Community Assessment

Running head: COMMUNITY ASSESSMENT

Community Assessment

Lewistown, Montana is a small rural community located n central Montana. Population is 8,000, and just under 12,000 for the entire county (Fergus county). The community has changed it's make-up over the past several years, school enrollment is dropping and the number of births at the local hospital is much less than 5-10 years ago. Like many other communities our aging population is growing. Presently, thirty (30) percent of the population is over the age of 65 Agriculture is the primary source of employment. The median income is 20,000 dollars less than the national average and 27 percent of the population is at or below poverty level (Facts for Congress, 2005). A large percentage of the population is uninsured or underinsured, carrying only major medical in case of large medical expenses (Facts for Congress, 2005). For this reason and because of a philosophy that one should only seek medical care when a problem becomes intolerable, preventive healthcare services are often not performed or neglected. Given the age and general make-up of our community I have selected the following three health care issues to address; mammography screening, smoking cessation and diabetes education. These areas have been selected because they have the potential for positive outcomes. Cholesterol levels have been studied and are higher than the national average in the age of the population studies. This issue however, would be difficult to resolves as cattle ranchers do not want nutritional programs to push chicken and fish rather than red meat. Any such suggestion would be met with great resistance and success difficult to achieve.

A mammography screening program could have a significant impact on the local population. The cancer registry at the local hospital has identified the following concern. The number of breast cancers identified fall within the expected range according to the national standards, however, the cancers are found at more advanced stages than the national average, placing the women at higher risk for dying from the breast cancer(Centers Disease Control (CDC, 2003). There are several reasons why mammogram is not performed regularly or earlier on women in the community. Cost, most people do not have preventive medical coverage and cannot afford the out of pocket expense associated with the exam. Misunderstanding and/or fear women need education regarding the necessity and benefits of the exam. Therefore, a screening mammography program would identify breast cancer in earlier stages improving outcomes and benefiting the women in our community.

Program development would need to involve the following community participants. The hospital(community owned, not-for-profit), the Chief Executive Office(CEO) and Chief Financial Officer(CFO), manager of radiology services, radiologist, department of health and local providers. Mammography is performed at our local hospital and films are interpreted by the radiologist. Program development would be coordinated between the hospital and radiologist. If the local radiologist is not willing to interpret films as a reduced rate for the program, out sourcing of radiology services may be required. A study performed in 1990 found that the average cost associated with a mammogram was approximately $70.00. A large portion of the expenses are fixed costs, costs to perform the exam including equipment and staff. A smaller portion is associated with flexible costs such as interpretation. Costs vary from facility to facility (Wolk, R., 1993). Women in our community comprise 50% of the population, and of those 6,000 approximately 900-1,000 women would meet the criteria for participation in the screening program (Fast Facts for Congress, 2005). Using the above information, the program would require approximately 70,000 dollars to ensure women get their required exams. Administrative including advertising and/or education expenses costs are inherent even in small programs, requiring additional expenses.

Funding may be available from multiple sources. The Woman's Health Coalition has money available for women who meet the eligibility requirements of age (50-65 years), income and insurance. The program will pay for the cost of the mammogram and the radiology fee (Women's Health Coalition, 2005). The Montana Breast and Cervical health program will also pay for mammograms if the woman qualities for support. Grants are available through the CDC (National Breast and Cervical Cancer Early Detection Program (NBCCEDP), Avon, the Susan G. Komen Foundation, plus other organizations which assist uninsured women with appropriate and necessary screening (CDC, 2005). Initially, the program will need to be supported by the hospital with the use of grants from the outside sources. Grants are intended to assist organizations set-up programs that can then be supported by local fund raising activities (CDC, 2005). Fundraising activities will be coordinated through the community relations department, possibilities include festival of tree program, capital campaign, race for the cure, plus many more that would be supported by the local community. I would need to present the program plus potential funding sources to the community board for approval. Once approved the radiology manager would be responsible for coordinating the program through the hospital. Education would involve local providers. The program would require advertising and promotional activities(including education) to ensure information is shared with the appropriate women.

The benefits of this program could mean earlier treatment for local women and better outcomes. The monies are available to support communities such as ours, but activities need to be organized and coordinated through the appropriate channels (CDC, 2005).

Evaluation of the programs success can be easily established by tracking the number of mammograms performed and comparing to previous years. Another avenue for establishing success is evaluation of comparative data for earlier identification of breast cancers. The goal of the program is earlier identification of breast cancer. The hospitals cancer registry can provide this data and we can identify if we are achieving earlier detection compared to previous years.

Diabetes education is the second targeted area. Presently, our community does not have any type of coordinated education available for new and /or established diabetes. If an individual with diabetes requires education, their options include; driving 2-3 hours to a larger community or meet with our local dietician who can provide