Berks County 2016 Community Health Needs Assessment Summit Meeting - - PowerPoint PPT Presentation

Berks County 2016

Community Health Needs Assessment

Summit Meeting April 7, 2016

What is a CHNA?

“A systematic process involving the community to identify and analyze community health needs and assets in order to prioritize needs and to plan and act upon unmet community health needs.”

Market Study or Needs Assessment?

Needs Assessment Market Study

 Primary and secondary research  Determine consumer wants and

needs

 Determine what competition offers  Determine what there is a market

for

 Determine what and how much

people or third parties are willing to pay (i.e., what will be purchased);

 Client is the organization  Data is proprietary  Primary and secondary research  Determine consumer needs  Determine how and if needs are

being met

 Determine gaps in services  Determine where nonprofit

• rganization may best meet its

mission by addressing community need, without expectation of reimbursement or payment

 Client is the community  Data is public

Source: ParenteBeard, HAP – 12.8.11

Background

• Patient Protection and Affordable Care Act mandate;
• Tax-exempt hospitals must perform CHNA once

every three years, to include:

• Report (publically available) including, community

and public health input;

• Implementation strategy;
• Report on IRS Form 990:
• How addressing needs identified;
• If not addressing them, why not;
• $50,000 fine per hospital per year, potential revoke
• f tax-exempt status

Collaborative Effort

Mary Hahn

Vice President of Strategy and Business Development

Desha Dickson

Director of Community Health and Engagement

Mary Kargbo

Chief Executive Officer

Heidi Williamson

Vice President for Programs and Initiatives

Pat Giles

Executive Vice President/ Chief Impact Officer

Collaborative Effort (Cont’d)

 Community Advisory Committee:

• Represent the broad interests of the community;
• Provide comment as to survey methods and focus of assessment;
• Give input into list of key interviews and focus group selection;
• Provide feedback as to survey findings;
• Help prioritize Summit feedback;
• Work together with hospitals for implementation plan to align

community benefit with identified needs.

CHNA Process

 RFP For Consulting Services  Consultant Selected:

• Holleran Consulting
• Franklin & Marshall College (Center for Opinion Research)

 Data Collection  Needs Assessment, Public Roll-Out of Findings  Prioritization of Recommendations  Implementation Plans  Board Approval (each hospital)  Public Posting  FINAL DEADLINE: Fall 2016

Berks County 2013

Community Health Needs Assessment Review

Berks County CHNA 2013: Survey Findings

• Berks County health reflects national

trends in health status and access to care;

• Overall, residents are in good health

and have good access to care;

• Poor access to primary and

preventive care results in poorer health status and higher rates of mortality for population sub-groups in Berks County;

• City of Reading residents are in

poorer health and are more likely to face barriers to care, as are certain subpopulations.

Berks County CHNA 2013: Recommendations – Consultant Report

 Increase Access to Care:

• Increase capacity of existing providers (specifically for uninsured

and underinsured and through establishing Berks County Health Department);

• Improve ability of providers to serve low income, Black,

undocumented, and Latino populations:  Expanding culturally appropriate services;  Expanding health education efforts that address cultural barriers to care;  Expanding outreach;

 Enhance Personal Health Behaviors:

• Increase programs and interventions

Berks County CHNA 2013: Priorities

 Preventive Care:

• Obesity
• Dental

 Prenatal Care  Specialty Care:

• Behavioral
• Other (Sub-specialists)

 All done with CULTURAL COMPETENCY

and all involve ACCESS TO CARE issues

Prenatal Care: Centering Pregnancy Program

Berks County CHNA 2013:

Addressing the Priorities

Mary Hahn

Vice President of Strategy and Business Development

Year Preterm Births (<37 weeks) Low Birth Weight (<2,500 grams) 2005-2008/9 7.7%

(8.8% in City of Reading)

2010-2012 6.3%

(9.7% in City of Reading)

7.4%

(9.8% in City of Reading)

Berks County CHNA 2013:

Prenatal Care (Where We Began)

Berks County and City of Reading Statistics

 Centering Pregnancy Program:

• Group setting, including self-monitoring and extended time with provider;
• 3 components: health assessment, education, and support;

 Program started in 2013 (Piloted in 2012);  6-8 ongoing groups at any given time;  Groups are facilitated by a CNM, OB Community Health

Worker (CHW), & OB Navigator;

 English & Spanish groups:

• Bilingual CHW assists the Spanish groups with interpretation

Berks County CHNA 2013:

Prenatal Care (Centering Program Overview)

 Target Population:

• Patients receiving low risk prenatal care at PSHSJ Downtown Reading Campus;
• Prenatal patients who desire to see a Certified Nurse Midwife (CNM)

throughout their pregnancy;

• Coordinated care for high risk patients who see physicians throughout their

pregnancy but also desire the group model;

Berks County CHNA 2013:

Prenatal Care (Centering Program Overview)

Ethnicity African American 15% Asian 0% Caucasian 10% Latina 75% Native American 0% Other 0% Payer Mix Private Insured 5% Medical Assistance 90% Uninsured 5% Other 0%

PSH-St. Joseph Downtown Reading Campus OB Patient Demographics

Centering Pregnancy vs. Routine Care

T

• tal # of

Deliveries Preterm Deliveries (<9.6%) Low Birth Weight Babies (<7.8%) Centering Pregnancy 98 3 (3.1%) 2 (2.0%) Routine Care 597 59 (9.9%) 57 (9.5%) T

• tal

695 62 (8.9%) 59 (8.5%)

Deliveries at PSHSJ: Jan – Dec 2015

Berks County CHNA 2013:

Prenatal Care (Health Outcomes)

Participants’ pregnancy outcome data is recorded & trended:

 Over 300 women have participated since 2012

• Currently have 51 enrolled in groups;

 Increase of enrollment by 28 percent in 12 months;  Exceeding goals for Health Outcomes FY2015;  3rd consecutive year providing Centering Pregnancy at Reading High

School;

 Plan to begin groups at Mary’s Shelter in Spring 2016;  2015 HAP’s “Community Champion” Award;

Berks County CHNA 2013:

Prenatal Care (Program Successes)

 Fully Certified as Approved

Centering Pregnancy site by Centering Healthcare Institute.

 Centering Pregnancy Program  Target population:

• Patients receiving low risk prenatal care RHS’s Women Health Center;
• Prenatal patients who desire to see a Certified Nurse Midwife (CNM)

throughout their pregnancy;

 Program started in January 2015;  4 ongoing groups at any given time;  Groups are facilitated by a CNM at 5th Street Conference

Room;

 English groups, Spanish instruction available Summer 2016

Berks County CHNA 2013:

Prenatal Care (Centering Program Overview)

Preventive Care (Dental): Oral Health Task Force

Berks County CHNA 2013:

Addressing the Priorities

Heidi Williamson

Vice President for Programs and Initiatives

• 30 percent of Berks County adults did not

see a dentist in the previous year; In the City of Reading, 43 percent of adults had not seen a dentist in the previous year; Those percentages were higher than in 2008.

Berks County CHNA 2013:

Preventive Care (Dental) -Where We Began

Berks County CHNA 2013:

Preventive Care (Dental) - Oral Health Task Force

• Attracted nearly $100,000 in funding from the

DentaQuest Foundation; Expanded to include organizations like the local libraries, Berks Encore, the Hispanic Center, and Olivet Boys and Girls Club; Conducted additional on-the-ground research.

Berks County CHNA 2013:

Preventive Care (Dental) - Oral Health Task Force

• Carole Snyder leads the task force;

Additional funding from DentaQuest to engage community members who are less likely to have insurance and visit a dentist; Continue to engage medical and dental professionals to share information that leads to better outcomes for all patients.

Berks County CHNA 2013:

Preventive Care (Dental) -What’s Next?

Access to Care: Berks Community Health Center (BCHC)

Mary Kargbo

Chief Executive Officer

Berks County CHNA 2013:

Addressing the Priorities

 Access to care was one of the major aspects of the 2013 CHNA report

as indicated in the following findings:

• 44 percent of survey respondents identified the cost of healthcare,

including insurance coverage, co‐pays, and deductibles, as the most common health concerns;

• 12 percent of adults (or about 37,000 individuals) reported that there was a

time in the previous year when they needed health care, but did not receive it due to the cost;

• Among the uninsured in Berks County, one‐quarter (24.8 percent) visited an

emergency room for care in the previous year due to a lack of health insurance;

 BCHC Board Members adopted the 2013 CHNA report findings in its

entirety;

Berks County CHNA 2013:

Access to Care (BCHC) -Where We Began

 Federally Qualified Health Center (FQHC):

• Established June 2012 by the Reading community;
• Located at 838 Penn Street in Downtown Reading;
• Provides primary care and preventive care on- site,

behavioral health and dental care by contract;

• Initiated a Behavioral Health Integrated Program on site in

2015.

Berks County CHNA 2013:

Access to Care (BCHC) - Organization Overview

 Everyone is treated regardless of their ability to

pay:

• All patients are eligible for a sliding fee scale and where necessary, payment

plan;

• Evening hours available Monday to Thursday and Saturday mornings in order

to reduce ER visits among BCHC patients;

• Penn Street has increased number of patients from 3,855 in the first year to

7,054 unduplicated patients representing 22,229 visits in 2015;

• Through outreach and enrollment into the Affordable Care Act, BCHC has

seen a decrease in the uninsured population;

 BCHC opened its second site in August 2015 in western Reading to

reduce ER visits for the underserved and uninsured patients in the Oakbrook homes site, as well as the surrounding community:

• In its first 4 months BCHC at Oakbrook saw 1,020 patients representing

1,600 visits

Berks County CHNA 2013:

Access to Care (BCHC) - Organization Overview

BCHC responded to these key health care needs in the following ways:

 Only 2/3 of the pregnant population receive early

prenatal care:

• Hired a part-time Obstetrician/Gynecologist
• Free pregnancy testing
• Saturday hours

 Chronic Diseases Care

• 20 percent of BCHC’s patient population are diagnosed with diabetes;

This caused BCHC to focus on care for this population by adding:

• Podiatry
• Optometry
• Nutrition
• Community Education

Berks County CHNA 2013:

Access to Care (BCHC) – Addition of Specialty Care

Community Health Assessment Overview of Findings

Center for Opinion Research Franklin & Marshall College April 7, 2015

2

In the next 30 minutes… MY GOALS:

• 1. Help you understand how I think about community need.
• 2. Describe the data we used to assess need.
• 3. Give you more specific information about how we conducted the

Behavioral Risk Factor Survey of county residents.

• 4. Help you understand where health disparities exist in the county.
• 5. Help you understand how Berks County’s health needs compare

to the health needs of other Pennsylvania counties. I will end with specific thoughts about the most significant health needs facing Berks County.

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This presentation focuses specifically on health risks that contribute to non-communicable disease that are among the leading causes of death and disability. The presentation also shows how these risk factors are unevenly distributed across demographic groups. This approach shows the most significant health risks in Berks County relate to obesity, including obesity-related behaviors such as diet and exercise, and mental health in terms of both the number of people affected and the amount of death and disability each creates.

Defining Need

Source: David S. Jones, M.D., Ph.D., Scott H. Podolsky, M.D., and Jeremy A. Greene, M.D., Ph.D. The Burden of Disease and the Changing Task of Medicine. N Engl J Med 2012; 366:2333-2338June 21, 2012DOI: 10.1056/NEJMp1113569

Pneumonia or Influenza, 202 Pneumonia or Influenza, 16 Tuberculosis, 194 Gastrointestinal infections 143 Heart Disease, 137 Heart Disease, 193 Cerebrovascular Disease 107 Cerebrovascular Disease, 42 Nephropathies, 89 Nephropathies, 16 Accidents, 72 Accidents, 38 Cancer, 64 Cancer, 186 Senility, 50 Diptheria, 40

Alzheimer's disease, 27 Diabetes, 22 Suicide, 12 100 200 300 400 500 600 700 800 900 1000 1100 1900 2010

• No. of Deaths/100,000

Risk Factors for Chronic Disease

A Community Approach to Health

Source: Centers for Disease Control and Prevention. Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize Community Needs. Atlanta: U.S. Department of Health and Human Services, 2010.

Data Sources

Behavioral Risk Factor Survey Indicators The primary source of local, current information comes from a Community Health Needs Assessment (CHNA) survey. The CHNA survey information is based on a behavioral risk factor survey of 1,001 adult residents of Berks

• County. The survey interviewing took place from September 21 – October

18, 2015. The survey sample was designed to be representative of the adult, non-institutionalized population of Berks County. The sample error is +/- 4.2 percentage points for Berks County when the design effects from weighting are considered. In addition to sampling error, this poll is also subject to other sources of non-sampling error. Generally speaking, two sources of error concern researchers most. Non-response bias is created when selected participants either choose not to participate in the survey or are unavailable for interviewing. Response errors are the product

• f the question and answer process. Surveys that rely on self-reported

behaviors and attitudes are susceptible to biases related to the way respondents process and respond to survey questions.

Survey Demographics

The survey is representative of the adult population of Berks County. This table shows the demographic characteristics of the survey sample. The survey estimates are similar to the county’s known distributions of these demographic characteristics.

35% 18% 17% 11% 10% 11% 14% 86% 53% 26% 22% 55% 23% 22% 28% 36% 36% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Central City East South North West Non-White White Married Single, never married Other High school or less Some college College degree or higher 18-35 35-54 55 and over 59% 30% 11% 93% 7% 64% 27% 9% 48% 52% 33% 35% 32% 59% 20% 22% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Above low-income threshold Low-income Below poverty threshold Yes No None-no children 1-2 children 3 or more children Male Female Under $35,000 $35-$75,000 Over $75,000 Employed Retired Other

Age Education Marital Status Race/Ethnicity Region Work Status Income Gender Children in Household Health Insurance Coverage Poverty Status

County Health Rankings A primary source of comparative health information is provided by the County Health Rankings. These rankings provide county-level information on health factors and health outcomes and the performance of individual counties can be compared to other Pennsylvania counties to provide a relative performance ranking. The figures based on County Health Rankings data were created by the Center for Opinion Research in March 2016.

Data Sources

Vital Statistics The third source of health related data comes from the Bureau of Health Statistics and Research, Pennsylvania Department of Health, and is accessed through its Epidemiological Query and Mapping System (EpiQMS). Demographic data comes from the Census Bureau American Community

• Survey. Those reported in this presentation are 1-year estimates for 2014

unless otherwise noted.

Data Sources

Behavioral Risk Factor Survey

Access Indicators

87% 93% 88% 82% 44% 14% 14% 12% 9% 2012 2015

Has health care coverage Has a personal physician Economic hardships (one or more) Did not fill prescription because of cost Did not receive health care in past year because of cost

84% 81% 66% 68% 45% 19% 20% 18% 17% 18% 9% 5% 4% 2012 2015 Participated in physical activities or exercise in past month Body Mass Index Category (overweight and obese) Strength training in past month Exercised 30 minutes on five days in past week Smoking behavior (regular smoker) Binge drinking behavior Ate fast food three or more days in past week Used illegal drugs in past year Consumed three servings of vegetables daily

Behavioral Risk Indicators

39% 33% 38% 19% 20% 18% 16% 12% 9% 10% 14% 10% 13% 9% 8% 6% 7% 2012 2015 Has high cholesterol Has high blood pressure Has an anxiety disorder Has a depressive disorder Has asthma Has ever had cancer Respondent is diabetic Told has heart disease, heart attack, or stroke PHQ-8 current depression indicator- currently depressed Ever had COPD, emphysema, or chronic bronchitis

Conditions

92% 80% 83% 75% 57% 45% 20% 38% 37% 35% 37% 35% 26% 9% 2012 2015 Gets needed social and emotional support Has ever had blood cholesterol checked Visited doctor for routine checkup in year One or more days with depressive symptoms in past two weeks Has had flu shot in past year Poor health limited participation in normal activities in past month At least one day physical health was not good in past month At least one day mental health was not good in past month Stressed about paying rent or mortgage Avoids or never uses health care system

Prevention Behaviors and Context

Berks County Population Counts for Selected Conditions

Total Adult Residents Reporting Condition, Berks County 2015

Conditions effecting more than 100,000 adults in Berks County

Total Adult Residents Reporting Condition, Berks County 2015

The survey data can identify the presence of health disparities, i.e., gaps in access, conditions, or behaviors that are larger for some demographic groups than for

• thers. The figure on the next slide displays the relationships that exist between

each survey indicator and a set of demographic and regional data. The color coding identifies whether there is a significant relationship between each indicator and each demographic subgroup and how strong those differences are; the darkest coloring indicates the strongest associations. Three findings about health disparities within Berks County are apparent.

• Poverty is significantly associated with differential outcomes related to access,

conditions, and prevention behaviors.

• Age is significantly associated with differential outcomes related to all indicator

groups.

• Race and ethnicity is also significantly associated with differential outcomes

related to access and prevention behaviors.

Health Disparities

Social Determinants Mapping

Social Determinants Analysis of Health for Berks County Legend

Recreation and Fitness Facilities

Recreation and Fitness Facilities in Berks County, PA.

Fast Food Restaurants

Fast Food Restaurants in Berks County, PA.

County Health Rankings

Overview – Berks County ranks 25 out of 67 counties in health outcomes. – Berks County ranks 27 out of 67 counties in health factors.

Health Factors Health Outcomes

RWJ County Health Rankings Trend Data – Berks County, Pennsylvania 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 2010 2011 2012 2013 2014 2015 2016

Berks County Comparative Health Rankings, 2010 - 2016

Relative County Ranks on County Health Rankings Outcomes and Factors

Community Needs: Housing, Education, and Poverty

The poverty rate in Berks County is higher than that of Pennsylvania, and lower than the U.S. rate. For families, the incidence of poverty is highest for families with children; 21% of Berks County families with children experience poverty. By age, poverty is lowest for older persons and highest for children. By race and ethnicity, the poverty rates of Blacks (28%) and Latinos (40%) are significantly higher than those of Asians and Whites.

35

Conclusions

• The most significant health risks in Berks County relate to obesity, including
• besity-related behaviors such as diet and exercise, and mental health.
• Sizable health disparities exist in the community, notably
• Older residents are more likely to have better access to healthcare and have

better rates on most prevention-related indicators. However, they are also more likely to have specific health conditions. Younger residents are more likely to have better rates for behavioral indicators, notably for overweight and obesity as well as physical activity, although they are more likely to smoke, drink, and use illegal drugs.

• Poverty is also significantly associated with differential outcomes related to

access, health conditions and prevention-related behaviors. Low-income or poor residents are more likely to have poor access to healthcare as well as asthma, diabetes, mental health problems and money concerns. Race and ethnicity is also significantly associated with differential outcomes related to access and prevention behaviors.

• Social and environmental factors leave many county residents at risk for poor

health.

So What?

Now What?

Areas of Priority

Access to Care Mental Health Obesity Chronic Disease

Criteria to Consider

Seriousness

– How significant is the consequence if we do not address this issue? – How pervasive is the scope of this issue? Does it effect the majority of our population or only a small fraction? – Is it getting worse? Negative trend?

Ability to Impact

– Can we make meaningful differences with this issue? What is our ability to truly make an impact? – Are there known proven interventions with this issue?

Small Group

Discussions

What community resources currently exist for your area of priority?

What community resources are missing for your area

• f priority?

How could the community best address your area of priority?

Small Group

Report Out