Methodology

In 2008, the Colorado Public Health Act, Senate Bill 08‐194, was passed to reform the public health system. The purpose of the law is to ensure that all Coloradans have access to quality public health services regardless of where they live. Under the law, local public health agencies are required to conduct a community health assessment up to every five years, and under Section 501(r)(3) of the Patient Protection and Affordable Care Act, nonprofit hospitals are required to conduct a community health needs assessment at least once every three years and to adopt an implementation strategy to meet the community health needs identified through the assessment. This assessment was designed to align with both requirements, as well as the Public Health Accreditation Board’s requirements for a local community health assessment.

To compile a comprehensive picture of health for Jefferson County, leverage collective resources, reduce duplication of efforts and build increased momentum and capacity to address shared health challenges, Jefferson County Public Health, St Anthony Hospital - Centura Health and Lutheran Medical Center - SCL Health partnered to conduct a joint Community Health Needs Assessment.

This assessment was designed based on a data model that was developed using the Robert Wood Johnson Foundation’s County Health Rankings’ County Health Rankings Model (1). The data model looks at health determinants and factors as well as health outcomes. Community members, partner organizations, and primary (original) and secondary (existing) data were used to comprehensively assess the current state of health in Jefferson County based on the factors identified in the data model. Data used in this assessment are both qualitative, meaning information gathered from community members about their opinions and experiences, and quantitative, meaning information that can be counted or measured.

Steering Committee

In April 2017,  Jefferson County Public Health, St Anthony Hospital - Centura Health and Lutheran Medical Center - SCL Health convened the first meeting of the Community Health Needs Assessment Steering Committee.  The Steering Committee is made up of a wide variety of Jefferson County community partners and key stakeholders. These members, and their organizations, represent many of Jefferson County's communities and populations, including many populations that are at higher risk of poor health outcomes. At this initial meeting, Jefferson County Public Health, St Anthony Hospital - Centura Health and Lutheran Medical Center - SCL Health provided updates on the Community Health Improvement activities they were each implementing. They also provided members with a first look at the data model that would be used for collecting data for the Community Health Needs Assessment and discussed the plan for the Community Health Needs Assessment through the next year received feedback from the members. At this meeting the three primary partners asked for volunteers to join the Data Advisory Committee. 

In January 2018, after extensive data collection, the preliminary results of the Community Health Needs Assessment were reported to the Steering Committee. Discussion followed regarding any gaps that members identified. Feedback was incorporated into the completed Community Health Needs Assessment.

Existing Data

There are a multitude of secondary (existing) data sources available within Jefferson County and from other sources across Colorado, including state agencies and nonprofits. Many secondary data sources were used in the development of this assessment, and a comprehensive list of sources is provided at the end of this page. Using the most recent data available, findings from the other components of this assessment were compared and analyzed to develop a profile of community health, with an eye for health equity and identification of health disparities and inequities within populations.

A Data Advisory Committee was formed from community partners with expertise in data analysis who reviewed secondary data from local, county, regional and internal sources. The data review covered population statistics, population health statistics and community health trends collected on health outcomes and each of the 28 health factors within the data model. After review, the Data Advisory Committee offered recommendations on which key indicators should be included in this assessment.

Adult Focus Groups

Students from the Colorado School of Public Health, in partnership with Jefferson County Public Health, facilitated focus group discussions that were conducted at key geographic points in the county to ensure equal representation of the county’s diverse communities, and to include both mountain and urban/suburban populations. The focus group discussions were facilitated at locations in Arvada, Conifer, Edgewater, Indian Hills and Lakewood, and included two Spanish language groups. The discussions with residents were used to gain unique insights into Jefferson County’s health challenges from the perspective of residents, which is vital to inform policy and program development.

Youth Focus Groups

The Jefferson County Communities That Care team hired 21 youth researchers from four Jefferson County high schools to conduct research on their peers' perceptions of youth substance misuse, violence and hopelessness/anxiety. Communities That Care staff led two focus groups with the youth researchers, and the youth researchers planned and led six focus groups that each included at least six other students from their schools.

Key Informant Interviews

Key informant interviews were facilitated with community leaders and stakeholders in organizations with special knowledge of community health concerns, especially those affecting our most vulnerable residents. These discussions were aimed at providing deep insights into the facets of health impacting our community, particularly with an emphasis on identifying health disparities or inequities affecting the most vulnerable people such as elders, people of color, LGBTQ groups, individuals living with disabilities and low-socioeconomic and geographically distinct populations.

Informants were selected from groups including health service providers, non-profits and other organizations in Jefferson County that serve the diverse populations noted above. The discussions were aimed at providing deep insights into the facets of health that affect our community, with particular emphasis on identifying health disparities or inequities.

Community Feedback

During the month of January 2018, all preliminary Community Health Needs Assessment data were posted on the Jefferson County Public Health website. The public had the opportunity to review the data on Google Slides and either make comments directly on the data pages or could leave comments and vote on top community priorities though a REDCap survey. This opportunity to provide feedback was promoted on Jefferson County Public Health's website and social media pages and our partners shared with their networks as well.  The comments received were used to strengthen the Community Health Needs Assessment data.

Asset Mapping

Asset mapping was conducted through an online survey to Jefferson County residents, with external partners through the Steering Committee and with Jefferson County Public Health staff to determine the capacity of our community to affect positive changes on population health issues in terms of resources, staff and partnerships. Asset mapping is a participatory exercise where the community documents the tangible and intangible resources within a community to mobilize previously unrecognized, but existing, strengths and capabilities that can be harnessed to collectively improve our community’s health.

Data Limitations*

Timeliness

There can be a lag between when data are collected and released. For instance, data collected in one calendar year may not be available for six months, or longer, after the close of that year. By combining years of data together, we can often create stable estimates or protect confidentiality; however, this can hide recent trends.

Completeness

Data can be incomplete for various reasons related to data collection, such as specific question or question wording changing year-by-year, specific populations not counted consistently or at all, or missing data elements due to errors in data entry.

Accuracy

Data can be inaccurate due to measurement errors, coding errors, or analytic errors. Response bias and recall bias can also affect accuracy. We do not know that people who respond to surveys are similar to those who do not respond; people who decide to respond may do so because of a motivation that someone else may not have. The error that may occur due to the people who respond – and their unknown motivations – is called response bias. Similarly, recall bias can occur when people are asked about things that may have occurred in the past.

Small numbers

Most of the data used in this report are based on samples of the population. If a sample is very small, it can create unstable estimates; caution must be used in their interpretation. Small samples or events that occur to a small portion of the population need to be displayed carefully so as not to identify an individual.

Geographic relevance

Most data are collected at particular geographic scales and therefore may be hard to apply to smaller or larger areas of interest. For example, most of the large, national surveillance systems in this country only collect data at the state level; therefore, data at the county, city, or neighborhood level may be limited or even unavailable.

Misrepresentation or underrepresentation

It is important to measure patterns of health among subgroups of the population. Years of research have established critical health differences among various populations. For instance, health conditions and risks can vary depending on age. Other characteristics that are important to measure are race and ethnicity, and sex and gender. Race and ethnicity are usually measured because they are important determinants of access to societal resources. There are also important social and symbolic meanings conveyed by the concepts of race and ethnicity which can impact health (2). The categories of race and ethnicity used in this report do not reflect biological characteristics but rather self-perceived membership in a particular group, or assigned race/ethnicity in the case of birth and death data. Self-reporting is limited by the choices given the respondent; this has the potential to misrepresent one’s true identify. In the case of sex and gender, sex is assigned at birth (typically by the appearance of external genitalia and recorded on the birth certificate as male or female) and people who self-identify with their assigned sex are “cisgender.” “Transgender” individuals are those who do not self-identify with their assigned sex at birth. The term gender, or gender expression, refers to psychological dimensions of sexual identity, social beliefs, and behavior, such as identifying as heterosexual, lesbian, gay, or bisexual (3). Most of the data systems used in this report only collect sex data by self-report, visual inspection, or voice sound in the case of telephone surveys. Gender identity is infrequently measured; therefore, misidentification and/or underrepresentation may be weaknesses of these data. 

*Used with permission from Tri-County Health Department, 2018 Community Health Assessment (4).

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Reference List


1. Explore Health Rankings | What and Why We Rank. (n.d.). Robert Wood Johnson Foundation. Retrieved from http://www.countyhealthrankings.org/explore-health-rankings/what-and-why-we-rank

2. Hahn, R. A., & Stroup, D. F. (1994). Race and ethnicity in public health surveillance: criteria for the scientific use of social categories. Public Health Reports, 109(1), 7–15.

3. Conron, K. J., Landers, S. J., Reisner, S. L., & Sell, R. L. (2014). Sex and Gender in the US Health Surveillance System: A Call to Action. American Journal of Public Health, 104(6),970–976. Retrieved from: http://doi.org/10.2105/AJPH.2013.301831

4. Tri-County Health Department. (2018). 2018 Community Health Assessment, Data Limitations. Retrieved from: https://co-tricountyhealth.civicplus.com/DocumentCenter/View/5134/TCHD_Community-Health-Assessment-2018

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Data Sources used in the Community Health Needs Assessment


2010 BRFSS via CHR 2014: Behavioral Risk Factor Surveillance Survey via County Health Rankings: http://www.countyhealthrankings.org/

CDC - National Immunization Survey: https://www.cdc.gov/vaccines/imz-managers/nis/data-tables.html

CDC BRFSS: Behavioral Risk Factor Surveillance Survey: https://www.cdc.gov/brfss/data_tools.htm

CDC National Outbreak Reporting System, Retrieved from: https://www.cdc.gov/foodsafety/pdfs/foods-that-sickened-people.pdf

CDC WONDER: https://wonder.cdc.gov/

CDC, Breastfeeding Report Card 2016: https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf

CDC, BRFSS, 2016, Available at: https://www.cdc.gov/sleep/pdf/states508/FS_ShortSleepByState_CO_508tagged.pdf

CDC, Environmental Public Health Tracking Network: https://ephtracking.cdc.gov/DataExplorer/#/

CDPHE BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey, Small Area Estimates: http://www.cohealthmaps.dphe.state.co.us/cdphe_community_level_estimates/

CDPHE Vital Records: Colorado Department of Public Health and Environment: http://www.chd.dphe.state.co.us/cohid/Default.aspx

CDPHE, CEDRS: Colorado Department of Public Health and Environment, Colorado Electronic Disease Reporting System: https://www.colorado.gov/pacific/cdphe/report-a-disease

CDPHE, School and Child Care Immunization Data: https://www.cohealthdata.dphe.state.co.us/Data/Details/1#bydistrict

CDPHE: Colorado Department of Public Health and Environment, Colorado Environmental Public Health Tracking: https://www.colorado.gov/pacific/coepht/public-drinking-water-data

CDPHE: Colorado Department of Public Health and Environment: 2016 Air Quality Data Report: https://www.colorado.gov/airquality/tech_doc_repository.aspx?action=open&file=2016AnnualDataReport.pdf

CDPHE: Colorado Department of Public Health and Environment: https://www.colorado.gov/airquality/tech_doc_repository.aspx?action=open&file=2015_CO_5yr_Network_Assessment.pdf

CDPHE: Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/harmful-algae-blooms

CDPHE: Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/coepht/air-quality-data

Center for Improving Value in Health Care: http://www.civhc.org/get-data/

CFPS State Data Overview Report (2011-2015): Child Fatality Prevention System: https://drive.google.com/file/d/0B4u1qfqmSaHjTy0wRTJwdnJzNzA/view

CFPS: 2017 Annual Legislative Report: Child Fatality Prevention System: http://www.cochildfatalityprevention.com/p/reports.html

CHI CHAS: Colorado Health Institute, Colorado Health Access Survey: https://www.coloradohealthinstitute.org/data

CO BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

CO Child Health Survey: https://drive.google.com/file/d/0B2nM-3jK5N8pUE5uRFVHM2RmOWc/view

CO Department of Education: http://www.cde.state.co.us/

CO Oral Health - Head Start Screening Report: https://www.colorado.gov/pacific/sites/default/files/PW_OH_Head-Start-Screening-Survey-Report.pdf

CO Oral Health Survey: Children's Oral Health Screening (2011-2012): https://www.colorado.gov/pacific/sites/default/files/PW_OH_Childrens-Oral-Health-Screening-2011-2012-Report-FINAL.pdf

Colorado BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

Colorado Cancer Registry via CDPHE: Colorado Department of Public Health and Environment: http://www.chd.dphe.state.co.us/cohid/Default.aspx

Colorado Department of Labor and Employment: https://www.colmigateway.com/vosnet/lmi/default.aspx?pu=1&plang=E

Colorado Dept of Regulatory Agencies, 2017 Licensure Data via Colorado Health Institute: https://www.coloradohealthinstitute.org/data

Colorado Gives, 2016 Report: https://www.coloradogives.org/Data&Reports

Colorado Hospital Association via CDPHE: Colorado Department of Public Health and Environment: direct request

Colorado Hospital Association via CDPHE: Colorado Department of Public Health and Environment: http://data-cdphe.opendata.arcgis.com

Colorado Injury Hospitalization Statistics, CDPHE: http://www.chd.dphe.state.co.us/cohid/Default.aspx

Colorado State Demography Office, Components of Change by County: https://demography.dola.colorado.gov/data/

Colorado Violent Death Reporting System Dashboard: https://cohealthviz.dphe.state.co.us/t/OPPIPublic/views/CoVDRSSuicideData/Story1?:embed=y&:showShareOptions=true&:display_count=no&:showVizHome=no

Colorado Vital Records Statistics, CDPHE: http://www.chd.dphe.state.co.us/cohid/Default.aspx

Colorado Wildfire Assessment Risk Portal. https://www.coloradowildfirerisk.com/

County Business Patterns (2014) via County Health Rankings (2017): http://www.countyhealthrankings.org/

Denver Regional Council of Governments (DRCOG): https://drcog.org/

EPA Environmental Justice Screening and Mapping Tool: https://ejscreen.epa.gov/mapper/

FARS: Fatality Analysis Reporting System, National Highway Traffic Safety Administration: https://www.nhtsa.gov/research-data/fatality-analysis-reporting-system-fars

Feeding American: Map the Meal Gap 2017: http://www.feedingamerica.org/research/map-the-meal-gap/2015/MMG_AllCounties_CDs_MMG_2015_1/CO_AllCounties_CDs_MMG_2015.pdf

Health Services Advisory Group: Enrollee Experiences in the Medicare-Medicaid Financial Alignment Initiative: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/FAICAHPSResultsDec2017.pdf

Health Statistics Section, CDPHE via Colorado Health Indicators Dashboard: https://www.colorado.gov/pacific/cdphe/colorado-health-indicators

Health Statistics Section, CDPHE: Health Watch, January 2012: Living Longer? Living Better? Estimates of Life Expectancy and Healthy Life Expectancy in Colorado: https://drive.google.com/file/d/0B2nM-3jK5N8pSjR6VUYzaXZvekE/view

HKCS: Healthy Kids Colorado Survey: https://www.colorado.gov/pacific/cdphe/hkcs

HRSA Data Warehouse: Health Resources and Services Administration: https://datawarehouse.hrsa.gov/tools/analyzers/geo/shortagearea.aspx

Hunger Free Colorado: https://www.hungerfreecolorado.org/

Institute for Health Metrics and Evaluation – Left behind: Widening disparities for males and females in US county life expectancy, 1985-2010: http://www.healthdata.org/research-article/left-behind-widening-disparities-males-and-females-us-county-life-expectancy-1985

Jefferson County Election Results: https://www.jeffco.us/578/Election-Results

Jefferson County Housing Authority: http://www.jcha.org/

Jefferson County Public Schools: http://www.jeffcopublicschools.org/

Kids Count 2017 Databook: http://www.aecf.org/resources/2017-kids-count-data-book/

Metro Denver Homeless Initiative: https://www.mdhi.org/

National Health Interview Survey: https://www.cdc.gov/nchs/nhis/index.htm

National Low Income Housing Coalition: http://nlihc.org/sites/default/files/oor/OOR_2017.pdf

National Survey of Family Growth: https://www.cdc.gov/nchs/nsfg/index.htm

National Vital Statistics System: https://www.cdc.gov/nchs/nvss/index.htm

PRAMS via CDPHE: Pregnancy Risk Assessment Monitoring System via Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/vision-data-tool and http://www.chd.dphe.state.co.us/cohid/Default.aspx

SAMHSA NSDUH: Substance Abuse and Mental Health Services Association - National Survey on Drug Use and Health: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health

STI/HIV Surveillance Program, CDPHE: Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/stihiv-data-and-trends

The Williams Institute, UCLA School of Law: Same-sex Couple and LGBT Demographic Data Interactive: https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats

Title One, Jefferson County Public Schools: http://www.jeffcopublicschools.org/programs/diversity_inclusion/title_1

United States Drought Monitor: http://droughtmonitor.unl.edu/

US Census, ACS: American Community Survey - American Factfinder: https://www.census.gov

US Census, Annual Population Estimates - American Factfinder: https://www.census.gov

YRBS: Youth Risk Behavior Surveillance System: https://www.cdc.gov/healthyyouth/data/yrbs/results.htm

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Published on July 17, 2018