Methodist Hospital of Sacramento Community Health Needs Assessment 2013 Community Benefit Implementation Plan

Transcription

1 Methodist Hospital of Sacramento 2013 Community Health Needs Assessment 2013 Community Benefit Implementation Plan

2 Table of Contents I Methodist Hospital of Sacramento Community Health Needs Assessment Summary: An assessment of the Hospital s Service Area in Sacramento County conducted jointly by Methodist Hospital of Sacramento, Valley Vision and Community Stakeholders Description of the Community Served by the Hospital 3 The Assessment Team 5 How the Assessment was Conducted 6 Health Needs Identified 10 Community Assets Identified 23 II. Methodist Hospital of Sacramento Implementation Strategy and Community Benefit Plan Summary Summary 24 Target Areas and Population 24 How the Implementation Strategy Was Developed 25 Major Needs and How Priorities Were Established 26 Description of What Methodist Hospital of Sacramento Will Do to Address Community Needs 27 Action Plans 28 Next Steps for Priorities 31 Priority Needs Not Being Addressed and the Reasons 31 Approval 32 Appendices Appendix A: List of Key Informants for Methodist Hospital of Sacramento CHNA Appendix B: Health Assets Table for Methodist Hospital of Sacramento Service Area Attachment: 2013 Methodist Hospital of Sacramento Community Needs Assessment 2

3 2013 Methodist Hospital of Sacramento Community Health Needs Assessment Summary: An Assessment of the Hospital s Service Area in Sacramento County conducted jointly by Methodist Hospital of Sacramento, Valley Vision and Community Stakeholders Beginning in early 2012 through February 2013 an assessment of the health needs of residents living in the service area of Methodist Hospital of Sacramento, a member of Dignity Health, was completed by the Hospital, Valley Vision, Inc., and community stakeholders. Situated in south Sacramento County, Methodist Hospital serves over half a million highly diverse residents residing in urban and suburban communities, including those of Elk Grove and Laguna, as well as outlying small rural towns of Wilton and Galt. A portion of the Hospital s primary service area, known as the Fruitridge area, is designated a Medically Underserved Area (MUA). Description of Community Served by the Hospital Defining the Hospital Service Area (HSA). Methodist Hospital of Sacramento s service area was determined by analyzing patient discharge data. Dignity Health hospitals define communities, or primary service areas, as the geographic areas which they serve. The HSA is based on a percentage of hospital discharges and is also used in various other departments of the system and hospital, including strategy and planning. The HSA identified for the focus of the needs assessment is depicted in the map below: Map of Methodist Hospital of Sacramento service area 3

4 Description of the Community. The south Sacramento community struggles with the lack of access to safety net health services. The region s safety net is characterized as having a fragmented group of small and financially fragile community health centers that together offer limited outpatient capacity. 1 A recent market analysis commissioned by Sierra Health Foundation identified critical issues impacting the region s safety net performance and sustainability, including: 1. The primary care capacity of community health centers and emergency departments to treat the safety net population has grown, but without further efforts will likely reach capacity prior to Currently, the safety net is overly dependent on expensive hospitals, and emergency departments (EDs), in particular, to provide outpatient care. 3. The number of community health centers in the Sacramento region has grown over the past few years, but falls significantly short of many other similar-sized regions in California. 4. Roughly half of the region s community health centers are financially challenged. Expenses consistently exceed revenues. 5. The region continues to struggle to respond to unmet needs for physical and mental health care for its underserved residents who are reflecting a growing level of chronic disease, including asthma, diabetes and high blood pressure, and are more at risk due to factors that include obesity and smoking. 2 As Health Reform approaches, it is imperative that initiatives in the Sacramento community come to fruition through collaboration to address the many vulnerabilities and inadequacies of the safety net. Community Demographics Methodist Hospital s primary service area encompasses a major portion of south Sacramento County. The Hospital s primary service area is comprised of 12 zip codes (95624, 95632, 95758, 95820, 95822, 95823, 95824, 95826, 95828, 95829, 95831, and 95832). Demographics within this area are as follows: Population: 564,968 o Under 18 = 28.4% o = 24.9% o = 36.9% o 65+ = 9.9% 1 California Healthcare Foundation, Sacramento Powerful Health Systems Dominate a Stable Market. 2 Sierra Health Foundation Regional Health Care Partnership Market Analysis, January

5 Diversity: o Caucasian: 30.7% o Hispanic: 26.9% o Asian: 24.2% o African American: 12.8% o American Indian/Alaska Native & Other: 5.4% Average Income: $69,487 Uninsured: 19.42% Unemployment: 7.6% No High School Diploma: 19.6% Medicaid Patients: 17.25% The Assessment Team The Community Health Needs Assessment (CHNA) was conducted through a participatory team process led by community benefit staff of Methodist Hospital of Sacramento, and Valley Vision, Inc., a community service organization dedicated to improving quality of life in the greater Sierra, Sacramento, and San Joaquin regions. Valley Vision ( is a nonprofit 501(c)(3) research and consulting firm serving a broad range of communities across Northern California. The organization s mission is to improve quality of life through the delivery of high-quality research on important topics such as healthcare, economic development, and sustainable environmental practices. Using a community-based participatory orientation to research, Valley Vision has conducted multiple CHNAs across an array of communities for over seven years. A team of experts from multiple sectors within the Hospital s service area was assembled to conduct the assessment, including: 1) a local public health expert with over a decade of experience in conducting CHNAs; 2) a geographer with expertise in using GIS technology to map health-related characteristics of populations across large geographic areas, and 3) local public health practitioners and consultants to collect and analyze data. Community-Based Participatory Research Approach. The assessment followed a community-based participatory research approach for identification and verification of results at every stage of the assessment. This orientation built capacity and enabled beneficial change within the Hospital CHNA workgroup, and the community members for which the assessment was conducted. Including participants in the process allowed for a deeper understanding of the results. CHNA Workgroup. The CHNA workgroup, comprised of Hospital community benefit representatives, other health systems, and Sierra Health Foundation, was an active contributor to the CHNA process. Using the community-based participatory research approach, monthly meetings were held with the workgroup at each critical stage in the assessment process. 5

6 In addition, data was collected from over 70 attendees at multiple Healthy Sacramento Coalition meetings over a nine-month period, allowing for identification of potential data sources, key informants, and focus groups. This data, combined with demographical data, informed the location and selection of key informants that participated in the assessment. Key informants included health and community experts such as the Sacramento County Public Health Officer, the Sacramento City Unified School District Chief Family and Community Engagement Center Officer, and physicians and leaders of community health and social service organizations. How the Assessment was Conducted Health Need and Objectives of the Assessment. The CHNA was anchored and guided by the following objective: In order to provide necessary information for the Methodist Hospital of Sacramento community health improvement plan, identify communities and specific groups within these communities experiencing health disparities, especially as these disparities relate to chronic disease, and further identify contributing factors that create both barriers and opportunities for these populations to live healthier lives. The World Health Organization defines health needs as objectively determined deficiencies in health that require health care, from promotion to palliation. Building from this, the CHNA used the following definitions for health need and driver: Health Need: A poor health outcome and its associated driver. Health Driver: A behavioral, environmental, and/or clinical factor, as well as more upstream social economic factors that impact health Methodology. The assessment used a mixed methods data collection approach that included primary data such as key informant interviews, community focus groups, and a community assets assessment. Secondary data included health outcomes, demographic data, behavioral data, and environmental data. Unit of Analysis and Study Area. The study area of the assessment included Methodist Hospital of Sacramento s service area. A key focus was to show specific communities (defined geographically) experiencing disparities as they related to chronic disease and mental health. To this end, zip code boundaries were selected as the unit-of-analysis for most indicators. This level of analysis allowed for examination of health outcomes at the community level that are often hidden when data are aggregated at the county level. Some indicators (demographic, behavioral, and environmental in nature) were included in the assessment at the census tract, census block, or point prevalence level, which allowed for deeper community level examination. 6

7 Selection of Data Criteria. Criteria were established to help identify and determine all data to be included for the study. Data were included only if they met the following standards: All data were to be sourced from credible and reputable sources Data must be consistently collected and organized in the same way to allow for future trending Data must be available at the zip code level or smaller County, state, and Healthy People 2020 targets (when available) were used as benchmarks to determine severity. All rates are reported per 10,000 of population. Health outcome indicator data were adjusted using Empirical Bayes Smoothing, where possible, to increase the stability of estimates by reducing the impact of the small number problem. To provide relative comparison across zip codes, rates of Emergency Department (ED) visits and hospitalization for heart disease, diabetes, hypertension, and stroke were age adjusted to reduce the influence of age. Primary Data - The Community Voice. Primary data collection included qualitative data gathered in four ways: Input from the Dignity Health community benefit team Key informant interviews with area health and community experts Focus groups with area community members Community health asset collection via phone interviews and website analyses Key Informants. Key informants are health and community experts familiar with populations and geographic areas residing within the Methodist Hospital of Sacramento s service area. To gain a deeper understanding of the health issues pertaining to chronic disease and populations living in more vulnerable communities, 25 key informants participated in the CHNA process. Interviews were conducted with these informants using a theoretically grounded interview guide. Each interview was recorded and content analysis was conducted to identify key themes and important points pertaining to each HSA geographic area. Findings from these interviews were also used to help identify communities most appropriate for focus groups. (See Appendix A for a list of key informants, including professional title, and description of their knowledge and expertise). Focus Groups. Members of the community representing subgroups, defined as groups with unique attributes (race and ethnicity, age, sex, culture, lifestyle, or residents of a particular area of the HSA), were recruited to participate in a focus group. A standard protocol was used for the focus group to understand the experiences of these community members as they relate to health disparities and chronic disease. In all, a total of five focus groups were conducted. Content analysis was performed on the focus group interview notes to identify salient health issues affecting these community residents. Secondary Quantitative Data. Secondary quantitative data used in the assessment are listed below in Tables 1 and 2. 7

8 Table 1: Health outcome data used in the CHNA reported as ED visits, hospitalization, and mortality. ED and Hospitalization Mortality Accidents Hypertension* All-Cause Mortality* Infant Mortality Asthma Mental Health Alzheimer s Disease Injuries Assault Substance Abuse Cancer Life Expectancy Cancer Stroke* Chronic Lower Respiratory Disease Liver Disease Chronic Obstructive Pulmonary Disease Unintentional Injuries Diabetes Renal Disease Diabetes* Self-inflicted injury Heart Disease Stroke Heart Disease* Hypertension Suicide *Age adjusted by 2010 California standard population Table 2: Socio-demographic, behavioral, and environmental data profiles used in the CHNA Socio-Demographic Total Population Limited English Proficiency Family Make-up Percent Uninsured Poverty Level Percent over 25 with No Nigh School Diploma Age Percent Unemployed Race/Ethnicity Percent Renting Behavioral and Environmental Profiles Safety Profile Food Environment Profile Major Crime Percent Obese/Percent Overweight Assault Fruit and Vegetable Consumption Unintentional Injury ( 5/day) Fatal Traffic Accidents Farmers Markets Accidents Food Deserts Modified Retail Food Environment Active Living Profile Park Access Index (mrfei) Physical Wellbeing Profile Age-adjusted Overall Mortality Life Expectancy Infant Mortality Health Care Professional Shortage Areas Health Assets Data Analysis - Identifying Vulnerable Communities. The first step in the process was to examine socio-demographics in order to identify areas of the HSA with high vulnerability to chronic disease disparities and poor mental health outcomes. Race/ethnicity, household make-up, income, and age variables were combined into a vulnerability index that described the level of vulnerability of each census tract. This index was then mapped for the entire HSA. A tract was considered more vulnerable, or more likely to have higher unwanted health outcomes than others, in the HSA if it had higher: 1) percent Hispanic or non-white population; 2) percent single parent headed households; 3) percent below 125% of the poverty level; 4) percent under 8

9 five years old; and 5) percent 65 years of age or older living in the census tract. This information was used in combination with input from the CHNA workgroup to identify prioritized areas for which key informants would be sought. The vulnerability index for the HSA is shown below. Methodist Hospital of Sacramento service area map of vulnerability Where to Focus Community Member Input? Focus Group Selection. The selection for the focus group was determined by feedback from key informants and analysis of health outcome indicators (ED visits, hospitalization, and mortality rates). Key informants were asked to identify populations that were most at risk for health disparities and mental health issues. In addition, analysis of health outcome indicators by zip code, race and ethnicity, age, and sex, revealed communities with high rates that exceeded established benchmarks of the state and county, as well as Healthy People 2020 targets. This information was compiled to determine the location of focus groups within the HSA. Identifying Communities of Concern : the First step in Prioritizing Area Health Needs. To identify Communities of Concern, primary data from key informant interviews, detailed analysis of secondary data, health outcome indicators, and socio-demographics were examined. 9

10 Zip code communities with rates that exceeded county, state, or Healthy People 2020 benchmarks for ED utilization, hospitalization, or mortality were considered. The health outcome data analysis was triangulated with primary data and socio-demographic data to identify specific Communities of Concern. What is the Health Profile for Communities of Concern? What are the Prioritized Health Needs of the Area? Data on socio-demographics of residents living in these communities, which included socio-economic status, race and ethnicity, educational attainment, housing status, employment status, and health insurance status, were examined. Area health needs were determined via in depth analysis of qualitative and quantitative data, and then confirmed by socio-demographic data. As noted earlier, a health need was defined as a poor health outcome and its associated driver. A health need was included as a priority if it was represented by rates worse than the established quantitative benchmarks or was consistently mentioned in the qualitative data. Health Needs Identified Analysis of data revealed six Communities of Concern listed in Table 3. Table 3: Identified Communities of Concern for Methodist Hospital HSA. Communities of Concern Zip Code Community/Area County Population* Tahoe Park Sacramento 36, Executive Airport/Meadowview Sacramento 42, Fruitridge Sacramento 73, Parkway Sacramento 30, Florin Sacramento 57, Lower Meadowview Sacramento 11,924 Total Communities of Concern Population 253,054 (*Source: 2010 Census data) The six Communities of Concern are home to more than 250,000 county residents. The areas consist of zip codes occupying the central and southern portions of the Sacramento County area. All of the zip code communities are very densely populated with the Fruitridge area having the highest population compared to the Meadowview area with the lowest. Socio-demographic Profile of Communities of Concern. These six zip codes are home to more than 250,000 residents. Data indicated that these areas of the HSA were highly diverse, with numerous areas characterized by high rates of poverty, low educational attainment, unemployment, uninsured, and residents renting their homes. All six zip codes had rates of at least 73% of residents reporting to be either non-white or Hispanic. The percent of residents over the age of five with limited English proficiency (LEP) ranged from 9% in zip code to 18.1% in

11 All of the Communities of Concern had a percent of poverty far exceeding the national benchmarks. Five zip codes had a higher percent of single female-headed households living in poverty than the national average of 31.2%. Two of the Communities of Concern had a higher percent of residents over age 65 living in poverty compared to the national benchmark, and in five of the six zip codes the percent of families with children living in poverty was higher than the national average of 15.1%. All of the area zip codes had a higher percent of residents over the age of 25 living without a high school diploma. All of the zip codes had a higher rate of unemployment compared to the national rate, and all had a much higher percent uninsured compared to the national rate of 16.3%. Looking at the percentage of residents in a zip code who rent versus own their place of residence provides a peak into a community s health and financial stability. The percent of residents who rent in the 10 HSA Communities of Concern ranged from 30% (95828) to 56% (95824). Table 4: Socio-demographic characteristics for Methodist Hospital Communities of Concern compared to national and state benchmarks. % Households in poverty over 65 headed % Families in poverty w/ kids % Families in poverty female headed % over 25 with no high school diploma % Non-White or Hispanic % pop over age 5 with limited Eng % Unemployed % No health insurance % Residents Renting CA State National (Source: Dignity Health Community Benefit, CNI Data, 2011) Priority Health Needs. The health needs identified through analysis of both quantitative and qualitative data are listed below. These were prioritized according to the degree of support in the findings. All needs are noted as a health driver, or a condition or situation that contributed to a poor health outcome. Health outcome results follow the list below: Safety as a health issue Stress of living in poverty Lack of access to primary health care services Lack of access to healthy food Lack of access to mental health treatment and prevention services Lack of alcohol/drug abuse treatment programs and prevention programs Unhealthy food environment 11

12 Limited opportunities for physical activity engagement Lack of access to health prevention programs and screening Lack of access to dental screenings and dental care services Health Outcomes - Diabetes, Heart Disease, Stroke, and Hypertension. Diabetes, heart disease, stroke, and hypertension were consistently mentioned in the qualitative data as priority health concerns for many area residents. Examination of mortality, ED visits, and hospitalization showed rates in these zip codes were drastically higher than the established benchmarks. Table 1: Mortality, ED visit, and hospitalization rates for diabetes compared to state, county, and Healthy People 2020 benchmarks (rates per 10,000 population). Zip Code Mortality ED Visits Hospitalization Diabetes Sacramento County CA State Healthy People (Sources: Mortality, CDPH, 2010; ED Visits and hospitalizations, OSHPD, 2011) All six zip codes had higher rates of ED visits and hospitalization related to diabetes than both the county and state benchmarks. Examination of diabetes rates by zip code and race and ethnicity revealed that Blacks consistently had rates drastically higher than any other subgroup, and rates were as high as two times the state and county rate (consider zip code at visits per 10,000). Community of Concern zip code had an ED visit rate for Blacks twice that of the county rate. This was followed by Whites with the second highest rates for the zip code. The disparate pattern was similar for rates of hospitalization due to diabetes. Table 2: Mortality, ED visit, and hospitalization rates for heart disease compared to state, county, and Healthy People 2020 benchmarks (rates per 10,000 population). Zip Code Mortality ED Visits Hospitalization Heart Disease Sacramento County CA State Healthy People (Sources: Mortality, CDPH, 2010; ED Visits and hospitalizations, OSHPD, 2011) 12

13 All zip codes had mortality rates above the Healthy People 2020 benchmark, as well as ED visit and hospitalization rates related to heart disease above the county and state benchmarks. Examination of ED visits and hospitalization by race and ethnicity revealed that Whites and Blacks, respectively, consistently had the highest rates compared to the other racial and ethnic groups. Table 3: Mortality, ED visit, and hospitalization rates for stroke compared to state and county, and Healthy People 2020 benchmarks (rates per 10,000 of population). Zip Code Mortality ED Visits Hospitalization Stroke Sacramento County CA State Healthy People (Sources: Mortality, CDPH, 2010; ED Visits and hospitalizations, OSHPD, 2011) Similar to heart disease, all Communities of Concern had mortality rates above the Healthy People 2020 benchmark, with the highest in zip code 95822, with 7.8 deaths per 10,000. This rate is more than twice the established benchmarks. In addition, the majority of zip codes had stroke-related ED visit and hospitalization rates above the benchmarks. Blacks had higher rates of stroke- related ED visits compared to any other subgroup, while Whites had higher rates of hospitalization. Table 4: ED visit and hospitalization rates for hypertension compared to state and county benchmarks (rates per 10,000 population). Zip Code ED Visits Hospitalization Hypertension Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) All Communities of Concern had higher ED visits and hospitalization related to hypertension clearly above the county and state benchmarks. Zip codes and had a rate more than two times the state rate. Rates were highest in Blacks, followed by Whites. What is specifically noteworthy is that the rates for these outcomes in Blacks and Whites were two to three times higher compared to Native Americans, Hispanics, Asians/Pacific Islanders, and Others. 13

14 Mental Health, Substance Abuse and Self-Inflicted Injury. Area experts and community members consistently reported the immense struggle HSA residents had in maintaining positive mental health and accessing treatment for mental illness. Such struggles ranged from overall daily coping in the midst of personal and financial pressures to the management of severe mental illness requiring in-patient care. Table 9 provides data on ED visits and hospitalization related to mental illness. Table 5: ED visits and hospitalization due to mental health issues compared to specific county and state benchmarks (rates per 10,000 population). Zip Code ED Visits Hospitalization Mental Health (overall) Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) All Communities of Concern had ED visit and hospitalization rates due to mental health illness clearly above the state benchmark. The rate in zip was two-and-half times the state benchmark for ED visits, and more than one-and-a-half times the state benchmark for hospitalization. Whites, followed by Blacks, had the highest rates for both ED visits and hospitalization related to mental health compared to all other races or ethnic groups. The rate of ED visits related to mental health illness in was visits per 10,000 for Whites (three times higher than the county rate and seven times higher than the state rate), compared to Blacks with visits per 10,000, Hispanics with visits per 10,000, Asians and Pacific Islanders with 78.3 visits per 10,000, and Native Americans with visits per 10,000. Key informants and focus group participants in the area stressed that living in poverty and perceptions of being unsafe often make it difficult to live healthy lives. One key informant described the living experience of many residents as, they are just in that environment where it s like constant crisis and when you are living in violence like that, you re in a state of crisis. And when you don t have enough money, you are in a state of crisis (KI_Sacramento_26). Another key informant described the struggle residents face in staying healthy as an issue of the generational continuation of stress, stating, I think there is this, I like to call it inherent trauma, that we haven t addressed a lot with our community, especially our communities of poverty (KI_Sacramento_11). Many focus group participants and key informants expressed that mental health services are difficult to access within the HSA. Key informants explained, Something really bad has to happen before you can get any mental health treatment, and that is very scary for everyone (KI_Sacramento_19) and A lot of mental health services that were available to our clients are gone now (KI_Sacramento_19). 14

15 As Table 10 shows, rates of substance abuse-related ED visits and hospitalization were clearly elevated in the Communities of Concern. Zip code had a rate for ED visits that was almost three times the state rate. Again, Blacks, followed by Whites, had the highest rates of ED visits and hospitalization related to substance abuse compared to other race/ethnic groups. A local key informant also pointed to substance abuse as a common coping mechanism for some area residents and stated, I think people tend to self-medicate and I have seen that a lot of times [here]. (KI_Sacramento_19). Table 6: ED visits and hospitalization due to substance abuse issues compared to specific county and state rates (rates listed per 10,000). Zip Code ED Visits Hospitalization Mental Health Substance Abuse Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) Mortality rates for suicide and ED visit and hospitalization rates for self-inflicted injury are displayed in Table 11 below. Except for zip code 95832, all Communities of Concern had suicide mortality rates above the Healthy People 2020 benchmark, and two of the four areas were at or above state and county rates. Rates of ED visits for self-inflicted injury were also clearly above the state rate, with zip code having the highest rate at 20.6 visits per 10,000. Table 7: Mortality, ED visits and hospitalization due to self-inflicted injury compared to specific county and state rates (rates listed per 10,000). Zip Code Suicide ED Visits Hospitalization Suicide/Self Inflicted Injury* Sacramento County CA State Healthy People (Sources: Mortality, CDPH, 2010; ED Visits and hospitalizations, OSHPD, 2011) Respiratory Illness-Chronic Obstructive Pulmonary Disease (COPD) and Asthma. Community residents and health professionals mentioned Chronic Obstructive Pulmonary Disease (COPD) and asthma as conditions that impact many community members. In an effort to understand the impact of tobacco use and respiratory illness in the Communities of Concern, rates of ED visits and hospitalization related to COPD, asthma, and bronchitis were examined 15

16 and are displayed in Table 12. Rates of ED visits and hospitalization due specifically to asthma are examined independently in Table 13. Table 8: ED Visits and Hospitalization due to COPD (rates listed per 10,000) compared to specific county and state rates. Zip Code ED Visits Hospitalization COPD, Asthma, and Bronchitis Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) All Communities of Concern had rates above the county and state benchmarks, with the highest rates for ED visits occurring in Blacks, followed by Whites. Zip Code showed a rate in Blacks of visits per 10,000 compared to Whites with visits per 10,000. Hospitalization rates related to COPD were also highest in Blacks, followed by Whites. Many community members and health professionals mentioned asthma as a health condition that greatly affected area residents. Rates of asthma-related ED visits and hospitalization are detailed below in Table 13. Table 9: ED Visits and Hospitalization due to Asthma (rates listed per 10,000) compared to specific county and state rates. Zip Code ED Visits Hospitalization Asthma Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) Rates of ED visits and hospitalization related to asthma were consistently high in the Communities of Concern. All of the rates were more than twice the state rate. Blacks had the highest rates of all racial and ethnic groups, with a rate of ED visits virtually twice that of Whites. For example, zip code had a rate of visits per 10,000 for ED visits due to asthma compared to visits per 10,000 for Whites in the same zip code. However, in the Communities of Concern, Blacks and Whites had similar hospitalization rates for asthma. 16

17 Behavioral and Environmental - Safety Profile. Local experts and community members stressed the impact of safety on the health of the area residents living in the various Communities of Concern. Examination of safety indicators included looking at local law enforcement data for the greater Sacramento region as reported by Sacramento Police Department and the Sacramento County Sheriff s Department. In addition, outcome safety indicators of ED visits and hospitalization due to assault and unintentional injury were examined. Crime Rates. The following map shows major crimes by municipality as reported by various jurisdictions. Darker colored areas denote higher rates of major crime, including homicide, forcible rape, robbery, aggravated assault, burglary, motor vehicle theft, larceny, and arson. The majority of all HSA Communities of Concern are located in the City of Sacramento, which has a major crimes rate of crimes per 10,000 residents. The Communities of Concern also have portions of their geographical area in Sacramento County, with a crime rate of 316 crimes per 10,000 residents. Major crimes by municipality as reported by California Attorney General s Office, 2010 Assault and Unintentional Injury. All of the Communities of Concern had rates of ED visits and hospitalization that clearly exceeded the county and state benchmarks. As Table 14 indicates, two zip codes had rates for ED visits more than twice the county rate, and had 17

18 the highest rate in the HSA with 85.5 visits per 10,000. This zip code also had the highest rate of hospitalization for assault in the HSA, at almost five times the county benchmark. Table 14: ED visits and hospitalization rates due to assault compared to county and state benchmarks (rates per 10,000 population). Zip Code ED Visits Hospitalization Assault Sacramento County CA State (Sources: ED Visits and hospitalizations, OSHPD, 2011) Unintentional Injury. As the fifth leading cause of death in the nation and the first leading cause of death in those under the age of 35, examining rates of unintentional injuries was important. As Table 15 displays, all HSA zip codes were clearly above the state benchmarks for mortality, ED visit, and hospitalization rates. Two areas also exceeded the county and Healthy People 2020 benchmarks. The rates of ED visits and hospitalization due to unintentional injuries were elevated for many of the Communities of Concern. Table 10: ED Visits and Hospitalization due to Unintentional Injury (rates listed per 10,000) compared to specific county and state rates. Zip Code Mortality ED Visits Hospitalization Unintentional Injury Sacramento County CA State Healthy People (Sources: Mortality; CDPH. 2010; ED Visits and hospitalizations: OSHPD, 2011) Fatality/Traffic Accidents. The following map examines traffic accidents that resulted in a fatality and Table 16 shows bicycle accidents and accidents involving a motor vehicle versus a pedestrian or bicyclist. Accidents resulting in a fatality, especially those in city streets, contribute to the perception of safety area residents feel when traveling through their community, particularly for area residents that rely on public, pedestrian, and/or bicycle travel. Both area experts and community members in the HSA stated that access to services and care is largely dependent on adequate transportation and many residents access services by walking, biking, or taking local, sporadically available public transportation. As one key informant stated, The way 18

19 the[se] suburbs are built, they are so dependent on somebody having a car (KI_Sacramento_5). Traffic accidents resulting in fatalities as reported by the National Highway Transportation Safety Administration, 2010 Table 11: ED Visits and Hospitalization due to Accidents (rates listed per 10,000) compared to specific county and state rates. Zip Code ED Visits Hospitalization Accidents (Bike and Bike/Pedestrian versus Car) Sacramento County CA State (Sources: ED Visits and hospitalizations: OSHPD, 2011) 19

20 Traffic accidents resulting in a fatality are noted only for the HSA and those beyond the HSA boundaries are not displayed in the map above. Communities of Concern zip codes and had more fatalities due to traffic accidents than any other zip code in the HSA. Examination of ED visit and hospitalization rates related to bicycle accidents and accidents involving motor vehicles versus bicycles or pedestrians showed zip codes 95817, 95820, and had the highest rates in the HSA. The concern over pedestrian safety was mentioned consistently in the qualitative data, as many residents used walking or biking as a primary mode of transportation. Concerns ranged from safety due to fast-moving traffic to concerns about violence. One key informant stated, in the Valley-Hi community, you have this big dense area of apartment complexes along this incredibly fast road and there s been a lot of accidents, people getting hit, people fearing for their lives there is like no crosswalk for miles (KI_Sacramento_26). Another informant said, I know two people that have gotten killed and they were elderly; or, they just do their daily strolls and they have gotten hit (KI_Sacramento_8). In addition, another key informant stated that for many residents, access to area services was also a concern. Participants stressed that transportation services in the area need improvement, Transportation needs to be improved because there is no point having a clinic that nobody can get to unless they have a car (KI_Sacramento_5). Food Environment. An examination of the food environment in the Communities of Concern showed that approximately 20% of residents in every zip code are obese and approximately 28% of residents are overweight. In every zip code more than 50% of residents reported not eating at least five servings of fruits or vegetables daily (5-a-day) as recommended by the state. Four of the six zip codes have federally designated food desert tracts located within their boundaries. Such tracts are designated by the federal government as census tracts in which at least 500 people and/or 33% of the population live more than one mile (10 miles in rural areas) from a supermarket or large grocery store. Only one certified farmers market is located within the Communities of Concern. Table 12: Percent obese, overweight, and percent eating at least five fruits and vegetables daily with presence (x) or absence (-) of federally defined food deserts and number of certified farmers markets by zip code. Food Environment Zip Code % Obese % Overweight % no 5-a-day Food Desert # of Farmers Markets X X X X 0 CA State (Sources: % Obese & overweight, fruit & vegetable consumption: Healthy City at ; Food deserts: Kaiser Permanente CHNA Data Platform/US Dept. of Agriculture, 2011; Farmers markets: California Federation of Certified Farmers Markets, 2012) 20

21 Retail food. The data displayed below provides information about the availability of health foods in the HSA. The map shows the modified Retail Food Environment Index (mrfei), which is the proportion of healthy food outlets to all available food outlets by census tract. Lighter areas indicate greater access to health foods and the darkest areas indicate no access to healthy foods. Modified Retail Food Environment Index (mrfei) by census tracts for HSA The above data indicated that most of the Communities of Concern contain census tracts with poor or fair access to healthy foods, specifically the zip codes of 95817, 95820, and Key informants and community members also mentioned a lack of access to healthy foods in these areas. As one key informant said, I think lower income means less access to everything including healthy food, so a lot of people are overweight, obese, heart disease, all those things (KI_Sacramento_17). As mentioned previously, the Communities of Concern have a high percentage of residents living in poverty, making access to healthy food challenging. As one key informant explained, so if you have this choice between a dollar burger that has no nutrition and tons of calories and two pieces of fruit, what are you [going to] choose to feed your family? (KI_Sacramento_26). Access to grocery stores in the area can be challenging for some residents. One key informant stated, So, even if you wanted to get to a good grocery store, 21

22 transportation, particularly in South Sacramento, is terrible. It s absolutely terrible and it is expensive (KI_Sacramento_26). All these issues serve as barriers for area residents trying to eat healthy foods. Expressed very simply, We should work at making the healthy choice the easy choice (KI_Sacramento_5). Active Living. One of the largest barriers to engagement in physical activity is access to a recreational area. The following map profiles the percent of the population in census tracts within the Communities of Concern that live within one-half mile of a recreational park. Percent population living in census tract within one-half mile of park space (per 10,000) Zip codes 95832, 95823, 95824, 95660, and had multiple census tracts with a low percentage of people living within one-half mile of a park. Specifically, more than half of the area within Zip code has no access to a park. While the availability of places to engage in physical activity was important to note, this assessment found that it was also critical to explore the perceived comfort and safety residents felt while using these parks. Area residents consistently expressed pronounced concerns over safety in their community parks. As one key informant stated, Are there parks in South Sacramento? There are. But people don t really frequent them because there [are] either fights or folks just hanging out [there] (KI_Sacramento_26). Physical Wellbeing. Age-adjusted all-cause mortality rates are a major indicator of the health of a community. Zip code had the highest age-adjusted overall mortality rate in the HSA with 81.5 deaths per 10,000. More residents died annually in this zip code due to all-causes 22

23 than any other zip code in the HSA. Life expectancy data showed that zip code had a lower life expectancy at birth than the county and state benchmarks. Infant mortality is a leading health status indicator of a community. Zip code had the highest rate of infant mortality in HSA with a rate of 6.6 deaths per 1,000 live births. This is well above the county rate of 5.8 deaths per 1,000, the state rate of 5.2 deaths per 1,000, and the Healthy People 2020 target of 6.0 deaths per 1,000. Zip code also had a high rate at 6.4 deaths per 1,000 live births. Table 13: Age adjusted all-cause mortality, life expectancy at birth and infant mortality. Age Adjusted Zip Code All-Cause Life expectancy Infant Mortality Mortality Sacramento County CA State National (Sources: 2010 CDPH and 2010 Census data; rates calculated) Community Assets Identified Communities require resources in order to maintain and improve their health. These include health related assets, including health care professionals and community-based nonprofit organizations. An assessment of these resources revealed nearly 40 assets that provide opportunities for partnership within Methodist Hospital s service area to address some of the health needs identified in this report. A full listing of health assets can be found in Appendix B. 23

24 Methodist Hospital of Sacramento Implementation Strategy and Community Benefit Plan Summary for FY Methodist Hospital of Sacramento has been meeting the health needs of residents in south Sacramento County for decades. Opening in 1973, after a decade-long effort to expand health care services for residents in the south area of the region, the Hospital is located at 7500 Hospital Drive, in Sacramento, With 1,133 employees, 162 licensed acute care beds, and 29 Emergency Department (ED) beds, the hospital offers a full range of inpatient and outpatient medical services. The Hospital is well known for specialty care such as a state-of-the-art Family Birth Center, where over 1,300 babies are born each year. As part of the hospital s Women s and Children s services, a Level II NICU is a specialized unit, equipped with the latest technologically advanced equipment and around-the-clock care. An Orthopedic Center delivers leading-edge inpatient and outpatient orthopedic services with innovative technology and high quality patient care, and the Hospital has been designated as a Blue Distinction Center for Knee and Hip Replacement by Blue Shield of California. The Hospital s Family Practice Residency Program, established in 1995, has received the highest level of residency accreditation and is nationally recognized for excellence in training, quality of residents and patient care. The program features an ethnically and culturally diverse faculty, resident and patient population. Through its mission, Methodist Hospital is committed to furthering the healing ministry of Jesus, dedicating resources to: delivering compassionate, high-quality, affordable health services; serving and advocating for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life. The Hospital carries out this mission daily by striving to address the needs of a region. This report summarizes the plans for Methodist Hospital to sustain and build upon community benefit programs that address priority health needs identified in the 2013 Community Health Needs Assessment (CHNA), and to engage with the community in developing new offerings that respond to needed care and services. Target Areas and Populations As outlined in the summary assessment, the 2013 CHNA identified six zip codes within Methodist Hospital s service area as Communities of Concern. More than 250,000 county residents live within these communities. The areas consist of zip codes occupying the central and southern portions of the Sacramento County area. All of the zip code communities are very densely populated, with the Fruitridge area, which is designated an MUA, having the highest population. The six Communities of Concern are characterized by high rates of poverty, low educational attainment, unemployment, lack of health insurance, and a higher number of 24

25 residents renting versus owning homes. All six zip codes had rates of at least 73% of residents reporting to be either non-white or Hispanic. Five Community of Concern zip codes had a higher percent of single female-headed households living in poverty than the national average of 31.2%. Two of the Communities of Concern had a higher percent of residents over age 65 living in poverty compared to the national benchmark, and in five of the six zip codes, the percent of families with children living in poverty was higher than the national average of 15.1%. All of the area zip codes had a higher percent of residents over the age of 25 living without a high school diploma. All of the zip codes had a higher rate of unemployment compared to the national rate, and all had higher rates for those with no insurance, as compared to the national rate of 16.3%. Looking at the percentage of residents in a zip code who rent versus own their place of residence provides a barometer of a community s health and financial stability. The high percentage of residents who rent in the 10 HSA Communities of Concern ranged from 30% (95828) to 56% (95824). Diabetes, heart disease, stroke, and hypertension were consistently mentioned in data as priority health concerns. Two other chronic diseases - asthma and chronic obstructive pulmonary disease - were also prevalent. Area experts and community members consistently reported the immense struggle residents had in accessing treatment for mental illness, which accounted for a greater number of ED visits and hospitalization, as did the problem of substance abuse. Safety was a greater concern in several of the Communities of Concern, with crime, violence, assault and accidents higher than overall county benchmarks. There is a lack of available healthy foods within the Communities of Concern, and a larger percentage of residents deal with the problem of obesity. A low percentage of people living in Communities of Concern have access to outdoor parks and recreation. Finally, infant mortality, a leading health status indicator of a community, was higher within these communities as compared to benchmarks. A priority for Methodist Hospital is to focus on populations with the greatest need; thus the Hospital will place increased emphasis on addressing health issues in the Communities of Concern for community benefit planning and implementation purposes. How the Implementation Strategy Was Developed The 2013 CHNA informed Methodist Hospital s implementation plan. Additionally, a review of existing community benefit programs and services was conducted to compare current programs and services against CHNA priorities. The Hospital had a leading role in the development of the CHNA in partnership with numerous community leaders and health providers. The Community Health Committee (a committee of the Dignity Health Sacramento Service Area Community Board), which is made up of both Hospital and community leaders and stakeholders, was engaged in developing the implementation strategy. Strategy is discussed at the Community Board level, and both the new 2013 CHNA findings, and implementation strategy, will be shared and discussed in community forums, with nonprofit agencies, public officials and other community leaders. 25