome, and cost. These measures tend to be operational in nature; that

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BCHS has also implemented a framework for identifying basic quality improvement goals, which were developed by each of the three CHAs and organized into three categories: service, outcome, and cost.

is, they are typically focused on clinical or administra- tive process improvement. Generally, these indicators emphasize improvement in service to key customers, outcomes (clinical and nonclinical), and cost. These in- dicators may be oriented toward improvements in community health status and will be incorporated into the CHAPIR report. For example, one CHA had as an expressed outcome goal the reduction in late- stage breast cancer. This goal could be related to mammography screening or breast self-examination education programs, and ultimately to reductions in breast cancer mortality.

REPORT FORMAT COMPONENTS

There are two major methods of data presentation incorporated into the CHAPIR report format: core indi- cator graphs and the total indicator table. The core indi- cator set is composed of each indicator selected for analysis in each CHA through the process of selection previously described utilizing three levels of indicators (i.e., generic, CHA-specific, and programmatic). For each indicator, a graph depicts the CHA value as a horizontal line and reference symbols placed above or below the line. A sample core indicator graph (Figure 3) illustrates morbidity due to psychoses in the St. Joseph’s–Baptist Health Care CHA and 12 symbols representing, from left to right, values for: the Florida state average, the Hillsborough and Pasco County averages, and the mean values for each of nine zip- code-defined communities within the CHA. Therefore, communities with unfavorable patterns of morbidity and mortality are easily identifiable. The number of core indicator graphs will vary somewhat between CHAs, and 27 were selected for St. Joseph’s–Baptist Health Care CHA. Other methods for presenting the core indi- cator data are available such as color-coded mapping. For a more comprehensive view, all indicators having zip code level data are also displayed in a summary Table 3. The table organizes the indicators

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HEALTH CARE MANAGEMENT REVIEW/WINTER 2002

FIGURE 2

ST. JOSEPH’S–BAPTIST HEALTH CARE COMMUNITY HEALTH ALLIANCE PERFORMANCE IMPACT REPORT (CHAPIR)

/W INTER 2002 FIGURE 2 ST. JOSEPH’S–BAPTIST HEALTH CARE COMMUNITY HEALTH ALLIANCE PERFORMANCE IMPACT REPORT (CHAPIR)

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FIGURE 3

CORE INDICATOR GRAPH: MORBIDITY DUE TO PSYCHOSES WITHIN ST. JOSEPH’S–BAPTIST CHA

Health Delivery System 85 FIGURE 3 CORE INDICATOR GRAPH: MORBIDITY DUE TO PSYCHOSES WITHIN ST. JOSEPH’S–BAPTIST

86 HEALTH CARE MANAGEMENT REVIEW/WINTER 2002

TABLE 3

TOTAL INDICATOR TABLE: ST. JOSEPH’S–BAPTIST CHA

St. Joseph/

Hillsborough

Pasco

NE Pasco

SE Pasco

Baptist CHA

County

County

Community

Community

1,042,571

918,084

310,517

51,260

73,227

CHA Indicators

Socio-Demographic Indicators

Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K

Non-White Population

185,764

175,040

14,535

7,812

2,912

 

17.82%

19.07%

4.68%

15.24%

3.98%

Median Household Income

$34,405

$35,549

$25,654

$24,006

$27,337

Population Over 65

151,197

119,200

104,015

8,767

23,230

 

14.50%

12.98%

33.50%

17.10%

31.72%

Population Under 15

250,549

223,213

55,947

13,792

13,544

 

24.03%

24.31%

18.02%

26.91%

18.50%

Disease Specific Mortality

Total Mortality

9,190

7,803

4,915

448

939

 

881.47

849.92

1582.84

873.98

1282.31

Cardiovascular Disease

3,548

3,045

1,988

160

343

 

340.31

331.67

640.22

312.13

468.41

Heart Disease

2,709

2,326

1,594

118

265

 

259.84

253.35

513.34

230.20

361.89

Total Cancer

2,261

1,954

1,238

90

217

 

216.87

212.83

398.69

175.58

296.34

Preventable Cancers

1,288

1,093

726

61

134

 

123.54

119.05

233.80

119.00

182.99

Smoking Related Cancers

885

749

527

41

95

 

84.89

81.58

169.72

79.98

129.73

Lung Cancer

712

595

433

36

81

 

68.29

64.81

139.44

70.23

110.61

Stroke

612

543

274

19

50

 

58.70

59.14

88.24

37.07

68.28

Chronic Obstructive Lung

491

412

312

20

59

Disease

47.10

44.88

100.48

39.02

80.57

Diabetes Mellitus

282

239

101

16

27

 

27.05

26.03

32.53

31.21

36.87

Colorectal Cancer

238

204

113

13

21

 

22.83

22.22

36.39

25.36

28.68

Pneumonia/Influenza

225

162

159

17

46

 

21.58

17.65

51.20

33.16

62.82

Colon Cancer

201

174

94

11

16

 

19.28

18.95

30.27

21.46

21.85

Prostate Cancer

158

141

92

7

10

 

31.06

31.46

62.18

27.80

28.24

Breast Cancer

158

139

67

5

14

 

29.60

29.58

41.22

19.17

37.02

Chronic Liver Disease

112

100

52

6

6

& Cirrhosis

10.74

10.89

16.75

11.71

8.19

AIDS

110

99

31

6

5

 

10.55

10.78

9.98

11.71

6.83

TABLE 3 (continued)

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87

NW Tampa

New Tampa

S Tampa

E Tampa

S Hillsborough

Brandon

Plant City

Community

Community

Community

Community

Community

Community

Community

95,134

230,650

Totl/R per 100K Totl/R per 100K

119,965

Totl/R per 100K

192,328

85,973

Totl/R per 100K Totl/R per 100K

138,594

55,440

Totl/R per 100K Totl/R per 100K

11,212

37,271

26,179

74,836

7,214

14,007

4,321

 

11.79%

16.16%

21.82%

38.91%

8.39%

10.11%

7.79%

$42,416

$38,110

$34,008

$25,428

$32,689

$44,527

$33,547

8,591

21,029

20,614

25,771

23,072

12,373

7,750

 

9.03%

9.12%

17.18%

13.40%

26.84%

8.93%

13.98%

22,768

54,169

24,146

50,416

18,067

38,465

15,182

 

23.93%

23.49%

20.13%

26.21%

21.02%

27.75%

27.38%

672

1,620

1,240

1,785

1,020

904

562

 

706.37

702.36

1033.63

928.10

1186.42

652.26

1013.71

230

589

523

711

481

316

195

 

241.76

255.37

435.96

369.68

559.48

228.00

351.73

166

416

412

561

369

251

151

 

174.49

180.36

343.43

291.69

429.20

181.10

272.37

195

429

281

401

232

262

154

 

204.97

186.00

234.23

208.50

269.85

189.04

277.78

116

244

153

235

114

148

83

 

121.93

105.79

127.54

122.19

132.60

106.79

149.71

77

163

104

167

87

93

58

 

80.94

70.67

86.69

86.83

101.19

67.10

104.62

64

121

80

137

69

79

45

 

67.27

52.46

66.69

71.23

80.26

57.00

81.17

44

137

82

111

78

51

40

 

46.25

59.40

68.35

57.71

90.73

36.80

72.15

38

105

62

77

56

47

27

 

39.94

45.52

51.68

40.04

65.14

33.91

48.70

22

45

32

72

21

30

17

 

23.13

19.51

26.67

37.44

24.43

21.65

30.66

18

43

25

44

21

37

16

 

18.92

18.64

20.84

22.88

24.43

26.70

28.86

11

28

35

33

16

19

20

 

11.56

12.14

29.18

17.16

18.61

13.71

36.08

16

39

18

37

19

33

12

 

16.82

16.91

15.00

19.24

22.10

23.81

21.65

5

34

21

36

22

14

9

 

10.75

30.24

36.42

38.80

50.95

20.41

33.31

18

27

20

23

18

20

13

 

37.02

22.84

32.10

23.11

42.06

28.57

45.74

5

20

18

39

5

11

2

 

5.26

8.67

15.00

20.28

5.82

7.94

3.61

8

22

15

40

3

7

4

 

8.41

9.54

12.50

20.80

3.49

5.05

7.22

TABLE 3 (continued)

St. Joseph/

Hillsborough

Pasco

NE Pasco

SE Pasco

Baptist CHA

County

County

Community

Community

1,042,571

918,084

310,517

51,260

73,227

CHA Indicators

Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K

Rectal Cancer

37

30

19

2

5

 

3.55

3.27

6.12

3.90

6.83

Melanoma

35

25

26

2

8

 

3.36

2.72

8.37

3.90

10.92

Cervical Cancer

22

21

5

0

1

 

4.12

4.47

3.08

0.00

2.64

Tuberculosis

3

3

1

0

0

 

0.29

0.33

0.32

0.00

0.00

Other Mortality Indicators

Unintentional Injuries

385

336

124

18

31

 

36.93

36.60

39.93

35.12

42.33

Suicide

132

103

57

11

18

 

12.66

11.22

18.36

21.46

24.58

Homicide

57

51

8

3

3

 

5.47

5.56

2.58

5.85

4.10

Drowning

16

10

11

5

1

 

1.53

1.09

3.54

9.75

1.37

Poison Mortality

2

2

0

0

0

 

0.19

0.22

0.00

0.00

0.00

Maternal/Child Health Indicators

Had Prenatal Care

10,164

8,901

2,827

440

823

1st trimester

661.03

654.05

794.99

518.26

896.51

Teen Births age 18–19

1,015

889

273

59

67

 

66.01

65.32

76.77

69.49

72.98

Low Birthweight

957

874

183

40

43

 

62.24

64.22

51.46

47.11

46.84

Teen Births age 15–17

669

589

168

44

36

 

43.51

43.28

47.24

51.83

39.22

Repeat Births

424

366

104

30

28

 

27.58

26.89

29.25

35.34

30.50

Had Prenatal Care

187

165

40

15

7

3rd trimester

12.16

12.12

11.25

17.67

7.63

Very Low Birthweight

179

161

37

11

7

 

11.64

11.83

10.40

12.96

7.63

Infant Mortality

90

81

21

4

5

 

8.63

8.82

6.76

7.80

6.83

No Prenatal Care

87

80

18

2

5

 

5.66

5.88

5.06

2.36

5.45

Neonatal Mortality

55

50

10

1

4

 

5.28

5.45

3.22

1.95

5.46

Teen Births under age 15

52

46

8

2

4

 

3.38

3.38

2.25

2.36

4.36

Child Mortality

47

36

15

6

5

 

18.76

16.13

26.81

43.50

36.92

Perinatal Conditions

45

40

9

3

2

 

4.32

4.36

2.90

5.85

2.73

Birth Defects

36

26

19

3

7

 

3.45

2.83

6.12

5.85

9.56

Post Neonatal Mortality

33

31

9

1

1

 

3.17

3.38

2.90

1.95

1.37

Morbidity Indicators

Psychoses

1,962

1,872

1,189

47

43

 

188.19

203.90

382.91

91.69

58.72

AIDS

395

379

50

6

11

 

37.89

41.23

15.94

11.71

14.34

TABLE 3 (continued)

NW Tampa

New Tampa

S Tampa

E Tampa

S Hillsborough

Brandon

Plant City

Community

Community

Community

Community

Community

Community

Community

95,134

230,650

Totl/R per 100K Totl/R per 100K

119,965

Totl/R per 100K

192,328

85,973

Totl/R per 100K Totl/R per 100K

138,594

55,440

Totl/R per 100K Totl/R per 100K

2477244

 

2.10

1.73

5.84

3.64

2.33

2.89

7.22

1743424

 

1.05

3.03

3.33

1.56

4.65

1.44

7.22

2714124

 

4.11

5.92

1.61

4.02

2.34

2.86

14.07

0011001

 

0.00

0.00

0.83

0.52

0.00

0.00

1.80

21

62

35

90

42

54

32

 

22.07

26.88

29.18

46.80

48.85

38.96

57.72

11

22

19

20

12

11

8

 

11.56

9.54

15.84

10.40

13.96

7.94

14.43

4

12

7

22

1

2

3

 

4.20

5.20

5.84

11.44

1.16

1.44

5.41

2421010

 

2.10

1.73

1.67

0.52

0.00

0.72

0.00

0010100

 

0.00

0.00

0.83

0.00

1.16

0.00

0.00

1,247

2,798

1,343

2,380

163

932

38

 

852.36

805.88

876.06

786.78

136.74

455.52

43.28

77

225

102

383

26

69

7

 

52.63

64.80

66.54

126.61

21.81

33.72

7.97

80

225

112

343

25

85

4

 

54.68

64.80

73.06

113.39

20.97

41.54

4.56

32

124

74

295

21

36

7

 

21.87

35.71

48.27

97.52

17.62

17.60

7.97

21

81

32

188

14

25

5

 

14.35

23.33

20.87

62.15

11.74

12.22

5.69

6

44

24

71

6

9

5

 

4.10

12.67

15.66

23.47

5.03

4.40

5.69

17

38

20

66

2

16

2

 

11.62

10.94

13.05

21.82

1.68

7.82

2.28

10

25

12

30

0

3

1

 

10.51

10.84

10.00

15.60

0.00

2.16

1.80

5

15

6

43

3

7

1

 

3.42

4.32

3.91

14.21

2.52

3.42

1.14

7

14

7

20

0

1

1

 

7.36

6.07

5.84

10.40

0.00

0.72

1.80

2

8

2

25

4

4

1

 

1.37

2.30

1.30

8.26

3.36

1.96

1.14

3

11

5

13

0

4

0

 

13.18

20.31

20.71

25.79

0.00

10.40

0.00

5

9

5

21

0

0

0

 

5.26

3.90

4.17

10.92

0.00

0.00

0.00

3

12

4

6

0

1

0

 

3.15

5.20

3.33

3.12

0.00

0.72

0.00

3

11

5

10

0

2

0

 

3.15

4.77

4.17

5.20

0.00

1.44

0.00

179

459

411

729

5

80

9

 

188.16

199.00

342.60

379.04

5.82

57.72

16.23

29

80

77

145

11

20

20

 

29.96

34.47

63.77

75.13

12.21

14.07

35.17

TABLE 3 (continued)

St. Joseph/

Hillsborough

Pasco

NE Pasco

SE Pasco

Baptist CHA

County

County

Community

Community

1,042,571

918,084

310,517

51,260

73,227

CHA Indicators

Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K Totl/R per 100K

Lead Poisoning

233

207

53

19

7

 

22.35

22.55

17.07

37.07

9.56

Giardiasis

203

168

54

13

22

 

19.47

18.30

17.39

25.36

30.04

Salmonellosis

187

164

25

8

15

 

17.94

17.86

8.05

15.61

20.48

Shigellosis

177

177

0

0

0

 

16.98

19.28

0.00

0.00

0.00

Chlamydia

172

0

186

104

68

 

16.50

0.00

59.90

202.89

92.86

Gonorrhea

109

0

116

50

59

 

10.45

0.00

37.36

97.54

80.57

Alcohol Dependency

105

98

34

5

2

 

10.07

10.67

10.95

9.75

2.73

Campylobacteriosis

92

74

29

7

11

 

8.82

8.06

9.34

13.66

15.02

Depressive Disorder

66

62

10

1

3

 

6.33

6.75

3.22

1.95

4.10

Hepatitis A

62

53

10

8

1

 

5.95

5.77

3.22

15.61

1.37

Alzheimer’s Disease

55

43

53

4

8

 

5.28

4.68

17.07

7.80

10.92

Hepatitis B

44

42

5

0

2

 

4.22

4.57

1.61

0.00

2.73

Drug Dependence

40

40

5

0

0

 

3.84

4.36

1.61

0.00

0.00

Rubella, including congenital

18

0

34

4

14

 

1.73

0.00

10.95

7.80

19.12

Syphilis, congenital

14

0

27

6

8

 

1.29

0.00

8.70

11.71

10.24

Tuberculosis

14

0

27

6

8

 

1.29

0.00

8.70

11.71

10.24

Pertussis

14

14

0

0

0

 

1.34

1.52

0.00

0.00

0.00

Meningitis (meningococcal)

9

9

0

0

0

 

0.86

0.98

0.00

0.00

0.00

Mumps

4

3

1

0

1

 

0.38

0.33

0.32

0.00

1.37

Rabies from Animal

1

0

2

1

0

 

0.10

0.00

0.64

1.95

0.00

Rabies, Human Bitten

0

0

0

0

0

 

0.00

0.00

0.00

0.00

0.00

Measles

0

0

2

0

0

 

0.00

0.00

0.64

0.00

0.00

Syphilis, infectious

0

0

0

0

0

 

0.00

0.00

0.00

0.00

0.00

Any foodborne disease

0

0

0

0

0

outbreak

0.00

0.00

0.00

0.00

0.00

Any waterborne disease

0

0

0

0

0

outbreak

0.00

0.00

0.00

0.00

0.00

Avoidable Hospitalizations