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Northeast Community Health Needs Assessment

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Northeast Community Health Needs Assessment Jefferson Health – Northeast Community Health Needs Assessment June 2018 Acknowledgements Authors and originators: Rickie Brawer, PhD, MPH, MCHES, Associate Director, Center for Urban Health, Thomas Jefferson University Hospital and Assistant Professor, Department of Family and Community Medicine, Jefferson University, Sidney Kimmel Medical College Maria Cerceo Slade, BA, MHA Vice President, Marketing, Jefferson Health – Northeast Consultant: Jane Elkis Berkowitz, MRP, MA Community Benefit Acknowledgement: Thank you to the key stakeholders in the Jefferson Health – Northeast communities who participated in the conversations, Community Health Need Assessment interviews, focus groups, and follow up meetings. Thank you to the Jefferson Health – Northeast administration, physicians, leaders, and employees who participated in interviews, focus groups, and follow up meetings. Table of Contents Executive Summary iii Introduction 1 Purpose of the Community Health Needs Assessment 5 Community Health Needs Assessment Methods 7 Community Health Needs Assessment Findings 11 Bucks and Philadelphia Counties and Jefferson Health – Northeast 12 Community Benefit Area Demographics Social Determinants of Health 16 Education 18 Income and poverty 18 Access to healthy and affordable food 22 Employment and job training 25 Community safety 28 Family and social support 29 Built and natural environment 33 Health Care Access 35 Health insurance 35 Transportation 39 Literacy 40 Cultural competence and language 42 Health Status 43 Mortality 43 Morbidity 48 o Asthma 48 o Cardiovascular Disease, Stroke, and Diabetes 49 o Obesity and nutrition education 56 o Mental health 58 o HIV Status 60 o Hospital re-admissions 60 Preventive Care and Early Detection of Disease 63 o Cancer screenings 65 o Dental care 69 Health Behaviors 70 o Smoking 70 o Physical activity 73 o Healthy and affordable food 75 o Substance abuse 79 i Communication 83 Special Populations 85 Older Adults 85 Immigrants and Refugees 114 Homeless 119 Recommendations 122 Appendices 125 References 144 ii Executive Summary Jefferson Health – Northeast is a Pennsylvania nonprofit organization with campuses in Philadelphia and Bucks County, Pennsylvania, that considers its community benefit service area to include proximate portions of Philadelphia and Bucks counties where almost 1,044,000 people live. This Community Health Needs Assessment (CHNA) utilizes information collected from the Public Health Management Corporation's household health survey, numerous secondary data and literature sources, and internal experts and external representatives of health care and community-based organizations who have knowledge of the health and social conditions of these communities. Jefferson Health – Northeast’s community benefit area is an area with diverse underlying economic and structural barriers such as income, culture/language, education, insurance, and housing that affect overall health. Although many health status indicators are improving, most are below the Healthy People 2020 goal (note that there is not a Healthy People 2020 target for many of the health status measures described in this CHNA). Racial/ethnic and income disparities exist, and for most indicators, people of color and/or Hispanic origin fare worse than their white neighbors. In addition to extensive information about the population residing in the community benefit areas, this CHNA includes focused sections on the following special populations: adults age 60+, immigrants/refugees, and the homeless. There is a portion of the population in serious need of support for a variety of issues. The following are health status measures related to the overall population that do not meet the Healthy People 2020 goal in Bucks and/or Philadelphia counties and/or the Jefferson Health – Northeast 's community benefit (CB) service areas: Insured adults age 18-64 Regular source of care (adults, age 60+) Hypertension (adults, age 60+) Obesity (Philadelphia adults, age 60+) HIV testing (adults, age 60+) PAP testing (adults, age 60+) Mammography (adults, age 60+) Smokers (adults, age 60+) Smokers who tried to quit (adults, age 60+) Mortality in Bucks: female breast, substance abuse Mortality in Philadelphia: bronchus and lung cancer, female breast cancer, male prostate cancer, colo-rectal cancer, diabetes, coronary heart disease, cerebrovascular disease, substance abuse In addition, the Pennsylvania Department of Health 2015-2020 State Health Improvement Plan's top 5 priorities for Southeastern Pennsylvania are: integration of healthcare and behavioral/mental healthcare iii preventive screenings obesity behavioral/mental health for adults primary care Using the quantitative and qualitative data presented in this CHNA and a prioritization process, Jefferson Health – Northeast identified the following most important priority health needs for the population of the Jefferson Health – Northeast CB areas: Chronic Disease Management (diabetes, heart disease and hypertension, stroke, asthma) Alcohol/Substance Abuse Smoking Cessation Access to Healthy Affordable Food and Nutrition Education and Food Security Health Education, Social Services and Regular Source of Care Social and Health Care Needs of Older Adults Women’s Cancer The mission of the Community Benefit Committee at Jefferson Health – Northeast is to develop targeted health outreach programs and screenings in response to the identified needs of its community in concert with the mission of Jefferson Health: We Improve Lives. iv Introduction Over the past century the major causes of morbidity and mortality in the United States have shifted from those related to communicable diseases to those due to chronic diseases. Just as the major causes of morbidity and mortality have changed, so too has understanding of health and what makes people healthy or ill. Research has documented the importance of the social determinants of health (for example, socioeconomic status and education), which affect health directly as well as through their impact on other health determinants such as risk factors. Targeting interventions toward the conditions associated with today’s challenges to living a healthy life requires an increased emphasis on the factors that affect the current causes of morbidity and mortality, factors such as the social determinants of health. Many community-based prevention interventions target such conditions. Community-based prevention interventions offer three distinct strengths. First, because the intervention is implemented population-wide it is inclusive and not dependent on access to the health care system. Second, by directing strategies at an entire population an intervention can reach individuals at all levels of risk. And finally, some lifestyle and behavioral risk factors are shaped by conditions not under an individual’s control. For example, encouraging an individual to eat healthy food when none is accessible undermines the potential for successful behavioral change. Community-based prevention interventions can be designed to affect environmental and social conditions that are out of the reach of clinical services.1 Description of Jefferson Health – Northeast Announced July 6, 2016, Thomas Jefferson University (TJU), a Pennsylvania nonprofit organization that is exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code, became the sole corporate member of Aria Health, now d/b/a Jefferson Health – Northeast. As a result of this transaction, Jefferson Health – Northeast and its subsidiaries, Jefferson Frankford Hospital, Jefferson Torresdale Hospital, Jefferson Bucks Hospital, its physician company and the Jefferson Health – Northeast Foundation (collectively, the “Subsidiaries”), became subsidiaries of TJU, joining the university health system known as Jefferson that encompasses Thomas Jefferson University plus Jefferson Health. Jefferson Health – Northeast is the Jefferson Health entity that encompasses its flagship hospital, Jefferson Torresdale Hospital in Northeast Philadelphia, Jefferson Frankford Hospital, also serving Northeast Philadelphia, and Jefferson Bucks County in Langhorne, PA, as well as a number of outpatient settings and a broad physician practice network serving the same geography. Jefferson Health – Northeast includes the following: Three hospitals: Jefferson Frankford Hospital, Jefferson Torresdale Hospital, and Jefferson Bucks Hospital combined have 485 licensed beds Four outpatient sites: Jefferson Health – The Pavilion, Jefferson Health – The Annex, Jefferson Health – The Professional Court, and Jefferson Health – Center for Rehabilitation and Wellness 1 Two Jefferson Health urgent care centers, one in Northeast Philadelphia on Grant Avenue and one in Bensalem, PA Jefferson Medical Group are employed and leased physician practices located in Northeast Philadelphia and Bucks County with almost 50 locations • Jefferson Health – Northeast, founded as Frankford Hospital in 1903, is the largest community teaching hospital serving Northeast Philadelphia and Bucks County. Staff members have the privilege of working with medical students, residents and fellows from various medical schools and training programs in the Philadelphia area. The hospital sponsors six residency programs: emergency medicine, family medicine, internal medicine, combined emergency medicine/internal medicine, combined emergency medicine/family medicine, and podiatry, and fellowship programs in critical care and orthopaedic sports medicine.
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