DISTRICT OF COLUMBIA COMMUNITY HEALTH NEEDS ASSESSMENT JUNE 2016 This report summarizes a community health needs assessment (CHNA) for the District of Columbia (DC) developed by the DC Healthy Communities Collaborative (DCHCC): a coalition of four hospitals (Children’s National Health System, Howard University Hospital, Providence Health System, and Sibley Memorial Hospital) and four federally qualified health centers (Bread for the City, Community of Hope, Mary’s Center, and Unity Health Care). Lead Authors: Chaya Merrill, DrPH; Linda Cottrell, MPH; and, Kimberle Searcy, MPH Children’s National Health System on behalf of the DC Healthy Communities Collaborative Questions related to this report can be directed to: [email protected] Letter of Commitment to Our Community The District of Columbia Healthy Communities Collaborative (DCHCC) is pleased to share with you our 2016 Community Health Needs Assessment. Since our beginning in 2012, the Collaborative has been committed to improving the lives and health of people living in our communities. This report is a tangible representation of our continued commitment to that goal. Building on our 2013 community health needs assessment and the information shared on our DC Health Matters website (www.dchealthmatters.org), the 2016 assessment represents a shift from a focus on individual clinical conditions to larger social determinants of health. In order to achieve this shift in direction, this assessment placed a much larger emphasis on having our community’s perspective shape this work. As a result, this report includes community thoughts from the following: • 113 online survey respondents, • 80 community forum attendees, • 60 community-based organizations, • 40 focus group participants, • 31 key informant interviews, • 15 hospitals and community health centers, • 11 government agencies, and • 8 elected officials, including DC Councilmembers and Advisory Neighborhood Commissioners. This wealth of qualitative data allowed us to fulfill our commitment to the community by prioritizing their needs in our assessment. The implementation plan that will be developed from this assessment is our roadmap to improving the health of District of Columbia residents. The Collaborative would like to thank everyone who was involved in development of this assessment. We would also like to thank you for reading this report, and your interest and commitment to improving the health of all of our District of Columbia communities. Thank you, Angelica Journagin, JD, MHA Chairperson, District of Columbia Healthy Communities Collaborative Unity Health Care, Inc. Unity Health Care, Inc. Letter of Commitment to Our Community i Executive Summary The DC Healthy Communities Collaborative - a unique collaboration among four DC hospitals (Children’s National Health System, Howard University Hospital, Providence Health System, and Sibley Memorial Hospital); four community health centers (Bread for the City, Community of Hope, Mary’s Center, and Unity Health Care); and two associations (DC Hospital Association and DC Primary Care Association) - authored this community health needs assessment to serve as an evidence-based, community-driven foundation for our community health improvement efforts. Four priority community needs emerged: MENTAL PLACE-BASED CARE HEALTH HEALTH CARE COORDINATION LITERACY to the identified priority areas. Per the most BACKGROUND: THE IMPETUS FOR ACTION recent regulations, the needs assessment and improvement plan must be adopted by New hospital community benefit requirements hospital boards as a measure of true integration within the Patient Protection and Affordable into each hospital’s strategic and operational Care Act of 2010 (ACA) shines light on non- priorities. While the needs assessment profit hospitals’ special obligation to invest in requirement was new for hospitals, federally- community needs. The ACA requires all non- qualified health centers have been held to a profit hospitals to develop a community health comparable requirement for decades and served needs assessment with an evidence-based as key partners in this initiative. planning and prioritization process. Hospitals are further required to adopt strategies to address In an effort to promote collaborative work that the identified needs. This strategy, formally reduces redundancy and positions us to make called the “Implementation Strategy”—often a meaningful impact on health, DC hospitals referred to as a community health improvement and community health centers voluntarily plan (CHIP)—guides hospitals’ investment came together in 2012 to form a coalition – the ii District of Columbia | Community Heath Needs Assessment DC Healthy Communities Collaborative – that would issue a joint community health needs DATA: MERGING COMMUNITY PERSPECTIVE assessment and improvement plan. To date, AND QUANTITATIVE DATA the Collaborative has sponsored two needs assessments – one in 2013 (contracted out to We used a mixed-methods approach – a the RAND Corporation) and this current 2016 combination of qualitative and quantitative data report (conducted in-house by the DC Healthy – to provide a balanced and comprehensive Communities Collaborative). view of health and well-being for DC residents. Community Perspective (Qualitative Data) KEY OBJECTIVES OF THIS REPORT In our qualitative work, we engaged with 300+ community stakeholders across a diverse cross The purpose of this assessment is to lay the section of DC spanning health and non-health foundation for community health improvement disciplines. Using structured data collection tools, efforts that lead to a more equitable state of we probed stakeholders about their perspectives health for DC residents. We present the most on health and well-being in DC, the facilitators recent data available at time of analysis – and inhibitors to leading healthy lives, and their generally 2015 data – as well as trend data from recommendations for improving health. We 2010 to 2014. The key objectives of this report conducted 39 individual interviews with leaders include: from 21 health care institutions, 12 administrators of local government agencies, and six members 1. Engage community stakeholders in a bi- of the Council of the District of Columbia. directional dialogue to identify unmet Additionally, we hosted five focus groups community needs related to health and well- with staff from 60 different community-based being. organizations and social service agencies. We also conducted two public town hall meetings 2. Describe the socio-demographic that each drew about 80 participants. DC characteristics, health behaviors, health status, residents, community representatives, and health and health care utilization of DC residents care providers completed 113 online surveys. with attention to differences by place of The qualitative analysis revealed nine pressing residence (ward), race, ethnicity, age, and sex. community health needs: care coordination, food insecurity, place-based care, mental health, 3. Arrive at a set of high priority community- health literacy, healthy behaviors, health data defined needs that set the foundation dissemination, community violence, and cultural for the Collaborative’s community health competency. improvement efforts. Population, Health Status, and Health Behavior Data (Quantitative Data) Note: This 2016 assessment represents a shift from a focus on individual clinical conditions to In our quantitative work, we relied largely on larger social determinants of health that affect a data within the DC Health Matters portal. We wide range of health and quality-of-life outcomes. used census data to provide a basic landscape In order to achieve this shift in direction, we of DC population characteristics, including placed a much larger emphasis on having our socioeconomic factors, such as those related to community’s perspective shape this work. poverty, education, and housing. We organized the bulk of the remaining data in the Healthy Executive Summary iii People 2020 framework, with a specific focus These four prioritized community needs cut on the Leading Health Indicators, ranging across nearly all clinical conditions and often from preventive services to access to care to contribute to health outcomes. The quantitative substance abuse. Additionally, we analyzed data (e.g., prevalence of specific health hospital, emergency department and community conditions, variations in preventive behavior by health center data to offer important insights race, geographic concentration of ED visits, etc.) into health care utilization among DC residents. guide the Collaborative in deciding where, within These data serve as proxy indicators of health each of the prioritized community needs, to care access and the efficacy of preventive and invest our resources for the greatest impact. primary care services. The quantitative analysis revealed troubling variances in health, well-being and preventive behaviors that often correlate with place of residence, race, and ethnicity. NEXT STEPS The Collaborative commits to working jointly with our community partners to address the IDENTIFYING AND PRIORITIZING aforementioned needs in a community-engaged, COMMUNITY NEEDS measurable fashion that will move DC closer to the state of health equity. Our efforts will be Analysis of the qualitative and quantitative data documented and disseminated in a data-driven revealed a series of community needs. We used community health improvement plan that will a structured prioritization process – a modified