Brooklyn Community Health Needs Assessment
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New York City Health Provider Partnership Brooklyn Community Needs Assessment Final Report October 3, 2014 Prepared by The New York Academy of Medicine TABLE OF CONTENTS Overview ....................................................................................................................................................... 1 Introduction ................................................................................................................................................ 18 Background ............................................................................................................................................. 18 Section A. Description of Health Care Resources and Community Resources ........................................... 19 Sections i and ii ....................................................................................................................................... 19 Health Care Resources ........................................................................................................................ 19 Community Based Resources .............................................................................................................. 30 Section iii Domain 2 Metrics ................................................................................................................... 37 Section B. Description of the Community to be Served ............................................................................. 37 Section i: Demographics of the Population in Brooklyn ......................................................................... 37 Section ii: Health Status .......................................................................................................................... 53 BEHAVIORAL HEALTH .......................................................................................................................... 61 ASTHMA/RESPIRATORY CONDITIONS ................................................................................................. 66 CARDIOVASCULAR DISEASE ................................................................................................................ 68 DIABETES ............................................................................................................................................. 69 HIV/AIDS and STDs .............................................................................................................................. 70 MATERNAL/CHILD HEALTH ................................................................................................................. 72 OBESITY ............................................................................................................................................... 72 TOBACCO USE/CESSATION .................................................................................................................. 74 Section iii: Domain 3 and 4 Metrics ........................................................................................................ 75 Domain 3 Metrics: Clinical Improvement ........................................................................................... 75 Domain 4 Metrics: Improve Health Status and Reduce Health Disparities ........................................ 75 Section C: Identification of the Main Health and Health Services Challenges............................................ 75 Section D: Summary of the Assets and Resources that Can Be Mobilized ................................................. 83 Section E: Summary Chart of the Projects to Be Implemented (Not Applicable) ....................................... 93 Section F: Documentation of the Process and Methods ............................................................................ 94 Methods: Primary Data ........................................................................................................................... 94 Partnering with Community-based Organizations ................................................................................. 96 Methods: Secondary Data ...................................................................................................................... 97 List of Appendices ..................................................................................................................................... 102 Glossary of Key Terms ............................................................................................................................... 103 Bibliography .............................................................................................................................................. 107 Overview The goal of the Delivery System Reform Incentive Payment (DSRIP) program is to promote community- level collaborations and focus on system reform in order to reduce avoidable inpatient admissions and emergency room visits by 25% over 5 years for the Medicaid and uninsured populations in New York State. To inform the health system transformation that is required under the DSRIP program, several emerging Performing Provider Systems (PPSs) contracted The New York Academy of Medicine (NYAM) to complete a Brooklyn-wide Community Needs Assessment (CNA). The CNA was governed and monitored by a Steering Committee consisting of representatives from each of the following emerging PPSs: A W Medical; The New York City Health and Hospitals Corporation (HHC) including representatives from their central office, Coney Island Hospital (HHC), Kings County Hospital (HHC), and Woodhull Medical and Mental Health Center (HHC); Lutheran Medical Center; Maimonides Medical Center; and SUNY Downstate Medical Center. The specific aims of the CNA are to: Describe health care and community resources, Describe communities served by the PPSs, Identify the main health and health service challenges facing these communities, and Summarize the assets, resources, and needs for the DSRIP projects. Methods To conduct this CNA, NYAM utilized both primary and secondary data collection and analyses. To ensure the perspective of community members and stakeholders was incorporated into the reported findings and to respond to specific questions that could not be sufficiently addressed through secondary source data alone, NYAM conducted and analyzed 28 key informant interviews (involving 35 individuals), 24 focus groups with community members and other stakeholders, and approximately 681 community surveys.1 NYAM developed the primary data protocol in collaboration with the PPSs using standard research methods consistent with DSRIP CNA guidance. Key Informant interviews, focus groups, and survey questions focused on community conditions conducive to health promotion, primary health concerns, available programing and services, disparities in access and use, and recommendations regarding strategies to promote improved health. NYAM collected this data, after IRB approval, in partnership with numerous community organizations, which were identified in collaboration with PPS representatives and represented a range of neighborhoods and populations, e.g., older adults, immigrant populations, and people with disabilities. NYAM also conducted street outreach for survey administration, focusing on neighborhoods identified as having large numbers of Medicaid and/or uninsured populations. The data collection materials were translated into ten languages. Socio- demographic characteristics of survey respondents included: 44.3% Black/African American, 31.8% Latino, 13.7% Asian, 53.7% foreign born, 26.3% limited English proficient, 82.4% living below the poverty line, 53.4% enrolled in Medicaid and 13.0% uninsured. The mean age of respondents was 44, with a range of 18 to 88. 1 NYAM collected primary data from July–September, 2014. Additional primary data analyses are forthcoming and will be included as Appendix D to this report. 1 The NYAM team analyzed the data using standard qualitative and quantitative analytic methods and reported common themes, as appropriate, throughout this report.2 NYAM also conducted a review of secondary source data, including an analysis of more than 70 data sets, and a review of the literature, including existing community health needs assessments and community reports.3 (See Section F. of this report and the attached Bibliography for a detailed list.) Summary of Findings Brooklyn is a diverse borough, rich in culture, commerce and open space, including parks, gardens and beaches. However, disparities are pronounced, given its mix of high, medium and low income neighborhoods, and significant populations from multiple racial and ethnic groups including—but not limited to African American and Caribbean populations, Latinos (originating from multiple countries), and Chinese, Russian, Polish, South Asian, and Arab populations, including immigrants. 4 Each of these communities has unique needs related to culture, language, education, and economics, as well as unique strengths.5 A number of Brooklyn neighborhoods have high concentrations of public housing. These areas, which often have concentrated poverty, are described by many residents as neglected neighborhoods, without appropriate services for meeting even basic needs.6 In contrast, rapid gentrification is evident in many traditionally lower income and minority Brooklyn neighborhoods, having consequences that are described by some in positive terms, including increased access to healthy foods.7 More commonly, the negative consequences of gentrification are noted, including