Hilary Jauregui, RN, BSNU CONJ 501

August 8, 2010

Klickitat County,

Washington

Where is Klickitat County?

Primary RUCA: Small

town/isolated rural2

Under 18

Over 65

18-64

Age

Who is Klickitat County?6

Black; 1% Asian; 1%Native Amer-

ican; 4%Latino; 10%

White; 84%

Ethnicity

17% live below the federal poverty level

Access to Care

No MUAs or MUPs8

HPSAs9

Primary Care Mental Health Care Dental Care

10% of county residents are more than 30 minutes from OB care11

10% of county residents are more than 30 minutes from acute care152

Coverage Type Percent Covered

Medicare7 16% 65+ years3% disabled

Medicaid7 25%

None1 18% of adults5% of children

Access to Care: Healthcare Coverage

Access to Care: Hospital & ClinicsCritical Access Hospitals/Trauma Centers14

Indian Health Centers/Tribal Clinics

Rural Health Clinics4

Klickitat Valley Hospital (Level IV G)Southwest RegionPO Box 5 310 S Roosevelt Goldendale WA 98620 Phone: (509) 773-4022

Yakama Nation Tribal Health Facility3 PO Box 151 401 Buster Rd.Toppenish, WA 98948 Phone: (509) 865-2025

Family Practice Clinic 711 East Collins Drive Goldendale, WA

Skyline Clinic 211 Skyline Drive White Salmon, WA

Skyline Hospital (Level IV)Southwest Region  P.O. Box 99 211 Skyline Dr White Salmon WA 98672 Phone: (509) 493-1101

No Community Health or Migrant Health Centers10

Mid-Columbia Family Health Center212 Skyline DriveWhite Salmon, WA http://www.mcfhc.com/

Health Indicator

Klickitat County

WA State

Physical Activity (teen)

50% 44%

Overweight (teen) 15% 25%

Substance Use: Binge Drinking (adults)

13% 16%

Community Strengths13

Community Needs AreasHealth Indicator Klickitat

CountyWA

StateObesity (adult)13 67% 61%

Environmental Quality: Access to Healthy Food1

20% 47%

Access: Personal Healthcare Provider1

71% 79%

Childhood Immunizations13

35% 42%

The obesity rate in Klickitat County is 10% higher than Washington state13

Obesity is a personal and public health issueObesity leads to a variety of health

issues, including diabetes, hypertension and many cancers

Stomach, colorectal, endometrial and pancreatic cancer rates are disproportionately high in KlickitatObesity is a risk factor for all of the above cancers

Priority Health Issue: Adult Obesity

Healthy U of DelmarvaComprehensive, community-based

program to holistically address obesity

Serves 3 counties in MarylandMore than 170 community partnersIncentive-based program that

provides awards for healthy behaviors

Evidence-Based Intervention5

Community Partnerships are critical for the program’s successProgram negotiated deep discounts

with community providers of health & exercise services for members

Fitness scholarships are provided for members unable to afford the services

Members receive complementary diet & exercise software

Program Design

Individual IncentivesParticipants earn entries into monthly

rafflesEntries earned through participation in

exercise classes, walking clubs or health lectures

Annual grand prize drawings (car or motorcycle) Earned through program participation for 1

year, with baseline and 1 year BMI measurements

Program Design

Community IncentivesRecognizes community settings that

work to promote long-term healthy lifestyle changesSchoolsFaith-based organizationsNon-profitsGovernmental agencies

Organizations are eligible to compete for prizes

Program Design

Program shows significant health gains for participants

Participants lost an average:5% weight loss6% BMI reduction7% of their waist circumference

6000 community members signed up at the initiation of the programAt 1 year, more than half of the participants

returned to have their weight and measurements reassessed

Another 1000 community members joined the program after the first year

Program Outcomes

Is lack of physical activity impacting obesity rates?Is it safe to participate in outdoor physical

activity?Are exercise facilities or programs

available for community members?Is the lack of access to healthy foods

impacting obesity rates?Are healthy eating educational programs

available?What is the level of health literacy in the

community?The teen obesity rate is much lower than the

rate in Washington State. Are there interventions in place with teens that can be incorporated into a program for adults?

Questions for Community Partners

1. County Health Rankings. (2010). Snapshot 2010: Klickitat, WA. Retrieved 06 30, 2010, from County Health Rankings: http://www.countyhealthrankings.org/washington/klickitat

2. Ginther, G. (2001, 07 25). Dominant RUCA County Code. Retrieved 06 25, 2010, from Washington State Department of Health, Office of Environmental Assessments: http://www.doh.wa.gov/Data/Guidelines/RuralUrban_images/figure6.gif

3. Northwest Portland Area Indian Health Board. (n.d.). Yakama Indian Nation. Retrieved 07 03, 2010, from Northwest Portland Area Indian Health Board: http://www.npaihb.org/member_tribes/tribe/yakama_indian_nation/

4. Olexa, L. (2009, 07 01). Federally Designated Rural Health Clinics By County as of July 1, 2009. Retrieved 07 03, 2010, from Washington State Department of Health: http://www.doh.wa.gov/hsqa/ocrh/RHC/Fed_DesignRHCs.pdf

5. Southwest Rural Health Research Center. (n.d.). Healthy U Delmarva. Retrieved 08 04, 2010 from RHP2010: Models for Practice: http://www.srph.tamhsc.edu/centers/rhp2010/html/education/delmarva.htm

6. U.S. Census Bureau. (2010, 04 22). Klickitat County, Washington. Retrieved 06 24, 2010, from State & County Facts: http://quickfacts.census.gov/qfd/states/53/53039.html

7. U.S. Department of Health & Human Services. (n.d.). Access to Care: Klickitat County. Retrieved 07 03, 2010, from Community Health Status Indicators: http://communityhealth.hhs.gov/AccessToCare.aspx?GeogCD=53039&PeerStrat=42&state=Washington&county=Klickitat

References

8. U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). Find Shortage Areas: MUA/P by State and County. Retrieved 06 25, 2010, from http://muafind.hrsa.gov/index.aspx

9. U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). Find Shortage Areas: HPSA by State & County. Retrieved 06 24, 2010, from http://hpsafind.hrsa.gov/HPSASearch.aspx

10. Washington Association of Community and Migrant Health Centers. (n.d.). CHCs in Washington. Retrieved 07 03, 2010, from Washington Association of Community and Migrant Health Centers: http://wacmhc.org/find-care/chcs-in-washington.

11. Washington State Department of Health. (2006, 09 07). Access of Hospital-Based Perinatal and Neonatal Care, 2006. Retrieved 06 25, 2010, from Geographic Information Systems: http://ww4.doh.wa.gov/gis/pdf.neon)tt.pdf

12. Washington State Department of Health. (2006, 07 28). Access to the Nearest Acute Care Hospital in Washington, 2006. Retrieved 06 24, 2010, from Geographic Information Systems: http://ww4.doh.wa.gov/gis/pdf/acute_tt.pdf

13. Washington State Department of Health. (2009). Klickitat County Public Health. Retrieved 06 30, 2010, from Washington State Local Public Health Indicators: http://www.doh.wa.gov/PHIP/khi/lphi/lhj/klickitat/hp/hp1.htm

14. Washington State Department of Health, Office of Community Health Systems. (2010, 05 04). Directory: Washington State Trauma Services. Retrieved 06 25, 2010, from www.doh.wa.gov/hsqa/emstrauma/download/atcf_directory.pdf

References