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Community Health Needs Assessment

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Community Health Needs Assessment C O M M U N I T Y H E A L T H N E E D S A S S E S S M E N T 2 0 1 9 Executive Summary Background and Purpose Winchester Hospital (WH), part of Beth Israel Lahey Health (BILH), was the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association’s highest honor for nursing excellence, three times. It has since received the recognition a fourth time. As the leading provider of comprehensive health care services in the northwest suburban Boston area, this 229-bed facility provides care in general, bariatric, and vascular surgery; orthopedics; pediatrics; cardiology; pulmonary medicine; oncology; gastroenterology; rehabilitation; radiation oncology; pain management; and obstetrics/gynecology. WH also has a Level IIB Special Care Nursery. For more information on Winchester Hospital, visit www.winchesterhospital.org. WH is committed to fulfilling requirements by the Massachusetts Attorney General’s Office (MAGO) and Internal Revenue Service (IRS) to assess and prioritize health needs in its community benefits service area (CBSA). WH’s CBSA includes the towns of Medford, North Reading, Reading, Stoneham, Tewksbury, Wilmington, Winchester, and Woburn. Given that WH operates multiple facilities under a single state license and serves different geographic areas and populations, the communities that are part of the CBSA are an aggregate of these geographic areas and residents. The CBSA does not exclude medically underserved, low-income, or minority populations. For this assessment, WH made efforts to identify the health needs of all residents within its community benefits service area, regardless of whether the residents use or have used services at Winchester Hospital or its outpatient clinics. WH strives to create and support opportunities for residents of the community benefits service area to lead healthy and productive lives through community benefits programming. The hospital acknowledges its role as a critical community resource, but it also recognizes the value in collaborating with community partners to identify, educate, prevent, and address issues that prevent community residents from accessing the health and social services they need. This Community Health Needs Assessment (CHNA) and the associated Implementation Strategy were done in close collaboration with WH’s leadership, staff, health and social services partners, and the community at large. This assessment involved input from nearly 1,000 community residents, stakeholders, and service providers. This assessment, including the process that was applied to develop the Implementation Strategy, Winchester Hospital Community Health Needs Assessment 2019 exemplifies the spirit of collaboration and community engagement that is such a vital part of WH’s mission. This CHNA provides information that will be used to make sure that WH’s services and programs are appropriately focused, are delivered in ways that are responsive to those in its CBSA, and are conducted to address leading barriers to health and well-being. This CHNA and the Implementation Strategy allow WH to meet commonwealth and federal Community Benefits requirements, per the Massachusetts Attorney General’s Office and the IRS as part of the Affordable Care Act. Approach and Methods The assessment began in December 2018 and was conducted in three phases, allowing for the collection of an extensive amount of quantitative and qualitative data (Phase 1); engagement of community residents, key stakeholders, and service providers (Phase 2); and analysis and prioritization of findings for use in developing a data-driven implementation strategy (Phase 3). 2019 CHNA and Implementation Strategy Project Phases Phase 1 – Preliminary Phase 2 – Targeted Phase 3 – Strategic Planning and Assessment and Engagement Reporting Engagement Develop Community Health Needs Identify health needs Engage key stakeholders Assessment and Implementation Strategy • Collection and analysis of • Focus groups with target • Meetings with the Community quantitative data to populations and service Benefits Advisory Committee and characterize community providers. Community Benefits Project characteristics, health • Community forums with Advisory Committee to present needs, and barriers to community residents and CHNA findings, prioritize care. service providers. community needs, identify • Qualitative data collection • Dissemination and analysis vulnerable populations, and through key informant of a Community Health discuss potential responses. interviews with hospital Survey to capture • Creation of a Resource Inventory leaders, local service residents’ perceptions of to catalog local organizations, providers, town leaders, barriers to good health, service providers, and community and community leading health issues, assets that have the potential to stakeholders. vulnerable populations, address identified needs. • Evaluation of the hospital’s accessibility of health • Literature review of evidence- current portfolio of services, and opportunities based strategies and identification community benefits for the hospital to improve of successful strategies being activities. the services it offers to the conducted by community-based • Synthesis of findings from community. organizations to respond to quantitative and identified priorities. qualitative research to • Development of a final CHNA identify themes and areas report and Implementation of consensus. Strategy. Steering Committee meetings to plan and manage project activities. Winchester Hospital Community Health Needs Assessment 2019 The quantitative assessment included an extensive analysis of demographic and socioeconomic data, health status, utilization rates, and behavioral risk survey data. Data sources included publicly available data as well as data collected from stakeholders through key informant interviews. Hundreds of individuals from across Winchester Hospital’s CBSA were engaged in the assessment and planning process, including: • Health and social services providers • Town administrators/elected officials • Public health officials • Public safety/first responders • Public school nurses and administrators • Leaders of faith-based organizations • Community organizers and advocates • Community residents • BILH senior leadership, staff, and board members • Winchester Hospital senior leaders, staff, and board members These individuals were invited to provide input through key informant interviews, focus groups, community listening sessions, and a widely distributed Community Health Survey. While it was not possible for this assessment to involve all community stakeholders, Winchester Hospital made every effort to be as inclusive as possible and to provide a broad range of opportunities for participation over the course of several months. Key Findings Below is a high-level summary of health-related findings that were identified after a comprehensive review of all the quantitative and qualitative information that was collected as part of the CHNA. A detailed and in-depth discussion of key findings is included in the full CHNA report. • The social determinants of health (e.g., economic stability, transportation, access to care, housing, food insecurity) impact many segments of the population. A key theme from the assessment’s key informant interviews, focus groups, listening sessions, and Community Health Survey was the continued impact that the social determinants of health have on residents of WH’s service area, especially those who are low to moderate income, are frail or homebound, have mental health or substance use issues, or lack a close support system. The increasing cost of housing in areas outside Boston was also noted as contributing to housing/financial instability. • Certain populations are more vulnerable to health care disparities and barriers to care. Despite the facts that Massachusetts has one of the highest rates of health insurance enrollment and the communities that make up WH’s CBSA are generally insured and employed, there was concern that families face financial stress because of high out-of-pocket costs for health care services and not being eligible for public benefits, or, if they are eligible, they are not enrolling because of the stigma of accepting public assistance. In addition, there are groups that face language and cultural barriers to accessing services. • Mental health issues (e.g., depression, anxiety/stress, access to treatment, stigma) underlie many health and social concerns. Nearly every key informant interview, focus group, and listening session included discussions on the impact of mental health issues. From a review of the quantitative and qualitative information, depression, anxiety/stress, and social isolation were the leading concerns. There were particular concerns about the impact of depression, anxiety, and e-cigarettes/vaping on youth and of social isolation among older adults. Access to mental health services was limited by the general lack of providers and the low number accepting even private health insurance. • Substance dependency continues to impact individuals, families, and communities. The opioid epidemic continues to be an area of focus. Beyond opioids, key informants were also concerned with Winchester Hospital Community Health Needs Assessment 2019 alcohol misuse, changing community norms in light of the legalization of recreational marijuana use, and e-cigarettes/vaping among adolescents. • Chronic diseases (e.g., cardiovascular disease, cancer, diabetes, asthma) require more education, screening/early
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