Community Health Plan 2010-2015

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2015 Illinois Project for Local Assessment of Needs
Coles County Health Department
IPLAN 2010 - 2015
Illinois Project for Local Assessment of Needs
COMMUNITY HEALTH PLAN
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Table of Contents
PURPOSE STATEMENT…………………………………………………...…… 4
REVIEW OF 2005-2010 IPLAN………………………………………………… 4
COMMUNITY INVOLVEMENT………………………………………………. 7
Organizational Capacity Assessment……………………………….…… 7
THE APEXPH PROCESS…………………………………………………….…. 7
HEALTHY PEOPLE 2020………………………………………………………. 8
STRATEGIC HEALTH ISSUES………………………………………………... 8
UNDERAGE BINGE DRINKING………………………………………….…… 10
Description…………………………………………………………..…….. 10
Data and Information…………………………………………..………...… 11
How the Finding of the Community Assessment resulted in the issues
being identified……………………………………………………...…….. 11
Proposed Health People 2020 Objectives……………………...…………... 11
Target Population………………………………………………………...… 11
Health Problem Worksheet…………………………………………...……. 12
Outcome Objective 1 : Decrease the number of school age youth who
Binge Drink…………………………………………………………...……. 12
Impact Objective 1.1……………………………………………….. 13
Interventions…………………………………………………..…… 13
Community Resources…………………………………………………..…. 13
Estimated Funding…………………………………………………..……... 13
Anticipated Sources of Funding………………………………………...…..13
HEART DISEASE……………………………………………………….……….. 14
Description……………………………………………………………...….. 14
Data and Information……………………………………………….……… 14
being identified………………………………………………………...….. 16
Proposed Health People 2020 Objectives…………………………..……... 16
Target Population………………………………………………..………… 16
Health Problem Worksheet…………………………………..……………. 17
Outcome Objective 2 : Decrease the Level of Cardiovascular Deaths
In Coles County………………………………….………………... 17
Impact Objective 2.1………………………….………….………... 18
Interventions………………………………………….………….… 18
Community Resources………………………………………………..……. 18
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Estimated Funding……………………………………………….……….... 18
Anticipated Sources of Funding……………………………………...……..19
ACCESS TO CARE…………………………………………………………….....20
Description……………………………………………………………...….. 20
Data and Information……………………………………………….……… 20
being identified……………………………………………………..…….. 22
Proposed Health People 2020 Objectives…………………………...……... 22
Target Population……………………………………………………...…… 22
Health Problem Worksheet…………………………………………...……. 23
Outcome Objective 3: Increase the Utilization of Services Currently Provided
within Coles County…………………………………………….……… 23
Impact Objective 3.1………………………………….…….……... 24
Interventions……………………………………………..………… 24
Community Resources………………………………………..……………. 24
Estimated Funding……………………………………………..…….…….. 24
Anticipated Sources of Funding……………………………...……………..24
LUNG CANCER….…………………………………………...………………….. 25
Description…………………………………………...…………………….. 25
Data and Information……………………………...………………..……… 25
being identified……………………………...…………………………….. 28
Proposed Health People 2020 Objectives……...…………………………... 29
Target Population…………………...……………………………………… 29
Health Problem Worksheet……...…………………………………………. 29
Outcome Objective 4: Reduce the incidence of Lung Cancer in Coles
County residents…………………………………………………………….30
Impact Objective 4.1…..………………………………….………... 30
Interventions….………………………………………….………… 30
Impact Objective 4.2…….…………………………………………. 30
Interventions……………………………………………………….. 30
Community Resources…..…………………………………………………. 31
Estimated Funding……..…………………………………………….…….. 31
Anticipated Sources of Funding……..…………………………………….. 31
APPENDIX A – IPLAN COMMITTEE MEMBERS…….32
APPENDIX B – MEETING DATES AND MINUTES...…34
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Purpose Statement
Comprehensive planning is essential to promoting a healthy community. Data needs to
be assessed to determine immediate needs as well as identify trends. A community
approach to addressing the needs is also essential so that ownership is distributed among
those responsible for implementation. The Health Department serves in a leadership role
to bring key stakeholders from both the public and private sector together to identify the
approach needed to see results and assure the opportunity for a healthier community. The
resulting plan will be made available to the medical and social service community as well
as the community at large. It will be used to direct the vision toward improving the
health status of the residents of Coles County.
IPLAN was developed by the Illinois Department of Public Health (IDPH) to meet the
requirements set forth in 77 Illinois Administrative Code 600. This administrative code
mandates all certified health departments in Illinois conduct an IPLAN process every five
years for recertification.
Review of the 2005 - 2010 IPLAN
To begin the Coles County IPLAN process, senior staff met to discuss the Organizational
Capacity Self-Assessment review. Health concerns, objectives and outcome measures
were analyzed from the previous five year plan to determine the impact on the
community, continued relevancy, and ideas for strengthening the plan.
As a result of the previous IPLAN the following Goals, Objectives and Interventions
were identified:
Outcome Objective #1 – By 2010, reduce the numbers of deaths attributed to major
cardiovascular diseases by 10%. (Baseline 186 – 2002)
Result 1.0.1 – The IPLAN Data System Report 2.02.02 Leading Causes of
Mortality, show that deaths caused by diseases of the heart have varied
from 27% of all deaths in Coles County in 2002 to 29% in 2006, the latest
year that data is currently available. The same data source shows that in
2002 105 persons accounting for 21% of total deaths were caused by
coronary heart disease. In 2006 93 people accounting for 20% of total
deaths were due to coronary heart disease.
Impact Objective 1.1 – By 2008, increase the proportion of Coles County
residents who meet the standards for moderate levels of physical activity as
defined by CDC (5 – 30 minute sessions per week). (Baseline 2005 34.9% IDPH
2005 BRFSS)
Result 1.1.1 – Round 4 (2007-2009) 4th Round BRFSS 59.8%
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Impact Objective 1.2 – By 2008, decrease the proportion of Coles County
residents who self-identify as smokers. (Baseline 2005 – 29% IDPH 2003 Center
for Health Statistics)
Result 1.2.1 – The 2007-2009 BRFSS identified 11,027 or 27.1% of the
population that identified as a smoker.
Impact Objective 1.3 – By 2008, decrease the proportion of adults who eat <3
servings of fruits and vegetables per day. (Baseline 2005 – 39.4%)
Result 1.3.1 – The 2007 – 2009 BRFSS identified 13,023, 32% of those
surveyed as eating <3 servings of fruits and vegetables per day.
Outcome Objective #2 – By 2010, reduce the incidence of death due to malignant
neoplasms by 10% (Baseline 110 – 2002)
Result 2.0.1 – The IPLAN Data System Report 2.02.02 Leading Causes of
Mortality report that in 2006 102 deaths were attributed to Malignant
Neoplasms accounting for 22% of total deaths.
Impact Objective 2.1 – By 2010, increase the proportion of physicians and
dentist who counsel their at-risk patients about tobacco use cessation, physical
activity, and cancer screening. (Baseline to be determined)
Impact Objective 2.2 – By 2008, increase the proportion of Coles County
residents who meet the standards for moderate levels of physical activity as
defined by CDC (5 – 30 minute sessions per week). (Baseline 2005 – 34.9%)
Result 2.2.1 - Round 4 (2007-2009) 4th Round BRFSS 59.8%
Impact Objective 2.3 – By 2008, decrease the proportion of Coles County
residents who self-identify as smokers. (Baseline 2005 29%, IDPH 2003 Center
for Health Statistics)
Result 2.3.1 - The 2007-2009 BRFSS identified 11,027 or 27.1% of the
population that identified as a smoker
Impact Objective 2.4 – By 2008, decrease the proportion of adults who eat <3
servings of fruits and vegetables per day. (Baseline 2005 – 39.4%, 2005 IDPH
BRFSS)
Result 2.4.1 - The 2007 – 2009 BRFSS identified 13,023, 32% of those
surveyed as eating <3 servings of fruits and vegetables per day.
Outcome Objective 3 – By 2010 reduce the number of residents who participate in “at
risk” sexual activity. (Baseline 8.2% - 2002 BRFSS)
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Result 3.0.1 – The 2007 – 2009 BRFSS identified 4,175 persons
representing 12.7% of the population participating in “at risk” sexual
activity.
Impact Objective 3.1 – By 2008, reduce the number of gonorrhea cases by 25%.
(Baseline 41 – 2004 IDPH STD)
Result 3.1.1 – The 2008 Gonorrhea Cases/Rates by Illinois County
provided by the Illinois Department of Public Health showed 26 cases at a
rate of 48.9 per 100,000 population
Impact Objective 3.2 – By 2010 reduce the incidence to teen pregnancy to no
greater than the state rate. (Baseline 11.8%, 2003 IDPH Births)
Result 3.2.1 – The Coles County incidence of teen pregnancy in 2007 is
reported at 10.5% with a State of Illinois rate at 10.1%.
Outcome Objective 4 – Reduce maltreatment and maltreatment fatalities among Coles
County residents.
Impact Objective 4.1 – By 2010 reduce the incidence of child abuse and neglect
to no more than the state average. (Baseline Coles 12.6, Illinois 7.9, County
Distribution of Indicated Investigations 2004 Illinois Criminal Justice Information
Authority.)
Result 4.1.1 – For FY 2007 the Illinois Criminal Justice Authority
indicated in their annual report that Coles County ranked 9th overall in the
State for the rate of indicated cases of child sex abuse
(http://www.icjia.org/public/pdf/ResearchReports/Juvenile%20Justice%20
System%20and%20Risk%20Factor%20Data%202007%20Appendix%20
H%20Data%20Tables.pdf ,pp 144)
Impact Objective 4.2 – By 2010 reduce the incidence of domestic violence to no
more than the state rate. (Baseline to be determined)
Result 4.2.1 – For FY 2007, the Illinois Criminal Justice Authority
indicated in their annual report that Coles County ranked 34th in the State
for
number
of
reported
domestic
offense
incidents.
http://www.icjia.org/public/pdf/ResearchReports/Juvenile%20Justice%20
System%20and%20Risk%20Factor%20Data%202007%20Appendix%20
H%20Data%20Tables.pdf , pp 136.)
Outcome Objective 5 – By 2010, decreases the number of residents who have avoided
medical care due to cost to no more than 5%. (Baseline 8.9%, 2002 BRFSS)
Result 5.0.1 – The 2007-2009 BRFSS reported that 4,134 residents, or
10.1% of the population, reported avoiding medical care due to cost.
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Impact Objective 5.1 – By 12/31/2006, identify existing gaps in services and
additional barriers to provider acceptance and client accessibility for all areas of
health care and develop a Task Force to address them.
Impact Objective 5.2 – By 2010, increase the number of providers accepting all
forms of payment for services by 25%.
Community Involvement and the Community Health Planning
Process
IPLAN is a community health planning process for identifying priority health issues,
building local partnerships and addressing identified issues. Community involvement in
the IPLAN is vital to ensure community ownership and buy-in.
Once participants were identified, a meeting was held March 17, 2010 to explain what
IPLAN is and the process by which health priorities and interventions would be
determined. An overview of the identified concerns from the previous IPLAN as well as
accomplishment was given. The committee members gave additional time outside of the
meetings to prepare for each session. A total of five meetings were held between March
and May 2010 to discuss and prioritize the issues.
A full list of committee members is included as Appendix A of this document.
Organizational Capacity Assessment
The Organizational Capacity Assessment is designed to identify strengths and
weaknesses of the Coles County Health Department. Staff members were instructed on
the rating system used on the forms and the forms were returned to the Assessment
Coordinator, Gregg Baker, in an anonymous manner.
The APEXPH Process
APEXPH began in July 1987 as a cooperative project of the American Public Health
Association (APHA), the Association of Schools of Public Health (ASPH), the
Association of State and Territorial Health Officials (ASTHO), the Centers for Disease
Control (CDC), the National Association of County Health Officials (NACHO) and the
United States Conference of Local Health Officers (ESCLHO).
APEXPH is a voluntary process for organizational and community self-assessment,
planned improvements and continuing evaluation and reassessment. Flexibility is one of
the primary features of the APEXPH process. For example, it can involve a large number
of staff in a highly structured process or very few people in a less formal approach; either
can lead to greater teamwork and improved strategic planning.
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Healthy People 2020
Healthy People provides science-based, 10-year national objectives for promoting health
and preventing disease. Since 1979, Healthy People has set and monitored national health
objectives to meet a broad range of health needs, encourage collaborations across sectors,
guide individuals toward making informed health decisions, and measure the impact of
our prevention activity. Currently, Healthy People 2010 is leading the way to achieve
increased quality and years of healthy life and the elimination of health disparities.
Each health priority identified in this health plan includes references to the proposed
HP2020 national objectives.
Strategic Health Issues
The IPLAN Committee met on March 30, 2010 to discuss and identify the top health
issues in Coles County. Measuring the health status of a community is a complex
process. In order for a true picture of the health of the community to be constructed, a
variety of sources were utilized which looked at health indicators, demographic census
data, environmental and geographic data, disease statistics, death rates, and self reported
behavioral surveys. By utilizing these data sources, the committee was able to examine
not only the biologic, behavioral and environmental factors, but also the social, economic
and cultural factors as well.
Data from the following sources was examined:
2000 Census Population for Illinois, Counties and Incorporated Places,
Illinois Department of Public Health Center for Health Statistics,
IPLAN Data System Report, Illinois Project for Local Assessment of Needs,
2005
Demographic Data, Community Profile, Agricultural Facts, Coles Together,
2005
Demographic Data, Community Profile, Wikipedia.org, 2010
Census 2000 Demographic Profile, U.S. Census Bureau, 2006-2008 American
Community Survey
Illinois Unemployment Rate by County, Illinois Department of Employment
Security, Economic Information & Analysis Division
Selected Natality Statistics among Residents of Coles County, Vital Statistics,
Illinois, 2005
Selected Mortality Statistics among Residents of Coles County, Vital
Statistics, Illinois, 2005
Health Statistics, Illinois Department of Public Health, 2007
Infant Natality Statistics, Illinois Department of Human Services, Division of
Community Health and Prevention, 2007
Child Abuse and Neglect Statistics Annual Report, Illinois Department of
Children and Family Services, 2007
Count and Percent of Women Starting Program Participation by Trimester,
Illinois Department of Human Services, WIC Program, FY’10
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Deaths Among Residents by Place of Residence and Cause, Illinois
Department of Public Health, Vital Statistics, 2007
1998-2008 State BRFSS Data, Illinois Behavioral Risk Factor Surveillance
System, 2007
ECIL Teen Survey Report 2008, I Sing the Body Electric, 2009.
Illinois Meth Project: Methamphetamine Impact: Illinois Statistics, Illinois
Meth Project, 2009
Annual Security Report 2008, Eastern Illinois University Police Department,
October 2009
Annual Security Report 2009, Lake Land Community College, 2009
Illinois Crime Rates per 100,000 Population by County, 2004, NIU Regional
Development Institute, 2006
Illinois Obesity Facts, Illinois Department of Public Health Institute,
www.iphionline.com, 2010
Coles County Cancer Incidence Counts & Average Annual Age-Adjusted
Rates by Sex, Illinois Department of Public Health, Illinois State Cancer
Registry, 2008
Women and Heart Disease Fact Sheet, Center for Disease Control, CDC’s
Cardiovascular Program, 2002
County Health Rankings: Mobilizing Action Toward Community Health,
RWJF & University of Wisconsin, 2010
Research and Program Evaluation in Illinois: The Extent and Nature of Drug
and Violent Crime in Illinois’ Counties. A Profile of the Coles County
Criminal and Juvenile Justice System, December 2004.
Domestic Violence Facts: Illinois. National Coalition Against Domestic
Violence Handout, www.publicpolicy@ncadv.org
Vital Statistics Illinois, 2003. May 2008.
Illinois Lead Program Surveillance Report – 2007. September, 2008
2010 Report on Illinois Poverty. Heartland Alliance,
www.heartlandalliance.org/research.
Backgrounder: The Hidden Health Costs of Transportation. A report
prepared for the American Public Health Association by Urban Design 4
Health, Inc. March 2010.
Illinois Rural Health Workshop. The Health Care Industry in Coles County,
Illinois. www.ace.uiuc.edu/ruralhealth/ February 2002.
The strategic health issues selected by the Coles County IPLAN Steering Committee are
listed below.
1. Underage Binge Drinking
2. Heart Disease
3. Access to Care
4. Lung Cancer
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Underage Binge Drinking
Description
Binge drinking is the modern definition of drinking alcoholic beverages with the primary
intention of becoming intoxicated by heavy consumption of alcohol over a short period of
time.
The National Institute on Alcohol Abuse and Alcoholism defines binge drinking
as a pattern of drinking that brings a person’s blood alcohol concentration (BAC)
to 0.08 grams percent or above. This typically happens when men consume 5 or
more drinks, and when women consume 4 or more drinks, in about 2 hours.1
Most people who binge drink are not alcohol dependent.
According to national surveys
- Approximately 92% of U.S. adults who drink excessively report binge drinking
in the past 30 days.
- Although college students commonly binge drink, 70% of binge drinking
episodes involve adults age 26 years and older.
- The prevalence of binge drinking among men is higher than the prevalence
among women.
- Binge drinkers are 14 times more likely to report alcohol-impaired driving than
non-binge drinkers.
- About 90% of the alcohol consumed by youth under the age of 21 in the United
States is in the form of binge drinks.
- About 75% of the alcohol consumed by adults in the United States is in the form
of binge drinks.
- The proportion of current drinkers that binge is highest in the 18- to 20-year-old
group (51%).
- Binge drinking is associated with many health problems, including—
Unintentional injuries
- Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence).
Alcohol poisoning.
- Sexually transmitted diseases.
- Unintended pregnancy.
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Data and Information
The 2008 East-Central Illinois I Sing the Body Electric Centers for Disease Control
Youth Behavior Survey shows that the activity has an overall decrease by 22.1% since
1998. Males however at 30.9% are still engaging in the activity at a rate higher than the
state average of 27.8% and national average of 24.7%. Citing the CDC, the report shows
that people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.
More than 90% of this alcohol is consumed in the form of binging and on average,
underage drinkers consume more drinks per drinking occasion than adult drinkers.
How the finding of the Community Assessment resulted in the
issue being identified
Data obtained by the Coles County IPLAN Committee clearly shows that underage binge
drinking is a severe problem. The priority strategic health issue was defined as:
How can the rate of underage binge drinking by Coles County youth be improved?
Proposed Healthy People 2020 Objectives
The Committee also took into consideration the Proposed Healthy People 2010
Objectives pertaining to adolescent drug and alcohol use by identifying the following
goals:
- SA HP 2020-5 Increase the age and proportion of adolescents who remain
alcohol and drug free;
- SA HP2020-6 Increase the proportion of adolescents not using alcohol or any
illicit drugs during the past 30 days;
- SA HP2020-7 Reduce the proportion of persons engaging in binge drinking of
alcoholic beverages.
Target Population
Coles County residents under the age of 18. 13,692. (Source 2006-2008 American
Community Survey 3 Year Estimates)
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Health Problem Worksheet
Introduction to Objectives and Strategies
The objectives and strategies in this section are designed to address the risk factors and
contributing factors listed in the Health Problem Analysis Worksheet that are within the
scope of the IPLAN to address. The major “outcome objective” focuses on reducing the
prevalence of binge drinking and is supported by “impact objectives” (interim objectives
that must be achieved on the way to achieving the outcomes) and “intervention
strategies” (actions that will be taken to achieve both impact and outcome objectives).
Outcome Objective 1: Decrease the number of school age
youth who binge drink.
By 2015 reduce the number of patients aged 0-21 who present to Sarah Bush Lincoln
Health Center for alcohol and drug related illness by 10 percent.
Baseline
According to Sarah Bush Lincoln Health Center 99 patients aged 0-21 presented to the
Emergency Department for alcohol and drug related illness for FY2009.
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Impact Objective 1.1
By the release of the 2012 I Sing the Body Electric Survey, reduce the number of youth
who report participating in episodic heavy drinking by 3%.
Baseline
The 2010 I Sing the Body Electric Survey reported that 30.9% of males and 24.7% of
females surveyed reported episodic heavy drinking.
Interventions
a. Implement Life Skills Training to all 6th grade students in Coles County
b. Support the efforts of organizations currently working with youth such as I
Sing the Body Electric on youth binge drinking issues.
Community Resources for Underage Binge Drinking
Interventions
Coles County School Districts
I Sing the Body Electric
Sarah Bush Lincoln Health Center
Mattoon Police Department
Eastern Illinois University Police Department
Lakeland College Public Safety Department
Charleston Police Department
Oakland Police Department
Business that sell alcohol
Community Programs
Estimated Funding for Underage Binge Drinking Interventions
$15,000 over five years.
Anticipated Sources of Funding for Underage Binge Drinking
Interventions
- Private Foundations
- County Government
- Federal and State Grants
- In-kind Resources
- Corporate Support
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Heart Disease
Description
Cardiovascular issues were identified as a major topic in the 2005-2010 IPLAN and once
again ranked as a high priority for the IPLAN committee. Other studies come to the
same conclusion regarding cardiovascular issues in Coles County. The 2010 CDC Atlas
of Heart Disease Hospitalizations found that for cardiovascular deaths Coles County
ranks in the top 50 of Illinois counties with a rate of 471-489 per 100,000 residents. The
same study also ranked Coles County in the top 20 of Illinois Counties with the highest
hospitalization rates.
Figure A
The graph above (Figure A) shows that deaths by diseases of the heart statewide have
been dropping since 2000. However the data for Coles County shows results that remain
higher then the state average.
Figure B
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Compared to the surrounding counties Coles remains consistently in the middle of the
pack and provides context to the larger issue that cardiovascular deaths are not just a
problem in Coles County but for all residents in East Central Illinois as well (Figure B).
The American Heart Association recognizes the role that cholesterol plays in heart health.
As a major factor in both heart disease and stroke the AHA endorses the National
Cholesterol Education Programs recommendation that everyone age 20 and older have a
fasting lipoprotein profile every five years. This test is done after a 9-12 hour fast
without food, liquids or pills. It gives information about total cholesterol, low-density
lipoprotein (LDL) or “bad” cholesterol, high-density lipoprotein (HDL) or “good”
cholesterol and triglycerides (blood fats).
According to the 2007 Coles County BRFSS 13.8% of Coles County residents age 25+
have never had their blood cholesterol checked. The same surveillance reported that of
those who did have their cholesterol checked, 55% in the 45-64 age range and 56% age
65+ reported having high levels. Unfortunately the surveillance makes no distinction
between LDL, HDL or triglyceride levels.
The 2007 surveillance also reveals that 6.3% of residents, which makes up 2,548 people,
have had a previous heart attack. With so many people at risk of a sudden, lifethreatening cardiovascular emergency, the response system to those events is a vital link
to survival.
Two organizations make up the bulk of training in CPR for Coles County, the
Coles/Clark County Branch of the American Red Cross and the Sarah Bush Lincoln
Health System EMS Office which serve as a training partner for the American Heart
Association. In addition other CPR programs such as the National Safety Council,
provide training as well. With so many organizations providing training no research
exists as to what percentage of the lay public has been trained in CPR.
Topic AHS HP2020-4 of the Proposed Healthy People 2020 Objectives addresses a
developmental objective of increasing the proportion of persons who have access to
rapidly responding pre-hospital emergency medical services in both basic life support and
advanced life support. In the Champaign Region, the Illinois Department of Public
Health reports that 179 ambulances serve a population of 782,259 or roughly one
ambulance for every 4,370 people.
Five ambulance services exist in Coles County providing Advanced Life Support care
with Illinois licensed Paramedics with as many as 12 ambulances serving a population of
52,065 or roughly one ambulance for every 4,338 residents. Residents in Mattoon,
Charleston and Oakland are within 2 miles of at least one of these services. In addition
Medical Fist Responders are dispatched with ambulances responding into the Ashmore,
Cooks Mill, Humboldt, Wabash and Lincoln Fire Protection Districts. These responders
are trained in basic medical care including CPR and respond with an Automated External
Defibrillator (AED).
15
Data obtained by the Coles County IPLAN Committee clearly shows that heart disease is
a severe problem. The priority strategic health issue was defined as:
How can the rate of death caused by heart disease in Coles County be improved?
Proposed Health People 2020 Objectives
- HDS HP2020-1 Reduce coronary heart disease deaths;
- HDS HP2020-2 Increase the proportion of eligible patients with heart attacks
who receive timely artery-opening therapy from symptom onset;
- HDS HP2020-6 Reduce the mean total blood cholesterol levels among adults;
- HDS HP2020-7 Reduce the proportion of adults with high total blood
cholesterol levels;
- HDS HP2020-8 Increase the proportion of adults who have had their blood
cholesterol checked within the preceding 5 years;
-HDS HP2020-10 Increase the proportion of out-of-hospital cardiac arrests in
which appropriate bystander and emergency medical services (EMS) were
administered.
Target Population
Coles County residents over the age of 18.
16
prevalence of heart disease and is supported by “impact objectives” (interim objectives
Outcome Objective 2 : Decrease the level of cardiovascular
deaths in Coles County.
By 2015 reduce the number of cardiovascular deaths in Coles County to less than 211 per
100,000 residents.
Baseline
According to information provided by the Illinois Department of Public Health, in 2006
21.1% of deaths in Coles County were caused by heart disease.
17
By Round 5 of the Illinois Behavioral Risk Factor Surveillance System (2010-2012)
decrease the level of cardiovascular related deaths in Coles County to less than 261.8 per
100,000 residents.
Baseline
The 2006 Illinois Behavioral risk Factor Surveillance System reported the rate of
cardiovascular death among Coles County residents as 261.8 per 100,000.
Interventions
a. Compile a database of physical activity programs currently available in the
community and make that information available on our website.
b. Increase the number of local participants in the Illinois Diabetes Control
Program
c. Coordinate and expand as needed existing community based initiatives that
focus on heart disease, stroke, obesity and/or diabetes
Community Resources for Heart Disease Prevention
Baker Ambulance
Dunn’s Ambulance
Mitchell-Jerdan Ambulance
Charleston Fire Department
Mattoon Fire Department
Coles County First Responders
Illinois Diabetic Program of the Coles County Health Department
Mattoon YMCA
Charleston Recreation Department
Eastern Illinois University
Coles County School System
Community Programs
Estimated Funding for Heart Disease Prevention Interventions
18
Anticipated Sources of Funding for Heart Disease Prevention
Interventions
- County Government
- In-kind Resources
- Corporate Support
19
Access to Care
Description
The IPLAN Committee studied the socioeconomic conditions of Coles County from the
perspective of poverty. There was little surprise that the relationship poverty has with
poor health including increased risk factors of unhealthy behavior and as a barrier to
receiving services.
Four definitions of poverty and generally accepted as the standard for analysis.
Income Poverty is defined by the federal government using food cost as a basis. There
are two slightly different versions of the federal poverty measure: the poverty
thresholds and the poverty guidelines.
The poverty thresholds are the original version of the federal poverty measure.
They are updated each year by the Census Bureau and are used mainly for
statistical purposes – for instance, preparing estimates of the number if Americans
in poverty each year.
The poverty guidelines, also called the Federal Poverty Level (FPL), are the other
version of the poverty measure. They are issued each year in the Federal Register
by the Department of Health and Human Services and are a simplification of the
poverty thresholds used for administrative purposes – for instance, determining
financial eligibility for certain federal programs.
Federal Poverty Guidelines, or 100% FPL
Size of Family
1
2
3
4
5
6
7
8
2009
$10,830
14,570
18,310
22,050
25,790
29,530
33,270
37,010
2008
$10,400
14,000
17,600
21,200
24,800
28,400
32,000
35,600
2007
$10,210
13,690
17,170
20,650
24,130
27,610
31,090
34,570
2006
$9,800
13,200
16,600
20,000
23,400
26,800
30,200
33,600
20
Deep or Extreme Poverty is defined as earning 50% or less of the Federal Poverty
Guidelines.
Deep or Extreme Poverty Guidelines
Size of Family
1
2
3
4
5
6
7
2009
$5,415
7,285
9,155
11,025
12,895
14,765
18,505
2008
$5,200
7,000
8,800
12,400
14,200
16,000
17,800
2007
$5,105
6,845
8,585
12,065
13,805
15,545
17,285
2006
$4,900
6,600
8,300
11,700
13,400
15,100
16,800
Low-Income or Near Poor is defined as living between 100% and 200% of the federal
poverty threshold. This is considered an income level where people often have
trouble meeting their basic needs due to increased costs with day to day bills.
Asset Poverty is defined as households without sufficient net worth to subsist at the
poverty level for 3 months. The result is that a crisis such as job loss, illness or
divorce, can push a household into poverty or homelessness.
The 2006-2008 American Community Survey 3-Year Estimates rate Coles County as
having 22.1% of individuals living below the poverty line (1).
The census tract with the largest county poverty rate of 58% is the campus of Eastern
Illinois University. This is an area that includes student dormitories, sorority housing,
and student apartments. Officials from EIU explained that students have access to a
reduced rate meal plan, medical care through health services and a number of campus
oriented programs for students with just about any needs. With an average cost of
attendance exceeding $20,000 a year (2) the committee reached the understanding that
while technically meeting the income definition of being in poverty, it is unlikely that the
census numbers accurately represent the EIU student body.
The Census tract with the second highest rate of overall poverty at 38% consists of an
area just north and to the east of campus continuing out of the Charleston city limits in an
area south of Illinois Route 16. Many low-income services including the main office of
the Coles County Health Department is located in this Census tract. The third highest
area with a poverty rate of 20.6% is tract 5 consisting of an area of Charleston northwest
of Charleston. This data makes up the majority of 40.2% of the population that lives
below the poverty line according to Census data. A more accurate view of the poverty
level in Charleston is viewed from information compiled by the Illinois State Board of
Education who evaluates the poverty rate of their students at 13.65%.
In Mattoon the story is much different. Census data shows that 13.4% of residents live
below the poverty line. 5.4% of the population lives in extreme poverty. 19.45% of
students live below poverty guidelines.
21
While information is not available on a county by county basis the Illinois Poverty
Summit identified in the 2008 Report on Illinois Poverty that there seems to be a large
disconnect between services that are available and those in low-income and poverty
situations getting those services. For instance, over three quarters of Illinois households
eligible for the Temporary Assistance for Needy Families cash and housing assistance do
not receive the benefit. The group also pointed out that Illinois ranks last among all states
for participation in school breakfast programs and 25.5% of Illinois households eligible
for Food Stamps are not receiving the benefit.
The IPLAN committee was able to identify a large disconnect between agencies that
offer services and other agencies that may be offering similar services. In some cases
agency representatives were learning about the other agency services by word of mouth
and through incidental contact with clients. The priority strategic health issue was
defined as:
How can we more efficiently utilize the services that are currently being offered to
residents of Coles County?
- AHS HP2020-7: Reduce the proportion of individuals that experience
difficulties or delays in obtaining necessary medical care, dental care, or
prescription medicines;
- HP2010 1-3: Increase in counseling on health behaviors among persons at risk
with a physician visit in the last year
Target Population
Low income, uninsured and Medicaid populations
22
prevalence of access to care and is supported by “impact objectives” (interim objectives
Outcome Objective 3: Increase the utilization of services
currently provided within Coles County.
By 2015 increase the number of referrals to Coles County service agencies providing
direct case management by 10%.
Baseline
- Family Planning (baseline 927, August 2010, department provided information)
- Children’s Advocates Center (baseline FY 09- 69 cases)
- WIC (baseline 1231, August 2010, department provided information)
23
By 2012 increase the number of referrals to Coles County service agencies providing
direct case management by 3%
Interventions
a. Create a sustainable printed county-wide directory of services that is updated a
minimum of every two years
b. Provide training in available resources to providers likely to interact with
residents who could benefit from early intervention. This can include school
teachers and administrators, police officers, emergency service workers, and
emergency department staff.
c. Create a feasibility study regarding the costs and potential implementation of a
local “one call” number such as 211 for access to social service agencies.
Community Resources for Access to Care
Community Online Resource Directory
Children’s Services Advisory Committee of Housing, Outreach, Prevention and
Education
Eastern Illinois University
Coles County School System
Community Programs
Estimated Funding for Access to Care Interventions
$100000 over five years.
Anticipated Sources of Funding for Access to Care
Interventions
- County Government
- In-kind Resources
- Corporate Support
24
Lung Cancer
Description
As the final health topic identified by the IPLAN Committee lung cancer stands out for a
number of reasons. As shown in the table below, lung cancer remains the number one
cause of overall cancer related death in Coles County. This is a consistent trend with
both state and national cancer numbers with the CDC reporting that in 2006 more people
died from lung cancer than breast cancer, prostate cancer and colon cancer combined (1).
Research has found several risk factors for lung cancer including:
- Smoking or exposure to second-hand smoke
- Radon gas
- family history of lung cancer
Smoking in Coles County
Round 4 of the Illinois Behavioral Risk Factor Surveillance System 2007-2009, reports
that 27.1% of Coles County respondents identified as being smokers. Even more
disturbing was the finding that for 2006 Coles County nearly doubled the state average
for women who smoked during pregnancy. This phenomenon was studied closer in the
Physical Health section of this report. The 2008 I Sing the Body Electric Study found
that 38.2% of area youth reported smoking in the past 30 days.
25
One of the most surprising findings of the IPLAN process was data on the number of
Coles County women who smoke during pregnancy.
Figure F
The increased levels are higher then the state average of smoking however is not reflected
by the number of Coles County mothers who drink during pregnancy.
Figure G
Education about the risks of smoking does not appear to be a limiting factor in the
number of women who smoke during pregnancy. The Kotelchuck Index, also called the
Adequacy of Prenatal Care Utilization (APNCU) Index, uses two crucial elements
obtained from birth certificate data-when prenatal care began (initiation) and the number
of prenatal visits from when prenatal care began until delivery (received services). The
Kotelchuck index classifies the adequacy of initiation as follows:




pregnancy months 1 and 2,
months 3 and 4,
months 5 and 6,
and months 7 to 9,
with the underlying assumption that the earlier prenatal care begins the better. To classify
the adequacy of received services, the number of prenatal visits is compared to the
expected number of visits for the period between when care began and the delivery date.
The expected number of visits is based on the American College of Obstetricians and
26
Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for
the gestational age when care began and for the gestational age at delivery.
A ratio of observed to expected visits is calculated and grouped into four categories:
1.
2.
3.
4.
Inadequate (received less than 50% of expected visits),
Intermediate (50%-79%),
Adequate (80%-109%),
Adequate Plus (110% or more).
The final Kotelchuck index measure combines these two dimensions into a single
summary score. The profiles define adequate prenatal care as a score of 80% or greater
on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories.
The Kotelchuck Index does not measure the quality of prenatal care. It also depends on
the accuracy of the patient or health care provider's recall of the timing of the first visit
and the number of subsequent visits. The Kotelchuck Index uses recommendations for
low-risk pregnancies, and may not measure the adequacy of care for high-risk women.
The Kotelchuck Index is preferable to other indices because it includes a category for
women who receive more than the recommended amount of care (adequate plus, or
intensive utilization).
Radon
Radon is a radioactive element that is part of the radioactive decay chain of naturally
occurring uranium in soil. Like carbon monoxide you can’t see it, you can’t smell it and
you can’t taste it. But unlike carbon monoxide radon’s adverse health effects is usually
not produced immediately.
The United States Environmental Protection Agency action level for radon is 4.0
picocuries per liter of air (pCi/L). USEPA estimates that up to 6 percent of US homes
have radon concentrations at or above the action level. In 2009 the World Health
Organization (WHO) revised its recommendation for a maximum acceptable radon
concentration in a residential building to 2.7 pCi/L.
Unfortunately only a few homes in Coles County have been tested for Radon. However,
according to the Illinois Emergency Management Agency, 53% of the homes tested in the
Charleston area and 20% of the homes in the Mattoon area tested higher than 4.0 pCi/L.
The impact of long-term radon exposure may increase in the future as the population ages
and exposure to radiation from medical sources escalates. Some evidence even suggests
that in addition to lung cancer, protracted radon exposure may increase risks for
leukemia, skin, stomach and liver cancers (2).
27
Current radon
protection policies
and standards are
based on a paradigm
for radon risk
assessment developed
in the 1980’s. The
Indoor Radon
Abatement Act of
1988 set a national
long-term goal of
reducing radon levels
in buildings to the
levels of ambient
outdoor air, but no
regulations mandate
specific radon levels
for indoor residential
buildings (2).
According to the
Illinois Emergency
Management Agency
the cost of an active
mitigation system is
typically between
$800 and $1200 for installation and the energy cost for running the fan will average
around $100 per year. At this time no Coles County persons are listed in the IEMA
Radon and Professional licensee Mitigation and Measurement Database for Mitigation
Services and only one Coles County person is listed for Measurement Services.
Data obtained by the Coles County IPLAN Committee clearly shows that lung cancer is a
severe problem. The priority strategic health issue was defined as:
How can the rate of lung cancer in Coles County be improved?
28
- MICH HP 2020-10 Increase abstinence from alcohol, cigarettes, and illicit drugs
among pregnant women;
- MICH HP 2020-23 Decrease postpartum relapse of smoking among women who
quit smoking during pregnancy;
- TU HP2020-1 Increase smoking cessation during pregnancy;
- increasing the proportion of persons living in homes at risk that have an
operating radon mitigation system; and
- increasing the number of new homes constructed with radon-reducing features,
especially in high-radon-potential areas.
Target Population
All residents of Coles County.
29
prevalence of lung cancer and is supported by “impact objectives” (interim objectives
Outcome Objective 4: Reduce the incidence of Lung Cancer in
Coles County residents
By 2015, decrease the incidence of Lung Cancer by 10%
Baseline
The Illinois Department of Public health, Illinois State Cancer Registry data as of
November 2007 identified a Lung and Bronchus Cancer Incidence rate as 229 per
100,000 Coles County residents.
By 2013, decrease the number of women who smoke during pregnancy to no more than
125 per 100,000 in Coles County.
Baseline
In 2006 the IPLAN Data System identified that expectant mothers in Coles County
smoked at a rate of 240 per 100,000.
Interventions
a. Increase communication efforts with the OB/GYN community regarding
stop smoking campaigns.
b. Develop and distribute program material such as brochures and other printed
material and content specifically for smokers who are pregnant.
30
By 2013, increase the number of homes tested for Radon to greater than 100.
Baseline
The Illinois Emergency Management Agency has identified that currently 26 homes in
Coles County have been tested for Radon.
Interventions
a. Educate Coles County realtors to provide home buyers with brochures or other
written information and materials on Radon and to follow-up with testing.
b. Educate the public on the dangers of radon and to dispel common myths
concerning radon removal.
Community Resources for Lung Cancer
Illinois Emergency Management Agency
Illinois Department of Public Health
Coles County Emergency Management Agency
Community Programs
American Cancer Society
Estimated Funding for Lung Cancer Interventions
Anticipated Sources of Lung Cancer Interventions
- County Government
- In-kind Resources
- Corporate Support
31
Appendix A – IPLAN Committee Members
Sheriff Darrell Cox
Coles County Sheriff's Dept.
701 7th St.
Charleston, IL 61920
Dee Braden
Coles County Council on Aging/LifeSpan Center
ECR 1650 E
Jeni Huckstep
WEIU TV
600 Lincoln Ave
Dr. Sheila Baker
EIU Health Service
600 Lincoln Ave.
Diane Ratliff
Charleston Parks & Recreation Dept.
520 Jackson Ave., 2nd Floor
Eric S. Davidson
EIU Health Service
600 Lincoln Ave.
Debby Cook
Life Links
750 Broadway E
Mattoon, IL 61938
Terry Diss, Principal
Mark Twain Elementary School
1021 13th Street
Sharon Uphoff
LLC Health Services
5001 Lake Land Blvd.
Mattoon, IL 61938
Rev. Krista L. Price
Charleston Otterbein United Methodist Church
2175 Harrison Ave.
32
Dr. Kathy Phillips
EIU Dept. of Health Studies
600 Lincoln Ave.
Sharon Kuhns
U of I Extension
707 Windsor Road, Ste. "A"
Pamela Irwin
CEAD
635 Division Street
Gaye Harrison
ISBE
105 Professional Plaza
Mattoon, IL 61938
Shirley Sherwood, EMS Coordinator
SBLHC
1000 Health Center Dr.
Mattoon, IL 61938
Angela Griffin, President & CEO
Coles Together
400 Airport Rd
Mattoon, IL 61938
Dr. Charles Ramsey
2108 Edgewood Dr.
Officer Amie Calvert
EIU PD
600 Lincoln Ave.
Sarah Betts, Healthy Kids Education Specialist
SBLHC
104 Professional Plaza
Mattoon, IL 61938
Mr. Bruce Barnard, Principal
Riddle Elementary School
Mattoon, IL 61938
33
Appendix B – Meeting Dates and Minutes
The IPLAN process was facilitated by Misti D. Farler, M.S., Health Educator, Coles
County Health Department and Gregg Baker, Emergency Response Coordinator, Coles
County Health Department.
March 17, 2010
Once participants were identified, a meeting was held to explain what IPLAN is and the
process by which health priorities and interventions would be determined. An overview
of the identified concerns from the previous IPLAN as well as accomplishment was
given. The committee members gave additional time outside of the meetings to prepare
for each session.
The committee carefully looked through a large amount of data from numerous sources
in identifying the health priorities for this plan. In an attempt to trim the list, each health
topic was assigned into one of four categories; Mental Health, Physical Health,
Socioeconomics and Lung Cancer. Those categories produced the chart as shown below.
34
March 30, 2010
For this meeting the committee concentrated on the issues identified in the Mental Health
category. After looking at further data the Committee decided that youth drug and alcohol
abuse was an area of greatest concern.
The 2008 East-Central Illinois I Sing the Body Electric Centers for Disease Control
Youth Behavior Survey shows that the activity has an overall decrease by 22.1% since
1998. Males however at 30.9% are still engaging in the activity at a rate higher than the
state average of 27.8% and national average of 24.7%. Citing the CDC, the report shows
that people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.
More than 90% of this alcohol is consumed in the form of binging and on average,
underage drinkers consume more drinks per drinking occasion than adult drinkers.
The Committee recognized a need for specific life-skills training to be introduced into the
classroom. It was acknowledged by many of the education-related members of the
committee that many children are not receiving the basic life-skills training that reduce
their participating in high-risk activities and that this is a worthy goal for the health
department to undertake.
One specific program mentioned was the program developed by Dr. Gilbert J. Botvin, a
Professor of Public Health and Psychiatry at Cornell University Medical College. The
program targets tobacco, alcohol, drug abuse and violence prevention for upper
elementary and middle or junior high students.
April 13, 2010
For this meeting the committee concentrated on the issues identified in the Physical
Health category. For this section the committee took a very in-depth look at Heart
Disease, Stroke, Obesity, Diabetes, and the risks of exposure to lead based paint.
Cardiovascular issues were identified as a major topic in the 2005-2010 IPLAN and once
again ranked as a high priority for the IPLAN committee. Other studies come to the
same conclusion regarding cardiovascular issues in Coles County. The 2010 CDC Atlas
of Heart Disease Hospitalizations found that for cardiovascular deaths Coles County
ranks in the top 50 of Illinois counties with a rate of 471-489 per 100,000 residents. The
same study also ranked Coles County in the top 20 of Illinois Counties with the highest
hospitalization rates.
According to the 2007 Coles County BRFSS 13.8% of Coles County residents age 25+
have never had their blood cholesterol checked. The same surveillance reported that of
those who did have their cholesterol checked, 55% in the 45-64 age range and 56% age
65+ reported having high levels. Unfortunately the surveillance makes no distinction
between LDL, HDL or triglyceride levels.
The 2007 surveillance also reveals that 6.3% of residents, which makes up 2,548 people,
have had a previous heart attack. With so many people at risk of a sudden, lifeColes County Health Department
35
threatening cardiovascular emergency, the response system to those events is a vital link
to survival.
Two organizations make up the bulk of training in CPR for Coles County, the
Coles/Clark County Branch of the American Red Cross and the Sarah Bush Lincoln
Health System EMS Office which serve as a training partner for the American Heart
Association. In addition other CPR programs such as the National Safety Council,
provide training as well. With so many organizations providing training no research
exists as to what percentage of the lay public has been trained in CPR.
Five ambulance services exist in Coles County providing Advanced Life Support care
with Illinois licensed Paramedics with as many as 12 ambulances serving a population of
52,065 or roughly one ambulance for every 4,338 residents. Residents in Mattoon,
Charleston and Oakland are within 2 miles of at least one of these services. In addition
Medical Fist Responders are dispatched with ambulances responding into the Ashmore,
Cooks Mill, Humboldt, Wabash and Lincoln Fire Protection Districts. These responders
are trained in basic medical care including CPR and respond with an Automated External
Defibrillator (AED).
April 27, 2010
For this meeting the committee concentrated on the issues identified in the Access to
Care category. The IPLAN Committee studied the socioeconomic conditions of Coles
County from the perspective of poverty. There was little surprise that the relationship
poverty has with poor health including increased risk factors of unhealthy behavior and
as a barrier to receiving services.
The census tract with the largest county poverty rate of 58% is the campus of Eastern
Illinois University. This is an area that includes student dormitories, sorority housing,
and student apartments. Officials from EIU explained that students have access to a
reduced rate meal plan, medical care through health services and a number of campus
oriented programs for students with just about any needs. With an average cost of
attendance exceeding $20,000 a year (2) the committee reached the understanding that
while technically meeting the income definition of being in poverty, it is unlikely that the
census numbers accurately represent the EIU student body.
The Census tract with the second highest rate of overall poverty at 38% consists of an
area just north and to the east of campus continuing out of the Charleston city limits in an
area south of Illinois Route 16. Many low-income services including the main office of
the Coles County Health Department is located in this Census tract. The third highest
area with a poverty rate of 20.6% is tract 5 consisting of an area of Charleston northwest
of Charleston. This data makes up the majority of 40.2% of the population that lives
below the poverty line according to Census data. A more accurate view of the poverty
level in Charleston is viewed from information compiled by the Illinois State Board of
Education who evaluates the poverty rate of their students at 13.65%.
36
In Mattoon the story is much different. Census data shows that 13.4% of residents live
below the poverty line. 5.4% of the population lives in extreme poverty. 19.45% of
students live below poverty guidelines.
While information is not available on a county by county basis the Illinois Poverty
Summit identified in the 2008 Report on Illinois Poverty that there seems to be a large
disconnect between services that are available and those in low-income and poverty
situations getting those services. For instance, over three quarters of Illinois households
eligible for the Temporary Assistance for Needy Families cash and housing assistance do
not receive the benefit. The group also pointed out that Illinois ranks last among all states
for participation in school breakfast programs and 25.5% of Illinois households eligible
for Food Stamps are not receiving the benefit.
The IPLAN committee was able to identify a large disconnect between agencies that
offer services and other agencies that may be offering similar services. In some cases
agency representatives were learning about the other agency services by word of mouth
and through incidental contact with clients.
Three current resources were identified that exist to help bridge this gap. The first is
Community Online Resource Directory (CORD) which is a listing of various diverse area
agencies and a detailed explanation of the programs they provide. The agency is
dedicated to providing a comprehensive, up-to-date, accessible guide to human services
which improves connection between community members and their needs with
appropriate resources in Clark, Coles, Cumberland, Douglas, Edgar, Jasper, Moultrie and
Shelby counties. The directory exists as a website at www.cordlink.org.
The second organization recognized was the Coles County Interagency Council which is
comprised of representatives from various businesses and human service agencies
offering services to residents of Coles County. The council holds informational,
educational and networking meetings/lunches six times a year.
The third organization recognized was The HOPE Guide produced by the Children’s
Services Advisory Committee of Housing, Outreach, Prevention and Education (HOPE)
Committee of East Central Illinois. The guide was published as a directory of basic
human and social services available to individuals and families of Coles County.
However funding limitations will prevent the organization from printing updated editions
of the guide.
The committee determined that a printed directory of services was vital to the efficient
referral of services to those in need. This request was echoed by the administrators of the
CEAD Council programs, the Children’s Advocate Center, SACIS and the Coles/ Clark
County Branch of the American Red Cross. It was determined that the guide needed to
be specific regarding services offered and needed to be made available to service
providers, other gateway providers such as school teachers, police officers and
emergency service workers, as well as the general public.
37
May 11, 2010
For this meeting the committee concentrated on the issues identified in the Lung Cancer
category. As the final health topic identified by the IPLAN Committee lung cancer
stands out for a number of reasons. Lung cancer remains the number one cause of overall
cancer related death in Coles County. This is a consistent trend with both state and
national cancer numbers with the CDC reporting that in 2006 more people died from lung
cancer than breast cancer, prostate cancer and colon cancer combined.
Round 4 of the Illinois Behavioral Risk Factor Surveillance System 2007-2009, reports
that 27.1% of Coles County respondents identified as being smokers. Even more
disturbing was the finding that for 2006 Coles County nearly doubled the state average
for women who smoked during pregnancy. This phenomenon was studied closer in the
Physical Health section of this report. The 2008 I Sing the Body Electric Study found
that 38.2% of area youth reported smoking in the past 30 days.
Education about the risks of smoking does not appear to be a limiting factor in the
number of women who smoke during pregnancy. The Kotelchuck Index, also called the
Adequacy of Prenatal Care Utilization (APNCU) Index, uses two crucial elements
obtained from birth certificate data-when prenatal care began (initiation) and the number
of prenatal visits from when prenatal care began until delivery (received services). The
Kotelchuck index classifies the adequacy of initiation as follows:




pregnancy months 1 and 2,
months 3 and 4,
months 5 and 6,
and months 7 to 9,
with the underlying assumption that the earlier prenatal care begins the better. To classify
the adequacy of received services, the number of prenatal visits is compared to the
expected number of visits for the period between when care began and the delivery date.
The expected number of visits is based on the American College of Obstetricians and
Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for
the gestational age when care began and for the gestational age at delivery.
A ratio of observed to expected visits is calculated and grouped into four categories:
5.
6.
7.
8.
Inadequate (received less than 50% of expected visits),
Intermediate (50%-79%),
Adequate (80%-109%),
Adequate Plus (110% or more).
The final Kotelchuck index measure combines these two dimensions into a single
summary score. The profiles define adequate prenatal care as a score of 80% or greater
on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories.
38
The Kotelchuck Index does not measure the quality of prenatal care. It also depends on
the accuracy of the patient or health care provider's recall of the timing of the first visit
and the number of subsequent visits. The Kotelchuck Index uses recommendations for
low-risk pregnancies, and may not measure the adequacy of care for high-risk women.
The Kotelchuck Index is preferable to other indices because it includes a category for
women who receive more than the recommended amount of care (adequate plus, or
intensive utilization).
On January 1, 2008 the Smoke Free Illinois Act went into effect. The Act bans cigarette
smoking in public places and has generated 36 complaints in Coles County since passed
by the Illinois legislature. Individuals can file a complaint by calling the Illinois
Department of Public Health’s toll-free complaint line at 866-973-4646 or on-line
through the web site www.smoke-free.illinois.gov. Complaints are relayed to the local
health department where the complaint took place for further follow-up action.
For those looking to kick the habit, the Illinois Tobacco Quitline at 1-866-QUIT-YES or
www.quityes.org provides information and help.
Radon is a radioactive element that is part of the radioactive decay chain of naturally
occurring uranium in soil. Like carbon monoxide you can’t see it, you can’t smell it and
you can’t taste it. But unlike carbon monoxide radon’s adverse health effects is usually
not produced immediately.
The United States Environmental Protection Agency action level for radon is 4.0
picocuries per liter of air (pCi/L). USEPA estimates that up to 6 percent of US homes
have radon concentrations at or above the action level. In 2009 the World Health
Organization (WHO) revised its recommendation for a maximum acceptable radon
concentration in a residential building to 2.7 pCi/L.
Unfortunately only a few homes in Coles County have been tested for Radon. However,
according to the Illinois Emergency Management Agency, 53% of the homes tested in the
Charleston area and 20% of the homes in the Mattoon area tested higher than 4.0 pCi/L.
39

Community Health Plan 2010-2015

Transcription

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