El Dorado County may be home to the largest population of those over the age of 55, but is also one of the healthiest counties in the state, coming in sixth out of 58 counties.
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That’s according to a recent community health assessment conducted by Marshall Medical Center in collaboration with Valley Vision Inc., a nonprofit consulting group.
Conducted every three years, all nonprofit hospitals are required to prepare such an assessment with the results used as the basis for a community health improvement plan.
Data used in the study came from interviewing health experts and community residents, from socio-demographic, environmental and crime statistics, an inventory of community health resources and health outcome data related to certain diseases. As part of the assessment, Marshall also put a value on the unreimbursed care it provides to the community. In 2011-12 that came to $84 million.
Communities of concern
While overall people in EDC are healthy, the assessment identified five “communities of concern” where the rates of negative health outcomes frequently exceed county, state and federal benchmarks.
Those communities were Diamond Springs, El Dorado, Georgetown, Placerville and Pollock Pines. Some 57,000 residents live in those areas making up slightly less than a third of the county’s total population.
Demographically, Diamond Springs led the other four areas in the percentage of households in poverty as well as the percentage of those over the age of 25 with no high school diploma, no health insurance and with limited English. Diamond Springs, at 34.3 percent, also had a higher percentage of single female-headed households living in poverty than the national average, which is 31.2 percent.
Georgetown registered the highest unemployment rate in the county at 13.6 percent. However all five communities had higher unemployment rates than the national average and three had higher unemployment rates than the state average.
Placerville led with the highest percentage of non-White Hispanic residents and also the highest percentage of those renting, with Diamond Springs a close second.
As far as crime, Placerville led with a major crime rate of 300.3 per 10,000 residents. The remaining areas had crime rates that were half that of Placerville’s.
Visits to the hospitals due to assaults were also highest in Placerville followed by Diamond Springs. In addition, three of the five communities of concern had rates of assault-related emergency department (ED) visits that exceeded the county benchmarks. Those three were Placerville, Diamond Springs and Pollock Pines.
Nonetheless, most of those interviewed during the assessment consistently reported feeling very safe in their communities.
Diamond Springs had the highest rates for ED visits and hospitalization due to unintentional injury closely followed by El Dorado. In particular, ED visit rates were higher than the county and state benchmarks in four communities of concern with the exception of Georgetown.
ED visit rates due to accidents were lower in all five communities than for the rest of El Dorado County and were lower than the state average as well, with the exception of Pollock Pines. However rates of hospitalization were similar except for Georgetown which had none.
Obesity was a condition of 20 percent of residents in the communities of concern while approximately 34 percent were overweight. In comparison, the statewide average for obesity was 24.8 percent.
Despite these different health issues, life expectancy in the county is high. Life expectancy overall in EDC for men is 77.3 years and for women is 81.6 years. In the five communities of concern, life expectancy varied from 79.2 to 81.7.
Shannon Truesdell, RN, and chief operating officer for Marshall Medical Center, said there is a concentration of certain health issues in the five communities of concern because they all have high senior populations.
“A good example is Lake Oaks Mobile Home Community,” she said. “They have lots of seniors. It’s not surprising to see some diagnoses that go with aging. El Dorado County has the largest population of 55-plus of every county in the entire state. And the growth rate is higher than any other county in the state. That growth rate is projected to be about 8 percent a year in this county. All healthcare services in our community are really going to be impacted by our aging population and the medical conditions that go along with aging.”
The health assessment also compared mortality rates, emergency department visits, and hospitalization rates for different medical conditions in the five communities of concern.
Diamond Springs led in the number of ED visits and hospitalizations for diabetes.
Diamond Springs, El Dorado, Placerville and Pollock Pines were leaders when it came to heart disease, although hospitalizations were lower than the state benchmark. However mortality rates were almost double in most of the five communities in comparison with state and national benchmarks.
Pollock Pines led when it came to ED visits and hospitalization rates related to strokes. Mortality due to strokes was highest in Georgetown, Placerville and Pollock Pines. ED visits and hospitalization for hypertension were similar for all five communities, with Diamond Springs, El Dorado, Placerville and Pollock Pines exceeding the county average.
Community members and health professionals identified high smoking rates as one of the challenges in the community. All communities of concern had hospitalization rates due to COPD, asthma and bronchitis above the county or state benchmarks.
Diamond Springs, El Dorado, Placerville and Pollock Pines had higher ED visits and hospitalization rates for mental health issues than either the county or the state. A related issue was the rate of ED visits for self-inflicted injuries. They were more than double for Diamond Springs than for the county as a whole and more than three times the state rate.
Communities of concern were above the county or state benchmarks rates for mortality and hospitalization when it came to unintentional injuries as well. The rate for ED visits for Diamond Springs was almost double the state rate. Rates were high in El Dorado, and Placerville as well.
ED visits and hospitalization rates related to substance abuse were also high. As a whole, the county had an ED visit rate of 442.3 in comparison with the state rate of only 232. In Diamond Springs, the rate was even higher at 747 while in El Dorado it was 620.8. Overall, the five communities of concern, with one exception, had higher rates for ED visits and hospitalizations due to substance abuse than either the county or state benchmarks.
According to the assessment report, “Community experts and focus groups reported an increase in the use of drugs and alcohol to cope with stress and anxiety. Qualitative data consistently identified substance abuse as a major health issue, and a lack of treatment and support group options frequently cited as a challenge.”
Putting the assessment to work
Several recommendations came out of the health assessment, including the need for more sites where both uninsured and undocumented residents can obtain affordable medical care. Better treatment and support services for those with mental health or substance abuse problems is needed as well as educational programs on health, nutrition, chronic disease management and physical activity. Last, transportation is an issue for those seeking medical care, especially those living in rural areas.
Truesdell said Marshall does have a rural health clinic in Georgetown that’s Marshall affiliated. “But we’re also looking at other rural health clinics in medically underserved areas,” she added. “Healthcare across the board is challenged with declining reimbursement. We’re seeing how we can do the best we can with the resources we have. How we can partner with others and create a safety net for those patients that aren’t being served as well as we’d like to.”
Regarding additional resources for those with mental illness or substance abuse problems, Truesdell said Marshall is considering putting behavior health professionals in their clinics to deal with depression and help clients better manage their conditions.
“We are also looking at telemedicine,” she said. “UC Davis and certain firms do telemedicine consultations. We have the telemedicine equipment on site at hospital and are starting to work with our physicians and potentially other agencies, like UC Davis or other entities, to help us look at way of offering care in a different way when there’s not a wealth of services in our community.”
Overall Truesdell said that despite some problem areas, there were many positives that came out of the assessment. One of which was discovering that EDC residents are among the healthiest in the state. Another was establishing closer working relationships with other service providers.
Residents can access the entire assessment and benefit plan at marshallmedical.org/Default.aspx?id=462&sid=1&CWFriendlyUrl=true.
Contact Dawn Hodson at 530-344-5071 or [email protected] Follow @DHodsonMtDemo on Twitter.