Community Health Needs Assessment Report & Implementation Strategy

Transcription

1 Community Health Needs Assessment Report & Implementation Strategy June 30, 2013 Sinai Hospital A member of LifeBridge Health, Inc. Baltimore, Maryland 1

2 Table of Contents I. Executive Summary... 3 II. Introduction... 4 A. Overview of Sinai Hospital... 4 B. Sinai Hospital Demographics... 4 C. The Community We Serve... 5 D. Community and Public Health Data... 8 E. Local Community Health Resources III. Process/Methods IV. Findings V. Implementation Strategy A. Prioritized Community Health Needs B. Other Top Community Health Needs C. Existing Resources and Partners D. Adoption of Implementation Strategy E. Motion to Approve Sinai s Community Health Improvement Project VI. Appendix A Community Health Needs Assessment Survey

3 I. Executive Summary Sinai Hospital ( Sinai ) conducted its first federally required Community Health Needs Assessment (CHNA) in fiscal year 2013 (July 1, 2012 June 30, 2013). Involvement of residents, stakeholders and community partners was an essential component of the CHNA process. Sinai s CHNA complies with the new Internal Revenue Service (IRS) mandate requiring all not-for-profit 501(c)(3) hospitals to conduct a CHNA and begin implementation of a community health improvement project once every three years. The process used to identify health needs of Sinai s community included analyzing primary and secondary health data at both the hospital and community level, and involving public health experts, community members and key community groups in further identification of priority concerns and needs. The CHNA team collected and analyzed 364 surveys from individuals living in Sinai s primary service area zip codes and held two community feedback sessions attended by community residents and stakeholders. The CHNA team evaluated results from surveys, community feedback sessions and public health experts recommendations to prioritize Sinai s top community health needs. An assessment of hospital resources, expertise and capacity led to a decision to focus the resulting community health improvement project on the Heart Disease Cluster (including heart disease, diabetes and stroke) while addressing an additional prioritized health need, Violence (i.e. street violence), through existing community and hospital-based programming. Throughout the assessment process, the hospital worked to align its priorities with local, state and national health improvement initiatives including Healthy Baltimore 2015, Maryland State Health Improvement Plan (SHIP) and Healthy People On May 9, 2013 and May 23, 2013 respectively, the Boards of Sinai Hospital and Lifebridge Health, Inc., Sinai s parent organization, approved Sinai s plan for a community health improvement project focused on the heart disease cluster and additional interventions focusing on street violence. 3

4 II. Introduction Sinai Hospital completed its formal community health needs assessment as required and defined by the Patient Protection and Affordable Care Act and Section 501(r)(3) of the Internal Revenue Code during fiscal year A. Overview of Sinai Hospital Founded in 1866 as the Hebrew Hospital and Asylum, Sinai has evolved into a Jewish-sponsored health care organization providing care for all people. Today, Sinai is a 529-bed community teaching hospital that provides patient care in a variety of settings including inpatient, surgical, outpatient, as well as a trauma unit (Level II designation), a high risk Neonatal Unit, a state-of-the-art Emergency Department and responsive community outreach and community health education departments. Sinai has 18 Centers of Excellence, including the Lapidus Cancer Institute, Berman Brain & Spine Institute, and Samuelson Children s Hospital. Sinai is the most comprehensive and largest community hospital in Maryland, and is the state s third largest teaching hospital. Community teaching hospitals such as Sinai find one of their greatest strengths is their clinicians commitment to direct patient care. The residents and medical students who train at Sinai have chosen a community-teaching setting over a classic academic medical center setting. Sinai provides medical education and training to 2,000 medical students, residents, fellows, nursing students, and others each year from the Johns Hopkins University, University of Maryland, and teaching institutions in the Baltimore/ Washington/ Southern Pennsylvania region. B. Sinai Hospital Demographics Of the 123,211 patients treated at Sinai in calendar year (CY) 2012, 28,881 (23.4%) were treated as inpatients, 12,872 (10.5%) had outpatient or same day surgery procedures and 81,458 (66.1%) were treated in the Emergency Department (ED). a) Race and Ethnicity Approximately 70% of all patients were Black/African American and 26.4% were White. Smaller percentages of patients identified as Other (1.4%), Hispanic (1.2%), Asian-Pacific (1.0%), American Indian (0.2%) and Biracial (0.2%). One notable difference in racial characteristics of patients between CY 2011 and CY 2012 is a slight increase in the Hispanic population (1.13% increased to 1.23%). Data reveal some variation in race/ethnicity by the area in which patients received care (e.g. inpatient, outpatient and emergency). Fifty-six percent (56.0%) of patients treated in inpatient settings were Black/African American followed by White patients at 38.6%. Patients receiving outpatient services were 52.5% White and 43.1% Black/African American. Lastly, the ED treated nearly 4 times as many Black/African American patients (78.6%) as White patients (18.0%). 4

5 b) Age The age category representing the highest percentage of inpatient and outpatient encounters is years old, accounting for 34.2% of inpatients and 42.3% of outpatients. Patients aged 66 years old and above make up 31.5% of inpatients and 33.8% of outpatients, followed by age category (19.4% of inpatients and 14.3% of outpatients) and 0-18 (14.9% of inpatients and 12.8% of outpatients). The age breakdown of patients treated in the ED differs from the age breakdown of those treated in inpatient and outpatient settings. The top age category in the ED is years old (32.6%), followed by years old (29.6%), 0-18 years old (22.6%) and above 65 years old (15.2%). c) Gender Overall in all hospital settings, 57.2% of CY 2012 patients were female and 42.8% were male. The setting with the highest percentage of females was outpatient at 58.1%. The setting with the highest percentage of males was the ED at 43.4%. C. The Community We Serve Sinai is located in the northwest quadrant of Baltimore City, serving both its immediate neighbors and others from throughout the Baltimore City and County region. The community served by Sinai can be defined by its (a) Primary Service Area (PSA), (b) Community Benefit Service Area (CBSA) or by (c) Community Statistical Areas (CSAs), representative of individual neighborhoods targeted for community health improvement. a) The Primary Service Area (PSA) is comprised of zip codes from which the top 60% of patient discharges originate. 1 Listed in order from largest to smallest number of discharges for fiscal year 2012, Sinai s PSA includes the following zip codes: 21215, 21207, 21208, 21209, 21117, 21216, 21133, and The racial composition and income distribution of these zip codes reflect the segregation and income disparity characteristic of the Baltimore metropolitan region. Those zip codes that have predominantly African American residents, including in which the hospital is located, reflect the racial composition and poverty representative of Baltimore City. This is in contrast to neighboring Baltimore County zip codes (21209 & 21208) in which the median household income range is higher and residents are predominantly White. b) The Community Benefit Service Area (CBSA) is comprised of zip codes, or geographic areas, targeted for Community Benefit programming due to the area s demonstration of need. Sinai s CBSA includes zip codes 21215, 21207, and and constitutes an area that is predominantly African American with a below average median family income and above average rates for unemployment and other social determinants of poor health. The chart below shows basic demographics for Sinai s CBSA. 1 Health Services Cost Review Commission (HSCRC),

6 Figure 1 Sinai Community Benefit Service Area (CBSA): Basic Demographics 2 CBSA Zip Codes 21215, 21216, 21217, Total Population, CBSA: 174,918 Sex Male: 79,019 Female: 95,899 Age Race/Ethnicity Household Income Education Level (Individuals 25 +) 0-14: 35, % 15-17: 7, % 18-24: 18, % 25-34: 27, % 35-54: 42, % 55-64: 19, % 65+ : 23, % White non-hispanic: 16, % Black non-hispanic: 149, % Hispanic: 4, % Asian and Pacific Islander non-hispanic: 1, % All others: 3, % < $15,000 15, % $15,000-25,000 9, % $25,000-50,000 19, % $50,000-75,000 11, % $75, ,000 5, % > $100,000 6, % Less than High School 6, % Some High School 16, % High School Degree 38, % Some College/Assoc. Degree 31, % Bachelor s Degree or Greater 21, % c) In addition to describing communities by zip code, the Baltimore City Health Department uses Community Statistical Areas (CSA) to define communities in Baltimore City. The CSAs were developed by the City s Planning Department based on recognizable city neighborhood perimeters and represent clusters of neighborhoods based on census track data rather than zip code. Although Sinai s community benefit programming serves the entire Community Benefit Service Area (CBSA) with great focus on zip code 21215, the hospital s CHNA and resulting community health improvement project will focus on two neighborhoods surrounding Sinai. These neighborhoods, or CSAs, are Southern Park Heights (SPH) and Pimlico/Arlington/Hilltop (PAH) 4 and will be defined as the community served by Sinai Hospital for the purposes of conducting a CHNA 2 Claritas, Inc., spans city/county lines. Sinai primarily serves the city-portion of the zip code. 4 Baltimore Neighborhood Indicators Alliance (BNIA),

7 and implementing a resulting community health improvement project. The map below shows zip code and CSAs SPH and PAH. Figure 2 Prior to the release of CSA boundaries, local residents referred to the areas within and above Northern Parkway as Upper Park Heights and areas below Northern Parkway as Lower Park Heights. The areas above Northern Parkway represent a more affluent and predominantly white population while areas below Northern Parkway are characterized by extreme poverty, an active drug trade, high crime and poorer health outcomes. Today, Sinai staff and community partners refer to the area below Northern Parkway, inclusive of both SPH and PAH, using the broad term of Park Heights. Park Heights, or Southern Park Heights (SPH) and Pimlico/Arlington/Hilltop (PAH), represents six (6) census tracts that make up a Northwest Baltimore City area categorized as a medically underserved area/population designation (MUA/P) according to the U.S. Department of Health and Human Services. This MUA/P received a score of out of 100 possible points on the Index of Medical Underservice (IMU). The IMU is based on four variables including infant mortality, poverty rate, age of population, and rate of primary medical care physicians per 1,000 population. 5 5 Maryland Medically Underserved Area/Population Designation (MUA/Ps), 7

8 D. Community and Public Health Data According to data from the 2009 American Community Survey 6, SPH s median household income was $27,365 and PAH s median household income was $29,031. This is compared to Baltimore City s median household income of $37,395. The percentage of families with incomes below federal poverty guidelines in SPH was 25.9%; in PAH, 21.3% of families had incomes below federal poverty guidelines. 7 In 2010, the average unemployment rates for SPH and PAH were 17.5% and 17.0% respectively, while the Baltimore City unemployment rate was 10.9 %. 8 The chart below displays community characteristics for SPH and PAH, as well as Baltimore City. Figure 3 Community Characteristics: Park Heights Community Statistical Areas (CSAs) compared to Baltimore City 7 Zip Code Socioeconomic Median Household Income, % of households with incomes below federal poverty, Unemployment, Baltimore City $37, % 11.1% Pimlico /Arlington /Hilltop $29, % 17.0% Southern Park Heights $27, % 17.5% Zip Code Education % of Kindergartners fully ready to learn, 07-08, % of High School students missing 20+ days, % of Residents with a high school degree or less, Baltimore City 65.0% 39.2% 52.6% Pimlico /Arlington /Hilltop % 46.8% 69.5% Southern Park Heights % 47.8% 69.6% Zip Code Access to Healthy Foods Corner Store Density (# corner stores per 10,000 residents), 09 Carryout Density (# carryouts per 10,000 residents), 09 Baltimore City Pimlico /Arlington /Hilltop Southern Park Heights American Community Survey, Baltimore City Health Department, Neighborhood Health Profiles, American Community Survey (ACS),

9 Zip Code Housing Vacant Building Density (# vacant buildings/10,000 units), 09 Energy Cut-off Rate (# of energy cut-offs/10,000 residents), Lead Paint Violation Rate (# of violations per year/10,000 residents), Baltimore City Pimlico /Arlington /Hilltop Southern Park Heights Community Built and Social Environment Zip Code Alcohol Store Density Rate (# stores/10,000 residents), Homicide Incidence Rate (# homicides/10,000 residents), Domestic Violence Rate (# reported incidents/1,000 residents), Baltimore City Pimlico /Arlington /Hilltop Southern Park Heights Life Expectancy & Mortality Zip Code Life Expectancy at birth (in years), 2010 Age adjusted mortality (deaths per 10,000 residents), 2010 Baltimore City Pimlico /Arlington /Hilltop Southern Park Heights Morality Data, Baltimore City 9 Using data from the Healthy Communities Institute s data platform on Sinai s website (see Section III, A), the CHNA team explored chronic disease outcomes for Baltimore City. The top cause of death for Baltimore City residents is heart disease, followed by cancer and stroke. For the following chronic disease outcome measures for which data are available, Baltimore City performs in the worst quartile compared to other Maryland Counties. Figure 4 9

10 Figure 5 Figure 6 Health Disparities Data, Baltimore City The presence of health disparities is another key factor in determining how Sinai can best serve community members most in need of health improvement. In Figures 8 and 9, significant racial disparities are shown in Baltimore City for two key chronic diseases, diabetes and coronary heart disease. Figure 8 9 Diabetes Mortality by Race/Ethnicity: Baltimore City Baltimore City 9 Healthy Communities Institute,

11 Figure 9 9 Coronary Heart Disease Mortality by Race/Ethnicity: Baltimore City Baltimore City 11

12 E. Local Community Health Resources The following health care resources are available to eligible residents living in or around Sinai s community. 1. Park West Health System, Inc. Locations include: (1) 4151 Park Heights Ave., Baltimore, Maryland (2) 5101 Lanier Ave., Baltimore, Maryland (3) 3319 W. Belvedere Ave., Baltimore, Maryland (4) 4120 Patterson Ave., Baltimore, Maryland Park West Health System, Inc. offers a full range of health services to individuals of all ages, averaging 50,000 patient visits per year. Total Health Care, Inc. Metroplaza Suite 113 Baltimore, Maryland Total Health Care, Inc. offers medical services to Baltimore s medically underserved and uninsured residents of all ages As Federally Qualified Health Centers (FQHCs), Park West s four locations and Total Health Care, Inc. expand access to primary health care for uninsured and underserved populations who experience financial, geographic, or cultural barriers to care and who live in or near medically underserved areas and areas that are federally designated as having a health professional shortage (HPSAs). FQHCs accept Medicaid and Medicare patients as well as uninsured individuals. 12

13 III. Process/Methods The process used to identify health needs of Sinai s community included analyzing primary and secondary data at both hospital and community levels, and involving public health experts, community members and key community groups in further identification of priority concerns and needs. Throughout the assessment process, the hospital worked to align its priorities with local, state and national health improvement initiatives: Healthy Baltimore 2015, the local action plan developed by the Baltimore City Health Department to implement the state of Maryland s health improvement plan, the Maryland State Health Improvement Plan (SHIP) and Healthy People The steps taken to complete the CHNA and plan for a resulting community health improvement project included the following: A. Exploration of Public Health Data Collection Mechanisms In order to respond to IRS guidelines requiring non-profit hospitals to complete a CHNA, Sinai partnered with the Maryland Hospital Association (MHA), Baltimore City and County Health Departments and other area hospital systems to explore mechanisms/methods for performing required CHNAs. Methods considered included the use of data software platforms, hiring an external consultant to conduct the assessment or having hospital staff members conduct the assessment. LifeBridge Health, Inc. decided to explore the Healthy Communities Institute (HCI) product, a web-based platform offering over 130 community health indicators from reputable data sources such as U.S. Census and American Community Survey to support the CHNA. Early in the exploration, Sinai held discussions with the local health departments and other hospital systems on the joint purchase of a shared product. These discussions did not ultimately lead to such partnership, but LifeBridge Health, Inc. contracted with the Healthy Communities Institute (HCI) to purchase a web-based software product to support its own hospitals CHNAs. Data provided by HCI is updated in real-time as soon as sources such as the American Community Survey of the U.S. Census release new reports. Data are available for Baltimore City and Baltimore County, as well as for zip code and census tract level data where available. In addition to presenting public health data values, measurement periods and sources, the HCI software has a built-in progress tracker that helps users identify how the location of interest (i.e. Baltimore City) compares to other county-level, state-level and national-level data. Other product features include promising practices searchable by health topic or keyword, health disparities data and a report center enabling users to create and send customized data reports. In order to supplement the public health data obtained from the HCI product and to complete the CHNA, LifeBridge Health, Inc. staff, comprising the CHNA team, engaged with local public health partners and community residents to gather input from persons representing broad community interest. 13

14 B. Engagement with Public Health Partners and Community Human Services Partners LifeBridge Health, Inc., a regional Maryland health system with hospitals located in both Baltimore City and Baltimore County, initiated early talks with both Baltimore City and Baltimore County Health Departments around local health improvement plans to support the Maryland State Health Improvement Plan (SHIP). In Fall 2011, Sinai Hospital President, Neil Meltzer, invited Dr. Oxiris Barbot, Baltimore City Health Commissioner, to present Healthy Baltimore 2015, the City s health policy agenda, to the Sinai Board. This invitation and Dr. Barbot s presentation sparked an early partnership between the Baltimore City Health Department and Sinai, leading to Sinai co-sponsoring and supporting the City s first neighborhood community forum in January 2012 held in Park Heights. This meeting was the first of many city-wide meetings as part of the Health Department s Neighborhood Health Initiative, an initiative aimed to begin a dialogue with local community residents about their health concerns and conditions that influence health outcomes where they live, work, learn and play. A second Park Heights community forum was held in June of 2012 in a community location recommended by Sinai to increase community resident participation. Members of Sinai s Community Initiatives Department as well as the CHNA team collaborated closely with the City and with community residents to promote the forum. In further support of Sinai s partnership with the Baltimore City Health Department (BCHD), BCHD s Director of Policy and Planning was invited to present the City s health improvement plan to the Community Mission Committee (CMC), a committee of the LifeBridge Health board that guides and monitors community benefit programming. Sinai s CHNA team and BCHD staff met regularly throughout the CHNA process in order to ensure alignment between the hospital s assessment and BCHD s Healthy Baltimore 2015 Plan. Sinai continued its routine practice of collaborating with community and human service partners in order to enhance community involvement and input during the CHNA process. Key partners included the Park Heights Community Health Alliance (PHCHA), Park Heights Renaissance (PHR), the Zeta Center for Healthy and Active Aging and the Zeta Healthy Aging Partnership (Z-HAP). Sinai representatives regularly attended meetings of each organization and sought support from each to facilitate the CHNA process. Assistance from partner organizations included spreading the word about the assessment, distributing and collecting community surveys, providing space and allocating meeting time for gathering community input on health needs, and offering consistent support for other tasks as needed. In addition, partners contributed feedback about their own perception of community health needs. Another key role of community partners will be participation in project-planning as we determine specific components of the community-wide community health improvement project and the role that each community partner will play in its implementation. 14

15 In addition to seeking input and assistance from external partners, Sinai identified clinical and community needs based on feedback from individual hospital departments. Such clinical input was derived from the treatment of patients and interactions with both patients and family members. This practice continues and offers additional clinical input regarding identification and prioritization of health needs. C. Data Collection: Surveys and In-person Feedback In order to gather community input on health needs, the CHNA team decided to use a two-pronged approach yielding both written survey and in-person feedback session data. a) Surveys: Paper and Electronic Surveys With approval from the source, Tanner Health System (Carrollton, Georgia), the CHNA team adapted an existing survey created by Tanner during their Community Health Needs Assessment process. The survey (Appendix A) had a total of 19 questions including 18 forced-choice questions and one final question asking for additional comments about health needs in the community. The first section of the survey asked questions about health concerns, barriers to seeking or receiving quality health care, community needs and health information sources. The second section asked eight demographic questions including gender, age, race, ethnicity, highest level of education, etc. in order to capture a snapshot of the survey respondents. The survey was available in paper and electronically via Survey Monkey, an online survey tool. The majority of respondents filled out a paper survey. The CHNA team distributed paper surveys at community events, meetings and fairs, as well as in waiting rooms, lobbies and communal spaces in or around various community sites in Park Heights. Sites included community centers and organizations, restaurants, pharmacies, schools, churches, etc. The team also relied upon partners to spread awareness about the survey as well as to hand out surveys for completion. All completed surveys were returned to the CHNA team. Over 350 surveys were collected from Sinai s primary service area zip codes (e.g , 21207, 21208, 21209, 21216, 21217). Due to the relatively close proximity of LifeBridge Health s three hospitals and the fact that the hospitals share certain primary service area zip codes, a second level of decision-making beyond zip code of residence was required to categorize survey responses as Sinai and Levindale (Note: Sinai and Levindale were combined because they are geographically located on a joint campus in Baltimore City) or Northwest. The respondents answers to the question When seeking care, which [acute care] hospital would you visit first? became the tiebreaker for categorizing responses from individuals living in a service area zip code shared by Sinai/Levindale and Northwest. b) In-Person Feedback: Community Feedback Sessions 15

16 The CHNA team worked with local partners to hold two face-to-face community feedback sessions in Park Heights. Feedback sessions were open to the general public including residents and representatives from local community-based organizations, churches, schools, etc. Community members and stakeholders learned about the feedback sessions through a variety of mechanisms including paper flyer distribution, notices, event postings on community calendars and social media sites, announcements at community meetings and gatherings, and through word of mouth. Due to the fact that the feedback sessions were scheduled to occur during regularly scheduled community meetings at partner organizations, most participants heard about the meeting through attendance at previous meetings. The feedback sessions lasted between one and one and 1/2 hours. During the session, participants were asked the same set of questions included in the community health needs assessment survey but were able to give in-depth narrative responses instead of the forced choice answers required by the survey. Session One: The first community feedback session was held on November 8, 2012 from 12:00 1:00pm during a regularly scheduled meeting of the Zeta Healthy and Active Aging Partnership (Z-HAP). The physical location of the session was the Zeta Center for Healthy and Active Aging at 4501 Reisterstown Road, Baltimore, MD Session Two: The second community feedback session was held on November 30, 2012 from 6:00 7:30pm during a regularly scheduled meeting of the Resident and Community Council, a council convened by Park Heights Renaissance (PHR). The physical location of the session was the Zeta Center for Healthy and Active Aging at 4501 Reisterstown Avenue, Baltimore, MD In order to prioritize community health needs, the CHNA team facilitated a multi-voting exercise at both community feedback sessions. Each participant used three Post-It notes to represent three votes for the health need(s) that they perceived to be greatest. Participants were instructed to vote by placing the Post-It notes onto flip charts posted around the meeting room. Each flip chart represented a different health concern. Topics were selected based on preliminary survey results of the top 5 community health concerns and top 5 causes of death identified by survey respondents. As of November 2012, 271 survey respondents selected in two questions, greatest cause of death and greatest health concern in their community, the following top health conditions: Top Cause of Death: 1. Heart Disease 2. Cancer 3. Diabetes 4. Violence 5. HIV/AIDS 16

17 Top Health Concern: 1. Drug/Alcohol Abuse 2. Heart Disease 3. Diabetes 4. Cancer 5. HIV/AIDS Heart Disease Cancer Diabetes Violence Drug/Alcohol Abuse HIV/AIDS The CHNA team decided to present the six unduplicated health conditions representing either top cause of death or top health concern to meeting participants for the voting exercise. The health topics eligible for voting included: 1. Heart Disease 2. Cancer 3. Diabetes 4. Violence 5. Drug/alcohol abuse 6. HIV/AIDS Community feedback session participants were asked to place their three votes in any distribution, weighting any health condition with more than one vote, if they wished; they could also submit write-in votes for health concerns not posted. Following a period of data analysis, the CHNA team returned in early 2013 to the original community feedback session sites (Z-HAP on January 10, 2013 and the Resident and Community Council Meeting on February 14, 2013) to present data results and request community input on how to prioritize and address identified needs. Participants offered ideas for resources, partners and community health improvement project strategies related to the top three community health needs: Heart Disease, Cancer and Violence. In addition to returning to community feedback session sites, the team presented community health needs assessment results and solicited feedback at additional meetings of Sinai stakeholders. Meetings included: Community Mission Committee of the LifeBridge Health Board on January 10, 2013 Sinai Hospital Health Equity Task Force on January 14, 2013 Community Advisory Panel of the Health Equity Task Force on January 17, 2013 Sinai Hospital M. Peter Moser Community Initiatives Department monthly staff meeting on February 13,

18 IV. Findings The following section is a compilation of responses from all community health needs assessment participants including those who completed the paper or online community health needs assessment survey and those who attended community feedback sessions. These results, combined with secondary data from the Healthy Communities Institute (HCI) data sources and information about community health needs from our partners and stakeholders, will help to inform future community benefit programming and implementation of a Community Health Improvement Project that will be initiated in response to this needs assessment process and will be described in greater detail later in this report. A. Survey Demographics A total of 364 individuals completed a community health needs assessment survey on paper or online. The zip code represented by the largest number of respondents (42%) is 21215, the hospital s zip code, followed by (15%), (15%) and (12%), representative of four out of the top five zip codes of Sinai Hospital s FY 2012 discharges. Approximately 68% of respondents were female and 32% were male. The majority of respondents (86%) were Black or African American and non-hispanic (95%). These results can be compared to the demographic breakdown of Sinai Hospital s primary service area, which is 55% female and 85% Black, non-hispanic. The age breakdown of survey respondents (n = 364) was: It is important to note that the make-up of community residents responding to the survey is not representative of the whole community due to convenience sampling and not random sampling. For example, collaboration with our local Park Heights senior center, the Zeta Center for Health and Active Aging, yielded great representation of the older adult population. Attempts will be made to increase input about community health needs from young adults and youth in future assessments. 18

19 B. Survey Results Top Cause of Death Of the 307 respondents who answered the question What do you think is the health cause that most people in your community die from?, 33% answered Heart Disease followed by Cancer (24%), Violence (17%), Diabetes (12%) and HIV/AIDS (5%). Individual responses that included more than one top cause of death are not represented in the following chart. 1 The chart below shows true mortality data for the top five (5) causes of death in Southern Park Heights, Pimlico/Arlington/Hilltop, and Baltimore City compared to the survey respondents perception of the top five (5) causes of death on the far right. Respondents perceptions of the top two causes of death were identical to the top two causes of death according to city and local community statistical area (CSA) mortality rates. And while homicide ranked as the 5 th top cause of death in Southern Park Heights and Pimlico/Arlington/Hilltop, the respondents felt that it was the 3 rd greatest cause of death in their community. Top Cause of Death: Mortality Rates 7 vs. Community Perception Southern Park Heights Heart Disease 32.2 Pimlico/ Arlington/ Hilltop Heart Disease 34.7 Baltimore City Heart Disease Community Survey Feedback (n = 307) 28.4 Heart Disease 33% 2 Cancer 24.6 Cancer 24.0 Cancer 23.1 Cancer 24% 3 Stroke 7.3 HIV/AIDS 7.5 Stroke 5.2 Violence (homicide) 17% 4 HIV/AIDS 7.2 Stroke 6.0 HIV/AIDS 3.9 Diabetes 12% 5 Homicide 4.8 Homicide 5.9 Chronic Lower Respiratory Disease 3.9 HIV/AIDS 5% * Morality rate = deaths per 10,000 % of cause of death over total responses 19

20 Top Health Concern In addition to identifying the top cause of death, we asked respondents to select their biggest health concern from a provided list. Of the 322 respondents who answered the question What do you think is the biggest health concern in your community?, 18% chose Diabetes followed by Cancer (16%), Drug/Alcohol Abuse (16%), Heart Disease (15%), HIV/AIDS (10%) and Violence (9%). Individual responses that included more than one top health concern are not represented in the following chart. Additional Survey Results The survey also included questions related to the respondents perceptions about barriers to seeking medical treatment and other factors that impact the quality of care community members receive or their own health literacy and ability to access and use existing health care resources. What do you think is the main reason why people in your community may not seek medical treatment? 1. Lack of Insurance 34% 2. Fear 25% 3. Unable to Pay 23% In your opinion, which factor most affects the quality of the health care you or people in your community receive? 1. Economic Reasons 62% 2. Do Not Know 12% 3. Age 9% 20

21 What health screenings or education/information services are needed in your community? 10 What does your community need in order to improve the health of your family, friends and neighbors? Respondents were instructed to Check all that apply. 11 Respondents were instructed to Check the Top Three Needs. 21

22 C. Community Feedback Results Qualitative results include responses provided at two in-person community feedback sessions as well as comments written on the community health needs assessment survey. On November 8, 2012, the CHNA team held a community feedback session during a regular monthly meeting of the Park Heights Renaissance s Resident and Community Council meeting. The meeting took place on a weekday evening at a central community location, the Zeta Center. A total of 40 attendees participated in the feedback session. A second community feedback session took place on November 30, 2012 during a Zeta Center Healthy and Active Aging Partnership (Z-HAP) meeting. This meeting was held during the daytime (12:00 1:00 pm) and was attended primarily by community residents ages 55 and above. A total of 34 attendees participated in the feedback session. The CHNA team organized each community feedback session by dividing responsibilities into three roles facilitator, recorder and note-taker. Each attendee was asked to sign in upon entry and complete an anonymous registration form. Registration forms asked for age, sex, zip code, race, ethnicity, highest level of education and insurance status. Such data was obtained for all participants at both meetings Of the 40 Resident and Community Council meeting participants, 26 were female and 14 were male. Eighty-five percent (85%) of participants were aged 55 or older and the majority (95%) of participants lived in zip code Ninety-five percent (95%) identified as Black of African American. The highest level of education of participants ranged from less than high school to graduate school and 88% reported having at least a high school degree or GED. The highest percentage of participants (30%) selected High School Graduate as their highest level of education. Of the 34 Z-HAP meeting participants, 31 were female and 3 were male. Ninety-seven percent of participants were aged 55 or older and the majority (62%) of participants lived in zip code Ninety-seven percent identified as Black of African American. The highest level of education of participants ranged from some high school to graduate school and 91% reported having at least a high school degree or GED. Nearly 60% of participants selected High School Graduate or Some College as their highest level of education. The results of the community feedback session were compiled from hand-written notes taken by the recorder and note-taker throughout the session. While the recorder interacted directly with the facilitator and participants while writing participant responses on a large flip chart, the note-taker took more detailed notes on a laptop computer. Following each feedback session, the recorder and note taker met to compare notes. A brief qualitative analysis of the results was conducted by the facilitator of the feedback sessions. Themes derived from analysis are listed below. 22

23 For both community sessions, the importance of context should be noted. Each community session was held in the same building, a centrally located, accessible and commonly used senior/community center in Southern Park Heights. Although the center offers and publicizes programming designed for older adults (55 and older) and intergenerational audiences, the majority of individuals who frequent the space are older adults. The fact that feedback session participants were older and many are also members of the Z-HAP program, which has a health-focus, may have influenced the attitudes and perceptions expressed. Certain emphasis on factors such as transportation, access, the need/desire for education and information, and concerns over healthy food access, medication and diabetes management may not have arisen as strongly in a group of younger respondents. Community Feedback Session Themes Guided by questions extracted from the Community Health Needs Assessment survey, community residents in attendance offered insight into community health needs and challenges. While participants suggested diseases and conditions (e.g. drug addiction, heart disease, violence (murder/injury), diabetes, HIV/AIDS, cancer, hepatitis, etc.) when answering questions related to top cause of death and greatest health concern, detailed discussions arose related to the following themes, listed in no particular order: Access Many participants discussed access concerns including lack of insurance, affordability of health care and health care coverage, and the availability of 24-hour or walk-in health care facilities. The groups specifically requested that an urgent care center be located in Park Heights, so as not to use Sinai s emergency room for non-emergencies, and to have an available facility that would not require travel to distant locations. Specifically, participants wanted greater availability of providers and instant access to care when needed (i.e. extended hours, or 24 hour, walk-in access). Education (Health-related) Respondents cited a need for education about common health conditions (e.g. diabetes, high blood pressure) and practical tips and tools for preventing and treating such conditions. Participants not only identified certain conditions as they contribute to more deaths in the community or are perceived by the community as the top health concerns, but they also discussed a need for Sinai Hospital to offer more information about the conditions that are cause for much concern. They requested that doctors visit community centers with expert advice, and that nurses come to provide screenings for cancer, heart disease, etc. Access to Healthy Foods The lack of available healthy foods rose as a significant concern during both feedback sessions. Related to the lack of healthy food options is the health concern, as voiced by the residents, of obesity, specifically childhood 23

24 obesity. The participants stated that Park Heights does not have a decent supermarket and that greasy chicken boxes are everywhere. They also expressed a concern for the quality of foods available in the closest supermarket; the food safety standards are too low, they stated. Participants wanted healthier food options and increased access to higher-quality food in existing food stores such as corner stores and the local supermarket. They felt that Sinai Hospital could serve as an advocate for residents by partnering with the local health department and corner stores to encourage the sale of healthier food options. They also asked that farmers markets be more accommodating with payment options (i.e. SNAP card eligible). Social and Psychological Concerns Participants readily provided psycho-social reasons for poor health and mortality in the community. Their concerns included murder, teenage pregnancy, sexually transmitted diseases, depression, or loneliness/isolation, poverty, drug/alcohol abuse and fear/anxiety. Chronic Disease Participants consistently cited heart disease, diabetes, high blood pressure and stroke as health concerns and reasons why people in their community die. Members of Z-HAP were knowledgeable about the link between the conditions listed above and commended Sinai Hospital for its involvement in their weekly health education sessions around diabetes, heart disease, etc. They requested more of this type of teaching and encouraged a cross-generational strategy in order to reach younger community members about chronic disease risk and ways to prevent chronic disease. Emergent Themes Emergent themes, or new learning from the qualitative analysis, included the desire for partnership. Z-HAP members recommended that health improvement programs utilize the Zeta Center space as well as join with existing programming within the space such as Z-HAP Fridays. They specifically identified the need for experts to provide education and practical tools for disease conditions such as diabetes, stroke, etc. For example, they asked for help navigating and using the health care and health insurance systems and help understanding and taking prescribed medication. While participants were primarily older adults, they expressed a desire to develop a cross-generational effort or intervention to improve the health of the community. They volunteered the resource of their own human capital their time, standing and role in the community as wise elders to advocate for and deliver positive health messaging to their families, neighbors and community groups, such as churches, where they are active. They noted that the model of using health ambassadors to reach out, share 24

25 information and encourage participation of other Park Heights residents and their families is already in use with Z-HAP. In addition to seeking information from participants about community health concerns, the facilitator also asked for information about barriers to seeking and receiving medical care, methods used to receive health information, and ideas for health improvement. Medical Care: Seeking Care and Information Respondents use a variety of sources for medical care and medical information. They visit hospitals, urgent care centers, walk-in clinics, drug stores and pharmacies, and the VA (Veteran s Affairs) when they (or their family members) are ill. When seeking health information, they ask their doctors, church group and family members; they seek information from existing health education programs such as Z-HAP; and they reference media sources (e.g. newspaper, online medical advice). Many reasons for not seeking medical care centered on fear, anxiety and uncertainty. Reasons included fear of or lack of trust in providers/doctors; previous negative experiences receiving care; uncertainty about the quality of care they will receive (e.g. misdiagnosis, incorrect prescription, etc.); fear of the unknown (e.g. the diagnosis itself); and a lack of understanding of the medical system. Individual level of motivation and psychological state (e.g. depressed, isolated) were also discussed as potential barriers to seeking care. Practical barriers included lack of transportation and childcare, affordability of insurance/co-pays, and inability to navigate the medical system. One respondent revealed cultural reasons for not seeking medical care. She said: People are often not raised to see a doctor. [They] believe in not using doctors. Alternatives [are used]. My mother didn t go to a doctor and she lived to 101 years old. Doctors don t know everything. Health Improvement Participants provided suggestions for improving community health. They voiced a need and request for education through in-person methods and through literature or media sources. They view Sinai Hospital and its health professionals as a valuable resource and encourage partnership. The participants acknowledged the challenge in reaching youth and suggested using technology (e.g. cell phones, Facebook, Twitter) to engage youth and young adults. The older adults who participated in the feedback session offered to serve as ambassadors within their churches and their own families. They emphasized a desire to engage their grandchildren in health improvement strategies and participate in family focused programming. Another suggestion made to improve youth 25

26 engagement was to partner with local schools to do mentoring, educational programs and events focusing on health topics. Many participants asked for help learning about nutrition and increasing access to healthy foods in the community. For example, a participant stated that Sinai should advocate for corners stores carrying certain healthier food options. 26

27 D. Multi-Voting Results In addition to recording participants answers to questions about community health and needs, the facilitators asked participants to prioritize community health needs by use of the multi-voting method described previously. The results are pictured below. Heart Disease Diabetes Drug/Alcohol Abuse Cancer HIV/AIDS Violence

28 E. Baltimore City Health Department: Neighborhood Health Initiative Results In addition to community feedback sessions organized by Sinai Hospital and its community partners, Sinai Hospital also participated in community input sessions as part of the Baltimore City Health Department s Neighborhood Health Initiative. Meetings covering the geographic location of City Council District 6 (inclusive of Southern Park Heights and Pimlico/Arlington/Hilltop) took place on January 31, 2012 and June 14, The first meeting was held on a weekday evening at the Cylburn Arboretum, a city-owned park and event space on the perimeter of Park Heights. Forty-nine participants attended that meeting, many of whom were professionals who work in Park Heights, but are not community residents. The second meeting was held on a weekday evening at the Zeta Center and was attended by 46 participants, who were primarily community residents. At the conclusion of meeting #1, facilitators asked participants to rank a list of health concerns that were taken from the Maryland State Health Improvement Plan. The top ten health concerns identified by attendees at the first meeting were used for a prioritization exercise during meeting #2. Participants were asked to vote three times for one to three health concerns that they perceived to be the greatest in their community. Results are as follows: Top 3 Health Concerns: 1. Children 0-18 being killed by someone or getting shot 2. Liquor stores in the neighborhood 3. HIV/AIDS Areas of Additional Concern: Vacant buildings in the neighborhood Adults who are obese Adults dying too young (under 75 y.o.) from heart disease Adults smoking cigarettes Adults getting some physical exercise Babies dying before their first birthday Adults with high blood pressure taking their medicine regularly 28

29 V. Implementation Strategy The CHNA team evaluated results from surveys, community input sessions and public health experts recommendations to arrive at the top community health needs indicated by those sources. Additionally the CHNA team made an assessment of hospital resources, expertise and capacity to determine top health needs to be addressed by the implementation strategy. The team arrived at the decision to focus on the HEART DISEASE CLUSTER (including heart disease, diabetes and stroke) for the hospital s community health improvement project (CHIP) while continuing to address VIOLENCE (i.e. street violence) through existing community and Emergency Department-based programming. A. Prioritized Community Health Needs: Heart Disease Cluster and Violence 1. Heart Disease Cluster Survey respondents perceived heart disease as the leading cause of death and diabetes as the top health concern in their community; community feedback session participants prioritized heart disease as their community s #1 health need followed by diabetes. Due to the fact residents continually cited heart disease and diabetes as both deadly and concerning, and health improvement efforts to address one have a great impact on addressing the others, the CHNA team decided to develop a health improvement project to address and prevent the cluster of heart disease related conditions including diabetes, high blood pressure, stroke, obesity, etc. According to the American Diabetes Association, two out of three individuals with diabetes die from heart disease or stroke 12 ; therefore, the prevention and treatment of diabetes is a step towards reducing the incidence and mortality of cardiovascular disease and stroke. Community residents and stakeholders also highlighted a health priority of addressing the lack of healthy foods in our community. Reducing risk factors for cardiovascular disease such as poor diet, limited physical activity, etc. are important components of any cardiovascular health improvement plan and will be included in Sinai s CHIP. The chart below details justification for selecting heart disease as the focus for Sinai s CHIP, described in section D. Adoption of Implementation Strategy. Public Health Evidence CHNA Survey and Input Session Feedback Heart Disease Heart disease is the leading cause of death in Baltimore City (28.4 deaths per 10,000), in Southern Park Heights (32.2 deaths per 10,000) and in Pimlico/Arlington/Hilltop (34.7 deaths per 10,000). 33% of survey respondents (n = 307) selected heart disease as the top health cause that most people in their community die from, followed by cancer (24%), violence (17%), diabetes (12%) 12 American Diabetes Association,

30 Evidence of Health Disparities Existing Hospital Resources and Strengths Alignment with local, state and national health improvement goals and HIV/AIDS (5%). In community feedback sessions, participants consistently cited heart disease as both a top cause of death and top health concern. Health improvement ideas offered by participants frequently addressed risk factors for heart disease such as lack of access to healthy foods and a lack of safe places to walk/play. In Baltimore City, there is a racial disparity for age-adjusted coronary heart disease death rates per 100,000 population for Black residents per 100,000 population for White residents The Community Health Education Department (CHE) at LifeBridge Health has provided successful wellness, health promotion and disease prevention programming in the community for over 30 years. Community Health Education provides comprehensive health education lectures, behavior change programs, individualized coaching and counseling, prevention screenings and risk assessments. One of its screening programs began as a Women s Heart Screening program over ten years ago. Healthy Baltimore 2015 identified the promotion of heart health as a priority area. The plan seeks to decrease the rate of premature deaths from cardiovascular disease by 10% and increase the percent of adults with high blood pressure on medication by 10%. Risk factors for cardiovascular disease are also addressed in other priority areas such as: Be Tobacco Free, Redesign Communities to Prevent Obesity and Create Health Promoting Neighborhoods. Park Heights has been selected by BCHD as the target community for a pilot project around physical activity promotion. Baltimore City s rate of heart disease deaths per 100,000 population is compared to the state baseline of 194.0, the national baseline of and the Maryland SHIP 2014 Target of Violence In Park Heights, street violence is consistently cited as a significant safety and community concern so its emergence as a top health concern and top cause of death according to CHNA results is not surprising to those who live or work in Park Heights. Results of the survey and feedback received during in-person community sessions revealed violence as a significant problem facing the communities surrounding Sinai Hospital. For example, violence arose as the 3 rd leading cause of death according to perceptions of community survey respondents. Further support for selecting violence as a top health priority resulted from stakeholder and partner organization s input. For example, the Baltimore City Health Department s (BCHD) own community health needs assessment and community feedback prioritization identified Youth Under Age 18 Dying by Violence as the #1 health concern for Park Heights and surrounding communities. 30

31 In addition, the Park Heights Renaissance (PHR) and other community partners including Sinai Hospital responded to the community s concern over increasing violence by advocating for the implementation of a violence reduction program in Park Heights. In particular, PHR worked with BCHD and the Johns Hopkins Bloomberg School of Public Health to bring the Safe Streets program, a program modeled by Chicago s Cease Fire program, to Park Heights. The chart below details justification for selecting violence as a significant priority and one that will continue to be addressed through Sinai s Violence Intervention Program, described in section D. Adoption of Implementation Strategy. Public Health Evidence CHNA Survey and Input Session Feedback Evidence of Health Disparities Existing Hospital Resources and Strengths Alignment with local, state and national health improvement goals Violence Homicide is the fifth leading cause of death Southern Park Heights (4.8 deaths per 10,000) and in Pimlico/Arlington/Hilltop (5.9 deaths per 10,000). The overall Violent Crime Rate for Baltimore City is crimes per 100,000 population compared to neighboring Baltimore County at Violence arose as the 3 rd leading cause of death according to survey respondents. Violence also ranked 6 th as a top health concern. In community feedback sessions, participants consistently cited violence (described by residents as gunshots, trauma, murder, etc.) as both a top cause of death and top health concern. According to the Johns Hopkins Urban Health Institute, in Baltimore City, African Americans, Asians and Whites are twice as likely to die as a result of homicide compared to their racial/ethnic groups in other Maryland counties. Sinai Hospital recently launched a Violence Intervention Program (SVIP) to prevent recurrent street violence in Park Heights. Males aged who come to the hospital with injuries related to street violence work with a case worker to develop and follow an individualized service plan with the goal of interrupting the cycle of violence and redirecting those men towards a more productive and positive lifestyle. Sinai Hospital partners with Park Heights Renaissance to implement the Safe Streets program in Park Heights. Healthy Baltimore 2015 seeks to create health promoting neighborhoods. In order for environments to promote health, there must be safe places for children and adults to exercise and play. Park Heights has been selected by BCHD as the target community for a pilot project around creating safe places for physical activity. Healthy People 2020 addresses violence by outlining a goal to reduce the age-adjusted death rate due to homicide to 5.5 deaths /100,000 population. 31

32 B. Other Top Health Needs Not Selected for Intervention Sinai recognizes that not all identified community needs can be addressed and that difficult choices must be made to properly allocate limited resources to the areas of greatest need. Fortunately, the results of the community health needs assessment reveal that Sinai s services are already well aligned with the following prioritized community health needs that were not selected as the focus of the CHIP. a) Cancer Cancer is the second leading cause of death in Baltimore City, Southern Park Heights and Pimlico/Arlington/Hilltop. A quarter of all survey respondents (n = 307) selected cancer as the top health cause that most people in their community die from. In community feedback sessions, participants consistently cited cancer as both a top cause of death and top health concern. Participants frequently mentioned a desire for education and screenings for various types of cancer. The LifeBridge Health Alvin & Lois Lapidus Cancer Institute located at Sinai offers advanced specialized care in all areas of cancer diagnosis and treatment. Cancer treatment centers and programs address the following conditions: breast, gynecologic, hematologic, lung/thoracic, gastroenterologic and urologic cancers, as well as bone, soft tissue and endocrine tumors. In addition to diagnosis and treatment, the Institute provides supportive services and personal development and enrichment opportunities for patients undergoing cancer treatment. Integrated therapies designed to relieve anxiety and promote socialization include stress reduction techniques for patients and families, art workshops, writing workshops, and music and beading therapy classes. Programs such as the American Cancer Society s Look and Feel Better Program, which provides makeup demonstrations, skin care therapies and special products, are also available to patients. The Freedom to Screen program at Sinai s sister hospital Northwest Hospital in nearby Baltimore County provides community outreach, breast cancer education, screenings and exams, mammograms, and follow-up diagnostic procedures for lower-income, uninsured and under-insured women in both hospital s catchment areas (e.g. Baltimore County and City). The goal of the program is to provide women with the resources they need to increase breast cancer awareness and prevention. Additional assistance is offered to women who need help with patient navigation services. Patient navigators help women who have received a breast cancer diagnosis deal with their medical fears and develop a road to recovery. b) Drug/Alcohol Abuse The CHNA s finding that drug and alcohol abuse is a top community health need in Sinai s surrounding community is not a new concern. Sinai has been well aware of the rampant drug abuse and trade in Park Heights and in Baltimore City generally. Indeed, Sinai has endeavored to respond to this need through the services of Sinai s Addictions Recovery Program (SHARP), an outpatient substance abuse treatment program that has provided treatment services to opiate-addicted 32

33 patients for over 20 years. SHARP s mission is to serve the uninsured and under-insured individuals who are opioid-dependent in Baltimore City. SHARP currently has 354 treatment slots, allowing it to serve that many individuals at any one time. Through the program, medication assisted treatment utilizing methadone is provided to patients 18 years of age and older. SHARP is staffed by a multi-disciplinary team of addictions professionals including a psychiatrist, clinical manager, physician assistant, RN nurse coordinator, LPNs, social workers, professional counselors, addictions counselors, and ancillary support staff. SHARP uses a comprehensive model of treatment that combines methadone maintenance with comprehensive treatment services. Services include: individual, group and family counseling; substance abuse education for patients and families; primary medical care (assessment and referral) for uninsured patients until connected with a provider; fully integrated dual diagnosis services for patients with co-existing psychiatric disorders; on-site testing and counseling for HIV and sexually transmitted diseases; and linkages with adjunctive services as needed. c) HIV/AIDS HIV/AIDS is among the community s top health needs identified through the CHNA. This need is being addressed by current hospital programming both for primary and specialty medical care in the hospital s Infectious Disease Ambulatory Center (IDAC) and for psychosocial needs through our HIV Support Services. The IDAC serves HIV+ adults in a comprehensive medical setting with attention to patients primary medical care as well as specialty services for the HIV infection needs. The HIV Support Services began in 1989 and addresses the social and economic barriers that impair the health and well-being of individuals and families affected by HIV who seek medical services at Sinai. HIV Support Services is unique for typical HIV support or case management services in that it serves several groups simultaneously: women with children, women of childbearing age, pregnant women, infants, children, and youth, a growing number of women of menopausal/post-menopausal age, and men. Services are provided by Clinical Social Workers and Community Health Workers who use interventions that enhance access to care and facilitate integration of medical and psychosocial services. The overall goal is to improve HIV-positive persons health by enhancing access to and utilization of care, and enhancing emotional and social well-being through psychosocial support and counseling. By utilizing a comprehensive family-focused approach, the HIV Support Services in partnership with the IDAC s medical services provide continuity of care unparalleled at other local hospital sites. 33

34 C. Existing Resources & Partners to Support Implementation Strategy Consistent with the way Sinai works with community partners to provide community benefit services to its patients and community, the implementation of a heart disease-focused community health improvement project and the continuation of efforts to address violence will require substantial support and involvement from hospital-based and community partners. 1. Hospital-based Resources and Partners: The following hospital resources and partners will aid the CHNA team in addressing heart disease and violence in Park Heights. a. M. Peter Moser Community Initiatives Department The M. Peter Moser Community Initiatives Department has a long history of providing services to the residents of the Park Heights community. In 1989 hospital social work staff recognized the need to respond to those patients seeking medical care at Sinai for whom the social determinants (i.e. poverty, crime, substandard housing, etc.) with which they lived influenced their health status and outcomes, perhaps more than their family history or health behaviors. This led to an early focus of the department on resolving poverty-driven barriers to the use of medical care and to good health. The department focuses its support on low-income minority persons whose health or well-being is threatened by generational poverty and associated social, economic, and health disparities. Para-professional outreach staff work to connect women, men and youth with service providers in the hospital system, at the community level, and with a broader human service network. Participating families are screened for various medical and social conditions and barriers to care (e.g. HIV+ diagnosis, substance abuse, domestic violence, post-partum depression, etc.), receive referrals to community resources equipped to meet their specific needs, and given assistance as needed to access those services. The tools used education, support, and advocacy are effective because of the trust-based relationships that are developed between the clients and the Community Initiatives staff. b. Community Health Education at LifeBridge Health The Community Health Education Department (CHE) has provided successful wellness, health promotion and disease prevention programming in the community for over 30 years. Community Health Education provides comprehensive health education lectures, behavior change programs, individualized coaching and counseling, prevention screenings and risk assessments to a wide audience within communities surrounding Sinai, and the other LifeBridge hospitals. A majority of CHE outreach is targeted to underserved communities who may have limited/no health insurance and/or access to care. All programs are based on community-based needs assessments and feedback, best practices, evidence-based strategies and include a stringent follow-up component for individuals identified as being 34

35 at-risk. The Heart Health and Lifestyle Screening program enlists the services of other hospital expertise for in-depth follow-up including a Cardiologist who will survey the laboratory results of those demonstrating risk, and LifeBridge Health and Fitness for lifestyle change. The comprehensiveness of CHE programs, the high quality education that is provided, and the collaborative nature of the health education team place CHE as a leader in the area of health promotion and disease prevention programming; as well as in the areas of wellness, disease management, and health coaching. c. The Diabetes Resource Center at Sinai Hospital The Diabetes Resource Center links patients and community members with resources and tools to manage diabetes. The center s multidisciplinary team including a pharmacist, dietician, nurse educators, and patients physicians work together to formulate individualized plans for individuals diabetes management. Services available include personal assessments, individualized goal setting, blood glucose self-monitoring strategies, medication management techniques, education to help patients recognize, treat and minimize adverse health outcomes, and nutritional counseling. Group classes are also offered for patients to share and learn from peers with diabetes. d. Grandparent s Pediatric Obesity Program Sinai Hospital s Department of Pediatrics has partnered with the University of Maryland School of Public Health to implement an initiative to help grandparents positively influence the lives of their grandchildren. The partnership involves training Sinai pediatric residents to provide current, evidence-based guidance on nutrition and physical activity to grandparents caring for grandchildren. The program s goal is to increase healthy eating habits and improve physical activity patterns of families living in Park Heights. 2. Community-based Resources and Partners: The following public health and community-based organizations will aid in responses to address identified community health needs. a. Baltimore City Health Department The Baltimore City Health Department s Cross Agency Task Force (CAHT) will work with Sinai Hospital and other local partners to promote physical activity in Park Heights. Additional resources offered by BCHD may include but are not limited to virtual supermarkets to increase access to healthy foods, community health worker (CHW) training programs to increase community participation in health improvement strategies, and the Bmore Fit for Healthy Babies program that helps postpartum women reach a healthy weight. b. Zeta Center for Healthy and Active Aging The Zeta Center for Healthy and Aging will offer its community room and classrooms for health screenings and educational activities offered as part of 35

36 Sinai s CHIP. Sinai Hospital will work with existing programming offered at the center to recruit participants for the CHIP. In addition to reaching older adults, the CHIP team will engage with youth and families around cardiac health. c. Zeta Healthy Aging Partnership (Z-HAP) Z-HAP, a community/family engagement and self-empowerment program, partners with local health experts, including Sinai physicians, nurses, and health educators, to educate residents of Park Heights on topics such as heart disease, diabetes, stroke, healthy eating, etc. During Z-HAP Friday and other community events held at the Zeta Center, the CHIP team will recruit individuals to participate in the CHIP and/or to become health ambassadors in their community. d. Park Heights Community Health Alliance (PHCHA) PHCHA will assist with CHIP participant recruitment. Their healthy lifestyle resources and programming (e.g. Walk, Jog Run program, community garden, farmer s market) will be available to CHIP participants. The physical location will also be a potential site for health screenings and educational activities. e. Park Heights Renaissance (PHR) As the sponsor of Safe Streets and the Safe & Supportive Park Heights project, Park Heights Renaissance is an integral partner for violence prevention efforts at Sinai Hospital. f. Youth programs sponsored by local churches and organizations (e.g. Park Heights Saints Football Program) Collaboration with youth programs in Park Heights will connect health improvement efforts with the community s youth population and lead to family engagement around increasing physical activity, reducing youth violence, and improving overall heart health. g. Park Heights Family Support Center The Park Heights Family Support Center will be a site from which young adults are recruited for CHIP and educated about heart disease and healthy lifestyles. h. American Heart Association (AHA) Mommy & Me, a program offered by the American Heart Association in collaboration with PHCHA, provides nutrition education and cooking demonstrations. The Community Health Education Department also partnered with AHA in the past to provide educational programs related to heart disease. 36

37 D. Adoption of Implementation Strategy In order to address the identified health needs of the heart disease cluster and street violence, the CHNA team will implement the Cardiovascular Screening and Health Improvement Project and continue programming in the ED to address street violence. 1. Heart Disease Project The Cardiovascular Screening and Health Improvement Project will expand the services of the Community Health Education Department s Heart Health & Lifestyle Screening Program and offer health and lifestyle screenings and risk assessments in the community to identify at-risk patients/residents. Community residents who are uninsured/underinsured will be targeted for assessment and enrollment. Those assessed as at-risk who enroll in the project will receive follow-up services in order to improve their cardiac health and link them with resources related to disease management, healthy eating and physical activity. Each program participant will receive follow-up services for six months to one year depending on their individualized service plan. Specific follow-up activities will include: health education on topics related to heart health, nutrition, diabetes, etc. individualized counseling routine follow-up (e.g. phone calls and/or home visits) disease management healthy eating and lifestyle counseling routine evaluations for outcomes-based measurements (e.g. metabolic blood profile, cholesterol, glucose, blood pressure, body composition, etc.) Partnerships with the Baltimore City Health Department and community-based organizations focusing on health improvement (described above in Section C) will be essential in implementation and evaluation of the project. 2. Street Violence Project Sinai currently addresses street violence through a pilot program called the Sinai Violence Intervention Program (SVIP). The goal of the project is to interrupt the cycle of violence experienced by young males in Park Heights and redirect them to live more positive and productive lives. The program is staffed by a male youth outreach worker who responds to referrals from internal hospital units, primarily the Emergency Department. Males ages who arrive at the hospital with injuries sustained due to violence are referred to the outreach worker. The role of the outreach worker is to engage with the young men at bedside and assess their immediate needs. The worker and patient collaborate to develop a service plan for meeting identified needs. They may include legal referrals for expungement, employment assistance, counseling referrals or assistance finding replacements for idle time once devoted to harmful street activity. The worker follows up with the young men up until and after discharge depending on details of the service plan. 37

38 E. Motion to Approve Community Health Improvement Projects The following motion to implement the community health improvement projects described above was approved by the Community Mission Committee, a committee of the LifeBridge Board, on March 7, 2013, and by the Sinai Hospital and LifeBridge Health Boards on May 9, 2013 and May 23, 2013 respectively. Proof of presentation and approval of Sinai s CHIP are documented in Board Meeting Minutes. Approved Motion: As a result of the Community Health Needs Assessment (CHNA) performed, Sinai Hospital will implement a community health improvement project (CHIP) that will address identified priority health needs. This project will specifically address prevention and treatment of the heart disease cluster. In addition, violence prevention will be addressed through separate interventions in the hospital and in the community. 38

39 Appendix A: Community Health Needs Assessment Survey 39