Community Health Needs Assessment

Transcription

1 2013 Community Health Needs Assessment

2 Table of Contents Executive Summary... 4 Community Benefit Service Area... 4 Data Collection... 5 Overview of Key Findings... 5 Identification and Prioritization of Health Needs Prioritization Process Introduction Background and Purpose Service Area Author Methods Secondary Data Collection Primary Data Collection Information Gaps Health Care Facilities and Community Resources Map of the Cedars-Sinai Community Benefit Service Area Demographics Population Race/Ethnicity Language Social and Economic Factors Poverty Households Free or Reduced Price Meals Unemployment Educational Attainment Homelessness Health Access Health Insurance Coverage Sources of Care Barriers to Care

3 Access to Primary Care Community Clinics Delayed Care Dental Care Birth Characteristics Births Teen Birth Rate Prenatal Care Low Birth Weight Infant Mortality Breastfeeding Mortality/Leading Causes of Death Leading Causes of Premature Death Mortality Rates Chronic Disease Health Status Diabetes Heart Disease High Blood Pressure Cancer Asthma Disability Hospitalization and ER Rates for Ambulatory Care Sensitive Conditions Health Behaviors Overweight and Obesity Fast Food Soda Consumption Fresh Fruits and Vegetables Physical Activity HIV/AIDS Sexually Transmitted Diseases Teen Sexual History Cigarette Smoking

4 Alcohol and Drug Use Mental Health Flu and Pneumonia Vaccines Mammograms Pap Smears Colorectal Cancer Screening Interview Results Attachment 1. Benchmark Comparisons Attachment 2. Interviewee Names, Roles and Organizations Attachment 3: Health Care Facilities and Community Resources

5 Executive Summary Cedars-Sinai conducted a state and federally-mandated Community Health Needs Assessment. Needs assessments are the primary tools used to determine a hospital s community benefit plans, that is, how the hospital will address unmet community needs through the provision of community health services. California legislation (SB 697) requires non-profit hospitals to report on the community benefit they provide. This legislation also requires hospitals to assess the health needs of the communities they serve and develop plans to address priority needs. In addition, the recent passage of the Patient Protection and Affordable Care Act, has instituted federal regulations for taxexempt hospitals to conduct a Community Health Needs Assessment and develop an Implementation Strategy every three years. Community Benefit Service Area Cedars-Sinai is located at 8700 Beverly Boulevard,, California The Community Benefit service area includes large portions of Service Planning Areas (SPAs): 4 (Metro), 5 (West) and 6 (South), and smaller portions of SPA 2 (San Fernando), SPA 7 (East) and SPA 8 (South Bay) in. The Community Benefit service area includes 44 zip codes, representing 25 cities or communities. Cedars-Sinai Medical Center Service Area City Zip Code SPA Baldwin Hills SPA 6 Beverly Hills 90210, 90211, SPA 5 Brentwood/Westwood 90024, SPA 5 Central LA 90012, 90017, SPA 4 Crenshaw 90016, SPA 6 Culver City SPA 5 Fairfax/Mid-City 90019, SPA 4 Gardena SPA 8 Hollywood 90027, 90028, 90038, SPA 4 Huntington Park SPA 7 Inglewood 90301, 90302, 90303, SPA 8 Ladera SPA 6 Lawndale SPA 8 Palms SPA 5 Playa del Rey SPA 5 Sherman Oaks SPA 2 South Central LA 90002, 90044, SPA 6 Studio City SPA 2 University SPA 6 Van Nuys SPA 2 West Hollywood 90046, 90048, SPA 4 West LA/Palms SPA 5 West LA/Rancho 90025, 90035, SPA 5 Wilshire/Koreatown SPA 4 Wilshire 90006, SPA 4 4

6 Data Collection This community health needs assessment includes collection and analyses of secondary and primary data. Secondary Data This report examines up-to-date data sources for the Community Benefit service area to present community demographics, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, and health behaviors. When applicable, these data sets are presented in the context of and compared to the Healthy People 2020 objectives. Primary Data - Stakeholder Interviews Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by the Hospital. Twenty-three interviews were completed from July through September, Interviewees included individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations. Additionally, input was obtained from Los Angeles Department of Public Health officials. Overview of Key Findings This overview summarizes significant findings drawn from an analysis of the data from each section of the report. Full data descriptions, findings, and data sources follow. Community Demographics The population of the Cedars-Sinai Community Benefit service area is 1,755,853. Children and youth, ages 0-17, make up 23.2% of the population; 66% are adults, ages 18-64; and 10.8% of the population are seniors, ages 65 and over. The median age in the service area is % of the population is Hispanic/Latino; 28.9% of the residents are White; 16.3% are African American; 10.8% are Asian; and 2.9% are American Indian/Alaskan Native or other race/ethnicity. Race/Ethnicity Cedars-Sinai Service Area Hispanic/Latino 41.0% 47.7% White 28.9% 27.8% Black/African American 16.3% 8.3% Asian 10.8% 13.5% American Indian/Alaska Native 0.2% 0.2% Native HI/PI 0.1% 0.2% Other 2.6% 2.3% Source: U.S. Census Bureau, 2010; Healthy City 5

7 Among the languages sometimes or always spoke at home; English is spoken among 45.2% of the service area population; 38.3 speak Spanish; 7.9% of the population speak an Asian language; and 7% of the population speaks an Indo- European language. Social and Economic Factors Among the residents in the SPAs represented in the Cedars-Sinai Community Benefit service area, SPA 6 has the highest poverty rates: 48.9% are at or below 100% of the federal poverty level (FPL) and 74.9% are at 200% or below FPL. In SPA 4, 29% of the population is at the poverty level, in SPA 5, 12.2% are living in poverty. Rates of poverty in SPAs 4 and 6 are higher than found in the county. Poverty Levels <100% FPL 29.0% 12.2% 48.9% 22.7% <200% FPL 51.3% 20.8% 74.9% 42.9% A view of children in poverty by Service Planning Area (SPA) indicates that over half (57.6%) of children in SPA 6 live in poverty, 41.7% of children in SPA 4 and 15.7% of children in SPA 5 are <100% FPL. Children in Poverty, Ages % FPL 41.7% 15.7% 57.6% 29.3% % FPL 24.8% 9.3% 24.6% 22.0% % FPL 14.0% 7.9% 11.3% 12.6% 300% FPL and above 19.5% 67.1% 6.5% 36.1% The median household income in the Community Benefit service area is $47,608 and the average household income is $69,500. The unemployment rate in the Community Benefit service area cities shows a diverse range from 8.5% in Culver City to 18.2% in Huntington Park. Among adults, ages 25 and older, in the Cedars-Sinai service area, approximately one-fourth of the population (23.7%) have no high school diploma. According to the 2011 Homeless Services Authority count, SPA 4 had an annualized estimate of 11,571 homeless individuals; SPA 5 had 3,512 homeless individuals; and SPA 6 had 8,735 homeless. In SPA 4, 83% are individuals and 15% of the homeless are families. In SPA 5, 80% of the 6

8 homeless are single adults and 19% are families. In SPA 6, 64% of the homeless are single adults and 35% are families. Health Access In SPA 6, over one-quarter of the population (26.0%) were uninsured; 21.9% were uninsured in SPA 4 and 11.6% were uninsured in SPA 5. In SPA 4, 39.2% of the population has employment-based insurance. In SPA 5, 50.6% have employment-based insurance. In SPA 6, 22.1% have employmentbased insurance. Insurance Coverage Medi-Cal 19.0% 5.1% 35.3% 17.5% Healthy Families 2.3% 0.1% 2.7% 2.0% Medicare Only 1.2% 0.8% 1.0% 0.9% Medi-Cal/Medicare 5.1% 4.1% 5.7% 3.5% Medicare & Others 4.3% 14.9% 2.4% 6.7% Other Public 1.7% 1.7% 0.8% 1.6% Employment Based 39.2% 50.6% 22.1% 44.8% Private Purchase 5.3% 11.1% 3.6% 6.0% No Insurance 21.9% 11.6% 26.4% 17.0% Community clinics provide primary care (including medical, dental and mental health services) for uninsured and medically underserved populations. Even with Community Health Centers serving the Community Benefit service area, there are a significant number of low-income residents who are not served by one of these clinic providers. 577,147 low-income residents, approximately 84.8% of the population at or below 200% FPL are not served by a Community Health Center. Adults in the Community Benefit service area experience a number of barriers to accessing care, including: cost of care, lack of a medical home, language barriers, and lack of transportation. Adults in SPA 6 had higher rates of being unable to afford care. 12.6% of children in SPA 4, 13.6% of children in SPA 5 and 15.7% of children in SPA 6 had never been to a dentist. Birth Characteristics In 2010, there were 23,789 births in the area. 7

9 Teen births occurred at a rate of 85.1 per 1,000 births (or 8.5% of total births). This rate is lower than the county rate of 8.8% teen births. Births to Teenage Mothers (Under Age 20) Geographical Area Births to Teen Mothers Live Births Rate per 1,000 Live Births Cedars-Sinai Service Area 2,025 23, , , California 43, , Source: California Department of Public Health, 2010 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 86.6% of women entering prenatal care within the first trimester. This is marginally better than the LA rate of 86.2% 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. For this measurement, a lower rate is a better indicator. The Cedars-Sinai service area rate of low birth weight babies is 7.9% (79.0 per 1,000 live births). This is higher than the state rate of 6.8% (68.1 per 1,000 live births). The infant (less than one year of age) mortality rate in the Cedars-Sinai service area was 5.2 deaths per 1,000 live births. In comparison, the infant death rate in the state was slightly lower at 4.7 deaths per 1,000 live births. Breastfeeding rates at Cedars-Sinai indicate 95.1% of new mothers use some breastfeeding and 68.6% use breastfeeding exclusively. These rates are better than found among hospitals in LA and the state. Mortality/Causes of Death The leading cause of premature death (before age 75) for SPAs 4 and 5 is heart disease. For SPA 6 the leading cause of premature death is homicide. The three leading causes of death in the Community Benefit service area are heart disease, cancer and stroke. The heart disease mortality rate in the Community Benefit service area is per 100,000 persons, which does not meet the Healthy People 2020 objective of deaths per 100,000 persons. 8

10 Mortality Rates, per 100,000 Persons, 2010 Cedars-Sinai Service Area California HP 2020 Number Rate Rate Rate Heart Disease 2, Cancer 2, Stroke Chronic Lower Respiratory Disease Influenza and Pneumonia No Objective Unintentional Injuries Alzheimer s Disease No Objective Diabetes Liver Disease No Objective Suicide Source: California Department of Public Health, Chronic Disease Diabetes is a growing concern in the community. 15.8% of adults in SPA 6 and 8.3% in SPAs 4 and 5 have been diagnosed with diabetes. In SPAs 4 and 6 Asians have the highest rates of diabetes and in SPA 5 a higher percentage of Latinos (16%) have diabetes. Adult Diabetes Diagnosed Pre/Borderline Diabetic 4.6% 6.5% 2.9% 7.1% Diagnosed with Diabetes 8.3% 8.3% 15.8% 10.9% Heart disease has been diagnosed among 7% of adults in SPA 4, 6.2% of SPA 5 and 5% of adults in SPA 6 have been diagnosed with heart disease. In SPA 4, Latinos (7.6%) have the highest rate of heart disease. Whites in SPA 5 (8.6%) and SPA 6 (39.3%) have the highest rates of being diagnosed with heart disease. Men have higher rates of heart disease than women. Adult Heart Disease Diagnosed with heart disease 7.0% 6.2% 5.0% 5.8% Hypertension (high blood pressure) is a health factor that can negatively impact diabetes and heart disease. In SPA 4, 61.5% of adults have been diagnosed with high blood pressure. In SPA 5, 24.2% have high BP and in SPA 6, 34.1% of adults have been diagnosed with high blood pressure. 9

11 High Blood Pressure Diagnosed with High Blood Pressure 26.0% 24.2% 34.1% 27.6% Takes Medication for High Blood Pressure 61.5% 83.4% 63.4% 70.2% The population diagnosed with asthma in SPA 4 is 11.3%, in SPA % and in SPA 6 is 13.5%. Among youth in SPA 4, 11.6% have been diagnosed with asthma, 10.8% in SPA 5 and 15.7% of youth in SPA 6 have been diagnosed asthma. The top three Ambulatory Care Sensitive (ACS) conditions resulting in hospitalization are congestive heart failure, diabetes and pneumonia. A look at the ER rates for the ACS conditions indicates that urinary tract infections, asthma and diabetes are the top three conditions presenting at the ER. Health Behaviors In SPA 5, 13.1% of children are overweight, 12.3% in SPA 4 and 11.8% of children in SPA 6 are overweight. SPA 6 has the lowest rate of teen overweight at 11.3%. In SPA 4, 29.3% of teens and in SPA 5, 20.8% of teens are overweight. Over one-third of adults are overweight in SPA 6 (38.4%). In SPA 4 28% and in SPA 5 29% of adults are overweight. Overweight Adult 28.0% 29.0% 38.4% 33.2% Teen 29.3% 20.8% 11.3% 18.6% Child 12.3% 13.1% 11.8% 12.1% Adult overweight and obesity by race and ethnicity indicates over half of the adult population among Latinos are overweight or obese. Adult Overweight and Obesity by Race/Ethnicity African American 48.8% 47.5% 56.2% 65.0% Asian 19.6% 21.9% 85.1% 34.9% Latino 61.9% 69.8% 69.9% 64.0% White 44.0% 40.3% 63.7% 51.5% 10

12 Beverly Hills, Culver City and West Hollywood tend to have lower obesity rates. In, over one-fourth of the youth are obese (25.4%) and 22.4% of adults are obese. Adults, ages 18-64, consume fast food at higher rates than children, SPA 5 has higher rates of fast food consumption among all age groups when compared to SPA 4 and SPA 6 and the county. In Service Planning Area 4, 14.8% of children and teens consume two or more soda or sweetened drinks a day. 21.3% of children and teens in SPA 5 and 21.7% in SPA 6 consume two or more soda or sweetened drinks a day. In SPA 4 and SPA 6 over half of the children consume five fruits and vegetables in a day. In SPA 5, 45.9% of children consume five servings of fruit and vegetables daily. Fresh fruit and vegetable consumption decreases considerably among teens. In SPA 4, 50.2% of children engaged in vigorous physical activity at least three days a week. In SPA 5, 75.7% and in SPA 6, 61.5% of children engaged in vigorous physical activity. And over 74% of youth visited a park, playground or open space. However, 15.1% of children in SPA 4, 6.6% in SPA 5, and 15.2% in SPA 6 were sedentary during the week. The rate of HIV/AIDS diagnosed in 2011 has decreased from Rates of diagnosis of HIV/AIDS are higher in SPAs 4 and 6 than found in the county. SPA 6 has high rates of Chlamydia (966.9 per 100,000 persons) and Gonorrhea (225.7). SPA 4 has rates of primary and secondary syphilis (20.9) and early latent syphilis (31.5). Females have the highest rates of Chlamydia. Young adults, ages 20-24, and Blacks/African Americans have the highest rates of sexually transmitted infections. Beverly Hills (8%) and Culver City (8.7%) have low rates of smoking in the service area. West Hollywood (19.6%) had the highest rate of smoking in the target service area. Among adults, 27.8% in SPA 4, 29.2% in SPA5, and 25.2% in SPA 6 had engaged in binge drinking in the past year. In SPA 4, less than 1% of teens and 5.6% of teens in SPA 5 had engaged in binge drinking. Among adults, 10.7% in SPA 4, 3.6% in SPA 5, and 14.8% in SPA 6 experienced serious psychological distress in the past year. 19.4% of adults needed help for mental health problems in SPA 4, 16% in SPA 5, and 13.2% of adults in SPA 6 needed help for mental health problems. 3.5% of teens needed help for mental health problems in SPA 4, 9.7% in SPA 5, and 26.4% of teens in SPA 6 needed help for mental health problems. 11

13 Mental Health Indicators, Teens Teens who Needed Help for Emotional- Mental and/or Alcohol-Drug Issues in Past Year Teens Received Psychological/ Emotional Counseling in Past year 3.5% 9.7% 26.4% 15.3% 5.7% 23.4% 4.3% 7.5% Over half the adults in SPA 4 (52.6%) and in SPA 6 (56.4%), and 41.2% of adults in SPA 5 who needed help for an emotional or mental health problem did not receive treatment. Among seniors, 42.9% in SPA 6, 62.6% in SPA 4, and 72% in SPA 5 had received a flu shot. Over half the seniors in SPA 4 (54.6%), SPA 5 (71.5% and SPA 6 (51.1%) had obtained a pneumonia vaccine. Flu Vaccine Received Flu Vaccine, 65+ Years Old 62.6% 73.0% 42.9% 63.8% Received Flu Vaccine, % 34.3% 25.3% 27.3% Received Flu Vaccine, 0-17 Years Old 48.8% 47.6% 42.3% 45.4% The Healthy People 2020 objective for mammograms is that 81.1% of women 40+ years have a mammogram in the past two years. In SPA 4, 68.5% of women have had a mammogram, 78.5% in SPA 5, and 72% of women, age 40+, had a mammogram in SPA 6. The Healthy People 2020 objective for Pap smears in the past three years is 93%. In SPA 4, 84.6% of women had a Pap smear, in SPA 5, 87.3% and in SPA 6, 88.3% of women have had a Pap smear in the past three years. The Healthy People 2020 objective for colorectal cancer screening is 70.5%. SPA 4 (73.1%) and SPA 5 (81.3%) exceed this screening objective. With 67.1% of adults obtaining colorectal screening, SPA 6 has a rate less than the Healthy People 2020 objective. Community Stakeholder Interviews Many of the issues of greatest concern to the interviewees stem from the impact of the economic downturn and economic insecurity 12

14 Lack of money/poverty Housing costs Unemployment and underemployment Lack of health insurance and difficulty accessing health care High stress levels, depression and hopelessness Lack of access to quality education Increases in substance abuse and domestic violence Transportation challenges People who face economic insecurity often live in neighborhoods where the environment does not support healthy lifestyle choices. This results in: Lack of access to healthy, affordable food (i.e., food deserts) Ubiquitous presence of fast food outlets and corner stores that sell junk food and do offer healthy options as well as presence of unregulated vendors outside schools Lack of access to safe recreational opportunities and physical activities, including parks In addition, the following public health problems were identified as concerns: Hepatitis B, particularly in the Korean population HIV/AIDS Chronic diseases, such as diabetes and heart disease, and increased incidence of stroke and heart problems among African Americans and Latinos Obesity, among children and adults Sexually Transmitted Infections and sex education Alcohol and tobacco use, particularly among youth Dental care Violence Other important issues of concern identified by the interviewees included: Access to quality, affordable primary care due to lack of health care service providers Access to affordable specialty care services Coordination of services Immigration issues such as limited ability to speak English and cultural isolation Issues related to being undocumented such as fears of deportation and fears of seeking services Homelessness 13

15 Difficulty among older adults and immigrant populations in understanding and navigating health care options and systems Issues for older adults related to mobility/transportation and planning for care Concern within the Latino community that a large proportion of the community has a lower education status, which in turn results in reduced access to highpaying jobs (and health insurance) as well as higher poverty and greater likelihood of living in neighborhoods with environments that do not promote health, increasing the risks for violence, obesity, alcohol use and chronic disease A number of recommendations were made to improve health and reduce disparities in the communities served by Cedars-Sinai Medical Center. Reduce health disparities among ethnic communities, particularly among the Latino, Korean and African American populations Increase the number and/or capacity of primary care clinics to meet the need/demand for services Provide resources for case management to support patient compliance with provider recommendations for chronic disease management Address the social and economic determinants of health such as education, jobs and housing as these have as great an impact on overall health status and access to health services. Specifically, several interviewees noted the importance of increasing high-school graduation rates, creating living-wage jobs, and meeting the need for safe and affordable housing Focus on healthy living and obesity prevention through advocacy and policy that increases access to affordable, fresh fruits and vegetables (and reduces access to fast food, soda and other junk food), and to safe places for physical activity Assure there are referrals and follow-up resources for conditions detected through screenings (e.g., breast health concerns, high blood pressure, high blood sugar levels) Affordable mental health services need to be increased, not reduced A coordinated, countywide fight against diabetes is needed Foster collaborations as a way to share information across organizations and reduce unnecessary duplications Assess and address health disparities among older populations 14

16 Identification and Prioritization of Health Needs Based on the results of the primary and secondary data collection, and the examination of ambulatory care sensitive conditions, health needs were identified. Each health need was confirmed by more than one indicator or data source (i.e., the health need was suggested by more than one source of secondary or primary data). In addition, the health needs were based on the size of the problem (number of people per 1,000, 10,000, or 100,000 population); or the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of a problem, the health need indicators identified in the secondary data were measured against benchmark data, specifically California state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. Additionally, primary data sources were asked to identify community and health issues based on the perceived size or seriousness of a problem. The identified health needs in alphabetical order: Access to Care Dental care Insurance coverage Medications Mental health Primary care Specialty care Transportation Chronic Disease Asthma Cancer Cardiovascular disease Diabetes Medications Overweight and obesity: healthy food choices Overweight and obesity: physical activity Preventive care and ongoing monitoring 15

17 Health Behaviors Alcohol use Health education Preventive care (Pap smears, mammograms, vaccines) Sexually transmitted diseases Smoking Prioritization Process Priority setting is a required step in the community benefit planning process. The IRS regulations indicate that the Community Health Needs Assessment must provide a prioritized description of the community health needs identified through the CHNA, and include a description of the process and criteria used in prioritizing the health needs. Cedars-Sinai completed the following steps to prioritize health needs that emerged as a result of the Community Health Needs Assessment (CHNA): Cedars-Sinai engaged Melissa Biel, Principal of Biel Consulting to lead the CHNA effort. The CHNA results integrated secondary data obtained from numerous data sources, as well as primary data collected through a series of interviews on community health needs as noted on page 17. The CHNA data collection and analysis occurred from July to October The preliminary CHNA results were presented to the Community Benefit Committee, a committee of the Board of Directors, in November, The Community Benefit Committee provided feedback on the preliminary analysis. The Cedars-Sinai Community Benefit Advisory Group, made up of Cedars-Sinai management and executives across disciplines, met in February, 2013 to review the CHNA results and community health needs. The Community Benefit Advisory Group prioritized health needs ranking each health need low, medium or high for all the identified criteria. Priority Setting Criteria o Current area of Community Benefit focus: Cedars-Sinai has acknowledged competencies and expertise to address the health need; and the health need fits with the organizational mission. o Established relationships: Cedars-Sinai has established relationships with community partners to address the health need. o Organizational capacity: Cedars-Sinai has the capacity to address the health need. Based on these criteria, health needs that obtained high rankings on any of the criteria were identified as community benefit priority areas. 16

18 The prioritized health needs were presented to the Community Benefit Committee in February, 2012 for review and approval. Time was allotted to incorporate feedback on the prioritized needs. The approved prioritized health needs are: Prioritized Health Needs 1. Prioritized by areas of highest need in Cedars-Sinai s Service Area, with a particular focus on Service Planning Areas 4 and 6 (including zip codes that may be slightly outside our service area), these planning areas include diverse, low-income communities where there are more uninsured adults and children and greater health challenges than in other parts of. We also focus on high-need populations closer to Cedars-Sinai. 2. Selected Community Benefit efforts are focused on increasing and supporting access to health care services through direct programs and partnerships with local community-based organizations. Primary care Specialty care Mental health Preventive care Health education 3. Selected Community Benefit efforts focused on the prevention of key chronic health conditions and their underlying risk factors. Cardiovascular disease Diabetes Cancer Overweight/obesity: healthy food choices and physical activity Preventive care Health education The CHNA, the prioritized health needs and Cedars-Sinai s Implementation Strategy were presented to the Board of Directors for review and approval in May, Time was allotted for incorporating feedback for all documents. 17

19 Introduction Background and Purpose Cedars-Sinai is a world-renowned, nonprofit academic medical center with 896 licensed beds located in, California. Since its inception in 1902, Cedars-Sinai has evolved to become the largest nonprofit hospital in the western United States one that is internationally renowned for the best patient care modern medicine has to offer. Cedars-Sinai is committed to providing superior outpatient, acute and sub-acute patient care, breakthrough biomedical research, graduate and undergraduate medical education and community service. Its mission reflects this commitment through: Leadership and excellence in delivering quality healthcare services. Expanding the horizons of medical knowledge through biomedical research. Educating and training physicians and other healthcare professionals Striving to improve the health status of our community Cedars-Sinai has undertaken a Community Health Needs Assessment (CHNA) as required by state and federal law. California Senate Bill 697 and the Patient Protection and Affordable Care Act and IRS section 501(r)(3) direct tax exempt hospitals to conduct a community health needs assessment and develop an Implementation Strategy every three years. The Community Health Needs Assessment is a primary tool used by Cedars-Sinai to determine its community benefit plan, which outlines how it 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. Service Area Cedars-Sinai is located at 8700 Beverly Boulevard,, California The service area includes large portions of Service Planning Areas SPAs) 4 (Metro), 5 (West) and 6 (South), and smaller portions of SPA 2 (San Fernando), SPA 7 (East) and SPA 8 (South Bay) in. The service area includes 44 zip codes, representing 25 cities or communities. Cedars-Sinai determines the Community Benefit Service Area by assigning zip codes based on patient discharges. The top 50% of inpatient discharges, excluding discharges for normal newborns, constitutes the Core Service Area. In addition, zip codes are added to the service area determination based on a current understanding of community need, and long-standing programs and 18

20 community partnerships. The Cedars-Sinai Community Benefit service area is presented below by community, zip code and Service Planning Area (SPA). Cedars-Sinai Medical Center Community Benefit Service Area City Zip Code SPA Baldwin Hills SPA 6 Beverly Hills 90210, 90211, SPA 5 Brentwood/Westwood 90024, SPA 5 Central LA 90012, 90017, SPA 4 Crenshaw 90016, SPA 6 Culver City SPA 5 Fairfax/Mid-City 90019, SPA 4 Gardena SPA 8 Hollywood 90027, 90028, 90038, SPA 4 Huntington Park SPA 7 Inglewood 90301, 90302, 90303, SPA 8 Ladera SPA 6 Lawndale SPA 8 Palms SPA 5 Playa del Rey SPA 5 Sherman Oaks SPA 2 South Central LA 90002, 90044, SPA 6 Studio City SPA 2 University SPA 6 Van Nuys SPA 2 West Hollywood 90046, 90048, SPA 4 West LA/Palms SPA 5 West LA/Rancho 90025, 90035, SPA 5 Wilshire/Koreatown SPA 4 Wilshire 90006, SPA 4 Author Melissa Biel of Biel Consulting conducted the Community Health Needs Assessment. Biel Consulting is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. Dr. Biel has over 10 years of experience conducting hospital Community Health Needs Assessments. 19

21 Methods Secondary Data Collection Secondary data were collected from a variety of local, county, and state sources to present community demographics, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, and health behaviors. Analyses were conducted at the most local level possible for the Hospital primary service area, given the availability of the data. For example, demographic data, birth and death data are based on zip codes. Housing and economic indicators are available by city. Other data are only available by SPA (Service Planning Area) or county. For the purposes of this Needs Assessment, when examining data by SPA the priority geographic areas of SPAs 4, 5, and 6 and are presented. Sources of data include the Healthy Communities Institute/Claritas, U.S. Census 2010 decennial census, California Health Interview Survey, California Department of Public Health, California Employment Development Department, Health Survey, Homeless Services Authority, Uniform Data Set, CDC National Health Statistics, National Cancer Institute, U.S. Department of Education, and others. When pertinent, these data sets are presented in the context of and California State, framing the scope of an issue as it relates to the broader community. The report includes benchmark comparison data that measures Cedars-Sinai community data findings with Healthy People 2020 objectives (Attachment 1). Healthy People 2020 objectives are a national initiative to improve the public s health by providing measurable objectives and goals that are applicable at national, state, and local levels. 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. Twenty-three interviews were completed during July through September, For the interviews, community stakeholders identified by Cedars-Sinai were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations, or regional, State or local health or other departments or agencies that have current data or other information relevant to the health needs of the community served by the hospital facility. Input was obtained from Department of Public Health officials: 20

22 Paul Simon, MD, MPH is the Director of the Division of Chronic Disease and Injury Prevention at the Department of Public Health. He is also an Adjunct Professor, Department of Epidemiology, UCLA School of Public Health. Jan King, MD is the Area Health Officer for the Department of Public Health, Service Planning Area 6. Prior to joining the LA Department of Health Services, Dr. King was an Epidemic Intelligence Service Officer for the Center for Disease Control. Cristin Mondy, RN, MSN, MPH is the Area Health Officer for the Department of Public Health, Service Planning Area 4. A list of the stakeholder interview respondents, their titles, organizations and leadership roles can be found in Attachment 2. Information Gaps Information gaps that impact the ability to assess health needs were identified. Specifically, cancer incidence rates are not available at a rate more local than Los Angeles, and the results of the most recent 2011 Health Survey (a population based telephone survey that provides information concerning the health of residents) were not yet available during the conduct of this CHNA. Health Care Facilities and Community Resources The size of the Cedars-Sinai community benefit service area and the large number of organizations and agencies serving the area in make it challenging to compile a comprehensive list of all community resources. Attachment 3 provides a representative list of existing health facilities and resources within the community that are available to meet identified community health needs. Additional resources can be accessed at:

23 Map of the Cedars-Sinai Community Benefit Service Area 22

24 Demographics Population The population of the Cedars-Sinai Community Benefit service area is 1,755,853. From 2000 to 2010, the population increased by 1.3%. This was a slower rate of growth than experienced countywide. Change in Total Population Population Cedars-Sinai Service Area Total population ,755,853 9,860,343 Change in population % 3.6% Source: Healthy Communities institute/claritas, 2012 Of the area population, 49.8% are male and 50.2% are female. Population by Gender Gender Cedars-Sinai Service Area Male 49.8% 49.6% Female 50.2% 50.4% Source: Healthy Communities institute/claritas, 2012 Children and youth, ages 0-17, make up 23.2% of the population; 66% are adults, ages 18-64; and 10.8% of the population are seniors, ages 65 and over. The median age in the Community Benefit service area is 35.03, slightly higher than the LA median age of Population by Age Age Ranges Cedars-Sinai Service Area % 7.4% % 6.9% % 6.7% % 4.4% % 4.4% % 5.6% % 15.8% % 14.8% % 13.8% % 9.8% % 5.5% % 3.5% % 1.5% 2012 Median Age Source: Healthy Communities Institute/Claritas, 2012 When the Community Benefit service area is examined by community in SPAS 4, 5 and 6, South Central, Wilshire and Crenshaw have the largest percentage of 23

25 youth, ages Beverly Hills, Brentwood, West Hollywood and West Los Angeles/Rancho have the highest percentage of residents 65 and older. Population by Youth, Ages 0-17, and Seniors, Ages 65+ Service Area Zip Code Youth Seniors Ages 0 17 Ages 65+ Baldwin Hills % 15.4% Beverly Hills % 21.0% Beverly Hills % 15.3% Beverly Hills % 16.3% Brentwood/Westwood % 13.5% Brentwood/Westwood % 18.7% Central LA % 15.4% Central LA % 7.7% Central LA % 8.8% Crenshaw % 10.6% Crenshaw % 10.3% Culver City % 15.2% Fairfax/Mid-City % 10.6% Fairfax/Mid-City % 12.2% Gardena % 11.4% Hollywood % 14.6% Hollywood % 8.9% Hollywood % 6.4% Hollywood % 12.9% Huntington Park % 5.3% Inglewood % 8.4% Inglewood % 7.7% Inglewood % 7.2% Inglewood % 5.2% Ladera % 12.9% Lawndale % 7.8% Palms % 12.7% Playa del Rey % 13.0% Sherman Oaks % 4.5% South Central LA % 5.7% South Central LA % 7.4% South Central LA % 12.1% Studio City % 14.8% University % 6.4% Van Nuys % 6.0% West Hollywood % 16.5% West Hollywood % 19.2% West Hollywood % 15.4% West LA/Palms % 8.9% West LA/Rancho % 11.9% West LA/Rancho % 14.7% West LA/Rancho % 16.1% Wilshire/Koreatown % 8.4% Wilshire % 7.6% Wilshire % 7.9% Cedars-Sinai Service Area 23.2% 10.8% 25.4% 10.5% 24

26 Race/Ethnicity In the Cedars-Sinai Community Benefit service area, 41% of the population is Hispanic/Latino; 28.9% of the residents are White; 16.3% are African American; 10.8% are Asian; and 2.9% are American Indian/Alaskan Native or other race/ethnicity. Race/Ethnicity Cedars-Sinai Service Area Hispanic/Latino 41.0% 47.7% White 28.9% 27.8% Black/African American 16.3% 8.3% Asian 10.8% 13.5% American Indian/Alaska Native 0.2% 0.2% Native HI/PI 0.1% 0.2% Other 2.6% 2.3% Source: U.S. Census Bureau, 2010; Healthy City Language The languages spoken at home by area residents mirror the racial/ethnic make-up of the Cedars-Sinai Community Benefit service area communities. English is spoken in the home among 45.2% of the service area population. Spanish is spoken at home among 38.3% of the population; 7.9% of the population speak and Asian language; and 7% of the population speaks an Indo-European language at home. Language Spoken at Home, Population 5 Years and Older Cedars-Sinai Service Area Speaks Only English 45.2% 43.1% Speaks Spanish 38.3% 40.0% Speaks Asian/PI Language 7.9% 10.4% Speak Indo-European Language 7.0% 5.5% Speaks Other Language 1.6% 1.0% Source: Healthy Communities Institute/Claritas, 2012 When communities in SPAs 4, 5, and 6 are examined by language spoken in the home, a number of communities have high percentages of Spanish speakers including: Central, South Central, University, and Wilshire. Areas with a high percentage of Asian language speakers include: Brentwood/Westwood, Central Los Angeles, Fairfax, and Wilshire. Beverly Hills, Brentwood/Westwood, Hollywood, West Hollywood and West have higher rates of residents who speak Indo- European languages at home. 25

27 Language Spoken at Home by Zip Code Geographic Area Zip Indo English Spanish Asian/PI Code European Baldwin Hills % 18.8% 1.9% 1.5% Beverly Hills % 4.6% 3.4% 31.1% Beverly Hills % 3.6% 8.2% 34.1% Beverly Hills % 3.2% 5.1% 26.1% Brentwood/Westwood % 8.9% 18.0% 15.9% Brentwood/Westwood % 5.8% 4.9% 16.9% Central LA % 29.9% 37.7% 1.9% Central LA % 72.7% 10.3% 1.6% Central LA % 55.5% 15.1% 2.4% Crenshaw % 53.8% 1.6% 1.2% Crenshaw % 57.1% 2.5% 0.8% Culver City % 27.4% 7.5% 5.7% Fairfax/Mid-City % 44.9% 12.8% 2.2% Fairfax/Mid-City % 8.3% 12.9% 10.9% Gardena % 29.1% 13.1% 1.4% Hollywood % 21.8% 8.3% 21.1% Hollywood % 34.5% 5.4% 18.5% Hollywood % 59.1% 7.0% 9.2% Hollywood % 7.5% 4.3% 11.5% Huntington Park % 82.9% 2.3% 0.1% Inglewood % 59.2% 1.3% 1.0% Inglewood % 42.6% 0.4% 1.2% Inglewood % 56.1% 1.9% 0.7% Inglewood % 84.6% 0.5% 0.4% Ladera % 26.8% 0.7% 2.1% Lawndale % 51.3% 6.8% 4.7% Palms % 26.7% 8.8% 5.7% Playa del Rey % 13.8% 4.8% 5.4% Sherman Oaks % 9.5% 4.6% 11.6% South Central LA % 72.3% 0.3% 0.3% South Central LA % 55.9% 0.8% 0.7% South Central LA % 31.9% 0.5% 0.6% Studio City % 7.1% 4.0% 10.8% University % 74.4% 1.0% 0.3% Van Nuys % 69.4% 11.7% 3.3% West Hollywood % 8.0% 3.1% 23.0% West Hollywood % 6.4% 3.2% 19.5% West Hollywood % 9.2% 2.4% 12.6% West LA/Palms % 23.3% 11.4% 9.8% West LA/Rancho % 13.3% 9.4% 18.2% West LA/Rancho % 9.7% 3.3% 16.0% West LA/Rancho % 10.1% 10.0% 9.0% Wilshire/Koreatown % 50.6% 20.6% 4.1% Wilshire % 70.0% 16.6% 1.4% Wilshire % 68.0% 19.7% 1.2% Cedars-Sinai Service Area 45.2% 38.3% 7.9% 7.0% 43.1% 40.0% 10.4% 5.5% Source: Healthy Communities Institute/Claritas,

28 Social and Economic Factors Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2010, the federal poverty level (FPL) for one person was $10,830 and for a family of four $22,050. Among the residents in the SPAs represented in the Cedars-Sinai Community Benefit service area, SPA 6 has the highest poverty rates: 48.9% are at or below 100% of the federal poverty level (FPL) and 74.9% are at 200% or below FPL. In SPA 4, 29% of the population is at the poverty level, in SPA 5, 12.2% are living in poverty. Rates of poverty in SPAs 4 and 6 are higher than found in the county. Poverty Levels <100% FPL 29.0% 12.2% 48.9% 22.7% <200% FPL 51.3% 20.8% 74.9% 42.9% A view of children in poverty by Service Planning Area (SPA) indicates that over half (57.6%) of children in SPA 6 live in poverty, 41.7% of children in SPA 4 and 15.7% of children in SPA 5 are <100% FPL. In SPA 6, 82.2% of children are categorized as lowincome (<200% FPL). In SPA % of children under age 18, and 25% of children in SPA 5 are low-income. Children in Poverty, Ages % FPL 41.7% 15.7% 57.6% 29.3% % FPL 24.8% 9.3% 24.6% 22.0% % FPL 14.0% 7.9% 11.3% 12.6% 300% FPL and above 19.5% 67.1% 6.5% 36.1% Families in poverty paint an important picture of the population within the Cedars-Sinai Community Benefit service area. The rate of families in poverty for the Community Benefit service area is 17.2%. When examined by our target areas of SPA 4, 5 and 6, community poverty rates are high among families in Central, South Central and the Wilshire area. 27

29 Families in Poverty by Zip Code (<100% FPL) Location Zip Code Poverty Rate Baldwin Hills % Beverly Hills % Beverly Hills % Beverly Hills % Brentwood/Westwood % Brentwood/Westwood % Central LA % Central LA % Central LA % Crenshaw % Crenshaw % Culver City % Fairfax/Mid-City % Fairfax/Mid-City % Gardena % Hollywood % Hollywood % Hollywood % Hollywood % Huntington Park % Inglewood % Inglewood % Inglewood % Inglewood % Ladera % Lawndale % Palms % Playa del Rey % Sherman Oaks % South Central LA % South Central LA % South Central LA % Studio City % University % Van Nuys % West Hollywood % West Hollywood % West Hollywood % West LA/Palms % West LA/Rancho % West LA/Rancho % West LA/Rancho % Wilshire/Koreatown % Wilshire % Wilshire % 28

30 Location Zip Code Poverty Rate Cedars-Sinai Service Area 17.2% 12.6% Source: Healthy Communities Institute/Claritas, 2012 The per capita income in the Community Benefit service area is $27,177, which is higher than the county per capita income of $25,164. Per Capita Income Cedars-Sinai Service Area $27,177 $25,164 Source: Healthy Communities Institute/Claritas, 2012 Households In the Cedars-Sinai Community Benefit service area there are 671,702 households, 724,196 housing units and 376,411 families. Over the last decade, households and families grew by approximately 2.7%-2.8%. Housing units grew at approximately twice the rate at 5.2%. These rates of growth in the service area are less than the county growth in households, families and housing units. Households, Housing Units, and Families, 2012 and Growth Rate, Cedars-Sinai Service Area Number Percent Growth Number Percent Growth Households 671, % 3,262, % Housing Units 724, % 3,467, % Families 376, % 2,226, % Source: Healthy Communities Institute/Claritas, 2012 The median household income in the Community Benefit service area is $47,608 and the average household income is $69,500. These rates are lower than the county household income rates. Household Income Cedars-Sinai Service Area Median Household Income $47,608 $52,136 Average Household Income $69,500 $74,800 Source: Healthy Communities Institute/Claritas, 2012 Free or Reduced Price Meals The percentage of students eligible for the free and reduced price meal program is one indicator of socioeconomic status. Among Unified School District schools, over three-fourths (76.1%) of the student population are eligible for the free and reduced price meal program, indicating a high level of low-income families. This rate is higher than the county and state rates. 29

31 Free and Reduced Price Meals Eligibility Public school students eligible for free or reduced price meals Source: California Department of Education, LAUSD California 76.1% 65.3% 56.7% Residents in SPA 6 have higher rates of participation in public programs (government sponsored) compared to residents in SPAs 4 and 5. In SPA % of residents cannot afford food and 13.3% utilize food stamps. Interestingly, SPA 5 has the highest percentage of residents who cannot afford food (44.1%) and the lowest rate of food stamp recipients (5.2%). In SPA 6, 40.1% of residents cannot afford food and 29.1% utilize food stamps. This indicates a considerable percentage of residents who may qualify for food stamps but do not access this resource. WIC benefits are more readily accessed and 42.2% of eligible adults in SPA 4, 38.2% in SPA 5 and 76.8% in SPA 6 use WIC. Among qualified children in SPA 4, 58% access WIC, 54.1% in SPA 5, and 70.5% in SPA 6 access WIC. Among SPA 6 residents, 13.8% are TANF/CalWorks recipients; 4.5% of SPA 4 residents and less than 1% of SPA 5 residents (0.4%) are TANF/CalWorks recipients. Public Program Participation Not Able to Afford Food (<200%FPL) 38.3% 44.1% 40.1% 38.2% Food Stamp Recipients 13.3% 5.2% 29.1% 13.4% WIC Usage among Qualified Adults 42.2% 38.2% 76.8% 52.5% WIC Usage among Qualified Children (Ages 6 and Under) 58.0% 54.1% 70.5% 60.1% TANF/CalWorks Recipients 4.5% 0.4% 13.8% 5.9% Unemployment The unemployment rate of Cedars-Sinai service area cities shows a diverse range from 8.5% in Culver City to 18.2% in Huntington Park. city has an unemployment rate of 13.6%. Unemployment Rate, 2011 Average Geographic Area* Unemployment Rate Beverly Hills 8.6% Culver City 8.5% Gardena 11.5% Huntington Park 18.2% Inglewood 15.3% 13.6% Lawndale 12.2% 30

32 West Hollywood 10.4% 12.3% California 11.7% Source: California Employment Development Department, Labor Market Information * Data available by city, therefore, zip code only areas in the Cedars-Sinai service area are not listed. Educational Attainment Among adults, ages 25 and older, in the Cedars-Sinai Community Benefit service area, approximately one-fourth of the population (23.7%) have no high school diploma. Population, 25 Years and Older, with No High School Diploma Cedars-Sinai Service Area 23.7% 24.3% Source: Healthy Communities Institute/Claritas, % of Community Benefit service area adults are high school graduates and 40% are college graduates. In 21.1% of residents are high school graduates and 35.5% are college graduates. Educational Attainment of Adults, 25 Years and Older Cedars-Sinai Service Area Less than 9 th Grade 14.1% 14.1% Some High School, No Diploma 9.6% 10.2% High School Graduate 18.3% 21.1% Some College, No Degree 18.1% 19.2% Associate Degree 5.6% 6.7% Bachelor Degree 22.0% 19.0% Master s Degree 7.5% 6.3% Professional School Degree 3.4% 2.3% Doctorate degree 1.5% 1.2% Source: Healthy Communities Institute/Claritas, 2012 Homelessness According to the 2011 Homeless Services Authority count, SPA 4 had an annualized estimate of 11,571 homeless individuals and SPA 5 had 3,512 homeless individuals, and SPA 6 had 8,735 homeless. In SPA 4, 83% are individuals and 15% of the homeless are families. In SPA 5 80% of the homeless are single adults and 19% are families. In SPA 6 64% of the homeless are single adults and 35% are families. 31