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 Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Page i 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. Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Page ii 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. Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Page iii 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. Sharp Coronado Hospital and Healthcare Center Community Health Needs Assessment Page iv 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