Pocahontas Memorial Hospital

Community Health Needs

Assessment

2013
 Pocahontas Memorial Hospital
Community Health Needs Assessment
October 2013

Table of Contents

Executive Summary Page 3

Background:
Hospital Profile Page 4
Community Profile Page 5
Methodology Page 5
Service Area Page 5
Data Sources Page 5

Community Needs Assessment:

Demographic Factors Page 6
Social and Economic Factors Page 7
Physical Environment Page 8
Clinical Care Page 8
Health Behaviors Page 10
Health Outcomes Page 11
Comparison of Pocahontas County to Peer Counties Page 13

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Executive Summary:

In 2013 Pocahontas Memorial Hospital (PMH) conducted a Community Health

Needs Assessment to identify health issues and community needs impacting the health
of Pocahontas County Residents. The results of this Community Health Needs
Assessment were used to inform PMH’s board and leadership decision-making with
regard to how the hospital can positively impact the health of residents in its service
area as part of the Hospital’s strategic planning process.

To assist PMH with conducting the community health needs assessment, PMH
contracted the Center for Rural Health Development, Inc. In conjunction with the board,
leadership and staff of Pocahontas Memorial Hospital, the needs assessment team
sought the participation of a wider circle of interested Pocahontas County residents
through the conduct of key informant interviews. This Community Health Needs
Assessment used multiple data collection tools and methods, both qualitative and
quantitative, to conduct an epidemiological needs assessment of the factors that impact
the health of Pocahontas County residents. Key points of this report include the
influence that the County’s demographic, geographic, socio-economic, clinical care and
physical environment have on health outcomes of the residents of Pocahontas County.

The needs assessment team ensured data collection efforts were as inclusive as
possible and incorporated the perspectives of diverse members of the community in
terms of age, race/ethnicity, gender, profession, and geographic location. The team
worked to develop meaningful partnerships with local agencies and other key
informants in an effort to identify and mobilize community assets that will be used for the
strategic planning process.

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Hospital Profile:

Marlinton Hospital and Infirmary was first established by the County Court in 1926. It
became known as Pocahontas Memorial Hospital as a tribute to the men and women who
served in the military from Pocahontas County. After nearly seventy years, the hospital was
moved to Buckeye in October 1995. PMH is now a 25 bed critical access hospital with a
federally designated Rural Health Clinic.

The mission of Pocahontas Memorial Hospital is to be the community’s first choice for
integrated health care by hardwiring excellence through continuing education, effective
collaboration and by providing exceptional customer service.

In pursuing its mission, Pocahontas Memorial Hospital strives to:

 Be the provider of choice for health care to our communities.
 Create an environment that promotes healthy living.
 Be a key resource to promote stability in our communities.
 Be a leader in patient education, prevention and outreach.
 Promote physical, emotional and financial well-being of our communities.

The guiding principles of Pocahontas Memorial Hospital are those principles which form the
foundation on which we perform work and conduct ourselves. Our Nine Guiding Principles are:
Principle 1: Commit to Excellence.
Principle 2: Use Measurement to Diagnose Problems and improve Processes.
Principle 3: Build a Culture around Service
Principle 4: Create and Develop Leaders
Principle 5: Focus on Employee Satisfaction
Principle 6: Build Individual Accountability
Principle 7: Align Behaviors with Goals and Values
Principle 8: Communicate at All Levels
Principle 9: Recognize and Reward Success

Pocahontas Memorial Hospital is a 25 bed Critical Access Hospital that provides a continuum of
services that include:
 Acute care  Emergency services
 Diabetes education  Laboratory services
 Occupational therapy  Physical therapy
 Physical therapy  X-ray and other imaging services
 Respite care for care givers  Respiratory therapy
 Community outreach services and programs  Skilled rehabilitation services
 Outpatient services, including physical
exams, chronic disease management, family
practice, immunizations and women’s and
children’s services

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Community Profile: Pocahontas Memorial Hospital is located in the county seat of
Marlinton, WV in Pocahontas County. Pocahontas County is the home to the National Radio
Astronomy Observatory Green Bank Telescope and is part of the National Radio Quiet Zone. In
addition, the county is known as the birthplace of rivers as it is the location of the headwaters for
eight rivers: Cherry River, Cranberry River, Elk River, Gauley River, Greenbrier River, Tygart
Valley River, Williams River, and Shavers Fork of the Cheat River. Pocahontas County has the
highest average elevation of any county east of the Mississippi. The county also has the largest
concentration of public lands in West Virginia of which 349,000 acres is either state or federal
property. More than 800 miles of hiking and biking trails are located in the county with more
than 1/3 of the Monongahela National Forest located within the county. Given its natural
landscape, more than one million tourists visit the county each year, although the county is one
of smallest in terms of population in West Virginia.

Methodology: The purpose of the community health needs assessment was to compile
current data on the key health issues faced by residents of Pocahontas County. The community
health needs assessment included both quantitative and qualitative assessments.

Quantitative Assessment: Data was collected to create a profile of the following characteristics
of the county:
 Demographic Factors  Social and Economic Factors
 Physical Environment  Clinical Care
 Health Behaviors  Health Outcomes

Qualitative Assessment: Key informant interviews were conducted with community leaders.
Information from 19 key informants was collected representing a variety of sectors including local
government, agriculture, education, industry and business, civic groups, public health, law enforcement,
service industry, etc.

Service Area: The service area is the geographic area from which a significant number of
people using the hospital’s services reside. As hospital utilization data provides the clearest
definition of the service area, based on hospital discharge data for 2012, the bulk of patients
discharged from Pocahontas Memorial Hospital resided in Pocahontas County. Thus,
Pocahontas County was defined as the service area for this Community Health Needs
Assessment.

Data Sources: The following data sources were used in compiling the August 2013
Community Needs Assessment for Pocahontas County, WV:
• Community Health Needs Assessment Data Report; Pocahontas County, WV; May 2013.
www.chna.org.
• Community Health Status Report; Pocahontas County, WV; 2009;
www.communityhealth.hhs.gov
• Key Informant Interviews; conducted June 2013.

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 Demographic Factors
It is important to examine demographic factors in the service area as current population
demographics and changes in demographic composition over time play a determining role in the
types of health and social services needed by communities. As demonstrated in Table 1,
Pocahontas County has realized a 4.51% loss in population from 2000 to 2010. However,

Table 1
Change in Total Population

Total Total Percent Change

Report Area Population, Population, from 2000-2010
2010 Census 2000 Census Census

Pocahontas County, West 8,719 9,131 - 4.51%

Virginia

West Virginia 1,852,994 1,808,344 + 2.47%

United States 308,745,538 281,421,906 + 9.71%

hospital utilization is greatly impacted by the age groups that make up the total population.
Thus, Table 2 indicates the total population by age groups in Pocahontas County. As indicated
the age group that uses the most health care services, age 65+ years, represents the greatest
proportion of residents in the county.

Table 2
Total Population, Percent by Age Groups

Age 0- Age Age Age 25- Age 35- Age 45- Age 55-
Report Area Age 65+
4 5-17 18-24 34 44 54 64

Pocahontas County 4.58% 13.98% 6.57% 10.87% 12.43% 16.84% 16.02% 18.72%

West Virginia 5.64% 15.52% 9.17% 11.94% 13.20% 15.15% 13.57% 15.82%

United States 6.62% 17.73% 9.94% 13.22% 13.89% 14.57% 11.28% 12.75%

The majority of Pocahontas County residents are white (99.16%), with the next highest being
Black (0.36%) and multiple races (0.26%). The Asian population was the only race identified as
linguistically isolated. That is, 100% of the Asian population in Pocahontas County aged 5 and
older reported to speaking a language other than English at home and speaking English less
than "very well." This indicator is relevant because an inability to speak English well creates
barriers to healthcare access, provider communications, and health literacy/education.

Key Informant interviews indicated that Pocahontas County’s aging population was a significant
health determinant and as a result transportation and distance were also identified as major

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problems in accessing health care services. In addition, a lack of availability for non-emergency
medical transportation was identified as a major barrier to health care services.

Social and Economic Factors

Social and economic factors are examined as part of a community health assessment as
economic and social insecurity often are associated with poor health. Poverty, unemployment,
and lack of educational achievement affect access to care and a community’s ability to engage
in healthy behaviors. Without a network of support and a safe community, families cannot thrive.
Ensuring access to social and economic resources provides a foundation for a healthy
community.

Tables 3 and 4 describe how Pocahontas County relates to West Virginia and the nation
in terms of the social and economic factors indicated. Those statistics highlighted in green
indicate factors in which the population is exceeding state and/or national data; while those
factors highlighted in red indicate areas in which the population is below state and/or national
data.
Table 3
Social and Economic Factors
%Adults %
%Population
Reporting % Population
%Free/Reduced On-Time with Income
Report Adequate Children with No
Price Lunch Graduation Below 200%
Area Social or in High
Eligible Rate Poverty
Emotional Poverty School
Level
Support Diploma
Pocahontas
83.80% 59.93% 20.59% 82.60 43.59% 20.99%
County
West
81.00% 51.48% 23.79% 77 39.09% 18.09%
Virginia
United
80.33% 48.34% 19.19% 75.50 31.98% 14.97%
States
HP 2020
>82.4
Target

Table 4
Social and Economic Factors
%
Percent Population
Teen Births Unemployment
Report Area Population Receiving
/1,000 Births Rate
in Poverty SNAP
Benefits
Pocahontas 15.27% 17.07% 42.50 0
County
West Virginia 17.35% 18.35% 46.20 7.30
United States 13.82% 12.60% 41.20 7.77

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Physical Environment
A community’s health also is affected by the physical environment. A safe, clean
environment that provides access to healthy food and recreational opportunities is important to
maintaining and improving community health.

Table 5 describes how Pocahontas County relates to West Virginia and the nation in
terms of the availability of healthy foods. Grocery stores are defined as supermarkets and
smaller grocery stores primarily engaged in retailing a general line of food, such as canned and
frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry.
Included are delicatessen-type establishments. Although data indicated that Pocahontas County
did not have problem with access to fresh fruits and vegetables, the key informant interviews
indicated that the population, especially children, used gas stations to purchase meals and that
many did not understand healthy eating concepts and thus were making very unhealthy food
choices.

Table 5
Physical Environment
# Beer,
# WIC-
# Fast Food Wine or
Grocery %Living Authorized Recreational
Restaurants Liquor
Stores / in Food Food Store/ Facilities /
/ 100,000 Stores /
100,000 Deserts 100,000 100,000 Pop.
Pop 100,000
Pop Pop.
Pop
Pocahontas
22.94 57.35 0 0% 56.91 no data
County
WV 68.27 20.67 2.54 8.82% 18.80 7.45
US 69.14 21.81 10.20 9.10% 15.60 9.68

Clinical Care
A lack of access to care presents barriers to good health. The supply and accessibility of
facilities and physicians, the rate of un-insurance, financial hardship, transportation barriers,
cultural competency, and coverage limitations affect access.

Rates of morbidity, mortality, and emergency hospitalizations can be reduced if

community residents access services such as health screenings, routine tests, and
vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding
one or more health issues and can inform program interventions.

Table 6 describes how Pocahontas County relates to West Virginia and the nation in
terms of the factors impacted by access to clinical care services. Unfortunately, residents of
Pocahontas County indicate that the population is below state and/or national data with regard
to clinical care indicators. Ambulatory Care Sensitive Conditions reports the discharge rate (per

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 1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACS
conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could
have been prevented if adequate primary care resources were available and accessed by those
patients. This indicator is relevant because analysis of ACS discharges allows demonstrating a
possible “return on investment” from interventions that reduce admissions (for example, for
uninsured or Medicaid patients) through better access to primary care resources.

Table 6
Clinical Care
%Medicare
% Females Enrollees
% Adults Preventable
Primary Care ages 67 – 69 with
w/o Hospitalizations
Report Area Providers / Mammogram Diabetes
Pneumonia (ACS discharge
100,000 Pop. in Past 2 receiving
Vaccine rate)
Years annual
Hb A1c test
Pocahontas 68.81 57.83% 81.53% no data 106.82
County
West 87.80 60.74% 82.86% 53.57% 99.07
Virginia
United 84.70 65.37% 83.81% 55.68% 66.54
States

Current Health Care Providers

Pocahontas Memorial Hospital’s Rural Health Clinic is designated as being located in a
Health Professions Shortage Area (HPSA). In addition, the northern and southern regions of
Pocahontas County are designated as a Medically Underserved Areas (MUA). Table 7 lists the
providers located in Pocahontas County in October 2013. Key Informants indicated that the
availability of local health care services was a concern. Although many indicated that they were
satisfied with their primary care providers, they were concerned about what would happen if
they left as many felt there were very few alternatives. Several key informants indicated that
lack of specialists was a concern and many indicated that this is why they seek care out of the
county. Although key informants indicated that PMH has made major improvements over the
past few years, several indicated that there was a lingering community perception that the
hospital was there to stabilize patients prior to transfer. Many of the key informants indicated a
desire for the following services to be available in Pocahontas County:
 OB/GYN, mammography, PAP tests
 MRI
 Non-emergency transportation
 Dialysis
 Pediatrics
 Expanded dental care, i.e. crowns and extractions
 Colonoscopy
 Orthopedics; need to be able to set bones
 Ophthalmology

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 Finally, key informants were pleased with the availability of after-hour and weekend care
at the rural health clinic, but indicated that many in the community were unaware that these
services were available. Several key informants indicated that they were well pleased with the
school-based health centers.

Table 7
Providers Located in Pocahontas County
October 2013
Provider Location Services
Frankie Puckett, M.D. General Surgery
Stephen Otto, M.D. PMH Emergency Medicine
Mark Spitzer, M.D. PMH Emergency Medicine
Luke McElwain, PMH Emergency Medicine
Jeffrey Davis, M.D. PMH Emergency Medicine
William Browning, JR, D.O. Northern Greenbrier Health Family Practice
Clinic
Neal Rehberg, D.O. PMH Family Practice
Patricia Browning, D.O. Northern Greenbrier Health Family Practice
Clinic
Sarita Bennett, D.O. Marlinton Family Practice
Terry Thomas, D.O. PMH Family Practice
Dr. Debra Auble, MD Community Care Family Practice
Donna Lidel Burley, NP PMH Nurse Practitioner; Family Practice
Rachel Taylor, PA-C Community Care Physician Assistant; Family Practice
Valarie Monico, PA-C PMH Physician Assistant; Family Practice
Dr. Jennifer Beverage, D.O. Community Care Osteopathic Manipulative Medicine
Dr. John Eilers, D.O. Big Springs Clinic Osteopathic Manipulative Medicine

Health Behaviors
Health behaviors such as poor diet, a lack of exercise, and substance abuse contribute
to poor health status and thus are important to understand in planning for future health services
in the service area.

Table 8 describes how Pocahontas County relates to West Virginia and the nation in
terms of selected health behaviors. Those statistics highlighted in green indicate factors in
which the population is exceeding state and/or national data; while those factors highlighted in
red indicate areas in which the population is below state and/or national data. Information from
the key informant interviews validated that obesity, as well as lack of physical activity and poor
eating habits were concerns. The key informants were especially concerned about these issues
in children. In addition, substance abuse was also identified as a concern by several key
informants.

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 Table 8
Health Behaviors
% Adults
% Adult % Adult
% Adult Heavy Consuming Few
Report Area Physically Cigarette
Drinkers Fruits or
Inactive Smokers
Vegetables
Pocahontas
17.40% 75.20% 18.70% 32.21%
County
West Virginia 11% 81.30% 28.30% 26.40%
United States 16.61% 75.92% 24.66% 19.27%

Health Outcomes
Measuring morbidity and mortality rates allows assessing linkages between social
determinants of health and outcomes. By comparing, for example, the prevalence of certain
chronic diseases to indicators in other categories (e.g., poor diet and exercise) with outcomes
(e.g., high rates of obesity and diabetes), various causal relationship may emerge, allowing a
better understanding of how certain community health needs may be addressed.

Tables 9, 10, 11 and 12 describe how Pocahontas County relates to West Virginia and
the nation in terms of health outcomes. Unfortunately, residents of Pocahontas County indicate
that the population is below state and/or national data with regard to health outcomes for
several of the health outcome indicators reported. It is important to note that 41.53% of the
suicide deaths are in males in Pocahontas County.

Table 9
Health Outcomes
Colon/rectal
Breast Cancer Cancer Cervical Cancer
Cancer
Report Area Incidence/ Mortality / Incidence /
incidence/
100,000 Pop 100,000 Pop. 100,000 Pop.
100,000 Pop.
Pocahontas
110.40 184.29 no data 39.90
County
West Virginia 112.20 201.68 9.80 52.60
United States 122 176.66 8 40.20
HP 2020
< 160.6 < 7.1 < 38.6
Target:

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 Table 10
Health Outcomes
Heart Disease
Percent Adults Infant Mortality / % Low Birth
Report Area Deaths / 100,000
with Diabetes 1,000 Births Weight
Pop.
Pocahontas
10.80% 140.28 17.19 9.32%
County
West Virginia 11.39% 154.65 7.60 9.31%
United States 8.77% 134.65 6.71 8.10%
HP 2020
< 100.8 < 6.0
Target:

Table 11
Health Outcomes
Lung Cancer Motor Vehicle % Adults
Report Area Incidence/ Deaths/ % Adult Obesity Reporting Poor
100,000 Pop 100,000 Pop General Health
Pocahontas
84.90 42.05 30.90% 22%
County
West Virginia 90.40 18.60 32.92% 21.60%
United States 67.20 11.13 27.35% 16.27%
HP 2020
< 12.4
Target:

Table 12
Health Outcomes
Prostate Cancer Prostate Cancer
Stroke Deaths / Suicide Deaths
Report Area Incidence / Incidence
100,000 Pop / 100,000 Pop
100,000 Pop /100,000 Pop
Pocahontas
91.80 60.37 20.54 91.80
County
West Virginia 138.40 48.19 14.14 138.40
United States 151.40 41.78 11.57 151.40
HP 2020
< 33.8 < 10.2
Target:

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Peer Counties
The Community Health Needs Assessment also identified counties and county-like
geographic areas were identified as peer counties to Pocahontas County. Peer counties were
stratified on the basis of the following factors: frontier status, population size, poverty, age,
population density. Below are peer county ranges representing the 10th and 90th percentile of
values:

Population size: 4,798 – 13,625

Population density (people/sq mile): 8 – 19

Individuals living below poverty level: 16.8 – 25.4%

Age Distribution: Race/Ethnicity:

Under age 19: 20.4 - 25.4% White: 71.2 - 98.0%
Age 19- 64: 55.1 - 62.0% Black: 0.2 - 26.1%
Age 65 – 84: 12.8 -19.7% American Indian: 0.2 - 16.4%
Age 85+: 2.3 - 4.3% Asian/Pacific Islander: 0.1 - 0.8%
Hispanic origin: 0.9 - 23.6%
Those counties identified a Peer Counties to Pocahontas County included:

Arkansas: Missouri: Texas:

 Bradley County  Oregon County  Childress County
 Fulton County  Ozark County  Coleman County
 Montgomery County  Putnam County  Comanche County
 Scott County  Scotland County  Delta County
 Searcy County  St. Clair County  Hardeman County
 Stone County  Wayne County  Haskell County
 Worth County  Houston County
Georgia:  Mitchell County
 Quitman County Montana:  Red River County
 Deer Lodge County  San Augustine County
Iowa:  Trinity County
 Decatur County Oklahoma:
 Atoka County
Michigan:  Cotton County
 Lake County  Greer County
 Hughes County
 Jefferson County
 Nowata County
 Okfuskee County
 Pushmataha County

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 Table 13 indicates how Pocahontas County compared to its Peer Counties in terms of
health indicators.

Table 13
Pocahontas County’s Health Indicators Compared to Peer Counties

Compared to Peer Counties

UNFAVORABLE FAVORABLE
Compared to US Rates
UNFAVORABLE

 Births to Women under 18

 Low Birth Weight (<2500 g)
 Colon Cancer
 Infant Mortality
 Coronary Heart Disease
 White non-Hispanic Infant Mortality
 Lung Cancer
 Neonatal Infant Mortality
 Motor Vehicle Injuries
 Post-neonatal Infant Mortality
 Stroke
 Breast Cancer (female)
 Suicide
 Unintentional Injury
FAVORABLE

 Very Low Birth Weight (<1500 g)

 Premature Births (< 37 weeks)  Births to Unmarried Women
 Births to Women age 40 - 54  No Care in First Trimester

Indicates a status favorable to peer county median value

Indicates that a closer look and perhaps redicution to the percent or rate
may be needed

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