Community Assessment Project For Quality and Safety Project
A Community Assessment of 36532, the Fairhope Community. The 36532 zip code for Fairhope, Alabama, is a very diverse community with a population consisting of snow birds and an area of some crime and poverty. A drive-through of the community would reveal an atmosphere of hope and hopelessness, wealth and poverty, the privately insured, and the government dependent. The 36532 zip code is a great challenge, both to assess and to create solutions. The following paper will examine the successes and failures of this community, continuously in need of safety and health care.
Description of the Community
The community zip code 36532 occupies a total of 11.0 square miles. It is bordered by the nearest cities, which are Point Clear, AL (1.5miles), Daphne, AL (2.7 miles ), Silverhill, AL (3.0 miles ), Spanish Fort, AL (3.2 miles ), Loxley, AL (3.3 miles ), Robertsdale, AL (3.4 miles ), Summerdale, AL (3.4 miles ), and Foley, AL (3.9 miles ). The city of Fairhope was first settled sometime around November of 1894, where Alabama City used to be located. The Fairhope Industrial Association founded the town as a Utopian colony espousing single taxation. The colony's principal founder was social philosopher Henry George. He had twenty-eight followers, the basis of the city's original citizens (Fairhope, Statistic Alabama 2012).
Their goals were to establish and conduct a model colony, which was to be free from all kinds of private monopoly, where they could secure city members equal opportunity, as well as rewards for individual efforts. The first citizens of Fairhope, Alabama, pooled money to purchase some land, including Stapleton's Pasture located on the eastern edge of Mobile Bay. The city fathers divided the land into long-term leaseholds. Rent paid all government taxes, and this simulated a single tax (Fairhope Public Library, 2012).
A corporation called Fairhope Single-Tax is still in operation. It has 1,800 leaseholds, spread out over 4,000 acres both around and in Fairhope, Alabama. Other noted intellectuals regularly wintered in the city, and it was a magnet for artists and writers. The esteemed writer, Upton Sinclair, often visited the city. Over time, the city has moved from a Utopian experiment to an intellectual's and artist's colony, and then on to an affluent suburb and boutique haven (Fairhope Public Library, 2012).
Community Population
As of the 2010 census, there were 12,480 people, 5,345 households, and 3,575 families residing in the city. Its population density was 1,135.1 per square mile. There were 6,000 housing units, with an average density of 545.7 per square mile. The racial makeup of the city is 90.22% White, 7.79% Black, 0.20% Native American, 0.62% Asian, 0.04% Pacific Islander, 0.21% from other races, and 0.93% from two or more races. 1.04% of the population were either Hispanic or Latino.
There were 5,345 households, out of which 27.0% had children under the age of 18 living with them, 54.8% were married couples living together, 10.1% had a female householder with no husband present, and 33.1% were non-families. Households made up of individuals is 30.3%, and 15.6% had someone living alone who was 65 years of age or older. The average household size was 2.27, and the average family size was 2.83. 21.6% of the population was under the age of 18, 5.4% from 18 to 24, 23.8% from 25 to 44, 25.6% from 45 to 64, and 23.7% were 65 years of age or older. The median age was 44 years. For every 100 females, there were 83.3 males. For every 100 females age 18 and over, there were 78.3 males. The median income for a household in the city was $42,913, and the median income for a family was $56,976. Males had a median income of $41,692 versus $27,959 for females. The per capita income for the city is $25,237. About 4.9% of families and 7.5% of the population were below the poverty line, including 7.3% of those under age 18 and 9.9% of those age 65 or over. The most popular occupation for the population in the 36532 zip code is in management or professional occupations. The second choice of career is in sales and secretarial work (American Fact Finder, 2000). Other occupations include maintenance, construction, and transportation.
Population of Interest/Factors Affecting Health
My population of interest is Thomas Hospital on 750 Morphy Avenue, Fairhope, Alabama 36532. "An estimated 71.3 million Americans suffer from at least one type of cardiovascular disease (CVD), of whom a large portion (27.4 million) are sixty five years or older" (Nash, 2011, p.69). The Fairhope Community is no different than the other parts of the nation. I will continue to focus on Thomas Hospital and the community in and around the hospital. I will identify three different factors that affect the overall health in our community. The first is cardiovascular disease. The cardiac function is altered in an age-related manner, and cardiovascular diseases increase with the increasing age populations. My purpose of this overview is to identify cardiac changes which are characteristic of physiologic aging - the altered presentation and modifications of therapy for elderly patients with common cardiovascular diseases, such as hypertension, atrial arrhythmias, and coronary artery disease. I will also identify cardiovascular diseases and treatments which are unique to the elderly population.
Treatment considerations for coronary artery disease in the elderly patient do not differ from those of the younger population with coronary artery disease, with the exception of the elderly diabetic patient with coronary artery disease. The therapeutic choices include medications (nitrates, beta-blockers, calcium blockers), lipid lowering regimens, and revascularization procedures. Revascularization procedures (angioplasty or surgery) may be a greater benefit than pharmacologic therapy in these patients with multi-vessel disease and decreased left ventricular function. In the elderly with diabetics and multi-vessel disease, surgical intervention is more favorable than angioplasty. Complication rates for angioplasty and surgery are slightly higher in the elderly patient, but still relatively low. It has been noted that fewer women than men have been treated with angioplasty or surgery, and that women undergoing such procedures have a more advanced disease. The findings could represent atypical presentation or failure in the community to recognize the prevalence of coronary artery disease in elderly women. Another issue that could be possible is the decrease in cognitive function among older patients undergoing coronary artery bypass graft procedures (McGoon, 1993).
The second focus will be congestive heart failure. In the elderly, the therapy does not change from that of younger patients. The therapy will be digoxin, diuretics, and angiotensin-converting enzyme inhibitor drugs. The renal function and potassium may need to be monitored a more closely in elderly patients, who may have a higher incidence of arthritis because of them ingesting non-steroidal anti-inflammatory drugs (Nettina, 1996). The role of beta blockers in the management of patients with congestive heart failure is just now coming to the surface, and I feel they will play a bigger role in the future, resulting in better treatment for these type patients.
Physicians/and nurses practitioners should focus not only on prescribing medications, but also on patient family education regarding other health professionals, such as dieticians, social workers, physical therapists, or exercise technicians. These professionals can and should closely follow-up on weight and symptoms of the patients in the home, with a goal of improving CHF and preventing hospitalizations. In a recently completed study of elderly patients with congestive heart failure at Thomas Hospital, patients cared for by these healthcare professionals had fewer hospitalizations, improved quality of life, and lower medical costs for up to one year after the study was completed. This data suggests that the geriatric multidisciplinary team approach is beneficial for cardiac diseases in the elderly patient.
The third problem identified would be strokes among the elderly. Atrial fibrillation (AF) is one of the most common, potent, and independent risk factors for ischemic stroke, with the incidences increasing with age. AF is the most important single cause of ischemic stroke in this age group. There are several clinical trials that have demonstrated that warfarin treatment reduces the risk of stroke and death compared with placebo in persons with AF. This benefit is accompanied by a relatively low annual bleeding rate. Warfarin can reduce the stroke risk in persons with AF and should be used independently of age, especially in the elderly with other associated risk factors (Nettina, 1996). This is an opportunity to improve the quality of life and care for our elderly patients.
Identifying the Health Disparities
Healthcare disparities are on the rise where there are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific population groups. Disparities in the current healthcare systems can affect population groups based on gender, age, ethnicity, socioeconomic status, and demographical factors. Age is a major factor in contributing to disparities in healthcare. Elderly patients usually are characterized by impaired mobility, which makes access to healthcare facilities challenging. As people progressively become older, health issues become more numerous, and the elderly are the most needed group for proper healthcare in order to prolong their life (Fairhope, Statistic Alabama, 2012). Due to impaired mobility, lack of transportation, and limited resources, it is sometimes difficult for the elderly to receive the proper healthcare they need. Elderly people live on fixed incomes, and they often find it difficult to pay for the expenses of healthcare, resulting in large disparities in healthcare. Because of these situations, I hold the elderly close to my heart. As far as the healthcare disparities among elderly patients, I feel we need to help educate the population about their diseases and continue to help them in general, as WE ARE GOING TO BE OLD ONE DAY!!!
Strategies Identified
The strategies would be in the cardiovascular section of my study. The Mayo Clinic identifies the strategies as to how stop smoking, lower blood pressure, and blood cholesterol, of which all would be beneficial to the patients. The risk factor screening tool will identify people who have a higher risk for disease and then treat them in a more effective approach. You should stop smoking, eat a heart healthy diet, exercise for at least 30 minutes, maintain your ideal weight, and go for routine check-ups (McGoon, 1993).
Conclusion
Aging is a natural and inevitable process. However, with age, there is an increase in medical conditions. Our quality book says it all too well, we are not suppose to live as long as we are living today, but with the advancements in healthcare, we are! As healthcare professionals, we need to educate the elderly patients better about their health conditions and meet their needs of daily living. The elderly see themselves as mature, independent, and capable of self-direction. They also perceive themselves as responsible and producers in society. In order to improve elderly patient teaching, we, as the educators, must show respect and treat the elderly as we would want to be treated. Educators should encourage elderly patients to express their needs, make choices, and take chances without fear or embarrassment. The elderly can be motivated to learn when they realize that they have a need to learn. Involve elderly patients in the entire educational process so they can keep control of their lives and maintain their individual self-concept.
HOW THOMAS HOSPITAL RATES NATIONALLY - HERE ARE THE FACTS
Measure Name Percentage Sample Size
Heart Attack Patients Given Aspirin at Arrival 100% 137
Heart Attack Patients Given Aspirin at Discharge 100% 188
Heart Attack Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction 100% 34
Heart Attack Patients Given Smoking Cessation Advice/Counseling 100% 65
Heart Attack Patients Given Beta Blocker at Discharge 100% 167
Heart Attack Patients Given PCI within 90 Minutes of Arrival 100% 31
Heart Failure Patients Given Discharge Instructions 97% 198
Heart Failure Patients Given an Evaluation of Left Ventricular Systolic 100% 235
Heart Failure Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction 100% 60
Heart Failure Patients Given Smoking Cessation Advice/Counseling 100% 29
Pneumonia Patients Assessed and Given Pneumococcal Vaccination 100% 108
Pneumonia Patients Whose Initial Emergency Room Blood Culture was Performed Prior to the Administration of the
First Hospital Dose of Antibiotics 100% 88
Pneumonia Patients Given Smoking Cessation Advice/Counseling 100% 50
Pneumonia Patients Given Initial Antibiotic(s) within 6 hours After Arrival 100% 119
Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s) 100% 52
Pneumonia Patients Assessed and Given Influenza Vaccination 100% 40
Surgery Patients who were Given an Antibiotic at the Right Time (within one hr. before surgery) to Help Prevent
Infection 96% 314
Surgery Patients who were Given the Right Kind of Antibiotic to Help Prevent Infection 98% 321
Surgery Patients Whose Preventive Antibiotics were Stopped at the Right Time (within 24 hrs. after surgery) 99% 308
Heart Surgery Patients Whose Blood Sugar (blood glucose) is Kept Under Control in the Days Right after Surgery 92% 125
Surgery Patients Needing Hair Removed from the Surgical Are Before Surgery, who had Hair Removed Using Safer Method
(electric clippers or hair removal cream, not a razor) 100% 474
Surgery Patients Whose Doctors Ordered Treatments to Prevent Blood Clots after Certain Types of Surgeries 97% 132
Patients who Got Treatment at the Right Time (within 24 hrs. Before or right after their surgery) to Help Prevent Blood Clots
after Certain Types of Surgeries 96% 132
A Community Assessment of 36532, the Fairhope Community. The 36532 zip code for Fairhope, Alabama, is a very diverse community with a population consisting of snow birds and an area of some crime and poverty. A drive-through of the community would reveal an atmosphere of hope and hopelessness, wealth and poverty, the privately insured, and the government dependent. The 36532 zip code is a great challenge, both to assess and to create solutions. The following paper will examine the successes and failures of this community, continuously in need of safety and health care.
Description of the Community
The community zip code 36532 occupies a total of 11.0 square miles. It is bordered by the nearest cities, which are Point Clear, AL (1.5miles), Daphne, AL (2.7 miles ), Silverhill, AL (3.0 miles ), Spanish Fort, AL (3.2 miles ), Loxley, AL (3.3 miles ), Robertsdale, AL (3.4 miles ), Summerdale, AL (3.4 miles ), and Foley, AL (3.9 miles ). The city of Fairhope was first settled sometime around November of 1894, where Alabama City used to be located. The Fairhope Industrial Association founded the town as a Utopian colony espousing single taxation. The colony's principal founder was social philosopher Henry George. He had twenty-eight followers, the basis of the city's original citizens (Fairhope, Statistic Alabama 2012).
Their goals were to establish and conduct a model colony, which was to be free from all kinds of private monopoly, where they could secure city members equal opportunity, as well as rewards for individual efforts. The first citizens of Fairhope, Alabama, pooled money to purchase some land, including Stapleton's Pasture located on the eastern edge of Mobile Bay. The city fathers divided the land into long-term leaseholds. Rent paid all government taxes, and this simulated a single tax (Fairhope Public Library, 2012).
A corporation called Fairhope Single-Tax is still in operation. It has 1,800 leaseholds, spread out over 4,000 acres both around and in Fairhope, Alabama. Other noted intellectuals regularly wintered in the city, and it was a magnet for artists and writers. The esteemed writer, Upton Sinclair, often visited the city. Over time, the city has moved from a Utopian experiment to an intellectual's and artist's colony, and then on to an affluent suburb and boutique haven (Fairhope Public Library, 2012).
Community Population
As of the 2010 census, there were 12,480 people, 5,345 households, and 3,575 families residing in the city. Its population density was 1,135.1 per square mile. There were 6,000 housing units, with an average density of 545.7 per square mile. The racial makeup of the city is 90.22% White, 7.79% Black, 0.20% Native American, 0.62% Asian, 0.04% Pacific Islander, 0.21% from other races, and 0.93% from two or more races. 1.04% of the population were either Hispanic or Latino.
There were 5,345 households, out of which 27.0% had children under the age of 18 living with them, 54.8% were married couples living together, 10.1% had a female householder with no husband present, and 33.1% were non-families. Households made up of individuals is 30.3%, and 15.6% had someone living alone who was 65 years of age or older. The average household size was 2.27, and the average family size was 2.83. 21.6% of the population was under the age of 18, 5.4% from 18 to 24, 23.8% from 25 to 44, 25.6% from 45 to 64, and 23.7% were 65 years of age or older. The median age was 44 years. For every 100 females, there were 83.3 males. For every 100 females age 18 and over, there were 78.3 males. The median income for a household in the city was $42,913, and the median income for a family was $56,976. Males had a median income of $41,692 versus $27,959 for females. The per capita income for the city is $25,237. About 4.9% of families and 7.5% of the population were below the poverty line, including 7.3% of those under age 18 and 9.9% of those age 65 or over. The most popular occupation for the population in the 36532 zip code is in management or professional occupations. The second choice of career is in sales and secretarial work (American Fact Finder, 2000). Other occupations include maintenance, construction, and transportation.
Population of Interest/Factors Affecting Health
My population of interest is Thomas Hospital on 750 Morphy Avenue, Fairhope, Alabama 36532. "An estimated 71.3 million Americans suffer from at least one type of cardiovascular disease (CVD), of whom a large portion (27.4 million) are sixty five years or older" (Nash, 2011, p.69). The Fairhope Community is no different than the other parts of the nation. I will continue to focus on Thomas Hospital and the community in and around the hospital. I will identify three different factors that affect the overall health in our community. The first is cardiovascular disease. The cardiac function is altered in an age-related manner, and cardiovascular diseases increase with the increasing age populations. My purpose of this overview is to identify cardiac changes which are characteristic of physiologic aging - the altered presentation and modifications of therapy for elderly patients with common cardiovascular diseases, such as hypertension, atrial arrhythmias, and coronary artery disease. I will also identify cardiovascular diseases and treatments which are unique to the elderly population.
Treatment considerations for coronary artery disease in the elderly patient do not differ from those of the younger population with coronary artery disease, with the exception of the elderly diabetic patient with coronary artery disease. The therapeutic choices include medications (nitrates, beta-blockers, calcium blockers), lipid lowering regimens, and revascularization procedures. Revascularization procedures (angioplasty or surgery) may be a greater benefit than pharmacologic therapy in these patients with multi-vessel disease and decreased left ventricular function. In the elderly with diabetics and multi-vessel disease, surgical intervention is more favorable than angioplasty. Complication rates for angioplasty and surgery are slightly higher in the elderly patient, but still relatively low. It has been noted that fewer women than men have been treated with angioplasty or surgery, and that women undergoing such procedures have a more advanced disease. The findings could represent atypical presentation or failure in the community to recognize the prevalence of coronary artery disease in elderly women. Another issue that could be possible is the decrease in cognitive function among older patients undergoing coronary artery bypass graft procedures (McGoon, 1993).
The second focus will be congestive heart failure. In the elderly, the therapy does not change from that of younger patients. The therapy will be digoxin, diuretics, and angiotensin-converting enzyme inhibitor drugs. The renal function and potassium may need to be monitored a more closely in elderly patients, who may have a higher incidence of arthritis because of them ingesting non-steroidal anti-inflammatory drugs (Nettina, 1996). The role of beta blockers in the management of patients with congestive heart failure is just now coming to the surface, and I feel they will play a bigger role in the future, resulting in better treatment for these type patients.
Physicians/and nurses practitioners should focus not only on prescribing medications, but also on patient family education regarding other health professionals, such as dieticians, social workers, physical therapists, or exercise technicians. These professionals can and should closely follow-up on weight and symptoms of the patients in the home, with a goal of improving CHF and preventing hospitalizations. In a recently completed study of elderly patients with congestive heart failure at Thomas Hospital, patients cared for by these healthcare professionals had fewer hospitalizations, improved quality of life, and lower medical costs for up to one year after the study was completed. This data suggests that the geriatric multidisciplinary team approach is beneficial for cardiac diseases in the elderly patient.
The third problem identified would be strokes among the elderly. Atrial fibrillation (AF) is one of the most common, potent, and independent risk factors for ischemic stroke, with the incidences increasing with age. AF is the most important single cause of ischemic stroke in this age group. There are several clinical trials that have demonstrated that warfarin treatment reduces the risk of stroke and death compared with placebo in persons with AF. This benefit is accompanied by a relatively low annual bleeding rate. Warfarin can reduce the stroke risk in persons with AF and should be used independently of age, especially in the elderly with other associated risk factors (Nettina, 1996). This is an opportunity to improve the quality of life and care for our elderly patients.
Identifying the Health Disparities
Healthcare disparities are on the rise where there are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific population groups. Disparities in the current healthcare systems can affect population groups based on gender, age, ethnicity, socioeconomic status, and demographical factors. Age is a major factor in contributing to disparities in healthcare. Elderly patients usually are characterized by impaired mobility, which makes access to healthcare facilities challenging. As people progressively become older, health issues become more numerous, and the elderly are the most needed group for proper healthcare in order to prolong their life (Fairhope, Statistic Alabama, 2012). Due to impaired mobility, lack of transportation, and limited resources, it is sometimes difficult for the elderly to receive the proper healthcare they need. Elderly people live on fixed incomes, and they often find it difficult to pay for the expenses of healthcare, resulting in large disparities in healthcare. Because of these situations, I hold the elderly close to my heart. As far as the healthcare disparities among elderly patients, I feel we need to help educate the population about their diseases and continue to help them in general, as WE ARE GOING TO BE OLD ONE DAY!!!
Strategies Identified
The strategies would be in the cardiovascular section of my study. The Mayo Clinic identifies the strategies as to how stop smoking, lower blood pressure, and blood cholesterol, of which all would be beneficial to the patients. The risk factor screening tool will identify people who have a higher risk for disease and then treat them in a more effective approach. You should stop smoking, eat a heart healthy diet, exercise for at least 30 minutes, maintain your ideal weight, and go for routine check-ups (McGoon, 1993).
Conclusion
Aging is a natural and inevitable process. However, with age, there is an increase in medical conditions. Our quality book says it all too well, we are not suppose to live as long as we are living today, but with the advancements in healthcare, we are! As healthcare professionals, we need to educate the elderly patients better about their health conditions and meet their needs of daily living. The elderly see themselves as mature, independent, and capable of self-direction. They also perceive themselves as responsible and producers in society. In order to improve elderly patient teaching, we, as the educators, must show respect and treat the elderly as we would want to be treated. Educators should encourage elderly patients to express their needs, make choices, and take chances without fear or embarrassment. The elderly can be motivated to learn when they realize that they have a need to learn. Involve elderly patients in the entire educational process so they can keep control of their lives and maintain their individual self-concept.
HOW THOMAS HOSPITAL RATES NATIONALLY - HERE ARE THE FACTS
Measure Name Percentage Sample Size
Heart Attack Patients Given Aspirin at Arrival 100% 137
Heart Attack Patients Given Aspirin at Discharge 100% 188
Heart Attack Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction 100% 34
Heart Attack Patients Given Smoking Cessation Advice/Counseling 100% 65
Heart Attack Patients Given Beta Blocker at Discharge 100% 167
Heart Attack Patients Given PCI within 90 Minutes of Arrival 100% 31
Heart Failure Patients Given Discharge Instructions 97% 198
Heart Failure Patients Given an Evaluation of Left Ventricular Systolic 100% 235
Heart Failure Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction 100% 60
Heart Failure Patients Given Smoking Cessation Advice/Counseling 100% 29
Pneumonia Patients Assessed and Given Pneumococcal Vaccination 100% 108
Pneumonia Patients Whose Initial Emergency Room Blood Culture was Performed Prior to the Administration of the
First Hospital Dose of Antibiotics 100% 88
Pneumonia Patients Given Smoking Cessation Advice/Counseling 100% 50
Pneumonia Patients Given Initial Antibiotic(s) within 6 hours After Arrival 100% 119
Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s) 100% 52
Pneumonia Patients Assessed and Given Influenza Vaccination 100% 40
Surgery Patients who were Given an Antibiotic at the Right Time (within one hr. before surgery) to Help Prevent
Infection 96% 314
Surgery Patients who were Given the Right Kind of Antibiotic to Help Prevent Infection 98% 321
Surgery Patients Whose Preventive Antibiotics were Stopped at the Right Time (within 24 hrs. after surgery) 99% 308
Heart Surgery Patients Whose Blood Sugar (blood glucose) is Kept Under Control in the Days Right after Surgery 92% 125
Surgery Patients Needing Hair Removed from the Surgical Are Before Surgery, who had Hair Removed Using Safer Method
(electric clippers or hair removal cream, not a razor) 100% 474
Surgery Patients Whose Doctors Ordered Treatments to Prevent Blood Clots after Certain Types of Surgeries 97% 132
Patients who Got Treatment at the Right Time (within 24 hrs. Before or right after their surgery) to Help Prevent Blood Clots
after Certain Types of Surgeries 96% 132