ReThink Health – Whatcom County, Washington Reference Data Summary

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Each local configuration of the ReThink Health model draws from a variety of data sources to create a broad and balanced profile of the health and health care system in a particular region. Data for the Whatcom County Health Service Area currently addresses:

  • Population composition, divided by 10 subgroups according to age, insurance status, and income, and projections for aging and overall growth through 2040;
  • Population health status, including the prevalence of physical and mental illness (by population subgroup);
  • Health risks, including fractions of the population with high risk behaviors, environmental hazards, and high crime (by population subgroup);
  • Provider resources, including office-based primary care providers (private and safety net) and specialists, and acute care hospital beds;
  • Health care utilization, including PCP visits and available slots for the indigent, ER visits urgent and non-urgent, inpatient stays and readmissions and discharge destinations, and people in nursing facilities or using home health care;
  • Health care costs, including nearly every category in the “personal healthcare expenditures” portion of the National Health Expenditures tracking system.

Some of the main sources for understanding conditions in the Whatcom County region are:

  • Office of Financial Management, Vital Statistics
  • Washington Department of Health
  • WhatcomAlliance.com
  • Hospicehelp.com
  • Local data from hospital representatives
  • U.S. Census 2010 (American Community Survey)
  • In addition, certain estimates were either calculated or cross-checked using local adjustments from national sources such as:
  • National Ambulatory Medical Care Survey (NAMCS)
  • National Hospital Ambulatory Medical Care Survey (NHAMCS)
  • National Survey of Children’s Health (NSCH)
  • National Nursing Home Survey (NNHS)
  • National Home Health Care Survey (NHHCS)
  • National Health Expenditure Accounts
  • National Health Interview Survey (NHIS)
  • National Health and Nutrition Examination Survey (NHANES)
  • Medical Expenditure Panel Survey (MEPS)

Whatcom County-specific Data Sources by Topic

POPULATION

  • Population by age group–U.S. Census 2010
  • Population projection by age group–Office of Financial Management – State of Washington
  • Disadvantaged fractions by age group–American Communities Survey – Public Use Micro-area
  • Insured fractions by age/income–American Communities Survey – Public Use Micro-area
  • Births, Deaths, Net Migration–Office of Financial Management–State of Washington

ILLNESS & RISK

  • Chronic mild and severe physical illness prevalence by pop segment–WA Dept. Of Health BRFSS Internet Query system: General Health Status (mild=“good”; severe=“fair or poor”)
  • Chronic mental illness prevalence by pop segment–For youth, scaled national data from the National Survey of Children’s Health: yes responses to “Does child have any kind of emotional, developmental, or behavioral problem for which [he/she] needs treatment or counseling?” For adults WA Dept. Of Health BRFSS Internet Query system: 7+ days as a response to: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
  • Risky behavior prevalence by pop segment–Youth: NSCH 2007 for WA state. Overweight or obese|no activity|smoker in the house|oral health problems
    Adults: BRFSS WA statewide data: obese|no activity|current smoker|binge drinking 2+ times per month|missing 6+ permanent teeth

PROVIDERS

  • Primary care physicians and physician- equivalents (private, safety net)–WhatcomAlliance.org; Hospicehelp.org; Office of Financial Management, State of WA
  • Specialist physicians— WhatcomAlliance.org
  • Acute Care Hospital Beds–Noreen Fassler (per Elya’s spreadsheet)

UTILIZATION

  • Visits to safety net PCPs, and visit capacity per safety net PCP–Awaiting data from SeaMar and Interfaith safety net clinics
  • Fraction of safety net PCP slots available to poor uninsured–Awaiting data from SeaMar and Interfaith safety net clinics
  • Fraction of private PCP slots available (1) to Medicaid, (2) to poor uninsured–Estimate based on experience at other RTH sites
  • ER visits in local & outside hospitals–St. Joseph’s data; assumption that ER utilization within and outside county by county residents follows same pattern as inpatient admissions
  • Non-urgent fraction of ER visits–Estimate based on pattern of ER utilization by population segment from St. Joseph’s and RTH methodology that reflects proportion of ambulatory sensitive conditions coming to the ER
  • Inpatient stays in local & outside hospital–Utilization by segment based on St. Joseph’s data; total utilization by Whatcom County residents from Washington Department of Health patient origin data; inflated St. Joseph’s data to reflect larger number of patients coming from county (SJMC has 87% share of county admissions)
  • Fraction of hospital discharges to SNF/rehab facility or home care agency–St. Joseph’s data on discharge status, assumed to hold true for entire county given SJMC’s large share
  • Nursing home population–Assume 90% Occupancy of 786 beds in 9 SNF’s in county

COSTS

  • Average charge per ER visit–Net revenue from St. Joseph’s data
  • Average charge per inpatient stay–Net revenue from St. Joseph’s data