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 Marianna Calabrese, MA, Manager, Community Benefit Kathryn McCarter, RN, MSHA, CCP, Director of Community Health Consultants: Jane Elkis Berkowitz, MRP, MA Karen Arnone, Financial and Market Planning Community Benefit Acknowledgement: Thank you to the key community stakeholders in the Abington and Lansdale communities who participated in the conversations, Community Health Need Assessment interviews, focus groups, and follow up meetings. Thank you to the Abington - Jefferson Health administration, physicians, leaders, and employees who participated in interviews, focus groups, and follow up meetings. We would like to acknowledge the time and continued support of the Abington Health Foundation Community Benefit Committee for their time, expertise, leadership, and support during the process. Table of Contents Executive Summary ii Introduction 1 Purpose of the Community Health Needs Assessment 5 Community Health Needs Assessment Methods 8 Community Health Needs Assessment Findings 13 Bucks/Montgomery Counties and Abington-Lansdale Community Benefit Area Demographics 14 Social Determinants of Health 18 Health Care Access 36 Health Status Mortality 46 Maternal and Child Health 52 Morbidity 57 Preventive Care and Early Detection of Disease 75 Health Behaviors 84 Special Populations Older Adults 99 Immigrants and Refugees 130 Homeless 135 Recommendations 137 Appendices 140 References 168 i Executive Summary Abington - Jefferson Health (AJH) is a Pennsylvania nonprofit organization located in Montgomery County, Pennsylvania that considers its community benefit service area to include proximate portions of Montgomery and Bucks counties where almost 544,000 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. AJH's community benefit area is an area with relatively low underlying economic and structural barriers such as income, culture/language, education, insurance, and housing, that affect overall health. Most health status indicators are improving, and many are better than 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. While the majority of health status measures indicate minimal to moderate deficiencies or hardship, 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/Montgomery Counties and/or the Abington-Lansdale CB service areas: Insured adults and children Regular source of care (children, adults, age 60+) First trimester prenatal care Hypertension (adults, age 60+) HIV testing (adults, age 60+) PAP testing (adults, age 60+) Mammography (age 60+) Smokers who tried to quit (adults, age 60+) Female breast cancer mortality Stroke mortality Although some of measures exceed the Healthy People 2020 goal, according to the Centers for Disease Control Community Health Status Indicators methodology, the following are in the least favorable quartile when compared to peer counties: Bucks Montgomery Overall cancer deaths X Motor vehicle deaths X Stroke deaths X Unintentional injury (including motor vehicle) deaths X ii Bucks Montgomery Older adult depression X X Alzheimers/Dementia X X Adult smoking X Cancer morbidity X Syphilis X Gonorrhea X Older adult preventable hospitalizations X Adult female routine PAP tests X Inadequate social support X Unemployment X 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 preventive screenings obesity behavioral/mental health for adults primary care Using the quantitative and qualitative data presented in this CHNA and a prioritization process, AJH identified the following most important priority health needs for the population of the Abington- Lansdale CB areas: Mental Health Services Social and Health Care Needs of Older Adults Obesity Alcohol/ Substance Abuse Women's Cancer Chronic Disease Management (diabetes, heart disease and hypertension, stroke, asthma) Health Education, Social Services and Regular Source of Care The Community Health Department of Abington Jefferson Health, working under the guidance of the Abington Health Foundation Community Benefit Committee is responsible for developing implementation plans focusing on priority issues including the above listed most important health needs. iii 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 Abington Jefferson Health Effective April 30, 2015 at 11:59 pm, 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 Abington Health (AH). As a result of this transaction, AH and its subsidiaries, Abington Memorial Hospital, Lansdale Hospital, and Abington Health Foundation (collectively, the "Subsidiaries"), became subsidiaries of TJU, creating a university health system, known as Jefferson, that encompasses Thomas Jefferson University plus Jefferson Health, the new combined clinical brand for the five hospitals and physician networks within the system. The newly named Abington – Jefferson Health (AJH) is the organization that encompasses its flagship hospital, Abington Hospital in Abington, PA (the largest community teaching hospital in Montgomery or Bucks counties) and Abington – Lansdale Hospital in Hatfield Township, PA, as well as a number of outpatient settings for obtaining expert medical care in Bucks, Montgomery, and Philadelphia counties. Abington – Jefferson Health entities include the following: Two hospitals: Together, Abington – Lansdale Hospital and Abington Hospital have 800 licensed beds Five outpatient campuses: Abington Health Center – Blue Bell, Abington Health Center – Lower Gwynedd, Abington Health Center – Montgomeryville, Abington Health Center – Warminster and Abington Health Center – Willow Grove Two urgent care centers, one in Feasterville and one in Flourtown 1 Abington Health Physicians – Physician practices located in Bucks, Montgomery, and Philadelphia counties with 65 locations Abington Hospital, founded in 1914, is the largest community teaching hospital in Montgomery or Bucks counties. 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 five residency programs: family medicine, internal medicine, obstetrics/gynecology, general surgery and dentistry. In addition, the hospital provides postgraduate medical education in affiliation with several area medical schools. Abington also operates the Dixon School of Nursing and supports a pharmacy residency program. Each year, AJH treats 125,000 patients in its two Emergency Departments with Abington Hospital having