County health rankings in Kentucky show few changes, but ranks are less important than the trove of data they reflect

By Tara Kaprowy
Kentucky Health News

The health evaluation tool that calls itself "the annual check-up of over 3,000 counties in the nation" was released today, showing little change from last year in how Kentucky counties compare when it comes to factors like obesity, smoking rates and mortality. But the data provide plenty of fresh angles for stories about the health status of individual counties and regions.

The County Health Rankings for Kentucky, which are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, ranked Appalachian counties at the bottom and Central Kentucky counties in the Lexington and Louisville markets at the top. The far western portion of the state ranked lower as well.

The rankings fall into two categories: health outcomes and health factors. Health outcomes, left, include factors such as premature death rates, low birthweight and how many days of the past 30 that someone said they felt bad physically or mentally. Boone, Oldham and Calloway counties ranked first, second and third in health outcomes category, and Wolfe, Martin and Owsley were at the bottom.

In health factors, right, Woodford, Boone and Fayette counties were first, second and third, and Jackson, Clay and McCreary at the bottom of the list. Health factors include the percentage of adults who smoke, are obese or drink excessively; and assess a county's health care landscape: the number of primary-care providers and what percentage of adults are uninsured, for example. Social and economic factors in this ranking include unemployment rates, high-school graduation rates, percentage of children in poverty, pollution rates, access to healthy food and the number of recreational facilities. (The last item replaced the number of liquor stores. "Some of the data were not available for the availability of alcohol and it was difficult to interpret," said Dr. Patrick Remington, project director and associate dean for public health at the University of Wisconsin. The change could have affected the rankings, because Kentucky has many "dry" counties and liquor stores often cluster in "wet" counties adjacent to dry ones.)

Interestingly, the rankings between the two categories vary considerably. Fayette County, for example, ranked third in the health factors list but 10th in the health outcomes assessment. McCracken County was listed eleventh in the health factors list but 45th in health outcomes.

Though Appalachian counties in Kentucky, West Virginia and Tennessee generally ranked very low, there was one very bright spot: Morgan County, which ranked 23rd in health outcomes despite being surrounded by counties that were down in the 100s. It also ranked high last year.

While the rankings didn't change drastically from last year, there was some deviation downward in the Southern Kentucky, including Adair, Clinton, Cumberland and Wayne counties. But Shawn Crabtree, executive director of the Lake Cumberland District Health Department, didn't see much reason for concern. "Naturally, the rank of counties are going to go up and down each time," he said. "I don't know that the communities are any sicker or that anyone is doing anything any different."

Crabtree said it is important to remember the assessment is ranking one county against another, not making a comment on if counties are getting healthier or not. "That's not to say our area isn't an unhealthy area; it is," he said. "That doesn't mean we don't need to improve; we do."

Also, statistical data from counties with small populations can greatly affect rankings. "That number is a little bit volatile," Remington said of certain disease numbers. "It's not a survey, it's the actual experience of what happened." He added, "When you present a statistic for an entire community, you realize it's an average. This is like a screening test. It tells people in a community where the problem areas are, but it really doesn't make the diagnosis."

 

Researchers assembled the snapshot county portraits with information from several sources, including the Behavioral Risk Factor Surveillance System, a random telephone survey by the Centers for Disease Control and Prevention. They also used data from the National Center for Education Statistics, the National Center for Health Statistics and the Census Bureau's American Community Survey and Small Area Income and Poverty Estimates. For a complete list of sources, click here.

Given the number of sources used and the conclusions drawn, researchers hope the data will spur community interest and, ultimately change. In a conference call with reporters, Mayor Joe Reardon of Kansas City, Kan., said, "It was a call to action for me personally and a wake-up call for our community."

Feds say they will post data on performance of dialysis centers

"Federal regulators say they are moving to make once-confidential data about the performance of kidney dialysis clinics more readily available to the public," reports Robin Fields of ProPublica, the nonprofit, investigative news group that posted the data online in December. (ProPublica map locates Kentucky dialysis facilities with dark blue dots; gray areas are lakes and national forests)

Last year, a ProPublica investigation showed inferior care and little oversight in some facilities. Officials with the Centers for Medicare and Medicaid Services told Sen. Charles Grassley, R-Iowa, they are now making public their statistical compilations on the country's 5,000 dialysis clinics. This has never been done before, though CMS "has used public money to collect and analyze the data in the reports for more than a decade," Fields reports. CMS is planning on posting the reports on Medicare's Dialysis Facility Compare website. ProPublica has already posted those reports, which can be viewed by clicking here.

ProPublica's investigation reviewed eight years of inspection records for more than 1,500 clinics and "turned up hundreds of lapses in care, some of which led to patient injuries and death," Fields reports. It also found hundreds of clinics had not been inspected for five years or more, though they are supposed to be checked every three years. Upon learning of the investigation, Grassley asked CMS about what it was doing to improve things.

CMS officials conceded that inspections were inadequate in more than a third of the states. Tougher standards had reportedly been implemented to make the inspections more comprehensive; they are apparently needed. In the past two fiscal years, 15 percent of facilities inspected had "deficiencies serious enough to warrant termination from the Medicare program if left uncorrected," Fields said. (Read more)

People with low health literacy are more likely to get sick, die

Health literacy rates are increasingly gaining the attention of providers, organizations and lawmakers. A new report based on study of medical literature says people who are unable to understand and act on issues related to their own health care have poorer health and a higher risk of death.

Adults with low health literacy are less likely to get a flu shot, understand medical labels and instructions, and have a greater likelihood of taking medicine incorrectly, the report says. Also, women with low health literacy are less likely to get mammograms. Overall, the report indicates that minorities have lower health literacy rates than the rest of the population.

More than 75 million English-speaking adults across the nation have difficulty understanding and using basic health information. That was the focus of the second annual Kentucky Health Literacy Summit last week.

The report, which was released Monday, updates 2004 literature that reviewed the findings of more than 100 studies. It was compiled by the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.

In May 2010, the department launched an action plan that asks stakeholders to simplify their health-related handouts, forms and websites by removing jargon and complicated explanations. It also calls for improving patient-provider communication. (Read more)

Rural hospitals in Kentucky say health reform will hurt them

Though the new national health-care law may increase the number of insured Americans by 32 million, rural hospitals in Kentucky aren't expecting a revenue windfall. That's because half of the people who will be newly covered will be Medicaid patients, "who have been big losers for hospitals in cash-strapped states where Medicaid payments do not cover costs," The New York Times' Milt Freudenheim reports.

"We should repeal it all and start over," said Milton Brooks, administrator of Pineville Community Hospital. "Most hospitals are barely breaking even. When you take a couple of million dollars out of our pocketbooks, we're gone." The Kentucky Hospital Association has said the law will cost its hospitals $1.28 billion over 10 years because of "reduced Medicaid payments for more Medicaid patients as well as lower federal payments to make up for losses," Freudenheim reports. The KHA is not calling for repeal, but is asking for some changes to the law.

Some major national players support the new health care law, including the American Hospital Association, the Catholic Health Association, the Federation of American Hospitals, the National Association of Children's Hospitals and the Association of American Medical Colleges. (Read more)

More N. Ky. kids taken from homes due to parents' drug use

An increasing number of children in Greater Cincinnati are being taken from their homes because their parents are drug users.

In Campbell County, Kentucky, 68 children were removed from their homes last year compared to 49 in 2008, a 39 percent increase in two years, The Cincinnati Enquirer's Barrett J. Brunsman reports. In the same period in Boone County, the number increased by 34 percent, from 38 to 51. In Kenton County, 346 children were taken last year compared to 286 in 2008, a 21 percent increase.

Ohio counties near Cincinnati showed larger increases and also showed that children are increasingly being removed because their parents are using heroin and other opiates. Kentucky does not track what substances parents use, and doesn't keep statistics on the number of babies who are born addicted, but Anya Weber, a spokeswoman for the Kentucky Cabinet for Health and Family Services, said drug or alcohol abuse by a parent or guardian is a factor in 80 percent of all cases of children who are removed.

Because of the increases, foster parents such as Mark and Denise Strimple (Enquirer photo by Carrie Cochran) are needed. "We always need more," said Brian Gregg, a spokesman for the Hamilton County Department of Job and Family Services. "Not just us, the whole region. I can't put a number on it. A lot of foster parents end up adopting children in their care, and that takes them out of the mix." (Read more)

Providers recommend restricting 3 cancer drugs in Medicaid

In an effort to save money, health officials are considering a move that would restrict three cancer drugs for the 800,000 Kentuckians who are enrolled in Medicaid.

Patients could still get the drugs but would need advance approval from Medicaid. The move was recommended to Cabinet for Health and Family Services Secretary Janie Miller by a committee of health care providers. Committee member and oncologist Dr. Cora Veza said the drugs are not commonly prescribed "and she did not believe the recommendation would limit the treatment of Medicaid cancer patients," The Associated Press reports.

As the number of Medicaid enrollments increases due to the recession, other states are reportedly considering making similar moves. (Read more)

Health literacy is 'at a tipping point' as an issue to be confronted, federal official tells second Kentucky Health Literacy Summit

By Tara Kaprowy, Kentucky Health News

BOWLING GREEN, Ky. – The idea that people will be healthier if they can better navigate the boggy, confusing landscape of health care and insurance is gaining traction in Kentucky – which, relatively speaking, has poor health and low literacy.

On Thursday and Friday, scores of health professionals and their allies in the health-literacy cause gathered in Bowling Green for the annual Kentucky Health Literacy Summit. It was the second such gathering, but the first was by invitation, so this was the first opportunity for anyone interested in health literacy to attend a statewide conference about it. The first conference resulted in the formation of Health Literacy Kentucky, an alliance of more than 35 groups.

Health literacy is the "degree that an individual can obtain, communicate, process and understand" basic health information, said Dr. Linda Harris, a Bowling Green native who leads the health communication unit in the U.S. Department of Health and Human Services. Only 12 percent of U.S. adults are considered proficient in health literacy, while 21 percent have basic knowledge and 14 percent are below basic. About half of adults have intermediate knowledge, between basic and proficient.

Health literacy has become an increasing problem as health care has become more technical and complex, and as America has more people for whom English is a second language. If people can't understand what they're being told about their health, they are more likely to get sick -- and less likely to get better once they're ill, Harris said.

She illustrated her point with the story of "Mrs. Jones," a composite individual with issues requiring health literacy: a 62-year-old woman with diabetes, heart failure, low income and a history of depression. She gets sick, goes to the doctor, is prescribed several medications she doesn't know how to take, avoids taking them and eventually needs to be hospitalized. Then she is given a second set of prescriptions that she also doesn't understand. She is re-hospitalized "and the cycle continues," Harris said.

Harris said the issue is at a "tipping point" because it has gone from simply being discussed among advocates to being made policy in legislation like the Patient Protection and Affordable Care Act; the National Action Plan for Health Literacy, the Plain Writing Act of 2010; and Healthy People 2020. "We really think this is the moment," Harris said. "It's not just those people who have been laboring in the vineyards for so long."

Insurance companies making headway

Some of the most innovative health-literacy work is being done by insurance companies, most of which are taking steps to make sure their policyholders understand the forms and documents they're sending them, Humana Inc. marketing consultant Betsy Shirey said. In the past year, Humana has simplified more than 400 of its documents, most of which have been rewritten at a sixth-grade level, as determined by a computerized assessment tool, she said.

To test the rewritten materials, Humana had some of its Medicare members look at the new documents. One person said a form could be simplified if it only had a date at the bottom of it. "They told us about really simple things, and yet we hadn't done it," Shirey said.

The new forms are better designed, with headlines and age-appropriate photography, and "always have a P.S., because everyone always reads the P.S," Shirey said. The document that gives patients a rundown of their to-date expenses, medications and doctors' visits looks like a credit-card statement. "You have a complete picture both financial and medical," Shirey said.

(Humana was the major sponsor of the summit, along with the University of Kentucky and Western Kentucky University.)

Revelations among providers

Simplifying documents was also the goal at People's Community Clinic in Texas, when Special Projects Supervisor Dana Carpenter came across a form that detailed how to take birth control pills. "Someone with a Ph.D. would have trouble understanding it," she said. With help from patients, Carpenter simplified the form, adding photos and "plenty of white space."

About 80 percent of the clinic's patients are Hispanic, so Carpenter was shocked to learn that, when she called the clinic, there was no telephone prompt asking the caller if they wanted to converse in Spanish. "You had to listen to the entire English menu before it would roll into Spanish," she said, and the clinic's directional signs were all in English and hidden by clutter. New signage is bilingual and prominently displayed.

Christine Nagy and Diane Sprowl said they went through a similar process in a joint venture between Western Kentucky University and the Barren River District Health Department. The goal was to get participants in the Women, Infants and Children food program to eat more fruits and vegetables. Patients were asked to fill out surveys, which needed to be designed for people who did not speak English well. Nagy, Sprowl and WKU students designed materials with bullet points, white space and culturally appropriate graphics. They kept the reading level low by using words with few syllables. They also met with patients face to face to help avoid communication breakdown.

Oral communication

More than just rewriting forms, health literacy involves making sure people understand what they're being told. To that end, insurance firms like Humana and providers like the People's Community Clinic are teaching employees how to communicate in a simple, uniform way. Often this involves the "teach-back technique," where you "have them explain back what you've gone over," said Dr. David Susman, psychology services coordinator at Eastern State Hospital.

Susman said it's important to look for clues that a person is having difficulty understanding, such as incomplete forms, lack of adherence to directions, or even looking in a pill bottle to determine what pill they're taking rather than reading the label.

Ultimately, the goal is to keep patients from the fate of Mrs. Jones. "No one is going to say, 'Oh by the way, I have limited health literacy,'" Susman said. "And no one complains about information being too simple."

For a list of advance registrants for the summit, click here.

Annual county health rankings will be released Wednesday

The national County Health Rankings for 2011 will be released Wednesday, March 30. The rankings give a snapshot view of every county in the nation by examining factors such as rates of obesity, smoking, uninsured adults and various diseases.

The Robert Wood Johnson Foundation will host a live teleconference that day to brief news media about the data. Speakers will include James Marks, senior vice president and director of the Health Group at the RWJF; project director Patrick Remington, associate dean for public health at the University of Wisconsin; and Joe Reardon, mayor of Kansas City, Kan.

The conference will be held from 10 to 11 a.m. EDT. For free registration, click here. To view the County Health Rankings for 2010, click here. The rankings are used to produce a county-by-county Health Outcomes Map for each state. Here is Kentucky's for last year; for an interactive version, which enables county-by-county information, click anywhere on the map.

Communities, crusaders for smoking bans honored at ceremony

The Bullitt County Health Department, the City of Bowling Green and the 2010 edition of the Campbell County Fiscal Court won 2011 Smoke-free Indoor Air Excellence awards from the Kentucky Center for Smoke-free Policy at a ceremony in Lexington Thursday. All recently passed smoking bans; a newly elected fiscal court in Campbell County repealed the ban there. The ban in Bullitt County faces a lawsuit from the Fiscal Court.

The Kenton County Fiscal Court and the City of Oak Grove received the 2011 Smoke-free Indoor Air Endeavor award. Those jurisdictions enacted bans that do not apply to bars.

Dr. Melissa Walton-Shirley, left, received the Dr. David B. Stevens Smoke-Free Advocate of the Year award. Walton-Shirley has been a private-practice cardiologist in Glasgow for the past 20 years. She spearheaded the successful smoke-free movement in Glasgow, which won passage of a smoking ban in June 2010, and has pioneered a push to improve access to acute heart attack care for hospitals without requiring onsite surgery.

To date, anti-smoking ordinances or Board of Health regulations have been implemented in 29 Kentucky communities. In 18, the restrictions cover all workplaces, including restaurants and bars. Bullitt County is the most recent addition; its health department passed an ordinance March 22. Nearly one-third of Kentuckians are protected by comprehensive workplace laws, according to the Center for Smoke-free Policy, based in the College of Nursing at the University of Kentucky.

Beshear will use line-item veto on Medicaid bill to remove mandatory cuts in other state programs and school funding

Democrats appear to have prevailed in the State Capitol battle over the budget and Medicaid. (Update, March 25: Beshear issued the vetoes.)

After the Republican-controlled Senate passed a budget fix that included mandatory spending cuts across state government and basic school funding, and Gov. Steve Beshear said he would remove the cuts with line-item vetoes, the House passed the Senate's bill and the legislature sent it to the governor.

Legislators will return April 6 to give each chamber a chance to override the promised vetoes, but in a rare floor speech before the 86-1 vote, House Speaker Greg Stumbo, D-Prestonsburg, left, made clear that the House considers the deal done.

"He said the unusual maneuver was necessary because lawmakers must pass a bill that balances Medicaid before April 1 to avoid what Beshear has said would be 35 percent cuts in rates paid to Medicaid providers. Such a move, Stumbo said, would damage rural health care providers," Tom Loftus and Deborah Yetter report for The Courier-Journal. "House Republican Leader Jeff Hoover of Jamestown urged House members to vote for the bill, saying that small health care providers will be spared devastating cuts on April 1 and education funding won't be cut."

The House wanted to adjourn the special session, but the Senate declined. Senate President David Williams, who is running to oust Beshear in the November election, "noted that the legislation approved by both chambers Thursday says that lawmakers will not be paid during the veto period. Each day of the session, which was in its 11th day Thursday, costs taxpayers about $63,500," Beth Musgrave and Jack Brammer report for the Lexington Herald-Leader. (Read more)

Groups try education to allay confusion about health reform

Though the Patient Protection and Affordable Care Act celebrates its first birthday today, most Americans admit they are still largely confused by what its provisions will mean for them. To help increase understanding, many organizations are launching or expanding their educational efforts.

Kentucky Voices for Health has put together a brief, right, to promote understanding, addressing a range of issues from pre-existing conditions to Medicare drug donut holes. It outlines what provisions will take effect when, answers other commonly asked questions, and looks at how the new law will benefit Kentuckians.

The group, which does not lobby but comprises organizations that do, has also issued statements on how the new law protects small business, seniors, patients' rights and protecting women.

The Health Foundation of Greater Cincinnati has launched a public education effort, FOX19's Matt Miller reports. "Sections of the Affordable Care Act have already begun to take effect and the community needs information," said Kate Keller, foundation senior program officer. "We want to help people understand changes coming and new benefits for which they may be eligible."

The foundation will distribute informational pamphlets through community organizations and will feature a website about the new law. (Read more)

Bullitt County health board votes to make county smoke-free; Fiscal Court wants a judge to decide if a board has that power

Bullitt County's board of health voted to enact a countywide smoking ban Tuesday evening, but the county's Fiscal Court wants a judge to decide if the board has that authority.

"This is not about the smoking ban," Judge-Executive Melanie Roberts told WAVE-TV's Connie Leonard. "This is about which agency can enact legislation." Health Department Director Swannie Jett said fighting the ban is "ludicrous if you just think about the health impacts."

The Bullitt County Board of Health is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties did likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department. (Read more)

Meanwhile, in a story healdined, "Smoking-ban advocates find Southern Kentucky a hard sell," the Lexington Herald-Leader's Bill Estep explains how a multi-county agency such as the Lake Cumberland District Health Department can enact a smoking ordinance. "A county health department that stands alone can approve a smoke-free law by regulation," he reports. "Counties under a district health department board can't, however; the multi-county board would have to approve such a regulation for the entire district." (Read more)