Bronx CNA Report November, 2014 New York City Health Provider Partnership Bronx Community Needs Assessment Final Draft November 14, 2014 Prepared by the New York Academy of Medicine Bronx CNA Report November, 2014 TABLE OF CONTENTS Table of Contents ...............................................................................................................................1 Overview ...........................................................................................................................................2 Introduction .................................................................................................................................... 20 Background ............................................................................................................................................. 20 Section A. Description of Health Care Resources and Community Resources ...................................... 21 Sections i and ii ....................................................................................................................................... 21 Community Based Resources .............................................................................................................. 21 Community Service Organizations ...................................................................................................... 28 Section iii Domain 2 Metrics ................................................................................................................... 31 Section B. Description of the Community to be Served ...................................................................... 32 Section i: Demographics of the Bronx Population .................................................................................. 32 Section ii: Health Status .......................................................................................................................... 50 BEHAVIORAL HEALTH .......................................................................................................................... 61 ASTHMA/RESPIRATORY CONDITIONS ................................................................................................. 64 Health Care Resources ........................................................................................................................ 65 CARDIOVASCULAR DISEASE ................................................................................................................ 79 DIABETES ............................................................................................................................................. 80 HIV/AIDS and STDs .............................................................................................................................. 81 MATERNAL/CHILD HEALTH ................................................................................................................. 83 OBESITY ............................................................................................................................................... 84 TOBACCO USE/CESSATION .................................................................................................................. 85 ACCESS TO AND QUALITY OF HEALTH CARE IN NEW YORK STATE BY INSURANCE STATUS ............... 86 Section C: Identification of the Main Health and Health Services Challenges ...................................... 90 Section D: Summary of the Assets and Resources that Can Be Mobilized ......................................... 101 Section F: Documentation of the Process and Methods ................................................................... 103 Methods: Primary Source Data ............................................................................................................. 103 Partnering with Community-based Organizations ............................................................................... 105 Methods: Secondary Source Data......................................................................................................... 107 List of Appendices .......................................................................................................................... 113 Glossary of Key Terms .................................................................................................................... 113 1 Bronx CNA Report November, 2014 Bibliography .................................................................................................................................. 117 OVERVIEW The goal of the Delivery System Reform Incentive Payment (DSRIP) program is to promote community- level collaborations and focus on system reform in order to reduce avoidable inpatient admissions and emergency room visits by 25% over 5 years for the Medicaid and uninsured populations in New York State. To inform the health system transformation that is required under the DSRIP program, several emerging Performing Provider Systems (PPSs) contracted with The New York Academy of Medicine (NYAM) to complete a Bronx-wide Community Needs Assessment (CNA). The CNA was governed and monitored by a Steering Committee consisting of representatives from each of the following emerging PPSs: A W Medical; The New York City Health and Hospitals Corporation (HHC) including representatives from their central office, Jacobi Medical Center (HHC), and Lincoln Medical Center (HHC); and St. Barnabas Hospital (dba SBH Health System). The specific aims of the CNA process are to: Describe health care and community resources, Describe communities served by the PPSs, Identify the main health and health service challenges facing the community, and Summarize the assets, resources, and needs for the DSRIP projects. Methods NYAM utilized both primary and secondary data collection and analyses to inform this CNA. To ensure the perspective of community members and stakeholders was incorporated into the reported findings and to respond to specific questions that could not be sufficiently addressed through secondary source data alone, NYAM collected and analyzed primary data, including 24 key informant interviews (involving 30 individuals), 21 focus groups with community members and other stakeholders, and approximately 600 community surveys. NYAM developed the primary data protocol in collaboration with the PPSs using standard research methods consistent with DSRIP CNA guidance. Key Informant interview, focus group, and survey questions focused on community conditions conducive to health promotion, primary health concerns, available programing and services, disparities in access and use, and recommendations regarding strategies to promote improved health. NYAM collected this data, after IRB approval, in partnership with numerous community organizations, which were identified in collaboration with PPS representatives and represented a range of populations, e.g., older adults, immigrant populations, and people with disabilities, and neighborhoods. NYAM also used street outreach for survey administration, focusing on neighborhoods identified as having large numbers of Medicaid and/or uninsured populations. The data collection materials were translated into ten languages. Socio-demographic 2 Bronx CNA Report November, 2014 characteristics of survey respondents included: 48% Black/African American, 38% Latino, 10% Asian, 43% foreign born, 12% limited English proficient, 78% living below the poverty line, 52% on Medicaid and 12% uninsured. The mean age of respondents was 46, with a range of 18 to 95. The NYAM team analyzed the data using standard qualitative and quantitative methods; we have reported common themes, as appropriate, throughout the report. NYAM also conducted a review of secondary source data, including an analysis of more than 70 data sets, and a review of the literature, including existing hospital community health needs assessments and community reports. (See Section F. of this report and the attached Bibliography for a detailed list.) Summary of Findings The population in the Bronx is burdened by a myriad of health challenges and socioeconomic circumstances that foster poor health outcomes. It is the least healthy county in New York State, and has high rates of chronic disease such as diabetes, cardiovascular disease, and respiratory disease including asthma/COPD, cancer and high rates of obesity.1 The Bronx leads New York State in the percentage of premature deaths in people aged less than 65 years; 2 the leading causes of these deaths in the county are cancer, heart disease, unintentional injury, AIDS and diabetes.3 The Bronx also outpaces NYC overall in household poverty and low educational attainment, and is approximately on par with city rates of unemployment and health insurance.4 More than half of the Bronx population speaks a language other than English in the home, and many are immigrants, presenting possible additional cultural and regulatory challenges to health care access.5 Among the Medicaid population, the Bronx ranks highest among all boroughs in NYC in the rate of potentially preventable inpatient hospitalizations, including for chronic conditions overall and for certain chronic conditions such as circulatory conditions, respiratory conditions and diabetes.6 It also ranks second among the NYC boroughs in the rate of preventable emergency room visits (PPV).7 From the perspective of the community, the main health issues include diabetes, obesity, cancer, cardiovascular disease, asthma, violence and behavioral health issues, including