Fredericksburg, Va

Delivered March 7th, 2018. Contributors: Erika O., Sara F., Ashley C. and

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Demographics - Fredricksburg Virginia

In Virginia, the combined population of the city of Fredericksburg and the counties of Culpeper, Arlington, Fairfax, Loudon, and Prince William totaled 2,241,849 in 2016. Of this combined population, 24.95% were children, 38.24% were women, and 21.35% were aged 55 or older. Around 30% of the residents aged 15 or older in these areas had an annual income of no lower than $75,000. Nearly 90% of the civilian non-institutionalized population in these areas had health insurance coverage. 
METHODOLOGYTo answer this request, I first prepared a list of the geographic areas to be covered. Since you mentioned that, apart from Fredericksburg, Culpeper, Haymarket, and Northern Virginia counties should be included as well, I came up with the following list: Fredericksburg City, Culpeper County, Arlington County, Fairfax County, Loudon County, and Prince William County. According to the Northern Virginia Regional Commission, the Northern Virginia counties are Arlington, Fairfax, Loudoun, and Prince William. Haymarket is a town in the Prince William county.

The demographic profile of these areas as a whole is not readily available in the public domain, so I searched within the site of the United States Census Bureau for details specific to each place and summed them up in the attached spreadsheet. I used the bureau's American FactFinder Guided Search facility to find information related to age, gender, income, and health insurance coverage. The data tables that were used to populate the spreadsheet can be seen in the attached screenshots, which I took because the links to the data tables expire after some time. The latest available data tables are for the year 2016.

For the health indicators, on the other hand, I referred to the latest profiles provided on the HealthData.org website. HealthData.org aims to provide "the best information on population health."
AGEThe six areas included in the list had a total population of 2,241,849 in 2016. Of these individuals, 75.05% or 1,682,619 were at least 18 years old, while 24.95% or 559,230 were below 18 years old. Those aged 55 or older accounted for 21.35% or 478,654 of the total population.
GENDERThere was an almost 50/50 split between the male and female populations in 2016. Of the six areas' total population, 49.58% or 1,111,436 were male, while 50.42% or 1,130,413 were female. Among adults, on the other hand, around the same split was observed. Of the six areas' adult population, 49.06% or 825,461 were male, while 50.95% or 857,323 were female. 
INCOMEIn 2016, the income of individuals aged 15 or older in the six areas listed was distributed as follows:

No income — 12.68%
$1 to $9,999 or loss — 12.37%
$10,000 to $14,999 — 5.10%
$15,000 to $24,999 — 8.97%
$25,000 to $34,999 — 7.73%
$35,000 to $49,999 — 9.58%
$50,000 to $64,999 — 8.97%
$65,000 to $74,999 — 4.54%
$75,000 or more — 30.07%

Of 1,772,059 individuals aged 15 or older, 30.07% had an income of at least $75,000.
HEALTH INSURANCE COVERAGEThe six areas, as a whole, had a civilian non-institutionalized population of 2,212,834 in 2016. This population refers to those residents that were not in "active-duty military" and were not staying in institutional facilities including "correctional institutions, juvenile facilities, skilled nursing facilities, and other long-term care living arrangements." Of this specific population, 89.87% or 1,988,582 had health insurance coverage, while 10.13% or 224,252 had no health insurance coverage.
RACEFredericksburg had a population of 28,297 in 2016. Of this population, 60.1% were white, 23.8% were African American, 10.7% were Hispanic or Latino, and 3.0% were Asian.
Health indicatorsBased on the latest profiles of Fredericksburg, Culpeper, Prince William, Arlington, Fairfax, and Loudon on the HealthData.org site, the life expectancy of males ranges from 76.5 to 82.3, while that of females ranges from 80.3 to 85.1. In a year, around 601.7 to 969.0 of every 100,000 males die, and around 461.1 to 765.0 of every 100,000 females die. 

The prevalence of smoking ranges from 11.8% to 24.0% among males and from 10.2% to 19.5% among females, while the prevalence of obesity ranges from 25.7% to 39.0% among males and from 24.3% to 36.9% among females.
CONCLUSIONThe city of Fredericksburg and the counties of Culpeper, Arlington, Fairfax, Loudon, and Prince William in Virginia had a combined population of 2,241,849 in 2016. Of these 2,241,849 individuals, 24.95% were below 18 years old, 38.24% were women, and 21.35% were at least 55 years old. An annual income of at least $75,000 was reported by approximately 30% of the residents aged 15 or older in these areas. Almost 90% of non-institutionalized civilians in these areas were with health insurance coverage. 

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Health Care Gaps in Fredricksburg, Virginia

Healthcare gaps in Fredericksburg, VA and surrounding areas include lack of behavioral or mental health services, limited access to primary care services, obesity management, healthcare promotion and preventive care, and oral health limitations. Several cities and counties near Fredericksburg have been designated as medically underserved areas (MUAs), with limited primary care and specialty healthcare providers noted in many areas. Gaps in the healthcare workforce often coincides with overall healthcare gaps.

METHODOLOGYI've consulted the Virginia Health Department, the Virginia Health Care Foundation, the Virginia Hospital & Healthcare Association, and other healthcare sources to compile data relevant to the target area. I've referenced maps of Virginia to ensure the data provided is pulled from areas within a 50-mile radius of Fredericksburg, VA. While I tried to find data from within the last two years, most of the publicly available data on healthcare gaps is more dated, likely as the result of the time needed to cull and compile such information into usable data sets. But I have provided the most recent data I was able to locate. I've covered as many regional reports as I could evaluate within the scope of a single Wonder response.

COMMUNITY HEALTH NEEDS ASSESSMENTSThe Rappahannock Area Health District covers the city of Fredericksburg and the surrounding counties of Caroline, King George, Spotsylvania, and Stafford. 

The Virginia Hospital & Healthcare Association (VHHA) conducts community health needs assessments (CHNA). Regional hospitals conduct surveys to assess the needs in their area. The results of the CHNA surveys provide insight into the top health needs, healthcare service gaps, and strategies for the assessed regions. I've identified the CHNA studies that covered the requested area, including Fredericksburg, Culpeper, Haymarket, and other northern Virginia regions.

MARY WASHINGTON HEALTHCARE CHNAFor the Rappahannock region (as defined above), Mary Washington Healthcare and the Healthy Communities Institute (HCI) collaborated to assess the critical health needs and gaps in October 2015. They determined the following five healthcare gap areas:
• Obesity in both adults and children
• Access to health services
• Substance abuse, especially tobacco and illicit drug use by teens and young adults
• Behavioral health for teens, young adults, and senior citizens
• Cancer, especially breast, lung, and prostate

 Data from Mary Washington Healthcare, as reported at the VHHA, is somewhat dated (2011), though the website URL confirms that this information was published in 2016, so it appears to be the most comprehensive data available for the region. The report covers Fredericksburg, as well as the counties of Caroline, King George, Orange, Prince William, Spotsylvania, Stafford, and Westmoreland. Haymarket is in Prince William County and would be included in this report.

The report indicates the following healthcare service gap areas:
• Awareness of services
• Behavioral health: one of the top ten most significant areas of need with a lack of providers accepting Medicaid
• Health care coverage: the counties of Caroline, King George, and Westmoreland "have primary care physician rates about 2x lower than what is considered a “good” primary care provider saturation."
• Health education
• Health promotion
• Oral health: one of the top ten most significant areas of need
• Primary care
• Specialty care

 Healthcare workforce gaps include: behavioral health, primary care, and specialty care.

INOVA FAIRFAX MEDICAL CAMPUS CHNAThe Inova Fairfax Medical Campus CHNA data, which covers Fairfax, Loudoun, and Prince William counties, as well as the cities of Falls Church and Manassas, cites several healthcare service gap areas, including: 
• Active living
• Behavioral health: lower than average number of service providers and higher suicide rate
• Chronic disease
• Health promotion
• Healthy eating: five areas considered food deserts
• Oral health: the ratio of dental healthcare providers to population is two times lower than the statewide ratio. Vulnerable populations are at particular risk of limited oral healthcare.
• Primary care
• Specialty care
• Substance abuse
• Tobacco use

Other contributing factors to the healthcare gaps are the high cost of living compared to family income, high air pollution, a higher concentration of linguistically challenged population, and high violent crime in Manassas, VA.

 Gaps in the healthcare workforce include behavioral health, dental, endocrinology, Ob/Gyn, pediatrics, primary care, psychiatry, and specialty care.

SENTARA NORTHERN VIRGINIA MEDICAL CENTER CHNAThe Sentara Northern Virginia Medical Center CHNA data from 2013 (the most recent year for which data is available) covers the counties of Fairfax, Prince William, and Stafford, which are all within a 50-mile radius of Fredericksburg. It identifies the critical healthcare service gaps as:
• Aging services: the rate of avoidable hospitalizations is higher than the state rate, specifically in the areas of adult asthma, pneumonia, congestive heart failure, diabetes, and urinary tract infections.
• Behavioral health: the most frequently cited health gap
• Health safety net
• Homeless services
• Oral health: the third-most reported service gap area

Other gaps that affect the health or access to healthcare for residents in the region include a lack of homeless services and limited transportation options, as well as food safety and social services gaps. Also, the population density per square mile is five times higher than the statewide rate, which may prevent adequate healthcare coverage. 

 Gaps in the healthcare workforce mimic the aforementioned service gaps: behavioral health, dental, psychiatry, and specialty care.

The primary health issues for the region include:
• Behavioral health
• Diabetes
• High blood pressure
• Depression
• Obesity
• Oral health

CULPEPER regional hospital chnaData compiled from Culpeper Regional Hospital in 2014, the most recent data found, offers insight into the healthcare gaps or needs in the Culpeper region. Some top needs identified include (in order of determined priority):

• Mental health: Ranked as the #1 concern among the focus group surveyed. Issues related to stress, inadequate resources, suicides, and substance abuse were cited as contributing factors. Stress is specifically noted as a problem in Culpeper, as compared to the overall region.

• Access to healthcare services: There is a limited supply of primary care physicians. Factors contributing to this issue include lack of affordable health insurance, transportation, cost of prescriptions and doctor visits, and issues related to undocumented residents. 
— About 34.3% of the region report difficulty in obtaining healthcare services with Culpeper reporting 35.7%. For the uninsured, cost was the top barrier (31.6%).
— Culpeper, specifically, rates low on visits to a physician due to inconvenient hours of availability, difficulty getting an appointment, and lower primary care physicians per 100,000 residents (35.8 compared to the regional average of 50.8). However, they rank better in terms of children seeing a doctor regularly (91.3 compared to 85.8 regional average).
— Prescriptions: 13.2% of people either skipped or reduced their dosage to stretch a prescription medication in order to save money. Culpeper came in at 14.2%.
— The region covered by this study has only one hospital and "no Federally Qualified Health Centers (FQHCs)."

• Diabetes: Culpeper's death rate is higher that the overall region

• Cancer: Culpeper has a higher rate of lung and colorectal cancer incidence

• Heart disease and stroke rank #2 and #3 in causes of death: Culpeper's death rate is higher than the regional average.

• Nutrition, Weight, Physical activity: Obesity, low food access, and limited access to parks were cited as factors. Culpeper has particularly low access to parks and limited physical activity for children.

• Oral health: #4 concern cited with a lack of providers and need for education on the importance of preventive care noted as factors.

• Respiratory diseases: Culpeper has higher death rates.

• Immunization and infectious diseases

• Chronic kidney disease: Culpeper is doing better than the overall region in terms if kidney disease death.

• Arthritis and back conditions

• Injury and violence prevention: including seat belt usage, firearms presence and storage issues

Another Culpeper healthcare gap areas cited include:
• Maternal, infant, and child health issues: 
Lower percentage of pregnant women receiving prenatal care
Low birth weight
Higher infant death rate

In terms of health insurance, 15.3% of Culpeper citizens are uninsured, compared to the state average of 18.2%. Low income individuals lack insurance at a higher rate that other groups at 35.7%, and non-white citizens (23.5%) outnumber white citizens (12.5%) in lack of insurance. Those without insurance are less likely to receive preventive care.

CHILDREN'S HOSPITAL OF RICHMOND OF THE VCU HEALTH SYSTEM CHNAThe Community Health Needs Assessment conducted by the Children's Hospital of Richmond, which includes data for Fredericksburg, as well as the counties of Chesterfield, Henrico, King George, Powhatan,
Spotsylvania and Stafford, identified for the following community health needs:
• Children's health support
• Children's health conditions: asthma, low birth weight, behavioral health, obesity, and intellectual and developmental disabilities.

Healthcare service gaps identified were numerous. The full list is in Exhibit 1-3 on page 6 of the CHNA overview document, but I have outlined the top gaps here:

• Behavioral services: 85%
• Health promotion and prevention: 69%
• Translation services: 69%
• Case management: 62%
• Transportation: 62%
• Disability services: 54%
• Early Childhood Intervention: 54%
• Healthcare coverage: 54%
• Respite care: 54%

Several areas in this study are designated at medically underserved areas (MUAs) by the U.S. Health Resources and Services Administration. They are King George County, city of Petersburg, Powhatan County, and Stafford County. Areas designated at partial MUAs include the city Fredericksburg, Chesterfield County, Henrico County, city of Richmond, and Spotsylvania County.

The region sees a higher death rate and more avoidable hospitalizations for those age 0-21, suggesting a lack of quality outpatient services. The region also sees higher teen pregnancy rates and infant mortality rates. Social and economic contributing factors include lack of transportation, community safety issues, and low environmental quality. Food insecurity, culturally unhealthy food choices, and limited walking and biking infrastructure were also reported.

CONCLUSIONIn conclusion, the primary healthcare gaps in Fredericksburg, VA and surrounding areas include behavioral or mental health services, access to primary care services, obesity, preventive healthcare, and oral health issues.

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Fredricksburg, Virginia Health Care Systems

The Fredericksburg, Virginia health care systems Mary Washington Healthcare, HCA Healthcare Spotsylvania Regional Medical Center, Novant Health UVA Health System and Inova Health System draw patients in from many cities and counties throughout Virginia. Inova Healthcare also has patients coming from the Washington D.C. metro area. Mary Washington Healthcare, Novant Health UVA, and Inova Healthcare all have or work with services that travel to patients homes while Spotsylvania Regional Medical Center does not. All information was gathered either from the individual websites of each healthcare organization or from news sources pertaining to patient travels. Below is a detailed account of our findings.

METHODOLOGYAfter an extensive search through the public domain, we were unable to find precise details on patient travel. During our research, we surveyed each organizations' website, various media sites, industry reports, and reports from the respective healthcare systems. This information is likely unavailable since these systems are private organizations and are not required to publish their data publicly.

Relevant information on where patients originated and the main service areas for each healthcare system were identified. However, data on the amount of patient travel was not accessible. Information on whether Novant Health UVA and Inova Health System travel to other clinics were also not available. Despite this, some helpful insights were available for Novant Health UVA and Inova Health System. In both cases, percentages were available that detailed where patients originated. Percentages on the number of Novant community members who believed they needed to travel outside of the community in order to receive care were also available. Similar statistics were not publicly accessible for Mary Washington Healthcare or Spotsylvania Regional Medical Center.

Mary Washington HealthcareMary Washington started as a small hospital in Fredericksburg, VA but is now a non-profit regional system with 28 facilities/wellness services and 2 hospitals. This organization serves patients in the communities of Fredericksburg, Colonial Beach/Oak Grove, Stafford, Locust Grove, Spotsylvania, Caroline, King George and Summerduck. They provide home healthcare services to patients who are unable to travel to and from their facilities. Also, they received the 2017 Top Agency Ability recognition from Home Health Elite and the Award of Excellence for their home health services eight times since 2008. Mary Washington does not travel to other clinics but they have many home health programs.

Spotsylvania Regional (HCA)Spotsylvania Regional Medical Center is a general acute care hospital made up of all private rooms (133 beds) and both in/outpatient services. This medical facility serves patients in the Greater Richmond and Tri-Cities area, the city of Fredericksburg along with the counties Caroline, Spotsylvania, and Stafford. Since this is an acute care hospital they do not travel to their patient's homes and do not offer any kind of home health services. They also do not travel to any other clinics.

Novant Health UVANovant Health UVA serves Northern Virginia in its three locations which are: Novant Health UVA Health System Culpeper Medical Center, Novant Health UVA Health System Haymarket Medical Center, and Novant Health UVA Health System Prince William Medical Center. They serve patients in Culpepper, Haymarket, Manasses, Gainsville, Bristow, South Riding, Chantilly, Warrenton, Woodbridge, Centreville and Prince William. According to the 2016-18 Novant Health UVA report, 75-85% of Novant Health UVA's in‐patient population comes from Manassas City, Manassas Park, and Prince William Count. Novant does offer home health care services where they collaborate with skilled nursing facilities and home health agencies to provide post-acute care in patients homes although they do not travel themselves to patients. There was no information indicating whether they travel to other clinics. 

In the 2016-18 report, 31% of respondents in Novant's community reported that they strongly agreed or agreed "that they must travel outside of their community for healthcare." On the other hand, 58% of respondents reported that they strongly disagreed or disagreed that they "must travel outside of their community for healthcare." While this does not provide precise figures on the number of patients that travel to receive Novant care, it does provide insight on how the community perceives healthcare travel. These percentages indicate that it is likely that most patients (58%) do not travel outside the community for healthcare but a significant number (31%) of people do.

Inova Health SystemInova Health has six hospitals, primary and specialty care, emergency and urgent care centers, outpatient services and institutes such as the Inova Heart and Vascular Institute. They serve patients in Washington, D. C., metro area, greater Loudoun counties and Northern Virginia. According to the 2016 Inova Community Health Needs Assessment report, 77% of those who were discharged in 2014 originated in the community. This does not show the number of patients who travel to receive this care or how far they must travel. However, it does offer insight into the fact that the bulk of the patients in this area are traveling from within the community.

Inova features a Mobile Health Service at their Loudoun Hospital which is a fully equipped bus with registered nurses that drives to the people in the Loudoun community to perform health screenings and preventive care. The information did not state that they traveled to other clinics. 

ConclusionTo wrap it up, each of the four facilities listed serves many communities throughout Virginia including Washington D.C.The Spotsylvania Hospital was the only medical facility that did not provide any type of care where they traveled to patients. Mary Washington, Novant UVA, and Inova all had some kind of program where they traveled to patients.