Residents in Muscatine County have more health challenges than those in Scott County, according to a new comprehensive Quad Cities report.
The study, posted at quadcities.healthforecast.net, is a follow-up to similar studies conducted since 2002 (most recently 2021) and builds upon a long history of collaboration. The report’s data sources include phone and internet surveys, area focus groups, and secondary data.
“Our collaborative health assessment process is the foundation for community health improvement,” says Nicole Carkner, executive director of the Quad City Health Initiative (QCHI), one of the many study partners. “The new report will help us to understand priority health issues based on information provided by community residents and to develop plans that help to address those issues. We invite all organizations in our community to partner with us and advance the health of Quad-Citians.”
The QC study was sponsored by Community Health Care, Inc., MercyOne Genesis, Quad City Health Initiative, Rock Island County Health Department, Scott County Health Department, Trinity Muscatine Public Health and UnityPoint Health – Trinity.
The report highlights improvements over time such as fewer Quad-Citians are unemployed, more have dental insurance coverage and cancer death rates have decreased. Our area also fares better than the national average on selected indicators, including the percentage of adults who have had a stroke, who are food insecure and who have had a routine checkup in the past year.
Additionally, the assessment identified areas of opportunity for Scott, Muscatine and Rock Island counties. “We will be working closely with the Community Stakeholder Committees formed in the Quad Cities and in Muscatine to help us determine how we can make an impact,” says Jennifer Craft, director of public health, Trinity Muscatine.
One of the surprises of the report was the continued decline of people receiving mammography screenings in the last two years, according to a Nov. 20 statement from UnityPoint Health – Trinity. The 2024 survey showed a decline of more than 12%. The decline in 2021 may have been attributed to the pandemic, but has not bounced back.
Mammograms remain one of the most effective tools for identifying breast cancer at an early, more treatable stage, significantly improving outcomes and saving lives, Trinity said, noting it recently expanded mammography services at Trinity Bettendorf with the addition of a new screening machine, ensuring women get the care they need – sooner.
And for those who do receive a diagnosis, UnityPoint Health – Trinity Cancer Center provides expert, compassionate care, and the latest in treatment options, guiding patients every step of the way.
“Since the 2021 assessment, health partners have taken action on these priority health issues,” says Pamela Samuelson, director of business planning and development at UnityPoint Health – Trinity. “We expect this new data will lead to new ideas for programs and community outreach.”
Partners also support existing coalitions in the community that have formed to address the health priority areas such as the Be Healthy QC Coalition, the Quad Cities Behavioral Health Coalition and the Access to Care Workgroup.
“Our health is influenced by economic disparities and inequalities where people are born, live, work, play, worship and age,” says Brooke Barnes, deputy director of the Scott County Health Department.
“Our challenge is to address the broad community conditions that contribute to poor health in our area by collaborating across sectors,” she adds.
“The collaborative community health assessment process and our community coalition work recognizes the important role that all sectors play,” says Tom Bowman, CEO of Community Health Care, Inc.
More than 1,000 surveyed
With funding provided by MercyOne Genesis and UnityPoint Health – Trinity, the partners hired Professional Research Consultants (PRC) of Omaha, Nebraska, to conduct a survey, analyze data and provide a comprehensive report. The assessment included a community survey of 1,150 individuals in Scott, Rock Island and Muscatine counties, extensive secondary data analysis, and the gathering of input from local community members in focus groups held across the counties.
The qualitative data were collected by the study sponsors in partnership with Community Stakeholder Committee members and other community partners. The integrated process leveraged best practices in assessment methodology and the study was designed to provide comparative data at the state and national levels.
The total survey sample yielded 152 interviews among African-American residents and 154 interviews among Hispanic residents. By county, there were 442 surveys completed in Scott County, 216 in Muscatine County, and 492 in Rock Island County.
There were 16 other focus groups held with 141 individuals from 15 sub-populations, including healthcare providers.
“We are proud to sponsor this assessment and hope this report is a resource for many local organizations,” says Ameya Kotwal, business development specialist, MercyOne Genesis. “We invite the community’s feedback and encourage conversations about how we can improve health together.”
7th study, but 3rd time for Muscatine
The needs assessment is a follow-up to similar studies conducted in 2002, 2007, 2012, 2015, 2018, and 2021 for Scott and Rock Island counties (and to 2018 and 2021 for the combined three-county area, including Muscatine County).
The report will serve as a tool toward reaching three basic goals:
To improve residents’ health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.
To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors that historically have had a negative impact on residents’ health.
To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care.
Both provider and community respondents would like to see an expansion of the local healthcare workforce and facilities, and described a desire for an increased presence of local specialists, and accessible health resources, according to the report.
Respondents would also like to see issues of poverty and inequity addressed, including an expansion of affordable housing and transportation, to further increase local wellbeing. The QC strengths include a high level of diversity, a strong sense of community, and an array of engaging community involvement opportunities.
Muscatine County results
In Muscatine County, there is significant demand for more local specialty providers, particularly in obstetrics, mental health, oncology, and dental services, with a focus on ensuring continuity of care. Affordable healthcare and accessible resources were themes that were tied to the importance of transportation as well as education to promote prevention.
The community expressed a desire for free or affordable wellness programs such as exercise opportunities, increased access to healthy foods, improved walkability, and bike access due to the high obesity rating in Muscatine County, the report says. Education on preventative care and affordable, healthy food is seen as vital, along with the need for a more holistic approach to healthcare in the Muscatine community.
Participants expressed the need for more diverse providers with expanded hours, easier access to resources, and support in navigating complex systems. Social determinants of health were highlighted by all focus groups in being the most important stepping stone necessary in increasing overall community wellness.
In Muscatine County, recruiting for rural healthcare is a challenge facing many communities. UnityPoint Health – Trinity Muscatine is taking steps to overcome those challenges, Trinity says.
For instance, Trinity and Community Health Foundation of Muscatine recently opened the new Mulberry Health Clinic, attached to Trinity Muscatine hospital. The new design expands the clinic’s footprint to 42,000 square feet, allowing for future expansion with multi-use space for services like telehealth, primary care, behavioral health and community health. This updated space will also better accommodate a growing number of providers to the Muscatine community.
Trinity Muscatine also hosts visiting specialists who bring essential expertise to patients, reducing the need for long-distance travel. The use of virtual nursing allows us to expand patient care capabilities and provide real-time support.
Trinity Muscatine is also making investments in technology to better improve patient care. It’s the first and only hospital system in the Muscatine region to offer robotic orthopedic surgery through Mako SmartRobotics, which helps surgeons perform knee and hip replacements with increased precision and accuracy.
“Muscatine County stakeholders are honing in on critical health challenges that set the community apart from neighboring areas like Rock Island County,” says Craft, the Trinity Muscatine Public Health Director. “Among the top priorities identified through the 2024 Community Health Needs Assessment are nutrition, physical activity and weight management – key factors seen as vital to addressing Muscatine’s high diabetes mortality rates, as well as rates of heart disease and stroke.”
During a recent stakeholder meeting, attendees discussed the severe impact of these chronic conditions on community health and explored opportunities to make meaningful progress, she said. “Improving nutrition and promoting physical activity could create a ripple effect, positively influencing related issues such as mental health and access to care,” Craft says.
“While Muscatine County shares some health concerns with Rock Island County, the focus on chronic disease prevention through lifestyle changes is particularly urgent,” she adds. “Stakeholders believe this approach will address not only individual health outcomes but also systemic challenges unique to Muscatine County.”
What are biggest QC health needs?
The report showed top needs throughout the QC were deemed:
Mental Health
Access to Health Care
Nutrition, Physical Activity & Weight
Diabetes
Heart Disease & Stroke
There were 34 percent of survey respondents in the area who have been diagnosed by a physician or other health professional as having a depressive disorder, which is much higher than the statewide percentages and marks a significant increase over time.
“I think we see that there have been themes emerging, cycle over cycle,” Carkner says of mental health being a high priority for years.
“We’re hopeful that people are more aware of brain health, behavioral health being just as important as other types of health,” Barnes of Scott County says.
“As a community, knowing how important this issue is, we have lots of coalitions,” Carkner says of mental health. “We’ve been looking at this issue for more than a decade now, trying to decrease the stigma. The topic of mental health appeared in our community health assessment many, many cycles ago. So, that’s why we’re not surprised it continues to appear. It’s such an important issue.
“I do think that locally, we have made efforts to make it a topic of conversation people are more comfortable discussing,” she adds. The area has a QC Behavioral Health Coalition, which formed in 2019. Carkner serves on its steering committee, with representatives of Vera French and Robert Young mental health centers, and the Quad Cities Open Network.
The Gray Matters Collective — also part of the coalition — was formed in 2018, focusing on mental health awareness and suicide prevention, with chapters at over 25 area high schools and colleges.
“We are not surprised that mental health is a top priority. It continues to top the list of important health priorities to those in our communities,” says Joseph Lilly, Director of Outpatient Services, UnityPoint Health – Robert Young Center. “We have come a long way in reducing the stigma associated with mental health treatment and we have individuals in our community more comfortable and willing to seek services when they need it.
As the only Certified Community Behavioral Health Clinic in the regio, the center recognizes the critical importance of behavioral health in the well-being of our community, Lilly noted.
The Robert Young Center continues to hire more professionals who provide psychiatric evaluations, medication management and psychotherapy.
“We are expanding our communities access to medication assisted treatment to address opioid addiction and offering counseling services to support those needs,” Lilly says. “We are focusing our efforts on screening for social determinants of health and are deploying care coordination and case management services to support our community members in addressing their fundamental needs such as food security and stable housing.”
Other health needs that have been top of mind since prior to the pandemic are nutrition, physical activity and weight. A recent national study shows that a full three-quarters of American adults are considered overweight or obese (the QC area is at that mark, 73.9%).
Frequent out-of-town referrals
Many community respondents reported frequent out-of-town referrals as major barriers to accessing healthcare, mainly due to a lack of means of transportation to and from these cities. In addition to an increase of healthcare facilities in general, people cited that an expansion of hours at health centers and pharmacies, as well as an increase in access, timeliness, and availability of public transit options could help improve access to local care.
Additionally, a lack of childcare and long working hours was frequently cited as barriers to accessing both local and nonlocal care, but these barriers were exceptionally worsened by the length of time needed to access care outside of the QC. Beyond a desired increase in physicians and facilities in the area, respondents desire an increase in childcare accessibility, reliable low-cost local transportation, and previously mentioned expanded hours at local sites.
While many providers appreciate the proximity of Scott and Muscatine counties to larger health centers in Iowa City, Peoria, Chicago, and Rochester, providers also noted disparities created by the lack of local care.
Suggested options included increasing walk-in clinic access (hours, locations, sites) and telehealth services. Repeatedly brought up was the idea of garnering a Certificate of Need to address the physician shortage, lack of Level 3 Trauma Center, and the need to attract and keep specialists and facilities in the area.
Respondents reported interest in partnering with local academic centers to develop more locally trained healthcare providers.
The cost and affordability of healthcare, housing, nutritious food, childcare, and transportation were frequently cited as being of the utmost concern in the community.
Respondents of the focus groups from the wider community were most concerned with high costs associated with daily life, frequently citing the cost of childcare and transportation as barriers to accessing healthcare and community involvement.
The high cost of direct health services and prescriptions reportedly discourages preventative, routine, and emergency care, while the necessity to work long hours acts as a major barrier to community involvement and connection. The cost of nutritious food was also frequently cited as inaccessible, even as respondents recognized the importance of quality nutrition, especially for children.
Access and trust
Regarding community responses on access and availability of care, the shortage of physicians was said to not only exacerbate wait times and out of town referrals, but also to affect trust, satisfaction, and overall relationships with providers. Trust in providers was also cited as being negatively affected by confusion navigating the complex arena of referrals, coverage, and copayments.
Lastly, trust in providers was reported as being hurt by frequent cancellations, rescheduling, and rushing during appointments. It was said that QC residents would prefer a focus on genuine or sincere care. Respondents felt that an increase in diversity amongst healthcare providers, particularly in relation to Black and Indigenous people of color (BIPOC) providers, as well as an increase in health care facilities and points of access would increase trust.
Frequent mentions were made of points of access including telehealth, mobile health clinics, and home health services.
On-site screenings at local YMCAs were considered a community strength, but respondents would like to see a connection between initial assessment and ongoing care.
Over time, there has been great improvement in tobacco use, mirroring national trends, Carkner says. About 22% smoke cigarettes in Muscatine County, compared with 18.3% in Scott, and a smaller percentage use vaping products.
“There have been cultural shifts around tobacco, cigarette use, so that’s a good example there,” she says.
The study always has included non-medical issues like socio-economic factors that influence health — such as housing, income, education and food insecurity.
“We know in health care, in public health, that are just factors within any community that impact health, that are not direct health factors,” Barnes says.
“We know that in order for the community to be healthy, those are factors that have to be focused on as well. That is part of the story that makes us more or less healthy,” she adds, noting Muscatine County is working on growing its local provider network and boosting access to care.
In recent years, there also has been national concern about nursing shortages, including in the QC region.
Barnes noted the health assessment partners will be developing recommendations and action plans in the next several months.
Community members are invited to provide feedback on the report through a survey at quadcities.healthforecast.net.
