Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Fiscal Year 2013
~ Committed to Improving the Health and Well-being of the Community ~
Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Fiscal Year 2013
Table of Contents
Preface ...... ii Section 1: Overview ...... 1 Section 2: Executive Summary ...... 3 Section 3: Methodology ...... 9 Section 4: Community Defined ...... 29 Section 5: Findings ...... 38 Section 6: Conclusion ...... 70
List of Appendices
Appendix A: Sharp Coronado Hospital and Healthcare Center Programs and Services ...... 105 Appendix B: An Overview of Sharp HealthCare ...... 106 Appendix C: Community Needs Index Map of San Diego County ...... 113 Appendix D: List of Modifiable Health Drivers Associated with Poor Health Outcomes ...... 114 Appendix E: Health Expert/ Community Leader Electronic Survey Questions ...... 115 Appendix F: Key Informant Interview Questions ...... 118 Appendix G: Community Forum Questions ...... 120 Appendix H: SCHHC Key Informant Interview Questions: Senior Health and End-of-Life Care ...... 121 Appendix I: SCHHC Community Member Feedback Survey Questions: Coronado and Imperial Beach ...... 123 Appendix J: Map of Community and Region Boundaries in San Diego County ...... 124 Appendix K: Map of Sharp HealthCare Locations ...... 125 Appendix L: Sharp HealthCare Involvement in Community Organizations ...... 126 Appendix M: Glossary of Abbreviations ...... 132
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Preface
Sharp Coronado Hospital and Healthcare Center (SCHHC) prepared this Community Health Needs Assessment (CHNA) for Fiscal Year 2013 (FY 2013) in accordance with the requirements of Section 501(r)(3) within Section 9007 of the Patient Protection and Affordable Care Act (Affordable Care Act) and IRS Form 990, Schedule H for not-for- profit hospitals.1
Under the Affordable Care Act enacted in March, 2010, IRS Code Section 501(r)(3) requires not-for-profit hospitals to conduct a triennial assessment of prioritized health needs for the communities served by its hospital facilities, and to adopt an implementation plan to address health needs identified as a result of the CHNA.
The Sharp Coronado Hospital and Healthcare Center 2013 Community Health Needs Assessment and Implementation Plan received approval from the Sharp Coronado Hospital and Healthcare Center Board of Directors on August 26, 2013.
Daniel L. Gross Executive Vice President, Hospital Operations Sharp HealthCare
1 See Section 9007(a) of the Patient Protection and Affordable Care Act (“Affordable Care Act”), Pub. L. No. 111-148, 124 Stat.119, enacted March 23, 2010. Notice 2011-52.
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Acknowledgements
Sharp Coronado Hospital and Healthcare Center’s (SCHHC) 2013 Community Health Needs Assessment (CHNA) process included the time, effort, insight and contributions of many members of the San Diego community. For both SCHHC’s 2013 CHNA and the Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA process, this included not only HASD&IC, the Institute for Public Health (IPH) at San Diego State University (SDSU), and other representatives from not-for-profit hospitals in San Diego, but also hundreds of community members including physicians, health care practitioners and professionals, community health leaders, public health officials, academics and other concerned residents who are dedicated to the care of vulnerable members of our community. We would like to express our profound appreciation for the contributions made by all who participated in this CHNA.
In particular, we are grateful to those community residents who shared their personal insight regarding health care concerns in San Diego during the community forums, as well as from the community feedback surveys collected throughout this process. These community residents – many from high-risk communities – volunteered their time and effort to contribute to this CHNA in order to improve the care, health and well-being for themselves, their families, and the communities in which they live. For this commitment and caring, we extend our deepest thanks.
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Background: Sharp HealthCare CHNA History
For the past 16 years, Sharp HealthCare (Sharp) has been actively involved in a triennial CHNA process, in accordance with the requirements of Senate Bill 697, community benefits legislation that requires not-for-profit hospitals in California to file an annual report with the Office of Statewide Health Planning and Development (OSHPD) on activities undertaken to address high-priority community needs within their mission and financial capacity as well as the financial value of those community benefit programs and services. In fiscal year (FY) 2012, Sharp provided more than $305 million in community benefit programs and services. To view the most recent Sharp HealthCare Community Benefits Plan and Report, please visit: http://www.sharp.com/about/community/community-benefits-health-needs.cfm.
Since 1995, Sharp has participated in a countywide collaborative that includes a broad range of hospitals, health care organizations, and community agencies to conduct a triennial CHNA. Findings from the CHNA, the program and services expertise of each Sharp hospital, and knowledge of the populations and communities served by those hospitals combine to provide a foundation for community benefits planning and program implementation.
To address the new requirements under Section 501(r) within Section 9007 of the Patient Protection and Affordable Care Act, and IRS Form 990, Schedule H for not-for- profit hospitals, San Diego County (SDC) hospitals engaged in a new, collaborative CHNA process. This process gathered both salient hospital data and the perspectives of community health leaders and residents in order to identify priority health needs for community members across the county, with particular focus on vulnerable populations. Additionally, the process aimed to highlight health issues that hospitals could impact through programs, services and collaboration.
In this endeavor, Sharp participated in collaboration with the Hospital Association of San Diego and Imperial Counties, the Institute for Public Health (IPH) at SDSU and San Diego County hospital systems including: Kaiser Foundation Hospital, San Diego; Palomar Health; Rady Children’s Hospital; Scripps Health; Tri-City Medical Center; and UC San Diego Health System.
The results of this collaborative process significantly informed this CHNA for SCHHC, and it was further supported by additional data collection and analysis, and community outreach specific to the primary communities served by SCHHC. This CHNA will help guide current and future community benefit programs and services, especially for high- need community members. The pages that follow detail the methodology and results of SCHHC’s 2013 CHNA. In addition, SCHHC will also submit an implementation plan to address the needs identified through the 2013 CHNA process.
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Section
1 Overview
Sharp Coronado Hospital and Healthcare Center (SCHHC) is located at 250 Prospect Place in Coronado, ZIP code 92118.
History
Coronado Hospital was built in 1926 and began as a 12-bed emergency hospital, privately owned by Mrs. Maude Lancaster and subsidized by the city of Coronado for 16 years. In 1938, Mrs. Lancaster retired and a group of physicians established the hospital as a not-for-profit, community-owned facility governed by a hospital board. A generous donation in 1942 from John D. Spreckels, then owner of the Hotel Del Coronado, allowed the hospital to expand to a 24-bed general hospital in its current location. In 1970, fundraising efforts and federal dollars funded a new full-service 64- bed four-story facility that was one of the most modern hospitals in the city at that time. Sharp HealthCare and Coronado Hospital became affiliated in 1994.
Today, Sharp Coronado Hospital and Healthcare Center is a 181-bed acute-care hospital that provides medical and surgical care, intensive care, sub-acute and long- term care, rehabilitation therapies, and emergency services to a geographically isolated island community. As the first of only two designated Planetree patient-centered hospitals in California and one of just fourteen hospitals nationwide to receive the designation, SCHHC promotes holistic healing by focusing on patient empowerment, patient and family education, and complementary therapies including Healing Touch, acupuncture, massage and aromatherapy. For a complete listing of the programs and services provided at SCHHC, please refer to Appendix A.
SCHHC is part of Sharp HealthCare – an integrated, regional health care delivery system based in San Diego, Calif. The Sharp system includes four acute care hospitals; three specialty hospitals; two affiliated medical groups; 20 medical clinics; five urgent care facilities; three skilled nursing facilities; two inpatient rehabilitation centers; home health, hospice, and home infusion programs; numerous outpatient facilities and programs; and a variety of other community health education programs and related services. Sharp offers a full continuum of care, including: emergency care, home care, hospice care, inpatient care, long-term care, mental health care, outpatient care, primary and specialty care, rehabilitation, and urgent care. Sharp also has a Knox- Keene-licensed health maintenance organization, Sharp Health Plan (SHP).
Sharp serves a population of approximately 3 million in San Diego County and as of June 2013, is licensed to operate 2,110 beds, and has approximately 2,600 Sharp- affiliated physicians and nearly 16,000 employees. Sharp’s mission is to improve the health of those it serves with a commitment to excellence in all that it does. Sharp’s goal Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Page 1
is to offer quality care and services that set community standards, exceed patient expectations, and are provided in a caring, convenient, cost-effective and accessible manner. More than 19,000 affiliated physicians, nurses, staff and volunteers are dedicated to providing the extraordinary level of care that is called The Sharp Experience.
Please refer to Appendix B for a detailed overview of the Sharp HealthCare system.
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Section
2 Executive Summary
Overview and Background
Sharp HealthCare (Sharp) has been a long-time partner in the process of identifying and responding to the health needs of the San Diego community. This partnership has included a broad range of hospitals, health care organizations, and community agencies in order to conduct triennial Community Health Needs Assessments (CHNAs) over the past 16 years. Previous collaborations among not-for-profit hospitals and other community partners have resulted in numerous well-regarded CHNA reports. Sharp hospitals, including Sharp Coronado Hospital and Healthcare Center (SCHHC), base their community benefit and community health programs on both the findings of these needs assessments and the combination of expertise in programs and services offered and the knowledge of the populations and communities served by each Sharp hospital.
The SCHHC 2013 CHNA examines the health needs of the community members it serves in San Diego County (SDC). SCHHC’s 2013 CHNA draws from and is based on the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA process and findings for the county. This collaborative process was conducted under the auspices of HASD&IC, and included partnerships with the Institute for Public Health at San Diego State University, and hospitals throughout the county, with which Sharp was a key collaborator.
CHNA Objectives
The objectives of SCHHC’s 2013 CHNA are: 1. Identify the top health conditions and health care needs of community members in its patient community. 2. Understand the challenges that community members – particularly those in communities of high-need - face in their attempts to access health care and maintain health and well-being. 3. Identify currently available community resources that support identified health conditions and health challenges. 4. Provide a foundation of information to begin discussions of opportunities for programs, services and collaborations that could further address the identified health needs and challenges for the community.
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Study Area Defined
The primary communities served by SCHHC include the City of Coronado, Downtown San Diego and Imperial Beach, an incorporated city. Table 1 below presents the ZIP codes where the majority of SCHHC patients reside.
Table 1: Primary Communities Served by SCHHC
ZIP Code Community 92118 Coronado 91932 Imperial Beach 92154 Otay Mesa 91910 Chula Vista 91911 Chula Vista 92101 Downtown San Diego 92113 Southeast San Diego 91950 National City
Source: SpeedTrack© California Universal Patient Information Discovery, OSHPD CY 2011 Hospital Discharge Data
Notably, most Coronado residents use SCHHC. Coronado is connected to central San Diego by a bridge to the east and an isthmus known as the Silver Strand to the south. SCHHC is located in the central area of Coronado, which includes hotels, shops, single family homes, condominiums and apartments. Coronado also includes Coronado Cays, a marina community located on the isthmus.
In addition to these communities, there are six military sites in Coronado including one of the largest Naval Commands in the United States with housing located both on- and off-base. Communities in close proximity to Coronado include downtown San Diego and Imperial Beach, an incorporated city.
Data Collection and Analysis
The HASD&IC 2013 CHNA process and findings significantly informed the SCHHC 2013 CHNA process and as such are described as applicable throughout this report. For complete details on the HASD&IC 2013 CHNA process, please visit the HASD&IC website at: www.hasdic.org or contact Lindsey Wade at [email protected].
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For the collaborative HASD&IC 2013 CHNA process, the IPH employed a rigorous methodology using both community input (primary data sources) and quantitative analysis (secondary data sources) to identify and prioritize the top health conditions in SDC. These health needs were prioritized based on the following criteria:
Have a significant prevalence in the community. Contribute significantly to the morbidity and mortality in San Diego County. Disproportionately impact vulnerable communities. Reflect a need that exists throughout San Diego County. Can be addressed through evidence-based practices by hospitals and health care systems.
HASD&IC 2013 CHNA Framework
QUALITATIVE DATA QUANTITATIVE DATA Health Expert/Community Leader Survey OSHPD, CDC, U.S. CENSUS, Community Forums SD COUNTY HHSA, UCLA CHIS Key Informant Interview
TOP HEALTH CONDITIONS & RECOMMENDATIONS
Source: www.hasdic.org
Quantitative data (secondary sources) for both the HASD&IC 2013 CHNA and SCHHC 2013 CHNA included the 2011 calendar year hospital discharge data at the ZIP code level, statistics from the San Diego County Health and Human Services Agency (HHSA), the U.S. Census Bureau, the Centers for Disease Control, and others. The variables analyzed are included in Table 2 below and were analyzed at the ZIP code level wherever possible.
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Table 2: Variables Analyzed in the HASD&IC and the SCHHC 2013 CHNAs
Secondary Data Variables Inpatient Hospitalizations by Cause Emergency Department Visits by Cause Demographic Data (socio-economic indicators) Mortality Data Regional Disease-Specific Health Data (County HHSA) Self-Reported Health Data (California Health Interview Survey) Specialized Health Data/Reports (various)
Recognizing that health needs differ across the region and that socioeconomic factors impact health outcomes, both HASD&IC’s and SCHHC’s 2013 CHNA processes utilized the Dignity Health Community Need Index (CNI) to identify communities with the highest level of health disparities and needs. Residents in five of these neighborhoods across SDC were asked to provide input in a community forum setting. Table 3 below presents communities (by ZIP code) served by SCHHC that have especially high need based on their CNI score (score = 5).
Table 3: High-Need Communities Served by SCHHC
ZIP Code Community 91932 Imperial Beach 91950 National City 92113 Southeast San Diego Source: Dignity Health, 2011 CNI Data
For the HASD&IC 2013 CHNA, IPH conducted primary data collection through three methods: an online community health leader/health expert survey, key informant interviews and community forums. The community health leader/health expert survey was completed by 89 members of the health care community, including health care and social service providers, academics, community-based organizations assisting the underserved, and other public health experts. Over the winter and spring of 2013, five community forums were held in communities of high need across San Diego County – including Southeast San Diego, a high-need community served by SCHHC – reaching a total of 106 community residents. In addition, IPH conducted five key informant interviews with individuals chosen by virtue of their professional discipline and knowledge of health issues in SDC. Key informants included county public health officers, health care and social service providers, and members of community-based organizations.
Following consultation with the SCHHC 2013 CHNA Planning Team, additional, specific feedback from SCHHC’s more vulnerable community members, as well as from key informants with insight into the concerns and health needs of seniors was collected.
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Four more key informant interviews provided expertise in senior health and end-of-life care as well as health disparities among older adults. SCHHC also collected eight community feedback surveys from community members that attended an educational session on advanced care planning, as well as eleven surveys from patients of the Imperial Beach Health Center. Community members were asked for open-ended feedback on the health issues of greatest importance to them, as well as any significant barriers they face in maintaining health and well-being.
Findings
Through the combined analyses of the results for all the data and information gathered, the following conditions were identified as priority health needs for the communities served by SCHHC (listed in alphabetical order):
Behavioral Health Cardiovascular Disease Diabetes, Type II Obesity Orthopedics Senior Health (including end-of-life care)
In addition, the IPH conducted a content analysis of all qualitative feedback collected through the HASD&IC 2013 CHNA process – key informants, online survey respondents and community members – and found that the input fell into one of the following five categories:
Access to Care or Insurance Care Management Education Screening Services Collaboration
SCHHC is committed to the health and well-being of its community, and the findings of SCHHC’s 2013 CHNA will help to inform the activities and services provided by SCHHC to improve the health of its community members. The 2013 CHNA process also generated a list of currently existing resources in SDC, an asset map, that address the health needs identified through the CHNA process. While not an exhaustive list of the available resources in San Diego, this map will serve as a resource for SCHHC to help continue, refine and create programs that meet the needs of its most vulnerable community members.
With the challenging and uncertain future of health care, there are many factors to consider in the development of programs to best serve members of the San Diego community. The health conditions and health issues identified in this CHNA – including but not limited to health care and insurance access, education, and information for all
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community members – will not be resolved with a “quick fix.” On the contrary, these resolutions will be a journey requiring time, persistence, collaboration and innovation. It is a journey that SCHHC and the entire Sharp system are committed to making, and the Sharp system remains steadfastly dedicated to the care and improvement of health and well-being for all San Diegans.
The complete Sharp Coronado Hospital and Healthcare Center 2013 Community Health Needs Assessment is available online at: http://www.sharp.com/coronado/about-us.cfm or by contacting Sharp HealthCare Community Benefits at: [email protected].
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Section
3 Methodology
Sharp Coronado Hospital and Healthcare Center’s (SCHHC’s) Community Health Needs Assessment (CHNA) draws from and is based on the process and findings of the collaborative Hospital Association of San Diego and Imperial Counties (HASD&IC) 2013 CHNA. Sharp HealthCare (Sharp) actively participated and collaborated in the HASD&IC 2013 CHNA process, which began in September 2012 and concluded in April 2013.
The objective of the collaboration with HASD&IC on the 2013 CHNA was to complete a hospital-focused CHNA for San Diego County (SDC) with three main components:
1. Countywide data, including publicly available hospital discharge data that can be broken down by ZIP code to allow for scalable measures and the development of customizable regional reports. 2. In-depth feedback from community health leaders and health experts collected through research proven strategies. 3. Guidance for developing hospital programs that will meet the needs of patients and the community – both countywide and in targeted regions.
The HASD&IC 2013 CHNA sought to identify and prioritize the health issues and needs of SDC in order to inform community benefit efforts and also to respond to IRS regulatory requirements that tax-exempt hospitals conduct a health needs assessment in the community once every 3 years. Complete details of the methodology and findings of the HASD&IC 2013 CHNA are available at: http://www.hasdic.org.
SCHHC conducted additional analyses of hospital discharge data and community member input to identify and address the specific needs of the communities it serves. As such, this section details the collaborative HASD&IC 2013 CHNA process, followed by a description of the additional methods and analyses employed by Sharp.
2013 CHNA Advisory Workgroup
HASD&IC staff worked with a CHNA Advisory Workgroup of hospital appointed representatives for seven hospitals. A request for proposal process occurred in May 2012 and the Institute for Public Health (IPH) at San Diego State University (SDSU) was selected and engaged. The IPH managed the design, implementation and interpretation of the CHNA process, which began in September 2012 and completed in April 2013.
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The seven SDC not-for-profit and district hospitals of the CHNA Advisory Workgroup (the Workgroup) were:
Kaiser Foundation Hospital, San Diego Palomar Health Rady Children’s Hospital Scripps Health Sharp HealthCare Tri-City Medical Center UC San Diego Health System
The CHNA process involved mixed methods of data collection, the analysis of currently existing health and socioeconomic data, and the collection and analysis of primary data directly from the community. For complete details on the HASD&IC 2013 CHNA process, including supplemental materials, please visit: http://www.hasdic.org.
Description of Partnering Organizations
The Hospital Association of San Diego and Imperial Counties
The Hospital Association of San Diego and Imperial Counties was established in 1956 (then the Hospital Council) and is a not-for-profit organization representing more than 35 hospitals and integrated health systems in the two-county area. Members range from small rural hospitals to large urban medical centers and total over 8,100 licensed beds. The facilities are 60 percent not-for-profits, 18 percent district owned, 9 percent investor owned and 15 percent government owned.
HASD&IC's mission is to support its members by advancing the organization, management and effective delivery of quality, affordable medically necessary health care services for the communities of San Diego and Imperial Counties. HASD&IC provides strong leadership, representation and advocacy with local governmental entities, business coalitions, the media, community organizations and the public. HASD&IC's board of directors represents all member sectors and provides policy direction to ensure the interests of member hospitals and health systems are preserved and promoted.
The Institute for Public Health at San Diego State University
The IPH was founded in 1992 and functions as an Institute of the Graduate School of Public Health in the College of Health and Human Services at SDSU. The mission of the IPH is to bridge the academic resources at SDSU and the considerable resources of the public health practice community in equal partnership to improve the health of our communities. The IPH specializes in community engaged scholarship, involving research, teaching and service, to promote the dissemination and implementation of evidence-based best practice to improve health.
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IPH staff supported the 2013 CHNA process through data collection and analysis, as well as the development and facilitation of primary studies. The HASD&IC 2013 CHNA process included a team of individuals from IPH, with the following key staff:
Suzanne Lindsay, PhD, MSW, MPH Project Director
Dr. Lindsay is an associate professor of epidemiology in the Graduate School of Public Health at SDSU and the Executive Director of the IPH (iph.sdsu.edu). Dr. Lindsay’s expertise is the application of the results of scientific research into practice-based settings with a focus on health equity and the elimination of health disparities. As such, she has been responsible for dissemination and implementation research, translational research, community-based participatory research, and applied research and evaluation with the goal of adapting and adopting evidence-based strategies into diverse community settings in full partnership with community practitioners and community members. She has particular expertise in the development of web-based information systems used to collect research and evaluation data across diverse and geographically distributed sites, and the development of web-based training for health and social service professionals to improve their understanding of evidence-based practice. For the last six years, Dr. Lindsay has taught a graduate course in health disparities and has mentored numerous internship and field placement opportunities for students interested in health disparities.
Tanya Penn, MPH, CPH Project Lead
Tanya Penn is an epidemiologist for the IPH in the Graduate School of Public Health, at SDSU. Trained in public health with an emphasis in epidemiology, Ms. Penn also holds a nationally recognized Certification in Public Health. Ms. Penn was the project lead on the 2013 HASD&IC CHNA and collaborated with the HASD&IC and the CHNA Advisory Workgroup. She was also an epidemiologist on the Communities Putting Prevention to Work project that was funded by the Center for Disease Control and Prevention providing evaluations of population-based interventions. Her expertise includes statistical analysis, data management and manipulation, and utilizing large public-use data sets. Her primary research interests are health disparities in underserved populations, health education and community-based participatory research. Before joining the IPH, Ms. Penn was part of a team that helped start one of the first free diabetic clinics for indigent patients in Wilmington, North Carolina. The process of opening the clinic involved many components: performing a needs assessment, gaining buy-in from the community, collaborating with doctors and health professionals, and ultimately running the operations of the clinic, where Ms. Penn was the Clinic Director.
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Kristine Ortwine, MPH Research and Data Analyst
Kristine Ortwine holds a BS in Chemistry from Old Dominion University, as well as an MPH in Epidemiology from SDSU. She has served as an epidemiology research assistant at the IPH since 2011, and has provided literary and data research support on projects such as Communities Putting Prevention to Work and the 2013 HASD&IC CHNA. Her research interests include border health and zoonotic disease surveillance, health disparities, issues surrounding social determinants of health, and establishing best practices for community-based participatory research methods. She is an active member of both the Latino Caucus of the American Public Health Association as well as the local San Diego Collaborative, One Border One Health. She was a 2012 APHA Latino Caucus Helen Rodriguez Scholarship recipient and is a UCSD Hispanic Center of Excellence Scholar, 2012-2013.
Amy Pan, PhD Senior Research Scientist
Dr. Amy Pan is a research associate at the IPH at SDSU. Dr. Pan provides program evaluation and grant writing support for the IPH. Her primary research interests include violence prevention and other preventative health issues in immigrant and refugee communities. Prior to working at the IPH, Amy worked at the Center for Community Solutions, the Tahirih Justice Center, and the Center for Child Welfare at George Mason University. Dr. Pan facilitated the key informant interviews as well as the focus groups for the HASD&IC 2013 CHNA process.
San Diego County Not-for-Profit and District Hospitals / CHNA Advisory Workgroup
The HASD&IC 2013 CHNA process also incorporated insight and direction from SDC not-for-profit acute care hospitals and district acute care hospitals. This input helped to ensure that the 2013 CHNA process considered the demographics, health indicators and other attributes of the specific populations served by individual hospitals and hospital systems. In addition, this focus allowed SDC specialty hospitals to provide feedback on specific needs of their patient populations that might otherwise not be revealed in a countywide assessment.
To this end, the CHNA Advisory Workgroup members participated in an ongoing process of planning and evaluation in partnership with HASD&IC and IPH, and met two to three times each month from September, 2012 through April 1, 2013 in order to foster information sharing and collaboration throughout the HASD&IC 2013 CHNA process. For additional information on the HASD&IC 2013 CHNA Advisory Workgroup, please refer to the HASD&IC 2013 CHNA summary report available at www.hasdic.org.
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CHNA Consultant
Debra Loomis Independent Contractor to HASD&IC
Debra Loomis holds a Master of Arts in Sociology from San Diego State University, as well as a Bachelor of Science in Sociology from Arizona State University. Ms. Loomis’ expertise includes community collaboration, where she facilitated over 300 community coalition members throughout San Diego County through consensus organizing efforts and has provided oversight to regional survey design, community-based distribution, data collection, evaluation and reporting. Ms. Loomis also has extensive experience in program management, public speaking on such topics such as youth violence and community organizing. Ms. Loomis’ professional work includes several years at the SDSU Research Foundation, where she held various positions including the management of a multi-state center, targeting workforce development and capacity building in the public health profession, as well as the management of the California Cancer Detection Section project, which sought to maintain a statewide cancer screening data management information system. Ms. Loomis worked on the Raising The Bar for a Violence-Free Childhood project, where among her many tasks, she trained representatives from multiple disciplines via public speaking and written curriculum; provided leadership and nurtured collaboration across multiple professions; and mentored and supervised graduate students in survey design, research and evaluation assistance, and thesis development.
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2013 HASD&IC CHNA Advisory Workgroup
Lindsey Wade Traci DelPurgatorio Vice President, Public Policy Member Programs Coordinator Hospital Association of San Diego and Hospital Association of San Diego and Imperial Counties Imperial Counties [email protected] [email protected]
Shreya Shah Sasaki, MPH Leonel Sanchez Senior Community Benefit Manager Media Relations Manager Kaiser Permanente, San Diego Medical Palomar Health Center Area [email protected] [email protected]
Lisa Lomas Anette Blatt Coordinator, Government Grants and Director Community Benefit and Advocacy Community Services Rady Children’s Hospital – San Diego Scripps Health [email protected] [email protected]
Chris Brown Michael Bardin Senior Director, Public and Government Senior Director, Strategic Planning Affairs Scripps Health Scripps Health [email protected] [email protected]
Jillian Barber, MPH Sara Steinhoffer Program Manager, Community Benefits and Vice President of Government Relations Health Improvement Sharp HealthCare Sharp HealthCare [email protected] [email protected]
Kristine White Jodie Wingo Planning Research and Community Benefits Director, Market Development Specialist Sharp HealthCare Tri-City Medical Center [email protected] [email protected]
Aaron Byzak, MBA, FACHE Debra Loomis Director of Government and Community Independent Contractor to HASD&IC Affairs University of California, San Diego Health San Diego, CA Sciences [email protected] [email protected]
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HASD&IC CHNA: Prioritization Summary and Data Collection Framework
In order to fully analyze and prioritize the community’s health needs, the IPH used both qualitative and quantitative data sources. Quantitative data included hospital discharge data and statistics from the San Diego County Health and Human Services Agency (HHSA), the U.S. Census Bureau, the Centers for Disease Control, University of California Los Angeles’s Community Health Interview Survey and others. Health experts and community leaders, key informant interviews, and community forums gave direct input through electronic surveys as the qualitative sources.
CHNA Methodology: A Six-Step Process
The IPH employed a six-step methodology to assess community health needs in the county. Figure 1 summarizes each step of the methodology for the HASD&IC 2013 CHNA.
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Figure 1: 2013 HASD&IC 2013 CHNA Methodology for Community Prioritization
Step 1: • Evaluated quantitative data using hospital Analyze Quantitative Data discharge data from inpatient, emergency Sources department, and ambulatory care, as well as (Primary Data) other county, state and federal data sources.
Step 2: • Identifed 15 health conditions that are Identify Health measurable, prevalent, disproportionately impact Conditions Affecting vulnerable communities, reflect a countywide Hospital Patients need and can be addressed by hospitals.
Step 3: • Determined the health vulnerability of every ZIP Identify Vulnerable code in SDC through use of the CNI data. Communities
Step 4: • Developed list of 26 health drivers through a review of the public health literature and other Identify Health Drivers national CHNA resources.
Step 5: • Gathered and analyzed Community Input (Qualitative & Primary Data), collected data Collect and Analyze through an Electronic Survey, Key Informant Community Input Interviews, and Community Forums.
Step 6: •Combined results from all data collection Identify and Prioritize methods to identify the top health conditions as Health Conditions well as strategies to address them.
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Step 1: Analyze Current Health and Socioeconomic Data
The first step in the CHNA process was to analyze the existing secondary data, starting with the 2011 Office of Statewide Health Planning and Development (OSHPD) discharge data by diagnosis. Data from hospital inpatient, emergency department (ED) and ambulatory care from all hospitals within San Diego County was analyzed through the SpeedTrack© California Universal Patient Information Discovery (CUPID) application. SpeedTrack© is an innovative software platform with revolutionary methods of organizing and presenting data. It contains four years of hospital discharge data from multiple sources (http//www.speedtrack.com). Patients included in the analysis were discharged from a San Diego County hospital and reported either a San Diego County ZIP code of residence or were described as homeless. Patients who entered through the ED and were then admitted into the hospital were counted as inpatient discharges.
Hospital data is not representative of all the health conditions present in the community, so the IPH used additional data sources for a more comprehensive picture. The sources include, but were not limited to: the San Diego County Health and Human Services Agency Community Health Statistics Unit, the UCLA California Health Interview Survey (CHIS), Community Commons, County Health Rankings, Centers for Disease Control and Prevention (CDC), and the Behavioral Risk Factor Surveillance System.
Step 2: Identify Top Health Conditions
The data analysis described in Step 1 identified the health conditions as priorities for SDC. Figure 2 lists the 15 priority health conditions identified in the HASD&IC 2013 CHNA.
Figure 2: Top 15 Health Conditions from the HASD&IC 2013 CHNA
Priority Health Conditions for SDC
1. Acute Respiratory Infections 9. High-Risk Pregnancy 2. Asthma 10. Lung Cancer 3. Back Pain 11. Mental Health/Mental Illness 4. Breast Cancer 12. Obesity 5. Cardiovascular Disease 13. Prostate Cancer 6. Colorectal Cancer 14. Skin Cancer 7. Dementia and Alzheimer’s 15. Unintentional Injuries 8. Diabetes (Type II)
In order to provide a similar base level of information, the IPH created detailed briefs on each of the health conditions. The briefs were later provided as background information to electronic survey participants (detailed in Step 5).In addition, comparisons across the regions, county, state and nation were made when possible.
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Step 3: Identify Vulnerable Communities within SDC
The IPH used the Dignity Health/Truven Health Community Need Index (CNI) to identify vulnerable communities within the county. The CNI identifies the severity of health disparity for every ZIP code in the United States based on specific barriers to health care access including education, income, culture/language, insurance and housing. As such, the CNI demonstrates the link between community need, access to care, and preventable hospitalizations.
The CNI data was mapped by ZIP code to identify high-risk neighborhoods and communities in SDC. The IPH and CHNA Advisory Workgroup then identified five communities with the highest CNI scores (highest levels of health disparity and need) as target regions for community forums (detailed in Step 5).
Please refer to Appendix C of this report for a CNI map of the county. The CNI tool is publicly accessible at http://www.dignityhealth.org/Who_We_Are/Community_Health/STGSS044508.
Step 4: Incorporate Other Factors that Contribute to Poor Health Outcomes: Identify Health Drivers
Data on reported health conditions only represent the manifestation of poor health, and do not include the socioeconomic factors that often contribute to individual and community health. In order to broaden the analysis, the IPH and the CHNA Advisory Workgroup compiled a list of 26 commonly examined health drivers known to contribute to poor health outcomes. The list was developed based on information provided through two publicly available tools that were developed with extensive research:
The CHNA toolkit by Community Commons: http://assessment.communitycommons.org/CHNA/ The CHNA data platform by Kaiser Permanente: http://www.chna.org/kp/
These health drivers were then divided into four categories as detailed in Figure 3.
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Figure 3: Modifiable Health Drivers Associated with Poor Health Outcomes
Physical Clinical Care Environment
Social and Health Economic Behaviors Factors
Source: www.hasdic.org
The complete list of the 26 identified health drivers can be found in Appendix D. Electronic survey respondents were asked to associate these health drivers with the 15 health conditions from Figure 2.
Step 5: Health Expert, Community Leader and Resident Feedback – Collect & Analyze Primary Data
Health Experts and Community Leaders Survey
Using the list of 15 health conditions and 26 health drivers, the IPH and CHNA Advisory Workgroup developed an electronic survey that asked community leaders and health experts to help prioritize the health conditions with the following requirements:
Have a significant prevalence in the community. Disproportionately impact vulnerable communities. Reflect a need that exists throughout SDC. Can be addressed in some way by hospitals and health care systems.
The IPH and the CHNA Advisory Workgroup developed a list of more than 100 possible community health experts and leaders to respond to the electronic survey. A health expert or leader was defined as a person with special knowledge of or expertise in public health. The list was compiled to ensure representation from all regions of SDC for the 15 health conditions and 26 health drivers that had been identified. Health experts and leaders were identified from hospital settings, community-based organizations, and government policy, legal and health advocacy organizations. Targeted outreach to health experts and leaders was also conducted to fill in gaps of under-represented conditions, regions or vulnerable populations.
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The electronic survey was submitted to more than 100 health experts and leaders and 89 people completed the survey. The diverse knowledge of the respondents was taken into account to design the survey. The survey allowed respondents to answer from either perspective of a health leader with expertise in health outcomes or with expertise in health drivers. Both perspectives allowed respondents to comment on poor health conditions and health drivers as they completed the survey. As mentioned in Step 2, participants were provided with electronic links to the 15 condition briefs and the opportunity to review those briefs, comparing data across the conditions prior to answering the survey questions.
For the online survey, scores were calculated for each survey participant on each specific condition or driver they responded to, and then the participant responses were combined for total scores on the condition or driver. The survey generated a very large data set; additional details are available by directly contacting Lindsey Wade of HASD&IC at: [email protected]. Please refer to Appendix E for a printed version of the survey.
Key Informant Interviews
The IPH completed five key informant interviews listed in Table 1 below. HASD&IC and the participating hospitals were very grateful that each of these experts agreed to share their perspectives. These leaders were chosen based on their discipline and knowledge of health issues throughout SDC, as well as their ability to understand health policy.
The purpose of the key informant interviews was to:
Gather more in-depth understanding of the health conditions most affecting San Diego. Aid in the process of prioritizing health conditions. Make connections between the health conditions and associated health drivers. Gain information about the system or policy changes that could potentially impact health conditions. Get specific recommendations for the health conditions as well as overall recommendations.
The 15 health conditions were shared with the participants during the interviews. Please refer to Appendix F for a listing of the questions given during the interviews.
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Table 1: HASD&IC 2013 CHNA Key Informant Interviews
Description of Area of Groups They Date of Name Leadership Expertise Represent Interview
Co-Chair of the Childhood Obesity Initiative, Advisory Chronic Wood, Christine Population with Committee for Local Chapter Disease, 1/11/2013 M.D. chronic diseases 3 American Academy of Obesity Pediatrics Low income, Head of San Diego City medically Emergency Medical Dunford, James, Chronic underserved, minority Services; Professor 1/23/2013 M.D. Disease, Injury population; Emeritus, School Of population with Medicine, UC San Diego chronic diseases Clinical Psychologist, Vice President of Clinical Low income, Services at Mental Health medically Mental/ Hanger, Philip, Services, Former Head of underserved, minority Behavioral 1/31/2013 Ph.D. SD County Behavioral population; Health Health Department & population with Manager of Low Income chronic diseases Health Program Executive Director/Chief Counsel for Legal Aid Society of San Diego, Inc.; Consumer Low income, Executive Director of Legal Health medically Knoll, Greg, Esq. Aid Society’s Consumer Education, 2/7/2013 underserved, minority Center for Health Education Advocacy & population and Advocacy; Chair, Empowerment Healthy San Diego
Low income, Public Health Officer for the medically Wooten, Wilma, County of San Diego Health Chronic underserved, minority 2/14/2013 M.D., M.P.H. and Human Services Disease population; Agency population with chronic diseases
Community Forums
The IPH conducted five community forums with local residents who were not affiliated with hospitals. Communities of high health need, based on their CNI score were selected for conducting the forums. The IPH partnered with neighborhood community collaborative agencies or organizations within each neighborhood to recruit community members to participate in the community forums.
The purpose of the community forums was to gain residents’ perspectives on the health needs of their communities, identify health conditions most affecting their communities,
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and identify community recommendations on how hospitals could help to meet their health needs.
In order to ensure unbiased community feedback, neither HASD&IC nor the participating hospitals attended. Table 2 below details the community forums conducted through the HASD&IC 2013 CHNA process.
Table 2: HASD&IC 2013 CHNA Community Forums
City Region Date Time # of Participants
El Cajon East 2/2/2013 1:00-2:30 pm 58
Oceanside North Coastal 2/8/2013 5:30-8:00 pm 8
Escondido North Inland 2/12/2013 3:30-5:00 pm 11 Logan Central 2/26/2013 5:00-6:30 pm 12 Heights
San Ysidro South 3/27/2013 5:30-7:00 pm 17
During the community forums, Geographical Informational Systems (GIS) maps displaying CNI scores by ZIP code in the county as well as the HHSA region of the neighborhood were displayed and handouts in both English and Spanish explaining the CNI score were distributed to each participant. Forum participants also received information regarding the health resources available to them in their neighborhoods. Please refer to Appendix G for a listing of the questions given during the forums.
Step 6: Identify and Prioritize Three to Five Health Conditions and/or Health Drivers
The combined results of all of the data and information gathered – secondary data sources, electronic survey responses, key informant interviews and community forums – clearly highlight four conditions as the top community health needs in SDC. They are, in alphabetical order:
1. Cardiovascular Disease 2. Diabetes, Type II 3. Mental/Behavioral Health 4. Obesity
For additional information on how the health expert and community leader electronic survey respondents, key informant interviewees and community forum participants prioritized the health conditions, please see Section 5: Findings of this report.
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To identify and select the top four health conditions from the existing hospital and socioeconomic data, as well as the primary data, the IPH and the CHNA Advisory Workgroup utilized the following strategy:
1. Indicators should reflect a health need/condition with significant prevalence in the community such that community implementation plans can reach the largest number of people for the greatest effect.
2. If the reduction of health disparities is a high priority, indicators should be selected that demonstrate health disparities.
3. Indicators should be selected that are derived from high-quality data that is as current as possible. Each indicator should be evaluated with an understanding of what it describes and what it does not describe. Different sources of data describe different aspects of the same phenomenon, but they are often not the same format, e.g. hospital-based data, population survey data, census data, etc.
4. Indicators should be selected that describe diseases or conditions that have a well-described scientific intervention evidence base. This will ensure that interventions designed to address these indicators have the best chance of success. Interventions that are prevention focused are optimal.
5. Indicators should be selected that describe a health need/condition that falls within the role and ability of the hospital systems to address.
6. Indicators should be selected that address health concerns throughout SDC.
When decisions requiring consensus were made, Lindsey Wade of HASD&IC connected with the members of the CHNA Advisory Workgroup that had not been in attendance to ensure a consensus was maintained. A minimum of one representative from each hospital was consulted on the final list of prioritized health issues.
Community Recommendations to Address Health Conditions
In addition, the IPH assimilated all the community input (survey respondents, key informant interviewees, community forum participants) into five broad categories:
1. Access to Care or Insurance 2. Care Management 3. Education 4. Screening Services 5. Collaboration
Because each method of obtaining community input was different, the results could not be combined numerically. However, the IPH analyzed the results in order to determine the following elements by each type of community input:
The relative importance of each recommendation (shown by numerical ranking)
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The association/alignment of each recommendation with the top four health conditions
Highlights from this analysis are included in Section 5: Findings of this report. Full details are available through the CHNA posted on HASD&IC at: http://www.hasdic.org.
Additional Steps by SCHHC
Upon completion of the HASD&IC 2013 CHNA process, both the methodology and results were reviewed with the SCHHC 2013 CHNA Planning Team, including SCHHC’s Chief Executive Officer, as well as team members from SCHHC Patient and Administrative Relations, SCHHC Finance and Clinical Services, and Sharp HealthCare Community Benefits.
The team discussed the results and methodologies of the HASD&IC 2013 CHNA in order to identify differences between SCHHC’s patient community and the collaborative results. This included a comparison between secondary data specifically for SCHHC’s patient community and the countywide data collected through the HASD&IC 2013 CHNA process. In addition, discussions of the HASD&IC 2013 CHNA process and results also lead to the development of additional outreach efforts and analyses in order to ensure that a complete picture of community members served by SCHHC was represented in this CHNA process. These additional steps are detailed in the remainder of this section. Members of the SCHHC 2013 CHNA Planning Team are listed below.
Sharp Coronado Hospital and Healthcare Center 2013 CHNA Planning Team
Susan Stone Jillian Barber Chief Executive Officer Program Manager, Community Benefits and Sharp Coronado Hospital and Healthcare Health Improvement Center Sharp HealthCare
Tony Guerra Kristine White Chief Financial Officer and Vice President of Planning Research and Community Benefits Clinical Services Specialist Sharp Coronado Hospital and Healthcare Sharp HealthCare Center
Harriet Sangrey Manager, Patient and Administrative Relations Sharp Coronado Hospital and Healthcare Center
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Step 1: Analyze Currently Existing Health and Socioeconomic Data
An analysis of 2011 OSHPD discharge data by diagnosis code (including inpatient and ED data) specifically for SCHHC was conducted through the SpeedTrack© CUPID application. Patients included in the analysis were those who were discharged from SCHHC and reported a ZIP code from the primary communities served by SCHHC. Please refer to Table 1 and Figure 1 in Section 4: Community Defined of this report for a listing and mapping of these primary communities. Patients who entered through the ED and then were admitted into the hospital were counted as an inpatient discharge. ED discharges were grouped into health indicator categories based on ICD-9 codes, and inpatient discharges were grouped by inpatient service line categories for ease of analysis.
Hospital data is not representative of all the health conditions present in the community, and additional data sources were used for this step, including the SDC Health and Human Services Agency Community Health Statistics Unit, Live Well, San Diego!, the UCLA California Health Interview Survey (CHIS), Community Commons, County Health Rankings, Centers for Disease Control and Prevention (CDC), and other sources.
Step 2: Identify Top Health Conditions
Analysis of SCHHC discharge and ED data, as well as additional secondary sources, reflected many of the top 15 health conditions as in Step 2 of the HASD&IC 2013 CHNA process. Please refer to Figure 3 in this section for details. However, In addition to the health conditions identified through the HASD&IC 2013 CHNA process, the analysis of SCHHC discharge data also revealed orthopedics to be a significant health condition addressed by SCHHC for its patient community.
Further, in consultation with the SCHHC 2013 CHNA Planning Team, the health needs of seniors, including wellness and issues regarding end-of-life care, were also identified as priority health needs to address through additional primary data collection.
Step 3: Identify Vulnerable Communities in SCHHC’s Service Area
As discussed in Step 3 of the HASD&IC 2013 CHNA process, Dignity Health’s CNI data was utilized in the identification of vulnerable communities/ZIP codes throughout SDC. High-need communities in SCHHC’s primary service area include Imperial Beach, National City, and Southeast San Diego. Please refer to Figure 1 in Section 5: Findings of this report for a CNI map of SDC’s south region.
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Step 4: Identify Health Drivers
The comprehensive list of health drivers compiled during the HASD&IC 2013 CHNA process was also applied during discussions with additional key informants interviewed specifically for SCHHC’s CHNA. Drivers were also used in the HASD&IC 2013 CHNA electronic survey of health experts and leaders, discussed in Step 5 below. The complete list of all 26 health drivers can be found in Appendix D.
Step 5: Collect and Analyze Primary Data
Health Experts and Leaders Survey
The online survey conducted as part of the collaborative HASD&IC 2013 CHNA process was comprehensive in terms of areas of expertise and representation of SDC’s six regions, and it was agreed upon by the SCHHC 2013 CHNA Planning Team that additional electronic surveys were not necessary. The electronic survey collected input from community leaders and health experts throughout SDC, including communities served by SCHHC. Of the 89 survey respondents, more than 60 percent either practiced and/or had expertise in SDC’s south region.
Please refer to Table 5 in Section 5: Findings of this report for details on the expertise and demographic focus of survey respondents, and the HASD&IC 2013 CHNA website at: http://www.hasdic.org for a complete listing of survey respondents.
Key Informant Interviews
Key informant interviews conducted as part of the HASD&IC 2013 CHNA process provided critical, high-level public health perspective on the health needs of SDC community members. This input provided valuable insight for SCHHC’s CHNA process; however, consultation with SCHHC’s CHNA Planning Team led to the collection of additional primary data to further reflect the needs of SCHHC’s specific patient community.
Seniors (community members aged 65+) are projected to increase more than any other age group over the next five years in SCHHC’s service area.1 Consequently, care options, access and support for this vulnerable population are of significant concern. In addition, an overall lack of hospice and end-of-life resources in the region contribute to the priority health needs of the older adult population in SCHHC’s patient community. To lend greater insight into these health issues, the key informant interviews detailed in Table 3 were conducted.
1 Truven Health Analytics Market Expert; Nielsen Claritas, Inc.; U.S. Census Bureau
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Table 3: SCHHC 2013 CHNA Key Informant Interviews
Description of Area of Groups They Date of Name Leadership Expertise Represent Interview
Johnson, Suzi, Vice President, Sharp Hospice, End Older adults 5/28/13 MPH, RN HospiceCare of Life Care Older adults; low Nurse Practitioner, Sharp income, medically Chapman, Nancy, Senior Health Center, Senior Health underserved, minority 5/28/13 RNP Downtown San Diego population; population with chronic diseases Low income, medically Program Coordinator, underserved, minority Holmberg, Andrea Sharp Senior Resource Senior Health 4/30/2013 population; population Center with chronic diseases Nurse Practitioner, Sharp Vales, Janice, Senior Health Center, Senior Health Older adults 4/25/13 RNP Clairemont
Key informant interview questions were based on the questions used for the key informant interviews conducted in the HASD&IC 2013 CHNA. Please refer to Appendices H for a listing of the questions given. Section 5: Findings of this report details the results of these key informant interviews.
Community Resident Feedback
The community forums held as part of the HASD&IC 2013 CHNA process provided valuable information from residents of vulnerable communities across the county, including Logan Heights, a high-need community served by SCHHC. For detailed results of specific community forums, please visit http://www.hasdic.org.
The SCHHC 2013 CHNA Planning Team decided to also collect insight from community residents in Coronado and Imperial Beach upon completion of the HASD&IC 2013 CHNA process. Community feedback surveys were developed for outreach to community members and modeled after the questions given during the HASD&IC 2013 CHNA community forums. Please see Appendix I for a sample community feedback survey.
In May 2013 community feedback surveys were distributed to:
Attendees of an educational session provided to senior community members on advanced care planning. The session was held at SCHHC and eight surveys were completed by community members during the session. Patients at the Imperial Beach Family Health Center located at: 707 Palm Ave, Imperial Beach, CA 91932. Eleven surveys were completed through this effort.
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Please see Section 5: Findings for further details on these outreach efforts. Step 6: Identify and Prioritize Health Conditions and/or Health Drivers
The SCHHC CHNA applied the same prioritization criteria that was in place for the HASD&IC 2013 CHNA for the county (please refer to Step 6 in the HASD&IC 2013 CHNA process for details).
In addition, SCHHC incorporated the results of the following analyses:
SCHHC discharge data CHIS and additional existing health and socioeconomic data for SDC’s east region Consultation with the SCHHC 2013 CHNA Planning Team Results of additional community feedback surveys and key informant interviews conducted for SCHHC’s patient community Specialized services provided by SCHHC to its patient communities (e.g., orthopedics)
Through the various analyses employed, the following health conditions were identified as top health priorities for community members served by SCHHC (listed alphabetically):
Behavioral Health Cardiovascular Disease Diabetes, Type II Obesity Orthopedics Senior Health (including end-of-life care)
Further details and results of these analyses can be found in Section 5: Findings.
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Section
4 Community Defined
The primary communities served by Sharp Coronado Hospital and Healthcare Center (SCHHC) include the City of Coronado, Downtown San Diego and Imperial Beach, an incorporated city. Table 1 below presents the ZIP codes where the majority of SCHHC patients reside.
Table 1: Primary Communities Served by SCHHC
ZIP Code Community 92118 Coronado 91932 Imperial Beach 92154 Otay Mesa 91910 Chula Vista 91911 Chula Vista 92101 Downtown 92113 Southeast San Diego 91950 National City Source: SpeedTrack© California Universal Patient Information Discovery, OSHPD CY 2011 Hospital Discharge Data
Notably, most Coronado residents use SCHHC. Coronado is connected to central San Diego by a bridge to the east and an isthmus known as the Silver Strand to the south. SCHHC is geographically isolated and located in the central area of Coronado, which includes hotels, shops, single family homes, condominiums and apartments. Coronado also includes Coronado Cays, a marina community located on the isthmus.
In addition to these communities, there are six military sites in Coronado including one of the largest Naval Commands, with housing located both on- and off-base. Communities in close proximity to Coronado include downtown San Diego and Imperial Beach, an incorporated city.
Feedback on community health needs was solicited from both community members and service providers living and working throughout San Diego in order to assess priority health issues for the community. See Figure 1 below for a map of the primary communities served by SCHHC. Please refer to Appendix J for a mapping of community and region boundaries in San Diego County (SDC).
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Figure 1: Map of SCHHC’s Primary Communities
Map created by Sharp HealthCare Strategic Planning Department, July, 2013.
Demographics
In this section, we describe the study area not only by its demographic makeup but also by particular socioeconomic barriers known to contribute to health care access and health outcomes. Specifically, this section examines the barriers associated with the Community Need Index (CNI), the scale used to identify high-risk ZIP codes within a community (see Section 3: Methodology for additional information on the CNI). These barriers include: language/culture, income, education, housing and health insurance/access.
Wherever possible, the descriptions that follow will focus on the communities served by SCHHC; however, certain secondary data sources are not available at this level of specificity and broader summaries of the south region, which includes Coronado and many of the primary communities served by SCHHC, are provided in these instances.
In the next 5 years, SCHHC’s service area will grow 2.1 percent. The service area’s two fastest growing ZIP codes are Eastlake and Downtown, as shown in Table 2.
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Table 2: Fastest Growing ZIP Codes Served by SCHHC, 2012-2017
ZIP Community Population 2012-2017 Code Name 2012 2017 Change 91915 Chula Vista – Eastlake 22,526 26,654 18.3% 92101 Downtown 39,253 45,087 14.9% 92154 Otay Mesa 79,454 83,482 5.1% 91911 Chula Vista 86,714 90,621 4.5% Source: Truven Health Analytics Market Expert; Nielsen Claritas, Inc.; U.S. Census Bureau
The Hispanic population, the area’s largest racial/ethnic group, will grow by more than 9 percent. The senior (65+) population is projected to have the most significant increase at 11.5 percent, a similar trend to the entire county. Tables 3 and 4 below present composition of gender, age and race/ethnicity in SCHHC’s service area.
Table 3: Population Estimates by Gender and Age, SCHHC Service Area
2012 Population 2017 Population Change, 2012-2017 SDC % Chg. Age Female Male Total Pct. of Total Female Male Total Pct. of Total Total Pct. Change 2012-2017
0-17 172,410 181,333 353,743 25.0% 178,485 188,047 366,532 25.4% 12,789 3.6% 5.1%
18-44 276,944 288,384 565,328 40.0% 267,409 278,219 545,628 37.8% -19,700 -3.5% -2.0% 45-64 170,624 167,907 338,531 24.0% 178,694 179,036 357,730 24.8% 19,199 5.7% 5.6%
65+ 89,683 65,116 154,799 11.0% 99,432 73,185 172,617 12.0% 17,818 11.5% 12.8% Total 709,661 702,740 1,412,401 -- 724,020 718,487 1,442,507 -- 30,106 2.10% 3.30%
Source: Truven Health Analytics Market Expert; Nielsen Claritas, Inc.; U.S. Census Bureau
Table 4: Population Estimates by Race/Ethnicity in the SCHHC Service Area
2012 2017 2012-2017 SDC % Race/Ethnicity Population Percentage Population Percentage Change Change Hispanic 557,579 39.5% 608,517 42.2% 50,938 9.1% 10.8% White 554,211 39.2% 528,572 36.6% (25,639) -4.6% -3.2% Asian/Pacific 168,870 12.0% 178,364 12.4% 9,494 5.6% 11.0% Islander Black 81,605 5.8% 76,052 5.3% (5,553) -6.8% -4.3% Multiracial 42,181 3.0% 43,240 3.0% 1,059 2.5% 6.1% Native American 4,965 0.4% 4,625 0.3% (340) -6.8% -5.9% Other 2,990 0.2% 3,137 0.2% 147 4.9% 5.5% Total 1,412,401 -- 1,442,507 -- 30,106 2.1% 3.3% Source: Truven Health Analytics Market Expert; Nielsen Claritas, Inc.; U.S. Census Bureau
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Language/Culture Barriers
In SDC’s south region, more than 32 percent of the population is foreign born, with nearly half of those individuals being U.S. citizens. This is higher than SDC overall, where 22.8 percent of the population is foreign born.1 Table 5 below presents select details for SDC’s south region.
Table 5: Selected Status Populations for SDC’s South Region (2011 American Community Survey)
Foreign Born Number Percent Total Population 469,455 100.00% Foreign Born 150,486 32.06% Foreign Born, Naturalized Citizen 77,196 16.44% Foreign Born, Not a U.S. Citizen 73,290 15.61% Veteran Status Number Percent Civilian Population, 18+ Years 318,567 100.00% Veteran Population 32,229 10.12% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Nearly 20 percent of community members in the south region speak only Spanish at home, compared to 11 percent for SDC overall.2 While more than 38 percent of individuals in the south region primarily speak English at home, nearly just as many (37 percent) are bilingual, as Table 6 below details.
Table 6: Primary Language Spoken at Home in SDC’s South Region (2011 ACS)
Total Population 5+ Years Old 422,884 Primary Language Spoken at Home English Only 38.87% Spanish Only 19.55% Asian/Pacific Island Language Only 3.82% Other Language Only 0.33% Bilingual 37.43% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
1 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch 2 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
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Income Barriers
As Table 7 below presents, the south region has a much higher rate of unemployment when compared to the unemployment rate for SDC overall (8.5 percent in 2011).1
Table 7: Unemployment Estimates for SDC’s South Region (2011 ACS)
Eligible Labor Force 16+ Years 221,158 Percent Unemployed 10.10% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Furthermore, 13.3 percent of the population in SDC’s south region was living below the poverty level in 2011, with more than 25 percent of that being families. These statistics are slightly higher for SDC overall with 13.0 percent of the population living below poverty level, and 22.7 percent of that population being families. Nearly 20 percent of families in the south region receive some form of cash public assistance, compared to 14.9 percent of families in SDC overall.1 Please refer to Tables 8 and 9 below for details on poverty estimates and public program participation in the south region.
Table 8: Poverty Estimates for SDC’s South Region (2011 ACS)
Income Percent of Poverty Level <50% 5.16% 50 - 74% 3.55% 75 - 99% 4.56% 100 - 124% 5.07% 125 - 149% 5.27% 150% - 199% 10.58% 200% + 65.82% Percent Below Poverty Level Population 13.27% Families 10.86% Families With Children 15.51% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
1 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/CHS-Demographics_South.pdf
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Table 9: Public Program Participation for SDC’s South Region (2011 ACS)
Food Stamps/SNAP Benefits Households 5.61% Families with Children 6.73% Cash Public Assistance Households 3.43% Families with Children 19.84% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Education Barriers
In terms of education barriers, the south region has a higher proportion of community members without a high school education compared to the 14.7 percent for SDC in general.1 Please refer to Tables 10 and 11 below for additional educational characteristics of SDC’s south region.
Table 10: 2011 Education Characteristics of SDC’s South Region (2011 ACS)
Total Population 25+ Years Old 280,284 Education Level < High School Graduate 23.00% High School Graduate 22.32% Some College or AA 31.74% Bachelor Degree 15.67% Graduate Degree 7.27% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Table 11: School Enrollment for SDC’s South Region (2011 ACS)
Eligible Population 4 to 18 years 107,358 School Enrollment Public Schools 93.53% Private Schools 6.47% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
1 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/CHS-Demographics_South.pdf
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Housing Barriers
In 2011, the south region experienced a slightly higher proportion of renter-occupied housing when compared to the 44.7 percent for SDC overall. Moreover, nearly 50 percent of residents in the south region have housing costs that account for at least 30 percent of their household income. See Tables 12 and 13 below for details.
Table 12: Housing Estimates for SDC’s South Region (2011 SANDAG & ACS)
Housing and Occupancy Total Units Occupied Total Housing Units 145,935 138,523 Single Family - Detached 69,401 67,062 Single Family - Multiple-Unit 16,170 15,311 Multi-Family 53,272 49,542 Mobile Home and Other 7,092 6,608 Owner Occupied 53.1% Renter Occupied 46.9% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Table 13: Monthly Housing Costs as a Percentage of Household Income in SDC’s South Region (2011 ACS)
Monthly Income Going to Housing Costs Percent of Population Less than 20% per Month 28.69% 20% to 29% per Month 21.39% 30% or more per Month 49.92% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Health Insurance/Access Barriers
In SCHHC’s service area, more than 19 percent of residents are uninsured, which is 3.3 percent higher than SDC overall.1 Figure 2 below presents 2012 insurance coverage estimates for SCHHC’s service area.
1Truven Health Analytics Market Expert; Nielsen Claritas, Inc., U.S. Census Bureau
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Figure 2: 2012 Insurance Coverage Estimates for SCHHC Service Area
Uninsured, 19.2% Medicare Dual Elig., 2.3% Private, ESI, Medi-Cal, 49.0% 14.2%
Medicare, 9.5% Private Direct 8.4%
Source: Truven Health Analytics Market Expert; Nielsen Claritas, Inc., U.S. Census Bureau
In addition, Tables 14 and 15 below provide a summary of key indicators of access to care in SDC’s south region, as well as data regarding eligibility for Medi-Cal Healthy Families for SDC overall.
Table 14: Health Care Access in SDC’s South Region, 2009
Year 2020 Health Insurance Coverage Rate Target Children 0 to 11 Years 98.4% 100% Children 12 to 17 Years 92.9% 100% Adults 18 and Older 80.1% 100% Year 2020 Regular Source of Medical Care Rate Target Children 0 to 11 Years 98.8% 100% Children 12 to 17 Years 80.9% 100% Adults 18 and Older 91.7% 89.4% Year 2020 Not Currently Insured Rate Target Adults 18 to 64 Years 23.8% Source: California Health Interview Survey (CHIS), 2009
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Table 15: Medi-Cal (Medicaid)/Healthy Families Eligibility Among Uninsured in SDC (Adults Ages 18 to 64 Years), 2009
Eligibility Rate Medi-Cal Eligible 8.3% Healthy Families Eligible 0.8% Not Eligible 90.9% Source: CHIS, 2009
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Section
5 Findings
This section describes findings of Sharp Coronado Hospital and Healthcare Center’s (SCHHC’s) 2013 Community Health Needs Assessment (CHNA) process, as well as applicable elements of the Hospital Association of San Diego & Imperial Counties (HASD&IC) 2013 CHNA process. Both processes included findings from the collection and analysis of currently existing health and socioeconomic data, the CNI data identifying vulnerable communities, and primary data from health experts, community health leaders, and community residents. These combined analyses, as well as consultation with the SCHHC 2013 CHNA Planning Team, yielded the final list of community health needs identified for SCHHC’s patient community.
Wherever possible, the descriptions and findings that follow will focus on communities served by SCHHC; however, due to SCHHC’s unique characteristics as a comparatively smaller (~181 beds) and geographically isolated hospital, certain secondary data sources are not available at this level of specificity and broader summaries of the south region, which includes Coronado as well as many of the primary communities served by Sharp Coronado Hospital, are provided in these instances.
Health Conditions Affecting Primary Communities Served by SCHHC
Modeling the HASD&IC 2013 CHNA process, SCHHC analyzed inpatient and emergency department (ED) data for calendar year 2011 from the Office of Statewide Health Planning and Development (OSHPD) via the same SpeedTrack software used in the HASD&IC 2013 CHNA. Data was pulled specifically for the SCHHC patients that reside in the primary communities served by the hospital. Please refer to Table 1 in Section 4: Community Defined for a listing of these primary communities.
Similar to the HASD&IC 2013 CHNA, the hospital data indicated the potential health conditions of concern to communities served by SCHHC. Tables 1 and 2 below provide inpatient discharge and ED visit data for SCHHC.
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Table 1: SCHHC Inpatient Discharges by Service Line
Service Line % Inpatient Discharges 1 General Medicine 18.8% 2 Orthopedics 17.8% 3 Cardiovascular 15.2% 4 Gastrointestinal (GI) 14.0% 5 Pulmonary 9.9% 6 General Surgery 6.9% 7 Neurology 6.8% 8 Nephrology 3.6% 9 Oncology 3.1% 10 Obstetrics/Gynecology 1.4% 11 Psychiatry 0.9% 12 Rehabilitation 0.5% 13 Urology 0.4% Total 100.0% Source: SpeedTrack© California Universal Patient Information Discovery, OSHPD CY 2011 Hospital Discharge Data
Table 2: SCHHC ED Discharges by Health Indicator Category
Health Indicator Category % ED Discharges 1 Cardiovascular 14.5% 2 Mental Health 8.9% 3 GI 8.6% 4 Trauma 7.5% 5 Respiratory (excluding asthma) 7.4% 6 Osteoporosis/Arthritis/Fractures 5.1% 7 Neurological 4.2% 8 Diabetes 2.7% 9 Substance Abuse 2.5% 10 Urology 2.8% All Other Categories 35.8% Total 100.0% Source: SpeedTrack© California Universal Patient Information Discovery, OSHPD CY 2011 Hospital Discharge Data
Generally speaking, many of the top health conditions found in the initial analysis of SCHHC’s hospital data were well aligned with the 15 health conditions identified through the secondary data analysis conducted as part of the HASD&IC 2013 CHNA process. Please refer to Figure 2 in Section 3: Methodology for a listing of the 15 health conditions identified.
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However, data specifically from SCHHC revealed that a significant portion of SCHHC’s inpatient volume is driven by orthopedic conditions. This distinction sets SCHHC apart from the combined analysis for all San Diego County (SDC) hospitals conducted as part of the HASD&IC 2013 CHNA process. Consequently, this unique factor was taken into account in the evaluation of community needs met by SCHHC.
Additionally, an analysis of 2010 mortality data for SDC’s south region revealed cancer and heart disease as the top leading causes of death, as seen in the summary in Table 3.
Table 3: Leading Causes of Death in SDC’s South Region, 2010
% of Total Cause of Death # of Deaths Deaths Malignant Neoplasms 701 26.6% Diseases of the Heart 652 24.7% Cerebrovascular Diseases 161 6.1% Alzheimer’s Disease 124 4.7% Chronic Lower Respiratory Disease 122 4.6% Diabetes Mellitus 109 4.1% Accidents (unintentional injuries) 92 3.5% Influenza and Pneumonia 40 1.5% Chronic Liver Disease and Cirrhosis 38 1.4% Intentional Self-Harm 30 1.1% Viral Hepatitis 26 1.0% Nephritis, Nephritic Syndrome and Nephrosis 24 0.9% Essential (primary) Hypertension and Hypertensive 24 0.9% Renal Disease Parkinson’s Disease 22 0.8% Septicemia 21 0.8% All Other Causes 450 17.1% Total Deaths 2,636 100.0% Source: County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
The comparison of SCHHC discharge data with regional mortality data connects many of the diseases and conditions observed at SCHHC and the leading causes of death for SDC’s south region.
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Identifying SCHHC’s Vulnerable Communities
SCHHC service area ZIP codes were analyzed using the same Community Need Index (CNI) methodology used in the HASD&IC 2013 CHNA to identify the specific high-need communities within the SCHHC service area. Please refer to Section 3: Methodology of this report for details on the CNI and its components.
Table 4 presents the primary communities served by SCHHC by their calculated CNI score. Areas with a lower CNI score of 1-3 are identified as having a lower level of need than those areas with higher CNI scores of a 4 or 5. Figure 1 presents a map of the CNI scores across SDC’s south region.
Table 4: CNI Scores for Primary Communities Served by SCHHC
ZIP Code Community 2011 Population 2011 CNI 91932 Imperial Beach 27,064 5 91950 National City 59,505 5 92113 Southeast San Diego 49,195 5 91910 Chula Vista 78821 4 91911 Chula Vista 81810 4 92101 Downtown San Diego 35,143 4 92118 Coronado 17,603 3 Source: Dignity Health, 2011 CNI Data
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Figure 1: CNI Map – SDC’s South Region
Primary Data
This section describes the findings from the primary data collection for both the HASD&IC 2013 CHNA and the SCHHC 2013 CHNA, as all data significantly impacted the overall findings of SCHHC’s CHNA. Three sources of primary data were collected and analyzed: an electronic survey distributed to community health experts and leaders throughout SDC, key informant interviews, and community health forums provided to residents in different regions of SDC.
Community Health Expert/Leader Online Survey
Table 5 below presents a distribution of the focus areas and regional expertise of the online survey participants. Given the breadth and comprehensiveness of this particular outreach, additional electronic surveys were not conducted for the purposes of
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SCHHC’s 2013 CHNA. For the full list of survey respondents’ names, organizations, and titles of position, please visit www.hasdic.org.
Table 5: Health Leaders Surveyed in HASD&IC 2013 CHNA Online Survey
# of Type of Organization of Current Position Participants Health Care Consumer Advocate 17 Non-profit Organization 56 Academic Expert 13 Local Government Official 1 Community Based Organization Focused on Health Issues 28 Private Business 1 Health Insurance and Managed Care Organizations 2 Health Care Provider 33 Community Health Center 17 Provider Focused on Medically Underserved, Low-income, Minority Groups 22 Expert Knowledge on Vulnerable Populations Low-Income 84 Medically Underserved 75 Minorities 76 People with Chronic Disease 50 Others 23 Regions Participants Have Experience Working In All Regions 26 North Coastal 40 North Inland 46 North Central 45 Central 63 South 54 East 46
These health experts and leaders prioritized the health conditions as listed in Table 6 below.
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Table 6: HASD&IC 2013 CHNA Online Survey Results: Health Conditions Rankings
# Rank Health Conditions 1 Type II Diabetes 2 Obesity 3 Cardiovascular Disease 4 Mental/Behavioral Health 5 Unintentional Injury 6 High-Risk Pregnancy 7 Asthma 8 Dementia & Alzheimer's Disease 9 Breast Cancer 10 Acute Respiratory Infections/Pneumonia 11 Back Pain 12 Colorectal Cancer 13 Lung Cancer 14 Prostate Cancer 15 Skin Cancer
These rankings reflect scores from the matrix methodology used by the Institute of Public Health (IPH) of San Diego State University (SDSU) to analyze the electronic survey responses; please refer to www.hasdic.org for full details. The IPH found a very dramatic break in the data with the top four conditions (Type II Diabetes, Obesity, Cardiovascular Disease and Mental/Behavioral Health) scoring significantly higher than the next highest health conditions.
The survey respondents were also asked to identify socio-demographic health drivers associated with these priority health conditions, as well as recommendations for San Diego hospitals to better contribute to the prevention and treatment of health conditions in SDC with specific regard to the four prioritized conditions (cardiovascular disease, diabetes, mental illness and obesity). Respondents provided feedback regarding resources available in the community related to the top four identified health conditions (and many others), evidence-based best practices for the prevention and treatment of those conditions, and recommendations for the hospitals. Highlights of these recommendations are featured later in this section and additional details are available by contacting HASD&IC.
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Key Informant Interviews
Five key informant interviews were conducted through the 2013 HASD&IC CHNA process. Please refer back to Table 1 in Section 3: Methodology of this report below for details about each expert.
Table 7 below presents the health conditions ranked by priority per the results of the interviews. Additional details are available by contacting HASD&IC.
Table 7: HASD&IC 2013 CHNA Key Informant Interview Results: Health Conditions Ranking
Rank Health Conditions 1 Mental/Behavioral Health 1 Obesity 2 Cardiovascular disease 2 Type II Diabetes 3 Acute Respiratory Disease 4 Asthma 4 Back 4 Cancer (general)
The five interviewees were given the list of 15 health conditions and asked, “From your perspective, which of the following are the most pressing health issues for San Diego?” The IPH calculated these rankings by reviewing the confidential individual key informant interview summaries and noting which health conditions were identified in each interview. Health conditions that were mentioned in one interview were given 1 point, health conditions that were mentioned in two interviews were given 2 points, and so on. The totals for each health condition were then ranked 1-5, with 1 being the highest priority as it was emphasized or addressed by the most interviewees.
SCHHC 2013 CHNA: Key Informants
Upon conclusion of the HASD&IC 2013 CHNA, additional outreach to community health leaders with expertise in senior health and end-of-life care was conducted by Sharp. Please refer back to Table 3 in Section 3: Methodology of this report for details on these additional interviewees.
Generally speaking, feedback from these additional key informants was well aligned with the overall feedback from the key informants interviewed in the collaborative HASD&IC 2013 CHNA process. In addition, these key informant interviews identified the following health conditions as chief concerns for seniors in San Diego: cardiovascular disease; Alzheimer’s disease; pain management; hearing loss (many seniors cannot afford treatment); and mobility issues (falls and resulting immobility). In addition, health issues such as medication management; social planning for the future (including
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housing, advanced care planning, etc.); and lack of education, management and support for behavioral changes were listed.
The key informants recommended the following potential activities and services to address senior health needs: additional educational classes for seniors at sites throughout the community to ease access challenges; increased transportation services to include educational programs, exercise classes, community senior centers and food banks; additional social workers for seniors in outpatient settings; and greater care management including follow-up after discharge to ensure compliance with medication and treatment and access to/affordability of medication and treatments.
Further, these key informants also expressed the need for greater community education regarding care options, including advance care planning, as seniors advance in age and consider the stage of their health and condition. The care management for these seniors was also identified as a key area of improvement because coordination amongst physicians, case managers, nurses, hospice, spiritual leaders, and others will ensure a positive experience for seniors as they approach the later stages of life.
Community Forums
To collect insight and perspective from community residents on the health issues that impact them, particularly residents of vulnerable and underserved communities, the Advisory Workgroup conducted five community forums between February and March of 2013. Please refer back to Table 2 in Section 3: Methodology for further details on these forums.
Community forum participants were not given the list of 15 health conditions and were instead asked, “What are the five most important health issues for adults and five most important health issues for children in your community?”
Overall results from the participants prioritized the health conditions for children and adults as listed in Tables 8 and 9.
Table 8: HASD&IC 2013 CHNA Overall Community Forum Results: Adult Health Conditions Ranking
Rank Adult Health Conditions 1 Obesity 2 Cardiovascular disease 2 Mental Health 3 Alzheimer’s/Dementia 3 Diabetes
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Table 9: HASD&IC 2013 CHNA Overall Community Forum Results: Child Health Conditions Ranking
Rank Child Health Conditions 1 Obesity 2 Asthma 2 Diabetes 2 Mental Health
These rankings were calculated by reviewing the community forum summaries (located in the CHNA Toolkit on www.hasdic.org ) and documenting which health conditions were mentioned at each forum. Health conditions that were mentioned in one interview were given 1 point, health conditions that were mentioned in two interviews were given 2 points, and so on. The totals for each health condition were then ranked 1-5, with 1 being the highest priority as it was emphasized or addressed at the most community forums.
Notably, HASD&IC and IPH conducted a community forum in Logan Heights (ZIP Code 92113), a high-need community served by SCHHC. Twelve community members attended the session, and identified the following top health concerns (in alphabetical order) for adults in their community. Tables 10 and 11 below present top health conditions identified at this forum.
Table 10: HASD&IC 2013 CHNA Logan Heights Community Forum Results: Top Identified Adult Health Conditions
Adult Health Conditions Cardiovascular Health Diabetes, Type II Mental Health Skin Infections Substance Abuse/Chronic Pain
Table 11: HASD&IC 2013 CHNA Logan Heights Community Forum Results: Top Identified Child Health Conditions
Child Health Conditions Asthma Diabetes Mental Health Obesity Sexual Abuse
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SCHHC 2013 CHNA: Community Resident Feedback and Recommendations
At the close of the HASD&IC 2013 CHNA process, the SCHHC 2013 CHNA Planning Team conducted additional outreach to community members served by the hospital to gain greater insight into health issues impacting senior community residents. Community feedback surveys were distributed to attendees of an educational session on advanced care planning held at SCHHC in May, 2013.
Additionally, in order to collect resident perspective from one of the more vulnerable communities in close proximity to SCHHC, community feedback surveys were also distributed to patients at the Imperial Beach Health Center over a period of three weeks in May 2013 (see Section 3: Methodology for details). Community members were asked for open-ended feedback on the health issues of greatest importance to them and any significant barriers they face in maintaining health and well-being.
Feedback from these community feedback surveys identified the following health- related issues as priorities for community members:
Obesity, Alzheimer’s, mental health, diabetes, end-of-life care, heart care (cardiovascular) and memory/cognitive care Health care access and affordability Need for additional education on health issues noted above Improved care management, e.g., follow-up and patient-provider communication
These targeted community feedback surveys provided additional recommendations for hospitals to help improve outcomes:
More educational resources, including in-person lectures and written materials, on the following topics: diet and exercise; care options and resources for seniors, including advance directives; and preventative care. Improve access and coordination of care, e.g., appointment scheduling, consistent and timely follow-up, patient-provider communication, more time with medical providers, patient transportation, etc. Nutrition, exercise and healthy lifestyle programs for community members, especially out in the community and not necessarily at the medical facility.
HASD&IC 2013 CHNA: Community Recommendations
As explained in Section 3: Methodology of this report, the IPH conducted a content analysis of the community input from the electronic survey respondents, key informant interviewees and community forum participants. Input was organized into five categories: Access to Care, Care Management, Education, Screening Services, and Collaboration. Highlights of this content analysis are summarized below. For complete details please refer to the 2013 CHNA toolkit available on the HASD&IC website at: www.hasdic.org.
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1. Access to Care or Insurance1 Most often this was described as the need to improve access to primary care physicians and referrals, and/or increased availability of insurance coverage.
“Continue to assist patients who qualify for health insurance. Advocate for improved coverage for patients. Connect patients to a medical home. Improve care transitions with medical home.” -- Electronic survey respondent
Key Informant Electronic Survey Community Forum Interview Rank 1 =- highest priority 2 3 4 5 =- lowest priority Respondents aligned Community members at Key Informants aligned Strength of Access to Care/ Insurance every forum made this Access to Care/ Recommendation with each of the top 4 recommendation. It was Insurance with and/or Alignment conditions. The strongest the strongest Cardiovascular Disease with Health alignment was with Type II recommendation from and Mental Conditions Diabetes and Mental Escondido participants. Health/Mental Illness. Health/Mental Illness.
2. Care Management1 This category included multiple types of programs that would ensure better care management and communication between health care providers and patients including outreach workers, promotoras, navigators, translators, culturally competent advocates, etc. This type of care management was described as being needed for both prevention and treatment services.
“Align with primary care providers to provide care coordination on related health issues” “Patient navigators to follow up with patients after hospital visits” --Electronic survey respondents
Key Informant Electronic Survey Community Forum Interview Rank 1 =- highest priority 1 2 1 5 =- lowest priority Respondents aligned Community members at Every Key Informant Care Management with every forum emphasized emphasized Care each of the top 4 this recommendation. Management, and there Strength of conditions. The strongest was strong alignment Recommendation alignment was with with Mental and/or Alignment Mental Health/Mental Health/Mental Illness in with Health Illness and Type II particular. Care Conditions Diabetes. Management was the strongest overall recommendation.
1 Adapted from the HASD&IC 2013 CHNA summary available at www.hasdic.org
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3. Education1 This broad category discusses the best methods to educate patients about prevention or about health conditions. Suggestions like literature for nonnative speakers of English, small educational classes, and health fairs were mentioned.
“Health information and authorization materials available at low literacy levels” “Improved health literacy strategies; i.e., stronger methods of communication to patients about how to best care for themselves upon discharge.” -- Electronic survey respondents
Electronic Survey Community Forum Key Informant Interview
Rank 1 =- highest priority 3 1 3 5 =- lowest priority Respondents aligned This was the strongest Every Key Informant Education with each recommendation from the mentioned Education. The Strength of of the top 4 health Community Forums. There was a strongest alignment was Recommendation conditions. The particular emphasis on the need with Obesity. Education was and/or Alignment strongest alignment for Education at the El Cajon and also emphasized as an with Health was with Type II San Ysidro Forums – in both overall recommendation. Conditions Diabetes. cases that was the strongest recommendation.
4. Screening Services1 The need for additional screening was expressed for a number of different conditions including cancer and heart disease.
“Hospitals are not primary care providers; however, they are often accessed as such by a particular section of our population. Screening for cancer would help prevent the patient from presenting only when there are symptoms.” – Electronic survey respondent
Key Informant Electronic Survey Community Forum Interview Rank 1 =- highest priority 5 5 5 5 =- lowest priority Strength of Respondents aligned This recommendation was Not all of the Key Recommendation Screening Services with raised at two Community Informants mentioned and/or Alignment Type II Diabetes and Forums, Escondido and Screening Services, and with Health Mental Health/Mental Oceanside. it was not an overall Conditions Illness. recommendation.
1 Adapted from the HASD&IC 2013 CHNA summary available at www.hasdic.org
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5. Collaboration1 Increasing collaboration to prevent fragmented health care was a frequently mentioned need throughout all documented responses. The need for collaboration was noted on several levels, including between hospitals and health care systems, clinics, community members and advocacy groups, in order to enhance opportunities for education and care management activities.
“Work with community partners to establish standardized protocols for at risk and individuals with chronic conditions.” –Electronic survey participant
Key Informant Electronic Survey Community Forum Interview Rank 1 =- highest priority 4 4 2 5 =- lowest priority Many respondents Community members at the Key Informants most mentioned the need for Logan Heights and strongly aligned Strength of collaboration in their open Oceanside Community Collaboration with Mental Recommendation responses. Forums emphasized Health/Mental Illness and and/or Alignment Collaboration. Obesity. It was also with Health strongly emphasized as Conditions an overall recommendation.
Identification of Priority Health Conditions
The SCHHC 2013 CHNA utilized the same framework as the collaborative HASD&IC 2013 CHNA process to identify top health conditions for its community members.
For details on the prioritization process used to identify these community needs for the HASD&IC 2013 CHNA, please refer back to Section 3: Methodology of this report or www.hasdic.org.
By combining the results of all primary and secondary data analyses, the following health conditions were identified as priorities for the communities served by SCHHC (listed in alphabetical order):
Behavioral Health Cardiovascular Disease Diabetes, Type II Obesity Orthopedics Senior Health (including end-of-life care)
These results were supported by the combination of hospital data for SCHHC as well as primary data collected through the HASD&IC 2013 CHNA process and additional
1 Adapted from the HASD&IC 2013 CHNA summary available at www.hasdic.org
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outreach efforts conducted by SCHHC. The following pages describe each of these priority health needs for SCHHC’s patient community.
The IPH created an array of maps that overlay CNI ZIP code-level data with hospital discharge data (when possible). The county-level CNI maps are included in the CHNA Toolkit on www.hasdic.org. In addition to these maps, the IPH generated regional maps with age adjusted discharge rates overlaying the CNI data (both at ZIP code level) for the select health conditions. Figures 2 through 4 below provide mappings of SDC’s south region CNI, overlaid with discharge rate data for cardiovascular disease, diabetes, and mental health (maps for orthopedics, obesity and senior health were not available).
Cardiovascular Disease
The World Health Organization defines cardiovascular disease (CVD) as a group of disorders of the heart and blood vessels that include coronary heart disease, cerebrovascular disease (stroke), peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism.1 Coronary heart disease is the most common form of heart disease.2 High blood pressure, high cholesterol and smoking are all risk factors that could lead to CVD and stroke. Additional risk factors include alcohol use, obesity, diabetes, and genetic factors. About half of Americans (49 percent) have at least one of these three risk factors.2
Figure 2 below presents inpatient discharge rates for cardiovascular disease in SDC’s south region, over a CNI map for the region. The map demonstrates that while cardiovascular disease is a health condition across communities of varying need, those areas with the highest CNI score (and thus highest vulnerability) often present with the higher rates of discharges for cardiovascular disease.
1 WHO. Cardiovascular Diseases. http://www.euro.who.int/en/what-we-do/health-topics/noncommunicable-diseases/cardiovascular- diseases/definition 2 CDC. http://www.cdc.gov/heartdisease/facts.htm
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Figure 2: SDC South Region CNI and Cardiovascular Disease Discharge Rates1
In 2011, the rate of hospitalizations for coronary heart disease in SDC’s south region was 367.2 discharges per 100,000 population, which is higher than the SDC age- adjusted rate of hospitalizations of 283.4 discharges per 100,000 population. For stroke, in 2011, the rate of hospitalizations was 247.7 discharges per 100,000 population; also higher than the SDC age-adjusted rate of 235.1 discharges per 100,000 population.2
Heart and cerebrovascular diseases are the second and third leading causes of death for SDC’s south region. Table 12 details mortality rates due to coronary heart disease for all regions of SDC.
1 ***Cardiovascular Discharge Rate Description: 2011 hospital discharge rate for patients where Cardiovascular was the condition established to be the principal diagnosis cause of the patients to the facility for care per 1,000 people (population stats: United States Census 2000 population, age adjusted by age groups; 0-17, 18-34, 35-64 and 65+) The following ICD-9 codes were used to identify a discharge as cardiovascular: 390-459. Universe: Total Population of San Diego County. Data Source: SpeedTrack©, Inc. Data Year: 2011 Data Level: Zip code 2 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit
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Table 12: Age-Adjusted Coronary Heart Disease Mortality Rates, 2006 & 2010
Geographical Area Death Ratea,b 2006 Death Ratea,b 2010 United States1 166.4 unavailable California1 187.2 unavailable SDC2 110.5 104.3 San Diego Regions2 Central 138.3 136.5 East 126.7 116.9 N. Central 89.8 84.2 N. Coastal 103.8 93.2 N. Inland 93.0 90.8 South 124.0 119.2 HP 2020 Targetc 100.8 100.8 aDeath Rate per 100,000 Population. bAdjusted rates are adjusted to 2000 U.S. Standard Population cThis Healthy People goal represents all types of diabetes.
Diabetes (Type II)
Type II diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way the body metabolizes sugar (glucose), the body's main source of fuel. If left untreated, type II diabetes can be life-threatening. Clinical symptoms can include: frequent urination, excessive thirst, extreme hunger, sudden vision changes, unexplained weight loss, extreme fatigue, sores that are slow to heal, and increased number of infections.3
According to the 3-4-50 Chronic Disease 2010 report from the county’s HHSA, the most common risk factors associated with type II diabetes include being overweight or obese, physical inactivity, smoking, hypertension and abnormal cholesterol.
In 2010, about 1.9 million people aged 20 years or older were newly diagnosed with diabetes in the United States.3 Diabetes is the seventh leading cause of death in the U.S. and the sixth leading cause of death for SDC’s south region.3,2 Diabetes is a major cause of heart disease and stroke as well as the leading cause of kidney failure, non- traumatic lower-limb amputations, and new cases of blindness among adults in the United States.3 Figure 3 presents inpatient discharge rates for type II diabetes in SDC, overlaid with CNI data for the region. Not surprisingly, those communities of higher need also present higher rates of discharges for type II diabetes.
1 Division for Heart Disease and Stroke Prevention: Data Trends & Maps Web site. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 2010. Available at http://www.cdc.gov/dhdsp/ 2 County of San Diego. Mortality Data. http://www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/epi_stats_mortality.html#regional_tables 3 CDC website: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
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Figure 3: SDC’s South Region CNI and Diabetes Discharge Rates1
In 2011, there were 862 hospitalizations due to diabetes in SDC’s south region at a rate of 184.7 hospitalizations per 100,000 population, the second highest rate in the region and also higher than the age-adjusted rate of hospitalizations for SDC overall of 132.6 per 100,000 population.
Table 13 presents mortality rates for type II diabetes in SDC.2
1 Type II Diabetes Discharge Rate: 2011 hospital discharge rate for patients where Type II Diabetes was used to establish the principal diagnosis cause of the patients to the facility for care per 1,000 people (population stats: United States Census 2000 population, age adjusted by age groups; 0-17, 18-34, 35-64 and 65+). The following ICD-9 codes were used to identify a discharge as type 2 diabetes: 249-259, 275.01, 588.1, 790.29, v58.67. 2 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit
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Table 13: Age-Adjusted Diabetes Mortality Rates, 2010
Geographic Area Death Ratea,b United States1 20.8 California1 19.8 SDC2 19.1 San Diego Regions Central 26.1 N. Central 12.2 N. Coastal 11.8 N. Inland 17.0 East 26.6 South 26.5 HP 2020 Targetc 65.8 aDeath rate per 100,000 Population. bRates are adjusted to 2000 US Standard Population. cThis Healthy People goal represents all types of diabetes.
In 2010, there were 109 deaths due to diabetes in SDC’s south region, or 26.5 deaths per 100,000 population, which is higher than the SDC age-adjusted rate of 19.1 deaths per 100,000 population.
Moreover, 9.5 percent of adults in the county’s south region participating in the 2009 California Health Information Survey (CHIS) indicated that they had ever been diagnosed with diabetes, which is higher than the county experience of 7.8 percent. Similarly, 9.3 percent of adults in SDC’s south region participating in the 2009 CHIS reported that they had borderline diabetes, which is also higher than the SDC overall of 6.9 percent.3
Behavioral Health
Mental health, professionally termed behavioral health, is defined as “a state of complete physical, mental and social well-being, and not merely the absence of disease.”4 Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”5
1 State Health Facts Website: http://www.statehealthfacts.org/comparemaptable.jsp?ind=74&cat=2 2 County of San Diego. Mortality Data. http://www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/epi_stats_mortality.html#regional_tables 3 California Health Interview Survey. 2009. 4 World Health Organization. Strengthening Mental Health Promotion. Geneva, World Health Organization (Fact sheet no. 220), 2001. 5 CDC. Mental Health Basics. http://www.cdc.gov/mentalhealth/basics.htm
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In the United States depression is the most common type of mental illness affecting more than 26 percent of the U.S. adult population. It has been estimated that by the year 2020, depression will be the second leading cause of disability throughout the world, trailing only ischemic heart disease.1
Figure 4 below presents inpatient discharge rates for mental health in SDC’s south region, overlaid on a CNI map for the region. The mappings display a marked disparity between mental/behavioral health discharges of communities of higher need and those communities with a lower need index.
Figure 4: SDC South Region CNI and Mental Health Discharge Rates2
1 CDC. Mental Health Basics. http://www.cdc.gov/mentalhealth/basics.htm 2 Mental Health Discharge Rate: 2011 hospital discharge rate for patients where Mental/Behavioral Health was the condition established to be the principal diagnosis cause of the patients to the facility for care per 1,000 people. The following ICD-9 codes were used to identify a discharge as mental/behavioral health: 291-302, 306-316. Universe: Total Population of San Diego County Data Source: SpeedTrack©, Inc. Data Year: 2011 Data Level: Zip code
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The Tables 14 and 15 below present hospitalization and emergency department (ED) discharge rates for different behavioral health issues in SDC. The south region leads SDC in hospitalization rates for personality disorders and ED visit rates for anxiety disorders.
Table 14: Behavioral Health Hospitalization Rates, SDC 2011
Schizophrenia and Self- Alzheimer's Anxiety Mood Personality Dementia Other Psychotic Inflicted Region Disease Disorder Disorders Disorders Disorders Injury
Central 10.3 21.6 3.3 451.0 1.4 161.5 91.9 East 24.2 27.2 2.6 433.9 1.1 156.9 73.5 North 19.8 18.2 3.3 284.5 1.3 51.0 51.2 Central North 15.7 16.5 3.3 293.0 -- 77.3 68.8 Coastal North 21.2 12.4 5.4 283.2 -- 89.1 51.3 Inland South 17.3 17.0 2.3 263.3 1.7 85.6 62.4 SDC 19.0 18.0 3.5 330.8 1.1 103.9 63.3 Overall
Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit Note: Discharge rate per 1,000 population.
Table 15: Behavioral Health ED Visit Rates, SDC, 2011
Schizophrenia and Self- Alzheimer's Anxiety Mood Personality Dementia Other Psychotic Inflicted Region Disease Disorder Disorders Disorders Disorders Injury
Central 3.5 330.5 -- 207.0 2.9 161.5 78.5 East 6.0 274.3 -- 205.5 5.8 156.9 134.8 North 5.2 163.0 -- 91.8 2.0 51.0 56.1 Central North 9.2 187.7 4.3 187.7 2.5 77.3 64.9 Coastal North 6.6 227.7 -- 162.0 2.1 89.1 68.6 Inland South 3.8 311.0 -- 129.3 1.3 85.6 67.5 SDC 5.9 241.0 0.9 161.6 2.7 103.9 74.9 Overall
Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit Note: Discharge rate per 1,000 population.
Research reveals that adults with the lowest income or education report more unhealthy days than those with higher income or education. In addition, associations have been
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found between mental illness and chronic diseases such as cardiovascular disease, diabetes, and obesity.1
In 2010, suicide was the eighth leading cause of death in SDC, and the tenth leading cause of death for SDC’s south region. The age-adjusted death rate due to suicide was 11.0 deaths per 100,000 and failed to meet the HP 2020 target of 10.2 deaths per 100,000.2 Table 16 below presents mortality rates for suicide and other behavioral health issues for SDC.
Table 16: SDC Behavioral Health Death Rates, 2010a,b
Region Alzheimer's Disease Dementia Suicide Central 20.0 17.3 10.3 East 39.9 28.3 13.2 North Central 36.9 18.9 13.4 North Coastal 50.6 17.6 10.9 North Inland 53.6 22.3 12.8 South 26.5 12.6 6.4 SDC Overall 37.2 18.9 11 aDeath Rate per 100,000 Population. bRates are adjusted to 2000 U.S. Standard Population. Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit
For SDC overall in 2010, males, whites and persons between the ages of 45 and 84 were most impacted by suicide as measured by the age-adjusted rate per 100,000. Between 2006 and 2010, the age-adjusted suicide rate increased by 1.4.3
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. Overweight and obese ranges are determined using weight and height to calculate a number known as a body mass index (BMI). An adult with a BMI between 25 and 29.9 is considered overweight and an adult who has a BMI of 30 or higher is considered obese.4 For children and adolescents aged 2-19, overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex, while obese is defined as a BMI at or above the 95th percentile for children of the same age and sex.5
1 CDC. Key Findings. http://www.cdc.gov/hrqol/key_findings.htm 2 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit 3 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit 4 CDC Website: Centers for Disease Control and Prevention. Def. Obesity and Overweight: http://www.cdc.gov/obesity/defining.html. 5 Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 Supplement December 2007:S164–S192.
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According to a recent study by the CDC, 42 percent of Americans are expected to be obese by 2030. The researchers estimated that the number of U.S. adults that are considered obese will increase from 78 million in 2012 to more than 100 million by 2030. In addition, the study found that 11 percent of U.S. adults are expected to be severely obese by 2030, and if obesity trends were to remain at 2010 levels, the combined savings in medical expenditures over the next two decades would be $549.5 billion.1
Research has shown that as weight increases to reach the levels of overweight and obese, the risks for the following conditions also increases: coronary heart disease, type II diabetes, cancers (including endometrial, breast, and colon), high blood pressure, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis and depression.2 Table 17 below presents self-reported obesity rates for all regions of SDC.
Table 17: Age-Adjusted Self-Reported Obesity Prevalence Rates, 2009
Geographical Area Prevalence Ratea (%) United States3 35.7%
California4 24.0% SDC3 21.9% Central 29.3% East 26.4% N. Central 14.4% N. Costal 19.9% N. Inland 19.0% South 24.8% HP 2020 Target 30.5% aRates are adjusted to 2000 U.S. Standard Population. Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit
Additionally, 36.5 percent of SDC’s seniors (age 65 and older) were overweight while 21.7 percent were obese in 2009. Also in 2009, 10 percent of adults (age 18 and older) in SDC self-reported eating at fast-food restaurants four or more times each week. Further, nearly 90 percent of adults in SDC self-reported that they did not engage in moderate physical activity.5
1 http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_33853-stamped2.pdf Finkelstein et al / Am J Prev Med 2012;xx(x):xxx 2 NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf 3 CDC Website: Centers for Disease Control and Prevention. Adult Obesity facts: http://www.cdc.gov/obesity/data/adult.html. 4 County of San Diego HHSA, Community Health Statistics Unit, Regional Profiles, CHIS 2009: http://www.chis.ucla.edu/main/DQ3/output.asp?_rn=0.9208795 5 California Health Interview Survey, 2009
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In June, 2013, the American Medical Association voted to “recognize obesity as a disease state with multiple pathophysiology aspects requiring a range of interventions to advance obesity treatment and prevention.” This new recognition presents the potential for significant impact on the treatments and interventions for this complex health issue, as well as the chronic health conditions linked to it, such as heart disease and type II diabetes.
Orthopedics
According to a 2011 report from the CDC, arthritis is the nation’s most common cause of disability. An estimated 50 million U.S. adults (about one in five) report doctor- diagnosed arthritis, and the age-adjusted prevalence of doctor-diagnosed arthritis is estimated to be 22.2 percent among adults ages 18 and over.1 As the U.S. population ages, these numbers are expected to increase sharply to 67 million by 2030 and more than one-third of these adults will have limited activity as a result.2
And according to the National Institute of Health (NIH), osteoporosis is responsible for more than 1.5 million fractures each year, including 250,000 wrist fractures, 300,000 hip fractures, 700,000 vertebral fractures and 300,000 fractures at other sites (2006).3 Consequently, a Healthy People 2010 Progress Review revealed that osteoporosis is responsible for more than $14 billion in health care costs annually.4
The HP 2020 review indicates that approximately 80 percent of Americans experience low back pain (LBP) in their lifetime. Each year, it is estimated that 15 to 20 percent of the population develop protracted back pain, 2 to 8 percent have chronic back pain (pain that lasts more than three months), 3 to 4 percent of the population is temporarily disabled due to back pain and 1 percent of the working-age population is disabled completely and permanently due to LBP. In addition, research for HP 2020 reveals that Americans spend $50 billion each year for LBP, as it is the third most common reason to undergo a surgical procedure and the fifth most frequent cause of hospitalization (2009).5
In 2011, the age-adjusted discharge rate for arthritis-related hospitalizations was 309.3 per 100,000 population in SDC. This translates to 9,553 hospitalizations for the year. Females had a higher hospitalization rate for arthritis-related diagnosis than males (348.2 and 265.3 per 100,000 population, respectively). Not surprisingly, older adults in SDC (ages 65 years and older) presented much higher hospitalization rates for arthritis when compared to all other age groups, as well as SDC overall, with a rate of 1,400.9
1 Centers for Disease Control and Prevention. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007-2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5939a1.htm 2 Centers for Disease Control. Meeting the Challenge of Living Well. At a Glance 2012. http://www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm 3 National Institute for Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/ 4 Centers for Disease Control and Prevention. Healthy People 2010: Progress Review Focus Area 2 – Arthritis, Osteoporosis, and Chronic Back Conditions. http://www.cdc.gov/nchs/healthy_people/hp2010/focus_areas/fa02_aocbc2.htm 5 HealthyPeople.gov.2020 Topics & Objectives: Arthritis, Osteoporosis, and Chronic Back Conditions. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=3
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per 100,000 population.1 Similar trends were also observed for dorsopathy (back pain/disorders of the spine) hospitalizations for women and older adults. Table 18 presents hospitalization rates for both arthritis and dorsopathy for SDC.
Table 18: Arthritis and Dorsopathy Hospitalization Rates for SDC, 2011
Region Arthritis Dorsopathy Central 230.7 109.8 East 381.7 218.6 North Central 281.6 134.5 North Coastal 322.5 154.0 North Inland 373.3 178.9 South 244.1 109.9 SDC Overall (age adjusted) 309.3 151.7 Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Statistics Unit Note: Discharge rate per 1,000 population.
ED discharges for both arthritis and dorsopathy again demonstrated similar trends for females and older adults (ages 65 and older) where rates of ED discharges were higher than the county overall. Notably, dorsopathy ED discharges for younger age groups (ages 25 to 44 years and ages 45 to 64 years) were also higher than the dorsopathy ED discharge rate for SDC overall.2 See Table 19 below for details.
Table 19: Arthritis and Dorsopathy ED Discharges for SDC, 2011
Region Arthritis Dorsopathy Central 758.3 832.4 East 604.3 786.0 North Central 341.8 478.4 North Coastal 324.6 483.9 North Inland 349.5 594.7 South 539.8 785.0 SDC Overall (age-adjusted) 477.0 647.8 Source: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit Note: Discharge rate per 1,000 population.
1 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit 2 County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit
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Senior Health and End-of-Life Care
Older adults are among the fastest growing age groups in the U.S.1 In 2011, the first of more than 70 million baby boomers (adults born between 1946 and 1964) turned 65, and in the next two decades, another 79 million baby boomers will move into this demographic.1,2,3
In SDC, there were 361,908 residents (11.6 percent of the population) aged 65 years or older in 2011, and the number is expected to nearly double by the year 2030.4 In the county’s south region, there were 49,401 residents (10.5 percent of the population) aged 65 years or older in 2011, and by the year 2020, the region expects a 51 percent growth among this population.5,6
For every age group of adults aged 55 years or older in SDC, females outnumber males, with the proportion of females increasing with each older age group.4 In 2012, 67.5 percent of seniors in SDC were white, while nearly 17 percent were Hispanic.7 This percentage is projected to decrease between now and 2030, primarily because of an increase in the number of Hispanic seniors (an expected 22.9 percent in 2030).4 Unlike the county as a whole, Hispanic seniors in the south region outnumber white seniors (44.7 percent Hispanic compared 31.4 percent white), and it is projected that the Hispanic population in both the south region and the county overall will continue to grow and outnumber other races.4,7 In SDC, most seniors speak only English (69.5 percent) while 19.7 percent of seniors are unable to speak English very well.4
In 2011, 15.5 percent of SDC seniors aged 65 years or older were in the labor force and the mean household income was $56,851. Approximately 48 percent of the county’s seniors had no retirement income, 2.6 percent received Food Stamps/Supplemental Nutrition Assistance Program benefits, and 1.7 percent received Cash Public Assistance Income. Moreover, 98.3 percent of the county’s seniors had health insurance in 2011.5
In the south region, nearly 33 percent of seniors were 200 percent below the federal poverty level (FPL), which was higher than the county’s numbers of 25 percent of seniors 200 percent below the FPL.5 See Table 20 for details on the older adult population in the south region.
1 American Hospital Association; First Consulting Group. When I’m 64: How boomers will change health care. Chicago: American Hospital Association; 2007. 23 p 2 Baby Boomers Approach 65 – Glumly. Pew Research Center Social & Demographic Trends, 2010. 3 America’s Health Ranking Senior Report: A Call to Action for Individuals and Their Communities. United Health Foundation; 2013. 4 County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2013). San Diego County Senior Health Report: Update and Leading Indicators. 5 County of San Diego HHSA, Public Health Services, Community Health Statistics Unit 6 2010 Community Health Needs Assessment, Community Health Improvement Partners (CHIP) 7 Truven Health Analytics Market Expert; Nielsen Claritas, Inc.; US Census Bureau
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Table 20: Older Adult Population in SDC’s South Region (2011 ACS)
Total Population 65+ Years Old 49,401 Household Type Married-Couple Family 51.57% Family Household, No Spouse Present 22.61% Non-Family Household 3.32% Group Quarters 2.49% Male, Living Alone 5.49% Female, Living Alone 14.52% Poverty Percent Below 100% FPL 32.88% Percent Below 200% FPL 24.94% Source: 2011 County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Adults age 65 and older are the largest consumers of health care services, as the process of aging brings upon the need for more frequent care.1 Seniors in SDC use the 9-1-1 system at higher rates than any other age group. In 2011, 68,817 calls were made to 9-1-1 for seniors in need of pre-hospital care in SDC, representing a call for one out of every five seniors.
Seniors are at high-risk for developing chronic illnesses and related disabilities, and chronic conditions are the leading cause of death among older adults.2 Nationwide, about 80 percent of seniors are living with at least one chronic condition, while 50 percent of seniors have two or more chronic conditions, thus increasing their need for care.2,5
Significant health issues for seniors include obesity, diabetes mellitus, stroke, chronic lower respiratory diseases, influenza and pneumonia, mental health issues including dementia and Alzheimer’s disease, and cancer and heart disease, which were the top two leading causes of death for seniors in SDC in 2010.3,4 Seniors are also at high risk for falls, which is the leading cause of death due to unintentional injury.5 See Tables 21, 22 and 23 for details on the leading causes of death for seniors in SDC.
1 American Hospital Association; First Consulting Group. When I’m 64: How boomers will change health care. Chicago: American Hospital Association; 2007. 23 p. 2 Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007. 3 County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2013). San Diego County Senior Health Report: Update and Leading Indicators. 4 County of San Diego, Health and Human Services Agency, Public Health Services, Epidemiology & Immunization Services Branch 5 County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2012). San Diego County Senior Falls Report
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Table 21: Leading Causes of Death for Ages 64-75 Years in SDC, 2010
Number of Percent of Total Cause of Death Deaths Deaths Malignant Neoplasms 1,076 39.7% Diseases of Heart 551 20.3% Chronic Lower Respiratory Disease 185 6.8% Diabetes Mellitus 119 4.4% Cerebrovascular Diseases 113 4.2% Accidents (unintentional injuries) 71 2.6% Alzheimer’s Disease 49 1.8% Chronic Liver Disease and Cirrhosis 44 1.6% Influenza and Pneumonia 36 1.3% Essential (primary) Hypertension and Hypertensive Renal Disease 30 1.1% All Other Causes 438 16.2% Total Deaths 2,712 100.0%
Source: County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Table 22: Leading Causes of Death for Ages 75-84 Years in SDC, 2010
Number Percent Cause of Death of of Total Deaths Deaths Malignant Neoplasms 1,370 28.1% Diseases of Heart 1,157 23.7% Chronic Lower Respiratory Disease 387 7.9% Diabetes Mellitus 298 6.1% Cerebrovascular Diseases 258 5.3% Accidents (unintentional injuries) 161 3.3% Alzheimer’s Disease 97 2.0% Chronic Liver Disease and Cirrhosis 88 1.8% Influenza and Pneumonia 74 1.5% Essential (primary) Hypertension and 67 1.4% Hypertensive Renal Disease All Other Causes 918 18.8% Total Deaths 4,875 100.0% Source: County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
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Table 23: Leading Causes of Death for Ages 85+ Years in SDC 2010
Number Percent Cause of Death of of Total Deaths Deaths Malignant Neoplasms 2,142 28.1% Diseases of Heart 1,000 23.7% Chronic Lower Respiratory Disease 876 7.9% Diabetes Mellitus 471 6.1% Cerebrovascular Diseases 379 5.3% Accidents (unintentional injuries) 160 3.3% Alzheimer’s Disease 153 2.0% Chronic Liver Disease and Cirrhosis 147 1.8% Influenza and Pneumonia 146 1.5% Essential (primary) Hypertension and 99 1.4% Hypertensive Renal Disease All Other Causes 1,366 18.8% Total Deaths 6,939 100.0% Source: County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
In 2011, 108,853 seniors were treated and discharged from SDC emergency departments (ED), representing nearly one out of every three senior residents, and 97,647 seniors aged 65 and over were hospitalized in SDC.1
Seniors in the south region experienced higher rates of hospitalization and ED discharge for coronary heart disease, stroke, diabetes mellitus, Chronic Obstructive Pulmonary Disease, influenza, pneumonia, and falls when compared to SDC overall. Falls are a substantial reason for hospitalization and ED discharge among older adults, and San Diego hospitals emergently treat or admit two older adults for falls every hour.2 See Table 24 for hospitalization and emergency department discharge rates for important health issues among seniors in SDC and the south region.
1 2011 County of San Diego HHSA, Public Health Services, Community Health Statistics Unit 2 County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2012). San Diego County Senior Falls Report
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Table 24: Hospitalization and ED Discharge Rates for Ages 65+ Years in SDC and the South Region, 2011
SDC South Region ED ED Hospitalization Hospitalization Health Condition Discharge Discharge Rate Rate Rate Rate Falls 1,995.0 4,277.6 2,204.4 4,825.8 Coronary Heart 1,423.8 178.5 2012.1 192.3 Disease Stroke 1,306.4 328.3 1,520.2 360.3 Pneumonia 1061 292.1 1267.2 344.1 Chronic Obstructive 609 606.8 815.8 1032.4 Pulmonary Disease Diabetes Mellitus 323.8 352 587 548.6 Alzheimer’s Disease 129 44.2 123.5 32.4 Influenza 39 25.7 66.8 34.4 Source: County of San Diego HHSA, Public Health Services, Community Epidemiology Branch
Care at the end-of-life is another critical issue for the senior population. End-of-life is when health care providers anticipate a patient’s death within approximately six months. In general, older Americans with chronic illness consider how they would prefer their lives to end, and they desire a “good death” without burdensome pain, symptoms and technology.1 Unfortunately, end-of-life care is marked by inefficient, expensive medical care that fails to align patient preferences with the care that is actually received.2
According to a 2012 survey, 70 percent of Californians would prefer to die at home. However, new data shows that compared to the national average, Californians at the end-of-life experience more deaths in hospitals and spend more time in the intensive care unit (ICU) than at home – these aggressive forms of care are not considered beneficial to dying patients. The data also revealed wide variation across California regions and hospitals in the use of hospice, hospital and ICU services during the last six months of life. Factors such as age, sex, race and level of education are likely to affect whether patient treatment preferences are followed, while differences in medical culture and the availability of medical resources across hospitals and regions can strongly determine the level of care that is delivered.3
A report of hospice services in California from 1994 to 2004 reveals that the number of hospice programs has remained fairly stable as of 1996, while the number of
1 What Are Older Adults Mental Health Needs Near the End of Life? American Psychological Association, 2013. http://www.apa.org/pi/aids/programs/eol/end-of-life-factsheet.aspx 2 End of Life & Palliative. California Healthcare Foundation, 2013. http://www.chcf.org/topics/end-of-life-and-palliative 3 End-of-Life Care in California: You Don’t Always Get What You Want. California Healthcare Foundation, 2013. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/E/PDF%20EOLWhatYouWant.pdf
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Californians seeking hospice care has increased by 93 percent. This growth is likely due to an increase in the awareness and acceptance of hospice, as well the state’s growing elderly population. During this time, half of hospice patients were over 80 years old, slightly more than half were female, and the majority of patients were white. Data also revealed that California’s non-white residents are more likely than whites to rate the health care system as fair or poor in caring for those who are dying.1,2
It is critical to provide resources and support to caregivers of older adults. In 2009, about 42.1 million family caregivers in the U.S. provided care to an adult with limitations in daily activities at any given point in time, and about 61.6 million provided care at some time during the year.3 Whether aging Californians live in their own homes, with a relative, in an assisted-living residential facility or in a nursing home, one of the keys to their care is family caregiving, defined as those family members and informal care providers who assist with the care of disabled elderly relatives. Reaching out to families and community members who are caring for older adults helps to maintain the health of older adults as well as their caregivers.
Limitations of the 2013 CHNA Process
Limitations of the 2013 CHNA processes for both SCHHC and the collaborative HASD&IC effort are discussed here, in order to potentially benefit future CHNA processes and reports.
The most significant limitation to both the collaborative HASD&IC 2013 CHNA and the SCHHC 2013 CHNA was the short timeline. Both processes were completed in less than one year, and this timeline impacted methods used and the availability of resources. In order to conduct a comprehensive community health needs assessment, multiple mixed methods are required including the collection and analysis of secondary and primary data.
To help address these limitations in the primary data collection, an online survey format for community health experts and leaders was used, which provided a large volume of comprehensive data. A significant number of people responded to the CHNA survey and provided wide-ranging responses and suggestions to address community health needs. In addition, key informants provided higher-level, broader public health perspective and expertise to community health issues in SDC. However, due to the limitation of time constraints, only five community forums were conducted. Although the five community forums were conducted in areas of high need in San Diego based on their CNI, they were certainly not representative of SDC, or even these high-need
1 Snapshot – Hospice in California: A Look at Cost and Quality. California Healthcare Foundation, 2006. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/H/PDF%20HospiceSnapshotCostQuality06.pdf 2 Snapshot – Death and Dying in California. California Healthcare Foundation, 2006. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/D/PDF%20DeathDyingSnapshot06.pdf 3 Valuing the Invaluable: 2011 Update The Growing Contributions and Costs of Family Caregiving. Lynn AARP Public Policy Institute. http://www.aarp.org/relationships/caregiving/info-07-2011/valuing-the-invaluable.print.html
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areas, as a whole. With greater time allotment, the exploration of additional community forums in SDC neighborhoods of high need would be beneficial to this effort.
Additionally, the age of the data used throughout the 2013 CHNA process is worth noting as a limitation. The secondary data used in both the HASD&IC and SCHHC 2013 CHNA processes was based on a number of different sources at the state and county level, often over different time periods that were not current to 2013. For example, the most recent period available for the hospital discharge data used in the report was calendar year 2011, and more current data (2012) will not be available until later 2013.
Relatedly, lack of obesity data at the ZIP code level demonstrates another limitation of the CHNA processes and reports. The lack of obesity data at the ZIP code level presents an obstacle for community programs designed to target the issue of obesity within specific communities below the county level. To help reduce the impact of this limit, data and statistics regarding obesity related-illnesses (e.g., diabetes, cardiovascular disease) are included in this CHNA.
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Section
6 Conclusion
The results of this Community Health Needs Assessment (CHNA) revealed priority health needs impacting the communities served by Sharp Coronado Hospital and Healthcare Center, particularly the most vulnerable communities, as well as provided insight gathered from direct conversations with the community. These findings will assist in the design and implementation of community benefit efforts provided at SCHHC for its community members.
Community Assets
Kaiser Permanente San Diego, in partnership with the CHNA Advisory Workgroup and the Institute of Public Health, developed a comprehensive list of community assets pertaining to the original 15 prioritized health conditions. This list is available to other hospitals and community partners online at: www.hasdic.org.
Additionally, the list includes a review of websites conducted by IPH:
2-1-1 San Diego - http://www.211sandiego.org Military One Source - http://www.militaryonesource.mil Scripps Health - http://www.scripps.org Sharp HealthCare - http://www.sharp.com UC San Diego Health System - http://www.health.ucsd.edu
Sharp conducted additional research to identify community assets that address senior health and orthopedics/bone health in the community as these were additional community needs identified through SCHHC’s 2013 CHNA process. Community assets pertaining to the priority health needs identified through SCHHC’s CHNA (behavioral health, cardiovascular disease, diabetes, obesity and senior health) are detailed on the following pages.
Note: Please note this is a survey of local assets and not an exhaustive list of those resources available in San Diego County (SDC). These resources were gathered based on responses to a question in the electronic survey asking the health experts and community leaders to provide information on available assets for each condition they addressed in their response.
The health care safety net in SDC is highly dependent upon hospitals and community health clinics to care for the uninsured and medically underserved communities. Finding more effective ways to coordinate and enhance the safety net is a critical policy challenge. Hospitals and their community partners will use this list to identify gaps in regions and neighborhoods.
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COMMUNITY ASSET LIST:
I. CARDIOVASCULAR HEALTH
Right Care Initiative Thanks to an NIH GO grant, the Right Care Initiative and its partners have initiated a community focused effort in San Diego centered on the Right Care goals of preventing heart attacks, strokes, and diabetes related complications. Address N/A Phone 916-323-2704 Email [email protected] Website http://www.dmhc.ca.gov/healthplans/gen/gen_rci.aspx
American Heart Association: Local Affiliate AHA offers various programs for the improvement of patient health and education including Go Red For Women, One Million Hearts Initiative, and My Heart. My Life. 9404 Genesee Ave, Suite 240 Address La Jolla, CA 92037 Phone 858-410-3850 Email N/A http://www.heart.org/HEARTORG/Affiliate/La%20Jolla/Califor Website nia/Home_UCM_WSA021_AffiliatePage.jsp
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San Ysidro Health Center Health Education and Healthy Cooking Classes
SYHC provides numerous patient and community programs to help gain a better understanding of diabetes, hypertension, obesity and other health problems. The center's health educators are a valuable source of information to aid patients in disease prevention and management. They also present a number of programs designed to help patients and their family adjust to the problems of illness in the family.
Address Various Locations at SYHC Clinics Phone (619) 662-4100 Email N/A Website http://www.syhc.org/
San Diego Prevention Research Center – Familias Sanas y Activas
The SDPRC is 1 of 37 Prevention Research Centers funded by the Centers for Disease Control and Prevention to reduce health disparities in underserved communities. Its main community research project is Familias Sanas y Activas or Healthy and Active Families. 9245 Sky Park Ct. Suite 221 Address San Diego, CA 92123 Phone 619-594-4504 Email [email protected] Website http://sdprc.net/community/?page_id=235
Sharp Hospice Care - Hospice Homes Sharp’s Homes for Hospice Program offers patients and their families a unique environment that delivers care for patients’ needs in a comfortable home setting.
8881 Fletcher Parkway #336 Address La Mesa, CA 91942 Phone 619-667-1900 Email [email protected] Website http://www.sharp.com/hospice/homes-for-hospice.cfm
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WomenHeart: The National Coalition for Women with Heart Disease
Sharp Memorial Hospital now provides a support group for women with heart disease in the San Diego community. The support group is affiliated with WomenHeart: The National Coalition for Women With Heart Disease, the only national advocacy organization for female heart patients. WomenHeart's goal is to improve the quality of life and the quality of health care for all women with heart disease through support, information and advocacy.
Sharp Memorial Hospital, Conference Center Address 7947 Birmingham Drive San Diego, CA 92123 Phone 858-793-0478 Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=149&ClassLink=2668&Survey=
Monthly Congestive Heart Failure Support Groups This is an outpatient support group meeting for patients with heart failure and their loved ones and friends. Come and learn how to care for yourself at home and share your experiences and successes with other heart failure patients. This meeting is facilitated by nursing specialists at Sharp Memorial Hospital. Meeting locations include Sharp Memorial Hospital, and Sharp McDonald Center. Free transportation may be available.
Address Sharp Memorial Hospital and Sharp McDonald Center Phone 1-800-827-4277 (1-800-82-SHARP) Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=149&ClassLink=2135&Survey=
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Heart Disease Support Group - Mended Hearts, Chula Vista The Heart Disease Support Group at Sharp Memorial Hospital is provided by Mended Hearts, a non-profit organization whose mission is to inspire hope in heart disease patients and their families. At each support group meeting, an expert will speak on topics identified by the group. There will be time at the end of each meeting for questions and networking with other participants.
Sharp Memorial Hospital, Classroom 1 Address 751 Medical Center Court Chula Vista, CA 91911 Phone 619-477-7702 Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=149&ClassLink=2672&Survey=
Heart Disease Support Group - Mended Hearts, La Mesa The East County chapter of Mended Hearts, a support for group for cardiac patients and their families, meets at Sharp Grossmont Hospital.
Grossmont HealthCare District - Board Room Address 9001 Wakarusa Street La Mesa, CA 91942 Phone 619-477-7702 Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=149&ClassLink=2678&Survey=
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Living Successfully with Heart Failure In the Living Successfully with Heart Failure class, you will learn more about what heart failure is and simple methods you can use to manage your disease. This is a two week, 90-minute class. Topics include: Definition; Causes and symptoms of heart failure, Managing your symptoms, Weight and fluid balance, Nutrition and low sodium diet, Medications, Exercise and activity, Managing feelings about heart failure, Tips for family and friends. Fee: Sharp Rees-Stealy Member-$10, Sharp Health Plan Member-Free.
Sharp Weight Management & Health Education 1380 El Cajon Blvd. Suite 100 Address El Cajon, CA 92020 3666 Kearny Villa Rd. Suite 310 San Diego, CA 92123 Phone 1-800-827-4277 (1-800-82-SHARP) Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=149&ClassLink=3607&Survey=
Stroke Support Group - YESS Young Enthusiastic Stroke Survivors (YESS) is a free support group for survivors and their families. A recognized member of the American Heart Association, YESS sponsors meetings and newsletters that focus on educating the community about stroke and highlighting the effects of stroke on young people and their families. Education topics include coping skills, adjustment, family and intimacy, work and school re-entry and support sharing. YESS also sponsors social activities such as adaptive sports, day trips, barbecues, special events and community projects. YESS is not limited to stroke survivors. It also supports adults with head injuries, family members, professionals and educators.
Sharp Rehabilitation Center - Sharp Memorial Hospital Address 2999 Health Center Drive San Diego, CA 92123 Phone 858-939-6761 Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&ServLink=1 Website 6&ClassLink=603&Survey=
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Stroke Club Support Group - East County This is a support group for stroke survivors and their families. The group meets on the 3rd Tuesday of each month for lunch Address at different locations in the East County. Phone 619-740-4104 Email [email protected] https://www.82sharp.sharp.com/Sections.asp?dblink=1&ServLi Website nk=16&ClassLink=232&Survey=
Stroke Communication Support Group
YESS sponsors a communication group at Sharp Grossmont Rehabilitation Center. Its focus is stroke and brain injury survivors with aphasia or other speech or language difficulties. Cost is $30 per month.
Sharp Grossmont Rehabilitation Center Address 5555 Grossmont Center Drive La Mesa, CA 91942 Phone 619-740-4108 Email N/A Website N/A
II. DIABETES (TYPE II)
Project Dulce The core of Project Dulce’s approach to patient care is a “Chronic Care Model.” A nurse-led team consisting of an RN/CDE (Certified Diabetes Educator), medical assistant, and dietitian provides clinical care in collaboration with the patient’s primary care provider in order to improve patient health outcomes.
(Main Location) Address 9894 Genesee Avenue La Jolla, CA 92037 Phone 1-866-791-8154 Email N/A http://www.scripps.org/services/metabolic-conditions__ Website diabetes/why-choose-scripps __project-dulce
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American Indian Infant Health Initiative The AIIHI is modeled after the “Healthy Families America" program, which offers home visitation to provide basic health care information for high-risk or at-risk families with young children. This service also connects families with available resources in the American Indian communities such as WIC, parenting classes, child safety classes, basic health care information as well as other social services. Families receive visits from American Indian paraprofessionals or Public Health Nurses who can offer health information about a variety of topics in the privacy of their own home.
Indian Health Program Primary and Rural Health Division California Department of Health Care Services Address 1501 Capitol Avenue Suite 71.6044, MS 8502 P.O. Box 997413 Sacramento, CA 95899-7413 Phone 916-440-7749 Email N/A http://www.dhcs.ca.gov/services/rural/Pages/AIIHIProgram.a Website spx
Right Care Initiative (under DMHC) Thanks to an NIH GO grant, the Right Care Initiative and its partners have initiated a community focused effort in San Diego centered on the Right Care goals of preventing heart attacks, strokes, and diabetes related complications.
Address N/A Phone 916-323-2704 Email [email protected] Website http://www.dmhc.ca.gov/healthplans/gen/gen_rci.aspx
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San Ysidro Health Center: Patient Education Programs
SYHC provides numerous patient and community programs to help gain a better understanding of diabetes, hypertension, obesity and other health problems. The center's health educators are a valuable source of information to aid patients in disease prevention and management. They also present a number of programs to help patients and their family adjust to the problems of illness in the family.
San Ysidro Health Center Address 4004 Beyer Boulevard San Ysidro, CA 92173 Phone 619-428-4463 Email N/A Website http://www.syhc.org/location.html#Medical
Olivewood Gardens Kitchen in National City
Olivewood Gardens provides science-based nutrition education, lessons in sustainable agriculture, and environmental stewardship. Children and parents can explore connections between plants, history, science, art, literature, math and nutrition where learning is centered within the context of organic gardens and a demonstration kitchen. Fruits and vegetables are grown and harvested for nutrition classes, cooking demonstrations, and environmental education workshops.
Olivewood Gardens and Kitchen Address 2525 N Avenue National City, CA 91950 Phone 619-434-4281 Email [email protected] Website http://olivewoodgardens.org/
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Taking Control of Your Diabetes TCOYD is a not-for-profit 501(c) 3 charitable organization dedicated to educating and motivating people with diabetes and their loved ones to take a more active role in their own health and to provide continuing diabetes education to medical professionals to better care for their patients.
TCOYD Address 1110 Camino Del Mar, Suite B Del Mar, CA 92014 1.800.99TCOYD or (800.998.26930) Phone Phone 858.755.5683/ Fax 858.755.6854 Email [email protected] Website http://www.tcoyd.org/index.php
Diabetes Education Department at Sharp Grossmont Hospital The Diabetes Education Department at Sharp Grossmont Hospital offers education classes and nutrition counseling for diabetes patients and their family members. These educational sessions present the latest clinical research, share strategies for successful disease management, and allow for open discussion time and a question-and-answer period. Class topics include Diabetes Management, Diabetes and Healthy Eating, Sweet Success: Diabetes and Pregnancy, and Stick-To-It Self-Blood Glucose Monitoring.
Sharp Grossmont Hospital- Brier Patch Campus Address 9000 Wakarusa La Mesa, CA 91942 Phone 619-740-4811 Email [email protected] https://www.82sharp.sharp.com/Sections.asp?dblink=1&ServLi Website nk=4&ClassLink=229&Survey=
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Diabetes Education Department at Sharp Memorial Hospital The Diabetes Education Department offers education classes and nutrition counseling for diabetes patients and their family members. These educational sessions present the latest clinical research, share strategies for successful disease management and allow for open discussion time and a question-and- answer period. Class topics include Diabetes Management, Diabetes and Healthy Eating, Diabetes and Pregnancy, and Diabetes and Kidney Health.
Sharp Memorial Outpatient Pavilion Address 3075 Health Center Drive San Diego, CA 92123 Phone 858-939-5040 Email [email protected] Website N/A
Diabetes Education Department at Sharp Chula Vista Medical Center
The Diabetes Education Department offers education classes and nutrition counseling for diabetes patients and their family members. These educational sessions present the latest clinical research, share strategies for successful disease management and allow for open discussion time and a question-and-answer period. Class topics include Diabetes Management, Diabetes and Healthy Eating, and Diabetes and Pregnancy. Sharp Chula Vista Medical Center Medical Office Building, Suite 200 765 Address Medical Center Court Chula Vista, CA. 91911 Phone 619-740-4811 Email [email protected] Website N/A
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Pre-Diabetes Class This class is for patients who have been diagnosed with pre-diabetes (previously called borderline diabetes) or patients who are at risk of developing diabetes. The focus of the class is on understanding the factors that contribute to developing diabetes and how to slow the progression to Type 2 diabetes by healthy lifestyle changes. The emphasis is on good nutrition and keeping active. Class is 2 hours long and is taught by a Registered Dietitian, Certified Diabetes Educator. Address SRS Locations throughout San Diego County Phone 1-800-827-4277(1-800-82-SHARP) Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=4&ClassLink=2151&Survey=
Sharp HealthCare Weight Management Programs (open to community members Programs include: medically supervised weight-loss; “Healthy Solutions," a long term program for those moderately over their ideal body weight; "New Weigh Education Program," an eight-week program providing education and support for those wanting to lose weight or improve health. Participants can choose their own foods or use meal replacements for additional structure. Includes weekly education sessions and individualized coaching and follow-up; Dietician consultations; At-home weight-loss kits; Fees apply, please call for details.
The following Sharp Rees-Stealy locations: SRS Kearny Villa: 3666 Kearny Villa Road, San Diego, CA 92123 SRS Mt Helix: 1380 El Cajon Blvd., El Cajon, Address CA 92019 SRS Otay Ranch: 1400 East Palomar Street, Chula Vista, CA 91913 SRS Rancho Bernardo: 16950 Via Tazon, San Diego, CA 92127 Phone 858-505-1400 or 1-800-827-4277 (1-800-82-SHARP) Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Serv Website Link=62&ClassLink=732&Survey=
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III. BEHAVIORAL HEALTH
Access and Crisis Line (24 hrs/7 days) If you need information about how to handle a mental health crisis, you can talk to a trained counselor who can help with your specific situation. Translation services are available in 140 languages
Address Call center/Available to all regions in San Diego Phone 1-800-479-3393 Email N/A http://www.sdcounty.ca.gov/hhsa/programs/bhs/mental_heal Website th_services_adult_older_adult/adult_emergency_and_crisis. html
Client Warm Line (4-11pm, daily) The Warm Line is a friendly telephone support line, answered by trained consumers who offer support and listen to concerns. The Warm Line is a non-crisis phone service, which serves as an alternative to the Access and Crisis Line or emergency services. Parent organization: The Meeting Place, Inc. (The Meeting Place) Address 2553 State Street San Diego, CA 92101 Phone 1-800-930-9276 Email [email protected] Website www.themeetingplaceinc.org
National Alliance on Mental Illness (NAMI) San Diego Helpline The National Alliance on Mental Illness in San Diego is the city’s voice on mental illness. We are part of the grass-roots, non-profit, national NAMI organization founded in 1979 by family members of people with mental illness. We are also an affiliate of NAMI California. 4480 30th Street Address San Diego, CA 92116 Phone 1-800-523-5933 Email [email protected] Website http://www.namisandiego.org/
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Jewish Family Service Patient Advocacy Program
The Patient Advocacy Program was created in response to California legislation requiring each county mental health director to appoint patient rights advocates to protect and further the Constitutional and statutory rights of people receiving mental health services; Monday - Friday, 8am - 5pm.
Address 2710 Adams Avenue San Diego, CA 92116 Phone 619-282-1134 or 1-800-479-2233 Email [email protected] http://www.jfssd.org/site/PageServer?pagename=programs_c Website ounseling_patient_advocate
The Consumer Center for Health Education & Advocacy Center advocates help healthcare consumers to access, understand, and use the State and County-administered physical and mental healthcare systems. 1764 San Diego Avenue Address San Diego, CA 92110 Phone Toll-free: 1-877-734-3258 Email N/A Website www.healthconsumer.org
Episcopal Community Services, Friend to Friend Program The Friend to Friend Program serves the needs of mentally ill homeless adults of Central San Diego. Friend to Friend members may be eligible to receive services in the areas of income, housing, and mental health with the goal of regaining independence.
2144 El Cajon Blvd. Address San Diego, CA 92104 Phone 619-955-8217 Email N/A Website http://www.ecscalifornia.org/
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Bayview Clubhouse Provides a free rehabilitation program for adults 18 years of age or older who have been diagnosed with a mental illness. Focuses on employment, education, and social support.
330 Moss Street Address Chula Vista, CA 91911 Phone 619-585-4646 Email www.paradisevalleyhospital.org http://www.paradisevalleyhospital.net/Services/Behavioral- Website Health-Services.aspx
Casa Del Sol Clubhouse Mission is to provide a safe, clean and sober environment for individuals in twelve-step and other recovery programs, as well as their friends and family, to gather for support, community, and personal growth. In recognizing that issues of alcoholism and other addictions arise more often among the Gay, Lesbian, Transgender, and Bisexual population, our focus is to serve this community.
1157 30th Street Address San Diego, CA 92154 Phone 619-429-1937 Email [email protected] Website http://www.lllac.org/
Sharp Mesa Vista Mid-City Outpatient Program The Sharp Mesa Vista Mid-City Outpatient Program cares for adults with severe and persistent mental health issues. Services include individualized treatment planning and medication management, group and expressive therapies, psychiatric rehabilitation, and transitional age youth programs.
Address Sharp Mesa Vista Mid-City Satellite Office 4275 El Cajon Blvd. San Diego, CA 92105 Phone 619-521-2850 Email N/A
Website www.sharp.com
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Sharp Mesa Vista El Cajon Outpatient Program The Sharp Mesa Vista El Cajon Outpatient Program cares for adults with severe and persistent mental health issues. Services include individualized treatment planning and medication management, group and expressive therapies, psychiatric rehabilitation, and transitional age youth programs.
Address Sharp Mesa Vista El Cajon Satellite Office 1460 E. Main Street El Cajon, CA 92021 Phone 619-588-3800 Email N/A
Website www.sharp.com
San Diego Dementia Consortium (SDDC) The SDDC is organized exclusively for charitable, scientific and educational purposes and more specifically to advance public knowledge and awareness of dementia and cognitive health as well as to develop and promote clinical and research programs to benefit those patients with dementia and cognitive disease. SDDC’s goal is to initiate new programs and projects hands-on which benefit the welfare of elderly, cognitively- impaired patients in our community. We also sponsor activities which promote cognitive health among seniors across the lifespan.
Address Belmont Village at Sabre Springs 13075 Evening Creek Dr. San Diego, CA 92128 Meets 3rd Wednesdays, 8:30 – 10:30 a.m. Phone Bill Mathis, 619-757-1114
Email [email protected] Website www.sddementiaconsortium.org https://www.facebook.com/sddementiaconsortium
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IV. OBESITY
Behavioral Diabetes Institute
The Behavioral Diabetes Institute (BDI) is a non-profit organization dedicated to helping people with diabetes live long, healthy and happy lives by providing clinical services for people with diabetes, professional services for healthcare professionals involved in diabetes care, and research and development in the field of diabetes and its related conditions.
P.O. Box 501866 Address San Diego, CA 92150-1866
Phone 858-336-8693
Email [email protected] http://behavioraldiabetesinstitute.org/about-Behavioral- Website Diabetes-Institute.html
Project Dulce
The core of Project Dulce’s approach to patient care is a “Chronic Care Model.” A nurse-led team consisting of an RN/CDE (Certified Diabetes Educator), medical assistant, and dietitian provides clinical care in collaboration with the patient’s primary care provider in order to improve patient health outcomes.
(Main Location) Address 9894 Genesee Avenue La Jolla, CA 92037 Phone 1-866-791-8154 Email N/A http://www.scripps.org/services/metabolic- Website conditions__diabetes/ why-choose- scripps__project-dulce
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Childhood Obesity Initiative (COI) The San Diego County Childhood Obesity Initiative is a public/private partnership whose mission is to reduce and prevent childhood obesity in San Diego County by creating healthy environments for all children and families through advocacy, education, policy development, and environmental change.
5095 Murphy Canyon Road, Suite #105 Address San Diego, CA 92123
Phone 858-609-7964 Email [email protected]
Website http://ourcommunityourkids.org/
The California Endowment: Building Healthy Communities in San Diego, City Heights
This 10-year initiative of Building Healthy Communities builds on the wisdom and past experience of all our grantees and partners throughout California. Their work has demonstrated that the economic, physical, social and service environments in which people live have profound and lasting effects on the health of individuals, families and communities.
5060 Shoreham Place, Suite 350 Address San Diego, CA 92122 Phone 858-526-2600 Email [email protected] http://www1.calendow.org/healthycommunities/communities. Website html
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Fresh Fund Program (Currently Run By IRC, San Diego)
Fresh Fund, run by the International Rescue Committee, was about community engagement in our local food environment. The way we grow, distribute, and eat food affects individual and community health, and has a personal, social, and economic impact. The campaign was valuable and relevant to all county residents, as shopping at local farmers markets for locally grown produce helps local farmers and stimulates the local economy.
5348 University Avenue, Suite 205 Address San Diego, CA 92105 Phone 619-641-7510 ext. 234 Email [email protected] http://www.healthyworks.org/healthy-foods/fresh-fund & Website http://www.rescue.org/us-program/us-san-diego-ca/fresh- fund
Breakfast in the Classroom The innovative Breakfast in the Classroom Program ensures each student starts the day right, with a nutritious breakfast. This program operates in more than 46 elementary schools in the San Diego Unified School District, providing students in underserved communities with no-cost meals to start the school day.
1425 Russ Blvd Address San Diego, CA 92101 (District Offices) Phone 858-627-7308 Email [email protected] Website http://www.sandi.net/Page/985
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Live Well, San Diego The County of San Diego and the County Board of Supervisors have adopted this long-term wellness strategy to help all County residents become healthy, safe and thriving is being implemented with community involvement. Live Well, San Diego! has three components: “Healthy,” “Safe,” and “Thriving.”
Address Health and Human Services Agency (HHSA) Phone N/A Email N/A http://www.sdcounty.ca.gov/hhsa/programs/sd/live_well_san_ Website diego /index.html
San Diego Prevention Research Center-Familias Sanas y Activas
The SDPRC is 1 of 37 Prevention Research Centers funded by the Centers for Disease Control and Prevention to reduce health disparities in underserved communities. Its main community research project is Familias Sanas y Activas or Healthy and Active Families.
9245 Sky Park Ct. Suite 221 Address San Diego, CA 92123 Phone 619-594-4504 Email [email protected] Website http://sdprc.net/community/?page_id=235
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City Heights Wellness Center The 4,500 square-foot City Heights Wellness Center serves to enhance existing community services, including health promotion and disease prevention. The Teaching Kitchen serves as a hub for community gatherings, classes, and a fun and informative nutrition program. Wellness Center services include counseling services, parenting classes, education for diabetics, assistance in obtaining health insurance and nutrition and meal planning.
4440 Wightman Street, Suite 200 Address San Diego, CA 92105 Phone 619-321-2920 Email N/A http://www.scripps.org/locations/well-being-centers__city- Website heights
Health Champions Health Champions is a program designed to increase physical activity and healthy lifestyle knowledge and behaviors, as well as to promote advocacy for a healthy environment among middle- and high-school participants. The program, provided free of charge, can be implemented by a facilitator at any school or organization in San Diego County that works with adolescents.
Center for Healthier Communities Address 3020 Children's Way, MC 5073 San Diego, CA 92123 Phone 858-966-7585 Email Email: [email protected] http://www.rchsd.org/programsservices/a-z/c- Website d/centerforhealthiercommunities/healthchampions/index. htm
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V. ORTHOPEDICS
Fall Prevention Seminar Series
A series of 3 classes one and one half hours long. Participants will learn how normal aging processes contribute to falls, the risk factors associated with falls, and how to create personal plans for fall prevention. Participants should be able to stand up from a chair without help and stand in place for 2 minutes. Times vary.
The following Sharp Rees-Stealy locations: SRS Kearny Villa: 3666 Kearny Villa Road, San Diego, CA 92123 Address SRS La Mesa West: 7862 El Cajon Blvd. La Mesa, CA 92941; SRS Rancho Bernardo: 16950 Via Tazon, San Diego, CA 92127 Phone 1-800-82-SHARP Email N/A https://www.82sharp.sharp.com/Sections.asp?dblink=1&Ser Website vLink=9&ClassLink=3293&Survey=
Bone Health Education and Support Group Join us each month for informative presentations by leading experts about the latest discoveries in the prevention, diagnosis and treatment of osteopenia and osteoporosis. You will have the opportunity to ask questions and talk with others who share your interest in bone health. Group is an affiliate of the national Osteoporosis Foundation (NOF).
UC San Diego Thornton Hospital 9300 Campus Point Drive Address La Jolla, CA 92037 Meets the first Wednesday of the month at 12pm, 3rd flr. SDG&E Rm. 3-102 Phone 858-657-7236 Email [email protected] http://health.ucsd.edu/specialties/surgery/ortho/Pages/patient- Website resources.aspx
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Joint Replacement Class
Learn more about hip or knee replacement surgery through our classes taught by our multidisciplinary joint surgery team, which includes nurses, physical therapists and occupational therapists. You’ll have the opportunity to ask questions so that you feel comfortable with every aspect of the joint replacement process.
UC San Diego Thornton Hospital 9300 Campus Point Drive La Jolla, CA 92037 Meets third Wednesday of the month, 1:00 - 3:00 p.m., Bldg.1/ Address UC San Diego Medical Center 200 W. Arbor Drive San Diego, CA 92130 Meets first Wednesday of the month,1:00 - 3:00 p.m., 5th Floor Conference Room. Classes also offered in Spanish. Phone 858-657-7236 Email [email protected] http://health.ucsd.edu/specialties/surgery/ortho/Pages/patient- Website resources.aspx
AIS Fall Prevention Task Force
With a mission to reduce falls and their devastating consequences in San Diego County, 2013 projects include educating health care providers and seniors on community fall prevention resources and best practices for fall prevention. Free. Public welcome. Members play an active role and in addition to meetings, work on projects outside of the meetings. 8825 Aero Dr. San Diego, CA 92123 Address Meets 2nd Tuesdays, 12:30 – 2:00, 1st Floor Conference Room Phone 858-495-5061
Email [email protected] Website www.SanDiegoFallPrevention.org
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AIS Fall Prevention Task Force
With a mission to reduce falls and their devastating consequences in San Diego County, 2013 projects include educating health care providers and seniors on community fall prevention resources and best practices for fall prevention. Free. Public welcome. Members play an active role and in addition to meetings, work on projects outside of the meetings.
Tri-City Wellness Center 6250 El Camino Real Address Carlsbad, CA 92009 Meets 3rd Tuesdays, 1:00 – 2:30 p.m. Conference room is just to the right of the entrance, off the main foyer. Phone 858-495-5061 Email [email protected] Website www.SanDiegoFallPrevention.org
AIS Seniors in Motion: Feeling Fit Club
The Feeling Fit Club is a wellness program created by San Diego County Aging and Independent Services (AIS), primarily intended for sedentary, at- risk older adults. The Feeling Fit Club encompasses the county’s goal, vision and direction for the future: Successful aging by keeping people physically active mentally stimulated, nutritionally healthy, and socially engaged. The program is implemented in two ways: classes offered throughout the county each week, and a television show that was created in collaboration with San Diego State University that allows people to do the exercises by watching at home. Classes are offered year-round and last 1 hour per session. All classes are free, except when taught at community colleges where they cost $5 per semester.
Classes are offered several times per week at numerous locations throughout the county; An hour-long Feeling Fit Club program can also be viewed at 8 a.m. and again at 1 p.m. Monday through Friday on the San Diego County Address Television Network (CTN) on Time Warner Cable Channel 22, Adelphia Cable Channel 66 and Cox Cable Channel 19 or 24).
Phone 858-495-5500 Email N/A http://www.sdcounty.ca.gov/hhsa/programs/ais/health_pro Website motions/feeling_fit_club.html
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San Diego Arthritis Foundation
The San Diego office of the Arthritis Foundation is working to improve the lives of more than 400,000 adults and children with arthritis and related diseases who struggle every day with this serious health epidemic. Our Branch sponsors hundreds of Arthritis Foundation Land and Aquatic Exercise programs as well as Tai Chi classes to help people to literally get back on their feet! Self-help courses, support groups youth camp and young adult networks are also offered.
Arthritis Foundation, Pacific Region Address 8555 Aero Drive, Suite 200 San Diego, CA 92123
Phone 858-492-1090 ext. 116 Email [email protected] Website http://www.arthritis.org/california/branch_sd/
VI. SENIOR HEALTH
Caregiver Coalition of San Diego The Caregiver Coalition of San Diego's mission is to identify and address the needs of Caregivers through advocacy efforts and collaboration of a broad coalition membership in order to improve the overall quality of life for Caregivers, their families and the community. The Coalition's goal is to host 8- 12 family caregiver conferences, webinars and distributes an e-newsletter. The coalition partners with others on programs of interest to caregivers and advocates for family caregivers. Committees include Education, Community Outreach and Speakers Bureau. Free. Public welcome.
Aging & Independence Services 5560 Overland St. Address San Diego 92123 Meets the last Thursday of the month 3rd Floor, Joaquin Anguera Room,10:00-11:30 a.m. Phone Martin Dare, Coordinator, 858-505-6300 Email [email protected] www.CaregiverCoalitionSD.org; Website https://www.facebook.com/pages/Caregiver- Coalition/142346875794950?v=wall
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East County Action Network for Older Adults & Adults with Disabilities (ECAN)
The mission of ECAN is to be the East County community based network that takes action and advocates for Older Adults and Adults with Disabilities. ECAN's goals are revised every 6 months. Current issues include: Transportation, Intergenerational Games, Health Care, Mental Health and Information. Educational Guest Speakers. Free. Public welcome.
Renette Recreation Center 935 S. Emerald Ave. El Cajon, CA 92020 Address Meets 3rd Wednesdays, alternating months, 1:00-3:00 p.m. Schedule can vary. Confirm meeting dates with Coordinator. Phone Kathy Holmes-Hardy, Coordinator, 619-401-3994 Email [email protected] Website None available at this time.
East County Senior Service Providers
East County Senior Service Providers works to identify, educate and advocate for issues relating to the quality of life of older adults residing in the East San Diego County area. Their goal is to develop and maintain a communication link for senior service providers, provide education on senior issues and resources, advocate for quality of life issues for the older adults of San Diego’s East County, host a senior health fair annually, and make donations to selected non-profits each year. Annual Dues: $25 per organization.
El Cajon Salvation Army Address 1011 E Main St. El Cajon 92020 Bill Mathis, Chair, 619-757-1114, or Phone Marian Mann, Co-Chair, 619-447-8782 Email [email protected], or [email protected] http://www.facebook.com/pages/East-County-Senior-Service- Website Providers/185953294773601
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AIS Fall Prevention Task Force
With a mission to reduce falls and their devastating consequences in San Diego County, 2013 projects include educating health care providers and seniors on community fall prevention resources and best practices for fall prevention. Free. Public welcome. Members play an active role and in addition to meetings, work on projects outside of the meetings.
8825 Aero Dr. San Diego, CA 92123 Address Meets 2nd Tuesdays, 12:30 – 2:00, 1st Floor Conference Room Phone Kristen Smith, AIS Health Promotion Manager, 858-495-5061 Email [email protected] Website www.SanDiegoFallPrevention.org
AIS Fall Prevention Task Force
With a mission to reduce falls and their devastating consequences in San Diego County, 2013 projects include educating health care providers and seniors on community fall prevention resources and best practices for fall prevention. Free. Public welcome. Members play an active role and in addition to meetings, work on projects outside of the meetings.
Tri-City Wellness Center 6250 El Camino Real Carlsbad, CA 92009 Address Meets 3rd Tuesdays, 1:00 – 2:30 p.m. Conference room is just to the right entrance, off the main foyer. Phone Kristen Smith, AIS Health Promotion Manager, 858-495-5061 Email [email protected] Website www.SanDiegoFallPrevention.org
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AIS Health Promotion Committee
With a mission to improve health of seniors so that they may live independently, 2013 projects include planning the Vital Aging Conference scheduled for June. Free. Public welcome.
Burn Institute 8825 Aero Drive Address San Diego, CA 92123 1st Floor Conference Room Meets 2nd Tuesdays, 2:30 - 4:00 p.m. Phone Kristen Smith, AIS Health Promotion Manager, 858-495-5061 Email [email protected] Website None
Long Term Care Integrated Project (LTCIP)
LTCIP's mission is to improve health and social services for the elderly and disabled in San Diego County. Free. Public welcome.
Consult website as location varies. Meets quarterly. Meeting Address dates and times are announced on the LTCIP website. Phone Brenda Schmitthenner, 858-495-5853 Email [email protected] Website www.sdltcip.org
North County Action Network (NorCAN)
Our mission is to advocate for and improve the lives of older adults, persons with disabilities and their families by working efficiently and collaboratively to enhance the services they receive. Free. Public welcome.
San Marcos Senior Center 111 Richmar Ave. Address San Marcos, CA 92069 Meets 4th Tuesdays, 1:00 - 3:00 p.m. Phone Marty Dare, 858-505-6300 Email [email protected] Website www.sdltcip.org
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San Diego Community Action Network (SanDi-CAN)
SanDi-CAN's mission is to be the community based action partnership of providers, volunteers and consumers of services dedicated to improving quality of life for older adults and adults with disabilities living in the City of San Diego. SanDi-CAN advocates for seniors & dependent adults in San Diego. Free. Public welcome.
War Memorial Bldg. 3325 Zoo Drive Address San Diego, CA 92101 Zoo North Parking Lot Phone Brian Rollins 858-505-6305 Email [email protected] Website www.localcommunities.org/lc/sandican
San Diego County Coalition for Improvement of End-of-Life Care
San Diego County Coalition for Improvement of End-of-Life Care's mission is to educate and raise awareness within San Diego County about end-of-life issues and to provide resources to help people make informed choices. The goal is to bring open conversations and increased awareness to the inevitable process we face in the process of living and dying. Dues for 2013: Individual $25. Organization $100.
Live Well San Diego 4425 Bannock Avenue Address San Diego, CA 92117 Meets 1st Wednesdays, 10:00 a.m. - 11:30 a.m. General Phone Line: 858-635-1224, or Phone Veva Arroyo, Chair: 619-667-1969 Email [email protected] www.sdcoalition.org; Website https://www.facebook.com/SDCCEOL
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San Diego County Council on Aging
The San Diego County Council on Aging is a multidisciplinary organization that promotes Education, Awareness, and Networking in the Greater San Diego area to enhance the quality of life for seniors. Goals include: Protecting the rights and lifestyles of the senior population; Remaining informed regarding the fair allocation of government and private resources to serve the needs of seniors; Providing education for professionals and the community to improve the quality of life for the senior population; Collaborating with other senior organizations. Dues for 2013: $35 yearly for 2 agency employees, the third employee is another $35. Members may bring a guest 2 times before membership dues are enforced.
Vibra Hospital of San Diego (Formerly Continental Rehab) 555 Washington St. San Diego, CA 92103 Address Located on parking level P2 in Cafeteria parking validation available. Meets 1st Thursdays Monthly, 8:15 -10 a.m. Phone Jeannine Nash Cell: 619-755-7315 Email [email protected] Website www.sdccoa.com
San Diego Dementia Consortium
The SDDC is organized exclusively for charitable, scientific and educational purposes and more specifically to advance public knowledge and awareness of dementia and cognitive health as well as to develop and promote clinical and research programs to benefit those patients with dementia and cognitive disease. SDDC's goal is to initiate new programs and projects hands-on which benefit the welfare of elderly cognitive impaired patients in our community. We also sponsor activities which promote cognitive health among seniors and across the lifespan.
Belmont Village at Sabre Springs 13075 Evening Creek Dr. Address San Diego, CA 92128 Meets 3rd Wednesdays, 8:30 – 10:30 a.m. Phone Bill Mathis, 619-757-1114 Email [email protected] www.sddementiaconsortium.org Website https://www.facebook.com/sddementiaconsortium
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San Diego Regional Home Care Council
The San Diego Regional Home Care Council is for people who provide services to seniors in their homes, as well as networking, business meetings and education on issues of interest to home care providers. The San Diego Regional Home Care Council promotes standards of practice for the home care community and supports the home care industry by all means possible, including a goal of sponsoring 1 luncheon per year. Dues for 2012: $50/year, January thru December. Attend twice for free. Due are collected at 3rd meeting.
San Diego County Health & Human Services 8965 Balboa Address Ave., San Diego 92123 3rd Thursday, 8-10 a.m. Phone NA Email Stephanie Phillips: [email protected] Website www.sdic-rhcc.org
Senior Resource Association
A group of dedicated business professionals meet once a month. Members learn how best to serve their senior clientele through education and business networking. Our goal is to provide the highest quality personalized care for the frail elderly, disabled vets and their family members seeking guidance and support with health care needs. Our top priority is the client’s overall well-being and enhancing their “quality of life”. Dues: $25.00 per year for each member for 2013.
Redwood Towncourt 500 E. Valley Pkwy Address Escondido, CA 92025 Meets 3rd Tuesdays, 8 – 10:00 a.m. Greenhouse room on the courtyard. Jason Pearson 760-936-2336 or Maribel Pearson 760-518- Phone 2480 Email [email protected] Website www.starfishresources.net
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Senior Specialists Networking Group The Senior Specialist Networking Group's goal is to build business relationships to better serve our senior clients. We invite you to increase your senior client referral base and knowledge about products & services. RSVP at www.meetup.com/sd-ssng or www.meetup.com/ssng-nc. Membership: $150 per year which includes lunch, printed business listing, online business listing, and slot on our speaker roster. Nonmember fee: $20 includes lunch, networking, and tour of host community.
Monthly Networking Luncheons at different facilities: 11:30 a.m. – 1:00 p.m. Address San Diego, 2nd Tuesday North County, 4th Thursday Phone Janette Beck Cell: 760-497-1150 Email [email protected] Website www.ssngdirectory.com
South Bay Senior Providers Our mission is to enhance the quality of life to the San Diego senior community by providing education and advocacy. We achieve this through networking & community collaboration. Free. Public welcome.
Meetings travel. Contact Co-Chair for location Address Meets 1st Wednesday of every month, 8 – 10 a.m. Maurice Borders, Chair, 619-952-6853, or Phone Jean Vaccaro, Co-Chair, 619-755-7316 Email [email protected], or [email protected] Website N/A
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Serving Seniors Networking Breakfast This networking organization is professionals serving the senior population in any capacity. Our purpose is to educate one another on our products, services, facilities and to build better relationships throughout monthly meetings. We can then make better recommendations to our senior clients who deserve professionals with integrity, knowledge, and a dedication to excellent services. $20 per breakfast if paid in advance.
Meetings travel. Contact Co-Chair for location Address Meets 1st Wednesday of every month, 8 – 10 a.m. Maurice Borders, Chair, 619-952-6853, or Phone Jean Vaccaro, Co-Chair, 619-755-7316 Email [email protected], or [email protected] Website N/A
South County Action Network (SoCAN)
With a finger on the community pulse and an eye on the future, the SoCAN collaborative works to continually improve the quality of life for seniors and adults with disabilities. Our vision is for older adults and adults with disabilities will be living healthy, safe and independent lives engaging with and enhancing the quality of life of the community. Free. Public welcome.
County Library - Bonita-Sunnyside Branch 4375 Bonita Rd. Address Bonita, CA 91902 Meets 4th Tuesdays, 1-3 p.m. in the Community Room Phone Anabel Kuykendall 619-476-6223 Email [email protected] Website N/A
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HASD&IC 2013 CHNA: Next Steps
The complete summary of the HASD&IC 2013 Community Health Needs Assessment is available online at: www.hasdic.org. Paper copies or electronic files are also available upon request, as well as items provided in the HASD&IC 2013 CHNA Toolkit developed by IPH. Questions may be directed to:
Lindsey Wade Vice President, Public Policy Hospital Association of San Diego & Imperial Counties 5575 Ruffin Road, Ste 225 • San Diego, CA 92123 P: 858.614.1553 [email protected]
SCHHC 2013 CHNA: Next Steps
Sharp Coronado Hospital and Healthcare Center has developed its FY13-FY16 implementation plan to address the needs identified through the 2013 CHNA process for the primary communities it serves. In addition, the SCHHC CHNA Planning Team, Sharp Community Benefits and team members across Sharp are committed to an ongoing evaluation of the programs provided to address the needs of SCHHC’s community members. Tools such as the asset map of currently existing resources within SDC, as well as the CNI data, will be utilized to help continue to identify gaps in community resources and provide insight into further program development. The FY13- FY16 SCHHC implementation plan is submitted along with the IRS Form 990, Schedule H, and will be publicly available on Guidestar (http://www.guidestar.org/) in the coming months.
However, it is recognized that all regions of SDC are experiencing many changes that may directly affect the health of the communities served by SCHHC. This uncertainty in the general environment continues to be a serious issue and key consideration for the health care community. While this CHNA provides a high-level view of health in the communities served by SCHHC, hospital community benefit and community relations efforts must also stay mindful of and responsive to the emerging trends and needs in health care as they arise.
Conclusion
SCHHC 2013 CHNA report focused on highlighting the health needs of its community members. In particular, addressing the unmet health needs of vulnerable community members is a continuing concern of hospitals and hospital community benefit efforts throughout SDC. Although community benefit programs have accomplished much in SDC, there is of course, still work to be done.
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With a challenging and uncertain health care landscape before us, community well- being is a prevalent concern. SCHHC and the Sharp system remain committed to the care and improvement of health for all San Diegans amidst these challenges. Many of the issues identified in this CHNA – access to care, affordable insurance and health care, education and information for all community members – will take time, patience and perseverance to improve. Sharp HealthCare remains committed to the challenges ahead, and welcomes the exploration of new opportunities to better the health and well- being of the San Diego community.
The information collected throughout the SCHHC 2013 CHNA process, as published here, is publicly available to the community. Readers are invited to read and download this CHNA report on http://www.sharp.com/coronado/about-us.cfm, and to utilize the findings in both this report and the HASD&IC 2013 CHNA to positively impact the health of community members throughout San Diego.
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Appendix Sharp Coronado Hospital and A Healthcare Center Programs and Services
. 24-hour emergency services . Acute care . Mammography . Complementary care services, including acupuncture, clinical aromatherapy, Healing Touch and massage . CT Scan . EEG . EKG . Endoscopy . Home health1 . Hospice2 . Inpatient hospice unit . Intensive Care Unit . Laboratory services . Liver care . MRI . Motion Center, providing therapy and fitness programs . Orthopedic surgery, including total joint replacement . Outpatient nutrition counseling . Pathology services . Pharmacy . Primary care . Senior services . Sub-acute services . Support groups, including family and bereavement . Surgical services . Ultrasound . Villa Coronado Skilled Nursing Facility . Wound Care Clinic
1 Provided through Sharp Memorial Hospital Home Health Agency 2 Provided through Sharp HospiceCare
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Appendix
B An Overview of Sharp HealthCare
FOUR ACUTE CARE HOSPITALS:
Sharp Chula Vista Medical Center (343 beds) The largest provider of health care services in San Diego’s rapidly expanding South Bay, Sharp Chula Vista Medical Center (SCVMC) operates the region’s busiest Emergency Department (ED) and is the closest hospital to the busiest international border in the world.
Sharp Coronado Hospital and Healthcare Center (181 beds) Sharp Coronado Hospital and Healthcare Center (SCHHC), an acute care hospital, provides services that include sub-acute and long-term care, rehabilitation therapies, joint replacement surgery, hospice and emergency services.
Sharp Grossmont Hospital (540 beds) Sharp Grossmont Hospital (SGH) is the largest provider of health care services in San Diego’s East County, and has one of the busiest EDs in San Diego County (SDC).
Sharp Memorial Hospital (675 beds) A regional tertiary care leader, Sharp Memorial Hospital (SMH) provides specialized care in trauma, oncology, orthopedics, organ transplantation, cardiology and rehabilitation.
THREE SPECIALTY CARE HOSPITALS:
Sharp Mary Birch Hospital for Women & Newborns (206 beds) A freestanding women’s hospital specializing in obstetrics, gynecology, gynecologic oncology, and neonatal intensive care, Sharp Mary Birch Hospital for Women & Newborns (SMBHWN) delivers more babies than any other private hospital in California.
Sharp Mesa Vista Hospital (149 beds) The largest private freestanding psychiatric hospital in California, Sharp Mesa Vista Hospital (SMV) is a premier provider of behavioral health services.
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Sharp McDonald Center (16 beds) Sharp McDonald Center (SMC) is SDC’s only licensed chemical dependency recovery hospital.
Collectively, the operations of SMH, SMBHWN, SMV and SMC are reported under the not-for-profit public benefit corporation of SMH, and are referred to herein as The Sharp Metropolitan Medical Campus (SMMC). The operations of Sharp Rees-Stealy Medical Centers (SRS) are included within the nonprofit public benefit corporation of Sharp, the parent organization. The operations of Sharp Grossmont Hospital (SGH) are reported under the nonprofit public benefit corporation Grossmont Hospital Corporation.
Mission Statement
It is Sharp’s mission to improve the health of those it serves with a commitment to excellence in all that it does. Sharp’s goal is to offer quality care and services that set community standards, exceed patient expectations, and are provided in a caring, convenient, cost-effective and accessible manner.
Vision
Sharp’s vision is to become the best health system in the universe. Sharp will attain this position by transforming the health care experience through a culture of caring, quality, service, innovation and excellence. Sharp will be recognized by employees, physicians, patients, volunteers and the community as the best place to work, the best place to practice medicine and the best place to receive care. Sharp will be known as an excellent community citizen, embodying an organization of people working together to do the right thing every day to improve the health and well-being of those it serves.
Values
. Integrity – Trustworthiness, Respect, Commitment to Organizational Values, and Decision Making
. Caring – Service Orientation, Communication, Teamwork and Collaboration, Serving and Developing Others, and Celebration
. Innovation – Creativity, Continuous Improvement, Initiating Breakthroughs, and Self-Development
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. Excellence – Quality, Safety, Operational and Service Excellence, Financial Results, and Accountability
Culture: The Sharp Experience
For more than 12 years, Sharp has been on a journey to transform the health care experience for patients and their families, physicians and staff. Through a sweeping organization-wide performance and experience improvement initiative called The Sharp Experience, the entire Sharp team has recommitted to purpose, worthwhile work, and creating the kind of health care people want and deserve. This work has added discipline and focus to every part of the organization, helping to make Sharp one of the nation’s top-ranked health care systems. Sharp is San Diego’s health care leader because it remains focused on the most important element of the health care equation: the people.
Through this extraordinary initiative, Sharp is transforming the health care experience in San Diego by striving to be:
. The best place to work: Attracting and retaining highly skilled and passionate staff members who are focused on providing quality health care and building a culture of teamwork, recognition, celebration, and professional and personal growth. This commitment to serving patients and supporting one another will make Sharp “the best health system in the universe.”
. The best place to practice medicine: Creating an environment in which physicians enjoy positive, collaborative relationships with nurses and other caregivers; experience unsurpassed service as valued customers; have access to state-of-the-art equipment and cutting-edge technology; and enjoy the camaraderie of the highest-caliber medical staff at San Diego’s health care leader.
. The best place to receive care: Providing a new standard of service in the health care industry, much like that of a five-star hotel; employing service- oriented individuals who see it as their privilege to exceed the expectations of every patient – treating them with the utmost care, compassion and respect; and creating healing environments that are pleasant, soothing, safe, immaculate, and easy to access and navigate.
Through all of this transformation, Sharp will continue to live its mission to care for all people, with special concern for the underserved and San Diego’s diverse population. This is something Sharp has been doing for more than half a century.
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Pillars of Excellence
In support of Sharp’s organizational commitment to transform the health care experience, the six Pillars of Excellence serve as a guide for team members, providing a framework and alignment for everything Sharp does. The six pillars listed below are a visible testament to Sharp’s commitment to become the best health care system in the universe by achieving excellence in these areas:
Demonstrate and improve clinical excellence and patient safety to set community standards and exceed patient expectations
Create exceptional experiences at every touch point for customers, physicians and partners by demonstrating service excellence
Create a workforce culture that attracts, retains and promotes the best and brightest people, who are committed to Sharp’s mission, vision and values
Achieve financial results to ensure Sharp’s ability to provide quality health care services, new technology and investment in the organization
Achieve consistent net revenue growth to enhance market dominance, sustain infrastructure improvements and support innovative development
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Be an exemplary community citizen by making a difference in our community and supporting the stewardship of our environment
Awards
Sharp recently received the following recognition:
Sharp is a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and organizational performance excellence. Sharp is the first health care system in California and eighth in the nation to receive this recognition.
Sharp was named the No. 1 “best integrated health-care network” in California and No. 12 nationally by Modern Healthcare magazine in 2012. The rankings are part of the “Top 100 Most Highly Integrated Healthcare Networks (IHN),” an annual survey conducted by health care data analyst IMS. This is the 14th year running that Sharp has placed among the top in the state in the survey.
Sharp Rees-Stealy Medical Group, practicing as the Sharp Rees- Stealy Medical Centers, was named “Best Medical Group” by U-T San Diego readers participating in the paper’s 2012 “Best of San Diego” Readers Poll. SMH and SGH were ranked second and third “Best Hospitals” while SCVMC, SCHCC and SMBHWN were honored as finalists.
SGH and SMH have both received MAGNET® Designation for Nursing Excellence by the American Nurses Credentialing Center (ANCC), and in The
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Magnet Recognition Program is the highest level of honor bestowed by the ANCC and is accepted nationally as the gold standard in nursing excellence.
Sharp was named one of the nation’s “Most Wired” health care systems in 2013 by Hospitals & Health Networks magazine in the annual Most Wired Survey and Benchmark Study. “Most Wired” hospitals are committed to using technology to enhance quality of care for both patients and staff.
In July 2010, SMH was named the “Most Beautiful Hospital in America” by Soliant Health, one of the largest medical staffing companies in the country. With over 10,000 votes from visitors to the Soliant Health website, SMH was voted to the top spot of the second annual “20 Most Beautiful Hospitals in America” list. Sharp Memorial Hospital was named to the list again in 2011.
In 2012 SMH was designated as a Planetree Patient-Centered Hospital, joining SCHCC as the second hospital in the state to earn the honor. SMH is the largest and most complex hospital in the world to receive designation. SCHCC was originally designated in 2007 and is the only hospital in the state to be re-designated, occurring in 2010. Planetree is a coalition of more than 100 hospitals worldwide that is committed to improving medical care from the patient’s perspective.
In 2010, Sharp received the Morehead Apex Workplace of Excellence Award. Sharp reached the 98th percentile in 2010 and the 99th percentile in 2011.With this singular award, Morehead annually recognizes a client who has reached and sustained the 90th percentile on their employee engagement surveys. From 2009-2012, Sharp HealthCare received the Morehead Apex Award for Workplace Distinction. With these two awards, Morehead awards the health care industry’s top achiever by objectively identifying the highest performer and acknowledging their contributions to health care.
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In FY 2012, SCHHC received Energy Star designation from the U.S. Environmental Protection Agency (EPA) for outstanding energy efficiency. Buildings that are awarded the designation use an average of 40 percent less energy than other buildings and release 35 percent less carbon dioxide into the atmosphere. SCVMC is eligible to receive this designation for 2012, and both SCHHC and SCVMC received the designation for the previous three years.
Sharp HealthCare was named the Crystal Winner of the 2011 Workplace Excellence Awards from the San Diego Society for Human Resource Management. This designation recognizes Sharp’s Human Resources Department as an innovative and valuable asset to overall company performance.
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Appendix Community Needs Index Map of C San Diego County
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Appendix List of Modifiable Health Drivers D Associated with Poor Health Outcomes1
Clinical Care 1. Lack of access to a primary care physician (whether or not insured) 2. A shortage of health professionals (HPSAs) 3. Lack of access to health screening services (such as cancer screening, HIV testing…) 4. Lack of access to immunizations 5. Lack of access to chronic disease management 6. Lack of the availability of dental care 7. Insufficient community health workers 8. Difficulty with patient communication including language and cultural issues 9. Lack of effective patient education about specific health conditions
Health Behaviors 1. Poor dietary habits 2. Tobacco use 3. Substance abuse 4. Lack of physical activity 5. Lack of breastfeeding 6. Insufficient prenatal care
Physical Environment 1. Limited accessibility to healthy food options 2. Limited access to parks and recreation facilities 3. Poor neighborhood walkability 4. Poor neighborhood safety 5. Poor air quality
Social and Economic Factors 1. Poverty 2. Unemployment or underemployment 3. Lack of education and/or literacy challenges 4. Lack of health insurance 5. Lack of social or emotional support 6. Exposure to community violence, intimate partner violence and/or child abuse
1 Source: http//www.chna.org/kp; http://www.chna.org/Home.aspx
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Appendix Health Expert/ Community Leader E Electronic Survey Questions1
Would you like to begin the survey focusing on poor health outcomes or health drivers? (Please hover over the options below to read more thorough definitions)
If user selected focus on health conditions:
Question 1: Please select up to 3 health conditions below that you feel you have expert knowledge of. (You will be asked a series of follow-up questions for each of the health conditions that you select). If you have expert knowledge of a condition not on this list that you feel presents a significant health need in San Diego, please also add it to the list.
If user selected focus on health drivers:
Question 1: Please select 5 health drivers below that you feel most directly contribute to poor health outcomes for people who reside in San Diego County. (You will be asked a series of follow-up questions for each of the health drivers that you select). Please include any other health drivers that you feel should be added to the list.
If user selected focus on health conditions OR health drivers:
Please respond to the questions in the matrix table as they relate to (responses from either selected conditions, or selected drivers from Question 1 will be inserted).
1 Electronic survey questions were developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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Question 2:
Strongly Somewhat Question Agree Disagree Agree Agree There are a large number of people affected by: [insert user’s responses from Question 1 health conditions or health drivers] Insert user’s responses from Question 1 health conditions or health drivers contributes significantly to poor health conditions in San Diego Insert user’s responses from Question 1 health conditions or health drivers contributes significantly to mortality in San Diego There are significant racial/ethnic and socioeconomic health disparities of (Insert user’s responses from Question 1 health conditions or health drivers ) in San Diego There are evidence-based strategies that could be implemented by San Diego hospitals to improve [Insert user’s responses from Question 1 health conditions or health drivers]
If user selected focus on health conditions:
Question 3: Please select up to 5 health drivers that you feel contribute most directly to poor health outcomes related to [insert responses from Question 1]
Question 4: The Hospital Association of San Diego and Imperial Counties is interested in developing programs that will improve poor health outcomes. Among the health drivers that you feel contribute most directly to poor health outcomes related
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to [insert responses from Question 1], which driver(s) do you feel the hospitals in San Diego County could affect the most?
If user selected focus on health drivers:
Question 3: Please select 3 health conditions below that you feel are most affected by [insert responses to Question 1] How could the hospitals in San Diego County affect [insert responses from Question 1]
If user selected focus on health conditions OR health drivers:
Question 5:
Are you aware of any community resources that are currently being used in San Diego County to address [insert responses from Question 1 health conditions or health drivers]? Please describe the community resources that you are aware of that are being used in San Diego County to address [insert responses from Question 1 health conditions or health drivers]
Question 6: Can you recommend any strategies, policies, practices, and/or partnerships that hospitals in San Diego County could implement to address [insert responses from Question 1 health conditions or health drivers]. Please describe the strategies, policies, practices, and/or partnerships that hospitals in San Diego County could implement to address [insert responses from Question 1 health conditions or health drivers]
Demographic Questions
1. Please select any of the categories below that best describes your current position. 2. Please select the San Diego County Region(s) that you have experience with. (You may select more than one region) 3. Please select the categories that represent populations you have experience working with. If you have expert knowledge of vulnerable populations other than those described below, please add to the list. 4. Would you be interested in joining our CHNA Advisory Workgroup to examine and interpret the results of this survey at one or more in-person meetings? 5. The Hospital Association of San Diego and Imperial Counties (HASD&IC) values your responses to this survey. HASD&IC would like to ask your permission to quote your open ended anonymous responses in its final CHNA report if helpful to illustrate a specific point.
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Appendix
F Key Informant Interview Questions1
1. From your perspective, which of the following are the most pressing health issues for San Diego?
a. Acute respiratory infections b. Asthma c. Back pain d. Breast cancer e. Cardiovascular disease f. Colorectal cancer g. Dementia/Alzheimer’s h. Diabetes, Type II i. High risk pregnancy j. Lung cancer k. Mental health/mental illness l. Obesity m. Prostate cancer n. Skin cancer o. Unintentional injuries
2. What do you think are the most important modifiable risk factors related to these health issues?
3. What strategies do you think would be most effective in addressing the health conditions or modifiable risk factors above?
4. What resources need to be developed in order to address the health conditions or modifiable risk factors above?
1 Key Informant Interview Questions were developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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5. Are there systems or policy changes that, if implemented, could help the hospitals address these health conditions or modifiable risk factors?
6. Did you complete the electronic survey?
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Appendix
G Community Forum Questions1
1. What are the five most important health issues for adults and five most important health issues for children in your community?
2. How would you rate these health issues from most important to least important?
3. What do you think are the most important things that you and other people in your community can do to address these health conditions?
a. What currently prevents you from doing this?
4. Do you go to the hospital?
a. If yes, what do you go to the hospital for?
5. What can hospitals do to help you more with your health issues?
6. Is there something that you need in your neighborhood that would help you be healthier?
1 Community Forum Focus Group Questions were developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) for community forums conducted as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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Appendix SCHHC Key Informant Interview H Questions: Senior Health and End-of-Life Care
Sharp Senior Health Center- Downtown Key Informant Interview Questions1 1. Tell me a little about what you do – your role in the senior community.
2. From your perspective, what have you observed as the most pressing health issues for San Diego seniors? Below are potential responses, but please feel free to add on to these.
a. Acute respiratory infections b. Asthma c. Back pain d. Cancer e. Cardiovascular disease f. Dementia/Alzheimer’s g. Diabetes, Type II h. Mental health/behavioral health i. Obesity j. Unintentional injuries
3. What do you think are the most important modifiable risk factors related to these health issues (e.g., access, etc.)?
4. What strategies do you think would be most effective in addressing the health conditions or modifiable risk factors above?
5. What resources need to be developed in order to address the health conditions or modifiable risk factors above?
1 Questions are sourced from Key Informant Interview Questions developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) for key informant interviews conducted as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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6. Are there systems or policy changes that, if implemented, could help the hospitals address these health conditions or modifiable risk factors?
Sharp HospiceCare Key Informant Interview Questions1
1. Tell me a little about what you do – your role in the end-of-life care community.
2. From your perspective, which of the following are the most pressing end- of-life health issues for San Diego (clinical and/or social)?
3. What do you think are the most important modifiable risk factors related to these health issues (e.g., access to care, culturally appropriate educational materials?)?
4. What strategies do you think would be most effective in addressing end- of-life care issues or the modifiable risk factors above?
5. What resources need to be developed in order to address end-of-life health care issues or the modifiable risk factors above?
6. Are there systems or policy changes that, if implemented, could help the hospitals address these health conditions or modifiable risk factors?
1 Questions are sourced from Key Informant Interview Questions developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) for key informant interviews conducted as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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Appendix SCHHC Community Member I Feedback Survey Questions: Coronado and Imperial Beach
Good morning. Sharp Coronado Hospital is working on a Community Health Needs Assessment (CHNA) in order to develop specific programs that meet community health needs, and we would like to hear from you about the health concerns within your community. In addition we would like to get your thoughts about ways you think Sharp Coronado Hospital can better help with your health needs. We will take the information we learn from you to help us better serve your community when developing outreach programs or educational activities.
Sharp Coronado and Imperial Beach Community Feedback Questions1 1. What are the five most important health issues for adults and five most important health issues for children in your community?
2. How would you rate these health issues from most important to least important?
3. What do you think are the most important things that you and other people in your community can do to address these health conditions?
a. What currently prevents you from doing this?
4. Do you go to the hospital?
a. If yes, what do you go to the hospital for?
5. What can hospitals do to help you more with your health issues?
6. Is there something that you need in your neighborhood that would help you be healthier?
1 Questions are sourced from Community Forum Focus Group Questions developed by the Institute for Public Health (IPH) at San Diego State University (SDSU) for community forums conducted as part of the 2013 San Diego County Community Health Needs Assessment (CHNA) in collaboration with the Hospital Association of San Diego and Imperial Counties (HASDIC) and hospitals throughout San Diego County.
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Appendix Map of Community and Region J Boundaries in San Diego County
Map created by Sharp Strategic Planning Department, January 2010.
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Appendix
K Map of Sharp HealthCare Locations
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Appendix Sharp HealthCare Involvement in L Community Organizations The list below shows the involvement of Sharp executive leadership and other staff in community organizations and coalitions in Fiscal Year 2012. Community organizations are listed alphabetically.
. 2-1-1 San Diego Board . Access to Independence . Adult Protective Services . Aging and Independence Services (AIS) . Alzheimer’s Association . American Association of Critical Care Nurses, San Diego Chapter . American Cancer Society (ACS) . American College of Cardiology . American College of Healthcare Executives (ACHE) . American Diabetes Association (ADA) . American Health Information Management Association . American Heart Association . American Hospital Association . American Lung Association (ALA) . American Liver Foundation . American Parkinson Disease Association, Inc. . American Psychiatric Nurses Association . American Red Cross of San Diego . Arthritis Foundation (AF) . Association for Ambulatory Behavioral Health Care (National) . Association for Ambulatory Behavioral Health Care of Southern California . Association for Clinical Pastoral Education . Association of California Nurse Leaders (ACNL) . Association of Practical and Professional Ethics (APPE) . Association of Rehabilitation Nurses . Association of Women’s Health and Obstetric Neonatal Nurses (AWHONN) . Azusa Pacific University . Bankers Hill Park West Community Development Corporation . Bayside Community Center . Boys and Girls Club of San Diego . Bonita Business and Professional Organization . California Association of Health Plans . California Association of Hospitals and Health Systems . California Association of Physician Groups . California Behavioral Health Board . California College, San Diego . California Council for Excellence
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. California Department for Public Health . California Dietetic Association, Executive Board . California HealthCare Foundation . California Health Information Association . California Hospice and Palliative Care Association . California Library Association . California Nursing Student Association . California State Bar, Health Subcommittee . California State University – San Marcos . California Teratogen Information Service . California Women Lead . Caring Hearts Medical Clinic . Chelsea’s Light Foundation . Community Health Improvement Partners (CHIP) Behavioral Health Work Team . CHIP Board . CHIP Health Literacy Task Force . CHIP Suicide Prevention Work Team . CHIP Independent Living Facilities (ILF) Work Team . Chula Vista Chamber of Commerce . Chula Vista Community Collaborative . Chula Vista Family Health Center . Chula Vista Rotary . City of Chula Vista Wellness Program . Community Emergency Response Team (CERT) . Consortium for Nursing Excellence, San Diego . Coronado Chapter of Rotary International . Coronado Christmas Parade . Coronado Fire Department . Creative Arts Consortium . Council of Women’s and Infants’ Specialty Hospitals (CWISH) . Cycle Eastlake . Diabetes Behavioral Institute . Disabled Services Advisory Board . Downtown San Diego Partnership . East County Senior Service Providers . El Cajon Community Collaborative Council . El Cajon Fire Department . El Cajon Rotary . Emergency Nurses Association, San Diego Chapter . Employee Assistance Professionals Association . EMSTA College . Facing Futures . Family Health Centers of San Diego (FHCSD) . Gardner Group . George Stevens Senior Center . Girl Scouts San Diego Imperial Council, Inc.
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. Grossmont College . Grossmont Healthcare District . Grossmont Union High School District . Health Care Communicators Board . Helen Woodward Animal Center . Helix Charter High School . Helping Older People Equally (HOPE) . Home of Guiding Hands . Hospital Association of San Diego and Imperial Counties (HASDIC) . HASDIC Community Health Needs Assessment Advisory Group . Health Sciences High and Middle College (HSHMC) Board . I Love a Clean San Diego . International Association of Eating Disorders Professionals (IAEDP) . International Lactation Consultants Association (ILCA) . Jewish Family Services of San Diego . John Brockington Foundation . Kaplan College Advisory Board . Kiwanis Club of Chula Vista . Komen Latina Advisory Council . Komen Race for the Cure Committee . La Maestra Family Clinics . La Mesa Lion’s Club . La Mesa Park and Recreation Foundation Board . Las Hermanas . LEAD, San Diego, Inc. . Leukemia & Lymphoma Society . Liberty Charter High School . Mama’s Kitchen . March of Dimes . Meals-on-Wheels Greater San Diego . Medical Library Group of Southern California and Arizona . Mended Hearts . Mental Health America Board . Mental Health Coalition . Miracle Babies . Mountain Health and Community Services, Inc. Advisory Board . MRI Joint Venture Board . National Alliance on Mental Illness (NAMI) . National Association of Neonatal Nurses (NANN) . National Association of Hispanic Nurses (NAHN), San Diego Chapter . National Association of Psychiatric Healthcare Systems . National Council on Alcoholism and Drug Dependence (NCADD) . National Hospice and Palliative Care Association . National Initiative for Children’s Healthcare Quality . National Kidney Foundation . National Perinatal Information Center
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. National University . Neighborhood Healthcare Community Clinic Board of Directors . NurseWeek . Orchard Apartments . Pacific Arts Movement (Pac-Arts, formerly the San Diego Asian Film Foundation) . Parents for Addiction, Treatment and Healing (PATH) . Partnership for Philanthropic Planning of San Diego (formerly San Diego Planned Giving Roundtable) . Partnership for Smoke-Free Families . Peninsula Shepherd Senior Center . Perinatal Safety Collaborative . Perinatal Social Work Cluster . Planetree Board of Directors . Professional Oncology Network . Project CARE Council . Public Health Nurse Advisory Board . Recovery Innovations of California (RICA) . Regional Home Care Council . Regional Perinatal System . Residential Care Council . Safety Net Connect . San Diego Community Action Network (SanDi-Can) . San Diegans for Healthcare Coverage . San Diego Healthcare Disaster Council . San Diego Association for Diabetes Educators . San Diego Association of Directors of Volunteer Services . San Diego Association for Healthcare Recruitment . San Diego Black Nurses Association . San Diego Blood Bank . San Diego Brain Injury Foundation . San Diego Caregiver Coalition . San Diego City College . San Diego City Parks and Recreation . San Diego Committee on Employment of People with Disabilities . San Diego Council on Suicide Prevention . San Diego County Perinatal Care Network . San Diego County Taxpayers Association . San Diego Diabetes Coalition . San Diego Dietetic Association Board . San Diego East County Chamber of Commerce Board . San Diego Emergency Medical Care Committee . San Diego Eye Bank Nurses Advisory Board . San Diego Food Bank . San Diego Foundation . San Diego Health Information Association
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. San Diego Healthcare Disaster Council . San Diego Imperial Council of Hospital Volunteers . San Diego Interreligious Committee . San Diego Lesbian, Gay, Bisexual, and Transgender Community Center, Inc. (The Center) . San Diego Mental Health Coalition . San Diego Mesa College . San Diego North Chamber of Commerce . San Diego Nutrition Council . San Diego Organization of Healthcare Leaders (SOHL), a local ACHE Chapter . San Diego Patient Safety Consortium . San Diego Regional Energy Office . San Diego Regional Homecare Council . San Diego Rescue Mission . San Diego Restorative Justice Mediation Program . San Diego Stroke Consortium . San Diego Urban League . San Diego-Imperial Council of Hospital Volunteers . San Diego Regional Chamber of Commerce . San Diego Science Alliance . San Ysidro High School . San Ysidro Middle School . Santee Chamber of Commerce . Schizophrenics in Transition . San Diego State University (SDSU) . Senior Community Centers of San Diego . Sigma Theta Tau International Honor Society of Nursing . Society of Trauma Nurses . South Bay Community Services . South County Economic Development Council . Southern California Association of Neonatal Nurses . St. Vincent de Paul Village . Susan G. Komen Breast Cancer Foundation . Sustainable San Diego . Sweetwater Union High School District (SUHSD) . The Meeting Place . Third Avenue Charitable Organization (TACO) . Trauma Center Association of America . United Way of San Diego County . University of California, San Diego (UCSD) . University of San Diego (USD) . VA San Diego Healthcare System . Veterans Home of Chula Vista . Veterans Village of San Diego . Vista Hill ParentCare . Women, Infants and Children (WIC)
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. YMCA . YWCA Becky’s House® . YWCA Board of Directors . YWCA Executive Committee . YWCA In the Company of Women Event
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Appendix M Glossary of Abbreviations
BMI Body Mass Index BRFSS Behavioral Risk Factor Surveillance System CDC Centers for Disease Control and Prevention CHIS California Health Information Survey CHNA Community Health Needs Assessment CNI Community Need Index CUPID California Universal Patient Information Discovery CVD cardiovascular disease FPL federal poverty level FY fiscal year GI gastrointestinal GIS Geographical Informational Systems HASD&IC Hospital Association of San Diego and Imperial Counties HHSA Health and Human Service Agency IPH Institute for Public Health LBP low back pain NIH National Institute of Health PPACA Patient Protection and Affordability Care Act OSHPD Office of Statewide Health Planning and Development SCHHC Sharp Coronado Hospital and Healthcare Center SCVMC Sharp Chula Vista Medical Center SGH Sharp Grossmont Hospital SHC Sharp HealthCare SHP Sharp Health Plan SMBHWN Sharp Mary Birch Hospital for Women & Newborns SMH Sharp Memorial Hospital SMC Sharp McDonald Center SMV Sharp Mesa Vista Hospital SDSU San Diego State University WHO World Health Organization
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