Community Health Needs Assessment 2018 2018 COMMUNITY HEALTH NEEDS ASSESSMENT Table of Contents

Executive Summary 1

CHNA Approach 2 Priorities and Implementation Strategies 2 Evaluation 2

CHNA Approach and Process 3

Community Health Needs Assessment (CHNA) Planning and Implementation 3 CHNA Guiding Principles and Frameworks 4 Key CHNA Contributors and Participant Groups 5 CHNA Methodology and Data Collection 5 Prioritization Process and Criteria 6 Hospital Role in Identified Priority Areas 7 Community Benefit Service Areas (CBSAs) 7

Systemwide Priorities and Implementation Strategies 8

A. Survey Results 8 B. Community Input Sessions: Key Themes 11 Evaluation 11 Priorities and Hospital Role 11

Individual Hospital CHNAs and Strategies 12

MedStar Franklin Square Medical Center 13 MedStar Georgetown University Hospital 20 MedStar Good Samaritan Hospital 28 MedStar Harbor Hospital 35 MedStar Montgomery Medical Center 43 MedStar National Rehabilitation Hospital 50 MedStar St. Mary’s Hospital 57 MedStar Southern Maryland Hospital Center 63 MedStar Union Memorial Hospital 69 MedStar Washington Hospital Center 76

References 83 Executive Summary

01 MedStar Health is a not-for-profit health system dedicated to caring for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. MedStar’s nearly 30,000 associates, 6,000 affiliated physicians, 10 hospitals, numerous ambulatory care and urgent care centers and the MedStar Health Research Institute are recognized regionally and nationally for excellence in medical care. As the medical education and clinical partner of Georgetown University, MedStar trains more than 1,100 medical residents annually. MedStar’s patient-first philosophy combines care, compassion and clinical excellence to advance health in the region.

At MedStar Health we recognize that a person’s health is interwoven with the health of the community in which they live. We work to help our patients thrive under our care, as well as outside our hospital and clinic walls. A person’s health is dependent on many different factors, including physical, social and economic factors such as access to housing, transportation, and employment. As a healthcare leader in the region, we play an important and significant role in advancing health and partnering with others to facilitate community health improvement. Our efforts are guided in large part by the results of our Community Health Needs Assessment (CHNA), which we perform every three years.

MedStar’s CHNA utilizes an organized, systematic approach to identify and address the needs PRIORITY HEALTH AREAS and assets of underserved communities across While each hospital identified its own MedStar’s geographic footprint. The CHNA community needs and priority health guides the development and implementation of a areas, several conditions were listed as top comprehensive plan to improve health outcomes priorities systemwide. They included: for those disproportionately affected by disease • Health and Wellness as well as social, environmental and economic —— Chronic disease prevention barriers to good health. The CHNA also informs and management the creation of a strategy for future community —— Behavioral health health programming and how to allocate • Access to Care and Services community benefit resources for fiscal years —— Addiction and mental health 2019–2021 across the 10 MedStar hospitals. As services a not-for-profit organization, MedStar is required —— Social need services by the Internal Revenue Service (IRS) to conduct —— Transportation a CHNA every three years. Our CHNAs align with • Social Determinants of Health guidelines established by the Affordable Care Act —— Housing and comply with IRS requirements. —— Employment

1 | Executive Summary 2018 Community Health Needs Assessment

CHNA Approach Priorities and Using both public health and healthcare utilization data, Implementation Strategies each hospital identified communities or geographic areas of focus, called a Community Benefit Service Area (CBSA). The CHNA process identified three overarching The CBSA served as the geographic target area for the categories of need across all 10 MedStar hospitals: health needs assessment and for the execution of the health and wellness, access to care and services and strategies to address health needs identified. In addition, social determinants of health. Within the health and the above data were used to identify specific populations wellness domain, chronic disease and prevention to assess and target for programmatic efforts. The CHNA (diabetes, heart disease, obesity and cancer) and will serve as a roadmap for targeted health promotion behavioral health (alcohol and drug addiction strategies conducted in the CBSA. The impact of the and mental health conditions) were identified as hospitals’ efforts in their respective CBSAs will be tracked systemwide priorities. and evaluated over the next three-year cycle. Under access to care and services, increased access The CHNA process involved local residents, community to behavioral health services for addiction and mental partners and stakeholders, along with hospital health were identified as systemwide priorities. Access leadership. Each hospital’s CHNA was led by an to specific social services such as housing and jobs, as Advisory Task Force (ATF) that included hospital leaders, well as transportation to or from health-related services community activists, residents, faith-based leaders, were the most frequently identified social needs. Several hospital representatives, public health leaders and other of these same areas were listed as priorities under stakeholders. Task Force members used population- social determinants of health, including housing and level data, community health needs survey findings homelessness, affordable child care and lack of jobs. and feedback from community input sessions to create As part of the assessment process, hospital ATFs recommendations for each hospital’s health priorities, determined the level of engagement each hospital potential implementation strategies, and to identify should take to address priority needs. The three key partners. Through a partnership with Georgetown different levels of engagement—leader, partner and University, public health and CHNA data were compiled, supporter—were based on factors such as system synthesized, and analyzed. Nearly 3,500 people were strengths and assets, community expertise and involved in the CHNA process, including 3,345 survey assets and current programming. Each hospital then respondents and 150 people who participated in developed implementation strategies according to the community input sessions. level of engagement assigned to each priority area. Each ATF used the health needs survey data, along with information elicited through the community input sessions, to make recommendations regarding health Evaluation priority areas and the appropriate level of hospital engagement in addressing these areas, and potential Progress and impact of hospital’s strategies will be strategies to address the identified needs. The final assessed annually and shared with ATF members CHNA implementation strategies were endorsed by and each hospital’s Board of Directors. each hospital’s Board of Directors and approved by MedStar Health’s Board of Directors.

2 | Executive Summary 2018 Community Health Needs Assessment

CHNA Approach and Process 02 Community Health Needs Assessment (CHNA) Planning and Implementation

The Community Health Department at MedStar Health oversees and coordinates the CHNA process and deliverables to improve health outcomes throughout the system’s service areas. The department drives CHNA program implementation and evaluation and community benefit reporting to the community and regulatory bodies. The department uses evidence-based methodologies to leverage internal and external stakeholder relationships and resources to target health-related disparities and address physical, social and economic contributors to suboptimal health. These efforts focus primarily on improving the health of underserved populations and addressing health disparities with the goal of achieving health equity.

CHNA Guiding Principles and Frameworks

The four guiding models for the CHNA were the Robert Wood Johnson Foundation’s County Health Rankings Model,21 Centers for Disease Control and Prevention’s Reaching for Health Equity Model,22 the Asset-Based Community Development Institutes’s Asset-Based Community Development Framework,23 and the National Center for Disease and Health Promotion’s Social Ecological Model.24 These models build upon a vast evidence-base and incorporate best practice standards that have been published by nationally recognized leaders in the healthcare field.

Equality

Equity

Equity means we all have the tools that we need to live a healthy, successful life.

© 2017 Robert Wood Johnson Foundation. May be reproduced with attribution.

3 | CHNA Approach and Process 2018 Community Health Needs Assessment ROBERT WOOD JOHNSON FOUNDATION COUNTY HEALTH RANKINGS MODEL

Length of Life (50 percent) Health Outcomes Quality of Life (50 percent)

Tobacco Use

Diet and Exercise Health Behaviors (30 percent) Alcohol Use

Sexual Activity

Access to Care Clinical Care (20 percent) Quality of Care Health Factors

Education

Employment Social and Economic Factors Income (40 percent) Family and Social Support

Community Safety

Physical Air and Water Quality Programs and Policies Environment (10 percent) Housing and Transit

County Health Rankings model ©2018 UWPHI

The models provide an understanding of what contributes During fiscal year 2018, each MedStar hospital used to the health of communities, how assets and strengths a multi-pronged approach to gather insights on their of communities should be identified and leveraged as respective community health issues, determine health part of community program development. They also help focus areas and develop targeted implementation identify the most effective ways to address individual, strategies to address the issues prioritized. This organizational, community and policy-level contributors included convening hospital ATFs to oversee to health in order to realize health equity. These models the process and development of frame MedStar’s community benefit efforts to improve the implementation strategies through health status of people in MedStar’s CBSAs. formal review and approval.

4 | CHNA Approach and Process 2018 Community Health Needs Assessment Key CHNA Contributors CHNA Methodology and Participant Groups and Data Collection

As previously noted, the CHNA involved the The data sources for the CHNA included quantitative participation of a wide range of organizations, secondary population-level data, hospital healthcare hospital leaders, community leaders, and community utilization data, a CHNA community survey and qualitative members. These included: community group input sessions. These data were used to broaden the types of information gathered and to engage • Community Health Department at MedStar Health: a diverse group of internal and external stakeholders to Established the CHNA methodology for all hospitals; inform the CHNA process and deliverables. The types of assisted in identification of strategic partners; provided information gathered for each data source were as follows: expertise and technical support as needed; ensured that processes, deliverables and deadlines comply with • Secondary Data: National, state, local health and the IRS mandate. disparity data, public health priorities and community health improvement plans. County-level ZIP code and • Hospital Advisory Task Forces: Reviewed secondary neighborhood level data (when available). public health data; designed CHNA survey tool and reviewed findings; recommended the hospital’s • Hospital Utilization Data: Patient healthcare utilization CBSA, health priorities and associated strategies. and charity care data (a proxy for economic status) were Task Force members included hospital leaders, used to identity each hospital’s CBSAs and geographic grassroots activists, community residents, faith-based areas of focus for needs assessment and strategy leaders, hospital representatives, public health implementation. leaders and other stakeholder organizations, such as representatives from local health departments. • CHNA Community Survey: Open and closed-ended questions about healthcare access, health equity, • Hospital Leadership Sponsors: Served as liaisons health condition concerns, social determinants between ATFs and hospital executive leadership and community strengths and assets were asked to ensure the hospital’s selected priorities and in a community questionnaire disseminated by the implementation strategy plans aligned with the hospitals in their CBSAs. strengths of the organization, its population health management strategies and clinical priorities. • Community Input Session Discussions: Hospitals facilitated nine community discussions with a diverse • CHNA Survey Respondents and Community Input group of community stakeholders to identify the most Session Participants: Nearly 3,500 people completed important community health issues. Guided discussion the CHNA survey and contributed to the community areas included topics related to community health and input sessions as part of the CHNA process. Diverse wellness, access to care and services and the social groups of community stakeholders—including CBSA determinants of health. residents and organizations, civic and faith-based leaders, public health officials and government Combined information from all of the above sources agencies—and hospital leadership were engaged to was used to: garner information about the most pressing issues across CBSAs. 1) Prioritize identified needs 2) Determine the appropriate hospital role in addressing the health issues prioritized for each hospital 3) Establish system, regional, and hospital specific approaches and outcome measures

This information was then used to develop each hospital’s implementation strategies and evaluation plans for the next three years.

5 | CHNA Approach and Process 2018 Community Health Needs Assessment evidence-based approaches and existing partnerships and Prioritization Process programming. These components were used to identify priority areas. The ATFs participated in a comprehensive and Criteria prioritization exercise that involved grouping and ranking identified needs and assets, as well as discussions about Identification of health priorities was shaped by an what existing and new initiatives and partners should be understanding of the public health priorities, needs included in a hospital’s three-year implementation plans. assessment data and each hospital’s strengths within The purpose was to determine how to best support the the context of the system’s priorities. Additionally, highest prioritized needs, while leveraging identified when selecting final targeted health priorities, MedStar community assets and resources. considered additional criteria such as availability of

Hospital Strengths/ Priorities Importance Identified by Magnitude of Community/ Health Issue Community Assets

Availability of Priority Severity of Evidence-Based Determination Health Issue Approaches

Potential Impact Disparity/ of Strategy Equity-focused

Existing/ Potential Partnerships

6 | CHNA Approach and Process 2018 Community Health Needs Assessment • Participation (Supporter) Role: MedStar will play a Hospital Role in Identified supporter role in areas it recognizes as significant contributors to health, but are beyond the scope of Priority Areas its organizational strengths. MedStar will participate as a supporter or advocate in these areas. Accordingly, Once the identified community health needs were the three-year plan will reference local organizations prioritized, each hospital ATF and hospital leadership leading efforts in those areas. determined the appropriate hospital role to address the prioritized needs. This determination was primarily based on hospital and community strengths, assessment Community Benefit Service findings, and priorities selected. The following types of hospital roles were established: Areas (CBSAs)

• Focus (Leader) Role: MedStar is well-positioned to Each hospital’s Advisory Task Force identified a take a leadership role in addressing identified focus geographic or target area to serve over the next areas. Strategies to address these areas are included three-year Community Health Needs Assessment in each hospital’s CHNA. cycle. These CBSAs were selected based on hospital patient utilization data; elevated disease incidence • Collaboration (Partner) Role: MedStar will partner with other leading organizations in which it is best and prevalence; a high density of underserved or low- positioned to serve as a collaborator. Hospitals’ income residents and evidenced health disparities; strategies will include the local organizations who are proximity to the hospital; and/or an existing presence leading this work and MedStar’s role as a partner. of programs and partnerships.

7 | Systemwide Priorities and Implementation Strategies 2018 Community Health Needs Assessment Systemwide Priorities and Implementation Strategies

This report provides an overview of systemwide assessment findings, identified priorities as well 03 as detailed information of the CHNA priorities and strategies for each hospital.

Assessment domains included examination of health needs in three areas:

• Health and wellness • Access to care and services • Social determinants of health

A. Survey Results

MedStar Health sought the input of various community stakeholders through a combination of community input sessions and the CHNA survey. As part of the CHNA process, 3,345 people age 18 and older completed the survey tool, and a majority of respondents were community residents.

SURVEY RESPONDENT ROLE IN THE COMMUNITY

59.3% 1,982

16.1% 17.5% 540 586 7.1% 237

Community Community Community Did not resident advocate/ service answer leader provider

8 | Systemwide Priorities and Implementation Strategies 2018 Community Health Needs Assessment Domain 1: Health and Wellness Domain 2: Access to Care and Services Within the Access to Care and Services domain, most Chronic disease prevention and management MedStar hospitals listed specific strategies and outcome emergedas a key health priority within the health targets to address these needs: and wellness domain across all 10 hospitals. More specifically, the following chronic conditions 1. Increased access to mental health and addiction services were prioritized as focus areas for the hospitals’ 2. Increased access to social needs services implementation strategies. 3. Improved access to transportation to and from health-related services • Chronic Disease Prevention and Management —— Diabetes ACCESS TO CARE —— Heart Disease The top healthcare access issues identified across MedStar —— Obesity communities were cost, no insurance insurance not accepted, —— Cancer appointment wait times, and transportation. Behavioral health was also identified as a priority Cost too expensive/can’t pay across the 9 acute MedStar hospitals. 75.10% Cultural/religious beliefs 4.78% • Behavioral Health Had to wait too long for 32.74% —— Alcohol and drug addiction an appointment —— Mental health conditions Insurance not accepted 38.92%

Lack of transportation 28.07% HEALTH AND WELLNESS Language barrier 5.17% The top health problems identified across MedStar No doctor nearby communities were alcohol and drug addiction, diabetes, 8.73% heart disease, mental health conditions and obesity. No insurance 47.23% Other 12.50% Alcohol/drug addiction 54.26% Did not answer 5.68% Arthritis 10.13% Alzheimer’s/dementia 8.07% ACCESS TO SERVICES Cancer 23.86% Specific services identified across MedStar communities Diabetes/high blood sugar 37.01% included greater access to substance abuse services, mental health services, housing, and employment. Heart disease/high blood pressure 28.49% Infant death 0.48% Affordable child care 26.52% Lung disease/asthma/COPD 5.14% Affordable, healthy food options 24.78% Mental health conditions 29.03% Affordable housing 37.67% Oral health 2.9% Better jobs 27.32% Overweight/obesity 25.68% Better law enforcement services 10.55% Sexually transmitted infections 5.47% Better places to exercise 9.69% Smoking/tobacco use 16.92% Better public transportation 17.25% Stroke 3.44% Better schools 15.55% Suicide 2.39% More health services 22.60% Teen pregnancy 3.14% More mental health services 27.35% Other 11.48% More substance abuse services 25.41% Did not answer 5.53% Other 9.33% Did not answer 9.36%

9 | Systemwide Priorities and Implementation Strategies 2018 Community Health Needs Assessment Domain 3: Social Determinants of Health Community Strengths and Assets MedStar understands and recognizes that the social In alignment with the Asset-Based Community and physical environments in which people live can Development Framework, the approximate 3,500 people have significant effects on the development and involved in the CHNA process helped identify current progression of disease and associated health status. strengths and assets in their community, as well as how Societal and physical environment can directly affect those strengths could be used to address identified individual behaviors and health outcomes. Addressing health issues and achieve health equity. such factors is essential to achieving improved health and health equity. In addition, social determinants such Respondents indicated that they had access to good as housing and employment instability , can directly medical providers and good overall health care impact healthcare costs. They are significant drivers of services that could be leveraged to address local health how often and what type of healthcare services people issues while also helping to shrink the health equity gap. use. Key social determinants identified to address were: The fact that their communities offered many community involvement opportunities was also viewed as a • Affordable housing and homelessness strength. Respondents also identified local organizations • Affordable child care that would be particularly suited to helping address • Better job opportunities community health issues in partnership with local health care providers. Within this domain, MedStar prioritized increased employment and workforce development Based on the assets identified, respondents as collaboration areas. MedStar’s three-year identified several critical collaborators to support implementation plan will include efforts in this MedStar’s priority areas. These included: space. In addition, MedStar will serve in a supporter role to address community issues around housing • Local health departments and homelessness. • Community healthcare providers and organizations • Social service agencies • Pharmacies SOCIAL DETERMINANTS OF HEALTH • Faith-based institutions The top social issues contributing to community health across • Schools MedStar communities were identified as housing, childcare, • Homeless shelters employment, poverty, and neighborhood violence/safety. • Employment Agencies • Food Banks Affordable child care 26.42% • Community-based organizations Air quality/pollution 7.56% Domestic violence 9.57% Housing problems/homelessness 29.03% Lack of job opportunities 24.10% Limited access to healthy food 15.61% Limited places to exercise 8.28% Neighborhood safety/street violence 19.55% Poverty 21.38% Racial/ethnic discrimination 6.67% School dropout/poor schools 8.61% Transportation problems 17.25% Other 9.81% Did not answer 9.48%

10 | Systemwide Priorities and Implementation Strategies 2018 Community Health Needs Assessment Domain 3: Social Determinants of Health B. Community Input There is a documented link between social determinants of health and their impact on health care use and costs. Sessions: Key Themes Basic needs such as affordable housing, child care and employment need to be met in order to improve At the qualitative community input sessions, community physical and mental health and generate overall members identified the health issues most important to improved health status in the community. Many people them. These issues fell into three overarching topic areas: overusing healthcare services, particularly emergency health and wellness, access to care and services and care, have social issues that are not being addressed. social determinants of health. Meeting community needs around social determinants is an essential component of delivering quality, Domain 1: Health and Wellness comprehensive care for patients. MedStar’s community There is a continued need for prevention and partners will play a critical role in helping to address the management programs and services focused on chronic social determinants of health. disease in the areas of drug and alcohol addiction, mental health conditions, diabetes, heart disease, obesity and cancer. Communities lack awareness of the health-related Evaluation resources available and how to access existing wellness, prevention and management services. Numerous Over fiscal years 2019-2021, the hospitals will execute community assets and resources are underutilized due to the approved implementation strategies. Plans will focus lack of awareness and social determinant barriers such on evidence and outcomes based strategies that align as housing instability, lack of transportation and financial with assessment findings and hospitals’ population health instability stemming from lack of employment. management efforts. Evidence-based programming for identified priority areas, systematic measurement and examination of program effectiveness, as well as progress Domain 2: Access to Care and Services and outcomes relative to program metrics and local public Increased collaboration between MedStar and community- health goals, will be tracked as part of the evaluation. based health providers and organizations will assist with Strategy progress and impact will be shared with hospitals’ strategy execution and bringing health education and ATF and Board of Directors. prevention services directly into communities, which will decrease barriers to access and appropriate use of healthcare services. Transportation services as well as access to behavioral health and social needs services were Priorities and Hospital Role routinely identified as areas of priority. MedStar hospitals are unable to address all of the health needs identified in the CHNA. Given this, each of the 10 hospitals determined appropriate roles to play in addressing their identified priorities.

SYSTEM-WIDE PRIORITIES BY HOSPITAL ROLE

FOCUS AREAS COLLABORATION AREAS PARTICIPATION AREAS

Chronic disease prevention Transportation Housing and management Employment and workforce Access to behavioral health services development Identification of social needs and linking to community social services

11 | Systemwide Priorities and Implementation Strategies 2018 Community Health Needs Assessment Individual Hospital Community Health Needs Assessments v and Strategies

12 | Individual Hospital CHNAs 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): SOUTHEAST BALTIMORE COUNTY MedStar Franklin Square Medical Center’s CBSA includes residents living in ZIP codes 21220 and 21221. This geographic area was selected as MedStar Franklin v Square Medical Center’s CBSA based on hospital utilization data and secondary public health data, as well as the longstanding collaborative partnership with the Baltimore County Southeast Area Network (Southeast Network) for its community benefit efforts.

COMMUNITY HEALTH PRIORITIES Community Health • Health and Wellness —— Chronic Disease Prevention Needs Assessment and Management —— Behavioral Health —— Maternal and Child Health

Health and Wellness • Access to Care and Services —— Mental Health Services and CHRONIC DISEASE Substance Use Services —— Linkage to Social Need Chronic Disease Objectives Resources and Services • Deliver evidence-based, outcome-focused chronic disease management and —— Transportation prevention programs and services in, or targeting individuals living in, MedStar Franklin Square Medical Center’s Community Benefit Service Area (CBSA) • Social Determinants of Health • Prevent the onset of type 2 diabetes through a 12-month lifestyle —— Employment change program —— Housing • Increase awareness and the intention to quit among smokers • Provide stroke survivors and their family caregivers an opportunity to support each other as they strive to rebuild their lives and promote health, independence, and well-being

13 2018 Community Health Needs Assessment Chronic Disease Secondary Data • Increased identification of social unmet needs and linkages to social need services among chronic DIABETES disease management program participants • Diabetes is the sixth leading cause of death in • Improved healthcare utilization patterns among Baltimore County.27 program participants • The death rate for diabetes in Baltimore County is 19.6 per 100,000 people, compared to 19.2 per Chronic Disease Metrics 100,000 in Maryland and to 21.0 per 100,000 in the US.27, 28 PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of HEART DISEASE AND STROKE programs and services implemented; and 2) relevance • Heart disease is the leading cause of death in to external public health goals. Baltimore County and Maryland.27 • Stroke is the third leading cause of death in • Living Well Program Baltimore County and Maryland.27 —— Percentage of program completers who report • Baltimore County has a heart disease death rate improved quality of life of 176.8 per 100,000 people in Baltimore County, —— Percentage of program completers reporting compared to 166.9 per 100,000 statewide.27 increased physical activity • In Baltimore County, the stroke death rate was —— Percentage of program completers who have 43.9 per 100,000 people in Baltimore County, decreased blood pressure and weight loss compared to 38.4 per 100,000 statewide.27 —— Percentage of people who screened positive for social needs and were linked to services at intake OBESITY and post program completion • 30.0 percent of adults in Baltimore County report —— Percentage of completers who do not readmit to a BMI of 30 or more.11 emergency department (ED) after the program ends SMOKING —— Potentially Avoidable Utilizations (PAU) and • 15.0 percent of adults in Baltimore County are readmission rates among program completers current smokers.13 —— Percentage of program completers who successfully complete follow-up assessments CANCER • Cancer is the second leading cause of death in • Diabetes Prevention Program 27 both Baltimore County and the state of Maryland. —— Number of Diabetes Prevention Program (DPP) • Baltimore County has a cancer death rate of 171.0 per programs conducted annually 100,000, higher than the state cancer death rate of —— Retention rates among DPP participants 27 157.4 per 100,000. —— Number of participants who meet weight loss goal • Baltimore County has a cancer death rate of 171.0 per of five percent 27 100,000, compared to 157.4 per 100,000 for the state. —— Number of participants who meet physical activity goal of 150 minutes per week Chronic Disease Strategies • Conduct Living Well Chronic Disease • Smoking Cessation: Cancer Prevention Self- Management Program —— Percentage of completers who report quitting after • Conduct Diabetes Prevention Program program participation • Conduct Smoking Cessation Program —— Quit rate of program completers • Conduct Stroke Support Group • Stroke Support —— Number of support groups held annually Chronic Disease Anticipated Outcomes —— Number of participants in support groups annually • Increased participation in chronic disease prevention and management programs and services • Increased retention rates among program participants • Improved health behaviors and health outcomes among program participants

14 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment From January to March 2017, there were 550 drug and alcohol overdose- related deaths in Maryland, including 372 fentanyl-related deaths.9

PUBLIC HEALTH METRICS Behavioral Health Secondary Data • Age-adjusted death rates for heart disease, stroke, cancer, and diabetes ALCOHOL ABUSE • • Prevalence rates of obesity among adults 16 percent of adults in Baltimore County report 11 • Emergency department visits and hospitalization rates excessive drinking. due to hypertension, heart disease, stroke, cancer, • Percentage of driving deaths in Baltimore County with 11 obesity, and diabetes alcohol involvement: 26 percent. • • Prevalence rates of diabetes among adults Percentage of Baltimore County adults reporting binge 11 • Percentage of adults who smoke drinking: 16 percent. • Percentage of adolescents using tobacco products OPIOID ABUSE • Baltimore County saw the largest increase in drug- KEY PARTNERS: CHRONIC DISEASE related deaths in 2017, where 176 people died in the first quarter of 2017, compared to 113 people in the American Cancer Society first quarter of 2016.9 American Stroke Association • From January to March 2017, there were 550 drug Baltimore County Department of Aging and alcohol overdose-related deaths in Maryland, Baltimore County Department of Health including 372 fentanyl-related deaths.9 Centers for Disease Control and Prevention (CDC) Maintaining Active Citizens, Inc. Maryland Department of Aging Behavioral Health Strategies Maryland Department of Health • Implement the Screening, Brief Intervention, and St. Stephens AME Church Referral to Treatment (SBIRT) strategy in emergency department and primary care settings • Embed Peer Recovery Coaches on hospital care teams to assist with improving access to substance BEHAVIORAL HEALTH use treatment and social service linkage, and support Behavioral Health Objectives: community education efforts Substance Use Disorders • Deliver evidence-based behavioral health programs and services targeting the identification of substance abuse and linkage to treatment services among high- risk individuals in MedStar Franklin Square’s CBSA

15 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment Behavioral Health Anticipated Outcomes MATERNAL AND CHILD HEALTH • Improved identification of high-risk substance use behaviors and access to substance abuse treatment, Maternal and Child Health Objectives education, and social services • Promote positive birth outcomes and increased breastfeeding practice for mothers and their families Behavioral Health Metrics in Southeast Baltimore County PROGRAM-SPECIFIC METRICS Maternal and Child Health Secondary Data Key factors will be tracked to determine: 1) impact of • In Baltimore County, nine percent of infants are born programs and services implemented; and 2) relevance with low birth weight. This is higher than the rate to external public health goals. for Maryland (8.5 percent) and the United States (7.8 percent). • Number of emergency department (ED) SBIRT • For every 1,000 live births in Baltimore County, screens annually there are six infant deaths per year.11 • Number of positive SBIRT screens annually • The infant mortality rate for black mothers in • Number of brief interventions completed annually Baltimore County is 11 per 1,000 live births.11 • Number of referrals to treatment provided annually • Number of patients linked to treatment annually Maternal and Child Health Strategies • ED readmission and potentially avoidable utilization • Support and coordinate the Healthy Babies (PAU) rates of patients who receive brief interventions Collaborative and/or linkage to treatment • Number of substance abuse or addiction support groups promoted and held in MedStar Franklin Square Maternal and Child Health CBSA annually Anticipated Outcomes • Increased number of babies being born healthy PUBLIC HEALTH METRICS and being raised in safe and stable families and • Percentage of individuals reporting a substance abuse communities in southeast Baltimore County disorder • Improved access to breastfeeding education and • Percentage of adults reporting excessive drinking services in southeast Baltimore County • Percentage of hospitalizations due to a substance abuse or alcohol abuse disorder Maternal and Child Health Metrics • Number of driving deaths involving alcohol • Age-adjusted death rate due to opioid overdose PROGRAM-SPECIFIC METRICS • Age-adjusted drug and alcohol related death rate Key factors will be tracked to determine: 1) impact of • Drug and alcohol related emergency department visits programs and services implemented; and 2) relevance to external public health goals.

KEY PARTNERS: BEHAVIORAL HEALTH • Number of support group meetings held annually • Number of participants in support group Baltimore County Department of Health meetings annually Mosaic Group • Percentage of infants being “fully formula-fed” Substance Abuse and Mental Health Services Administration (SAMSHA) PUBLIC HEALTH METRICS • Percentage of babies with low birth weight • Percentage of babies exclusively breastfed • Percentage of infants being “fully formula-fed” • Infant mortality rate • Maternal mortality rate • Child mortality rate

16 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment Access to Care and Services KEY PARTNERS: MATERNAL AND CHILD HEALTH Anticipated Outcomes Abilities Network Healthy Families Program • Increased access to mental health services in primary Baltimore County Department of Health care settings Baltimore County Department of Planning • Increased use of uniform social needs screener in Baltimore County Department of Social Services MedStar Franklin Square care delivery sites and as part Baltimore County Health Coalition of the Living Well Program Baltimore County Local Management Board • Improved identification of patients’ unmet social Centers for Disease Control and Prevention (CDC) needs and service linkage at point of care Mental Health Association of Maryland • Improved health care utilization among individuals National Association of County and City Health Officials linked to social need services, transportation services (NACCHO) or mental health services Southeast Network United Way of Central Maryland Access to Care and Services Metrics University of Maryland School of Nursing PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevance Access to Care and Services to external public health goals. • Mental Health Services Access to Care and Services Objectives —— Number of people who receive mental health • Increase access to mental health services as part of the treatment services in program primary care primary care model setting annually • Improve appropriate healthcare utilization practices —— Number of people screened for selected mental and health outcomes of high-need, high-risk patients health conditions (substance use, depression, and by identifying social unmet needs and linkage to anxiety) annually community social needs resources at point of care —— Number of people with positive mental health using the Aunt Bertha tool screening annually —— Number of people who screen positively for mental Access to Care and Services Secondary Data health conditions that are referred or linked to • In Baltimore County, there are 400 mental health services annually providers for every one patient.11 —— ED readmission and PAU rates of people with • Seven percent of the Baltimore County population positive mental health screening that were under the age of 65 do not have health insurance.11 referred or linked to services • The ratio of the population to primary care physicians in Baltimore County is 990:1.11 • Social Need Services • 12.0 percent of children in Baltimore County are —— Number of social needs screenings living in poverty; among black children, the rate conducted annually is 16.0 percent; among Latino children, the rate —— Number of positive social needs screens annually is 22.0 percent; among white children, the rate is —— Number of people referred to services annually seven percent.11 —— Number of people linked to services annually —— ED readmission and PAU rates of people with Access to Care and Services Strategies positive social needs screenings that are referred • Provide mental health services as part of a or linked to services primary care model PUBLIC HEALTH METRICS • Conduct social needs screenings and support linkages • Depression and anxiety disorder prevalence rates to social need services as part of care delivery and • Percentage of adults unemployed chronic disease self-management programming • Percentage of households experiencing food insecurity • Percentage of uninsured individuals

17 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment • Number of individuals reporting avoiding medical care due to cost 19 percent • Percentage of individuals living below the poverty line of youth ages 16 to 24 are classified as “disconnected youth” 21 KEY PARTNERS: ACCESS TO CARE (neither in school nor working).

Aunt Bertha, Inc. Community-based addiction and mental health services —— ED readmission and PAU rates of people who organizations receive rides Community medical providers —— Medical appointment no show rates Community-based social services organizations —— Percentage of people who identify transportation as a barrier

PUBLIC HEALTH METRICS Collaboration Areas • Percentage of the population with access to public transportation Collaboration areas were identified as social determinant • Percentage of population who have delayed getting areas in which the hospital will serve as a partner with medical care due to lack of transportation outside organizations.

TRANSPORTATION KEY PARTNERS: TRANSPORTATION Aunt Bertha, Inc. Transportation Objectives Uber Technologies, Inc. • Address the barrier of transportation to medical and health services and programs among individuals who identify transportation as a social unmet need EMPLOYMENT

Transportation Secondary Data Employment Objectives • 28 percent of MedStar Franklin Square CHNA survey • Hire individuals from underserved communities respondents identified lack of transportation as a as Community Health Advocates (CHA) and Peer barrier to accessing care. Recovery Coaches (PRC) to contribute to MedStar Health’s population health management efforts in the Transportation Strategies Baltimore region through the Baltimore Population • Implement MedStar Health UBER program Health Workforce Support for Disadvantaged Areas Program (PHWSDA) Transportation Anticipated Outcomes • Prepare local underserved students for healthcare- • Increased number of available rides to and from related collegiate studies and careers through an medical and health services and community established pipeline internship program health programs • Decreased no-show rates among participants Employment Secondary Data • 4.5 percent of the population in Baltimore County Transportation Metrics over the age of 16 is unemployed and seeking work.11 • The Baltimore County unemployment rate is five percent, PROGRAM-SPECIFIC METRICS which is the same as the US, but higher than the Key factors will be tracked to determine: 1) impact of unemployment rate in Maryland (four percent).21 programs and services implemented; and 2) relevance • In Baltimore County, the high school graduation to external public health goals. rate is 89.9 percent. Racial disparities exist in high school graduation rates in Maryland. White • MSH UBER Program students graduation rate is 90.0 percent compared —— Number of rides supported annually to 77.0 percent and 73.0 percent among black and —— Number of people who receive rides annually Hispanic students, respectively.26

18 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment • 19.0 percent of Baltimore County youth ages 16 to • Rx for Success Pipeline Summer Internship Program 24 are classified as “disconnected youth” (neither —— Number of students who apply to the internship in school nor working)21 annually —— Number of students selected or placed in the Employment Strategies internship annually • Conduct PHWSDA program —— Number of student interns from MedStar • Conduct the Rx for Success Pipeline Summer Internship Franklin Square’s CBSA annually Program for underserved high school students —— Graduation rates of interns —— Number of seniors who complete the internship Employment Anticipated Outcomes and pursue a health-related college major • Increased number of CHAs and PRCs hired and —— Number of seniors who complete the internship trained by 2019 and are employed in a health-related position • Increased number of underserved, racial and within MedStar Health ethnic minority interns in the Rx for Success summer —— Student, supervisor, and community partner internship at MedStar Franklin Square annually satisfaction rate • Improved satisfaction rates among student —— Type of intern placements within MedStar interns, intern supervisors, and school partner Franklin Square leadership annually PUBLIC HEALTH METRICS • Improved pipeline processes to increase • Unemployment rate employment opportunities post-internship • High school graduation and completion rate for eligible students • Percentage of new hires to healthcare fields25 Employment Metrics KEY PARTNERS: EMPLOYMENT PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of Baltimore Alliance for Careers in Healthcare (BACH) programs and services implemented; and 2) relevance Baltimoreans United in Leadership Development (BUILD) to external public health goals. Eastern Technical High School Project SEARCH—Arc of Baltimore • Population Health Workforce Support for Turnaround Tuesday Disadvantaged Areas “Jobs” Program Other local health systems —— Number of individuals trained from MedStar Franklin Square’s CBSA —— Number of individuals hired from MedStar Franklin Square’s CBSA Participation Areas —— Retention rates of hired associates —— Number of patients or clients assisted by Participation areas are those that the hospital supports, but these positions is not positioned to take a leadership role in addressing. —— Average caseload for positions —— Average length of patient engagement by positions PARTICIPATION —— Number of patients screened for social needs and • Housing number of those referred or linked to services —— Readmission rates among patients assigned to CHAs or PRCs KEY PARTNERS: PARTICIPATION

—— ED utilization among patients assigned to Baltimore County Communities for the Homeless CHAs or PRCs Baltimore County Department of Planning Health Care for the Homeless Neighbor to Neighbor United Way of Central Maryland

19 | MedStar Franklin Square Medical Center 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): 20011, 20019, 20020 (WITH EMPHASIS ON WARDS 7 AND 8) MedStar Georgetown University Hospital’s CBSA includes residents in Washington, DC zip codes 20011, 20019, and 20020. This geographic area was selected based on hospital utilization and secondary public health data with the goal of expanding services and programs to underinsured, uninsured, and low income people.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management —— Behavioral Health

• Access to Care and Services —— Mental Health and Substance Community Health Use Services —— Linkage to Resources and Needs Assessment Services—Schools —— Transportation

• Social Determinants of Health Health and Wellness —— Food Access —— Employment CHRONIC DISEASE —— Housing

Chronic Disease Objectives • Deliver evidence-based and outcome-focused chronic disease management and prevention programs and services in, or targeting at-risk, high-need individuals living in, MedStar Georgetown University Hospital’s Community Benefit Service Area (CBSA)

20 2018 Community Health Needs Assessment • Increase access to health care and support services • More than one-third (33.8 percent) of 10-12 year-olds in by providing patient visits to children and adolescents DC are obese.36 living in the underserved communities of DC, who are • DC ranks 11th among all states for obesity rates among at risk or have poor access to comprehensive pediatric kids ages 10-12.36 health care services CANCER • Cancer is the second leading cause of death among Chronic Disease Secondary Data DC residents, with 1,044 deaths in 2016 (and a DIABETES mortality rate of 160.1).32 • Diabetes was the sixth leading cause of death in DC, • The crude death rate of deaths from cancer in Ward with 127 deaths in 2016 (and a mortality rate of 19.8).32 7 is about 22.0 percent higher than the DC-wide rate, • In 2014, one in eleven (or 9.1 percent) DC residents and 26.0 percent higher than the nation.35 had diabetes. In 2013, diabetes was the ninth leading • DC has the highest liver cancer rates in the country, cause of hospitalization in DC, with 1,572 visits.6 with 15 deaths per 100,000 men, and five such deaths • In DC, emergency department (ED) visits related to per 100,000 women.35 diabetes were over six times higher African-Americans than for Whites.6 Chronic Disease Strategies • An analysis of ED records found that up to 30 percent of • Conduct Living Well – Chronic Disease visits for diabetes, asthma, and other chronic conditions Self-Management Program were potentially preventable with better access to • Deliver Mobile Health Clinics: Kids Mobile Medical effective primary and preventive care.6 Clinic & Mobile FITNESS Program

HEART DISEASE AND STROKE Chronic Disease Anticipated Outcomes • Heart disease is the leading cause of death among DC • Increased participation in chronic disease prevention residents, with 1,375 deaths in 2016 (and a mortality and management programs and services rate of 211.7).32 • Increased retention rates among program participants • Heart disease in DC can be attributed to preventable • Improved health behaviors and health outcomes factors like obesity, poor physical activity, heavy among program participants drinking, eating unhealthy foods, and not keeping • Increased identification of social unmet needs and blood pressure and cholesterol under control. linkages to social need services among chronic • The hospitalization rate for heart disease in DC disease management program participants was 41.9 per 1,000 Medicare beneficiaries. • Improved healthcare utilization patterns among • Heart disease is the top reason for hospitalization program participants in DC. • Increased number of children and adolescent patients • Stroke is the fourth leading cause of death in DC, at mobile health clinics with 252 deaths in 2016 (and mortality rate of 38.4).32 • Increased children and adolescent body mass index OBESITY (BMI) screenings • In DC, 26.2 percent of adults are obese. DC has the second lowest adult obesity rate in the nation.36

21 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment Chronic Disease Metrics • Percentage of children and adolescents who are obese or overweight PROGRAM-SPECIFIC METRICS

• Living Well Program KEY PARTNERS: CHRONIC DISEASE —— Percentage of program completers who report Build Our Kids Success (BOKS) improved quality of life —— Percentage of program completers reporting DC Department of Aging and Human Services increased physical activity DC Department of Family Services —— Percentage of program completers who have DC Health decreased blood pressure and weight loss DC Public Schools —— Percentage of people who screened positive for Maintaining Active Citizens, Inc. social needs and were linked to services at intake and program completion Maryland Department of Aging —— Percentage of completers who do not readmit Ronald McDonald House Charities of Greater to the ED Washington, DC —— Potentially avoidable utilizations (PAU) and Schools (Barnard Elementary School, KIPP D.C. AIM readmission rates among program completers Academy, KIPP DC Heights Academy, and Neval Thomas —— Percentage of program completers who Elementary School) successfully complete follow-up assessments Share Our Strength’s Cooking Matters Program The NHLBI’s We Can! (Ways to Enhance Children’s • Pediatric Health Care Services Activity & Nutrition) and Healthy Kids Challenge —— Number of patient visits completed annually —— Number of unique patients annually —— Number of patients screened for BMI annually BEHAVIORAL HEALTH —— Number of patients (or students) served or reached annually Behavioral Health Objectives —— Number of participants reached through fitness • Deliver evidence-based behavioral health programs programs and events (including Build Our Kids and services targeting the identification of substance Success program) annually abuse and linkage to treatment services among high- risk individuals in MedStar Georgetown University PUBLIC HEALTH METRICS Hospital’s CBSA • Age-adjusted death rate from diabetes, heart disease, stroke, and cancer Behavioral Health Secondary Data • Emergency department visit rates and hospitalizations due to hypertension, diabetes, heart disease, stroke SUBSTANCE ABUSE and cancer • Nationally, over 20 million adults have a substance use • Prevalence of diabetes in DC disorder. • Incidence and prevalence of heart disease and stroke • In 2016, there were more than 63,600 drug overdose in DC deaths in the United States.41 • Percentage of adults at a healthy weight or BMI • The rate of drug overdose deaths in DC in 2016 was • Percentage of adults participating in recommended 38.8 per 100,000 population.41 levels of physical activity • More DC residents report use of illicit drugs • Percentage of adults who are obese (12.3 percent) than the national rate, 8.8 percent.30

ALCOHOL ABUSE • 28.0 percent of adults in DC report binge drinking DC’s mortality rate for opioid- compared to 18.0 percent nationally.11 overdose deaths is among • In DC, the percentage of driving deaths with related alcoho involvement was 25 percent compared to 37 the highest in the nation. 33.0 percent nationally.11

22 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment • The percentage of driving deaths with alcohol • Percentage of adults reporting excessive drinking involvement in DC increased from 43.0 percent in • Percentage of adults and adolescents who report 2015 to 74.0 percent in 2016.5 alcohol use and binge drinking • White adults were more than twice as likely to • Percentage of hospitalizations due to a substance report as binge drinkers compared to Black adults abuse or alcohol abuse disorder (35.0 percent and 14.0 percent, respectively).5 • Number of driving deaths involving alcohol • The percent of adults reporting as binge drinkers • Number of hospitalizations due to opioid overdose varied significantly by ward, with the highest • Age-adjusted death rate due to opioid overdose percentages in Wards 1 (42.0 percent) and 2 • Age-adjusted drug and alcohol related death rate (30.0 percent) and lowest in Wards 4 (16.0 percent) • Drug- and alcohol-related ED visits and 7 (18.0 percent).5

OPIOID ABUSE KEY PARTNERS: BEHAVIORAL HEALTH • DC’s mortality rate for opioid-related overdose Community-based addiction and mental health services deaths is among the highest in the nation, with organizations a 2016 rate of 30 deaths per 100,000 people DC Health (or 209 deaths). The national rate is 13.3 per Maryland Department of Health and Mental Hygiene - Behavioral Health Administration 100,000 people.37 Mosaic Group Substance Abuse and Mental Health Services Administration Behavioral Health Strategies (SAMSHA) • Conduct Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program Behavioral Health Anticipated Outcomes Access to Care and Services • Improved identification of high-risk substance use behaviors and access to substance abuse treatment, Access to Care and Services Objectives education, and social need services • Increase access to mental health services as part of the primary care model Behavioral Health Metrics • Improve appropriate healthcare utilization practices and health outcomes of high-need, high-risk patients PROGRAM-SPECIFIC METRICS by identifying social unmet needs and linkage to Key factors will be tracked to determine: 1) impact of community social needs resources at point of care programs and services implemented; and 2) relevance using the Aunt Bertha tool to external public health goals.

• Number of SBIRT screens annually Access to Care and Services Secondary Data • Number of positive SBIRT screens annually MENTAL HEALTH SERVICES • Number of brief interventions completed annually • In 2014, approximately 18.0 percent of DC adults • Number of referrals to treatment provided annually had ever been told they had a depressive disorder.5 • Number of patients linked to treatment annually • Rates of reported depression were highest in Ward • ED readmission and PAU rates of patients who receive 8 (30.0 percent), Ward 1 (22.0 percent), and Ward 7 brief interventions and/or linkage to treatment (18.0 percent).5 • Number of substance abuse and addiction support • Areas of Wards 7 and 8 were designated by the Health groups held in Medstar Georgetown University Resources and Services Administration (HRSA) as Hospital’s CBSA annually mental health professional shortage areas in 2015.5 • In 2014, the second most common inpatient hospital PUBLIC HEALTH METRICS discharge among all DC residents was for mood • Percentage of individuals reporting a substance disorders (3.9 percent).5 abuse disorder

23 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment SOCIAL NEEDS SERVICES • 93.0 percent of adult residents and 96.0 percent of children have insurance coverage in DC. It is the DC-wide, 10 percent of adults second highest coverage rate in the nation.5 reported that they had delayed • Residents in Wards 7 and 8 had the lowest coverage getting medical care because they amongst all wards (90.0 percent and 91.0 percent, respectively).5 could not get an appointment soon • Health insurance coverage was lowest among enough.5 Hispanic/Latino residents (78.0 percent) compared to 91.0 percent coverage among Black residents and 97.0 percent coverage among White residents.5 —— Number of people with positive mental health • DC-wide, 10.0 percent of adults reported that they screenings annually had delayed getting medical care because they could —— Number of people who screen positively for mental not get an appointment soon enough.5 health conditions that are referred or linked to services annually Access to Care and Services Strategies —— ED Readmission and PAU rates of people with • Provide mental health services as part of the positive mental health screening that were referred primary care model or linked to services • Conduct social needs screening and support linkages to social need services as part of care delivery and • Social Needs Services chronic disease self-management programming —— Number of social needs screenings conducted annually Access to Care and Services —— Number of positive social needs screened annually Anticipated Outcomes —— Number of people referred to services annually • Increased access to mental health services in primary —— Number of people linked to services annually care settings —— ED Readmission and PAU rates of people with • Increased use of uniform social needs screener in positive social needs screening that were referred MedStar Georgetown University care delivery sites or linked to services and as part of the Living Well program PUBLIC HEALTH METRICS • Improved identification of patients’ social unmet • Depression and anxiety disorder prevalence rates needs and service linkage at point of care • Percentage of adults unemployed • Improved healthcare utilization among individuals • Percentage of households experiencing food linked to social need services, transportation services insecurity or mental health services • Percentage of uninsured individuals • Number of individuals reporting avoiding medical Access to Care and Services Metrics care due to cost PROGRAM-SPECIFIC METRICS • Percentage of individuals living below the poverty line Key factors will be tracked to determine: 1) impact of • Percentage of people reporting unmet healthcare programs and services implemented; and 2) relevance needs in the past 12 months to external public health goals. • Percentage of people reporting they could not afford to see a doctor in the past 12 months • Mental Health Services —— Number of people who receive or are referred to mental health treatment services in primary care settings annually —— Number of people screened for selected mental health conditions (substance use, depression, and anxiety) annually

24 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment • MSH UBER Program KEY PARTNERS: ACCESS TO CARE —— Number of rides supported annually Aunt Bertha, Inc. —— Number of people who receive rides annually Community-based addiction and mental health services —— ED readmission and PAU rates of people who organizations receive rides Community-based social services organizations —— No show rates among program participants —— Percentage of people who identify transportation as a barrier Collaboration Areas PUBLIC HEALTH METRICS • Percentage of the population with access to public Collaboration areas were identified as social determinant transportation areas in which the hospital will serve as a partner with • Percentage of population who have delayed getting outside organizations. medical care due to lack of transportation

TRANSPORTATION KEY PARTNERS: TRANSPORTATION Transportation Objectives Aunt Bertha, Inc. • Address the barrier of transportation to medical and Uber Technologies, Inc. health services and programs among individuals who identify transportation as a social unmet need EMPLOYMENT

Transportation Secondary Data Employment Objectives • Lack of transportation is cited as having a significant • Prepare local underserved students for healthcare- impact on access to health care services and is a related collegiate studies and careers through an determinant of a person’s ability to access basic established pipeline internship program resources that can affect quality of life.5 • In DC, many characterize public transportation as Employment Secondary Data expensive and unreliable.5 • In 2015, 14.0 percent of DC families lived in poverty. • Metro stations in DC are concentrated in the central In Wards 7 and 8, 75.0 percent more families live in region (Wards 2 and 6) and are lacking in other areas, poverty, at 25.0 percent and 29.0 percent respectively, especially in Wards 4, 7 and 8.5 compared to the DC benchmark.5 • 19.0 percent of MedStar Georgetown University • DC’s unemployment rate has decreased since 2011, Hospital’s CHNA survey respondents identified lack of but the rate varies from ward to ward. Compared transportation as a barrier to accessing care. to the national rate, unemployment was two times higher in Ward 7 and three times higher in Ward 8 Transportation Strategies in 2016.5 • Implement MedStar Health UBER program • Compared to the national average, as of June 2016, unemployment is two times higher in Ward 7 and three Transportation Anticipated Outcomes times higher in Ward 8.5 • Increased number of available rides to and • DC’s income inequality ratio is 7.0 percent (ratio of from medical and health services and community household income at the 80th percentile to income at health programs the 20th percentile).5 • Decreased no-show rates among participants • Income and employment status are closely linked to morbidity, mortality, and overall well-being; lower than Transportation Metrics average life expectancy is highly correlated with low- 5 PROGRAM-SPECIFIC METRICS income status. Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevance to external public health goals.

25 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment Employment Strategies • Conduct the Rx for Success Pipeline Summer Internship 13 percent Program for underserved high school students of the population in DC reports food insecurity, Employment Anticipated Outcomes or insufficient access to healthy • Increased number of underserved, racial and ethnic minority interns in the Rx for Success summer food, compared to 10 percent 5 internship at MedStar Georgetown University nationally. Hospital’s annually • Improved satisfaction rates among student interns, intern supervisors and school partner leadership annually • Improved pipeline processes to increase employment opportunities post-internship KEY PARTNERS: EMPLOYMENT for eligible students Eastern High School Companies for Causes Employment Metrics

PROGRAM-SPECIFIC METRICS FOOD ACCESS Key factors will be tracked to determine: 1) impact of Food Access Objectives programs and services implemented; and 2) relevance • Improve access to healthy food among individuals to external public health goals. who identify food insecurity as a social need • Rx for Success Pipeline Summer Internship Program —— Number of students who apply to the internship Food Access Secondary Data annually • 29.0 percent of MedStar Georgetown University —— Number of students selected and placed in the Hospital’s CHNA respondents identified healthy food internship annually options as a community need. —— Number of student interns from MedStar • Residents in Wards 7 and 8 have reported they Georgetown University Hospital’s CBSA annually struggled to afford the cost of healthy produce.5 —— Graduation rates of interns • 13.0 percent of the population in DC reports food —— Number of seniors who complete the internship insecurity, or insufficient access to healthy food, and pursue a health-related college major compared to 10.0 percent nationally.5 —— Number of seniors who complete the internship and are employed in a health-related position Food Access Strategies within MedStar Health • Conduct Food & Friends Meal Referral Program —— Student, supervisor and community partner satisfaction rate Food Access Anticipated Outcomes —— Type of intern placements within MedStar • Increased number of people with positive social needs Georgetown University Hospital screened for food insecurity that are referred or linked to food-related services PUBLIC HEALTH METRICS • Increased number of annual MedStar Georgetown • Unemployment rate University Hospital-supported meals • Percentage of adults who are unemployed and seeking work (unemployment rate) • High school graduation and completion rate • Percentage of new hires to healthcare fields

26 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment Food Access Metrics School-Based Health Centers Metrics

PROGRAM-SPECIFIC METRICS PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevance programs and services implemented; and 2) relevance to external public health goals. to external public health goals.

• Food and Friends Meal Referral Program • Number of students served annually —— Number of referrals to Food & Friends annually • Number of patient visits completed annually —— Number of people linked to food services annually —— Number of meals supported annually PUBLIC HEALTH METRICS —— ED readmission and PAU rates of people linked to • Emergency department visit rates due to asthma food services for children ages 5–14

PUBLIC HEALTH METRICS • Percentage of food insecure households KEY PARTNERS: EMPLOYMENT Anacostia Senior High School • Percentage of population lacking access to healthy food Anacostia Wellness Clinic Roosevelt Senior High School DC Health KEY PARTNERS: FOOD ACCESS DC Public Schools Food & Friends Health Justice Alliance Capital Area Food Bank Mary’s Center Inc. MWHC TAPP program National Alliance to Advance Adolescent Health SCHOOL-BASED HEALTH CENTERS New Heights Program

School-Based Health Centers Objectives • Improve access to health care services for adolescents living in the underserved areas of DC Participation Areas

School-Based Health Centers Secondary Data Participation areas are those that the hospital • There are eight school-based health centers in DC, and supports, but is not positioned to take a leadership DC Health oversees seven of them.39 role in addressing. • A SBHC can serve as a student’s primary health care

provider or supplement the services they would PARTICIPATION 39 normally receive. • Housing • Each SBHC offers medical, oral, social and mental health services, and education to enrolled students, and to the children of enrolled students.39 KEY PARTNERS: PARTICIPATION Central Union Mission School-Based Health Centers Strategies Coalition for the Homeless • Provide health care services through the school-based DC Department of Human Services—Family Services health centers at Roosevelt Senior High School and Administration Anacostia Senior High School DC Health District of Columbia Primary Care Association (DCPCA)—DC Positive Accountable Community Transformation (DC PACT) School-Based Health Centers Housing and Urban Development Anticipated Outcomes Pathways to Housing • Improved health outcomes among program participants

27 | MedStar Georgetown University Hospital 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): GOVANS AREA MedStar Good Samaritan Hospital’s CBSA includes residents in zip codes 21206 and 21239. This geographic area was selected based on hospital utilization and secondary public health data as well as its close proximity to the hospital, coupled with a high density of residents with low incomes.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management —— Behavioral Health

• Access to Care and Services Community Health —— Mental Health Services —— Linkage to Resources and Needs Assessment Services —— Transportation

• Social Determinants of Health Health and Wellness —— Employment —— Neighborhood Violence and CHRONIC DISEASE Street Safety —— Housing Chronic Disease Objectives Deliver evidence-based, outcome-focused chronic disease management and prevention programs and services in, or targeting individuals living in, MedStar Good Samaritan Hospital’s Community Benefit Service Area (CBSA)

• Prevent the onset of type 2 diabetes through a 12-month lifestyle change program • Increase awareness and the intention to quit among smokers • Provide stroke survivors and their family caregivers an opportunity to support each other as they strive to rebuild their lives and promote health, independence and well-being

28 2018 Community Health Needs Assessment Chronic Disease Secondary Data Chronic Disease Anticipated Outcomes • Increased participation in chronic disease prevention DIABETES and management programs and services • Diabetes is the sixth leading cause of death in • Increased retention rates among program participants Baltimore City and Maryland.27 • Improved health behaviors and health outcomes • The prevalence of diabetes in Baltimore City is among program participants 13.65 percent.11 • Increased identification of social unmet needs and • The prevalence of diabetes among African linkages to social need services among chronic Americans (18.58 percent) is more than twice as high disease management program participants as the prevalence among Whites in Baltimore City • Improved healthcare utilization patterns among (7.44 percent).11 program participants HEART DISEASE AND STROKE • Heart disease is the leading cause of death in Chronic Disease Metrics Baltimore City and Maryland.27 PROGRAM-SPECIFIC METRICS • Stroke is the third leading cause of death in Key factors will be tracked to determine: 1) impact of Baltimore City and Maryland.27 programs and services implemented; and 2) relevance • 145 out of 100,000 people die prematurely due to to external public health goals. cardiovascular disease (CVD).2 • In 2014, the CVD premature death rate among Black • Living Well Program residents was about 1.6 times the same rate among —— Percentage of program completers who report White residents.2 improved quality of life • Baltimore City has the highest stroke death rate per —— Percentage of program completers reporting 100,000 people in Maryland at a rate of 108.4 per increased physical activity 4 100,000 individuals. —— Percentage of program completers who have

OBESITY decreased blood pressure and weight loss —— Percentage of people who screened positive for • 34.0 percent of adults in Baltimore City report a body mass index (BMI) of 30 or higher, compared to social needs and were linked to services at intake 26.0 percent for the top US performers.11 and post program completion —— Percentage of completers who do not readmit to CANCER emergency department (ED) after program ends • Cancer is the second leading cause of death in —— Potentially avoidable utilizations (PAU) and Maryland and Baltimore City has the highest cancer readmission rates among program completers 8 mortality rate among all Maryland jurisdictions. —— Percentage of program completers who successfully • Baltimore City has a cancer death rate of 213.9 per complete follow-up assessments 100,000, higher than the state cancer death rate of 157.4 per 100,000.19, 27 • Diabetes Prevention Program —— Number of Diabetes Prevention Program (DPP) SMOKING programs conducted annually • 20.0 percent of adults smoke in Baltimore City, —— Retention rates among DPP participants compared to 15.5 percent of adults nationally in 2016.11 —— Number of participants who meet weight loss goal of five percent Chronic Disease Strategies —— Number of participants who meet physical activity • Conduct Living Well – Chronic Disease goal of 150 minutes per week Self-Management Program • Conduct Diabetes Prevention Program • Smoking Cessation Program • Conduct Smoking Cessation Program —— Percentage of completers who report quitting after • Conduct Stroke Support Group program participation —— Quit rate of program completers

29 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment • Stroke Support Group OPIOID ABUSE —— Number of support groups held annually • Number of prescription opioid-related intoxication —— Number of participants in support groups annually deaths increased from 61 in 2010 to 113 in 2016.10

PUBLIC HEALTH METRICS Behavioral Health Strategies • Age-adjusted death rates for heart disease, stroke, • Implement the Screening, Brief Intervention, and cancer, and diabetes Referral to Treatment (SBIRT) Program • Prevalence rates of obesity among adults • Embed Peer Recovery Coaches on hospital care • ED visits and hospitalization rates due to hypertension, teams to assist with improving access to substance heart disease, stroke, cancer, obesity, and diabetes use treatment and social service linkage, and support • Prevalence rates of diabetes among adults community education efforts • Percentage of adults who smoke • Offer naloxone training to community • Percentage of adolescents using tobacco products • Develop and implement Opioid Survivor Outreach Program (OSOP) to provide support and resources to KEY PARTNERS: CHRONIC DISEASE opioid survivors that visit hospital-based emergency American Cancer Society departments American Stroke Association Baltimore City Department of Aging Behavioral Health Anticipated Outcomes Baltimore City Health Department • Improved identification of high-risk substance use Centers for Disease Control and Prevention (CDC) behaviors and access to substance abuse treatment Maintaining Active Citizens, Inc. education, and social need services Maryland Department of Aging Maryland Department of Health Behavioral Health Metrics

PROGRAM-SPECIFIC METRICS BEHAVIORAL HEALTH Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevance Behavioral Health Objectives: to external public health goals. Substance Use Disorders • SBIRT Program • Identify people with at-risk and dependent substance —— Number of SBIRT screens annually and/or alcohol use behaviors, and provide brief early —— Number of positive SBIRT screens annually intervention services to those who screen positively for —— Number of brief interventions completed annually risky drug and alcohol use —— Number of referrals to treatment provided annually • Empower community members and stakeholders to —— Number of patients linked to treatment annually save lives in response to an opioid overdose through —— ED readmission and PAU rates of patients who receive naloxone training brief interventions and/or linkage to treatment • Identify people with at-risk and dependent substance —— Number of substance abuse and addiction support abuse behaviors and provide community navigation groups held in MGSH CBSA annually and support services through the Opioid Survivor Outreach Program • Naloxone Training and OSOP —— Number of naloxone administration trainings Behavioral Health Secondary Data offered at the hospital or CBSA annually —— Number of community members trained to ALCOHOL ABUSE administer naloxone annually • Percentage of driving deaths with alcohol involvement —— Number of referrals to treatment annually in Baltimore City: 20.0 percent.1 —— Number of suspected overdoses annually • Percentage of Baltimore City adults reporting binge —— Number of referrals to OSOP peer recovery drinking: 18.0 percent.11 coaches annually • Substance Abuse: Total number of drug- and alcohol- —— Number of patients successfully contacted related intoxication deaths in Maryland increased from by OSOP recovery coach annually 1,259 in 2015 to 2,089 in 2016.10

30 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment —— Number of OSOP patients referred to Access to Care and Services Secondary Data treatment monthly HEALTH CARE —— Number of OSOP patients linked to recovery • In Baltimore City, there is one primary care physician support groups annually for 1,060 people (ratio 1060:1).11 —— Number of naloxone kits provided to OSOP • In 2014, 10.0 percent of survey respondents in patients annually Baltimore City reported being unable to get the —— Number of naloxone prescriptions provided medical care they needed in the past 12 months1 to OSOP patients annually • Mental Health. —— Number of known OSOP deaths annually • One out of 5 (110,468) Baltimoreans will experience a 3 PUBLIC HEALTH METRICS mental illness each year. • Percentage of individuals reporting a substance • One out of 20 (24,093) Baltimore City adults have abuse disorder a serious mental illness such as major depressive 3 • Percentage of adults reporting excessive drinking disorder, bipolar disorder, or schizophrenia. • Percentage of adults and adolescents who report • One out of 25 (19,275) Baltimore City adults need 3 alcohol use and binge drinking both mental health and substance abuse treatment. • Percentage of hospitalizations due to a substance • 20.0 percent of Baltimoreans with serious mental 3 abuse or alcohol abuse disorder illness lack health insurance.

• Number of driving deaths involving alcohol HEALTH EQUITY AND DISPARITIES • Number of hospitalizations due to opioid overdose • While Baltimore’s overall population diminished • Age-adjusted death rate due to opioid overdose by 4.6% between 2000-2010, the Hispanic/Latino • Age-adjusted drug and alcohol related death rate population grew dramatically by 134.7%.42 • Drug- and alcohol-related ED visits Access to Care and Services Strategies KEY PARTNERS: BEHAVIORAL HEALTH • Provide mental health services as part of the primary Baltimore City Health Department care model Community substance abuse and mental health treatment • Conduct social needs screenings and support linkages service organizations to social needs services as part of care delivery and Mosaic Group chronic disease self-management programming Substance Abuse and Mental Health Services Administration (SAMHSA) Access to Care and Services Anticipated Outcomes • Increased access to mental health treatment services Access to Care and Services and education services for hospital primary care patients Access to Care and Services Objectives • Increased access to community mental health • Increase access to mental health services as part of education opportunities the primary care model • Improved identification of patients’ social unmet • Improve healthcare utilization practices and needs and service linkage at point of care health outcomes of high-need, high-risk patients • Improved healthcare utilization among by identifying social unmet needs and linkage to individuals linked to mental health, social need or community social needs resources at point of care transportation services using the Aunt Bertha tool • Increased health education courses in Hispanic/Latino • Ensure access to health care services and health and immigrant communities education for the Hispanic/Latino and immigrant communities

31 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment Access to Care and Services Metrics —— Number of people referred to services annually —— Number of people linked to services annually PROGRAM-SPECIFIC METRICS —— ED readmission and PAU rates of people with Key factors will be tracked to determine: 1) impact of positive social needs screening that were referred programs and services implemented; and 2) relevance or linked to services to external public health goals. • Health Equity and Disparities • Mental Health Services —— Number of lay leaders from Hispanic/Latino and —— Number of people who receive mental health immigrant communities trained annually treatment services in program primary care setting —— Number of participants from Hispanic/Latino and annually immigrant communities in health education courses —— Number of people screened for selected mental annually health conditions (substance use, depression, and —— Number of health education courses delivered anxiety) annually in Hispanic/Latino and immigrant communities —— Number of people with positive mental health annually screening annually —— Number of people who screen positively for mental PUBLIC HEALTH METRICS health conditions that are referred or linked to • Percentage of people reporting unmet health care services annually needs in the past 12 months —— ED readmission and PAU rates of people with • Percentage of people reporting they could not afford positive mental health screening that were referred to see a doctor in the past 12 months or linked to services • Percentage of people diagnosed with mental illness that are uninsured • Social Needs Services • Percentage of adults unemployed —— Number of social needs screenings conducted • Percentage of households living in poverty annually • Percentage of households experiencing food —— Number of positive social needs screen annually insecurity

32 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment —— No show rates among program participants KEY PARTNERS: ACCESS TO CARE AND SERVICES —— Percentage of people who identify transportation Aunt Bertha, Inc. as a barrier Community-based addiction and mental health services organizations PUBLIC HEALTH METRICS Esperanza Center • Percentage of the population with access to public Greater Baybrook Alliance transportation Immigration Outreach Service Center • Percentage of population who have delayed getting Shepherd’s Clinic medical care due to lack of transportation

KEY PARTNERS: TRANSPORTATION Aunt Bertha, Inc. Collaboration Areas Uber Technologies, Inc.

Collaboration areas were identified as social determinant areas in which the hospital will serve as a partner with EMPLOYMENT outside organizations. Employment Objectives TRANSPORTATION • Hire individuals from underserved communities as community health advocates (CHAs) and peer Transportation Objectives recovery coaches (PRCs) to contribute to MedStar • Address the barrier of transportation to medical and Health’s population health management efforts in the health services and programs among individuals who Baltimore region through the Baltimore Population identify transportation as a social unmet need Health Workforce Support for Disadvantaged Areas Program (PHWSDA) Transportation Secondary Data • Prepare local underserved students for health care- • 28 percent of MedStar Good Samaritan Hospital related collegiate studies and careers through an CHNA survey respondents identified lack of established pipeline internship program transportation as a barrier to accessing care. Employment Secondary Data Transportation Strategies • 28.8 percent of Baltimore City families live in poverty.11 • Implement MedStar Health UBER program • 19.0 percent of youth between the ages of 16-24 are classified as disconnected youth (neither in school nor Transportation Anticipated Outcomes working), compared to 13.0 percent in Maryland and • Increased number of available rides to and from 10.0 percent for the top US performers.11 medical and health services and community • 70.0 percent of Baltimore City high schoolers graduate health programs within four years, compared to 87.0 percent in Maryland • Decreased no-show rates among participants and 95.0 percent among the top US performers.11

Transportation Metrics Employment Strategies PROGRAM-SPECIFIC METRICS • Conduct PHWSDA program Key factors will be tracked to determine: 1) impact of • Conduct the Rx for Success Pipeline Summer Internship programs and services implemented; and 2) relevance Program for underserved high school students to external public health goals. • Provide educational opportunities, skills training, professional mentorship and internship opportunities • MedStar Health UBER Program to local high school students. —— Number of rides supported annually —— Number of people who receive rides annually —— ED readmission and PAU rates of people who receive rides

33 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment Employment Anticipated Outcomes —— Type of intern placements within MedStar Good • Increased number of CHAs and PRCs hired and Samaritan Hospital trained by 2019 • FUTURE OF HEALTH Program • Increased number of underserved, racial and ethnic —— Number of students who apply to the cohorts minority interns in the Rx for Success summer internship annually at MedStar Good Samaritan Hospital annually —— Number of students selected and placed in the • Improved satisfaction rates among student interns, intern cohorts annually supervisors and school partner leadership annually —— Number of students from MedStar Good Samaritan • Improved pipeline processes to increase employment Hospital’s CBSA annually opportunities post-internship for eligible students —— Graduation rates of students in cohorts —— Number of seniors who complete the experience Employment Metrics and pursue a health related-college major PROGRAM-SPECIFIC METRICS —— Number of seniors who complete the experience Key factors will be tracked to determine: 1) impact of and are employed in a health-related position programs and services implemented; and 2) relevance within MedStar Health to external public health goals. PUBLIC HEALTH METRICS • PHWSDA “Jobs” Program • Unemployment rate —— Number of individuals trained from MedStar • High school graduation and completion rate Good Samaritan Hospital CBSA • Percentage of new hires to health care fields —— Number of individuals hired from MedStar Good Samaritan Hospital CBSA KEY PARTNERS: EMPLOYMENT —— Retention rates of hired associates Baltimore Alliance for Careers in HealthCare —— Number of patients or clients assisted by BUILD - Baltimoreans United in Leadership Development these positions Mercy High School —— Average caseload for positions Mission Integration and Volunteer Services —— Average length of patient engagement by positions NACA Freedom and Democracy Academy —— Number patients screened for social needs and Turnaround Tuesday number of those referred or linked to services Vivien T. Thomas Medical Arts Academy —— Readmission rates among patients assigned to CHAs or PRCs —— ED utilization among patients assigned to CHAs or PRCs Participation Areas • Rx for Success Pipeline Summer Internship Program Participation areas are those that the hospital supports, but —— Number of students who apply to the internship is not positioned to take a leadership role in addressing. annually —— Number of students selected and placed in the internship annually Participation • Neighborhood Violence and Street Safety —— Number of student interns from MedStar Good • Housing Samaritan Hospital’s CBSA annually —— Graduation rates of interns —— Number of seniors who complete the internship KEY PARTNERS: PARTICIPATION and pursue a health-related college major American Heart Association —— Number of seniors who complete the internship BUILD - Baltimoreans United in Leadership Development and are employed in a health-related position Habitat for Humanity within MedStar Health Healthcare for the Homeless —— Student, supervisor, and community partner Penn North - UTURNS/SAMHSA satisfaction rate Safe Streets

34 | MedStar Good Samaritan Hospital 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA: SOUTHERN BALTIMORE CITY AND NORTHERN ANNE ARUNDEL COUNTY MedStar Harbor Hospital’s CBSA includes all residents of the hospital’s zip code, 21225. This area covers Southern Baltimore City and Northern Anne Arundel County, and includes four neighborhoods: Brooklyn, Brooklyn Park, Cherry Hill, and Pumphrey. In particular, the hospital will focus on the Cherry Hill community. This geographic area was selected based on hospital utilization data and secondary public health data as well as its high poverty rate and proximity to the hospital.

Community Health COMMUNITY HEALTH PRIORITIES • Health and Wellness Needs Assessment —— Chronic Disease Prevention and Management —— Behavioral Health

Health and Wellness • Access to Care and Services —— Mental Health CHRONIC DISEASE —— Linkage to Resources and Services Chronic Disease Objectives —— Transportation Deliver evidence-based, outcome-focused chronic disease management and prevention programs and services targeting at-risk, high-need individuals • Social Determinants of Health living in MedStar Harbor Hospital’s Community Benefit Service Area (CBSA) —— Employment —— Food Access and Insecurity • Prevent the onset of type 2 diabetes through a 12-month lifestyle —— Housing change program • Increase awareness and the intention to quit among smokers • Detect breast, cervical, and colon cancer through screening for those that may not be able to afford the screening services on their own

35 2018 Community Health Needs Assessment Cancer is the second leading cause of death in Maryland, and Baltimore City has the highest cancer mortality rate among all Maryland jurisdictions.8

Chronic Disease Secondary Data Chronic Disease Strategies • Conduct Living Well – Chronic Disease DIABETES Self-Management Program • Diabetes is the sixth leading cause of death in • Conduct Diabetes Prevention Program Baltimore City and Maryland.27 • Conduct Smoking Cessation Program • The prevalence of diabetes in Baltimore City is • Conduct Cancer Screening Program 13.65 percent.11 • The prevalence of diabetes among African Americans Chronic Disease Anticipated Outcomes (18.58 percent) is more than twice as high as • Increased participation in chronic disease prevention the prevalence among Whites (7.44 percent) in and management programs and services Baltimore City.11 • Increased retention rates among program participants HEART DISEASE AND STROKE • Improved health behaviors and health outcomes • Heart disease is the leading cause of death in among program participants Baltimore City and Maryland.27 • Increased identification of social unmet needs and • Stroke is the third leading cause of death in Baltimore linkages to social need services among chronic City and Maryland.27 disease management program participants • 145 out of 100,000 people in Baltimore City die • Improved health care utilization patterns among prematurely due to cardiovascular disease (CVD).2 program participants • In 2014, the CVD premature death rate among Black residents of Baltimore City was about 1.6 times the Chronic Disease Metrics same rate among White residents.2 PROGRAM-SPECIFIC METRICS • Baltimore City has the highest stroke death rate per Key factors will be tracked to determine: 1) impact of 100,000 people in Maryland at a rate of 108.4 per programs and services implemented; and 2) relevance 100,000 individuals.4 to external public health goals. OBESITY • 34 percent of adults in Baltimore City and 29 percent • Living Well Program of adults in Anne Arundel County report a body mass —— Percentage of program completers who report index (BMI) of 30 or higher report, compared to 26 improved quality of life percent for the top US performers.11 —— Percentage of program completers reporting increased physical activity CANCER —— Percentage of program completers who have • Cancer is the second leading cause of death in decreased blood pressure and weight loss Maryland, and Baltimore City has the highest cancer —— Percentage of people who screened positive for 8 mortality rate among all Maryland jurisdictions. social needs and were linked to services at intake • Baltimore City has a cancer death rate of 213.9 per and post program completion 100,000, higher than the state cancer death rate of —— Percentage of completers who do not readmit to 19, 27 157.4 per 100,000. emergency department (ED) after the program

SMOKING ends • 20 percent of adults in Baltimore City smoke, compared —— Potentially avoidable utilizations (PAU) and to 15.5 percent of adults nationally in 2016.11 readmission rates among program completers —— Percentage of program completers who successfully complete follow-up assessments

36 | MedStar Harbor Hospital 2018 Community Health Needs Assessment • Diabetes Prevention Program BEHAVIORAL HEALTH —— Number of Diabetes Prevention Program (DPP) programs conducted annually Behavioral Health Objectives: —— Retention rates among DPP participants Substance Use Disorders —— Number of participants who meet weight loss goal • Deliver evidence-based behavioral health programs of five percent and services targeting the identification of substance —— Number of participants who meet physical activity abuse and linkage to treatment services among high- goal of 150 minutes per week risk individuals in MedStar Harbor Hospital’s CBSA • Empower community members and stakeholders to • Smoking Cessation: Cancer Prevention save lives in response to an opioid overdose —— Percentage of completers who report quitting • Identify people with at-risk and dependent substance after program participation abuse behaviors and provide community navigation —— Quit rate of program completers and support services • Cancer Screening Programs • Provide educational programs to ensure individuals —— Number of breast and cervical cancer and families experiencing, or impacted by, mental screenings annually illness get the support and information needed —— Number of colon cancer screenings annually —— Number of patients referred to treatment from Behavioral Health Secondary Data screenings annually SUBSTANCE ABUSE —— Number of cancer support groups offered at • The total number of drug- and alcohol-related hospital annually intoxication deaths in Maryland increased from 1,259 in 2015 to 2,089 in 2016.10 PUBLIC HEALTH METRICS • Age-adjusted death rates for heart disease, stroke, ALCOHOL ABUSE cancer, and diabetes • Percentage of driving deaths with alcohol • Prevalence rates of obesity among adults involvement: 20 percent in Baltimore City and 36 • Emergency department visits and hospitalization rates percent in Anne Arundel County.11 due to hypertension, heart disease, stroke, cancer, • Percentage of adults reporting binge drinking: obesity, and diabetes 18 percent in Baltimore City and 20 percent in • Prevalence rates of diabetes among adults Anne Arundel County.11 • Percentage of adults who smoke OPIOID ABUSE • Percentage of adolescents using tobacco products • The number of prescription opioid-related intoxication deaths in Maryland increased from 61 in 2010 to KEY PARTNERS: CHRONIC DISEASE 113 in 2016.10 Baltimore City Breast and Cervical Cancer Screening Program Baltimore City Department of Aging Behavioral Health Strategies Baltimore City Department of Health and Human Services • Provide Screening, Brief Intervention, and Referral to Baltimore City Health Department Treatment (SBIRT) program and peer recovery coaches Centers for Disease Control and Prevention (CDC) • Offer Naloxone training to community Maintaining Active Citizens, Inc. • Develop and implement Opioid Survivor Outreach Maryland Department of Aging Program (OSOP) to provide support and resources Maryland Department of Health to opioid survivors that visit hospital-based emergency departments

37 | MedStar Harbor Hospital 2018 Community Health Needs Assessment

• Provide National Alliance on Mental Illness (NAMI) —— Number of naloxone kits provided to OSOP Basics Class—geared to parents and family caregivers patients annually of children and adolescents who have been —— Number of naloxone prescriptions provided to diagnosed with a mental health condition OSOP patients annually • Provide Peer to Peer Class—peer recovery —— Number of known OSOP deaths annually education course open to anyone experiencing a mental health challenge • NAMI Educational Program —— Number of education programs and events held • Host an annual Mental Health Forum on campus or in the CBSA annually Behavioral Health Anticipated Outcomes —— Number of attendees or participants per educational program • Improved identification of high-risk substance use behaviors and access to substance abuse treatment, PUBLIC HEALTH METRICS education, and social need services. • Percentage of individuals reporting a substance abuse disorder Behavioral Health Metrics • Percentage of adults reporting excessive drinking PROGRAM-SPECIFIC METRICS • Percentage of adults and adolescents who report Key factors will be tracked to determine: 1) impact of alcohol use and binge drinking programs and services implemented; and 2) relevance • Percentage of hospitalizations due to a substance to external public health goals. abuse or alcohol abuse disorder • Number of driving deaths involving alcohol • SBIRT Program • Number of hospitalizations due to opioid overdose —— Number of ED SBIRT screens annually • Age-adjusted death rate due to opioid overdose —— Number of positive SBIRT screens annually • Age-adjusted drug and alcohol related death rate —— Number of brief interventions completed annually • Drug- and alcohol-related ED visits —— Number of referrals to treatment provided annually —— Number of patients linked to treatment annually KEY PARTNERS: BEHAVIORAL HEALTH —— ED readmission and PAU rates of patients who receive Community mental health and substance use treatment service brief interventions and/or linkage to treatment organizations —— Number of substance abuse and addiction support Mosaic Group groups promoted and held in MedStar Harbor National Alliance on Mental Illness Hospital’s CBSA annually Substance Abuse and Mental Health Services Administration (SAMSHA) • Naloxone Training and OSOP —— Number of naloxone administration trainings offered at the hospital or community partner locations annually Access to Care and Services —— Number of community members trained to Access to Care and Services Objectives administer naloxone annually • Increase access to mental health services as part of the —— Number of referrals to treatment annually primary care model —— Number of suspected overdoses annually • Improve appropriate healthcare utilization practices —— Number of referrals to OSOP peer recovery and health outcomes of high-need, high-risk patients coaches annually by identifying social unmet needs and linkage to —— Number of patients successfully contacted by community social needs resources at point of care OSOP recovery coach annually using the Aunt Bertha tool —— Number of OSOP patient referred to treatment monthly —— Number of OSOP patients linked to recovery support groups annually

38 | MedStar Harbor Hospital 2018 Community Health Needs Assessment Access to Care and Services Secondary Data Access to Care and Services Metrics • One out of five (110,468) Baltimoreans will experience PROGRAM-SPECIFIC METRICS a mental illness each year.3 Key factors will be tracked to determine: 1) impact of • One out of 20 (24,093) Baltimore City adults have programs and services implemented; and 2) relevance a serious mental illness such as major depressive to external public health goals. disorder, bipolar disorder, or schizophrenia.3 • One out of 25 (19,275) Baltimore City adults need • Mental Health Services 3 both mental health and substance abuse treatment. —— Number of people who receive mental health • 14 percent of Americans with serious mental illness treatment services in program primary care lack health insurance coverage.31 setting annually • In Baltimore City, 31 percent of children under the age —— Number of people screened for selected mental of 18 live in poverty.11 health conditions (substance use, depression, and anxiety) annually Access to Care and Services Strategies —— Number of people with positive mental health • Provide mental health services as part of a primary screening annually care model —— Number of people who screen positively for mental • Conduct social needs screening and support linkages health conditions that are referred or linked to to social need services as part of care delivery and services annually chronic disease self-management programming —— ED readmission and PAU rates of people with positive mental health screening that were referred Access to Care and Services or linked to services Anticipated Outcomes • Social Needs Services • Increased access to mental health services in primary care settings —— Number of social needs screenings conducted annually • Increased use of uniform social needs screener in MedStar Harbor Hospital’s care delivery sites and —— Number of positive social needs screen annually as part of the Living Well Program —— Number of people referred to services annually —— Number of people linked to services annually • Improved identification of patients’ unmet social needs and service linkage at point of service —— ED readmission and PAU rates of people with positive social needs screening that are referred • Improved healthcare utilization among individuals like to social need services, transportation services, or linked to services or mental health services

39 | MedStar Harbor Hospital 2018 Community Health Needs Assessment PUBLIC HEALTH METRICS Transportation Metrics • Percentage of people reporting unmet healthcare needs in the past 12 months PROGRAM-SPECIFIC METRICS • Percentage of people reporting they could not afford Key factors will be tracked to determine: 1) impact of to see a doctor in the past 12 months programs and services implemented; and 2) relevance • Percentage of people diagnosed with mental illness to external public health goals. that are uninsured • MedStar Health UBER Program • Percentage of adults unemployed —— Number of rides supported annually • Percentage of households living in poverty —— Number of people who receive rides annually • Percentage of households experiencing food insecurity —— ED readmission and PAU rates of people who receive rides KEY PARTNERS: ACCESS TO CARE —— No show rates among program participants Aunt Bertha, Inc. —— Percentage of people who identify transportation Family Health Centers of Baltimore as a barrier

PUBLIC HEALTH METRICS • Percentage of the population with access to public Collaboration Areas transportation • Percentage of population who have delayed getting Collaboration areas were identified as social determinant medical care due to lack of transportation areas in which the hospital will serve as a partner with outside organizations. KEY PARTNERS: TRANSPORTATION TRANSPORTATION Aunt Bertha, Inc. Uber Technologies, Inc. Transportation Objectives • Address the barrier of transportation to medical and health services and programs among individuals who EMPLOYMENT identify transportation as a social unmet need Employment Objectives Transportation Secondary Data • Hire individuals from underserved communities • In 2014, about 29 percent of households in Baltimore as community health advocates (CHAs) and peer City did not own a car and many of these households recovery coaches (PRCs) to contribute to MedStar relied on public transportation for commuting.14 Health’s population health management efforts in the • 29 percent of MedStar Harbor Hospital CHNA survey Baltimore region through the Baltimore Population respondents identified lack of transportation as a Health Workforce Support for Disadvantaged Areas barrier to accessing care. Program (PHWSDA). • Prepare local underserved students for health care- Transportation Strategies related collegiate studies and careers through an • Implement MedStar Health UBER program established pipeline internship program.

Transportation Anticipated Outcomes Employment Secondary Data • Increased number of available rides to and from • The unemployment rate in Baltimore city medical and health services and community is 13.1 percent.11 health programs • Decreased no-show rates among participants

40 | MedStar Harbor Hospital 2018 Community Health Needs Assessment • 19 percent of Baltimore City youth between the —— Number of student interns from MedStar Harbor ages of 16-24 are classified as “disconnected youth” Hospital’s CBSA annually (neither working nor in school).11 —— Graduation rates of interns • 28.8 percent of families live in poverty in Baltimore City.11 —— Number of seniors who complete the internship and pursue a health-related college major Employment Strategies —— Number of seniors who complete the internship • Conduct PHWSDA program and are employed in a health-related position • Conduct the Rx for Success Pipeline Summer Internship within MedStar Health Program for underserved high school students —— Student, supervisor, and community partner satisfaction rate Employment Anticipated Outcomes —— Type of intern placements within MedStar • Increased number of CHAs and PRCs hired and Harbor Hospital trained by 2019 • Increased number of underserved, racial and ethnic PUBLIC HEALTH METRICS minority interns in the Rx for Success summer • Percentage of individuals unemployed yet seeking internship at MedStar Harbor Hospital annually employment • Improved satisfaction rates among student interns, intern • Unemployment rate supervisors and school partner leadership annually • High school graduation and completion rate • Improved pipeline processes to increase employment • Percentage of new hires to health care fields opportunities post-internship for eligible students KEY PARTNERS: EMPLOYMENT Employment Metrics Baltimore Alliance for Careers in HealthCare Baltimore Population Health Workforce Collaborative (BPHWC) PROGRAM-SPECIFIC METRICS “Jobs” Program Key factors will be tracked to determine: 1) impact of Baltimore Youth Works programs and services implemented; and 2) relevance Start on Success—Humanim to external public health goals. Vivien T. Thomas Medical Arts Academy

• PHWSDA “Jobs” Program —— Number of individuals trained from MedStar Harbor FOOD ACCESS Hospital CBSA —— Number of individuals hired from MedStar Harbor Hospital CBSA Food Access Objectives • Address food insecurity among individuals who —— Retention rates of hired associates identify food insecurity as a social unmet need in —— Number of patients or clients assisted by MedStar Harbor Hospital’s CBSA these positions —— Average caseload for positions Food Access Secondary Data —— Average length of patient engagement by positions • 24 percent of MedStar Harbor Hospital CHNA —— Number patients screened for social needs and number of those referred or linked to services respondents identified access to affordable, healthy food as a community need. —— Readmission rates among patients assigned to CHAs or PRCs —— ED utilization among patients assigned to CHAs Food Access Strategies or PRCs • Provide access to affordable healthy foods through the Baltimarket community-based food access • Rx for Success Pipeline Summer Internship Program program with the Baltimore City Health Department —— Number of students who apply to the internship annually Food Access Anticipated Outcomes —— Number of students selected and placed in the • Improved access to healthy and affordable foods in internship annually MedStar Harbor Health’s CBSA

41 | MedStar Harbor Hospital 2018 Community Health Needs Assessment Food Access Metrics Participation Areas PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of Participation areas are those that the hospital supports, programs and services implemented; and 2) relevance but is not positioned to take a leadership role in to external public health goals. addressing.

• Number of people who participate in education and cooking demonstrations annually Participation • Number of nutritional education and cooking • Housing demonstrations provided to the community on-site at corner stores in MedStar Harbor Health’s CBSA annually KEY PARTNERS: PARTICIPATION Baltimore City government agencies PUBLIC HEALTH METRICS Greater Baybrook Alliance • Percentage of households experiencing food insecurity Habitat for Humanity/Baltimore South Gateway Partnership Healthcare for the Homeless KEY PARTNERS: FOOD ACCESS Public housing associations in East Baltimore American Heart Association Baltimore City—Baltimarket Baltimore South Gateway Partnership Cherry Hill Town Center—Community Action Partnership Maryland Food Bank United Way of Central Maryland

42 | MedStar Harbor Hospital 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): ASPEN HILL/BEL PRE MedStar Montgomery Medical Center’s CBSA includes residents in the Aspen Hill/Bel Pre neighborhoods of Montgomery County, Maryland (zip codes 20906 and 20853). This geographic area was selected based on hospital utilization and secondary public health data as well as its close proximity to the hospital, coupled with a high density of low-income residents.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management Community Health —— Behavioral Health Needs Assessment • Access to Care and Services —— Emergency and Primary Care —— Mental Health Services Health and Wellness —— Transportation —— Medication Adherence

CHRONIC DISEASE • Social Determinants of Health —— Employment Chronic Disease Objectives —— Housing • Deliver evidence-based, outcome-focused chronic disease management and prevention programs and services in, or targeting individuals living in, MedStar Montgomery Medical Center’s CBSA

Chronic Disease Secondary Data

DIABETES • Among adults in Montgomery County, 7.4 percent have been diagnosed with diabetes.7

43 2018 Community Health Needs Assessment • In Montgomery County, there are 11.6 hospitalizations —— Percentage of program completers who have per 10,000 people aged 18+ years due to diabetes.7 decreased blood pressure and weight loss • There also are 11.6 deaths per 100,000 people in the —— Percentage of people who screened positive for county due to diabetes.7 social needs and were linked to services at intake and post program completion HEART DISEASE —— Percentage of completers who do not readmit to • In Montgomery County, there are 107.5 deaths per emergency department (ED) after the program ends 100,000 people due to heart disease.7 —— Potentially avoidable utilizations (PAU) and OBESITY readmission rates among program completers • Nearly 53 percent of Montgomery County adults —— Percentage of program completers who successfully have been told they are overweight,11 and more than complete follow-up assessments one in five adults report a body mass index (BMI) of 30 or above.7 • Senior Strength and Balance Program —— Number of participants screened annually CANCER —— Number of participants registered annually • Montgomery County’s age-adjusted mortality rate due —— Number of participants who report improvements to cancer is 118.7 deaths per 100,000 people.7 in blood pressure reading after the program ends —— Number of participants who report improvements Chronic Disease Strategies in cholesterol reading after the program ends • Conduct Living Well – Chronic Disease —— Number of participants who report improvements Self-Management Program in glucose HbA1c reading after the program ends • Deliver Senior Strength and Balance Program —— Number of participants who report weight loss improvements after the program ends Chronic Disease Anticipated Outcomes —— Percentage of participants who report zero ED visits • Increased participation in chronic disease prevention during the past 12 months and management programs and services —— Percentage of participants who report being • Increased retention rates among program participants admitted to a hospital overnight or longer • Improved health behaviors and health outcomes among program participants PUBLIC HEALTH METRICS • Increased identification of social unmet needs and • Age-adjusted death rate from heart disease, diabetes, linkages to social need services among chronic and cancer disease management program participants • Percentage of adults at a healthy weight • Improved health care utilization patterns among (BMI < 25 kg/m2) program participants • Prevalence rates of diabetes, heart disease, and cancer among adults Chronic Disease Metrics • Emergency department admission rates for diabetes, heart disease, cancer, and hypertension PROGRAM-SPECIFIC METRICS in Montgomery County Key factors will be tracked to determine 1) impact of programs and services implemented; and 2) relevance to external public health goals. KEY PARTNERS: CHRONIC DISEASE Longwood Community Center Maintaining Active Citizens, Inc. • Living Well Program Maryland Department of Aging —— Percentage of program completers who report Mid-County Community Center improved quality of life Montgomery County Department of Aging and Human Services —— Percentage of program completers reporting Montgomery County Recreation increased physical activity

44 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment Behavioral Health Metrics

In 2016, 102 drug- or alcohol- PROGRAM-SPECIFIC METRICS related intoxication deaths • Number of SBIRT screens annually occurred in Montgomery County.16 • Number of positive SBIRT screens annually • Number of brief interventions completed annually • Number of referrals to treatment provided annually • Number of patients linked to treatment annually Behavioral Health Objectives: • ED readmission and PAU rates of patients who receive Substance Use Disorder brief interventions and/or linkage to treatment • To deliver evidence-based behavioral health • Number of substance abuse and addiction support programs and services targeting the identification of groups promoted and held in MedStar Montgomery substance abuse and linkage to treatment services Medical Center’s CBSA annually among high-risk individuals in MedStar Montgomery Medical Center’s CBSA PUBLIC HEALTH METRICS • Percentage of individuals reporting a substance Behavioral Health Secondary Data abuse disorder • Percentage of adults reporting excessive drinking SUBSTANCE ABUSE • Percentage of adults and adolescents who report • Among youth (12 and up) and adults in Montgomery alcohol use and binge drinking county, 70,363 (8.2 percent) have substance abuse • Percentage of hospitalizations due to a substance disorders; 70 percent are age 26 or older.15 abuse or alcohol abuse disorder • Number of driving deaths involving alcohol ALCOHOL ABUSE • Number of hospitalizations due to opioid overdose • In Montgomery County, 15 percent of adults report excessive drinking.11 • Age-adjusted death rate due to opioid overdose • Age-adjusted drug- and alcohol-related death rate • In Montgomery County, 33 percent of driving deaths involve alcohol.11 • Drug and alcohol related ED visits • Some 7.4 hospitalizations per 10,000 adults in Montgomery County are due to alcohol abuse.15 KEY PARTNERS: BEHAVIORAL HEALTH Maryland Department of Health and Mental Hygiene - OPIOID ABUSE Behavioral Health Administration • In 2016, 102 drug- or alcohol-related intoxication Substance Abuse and Mental Health Services Administration deaths occurred in Montgomery County, of which (SAMSHA) 26 were related to prescription opioids (including prescribed fentanyl), 48 were related to heroin, and 43 were related to either prescribed or illicit fentanyl.16 Access to Care and Services • The number of heroin-related ED visits in Montgomery County tripled between 2009 and 2014. However, Access to Care and Services Objectives Montgomery County still has the second lowest rate • Increase access to medical and social need 16 of ED visits related to heroin in the state. services and hospital community-based health programs for individuals in MedStar Montgomery Behavioral Health Strategies Medical Center’s CBSA • Conduct Screening, Brief Intervention, and Referral • Improve access to mental health services and reduce to Treatment (SBIRT) Program ED utilization among behavioral health patients • Connect uninsured and underserved self-pay patients Behavioral Health Anticipated Outcomes to primary and specialty care services • Improved identification of high-risk substance use • Identify and connect high-need, high-risk individuals behaviors and access to substance abuse treatment, with social unmet needs to community resources education, and social need services

45 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment • Improve healthcare utilization practices and health • Mental Health Services outcomes of high-need, high-risk patients by identifying —— Number of patients enrolled in program annually social unmet needs and linkage to social needs —— Number of referrals to treatment provided annually resources at point of care using the Aunt Bertha tool —— Number of patients linked to treatment annually —— ED readmission and PAU rates of people who Access to Care and Services Secondary Data receive case management and/or clinical mental • In Montgomery County, 87.4 percent of adults have health services had a routine check-up in the last two years.7 • Primary and Specialty Care Services • Over eight percent of Montgomery County residents —— Number of patients served annually cannot afford to see a doctor.7 —— Number of uninsured patients identified annually • The number of people in Montgomery County who —— Number of referrals made to safety net clinics annually don’t have insurance has dropped from 22 percent in —— Number of patients who schedule a primary care 2010 to 12.5 percent in 2014 and 10 percent in 2017.11 follow-up visit annually • While the Affordable Care Act (ACA) has made —— Number of patients referred who are CBSA insurance and health care more affordable, residents annually Montgomery County residents are having trouble signing up for health insurance plans, understanding • Social Needs Services 7 their coverage, and using services. —— Number of social needs screenings conducted • More than three-quarters of Montgomery County annually adults (77.4 percent) said they experienced two or —— Number of positive social needs screen annually 7 fewer days of poor mental health in the past month. —— Number of people referred to services annually —— Number of people linked to services annually Access to Care and Services Strategies —— ED Readmission and PAU rates of people with • Provide Mindoula Behavioral Health Program positive social needs screening that were referred • Implement Emergency Department-Primary Care or linked to services Connect Program • Conduct social needs screenings and support linkages PUBLIC HEALTH METRICS to social need services as part of care delivery and • Ratio of primary care providers to the general population chronic disease self-management programming • Ratio of mental health care providers to the general population Access to Care and Services • Percentage of uninsured adults Anticipated Outcomes • Increased access to mental health treatment services and KEY PARTNERS: ACCESS TO CARE AND SERVICES education services for hospital primary care patients Aunt Bertha, Inc. • Improved health care utilization among individuals Community-based social services organizations linked to transportation, mental health and social Holy Cross Aspen Hill Community Clinic need services Mindoula Behavioral Health • Improved identification of patients’ social unmet Montgomery County Safety-Net Clinics needs and service linkage at point of care Proyecto Salud Community Clinic • Increased access to community social needs resources

Access to Care and Services Metrics

PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevant to external public health goals.

46 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment Transportation Anticipated Outcomes Collaboration Areas • Increased number of available rides to and from medical and health services and community Collaboration areas were identified as social determinant health programs areas in which the hospital will serve as a partner with • Decreased no-show rates among participants outside organizations. Transportation Metrics TRANSPORTATION PROGRAM-SPECIFIC METRICS Transportation Objectives Key factors will be tracked to determine: 1) impact of • Address the barrier of transportation to medical and programs and services implemented; and 2) relevance health services and programs among individuals who to external public health goals. identify transportation as a social unmet need • Olney Home for Life and Manor Connections Transportation Program Transportation Secondary Data —— Number of rides supported annually • An estimated 3.6 million Americans lack a car or access —— Number of people who receive rides annually to public transportation or can’t afford taxis or Ubers. —— ED readmission and PAU rates of people who Missed appointments and resulting delays in care cost receive rides the health system an extra $150 billion a year.7 —— No show rates among program participants • 28 percent of MedStar Montgomery Medical —— Percentage of people who identify Center CHNA survey respondents identified lack of transportation as a barrier transportation as a barrier to accessing care.

PUBLIC HEALTH METRICS Transportation Strategies • Percentage of the population with access to public • Implement Olney Home for Life and Manor transportation Connections Transportation programs

47 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment • Percentage of population who have delayed getting Employment Anticipated Outcomes medical care due to lack of transportation • Increased number of underserved, racial and ethnic minority interns in the Rx for Success summer internship

KEY PARTNERS: TRANSPORTATION at MedStar Montgomery Medical Center annually Aunt Bertha, Inc. • Improved satisfaction rates among student interns, Manor Connections intern supervisors, and school partner leadership Olney Home for Life annually • Improved pipeline processes to increase employment opportunities post-internship for eligible students EMPLOYMENT Employment Metrics

Employment Objectives PROGRAM-SPECIFIC METRICS • Prepare local underserved students for health care- Key factors will be tracked to determine: related collegiate studies and careers through an 1) impact of programs and services established pipeline internship program implemented; and 2) relevance to external public health goals. Employment Secondary Data • 11.0 percent of Montgomery County residents live • Rx for Success Pipeline Summer Internship Program in poverty.7 —— Number of students who apply to the internship • 3.3 percent of county residents are unemployed.11 annually • 89.0 percent of county residents graduate high school.11 —— Number of students selected and placed in the • 77.0 percent of county residents have had internship annually some college.11 —— Number of student interns from MedStar Montgomery Medical Center’s CBSA annually Employment Strategies —— Graduation rates of interns • Conduct the Rx for Success Pipeline Summer Internship Program for underserved high school students

48 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment —— Number of seniors who complete the internship Medication Adherence Anticipated Outcomes and pursue a health-related college major • Increased medication adherence rates among patients —— Number of seniors who complete the internship discharged from MedStar Montgomery Medical Center and are employed in a health-related position within MedStar Health Medication Adherence Metrics —— Student, supervisor, and community partner satisfaction rate PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of —— Type of intern placements within MedStar Montgomery Medical Center programs and services implemented; and 2) relevance to external public health goals. PUBLIC HEALTH METRICS • Number of patients who receive bedside medication • Unemployment rate delivery and education prior to hospital discharge • High school graduation and completion rate • Number of patients who receive discounted • Percentage of new hires to health care fields medications through MedStar Montgomery Medical Center’s partnership with Giant Pharmacy KEY PARTNERS: EMPLOYMENT PUBLIC HEALTH METRICS John F. Kennedy High School • Medication adherence rate

MEDICATION ADHERENCE KEY PARTNERS: MEDICATION ADHERENCE Giant Pharmacy Medication Adherence Objectives Family and Nursing Care • Improve medication adherence, ensure proper medication administration, and decrease drug interactions among MedStar Montgomery Medical Participation Areas Center patients Participation areas are those that the hospital supports, Medication Adherence Secondary Data but is not positioned to take a leadership role in • 29.0 percent of MedStar Montgomery Medical addressing. Center CHNA respondents identified lack of taking prescribed medication as a community need and identified the need for more medication adherence Participation services and resources. • Housing

Medication Adherence Strategies KEY PARTNERS: PARTICIPATION • Provide bedside delivery of medications to patients at Department of Health and Human Services MedStar Montgomery Medical Center prior to discharge Housing Opportunities Commission • Provide discounted medications to discharged patients who cannot afford the cost, in partnership with Giant Pharmacy

49 | MedStar Montgomery Medical Center 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): 20011, 20019, 20020 (WITH EMPHASIS ON WARDS 5, 7, AND 8) MedStar National Rehabilitation Hospital’s CBSA includes residents living with disabilities in Washington, DC zip codes 20011, 20019, and 20020. This geographic area was selected based on hospital utilization and secondary public health data as well as the hospital’s strengths and primary service area.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management

• Access to Care and Services —— Linkage to Resources and Services —— Transportation Community Health • Social Determinants of Health —— Food Access and Insecurity Needs Assessment —— Employment —— Housing Health and Wellness

CHRONIC DISEASE

Chronic Disease Objectives • To deliver evidence-based, outcome-focused chronic disease management and prevention community-based programs and services targeting at-risk, high need individuals living in MedStar National Rehabilitation Hospital’s Community Benefit Service Area (CBSA)

50 2018 Community Health Needs Assessment Chronic Disease Secondary Data • The crude death rate of deaths from cancer in Ward 7 is about 22.0 percent higher than the DC-wide rate, DIABETES and 26.0 percent higher than the nation.35 • Diabetes was the sixth leading cause of death in • DC has the highest liver cancer rates in the country, Washington, DC, with 127 deaths in 2016 (and a with 15 deaths per 100,000 men, and five such deaths mortality rate of 19.8).32 per 100,000 women.35 • In 2014, one in eleven (or 9.1 percent) DC residents had • Women with disabilities are less likely to receive diabetes. In 2013, diabetes was the ninth leading cause mammogram than women without disabilities.44 of hospitalization in DC, with 1,572 visits.6 • Cigarette smoking is significantly higher among • In DC, emergency department (ED) visits related to adults with disabilities compared to adults without diabetes were over six times higher African Americans disabilities.45 than for Whites.6 • An analysis of ED records found that up to 30 percent DISABILITY of visits for diabetes, asthma, and other chronic • Among DC residents, 11.1 percent have some type conditions were potentially preventable with better of disability.38 access to effective primary and preventive care.6 • Among the six types of disabilities identified, the highest prevalence rate was for ambulatory disability (6.8 percent). The lowest prevalence rate was for self- HEART DISEASE AND STROKE care disability, 2.2 percent.38 • Heart disease is the leading cause of death among DC • In 2016, 75,100 of the 674,300 individuals of all ages residents, with 1,375 deaths in 2016 (and a mortality in DC reported one or more disabilities.38 rate of 211.7).32 • In Ward 8, 17.0 percent of residents have a disability.38 • Heart disease in DC can be attributed to preventable • Studies show that individuals living with disabilities factors like obesity, poor physical activity, heavy are more likely to report poor health, less access to drinking, eating unhealthy foods, and not keeping healthcare, as well as smoking and physical inactivity.46 blood pressure and cholesterol under control. • The hospitalization rate for heart disease in DC was Chronic Disease Strategies 41.9 per 1,000 Medicare beneficiaries.5 • Implement the Living Well Chronic Disease • In DC, 29.4 percent of adults have been told they Self Management Program for adults living with have high blood pressure. Of those, 74.4 percent physical disabilities were taking blood pressure control medication.5 • Stroke is the fourth leading cause of death in DC, with Chronic Disease Anticipated Outcomes 252 deaths in 2016 (and mortality rate of 38.4).32 • Increased participation in chronic disease prevention OBESITY and management programs and services • In DC, obesity rates for adults with disabilities are • Increased retention rates among program participants significantly higher than adults without disabilities.43 • Improved health behaviors and health outcomes • In DC, 26.2 percent of adults are obese, up from among program participants 20.1 percent in 2000 and 14.4 percent in 1990. • Increased identification of social unmet needs and • DC has the second lowest adult obesity rate in linkages to social need services among chronic the nation.36 disease management program participants • More than one-third (33.8 percent) of 10-12 year-olds • Improved healthcare utilization patterns among in DC are obese.36 program participants • DC ranks 11th among all states for obesity rates among children ages 10-12.36 Chronic Disease Metrics

CANCER PROGRAM-SPECIFIC METRICS • Cancer is the second leading cause of death among • Living Well Program DC residents, with 1,044 deaths in 2016 (and a —— Percentage of program completers who report mortality rate of 160.1 per 100,000).32 improved quality of life —— Percentage of program completers reporting increased physical activity

51 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment —— Percentage of program completers who have decreased blood pressure and weight loss KEY PARTNERS: CHRONIC DISEASE —— Percentage of people who screened positive for DC Department of Aging and Human Services social needs and were linked to services (Aunt DC Department of Family Services Bertha) at intake and post program completion DC Health —— Percentage of completers who do not readmit to Maintaining Active Citizens, Inc. emergency department (ED) after the program ends Maryland Department of Aging —— Potentially avoidable utilizations (PAU) and readmission rates among program completers —— Percentage of program completers who successfully PHYSICAL ACTIVITY AND FITNESS complete follow-up assessments Physical Activity and Fitness Objectives PUBLIC HEALTH METRICS • Delivery quality fitness programs designed specifically • Age-adjusted death rate from diabetes, heart disease, for individuals with physical disabilities living in and cancer MedStar National Rehabilitation Hospital CBSA. • Emergency department visit rate due to hypertension, heart disease, stroke, diabetes, and cancer Physical Activity Secondary Data • Prevalence of diabetes in DC • Of the adult population in DC over the age of 20, 17.0 • Incidence and prevalence of heart disease and stroke percent reports no leisure-time physical activity.5 in DC • 23.0 percent of adults report a BMI of 30 or more.5 • Percentage of adults at a healthy weight or body mass • Rates of obesity were highest in Wards 8 index (BMI) (37.0 percent), 7 (34.0 percent), and 5 (26.0 percent).5 • Percentage of adults who are obese • By race and ethnicity, 34.0 percent of Black residents • Percentage of adults who participate in the were obese, compared to 20.0 percent of Hispanic recommended levels of physical activity residents and 10.0 percent of White residents.5

52 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment Physical Activity Strategies • Health insurance coverage was lowest among • Provide adapted fitness classes for individuals with Hispanic/Latino residents (78.0 percent) compared physical disabilities in MedStar National Rehabilitation to 91.0 percent coverage among Black residents and Hospital’s CBSA 97.0 percent coverage among White residents.5 • Residents in Ward 7 and Ward 8 had the lowest Physical Activity Anticipated Outcomes coverage amongst all wards (90.0 percent and 5 • Improved access to physical fitness classes and 91.0 percent, respectively). activities for physically disabled people in the • DC-wide, 10.0 percent of adults reported that they had community delayed getting medical care because they could not get an appointment soon enough. Rates were highest Physical Activity Metrics in Ward 1 (14.0 percent), Ward 6 (12.0 percent), and Ward 2 (11.0 percent).5 PROGRAM-SPECIFIC METRICS • Number of adapted fitness classes held annually Access to Care and Services Strategies • Number of participants in adapted fitness classes • Conduct social needs screening and support linkages annually to social need services as part of care delivery and • Number of participants in adapted fitness classes chronic disease self-management programming from CBSA • Percentage of participants who report physical Access to Care and Services progress after each class Anticipated Outcomes • Percentage of participants who report weekly • Increased use of uniform social needs screener in physical activity MedStar National Rehabilitation Hospital care delivery PUBLIC HEALTH METRICS sites and as part of the Living Well program • Percentage of adults living with disabilities reporting • Improved identification of patients’ social unmet a BMI of 30 or more needs and service linkage at point of care • Percentage of adults living with disabilities reporting • Improved healthcare utilization among individuals linked no leisure-time physical activity to social need services and transportation services

KEY PARTNERS: PHYSICAL ACTIVITY AND FITNESS Access to Care and Services Metrics DC Health PROGRAM-SPECIFIC METRICS DC Parks & Recreation • Number of social needs screenings conducted annually Division of Program Integrity Fitness • Number of positive social needs screen annually • Number of people referred to services annually • Number of people linked to services annually Access to Care and Services • ED readmission and PAU rates of people with positive social needs screening that are referred Access to Care and Services Objectives or linked to services • Improve appropriate healthcare utilization practices and health outcomes of high need, high risk patients PUBLIC HEALTH METRICS by identifying social unmet needs and linkage to • Percentage of uninsured adults community social needs resources at point of care • Percentage of adults reporting avoiding medical using the Aunt Bertha tool care due to high cost • Percentage of adults with disabilities Access to Care and Services Secondary Data • Among DC residents, 11.1 percent have some KEY PARTNERS: ACCESS TO CARE AND SERVICES type of disability.37 Aunt Bertha Inc. • Four percent of the population under the age of Community-based social services 65 is uninsured.5

53 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment

—— No show rates among program participants Collaboration Areas —— Percentage of people who identify transportation as a barrier Collaboration areas were identified as social determinant areas in which the hospital will serve as a partner with PUBLIC HEALTH METRICS outside organizations. • Percentage of the population with access to public transportation TRANSPORTATION • Percentage of population who have delayed getting medical care due to lack of transportation Transportation Objectives • Address the barrier of transportation to medical and KEY PARTNERS: TRANSPORTATION health services and programs among individuals who Aunt Bertha, Inc. identify transportation as a social unmet need. Uber Technologies, Inc. Transportation Secondary Data • Lack of transportation is cited as having a significant EMPLOYMENT impact on access to health care services and is a determinant of a person’s ability to access basic Employment Objectives resources that can affect quality of life.5 • Prepare local underserved students for healthcare- • In DC, many characterize public transportation as related collegiate studies and careers through an expensive and unreliable. Metro stations in DC are established pipeline internship program concentrated in the central region (Wards 2 and 6) and are lacking in other areas, especially in Wards 4, 7 and 8.5 Employment Secondary Data • In 2015, 14.0 percent of DC families lived in poverty. Transportation Strategies In Wards 7 and 8, 75.0 percent more families live in • Implement MedStar Health UBER program poverty, at 25.0 percent and 29.0 percent respectively, compared to the DC benchmark.5 Transportation Anticipated Outcomes • DC’s unemployment rate has decreased since 2011, • Improved access to transportation for individuals but the rate varies from ward to ward. Compared to identifying transportation as a social need the national rate, unemployment was two times higher • Increased number of available rides to and from in Ward 7 and three times higher in Ward 8 in 2016.5 medical and health services and community • Compared to the national average, as of June 2016, health programs unemployment is two times higher in Ward 7 and • Decreased no-show rates among participants three times higher in Ward 8.5 • DC’s income inequality ratio is 7.0 percent (ratio of Transportation Metrics household income at the 80th percentile to income PROGRAM-SPECIFIC METRICS at the 20th percentile).5 Key factors will be tracked to determine: 1) impact of • Income and employment status are closely linked programs and services implemented; and 2) relevance to morbidity, mortality, and overall well-being;, lower to external public health goals. than average life expectancy is highly correlated with low-income status.5 • MSH UBER Program —— Number of rides supported annually —— Number of people who receive rides annually —— ED readmission and PAU rates of people who receive rides

54 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment Employment Strategies PUBLIC HEALTH METRICS • Conduct the Rx for Success Pipeline Summer Internship • Unemployment rate Program for underserved high school students • Percentage of adults who are unemployed and seeking work (unemployment rate) Employment Anticipated Outcomes • High school graduation and completion rate • Increased number of underserved, racial and ethnic • Percentage of new hires to health care fields minority interns in the Rx for Success summer internship at MedStar National Rehabilitation KEY PARTNERS: EMPLOYMENT Hospital annually Eastern High School • Improved satisfaction rates among student interns, Companies for Causes intern supervisors and school partner leadership annually • Improved pipeline processes to increase employment FOOD ACCESS opportunities post-internship for eligible students Food Access Objectives Employment Metrics • Improve access to healthy food among individuals with physical disabilities who identify food insecurity PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of as a social need programs and services implemented; and 2) relevance to external public health goals. Food Access Secondary Data • 30.0 percent of MedStar National Rehabilitation • Rx for Success Pipeline Summer Internship Program Hospital CHNA respondents identified healthy food —— Number of students who apply to the internship options as a community need. annually • Residents in Wards 7 and 8 have reported they —— Number of students selected and placed in the struggled to afford the cost of healthy produce.5 internship annually • Among DC residents, 13.0 percent report food —— Number of student interns from MedStar National insecurity, or insufficient access to healthy food, Rehabilitation Hospital’s CBSA annually compared to 10.0 percent nationally.5 —— Graduation rates of interns —— Number of seniors who complete the internship Food Access Strategies and pursue a health-related college major • Conduct Food and Friends Meal Referral Program —— Number of seniors who complete the internship and are employed in a health-related position Food Access Anticipated Outcomes within MedStar Health • Increased number of people with positive social needs —— Student, supervisor and community partner screened for food insecurity that are referred or linked satisfaction rate to food-related services —— Type of intern placements within • Increased number of annual MedStar National MedStar National Rehabilitation Hospital Rehabilitation Hospital-supported meals

55 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment Food Access Metrics Participation Areas PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of Participation areas are those that the hospital supports, but programs and services implemented; and 2) relevance is not positioned to take a leadership role in addressing. to external public health goals. Participation • Food and Friends Meal Referral Program • Housing —— Number of referrals to Food & Friends annually —— Number of people linked to food services annually —— Number of meals supported annually KEY PARTNERS: PARTICIPATION —— ED readmission and PAU rates of people linked to Central Union Mission food services Coalition for the Homeless DC Department of Human Services—Family Services Administration PUBLIC HEALTH METRICS District of Columbia Primary Care Association (DCPCA)— • Percentage of food insecure households DC Positive Accountable Community Transformation (DC PACT) • Percentage of population lacking access to Housing and Urban Development Pathways to Housing healthy food

KEY PARTNERS: FOOD ACCESS Food & Friends Capital Area Food Bank

56 | MedStar National Rehabilitation Network 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): LEXINGTON PARK MedStar St. Mary’s Hospital’s CBSA includes residents of St. Mary’s County, Maryland, with a focus on the Lexington Park community (zip code 20653). The Lexington Park community was selected based on hospital utilization and secondary public health data as well as the fact that it has the greatest number of medically underserved citizens in the area, with approximately 9.1 percent of the population living below the federal poverty level.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention Community Health and Management Needs Assessment —— Behavioral Health • Access to Care and Services —— Mental Health Services Health and Wellness —— Dental, Primary Care, and Behavioral Health Services CHRONIC DISEASE —— Transportation • Social Determinants of Health Chronic Disease Objectives —— Employment • Deliver evidence-based, outcome-focused chronic disease management —— Housing and prevention programs and services in, or targeting individuals living in, MedStar St. Mary’s Hospital’s Community Benefit Service Area (CBSA) • Prevent the onset of type 2 diabetes through a 12-month lifestyle change program • Provide Health Connections classes and programs at the East Run Center

57 2018 Community Health Needs Assessment Chronic Disease Secondary Data • Increased retention rates among program participants • Improved health behaviors and health outcomes DIABETES among program participants • Diabetes is the sixth leading cause of death in • Increased identification of social unmet needs and St. Mary’s County.12 linkages to social need services among chronic • The percentage of adults ever diagnosed with disease management program participants diabetes in St. Mary’s County increased from • Improved health care utilization patterns among 7.2 percent in 2004 to 10.4 percent in 2013.12 program participants HEART DISEASE AND STROKE • Heart disease is the leading cause of death in Chronic Disease Metrics St. Mary’s County and in Maryland.12 PROGRAM-SPECIFIC METRICS • Stroke is the third leading cause of death in Maryland.27 Key factors will be tracked to determine: 1) impact of OBESITY programs and services implemented; and 2) relevance • In St. Mary’s County, 32.0 percent of adults report a to external public health goals. body mass index (BMI) over 30.0 vs. 29.0 percent of • Living Well Program adults in Maryland overall.11 —— Percentage of program completers who report • 24.0 percent of St. Mary’s adults get little or no improved quality of life exercise, partly because they have less access to —— Percentage of program completers reporting exercise opportunities than others in Maryland increased physical activity (62.0 percent compared to 93.0 percent).11 —— Percentage of program completers who have CANCER decreased blood pressure and weight loss • Cancer is the second leading cause of death in —— Percentage of people who screened positive for St. Mary’s County.12 social needs and were linked to services at intake • In St. Mary’s County, the 2014 cancer mortality and post program completion rate was 184.4 per 100,000 people, compared to —— Percentage of completers who do not readmit to Maryland’s 162 per 100,000 people.12 the emergency department (ED) —— Potentially avoidable utilizations (PAU) and SMOKING readmission rates among program completers • Cigarette smoking is the leading cause of —— Percentage of program completers who successfully preventable disease and death in the United States. complete follow-up assessments • In 2016, more than 16 million Americans lived with a smoking-related disease. • Diabetes Prevention Program • In St. Mary’s County, 15.0 percent of adults report —— Number of DPP programs conducted annually smoking, which is on par with the national average —— Retention rates among DPP participants 11 of 15.5 percent. —— Number of participants who achieve an average weight loss goal of five percent Chronic Disease Strategies —— Number of participants who meet physical activity • Conduct the Living Well Chronic Disease goal of 150 minutes per week Self-Management Program • Deliver the Diabetes Prevention Program (DPP) • Health Connections Programs • Deliver Health Connections classes and programs, —— Number of participants registered in each including Parents to Be, support groups, and program annually diabetes and nutrition programs —— Number of no shows annually —— Number of participants citing barriers Chronic Disease Anticipated Outcomes to attending programs annually • Increased participation in chronic disease prevention —— Number of participants demonstrating pre and management programs and services and post program improvement on basic knowledge questionnaire for diabetes and nutrition programs

58 | MedStar St. Mary’s Hospital 2018 Community Health Needs Assessment —— Number of new participants in support groups Behavioral Health Strategies annually • Implement the Screening, Brief Intervention, and —— Number of returning participants in support Referral to Treatment (SBIRT) Program groups annually —— Number of Parents to Be program participants Behavioral Health Anticipated Outcomes indicating improved knowledge post-delivery • Improved identification of high-risk substance use behaviors and access to substance abuse treatment PUBLIC HEALTH METRICS education and social need services • Age-adjusted death rate from diabetes, heart disease, and cancer • Percentage of adults at a healthy weight (BMI < Behavioral Health Metrics 25 kg/m2) PROGRAM-SPECIFIC METRICS • ED visits due to diabetes, heart disease, cancer, Key factors will be tracked to determine: 1) impact of and hypertension programs and services implemented; and 2) relevance to external public health goals. KEY PARTNERS: CHRONIC DISEASE • SBIRT Program Centers for Disease Control and Prevention —— Number of SBIRT screens annually Maintaining Active Citizens Inc. —— Number of positive SBIRT screens annually Maryland Department of Aging —— Number of brief interventions completed annually Maryland Department of Health —— Number of referrals to treatment provided annually St. Mary’s County Department of Aging and Human Services —— Number of patients linked to treatment annually St. Mary’s County Health Department —— ED readmission and PAU rates of patients who receive brief interventions and/or linkage to treatment BEHAVIORAL HEALTH —— Number of substance abuse and addiction support groups promoted and held in MedStar St. Mary’s Behavioral Health Objectives: Hopsital’s CBSA annually Substance Use Disorders • To deliver evidence-based behavioral health programs PUBLIC HEALTH METRICS and services targeting the identification of substance • Percentage of individuals reporting a substance abuse abuse and linkage to treatment services among high- disorder risk individuals in MedStar St. Mary’s Hospital’s CBSA • Percentage of adults reporting excessive drinking • Percentage of adults and adolescents who report Behavioral Health Secondary Data alcohol use and binge drinking

ALCOHOL ABUSE • Percentage of hospitalizations due to a substance • 18 percent of St. Mary’s residents report excessive abuse or alcohol abuse disorder drinking, compared to a 13 percent rate for the top US • Number of driving deaths involving alcohol performers.11 • Number of hospitalizations due to opioid overdose • 38 percent of driving deaths in St. Mary’s involved • Age-adjusted death rate due to opioid overdose alcohol impairment.11 • Age-adjusted drug and alcohol related death rate • Drug- and alcohol-related ED visits OPIOID ABUSE • In St. Mary’s County, 59 per 100,000 population died KEY PARTNERS: BEHAVIORAL HEALTH from drug overdose in 2014-2016. This is compared Maryland Department of Health and Mental Hygiene - to 24 per 100,000 during the same time period in the Behavioral Health Administration 10 rest of the state. Mosaic Group • The drug overdose rate for top US performers was Substance Abuse and Mental Health Services Administration 10 per 100,000.10 (SAMSHA) • In 2016, there were nine heroin-related deaths in St. Mary’s County.10

59 | MedStar St. Mary’s Hospital 2018 Community Health Needs Assessment • Provide dental care services at the Dental Clinic at Access to Care and Services East Run • Conduct social needs screenings and support linkages Access to Care and Services Objectives to social need services as part of care delivery and • Improve access to mental health services and reduce chronic disease self-management programming ED utilization among behavioral health patients • Expand access to dental care, basic primary care, Access to Care and Services Anticipated and behavioral health services in MedStar St. Mary’s Outcomes Hospital’s CBSA • Increased access to mental health treatment and • Improve health care utilization practices and education services health outcomes of high need, high risk patients • Growth in primary care, psychiatric, and dental by identifying social unmet needs and linkage to practice patient base community social needs resources at point of care • Improved identification of patients’ social unmet using the Aunt Bertha tool needs and service linkage at point of care • Improved health care utilization among individuals Access to Care and Services Secondary Data linked to social need, transportation, mental health, • Five percent of the St. Mary’s population under the primary care, behavioral health, and dental services age of 65 is without health insurance.11 • Ratio of mental health providers in St. Mary’s County Access to Care and Services Metrics is one for every 1,000 people.11 • Ratio of dentists in St. Mary’s County is one for every PROGRAM-SPECIFIC METRICS 1,940 people, compared to 1,280:1 for the top US Key factors will be tracked to determine: 1) impact of performers.11 programs and services implemented; and 2) relevance to external public health goals. Access to Care and Services Strategies • Mental Health Services • Conduct Mindoula Health Behavioral Health program —— Number of patients enrolled in the program • Deliver behavioral health services through MedStar annually Behavioral Health at East Run —— Number of referrals to treatment • Deliver primary care services via MedStar St Mary’s provided annually Hospital Primary Care at East Run program

60 | MedStar St. Mary’s Hospital 2018 Community Health Needs Assessment —— Number of patients linked to treatment annually TRANSPORTATION —— ED readmission and PAU rates of people who receive case management and/or clinical mental Transportation Objectives health services • Address the barrier of transportation to medical and health services and programs among individuals • Primary Care, Behavioral Health, and Dental Services who identify transportation as a social unmet need —— Number of new patients in each practice annually —— ED utilization for new patients in each practice Transportation Secondary Data annually • 34.0 percent of MedStar St. Mary’s Hospital CHNA —— Readmission and PAU rates for new patients in survey respondents identified lack of transportation primary care and behavioral health practices as a barrier to accessing care. —— Quality measures for primary care as reported to Medicare Transportation Strategies • Social Needs Services • Provide transportation to medical services via the —— Number of social needs screenings conducted AccessHealth program and a Tri-County Council annually transportation grant —— Number of positive social needs screen annually —— Number of people referred to services annually Transportation Anticipated Outcomes —— Number of people linked to services annually • Increased transportation services to and from medical —— ED readmission and PAU rates of people with and health services and community health programs positive social needs screening that were • Decreased no-show rates among participants referred or linked to services Transportation Metrics PUBLIC HEALTH METRICS • Ratio of primary care, behavioral health, and dental PROGRAM-SPECIFIC METRICS health care providers to population Key factors will be tracked to determine: 1) impact of • Percentage of households living in poverty programs and services implemented; and 2) relevance • Percentage of households experiencing food insecurity to external public health goals. • Percentage of uninsured adults • Transportation Services —— Number of rides supported annually KEY PARTNERS: ACCESS TO CARE AND SERVICES —— Number of people who receive rides annually Aunt Bertha, Inc. —— ED readmission and PAU rates of people who Community-based social services organizations receive rides Dental Schools —— No show rates among program participants HealthShare —— Percentage of people who identify transportation Mindoula Health as a barrier Missions of Mercy —— Number of participants utilizing transportation St. Mary’s County Health Department options to attend programs annually

PUBLIC HEALTH METRICS • Percentage of the population with access to public Collaboration Areas transportation • Percentage of population who have delayed getting Collaboration areas were identified as social determinant medical care due to lack of transportation areas in which the hospital will serve as a partner with outside organizations.

61 | MedStar St. Mary’s Hospital 2018 Community Health Needs Assessment • Rx for Success Pipeline Summer Internship Program KEY PARTNERS: TRANSPORTATION —— Number of students who apply to the Aunt Bertha, Inc. internship annually Axis Healthcare Group —— Number of students selected and placed in Southern Maryland Center for Life Enrichment the internship annually Tri-County Council —— Number of student interns from MedStar St. Mary’s Hospital’s CBSA annually —— Graduation rates of interns EMPLOYMENT —— Number of seniors who complete the internship and pursue a health-related college major Employment Objectives —— Number of seniors who complete the internship • Prepare local underserved students for health care- and are employed in a health-related position related collegiate studies and careers through an within MedStar Health established pipeline internship program —— Student, supervisor, and community partner satisfaction rate Employment Secondary Data —— Type of intern placements within MedStar • In St. Mary’s County, 4.1 percent of the population over St. Mary’s Hospital the age of 16 is unemployed and looking for work.11 • In St. Mary’s, 11.0 percent of teens between the ages PUBLIC HEALTH METRICS of 16-24 are classified as disconnected youth (neither • Unemployment rate working nor in school).11 • High school graduation and completion rate • Percentage of new hires to health care fields Employment Strategies • Conduct the Rx for Success Pipeline Summer Internship KEY PARTNERS: EMPLOYMENT Program for underserved high school students James A. Forrest Career and Technology Center

Employment Anticipated Outcomes • Increased number of underserved, racial and ethnic minority interns in the Rx for Success summer internship at MSMH annually Participation Areas • Improved satisfaction rates among student interns, intern Participation areas are those that the hospital supports, but supervisors, and school partner leadership annually is not positioned to take a leadership role in addressing. • Improved pipeline processes to increase employment opportunities post-internship for eligible students Participation Employment Metrics • Housing

PROGRAM-SPECIFIC METRICS KEY PARTNERS: PARTICIPATION Key factors will be tracked to determine: 1) impact of St. Mary’s Department of Social Services programs and services implemented; and 2) relevance Three Oaks Shelter to external public health goals.

62 | MedStar St. Mary’s Hospital 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): SOUTHERN PRINCE GEORGE’S COUNTY MedStar Southern Maryland Hospital Center’s CBSA includes residents of Southern Prince George’s County (zip codes 20735 and 20747). This geographic area was selected based on hospital utilization and secondary public health data as well as its proximity to the hospital.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management —— Behavioral Health

• Access to Care and Services —— Mental Health —— Linkage to Resources and Services —— Transportation Community Health • Social Determinants of Health —— Employment Needs Assessment —— Housing Health and Wellness

CHRONIC DISEASE

Chronic Disease Objectives • Deliver evidence-based, outcome-focused chronic disease management and prevention programs and services in, or targeting individuals living in, MedStar Southern Maryland Hospital Center Community Benefit Service Area (CBSA) • Increase awareness and the intention to quit among smokers

63 2018 Community Health Needs Assessment Chronic Disease Secondary Data • Living Well Program —— Percentage of program completers who report DIABETES improved quality of life • Two percent of adults in Prince George’s County —— Percentage of program completers reporting have diabetes.11 increased physical activity HEART DISEASE —— Percentage of program completers who have • Heart disease (24.6 percent) and cancer (25.0 percent) decreased blood pressure and weight loss are responsible for half of all deaths in the county.17 —— Percentage of people who screened positive for social needs and were linked to services at intake OBESITY and post program completion • In Prince George’s County, 33.0 percent of adults —— Percentage of completers who do not readmit to are obese.11 emergency department (ED) after the program CANCER ends • In Prince George’s County, there were 1,417 deaths —— Potentially avoidable utilizations (PAU) and due to cancer in 2014. The cancer mortality rate was readmission rates among program completers 168.6 per 100,000 people.8 —— Percentage of program completers who successfully complete follow-up assessments SMOKING • Cigarette smoking is the leading cause of preventable • Smoking Cessation Program disease and death in the United States. —— Percentage of completers who report quitting after • In 2016, more than 16 million Americans lived with program participation a smoking-related disease. —— Quit rate of program completers • In Prince George’s County, 12.0 percent of adults PUBLIC HEALTH METRICS smoke compared to 15.0 percent nationally.11 • Age-adjusted death rate for diabetes, heart disease, stroke, and cancer Chronic Disease Strategies • ED visits and hospitalization rates due to hypertension, • Conduct the Living Well Chronic Disease heart disease, stroke, cancer, obesity, and diabetes Self Management Program • Percentage of adults at a healthy weight (body mass • Conduct the Smoking Cessation Program index < 25 kg/m2) • Percentage of adults participating in the Chronic Disease Anticipated Outcomes recommended levels of physical activity • Increased participation in chronic disease prevention • Prevalence rates of obesity among adults and management programs and services • Prevalence rates of diabetes among adults • Increased retention rates among program participants • Percentage of adults who smoke • Improved health behaviors and health outcomes among program participants • Increased identification of social unmet needs and KEY PARTNERS: CHRONIC DISEASE linkages to social need services among chronic American Cancer Society disease management program participants Maintaining Active Citizens, Inc. • Improved health care utilization patterns among Maryland Department of Aging program participants Prince George’s County Department of Aging and Human Services Prince George’s County Health Department Chronic Disease Metrics

PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of programs and services implemented; and 2) relevance to external public health goals.

64 | MedStar Southern Maryland Hospital Center 2018 Community Health Needs Assessment BEHAVIORAL HEALTH • Number of hospitalizations due to opioid overdose • Age-adjusted death rate due to opioid overdose Behavioral Health Objectives • Age-adjusted drug and alcohol related death rate • Identify people with at-risk and dependent substance • Drug- and alcohol-related ED visits and/or alcohol use behaviors, and provide brief early

intervention services to those who screen positively for KEY PARTNERS: BEHAVIORAL HEALTH risky drug and alcohol use Community substance abuse and mental health treatment service organizations Behavioral Health Secondary Data Maryland Department of Health and Mental Hygiene - Behavioral Health Administration ALCOHOL ABUSE Mosaic Group • In Prince George’s County,15.0 percent of residents Substance Abuse and Mental Health Services Administration report excessive drinking.11 (SAMHSA) • 34.0 percent of driving deaths in Prince George’s County involved alcohol.11 • 26.2 percent of ED visits in Prince George’s County are from alcohol-related disorders.18 Access to Care and Services SUBSTANCE ABUSE • Prince George’s County has a 10.0 percent drug Access to Care and Services Objectives 18 overdose death rate. • Improve access to mental health services and reduce ED utilization among behavioral health patients Behavioral Health Strategies • Improve appropriate healthcare utilization practices • Conduct Screening, Brief Intervention, and Referral to and health outcomes of high-need, high-risk patients Treatment (SBIRT) Program by identifying social unmet needs and linkage to community social needs resources at point of care Behavioral Health Anticipated Outcomes using the Aunt Bertha tool • Improved identification of high-risk substance use behaviors and access to substance abuse treatment, Access to Care and Services Secondary Data education, and social need services MENTAL HEALTH SERVICES Behavioral Health Metrics • 27.0 percent of Prince George’s County high school students reported they stopped their normal activities PROGRAM-SPECIFIC METRICS for two weeks or more due to feeling sad or hopeless, • Number of SBIRT screens annually and 14.7 percent reported they have seriously • Number of positive SBIRT screens annually considered suicide.17 • Number of brief interventions completed annually • 3.3 percent of Prince George’s County residents report • Number of referrals to treatment provided annually having poor mental health days.17 • Number of patients linked to treatment annually • In Prince George’s County, the ratio of mental health • ED readmission and PAU rates of patients who receive providers to the population is 890:1, compared to brief interventions and/or linkage to treatment 460:1 for the top US performers17 • Number of substance abuse and addiction support groups promoted and held in CBSA annually

PUBLIC HEALTH METRICS • Percentage of individuals reporting a substance abuse disorder • Percentage of adults reporting excessive drinking 26.2 percent of ED visits in • Percentage of adults and adolescents who report Prince George’s County are from alcohol use and binge drinking 18 • Percentage of hospitalizations due to a substance alcohol-related disorders. abuse or alcohol abuse disorder

65 | MedStar Southern Maryland Hospital Center 2018 Community Health Needs Assessment Access to Care and Services Strategies PUBLIC HEALTH METRICS • Conduct Mindoula Behavioral Health Program • Percentage of uninsured adults • Conduct social needs screenings and support linkages • Adults reporting delaying access to medical care to social need services as part of care delivery and due to high cost chronic disease self-management programming • Percentage of adults with mood disorders • Ratio of mental health providers to the general Access to Care and Services population Anticipated Outcomes • Increased number of eligible patients who complete KEY PARTNERS: ACCESS TO CARE AND SERVICES Mindoula mental health assessment annually Aunt Bertha, Inc. • Increased number of patients with selected mental Mindoula Health health diagnoses who are referred to treatment annually • Improved use of uniform social needs screener in MedStar Southern Maryland Hospital Center’s care Collaboration Areas delivery sites and as part of the Living Well Program Collaboration areas were identified as social determinant • Improved identification of patients’ unmet social areas in which the hospital will serve as a partner with needs and service linkage at point of care outside organizations. • Improved healthcare utilization among individuals liked to social need services, transportation or TRANSPORTATION mental health services Transportation Objectives Access to Care and Services Metrics • Address the barrier of transportation to medical and PROGRAM-SPECIFIC METRICS health services and programs among individuals who Key factors will be tracked to determine: 1) impact of identify transportation as a social unmet need programs and services implemented; and 2) relevance to external public health goals. Transportation Secondary Data • In 2014, 23.5 percent of adults in Prince George’s • Mental Health Services County indicated they had delayed medical care —— Number of patients enrolled in the program annually mainly due to a lack of transportation, lack of timely —— Number of referrals to treatment provided annually appointments, and long wait times to see a provider.17 —— Number of patients linked to treatment annually • 24.0 percent of MedStar Southern Maryland Hospital —— ED readmission and PAU rates of people who Center CHNA survey respondents identified lack of receive case management and/or clinical mental transportation as a barrier to accessing care. health services Transportation Strategies • Social Needs Services • Implement MedStar Health UBER program —— Number of social needs screenings conducted annually —— Number of positive social needs screen annually Transportation Anticipated Outcomes • Increased number of available rides to and from —— Number of people referred to services annually medical and health services and community —— Number of people linked to services annually health programs —— ED readmission and PAU rates of people with positive social needs screening that were referred • Decreased no-show rates among participants or linked to services

66 | MedStar Southern Maryland Hospital Center 2018 Community Health Needs Assessment Transportation Metrics EMPLOYMENT

PROGRAM-SPECIFIC METRICS Employment Objectives Key factors will be tracked to determine: 1) impact of • Prepare local underserved students for health care- programs and services implemented; and 2) relevance related collegiate studies and careers through an to external public health goals. established pipeline internship program • MedStar Health UBER Program • Improve access to local employment opportunities —— Number of rides supported annually within the community —— Number of people who receive rides annually —— ED readmission and PAU rates of people who Employment Secondary Data receive rides • In Prince George’s County, over four percent of —— No show rates among program participants the population (ages 16 and older seeking work) 11 —— Percentage of people who identify transportation is unemployed. as a barrier • 79.0 percent of Prince George’s County high school students graduate within four years.11 PUBLIC HEALTH METRICS • 14.0 percent of Prince George’s County teens ages • Percentage of the population with access to public 16-24 are neither working nor in school.11 transportation • Percentage of population who have delayed getting Employment Strategies medical care due to lack of transportation • Conduct the Rx for Success Pipeline Summer Internship Program for underserved high school students

KEY PARTNERS: TRANSPORTATION • Conduct semi-annual career fairs at MedStar Aunt Bertha, Inc. Southern Maryland Hospital Center Uber Technologies, Inc.

67 | MedStar Southern Maryland Hospital Center 2018 Community Health Needs Assessment Employment Anticipated Outcomes • Annual Career Fairs • Increased number of underserved, racial and ethnic —— Number of participants who apply to positions minority interns in the Rx for Success summer during the career fair annually internship at MedStar Southern Maryland Hospital —— Number of participants selected and placed into Center annually open positions annually • Improved satisfaction rates among student —— Number of participants from MedStar Southern interns, intern supervisors, and school partner Maryland Hospital Center’s CBSA annually leadership annually —— Number of people hired from MedStar Southern • Improved pipeline processes to increase employment Maryland Hospital Center’s CBSA opportunities post-internship for eligible students • Increased employment opportunities available in PUBLIC HEALTH METRICS Prince George’s County • Unemployment rate • High school graduation and completion rate Employment Metrics • Percentage of new hires to health care fields

PROGRAM-SPECIFIC METRICS KEY PARTNERS: EMPLOYMENT Key factors will be tracked to determine: 1) impact of Community-based providers programs and services implemented; and 2) relevance Health-focused employment seekers in Prince George’s County to external public health goals. Health-focused high schools in Prince George’s County • Rx for Success Pipeline Summer Internship Program —— Number of students who apply to the internship annually —— Number of students selected and placed in the Participation Areas internship annually —— Number of student interns from MedStar Southern Participation areas are those that the hospital supports, but Maryland Hospital Center’s CBSA annually is not positioned to take a leadership role in addressing. —— Graduation rates of interns —— Number of seniors who complete the internship Participation and pursue a health-related college major • Housing —— Number of seniors who complete the internship and are employed in a health-related position KEY PARTNERS: PARTICIPATION within MedStar Health Catholic Charities —— Student, supervisor, and community partner Prince George’s County Chamber of Commerce satisfaction rate Prince George’s County Department of Planning and —— Type of intern placements within MedStar Southern Development Maryland Hospital Center Prince George’s County Department of Social Services

68 | MedStar Southern Maryland Hospital Center 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): NORTH CENTRAL BALTIMORE CITY MedStar Union Memorial Hospital’s CBSA includes residents in Baltimore City zip codes 21211, 21213, and 21218. This geographic area was selected based on hospital utilization and secondary public health data as well as its close proximity to the hospital, coupled with a high density of low-income residents, high rates of chronic disease prevalence, and hospital utilization information.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention Community Health and Management Needs Assessment —— Behavioral Health • Access to Care and Services —— Mental Health Services and Health and Wellness Substance Use Services —— Transportation

CHRONIC DISEASE • Social Determinants of Health —— Employment Chronic Disease Objectives —— Neighborhood Violence • To deliver evidence-based, outcome-focused chronic disease management and Safety and prevention community-based programs and services targeting at-risk, —— Housing high-need individuals living in MedStar Union Memorial Hospital’s CBSA

Chronic Disease Secondary Data

DIABETES • Diabetes is the sixth leading cause of death in Baltimore City and Maryland.27 • The prevalence of diabetes in Baltimore City is 13.65 percent.11

69 2018 Community Health Needs Assessment • The prevalence of diabetes among African Americans Chronic Disease Anticipated Outcomes (18.58 percent) is more than twice as high as the • Increased participation in chronic disease prevention prevalence among Whites (7.44 percent).11 and management programs and services • Increased retention rates among program participants HEART DISEASE AND STROKE • Improved health behaviors and health outcomes • Heart disease is the leading cause of death in among program participants Baltimore City and Maryland.27 • Increased identification of social unmet needs and • Stroke is the third leading cause of death in linkages to social need services among chronic Baltimore City and Maryland.27 disease management program participants • 145 out of 100,000 people in Baltimore City die • Improved health care utilization patterns among prematurely due to cardiovascular disease (CVD).2 program participants • In 2014, the CVD premature death rate among Black residents of Baltimore City was about 1.6 times that of White residents.2 Chronic Disease Metrics • Baltimore City has the highest stroke death rate per PROGRAM-SPECIFIC METRICS 100,000 people in Maryland at a rate of 108.4 per Key factors will be tracked to determine: 1) impact of 100,000 individuals.4 programs and services implemented; and 2) relevance to external public health goals. OBESITY

• 34.0 percent of adults in Baltimore City report a body • Living Well Program mass index (BMI) of 30 or higher report, compared to —— Percentage of program completers who report 11 26.0 percent for the top US performers. improved quality of life CANCER —— Percentage of program completers reporting • Cancer is the second leading cause of death in increased physical activity Maryland, and Baltimore City has the highest cancer —— Percentage of program completers who have mortality rate among all Maryland jurisdictions.8 decreased blood pressure and weight loss • Baltimore City has a cancer death rate of 213.9 per —— Percentage of people who screened positive for 100,000, higher than the state cancer death rate of social needs and are linked to services at intake and 157.4 per 100,000.19, 27 post program completion —— Percentage of completers who do not readmit to SMOKING emergency department (ED) after program ends • Cigarette smoking is the leading cause of preventable —— Potentially Avoidable Utilizations (PAU) and disease and death in the United States. readmission rates among program completers • In 2016, more than 16 million Americans lived with a —— Percentage of program completers who successfully smoking-related disease. complete follow-up assessments • 20.0 percent of adults in Baltimore smoke, compared to 15.5 percent nationally (2016).11 • Diabetes Prevention Program —— Number of DPP programs conducted annually Chronic Disease Strategies —— Retention rates among DPP participants • Conduct Living Well – Chronic Disease —— Number of participants who meet weight loss goal Self-Management Program of 5 percent • Conduct Diabetes Prevention Program (DPP) —— Number of participants who meet physical activity • Conduct smoking cessation Programs goal of 150 minutes per week • Conduct breast, cervical, and colon cancer screenings • Smoking Cessation Program • Embed community health advocates (CHAs) in —— Percentage of completers who report quitting after hospital care teams and in the CBSA to assist with program participation chronic disease management and education efforts —— Quit rate of program completers

70 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment • Cancer Screenings —— Numbers of breast, cervical, and colon cancer screenings annually The total number of drug and —— Number of patients referred to treatment from alcohol-related intoxication screenings annually deaths in Maryland increased —— Number of cancer support groups offered in from 1,259 in 2015 to 2,089 MedStar Union Memorial Hospital CBSA annually in 2016.10 PUBLIC HEALTH METRICS • Age-adjusted death rate for diabetes, heart disease, and cancer • ED visits and hospitalization rates due to hypertension, ALCOHOL ABUSE heart disease, cancer, obesity, and diabetes • Percentage of driving deaths with alcohol • Percentage of adults at a healthy weight or BMI involvement: 20.0 percent in Baltimore City compared • Percentage of adults who participate in the to 13.0 percent for the top US performers.11 recommended levels of physical activity • Percentage of adults reporting binge drinking: • Prevalence rates of obesity among adults 18.0 percent in Baltimore City compared to • Prevalence rates of diabetes among adults 13.0 percent for the top US performers.11 • Percentage of adults who smoke OPIOID ABUSE • In Maryland, the number of prescription opioid-related KEY PARTNERS: CHRONIC DISEASE intoxication deaths increased from 61 in 2010 to 113 American Cancer Society in 2016.10 Baltimore City Breast and Cervical Cancer Screening Program Baltimore City Department of Aging BEHAVIORAL HEALTH STRATEGIES Baltimore City Health Department • Implement the Screening, Brief Intervention, and Centers for Disease Control & Prevention Referral to Treatment (SBIRT) strategy in ED and Maintaining Active Citizens, Inc. primary care settings. Maryland Department of Aging • Embed peer recovery coaches (PRCs) on hospital care Maryland Department of Health teams to assist with improving access to substance use treatment and social service linkage, and support community education efforts. BEHAVIORAL HEALTH • Offer Naloxone trainings in the community. • Develop and implement Opioid Survivor Outreach Behavioral Health Objectives: Program (OSOP) to provide support and resources to Substance Use Disorders opioid survivors that visit hospital-based emergency • To deliver evidence-based behavioral health departments. programs and services targeting the identification of substance abuse and linkage to treatment services Behavioral Health Anticipated Outcomes among high-risk individuals in MedStar Union • Improved identification of high-risk substance use Memorial Hospital’s CBSA behaviors and access to substance abuse treatment education, and social need services Behavioral Health Secondary Data

SUBSTANCE ABUSE • The total number of drug- and alcohol-related intoxication deaths in Maryland increased from 1,259 in 2015 to 2,089 in 2016.10

71 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment Behavioral Health Metrics —— Number of OSOP patients linked to recovery support groups annually PROGRAM-SPECIFIC METRICS —— Number of naloxone kits provided to OSOP Key factors will be tracked to determine: 1) impact of patients annually programs and services implemented; and 2) relevance —— Number of naloxone prescriptions provided to to external public health goals. OSOP patients annually • Number of SBIRT screens annually —— Number of known OSOP deaths annually • Number of positive SBIRT screens annually PUBLIC HEALTH METRICS • Number of brief interventions completed annually • Percentage of individuals reporting a substance • Number of referrals to treatment provided annually abuse disorder • Number of patients linked to treatment annually • Percentage of adults reporting excessive drinking • ED readmission and PAU rates of patients who receive • Percentage of adults and adolescents who report brief interventions and/or linkage to treatment alcohol use and binge drinking • Number of substance abuse and addiction support • Percentage of hospitalizations due to a substance groups held in MedStar Union Memorial Hospital abuse or alcohol abuse disorder CBSA annually • Number of driving deaths involving alcohol • Naloxone Training and OSOP • Number of hospitalizations due to opioid overdose —— Number of naloxone administration trainings • Age-adjusted death rate due to opioid overdose offered at the hospital or CBSA annually • Age-adjusted drug and alcohol related death rate —— Number of community members trained to • Drug- and alcohol-related emergency department visits administer naloxone annually

—— Number of referrals to treatment annually KEY PARTNERS: BEHAVIORAL HEALTH —— Number of suspected overdoses annually Baltimore City Health Department —— Number of referrals to OSOP peer recovery Mosaic Group coaches annually Substance Abuse and Mental Health Services Administration —— Number of patients successfully contacted by (SAMSHA) OSOP recovery coach annually —— Number of OSOP patients referred to treatment monthly

72 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment • Improved identification of patients’ social unmet Access to Care and Services needs and service linkage at point of care • Improved health care utilization among individuals linked Access to Care and Services Objectives to mental health, social need or transportation services • Increase access to medical and social need services • Increased health education courses in Hispanic/Latino and hospital community-based community health and immigrant communities programs for individuals in MedStar Union Memorial Hospital’s CBSA Access to Care and Services Metrics • Increase access to mental health services and education • Improve health care utilization practices and PROGRAM-SPECIFIC METRICS health outcomes of high-need, high-risk patients Key factors will be tracked to determine: 1) impact of by identifying social unmet needs and linkage to programs and services implemented; and 2) relevance community social needs resources at point of care to external public health goals. using the Aunt Bertha tool • Mental Health Services • Ensure access to health care services and health —— Number of people who receive or are referred education for the Hispanic/Latino and immigrant to mental health treatment services in program communities primary care setting annually —— Number of people screened for selected mental Access to Care and Services Secondary Data health conditions (substance use, depression, and ACCESS TO CARE anxiety) annually • In 2014, only 10.0 percent of respondents reported —— Number of people with positive mental health being unable to get the medical care they needed in screening annually the past 12 months, compared to 22.0 percent in 2009.1 —— Number of people who screen positively for mental • Eight percent of Baltimore city residents are uninsured.11 health conditions that are referred or linked to • In Baltimore, the ratio of residents to mental health services annually providers is 270:1.11 —— ED readmission and PAU rates of people with positive mental health screenings that are referred HEALTH DISPARITIES or linked to services • While Baltimore’s overall population diminished by 4.6% between 2000-2010, the Hispanic/Latino • Social Need Services population grew dramatically by 134.7%.42 —— Number of social needs screenings conducted annually Access to Care and Services Strategies —— Number of positive social needs screen annually • Provide mental health services as part of the primary —— Number of people referred to services annually care model —— Number of people linked to services annually • Conduct social needs screenings and support —— ED readmission and PAU rates of people with linkages to social need services as part of care positive social needs screenings that are referred delivery and chronic disease self-management or linked to services programming using CHAs and PRCs • Deliver health education courses in Hispanic/Latino and • Health Equity and Disparities immigrant communities to improve healthcare access —— Number of lay leaders from Hispanic/Latino and immigrant communities trained annually Access to Care and Services Anticipated —— Number of participants from Hispanic/Latino Outcomes and immigrant communities in health education courses annually • Increased access to mental health treatment services and —— Number of health education courses delivered in education services for hospital primary care patients Hispanic/Latino and immigrant communities annually • Increased access to community mental health education opportunities PUBLIC HEALTH METRICS • Increased use of uniform social needs screener in • Percentage of people reporting unmet healthcare MedStar Union Memorial Hospital care delivery sites needs in the past 12 months and as part of the Living Well program

73 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment • Percentage of people reporting they could not afford Transportation Metrics to see a doctor in the past 12 months PROGRAM-SPECIFIC METRICS • Percentage of people diagnosed with mental illness Key factors will be tracked to determine: 1) impact of that are uninsured programs and services implemented; and 2) relevance • Percentage of adults unemployed to external public health goals. • Percentage of households living in poverty • Percentage of households experiencing food insecurity • MedStar Health UBER Program —— Number of rides supported annually KEY PARTNERS: ACCESS TO CARE AND SERVICES —— Number of people who receive rides annually Aunt Bertha, Inc. —— ED readmission and PAU rates of people who Community-based addiction and mental health services receive rides organizations —— No show rates among program participants Esperanza Center —— Percentage of people who identify transportation Greater Baybrook Alliance as a barrier Immigration Outreach Service Center Shepherd’s Clinic PUBLIC HEALTH METRICS • Percentage of the population with access to public transportation Collaboration Areas • Percentage of population who have delayed getting medical care due to lack of transportation Collaboration areas were identified as social determinant areas in which the hospital will serve as a partner with KEY PARTNERS: TRANSPORTATION outside organizations. Aunt Bertha, Inc. Uber Technologies, Inc. TRANSPORTATION

Transportation Objectives EMPLOYMENT • Address the barrier of transportation to medical and health services and programs among individuals Employment Objectives who identify transportation as a social unmet need • Hire individuals from underserved communities as CHAs and PRCs to contribute to MedStar Health’s Transportation Secondary Data population health management efforts in the • Lack of transportation is cited as having a significant Baltimore region through the Baltimore Population impact on access to health care services and is a Health Workforce Support for Disadvantaged Areas determinant of a person’s ability to access basic Program (PHWSDA) 5 resources that can affect quality of life. • Prepare local underserved students for health care- • 25 percent of MedStar Union Memorial Hospital related collegiate studies and careers through an CHNA survey respondents identified lack of established pipeline internship program transportation as a barrier to accessing care. Employment Secondary Data Transportation Strategies • The current unemployment rate is 6.4 percent in • Implement MedStar Health UBER program Baltimore, compared to 3.2 percent for the top US performers.20 Transportation Anticipated Outcomes • 19.0 percent of youth between the ages of 16-24 are • Increased number of available rides to and from classified as disconnected youth (neither in school nor medical and health services and community working), compared to 13.0 percent in Maryland and health programs 10.0 percent for the top US performers.11 • Decreased no-show rates among participants

74 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment • 70.0 percent of high schoolers graduate within four —— Graduation rates of interns years, compared to 87.0 percent in Maryland and a —— Number of seniors who complete the internship 95.0 percent rate for the top US performers.11 and pursue a health-related college major —— Number of seniors who complete the internship Employment Strategies and are employed in a health-related position • Conduct PHWSDA program within MedStar Health • Conduct the Rx for Success Pipeline Summer Internship —— Student, supervisor, and community partner Program for underserved high school students satisfaction rate —— Type of intern placements within MedStar Union Employment Anticipated Outcomes Memorial Hospital • Increased number of CHAs and PRCs hired and trained by 2019 PUBLIC HEALTH METRICS • Increased number of underserved, racial and ethnic • Unemployment rate minority interns in the Rx for Success summer internship • High school graduation and completion rate at MedStar Union Memorial Hospital annually • Percentage of new hires to healthcare fields • Improved satisfaction rates among student interns, intern supervisors, and school partner leadership annually KEY PARTNERS: EMPLOYMENT • Improved pipeline processes to increase employment Baltimore Alliance for Careers in HealthCare opportunities post-internship for eligible students BUILD - Baltimoreans United in Leadership Development Mercy High School Employment Metrics Mission Integration and Volunteer Services NACA Freedom and Democracy Academy PROGRAM-SPECIFIC METRICS Other local health systems Key factors will be tracked to determine: 1) impact of Project SEARCH – Arc of Baltimore programs and services implemented; and 2) relevance Turnaround Tuesday to external public health goals. Vivien T. Thomas Medical Arts Academy

• PHWSDA “Jobs” Program —— Number of individuals trained from MedStar Union Memorial Hospital CBSA Participation Areas —— Number of individuals hired from MedStar Union Memorial Hospital CBSA Participation areas are those that the hospital supports, —— Retention rates of hired associates but is not positioned to take a leadership role in —— Number of patients or clients assisted by addressing. these positions —— Average caseload for positions Participation —— Average length of patient engagement by positions • Neighborhood Violence and Street Safety —— Number patients screened for social needs and • Housing number of those referred or linked to services —— Readmission rates among patients assigned to KEY PARTNERS: PARTICIPATION CHAs or PRCs Baltimore City governmental agencies —— ED utilization among patients assigned to CHAs BUILD – Baltimoreans United in Leadership Development or PRCs Central Baltimore Partnership Habitat for Humanity • Rx for Success Pipeline Summer Internship Program Healthcare for the Homeless —— Number of students who apply to the Penn North - UTURNS internship annually SAFE Streets —— Number of students selected and placed in the internship annually —— Number of student interns from MedStar Union Memorial Hospital’s CBSA annually

75 | MedStar Union Memorial Hospital 2018 Community Health Needs Assessment COMMUNITY BENEFIT SERVICE AREA (CBSA): 20011, 20019, 20020 (WITH EMPHASIS ON WARDS 7 AND 8) MedStar Washington Hospital Center’s CBSA includes residents in Washington, DC zip codes 20011, 20019, 20020. This geographic area was selected based on hospital utilization and secondary public health data as well as its close proximity to the hospital, coupled with an opportunity to build upon longstanding programs and services.

COMMUNITY HEALTH PRIORITIES • Health and Wellness —— Chronic Disease Prevention and Management —— Behavioral Health

• Access to Care and Services Community Health —— Mental Health —— Linkage to Resources and Needs Assessment Services —— Transportation

Health and Wellness • Social Determinants of Health —— Food Access CHRONIC DISEASE —— Employment —— Housing Chronic Disease Objectives • Deliver evidence-based, outcome-focused chronic disease management and prevention programs and services in, or targeting individuals living in, MedStar Washington Hospital Center Community Benefit Service Area (CBSA).

76 2018 Community Health Needs Assessment CANCER • Cancer is the second leading cause of death among Diabetes was the sixth leading DC residents, with 1,044 deaths in 2016 (and a cause of death in DC, with mortality rate of 160.1 per 100,000).32 127 deaths in 2016 (and a • The crude death rate of deaths from cancer in Ward 7 is about 22 percent higher than the DC-wide rate, and 32 mortality rate of 19.8). 26 percent higher than the nation.35 • DC has the highest liver cancer rates in the country, with 15 deaths per 100,000 men, and five such deaths Chronic Disease Secondary Data per 100,000 women.35 DIABETES • Diabetes was the sixth leading cause of death in Chronic Disease Strategies Washington, DC, with 127 deaths in 2016 (and a • Conduct Living Well Chronic Disease mortality rate of 19.8).32 Self-Management Program • In 2014, one in eleven (or 9.1 percent) DC residents had diabetes. In 2013, diabetes was the ninth leading Chronic Disease Anticipated Outcomes cause of hospitalization in DC, with 1,572 visits.6 • Increased participation in chronic disease prevention • In DC, emergency department (ED) visits related and management programs and services to diabetes were over six times higher for African • Increased retention rates among program participants Americans than for Whites.6 • Improved health behaviors and health outcomes • An analysis of ED records found that up to 30 percent among program participants of visits for diabetes, asthma, and other chronic • Increased identification of social unmet needs and conditions were potentially preventable with better linkages to social need services among chronic access to effective primary and preventive care.6 disease management program participants • Improved healthcare utilization patterns among HEART DISEASE AND STROKE program participants • Heart disease is the leading cause of death among DC residents, with 1,375 deaths in 2016 (and a mortality Chronic Disease Metrics rate of 211.7).32 • Heart disease in DC can be attributed to preventable PROGRAM-SPECIFIC METRICS factors like obesity, poor physical activity, heavy Key factors will be tracked to determine: 1) impact of drinking, eating unhealthy foods, and not keeping programs and services implemented; and 2) relevance blood pressure and cholesterol under control. to external public health goals. • The hospitalization rate for heart disease in DC was 41.9 per 1,000 Medicare beneficiaries. • Living Well Program • Heart disease is the top reason for hospitalization in DC —— Percentage of program completers who report • Stroke is the fourth leading cause of death in DC, with improved quality of life 252 deaths in 2016 (and mortality rate of 38.4).32 —— Percentage of program completers reporting increased physical activity OBESITY —— Percentage of program completers who have • In DC, 26.2 percent of adults are obese. DC has the decreased blood pressure and weight loss 36 second lowest adult obesity rate in the nation. —— Percentage of people who screen positive for social • More than one-third (33.8 percent) of 10-12 year-olds needs and are linked to services at intake and post 36 in DC are obese. program completion • DC ranks 11th among all states for obesity rates —— Percentage of completers who do not readmit to 36 among children ages 10-12. the ED after program ends —— Potentially Avoidable Utilizations (PAU) and readmission rates among program completers —— Percentage of program completers who successfully complete follow-up assessments

77 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment PUBLIC HEALTH METRICS • The percentage of driving deaths with alcohol • Age-adjusted death rate from diabetes, heart disease, involvement in DC increased from 43.0 percent in stroke, and cancer 2015 to 74.0 percent in 2016.5 • ED visit rates and hospitalizations due to hypertension, • White adults were more than twice as likely to diabetes, heart disease, stroke, and cancer report as binge drinkers compared to Black adults • Prevalence of diabetes in DC (35.0 percent and 14.0 percent, respectively).5 • Incidence and prevalence of heart disease and • The percent of adults reporting as binge drinkers stroke in DC varied significantly by ward, with the highest • Percentage of adults at a healthy weight or body percentages in Wards 1 (42.0 percent) and 2 mass index (BMI) (30.0 percent) and lowest in Wards 4 (16.0 percent) • Percentage of adults who are obese and 7 (18.0 percent).5 • Percentage of adults participating in recommended OPIOID ABUSE levels of physical activity • DC’s mortality rate for opioid-related overdose deaths is among the highest in the nation, with a 2016 rate KEY PARTNERS: CHRONIC DISEASE of 30 deaths per 100,000 people (or 209 deaths). The DC Department of Aging and Human Services national rate is 13.3 per 100,000 people.37 DC Department of Family Services DC Health Behavioral Health Strategies Maintaining Active Citizens, Inc. • Conduct Screening, Brief Intervention, and Referral Maryland Department of Aging to Treatment (SBIRT) Program

Behavioral Health Anticipated Outcomes BEHAVIORAL HEALTH • Improved identification of high-risk substance use behaviors and access to substance abuse treatment, Behavioral Health Objectives: education and social need services Substance Use Disorders • Deliver evidence-based behavioral health programs Behavioral Health Metrics and services targeting the identification of substance abuse and linkage to treatment services among PROGRAM-SPECIFIC METRICS high-risk individuals in MedStar Washington Hospital Key factors will be tracked to determine: 1) impact of Center’s CBSA programs and services implemented; and 2) relevance to external public health goals. Behavioral Health Secondary Data • Number of SBIRT screens annually SUBSTANCE ABUSE • Number of positive SBIRT screens annually • Nationally, over 20 million adults had a substance • Number of brief interventions completed annually use disorder in 2014.40 • Number of referrals to treatment provided annually • In 2016, there were more than 63,600 drug overdose • Number of patients linked to treatment annually deaths in the United States.41 • ED readmission and PAU rates of patients who receive • The rate of drug overdose deaths in DC in 2016 was brief interventions and/or linkage to treatment 38.8 per 100,000 population.41 • Number of substance abuse and addiction support • More DC residents report use of illicit drugs groups promoted and held in MedStar Washington (12.3 percent) than the national rate, 8.8 percent.30 Hospital Center’s CBSA annually

ALCOHOL ABUSE PUBLIC HEALTH METRICS • 28.0 percent of adults in DC report binge drinking • Percentage of individuals reporting a substance compared to 18.0 percent nationally.11 abuse disorder • In DC, the percentage of driving deaths with • Percentage of adults reporting excessive drinking alcohol involvement was 25.0 percent compared • Percentage of adults and adolescents who report to 33.0 percent nationally.11 alcohol use and binge drinking

78 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment • Percentage of hospitalizations due to a substance Access to Care and Services Secondary Data abuse or alcohol abuse disorder MENTAL HEALTH SERVICES • Number of driving deaths involving alcohol • In 2014, approximately 18.0 percent of DC adults had • Number of hospitalizations due to opioid overdose ever been told they had a depressive disorder.5 • Age-adjusted death rate due to opioid overdose • Rates were highest in Ward 8 (30.0 percent), Ward 1 • Age-adjusted drug and alcohol related death rate (22.0 percent), and Ward 7 (18.0 percent).5 • Drug- and alcohol-related ED visits • Areas of Wards 7 and 8 were designated by the Health Resources and Services Administration (HRSA) as KEY PARTNERS: BEHAVIORAL HEALTH mental health professional shortage areas in 2015.5 Community-based addiction and mental health • In 2014, the second most common inpatient hospital services organizations discharge among all DC residents was for mood DC Health disorders (3.9 percent).5 Maryland Department of Health and Mental Hygiene - Behavioral Health Administration SOCIAL NEEDS SERVICES Mosaic Group • 93.0 percent of adult residents and 96.0 percent Substance Abuse and Mental Health Services Administration (SAMSHA) of children have insurance coverage in DC. It is the second highest coverage rate in the nation.5 • Residents in Wards 7 and 8 had the lowest coverage amongst all wards (90.0 percent and Access to Care and Services 91.0 percent, respectively).5 • Health insurance coverage was lowest among Access to Care and Services Objectives Hispanic/Latino residents (78.0 percent) compared • Increase access to mental health services as part of the to 91.0 percent coverage among Black residents and primary care model 97.0 percent coverage among White residents.5 • Improve appropriate healthcare utilization practices • DC-wide, 10.0 percent of adults reported that they had and health outcomes of high-need, high-risk patients delayed getting medical care because they could not by identifying social unmet needs and linkage to get an appointment soon enough.5 community social needs resources at point of care using the Aunt Bertha tool

79 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment Access to Care and Services Strategies PUBLIC HEALTH METRICS • Provide mental health services as part of the • Percentage of people reporting unmet healthcare primary care model needs in the past 12 months • Conduct social needs screening and support linkages • Percentage of people reporting they could not afford to social need services as part of care delivery and to see a doctor in the past 12 months chronic disease self-management programming • Depression and anxiety disorder prevalence rates • Percentage of adults unemployed Access to Care and Services • Percentage of households experiencing food insecurity Anticipated Outcomes • Percentage of uninsured individuals • Increased access to mental health services in • Number of individuals reporting avoiding medical primary care settings care due to cost • Increased use of uniform social needs screener in • Percentage of individuals living below the poverty line MedStar Washington Hospital Center care delivery • Percentage of adults with disabilities sites and as part of the Living Well program • Improved identification of patients’ social unmet KEY PARTNERS: ACCESS TO CARE AND SERVICES needs and service linkage at point of care Aunt Bertha, Inc. • Improved health care utilization among individuals Community-based addiction and mental health services linked to social need, transportation services or organizations mental health services Community-based social services organizations

Access to Care and Services Metrics

PROGRAM-SPECIFIC METRICS Collaboration Areas • Mental Health Services Collaboration areas were identified as social determinant —— Number of people who receive or are referred areas in which the hospital will serve as a partner with to mental health treatment services in primary outside organizations. care settings annually —— Number of people screened for selected mental TRANSPORTATION health conditions (substance use, depression and anxiety) annually Transportation Objectives —— Number of people with positive mental health • Address the barrier of transportation to medical and screenings annually health services and programs among individuals —— Number of people who screen positively for who identify transportation as a social unmet need mental health conditions that are referred or linked to services annually Transportation Secondary Data —— ED readmission and PAU rates of people with • Lack of transportation is cited as having a significant positive mental health screening that were impact on access to health care services and is a referred or linked to services determinant of a person’s ability to access basic • Social Needs Services resources that can affect quality of life.5 —— Number of social needs screenings • In DC, many characterize public transportation as conducted annually expensive and unreliable.5 —— Number of positive social needs screened annually • Metro stations in DC are concentrated in the central —— Number of people referred to services annually region (Wards 2 and 6) and are lacking in other areas, —— Number of people linked to services annually especially in Wards 4, 7, and 8.5 —— ED readmission and PAU rates of people with • 19 percent of MedStar Washington Hospital positive social needs screening that were referred Center CHNA survey respondents identified lack of or linked to services transportation as a barrier to accessing care.

80 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment Transportation Strategies • DC’s unemployment rate has decreased since 2011, • Implement MedStar Health UBER program but the rate varies from ward to ward. Compared to the national rate, unemployment was two times higher Transportation Anticipated Outcomes in Ward 7 and three times higher in Ward 8 in 2016.5 • Increased number of available rides to and from • Compared to the national average, as of June 2016, medical and health services and community unemployment is two times higher in Ward 7 and health programs three times higher in Ward 8.5 • Decreased no-show rates among participants • Income and employment status are closely linked to morbidity, mortality, and overall well-being;, lower than Transportation Metrics average life expectancy is highly correlated with low- income status.5 PROGRAM-SPECIFIC METRICS Key factors will be tracked to determine: 1) impact of Employment Strategies programs and services implemented; and 2) relevance • Deliver the Rx for Success Pipeline Summer Internship to external public health goals. Program for underserved high school students

• MedStar Health UBER Program —— Number of rides supported annually Employment Anticipated Outcomes —— Number of people who receive rides annually • Increased number of underserved, racial and ethnic —— ED readmission and PAU rates of people who minority interns in the Rx for Success summer internship receive rides at MedStar Washington Hospital Center annually —— No show rates among program participants • Improved satisfaction rates among student interns, intern —— Percentage of people who identify transportation supervisors, and school partner leadership annually as a barrier • Improved pipeline processes to increase employment opportunities post-internship for eligible students PUBLIC HEALTH METRICS • Percentage of the population with access to public Employment Metrics transportation PROGRAM-SPECIFIC METRICS • Percentage of population who have delayed getting Key factors will be tracked to determine: 1) impact of medical care due to lack of transportation programs and services implemented; and 2) relevance to external public health goals. KEY PARTNERS: TRANSPORTATION Aunt Bertha, Inc. • Rx for Success Pipeline Summer Internship Program Uber Technologies, Inc. —— Number of students who apply to the internship annually —— Number of students selected and placed in the EMPLOYMENT internship annually —— Number of student interns from MedStar Employment Objectives Washington Hospital Center’s CBSA annually —— • Prepare local underserved students for healthcare- Graduation rates of interns related collegiate studies and careers through an —— Number of seniors who complete the internship established pipeline internship program and pursue a health-related college major —— Number of seniors who complete the internship Employment Secondary Data and are employed in a health-related position within MedStar Health • In 2015, 14.0 percent of DC families lived in poverty. In Wards 7 and 8, 75.0 percent more families live in —— Student, supervisor and community partner poverty, at 25.0 percent and 29.0 percent respectively, satisfaction rate compared to the DC benchmark.5 —— Type of intern placements within MWHC

81 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment PUBLIC HEALTH METRICS Food Access Metrics • Unemployment rate PROGRAM-SPECIFIC METRICS • Percentage of adults who are unemployed and seeking work (unemployment rate) Key factors will be tracked to determine: 1) impact of • High school graduation and completion rate programs and services implemented; and 2) relevance • Percentage of new hires to healthcare fields to external public health goals.

• Food & Friends Meal Referral Program KEY PARTNERS: EMPLOYMENT —— Number of referrals to Food & Friends annually Eastern High School —— Number of people linked to food services annually Companies for Causes —— Number of meals supported annually —— ED readmission and PAU rates of people linked to food services FOOD ACCESS • Food Access Public Health Metrics Food Access Objectives —— Percentage of food insecure households —— Percentage of population experiencing • Improve access to healthy food among individuals food insecurity 11 who identify food insecurity as a social need

Food Access Secondary Data KEY PARTNERS: FOOD ACCESS • 21.0 percent of Medstar Washington Hospital CHNA Food & Friends respondents identified healthy food options as a Capital Area Food Bank community need. • Residents in Wards 7 and 8 have reported they struggled to afford the cost of healthy produce.5 Participation Areas • 13.0 percent of the population of DC reports food insecurity, or insufficient access to healthy food, Participation areas are those that the hospital supports, but compared to 10.0 percent nationally.5 is not positioned to take a leadership role in addressing.

Food Access Strategies Participation • Conduct Food & Friends Meal Referral Program • Housing

Food Access Anticipated Outcomes KEY PARTNERS: PARTICIPATION • Increased number of people with positive social needs Central Union Mission screened for food insecurity that are referred or linked Coalition for the Homeless to food-related services DC Department of Housing and Urban Development • Increased number of annual MedStar Washington DC Department of Human Services – Family Services Hospital Center-supported meals Administration DC Health District of Columbia Primary Care Association (DCPCA)- DC Positive Accountable Community Transformation (DC PACT) Pathways to Housing

82 | MedStar Washington Hospital Center 2018 Community Health Needs Assessment References

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84 | References 2018 Community Health Needs Assessment PHOTO CREDITS Cover: Stocksy/Sean Locke; iStock/vgajic. Page 7: Flickr/Marc Monaghan. Page 12: Stocksy/Sean Locke; iStock/Joel Carillet. Page 15: iStock/VukasS. Page 32: LEE SNIDER/Alamy Stock Photo. Page 39: iStock/PeopleImages. Page 42: iStock/julief514. Page 47: WorldFoto/Alamy Stock Photo. Page 48: Stocksy/Lumina. Page 52: Stocksy/Tana Teel. Page 56: Michael Ventura/Alamy Stock Photo. Page 60: Stocksy/Gary Radler Photography. Page 67: Stocksy/Lauren Light. Page 72: iStock/LaraBelova. Page 79: iStock/filipefrazao.