05916 CH Needs Assess CVR 3-16_Layout 1 3/31/16 10:40 AM Page 1 2013MARCH 2016 ThomasAbington Jefferson Hospital – JUniversityefferson HHospitalsealth CommunityCommunity HealthHealth NeedsNeeds AssessmentAssessment ReportReport HHOMEO M E OOFF SSIDNEYI D N E Y KKIMMELI M M E L MMEDICALE D I C A L CCOLLEGEO L L E G E Thomas Jefferson University Hospitals, Inc. Community Health Needs Assessment Thomas Jefferson University Hospital – Center for Urban Health Rickie Brawer, PhD, MPH and James Plumb MD, MPH 4/21/2013 Table of Contents Introduction ................................................................................................................................. 1 Purpose of the Community Health Needs Assessment................................................................................ 5 Community Health Needs Assessments Methods ....................................................................................... 8 Community Health Needs Assessment Findings………………………………………………………………………………………..13 Philadelphia and TJUH Community Benefit Area Demographics………………………………………………………………..13 Social Determinants of Health…………………………………………………………………………………………………………………..18 Health Care Access……………………………………………………………………………………………………………………………………40 Health Status…………………………………………………………………………………………………………………………………………...58 Mortality………………………………………………………………………………………………………………………………………58 Maternal and Child Health…………………………………………………………………………………………………………...68 Morbidity……………………………………………………………………………………………………………………………………..79 Preventive Care and Early Detection of Disease………………………………………………………………………….101 Health Behaviors………………………………………………………………………………………………………………………..107 Special Populations………………………………………………………………………………………………………………………………...130 Older Adults……………………………………………………………………………………………………………………………….130 Immigrants and Refugees……………………………………………………………………………………………………………153 Homeless……………………………………………………………………………………………………………………………………165 LGBT…………………………………………………………………………………………………………………………………………..169 Recommendations………………………………………………………………………………………………………………………………….171 References………………………………………………………………………………………………………………………………………………174 Introduction Over the past century the major causes of morbidity and mortality in the United States have shifted from those related to communicable diseases to those due to chronic diseases. Just as the major causes of morbidity and mortality have changed, so too has understanding of health and what makes people healthy or ill. Research has documented the importance of the social determinants of health (for example, socioeconomic status and education), which affect health directly as well as through their impact on other health determinants such as risk factors. Targeting interventions toward the conditions associated with today’s challenges to living a healthy life requires an increased emphasis on the factors that affect the current causes of morbidity and mortality, factors such as the social determinants of health. Many community- based prevention interventions target such conditions. Community-based prevention interventions offer three distinct strengths. First, because the intervention is implemented population-wide it is inclusive and not dependent on access to the health care system. Second, by directing strategies at an entire population an intervention can reach individuals at all levels of risk. And finally, some lifestyle and behavioral risk factors are shaped by conditions not under an individual’s control. For example, encouraging an individual to eat healthy food when none is accessible undermines the potential for successful behavioral change. Community-based prevention interventions can be designed to affect environmental and social conditions that are out of the reach of clinical services. (An Integrated Framework for Assessing the Value of Community- Based Prevention – Institute of Medicine 2012)1 “The best care/access in the world won’t trump the social issues” (CBO representative) Thomas Jefferson University Hospitals, an academic medical center within the Jefferson Health System, serves patients in Philadelphia and the surrounding communities in the Delaware Valley. Thomas Jefferson University Hospitals and Thomas Jefferson University are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care. Thomas Jefferson University Hospitals (TJUHs) - Thomas Jefferson University Hospital, Jefferson Hospital for Neuroscience, and Methodist Hospital Division - trace its origins to 1825, when Jefferson Medical College started an infirmary to provide medical treatment to the indigent. In 1877, Jefferson opened a 125-bed hospital, the first in the nation affiliated with a medical school. Recognized nationally as a center for excellence in medical education, research, and health services, Jefferson is committed to serving the healthcare needs of its community. Founded in 1892, Jefferson's Methodist Hospital has a long history of providing the highest level of compassionate care to South Philadelphia. Methodist offers the unique warmth and hospitality of a smaller community hospital combined with the leading experts, treatments and technologies you expect from larger teaching institutions. As the leading healthcare provider in the heart of South Philadelphia, Methodist serves the community by offering numerous health education programs, 1 fitness and nutrition classes and screenings to enhance the well-being of area residents and partners with various civic organizations to address the community’s healthcare needs. Jefferson Hospital for Neuroscience (JHN) is the Philadelphia area's preeminent center for the diagnosis and treatment of stroke and cerebrovascular diseases, brain tumors, epilepsy, movement disorders, neuromuscular diseases, headaches, Alzheimer's disease and spine and spinal cord injuries. With the growing burden of chronic disease, the medical and public health communities are reexamining their roles and opportunities for more effective prevention and clinical interventions. The potential to significantly improve chronic disease prevention and impact morbidity and mortality from chronic conditions is enhanced by adopting strategies that incorporate a social ecology perspective, realigning the patient-physician relationship, integrating population health perspectives into the chronic care model, and effectively engaging communities. Jefferson highly values the principles of community engagement articulated by the Centers for Disease Control (Table 1) and has built its community benefit efforts on a community engagement model. Jefferson also recognizes the value of an Expanded Chronic Care Model (Figure 1) as a framework for addressing chronic disease in a comprehensive way that respects clinical care, the health system, community and patients as equal partners in meeting the Triple Aim of improving population health, the patient experience, and reducing per capita costs. Table 1 - Principles of Community Engagement2 Principle Key elements Set Goals Clarify the purposes/goals of the engagement effort Specify populations and/or communities Study Community Economic conditions Political structures Norms and values Demographic trends History Experience with engagement efforts Perceptions of those initiating the engagement activities Build Trust Establish relationships Work with the formal and informal leadership Seek commitment from community organizations and leaders Create processes for mobilizing the community Encourage self-determination Community self-determination is the responsibility and right of all people No external entity should assume that it can bestow on a community the power to act in its own self-interest Establish partnerships Equitable partnerships are necessary for success Respect diversity Utilize multiple engagement strategies Explicitly recognize cultural influences 2 Principle Key elements Identify community assets and View community structures as resources for change develop capacity and action Provide experts and resources to assist with analysis, decision-making, and action Provide support to develop leadership training, meeting facilitation, skill building Release control to the community Include as many elements of a community as possible Adapt to meet changing needs and growth Make a long-term commitment Recognize different stages of development and Provide ongoing technical assistance Principles of Community Engagement: Edition 2. Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement. 2011;11-7782. 3 Community Build Healthy Policy Health System Create Supportive Environment Information Self- Decision Management Delivery stems Strengthen Support System Community Action Redesign Productive Interactions and Activated Activated Proactive Continuous Relationships Activated Community Patient Team Community Figure 1 - Adapted From: Barr, V., Robinson, S.,Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D., & Salivaras, S. (2003). The Expanded Chronic Care Model: An Integration of Concepts and Strategies from Population Health Promotion and the Chronic Care Model. Hospital Quarterly, 7(1), 73-82.3 The Community Benefit Committee recommends using the following model to guide planning and programmatic efforts, and to explain to internal and external stakeholders the