USC University Hospital 2010 COMMUNITY HEALTH NEEDS ASSESSMENT

Transcription

1 USC University Hospital 2010 COMMUNITY HEALTH NEEDS ASSESSMENT Published February 2011

2 Contents Introduction... 3 Background and Purpose... 3 Methods... 4 Primary Data Collection... 4 Secondary Data Collection... 4 Maps... 4 Overview of Key Findings and Community Needs... 5 Community Profile... 7 Population... 7 Race/Ethnicity... 8 Income... 9 Unemployment... 9 Poverty...10 Housing and Households...10 Language...11 Education...11 Birth and Death Characteristics...12 Births...12 Teen Pregnancy...12 Prenatal Care...12 Low Birth Weight and Infant Mortality...13 Deaths...13 Death and Premature Death by Race/Ethnicity...14 Access to Health Care...15 Health Insurance...15 Barriers to Care...16 Chronic Disease...16 Chronic Diseases among Adults...16 Childhood Asthma...17 AIDS Infection...17 STD Cases...17 Tuberculosis...18 Preventive Practices...18 Social Issues...19 Overweight and Obesity...19 Access to Safe Places to Play

3 Fast Food Consumption...19 Soda Consumption...20 Fresh Fruits and Vegetables...20 Physical Activity...20 Alcohol, Tobacco and Drug Use...21 Youth Alcohol, Tobacco and Drug Use...21 Mental Health...21 Homelessness...22 Key Stakeholder Interviews...23 The Hospital s Charitable Mission and Purpose...23 Biggest Issues or Concerns...24 Causes of Issues of Concern...25 Current Activities in the Community to Address Issues...25 Other Possible Solutions for Stated Issues...26 Demographic Trends...27 Trends in the Economy and its Impact...27 Trends in the Health Care Provider Community...27 Trends in Community Health Status...28 Influencers of Health...28 Attitudes toward Health...28 Availability of Healthy Food Options...29 Changes in the Physical Environment Supporting or Limiting Physical Activity...29 Barriers to Care and Treatment for Chronic Conditions...29 What People do to Prevent Chronic Conditions from Worsening...30 Obesity...31 The Role Hospitals are Seen as Currently Playing...32 Role Which It Is Thought Hospitals Should Play...32 Recommendations for Improving Access to Care and Enhancing Public Health...33 Additional Information which USC University Hospital Needs To Know...34 Benchmark Comparisons...35 Attachment 1. Key Stakeholder Interviews...36 Attachment 2. USC University Hospital Service Area Maps

4 Introduction Background and Purpose USC University Hospital is a 411-bed acute care hospital staffed by the Doctors of USC, who are also faculty at the renowned Keck School of Medicine of the University of Southern California. USC University Hospital has undertaken a community health needs assessment as required by California law (SB 697). As well, the recent passage of the Patient Protection and Affordable Care Act requires tax exempt hospitals to conduct needs assessments and develop community benefit plans every three years. The community health needs assessment is a primary tool used by the Hospital to determine its community benefit plan, which outlines how the Hospital will give back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the service area. USC University Hospital is located east of downtown Los Angeles on USC s Health Sciences Campus. The Hospital draws patients regionally from Southern California, with a primary service area of Los Angeles County, California. 68% of the Hospitals patients originate from L.A. County, Within L.A. County, 22% of the Hospitals patients are from SPA 3, San Gabriel Valley; 11% are from SPA 2, San Fernando Valley; 10% from SPA 7, East; 9% from SPA 4, L.A. Metro; and 8% from SPA 8, South Bay. USC University Hospital and USC Norris Cancer Hospital Patients by Service Planning Area or County of Residence SPA or County Patient Count Percent of Total Los Angeles County 6,995 68% SPA % SPA 2 1,015 11% SPA 3 2,090 22% SPA % SPA % SPA % SPA % SPA % Orange County % San Bernardino County 508 5% Ventura County 352 4% Kern County 178 2% Other % USC Patient Zip Codes tabulated by the Center for Economic Development, CSU, Chico 3

5 Methods Primary Data Collection Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by the Hospital. For the interviews, community stakeholders, identified by USC University Hospital, were contacted and asked to participate in the needs assessment. Thirty interviews were completed for the USC University Hospital Community Health Needs Assessment from September - November, A list of the key stakeholder interview respondents can be found in Attachment 1. A summary of the primary data collection findings begins on page 23. Secondary Data Collection Secondary data were collected from a variety of county and state sources to present a community profile, birth and death characteristics, access to health care, chronic diseases, and social issues. This report presents a summary that highlights the data findings, presents key needs and opportunities for action. What follows is a detailed narrative that examines each of the data sets. The report concludes with benchmark comparison data. USC University Hospital community data findings are compared to national benchmarks. Maps Maps of the USC University Hospital service area are presented in Attachment 2. 4

6 Overview of Key Findings and Community Needs This overview summarizes some of the significant findings drawn from an analysis of the data from the L.A. County service area. Full data descriptions, findings, and data sources follow in the full report. Community Profile The residents of the USC University Hospital services area are primarily Latino (48.3%) and White/Caucasian (27.7%). Asians comprise 13.3% of the population, and Blacks are 8.3% of the population. The area has high percentages of children, ages 0-9 (13.8%), youth, ages (7.1%), and teens, (8.3%). Spurred by the recent economic downturn, unemployment has more than doubled from 2000 to % of the population lives at or below the poverty level and 39.9% are at or below 200% of poverty. Less than half the population in L.A. County (49.7%) has more than a High School Education 54.1% of residents speak a language other than English in their homes; Spanish is spoken most frequently, among 37.9% of resident households. Birth and Death Characteristics Among pregnant women, 87.2% obtain prenatal care in the recommended first trimester. L.A. County has a high rate of low birth weight babies at 73.1 per 1,000 live births; the State rate is 68.3 per 1,000 live births. When adjusted for age, the USC University Hospital service area has a considerably higher death rate (774.8 per 100,000) than that of the State (650.1). Heart disease, cancer and stroke are the top three leading causes of death. When mortality rates are examined by race/ethnicity, Blacks have the highest rates of death (940 per 100,000 population). Among Hispanics, heart disease, diabetes and stroke are the leading causes of death. The top three causes of premature death (before age 75) in L.A. County are due to coronary heart disease, homicide and motor vehicle crashes. Access to Health Care In L.A. County, 22% of adults and 7% of children are uninsured. Adults experience a number of barriers to accessing care, including: the high cost of medical and dental care, no regular source of care (medical home), and linguistic isolation. Chronic Disease Area residents have high rates of blood cholesterol, diabetes and hypertension. 7.9% of children have been diagnosed with asthma. Rates of TB in the County have fallen almost 8% from 2006 to

7 Seniors are not receiving flu shots and pneumonia vaccines at the recommended rates. Social Issues In L.A. County, 34.8% of adults are overweight and 22.6% are obese. Almost one-quarter (23.3%) of all children are considered obese. 47.6% of adults and 40.2% of children consume fast foods one or more times a week. Among area residents, 15.2% of youth and 36.2% of adults are sedentary and participate in minimal activity during the week. 14.3% of the population in the service area smoke; 16.2% have engaged in binge drinking. Over 8% of adults experienced mental illness/psychological distress last year. The number of homeless individuals has decreased over the last three years with a noticeable move from being unsheltered to sheltered. Community Stakeholder Interview Findings Health care access is a major concern aggravated by a worsening economy, loss of jobs and the subsequent lack of health insurance. There is a need for culturally-competent and linguistically appropriate care, made all the more difficult by the high level of diversity within the community. Fragmentation within the health care system leads to duplication of services or patients being bounced around among providers; no coordination of services, and a low level of communication between the various providers and agencies. There is a lack of information or knowledge among community residents regarding available health care options, criteria from program to program, and how to access the system. There is a high level of medical illiteracy and a need for basic health education. Chronic illness is increasing, particularly diabetes, heart disease and hypertension. There has been an increase in overweight or obesity, including the development of Type II Diabetes in children. The impact of obesity has resulted in an increase in related health problems, such as heart disease, hypertension, kidney disease, respiratory problems, joint problems, amputations, diabetes, depression, strokes and certain types of cancer. Contributing to the increase in obesity is the lack of access to safe areas to exercise and lack of access to, and education about, healthy food options. It is becoming harder to find doctors who take various types of insurance, particularly Medi-Cal and Medicaid, probably because of low reimbursement rates offered. The Hospital is encouraged to get involved in joint strategic planning; join in discussions around developing integrated delivery models, particularly around implementation of Health Care Reform. 6

8 Community Profile Population The population for Los Angeles County, the USC University Hospital primary service area, is estimated at 10,441,080 in 2010, an increase of 0.8% from For the last five years, the rate of population growth in L.A. County has slowed when compared to the rate of growth in the State. Total Population Year LA County Number Percent Change Number California Percent Change ,519,330 N/A 33,873,086 N/A ,656, % 34,430, % ,814, % 35,063, % ,957, % 35,652, % ,071, % 36,199, % ,153, % 36,676, % ,202, % 37,087, % ,231, % 37,463, % ,285, % 37,871, % ,355, % 38,255, % ,441, % 38,648, % Source: California Department of Finance Children and youth, ages 0-19 make up 29.2% of the population; 59.8% are years of age; and 11% of the population are seniors, 65 years of age and older. The area has higher percentages of children than found in the State. Most notably, L.A. County has a greater percentage of teens, ages (8.3%) than in the State (7.8%). 7

9 Population by Age Los Angeles County California Number Percent Number Percent Age , % 2,771, % Age , % 2,742, % Age , % 2,685, % Age , % 3,054, % Age , % 2,915, % Age , % 2,670, % Age , % 2,486, % Age , % 2,659, % Age , % 2,830, % Age , % 2,904, % Age , % 2,724, % Age , % 2,329, % Age , % 1,949, % Age , % 1,375, % Age , % 1,012, % Age , % 784, % Age , % 611, % Age , % 628, % Total 10,514, % 39,135, % Source: California Department of Finance, July 1, 2010 Race/Ethnicity The population of the service area consists primarily of Hispanic or Latino (48.3%) and White (27.7%) race and ethnicity. Asians comprise 13.3% of the population, and African Americans/Blacks are 8.3% of the population. The area has a larger percentage of Latinos, African Americans/Blacks, and Asians, and a smaller percentage of Whites when compared to the State. Among the population in L.A. County, 32.8% are foreign born. Of the foreign born, 62.1% are from Latin American countries and 29.6% are from Asian countries. 8

10 Population by Race and Ethnicity Los Angeles County California Number Percent Number Percent White 2,913, % 16,438, % Black or African American 877, % 2,287, % Hispanic or Latino 5,079, % 14,512, % American Indian/Alaska Native 31, % 240, % Asian 1,397, % 4,684, % Native Hawaiian/Pacific Islander 29, % 149, % Other or Multiple 184, % 822, % Total 10,514, % 39,135, % Source: California Department of Finance, 2010 Income Per capita income in L.A. County in 2008 was $42,265. While income did grow from 2007 to 2008, the rate of growth has slowed. Per capita income in the County is $1,587 less than the per capita income in the State. Year LA County Number Percent Change Number California Percent Change , % 33, % , % 33, % , % 34, % , % 34, % , % 36, % , % 38, % , % 41, % , % 43, % , % 43, % Source: Bureau of Economic Analysis, U.S. Department of Commerce, Personal Income and Employment Summary Unemployment From 2000 to 2007, unemployment in L.A. County has held relatively steady. With the economic downturn unemployment in L.A. County has more than doubled since L.A. County s unemployment rate in 2009 was 11.6%, which is slightly higher than the State s unemployment rate of 11.4%. 9

11 12 Month Annual Average Unemployment Year LA County California Number Rate Number Rate , % 833, % , % 932, % , % 1,162, % , % 1,190, % , % 1,089, % , % 952, % , % 866, % , % 959, % , % 1,313, % , % 2,086, % Source: California Employment Development Department, Labor Market Information Division, Sub-County Annual Averages, Data Not Seasonally Adjusted Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2000, the federal poverty threshold for one person was $8,794 and for a family of four $17,603. The poverty rates paint an important picture of the population within the USC University Hospital primary service area. Poverty rates show 17.9% of the population living at or below 100% of the Federal Poverty Level (FPL) and 39.9% at 200% of FPL. The rates of poverty are higher in L.A. County than in the State. Ratio of Income to Poverty Level Below 100 % Poverty Below 200 % Poverty Number Percent Number Percent Los Angeles County 1,674, % 3,734, % California 4,706, % 10,943, % Source: U.S. Bureau of the Census, 2000 Housing and Households Most of the housing in the service area consists of single family dwellings (55.2%). However, 43.2% of the housing units are multiple family dwellings, a percentage that is higher than the State (31.3%). 10

12 Types of Housing Units Single Family Multiple Family Mobile Homes, RVs, Vans Number Percent Number Percent Number Percent Los Angeles County 1,893, % 1,481, % 56, % California 8,747, % 4,247, % 596, % Source: C.A. Department of Finance, 2010 Section 8 is a federally funded program that provides rental assistance in the form of vouchers to low and very-low income families, singles, senior citizens, disabled and handicapped individuals. The wait time in Los Angeles County for public housing ranges from 730 to 1,460 days (2-4 years). Waiting Time for Public Housing (Days) Los Angeles County Wait Time in Days 730-1,460 Source: Los Angeles County Housing Authority, Public Housing FAQ webpage Language In the overall Hospital service area, a language other than English is spoken in over half the homes (54.1%). Spanish is spoken in 37.9% of the homes; this is greater than the number of Spanish speaking households in the State (25.8%). Language Spoken at Home for the Population 5 Years and Over Los Angeles County California Number Percent Number Percent Total Population 5 and Over 8,791, % 31,416, % Speak only English 4,032, % 19,014, % Speak language other than English at home 4,758, % 12,401, % Speak Spanish 3,330, % 8,105, % Speak Other Indo-European Languages 459, % 1,335, % Speak Asian/Pacific Island Languages 875, % 2,709, % Speak Other Languages 92, % 251, % Source: U.S. Bureau of the Census, 2000 Education Of the population age 18 and over in L.A. County, 30.6% has less than a high school education and only 19.7% has graduated high school; which equates to half the population (50.3%) with little education. When compared to the State, L.A. County residents have lower rates of college attainment at all levels. Lack of education is a critical marker of at-risk populations. Low educational attainment negatively impacts on employment and income, resulting in increased levels of poverty. These factors also directly contribute to high rates of disease and poor health outcomes. 11

13 Population by Educational Attainment (Age 18+) Los Angeles County California Number Percent Number Percent Less than 9 th Grade 1,042, % 2,687, % 9 th to 12 th Grade 1,053, % 3,235, % High School Graduate 1,352, % 5,192, % Some College, no degree 1,474, % 5,981, % Associate s Degree 403, % 1,657, % Bachelor s Degree 1,009, % 3,847, % Graduate or Professional Degree 522, % 2,047, % Total Age 18+ 6,859, % 24,650, % Source: U.S. Bureau of the Census, 2000 Birth and Death Characteristics Birth characteristics and major causes of death for residents of the USC University Hospital service area follow. Births In 2008, there were 14,111 births in the area. Teen Pregnancy In 2008, teen pregnancy rates occurred at a rate of 95.6 per 1,000 births (or 9.6% of total births). This rate is slightly higher than the teen pregnancy rate found in the State (94.9 per 1,000 births). Births to Teenage Mothers (Under Age 20) Births to Teen Rate per 1,000 Live Live Births Mothers Births Los Angeles County 14, , California 52, , Source: California Department of Public Health, 2008 Prenatal Care In 2008, pregnant women in the service area entered prenatal care late - after the first trimester - at a rate of per 1,000 live births. This rate of late entry into prenatal care translates to 87.2% of women entering prenatal care within the first trimester. The area rate of early entry into prenatal care does not meet the Healthy People 2010 benchmark of 90% of women entering prenatal care in the first trimester. 12

14 Late Entry into Prenatal Care (After First Trimester) Births With Late Rate per 1,000 Live Births Prenatal Care Live Births Los Angeles County 19, , California 94, , Source: California Department of Public Health, 2007 Low Birth Weight and Infant Mortality Low birth weight is a negative birth indicator. Babies born at a low birth weight are at higher risk for disease, disability and possibly death. The Los Angeles County service area has a higher rate of low birth weight babies (73.1 per 1,000 live births) when compared to the State (68.3 per 1,000 live births). Low Birth Weight (Under 2,500 g) Low Weight Births Live Births Rate per 1,000 Live Births Los Angeles County 10, , California 37, , Source: California Department of Public Health, 2008 The service area has a rate of infant mortality of 5.0 per 1,000 live births. In comparison, the infant death rate in the State is 5.1 deaths per 1,000 live births. Infant Mortality Rate Infant Deaths Live Births Rate per 1,000 Live Births Los Angeles County , California 2, , Source: California Department of Public Health, 2008 Deaths Age-adjusted death rates are an important factor to examine when comparing mortality data. The crude death rate is a ratio of the number of deaths to the entire population. Age-adjusted death rates eliminate the bias of age in the makeup of the populations being compared. When adjusted for age, the County area has a considerably higher death rate (774.8) than the State (650.1). 13

15 Age-Adjusted Death Rate, 2008 Los Angeles County California Crude Age-Adjusted Source: California Department of Public Health 2007, U.S. Bureau of the Census, and Center for Economic Development at California State University, Chico using Census 2000 age distribution A more complete picture of disease risk and mortality is seen when the service area is examined by disease state. The top three causes of death are heart disease, cancer and stroke. The rates of death in the County for heart disease, diabetes, pneumonia and liver disease are higher than the State rates. Causes of Death, 2008 Los Angeles County Deaths Rate per 100,000 Persons Deaths California Rate per 100,000 Persons Heart Disease 16, , Cancer 13, , Stroke 3, , Chronic Lower Respiratory Disease 3, , Unintentional Injuries 2, , Alzheimer s Disease 2, , Diabetes 2, , Pneumonia 2, , Chronic Liver Disease 1, , Suicide , Total 58, , Source: California Department of Public Health, 2008, Center for Economic Development at California State University, ESRI Business Analyst 2008 Death and Premature Death by Race/Ethnicity When death rates are examined by race, Blacks have the highest overall rate of death (940 per 100,000) in L.A. County. Coronary heart disease is the number one cause of death for all racial/ethnic groups in L.A. County. However, Blacks have the highest rate of death by Coronary heart disease (231 per 100,000). The second leading cause of death in L.A. County is stroke (36 per 100,000). For Whites it is emphysema/copd and for Hispanics it is diabetes. The third highest cause of death in the County is lung cancer (33 per 100,000), except for Hispanics, who experience stroke as the third leading cause of death (32 per 100,000). 14

16 Age-Adjusted Leading Causes of Death by Race/Ethnicity, 2007 Race/Ethnicity #1 Cause #2 Cause #3 Cause Age Adjusted Death Rate White 673 per 100,000 Coronary heart disease 167 per 100,000 Emphysema/COPD 39 per 100,000 Lung cancer 39 per 100,000 Hispanic 506 per 100,000 Coronary heart disease 109 per 100,000 Diabetes 31 per 100,000 Stroke 32 per 100,000 Black 940 per 100,000 Coronary heart disease 231 per 100,000 Stroke 62 per 100,000 Lung cancer 54 per 100,000 Asian/PI 440 per 100,000 Coronary heart disease 106per 100,000 Stroke 34 per 100,000 Lung cancer 27per 100,000 L.A. County Total 624 per 100,000 Coronary heart disease 150 per 100,000 Stroke 36 per 100,000 Lung cancer 33 per 100,000 Source: L.A. County Department of Public Health, Office of Health Assessment and Epidemiology. Mortality in Los Angeles County 2007: Leading Causes of death and premature death with trends for , In Los Angeles County, 45% of people in 2007 died before they reached age 75. With 75 years set as a cut-off date, everyone who dies younger than 75 is considered to have died prematurely. When examined County wide, coronary heart disease was the number one cause of premature death, followed by homicide and motor vehicle crash. Causes of premature death differ when examined by race/ethnicity. Among Hispanics, homicide is the number one cause of premature death, and the number two cause among Blacks. Lung cancer, drug overdose, and stroke are among the top three causes of premature death when broken down by race and ethnicity. Leading Causes of Premature Death (before age 75) by Race/Ethnicity, 2007 Race/Ethnicity #1 Cause #2 Cause #3 Cause White Coronary heart disease Drug overdose Lung cancer Hispanic Homicide Motor vehicle crash Coronary heart disease Black Coronary heart disease Homicide Lung cancer Asian/PI Coronary heart disease Stroke Lung cancer L.A. County Total Coronary heart disease Homicide Motor vehicle crash Source: L.A. County Department of Public Health, Office of Health Assessment and Epidemiology. Mortality in Los Angeles County 2007: Leading Causes of death and premature death with trends for , Among all males in L.A. County, the leading causes of premature death are: coronary heart disease, homicide and motor vehicle accident. Among females the top three causes of premature death are: coronary heart disease, breast cancer and lung cancer. Access to Health Care Health Insurance Health insurance coverage is considered a key component to accessing health care. In Los Angeles County, 78% of the adult population has health insurance. 22% of the adult population is uninsured. 15

17 Insurance Coverage, Adults Los Angeles County Medi-Cal 15.8% Medicare 1.4% Private 60.8% No Insurance 22.0% Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey, 2007 According to data from the LA County Health Survey, 7% of children, ages 0-17, in the County are uninsured.. Insurance Coverage, Children Los Angeles County Healthy Families 10.7% Healthy Kids 1.3% Medi-Cal 35.6% Private 45.4% No Insurance 7.0% Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey, 2007 Barriers to Care Adults in Los Angeles County experience a number of barriers to accessing care, including: cost of care, lack of a medical home, and language barriers. Barriers to Accessing Health Care Indicators LA County Adults Unable to Afford Dental Care in the Past Year 22.3 % Adults Unable to Afford Medical Care in the Past Year 11.8 % Adults Unable to Afford Mental Health Care in the Past Year 5.9 % Adults Unable to Afford Prescription Medication in the Past Year 12.1 % Adults Who Reported Difficulty Accessing Medical Care 27.3 % Adults Who Reported Not Having a Regular Source of Health Care 19.2 % Adults Who Reported Difficulty Talking to a Doctor because of a Language Barrier in the Past Year 15.1 % Adults Who Reported Transportation Problems Prevented Obtainment of Medical Care 7.4 % Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey 2007 Chronic Disease Chronic Diseases among Adults Among adults with chronic diseases in the area, there are some notable findings. The residents of Los Angeles County have higher rates of high cholesterol and diabetes than found in the State. 16

18 Chronic Diseases among Adults Los Angeles California County Adults diagnosed with Arthritis 16.9% 19.0% Adults diagnosed with Asthma 10.6% 12,8% Adults diagnosed with High Blood Cholesterol 24,2% 22.1% Adults diagnosed with Diabetes 6.3% 5.4% Adults diagnosed with Heart Disease 6.2% 6.3% Adults diagnosed with Hypertension 25.5% 26.1% Source: Source: California Health Interview Survey, 2007 Childhood Asthma Among children, ages 0-17, 8.8% have been diagnosed with asthma. Rates of asthma are climbing when compared to the 2005 LA Health Survey when the rate of asthma among children was 7.9%. Asthma among Children (0-17), 2005/2007 Comparison Los Angeles County Children Diagnosed with Asthma 7.9% 8.8% Source: Los Angeles County Health Survey AIDS Infection L.A. County has a prevalence rate of AIDS per 100,000 persons. Total AIDS Infection Diagnoses, Through December 2009 Los Angeles County Number Prevalence per 100,000 Population HIV Infection Diagnoses 56, Source: HIV Epidemiology Program, Los Angeles County Department of Health Services, 2009 STD Cases The County has higher rates of all the sexually transmitted disease when compared to the State. Young adults, ages 20-29, and Latinos have the highest rates of sexually transmitted infections. STD Cases, 2009 Los Angeles County California Rate per 100,000 Persons Chlamydia Gonorrhea Primary & Secondary Syphilis Early Latent Syphilis Late/Late Latent Syphilis Source: California Department of Public Health, STD Control Branch,

19 Tuberculosis The number of cases of TB has declined by 8% from 2006 to The rate of tuberculosis in the County is 8.4 per 100,000 cases. This is higher than the rate of TB in the State. Tuberculosis, Geographical Area Percent Cases Rate Cases Rate Change Los Angeles County % California 2, , % Source: Los Angeles County Department of Public Health, Tuberculosis Morbidity Data Tables LA County, The Cases and Rates are Listed as Reported by the California Department of Public Health. Preventive Practices Health screenings and immunizations are two widely accepted methods to help identify and prevent disease. Seniors are particularly vulnerable to communicable respiratory diseases, and are recommended to obtain yearly flu shots. Over a year period, 66.9% of seniors in L.A. County had obtained a flu shot. And 59.2% of seniors had a pneumonia vaccine sometime in their lives. Pap smears screen for cervical cancer. Among adult women, 83.4% had received a Pap smear in the last three years; and 63.6% received a mammogram in the last two years. Blood stool tests, and sigmoidoscopy and colonoscopy are screening measures for colon cancer. For adults 50 and over in L.A. County, 71.1% had received the recommended screening measures. Preventive Practices Los Angeles County California Senior flu shot 66.9% 68.8% Senior pneumonia vaccine 59.2% 63.1% Pap smear in last 3 years 83.4% 84.1% Mammogram in the last 2 years 63.6% 63.6% Screening for colorectal cancer 71.1% 74.5% Source: California Health Interview Survey,

20 Social Issues A variety of social issues face the residents in the USC University Hospital service area. Overweight and Obesity In Los Angeles County, 34.8% of adults are overweight and 22.6% are obese. 15.8% of adults are sedentary. Adult Overweight and Obesity Los Angeles County California Persons Who are Overweight 34.8 % 34.4% Persons Who are Obese 22.6 % 22.7% Source: California Health Interview Survey, 2007 Childhood Obesity L.A. County has collected data on childhood obesity from 128 cities and communities. 1 Based on the prevalence of obesity in these areas, the cities were ranked for obesity prevalence with a ranking of 1 indicating the lowest prevalence of obesity and 128 the highest ranking. The city rankings range from Manhattan Beach with a 4% prevalence of childhood obesity to Maywood with a high of 37%. In L.A. County overall close to one-fourth of the children are obese (23.3%). Obesity has been found to be strongly associated with economic hardship. Access to Safe Places to Play Access to parks, playgrounds and safe places to play in a community is a key environmental factor to promote exercise and play. The percent of children whose parents report they can easily get to parks or playgrounds is 79.8% in the County. This rate has decreased from 83.1% in Access to Safe Places to Play, 2005/2007 Comparison Los Angeles County % % Source: Los Angeles County Health Survey, 2007 Fast Food Consumption 40% of adults and 48% of children in the area consumed fast food one or more times a week. Fast Food Consumption, One or More Times a Week Los Angeles County Children (0-17) 47.6% Adults over % Source: Los Angeles County Health Survey, For full report

21 Soda Consumption In Los Angeles County, the percent of children that consume one or more soda or sweetened drink a day is 43.3% and 38.8% of adults consume a soda or sweetened drink a day. Soda or Sweetened Drink Consumption, One or More a Day Los Angeles County Children (0-17) 43.3% Adults over % Source: Los Angeles County Health Survey, 2007 Fresh Fruits and Vegetables In L.A. County, 15.1% of adults indicated they ate a minimum of five fruits and vegetables in the previous day. Consumption of 5 or More Fresh Fruits and Vegetables a Day Los Angeles County Adults over % Source: Los Angeles County Health Survey, 2007 When asked to rate the quality of fresh fruits and vegetables available to them, 36% of residents indicated the quality was very high. Only 5.4% of residents felt the fruits and vegetables available to them were of low quality. And 1.5% of the population indicated fresh fruits and vegetables were not available to them. Quality of Available Fresh Fruits and Vegetables Los Angeles County Very High 36.0% Somewhat High 57.1% Not High Quality 5.4% Not Available 1.5% Source: Los Angeles County Health Survey, 2007 Physical Activity Over 84% of youth are Active or Somewhat Active. Among adults, 53.2% are physically active. However, over one-third of the adult population (36.2%) is sedentary. A sedentary lifestyle can lead to overweight and obesity and is a contributing factor to many chronic diseases and disabilities. Physical Activity Los Angeles County Youth Adults Active 37.6% 53.2% Somewhat Active 47.2% 10.7% Minimally Active/Sedentary 15.2% 36.2% Source: Los Angeles County Health Survey,

22 Alcohol, Tobacco and Drug Use Among adults in L.A. County, 14.3% smoke cigarettes and 16.2% engage in binge drinking. Alcohol and Tobacco Use Estimated Number Percent Adults Who Reported Alcohol Consumption in the Past Month 3,877, % Adults Who Engaged in Binge Drinking in the Past Month 1,190, % Adults Who Reported Heavy Drinking in the Past Month 242, % Adults Who Smoke Cigarettes 1,061, % Source: Los Angeles County Health Survey; Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services, 2007 Youth Alcohol, Tobacco and Drug Use Among adolescents in Los Angeles County less than 3% smoke regularly. Smoking History Adolescents Estimated Number Percent Never smoked regularly 904, % Started smoking at 11 years or younger 13, % Started smoking at 12 years of age 3, % Started smoking at 13 years of age 2, % Started smoking at 14 years of age 3, % Started smoking at 15 years or older 6, % Source: California Health Interview Survey, 2005 Close to 30% of youth have tried alcohol and 2.9% have engaged in binge drinking. Youth Alcohol Consumption Estimated Number Percent Have had an alcoholic drink 306, % Have never had an alcoholic drink 717, % Engaged in binge drinking in the past month 30, % Did not engage in binge drinking in the past month 994, % Source: California Health Interview Survey, 2007 Mental Health Among adults in L.A. County, 8.3% experienced some type of psychological distress in the past year; 11% of adults saw a health care provider for mental health or 21

23 drug/alcohol related issues, and 9% have taken medicine for more than two weeks for mental health issues. These mental health indicators are less frequent among residents of L.A. County than compared to the State overall. Mental Health Indicators Los Angeles County California Adults who had psychological distress during past year 8.3% 8.5 % Adults who saw a health care provider for emotionalmental and/or alcohol-drug issues in past year Has taken prescription medicine for emotional/mental health issue in past year Source: California Health Interview Survey, % 12.4 % 9.0% 10.0% Homelessness Every two years the Los Angeles Homeless Services Authority (LAHSA) conducts the Greater Los Angeles Homeless County as a snapshot to determine how many people are homeless on a given day. The homeless census results show a decrease in homelessness from 2005 to 2009 and an increase in the percentage of sheltered homeless. Homelessness in Los Angeles County, Los Angeles County Homeless Persons Sheltered 33% 17% 12% Unsheltered 67% 83% 88% Total 48,053 68,608 88,345 Source: Los Angeles Homeless Services Authority, 2005, 2007, 2009 Among the homeless, 40.8% have substance abuse problems and 24.3% have mental illness, 15.3% are veterans, and 11.4% are families. Homeless Subpopulations Los Angeles County Number Percent Chronic Homeless 10, % Families 4, % Individuals 37, % Persons with AIDS or HIV-Related Illnesses 1, % Persons with Mental Illness 10, % Persons with Substance Abuse Problems 17, % Veterans 6, % Victims of Domestic Violence 3, % Youth (Under 18) Unaccompanied % Source: Los Angeles Homeless Services Authority,

24 Key Stakeholder Interviews The community stakeholders who participated in this needs assessment represent a cross-section of agencies serving the USC University Hospital service area. In addition, a number of USC Keck School of Medicine Department Chairs and members of the Hospital s upper-level guidance and management teams were interviewed. They provide a broad continuum of health and social services to all segments of the population. There were 15 interviews conducted with community stakeholders and 15 conducted with Hospital-affiliated participants. Interview participants were asked to share their perspectives on a number of topics, including: Biggest issues or concerns in the community Trends relative to demographics, the economy, the health care provider community, community health status, influencers of and attitudes toward health, availability of healthy food options, and changes in the local physical environment which might support or limit physical activity In caring for chronic conditions: the barriers people in the community face in obtaining treatment, things they may do to prevent their condition from worsening, and what services or educational programs and materials they use. Whether they have seen an increase in obesity within the community and what effect that is having, possible contributing causes of obesity, current activities within the community to address the issue of obesity, and other possible solutions The role hospitals are currently seen as playing in addressing the health needs of low-income community members, and what role it is thought that they should be playing Recommendations for improving access to care and enhancing public health Any additional concerns or comments they wished to share. Below is a summary of responses and trends in responses to each of these topics. The Hospital s Charitable Mission and Purpose There seemed to be some confusion among community stakeholders as to whether the Hospital is a for-profit or non-profit entity. Even among those respondents affiliated with the Hospital, there seemed to be some confusion as to why a Community Health Needs Assessment was being administered, and why the questions focused on the needs of the community that surrounds the Hospital. Because of this confusion, a question was asked: What do you see as the Hospital s charitable mission or purpose? Respondents said that they had never heard the subject of a charitable mission or purpose, or indeed the needs of the surrounding population. One said that the Hospital is currently funding community based organizations, education and outreach and should continue doing that. The mission is to meet the health needs of the community that we serve [many respondents made it clear in their interviews that the Hospital does not serve the surrounding community so it is unclear what was meant by this statement]. 23

25 And one said that the Hospital has the opportunity to make an impact in this community and to serve as a resource for primary care providers in the area. Respondents also pointed to the Hospital s strength in developing cures and treatments and translating research into practice, shortening the window of time for how long it takes best practices to be implemented in the community. Biggest Issues or Concerns When asked to discuss issues or concerns of the people in the surrounding area, a number of Hospital-affiliated participants pointed out residents of the local community are basically not seen at USC University Hospital. They were therefore directed to think of the population served throughout the County. There were two issues of equal concern to the respondents: the general poverty level of the surrounding area and the lack of access to health care. On the subject of health care access, almost all respondents mentioned the lack of health insurance or insufficient insurance as being the major concern. In addition, the following issues were addressed: Waits of many hours for emergency care and urgent care, and up to a year or more for some specialty or diagnostic care The fact that LAC+USC Medical Center was built with too few beds for the area s requirements A need for culturally-competent and linguistically appropriate care, made all the more difficult by the high level of diversity within the community. Materials, i.e. regarding obesity, diabetes, cancer, need to be available in other languages, particularly Spanish Fragmentation within the system leading to duplication of services or patients being bounced around among providers; no coordination of services, and a low level of communication between the various providers and agencies. There is a lack of information or knowledge among area residents regarding available health care options, criteria from program to program, and how to access the system A high level of medical illiteracy and a need for more basic health education High levels of chronic illness within the area s population, particularly obesity, diabetes, heart disease and hypertension Insufficient primary care within the community, leading to late diagnosis and delayed treatment. There was disagreement about whether this was primarily due to not enough primary care providers available, financial considerations, or cultural tendencies to only access medical care when issues reach a crisis level The issue of the poverty level in the area encompassed many related concerns: Lack of employment in the area, and many transitory jobs The blue-collar nature of the area means more job-related injuries Housing issues, including homelessness, a lack of affordable housing, poor housing quality (i.e. issues of lead paint, vermin infestations) and fear of displacement due to development and gentrification. 24

26 Area residents have personal safety concerns: violence, homicide, and a lack of safe areas to play and exercise Other issues of concern included: Lack of access to healthy foods due to the higher cost of fruits and vegetables, the lack of grocery stores, and the prevalence of fast-food restaurants in the area; South Central L.A. is considered a food desert. A large number of area residents are recent immigrants; some are undocumented High levels of illiteracy or low-literacy as much as 30% Transportation options are poor or lacking High levels of drug and alcohol abuse Causes of Issues of Concern In addition to the answers poverty and lack of adequate health insurance, other reasons given for the incidence of the above-mentioned issues included: The prevalence of jobs that don t pay a living wage or offer health benefits The rising cost of health care and medications Insufficient low-cost/free primary care / primary care centers An undereducated population Lack of access to safe areas to exercise Lack of access to, and education about, healthy food options A genetic predisposition to diabetes among the Latino population, along with a traditional diet that is higher in carbohydrates and lower in protein than some other diets Language and cultural issues; finding the right people to deliver the message The closure of ERs in past years, and the fact that the County s safety-net system is being overwhelmed by demand Families need weekend and evening hours for clinics they can t get time off The population is transient and may move before an appointment that is many months in the future, if they don t simply forget about it Not enough communication, and even some mistrust hospital specialists seem distrustful of community clinic provider quality Current Activities in the Community to Address Issues Community stakeholders tended to be more aware of what was going on within the broader community to address the issues, while those affiliated with the Hospital were mostly aware of those outreach programs either being done at the Hospital or at LAC+USC Medical Center. Individual programs were mentioned by name by a number of people, but none was mentioned more than once. The following items were addressed by multiple respondents: County-sponsored clinics provide free or low-cost care A push by stakeholders to get people enrolled in government programs to increase access to primary care and reduce the burden on the ERs Health care reform: the opportunities and uncertainties surrounding it 25

27 A push toward integration and partnerships, and implementing best practices An increase in non-profits, grants, and physician awareness of, and aggressive treatment of, obesity and diabetes The benefit of radio stations for reaching specific targeted audiences in culturally appropriate ways to discuss health issues and announce screenings Small improvements and initiatives around bringing healthier food to the community Other Possible Solutions for Stated Issues Health Care Reform, the California Healthcare Exchange and the 1115 Waiver were mentioned by a number of participants. Issues related to Health Care Reform that came up repeatedly in the interviews were: Increased capacity and lowered barriers will be needed to allow for servicing the needs of the newly-insured; current capacity is insufficient more clinics / more providers are required More culturally-competent providers will be needed; perhaps recruiting more NPs, and PAs from within the community, since it is hard to attract medical students to General Practice; better communication is needed between local community colleges to allow for an increased capacity for training A need for greater collaboration and communication across Supervisorial Districts and between organizations; the need for regional or area not Countywide or District-specific - road-maps to capitalize on strengths and allow for real referrals based on understanding of one-another s programs Improved information-sharing between providers (i.e. patient files) to allow for the creation of truly integrated care delivery Under Health Care Reform, undocumented immigrants will be further marginalized; funding will dry up and caring for them will become politicized Things that could be done on a local level, unrelated to Health Care Reform, were mentioned by a number of the respondents as well: More hospital beds are needed; LAC+USC Medical Center is overflowing and wait times for beds are hours. Perhaps build another hospital in the San Gabriel Valley or have another contracted hospital like California Hospital More affordable, accessible screenings are needed perhaps $25 and everyother Saturday, or annual free screenings More education both early education/pre-school/basic education to alleviate poverty, and health education to dispel myths and improve appropriate, timely accessing of primary care More support for safe, affordable housing in the area; current housing codes should be enforced and slumlords should be prosecuted; more care should be taken with development, to protect small businesses and affordable housing; it was also stated that the homeless are being squeezed out of Skid Row and into South L.A. where there is no infrastructure to deal with them Finally, several of the interviewees who are affiliated with the Hospital seemed excited about the possibility of helping to provide solutions to the problems mentioned. 26

28 Education, outreach, and Health Fairs were mentioned, specifically around areas where the Hospital excels, such as breast health and diabetes. Also, the Hospital s core competency in education was mentioned, and the influence they might have in guiding students toward careers in primary care. The need for a more engaged culture within the Hospital, and the potential benefits from an improved public image were also mentioned. Demographic Trends The largest demographic trend noted was the loss of insurance, including to those members of the community that were formerly middle-class, and a trend toward a higher-income level of poverty. In addition, the loss of affordable housing and rising homelessness was identified. Other trends noted were: The population is aging The new-immigrant population in the area is rising Hispanic population in the area is increasing The number of Spanish-only residents is rising; this is particularly an issue among the elderly, who don t know where to go to access care in Spanish The Asian population was also noted to be rising Trends in the Economy and its Impact Job loss, insurance loss and unemployment levels in the high 20% s (taking into account the under-employed and no longer looking ) were the overwhelming trends in the economy. In addition: People are having trouble meeting their basic needs: food, utilities, housing, including young families There have been foreclosures on multi-family units, further decreasing housing availability There has been a mental and physical toll of the foreclosure rate and financial difficulties: more stress-related health issues Poverty is driving families out; school enrollments are down Smaller non-profits are closing and funding is down, so there are fewer resources for the poor and health-related messaging isn t getting out People with health conditions who lose insurance and can t afford COBRA will have trouble becoming insured again Trends in the Health Care Provider Community The closure of several hospitals in L.A. County in the past 10 years was mentioned by respondents, with the burden of caring for the poor believed to be one of the contributing factors in those closures. Further closures are feared or expected. In addition: One hospital site in the area and a portion of another hospital s campus were said to have been sold to developers for upper-end housing developments The point that LAC+USC Medical Center was built with too few beds was brought up again, with the result of rising wait times and diversions 27

29 Community clinics were said to be overwhelmed, but also said to be reaching out, and it was not felt that there was any risk of closures among the clinics Not only are insufficient numbers of medical students choosing to go into General Practice, those that do become primary care providers emerge with too high of a debt load to allow them to choose work in the health care safety net they can t afford to It is becoming harder to find doctors who take various types of insurance, particularly Medi-Cal and Medicaid, probably because of low reimbursement rates offered The population of doctors is aging, and younger doctors demand a better work/life balance; on the plus side, there is a move toward Hospitalists, which may improve quality of life for admitting physicians More nurses are coming out of school from the local community; on the downside, there is less hiring of nurses, even in the face of a shortage, and there is a reluctance to hire new grads, who represent a significant financial investment to train; new grads are having a tough time finding employment There has been an increase in collaboration and communication around specialty care referrals Specialty care access is still difficult; and mental health, dental, and drug/alcohol services are almost non-existent. Trends in Community Health Status The major trend mentioned was increasing obesity, including childhood obesity. Other negative trends in community health status included: Fewer people accessing preventive care or screenings, leading to delayed diagnoses, more expensive treatments and worse outcomes Chronic disease rates are up, including diabetes. More substance abuse, although some participants felt that this indicator was level or perhaps just a perceived increase due to a decrease in the availability of, and access to, substance abuse treatment programs Positive trends in community health status mentioned included a decrease in smoking among certain groups of adults (possibly excluding veterans and African-Americans), a reduction in injuries and deaths from car accidents, due to seatbelts and airbags, and fewer gunshot wounds presenting in emergency rooms. Influencers of Health Health Care Reform was talked about by one-third of respondents, but more as a potential influencer whose effects on health care have yet to be seen. Attitudes toward it were varied, including hopeful, uncertain, skeptical, and simply being thankful that it engendered a much-needed debate. In addition to National Health Care Reform, several programs and grants were mentioned that target obesity, nutrition, diet and exercise, including a $20 million Renew Grant recently received in the County. Attitudes toward Health Among respondents who felt they were seeing trends in this area most have a sense that community members are thinking a lot more about their health status obesity and 28

30 exercise, particularly. Most felt, however, that it has yet to lead to any real improvement, due to the primacy of economic concerns. The media and Promotoras were felt to have played a part in the growing realization of personal actions and responsibility as a part of the heath picture, and a focus on wellness, not just illness. The media and Promotoras were also credited with a perceived increase in willingness to seek mental health care, and a lessening of the stigma related to it, though there was said to be little to no low-cost mental health available, even for those who seek it out. Availability of Healthy Food Options The need for more grocery stores, corner stores and Farmer s Markets in the area was clearly expressed; several participants said that there are non-profits working on these things but that action was still in the early stages. While most interviewees felt that there have been improvements in the availability of healthy food options in the few existing grocery stores, restaurants and increasing numbers of Farmer s Markets and Fresh and Easy stores, they were divided on the subject of whether those things were affordable; the cost differential still means lowincome people are eating mostly processed foods and eating at fast food restaurants. Healthy food is still perceived as costing more, and costing too much for low-income families to access. A number of the respondents agreed that in places where food choices are limited, and provided by an organization or agency such as schools, homeless shelters, hospitals, food banks and vending machines healthier options are being provided now than were provided in the past. Changes in the Physical Environment Supporting or Limiting Physical Activity Several respondents said that the City of L.A. and various community partners are working on making Los Angeles more bicycle and pedestrian friendly and improving walkability, parks, clean air, and neighborhood safety, but that efforts are in the early stages and there is still very little currently available. Several respondents also mentioned that exercise equipment and skate parks have been installed in two parks and are getting a lot of use, with exercise classes being offered in some parks; other parks, however, have had benches installed specifically to IMPEDE use as a sports area. Completion of the Gold Line was mentioned as a positive, with an end to construction leading to better air quality, less impediment to movement in the area, and a planned rebuild of area sidewalks. Barriers to Care and Treatment for Chronic Conditions The vast majority of respondents pointed to both the high cost of care/lack of insurance, and access to long waits for specialty and diagnostic care; many specialists won t take 29

31 Medicare or Medi-Cal and waits at County facilities can be many months; in the meantime, the disease or condition progresses. Participants were very divided, though, on the issue of access to primary care. Some felt that there were not enough primary care doctors or appointments available at free or low-cost clinics no one answers the phones or if they do it s call back in two weeks, while other respondents felt that there is plenty of primary care access available for the current demand and that the education and desire to access primary care is what is lacking. Some pointed out that many immigrants view doctors as pill pushers, not agents of preventive health care, and that undocumented immigrants may be too scared to attempt to access care outside of an emergency situation. The third-most-mentioned issue was the difficulty patients have managing a complex condition without a care manager: juggling multiple appointments and medications, often along with multiple jobs and no insurance. Self-management programs were said to help, although not all patients can take time off of work to attend self-management classes. Primary care providers organized around panels of specialists in order to coordinate care was suggested by one respondent as a way to alleviate this problem. The following issues were also mentioned by several respondents: A lack of understanding of how to care for their conditions and personal responsibility The high cost of medications Transportation issues Child care issues A lack of linguistically and culturally-appropriate care Not knowing how to access care Lack of paid time off Less money for healthy food Patients tend to be treated episodically in ERs rather than holistically. What People do to Prevent Chronic Conditions from Worsening The most frequently-identified activities include: Increase exercise/physical activity Change diets to eat healthier food a challenge, because diet and nutrition examples tend to be so different from residents typical diets Health education and food education from clinics Home remedies or going to Mexico to obtain remedies Nothing; due to lack of education or having food and shelter concerns, they rely on the ER as a chronic health care provider rather than go to their appointments Health Services, Education and Materials for People with Chronic Conditions The most frequently-mentioned resource for information for people with chronic conditions were the videos, materials and handouts they receive at the clinics they 30

32 attend; some County clinics, however, were said to have no videos or other materials available, or only in English. Other resources identified included: The Internet, for those with access; quality of information, though, can vary and some of these patients may not be very discerning Spanish-language television Friends and family with similar conditions again, the quality of the information can vary One-on-one counseling with health educators Promotoras LA County Breath Mobile a van for asthma Obesity All but two respondents had noticed an increase in overweight or obesity in the last few years. A number also mentioned the development of Type II Diabetes in children.when asked about the impact of that within the community, most mentioned an increase in related health problems, such as heart disease, hypertension, kidney disease, respiratory problems, joint problems, amputations, diabetes, depression, strokes and certain types of cancer. In addition, the difficulty of caring for obese patients was mentioned it is harder to diagnose and operate, and their size may make it difficult for them to fit on or into some equipment, such as normal beds and CT scanners. When asked about the causes of obesity in the area, participants generally mentioned poor eating habits and/or a lack of exercise and physical fitness. More specifically they mentioned: The prevalence, low-cost, and long-shelf-life of processed food, fast-food and junk-food. Poor food choices made by parents due to lack of knowledge or culture/habit, as well as a cultural preference for well-fed (obese) kids. Lack of knowledge / understanding of the disease process, healthy lifestyles and how to change habits Lack of time to shop for or prepare healthy meals, or to exercise, due to parents/individuals working long hours at multiple jobs Safety issues and concerns keep children indoors When asked what is going on in the community to address the issue of obesity, a few participants felt that there was nothing being done. Most, however, mentioned some activities / changes (i.e. improvements in access to healthy foods, changes in the environment promoting exercise). A number of participants mentioned: Improving nutrition in the schools Classes on nutrition and fitness being taught in schools or as part of after-school programs, such as HAZARD (OT); in the parks, such as Fit Families (USC Dept); or through clinics such as HELP (California Hospital) or ENERGY (QueensCare) 31

33 Educational programs on TV, but only very late or very early, not prime-time Employers incentivizing better health / gym memberships Regarding other possible solutions to the issue of obesity in the community, a large range of answers was given. The only component of responses that was given by a majority of participants was that a great deal of the focus needs to be on children and/or through the School Districts. Other responses included: More education: more classes on diet, exercise and food preparation for students and adults USC University Hospital maybe the medical school could help with education, Health Fairs and screenings Create healthier versions of ethnic food menus, around food they already eat and are familiar with, and which they can find easily in their neighborhood Improve grocery store access and fruit-and-veggie offerings at local stores; incentivize grocery stores to carry healthier food; subsidize Farmer s Markets Utilize the Promotoras model it is community-based and a great investment Treat obesity as a chronic, relapsing disease, managed under the care of a doctor over the life of an individual; educate doctors more on nutrition and weight loss; recognize and address the behavioral component and treat that too. The Role Hospitals are Seen as Currently Playing Responses to this question ran the gamut, from a simple None, to Acute care only, to praise for various hospitals and the myriad ways in which they are involved. In general: Some hospitals are seen as reaching out, through community benefit programs, leadership, policy and organizing, seeing some Medi-Cal or uninsured patients, while others get stuck in a bubble no community access or outreach, and people don t know how to access what they DO have available They re focused on treatment, but not on prevention or education They re starting to make moves toward partnering with local agencies and clinics, perhaps in part due to the coming changes due to Health Care Reform They may view their over-crowded ERs as their community service Role Which It Is Thought Hospitals Should Play When asked what role they though hospitals SHOULD play, community participants overwhelmingly said More partnerships, and hospital-affiliated participants for the most part said Education. In addition to just more partnerships, community participants felt hospitals should: Connect with the community clinics to create seamless coordination of care, to disseminate information - including appropriate access of care - and to refer out to other agencies, services and clinics, such as mental health or substance abuse clinics; they should help people understand where to get treatment Support primary care clinics 32

34 Be involved in joint strategic planning; join in discussions around developing integrated delivery models, particularly around implementation of Health Care Reform Be involved in prevention education, in schools and through existing community groups Do anything: anything they do would be an improvement and increase good will in the community Reach out and take care of the community; marketing seems to focus on bringing people in from other areas; even area business leaders who have insurance go to the Westside for care; advertise the services that ARE available Hospital-affiliated participants responded, in more detail: The Hospital should be involved in community education programs, screenings and Fairs around healthy behaviors and preventive care Be inclusive about sharing best practices; be a clearinghouse of information to answer questions and get reliable information Several respondents mentioned the financial issues around serving Medi-Cal and uninsured patients; some felt that it was necessary to do some of that in order to improve the Hospital s image; others simply felt that the Hospital wouldn t stay solvent if they did. Recommendations for Improving Access to Care and Enhancing Public Health Asked how they would improve access to care and enhance public health, the largest number of responses were to improve access: Provide access to preventive health care: o more free or low-cost clinics o prevention screenings and education o get more people insured o train more nurses, NPs, PAs and Promotoras from the local area, to have enough local providers, who are culturally-competent; train the NPs and PAs to provide primary care o promote medical homes o improve transportation barriers - a better transportation system and/or more mobile units More resources in specialty care: more specialists, access, diagnostics A bigger LAC+USC Medical Center Several felt that the very structure of the health care system was what most needed to be changed: Ambulatory care systems and structures Change the fee-for-service so doctors, hospitals and clinics could get paid for preventive care An independent health care authority, not political change the administrative structure of DHS to give a private sector intensity to County health care 33

35 Redesign the grid to make more sense and be more egalitarian in terms of health care and education On legislative advocacy efforts more systemic rather than direct services People are ashamed to access services, so spend the money on economic development so that they can afford the services themselves The food environment and physical environment an ounce of prevention is worth a pound of cure Additional Information which USC University Hospital Needs To Know The opportunity which USC University Hospital has, to play a leadership role, was pointed out by several participants, particularly in light of the new ownership situation. Several participants mentioned being excited at the possibilities. Many participants took the opportunity to reiterate their desire for USC University Hospital and the USC Norris Cancer Hospital to become more involved with the community, through partnerships, education, and specialty care, preferably through leveraging their strengths, such as education, mammograms and diabetic eye exams; perhaps through telemedicine or other technologies they have access to. Also, that they need to do a better job of communicating what s available and how to access care at both University Hospital and County facilities more specifics, including numbers to contact. 34

36 Benchmark Comparisons Where data are available, health and social indicators in the USC University Hospital service area are compared to established goals or benchmarks. The bolded items are indicators in the Hospital service area that do not meet established benchmarks; nonbolded items meet or exceed benchmarks. Service Area Data Goal/Benchmark Source Heart disease deaths Heart disease deaths Healthy People per 100, per 100,000 Diabetes deaths Diabetes deaths Healthy People per 100, per 100,000 Cancer deaths Cancer deaths Healthy People per 100, per 100,000 Unintentional injury deaths Unintentional injury deaths Healthy People per 100, per 100,000 Suicides Suicides Healthy People per 100, per 100,000 Early prenatal care Early prenatal care Healthy People % of women 90% of women Low birth weight infants Low birth weight infants Healthy People % of live births 5.0% of live births Infant death rate Infant death rate Healthy People per 1,000 live births 4.5 per 1,000 live births Child health insurance rate Child health insurance rate Healthy People % 100% Adult health insurance rate Adult health insurance rate Healthy People % 100% Adult obese Adult obese Healthy People % 15% Youth overweight or obese Youth overweight or obese Healthy People % 5% No regular source of care adults No regular source of care adults Healthy People % 4% Adults who are sedentary Adults who are sedentary Healthy People % 20% Annual adult influenza vaccination Annual adult influenza vaccination Healthy People % 90% Adults who have received Adults who have received Healthy People 2010 pneumococcal vaccination 59.2% pneumococcal vaccination 90% Adults engaging in binge drinking Adults engaging in binge drinking Healthy People % 6% Cigarette smoking by adults Cigarette smoking by adults Healthy People % Adults 50+ who have had a sigmoidoscopy or colonoscopy in the last 5 years and/or blood stool test in the last 2 years 71.1% Adult women who have had a Pap smear in the last three years 83.4% 12% Adults 50+ who have had a sigmoidoscopy or colonoscopy in the last 5 years and/or blood stool test in the last 2 years 50% Adult women who have had a Pap smear in the last three years 90% Healthy People 2010 Healthy People

37 Attachment 1. Key Stakeholder Interviews Organization Contact Title American Cancer Society Chrissy Kim Director of Health Programs Los Angeles Area Affiliate Bienvenidos Amanda Guzman-Perez Director of Community Service Building a Healthy Boyle Heights Isela Gracian Associate Director Collaborative Cancer Legal Resource Center Joanna Morales Director Clinica Msr. Oscar Romero Paul Giboney, MD Medical Director COPE Health Solutions Sarita Mohanty, MD, MPH Medical Director Esperanza Community Housing Nancy Ibrahim Executive Director Corporation LAC + USC Healthcare Network Pete Delgado CEO L.A. County Board of Supervisors Amy Luftig Viste Senior Health Deputy Office of Gloria Molina L.A. County Department of Health Irene Dyer Director, Office of Planning Services L.A. County Department of Public Shereee Poitier, MD Area Medical Officer Health, SPAs L.A. Health Action Neelam Gupta Deputy Director Los Angeles Area Chamber of Samuel Garrison Vice President of Public Policy Commerce Los Angeles Health Care Diane Factor Program Director Workforce Development Program MAOF (Mexican American Martin Castro President & CEO Opportunity Foundation) Susan G. Komen for the Cure Los Angeles Affiliate Deborah Anthony Deb Weintraub Executive Director Director of Missions USC, Government and Civic Engagement Cesar Armendariz Director for USC Health Sciences Campus Community Partnerships USC, Government and Civic Engagement Carolina Castillo Executive Director, Planning & Development USC University Hospital Ellen Whalen Chief Nursing Officer USC University Hospital and USC Norris Cancer Hospital Mitch Creem CEO USC Keck School of Medicine, Department Chairs Contact Department Jerry D. Gates, Phd Family Medicine Steven L. Gianotta, MD, FACS Neurological Surgery Edward G. Grant, MD Radiology Philip D. Lumb, MD, BA, FCCM Anesthesiology Laila I. Muderspach, MD Obstetrics and Gynecology Edward Newton, Jr., MD Emergency Medicine Michael J. Patzakis, MD Orthopaedics Ronald E. Smith, MD Ophthalmology David T. Woodley, MD Dermatology 36

38 Attachment 2. USC University Hospital Service Area Maps 37

39 Coronary Heart Disease Deaths by Zip Code, Los Angeles County Center for Economic Development California State University, Chico Chico, CA County Boundaries 22 Freeway Heart Disease Deaths 1 Dot = 5 Deaths 0 5Sheet1$.HTD_Deaths Miles

40 Coronary Heart Disease Death Rate by Zip Code, Los Angeles County Center for Economic Development California State University, Chico Chico, CA County Boundaries Freeway Heart Disease Death Rate per 100,000 Persons Miles

41 Obesity by Health District Los Angeles County Center for Economic Development California State University, Chico Chico, CA County Boundaries Freeway Obesity-2007 LA Health Survey Percent of Respondents < 19.9% % % % % % % % Miles