community health needs assessment June 1, 2013

Transcription

1 PeaceHealth Southwest Medical Center community health needs assessment June 1, 2013 Operational Leads: Joe Rogers Business Development Program Director PeaceHealth Southwest Medical Center

2 table of contents 2 I. Executive Summary 6 II. Mission, Vision and Values 7 III. Service Area and Demographics 8 A. Population Base 8 B. Education and Income 10 C. CNI Scores 11 IV. The Community Health Needs Assessment 11 A. Overview of Process and Sources 12 B. Assessment Findings 21 C. Opportunity Summary 23 V. Partners and Priorities for Community Health Improvement 23 A. Clark CHNA Partners 24 B. Clark CHNA Priorities 26 VI. PeaceHealth Southwest Medical Center Implementation Plan 26 A. Top Priorities and Implementation Plan 29 B. Effects on Community 31 VII. Appendix: PeaceHealth Southwest CHNA Prioritization Process 32 VIII. Resources 32 A. Data and Data Links 32 B. Contracted Third Party Community Health Needs Assessment PeaceHealth Southwest Medical Center 1

3 I. Executive Summary PeaceHealth Southwest Medical Center (PHSW) is one of nine hospitals within PeaceHealth, an integrated, not-for-profit health system that offers a full continuum of health and wellness services in the Northwest. Located in Vancouver, Washington, the service area for PHSW is Clark. In addition, four counties (Multnomah, Clackamas, and Washington in Oregon State and Clark in Washington State) created a joint partnership in 2010, Healthy Columbia Willamette, to characterize and address the health needs of the greater Portland/Vancouver Metropolitan area. PHSW s mission is to carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way. Our vision is to ensure that every person receives safe, compassionate care; every time, every touch. PeaceHealth and PHSW provide exceptional medicine, and endeavor to always serve the most vulnerable among us. PeaceHealth recognizes the need for individuals who are uninsured or underinsured to access health care and PeaceHealth provides those services equally to all. These goals are becoming increasingly important in the changing face of health care. Our broad, new vision for achieving population health is captured in the PeaceHealth VISTA Strategic Plan ( ). Through VISTA, PeaceHealth is making a deliberate shift away from focusing only on illness and individual episodes of care. While still providing acute care, we are also now aiming our attention and resources toward supporting behaviors and initiatives that improve outcomes, promote wellness behaviors, and support health management for entire communities. The priorities we identified in this Community Health Needs Assessment (CHNA) for PeaceHealth Southwest Medical Center are integral to this process. Community Health Needs Assessment This CHNA process was conducted by the Healthy Columbia Willamette group (see page 11 for a description) using the Mobilizing for Action through Planning and Partnerships (MAPP) model, an evidence-based community-wide strategic planning process for improving community health. Healthy Communities Institute (HCI), was instrumental in identifying and contextualizing data. Four health departments and 14 hospitals, represented by the area s major health systems (PeaceHealth, Providence, Legacy, Adventist, Tuality, one health system/health insurer in Kaiser, and one academic medical center/university in Oregon Health & Science University), participated in the needs assessment, as shown in Table 13. For more information on Healthy Columbia Willamette, visit The information, conclusions, and priorities were drawn from a large body of secondary data about the health and socioeconomic status of Clark residents vs. their statewide and regional counterparts. We also incorporated an abundance of valuable and forthright input from community groups, public officials, public forums, focus groups, and key informant interviews that were collectively hosted over several months. Clark is, for some health status measures, currently as healthy as the Portland region (and in some cases is healthier than the National Healthy People 2020 benchmarks). The data collected and analyzed in this CHNA, coupled with the robust community outreach effort, revealed that Clark generally performs poorly in comparison to regional benchmarks. These concerns led to our overarching priority of Healthy Communities achieved by improving the conditions under which Clark residents, live, work, play, and learn. Community Health Needs Assessment PeaceHealth Southwest Medical Center 2

4 Using this priority of a Healthy Community as a framework, participants agreed that CHNA-based changes should help our achieve three community goals: Quality, Accessible Health Care Healthy Children & Families Healthy Neighborhoods & Social Connections The comprehensive CHNA process identified the following gaps and needs: 1. Overall, Clark residents tend to be slightly less healthy than other residents of the Portland region: On measures of general health, such as self-ratings of overall health, Clark residents perform poorly in comparison to the remainder of the region. Residents are more likely to rate their health as poor or fair and the death rates for multiple causes are higher in comparison to the region. 2. Access to affordable care remains a challenge for many Clark residents: In Clark, nearly 19% of adults and 7.2% of children are uninsured. The adult uninsurance rate is the second highest in the region. Furthermore, 15% of residents elected not to visit the doctor because of concern about the cost. Access to affordable care was identified by residents as the top health care concern in Clark. 3. Mental Health and Substance Abuse are significant challenges in Clark : Though only 11% of Clark residents report binge drinking (four or more drinks in one sitting), this means that more than one in ten of all adults are binge drinking, which is likely to have a significant effect on the overall health of residents. The rate of alcohol-related deaths is the second-highest in the region. The suicide death rate is also the second-highest in the region and is significantly higher than the national rate. Furthermore, there are fewer mental health providers per population in Clark than any other in the Portland region. 4. Residents of Clark are slightly more likely to smoke than all residents of the Portland region: Clark has the highest rates of adult and teen smoking in the region, with nearly 14% of Clark teens admitting to smoking. The rate of smoking in pregnant women is also the highest in the region (12%). 5. Clark has the highest rate of obesity in the region: The rate of obesity in Clark is the highest in the region, as is the rate of diagnosed diabetes. Clark residents are also the least likely in the region to have adequate fruit and vegetable consumption. Access to healthy foods, a cornerstone of maintaining a healthy weight, was a significant concern raised by residents. 6. In general, with the exception of a higher unemployment rate, Clark performs similarly to the region on social factors affecting health: Overall, Clark is affluent, with a low poverty rate and a high rate of homeownership. Residents are well-educated and in comparison to the State, they are more likely to speak English at home. Those who speak a language other than English are more likely to speak English well. Clark has the highest unemployment rate in the four area. 7. Clark s performance on birth outcomes is similar to the region: Overall, the rates of low birth weight and receipt of early prenatal care for residents of Clark are similar to that of the region. Community Health Needs Assessment PeaceHealth Southwest Medical Center 3

5 Our CHNA Priorities Based on our resources and expertise, and in close coordination with the community, PHSW has elected to focus its health improvement efforts on four high-profile needs that fall well within our purview and mission: 1. Increase Access to Affordable Care IMPACT: Health care reform will provide previously uninsured residents eligibility for health insurance, but this population will likely need assistance enrolling in Medicaid or Exchange plans. Many newlyeligible people are used to obtaining care at hospital emergency departments. PeaceHealth Southwest Medical Center will assist emergency room patients in enrolling in plans in addition to continuing to provide care to patients who cannot pay for services. This includes increasing the number of children and adults with health insurance, and improving access to low-cost medical and dental services. 2. Improve Mental Wellbeing IMPACT: To improve mental wellbeing, PHSW will work to increase people s awareness of mental illness and support social and policy changes that allow people to live substance free (a common correlation with mental illness). This includes increasing screening for mental health and providing better access to mental health services. 3. Reduce Substance Abuse IMPACT: PHSW will support social and policy changes that allow people to live substance free. PHSW will support efforts to intervene early in substance use, identifying youth and treating them before substance abuse becomes a habit. We will help increase access to substance abuse services, screening, and early detection. 4. Increase Health Habits IMPACT: Improving access to healthy food and safe recreational activities will combat obesity and chronic diseases such as diabetes. PHSW will support programs, education, and social networks that encourage people to increase physical activity and eat more healthy food. We will support programs that improve access to healthy foods and increase opportunities for physical activity in neighborhoods. We will incorporate weight control into health care services and promote physical activity and nutrition in the clinical setting. Healthy habits established during childhood will benefit individuals throughout their lives. Messages encouraging healthy eating and active living will be communicated across the lifespan. The Implementation Plan is outlined in Section VI. Key Contributors to Success Leadership commitment. Successful implementation of CHNA goals for PHSW has our hospital leadership s firm and public commitment. PeaceHealth Southwest will assign our leaders specific responsibilities to carry out these goals. Their commitment will encourage similar leadership involvement within the broader community. Coordination and alignment with VISTA Strategies (internal). This CHNA reflects population-based health needs that closely parallel the aims outlined in PeaceHealth s VISTA Strategic Plan to reposition our Community Health Needs Assessment PeaceHealth Southwest Medical Center 4

6 priorities from caring for illness to promoting population health. To coordinate this care, we will collaborate with multiple departments and medical specialties to carry out our objectives and measure progress. Community partnerships (external). This CHNA process brought together many stakeholders in Healthy Columbia Willamette, and achieving its goals requires cooperation with many external agencies. Going forward, PeaceHealth Southwest will work closely with groups such as Clark Health Department, Kaiser, Legacy and others to serve the needs of individuals living at or near the poverty level and to monitor the progress of CHNA objectives. Extending the Reach of Population Health Based on the Affordable Care Act s CHNA guidelines, every 501 (c) 3 hospital must conduct its own unique CHNA. As a large health system, PeaceHealth has recently conducted a CHNA for each PeaceHealth hospital required to provide one (eight total). Our broad analysis of secondary data, community feedback, and systemwide PeaceHealth input revealed a remarkable level of commonality in the health concerns of our various communities. The overarching framework that is being applied within Clark creating a Healthy Community by improving access to care and the conditions under which residents, live, work, play and learn resonates with the goals of each PeaceHealth community. This commonality forms a unifying structure that will allow us to leverage our resources and partnerships across every community as we tailor our support to the people we serve. With this CHNA plan in hand and guided by VISTA, PeaceHealth has the wherewithal to improve population health in all of Clark. Even better, through systemwide sharing of best practices, every effort made in Clark can inform and spread to other PeaceHealth Southwest service areas and, indeed, across the entire PeaceHealth system improving and supporting the population health of our communities across the Northwest. Community Health Needs Assessment PeaceHealth Southwest Medical Center 5

7 II. Mission, Vision and Values Founded by the Sisters of St. Joseph of Peace, PeaceHealth is a not-for-profit health system that offers a full continuum of health and wellness services to communities in three integrated Networks of Care across Washington, Oregon, and Alaska. We have more than 17,000 caregivers, nine medical centers, an 800-provider group practice, and a comprehensive, state-of-the-art laboratory system. PeaceHealth Mission We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way. Vision Every person receives safe, compassionate care; every time, every touch. Values Respect, Stewardship, Collaboration, and Social Justice. Commitment to CHNA, improved health and the Triple Aim PeaceHealth s VISTA Strategic Plan ( ) aligns well with this CHNA s focus on population-based care, health, and wellness. The strategic plan s four Aims Value, Innovate, Serve and Thrive coalesce into ten tightly integrated performing and transforming strategies that recalibrate PeaceHealth for continued success in our constantly changing health care environment. VISTA rests upon the foundation of our Mission and Values and embodies the Spirit of Healing. It shapes and guides our work over the next five years toward more sustainable value that reflects the Triple Aim of higher quality care experiences and improved population health at the same or lower costs. Community-focused service at PHSW In FY2012 PeaceHealth PHSW provided $48,982,843 in charity care, which included; uncompensated care, unreimbursed Medicaid services and subsidized health services. It also included community benefits for community health programs, medical training, and cash and in-kind donations to local organizations that have complementary missions. PHSW, consistent with other PeaceHealth hospitals, adheres to a set of standards that guides our day-to-day community benefit activities, including: Priority to those marginalized and living in poverty Responsibility to work toward improved health in communities served Actively engaging the community in improving health Demonstrating the value of the community service/programs Integrating community benefit activities throughout the entire organization Community Health Needs Assessment PeaceHealth Southwest Medical Center 6

8 III. Service Area and Demographics For the purpose of the CHNA, the service area for PHSW is defined as Clark, Washington. Clark, located in southwest Washington State, lies just across the Columbia River from Portland, Oregon and is sandwiched between Skamania and Cowlitz Counties in Washington. It is the fifth most populous in the State and is comprised mostly of suburbs of Portland, OR. The Service Area encompasses 629 square miles and its multiple large suburban communities have a total population of over 425,000, as noted in Table 1 below. Though both Clark Department of Health and PHSW are part of Healthy Columbia Willamette, which encompasses four counties (Multnomah, Clackamas, and Washington in the State of Oregon and Clark in the State of Washington),PHSW s CHNA service area is defined as Clark because over 88% of the hospital s patient volume is Clark residents and PHSW is physically located within Clark. There is one other hospital (Legacy Salmon Creek Medical Center) that serves Clark. It is also located in Vancouver. Figure 1 Map of the Service Area Community Health Needs Assessment PeaceHealth Southwest Medical Center 7

9 A. Population Base Within the four Portland metropolitan area, Clark is the third most populous. Between 2000 and 2010, the population grew by over 23%. The largest city in the is Vancouver, which has 38% of the s population. Other larger cities include Camas, Salmon Creek, Battle Ground and Washougal. As with many primarily suburban communities, Clark is fast-growing and affluent; Health Rankings currently ranks Clark the eighth healthiest in the State of Washington. At 7.8% Clark has a smaller Hispanic population than the rest of the State of Washington and the smallest Hispanic population in the Portland metro area. Within Clark, the cities of Vancouver and Woodland have relatively large Hispanic populations. The proportion of elderly population in Clark (12.0%) is similar to the State of Washington (12.7%) and varies by locale within Clark. It is the second largest in the Portland region, with only Clackamas having a larger elderly population. Table 1 Key Racial, Ethnic and Age Demographics in Clark City Total Population White Hispanic Percent age 65 or older Battle Ground 17, % 6.5% 7.9% Camas 19, % 4.1% 8.7% La Center 2, % 4.6% 4.6% Ridgefield 4, % 5.1% 7.7% Salmon Creek 19, % 6.5% 12.5% Vancouver 161, % 10.4% 12.4% Washougal 14, % 5.3% 10.1% Woodland 5, % 16.6% 12.3% Yacolt 1, % 2.1% 5.0% Clark 433, % 7.8% 12.0% Clackamas (OR) 380, % 8.0% 14.2% Multnomah (OR) 748, % 11.1% 10.7% Washington (OR) 540, % 16.0% 10.4% Washington State 6,897, % 11.6% 12.7% United States 308,745, % 16.3% 13.0% Source: and State data, HCI, National and City Data, US Census Note, numbers refer to city boundaries; Woodland lies in both in Cowlitz and Clark Counties, with most residents residing in Cowlitz ; White includes residents identifying white ancestry alone or in combination with any other race; Hispanic is of any race. B. Education and Income The social determinants of health in any community the conditions in which people are born, grow, live, work, and age play an important role in health and health status. Residents with low income or education are more likely to have difficulty accessing health care services and are more likely to have chronic health problems. While Clark s health status is very similar to the region and State on many levels, there are several notable differences, as shown in Table 2. Overall, Clark residents are slightly more likely to have graduated from high school than all Washington residents, and significantly more likely than the United Community Health Needs Assessment PeaceHealth Southwest Medical Center 8

10 States population at large. Clark has the second highest rate of high school completion in the Portland region. Residents of Clark are less likely than all Washington State residents or residents of Multnomah or Washington counties to have been born abroad, and this pattern holds for each major city within the. Interestingly, while the foreign born population of Clark is proportionally smaller than that of the nation, Clark residents are more likely than United States residents on average to speak a language other than English at home. Like many suburban communities, the total poverty rate is lower in Clark compared to both the State and national rates. However, within the Portland metro area, only Multnomah has a higher poverty rate. Table 2 Education and Social Indicators Percent with High School Diploma Percent over age 5 who speak a language other than English at home Percent below the Poverty Level City Foreign Born Battle Ground 89.9% 12.2% 17.8% 11.0% Camas 94.4% 9.2% 12.0% 7.2% La Center 93.7% 3.5% 5.4% 4.7% Ridgefield 96.4% 9.4% 8.9% 15.3% Salmon Creek 92.1% 7.8% 10.8% 14.7% Vancouver 89.0% 12.3% 16.6% 15.5% Washougal 91.0% 4.9% 6.7% 12.8% Woodland 85.2% 5.8% 12.7% 16.9% Yacolt 85.0% 2.1% 4.5% 7.5% Clark 90.8% 10.0% 13.5% 11.7% Clackamas (OR) 91.8% 8.5% 11.3% 9.5% Multnomah (OR) 89.3% 14.0% 19.5% 16.5% Washington (OR) 90.5% 16.8% 22.9% 9.5% Washington State 89.8% 12.8% 17.8% 12.5% United States 85.4% 12.8% 12.8% 14.3% Source: and State, HCI, national and city data, United States American Community Survey (ACS) Community Health Needs Assessment PeaceHealth Southwest Medical Center 9

11 C. Community Need Index Scores To help communities understand the degree to which their populations might need socioeconomic support, Dignity Health and Thomson/Reuters developed the Community Need Index (CNI). This index scores a community based on combined social determinants, such as how many elderly residents live in poverty, how many residents speak limited English, how many lack a high school diploma, and how many don t have health insurance. Scores range from 1 (lowest need) to 5 (greatest need). As shown in table 3, the overall Clark CNI score is 2.8, indicating a lower overall need in comparison to the State and both Multnomah and Washington Counties as indicated in Table 4. None of the communities in the has a CNI score that indicates a greater need than the statewide score of 3.2. The highest is Vancouver, which has a CNI score of 3.2, though the city has pockets of need as high as 4.4 (classified as the highest category of need), as well as pockets in which the need is as low as 2.2. Overall, these data indicate that in comparison to the remainder of the State, Clark has a lower overall need, consistent with the socio-economic indicators in the. Table 3 CNI Scores of Larger Cities City CNI Score Battle Ground 2.4 Camas 1.8 La Center 2.0 Ridgefield 2.0 Salmon Creek 2.2 Vancouver 3.2 Washougal 2.6 Woodland 2.8 Yacolt 2.4 Clark 2.8 Clackamas (OR) 2.7 Multnomah (OR) 3.6 Washington (OR) 3.0 Washington State 3.2 Source: Thomson/Reuters and Dignity Health. Community Health Needs Assessment PeaceHealth Southwest Medical Center 10

12 IV. Community Health Needs Assessment A. Overview of Process and Sources In the winter of 2012, the four counties in the Portland/Vancouver metropolitan area (Clackamas, Multnomah, and Washington Counties in the State of Oregon and Clark in the State of Washington), in collaboration with the local hospitals, Kaiser Permanente, Oregon Health & Sciences University, and the Healthy Communities Institute (HCI), launched a comprehensive community health assessment and planning process, Healthy Columbia Willamette. This process was undertaken jointly due to the highly interrelated nature of the Portland/Vancouver region; hospitals in this region regularly collaborate, as do local health departments. Through a robust collaboration process and with a wide range of community partners, the overall aim of the work was to identify key areas where the community can take action to improve community health and reduce health disparities. In addition to addressing the hospitals CHNA federal requirements, the assessment process is based on the national Mobilizing for Action through Planning and Partnerships (MAPP) model, an evidence-based community-wide strategic planning process for improving community health. Following the collection of the data, the health departments involved in Healthy Columbia Willamette developed a scoring process to provide a numerical score for select indicators (range 1-6), with higher scores indicating greater concern and lower scores indicating lesser concern. This scoring process incorporates the degree of disparities between groups, the change in the indicator over time, the severity of the health issue, comparison to the State, as well as the magnitude of the population affected. To paint a comprehensive picture of the community s status and health care needs, both secondary and primary data were collected. HCI collected and analyzed health data and programs that showed promise for combating persistent health concerns. Many of the data collected by HCI were derived from the Behavioral Risk Factor Surveillance Survey (BRFSS), which is conducted by State health departments on behalf of the Centers for Disease Control and Prevention (CDC). This survey collects data on health status and behaviors affecting health status by telephone survey. BRFSS data on multiple indicators were readily available for Clark and the State as a whole, analyzed either by the Department of Health or obtained from Health Rankings, an assessment tool created by the Robert Wood Johnson Foundation and the University of Wisconsin. BRFSS data should be interpreted with the understanding that respondents report their own health conditions. Diagnoses and other information are not verified by medical staff. In Clark, BRFSS data on diabetes suggest over-reporting by respondents when those data are compared to diabetesrelated hospitalization rates and death rates. Other valuable sources of information were the US Census of 2010 and the American Community Survey, which is conducted by the US Census Bureau, and State mortality statistics. Health status data, hospital data and data collected in schools are not usually collected the same way indifferent states. Therefore, Clark outcomes may seem more different than Clackamas, Multnomah and Washington data because of different methods of collecting, characterizing and analyzing data. Primary data are qualitative and were obtained through outreach and connections with the community. Twelve health-related community engagement projects that had been conducted since 2009 were reviewed to learn what was important to community members. Over 120 organizations were surveyed and/or interviewed to find out what their health priorities were and what each organization s capacity was to address health Community Health Needs Assessment PeaceHealth Southwest Medical Center 11

13 needs. Finally, we conducted three listening sessions in Clark specifically with uninsured and lowincome persons to hear their priorities and suggested solutions. B. Assessment Findings Agreed-upon Priority and Goals Working together, the Clark Department of Health, participating partners, constituents, and PeaceHealth agreed upon a framework (Figure 1) that is built around a single priority creating a Healthy Community which is to be defined and achieved through three goals: Healthy Children & Families; Healthy Neighborhoods & Social Connections; and Quality, Accessible Health Care Figure 1 Clark Top Priority and Goals Data Results The data collected and analyzed in this CHNA revealed several areas of concern that, when addressed, will take us far along the path of achieving our goal of a Healthy Community as defined above: 1. Overall Health Status Clark residents tend to be slightly less healthy than other residents of the Portland region. 2. Access to Health Care Nearly 19% of adults and 7.2% of children are uninsured. The adult uninsured rate is the second highest in the region. 3. Risk Factor Behaviors Clark has the highest rates of adult and teen smoking and obesity in the region. The death rate due to alcohol and the suicide death rate are the second-highest in the region. 4. Social Factors Clark performs similarly to the region on social factors affecting health, although it has the highest unemployment rate. Community Health Needs Assessment PeaceHealth Southwest Medical Center 12

14 5. Birth Outcomes The rates of low birth weight and receipt of early prenatal care for residents of Clark are similar to that of the region. 5. Affordable Health Care Access to affordable care was identified by residents as the top health care concern in Clark. The data behind these findings are described in more detail below. 1. Overall Health Status Clark residents perform worse than the rest of the Portland region on many standard health measures: They are more likely to rate their overall health as fair or poor. They have the second highest rate of premature death in the region. They are more likely to be hospitalized unnecessarily. They have the highest rate of deaths caused by unintentional injury in the region. Poorer health than nearby counties The population s self-assessed health status reported in Table 4 provides insight into the health of the population. Overall, in comparison to the other four counties in the Portland area, Clark residents were more likely to rate their health as poor or fair. However, their health status is better than that of most Washington State residents. More premature deaths Deaths before the age of 75, often termed premature death or Years of Potential Life Lost (YPLL), are an important piece in the overall health puzzle. Clark s rate of YPLL is 8% lower than that Multnomah, but significantly higher (nearly 22%) than Washington and slightly higher than Clackamas. Higher rate of hospitalizations The rate of unnecessary hospitalizations (hospitalizations for conditions that can be successfully treated in a doctor s office rather than a hospital, such as diabetes) is more than 25% higher than Multnomah, which has the second highest rate of unnecessary hospitalizations. This indicates that, for some residents at least, these conditions are not being treated at an early stage. Community Health Needs Assessment PeaceHealth Southwest Medical Center 13

15 Table 4 General Health in the Portland Region Clark Clackamas Multnomah Washington Adults rating general health as poor or fair* 13.4% 11.4% 12.1% 10.8% Years of Potential Life Lost 5,328 5,157 6,649 4,372 Unnecessary Hospitalizations per 1,000 Medicare Beneficiaries Source: Health Rankings, 2012, except for *, HCI. Greater number of deaths from top causes Death rates can be a valuable tool to understanding the diseases that afflict a given community. Clark leads the region in the rate of deaths caused by unintentional injury and Alzheimer s disease. Overall, Clark s death rate due to cancer is higher than all of the other counties in the region with the exception of Multnomah, as indicated in Table 5. Similarly, only Multnomah has a higher rate of deaths due to lung cancer, the leading cause of cancer deaths in the United States. Death rates due to suicide and alcohol use are important indicators for the region s mental health. Clark has the second lowest suicide death rate in the region at 13.0 per 100,000, but it is still substantially elevated in comparison to the national rate of In sharp contrast, the death rate for alcohol-related causes is the second highest in the region, with only Multnomah having a higher rate. Relative burden of selected causes of death The Healthy Columbia Willamette coalition developed a scoring process that incorporates features such as disparities between groups, the severity of the health issue, and the trend over time. Ranging from 1 6, lower scores indicate less disparities etc., while higher scores indicate higher degrees of disparities and severities. In Clark, the diabetes death rate is scored low in comparison to the remainder of the region, indicating that for Clark, diabetes deaths have few disparities and lower disparities. In contrast, Clark has the highest score among the four Counties for drug-related deaths, indicating that deaths related to drugs have greater disparities and greater severities than in Clark in comparison to the rest of the region. See Table 5. Community Health Needs Assessment PeaceHealth Southwest Medical Center 14

16 Table 5 Causes of Death and Related Burden, by Clark Clackamas Multnomah Washington Death Rates Per 100,000 top causes Colorectal Cancer Deaths Lung Cancer Deaths Breast Cancer Deaths (females Prostate Cancer Deaths Total Cancer Deaths Diabetes-related Deaths Heart Disease Deaths Stroke Deaths Alzheimer s Deaths Unintentional Injury Deaths Alcohol-related Deaths Motor Vehicle Collision Deaths Suicide Relative Burden of Selected Causes of Death Diabetes Related Death Scoring Suicide Scoring Unintentional Injury Death Scoring Drug-related Death Scoring Source: HCI, Healthy Columbia Willamette 2. Health Disparities Clark residents have less access to health care: Clark residents were the least likely among Portland area residents to have a usual source of health care. Clark residents were the most likely to report not seeing a doctor because of cost. Despite similar insurance coverage rates, Clark residents access care less The affluence of Clark notwithstanding, significant barriers exist for residents. Clark residents were the least likely to have a usual source of health care more than one in four residents reported that they did not have a usual source of care, as indicated in Table 6 below. Fifteen percent of Clark residents reported being unable to afford to see a doctor, a rate higher than in Oregon counties. Community Health Needs Assessment PeaceHealth Southwest Medical Center 15

17 Table 6 Access Indicators Clark Clackamas Multnomah Washington Adults with usual source of health care 74.0% 81.5% 77.1% 80.5% Adults with health insurance 81.2% 83.1% 77.5% 81.8% Children with health insurance 92.2% 93.7% 95.8% 92.5% Adults unable to afford to see a doctor* 15.0% 12.0% 14.4% 12.1% Source: HCI, except for *, Health Rankings Risk factor behaviors Clark residents perform worse than the rest of the Portland region on many standard health measures and better on others: Eleven percent of adults report binge drinking. More pregnant women and teens smoke than their neighbors in Oregon. Clark residents have the fewest behavioral health care providers in the region. Clark residents eat fewer fruits and vegetables than others in the region. Alcohol use among Clark teens is the lowest in the region. More Clark residents report being physically active than their neighbors in Oregon. High rates of binge drinking Substance abuse can be a major risk factor for many chronic diseases. Both alcohol and illegal drug use raise the risk for diabetes and heart disease. In addition, substance abuse is a major cause of lost economic activity. Binge drinking is a dramatic manifestation of alcohol abuse, defined as consuming at least four (women) or five (men) drinks on a single occasion in the past month. Clark performs well in comparison to the rest of the region. The overall rate (both genders) of binge drinking is 11%, as noted in Table 7. For Oregon Counties, the rate is broken down by gender (females tend to have much lower rates of binge drinking), and the overall rate of binge drinking in Clark is even lower than the rate of female binge drinking in Multnomah. Importantly, this rate indicates that Clark has surpassed the Healthy People 2020 goal of reducing the binge drinking rate to 14%. Lack of support for mental health issues Substance abuse often goes hand-in-hand with mental health conditions. An important indicator for poor mental health is residents who report inadequate social support, as people lacking social support are more likely to suffer from a host of mental health conditions. Throughout the region, only Multnomah (17.1%) has a higher rate of inadequate social support than Clark (16.5%), as shown in Table 7. Clark s ratio of mental health providers per population is substantially lower than that of any other in the region, at 0.24 providers per 1,000 population (Table 8). As a result, the residents of Clark may have to cross into other counties within the region in order to obtain mental health care. Community Health Needs Assessment PeaceHealth Southwest Medical Center 16

18 Table 7 Substance Abuse and Mental Health Indicators Clark Adult binge drinking 11.0% Clackamas Multnomah Washington Male binge drinking ND 18.9% 21.8% 15.3% Female binge drinking ND 9.3% 14.0% 9.0% Teens who use alcohol 28.0% 37.1% 39.4% 29.1% Death rate due to alcohol-related causes, per 100, Inadequate social support* 16.5% 13.4% 17.1% 14.7% Teens who felt sad or hopeless 29.0% ND ND ND Teens with poor or fair mental health ND 13.4% 12.8% 13.7% ND indicates no data. Source: HCI, except for *, Clackamas, Multnomah and Washington Counties, Health Rankings Table 8 Behavioral Health Care Indicators Age-adjusted hospitalizations due to alcohol abuse, per 10,000 Mental health providers per 1,000 population* Clark Clackamas Multnomah Washington Source: HCI, except for *, Clackamas, Multnomah and Washington Counties, Health Rankings Higher smoking rates among teens, pregnant women In comparison to the other counties in the Portland region, Clark teens and pregnant women are more likely to smoke, as indicated below in Figure 2. Nearly 14% of Clark teens smoke in contrast to 12% of Clackamas teens and 8% of Washington teens. Smoking by pregnant women is of particular concern, because smoking during pregnancy is associated with a host of poor birth outcomes including low birth weight. Twelve percent of pregnant women in Clark smoke in comparison to 9.1% in Clackamas, which has the second highest rate of pregnant smokers. Overall, 16% of Clark adults smoke, which is slightly higher than the Washington State rate of 15%. Community Health Needs Assessment PeaceHealth Southwest Medical Center 17

19 Figure 2 Smoking in Clark Relatively high rates of obesity, diabetes Source: HCI As the second leading cause of preventable death, obesity lags far behind smoking. Deaths due to obesity, poor diet, and lack of exercise are approximately one seventh as frequent as those due to tobacco. However, obesity is expected to increase in importance as the rates of obesity and obesity-related diseases rise. Currently, 29% of Clark residents are obese, compared to 23.6% of Clackamas residents, as indicated in Figure 3 below. Similarly, the rate of diabetes in Clark is also elevated in comparison to the rest of the region, with fully 8% of all adult residents reporting that they had been diagnosed with diabetes. No other in the region reported a diabetes rate over 6.6%, placing the Clark rate 21% higher than the remainder of the region. Despite this higher rate of diagnosed diabetes, the overall hospitalization rate due to diabetes in Clark is substantially lower than that for the other counties in the region. Figure 3 Obesity and Diabetes Source: HCI Community Health Needs Assessment PeaceHealth Southwest Medical Center 18

20 Fruit and vegetable consumption needs improvement Clark has the lowest rate of adequate fruit and vegetable consumption in the region, and Healthy Columbia Willamette scoring process has their consumption ranked the second highest (greatest disparities/ worst trend over time) of all four counties. This indicates that Clark performs poorly in comparison to the rest of the region and that this is a greater issue for residents of Clark compared to two other counties, as indicated in Table 9. Exercise rates best in region Another important factor in the maintenance of healthy weight is regular exercise. Clark residents are the most likely to engage in regular physical activity, with 62% of adults reporting regular exercise. The scoring methodology by Healthy Columbia Willamette also indicates that Clark has the lowest score, indicating that the level of concern for Clark is the lowest throughout the region. Interestingly, while Clark residents are most likely to engage in physical activity, Clark has the lowest ratio of recreational and physical fitness facilities per population. Table 9 Healthy Lifestyle Indicators Clark Clackamas Multnomah Washington Adult fruit and vegetable consumption 22.0% 24.7% 30.0% 24.9% Adults with regular physical activity 62.0% 55.6% 55.1% 53.8% Adult fruit and vegetable consumption scoring 4.2% 3.8% 3.5% 4.5% Adult regular physical activity scoring 3.0% 4.5% 3.5% 3.8% Recreation and fitness facilities per 10, % 0.14% 0.12% 0.12% Hospitalization rate due to diabetes, per 10, % 25.6% 26.2% 21.3% Source: HCI, except for Scoring, Healthy Columbia Willamette. 4. Social Factors Highest unemployment rate in Portland area Social factors are very important in overall health in a community. A summary of additional social indicators in the community can be found in Table 10. Clark s November 2012 unemployment rate was the highest in the region, at 8.1%. Community Health Needs Assessment PeaceHealth Southwest Medical Center 19

21 Table 10 Social Risk Factors Clark Clackamas Multnomah Washington Unemployment rate, November % 7.4% 7.3% 6.6% Renters who spend more than 30% of income on rent 49.9% 49.2% 52.9% 46.4% Households with cash public assistance income 3.7% 2.3% 3.6% 2.0% Homeownership rate 63.8% 65.5% 52.5% 59.0% Source: HCI 5. Birth Outcomes Birth outcomes on par with region Throughout the region, Washington has the best birth outcomes, with the remaining three counties performing similarly, as indicated in Table 11 below. Fewer than 6.5% of all Clark births are low birth weight. More than 75% of all mothers receive early prenatal care. Table 11 Birth Outcomes Clark Clackamas Multnomah Washington Low birth weight babies 6.4% 6.5% 6.6% 5.6% Preterm births 10.1% ND ND ND Mother who receive early prenatal care 76.6% 73.2% 70.1% 79.1% Source: HCI 6. Community names affordable health care top priority In addition to the data collected from other sources, Healthy Columbia Willamette conducted a Community Themes and Strengths Assessment. The number one need identified by Clark residents (more than half of whom responded) was access to affordable health care, which was also the top need identified by the entire region. Following in importance to access to affordable care was access to patient-centered care, indicating that residents are eager for a change in the way that health care is delivered. Half of all respondents also identified a need for mental health and addictions treatment and access to healthy foods. Taken together, these findings correlate with the secondary data findings indicating a lack of mental health providers, elevated obesity levels, and a significant uninsured population. Community Health Needs Assessment PeaceHealth Southwest Medical Center 20

22 C. Opportunity Summary The data and information obtained during the CHNA are summarized in Table 12. As indicated, the community has some very important strengths, as well as several areas in which its community health can be significantly improved. As the eighth healthiest county in Washington State, Clark residents have relatively low rates of many common health concerns. The fact that Clark currently exceeds the Healthy People 2020 target rates for adult binge drinking, consumption of fruits and vegetables, obesity and proportion of adults who engage in regular physical activity reinforces their relatively good health status. At the same time, 29% of Clark residents are obese and 15% of adults report binge drinking. These numbers show there is plenty of room for health to improve. residents themselves rank access to health care and access to healthy food their top health priorities. Access to health care has two components: fraction of the population that has health insurance and fraction that can t afford to receive care with or without insurance. Suicide rates are higher than the national average and Alzheimer s deaths lead the region. The regional needs ranking process showed that suicide, unintentional injury deaths and drug-related deaths are top areas of concern in our community. Taking our community s needs together with PeaceHealth s unique position as one of two hospitals in the county, PeaceHealth Southwest Medical Center has identified the areas where we can best make a positive improvement on community health. They are: Improving access to low-cost medical and dental services and increasing the number of insured persons Raising awareness of mental illness; supporting positive substance abuse policy and increasing access to mental health and substance abuse services Promote public awareness of the benefits of healthy eating and active living and increasing opportunities for people to make healthy choices by increasing accessibility of fruits and vegetables and assuring safe places to exercise. How the many community partners intend to team up to respond to these needs, as well as the priorities that PeaceHealth Southwest has elected to focus on, are described in more detail in Sections V and VI. Community Health Needs Assessment PeaceHealth Southwest Medical Center 21

23 Table 12 Clark CHNA-Identified Strengths and Opportunities COMMUNITY GOALS Healthy Children & Families Healthy Neighborhoods & Social Connections Quality, Accessible Health Care Area of Concern Strengths Room for Improvement Methods to Overcome Challenges Overall Health Status Health is generally good. In comparison to the region, Clark residents are less healthy. Overall Health Status is a result of an interaction of many complex factors. Mental Health & Substance and Tobacco Use Residents are less likely than residents throughout the region to binge drink. Low number of mental health providers per population in comparison to the region. Residents noted a lack of mental health and substance abuse treatment. Tobacco Use Highest rate of teen and adult and pregnant women smoking in the region. Smoking cessation is difficult due to the addictive nature of nicotine. Socioeconomic Factors Overall, social indicators are similar to the region. High unemployment rate. Socioeconomic factors are complex and difficult to address. Birth Outcomes Rates of low birth weight and receipt of early prenatal care are comparable to regional rates. Birth outcomes are a result of multiple factors. Obesity and Healthy Eating Rates of low birth weight and receipt of early prenatal care are comparable to regional rates. Clark has the highest rate of adult obesity and the lowest rate of fruit and vegetable consumption in the region. Obesity results from complex lifestyle factors that are difficult to change. Access to Health Care Rates of insurance for children are comparable to the region. Clark has the second highest rate of adult uninsured in the region. Residents report that access to affordable care remains a challenge. Community Health Needs Assessment PeaceHealth Southwest Medical Center 22

24 V. Partners and Priorities for Community Health Improvement A. Clark CHNA Partners The Clark community, though it has unmet needs, also has significant strengths and resources. The community is well-off economically and residents tend to be well-educated - two population features that are associated with better health outcomes. The CHNA process was carried out as part of Healthy Columbia Willamette coalition, which brings expertise from across the Portland region. The major partners are listed in Table 13. Each of these organizations brings different capabilities to the community. For instance, the local health departments bring significant experience in social marketing of healthy lifestyles and behaviors, as well as strong skills in monitoring disease rates over time. Local hospitals have deep knowledge of residents use of health care services. HCI has longstanding experience in multi-disciplinary approaches to community health. Table 13 CHNA Partner Organizations Organization Adventist Medical Center Clark Health Department Clackamas Health Department The Healthy Communities Institute (HCI) Kaiser Permanente Legacy Emanuel Medical Center Legacy Good Samaritan Medical Center Legacy Meridian Park Medical Center Legacy Mount Hood Medical Center Legacy Salmon Creek Medical Center Multnomah Health Department Oregon Health & Science University PeaceHealth Southwest Washington Medical Center Providence Milwaukie Providence Portland Providence St. Vincent Providence Willamette Falls Tuality Healthcare Washington Health Department Type of Organization Large hospital located in Portland Health Department Health Department Multi-disciplinary health care information organization Large hospital located in Clackamas; Local Health Insurer Large hospital located in Portland Large hospital located in Portland Large hospital located in Tualatin Hospital located in Gresham Large hospital located in Vancouver Health Department Quaternary Academic Medical Center located in Portland Large hospital located in Vancouver Hospital located in Milwaukie Large hospital located in Portland Large hospital located in Portland Hospital located in Oregon City Hospital located in Hillsboro Health Department Community Health Needs Assessment PeaceHealth Southwest Medical Center 23

25 B. Clark CHNA Priorities Healthy Columbia Willamette used the following criteria to identify the top health concerns in the four county region: The issue was identified by at least 2 of 3 community input-related criteria (engagement projects, stakeholder interviews, listening sessions) Analysis of health outcomes and behaviors showed the greatest room for improvement The health issue is one of the top-5 most expensive in the metropolitan statistical areas in western U.S. There are identified evidence-based practices to address the health issue Because several community organizations in Table 13 were required to perform needs assessments, we all worked together to do so, actively participating in each other s community needs assessment processes. Our groups collaborated on much of the data collection, jointly participated in the community forums, and collectively reviewed the data and priorities. Table 14 details the priorities and specific strategies that came out of the CHNA processes for PeaceHealth PHSW and the Clark Health Department. Table 14 Clark Objective Tracking and Organizational Lead PeaceHealth Southwest Medical Center Healthy Communities Initiative Improving the conditions under which Clark residents, live, work, play and learn. Objective Measure Current Status Target Organizational Lead Increase Access to Affordable Care Adults who are currently insured 81% 100% Clark Health Department Children who are currently insured 92% 100% Clark Health Department Improve Mental Wellbeing Suicide death rate (per 100,000 population) 13/100,000 10/100,000 PeaceHealth Southwest Medical Center Community Health Needs Assessment PeaceHealth Southwest Medical Center 24