Community Health Needs Assessment Summary: 2014/2015. Houston Methodist Hospital

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1 Community Health Needs Assessment Summary: 2014/2015 Houston Methodist Hospital 1

2 Contents Introduction... 3 Houston Methodist Hospital... 3 Conducting the 2015 CHNA... 4 Methods... 4 Secondary Data Collection... 4 Community Health Needs Summary:... 4 Purpose... 4 Our Community... 5 Population... 5 Prioritized Community Needs... 8 Priority#1: Prevention of Chronic Disease and Related Conditions... 8 Heart Disease... 9 Cancer... 9 Stroke Diabetes Other Contributing Factors Obesity Mental Illness Priority #2: Access to Care Improvement Access to Health Care Demand for Primary Care Physicians Priority #3: Education to Decrease Risk Behaviors Tobacco Use Communicable Diseases Accidents Drug and Alcohol Use Conclusion Works Cited

3 Introduction Houston Methodist Hospital is a nonprofit Hospital based in Houston, Texas and is part of the Houston Methodist system of hospitals. Affiliated with the Texas Annual Conference of the United Methodist Church, Houston Methodist Hospital works closely with local church leaders to bring compassion and spirituality to all of its endeavors and to help meet the health needs of the community it serves. The Houston Methodist system includes Houston Methodist Hospital, a flagship teaching hospital in the Texas Medical Center, as well as 6 community hospitals, a top-ranked research institute, Physicians Organization network of care, a Primary Care Group, and four Emergency Care Centers. The system is affiliated with Weill Cornell Medical College and New York-Presbyterian Hospital. In 2014 Houston Methodist appeared on Fortune magazine s 100 Best Companies to Work For list, for the ninth consecutive year. Consistently cited by U.S. News & World Report as one of the country s best hospitals, Houston Methodist Hospital earned rankings in 11 medical specialties and was cited as the No. 1 hospital in Texas and in Houston. Community hospitals, Houston Methodist Willowbrook Hospital, Houston Methodist San Jacinto Hospital and Houston Methodist Sugar Land Hospital, each earned state and local rankings from U.S. News & World Report. Houston Methodist Hospital Houston Methodist Hospital, an acute care complex with 828 operating beds, 67 operating rooms, 1,498 affiliated physicians and 6,187 employees, is the flagship of all Houston Methodist Hospitals. It is located in Houston s world-renowned Texas Medical Center. Houston Methodist Hospital recorded 310,045 outpatient visits, 36,680 inpatient visits and 67,720 emergency room visits by Houston area residents during In addition, Houston Methodist Hospital recorded more than 9,472 international patient visits from 92 countries in Although these individuals represent a diverse group of backgrounds, cultures and socioeconomic status, as patients at Houston Methodist Hospital they all share one thing in common -- each has been treated with dignity and compassion. This respect for each person is reflected in the Mission Statement and Statement of Values of Houston Methodist Hospital. 3

4 Conducting the 2015 CHNA Methods Houston Methodist Hospital identified its community health priorities through the execution of a large scale community health needs assessment conducted in 2013 in compliance with federal Affordable Care Act requirements. This assessment was conducted using several methods including but not limited to review of the Texas State Data Center and Office of the State Demographer information, U.S. Census data, Texas Department of Public Health selected health data, Behavioral Risk Factor Surveillance System, and community advisory groups committee reports for nonprofit clinics and agencies. Interviews were conducted with community stakeholders and public health experts from around the city and state as well. The needs identified in this assessment were used as the guide for outlining the hospital s community health objectives for 2014 through 2016 and were adopted and approved by the Houston Methodist Board of Directors. A large scale and in depth needs assessment was performed in 2013 to comply with the requirements of the ACA. That assessment was updated with available data for These findings were used as the foundation to outline the community benefits plan for Houston Methodist Hospital. Secondary Data Collection Several secondary sources were used in conducting this needs assessment. The sources include but are not limited to: The State of Health in Harris County, Houston State of Health, U.S Census Date, The National Survey on Drug Use and Health, Texas Department of State Health Services, The Center for Disease Control and Prevention, and Healthy People Community Health Needs Summary: Purpose The Community Benefits Department at Houston Methodist (HM) conducted a community health needs assessment (CHNA) for each HM hospital to best identify the health needs of the Greater Houston community. This CHNA provides a set of community health priorities that were identified and adopted by the Houston Methodist board of directors. These priorities were used to guide the formation of the community benefits plan for 2014 as well as the implementation plan for HMH. 4

5 The Community Health Needs Summary that readers will review on the following pages serves to meet the Texas state requirements of reporting on community benefit standards of which includes the production of an annual needs assessment. This summary also serves the purpose of ensuring that HMH is keeping its finger on the pulse of the Houston community s most pressing needs. Our Community Population Houston Methodist Hospital (HMH) defines the Houston-Baytown-Sugarland combined metropolitan statistical area as its community. This community encompasses Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties. The HMH community spans 8,928.2 square miles and according to the U.S. Census contains a 2014 estimated population of 6,441, 882 people. Harris County accounts for an estimated 4.4 million HMH community residents or approximately 68.1% of the designated service area. Harris County is the largest county in Texas. Three major age groups make up the HMH community. They are the youth, adolescent, and young adult population; the adult population; and the senior population. Houston Methodist defines the youth, adolescent, and young adult population as any person between the ages of 0 24 years. The youth, adolescent, and young adult population accounts for the second highest percentage of the HMH community (37%). Houston Methodist defines the adult population as any person between the ages of years. The adult population accounts for the highest percentage of the HMH community (53%). Houston Methodist defines the senior population as any person over the age of 65 years. The senior population currently accounts for 10% of the HMH community. 5

6 The most apparent trend for the HMH community over the past twenty years has been increasing community diversification. The Houston-Baytown-Sugarland MSA comprises the most diverse major metropolitan area in the United States and Houston maintains a minority-majority city status. The most apparent trend for the HMH community over the past twenty years has been increasing community diversification. Harris County, the largest county in the HMH service area, has a racial population that reflects 19.5% as Black/African, 31.9% as White/Non-Hispanic, 41.6% as Hispanic/Latino and 8% total identifying as other (Asian, Indian, etc.). These numbers enhance the idea that Houston is considered a minority-majority city. In fact, according to the State of Health report (2015) whites are now a majority only in persons age 65 and older. 5 Another trend in the HMH community is an expanding economic gap. The Kinder Institute (2014) surveyed Houstonians attitude towards this increasing discrepancy. 71% of respondents in the survey were in favor of raising minimum wage. Furthermore, 18% of Houstonians surveyed reported having difficulty paying for groceries to feed their families. 62% of respondents agreed that the government should take action to reduce the economic gap, which is an increase from a 45% agreement in The existing gap between the rich and poor is a significant predictor of access to education. The thought that higher education is necessary for success varies among different ethnicities. For instance, 81% of Latinos, 78% of African Americans, and only 63% of non- Hispanic whites who were surveyed believed in the necessity of a secondary education. 18 The HMH designated service areas reflect an incredibly dynamic and diverse community. See figure 1 below for the racial and age breakdown of the largest county, Harris County, served by HMH according to the 2014 estimates given by U.S. Census Bureau. 6

7 Figure 1: Statistics QuickFacts Harris County Texas Population, 2014 estimate 4,441,370 26,956,958 Population, percent change - April 1, 2010 to July 1, % 7.2% Population, ,092,459 25,145,561 Persons under 18 years, percent, % 26.60% Persons 65 years and over, percent, % 11.20% Female persons, percent, % 50.30% White alone, percent, 2013 (a) 70.70% 80.30% Black or African American alone, percent, 2013 (a) 19.50% 12.40% American Indian and Alaska Native alone, percent, 2013 (a) 1.10% 1.00% Asian alone, percent, 2013 (a) 6.80% 4.30% Native Hawaiian and Other Pacific Islander alone, percent, 2013 (a) 0.10% 0.10% Two or More Races, percent, % 1.80% Hispanic or Latino, percent, 2013 (b) 41.60% 38.40% White alone, not Hispanic or Latino, percent, % 44.00% Data Source: U.S. Census,

8 Prioritized Community Needs Priority#1: Prevention of Chronic Disease and Related Conditions Houston Methodist Hospital has prioritized prevention for chronic disease and related conditions based on analysis of primary and secondary sources. Chronic diseases include high prevalence of heart disease, diabetes, obesity, cancer, stroke and other health related conditions that are persistent or otherwise long lasting in its effect. Chronic diseases contribute to the most community resident deaths each year. Heart disease, all cancer, stroke, and chronic low respiratory disease comprise the chronic diseases with the highest mortality rates. Below are examples of chronic disease conditions that the community faces and their impact from a statewide and HMH county perspective. Houston Methodist will analyze the chronic diseases that have been identified as leaders of mortality statistics for Texans. By prioritizing prevention of chronic disease and contributing conditions, Houston Methodist Hospital hopes to build a healthier community and world. The leading causes of death in the United States and in Texas are heart disease, cancer, and cerebrovascular diseases. Obesity, while not a direct cause of death, is one of the leading comorbities in individuals with diagnoses of heart disease, stroke, and diabetes mellitus. 13 See Figure 2 on the following page for an illustration of leading causes of death in Harris County, the largest county in the state of Texas. 8

9 Figure 2: Total # of Deaths Leading Causes of Death in Harris County-2012 Total Deaths Cancer Heart Disease Cause of Death Accidents Stroke Chronic Lower Respiratory Disease Date Source: The State of Health, Heart Disease Heart disease is an umbrella term used to identify conditions such as coronary artery disease, arrhythmias, and congenital heart defects. Heart disease is the primary cause of death in the United States and Harris County. 4 High blood pressure and high cholesterol are the two main risk factors to heart disease. The Houston State of Health report states that, in 2013, 32.8% of Houstonians age 18 and over had high blood pressure, and 38.0% had high cholesterol. 5 Approximately 4.9% of adults living in Harris County have been diagnosed with some form of ischemic heart disease. 4 In the Houston-Sugarland-Baytown MSA, there is an increased prevalence of heart disease within the Black and White populations. In 2014, 8.9% of blacks and 7.4% of whites surveyed were diagnosed with heart disease. The incidence of heart disease within the Latino population is 4.2%. 4 Cancer Cancer is the second leading cause of death in the United States and Harris County. 4 In fact, one in four deaths in Harris County are related to cancer. 4 Risk factors for cancer include genetics, 9

10 lifestyle, and environment. Incidence of cancer is significantly higher within the Black population of Harris County, followed by Whites, Latinos, and Asians. 4 Of all the various types of cancer, lung cancer is the leading cause of cancer-related deaths in both Texas and in the U.S. 12 Breast cancer is the second leading cause of cancer death for women, preceded only by lung cancer. 1 Through early detection and diligent screening practices, mortality due to breast cancer can be decreased. However, 29.1% of women in Texas age 40 and over reported not undergoing a mammogram within the past two years. 3 Colorectal cancer is the third most common cancer diagnosed for both men and women. Fortunately, the mortality rate for colorectal cancer has decreased steadily for both men and women for the past 20 years. A likely reason for this decline is screening practices. 2 Procedures such as colonoscopies and sigmoidoscopies allow for physicians to detect and remove pre-cancerous polyps in the colon. However, 37.4% of adult Texans aged 50 years or older reported not undergoing preventative colorectal cancer measures such as a sigmoidoscopy or colonoscopy. 3 Figure 3: Expected New Cases of Cancer in Texas # New Cases Expected 120, ,000 80,000 60,000 40,000 20,000 0 Type of Cancer Data Source: Texas Department of State Health Services, Stroke Stroke is the third leading cause of death in Texas and Harris County. 4 According to the CDC, a stroke occurs when something happens to interrupt flow of blood to the brain, and subsequently, brain cells start to die within minutes because they can t get oxygen. 3 In the Houston-Sugarland-Baytown MSA, 1,214 people died from complications related to stroke in Additionally, 2.7% of the population in the Houston-Sugarland-Baytown MSA were at risk for 10

11 having a stroke. 11 Incidence of stroke is most common within the Black and White populations, as well as individuals 65 years of age or older. 11 It should be noted that, although the incidence of stroke is higher in the Black population, the rate of deaths related to stroke have decreased by 7.8% within that same population between 2008 and Learning the signs of a stroke is critical to decreasing mortality and long-term effects, as some treatments for a stroke only work for up to 3 hours after symptoms first appear. Signs of a stroke include numbness in the face or arms, confusion, trouble speaking, trouble seeing, difficulty walking, and a sudden headache. 3 Diabetes According to the CDC, diabetes is a disease in which blood glucose levels are above normal. 3 There are two types of diabetes. Type 1 Diabetes is genetic, and therefore can t be prevented. However, Type 2 Diabetes can often be a result of lifestyle and nutrition. Type 2 Diabetes can often be delayed or prevented with weight loss, physical activity, and healthier eating. 3 Diabetes mellitus is the seventh leading cause of death in the United States and Texas % of Houstonarea adults have been diagnosed with diabetes. 5 The incidence of diabetes is highest among Blacks and Latinos, 13.2% and 12.8% respectively. Across all ethnicities, diabetes is most prevalent in individuals age 65 and older. 3 Furthermore, 4.9% of adult men and 5.9% of adult women in Texas have been diagnosed as having pre-diabetes. The incidence of pre-diabetes is highest among Blacks and Whites, 6.7% and 5.2% respectively. 13 Other Contributing Factors Obesity Adults who have a BMI of 30 or higher are considered obese. While obesity is not a primary cause of death, it is a leading contributor to coronary heart disease, type 2 diabetes, cancers (endometrial, breast and colon), hypertension, and stroke. 3 The Harris County Healthcare Alliance reports that as of 2014, 64.6% of adults in the Houston-Baytown-Sugarland MSA were overweight or obese. Of that amount, 45% of Blacks, 38.7% of Latinos, and 26.4% of Whites are considered obese. 5 According to the Texas Department of State Health Services Behavioral Risk Factor Surveillance System (BRFSS), overweight and obesity are more pronounced in minorities and middle-aged adults. 3 Although men are more likely to be overweight, women are more likely to be obese. Obesity is caused by an energy imbalance. According to the CDC, this involves eating too many calories and not getting enough physical activity. 3 Therefore, it is important to note that 35% of people in the Houston-Baytown-Sugarland MSA report no physical activity per week. 5 11

12 Mental Illness Mental illness is an umbrella term that encompasses conditions such as bipolar disorder, schizophrenia, depression, anxiety, and many others. According to Healthy People 2020, Mental health disorders are the leading cause of disability in the United States and Canada, accounting for 25 percent of all years of life lost to disability and premature mortality. 8 In 2012, nearly 500,000 adults in Harris County suffered from a mental illness. Of this amount, 74% reported not being able to access treatment. 5 Women report mental health problems slightly more often than men, 22.5% versus 17.5%. Since 2006, mental health problems have been reported mostly by Blacks, followed by Whites and Latinos. 5 People who report having a severe mental illness often have a high rate of comorbidities, and die on average 25 years sooner than those without a mental illness. 12 Priority #2: Access to Care Improvement We plan to analyze stakeholder interviews and sources identified to allow for improved accessibility to health care services as a key need for the Houston Methodist Hospital community. By prioritizing improved access, Houston Methodist Hospital hopes to expand the delivery of quality health care to the community and world. Improved access includes a plan for continuum of care and leveraging of community partner collaborations. Access to Health Care Insurance rates and medical costs indirectly impact access to health care. According to the 2014 report by the Texas Department of Health Services Access to health services is the timely use of personal health services to achieve the best health outcomes. 15 One of the barriers to access to health care is insurance status. The national baseline percentage for persons with medical insurance is 82.8%. The Houston-Baytown-Sugarland MSA falls short of this baseline at 69.7%. 5 People who don t have insurance are more likely to have preventable hospitalizations and delayed diagnoses. The percentage of uninsured persons in Texas has seen a decrease since 2010, with 25.4% of Texans having no insurance. This is down from 27.9%. Despite the decline in uninsured people, Texas still has the highest rate of uninsured population in the country. 14 Harris County has the highest percent of persons between the ages 0-65 years living without insurance. All community counties have decreasing percentages of uninsured peoples from See Figure 4. There are several factors that contribute to Texans being uninsured. Some people are unable to contribute a portion of their paycheck for insurance coverage. Others are not offered health insurance through their employer. According to the Texas Medical Association, People making 12

13 moderate and low wages are much less likely to have job-based health insurance coverage than those earning more. 16 Figure 4: 30% Uninsured Population Estimates 25% 20% 15% 10% 5% 0% United States Texas Harris County City of Houston Data Source: U.S. Census, The Affordable Care Act, which was signed into law in 2010, has assisted with decreasing the number of uninsured Texans. Since the act has gone into effect, an estimated 378,684 Texans are now insured. This number is equivalent to 2.4% of the population of uninsured Texans. 7 The Affordable Care Act provided an online Exchange Marketplace, where people who are uninsured were able to view insurance plans from competing companies and select a plan that was within their budget. Demand for Primary Care Physicians Another barrier to accessing healthcare is an increasing demand for primary care doctors. The State of Health 2015 report states: In 2013, there were 81 primary care doctors for every 100,000 people in Harris County. 5 This number exceeds the Texas average. However, the demand for primary care doctors is quickly outgrowing the supply. The Potential Primary Care Crisis in Texas: A County- Based Analysis argues that access problems revolving around health care services could become exacerbated by the increase in insured persons seeking health care, the aging Baby Boomer population, the retirement of existing primary care physicians, and the avoidance of primary care. 6 This report projects the already dilapidated Texas primary care capacity to drop from 86% of the 13

14 national average to approximately 80 % of the national average the average capacity drops to 73% of the national average for low-income residents. Priority #3: Education to Decrease Risk Behaviors According to the Center for Disease Control, six types of health risk behaviors contribute to the leading causes of death, disability, and social problems in the United States: (1) tobacco use; (2) unhealthy eating; (3) inadequate physical activity; (4) alcohol and other drug use; (5) sexual behaviors that may result in HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy; and (6) behaviors that contribute to unintentional injury and violence. These behaviors are often established during childhood or adolescence, persist into adulthood, and are preventable. HMH has prioritized improving community education and awareness about health and wellness based on analysis of the HMH community county Health Fact Profiles, the 2014 Texas Behavioral Risk Factor Surveillance System report, the 2014 Houston and Texas Youth Behavioral Risk Factor Surveillance System (YRBSS) reports, and community stakeholder interviews. These sources support education related to community health and wellness as a HMH community health need and a key component for the other priorities listed above. The most recent Health Fact Profiles, the Houston and Texas Behavioral Risk Factor Surveillance Systems, and the Texas Youth Risk Behavior Surveillance System indicate a high prevalence of unhealthy lifestyle behaviors taking place in the HMH community. Evidence includes high rates of accidents, communicable disease, smoking, substance abuse, lack of physical activity, and poor nutritional habits. Tobacco Use Healthy People 2020 states: Tobacco use is the single most preventable cause of death and disease in the United States. 8 The use of tobacco is associated with numerous diseases such as stroke, diabetes, multiple cancers, and heart and vascular disease. 3 Each year, over 440,000 Americans die from diseases related to tobacco. 8 Additionally, secondhand smoke exposure can cause conditions such as respiratory infections, asthma attacks, ear problems, heart disease, and lung cancer. The CDC reports that Harris County s tobacco use rate is slightly higher than the state average, 16% and 17% respectively. 3 14

15 Communicable Diseases Harris County reports a similar number of communicable disease cases in the Health Fact Profiles when compared to the state. For example, Harris County, reports cases of AIDS (13.9 reported cases per 100,000), primary and secondary syphilis (7.4 reported cases per 100,000), and gonorrhea (105.2 reported cases per 100,000). 15 In 2013, the state of Texas reported cases of HIV (22.3 reported cases per 100,000), primary and secondary syphilis (6.3 reported cases per 100,000) and gonorrhea (126 reported cases per 100,000). It is important to note that syphilis has recently spiked in Harris County. In 2009, the incidence of syphilis was 7.4 cases per 100,000. In 2012, this number has increased to 11.6 per 100, Furthermore, in 2012, 2,526 adult AIDS cases were reported in Texas. Of these new cases, 84.8% were transmitted sexually. 12 Accidents Accidents (2,071 deaths), according to the most recent Health Fact Profiles for the HMH community, rank as a leading cause of death trailing only heart disease (7,443 reported deaths) and all cancer (7,285 reported deaths). The vast majority of Houston-Baytown-Sugarland MSA community and state indicators related to YRBSS, though not statistically different from one another, also indicate a high prevalence of unhealthy behaviors in the HMH community. These include rarely or never wearing a helmet while riding a bike (Houston-Baytown-Sugarland MSA: 89.9%: Texas: 91.9%), and riding with a driver who had been drinking alcohol one or more times (Houston-Baytown-Sugarland MSA: 31.7%: Texas: 32.2%). 15 In 2012, motor vehicle accidents were the leading cause of accidental deaths in the Houston-Baytown-Sugarland MSA. 5 Seatbelts and appropriate child restraints can offer a significant reduction in mortality due to motor vehicle accidents. The Health Status of Texas report (2012) states: Among those killed in Texas in 2012, 43.4% were reported as not restrained when the crash occurred. 12 Furthermore, 32.3% of all deaths due to motor vehicle accidents were a result of the driver being under the influence of alcohol. Drug and Alcohol Use According to the National Survey on Drug Use and Health (2012), an average of 490,000 people in the Houston-Baytown-Sugarland MSA used illicit drugs in the past year. 9 This is representative of nearly 12% of the total population. This number is similar to the Texas rate (12.6%), and lower than the national rate (14.7%). Specifically, marijuana use has experienced a steady 15

16 incline in Texas. This number has increased from slightly over 20% in 2007 to nearly 25% in Furthermore, 8.9% of the population in the Houston-Baytown-Sugarland MSA were classified as having a substance use disorder. 9 Binge alcohol consumption is defined as having more than five drinks on the same occasion. The report from the National Survey on Drug Use and Health states that 25.1% of the population age 12 and older in the Houston-Baytown-Sugarland MSA have participated in binge alcohol consumption in the past month. 9 Additionally, 28.2% of people age 18 and older have participated in binge alcohol in the past month. Conclusion Moving forward, Houston Methodist Hospital will continue to monitor the health needs of our community. We are dedicated to providing tailored implementation plans to address prevention and education throughout our entire system of Houston-area hospitals. Furthermore, we will seek out new methods to increase access to healthcare for the underserved community. 16

17 Works Cited 1. American Cancer Society (2015). What are the key statistics about breast cancer? 2. American Cancer Society (2015). What is colorectal cancer? 3. Centers for Disease Control and Prevention (CDC); [2011]Behavioral Risk Factor Surveillance System 4. Harris County Public Health and Environmental Services. (2014). Leading Causes of Death in Harris County, Texas; 5. Harris County Health Care Alliance. (2012). The State of Health of Houston/Harris County Ku, L., Levy, A., & Bruen, B. (2012). Potential Primary Care Crisis in Texas: A County- Based Analysis. Center for Health Policy Research School of Public Health and Health Services George Washington University. 7. Martin, Joe. (2014). Obamacare made a dent in the number of uninsured in Texas. Houston Business Journal, 8. Office of Disease Prevention and Health Promotion, Healthy People 2020, Mental Health and Mental Disorders; 9. Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2011, The NSDUH Report. NSDUHMetroBriefReports/NSDUHMetroBriefReports/NSDUH-Metro-Houston.pdf 10. Survey Data; Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention [June-August 2014] 11. Texas Department of State Health Service, Center for Health Statistics, 2009 Stroke Prevalence; 12. Texas Department of State Health Service, Center for Health Statistics, 2012 Harris County Health Fact Profile; Texas Department of State Health Service, Center for Health Statistics, Diabetes Fact Sheet Texas Department of State Health Service, Center for Health Statistics, 2014 Harris County Health Fact Profile; Texas Department of State Health Service, Center for Health Statistics, 2009 Houston-Baytown- Sugarland Metropolitan Statistical Area Health Fact Profile; 17

18 16. Texas Medical Association, The Uninsured in Texas (2012). /uninsured_in_texas/ 17. U.S. Census Bureau, Harris County quick facts. Retrieved February 27, 2015 from U.S. Census Website: Rice University Kinder Institute. The 33 rd Kinder Institute Area Survey. Retrieved May 14, 2015 from RiceWebsite: HAS/2014%20Houston%20Area%20Survey%20Report%20-%20Klineberg%20-%20FINAL%20- % pdf. 18

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