Community Health Needs Assessment

Transcription

2013
Community Health Needs Assessment
Kaiser Foundation Hospital – WEST LOS ANGELES
License #930000081
To provide feedback about this
Community Health Needs Assessment, email CHNA-communications@kp.org.
Authors
The Center for Nonprofit Management
Maura J. Harrington, Ph.D., MBA
Jessica Vallejo
Brianna Freiheit
Heather Tunis
Malka Fenyvesi
Gigi Nang
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Acknowledgements
The 2013 Community Health Needs Assessment East Metro West Collaborative, composed of Kaiser
Foundation Hospital–Baldwin Park (KFH-BP), Kaiser Foundation Hospital–Los Angeles (KFH-LA),
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA), and Citrus Valley Health Partners (nonKaiser Foundation Hospital), worked in partnership to conduct this needs assessment.
211 Los Angeles County
A Place Called Home
Early Identification and Intervention
Collaborative for Los Angeles County
Airport Marina Counseling Service
FAME Assistance Corporation
Alliance for Housing and Healing
Felicia Mahood Senior Multipurpose Center
AltaMed Health Services Corporation
Food and Nutrition Management Systems
Alzheimer's Association, California Southland
Chapter
Foundation for Children's Dental Health
American Heart Association
Healthy African American Families II
American Lung Association
In the Meantime Men's Group
Asian American Drug Abuse Program
Inside Out Community Arts
BREATHE California of Los Angeles County
Jewish Family Service of Los Angeles
California Black Women's Health Project
John Wesley Community Health Institute
CANGRESS Los Angeles Community Action
Network
Junior Blind of America
Catholic Charities of Los Angeles, Inc.
LA County Department of Public Health
CCEO YouthBuild
LA Promise
Center for Lupus Care
Latino Diabetes Association
Centinela Youth Services
LetsMove! West LA
Challengers Boys & Girls Club
Living Advantage, Inc.
Charles Drew University
City of Inglewood
Los Angeles County Department of Health
Services
Community Coalition For Substance Abuse
Prevention and Treatment
Los Angeles County Department of Mental
Health
Community Health Councils
Los Angeles County Department of Public
Health, Maternal, Child and Adolescent Health
Programs
Health Services Academy High School
LA City (Western) District 10 Office
Connections for Children
Crenshaw Christian Center
Los Angeles Urban League
Culver City Education Foundation
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Model Neighborhood Program
NAMI - Urban Los Angeles
The Children's Dental Center of Greater Los
Angeles
National Health Foundation
The Saban Free Clinic
Open PATHS Counseling Center
UCLA Center for Health Policy Research
Planned Parenthood Los Angeles
University Muslim Medical Association
Community Clinic
Project Angel Food
Venice Boys & Girls Club
Project Chicken Soup
Venice Family Clinic
Sickle Cell Disease Foundation of California
W.A.R.P.
Southern California Counseling Center
Watts Health Care Corporation
Southside Coalition of Community Health
Centers
Weingart YMCA
Special Needs Network
Westchester Playa Village
Special Olympics Southern California
WISE & Healthy Aging
St. Francis Medical Center
Women's Missionary
St. Joseph Center
YMCA
Students Run America DBA Students Run LA
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Table of Contents
Authors ......................................................................................................................................................... i
Acknowledgements ..................................................................................................................................... ii
Table of Contents ........................................................................................................................................ ii
I.
Executive Summary ........................................................................................................................ 1
a.
b.
II.
Introduction/Background .............................................................................................................. 13
a.
b.
c.
d.
III.
The Center for Nonprofit Management Team .................................................................. 35
East Metro West Collaborative ......................................................................................... 35
East .................................................................................................................................... 36
Metro ................................................................................................................................. 36
West .................................................................................................................................. 37
Process and Methods Used to Conduct the CHNA ...................................................................... 38
a.
b.
c.
VI.
Kaiser Permanente’s definition of community served by KFH-West Los Angeles ......... 17
Description and map of community served by KFH-West Los Angeles.......................... 17
History............................................................................................................................... 17
Service area ....................................................................................................................... 17
Demographic profile ......................................................................................................... 21
Access to health care ......................................................................................................... 26
Chronic diseases in the KFH-WLA service area .............................................................. 28
Who Was Involved In The Assessment ........................................................................................ 35
a.
b.
V.
Purpose of the community health needs assessment report .............................................. 13
About Kaiser Permanente ................................................................................................. 13
About Kaiser Permanente community benefit .................................................................. 14
Kaiser Permanente’s approach to the community health needs assessment ..................... 14
About the new federal requirements ................................................................................. 14
SB 697 and California’s history with past assessments .................................................... 14
Kaiser Permanente’s CHNA framework and process ....................................................... 15
Community Served ....................................................................................................................... 17
a.
b.
IV.
Health needs ........................................................................................................................ 3
Health drivers .................................................................................................................... 11
Secondary data .................................................................................................................. 38
Community input .............................................................................................................. 40
Data limitations and information gaps .............................................................................. 43
Identification and Prioritization of Community’s Health Needs .................................................. 45
a.
b.
Identifying community health needs ................................................................................. 45
Process and criteria used for prioritization of the health needs ........................................ 47
Community Forums .......................................................................................................... 48
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c.
VII.
Description of prioritized community health needs .......................................................... 51
Community Assets and Resources Available to Respond to the Identified Health Needs of
the Community.............................................................................................................................. 60
a.
b.
Health Care Facilities ........................................................................................................ 60
Hospitals ........................................................................................................................... 60
Community Clinics ........................................................................................................... 60
Dental Care ....................................................................................................................... 61
Mental Health.................................................................................................................... 61
Other Community Resources ............................................................................................ 62
School Districts ................................................................................................................. 62
Community Organizations and Public Agencies .............................................................. 62
Appendix A: Glossary............................................................................................................................... 70
Appendix B: KFH-WLA Health Needs Profiles ..................................................................................... 76
Health Need Profile: Mental Health ............................................................................................. 77
Health Need Profile: Obesity/Overweight .................................................................................... 82
Health Need Profile: Diabetes ...................................................................................................... 88
Health Need Profile: Cardiovascular Disease ............................................................................... 93
Health Need Profile: Oral Health .................................................................................................. 97
Health Need Profile: Hypertension ............................................................................................. 103
Health Need Profile: Cancer ....................................................................................................... 107
Health Need Profile: Cholesterol ................................................................................................ 111
Health Need Profile: Intentional Injury ...................................................................................... 114
Health Need Profile: Cervical Cancer......................................................................................... 118
Health Need Profile: Asthma ...................................................................................................... 122
Health Need Profile: Breast Cancer ............................................................................................ 126
Health Need Profile: HIV/AIDS ................................................................................................. 130
Health Need Profile: Vision ........................................................................................................ 135
Health Need Profile: Alcohol and Substance Abuse .................................................................. 138
Health Need Profile: Colorectal Cancer ..................................................................................... 142
Health Need Profile: Chlamydia ................................................................................................. 146
Health Need Profile: Alzheimer’s Disease ................................................................................. 149
Health Need Profile: Unintentional Injury.................................................................................. 153
Health Need Profile: Podiatry ..................................................................................................... 157
Health Need Profile: Allergies .................................................................................................... 160
Health Need Profile: Arthritis ..................................................................................................... 163
Health Need Profile: Infant Mortality ......................................................................................... 165
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Appendix C: Secondary Data Sources from Kaiser Permanente CHNA Data Platform and Other
Sources ........................................................................................................................................ 169
Appendix D: KFH-WLA Scorecard ...................................................................................................... 187
Appendix E: Data Collection Tools and Instruments ............................................................................ 197
Appendix F: Stakeholder Interviews Summary for KFH-WLA ............................................................ 226
Health Trends and Drivers Impacting Communities .................................................................. 227
Health-Related Trends in the Community .................................................................................. 229
Barriers to Access ....................................................................................................................... 230
Most Severely Impacted Sub-Populations and Geographic Disparities ..................................... 231
Health Care Utilization ............................................................................................................... 232
Ideas for Collaboration and Cooperation among Service Providers ........................................... 234
Appendix G: Focus Group Summary for KFH-WLA ............................................................................ 239
Health Needs and Drivers ........................................................................................................... 240
Health-Related Trends in the Community .................................................................................. 242
Sub-Populations Most Affected by These General Health Needs .............................................. 243
Barriers to Access ....................................................................................................................... 243
Health care utilization ................................................................................................................. 244
How Hospitals Can Address the Health Service Needs of This Community ............................. 245
Appendix H: Tier Results ....................................................................................................................... 247
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I. Executive Summary
The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, included the
requirement, under Section 501(r), that nonprofit hospital organizations must conduct a
Community Health Needs Assessment (CHNA) at least once every three years to maintain taxexempt status under section 501(c)(3) of the Internal Revenue Service Code. As part of the
CHNA, each hospital is required to collect input from designated individuals in the community,
including public health experts as well as members, representatives or leaders of low-income,
minority, and medically underserved populations and individuals with chronic conditions.
Though the CHNA process is a new national mandate within the ACA, nonprofit hospitals in
California have been required to conduct a CHNA every three years following passage of
California Senate Bill 697 (SB697) in 1994.
Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in its
communities and to guide the development of Community Benefit plans. The adoption of ACA
legislation has provided an opportunity to revisit the needs assessment and strategic planning
processes with an eye toward enhanced compliance and transparency and leveraging emerging
technologies. The CHNA process undertaken in 2013 and described in this report was conducted
in compliance with these new federal requirements.
The new legislation guiding the CHNA for nonprofit hospitals requires a greater emphasis on
structured and standardized methodologies in terms of how community needs are identified and
prioritized. The assessment had to balance a strict focus on methodology with the individual
needs of local hospitals and the desire to have an inclusive process, engaging a range of stakeholders and consideration of the diverse needs of the communities served. A glossary of terms
used throughout this report is included in Appendix A.
For the 2013 CHNA, three Kaiser Foundation Hospitals and one non-Kaiser Foundation hospital
in Los Angeles, West Los Angeles and the San Gabriel Valley formed a collaborative to work
with the Center for Nonprofit Management evaluation consulting team in conducting the
CHNA. Known as the East Metro West Collaborative, the four hospitals include: Kaiser
Foundation Hospital–Baldwin Park (KFH-BP) Kaiser Foundation Hospital–Los Angeles (KFHLA), Kaiser Foundation Hospital–West Los Angeles (KFH-WLA) and Citrus Valley Health
Partners. This CHNA report was produced for, and in collaboration with, Kaiser Foundation
Hospital-West Los Angeles.
During the initial phase of the CHNA process, community input was collected during six focus
groups and 22 interviews with key stakeholders including health care professionals, government
officials, social service providers, community residents, leaders and other relevant community
representatives. Concurrently, secondary data were collected and compared to relevant
benchmarks including Healthy People 2020, Los Angeles County or California when possible.
The data were also collected at smaller geographies, when possible, to allow for more in-depth
analysis and identification of community health issues. In addition, previous CHNAs were
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reviewed to identify trends and ensure that previously identified needs were not overlooked. Primary and secondary data were compiled into a scorecard presenting health needs and health drivers with highlighted comparisons to the available data benchmarks. The scorecard was designed
to allow for a comprehensive analysis across all data sources and for use during the prioritization
phase of the CHNA process.
After primary and secondary data were analyzed, a process was created in collaboration with the
local medical center’s Community Benefit Manager and the Kaiser Permanente Regional Office
to analyze the identified needs into three levels or tiers, based on the amount of data indicating a
need. The first step involved designing a method for sorting the extensive list of health issues
and drivers identified through the primary and secondary sources described above. The method
developed by the team sorted the identified needs into three levels or tiers, based on the amount
of data indicating a need. The first and most inclusive tier included any need or driver identified
as performing poorly against a set benchmark in secondary data or mentioned at least once in
primary data collection. The second tier included those issues identified as poorly performing
against a set benchmark or mentioned multiple times in primary data collection. The third and
most exclusive tier included those issues identified as poorly performing against a set benchmark
that also received multiple mentions in primary data collection.
After application of the rating method, tier two was deemed as the most appropriate identifier of
a potential prioritized health need (and/or driver) as these criteria provided a stringent yet inclusive approach that would allow for a comprehensive list of 23 health needs to be brought forth
for community input in the prioritization process.
A modified Simplex Method was used to implement the prioritization process, consisting of two
facilitated group sessions engaging participants in the first phase of community input and new
participants in a discussion of the data (as presented in the scorecards and accompanying health
need narratives) and the prioritization process. At the sessions, participants were provided with a
brief overview of the CHNA process, a list of identified needs in the scorecard format and the
brief narrative summary descriptions of the identified health needs described above. Then, in
smaller break-out groups, participants considered the scorecards and health needs summaries in
completing a prioritization grid exercise which was then shared with the larger group. (These
prioritization grids will also serve as supplemental information for the Implementation Strategy
Phase which is included in the CHNA process under the ACA requirements.) Following this
series of discussions, participants completed a brief questionnaire about health needs, drivers and
resources and ranked each health need according to several criteria including severity, change
over time, resources available to address the need or driver and community readiness to support
action on behalf of any health need or driver. After completing the questionnaires, participants
were each given ten (10) sticker dots and invited to place five dots on any health needs and five
dots on any health drivers that were listed in alphabetical order on large flip chart paper posted
around the meeting space. Participants could place the five dots in each section (health needs and
health drivers) in any manner they wished, and each dot counted as one vote. Data gathered
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through the survey were analyzed and given an overall score, ranging from 1 for least need to 12
for highest need. Health needs were also ranked by the criteria including severity, change over
time and available resources to address the need.
a. Health needs
The following list of 23 prioritized needs resulted from the above described process. Further
indicators and qualitative information about each need is included in Appendix B: KFH-WLA
Health Needs Profiles.
Data sources for data listed within the health summaries below came from the Kaiser Permanente
CHNA data platform. (See Appendix C for data source reference detail.)
1.
Mental Health
Among adults, mental disorders are common, with approximately one quarter of adults being
diagnosable for one or more disorders. Research shows that more than 90 percent of those who
die by suicide suffer from depression or other mental disorders, or a substance-abuse disorder
(often in combination with other mental disorders). Not only are mental disorders associated with
suicide, but also with chronic diseases, family history of mental illness, age, substance abuse,
and life event stresses. Mental health emerged as a health need through various indicators. The
percent of people needing help for mental/emotional/alcohol-drug related issues who did not
receive treatment in the KFH-WLA service area was nearly double (84.5%) that of Los Angeles
County (47.3%). The percentages were higher in SPA 6 at 86.8% and SPA 8 at 86.5%. The rate
of hospitalization for mental health for youth under 18 years of age per 100,000 persons in the
KFH-WLA service area is 268.7 per 100,000 persons compared to a statewide rate of 256.4.
However, the hospitalization rate of adults for mental health issues in the service area is
significantly higher at 2281.1 per 100,000 persons in comparison to the statewide rate of 551.7.
The geographic impact of mental health issues is apparent in the higher rates of adult
hospitalizations per 100,000 persons in SPA 5 (5626.2) and SPA 6 (2316.7). The percentage of
people per 100,000 persons who had serious psychological distress in the last year was higher in
the KFH-WLA service area (9.2%) than in Los Angeles County (7.3%). In 2010, the suicide rate
per 100,000 persons was also higher in the KFH-WLA service area at 8.7 compared to the Los
Angeles County rate of 8.0. Community stakeholders highlighted mental health as impacting a
spectrum of populations including those under 30 years of age, low-income women, homeless,
African Americans, the elderly, and undocumented individuals. Mental health is associated with
many other health factors including poverty, low birth rate, heavy alcohol consumption, poverty,
and unemployment. Mental health issues were identified by community stakeholders in 18 out of
22 interviews and all six focus groups. Mental health was identified as a health need in the 2010
KFH-WLA Community Health Needs Assessment.
2.
Obesity/Overweight
Obesity/overweight is defined as the percentage of adults ages 18 and older who self-report a
Body Mass Index (BMI) between 25.0 and 30.0. The Los Angeles County rate of obesity 26.4%
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is ten percentage points lower than the KFH-WLA service area rate of 36.4%, which is slightly
above both the statewide rate of 36.2% and national of 36.3%. The KFH-WLA service area rate
of youth obesity is 36.6%, higher than the statewide rate of 29.8%. In overweight adults, KFHWLA is higher again at 36.4% compared to Los Angeles County at 26.4%. Excess weight is
recognized as a significant national problem and indicates an unhealthy lifestyle that influences
further health issues. Obesity is associated with health factors including poverty, inadequate
fruit/vegetable consumption, breastfeeding and access to grocery stores, parks and open space.
Obesity was identified in four out of six focus groups and seven out of 22 interviews and was
identified as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
3.
Diabetes
Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading
cause of death. A diabetes diagnosis can indicate an unhealthy lifestyle, a risk factor for further
health issues, and is also linked to obesity. The diabetes hospitalization rate for adults in the
KFH-WLA service area is higher (200.2) when compared to the Los Angeles County rate of
145.6 per 100,000 persons. In SPA 6 (325.3) and SPA 8 (282.7), the rate of adult hospitalization
for diabetes is higher than the average hospitalization rate for the KFH-WLA service area as a
whole. The uncontrolled diabetes hospitalization rate per 100,000 adults is also higher (18.3)
when compared to Los Angeles County (9.5). Hospitalizations for uncontrolled diabetes are
significantly higher in SPA 6 (33.6). Community stakeholders noted that African-Americans,
Latinos, recent immigrants, and the homeless are particularly impacted by diabetes. Diabetes is
associated with a lack of physical activity, inadequate fruit and vegetable consumption, obesity,
and poverty among other factors. Diabetes diagnosis can indicate an unhealthy lifestyle, a risk
factor for further health issues, and is linked to obesity. Diabetes was also identified as a health
need in the 2010 KFH-WLA Community Health Needs Assessment.
4.
Cardiovascular Disease
Cardiovascular disease – also called heart disease and coronary heart disease – includes several
problems related to plaque buildup in the walls of the arteries, or atherosclerosis. As the plaque
builds up, the arteries narrow, restricting blood flow and creating a risk for a heart attack.
Currently more than one in three adults (81.1 million) lives with one or more types of
cardiovascular disease. The rate of cardiovascular disease mortality per 10,000 persons is higher
in the KFH-WLA service area (19.6) than the state average (15.6). Three of four SPAs within
the KFH-WLA service area have notably higher rates of cardiovascular disease per 10,000
persons, including SPA 6 (23.2), SPA 4 (21.4), and SPA 5 (19.9). The heart disease
hospitalization rate of 1129.9 people per 100,000 is notably higher than the statewide rate of
367.1 per 100,000 persons, particularly in SPA 5 where the heart disease hospitalization rate is
2882.5 per 100,000 persons. Heart disease hospitalization rates in SPA 8 (486.8) and SPA 4
(444.8) per 100,000 persons are also above the state average. Coronary heart disease is a leading
cause of death in the United States and associated with high blood pressure, high cholesterol, and
heart attacks as well as other health outcomes including obesity, heavy alcohol consumption, and
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diabetes. Heart disease/coronary disease was identified as a major health issue in four of 22
interviews and two out of six focus groups. Cardiovascular disease was also identified as a health
5.
Oral Health
Oral health is essential to overall health and is relevant because engaging in preventative
behaviors decreases the likelihood of developing future health problems. In addition, oral
diseases like cavities and oral cancer, cause pain and disability for many Americans. Oral health
indicators include the percentage of adults ages 18 and older who self-report that six or more of
their permanent teeth have been removed due to decay, gum disease or infection, an indication of
lack of access to dental care and/or social barriers to utilization of dental services. Los Angeles
County and the KFH-WLA service area have the same rate of adults with poor dental health
(11.6%), which is slightly higher than the statewide rate of 11.3% and lower than the national
rate of 15.6%. Poor dental health is linked to several health factors including poverty, soft drink
expenditures, and dental care affordability. Oral health and dental care was identified by
community stakeholders in two out of six focus groups and seven out of 22 interviews. Oral
health was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
6.
Hypertension
Hypertension, defined as a blood pressure reading of 140/90 or higher, affects 1 in 3 adults in the
United States. The condition has been called a silent killer as it has no symptoms or warning
signs and can cause serious damage to the body. High blood pressure, if untreated, can lead to
heart failure, blood vessel aneurysms, kidney failure, heart attack, stroke, and vision changes or
blindness. The percentage of those taking medicine to lower blood pressure is higher in the
KFH-WLA (28.5%) service area than in Los Angeles County (25.5%). In SPA 6 (34.1%), SPA
8 (29.8%), and SPA 4 (26.0%) the percent of adults taking medicine to lower blood pressure is
also higher than the Los Angeles County rate. Hypertension is indicated by high blood pressure
and was identified as a health issue by stakeholders in four out of 22 interviews and two out of
six focus groups. Hypertension and high blood pressure were identified as health needs in the
2010 KFH-WLA Community Health Needs Assessment.
7.
Cancer, in general
Cancer is the second leading cause of death in the United States, claiming the lives of more than
half a million Americans every year. The rate of death due to cancer in the KFH-WLA service
area is 154.5 people per 100,000 persons, which is lower than the Los Angeles County rate of
156.5. Community stakeholders in three out of 22 interviews and three out of six focus groups
identified cancer as a major health issue. Cancer is associated with access to health care, obesity,
heavy alcohol consumption, and specific cancers (breast, cervical, etc.). Cancer is recognized as
a leading cause of death in the United States and cancer mortality was identified as a health need
in the 2010 KFH-WLA Community Health Needs Assessment.
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8.
Cholesterol
Cholesterol is a waxy, fat-like substance needed in the body. Some health conditions, as well as
lifestyle and genetic factors, can put people at a higher risk for developing high cholesterol. Age
is a contributing factor, as is diabetes. Some behaviors that can lead to high cholesterol include a
diet high in saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. The
percent of adults who take medicine to lower cholesterol was slightly lower in the KFH-WLA
service area (69.8%) compared to Los Angeles County (71.2%); however, more adults take
medicine to control cholesterol in SPA 5 (75.8%) and SPA 6 (78.3%) when compared to Los
Angeles County. Cholesterol was identified in two of 22 interviews and three of six focus
groups. Cholesterol was not identified as a health need in the 2010 KFH-WLA Community
Health Needs Assessment.
9.
Intentional Injury
Intentional injuries and violence are widespread in society and are among the top 15 killers for
Americans of all ages. Intentional injury is defined as homicide or suicide; homicide is a measure
of community safety and a leading cause of premature death. The homicide rate for the KFHWLA service area is 12.4 per 100,000 persons, notably higher than the Los Angeles County rate
of 7.0 and above the statewide rate of 5.15. The 2008 homicide rates in SPA 6 (24.5) and SPA 8
(16.6) were higher than the KFH-WLA service area average of 13.7 at that time. Community
stakeholders noted adult males and women with children as impacted populations. Intentional
injury is associated with several health factors, including poverty rate, degree of education,
heavy alcohol consumption, and violent crime. Homicide was identified as a health issue by
community stakeholders in one out of 22 interviews and one out of six focus groups. Intentional
injury/homicide was identified as a health need in the 2010 KFH-WLA Community Health
Needs Assessment.
10.
Cervical Cancer
Cervical cancer is a disease in which cells in the cervix - the lower, narrow end of the uterus
connected to the vagina (the birth canal) to the upper part of the uterus - grow out of control. All
women are at risk for cervical cancer and it occurs most often in women over the age of 30. The
human papillomavirus (HPV), a common virus that is passed from one person to another during
sex, is the main cause of cervical cancer. The annual incidence rate of cervical cancer per
100,000 persons is higher in the KFH-WLA service area (9.8) when compared the statewide rate
(8.3). Additionally, the cervical cancer death rate is significantly higher at 9.5 per 100,000
persons in the KFH-WLA service area as compared to the rate in Los Angeles County of 3.0 per
100,000 persons. In SPA 4 (11.8) and SPA 6 (10.0), the cervical cancer mortality rate, ageadjusted per 100,000 persons, is higher than the KFH-WLA service area rate of 9.5. Cervical
cancer is associated with several indicators including unhealthy eating habits, access to
screening, obesity, and sexually transmitted diseases. Cervical cancer was identified as a health
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11.
Asthma
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of
children. Adults also may suffer from asthma and the condition is considered hereditary. Asthma
symptoms include wheezing, breathlessness, chest tightness, and coughing. The adult asthma
hospitalization rates are notable with 129.3 adults per 100,000 persons compared to a state
average of 94.3 adults per 100,000 persons. Subpopulations highlighted by community
stakeholders as particularly impacted by asthma include low-income women, youth and
homeless individuals. Rates for hospitalization in adults per 100,000 persons are particularly
high in SPA 6 (215.3) and SPA 8 (145.8). The rate of adult asthma hospitalizations of 10 per
1,000 admissions was also notably higher than the state average of 7.7 per 10,000 admissions.
Asthma is associated with tobacco use, obesity, aspects of poverty, and poor air quality and other
exacerbating environmental conditions. Asthma was mentioned as a major health issue in two
out of six focus groups and four out of 22 interviews and was identified as a health need in the
12.
Breast Cancer
In the United States, breast cancer is the most common non-skin cancer and the second leading
cause of cancer-related death in women. The incidence of breast cancer is highest in white
women for most age groups, but African-American women have higher incidence rates before 40
years of age and higher breast cancer mortality rates than women of any other racial/ethnic
groups in the United States at every age. Risk factors for breast cancer include older age, certain
inherited genetic alterations, hormone therapy, chest radiation therapy, alcohol consumption, and
obesity. The annual rate of incidence of females with breast cancer is 117.9 per 100,000 persons
in Los Angeles County and in the KFH-WLA service area, which is lower than the statewide rate
of 123.3 per 100,000 persons. Community stakeholders in two out of 22 interviews and one out
of six focus groups identified breast cancer as a major health issue. Breast cancer is associated
with overall cancer mortality, breast cancer screening, obesity, and heavy alcohol assumption.
Breast cancer was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
13.
HIV/AIDS
More than 1.1 million people in the United States are living with HIV and almost 1 in 5 (18.1%)
are unaware of their infection. HIV infection weakens the immune system, making those living
with HIV highly susceptible to a variety of illnesses and cancers, including tuberculosis (TB),
cytomegalovirus (CMV), cryptococcal meningitis, lymphomas, kidney disease, and
cardiovascular disease. Without treatment, almost all people infected with HIV will develop
AIDS. The KFH-WLA service area has an HIV prevalence rate of 480.3 per 100,000 persons,
close to the Los Angeles County rate of 480.4 and notably higher than the statewide rate of 345.5
and the national rate of 334 per 100,000 persons. The HIV hospitalization rate of 35.0 per
100,000 persons in the KFH-WLA service area is higher than the Los Angeles County rate of
11.0. The HIV hospitalization rate is highest in SPA 4 (60.5) and SPA 6 (48.5). HIV is
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associated with numerous other health factors including poverty, heavy alcohol consumption and
access to/use of HIV screenings. Community stakeholders identified HIV as a major health need
in two out of 22 interviews. HIV was also a health need in the 2010 KFH-WLA Community
14.
Vision
People with diabetes are at an increased risk of vision problems, as diabetes can damage the
blood vessels of the eye, potentially leading to blindness. As diabetes rates continue to rise
among all age groups, vision complications tied to the disease are expected to increase as well.
The percent of diabetic adults who had their vision checked within the last year was lower in the
KFH-WLA service area (57.6%) compared to Los Angeles County (63.3%), and lower still in
SPA 4 (37.3%). Vision was identified a major health issue in two out of 22 interviews and two
of out six focus groups. Vision was not identified as a need in the 2010 KFH-WLA Community
15.
Alcohol and Substance Abuse
The effects of substance abuse significantly contribute to costly social, physical, mental, and
public health problems including teenage pregnancy, HIV/AIDS, STDs, domestic violence, child
abuse, motor vehicle crashes (unintentional injuries), physical fights, crime, homicide, and
suicide. Alcohol and Substance Abuse is defined as adults (age 18 and older) who self-report
heavy alcohol consumption. The alcohol/drug-induced mental disease hospitalization rate in the
KFH-WLA service area is 480 per 100,000 persons, which is notably higher than the state
average of 109.1. While the average rate of hospitalization in the KFH-WLA service area is
480.0, the rate for SPA 5 is significantly higher at 1,549.9 per 100,000 persons. Heavy alcohol
consumption is defined as adults age 18 and older who self-report heavy alcohol consumption of
more than two drinks per day for men and one drink per day for women. Stakeholders
highlighted youth, women, Latinos, African Americans, and people with low and middle class
income levels as significantly affected by substance abuse. Alcoholism was identified as a major
concern in four out of 22 interviews and one out of six focus groups. Heavy alcohol consumption
is relevant as a behavior and determinant of future health conditions that include cirrhosis,
cancers, and untreated mental and behavioral health issues. Alcohol and substance abuse was not
indicated as an area of major need in the 2010 KFH-WLA Community Health Needs
Assessment.
16.
Colorectal Cancer
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading
cause of cancer-related deaths in the United States and is expected to cause about 50,830 deaths
during 2013. The annual incidence rate of colon and rectum cancer in the KFH-WLA service
area is 45.2 individuals per 100,000 persons, which is the same as the Los Angeles County rate.
However, these rates are above the statewide rate of 43.7 and the national rate of 40.2. The
KFH-WLA service area average rate for colorectal cancer mortality, age-adjusted per 100,000
Page 8
persons, is 13.5, which is higher than the Los Angeles County rate of 11.5. The colorectal
mortality rate is significantly higher in SPA 5 (17.6), SPA 6 (15.4) and SPA 8 (12.7). High rates
of colorectal cancer are associated with overall cancer mortality, heavy alcohol consumption,
obesity, diabetes prevalence and colon cancer screening. Colorectal cancer was mentioned as a
major health issue in one out of 22 interviews with community stakeholders and was identified
as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
17.
Chlamydia
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United
States. Chlamydial infections can lead to serious health problems. In women, untreated infection
can cause pelvic inflammatory disease (PID), permanently damage a woman’s reproductive tract
and lead to long-term pelvic pain, inability to get pregnant and potentially deadly ectopic
pregnancy. In men, infection sometimes spreads to the tube that carries sperm from the testis,
causing pain, fever, and, rarely, preventing a man from being able to father children. Untreated
Chlamydia may increase a person’s chances of acquiring or transmitting HIV. The incidence rate
for chlamydia in the KFH-WLA service area is 538.7 per 100,000 persons, significantly higher
than Los Angeles County (455.1). Incidence rates are significantly higher in SPA 6 (969.6) when
compared to the KFH-WLA service area (538.7). Chlamydia is associated with other health
factors including poverty and heavy alcohol consumption and is an indicator of unsafe sex
practices and a measure of poor health status. Chlamydia was not identified as a health need in
the 2010 KFH-WLA Community Health Needs Assessment.
18.
Alzheimer’s Disease
An estimated 5.4 million Americans have Alzheimer’s disease and it is the sixth-leading cause of
death in the U.S. Alzheimer’s, an irreversible and progressive brain disease, is the most common
cause of dementia among older people. The rate of mortality due to Alzheimer’s disease was
lower for the KFH-WLA (15.7) service area compared to Los Angeles County (17.6).
Alzheimer’s disease was identified as a major health need in three out of 22 interviews and two
out of six focus groups. Alzheimer’s disease was not indicated as a major need in the 2010 KFHWLA Community Health Needs Assessment.
19.
Unintentional Injury (Pedestrian/Motor Vehicle)
Unintentional injuries include those resulting from motor vehicle crashes resulting in death and
pedestrians being killed in crashes. Motor vehicle crashes are one of the leading causes of death
in the U.S. with more than 2.3 million adult drivers and passengers being treated in 2009.
Pedestrians are 1.5 times more likely than passenger vehicle occupants to be killed in a car crash
on each trip. The rate of mortality by motor vehicle accident per 100,000 persons in the KFHWLA service area is slightly higher (7.2) when compared to Los Angeles County (7.1) and the
statewide rate (8.2). The percent of pedestrians killed by motor vehicles was higher in the KFHWLA service area (25.9%) when compared to Los Angeles County (25.7%). Notably, the
percent of pedestrians killed by motor vehicles was slightly higher in SPA 8 at 26.0% and higher
Page 9
still in SPA 5 at 30.7%. Some health factors associated with unintentional injury are poverty,
education, walkability, heavy alcohol consumption, and liquor store access. Unintentional injury
was not identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
20.
Podiatry
Foot problems can be caused by arthritis, diabetes, cardiovascular disease, foot and ankle
injuries, muscle and tendon problems, skin disorders, toe joint and nerve disorders, and toenail
problems. Complications in the feet are a serious issue for the 26 million diabetics living in the
United States. In fact, diabetes is the leading cause of non-traumatic lower-limb amputation. In
the KFH-WLA service area SPA 5 (81.7%) and SPA 8 (81.2%) have higher percentages of
adults who had their feet checked for sores when compared to Los Angeles County. Podiatry was
identified as a specialty care need by community stakeholders in two out of 22 interviews.
Podiatry was not identified as a need in the 2010 KFH-WLA Community Health Needs
Assessment.
21.
Allergies
Allergies are an overreaction of the immune system to substances that usually cause no reaction
in most individuals. These substances can trigger sneezing, wheezing, coughing and itching. Risk
factors associated with allergic reactions include pollen, dust, food, insect stings, animal dander,
mold, medications, and latex. Other social and economic factors that can cause or trigger
allergic reactions include poor housing conditions (living with cockroaches, mites, asbestos,
mold etc.) and living in an environment or home with smokers. Allergies among teens were
higher in the KFH-WLA service area (27.1%) compared to Los Angeles County (24.9%). The
percent of teens with allergies were also higher in SPA 5 (45.6%) and SPA 8 (29.5%) when
compared to Los Angeles County. Allergies were also identified as a major health concern in
three out of 22 interviews. Allergies were not indicated as a major need in the 2010 KFH-WLA
Community Health Needs Assessment.
22.
Arthritis
Arthritis affects one in five adults and continues to be the most common cause of physical
disability. Risk factors associated with arthritis include being overweight or obese, lack of
education around self-management strategies and techniques, and limited or no physical activity.
In the KFH-WLA service area, a larger portion of the population was diagnosed with arthritis in
SPA 5 (17.7%) than in Los Angeles County (17.4%). Arthritis was identified as a major health
concern in three out of 22 interviews and two out of six focus groups. Arthritis was not indicated
as a major need in the 2010 KFH-WLA Community Health Needs Assessment.
23.
Infant Mortality
Infant mortality remains a concern in the United States as each year approximately 25,000
infants die before their first birthday. The leading causes of infant death include congenital
Page 10
abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems
related to complications of pregnancy, and respiratory distress syndrome. Infant mortality is the
rate of infant death at less than one year of age per 1,000 births. Infant mortality is associated
with low birth weight, and in the KFH-WLA service area, the percentage rate (8.3%) is higher
than the Los Angeles County percentage rate of 6.8%. The percent of infants with very low birth
weight is also higher (1.4% per 1,000 births) than the Los Angeles County rate of 1.3% per 1,000
births. This rate is slightly higher in SPA 6 (1.6%) and SPA 8 (1.8%). Stakeholders highlight that
Latina and African-American populations are particularly impacted by the infant mortality rate.
High rates of infant mortality can indicate broader issues such as access to health care, maternal
and child health, poverty, education, teen births, and lack of insurance and of prenatal care.
Infant mortality was not identified as a health need in the 2010 KFH-WLA Community Health
Needs Assessment.
b. Health drivers
Drivers such as poverty and behaviors are very much linked and are often the root or cause of
many health problems. For this reason, drivers were put through the same rigorous process of
identification and prioritization as health needs. The following list includes the prioritized list of
drivers:
1. Health Insurance
2. Health Care Access
3. Healthy Eating
4. Physical Activity
5. Cardiovascular Disease Management
6. Employment
7. Nutritional Access
8. Homelessness
9. Alcohol and Substance Use
10. Income
11. Preventative Care Services
12. Dental Care Access
13. Safety
14. Awareness and Education
15. Education
16. Cancer Screenings
Page 11
17. Air Quality
18. Language Barrier
19. Transportation
Page 12
II. Introduction/Background
a. Purpose of the community health needs assessment report
Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The
findings from this CHNA report will serve as a foundation for understanding the health needs
found in the community and will inform the Implementation Strategy for Kaiser Foundation
Hospitals as part of their Community Benefit planning. This report complies with federal tax law
requirements set forth in Internal Revenue Service Code section 501(r) requiring hospital
facilities owned and operated by an organization described in Code section 501(c)(3) to conduct
a community health needs assessment at least once every three years. The required written plan
of Implementation Strategy is set forth in a separate written document. At the time that hospitals
within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal
Revenue Service provided the most recent guidance on how to conduct a CHNA. This written
plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52
regarding conducting the CHNA for the hospital facility.
b. About Kaiser Permanente
Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945,
Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit
health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go
to a doctor. Since our beginnings, we have been committed to helping shape the future of health
care. Among the innovations Kaiser Permanente has brought to U.S. health care are:
Prepaid health plans, which spread the cost to make it more affordable
A focus on preventing illness and disease as much as on caring for the sick
An organized coordinated system that puts as many services as possible under one roof—all
connected by an electronic medical record
Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation
Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups.
Today we serve more than 9 million members in nine states and the District of Columbia. Our
mission is to provide high-quality, affordable health care services and to improve the health of
our members and the communities we serve.
Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered
and supported by industry-leading technology advances and tools for health promotion, disease
prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser
Permanente is dedicated to care innovations, clinical research, health education, and the support
of community health.
Page 13
c. About Kaiser Permanente community benefit
For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we
serve. We believe good health is a fundamental right shared by all and we recognize that good
health extends beyond the doctor’s office and the hospital. It begins with healthy environments:
fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks,
and safe playgrounds. These are the vital signs of healthy communities. Good health for the
entire community, which we call Total Health, requires equity and social and economic wellbeing.
Like our approach to medicine, our work in the community takes a prevention-focused, evidence-based approach. We go beyond traditional corporate philanthropy or grantmaking to pair
financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—Health Access, Healthy Communities, and
Health Knowledge—to address critical health issues in our communities.
For many years, we’ve worked side-by-side with other organizations to address serious public
health issues such as obesity, access to care, and violence. And we’ve conducted Community
Health Needs Assessments to better understand each community’s unique needs and resources.
The CHNA process informs our community investments and helps us develop strategies aimed at
making long-term, sustainable change—and it allows us to deepen the strong relationships we
have with other organizations that are working to improve community health.
d. Kaiser Permanente’s approach to the community health needs
assessment
About the new federal requirements
Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that
hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is
conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires
nonprofit hospitals to: collect and take into account input from public health experts as well as
community leaders and representatives of high need populations—this includes minority groups,
low-income individuals, medically underserved populations, and those with chronic conditions;
identify and prioritize community health needs; document a separate CHNA for each individual
hospital; and make the CHNA report widely available to the public. In addition, each nonprofit
hospital must adopt an Implementation Strategy to address the identified community health
needs and submit a copy of the Implementation Strategy along with the organization’s annual
Form 990.
SB 697 and California’s history with past assessments
For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our
allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill
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697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA
every three years. As part of SB 697 hospitals are also required to annually submit a summary of
their Community Benefit contributions, particularly those activities undertaken to address the
community needs that arose during the CHNA. Kaiser Permanente has designed a process that
will continue to comply with SB 697 and that also meets the new federal CHNA requirements.
Kaiser Permanente’s CHNA framework and process
Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked
together to establish an approach for implementing the new federally legislated CHNA. From
data collection and analysis to the identification of prioritized needs and the development of an
implementation strategy, the intent was to develop a rigorous process that would yield meaningful results.
Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and
the Center for Applied Research and Environmental Studies (CARES), developed a web-based
CHNA data platform to facilitate implementation of the CHNA process. More information about
the CHNA platform can be found at http://www.CHNA.org/kp/. Because data collection, review,
and interpretation are the foundation of the CHNA process, each CHNA includes a review of
secondary and primary data.
Page 15
To ensure a minimum level of consistency across the organization, Kaiser Permanente included a
list of roughly 100 indicators in the CHNA data platform that, when looked at together, help
illustrate the health of a community. California data sources were used whenever possible. When
California data sources weren’t available, national data sources were used. Once a user explores
the data available, the CHNA data platform has the ability to generate a report that can be used to
guide primary data collection and inform the identification and prioritization of health needs.
In addition to reviewing the secondary data available through the CHNA data platform, and in
some cases other local sources, each Kaiser Permanente hospital collected primary data through
key informant interviews, focus groups, and surveys. They asked local public health experts,
community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources.
Each hospital/collaborative used a set of criteria to determine what constituted a health need in
their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized
community health needs. The process and the outcome of the CHNA are described in this report.
In conjunction with this report, Kaiser Permanente will examine the list of prioritized health
needs and develop an implementation strategy for those health needs it will address. These
strategies will build on Kaiser Permanente’s assets and resources, as well as evidence-based
strategies, wherever possible. The Implementation Strategy will be filed with the Internal
Revenue Service using Form 990 Schedule H.
Page 16
III. Community Served
a. Kaiser Permanente’s definition of community served by KFH-West
Los Angeles
Kaiser Permanente defines the community served by a hospital as those individuals residing
within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved
populations.
b. Description and map of community served by KFH-West Los Angeles
History
Kaiser Permanente evolved from industrial health care programs for construction, shipyard and
steel mill workers during World War II. Its founders were Sidney Garfield, M.D., and Henry J.
Kaiser, who became partners in advancing the concept of pre-paid health care.
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA) provides primary and specialty
health care services, in addition to health education, training, public health, and community
services, and ensures that underserved persons living in the overall service area receive
coordinated high-quality prevention and medical care services.
Service area
The KFH-WLA service area is presented below by city or community, ZIP Code and Service
Planning Area.
KFH-WLA Service Area
Service
Planning Area
(SPA)*
SPA 5
SPA 5
SPA 8
SPA 5
City/Community
Beverly Hills
Culver City
El Segundo
Inglewood
ZIP Code
90209, 90210, 90211, 90212, 90213
90230, 90231, 90232, 90233
90245
90397
Inglewood
90301, 90302, 90303, 90304, 90305, 90306,
90307, 90308, 90309, 90311, 90312, 90313, 90398
SPA 8
Los Angeles
90019, 90036, 90048, 90069, 90189
SPA 4
Los Angeles
90009, 90024, 90025, 90034, 90035, 90045,
90049, 90056, 90064, 90066, 90067, 90073,
90080, 90083, 90094, 90095, 90230, 90272,
90291, 90292, 90293, 90294, 90295, 90296
SPA 5
Los Angeles
Los Angeles
Malibu
90008, 90016, 90018, 90043, 90047, 90062
90044
Page 17
SPA 6
SPA 8
SPA 5
City/Community
Santa Monica
Santa Monica
ZIP Code
90401, 90402, 90403, 90404, 90405
90406, 90407, 90408, 90409, 90410, 90411
Unincorporated Areas
of LA County (incl:
Ladera Heights,
Lennox, Marina del
Rey, View Park,
Westmont,
Windsor Hills)
90043, 90047, 90056, 90291, 90292, 90295, 90304
West Hollywood
90048, 90069
Service
Planning Area
(SPA)*
SPA 5
SPA 8
SPA 5/6/8
SPA 4
*Los Angeles County Department of Public Health Service Planning Area (SPA): SPA 4–Metro Los Angeles; SPA
5–West Los Angeles; SPA 6–South; SPA 8–South Bay/Harbor
Notes: The ZIP code 90895 is currently noted in the CHNA data platform however no data is associated with this
ZIP code and is not considered part of the KFH-WLA service area.
Though the KFH-WLA service area currently includes portions of the City of Malibu, ZIP codes for this community
were not included in the KFH-WLA service area at the time health needs data was collected and prioritized for this
report.
Page 18
KFH-WLA Service Area Map
Page 19
KFH-WLA Service Area Map with SPA Boundaries
Page 20
A description of the community served by KFH-WLA is provided in the following data tables
and narrative. Depending upon the available data sources for each variable, KFH-WLA
information are presented as representing the entirety of the service areas when possible or by
Service Planning Areas 4, 5, 6 and 8, portions of which are served by KFH-WLA. Data are
organized in the following sections: Demographic Profile, Access to Health Care and Chronic
Disease Prevalence and Incidence.
Demographic profile
Population
The KFH-WLA service area has a population of 1,253,910, which is 12.8% of the total Los
Angeles County population (U.S. Census Bureau Decennial Census, 2010). Close to half
(48.9%) of the population living in the KFH-WLA service area reside in SPA 5. Approximately
one in five (20.4%) KFH-WLA service area residents live in SPA 6 (U.S. Census Bureau
Decennial Census, 2010).
Total Population, 2010
Service Planning Area 4
Los Angeles County
Number
143,203
613,603
255,449
241,655
1,253,910
9,818,605
Percent
11.4%
48.9%
20.4%
19.3%
12.8%
100.0%
Source: U.S. Census Bureau Decennial Census, 2010
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP codes in KFH-WLA service area)
Gender
There are slightly more females (51.8%) living in the KFH-WLA service area compared with
males (48.2%). A similar gender breakdown is found for females (50.7%) and males (49.3%)
living in Los Angeles County (U.S. Census Bureau Decennial Census, 2010).
Gender, 2010
Los Angeles County
Male
#
69,039
293,138
113,511
123,637
599,325
4,839,654
Female
%
50.0%
48.3%
46.8%
48.2%
48.2%
49.3%
#
69,014
313,794
129,175
132,920
644,903
4,978,951
%
50.0%
51.7%
53.2%
51.8%
51.8%
50.7%
Page 21
Age
By age, nearly one third (32.3%) of residents in the KFH-WLA service area are between the ages
of 25 and 44 compared to 29.6% in Los Angeles County (U.S. Census Bureau Decennial Census,
2010). Adults over 50 years of age make up over one quarter (29.1%) of the residents in the
KFH-WLA service area and 27.9% in Los Angeles County (U.S. Census Bureau Decennial
Census, 2010).
Age, 2010
85 years and over
75-84 years
65-74 years
60-64 years
55-59 years
50-54 years
45-49 years
2.0%
1.5%
KP-WLAMC
3.7%
3.6%
6.2%
5.8%
4.9%
4.6%
5.7%
5.7%
6.6%
6.7%
7.0%
7.2%
35-44 years
25-34 years
21-24 yrars
18-20 years
15-17 years
10-14 years
5-9 years
0-4 years
0.0%
15.1%
14.6%
17.2%
15.0%
6.4%
6.1%
4.6%
4.8%
3.6%
4.5%
5.6%
6.9%
5.4%
6.5%
5.9%
6.6%
5.0%
LA County
10.0%
15.0%
20.0%
Race and Ethnicity
Caucasians (36.5%) make up the largest racial/ethnic group in the KFH-WLA service area
compared to 27.8% in Los Angeles County (U.S. Census Bureau Decennial Census, 2010). The
second largest racial/ethnic group is Hispanics or Latinos making up slightly less than one third
(30.4%) of the KFH-WLA service area population compared to 47.7% in Los Angeles County
(U.S. Census Bureau Decennial Census, 2010). African Americans are the third largest
racial/ethnic group comprising over one-fifth (21.0%) of the service area population.
Page 22
Race and Ethnicity, 2010
Hispanic/ Latino
Caucasian
African American
American Indian/Alaskan Native
Asian/Pacific Islander
Other
Two or More Races
KFH-WLA Service
Area
(381,146) 30.4%
(457,639) 36.5%
(263,314) 21.0%
(2,029) 0.2%
(109,306) 8.7%
(5,403) 0.4%
(35,073) 2.8%
Los Angeles County
(4,687,889) 47.7%
(2,728,321) 27.8%
(815,086) 8.3%
(18,886) 0.2%
(1,348,135) 13.7%
(25,367) 0.3%
(194,921) 2.0%
Language Spoken At Home
A larger percentage of the population in KFH-WLA service area speaks English only (58.1%) at
home when compared to Los Angeles County (42.9%). Another third speak Spanish (27.2%) at
home; which less than those in homes in Los Angeles County (39.7%). A slightly smaller
percentage of the population speaks an Asian/Pacific Island language (5.7%) at home when
compared to Los Angeles County (10.9%).
Language Spoken At Home, 2013
Language
English Only
Asian/Pacific Island
Indo-European
Spanish
Other
Total
KFH-WLA service area
#
%
696,673
58.1%
68,741
5.7%
85,227
7.1%
326,302
27.2%
22,622
1.9%
1,199,565
100.0%
Los Angeles County
#
%
3,998,524
42.9%
1,016,304
10.9%
494,736
5.3%
3,699,298
39.7%
102,818
1.1%
9,311,680
100.0%
Data source: Nielson Claritas, 2013
Source geography: ZIP code
Educational Attainment
Nearly one quarter (24.1%) of the population in the KFH-WLA service area has less than a ninth
grade education, which is slightly lower than Los Angeles County (26.9%) (U.S. Census Bureau
Public Use Microdata Statistics (PUMS), 2010). The KFH-WLA service area has a higher
proportion of people who have achieved a bachelor’s degree (18.1%) or a graduate or
professional degree (9.8%) compared to Los Angeles County where 13.6% have a bachelor’s
degree and 7.0% have a graduate or professional degree (U.S. Census Bureau Public Use
Microdata Statistics (PUMS), 2010).
Page 23
Education Attainment, 2010
KFH-WLA Service
Area
Los Angeles County
th
9 to 12th High School
Grade
Graduate
(no
(includes
diploma) Equivalency)
6.6%
11.7%
4.8%
9.9%
15.8%
17.4%
18.5%
18.2%
Less
than
9th
Grade
20.6%
12.8%
29.6%
33.3%
Some
Graduate
College
or
(no
Associate’s Bachelor’s Professional
degree)
Degree
Degree
Degree
14.5%
4.1%
29.3%
13.1%
18.9%
5.2%
28.5%
19.9%
20.2%
4.5%
8.7%
3.8%
18.9%
3.1%
5.8%
2.3%
24.1%
11.4%
14.3%
18.1%
4.2%
18.1%
9.8%
26.9%
12.7%
16.9%
18.0%
5.0%
13.6%
7.0%
Source: U.S. Census Bureau Public Use Microdata Statistics (PUMS), 2010
Household Income
In 2009, nearly a quarter of residents in the KFH-WLA service area (24.8%) had an annual
household income between $20,001 and $40,000, a slightly smaller proportion of Los Angeles
County (23.8%) reported the same income range (California Health Interview Survey, 2009).
Nearly a third (29.1%) have an annual household income of $20,000 or below, which is slightly
less when compared to Los Angeles County (25.1%) (California Health Interview Survey, 2009).
Annual Household Income, 2009
12.7%
12.2%
<=$135,000
$100,001-$135,000
$90,001-$100,000
$80,001-$90,000
$70,001-$80,000
$60,001-$70,000
$50,001-$60,000
$40,001-$50,000
4.2%
4.6%
6.0%
7.1%
KFH-WLA
LA County
2.2%
3.5%
4.4%
5.0%
4.4%
4.7%
6.0%
6.8%
6.3%
7.4%
10.6%
10.4%
$30,001-$40,000
$20,001-$30,000
$15,001-$20,000
$10,001-$15,000
$5,001-$10,000
>=$5,000
0.0%
5.8%
5.2%
4.3%
3.5%
5.0%
7.9%
7.4%
9.0%
10.0%
Source: California Health Interview Survey (CHIS), 2009
Source Geography: SPA (data not available at the ZIP code level)
Page 24
14.2%
13.4%
11.1%
15.0%
Poverty
Poverty thresholds are used for calculating all official poverty population statistics and are
updated by the Census Bureau on an annual basis. For 2010, the federal poverty level for one
person was $10,830 and $22,050 for a family of four.
Poverty level in the KFH-WLA service area is more prominent when compared to Los Angeles
County. The population in the KFH-WLA service area living below 100% of the Federal
Poverty Level (FPL) is larger (16.6%) when compared to Los Angeles County (15.7%). In
contrast, a slightly smaller portion of the population in the KFH-WLA service area is living
below 200% of the FPL (35.1%) than in Los Angeles County (37.6%). More children in the
KFH-WLA service area (24.2%) live below 100% of the FPL when compared to Los Angeles
County (22.4%).
Poverty Level, 2010
Population living below 100% of the Federal Poverty Level
Population living below 200% of the Federal Poverty Level
Children (0-17 years) living below 100% of the Federal Poverty Level
KFH-WLA
service area
16.6%
35.1%
24.2%
Los Angeles
County
15.7%
37.6%
22.4%
Data source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates
Source geography: Tract
Homeless Persons
More than half of the homeless population in Los Angeles County resides in Service Planning
Areas (SPAs) 4, 5, 6, and 8, which comprise KFH-WLA service area and surrounding
communities. In SPAs 4, 5, 6, and 8 there are 30,606 homeless persons. This is 67% of the LA
County homeless population.
Homeless Persons in Service Area, 2011
Los Angeles County
Number
11,571
3,512
8,735
6,788
30,606
45,422
Percent
25.47%
7.73%
19.23%
22.20%
67%
100%
Data source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless County Report, 2011
Source geography: SPA
Homeless Persons by Age
More than half of the homeless population in SPAs 4,5,6, and 8, including the KFH-WLA
service area and surrounding communities, is between the ages of 25 and 54 (53.8%), similar to
Los Angeles County (57.4%). Another 15.5% are between the ages of 55 and 61 and 13.8% are
Page 25
under the age of 18, followed by those between the ages of 18 and 24 (9.0%). Finally, 8.0% of
the homeless population in the KFH-WLA service area and surrounding communities is 65 years
of age or older.
Homeless Persons by Age, 2011
KFH-WLA
service area
(SPAs 4,5,6,8)
13.8%
9.0%
53.8%
15.5%
8.0%
Age group
Under 18
18-24
25-54
55-61
62 and Older
Los Angeles
County
13.4%
7.9%
57.4%
14.1%
7.2%
Data source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless County
Report, 2011
Source geography: SPA
Employment Status
In 2012, the U.S. Bureau of Labor Statistics reported an unemployment rate of 10.2 in the KFHWLA service area, slightly higher when compared to Los Angeles County (9.7) In 2010, the
percent of the population who was unemployed was on average 6.0% in the KFH-WLA service
area, the same as Los Angeles County (American Community Survey 5-Year Estimates, 2010).
Over a third of the population in the KFH-WLA service area (34.3%) were not in the labor force,
which is slightly lower when compared to Los Angeles County (34.8%) (American Community
Survey Five-Year Estimates, 2010). However, over half of the population (59.7%) in the KFHWLA service area was employed, slightly more when compared to Los Angeles County (59.5%).
Employment Status, 2010
Los Angeles County
CA
Employed
60.7%
63.7%
53.4%
60.9%
59.7%
59.5%
58.5%
Unemployed
6.6%
4.7%
6.9%
5.7%
6.0%
5.7%
5.8%
Armed
Forces
0.0%
0.1%
0.0%
0.1%
0.1%
0.1%
0.5%
Not in Labor
Force1
32.7%
31.5%
39.7%
33.2%
34.3%
34.8%
35.3%
Source: American Community Survey 5-Year Estimates, 2006-2010
1
All people 16 years and over who are not classified as members of the labor force, including students, retired
workers, seasonal workers, individuals taking care of home or family, etc
Access to health care
Medical Insurance
Page 26
Nearly one quarter (24.6%) of the population in the KFH-WLA service area does not have
medical insurance, compared to 17.0% in Los Angeles County and 14.5% in California
(California Health Interview Survey (CHIS), 2009). Likewise, the KFH-WLA service area
(19.3%) has a higher proportion of residents who do not have a usual source of care compared
with Los Angeles County (16.2%) and statewide (14.2%) (California Health Interview Survey
(CHIS), 2009). In the KFH-WLA service area, 525,887 individuals are eligible and enrolled in
Medi-Cal, with the largest portion living in SPA 4 (295,097) (California Department of Health
Care Services (DHCS), 2011).
Insurance Status, 2009 and 2011
Los Angeles County
CA
Percent of
population (0 to 64
years) without
insurance1
24.6%
17.0%
14.5%
Percent of
population (0 to 64
years) who do not
have a usual source
of care1
19.3%
16.2%
14.2%
Number of
individuals who are
eligible and enrolled
Medi-Cal2
525,887
2,444,850
7,790,828
Source: California Health Interview Survey (CHIS), 2009 1, California Department of Health Care Services (DHCS), 2011
2
Population without a Usual Source of Care
A slightly smaller portion of the population in the KFH-WLA service area (16.0%) do not have a
usual source of care (a place they go when they get sick such as primary doctor) when compared
to Los Angeles County (16.2%). A larger portion of the population without a usual source of
care is within SPA 6 (22.3%) and SPA 4 (19.3%).
Population without a Usual Source of Care, 2009
Percent
19.3%
8.1%
22.3%
14.3%
16.0%
16.2%
Los Angeles County
Data source: California Health Interview Survey (CHIS), 2009
Source geographic: SPA
Health Professional Shortage Areas
Only 10% (n=14) of facilities in Los Angeles County (n=137) that are designated as health
professional shortage areas (HPSAs) are within the KFH-WLA service area. Despite only 10%
of HPSAs being within the KFH-WLA service area, nearly three quarters (67.3%) of the
population live in a HPSA. Please refer to Section VII of the Community Health Needs
Page 27
Assessment report for a comprehensive list of community assets including facilities designated
as health professional shortage areas.
Health Professional Shortage Areas, 2012
KFH-WLA
service area
Facilities designated as health professional
shortage areas
Population living in a health professional
shortage area
Los Angeles
County
14
137
67.3%
53.2%
Data source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File,
2012
Source geographic: HPSA
Federally Qualified Health Centers (FQHC) in Service Area
Only 7.9% (n=8) of Federally Qualified Health Centers in Los Angeles County (n=101) are
located in the KFH-WLA service area. Please refer to Section VII of the Community Health
Needs Assessment report for a comprehensive list of community assets including facilities
designated as health professional shortage areas.
Federally Qualified Health Center (FQHC), 2011
KFH-WLA
service area
Number of federally qualified health centers
8
Los Angeles
County
101
Data source: U.S. Health Resources and Services Administration, Centers for Medicare & Medicaid
Services, Provider of Service File, 2011
Source geographic: Address
Chronic diseases in the KFH-WLA service area
Diabetes Prevalence and Hospitalizations
Diabetes, among adults 45 and older, is more prevalent in the KFH-WLA service area (19.1%)
compared with Los Angeles County (10.5%). In 2009, adults living in SPA 6 and SPA 8 or
South Bay had the highest rates of diabetes in the KFH-WLA service area (24.1% and 25.1%,
respectively) (California Health Interview Survey (CHIS), 2009).
In 2010, the total number of hospitalizations in the KFH-WLA service area for uncontrolled
diabetes was 186, with the largest number occurring in SPA 6 (88) (Office of Statewide Health
and Planning and Development, 2010). Similarly, the highest rate of hospitalizations for
uncontrolled diabetes, per 100,000 people, was in SPA 6 (33.6). This rate was much higher than
the KFH-WLA service area rate of 18.3 and the statewide rate of 9.5 (Office of Statewide Health
and Planning and Development (OSHPD), 2010).
Page 28
Diabetes Prevalence, 2009 and 2010
LA County
CA
Percent Diagnosed
with Diabetes
(Adults age 45 and
over)1
13.7%
13.3%
24.1%
25.1%
19.1%
10.5%
8.5%
Number of
Hospitalizations for
Uncontrolled
Diabetes2
18
30
88
50
186
No data
3,581
Rate of
Hospitalizations for
Uncontrolled
Diabetes (per
100,000 pop.)2
11.5
9.2
33.6
18.7
18.3
No data
9.5
Source: California Health Interview Survey (CHIS), 2009 1, Office of Statewide Health and Planning and Development
(OSHPD), 2010
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP codes in KFH-WLA service area)2
Among adults in the KFH-WLA service area, 2,264 were hospitalized in 2010 for diabetes
compared with 87 diabetes-related hospitalizations among youth under the age of 18 (Office of
Statewide Health Planning and Development, 2010). The diabetes hospitalization rate, per
100,000 people, for adults in the KFH-WLA service area was 200.2, which was higher than the
rate for California (145.6). Adults living in SPA 6 had the highest hospitalization rate at 325.3.
The diabetes hospitalization rate (45.9) for youth in the KFH-WLA service area was higher than
the statewide rate (34.9). SPA 5 (85.7) had the highest hospitalization rate for treating diabetes
among youth (Office of Statewide Health Planning and Development (OSHPD), 2010).
Diabetes Hospitalizations, 2010
LA County
CA
Number of
Hospitalizations
(adults)
184
510
829
741
2,264
No data
54,244
Number of
Hospitalizations
(Youth-under 18)
1
29
26
31
87
No data
3,247
Hospitalization
Rate for Adults
(per 100,000 pop.)
110.5
82.1
325.3
282.7
200.2
No data
145.6
Hospitalization
Rate for Youth
(per 100,000 pop.)
7.2
85.7
41.7
48.9
45.9
No data
34.9
Source: Office of Statewide Health Planning and Development (OSHPD), 2010
In the KFH-WLA service area the hospitalization rate for heart disease, per 100,000 people, was
1,129.9, which is substantially higher than the state rate (367.1). SPA 5 had a hospitalization rate
of 2,882.5, which was the highest in the KFH-WLA service area (Office of Statewide Health and
Planning and Development (OSHPD), 2010). In 2009, 6.3% of KFH-WLA service area residents
were diagnosed with heart disease, which is slightly higher than the rate for Los Angeles County
Page 29
(5.7%). Those living in SPA 8 had the largest percent of heart disease diagnoses (6.8%)
(California Health Interview Survey (CHIS), 2009).
Over half (51.2%) of KFH-WLA service area residents with heart disease received a heart
disease management plan by a health professional, which is lower than the 65.5% in Los Angeles
County and 70.9% statewide who received a heart disease management plan (California Health
Interview Survey (CHIS), 2009). People living in SPA 4 (44.7%) were the least likely to receive
a heart disease management plan compared to people living in the other SPAs.
Heart disease had a large impact on KFH-WLA service area residents in 2010. The KFH-WLA
service area heart disease mortality rate, per 10,000 people, was 19.6 compared with the Los
Angeles County rate of 15.6. The mortality rate for heart disease was especially high in SPA 6
(23.2) and SPA 4 (21.4) (California Department of Public Health (CDPH), 2010).
Cardiovascular Disease Prevalence, 2009 and 2010
LA County
CA
Hospitalization
Rate (per
100,000 pop.)1
444.8
2,882.5
705.6
486.8
1,129.9
No data
367.1
Percent
Diagnosed
with Heart
Disease2
6.2%
7.0%
5.0%
6.8%
6.3%
5.7%
5.9%
Health Professional
Provided Heart
Disease
Management Plan2
44.7%
73.3%
51.7%
62.9%
51.2%
65.5%
70.9%
Death Rate
for Heart
Disease (per
10,000 pop.) 3
21.4
19.9
23.2
14.0
19.6
No data
15.6
Source: Office of Statewide Health and Planning and Development (OSHPD), 20101, California Health Interview
Survey (CHIS), 20092, California Department of Public Health (CDPH), 20103
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP codes in KFH-WLA service area)1,
SPA data not available at the ZIP code level)2
Cervical Cancer
Cervical cancer can be prevented by receiving regular pap smear tests. While 86.3% of women
living in the KFH-WLA service area received a pap smear test in the last three years, which is
higher than the Los Angeles County rate of 84.4%, this is below the Healthy People 2020 goal of
having 93% or more women receiving a pap smear test (Los Angeles County Department of
Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health
Survey, 2007).
The KFH-WLA service area is impacted greatly by cervical cancer. In 2008, the cervical cancer
mortality rate per 100,000 people in KFH-WLA service area was 9.5, which was much higher
than the Los Angeles County rate (3.0), California rate (2.3), and Healthy People 2020 goal of
2.2 or lower. SPA 4 (11.8) and SPA 6 (10.0) had the highest cervical cancer mortality rates in the
KFH-WLA service area (California Department of Public Health, Death Statistical Master File,
2008).
Page 30
Cervical Cancer, 2007 and 2008
LA County
CA
HP 2020
Received Pap smear in
the last 3 years2
84.6%
87.3%
88.3%
84.8%
86.3%
84.4%
No data
>=93%
Death Rate (age-adjusted
per 100,000 pop.)1
11.8
8.5
10.0
7.6
9.5
3.0
2.3
<=2.2
Source: California Department of Public Health, Death Statistical Master File, 2008 1; Los Angeles County Department
of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey, 2007 2
Source Geography: SPA (data not available at the ZIP code level)2, ZIP Code (each SPA aggregated to include only
those ZIP codes in KFH-WLA service area)1
** if <20 deaths a reliable rate cannot be calculated
Colorectal Cancer
The colorectal cancer mortality rate, age-adjusted per 100,000 people, in the KFH-WLA service
area is 13.5, which is higher than the Los Angeles County rate of 11.2. Specifically, SPA 5
(17.6), SPA 6 (15.4) and SPA 8 (12.7) have higher colorectal cancer mortality rates than Los
Angeles County (California Department of Public Health, Death Statistical Master File, 2008).
More than three quarters (75.2%) of adults ages 50 or older living in the KFH-WLA service area
have ever had a sigmoidoscopy, colonoscopy, or fecal occult blood test, compared with 75.7% in
Los Angeles County and 78.0% in California. These rates exceed the Healthy People 2020 goal
of a rate of 70.5% or higher. Approximately two thirds (66.5%) of adults ages 50 or older in the
KFH-WLA service area have had a sigmoidoscopy or colonoscopy in the past 5 years, which is
slightly higher than the Los Angeles County rate (65.5%) and slightly lower than the State rate
(68.1%). All three rates do not achieve the Healthy People 2020 goal of 70.5% or higher for
adults to have had a sigmoidoscopy or colonoscopy in the last 5 years (California Health
Interview Surveys (CHIS), 2009).
Colorectal Cancer Incidence, 2008 and 2009
Death Rate (ageadjusted per
100,000 pop.)1
8.3
17.6
15.4
12.7
Percent of Adults
ages 50 or older
ever having a
sigmoidoscopy,
colonoscopy or
FOBT2
73.1%
81.3%
67.1%
79.1%
LA County
13.5
11.2
75.2%
75.7%
Page 31
Percent of Adults
ages 50 or older
who had a
sigmoidoscopy or
colonoscopy in the
last 5 years2
64.4%
73.4%
57.9%
70.1%
66.5%
65.5%
CA
HP 2020
Death Rate (ageadjusted per
100,000 pop.)1
11.1
n/a
Percent of Adults
ages 50 or older
ever having a
sigmoidoscopy,
colonoscopy or
FOBT2
78.0%
>=70.5%
Percent of Adults
ages 50 or older
who had a
sigmoidoscopy or
colonoscopy in the
last 5 years2
68.1%
>=70.5%
Source: California Department of Public Health, Death Statistical Master File, 2008 1, California Health Interview
Surveys (CHIS), 20092
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP codes in KFH-WLA service area)1,
SPA data not available at the ZIP code level)2
Mental Health
The mental health hospitalization rate, per 100,000 people, for youth under 18 years of age in the
KFH-WLA service area is 268.7 compared to a statewide rate of 256.4. However, the
hospitalization rate of adults for mental health issues in the KFH-WLA service area is
significantly higher at 2281.1 compared to the statewide rate of 551.7. The geographic impact of
mental health issues is apparent in the higher rates of adult hospitalizations per 100,000 in SPA 5
(5,626.2) and SPA 6 (2,316.7) (Office of Statewide Health Planning and Development
(OSHPD), 2010).
Mental Health Hospitalizations, 2010
LA County
CA
Hospitalizations
(adult)
971
2,976
2,439
1,483
7,869
No data
205,526
Hospitalizations
(youth under 18)
55
238
257
193
743
No data
23,836
Hospitalization
Hospitalization
Rate (youth under
Rate (adult)
18)
695.1
211.2
5,626.2
254.9
2,316.7
386.9
486.4
221.8
2,281.1
268.7
No data
No data
551.7
256.4
In 2010, the KFH-WLA service area had an alcohol/drug induced mental disease hospitalization
rate (480.0), per 100,000 people, that was over four times that of the California rate (109.1). In
particular, the KFH-WLA service area hospitalization rate was extremely high in the SPA 5, with
a rate of 1,549.9 (Office of Statewide Health Planning and Development (OSHPD), 2010).
Page 32
Alcohol/Drug Induced Mental Health Hospitalizations, 2010
Alcohol/Drug Induced
Mental Disease
Hospitalizations
223
1,038
274
252
1,787
No data
40,651
LA County
CA
Alcohol/Drug Induced
Mental Disease
Hospitalization Rate
170.8
1,549.9
105.7
93.6
480.0
No data
109.1
Close to one in ten (9.2%) people living in the KFH-WLA service area in 2009 likely had serious
psychological distress in the past year compared with 7.3% of Los Angeles County residents.
The distress rate in SPA 6 (14.8%) was over twice that of the Los Angeles County rate (7.3%)
(California Health Interview Survey (CHIS), 2009).
A sizable portion (84.5%) of people residing in the KFH-WLA service area needed help for
mental/emotional/alcohol-drug related issues but did not receive treatment, compared with the
47.3% of people residing in Los Angeles County. These rates were highest in SPA 6 (86.8%) and
SPA 8 (86.5%) (California Health Interview Survey (CHIS), 2009).
Mental Health—Psychological Distress, 2009
KFH-WLA Service
Area
LA County
CA
Likely had serious
psychological
distress in past year
#
%
101,000
10.7%
18,000
3.6%
101,000
14.8%
55,000
7.1%
Needed help for
mental/emotional/alcoholdrug issues but did not
receive treatment
#
%
96,000
80.6%
33,000
84.0%
51,000
86.8%
54,000
86.5%
Needed help for
mental/emotional/alcoholdrug issues and received
treatment
#
%
87,000
19.4%
47,000
16.0%
39,000
13.2%
64,000
13.5%
442,000
9.2%
414,000
84.5%
451,000
15.5%
541,000
1,785,000
7.3%
6.5%
495,000
1,741,000
47.3%
44.5%
550,000
2,173,000
52.7%
55.5%
Source: California Health Interview Surveys (CHIS), 2009
Obesity/Overweight
Close to one third (31.3%) of people living in the KFH-WLA service area were overweight in
2009. Among the four SPAs, SPA 8 (33.7%) had the greatest number of overweight residents. In
regards to obesity, the KFH-WLA service area had an obesity rate of 23.0%. SPA 6 had the most
residents who were obese (30.0%) (California Health Interview Survey (CHIS), 2009).
Page 33
Obesity/Overweight, 2009
Los Angeles County
CA
Percent Overweight
(BMI 26-29)1
28.6%
29.3%
32.6%
33.7%
31.3%
29.7%
31.5%
Percent Obese
(BMI >=30)1
20.0%
13.9%
30.0%
28.1%
23.0%
21.2%
21.1%
Source: California Health Interview Survey (CHIS), 2009
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP codes in KFH-WLA service
area)1
When compared to Los Angeles County, the same portion of adults are obese (21.4%), however,
a larger portion of youth are obese (36.6% in KFH-WLA service area and 29.8% in Los Angeles
County). A larger portion of adults are overweight (36.4%) in KFH-WLA service area when
compared to Los Angeles County (26.4%). Similarly, more youth are overweight in KFH-WLA
service area (14.7%) when compared to Los Angeles County (14.3%).
Obesity/Overweight – Adults and Youth, 2010
Los Angeles County
Percent of
adults who
are obese
21.4%
21.4%
Percent of youth
who are obese
36.6%
29.8%
Percent of adults
who are
overweight
36.4%
26.4%
Percent of youth
who are
overweight
14.7%
14.3%
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010
Source Geography: County
Page 34
IV. Who Was Involved In The Assessment
a. The Center for Nonprofit Management Team
The Center for Nonprofit Management was hired as the consultant team to conduct the assessment for the East Metro West Collaborative, which is a partnership among three Kaiser Permanente medical centers and one non-Kaiser Hospital, Citrus Valley Health Partners.
The Center for Nonprofit Management (CNM) Evaluation Consulting team conducted the 2013
Community Health Needs Assessment for the three Kaiser Foundation Hospitals and the Citrus
Valley Medical Center, also known as the East Metro West Collaborative. CNM is the leading
management assistance organization in Southern California, providing training, technical assistance, capacity-building resources and services, and customized counsel to the nonprofit sector
since 1979.
The principal members of the CNM evaluation team—Dr. Maura Harrington and Ms. Jessica
Vallejo—have extensive experience with SB 697 community health needs assessments and public health data. The team was involved in conducting the 2004, 2007, and 2010 CHNAs for the
Metro Hospital Collaborative (California Hospital Medical Center, Children’s Hospital Los
Angeles, Good Samaritan Hospital, Kaiser Foundation Hospital Los Angeles, QueensCare, and
St. Vincent Medical Center) and has participated in other CHNAs in the region. Dr. Harrington
has worked on projects with the Pasadena Public Health Department and California Wellness
Foundation and many other health-related projects. The CNM team has extensive experience
with a broad range of evaluation projects involving qualitative and quantitative data collection
and analysis and the preparation of reports and documentation appropriate for diverse audiences
and constituencies.
b. East Metro West Collaborative
The Collaborative includes the following partners:
Kaiser Foundation Hospital - Baldwin Park (KFH-BP)
Gloria R. Bañuelos, Community Benefit Manager
Kaiser Foundation Hospital - Los Angeles (KFH-LA)
Mario P. Ceballos, Community Benefit Manager
Kaiser Foundation Hospital - West Los Angeles (KFH-WLA)
Celia A. Brugman, Community Benefit Manager
Citrus Valley Health Partners (Non-Kaiser Foundation Hospital)
Maria Peacock, Community Benefit Department
Page 35
East
Kaiser Foundation Hospital–Baldwin Park
Kaiser Foundation Hospital–Baldwin Park (KFH-BP) is a 272 licensed-bed hospital offering
comprehensive services including primary care and specialty services. KFH-BP serves 246,000
members in the San Gabriel Valley through a network of more than 3,300 employees and 498
physicians at its medical center campus, four outlying medical office buildings, a behavioral and
addiction medicine facility, and three retail Vision Essentials offices.
KFH-BP’s service area includes the Southern California communities of Azusa, Baldwin Park,
Covina, Diamond Bar, El Monte, Glendora, Hacienda Heights, Irwindale, Industry, La Puente,
Montebello, Rosemead, Rowland Heights, San Dimas, San Gabriel, South El Monte, Valinda,
Walnut, and West Covina.
Citrus Valley Health Partners
Citrus Valley Health Partners, through its three hospital campuses (Citrus Valley Medical Center—Inter-Community Campus in Covina; Citrus Valley Medical Center—Queen of the Valley
Campus in West Covina; and Foothill Presbyterian Hospital in Glendora) and hospice (Citrus
Valley Hospice in West Covina), serves a community of nearly one million people in the San
Gabriel Valley. Its mission is lived through the work of its 3,000+ staff members and nearly
1,000 physicians. Each hospital campus offers different areas of specialty, including cardiac care,
family-centered maternity services, a Level IIIB Newborn Intensive Care Unit (NICU), the
Geleris Family Cancer Center, a Robotic Surgery Program, a full range of rehabilitation services,
and an Outpatient Diabetes Education Program. Citrus Valley Hospice has an extensive home
care program as well as a 10-bed inpatient hospice facility. Associated with Hospice, Citrus
Valley Home Health provides physician-supervised nursing and rehabilitation care to individuals
recovering at home from accidents, surgery, or illness.
Metro
Kaiser Foundation Hospital–Los Angeles
The Kaiser Foundation Hospital–Los Angeles (KFH-LA) is Kaiser Permanente’s tertiary center
of excellence in Southern California. KFH-LA offers a wide range of specialty care services,
featuring 39 Centers of Excellence—including complex neurosurgery, pediatrics, comprehensive
cancer care—and has the largest cardiac surgery program in the western United States. KFH-LA
is also a medical learning institution where highly trained doctors mentor and teach new generations of physicians and caregivers. KFH-LA is home to The Center for Medical Education
(CME) which includes an extensive graduate medical education program with more than 250
interns, residents, and fellows in 22 different specialties and subspecialties. KFH-LA currently
hosts approximately 300 active medical research projects across a range of disciplines. More
than 750,000 patients visit KFH-LA a year. For more information, visit www.kp.org/losangeles.
Page 36
The KFH-Los Angeles service area includes the communities of Alhambra, Altadena, Arcadia,
Burbank, Glendale, La Cãnada Flintridge, La Crescenta, Los Angeles (primarily SPA 4), Monrovia, Monterey Park, Montrose, Pasadena, San Gabriel, San Marino, Sierra Madre, South Pasadena, and West Hollywood (East). City of Los Angeles neighborhoods include Atwater Village,
Boyle Heights, Chinatown, City Terrace, Downtown Los Angeles, Eagle Rock, East Los Angeles, Echo Park, El Sereno, Glassell Park, Hancock Park, Highland Park, Hollywood, Hollywood
Hills, Laurel Canyon, Los Feliz, Montecito Heights, and Silverlake.
West
Kaiser Foundation Hospital–West Los Angeles
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA) is a 305 licensed-bed hospital
offering comprehensive services including primary care and specialty services. KFH-WLA
serves 189,013 members and has a staff of 2,916 employees and 517 physicians. Four outlying
medical offices, two retail Vision Service offices, and a Health Education Center expand KFHWLA services throughout the West Los Angeles service area—in Playa Vista, Culver Marina,
Inglewood, and South Los Angeles. KFH-WLA is home to six award-wining centers of expertise
that provide innovative treatments and surgical procedures.
The WLA Service Area includes the cities of Beverly Hills, Culver City, El Segundo, Inglewood,
Malibu, Santa Monica, West Hollywood, and the City of Los Angeles, including the communities of Baldwin Hills, Cheviot Hills, Crenshaw, Hyde Park, Jefferson Park, La Tijera, Leimert
Park, Mar Vista, Mid City, Miracle Mile, Ocean Park, Pacific Palisades, Palms, Playa Del Rey,
Rancho Park, Rimpau, University Park, Venice, Vermont Knolls, West Adams, Westchester,
Westwood, Wilshire, and unincorporated areas such as Ladera Heights, Lennox, Marina del Rey,
View Park, Westmont, and Windsor Hills, among others.
Page 37
V. Process and Methods Used to Conduct the CHNA
a. Secondary data
Secondary data were collected from a wide range of local, county and state sources to present
demographics, mortality, morbidity, health behaviors, clinical care, social and economic factors
and physical environment. These categories are based on the Mobilizing Action Toward
Community Health (MATCH) framework which illustrates the inter-relationships among the
elements of health, and their relationship to each other: social and economic factors, health
behaviors, clinical care, physical environmental, and health outcomes.
To promote consistency across the organization, Kaiser Permanente identified a minimum set of
required indicators for each of the data categories to be used by all Kaiser Permanente Regions
for the Community Health Needs Assessments. Kaiser Permanente partnered with the Center for
Applied Research and Environmental Systems (CARES) at the University of Missouri to develop
a web-based data platform to provide the common indicators across service areas. The
secondary data for this report was obtained from the Kaiser Permanente CHNA data platform
Page 38
from October 2012 through February 2013. The CHNA data platform is undergoing continual
enhancements and certain data indicators may have been updated since the data were obtained
for this report. As such, the most updated data may not be reflected in the tables, graphs, and/or
maps provided in this report. For the most recent data and/or additional health data indicators,
please visit CHNA.org/kp.
The Kaiser Permanente common indicator data were calculated to obtain unique service area
rates. In most cases, the service area values represent the aggregate of all data for geographies
(ZIP Codes, counties, tracts, etc.), which fall within the service area boundary. When one or
more geographic boundaries are not entirely encompassed by a service area, the measure is
aggregated proportionally. The options for weighting “small area estimations” are based upon
total area, total population, and demographic-group population. The specific methodology for
how service area rates are calculated for each indicator can be found on the CHNA.org/kp
website.
Additional data sets were accessed to supplement the minimum required data sets. These data
were selected from local sources that were not offered on the common indicators database. The
data sets were accessed electronically. When data from supplemental sources were available by
ZIP code, the data from the ZIP codes of the service area were compiled for a medical service
area indicator. For geographic comparisons across cities within the medical service area, if the
source provided data by ZIP codes, then ZIP codes were aggregated to calculate medical service
area rates in respective cities; when the data were not available by ZIP code, then the data for the
entire city was utilized.
Secondary data for KFH-WLA downloaded from the Kaiser Permanente CHNA data platform as
well as from the supplementary resources, were input into tables to be included in the analysis.
The tables present the data indicator, the geographical area the data represented, the data
measurement (e.g. rate, number, percent), and the data source and year. Data are presented based
on the data source and geographic level of available data. When possible, these data are
presented in the context of larger geographies such as county or state for comparison.
To allow for a comprehensive analysis across data sources, and to assist with the identification of
a health need, a matrix (Appendix D: KFH-WLA Scorecard) was created listing all identified
secondary indicators and primary issues in one location. The matrix included medical center–
level secondary data (averaged), primary data counts (number of times an issue was mentioned)
for both interviews and focus groups and sub-populations noted as most severely impacted. The
matrix also included benchmark data in the form of Healthy People 2020 (HP2020) benchmarks
which are nationally recognized when the indicator matched the data on hand. If, however, an
appropriate HP2020 indicator was not available, then the most recent county or state data source
was used as a comparison.
Each data indicator for the medical center hospital was first compared to the HP2020 benchmark
if available and then to the geographic level for benchmark data to assess whether the medical
service area performance was better or worse than the benchmark. When more than one source
Page 39
(from the primary or secondary data) identified an issue, the issue was designated as a health
need or driver.
Two additional steps of analysis were conducted. The first reviewed data in smaller relevant
geographies, repeating the process described above to identify areas in which needs were more
acute. In the second step, the previous Community Health Needs Assessment was reviewed to
identify trends and ensure that a previously identified need had not been overlooked.
b. Community input
Information and opinions were gathered directly from persons who represent the broad interests
of the community served by KFH-WLA. Between September and December 2012, the
consultants convened six focus groups and conducted twenty two telephone interviews with a
broad range of community stakeholders, including area residents. The purpose for the primary
data collection component of the Community Health Needs Assessment is to identify broad
health needs and key drivers, as well as assets and gaps in resources, through the perceptions and
knowledge of varied and multiple stakeholders.
Focus group and interview candidates were selected with the assistance of the KFH-WLA
Community Benefit Manager and recommendations from other key informants, and included
representation from a range of health and social service providers and other community based
organizations and agencies as well as community residents.
The interviews were conducted primarily via telephone for approximately 30 to 45 minutes each;
the conversations were confidential and interviewers adhered to standard ethical research
guidelines. The interview protocol was designed to collect reliable and representative
information about health and other needs and challenges faced by the community, access and
utilization of health care services, and other relevant topics. (See Appendix E for data collection
tools and instruments used in primary data collection.)
Focus groups took place in a range of locations throughout the service area, with translation and
interpretation services provided when appropriate. Focus group sessions were 60 to 90 minutes
each. As with the interviews, the focus group topics also were designed to collect representative
information about health care utilization, preventive and primary care, health insurance, access
and barriers to care, emergency room use, chronic disease management and other community
issues. Participants included groups that the hospital identified as prioritized stakeholders for the
needs assessment including residents from major ethnic groups, geographic areas and service
providers in the service area. Ethnic groups represented included residents from AfricanAmerican and Latino communities. Interpretation services were provided in Spanish. Focus
groups of individuals representing the geographies of West and South Los Angeles were engaged
as were focus groups that included representatives of community agencies and service providers
who interact with residents on issues related to health care.
The stakeholders engaged through the six focus groups and twenty two interviews represent a
broad range of individuals from the community, including health care professionals, government
Page 40
officials, social service providers, local residents, leaders, and other relevant community
representatives, as per the IRS requirement. The charts below demonstrate this broad diversity,
highlighting the expertise/perspective, key categories and geographies represented by the
participants in interviews and focus groups. Please see Appendix F for a summary of the
stakeholder interview responses and Appendix G for a summary of the focus group responses.
The following charts provide information on community input participants in the interviews and
focus groups.
Individuals with Special Knowledge of or Expertise in Public Health
1.
Name(Last,
First,
Academic
Distinction)
Arafiena,
Farlene
Title
Affiliation
Lead Case
Manager
Crenshaw Christian
Center
Grant Writer
Project Angel Food
2.
Arizemendi,
Marcos
3.
Ballesteros, Al CEO
JWCH Institute
(John Wesley
Community Health)
3.
Cox, Debra
American Heart
Association
4.
Davis,
Cynthia
Donovan,
Kevin
5.
Sr. Director
Foundation
Relations
Assistant
Professor
Staff Analyst
6.
Hall, Wesley
Director of
Development
and
Communicati
on
7.
Hart, Bonita
Co-founder
Charles Drew
University
LA County Dept. of
Public Health,
Maternal, Child and
Adolescent Health
Programs
Project Angel Food
Food and Nutrition
Mgmt Systems
Page 41
Description of
public health
knowledge/experti
se
Federally funded
assistance
programs,
adolescence and
substance abuse
Nutrition and food
delivery for
populations with
AIDS/HIV, cancer
and other life
threatening
diseases
FQHC, primary
care, mental health
care for homeless
and dual diagnosis,
HIV services
Health equity,
research and
funding
Urban Public
Health, AIDS/HIV
Maternal, child and
adolescent health
Nutrition and food
delivery for
populations with
AIDS/HIV, cancer
and other life
threatening
diseases
Nutrition, food
services and
Date of
Consult
Type of
Consult
10/15/12
Interview
10/16/12
Interview
10/19/12
Interview
10/5/12
Interview
9/20/12
Interview
10/2/12
Interview
10/16/12
Interview
10/9/12
Interview
Name(Last,
First,
Academic
Distinction)
8.
9.
Hobson,
William
Jew, Jessica
10.
Kun, Heather
Title
President and
CEO
Health Policy
Analyst
Affiliation
Watts Health Care
Corporation
Community Health
Councils
12.
Vice
President of
Research and
Evaluation
Marin,
Los Angeles
Maribel
Executive
Director
Munoz, Randy Vice Chair
13.
Oblath, Patti
Executive
Director
Connections for
Children
14.
Park, Annie
Executive
Director
Community Health
Councils
11.
National Health
Foundation
211 Los Angeles
County
Latino Diabetes
Association
15.
Paul, Jennifer
Regional
Director of
Program and
Advocacy
American Lung
Association
16.
Vaccaro, Nina
L. MPH
Executive
Director
Southside Coalition
of Community
Health Center
17.
Watson,
Ericka
Executive
Director
Foundation for
Children's Dental
Health
Page 42
Description of
public health
knowledge/experti
se
administration
Health care
administration
Health policy and
advocacy to
increase access for
uninsured
Policy, evaluation
and health care for
the uninsured
Information and
referral service
serving LA County
Diabetes,
preventative
medicine, lowincome,
undocumented and
un/underinsured
Child care
resources and
referral, child
development and
training
Health care
improvement and
access for the
un/underinsured
Health education
and training,
specialty in lung
disease
management
Building
partnerships and
administrating
clinics
Dental and health
education and
services
Date of
Consult
Type of
Consult
10/17/12
Interview
10/17/12
Interview
9/21/12
Interview
10/15/12
Interview
10/22/12
Interview
10/11/12
Interview
Interview
10/17/12
9/25/12
Interview
10/5/12
Interview
10/16/12
Interview
Individuals Consulted from Federal, Tribal, Regional, State or Local Health Departments or Other Departments or
Agencies with Current Data or Other Relevant Information
Name(Last,
First, Academic
Distinction)
Nosset, Angelea
MD
Title
Affiliation
Type of
Department
Date of
Consult
Type of
Consult
Chief
Medical
Officer
Local Health
Department
10/19/2012
Interview
2.
Donovan, Kevin
Staff
Analyst
Local Health
Department
10/22/12
Interview
3.
Marin, Maribel
Los Angeles
Executive
Director
Los Angeles
County
Department of
Health Services
LA County Dept.
of Public Health,
Maternal, Child
and Adolescent
Health Programs
211, Los Angeles
Executive
Director
Information and
referral service
serving LA
County
10/15/12
Interview
1.
Leaders, Representatives, or Members of Medically Underserved Persons, Low-Income Persons,
Minority Populations, and Populations With Chronic Disease Needs
Description of
Leadership,
Representative, or
Member Role
Health Care
Providers
1.
Group Size
6 participants
2.
12 participants
Social Service
Providers
3.
4 participants
4.
3 participants
Promotoras and
Community
Leaders
Business and
Education leaders
5.
9 participants
6.
12 participants
Residents and
clients
Residents and
Clients
What Group(s) Do They
Represent?
Health access, children, youth
and families, chronic disease
populations, minority
populations
Social service providers serving
low-income, minority, chronic
disease populations
Minority populations,
underserved, dental care,
reproductive care, outreach
Minority populations, at-risk
youth, adults and seniors,
underserved populations
West Los Angeles Residents and
clients
South West Los Angeles
Residents and Clients
Date of
Consult
10/9/12
Type of
Consult
Focus
Group
10/11/12
Focus
Group
10/5/12
Focus
Group
10/9/12
Focus
Group
9/27/12
Focus
Group
Focus
Group
9/25/12
c. Data limitations and information gaps
The Kaiser Permanente common data set includes a robust set of nearly 100 secondary data
indicators that, when taken together, enable an examination of the broad health needs within a
community. However, there are some limitations with regard to this data, as is true with any
Page 43
secondary data. Some data were available only at a county level or SPA level, making an
assessment of health needs at a neighborhood level challenging. Moreover, disaggregated data
for age, ethnicity, race, and gender are not available for all data indicators, which limited the
ability to examine disparities of health issues within the community. This issue became more
prevalent when stakeholders identified a health issue such as Chronic Obstructive Pulmonary
Disease (COPD) and secondary data were not available. In addition, data are not always
collected on an annual basis, meaning that some data are several years old. Lastly, the project
timeframe did not allow for additional data collection or data requests to other sources.
The goal of primary data collection is to gather information from a broad, relevant selection of
stakeholders, from government officials to health care professionals and service providers to
community members. Given busy schedules, stakeholders were offered several different ways in
which to participate. Again, given the project timeframe, focus groups and interviews were
organized with relatively short lead time. In each medical center, the local community benefit
manager actively participated in outreach through personalized invitations and reminders.
Page 44
VI. Identification and Prioritization of Community’s Health
Needs
a. Identifying community health needs
For the purposes of the CHNA, Kaiser Permanente defines a health need as a poor health outcome and associated health driver(s) or a health driver associated with a poor health outcome
where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive
identification, interpretation, and analysis of a robust set of primary and secondary data. Please
refer to Appendix A for additional definitions.
Primary data were analyzed, by service area, by inputting all interviews and focus groups into
Microsoft Excel. The data were then reviewed using content analysis to identify themes and
determine a comprehensive list of codes; the data were coded and the number of times an issue
was identified was tallied. In addition, sub-populations mentioned as being most affected by a
specific issue were noted.
Secondary data were input into tables to be included in the analysis. When possible, benchmark
data were included (Healthy People 2020, Los Angeles County, or California). Each medical
center agreed to use county levels as the benchmark, when available. However, if the data source
was not available at the county level, state-level data was used.
Health needs and drivers were identified from both primary and secondary data sources using the
size of the problem relative to the portion of population affected by the problem as well as the
seriousness of the problem (impact at the individual, family or community levels). To examine
the size and seriousness of the problem, the indicators from the secondary data were compared to
the available benchmark (HP2020, County, or State). Those indicators that performed poorly
against a benchmark were considered to have met the size and seriousness criterion and were
added to the master list of health needs and drivers. Concurrently, health needs and drivers that
were identified by stakeholders in the primary data collection were also added to the master list
of health needs and drivers.
After primary and secondary data were analyzed, a process was created in collaboration with the
local medical center’s Community Benefit Manager and the Kaiser Permanente Regional Office
to analyze the identified needs into three levels or tiers, based on the amount of data indicating a
need.
The identification of a community health need was conducted through a multi-tiered process,
using results from primary and secondary data analysis. This tiered system serves to document
the process of analyzing health issues identified by both primary and secondary data. The
following criteria were used for the tiers:
Tier 1: Health issues that were identified in secondary data as poorly performing against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) or mentioned once
in either primary data source (focus group or interview).
Page 45
Tier 2: Health issues that were identified in secondary data as performing poorly against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) or received
repeated mentions in either primary data source (focus group or interview).
Tier 3: Health issues that were identified in secondary data as performing poorly against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) and received
repeated mentions in primary data sources (focus group or interview).
Tier
1
2
3
Secondary Data:
Poorly Performing Indicators
Single
Single
Single
Or/And
Primary Data: Mentions
Or
Or
And
Single
Multiple
Multiple
Upon application of the tiers, a number of observations were made by the CNM team. First, use
of the most inclusive criteria (tier one) resulted in a very long list. Furthermore, the use of the
most stringent criteria, requiring identification by both a quantitative indicator as well as a
qualitative indicator, yielded what was regarded as too few needs and drivers—in one case, five
needs and eight drivers. Thus, the decision was made to use tier two for the list of needs used in
the prioritization process.
After application of this process, the tier-two designation was determined as most appropriate,
providing a stringent yet inclusive approach that would allow for a comprehensive list of 23
health needs and 19 drivers to be brought forth in the second phase or prioritization process for
the KFH-WLA service area. The results of the application of this tiered approach can be found in
Appendix H.
Health Needs and Drivers Carried Into Prioritization Phase
Health Need
Health Driver
Air Quality
Allergies
Alcohol and Substance Use
Alzheimer's Disease
Awareness and Education
Arthritis
Cancer Screenings
Asthma
Cardiovascular Disease Management
Breast Cancer
Dental Care Access
Cancer, in General
Education
Employment
Cervical Cancer
Health Care Access
Chlamydia
Health Insurance
Cholesterol
Healthy Eating
Colorectal Cancer
Homelessness
Diabetes
Income
HIV/AIDS
Language Barrier
Hypertension
Nutritional Access
Page 46
Infant Mortality
Intentional Injury
Mental Health
Obesity/Overweight
Oral Health
Podiatry
Unintentional injury
Vision
Physical Activity
Preventive Care Services
Safety
Transportation
Note: Presented in alphabetical order
A matrix (or scorecard) was created listing Tier 2 health needs and drivers (listed above) that
were to be carried into the prioritization phase which included secondary and primary data
related to the 23 health needs and 19 drivers (see Appendix D). To allow for a comprehensive
analysis, and to assist with the prioritization of health needs identified in Tier 2, the matrix lists
health issues correlated with secondary data indicators and primary data results. For example,
the secondary indicators for adult hospitalizations due to mental health and reported serious
psychological distress as well as primary data results that identified specific mental healthrelated issues found in the community are grouped under ‘mental health’.
This matrix included benchmark data from Healthy People 2020 (HP2020) benchmarks when the
indicator matched the data on hand. If an appropriate HP2020 indicator was not available, the
most recent county or state rate was used. The matrix also included medical center–level
secondary data (averaged), primary data counts (number of times an issue was mentioned) for
interviews and focus groups, and sub-populations noted as most severely impacted. Each data
indicator for the medical center was first compared to the HP2020 benchmark, if available, and
then to the geographic level for benchmark data to assess whether the medical center
performance was better or worse than the benchmark. When the process identified an issue from
more than one source (from primary or secondary data), the issue was designated as a health
need or driver.
b. Process and criteria used for prioritization of the health needs
After a series of discussions about possible approaches, all medical centers in the collaborative
agreed to use the same method for prioritization and selected the Simplex Method as a guide. A
Simplex Method is the process in which input is gathered through a close-ended survey where
respondents rate each health need and driver using a set of criterion. After surveys are
completed, the surveys are scored for each health need and driver. The health needs and drivers
are then ranked in order of highest priority. Preferences for the approach included:
•
To be inclusive of stakeholders
•
That the method involve a moderate amount of rigor but not with so much
math/statistics as to be difficult to use and to communicate
•
That the rigor be balanced by a relatively easy-to-use methodology
Page 47
Community Forums
1.
Facilitated Group Discussion. Community forums were designed to provide the
opportunity for a range of stakeholders to engage in a discussion of the data and participate in the prioritization process.
•
Two community forums were held in each medical service area. Community
representatives (stakeholders) were invited to participate in one of the two forums,
according to their availability. A maximum of two representatives from an organization were invited to participate, and the two forums drew a total of 62 participants.
•
All individuals who were invited to take part in the primary data collection (phase
one: focus groups and interviews, irrespective of whether or not they actually
participated in that phase) were invited to attend a community forum.
•
Each forum included a brief presentation that provided an overview of the CHNA
data collection and prioritization processes, and a review of the documents to be used
in the facilitated discussion.
•
Participants were provided with a list of identified health needs and drivers in the
scorecard format, developed from the matrix described previously in this report, and a
narrative document of brief summary descriptions of the identified health needs.
•
Participants engaged in a facilitated discussion about the findings as presented in the
scorecard and the narrative document, and a prioritization of the identified health
needs.
•
In smaller groups, participants completed a group prioritization grid exercise to share
back with the larger group and to be used as supplemental information for the
implementation strategy phase. The following questions were addressed in the grid
exercise:
•
2.

Which health needs most severely impact the community (communities) you
serve?

For which health needs/issues are there the most community assets/gaps in
resources?

What are the drivers that can be addressed?
Each participant was then asked to complete a questionnaire and to rank each health
need according to several criteria, as described below.
Administration of the questionnaire. Community forum participants were asked to
complete a questionnaire after the forum rating each health need and driver according to
severity, change over time, resources available to address the needs and/or drivers, and
the community’s readiness to support initiatives to address the needs and/or drivers.
Page 48
Appendix G provides a description of the scale used for each criterion to rank each health
issue and driver.
After the community forums, the 58 completed questionnaires (the net completed
questionnaires received from the 62 participants) were entered and analyzed using Microsoft Excel. Each participant’s scores for each health need and driver by each criterion
(severity, change over time, resources, and community’s readiness to support) were
totaled. Scores were then averaged using the criterion severity, change over time and
shortage of resources, for a final overall score (or rating) for each health need and driver.
(The “community readiness to support” criterion was not used in the calculation because
this would better serve as supplementary information for the implementation strategy
phase.) Health needs and drivers were sorted by each criterion, including overall average
(or rating), and placed in a grid to allow each medical center to weigh the information by
criterion or overall. Please see the tables on pages 50-51 for more information.
3.
Secondary ranking of health needs and drivers. After completing the questionnaires,
participants were given 10 sticker dots and asked to place five dots on the health needs
and five dots on the health drivers—listed in alphabetical order on flipchart paper—
placed in a designated area in the meeting space. Each sticker dot counted as one vote;
participants were able to place the dots in any manner they wished. For example, a
participant could place all five of their health-need dots on diabetes. These counts served
as a way to validate questionnaire findings and to serve as additional information that
may be carried into the implementation strategy phase.
Analysis of Survey Scores
As described above, averages were computed for each criterion. The overall average was calculated by adding the total across severity (total possible score equals 4), change over time (total
possible equals 4), and resources (total possible equals 4) for each survey (with a total possible
score of 12). The total scores were divided by the total number of surveys for which data was
provided, resulting in an overall average per health need.
Page 49
Overall Averages by Health Need and Criteria Resulting from Prioritization Process, n=58
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Health Need
Mental Health
Obesity/Overweight
Diabetes
Cardiovascular
Disease
Oral Health
Hypertension
Cancer, in General
Cholesterol
Intentional Injury
Cervical Cancer
Asthma
Breast Cancer
HIV/AIDS
Vision
Alcohol and
Substance abuse
Colorectal Cancer
Chlamydia
Unintentional injury
Podiatry
Allergies
Arthritis
Infant Mortality
Severe
impact on the
community
3.85
3.83
3.86
Gotten
worse over
time
3.47
3.59
3.57
Shortage of
resources in the
community
3.43
3.10
3.04
Community
unable to
address/support
2.73
3.07
3.11
Overall
rating
10.52
10.40
10.09
3.80
3.37
3.02
2.86
9.77
3.48
3.60
3.43
3.42
3.56
3.43
3.25
3.50
3.41
3.21
3.47
3.25
3.02
3.13
2.88
2.89
2.98
2.76
2.82
3.03
3.26
2.91
2.84
2.94
3.15
2.87
2.83
2.83
2.66
3.08
2.67
2.95
3.20
2.75
2.94
3.18
2.85
3.43
3.00
2.72
9.57
9.12
8.92
8.85
8.82
8.76
8.63
8.61
8.52
8.49
3.51
3.08
3.02
2.67
8.43
3.21
3.19
3.08
2.97
2.69
2.55
2.70
2.75
3.06
3.17
3.09
2.82
3.21
2.78
2.78
2.46
3.00
2.81
2.86
2.86
3.00
2.81
2.78
2.60
2.84
2.48
2.61
3.06
2.14
2.50
1.75
2.97
8.35
8.26
8.15
7.70
7.58
7.24
7.03
6.84
Note: Health needs are in prioritized order. The overall rating was calculated by averaging the variables “severe
impact on the community,” “gotten worse over time,” and “shortage of resources in the community.”
Page 50
Overall Averages by Driver and Criteria Resulting from Prioritization Process, n=58
Health Driver
Health Insurance
Health Care Access
Healthy Eating
Physical Activity
Severity
3.87
3.82
3.76
3.80
Change
Over Time
3.53
3.38
3.40
3.33
5. Cardiovascular Disease
Management
3.80
3.36
3.33
3.02
10.48
3.75
3.74
3.76
3.32
3.24
3.19
3.24
3.24
3.15
2.87
3.22
3.03
10.31
10.22
10.10
3.65
3.20
3.14
3.05
9.99
3.68
3.63
3.64
3.43
3.59
3.60
3.54
3.31
3.27
3.22
3.13
3.19
3.11
3.08
2.96
2.91
2.91
2.88
2.83
2.73
3.13
3.04
3.09
3.19
3.09
3.02
3.04
3.06
2.84
2.78
3.04
2.82
3.11
2.93
3.12
2.98
3.16
2.98
2.85
2.71
9.93
9.85
9.84
9.71
9.64
9.53
9.49
9.24
8.95
8.73
1.
2.
3.
4.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Employment
Nutritional Access
Homelessness
Alcohol and Substance
Use
Income
Preventative Care Services
Dental Care Access
Safety
Awareness and Education
Education
Cancer Screenings
Air Quality
Language Barrier
Transportation
Resources
available
3.43
3.39
3.38
3.36
Community
Readiness
2.79
3.36
3.27
2.85
Overall
Rating
10.84
10.59
10.54
10.49
Note: Health drivers are in prioritized order. The overall rating was calculated by averaging the variables “severe
impact on the community,” “gotten worse over time,” and “shortage of resources in the community.”
c. Description of prioritized community health needs
The following list of 23 prioritized needs resulted from the above described process. Further
details are included in Appendix B: KFH-BP Health Needs Profiles. See Appendix C for data
source reference information.
1.
Mental Health
Among adults, mental disorders are common, with approximately one quarter of adults being
diagnosable for one or more disorders. Research shows that more than 90 percent of those who
die by suicide suffer from depression or other mental disorders, or a substance-abuse disorder
(often in combination with other mental disorders). Not only are mental disorders associated with
suicide, but also with chronic diseases, family history of mental illness, age, substance abuse,
and life event stresses. Mental health emerged as a health need through various indicators. The
percent of people needing help for mental/emotional/alcohol-drug related issues who did not
receive treatment in the KFH-WLA service area was nearly double (84.5%) that of Los Angeles
County (47.3%). The percentages were higher in SPA 6 at 86.8% and SPA 8 at 86.5%. The rate
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of hospitalization for mental health for youth under 18 years of age per 100,000 persons in the
KFH-WLA service area is 268.7 per 100,000 persons compared to a statewide rate of 256.4.
However, the hospitalization rate of adults for mental health issues in the service area is
significantly higher at 2281.1 per 100,000 persons in comparison to the statewide rate of 551.7.
The geographic impact of mental health issues is apparent in the higher rates of adult
hospitalizations per 100,000 persons in SPA 5 (5626.2) and SPA 6 (2316.7). The percentage of
people per 100,000 persons who had serious psychological distress in the last year was higher in
the KFH-WLA service area (9.2%) than in Los Angeles County (7.3%). In 2010, the suicide rate
per 100,000 persons was also higher in the KFH-WLA service area at 8.7 compared to the Los
Angeles County rate of 8.0. Community stakeholders highlighted mental health as impacting a
spectrum of populations including those under 30 years of age, low-income women, homeless,
African Americans, the elderly, and undocumented individuals. Mental health is associated with
many other health factors including poverty, low birth rate, heavy alcohol consumption, poverty,
and unemployment. Mental health issues were identified by community stakeholders in 18 out of
22 interviews and all six focus groups. Mental health was identified as a health need in the 2010
KFH-WLA Community Health Needs Assessment.
2.
Obesity/Overweight
Obesity, a condition in which a person has an abnormally high and unhealthy proportion of body
fat, has risen to epidemic levels in the United States. Nationally, 68 percent of U.S. adults age 20
years and older are overweight or obese. Obesity is defined as the percentage of adults ages 18
and older who self-report a Body Mass Index (BMI) between 25.0 and 30.0. In the KFH-WLA
service area more adults are obese (22.5%) when compared to Los Angeles County (21.2%).
Similarly, more adults are overweight in the KFH-WLA service area (31.3%) when compared to
Los Angeles County (29.7%). In addition, more youth are obese in the KFH-WLA service area
(36.6%) when compared to the state (29.8%). Excess weight is recognized as a significant
national problem and indicates an unhealthy lifestyle that influences further health issues.
Obesity is associated with health factors including poverty, inadequate fruit/vegetable
consumption, breastfeeding and access to grocery stores, parks and open space. Obesity was
identified in four out of six focus groups and seven out of 22 interviews and was identified as a
health need in the 2010 KFH-WLA Community Health Needs Assessment.
3.
Diabetes
Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading
cause of death. A diabetes diagnosis can indicate an unhealthy lifestyle, a risk factor for further
health issues, and is also linked to obesity. The diabetes hospitalization rate for adults in the
KFH-WLA service area is higher (200.2) when compared to the Los Angeles County rate of
145.6 per 100,000 persons. In SPA 6 (325.3) and SPA 8 (282.7), the rate of adult hospitalization
for diabetes is higher than the average hospitalization rate for the KFH-WLA service area as a
whole. The uncontrolled diabetes hospitalization rate per 100,000 adults is also higher (18.3)
when compared to Los Angeles County (9.5). Hospitalizations for uncontrolled diabetes are
Page 52
significantly higher in SPA 6 (33.6). Community stakeholders noted that African-Americans,
Latinos, recent immigrants, and the homeless are particularly impacted by diabetes. Diabetes is
associated with a lack of physical activity, inadequate fruit and vegetable consumption, obesity,
and poverty among other factors. Diabetes diagnosis can indicate an unhealthy lifestyle, a risk
factor for further health issues, and is linked to obesity. Diabetes was also identified as a health
4.
Cardiovascular disease – also called heart disease and coronary heart disease – includes several
problems related to plaque buildup in the walls of the arteries, or atherosclerosis. As the plaque
builds up, the arteries narrow, restricting blood flow and creating a risk for a heart attack.
Currently more than one in three adults (81.1 million) lives with one or more types of
cardiovascular disease. The rate of cardiovascular disease mortality per 10,000 persons is higher
in the KFH-WLA service area (19.6) than the state average (15.6). Three of four SPAs within
the KFH-WLA service area have notably higher rates of cardiovascular disease per 10,000
persons, including SPA 6 (23.2), SPA 4 (21.4), and SPA 5 (19.9). The heart disease
hospitalization rate of 1129.9 people per 100,000 is notably higher than the statewide rate of
367.1 per 100,000 persons, particularly in SPA 5 where the heart disease hospitalization rate is
2882.5 per 100,000 persons. Heart disease hospitalization rates in SPA 8 (486.8) and SPA 4
(444.8) per 100,000 persons are also above the state average. Coronary heart disease is a leading
cause of death in the United States and associated with high blood pressure, high cholesterol, and
heart attacks as well as other health outcomes including obesity, heavy alcohol consumption, and
diabetes. Heart disease/coronary disease was identified as a major health issue in four of 22
interviews and two out of six focus groups. Cardiovascular disease was also identified as a health
5.
Oral Health
Oral health is essential to overall health and is relevant because engaging in preventative
behaviors decreases the likelihood of developing future health problems. In addition, oral
diseases like cavities and oral cancer, cause pain and disability for many Americans. Oral health
indicators include the percentage of adults ages 18 and older who self-report that six or more of
their permanent teeth have been removed due to decay, gum disease or infection, an indication of
lack of access to dental care and/or social barriers to utilization of dental services. Los Angeles
County and the KFH-WLA service area have the same rate of adults with poor dental health
(11.6%), which is slightly higher than the statewide rate of 11.3% and lower than the national
rate of 15.6%. Poor dental health is linked to several health factors including poverty, soft drink
expenditures, and dental care affordability. Oral health and dental care was identified by
community stakeholders in two out of six focus groups and seven out of 22 interviews. Oral
health was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
6.
Hypertension
Page 53
Hypertension, defined as a blood pressure reading of 140/90 or higher, affects 1 in 3 adults in the
United States. The condition has been called a silent killer as it has no symptoms or warning
signs and can cause serious damage to the body. High blood pressure, if untreated, can lead to
heart failure, blood vessel aneurysms, kidney failure, heart attack, stroke, and vision changes or
blindness. The percentage of those taking medicine to lower blood pressure is higher in the
KFH-WLA (28.5%) service area than in Los Angeles County (25.5%). In SPA 6 (34.1%), SPA
8 (29.8%), and SPA 4 (26.0%) the percent of adults taking medicine to lower blood pressure is
also higher than the Los Angeles County rate. Hypertension is indicated by high blood pressure
and was identified as a health issue by stakeholders in four out of 22 interviews and two out of
six focus groups. Hypertension and high blood pressure were identified as health needs in the
7.
Cancer, in general
Cancer is the second leading cause of death in the United States, claiming the lives of more than
half a million Americans every year. The rate of death due to cancer in the KFH-WLA service
area is 154.5 people per 100,000 persons, which is lower than the Los Angeles County rate of
156.5. Community stakeholders in three out of 22 interviews and three out of six focus groups
identified cancer as a major health issue. Cancer is associated with access to health care, obesity,
heavy alcohol consumption, and specific cancers (breast, cervical, etc.). Cancer is recognized as
a leading cause of death in the United States and cancer mortality was identified as a health need
8.
Cholesterol
Cholesterol is a waxy, fat-like substance needed in the body. Some health conditions, as well as
lifestyle and genetic factors, can put people at a higher risk for developing high cholesterol. Age
is a contributing factor, as is diabetes. Some behaviors that can lead to high cholesterol include a
diet high in saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. The
percent of adults who take medicine to lower cholesterol was slightly lower in the KFH-WLA
service area (69.8%) compared to Los Angeles County (71.2%); however, more adults take
medicine to control cholesterol in SPA 5 (75.8%) and SPA 6 (78.3%) when compared to Los
Angeles County. Cholesterol was identified in two of 22 interviews and three of six focus
groups. Cholesterol was not identified as a health need in the 2010 KFH-WLA Community
9.
Intentional Injury
Intentional injuries and violence are widespread in society and are among the top 15 killers for
Americans of all ages. Intentional injury is defined as homicide or suicide; homicide is a measure
of community safety and a leading cause of premature death. Intentional injury is defined as
homicide or suicide; homicide is a measure of community safety and a leading cause of
premature death. The homicide rate for the KFH-WLA service area is 12.4 per 100,000 persons,
notably higher than the Los Angeles County rate of 7.0 and above the statewide rate of 5.15.
Page 54
The 2008 homicide rates in SPA 6 (24.5) and SPA 8 (16.6) were higher than the KFH-WLA
service area average of 13.7 at that time. Community stakeholders noted adult males and women
with children as impacted populations. Intentional injury is associated with several health factors,
including poverty rate, degree of education, heavy alcohol consumption, and violent crime.
Homicide was identified as a health issue by community stakeholders in one out of 22 interviews
and one out of six focus groups. Intentional injury/homicide was identified as a health need in
10.
Cervical Cancer
Cervical cancer is a disease in which cells in the cervix - the lower, narrow end of the uterus
connected to the vagina (the birth canal) to the upper part of the uterus - grow out of control. All
women are at risk for cervical cancer and it occurs most often in women over the age of 30. The
human papillomavirus (HPV), a common virus that is passed from one person to another during
sex, is the main cause of cervical cancer. The annual incidence rate of cervical cancer is slightly
lower - at 9.8 individuals per 100,000 - in the KFH-WLA service area as compared to a 9.9 rate
in Los Angeles, however both are higher than the statewide rate of 8.3 and the nationwide rate of
8. Additionally, the cervical cancer death rate is higher at 9.5 per 100,000 persons in the KFHWLA service area as compared to the rate in Los Angeles County of 3.0 per 100,000 persons. In
SPA 4 (11.8) and SPA 6 (10.0), the cervical cancer mortality rate, age-adjusted per 100,000
persons, is higher than the KFH-WLA service area rate of 9.5. Cervical cancer is associated with
several indicators including unhealthy eating habits, access to screening, obesity, and sexually
transmitted diseases. Cervical cancer was identified as a health need in the 2010 KFH-WLA
Community Health Needs Assessment.
11.
Asthma
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of
children. Adults also may suffer from asthma and the condition is considered hereditary. Asthma
symptoms include wheezing, breathlessness, chest tightness, and coughing. The adult asthma
hospitalization rates are notable with 129.3 adults per 100,000 persons compared to a state
average of 94.3 adults per 100,000 persons. Subpopulations highlighted by community
stakeholders as particularly impacted by asthma include low-income women, youth and
homeless individuals. Rates for hospitalization in adults per 100,000 persons are particularly
high in SPA 6 (215.3 ) and SPA 8 (145.8). The rate of adult asthma hospitalizations of 10 per
1,000 admissions was also notably higher than the state average of 7.7 per 1,000 admissions.
Asthma is associated with tobacco use, obesity, aspects of poverty, and poor air quality and other
exacerbating environmental conditions. Asthma was mentioned as a major health issue in two
out of six focus groups and four out of 22 interviews and was identified as a health need in the
Page 55
12.
Breast Cancer
In the United States, breast cancer is the most common non-skin cancer and the second leading
cause of cancer-related death in women. The incidence of breast cancer is highest in white
women for most age groups, but African-American women have higher incidence rates before 40
years of age and higher breast cancer mortality rates than women of any other racial/ethnic
groups in the United States at every age. Risk factors for breast cancer include older age, certain
inherited genetic alterations, hormone therapy, chest radiation therapy, alcohol consumption, and
obesity. The annual rate of incidence of females with breast cancer is 117.9 per 100,000 persons
in Los Angeles County and in the KFH-WLA service area, which is lower than the statewide rate
of 123.3 per 100,000 persons. Community stakeholders in two out of 22 interviews and one out
of six focus groups identified breast cancer as a major health issue. Breast cancer is associated
with overall cancer mortality, breast cancer screening, obesity, and heavy alcohol assumption.
Breast cancer was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
13.
HIV/AIDS
More than 1.1 million people in the United States are living with HIV and almost 1 in 5 (18.1%)
are unaware of their infection. HIV infection weakens the immune system, making those living
with HIV highly susceptible to a variety of illnesses and cancers, including tuberculosis (TB),
cytomegalovirus (CMV), cryptococcal meningitis, lymphomas, kidney disease, and
cardiovascular disease. Without treatment, almost all people infected with HIV will develop
AIDS. The KFH-WLA service area has an HIV prevalence rate of 480.3 per 100,000 persons,
close to the Los Angeles County rate of 480.4 and notably higher than the statewide rate of 345.5
and the national rate of 334 per 100,000 persons. The HIV hospitalization rate of 35.0 per
100,000 persons in the KFH-WLA service area is higher than the Los Angeles County rate of
11.0. The HIV hospitalization rate is highest in SPA 4 (60.5) and SPA 6 (48.5). HIV is
associated with numerous other health factors including poverty, heavy alcohol consumption and
access to/use of HIV screenings. Community stakeholders identified HIV as a major health need
in two out of 22 interviews. HIV was also a health need in the 2010 KFH-WLA Community
14.
Vision
People with diabetes are at an increased risk of vision problems, as diabetes can damage the
blood vessels of the eye, potentially leading to blindness. As diabetes rates continue to rise
among all age groups, vision complications tied to the disease are expected to increase as well.
The percent of diabetic adults who had their vision checked within the last year was lower in the
KFH-WLA service area (57.6%) compared to Los Angeles County (63.3%), and lower still in
SPA 4 (37.3%). Vision was identified a major health issue in two out of 22 interviews and two
of out six focus groups. Vision was not identified as a need in the 2010 KFH-WLA Community
Page 56
15.
The effects of substance abuse significantly contribute to costly social, physical, mental, and
public health problems including teenage pregnancy, HIV/AIDS, STDs, domestic violence, child
abuse, motor vehicle crashes (unintentional injuries), physical fights, crime, homicide, and
suicide. Alcohol and Substance Abuse is defined as adults (age 18 and older) who self-report
heavy alcohol consumption. The alcohol/drug-induced mental disease hospitalization rate in the
KFH-WLA service area is 480 per 100,000 persons, which is notably higher than the state
average of 109.1. While the average rate of hospitalization in the KFH-WLA service area is
480.0, the rate for SPA 5 is significantly higher at 1,549.9 per 100,000 persons. Heavy alcohol
consumption is defined as adults age 18 and older who self-report heavy alcohol consumption of
more than two drinks per day for men and one drink per day for women. Stakeholders
highlighted youth, women, Latinos, African Americans, and people with low and middle class
income levels as significantly affected by substance abuse. Alcoholism was identified as a major
concern in four out of 22 interviews and one out of six focus groups. Heavy alcohol consumption
is relevant as a behavior and determinant of future health conditions that include cirrhosis,
cancers, and untreated mental and behavioral health issues. Alcohol and substance abuse was not
indicated as an area of major need in the 2010 KFH-WLA Community Health Needs
Assessment.
16.
Colorectal Cancer
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading
cause of cancer-related deaths in the United States and is expected to cause about 50,830 deaths
during 2013. The annual incidence rate of colon and rectum cancer in the KFH-WLA service
area is 45.2 individuals per 100,000 persons, which is the same as the Los Angeles County rate.
However, these rates are above the statewide rate of 43.7 and the national rate of 40.2. The
KFH-WLA service area average rate for colorectal cancer mortality, age-adjusted per 100,000
persons, is 13.5, which is higher than the Los Angeles County rate of 11.5. The colorectal cancer
mortality rate is significantly higher in SPA 5 (17.6), SPA 6 (15.4) and SPA 8 (12.7). High rates
of colorectal cancer are associated with overall cancer mortality, heavy alcohol consumption,
obesity, diabetes prevalence and colon cancer screening. Colorectal cancer was mentioned as a
major health issue in one out of 22 interviews with community stakeholders and was identified
as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
17.
Chlamydia
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United
States. Chlamydial infections can lead to serious health problems. In women, untreated infection
can cause pelvic inflammatory disease (PID), permanently damage a woman’s reproductive tract
and lead to long-term pelvic pain, inability to get pregnant and potentially deadly ectopic
pregnancy. In men, infection sometimes spreads to the tube that carries sperm from the testis,
causing pain, fever, and, rarely, preventing a man from being able to father children. Untreated
Chlamydia may increase a person’s chances of acquiring or transmitting HIV. The incidence rate
Page 57
for chlamydia in the KFH-WLA service area is 538.7 per 100,000 persons, significantly higher
than Los Angeles County (455.1). Incidence rates are significantly higher in SPA 6 (969.6) when
compared to the KFH-WLA service area (538.7). Chlamydia is associated with other health
factors including poverty and heavy alcohol consumption and is an indicator of unsafe sex
practices and a measure of poor health status. Chlamydia was not identified as a health need in
18.
An estimated 5.4 million Americans have Alzheimer’s disease and it is the sixth-leading cause of
death in the U.S. Alzheimer’s, an irreversible and progressive brain disease, is the most common
cause of dementia among older people. The rate of mortality due to Alzheimer’s disease was
lower for the KFH-WLA (15.7) service area compared to Los Angeles County (17.6).
Alzheimer’s disease was identified as a major health need in three out of 22 interviews and two
out of six focus groups. Alzheimer’s disease was not indicated as a major need in the 2010 KFHWLA Community Health Needs Assessment.
19.
Unintentional Injury (Pedestrian/Motor Vehicle)
Unintentional injuries include those resulting from motor vehicle crashes resulting in death and
pedestrians being killed in crashes. Motor vehicle crashes are one of the leading causes of death
in the U.S. with more than 2.3 million adult drivers and passengers being treated in 2009.
Pedestrians are 1.5 times more likely than passenger vehicle occupants to be killed in a car crash
on each trip. The rate of mortality by motor vehicle accident per 100,000 persons in the KFHWLA service area is slightly higher (7.2) when compared to Los Angeles County (7.1) and the
statewide rate (8.2). The percent of pedestrians killed by motor vehicles was higher in the KFHWLA service area (25.9%) when compared to Los Angeles County (25.7%). Notably, the
percent of pedestrians killed by motor vehicles was slightly higher in SPA 8 at 26.0% and higher
still in SPA 5 at 30.7%. Some health factors associated with unintentional injury are poverty,
education, walkability, heavy alcohol consumption, and liquor store access. Unintentional injury
was not identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
20.
Podiatry
Foot problems can be caused by arthritis, diabetes, cardiovascular disease, foot and ankle
injuries, muscle and tendon problems, skin disorders, toe joint and nerve disorders, and toenail
problems. Complications in the feet are a serious issue for the 26 million diabetics living in the
United States. In fact, diabetes is the leading cause of non-traumatic lower-limb amputation. In
the KFH-WLA service area SPA 5 (81.7%) and SPA 8 (81.2%) have higher percentages of
adults who had their feet checked for sores when compared to Los Angeles County. Podiatry was
identified as a specialty care need by community stakeholders in two out of 22 interviews.
Podiatry was not identified as a need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 58
21.
Allergies
Allergies among teens were higher in the KFH-WLA service area (27.1%) compared to Los
Angeles County (24.9%). The percent of teens with allergies were also higher in SPA 5 (45.6%)
and SPA 8 (29.5%) when compared to Los Angeles County. Allergies were also identified as a
major health concern in three out of 22 interviews. Allergies were not indicated as a major need
22.
Arthritis
Arthritis affects one in five adults and continues to be the most common cause of physical
disability. Risk factors associated with arthritis include being overweight or obese, lack of
education around self-management strategies and techniques, and limited or no physical activity.
In the KFH-WLA service area, a larger portion of the population was diagnosed with arthritis in
SPA 5 (17.7%) than in Los Angeles County (17.4%). Arthritis was identified as a major health
concern in three out of 22 interviews and two out of six focus groups. Arthritis was not indicated
as a major need in the 2010 KFH-WLA Community Health Needs Assessment.
23.
Infant Mortality
Infant mortality remains a concern in the United States as each year approximately 25,000
infants die before their first birthday. The leading causes of infant death include congenital
abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems
related to complications of pregnancy, and respiratory distress syndrome. Infant mortality is the
rate of infant death at less than one year of age per 1,000 births. Infant mortality is associated
with low birth weight, and in the KFH-WLA service area, the percentage rate (8.3%) is higher
than the Los Angeles County percentage rate of 6.8%. The percent of infants with very low birth
weight is also higher (1.4% per 1,000 births) than the Los Angeles County rate of 1.3% per 1,000
births. This rate is slightly higher in SPA 6 (1.6%) and SPA 8 (1.8%). Stakeholders highlight that
Latina and African-American populations are particularly impacted by the infant mortality rate.
High rates of infant mortality can indicate broader issues such as access to health care, maternal
and child health, poverty, education, teen births, and lack of insurance and of prenatal care.
Infant mortality was not identified as a health need in the 2010 KFH-WLA Community Health
Needs Assessment.
Page 59
VII. Community Assets and Resources Available to Respond to
the Identified Health Needs of the Community
Numerous community assets and resources are available to respond to the health needs of the
KFH-WLA community. These include health care facilities as well as community organizations
and public agencies that provide health services, health promotion activities, social services, and
referrals. A sampling of these programs and KFH-WLA partners is below. Community assets
identified that address specific health needs are included in this list and noted in the individual
KFH-WLA Health Needs Profiles in Appendix B.
a. Health Care Facilities
Hospitals
Brotman Medical Center
Cedars-Sinai Medical Center
Centinela Freeman Regional Medical Center
Centinela Hospital Medical Center
Kaiser Permanente–West Los Angeles
Kindred Hospital Los Angeles
Los Angeles Metropolitan Medical Center, Los Angeles Campus
Marina Del Rey Hospital
Miracle Mile Medical Center
Olympia Medical Center
Resnick Neuropsychiatric Hospital at UCLA
Ronald Reagan UCLA Medical Center
UCLA Medical Center and Hospital–Santa Monica
Veterans Administration (VA) Greater Los Angeles Healthcare System
Community Clinics
Crenshaw Community Health Center
Imperial-Vermont Clinic
LA Gay and Lesbian Center
Los Angeles County Department of Public Health—Ruth Temple Health Center; Curtis
Tucker Health Center
Mission City Community Network—Prairie
South Bay Family Healthcare Center—Inglewood
South Central Family Health Center
St. Anthony Medical Center—Imperial
Saint John’s Well Child and Family Center—Hyde Park
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T.H.E. Clinic, Inc.
The Saban Free Clinic (formerly known as The Los Angeles Free Clinic)
UMMA (University Muslim Medical Association) Community Clinic
Venice Family Clinic (Daybreak Day Center, Irma Colen Health Center, Mar Vista Braddock
Clinic, OPCC Access Center, Simms Mann Health and Wellness Center)
Watts Healthcare Corporation
Westside Family Health Center
Women’s Clinic and Family Counseling Center
Dental Care
AIDS Project Los Angeles
Los Angeles County Department of Health Services
South Bay Family Healthcare Center
The Children’s Center
The Saban Free Clinic—Beverly Health Center
University of California Los Angles (UCLA) School of Dentistry
University of Southern California (USC) School of Dentistry
Watts Healthcare Corporation
Mental Health
A Place Called Home
Alcott Center for Mental Health
Being Alive—People with HIV/AIDS Coalition
Didi Hirsch Mental Health Services
Exodus Recovery Center
Kaiser Foundation Hospital–Wateridge; Watts Counseling and Learning Center
Kedren Community Mental Health Center
Korean American Family Service Center
Los Angeles County Department of Mental Health
NAMI (National Alliance on Mental Illness) Urban Los Angeles
NAMI (National Alliance on Mental Illness) Westside
OPCC (Ocean Park Community Center)
Open Paths Counseling Center
Southern California Counseling Center
Vista del Mar Child and Family Services
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b. Other Community Resources
A partial list of community resources available to address identified community health needs is
listed below. Additional resources can be found at:
www.211LA.org
www.HealthyCity.org
School Districts
Beverly Hills Unified School District
Culver City Unified School District
El Segundo Unified School District
Inglewood Unified School District
Lennox School District
Los Angeles Unified School District
Santa Monica Malibu Unified School District
Community Organizations and Public Agencies
A Place Called Home
Abbot Kinney Festival Association
Access Services
AIDS Drug Assistance Program (ADAP)
AIDS Healthcare Foundation
AIDS Project Los Angeles (APLA)
Alcott Center for Mental Health Services
Alliance for Housing and Healing
Alliance of Jamaican and American Humanitarians (AOJAH)
Alzheimer’s Association—California Southland Chapter
American Cancer Society
American Health Services—El Dorado Community Service Centers
American Heart Association
American Liver Foundation—Greater Los Angeles Chapter
American Lung Association (ALA)
Area 10 Disabilities Board
Arthritis Foundation—Los Angeles County Office
Asian American Drug Abuse Program
Association of Black Women Physicians
Asthma and Allergy Foundation of America—California Chapter
Asthma Coalition of Los Angeles County (ACLAC)
Page 62
Being Alive—People with HIV/AIDS Coalition
Bethany Baptist Church
Bethel AME Church
Black Women for Wellness
Braille Institute
BREATHE California of Los Angeles County
Bryant Temple AME Church
California Black Women’s Health Project
California Certified Farmers Markets
California Children’s Medical Services
California State Assembly 54th District: Office of Assemblymember Holly Mitchell
California State Assembly 59th District: Office of Assemblymember Reggie Jones Sawyer
California State Assembly 62nd District: Office of Assemblymember Steven Bradford
California State Senate 26th District: Office of Senator Curren D. Price, Jr.
California State Senate 35th District: Office of Senator Roderick D. Wright
California Wellness Foundation
Camp Kesem National
CANGRESS Los Angeles Community Action Network
Catholic Charities of Los Angeles, Inc.
Century Center for Economic Opportunity (CCEO) and CCEO YouthBuild
Center for Lupus Care
Center for the Partially Sighted
Centinela Youth Services
Challengers Boys & Girls Club
Charles Drew University Of Medicine & Science
Children’s Institute, Inc.
Churches/congregations—general
City of Beverly Hills
City of Carson
City of Culver City—Culver City Cultural Affairs Foundation; Senior Center
City of El Segundo
City of Inglewood
City of Los Angeles
City of Los Angeles Department of Aging
City of Malibu
City of Santa Monica
City of West Hollywood
Claude Pepper Senior Citizen Center
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Common Ground—The Westside HIV Community Center
Community Clinic Association of Los Angeles County (CCALAC)
Community Coalition For Substance Abuse Prevention and Treatment
Community Health Councils
Concerned Citizens Community Involvement- Southside Church of Christ
Connections for Children
Cover the Homeless Ministry
CreateNow
Crenshaw Christian Center
Crohn’s and Colitis Foundation of America—Greater Los Angeles Chapter
Crystal Stairs
Culver City Education Foundation
Culver City Youth Center
David Geffen School of Medicine at UCLA
Disability Rights California
El Nido Family Centers
Early Head Start or Head Start: general
Early Identification and Intervention Collaborative for Los Angeles County
Economic Development Corporation of Los Angeles-LAEDC
Esperanza Community Housing Corporation
Exodus Recovery Center
Faith Calvary Baptist Church
Faithful Central Bible Church
FAME Assistance Corporation
Family Planning, Access, Care and Treatment (F-PACT)
Family Resource Network
Farmers markets: general
Felicia Mahood Senior Multipurpose Center
First 5 Los Angeles
First AME Church
First Church of God-Center of Hope
First Ladies Health Initiative
Food & Nutrition Management Systems: BE WELL Program
Foundation for Children’s Dental Health
Freedom in Christ Christian Fellowship Church
Friends of LACES
Friends of the Culver City Youth Health Center
Global Wellness Project
Page 64
Great Beginnings for Black Babies
Greater Ebenezer Missionary Baptist Church
Greater Open Door Church of God in Christ
Hawk Hoops Sports Foundation
Health Services Academy High School
Healthy African American Families
Healthy Families
Healthy Way LA
Holman United Methodist Church
Holy Apostolic Church Los Angeles
Holy Name of Jesus School
Holy Spirit Catholic Church
Homies Unidos, Inc.
In the Meantime Men’s Group
Inglewood Unified School District
Inner Images
Inside Out Community Arts
J.W. Anthony Youth and Family Outreach, Inc.
Jenesse Center
Jewish Family Service of Los Angeles
Junior Blind of America
Kingdom Hall of Jehovah’s Witness
KJLH Annual Women’s Health Forum
Korean Health Education Information & Research Center (KHEIR)
Korean American Family Service Center
LA Best Babies Network
LA Conservation Corps
La Opinión
LA’s Promise
Latino Diabetes Association
Latino Resource Organization
Let'sMove! West LA
Libraries: general
Living Advantage, Inc.
Los Angeles Community Garden Council
Los Angeles County Area Agency on Aging
Los Angeles County Bicycle Coalition
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Los Angeles County Department of Health Services
Los Angeles County Department of Human Services and Development
Los Angeles County Department of Mental Health (DMH)
Los Angeles County Department of Public Health—Substance Abuse Prevention and
Control; Maternal, Child and Adolescent Health Programs
Los Angeles County Emergency Medical Services (EMS)
Los Angeles Jewish AIDS Services
Los Angeles Regional Food Bank
Los Angeles Urban League
Los Angeles Walks
Loved Ones of Homicide Victims
Loved Ones Victims Services
Loyola Marymount University
MALDEF
Mar Vista Family Center
March of Dimes—California Programs
Meals On Wheels
Medi-Cal
Medicare
Mid City West Community Council
Minority AIDS Project
MLK-LA Community Healthcare Corporation
MMB Youth Foundation
Mobile Clinic Project at UCLA
Model Neighborhood Program/La Cienega Farmer’s Market
Mother of Many
Mt. Moriah Baptist Church
Multi-Service Center on King Drew Campus
Muscular Dystrophy Association
National Congress of Black Women
National Health Foundation
Nature Bridge
Navigating Cancer Survivorship
Neighbors United at Faircrest Heights
New Life Christian Center
Niswa Association Incorporated
Oasis at King-Harbor campus
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Los Angeles County Board of Supervisors District 2: Office of Supervisor Mark RidleyThomas
Los Angeles County Board of Supervisors District 3: Office of Supervisor Zev Yaroslavsky
Los Angeles County Board of Supervisors District 4: Office of Supervisor Don Knabe
OPCC (Ocean Park Community Center)
OPICA Adult Day Care Center Inc.
Our House Grief Support Center
Pacific Asian Counseling Services
PADRES Contra El Cancer
Parent Institute for Quality Education
PATH (People Assisting the Homeless)
Planned Parenthood Los Angeles
Project Angel Food
Project Chicken Soup
Public housing offices: general
School parent resource centers: general
Schools: general
SEIU ULTCW
Senior centers: general
SHARE! The Self-Help and Recovery Exchange
Sickle Cell Disease Foundation of California
Smyrna Seventh-Day Adventist Church
Social Justice Learning Institute
SoRo Inc.
SOS Mentor Shape Up
South Bay Center for Counseling, Community & Economic Development
South Central Los Angeles Ministry Project (LAMP)
South Central Prevention Coalition
Southern California Counseling Center (SCCC)
Southside Church of Christ
Southside Coalition of Community Health Centers
Special Needs Network
Special Olympics Southern California
St. Joseph Center
Step Up on Second
Students Run LA
Susan G. Komen for the Cure —Los Angeles County Affiliate
Team HEAL Foundation (Helping Enrich Athletes Lives)
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Team Survivor Los Angeles
The Achievable Foundation
The California Endowment
The Children’s Dental Center of Greater Los Angeles
The City Project
The H.E.L.P. Group
The Laurel Foundation
The Maple Counseling Center
TreePeople
UCLA Center for Health Policy Research
UMMA (University Muslim Medical Association) Community Clinic
United States Congress 33th Congressional District of California: Office of Representative
Henry Waxman
Karen Bass
Maxine Waters
United States Senate: Office of Senator Barbara Boxer
United States Senate: Office of Senator Dianne Feinstein
University of Southern California (USC)
Upward Bound House
Venice Boys and Girls Club
Veterans Administration (VA) Greater Los Angeles Healthcare System
Vision to Learn
Vision y Compromiso
Vista Del Mar Child and Family Services
Ward AME Church
Weingart YMCA
Wellington Square Farmers Market
West Angeles Church of God in Christ
Westchester Playa Village
Westchester Senior Citizen Center
Westside Family Health Center
Westside Pregnancy Clinic
Westside Regional Center
WIC (Women, Infants and Children)
WISE & Healthy Aging
Women At Risk
Women of Color Breast Cancer Survivors Support Project
Page 68
Women’s Missionary Union
Worksite Wellness LA
YMCA of Metro Los Angeles—Crenshaw Branch
YWCA Santa Monica/Westside
Page 69
Appendix A: Glossary
Page 70
This glossary has been developed to provide definitions for key terms and terminology used throughout the East
Metro West Kaiser Foundation Hospitals 2013 Community Health Needs Assessments (CHNA). The terms with
footnotes have been adapted from the Kaiser CHNA Toolkit, developed “in order to standardize the [CHNA] process across the region and to ensure compliance with the Affordable Care Act (ACA) regulations,” as well as to
create a shared understanding of the terms within the CHNA consultants and Kaiser Foundation Hospitals
Community Benefit Managers.
Age-adjusted rate
The incidence or mortality rate of a disease can depend on age distribution within a community. Because chronic
diseases and some cancers affect older adults disproportionately, a community with a higher number of older
adults might have a higher mortality or incidence rate for some diseases than another community with a higher
percentage of population of younger people. An age-adjusted incidence or mortality rate allows for taking the
proportion of persons in corresponding age groups into consideration when reviewing statistics, which allows for
more meaningful comparisons between communities with different age distributions.
Benchmark1
A benchmark is a measurement that serves as a standard by which other measurements and/or statistics may be
measured or judged. In the case of the CHNA reports, the term “benchmark” indicates a standard by which a
community can determine how well or not well the community is performing in comparison to the standard for
specific health outcomes. For the purpose of the Kaiser Foundation Hospitals CHNA reports, one of three benchmarks has been used to make comparisons with the medical service area. These include statistics published by
Healthy People 2020, Los Angeles County and California.
Community assets
Those people, places, and relationships that provide resources, individually or in the aggregate, to bring about the
maximal functioning of a community. (Example: Federally Qualified Health Care Centers, primary care physicians, hospitals and medical clinics, community-based organizations, social service and other public agencies,
parks, community gardens, etc.)
Community Health Needs Assessment2
Abbreviated as CHNA, a systematic process involving the review of public data and input from a broad cross-section of community resources and participants to identify and analyze community health needs and assets.
Community served
Based on Affordable Care Act (ACA) regulations, the “community served” is to be determined by each individual
hospital. The community served is generally defined by a geographical location such as a city, county, or
metropolitan region. A community served may also take into consideration certain hospital focus areas (i.e.,
cancer, pediatrics) though is not defined so narrowly as to intentionally exclude high-need groups such as the
elderly or low-income individuals.
Consultant
Individuals or firms with specific expertise in designing, conducting, and managing a process on behalf of the
client.
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Data set
A data set refers to a set or grouping of secondary, usually quantitative, data.
Data source
Data source refers to the original source (i.e., database, interview, focus group, etc.) from which quantitative or
qualitative data were collected.
Disease burden
Disease burden refers to the impact of a health issue not only on the health of the individuals affected by the disease, but also on the financial cost of addressing the health issue, such as public expenditures. The burden of disease can also refer to the disproportionate impact of a disease on certain populations, which may negatively affect
quality of life, socioeconomic status, and other factors.
Drivers of health
Drivers of health are risk factors that may positively or negatively impact a health outcome. For the purposes of
the Kaiser Foundation Hospitals CHNA, drivers have been separated into four categories: social and economic
factors, physical environment, health behaviors, and clinical care access and delivery.
FQHC3
Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the
federal Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. Certain tribal organizations and FQHC look-alikes (organizations that meet PHS Section 330 eligibility
requirements but do not receive grant funding) also may receive special Medicare and Medicaid reimbursements.
Focus group
A gathering of people (also referred to as stakeholders) for the purpose of sharing and discussing a specific
topic—in this case, community health.
Health disparity
Diseases and health problems do not affect all populations in the same way. Health disparity refers to the
disproportionate impact of a disease or a health problem on specific populations. Much health disparity research
literature focuses on racial and ethnic differences—as to how these communities experience specific diseases—
however, health disparity can also be correlated with gender, age, and other factors, such as veteran, disability,
and housing status.
Health driver
Health drivers are behavioral, environmental, social, economic, and clinical-care factors that positively or negatively impact health. For example, smoking (behavioral) is a health driver for lung cancer, and access to safe
parks (environmental) is a health driver for obesity/overweight. Some health drivers, such as poverty or lack of
insurance, impact multiple health issues.
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Health indicator4
A characteristic of an individual, population, or environment that is subject to measurement (directly or indirectly)
and can be used to describe one or more aspects of the health of an individual or population. (Example: Percent of
children overweight in Los Angeles County, incidence of breast cancer in Los Angeles County)
Health need
Kaiser Permanente uses the Mobilizing Action Toward Community Health (MATCH) framework to understand
population health, and defines a health need as any of the following that arise from a comprehensive review and
interpretation of a robust data set: a) a poor health outcome and its associated health driver and/or b) a health
drive/factor associated with poor health outcome(s), where the outcome itself has not yet arisen as a need. (Example: breast cancer, obesity and overweight, asthma, physical inactivity, access to healthcare)
Health outcomes5
Snapshots of diseases in a community that can be described in terms of both morbidity and mortality. (Example:
breast cancer prevalence, lung cancer mortality, homicide rate)
Healthy People 20206
Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to
encourage collaborations across communities and sectors, empower individuals toward making informed health
decisions, and measure the impact of prevention activities.
Implementation strategy7
The nonprofit hospital’s plan for addressing the health needs identified through the CHNA.
Incidence8 rate
Incidence is a measure of the occurrence of new disease or health problem in a population of people at risk for the
disease within a given time period. (Example: 1,000 new cases of breast cancer in 2011) Incidence rate is
expressed either as a fraction (e.g., percentage) or a density rate (e.g., x number of cases per 10,000 people) to
allow for comparison between different communities. Incidence rate should not be confused with prevalence rate,
which measures the proportion of people found to have a specific disease or health problem (see prevalence rate).
Morbidity rate
Morbidity rate refers to the prevalence of a disease. Morbidity rate is usually expressed as a density rate (e.g. x
number of cases per 10,000 people). Prevalence is often used to measure the level of morbidity in a population.9
Mortality rate
Mortality rate refers to the number of deaths in a population resulting from a disease. Mortality rate is usually
expressed as a density rate (e.g., x number of cases per 10,000 people).
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Percent
A percent is the portion of the total population that currently has a given disease or health problem. Percent is
used to communicate prevalence, for example, and to give an idea of the severity (or lack thereof) of a disease or
health problem.
Prevalence10
Prevalence is the proportion of total population that currently has a given disease. (Example: 1,000 total cases of
lung cancer in 2011)
Prevalence rate
Prevalence rate is the proportion of total population that currently has a given disease or health problem. Prevalence rate is expressed either as a fraction (e.g., percentage) or a density rate (e.g., x number of cases per 10,000
people) to allow for comparison between different communities. Prevalence rate is distinct from incidence rate,
which focuses on new cases. For instance, a community may experience a decrease in new cases of a certain disease (incidence) but an increase in the total number of people suffering that disease (prevalence) because people
are living longer as a result of better screening or treatment for that disease.
Primary data
Primary data are new data collected or observed directly from first-hand experience. They are typically qualitative
(not numerical) in nature. For this CHNA, primary data were collected through focus groups and interviews with
key stakeholders. Primary data describes what is important to the people who provide the information and is useful in interpreting secondary data (see qualitative data, quantitative data, secondary data). (Example: Focus
groups, key informant interviews)
Qualitative data11
These are typically descriptive in nature and not numerical; however, qualitative data can be coded into numeric
categories for analysis. Qualitative data is considered to be more subjective than quantitative data, but they provide information about what is important to the people (see stakeholder) who provide the information. (Example:
focus group data)
Quantitative data12
Data that has a numeric value. Quantitative data is considered to be more objective than qualitative data (Example: State or National survey data)
Risk factor13
Characteristics (genetic, behavioral, and environmental exposures and sociocultural living conditions) that
increase the probability that an individual will experience a disease (morbidity) or specific cause of death (mortality). Some risk factors can be changed through behavioral or external changes or influences (e.g., smoking) while
others cannot (e.g., family history).
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Secondary data
Data that has already been collected and published by another party. Typically, secondary data collected for
CHNAs is quantitative (numerical) in nature (Example: California Health Interview Survey [CHIS], Behavioral
Risk Factor Surveillance System [BRFSS]) Secondary data are useful in highlighting in an objective manner
health outcomes that significantly impact a community.
Stakeholder
Stakeholders are people who represent and provide informed, interested perspectives regarding an issue or topic.
In the case of CHNAs, stakeholders include health care professionals, government officials, social service providers, community residents, and community leaders, among others.
1
Merriam-Webster Dictionary. Retrieved from [http://www.merriam-webster.com/dictionary/benchmark]
2
World Health Organization (WHO). Retrieved from [http://www.who.int/hia/evidence/doh/en/]
3
U.S. Department of Health and Human Services. Rural Health IT Toolbox. Retrieved from
[http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/qualified.html] Accessed [April 30, 2013].
4
“Health Promotion Glossary,” World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health
Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998.
5
“Health Promotion Glossary,” World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health
Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998.
6
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington,
DC. Available at [http://healthypeople.gov/2020/default.aspx] Accessed [April 30, 2013]
7
Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft.
Retrieved from [http://www.chausa.org/Assessing_and_Addressing_Community_Health_Needs.aspx]
8
Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett
Publishers.
9
New York State Department of Health. Basic Statistics: About Incidence, Prevalence, Morbidity, and Mortality—Statistical Teaching
Tools. Retrieved from [http://www.health.ny.gov/diseases/chronic/basicstat.htm] Accessed on [May 1, 2013].
10
Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett
Publishers.
11
Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft.
Retrieved from [http://www.chausa.org/Assessing_and_Addressing_Community_Health_Needs.aspx]
12
Ibid.
13
Adapted from: Green L. & Kreuter M. (2005). Health program planning: An educational and ecological approach. 4th edition. New
York, NY: McGraw Hill.
Page 75
Appendix B:
KFH-WLA
Health Needs Profiles
Page 76
Health Need Profile: Mental Health
**Overall Ranking Resulting from Prioritization: 1 of 23
About Mental Health—Why is it important?
Mental illness is a common cause of disability. Untreated disorders may leave individuals at-risk for substance
abuse, self-destructive behavior, and suicide. Additionally, mental health disorders can have a serious impact on
physical health and are associated with the prevalence, progression and outcome of chronic diseases. Suicide is
considered a major preventable public health problem. In 2010,
suicide was the tenth leading cause of death among Americans of
“There is a large gap in available
all ages, and the second leading cause of death among people
mental health services. Staff does what
between the ages of 25 to 34. An estimated 11 attempted
they can in urgent cases to stabilize
suicides occur per every suicide death.
people. There are facilities in the
community, though these are at max in
Research shows that more than 90 percent of those who die by
terms of patient capacity.”
suicide suffer from depression or other mental disorders, or a
(health professional, LA County
substance-abuse disorder (often in combination with other
Department of Public Health)
men¬tal disorders). Among adults, mental disorders are
common, with approximately one-quarter of adults being diagnosable for one or more disor¬ders. Mental
disor¬ders are not only associated with suicide, but also with chronic diseases, a family history of mental illness,
age, sub¬stance abuse, and life-event stresses.1
Interventions to prevent suicide include therapy, medication, and programs that focus both on suicide risk and
mental or substance-abuse disorders. Another intervention is improving primary care providers’ ability to
recognize and treat suicide risk factors, given the research showing that older adults and women who die by
suicide are likely to have seen a primary care provider in the year before death.
Major Findings in the Kaiser Foundation Hospital–West Los Angeles Service Area (KFH-WLA)
 The rates for Los Angeles County and the KFH-WLA service area were the same at 14.0%, slightly lower
than the statewide rate of 14.2%.
 The percent of people needing help for mental/emotional/alcohol/drug-related issues who did not receive
treatment in the KFH-WLA service area was 84.5%, a higher rate than Los Angeles County at 47.3%
(higher rates in SPA 6 at 86.8% and SPA 8 at 86.5%).
 The rate of mental health hospitalizations per 100,000 youth under 18 years of age in the KFH-WLA
service area was higher (268.7) when compared to the statewide rate of 256.4.
 The adult mental health hospitalizations rate per 100,000 persons in the KF-WLA service area was
significantly higher at 2,281.1 in comparison to the statewide rate of 551.7.
 The geographic impact of mental health issues was apparent in the higher rates of adult hospitalizations
per 100,000 in SPA 5 (5,626.2) and SPA 6 (2,316.7).
 The percentage of people per 100,000 persons with psychological distress in the last year was higher in
the KFH-WLA service area (9.2%) than in Los Angeles County (7.3%).
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 In 2010, the suicide rate per 100,000 persons was higher in the KFH-WLA service area at 8.7% compared
to the Los Angeles County rate of 8.0%.
 Stakeholders2 highlighted mental health as a factor that impacts a spectrum of populations, including
those under 30 years old, low-income women, the homeless, African-Americans, the elderly and undocumented individuals. Mental health is associated with many other health factors, including poverty, heavy
alcohol consumption, and unemployment.
 Mental health issues were identified by community stakeholders in 18 out of 22 interviews and all six
focus groups. Mental health was identified as a health need in the 2010 KFH-WLA Community Health
Needs Assessment.
Statistical data—How is mental health measured? What is the prevalence/incidence rate of mental health issues
in the community?
In the KFH-WLA service area:
 In 2010, the mental health
hospitalization rate per
100,000 adults was more
than three times (2,281.1)
that of California (551.7).
 In 2010, the mental health
100,000 youth was higher
(268.7) than California
(256.4).
Mental Health Indicators
KFHWLA
Service
Indicators
Year
Area
Mental health hospitalization rate
2010
2,281.1
per 100,000 adults
Mental health hospitalization rate
2010
268.7
per 100,000 youth
Mental health treatment not
2009
84.5%
received
Poor mental health
2009
14.0%
Serious psychological distress
2009
9.2%
Suicide rate per 100,00 persons1
2010
8.7
Comparison
Level
Avg.
CA
551.7
CA
256.4
LAC
47.3%
LAC
LAC
LAC
14.0%
7.3%
8.0
LAC=Los Angeles County
CA=California
 In 2009, nearly twice as
1
Healthy People 2020 = <=10.2
many (84.5%) needed treatment for their mental illness
and did not receive it when compared to Los Angeles County (47.3%).
 In 2009, more people (9.2%) had serious psychological distress than in Los Angeles County (7.3%).
 In 2010, the suicide rate was higher (8.7) than Los Angeles County (8.0).
Sub-populations experiencing greatest impact (disparities)
Within the KFH-WLA service area, the following sub-populations are most severely impacted:
 African-Americans (19.3%) had the highest rates of poor mental health within the KFH-WLA service
area, followed by Whites (17.8%) and Hispanics/Latinos (13.0%).
 The prevalence of poor mental health was almost 3% higher for African-Americans in Los Angeles
County (19.3%) than it was in California as a whole (16.5%).
 The rate of poor mental health for Hispanics/Latinos in Los Angeles County (13.05) was about the same
as the statewide rate (13.4%).
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Stakeholders identified Latinos, African-Americans, low-income people, caregivers, and the uninsured as the
most impacted. Stakeholders also added that age is not a factor, that all age groups are impacted.
Geographic areas of greatest impact (disparities)
Communities experiencing high suicide rates
include (see map):
Suicide Mortality, Rate (Per 100,000 Pop.), CDPH, 2008-10
Over 30.0
 Downtown Santa Monica (30.3)
By Service Planning Area (SPA), the following disparities were found:
20.1 - 30.0
 Mental health hospitalizations per 100,000
adults were higher in SPA 5 (5,626.2), SPA
6 (2,316.7), and SPA 4 (695.1) when compared to California (551.7).
Under 10.1
10.1 - 20.0
No Suicide
Deaths
No Data or Data
Suppressed
 Larger portions of people had serious psychological stress in SPA 6 (14.8%) and SPA
4 (10.7%) when compared to Los Angeles County (7.3%).
 Far more people had not had mental health treatment in SPA 6 (86.8%), SPA 8 (86.5%), SPA 5 (84.0%),
and SPA 4 (80.6%) than in Los Angeles County (47.3%).
Stakeholders identified South Los Angeles as the most impacted.
Associated drivers and risk factors—What is driving the high rates of poor mental health in the community?
Poor mental health is associated with many other health factors, including poverty, heavy alcohol consumption,
and unemployment. Substance use and chronic diseases such as cardiovascular disease, diabetes, and obesity are
also associated with mental health disorders. The table below includes drivers that did not meet the indicated
benchmark, indicating that the KFH-WLA service area is performing worse than the comparison area/benchmark.
For data on additional indicators please refer to the KFH-WLA Scorecard in Appendix D.
Poor-Performing Drivers
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Alcohol- and drug-induced mental disease
hospitalizations per 100,000 adults
Cardiovascular disease mortality rate per 10,000
persons
Heart disease hospitalizations per 100,000 persons
Heart disease mortality rate per 100,000 persons1
Diabetes
Diabetes prevalence
Diabetes hospitalizations per 100,000 adults
Comparison
Level
Avg.
2010
480.0
LAC
109.1
2010
19.6
CA
15.6
2010
2010
1,129.9
142.0
CA
LAC
367.1
147.1
2009
2010
2010
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
Page 79
Indicators
Hospitalizations for uncontrolled diabetes per 100,000
persons
Unemployed
Year
Level
Avg.
2010
18.3
CA
9.5
1.7%
CA
1.7%
LAC
10.4%
16.6%
LAC
15.7%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
BEHAVIORAL
2011
Alcohol expenditures
SOCIAL AND ECONOMIC
2012
10.3%
Living below 100% of FPL
Delayed or didn’t get medical care
Delayed or didn’t get prescriptions
Living in a health professional shortage area
Primary care providers per 100,000 persons
Comparison
KFH-WLA
Service Area
2010
ACCESS TO CARE
2009
2009
2012
2011
LAC—Los Angeles County
CA—California
1
Community input—What do community stakeholders think about the issue of mental health?
Stakeholders attributed poor mental health to
stress resulting from the economic downturn,
and trauma related to violence. There is also
a lack of access to care and stigma attached
to mental health. Stakeholders identified a
need for parent and family education
programs around mental health.
“Underserved[individuals] don’t seek out mental health
care; they tend to be referred as a second stage of
treatment for another more physical condition.”
(vice president of research and evaluation,
national health foundation)
Assets—What are some examples of community assets that can address the health need?
Numerous assets and resources are available to respond to health needs within a given community, including
health care facilities, community organizations, and public agencies. The following list includes assets that have
been identified as specifically addressing this health need and/or key drivers related to this health need through
various sources including KFH-WLA community partners. Where available, a sampling of community assets
specifically highlighted by stakeholders during interviews and/or focus groups is noted as well.
Sample of mental health–specific community assets:
 A Place Called Home
 Airport Marina Counseling Service
 Alcott Center for Mental Health
 Being Alive - People with HIV/AIDS Coalition
 Brotman Medical Center
 California Black Women Health Project
 Community Clinic Association of Los Angeles County (CCALAC)
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 Exodus Recovery Center
 Kaiser Foundation Hospital – Wateridge; Watts Counseling & Learning Center
 Kedren Community Mental Health Center
 Korean American Family Service Center
 LA Gay and Lesbian Center
 Los Angeles County Department of Mental Health
 NAMI Urban Los Angeles
 NAMI Westside
 OPCC (Ocean Park Community Center)
 Open Paths Counseling Center
 PATH People Assisting the Homeless
 Step Up on Second
 Southern California Counseling Center
 UCLA Resnick Neuropsychiatric Hospital
 Vista del Mar Child and Family Services
 Veterans Administration (VA) Greater Los Angeles Healthcare System
Stakeholders identified the following community resources available to address mental health:
 Culver City Youth Center—community resource for mental health care; free services; had local partnerships with schools to provide mental health screening for students
 Didi Hirsch Mental Health Services—community resource for mental health care
 The Saban Free Clinic—community resource for medical and mental health care
For information on other assets in the community, please refer to Section 0 of the Community Health Needs
Assessment report.
1
Public Health Agency of Canada. Mental Illness. Available at [http://www.phac-aspc.gc.ca/cd-mc/mi-mm/index-eng.php]. Accessed
[March 12, 2013].
2
Stakeholders included health care professionals, government officials, social service providers, community residents, and community
leaders, among others.
Page 81
Health Need Profile: Obesity/Overweight
** Overall Ranking Resulting from Prioritization: 2 of 23
About Obesity/Overweight—Why is it important?
Obesity, a condition in which a person has an abnormally high and unhealthy proportion of body fat, has risen to
epidemic levels in the United States; 68 percent of adults age 20 years and older are overweight or obese.1
Obesity reduces life expectancy and causes devastating and costly
health problems, increasing the risk of coronary heart disease, stroke,
high blood pressure, diabetes, and a number of other chronic
diseases. Findings suggest that obesity also increases the risks for
cancers of the esophagus, breast (postmenopausal), endometrium,
colon and rectum, kidney, pancreas, thyroid, gallbladder, and
possibly other cancer types.2
“Obesity is escalating at its highest
rate, which causes other chronic
diseases and ailments that shorten a
person’s lifespan”
(foundation relations director,
national health organization)
A number of factors contribute to obesity, including genetics, physical inactivity, unhealthy diet and eating habits,
lack of sleep, certain medications, age, social and economic issues, and medical problems.3
 A third of the population in the KFH-WLA service area (36.4%) was obese and higher when compared to
Los Angeles County (26.4%).
 More youth were obese in the KFH-WLA service area (36.6%) when compared to California (29.8%).
 Slightly more males were obese (21.5%) than females (21.3%).
 More Hispanics/Latinos (41.7%) youth were obese, followed by American Indians/Alaskan Natives
(34.7%), and African-Americans (33.6%).
 More (16.8%) American Indian/Alaskan Native youth were overweight.
 Inglewood (43.1%) and Lennox (48.1%) had the largest portion of students who are obese.
 Students were generally overweight in the KFH-WLA service area, ranging between 13.1% and 16.0%.
 Inglewood (17.1%) and Culver City (16.9%) had the largest portion of students who are overweight.
 More adults in SPA 8 (33.7%) and SPA 6 (32.6%) were obese when compared to the overall KFH-WLA
service area (31.3%).
 More adults were overweight in SPA 6 (30.0%) and SPA 8 (28.1%) when compared to the overall KFHWLA service area (22.5%).
 Stakeholders4 identified South Los Angeles as the most severely impacted.
 Stakeholders indicated that obesity and being overweight are increasing issues, impacting people who
lack access to health care, green space, and healthy food, and those who live in food deserts. Stakeholders
added that obesity and being overweight are linked to diabetes and hypertension.
 Obesity was identified in four out of six focus groups and seven out of 22 interviews
Page 82

Obesity was identified as a health need in the 2010 Kaiser Permanente West Los Angeles Community
Statistical data—How is obesity/overweight measured? What is the prevalence/incidence rate of
obesity/overweight in the community?
 In 2009, more adults are obese
(22.5%) when compared to Los
Angeles County (21.2%).
 In 2009, more adults are
overweight (31.3%) when
compared to Los Angeles
County (29.7%).
Obesity/Overweight Indicators
KFH-WLA
Indicators
Year
Service Area
Adults who are obese
2009
21.4%
Adults who are
2010
26.4%
overweight
2009
22.5%
Adults who are
2009
31.3%
overweight
Youth who are obese
2011
36.6%
Youth who are overweight
2011
14.7%
Comparison
Level
Avg.
LAC
21.4%
LAC
36.4%
LAC
21.2%
LAC
29.7%
CA
CA
29.8%
14.3%
 In 2011, the portion of youth
who were obese was higher (36.6%) when compared to California (29.8%).
 In 2011, slightly more youth were overweight (14.7%) when compared to California (14.3%).
Within the KFH-WLA service area, the following sub-populations are the most severely impacted:
 Slightly more males were obese (21.5%) than females (21.3%).
 More Hispanics/Latinos (41.7%) youth were obese, followed by American Indians/Alaskan Natives
(34.7%), and African-Americans (33.6%).
 More (16.8%) American Indian/Alaskan Native youth were overweight.
Stakeholders identified Latinos, African-Americans, low-income people, and youth as the most severely
impacted.
Page 83
Communities experiencing the highest disparities include (see maps):
 Inglewood (43.1%) and Lennox
(48.1%) had the largest portion
of students who are obese.
Students In 'Needs Improvement' Body Composition Zone
(Overweight), CA Dept. of Education, 2011
 Students were generally overweight in the KFH-WLA service
area, ranging between 13.1% and
16.0%.
Over 19.0%
 Inglewood (17.1%) and Culver
City (16.9%) had the largest portion of students who were overweight.
10.1 - 13.0%
16.1 - 19.0%
13.1 - 16.0%
Under 10.1%
By Service Planning Area (SPA), the
following disparities were found:
 More adults in SPA 8 (33.7%)
and SPA 6 (32.6%) were obese
when compared to the overall
KFH-WLA service area (31.3%).
Percentage of Students In 'At High Risk' Body Composition Zone
(Obese), CA Dept. of Education, 2011
Over 40.0%
30.1 - 40.0%
 More adults were overweight in
SPA 6 (30.0%) and SPA 8
(28.1%) when compared to the
overall KFH-WLA service area
(22.5%).
20.1 - 30.0%
10.1 - 20.0%
Under 10.1%
Stakeholders identified South Los
Angeles is the most severely impacted.
Associated drivers and risk factors—What is driving the high rates of obesity/overweight in the community?
Obesity is associated with factors such as poverty, the inadequate consumption of fruits and vegetables, physical
inactivity, and lack of access to grocery stores, parks, and open space. Obesity increases the risk of coronary heart
disease, stroke, high blood pressure, diabetes, and a number of other chronic diseases. Obesity also increases the
risks of cancers of the esophagus, breast (postmenopausal), endometrium, colon and rectum, kidney, pancreas,
thyroid, gallbladder, and possibly other cancer types.5 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison
area/benchmark. For data on additional indicators please refer to the KFH-WLA Scorecard in Appendix D.
Page 84
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Cardiovascular disease mortality per 10,000 persons
Heart disease mortality per 100,000 persons1
Colorectal Cancer
Colorectal cancer incidence rate per 100,000 persons2
Colorectal cancer mortality rate per 100,000 persons3
Diabetes
Diabetes prevalence
persons
Hypertension
Adults ever diagnosed with high blood pressure
Comparison
Level
Avg.
2010
2010
2010
19.6
1,129.9
142.0
CA
CA
LAC
15.6
367.1
147.1
2009
2008
45.2
13.5
LAC
LAC
45.2
11.2
2009
2010
2010
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
2010
18.3
CA
9.5
LAC
25.5%
CA
37.5%
LAC
72.5
LAC
LAC
15.7%
22.4%
LAC
65.5%
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
2009
28.5%
BEHAVIORAL
Not physically active (youth)
2010
45.0%
PHYSICAL ENVIRONMENT
Fast food restaurants per 100,000 persons
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
Living below 100% FPL (children and teens)
2010
24.2%
CLINICAL CARE
Receiving heart disease management
2009
51.2%
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
Primary care provider per 100,000 persons
2011
80.6
LAC = Los Angeles County
1
2
3
Community input—What do community stakeholders think about the issue of obesity/overweight?
Stakeholders indicated that obesity and being overweight are growing
problems impacting those who lack access to health care, green
space, and healthy food, and those who live in food deserts. Stakeholders added that obesity and being overweight are linked to diabetes and hypertension.
“Given the high rates of obesity,
there is really a need to address the
food desert issue and food insecurity
(inability to afford food)”
(assistant professor, university)
Page 85
Sample of obesity/overweight-specific community assets:
 Black Women for Wellness
 California Certified Farmers Markets
 Centinela Hospital Medical Center
 FAME Assistance Corporation
 Kaiser Foundation Hospital – West Los Angeles
 LetsMove! WestLA
 Los Angeles Community Garden Council
 Los Angeles Urban League
 Model Neighborhood Program / La Cienega Farmer's Market
 Special Olympics Greater Los Angeles
 Students Run LA
 T.H.E. Clinic
 Vision y Compromiso
 Weingart YMCA
Stakeholders identified the following community resources available to address obesity/overweight issues:
 Farmers markets (general)—make healthy food available in the community on a regular basis; connects to
the wholesomeness of fresh food
 Food and nutrition management systems (BE WELL program)—offers exercise and weight management
for high-risk seniors
 Senior centers (general)—community resource for healthy and affordable lunches
 Saint John’s Well Child & Family Center—provides dance and nutrition classes
 Watts Health Care Corporation—provides health promotion classes on diet, diabetes, hypertension
Assessment report.
1
National Cancer Institute. Obesity and Cancer Risk. Available at [http://www.cancer.gov/cancertopics/factsheet/Risk/obesity]. Accessed
[March 10, 2013].
2
Ibid.
3
May Clinic. Obesity Risk Factors. Available at [http://www.mayoclinic.com/health/obesity/DS00314/DSECTION=risk-factors].
Accessed [March 10, 2013].
Page 86
4
5
National Cancer Institute. Obesity and Cancer Risk. Available at [http://www.cancer.gov/cancertopics/factsheet/Risk/obesity]. Accessed
[March 10, 2013].
Page 87
Health Need Profile: Diabetes
** Overall Ranking Resulting from Prioritization: 3 of 23
About Diabetes—Why is it important?
Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading cause of death.
Diabetes also lowers life expectancy by up to 15 years, increases the risk of heart disease by two to four times,
and is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness.1
Given the steady rise in the number of people with diabetes and the
“There is a lack of access to quality
earlier onset of Type 2 diabetes, there is growing concern about
prevention and self-management
substantial increases in diabetes-related complications and their
education and to healthy food.”
potential to impact and overwhelm the health care system. There is a
(vice chair, national health
clear necessity to take advantage of recent discoveries about the
association)
individual and societal benefits of improved diabetes management
and prevention by bringing life-saving findings into wider practice and complementing those strategies with
efforts in primary prevention among those at risk for developing diabetes.2
In addition, evidence is emerging that diabetes is associated with additional co-morbidities, including cognitive
impairment, incontinence, fracture risk, and cancer risk and prognosis.3
 The percentage of adults who had been told by a doctor that they have diabetes was similar for the KFHWLA service area and Los Angeles County (7.7%).
 The KFH-WLA diabetes hospitalization rate for adults was 200.2 per 100,000 persons, which was higher
than the statewide rate of 145.6. In SPA 6 (325.3) and SPA 8 (282.7), the rate of adult hospitalization for
diabetes was higher than the average hospitalization rate for the KFH-WLA service area as a whole.
 The rate of adult diabetes hospitalizations per 100,000 persons in the KFH-WLA service area (11.1) was
higher than the state rate of 9.7 per 100,000.
 Stakeholders4 noted that African-Americans, Latinos, recent immigrants, and the homeless are particularly impacted by diabetes.
 Diabetes is associated with a lack of physical activity, inadequate fruit and vegetable consumption,
obesity, and poverty, among other factors.
 Diabetes diagnoses can indicate an unhealthy lifestyle, a risk factor for further health issues, and is linked
to obesity.
 Diabetes was also identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 88
Statistical data—How is diabetes measured? What is the prevalence/incidence rate of diabetes in the
community?
 In 2010, diabetes hospitalizations per 100,000 adults
were higher (200.2) when
County (145.6).
 In 2010, uncontrolled diabetes hospitalizations per
100,000 persons was
nearly double (18.3) that
of Los Angeles County
(9.5).
Indicators
Diabetes prevalence among
adults
Diabetes hospitalizations per
100,000 adults
10,000 adults
Uncontrolled diabetes
hospitalizations per 100,000
persons
10,000 children
Diabetes Indicators
KFHWLA
Service
Year
Area
Comparison
Level
Avg.
2009
7.7%
LAC
7.7%
2010
200.2
LAC
145.6
2010
11.1
LAC
9.7
2010
18.3
LAC
9.5
2010
3.6
LAC
4.8
Sub-populations experiencing
greatest impact (disparities)
 More males (8.5%) had diabetes than females (7.1%).
 More males (1.1%) were discharged from hospitals for diabetes-related incidents than females (0.8%).
 More African-Americans (1.6%) experienced hospital discharges resulting from diabetes than other
groups. In addition, 0.9% of Hispanic/Latinos were hospitalized as a result of diabetes.
 Those between the ages of 45 and 64 (1.5%) and one and 19 (1.3%) experienced the most hospital incidents resulting from diabetes when compared to other age groups.
 Stakeholders identified Latinos, African-Americans, women, low-income, the undocumented, the uninsured and young men as the most impacted sub-populations.
Communities experiencing the highest disparities include (see map):
 Inglewood, including the ZIP Codes
90044 (23.7), 90303 (22.9), 90047
(19.0), 90301 (18.9), 90016 (18.5),
90018 (18.3), 900302 (18.2), 90305
(17.3), 90008 (17.1), 90043 (15.7),
90304 (14.8), and 90062 (14.5)
Diabetes Discharge Rate (Per 10,000 Pop.), OSHPD, 2010-11
Over 14.00
10.01 - 14.00
6.01 - 10.00
 Hawthorne, including ZIP Code 90250
(15.2)
2.01 - 6.00
Under 2.01
 Santa Monica, including ZIP Code
90404 (10.4)
Page 89
 Diabetes was more prevalent in SPA 8 (25.1%), SPA 6 (24.1%), SPA 4 (13.7%), and SPA 5 (13.3%)
when compared to Los Angeles County (10.5%).
 There were more diabetes hospitalizations per 100,000 adults in SPA 6 (325.3) and SPA 8 (282.7).
 There were more uncontrolled diabetes hospitalizations per 100,000 persons in SPA 6 (33.6), SPA 8
(18.7), and SPA 4 (11.5).
Stakeholders identified South Los Angeles as the most severely impacted.
Associated drivers and risk factors—What is driving the high rates of diabetes in the community?
Factors associated with diabetes include being overweight; having high blood pressure, high cholesterol, high
blood sugar (or glucose); physical inactivity, smoking, unhealthy eating, age, race, gender, and having a family
history of diabetes.5 The table below includes drivers that did not meet the indicated benchmark, indicating that
the KFH-WLA service area is performing worse than the comparison area/benchmark. For data on additional
indicators please refer to the KFH-WLA Scorecard in Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Cardiovascular disease mortality per 10,000 persons…
2010
19.6
2010
1,129.9
2010
142.0
Hypertension
2009
28.5%
Obesity/Overweight
2009
22.5%
Adults who are overweight
2009
31.3%
Children who are obese
2011
36.6%
Children who are overweight
2011
14.7%
BEHAVIORAL
2011
1.7%
2010
45.0%
Unable to afford enough food
2009
42.2%
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
CLINICAL CARE
2009
51.2%
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
2011
80.6
1
Page 90
Comparison
Level
Avg.
CA
CA
LAC
15.6
367.1
147.1
LAC
25.5%
LAC
LAC
CA
CA
21.2%
29.7%
29.8%
14.3%
CA
CA
LAC
1.7%
37.5%
38.2%
LAC
72.5
LAC
LAC
15.7%
22.4%
LAC
65.5%
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
Community input—What do community stakeholders think about the issue of diabetes?
Stakeholders attribute diabetes to the lack of access to healthy food—including its high cost, living in food
deserts, and a lack of education around healthy habits. Stakeholders identified factors that contribute to diabetes,
including access to health care, lack of transportation, language barriers, and poverty. Stakeholders added that
diabetes is linked to obesity and hypertension.
“People are not motivated to be
active. In some of our communities
this is not convenient; there are no
places to go and have recreation.”
(CEO, community health clinic)
“Poverty is the source of chronic
disease—[it] comes from multiple
interacting issues, including the
economy, family stresses, etc.”
(vice chair, national health association)
Sample of diabetes-specific community assets:
 American Diabetes Association
 Food & Nutrition Management Systems: BE WELL Program
 LetsMove! West LA
 Saint John’s Well Child and Family Center
 Westside Family Health Center
 Vision y Compromiso
Stakeholders identified the following community resources available to address diabetes:
 Watts Health Care Corporation—provides health promotion classes on diet, diabetes, and hypertension;
provides a podiatrist four days a week and wound care for diabetes-related foot conditions
 MLK Multi-Service Ambulatory Care Center—provides ophthalmology and podiatry services, especially
related to diabetes
Assessment report.
Page 91
1
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32]. Accessed [February 26, 2013].
2
Ibid.
3
Ibid.
4
Page 92
Health Need Profile: Cardiovascular Disease
About Cardiovascular Disease—Why is it important?
Cardiovascular disease—also called heart disease and coronary heart disease—includes several problems related
to the buildup of plaque in the walls of the arteries, or atherosclerosis. Coronary heart disease is a leading cause of
death in the United States and is associated with high blood pressure, high cholesterol, and heart attacks as well as
other health outcomes including obesity, heavy alcohol consumption, and diabetes. As the plaque builds up, the
arteries narrow, restricting blood flow and creating a risk for a heart attack. Currently more than one in three
adults (81.1 million) lives with one or more types of cardiovascular disease. In addition to being the first and third
leading causes of death, heart disease result in serious illness and disability, decreased quality of life, and hundreds of billions of dollars in economic loss every year.1
Cardiovascular disease encompasses and/or is closely linked to a number of health conditions that include
arrhythmia, atrial fibrillation, cardiac arrest, cardiac rehab, cardiomyopathy, cardiovascular conditions of childhood, cholesterol, congenital heart effects, diabetes, heart attack, heart failure, high blood pressure, HIV, metabolic syndrome, pericarditis, peripheral artery disease (PAD), and stroke.2
The burden of cardiovascular disease is disproportionately distributed across the population. There are significant
disparities based on gender, age, race/ethnicity, geographic area, and socioeconomic status with regard to prevalence of risk factors, access to treatment, appropriate and timely treatment, treatment outcomes, and mortality.3
 The rate of cardiovascular disease per 10,000 persons was higher in the KFH-WLA service area (19.6)
than California (15.6).
 Within the KFH-WLA service area, SPA 4 (21.4), SPA 5 (19.9), and SPA 6 (23.2) had higher rates of
cardiovascular disease per 10,000 persons than California (15.6).
 The heart disease hospitalization rate per 100,000 was higher (1,129.9) than California (367.1).
 The heart disease hospitalization rate per 100,000 was higher in SPA 5 (2882.5), SPA 4 (444.8) and SPA
8 (486.8) when compared to California (15.6).
 Those most often diagnosed with heart disease include the White (8.2%) and Hispanic/Latino (5.1%)
populations.
 In Los Angeles County, rates of heart disease mortality were highest among Asian/Pacific Islanders
(376.1) and African-Americans (226.0).
 Stakeholders4 identified Latinos, American-Americans, the uninsured, and the undocumented as the most
severely impacted sub-populations.
 Heart disease/coronary disease was identified as a major health issue in four of 220 interviews and two
out of six focus groups.
 Cardiovascular disease was also identified as a health need in the 2010 KFH-WLA Community Health
Needs Assessment.
Page 93
Statistical data—How is cardiovascular disease measured? What is the prevalence/incidence rate of
cardiovascular disease in the community?
 In 2010, the cardiovascular disease mortality rate per 10,000
adults was higher (19.6) when
County (15.6).
 In 2010, the heart disease hospitalization rate was over three
times as high (1,129.9) as Los
Angeles County’s (367.1).
Cardiovascular Disease Indicators
KFHWLA
Service
Indicators
Year
Area
Cardiovascular disease mortality
2010
19.6
rate per 10,000 adults
Heart disease hospitalization rate
2010
1,129.9
per 100,000 adults
Heart disease mortality rate per
2010
142.0
100,000 adults1
Heart disease prevalence (adults) 2009
5.8%
Stroke mortality per 100,000
2010
36.5
persons
Comparison
Level
Avg.
LAC
15.6
LAC
367.1
LAC
147.1
LAC
5.8%
LAC
37.6
1
Healthy People 2020 heart disease mortality rate goal = <=100.8
 Those most often diagnosed with heart disease include the White (8.2%) and Hispanic/Latino (5.1%)
populations.
 In Los Angeles County, rates of heart disease mortality were highest among Asian/Pacific Islanders
(376.1) and African-Americans (226.0).
Stakeholders identified Latinos, American-Americans, the uninsured, and the undocumented as the most severely
impacted sub-populations.
 The cardiovascular disease mortality rate was particularly high
in ZIP Codes 90047 (230.4),
90018 (210.7), and 90043
(208.7).
Cardiovascular Disease Mortality, Rate (Per 100,000 Pop.),
CDPH, 2008-10
Over 200.0
160.1 - 200.0
120.1 - 160.0
80.1 - 120.0
 More adults were hospitalized
per 100,000 persons in SPA 5
(2,882.5), SPA 6 (705.6), SPA 8
(486.8), and SPA 4 (444.8) when
compared to Los Angeles County
(367.1).
Under 80.1
Data suppressed
or no data
Page 94
 More adults per 10,000 persons die of cardiovascular disease in SPA 6 (23.2), SPA 4 (21.4), and SPA 5
(19.9) than in Los Angeles County (15.6).
Stakeholders did not identify geographic disparities.
Associated drivers and risk factors—What is driving the high rates of cardiovascular disease in the community?
The leading risk factors for heart disease are high blood pressure, high cholesterol, smoking, diabetes, poor diet,
physical inactivity, and overweight and obesity. Cardiovascular disease is closely linked and can often lead to
stroke5. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFHWLA service area is performing worse than the comparison area/benchmark. For data on additional indicators
please refer to the KFH-WLA Scorecard in Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
2009
2010
2010
Hospitalizations for uncontrolled diabetes per 100,000 persons
2010
Hypertension
2009
HIV/AIDS
HIV prevalence per 100,000 persons
2010
HIV hospitalizations per 10,000 adults
2011
HIV hospitalizations per 100,000 adults
2010
Obesity/Overweight
2009
2009
Children who are obese
2011
Children who are overweight
2011
BEHAVIORAL
2010
2009
SOCIAL AND ECONOMIC
2010
2010
CLINICAL CARE
2009
Preventable hospital admission (ACSC) per 1,000 total admis2010
sions
ACCESS TO CARE
2009
2009
2012
2011
Page 95
Comparison
Level
Avg.
19.1%
200.2
11.1
18.3
LAC
CA
CA
CA
10.5%
145.6
9.7
9.5
28.5%
LAC
25.5%
21.8
3.4
35.0
LAC
LAC
CA
14.0
2.2
11.0
22.5%
31.3%
36.6%
14.7%
LAC
LAC
CA
CA
21.2%
29.7%
29.8%
14.3%
45.0%
CA
37.5%
79.1
LAC
72.5
16.6%
24.2%
LAC
LAC
15.7%
22.4%
51.2%
LAC
65.5%
108.7
CA
88.5
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
Community input—What do community stakeholders think about the issue of cardiovascular disease?
Stakeholders attributed the prevalence of cardiovascular disease to a lack of understanding and knowledge of
healthy habits/lifestyle (exercising, eating), lack of access to health care (including preventive care), and living in
food deserts.
Sample of cardiovascular disease–specific community assets:
 American Heart Association, Los Angeles
 Ronald Reagan UCLA Medical Center
Stakeholders did not identify community assets specific to cardiovascular disease.
Assessment report.
1
2
Ibid.
3
Ibid.
4
5
Page 96
Health Need Profile: Oral Health
About Oral Health—Why is it important?
Oral health is essential to overall health and is
relevant because engaging in preventive behaviors decreases the likelihood of developing
future oral health and related health problems.
In addition, oral diseases such as cavities and
oral cancer cause pain and disability for many
Americans.1
“Very few dental services are available other than
[in] other programs; one or two more organizations
are coming into the area, but this will still not be
enough. Also, dental care is not at the forefront of
priorities; people just don’t access much routine
dental care, just as with basic health care. Need to
educate parents on [the] importance of routine
dental care and how to qualify for service, help them
register and enroll.”
(executive director, health foundation)
Behaviors that may lead to poor oral health
include tobacco use, excessive alcohol consumption, and poor dietary choices. Barriers
that prevent or limit a person’s use of
preventive intervention and treatments for oral health include limited access to and availability of dental services,
a lack of awareness of the need, cost, and fear of dental procedures. Social factors associated with poor dental
health include lower levels or lack of education, having a disability, and other health conditions such as diabetes.2
 Oral health indicators include the percentage of adults aged 18 and older who self-report that six or more
of their permanent teeth have been removed as a result of decay, gum disease, or infection, an indication
of lack of access to dental care and/or social barriers to the utilization of dental services.
 Los Angeles County and the KFH-WLA service area had the same rate of adults with poor dental health
(11.6%), which was slightly higher than the statewide rate of 11.27% and lower than the national rate of
15.57%.
 Poor oral health was more common among Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%)
populations.
 Hispanic/Latino youth (or children) were the largest portion (8.3%) among youth who are unable to afford
dental care and had not had a dental exam (49.3%).
 Hispanic/Latino youth (8.3%) were more unable to afford dental care than Whites (2.95).
 Stakeholders3 identified Latinos, children, and adults as the most severely impacted.
 Stakeholders identified South Los Angeles as the most severely impacted.
 Poor dental health is linked to several health factors, including poverty, soft drink expenditures, and dental care affordability. Oral health and dental care was identified by community stakeholders in two out of
six focus groups and seven out of 22 interviews.
 Oral health was identified as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 97
Statistical data—How is oral health measured? What is the prevalence/incidence rate of oral health in the
community?
 In 2010, the portion of adults with
poor dental health was the same
(11.6%) when compared to Los
Angeles County.
Oral Health Indicators
KFHWLA
Service
Indicators
Year
Area
Poor dental health (adults)
2010
11.6%
Comparison
Level
LAC
Avg.
11.6%
Sub-populations experiencing greatest
impact (disparities)
Within the KFH-WLA service area, the following sub-populations are
the most severely impacted:
 Poor oral health was more common among the Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%)
populations.
 Hispanic/Latino youth (or children) were the largest portion
(8.3%) among youth who are unable to afford dental care and
had not had a dental exam (49.3%).
 Hispanic/Latino youth (8.3%) were more unable to afford dental care than Whites (2.95)
“Dental care is a challenge for lowincome adults because they are so
wrapped up in day-to-day survival
that they don’t get routine care.
Dental care is just not a priority;
they are more driven by immediate
need for care services, not
preventative services. They care for
their kids before themselves.”
(health care professional,
community clinic)
Stakeholders identified Latinos, children, and adults as the most
severely impacted.
Communities experiencing the highest
disparities are widespread (see maps):
Children and Teens Unable to Afford Dental Care, CHIS 2007
Over 10.0%
 The portion of children and teens
that was unable to afford dental
care ranges between 6.1% and
8.0%.
8.1 - 10.0%
6.1 - 8.0%
4.1 - 6.0%
Under 4.1%
Page 98
 Throughout the service area at least
37% of adults had no dental insurance
in the past year.
Adults Without Dental Insurance for the Past Year, CHIS 2007
Over 40.0%
37.1 - 40.0%
34.1 - 37.0%
31.1 - 34.0%
Under 31.0%
 At least 30% of adults (over 18) in
the service area went without a
dental exam in the past year.
Population (Age 18) without Dental Exam within Past Year,
CDC BRFSS 2006-2010
Over 50.0%
40.1 - 50.0%
30.1 - 40.0%
20.1 - 30.0%
Under 20.1%
 More than 10% of teens in the
service area went without a dental
exam in the past year.
Teens Without Dental Exam in Past Year, by Region, CHIS
2007
Over 20.0%
15.1 - 20.0%
10.1 - 15.0%
5.1 - 10.0%
Under 5.1%
Associated drivers and risk factors—What is driving the high rates of poor oral health in the community?
Poor oral health can be prevented by decreasing sugar intake and eating well to prevent tooth decay and premature
tooth loss; eating more fruits and vegetables to protect against oral cancer; smoking cessation; decreased alcohol
consumption to reduce the risk of oral cancers, periodontal disease, and tooth loss; using protective gear when
playing sports; and living in a safe physical environment.4 The table below includes drivers that did not meet the
indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison
Page 99
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
persons
Comparison
Level
Avg.
2010
2010
2010
19.6
1,129.6
142.0
CA
CA
LAC
15.6
367.1
147.1
2009
2010
2010
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
2010
18.3
CA
9.5
CA
1.7%
LAC
72.5
LAC
LAC
LAC
15.7%
22.4%
38.2%
LAC
LAC
LAC
65.5%
10.5%
6.2%
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
BEHAVIORAL
2011
1.7%
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
Unable to afford food
2009
42.2%
CLINICAL CARE
2009
51.2%
Children who have never seen a dentist
2009
13.2%
Children and teens who can’t afford dental care
2007
6.3%
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
2011
80.6
1
Page 100
Community input—What do community stakeholders think about the issue of oral health?
Stakeholders attributed poor oral health to a lack of access to dental services and the high cost of dental services.
“People rarely seek out dental care if they don’t
have private insurance. Most uninsured people
probably get dental care at annual health fairs.
Drew University and USC dental students
provide services at health fairs.”
(assistant professor, university)
“People don’t have and can’t get dental care.
Even the pro bono dental services at USC are
hard to get. People can wait a year to get an
appointment.”
(city employee, City of Inglewood)
Sample of oral health–specific community assets:
 AIDS Project Los Angeles
 Los Angeles County Department of Health Services
 South Bay Family Health Care Center
 The Children's Dental Center of Greater Los Angeles
 The Saban Free Clinic – Beverly Health Center
 University of California Los Angeles (UCLA) School of Dentistry

University of Southern California (USC) Herman Ostrow School of Dentistry
 Challengers Boys and Girls Club
Stakeholders identified the following community resources available to address oral health:
 Charles Drew University of Medicine and Science—community resource for oral health care; dental students provide services
 Oasis at King-Harbor Campus—community resource for dental care for patients with HIV
 University of Southern California (USC)—community resource for oral health care; dental students provide services
 Watts Health Care Corporation—community resource for dental care; offers translation services in dental
clinic
Assessment report.
Page 101
1
2
Ibid.
3
4
World Health Organization, Oral health Fact sheet. Geneva, Switzerland. Available at
[http://www.who.int/mediacentre/factsheets/fs318/en/index.html]. Accessed [February 26, 2013].
Page 102
Health Need Profile: Hypertension
About Hypertension—Why is it important?
Hypertension, defined as a blood pressure reading of 140/90 or higher, affects one in three adults in the United
States.1 With no symptoms or warning signs, the condition has been called a silent killer that can cause serious
damage throughout the body. High blood pressure, if untreated, can lead to heart failure, blood vessel aneurysms,
kidney failure, heart attack, stroke, and vision changes or blindness.2 High blood pressure can be controlled
through medicines and lifestyle changes. However, a significant barrier to controlling high blood pressure is
patient adherence to treatment regimens.3
High blood pressure is associated with smoking, obesity, eating salt and fat regularly, excessive drinking, and
physical inactivity. Those who are at higher risk of developing hypertension are people who have had a stroke
previously, have a high level of cholesterol, or have heart or kidney disease. African-Americans and people with a
family history of hypertension have an increased risk for hypertension.4
 A higher portion (28.5%) was diagnosed with high blood pressure when compared to Los Angeles
County (25.5%).
 More were diagnosed with high blood pressure in SPA 6 (34.1%), SPA 8 (29.8%), and SPA 4 (26.0%)
than in Los Angeles County (25.5%).
 Hypertension is indicated by high blood pressure and was identified as a health issue by stakeholders in
four out of 22 interviews and two out of six focus groups.
 Stakeholders5 identified Latinos, African-Americans, the uninsured and underinsured, low-income people, and the homeless as the most severely impacted.
 Hypertension and high blood pressure were identified as health needs in the 2010 KFH-WLA Community
Statistical data—How is hypertension measured? What is the prevalence/incidence rate of hypertension in the
community?
 In 2009, a higher portion (28.5%) was
diagnosed with high blood pressure when
(25.5%).
Indicators
High blood pressure
diagnoses
Hypertension Indicators
KFH-WLA
Service
Year
Area
Page 103
2009
28.5%
Comparison
Level
Avg.
LAC
25.5%
Secondary data for hypertension disparities among sub-populations were not available on the Kaiser Permanente
CHNA data platform.
Stakeholders identified Latinos, African-Americans, the uninsured and underinsured, low-income people, and the
homeless as the most severely impacted.
 More were diagnosed with high blood pressure in SPA 6 (34.1%), SPA 8 (29.8%), and SPA 4 (26.0%)
than in Los Angeles County (25.5%).
Associated drivers and risk factors—What is driving the high rates of hypertension in the community?
Smoking, obesity, eating salt and fat regularly, drinking excessively, and physical inactivity are risk factors for
hypertension. People who have had a stroke previously, have a high level of cholesterol, or have heart or kidney
disease are at higher risk of developing hypertension. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Hypertension
Obesity/Overweight
Comparison
Level
Avg.
2010
2010
2010
19.6
1,129.9
142.0
CA
CA
LAC
15.6
367.1
147.1
2009
28.5%
LAC
25.5%
2009
22.5%
2009
31.3%
BEHAVIORAL
2010
45.0%
2009
42.2%
2011
1.7%
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
CLINICAL CARE
2009
51.2%
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
LAC
LAC
21.2%
29.7
CA
LAC
CA
37.5%
38.2%
1.7%
LAC
72.5
LAC
LAC
15.7%
22.4%
LAC
65.5%
LAC
LAC
CA
11.6%
7.5%
53.2%
Page 104
Indicators
Year
2011
KFH-WLA
Service Area
80.6
Comparison
Level
Avg.
LAC
80.7
1
Community input—What do community stakeholders think about the issue of hypertension?
Stakeholders attributed hypertension to a lack of regular medical appointments and access to health care, the high
cost of treatment, and stress. Stakeholders also indicated a connection between hypertension and diabetes, obesity,
and high cholesterol.
Assets—What are some examples of
community assets that can address the
health need?
“Hypertension is becoming more common because people
are not getting it checked, are not aware they have it, and
are not going to the doctor on a regular basis. In addition,
as the population ages, it is more common
to have higher blood pressure.”
(foundation relations director, national health association)
Numerous assets and resources are
available to respond to health needs within
a given community, including health care
facilities, community organizations, and
public agencies. The following list includes assets that have been identified as specifically addressing this health
need and/or key drivers related to this health need through various sources including KFH-WLA community partners. Where available, a sampling of community assets specifically highlighted by stakeholders during interviews
and/or focus groups is noted as well.
Sample of hypertension-specific community assets:
 American Heart Association
 Food & Nutrition Management Systems: BE WELL Program
 Wellington Square Farmers Market
Stakeholders identified the following community resources available to address hypertension:
 Watts Health Care Corporation—provides health promotion classes on diet, diabetes, and hypertension;
provides a podiatrist four days a week and wound care for diabetes-related foot conditions
Assessment report.
1
National Institutes of Health. Hypertension (High Blood Pressure). Available at
[http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=97]. Accessed [March 12, 2013].
Page 105
2
National Heart, Lung, and Blood Institute. Blood Pressure: Signs & Symptoms. Available at [http://www.nhlbi.nih.gov/health/healthtopics/topics/hbp/signs.html]. Accessed [March 12, 2013].
3
National Institutes of Health. Hypertension (High Blood Pressure). Available at
[http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=97]. Accessed [March 12, 2013].
4
The Patient Education Institute. Essential Hypertension. Available at
[http://www.nlm.nih.gov/medlineplus/tutorials/hypertension/hp039105.pdf]. Accessed [March 12, 2013].
5
Page 106
Health Need Profile: Cancer
About Cancer—Why is it important?
Cancer is the second leading cause of death in the United States, claiming the lives of more than half a million
Americans every year.1 Cancer incidence rates per 100,000 people show that the three most common cancers
among American men are prostate cancer (137.7), lung cancer (78.2), and colorectal cancer (49.2). Likewise, the
leading causes of cancer death among men are lung cancer (62.0), prostate cancer (22.0), and colorectal cancer
(19.1). Among women, the three most common cancers are breast cancer (123.1), lung cancer (54.1), and colorectal cancer (37.1). Lung (38.6), breast (22.2), and colorectal (13.1) cancers are also the leading causes of cancerrelated deaths among women.2
Medical advances have allowed the number of new cancer cases to be reduced, and many cancer deaths can be
prevented. Research indicates that screening for cervical and colorectal cancers, as recommended, helps to
prevent these diseases by finding and treating precancerous lesions to prevent them from becoming cancerous.
Screening for cervical, colorectal, and breast cancers also helps to find these diseases at an early, often highly
treatable stage.3 The most common risk factors for cancer are growing older, obesity, tobacco, alcohol, sunlight,
certain chemicals, some viruses and bacteria, a family history of cancer, poor diet, and lack of physical activity. 4
Cancer is associated with access to health care, obesity, heavy alcohol consumption, and specific cancers (breast,
cervical, etc.).
 Stakeholders5 identified Latinos, African-Americans, low-income persons, and the aging population as
the most impacted.
 Stakeholders attributed the prevalence of cancer to a lack of access to screenings and a general lack of
access to health care.
 Cancer is associated with access to health care, obesity, heavy alcohol consumption, and specific cancers
(breast, cervical, etc.).
 Cancer is recognized as a leading cause of death in the United States.
 Community stakeholders in three out of 22 interviews and three out of six focus groups identified cancer
as a major health issue.
 Cancer mortality was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 107
Statistical data—How is cancer measured? What is the prevalence/incidence rate of cancer in the community?
 In 2010, the cancer mortality rate
per 100,000 persons was slightly
lower (154.5) when compared to
Los Angeles County (156.5).
Sub-populations experiencing greatest
impact (disparities)
Indicators
Cancer mortality rate per
100,000 persons1
Cancer Indicators
KFH-WLA
Service
Year
Area
2010
154.5
Comparison
Level
Avg.
LAC
156.5
1
Healthy People = <=106.6
Secondary data for cancer disparities among sub-populations were not available on the Kaiser Permanente CHNA
data platform or other secondary sources.
Stakeholders identified Latinos, African-Americans, low-income persons, and the aging population as the most
impacted.
Secondary data for cancer geographic disparities were not available on the Kaiser Permanente CHNA data platform or other secondary sources.
Stakeholders did not indicate geographic disparities.
Associated drivers and risk factors—What is driving the high rates of cancer in the community?
A primary method of cancer prevention is screening for cervical, colorectal, and breast cancers.6 The most common risk factors for cancer are growing older, obesity, tobacco, alcohol, sunlight exposure, certain chemicals,
some viruses and bacteria, a family history of cancer, poor diet, and lack of physical activity.7 The table below
includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison area/benchmark. For data on additional indicators please refer to the KFHWLA Scorecard in Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Cervical Cancer
Cervical cancer rate per 100,000 women1
2009
9.8
Cervical cancer mortality rate per 100,000 women2
2008
9.5
Colorectal Cancer
Colorectal cancer incidence rate per 100,000 persons3
2009
45.2
Colorectal mortality rate per 100,000 persons (age-adjusted)
2008
13.5
Obesity/Overweight
2009
22.5%
2009
31.3%
BEHAVIORAL
2011
1.7%
2010
45.0%
2009
42.2%
Page 108
Comparison
Level
Avg.
LAC
LAC
9.9
3.0
LAC
LAC
45.2
11.2
LAC
LAC
21.2%
29.7%
CA
CA
LAC
1.7%
37.5%
38.2%
KFH-WLA
Year
Service Area
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
CLINICAL CARE
2009
51.2%
Women screened for cervical cancer in last 3 years4
2010
67.6%
Women screened for cervical cancer in last 3 years
2007
86.3%
Adults 50 years and older who received a sigmoidoscopy,
2009
66.5%
colonoscopy in last 5 years5
Adults 50 years and older who received a sigmoidoscopy,
2009
75.2%
colonoscopy or fecal occult blood test
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
2011
80.6
Indicators
Comparison
Level
Avg.
LAC
72.5
LAC
LAC
15.7%
22.4%
LAC
LAC
LAC
65.5%
67.6%
84.4%
LAC
65.5%
LAC
75.7%
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
1
2
3
4
Healthy People 2020 = >=93%
5
Healthy People 2020 = >=70.5%
Community input—What do community stakeholders think about the issue of cancer?
Stakeholders attributed the prevalence of cancer to a lack of access to screenings and a general lack of access to
health care.
Cancer-specific community assets:
 American Cancer Society
 Camp Kesem National
 Cedars-Sinai Medical Center
 Navigating Cancer Survivorship
 PADRES Contra El Cancer
Page 109
 Team Survivor Los Angeles
Stakeholders did not identify community assets specific to cancer.
Assessment report.
1
Centers for Disease Control and Prevention. Using Science to Reduce the Burden of Cancer. Available at
[http://www.cdc.gov/Features/CancerResearch/]. Accessed [March 7, 2013].
2
Centers for Disease Control and Prevention. United States Cancer Statistics (USCS). Available at
[http://www.cdc.gov/Features/CancerStatistics/]. Accessed [March 7, 2013].
3
Centers for Disease Control and Prevention. Cancer Prevention. Available at [http://www.cdc.gov/cancer/dcpc/prevention/index.htm].
4
National Cancer Institute. Risk Factors. Available at [http://www.cancer.gov/cancertopics/wyntk/cancer/page3]. Accessed [March 7,
2013].
5
6
Centers for Disease Control and Prevention. Cancer Prevention. Available at [http://www.cdc.gov/cancer/dcpc/prevention/index.htm].
7
National Cancer Institute. Risk Factors. Available at [http://www.cancer.gov/cancertopics/wyntk/cancer/page3]. Accessed [March 7,
2013].
Page 110
Health Need Profile: Cholesterol
About Cholesterol—Why is it important?
Cholesterol is a waxy, fat-like substance needed in the body. However, too much cholesterol in the blood can
build up on the walls of the arteries, which can lead to heart disease—one of the leading causes of death in the
United States—and stroke. About one of every six adult Americans has high cholesterol. In addition, 2,200
Americans die of heart disease each day, an average of one death every 39 seconds.1
Some health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for developing high
cholesterol. Age is a contributing factor, as is diabetes. Some behaviors that can lead to high cholesterol include a
diet high in saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. Being overweight and
physical inactivity can also contribute to high cholesterol. Finally, high cholesterol can be hereditary.2
 The percent of adults who take medicine to lower cholesterol was slightly lower in the KFH-WLA
(69.8%) compared to Los Angeles County (71.2%),
 More adults take medicine to control cholesterol in SPA 5 (75.8%) and SPA 6 (78.3%) when compared to
Los Angeles County.
 Stakeholders3 identified Latinos, African-Americans, low-income persons, and uninsured populations as
the most impacted.
 Stakeholders attribute high cholesterol to poor eating habits, living in a food desert with no access to
healthy food options, and lack of access to health care. Stakeholders linked cholesterol to obesity, diabetes, and hypertension.
 Cholesterol was identified in two of 22 interviews and three of six focus groups.
 Cholesterol was not identified as a health need in the 2010 KFH-WLA Health Needs Assessment.
Statistical data—How is cholesterol measured? What is the prevalence/incidence rate of cholesterol in the
community?
 In 2009, slightly fewer (69.8%)
adults were taking medication to
lower their cholesterol when compared to Los Angeles County
(70.5%).
Indicators
Adults taking medication
to lower cholesterol
Cholesterol Indicators
KFH-WLA
Service
Year
Area
2009
69.8%
Comparison
Level
Avg.
LAC
71.2%
Secondary data for cholesterol disparities among sub-populations were not available on the Kaiser Permanente
CHNA data platform or other secondary sources.
Page 111
Stakeholders identified Latinos, African-Americans, low-income persons, and uninsured populations as the most
impacted.
 More adults were taking medication to lower their cholesterol in SPA 6 (78.3%) and SPA 5 (75.8%) when
compared to Los Angeles County (71.2%).
Associated drivers and risk factors—What is driving the high rates of cholesterol in the community?
Some health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for developing high
cholesterol. Age is a contributing factor; as people get older, cholesterol levels rise. Diabetes can also lead to the
development of high cholesterol. Behaviors that can lead to high cholesterol include a diet high in saturated fats,
trans fatty acids (trans fats), dietary cholesterol, or triglycerides. Being overweight and physical inactivity can
also contribute to high cholesterol. Finally, high cholesterol can be hereditary.4 The table below includes drivers
that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than
the comparison area/benchmark. For data on additional indicators please refer to the KFH-WLA Scorecard in
Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
2010
19.6
2010
1,129.9
2010
142.0
Diabetes
2010
200.2
2010
11.1
Uncontrolled diabetes hospitalizations per 100,000 persons
2010
18.3
Obesity/Overweight
2009
22.5%
2009
31.3%
BEHAVIORAL
2011
1.7%
2010
45.0%
2009
42.2%
2009
79.1
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
CLINICAL CARE
2009
51.2%
Page 112
Comparison
Level
Avg.
CA
CA
LAC
15.6
367.1
147.1
LAC
LAC
LAC
145.6
9.7
9.5
LAC
LAC
21.2%
29.7%
CA
CA
LAC
1.7%
37.5%
38.2%
LAC
72.5
LAC
LAC
15.7%
22.4%
LAC
65.5%
Indicators
KFH-WLA
Year
Service Area
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
2011
80.6
Comparison
Level
Avg.
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
1
Community input—What do community stakeholders think about the issue of cholesterol?
Stakeholders attributed high cholesterol to poor eating habits, living in a food desert with no access to healthy
food options, and lack of access to health care. Stakeholders linked cholesterol to obesity, diabetes, and hypertension.
Sample of cholesterol-specific community assets:
 American Heart Association
 Food and nutrition management systems—BE WELL Program
 Kaiser Foundation Hospital, West Los Angeles
 Let’sMove! West LA
 Model Neighborhood Program/La Cienega Farmer’s Market
Stakeholders did not identify community assets specific to cholesterol.
Assessment report.
1
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. High Cholesterol. Atlanta, GA.
Available at [http://www.cdc.gov/cholesterol/index.htm]. Accessed [March 4, 2013].
2
Ibid.
3
4
Ibid.
Page 113
Health Need Profile: Intentional Injury
About Intentional Injury—Why is it important?
Intentional injuries and violence are widespread in society and are among the top 15 causes of death of Americans
of all ages. Injuries are the leading cause of death for Americans ages one to 44, and a leading cause of disability
for all ages, regardless of sex, race/ethnicity, or socioeconomic status. More than 180,000 people die from intentional injuries each year, and approximately one in 10 sustains a nonfatal injury serious enough to be treated in a
hospital emergency department. Beyond the immediate health consequences, injuries and violence have a significant impact on the well-being of Americans by contributing to premature death, disability, poor mental health,
high medical costs, and lost productivity.1 In addition, violence erodes communities by reducing productivity,
decreasing property values, and disrupting social services.2
 Intentional injury is defined as homicide or suicide; homicide is a measure of community safety and a
leading cause of premature death.
 The homicide rate for the KFH-WLA service area was 12.4 per 100,000 persons, notably higher than the
Los Angeles County rate of 7.0 and the statewide rate of 5.15.
 The 2008 homicide rates in SPA 6 (24.5) and SPA 8 (16.6) were higher than the KFH-WLA service area
average of 13.7 at that time.
 Community stakeholders noted adult males and women with children as impacted populations. Intentional
injury is associated with several health factors, including poverty rate, degree of education, heavy alcohol
consumption, and violent crime.
 Homicide was identified as a health issue by community stakeholders in one out of 22 interviews and one
out of six focus groups. Intentional injury/homicide was identified as a health need in the 2010 KFHWLA Community Health Needs Assessment.
Statistical data—How is intentional injury measured? What is the prevalence/incidence rate of intentional injury
in the community?
 In 2010, the homicide rate per
100,000 persons was higher
(13.7) when compared to Los
Angeles County (8.4).
Intentional Injury Indicators
KFH-WLA
Service
Indicators
Year
Area
Homicide rate per 100,000 persons
2008
13.7
Homicide rate per 100,000 persons
2010
12.4
Healthy People 2020: <=5.5
 In 2008, the homicide rate per
100,000 persons was higher (12.4) when compared to Los Angeles County (7.0).
Page 114
Comparison
Level
LAC
LAC
Avg.
8.4
7.0
 In Los Angeles County, homicide rates were highest among African-Americans (25.2).
Stakeholders identified youth, specifically minority youth, as the most severely impacted.
Communities experiencing the
highest disparities include (see
map):
Homicide Mortality, Rate (Per 100,000 Pop.), CDPH, 2008–10
Over 12.0
 Homicide rates were highest (over 12.0 homicides
per 100,000 persons) in the
easternmost part of the
including Los Angeles—
South Los Angeles,
Crenshaw, Leimert Park,
Baldwin Park, Park Mesa
Heights, Ladera Heights,
View Park-Windsor Hills,
Westmont, and West
Athens—and Inglewood.
6.1 - 12.0
3.1 - 6.0
Under 3.1
No Homicide
Deaths
Data Suppressed
or No Data
 In Los Angeles, ZIP Codes 90047 (43.5), 90044 (40.1), 90008 (29.6), 90018 (29.6), 90062 (24.3), 90056
(22.3), 90043 (15.1), and 90016 (12.7) experienced high rates of homicides per 100,000 persons.
 In Inglewood, rates were over 12.0 homicides per 100,000 population throughout the city, but the rate was
particularly high in ZIP Code 90305 (41.2).
 The homicide rate per 100,000 persons was highest in SPA 6 (24.5), SPA 8 (16.6), and SPA 5 (8.8).
Associated drivers and risk factors—What is driving the high rates of intentional injury in the community?
Factors associated with intentional injuries include high-risk behaviors such as alcohol use, risk-taking, socializing in unsafe and violent physical environments, as well as economic factors including poverty and unemployment.3 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA
service area is performing worse than the comparison area/ benchmark. For data on additional indicators please
refer to the KFH-WLA Scorecard in Appendix D.
Page 115
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Alcohol- and drug-induced mental disease hospitalizations
2010
per 100,000 adults
BEHAVIORAL
2011
2009
SOCIAL AND ECONOMIC
2010
2010
High school graduation rate1
2009
Unemployment rate
2012
Comparison
Level
Avg.
480.0
CA
109.1
1.7%
42.2%
CA
LAC
1.7%
38.2%
16.6%
24.2%
72.9
10.4%
LAC
LAC
CA
LAC
15.7%
22.4%
82.3
10.3%
1
Healthy People 2020 = >82.4
Community input—What do community stakeholders think about the issue of intentional injuries?
Stakeholders identified violence, including homicide and teen suicide, as issues. Stakeholders also identified a
connection to schools and mental health, including post-traumatic stress syndrome (PTSD), trauma, depression,
and anxiety.
Sample of intentional injury community assets:
 Centinela Youth Services
 Century Center for Economic Opportunity (CCEO)
 Children's Institute, Inc.
 Healthy African American Families
 Homies Unidos, Inc.
 Los Angeles Conservation Corps
 Los Angeles Metropolitan Medical Center, Los Angeles Campus
 Loved Ones of Homicide Victims
 Midnight Mission – Family Housing Program – Inglewood
 Open Paths and Open Paths Counseling Center
Page 116
Stakeholders did not identify community assets specific to intentional injuries.
Assessment report.
1
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=24]. Accessed [March 6, 2013].
2
Centers for Disease Control and Prevention. Injury Center: Violence Prevention. Atlanta, GA. Available at
[http://www.cdc.gov/ViolencePrevention/index.html]. Accessed [March 6, 2013].
3
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=24]. Accessed [March 6, 2013].
Page 117
Health Need Profile: Cervical Cancer
About Cervical Cancer—Why is it important?
Cervical cancer is a disease in which cells in the cervix—the lower, narrow end of the uterus connecting the
vagina (the birth canal) to the upper part of the uterus1—grow out of control. All women are at risk for cervical
cancer, which occurs most often in women over the age of 30. Each year, approximately 12,000 women in the
United States are diagnosed with cervical cancer. The human papillomavirus (HPV), a common virus that is
passed from one person to another during sex, is the main cause of cervical cancer. At least half of sexually active
people will have HPV at some point in their lives, but fortunately, fewer women will get cervical cancer2.
Most adults have been infected with HPV at some time in their lives, though most infections clear up on their
own. An HPV infection that doesn’t go away can cause cervical cancer in some women. Other risk factors, such
as smoking, can increase the risk of cervical cancer among women infected with HPV. A woman’s risk of cervical
cancer can be reduced by having regular cervical cancer screening tests. Cervical cancer can be prevented, if
abnormal cervical cell changes are found early on, by removing or destroying the cells before they become
cancerous. Women can also reduce the risk of cervical cancer by getting an HPV vaccine before becoming sexually active (between the ages of 9 and 26). Even women who have had an HPV vaccine need regular cervical cancer screening tests.3
 In 2009, the cervical cancer rate per 100,000 women (9.8) did not meet the Healthy People 2020 goal
(<=7.1).
 In 2008, the cervical cancer mortality rate per 100,000 women (9.5) did not meet the Healthy People 2020
goal (<=2.2).
 The cervical cancer mortality rate per 100,000 women was much higher in SPA 4 (11.8), SPA 6 (10.0),
SPA 5 (8.5), and SPA 8 (7.6) when compared to Los Angeles County (3.0).
 Stakeholders4 identified South Los Angeles as the most severely impacted.
 Cervical cancer was identified as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 118
Statistical data—How is cervical cancer measured? What is the prevalence/incidence rate of cervical cancer in
the community?
 In 2009, the cervical cancer rate per
100,000 women (9.8) did not meet the
Healthy People 2020 goal (<=7.1).
 In 2008, the cervical cancer mortality
rate per 100,000 women (9.5) did not
meet the Healthy People 2020 goal
(<=2.2).
Cervical Cancer Indicators
KFH-WLA
Service
Indicators
Year
Area
Cervical cancer incidence
2009
9.8
rate per 100,000 women1
Cervical cancer mortality
2008
9.5
rate per 100,000 women2
Comparison
Level
Avg.
LAC
9.9
LAC
3.0
1
Healthy People 2020 target= <=7.1
2
Healthy People 2020 target= <=2.2
 Cervical cancer–related hospital discharge rates were higher among the Hispanic/Latino population
(13.1), White population (10.2), and Asian population (9.1).
Stakeholders identified low-income women and the aging population as the most severely impacted.
Communities experiencing the highest disparities
include (see map):
Age Adjusted Rate (Per 100,000 Pop.), NCI 2005-2009
Over 12.0
 Cervical cancer prevalence was generally
widespread across the KFH-WLA service
area, with rates ranging between 9.1 and
10.0.
10.1 - 12.0
8.1 - 10.0
6.1 - 8.0
By Service Planning Area (SPA), the following
disparities were found:
Under 6.0
 The cervical cancer mortality rate per
100,000 women was much higher in SPA 4 (11.8), SPA 6 (10.0), SPA 5 (8.5), and SPA 8 (7.6) when
compared to Los Angeles County (3.0).
Associated drivers and risk factors—What is driving the high rates of cervical cancer in the community?
Factors associated with cervical cancer include the common sexually transmitted human papillomavirus virus
(HPV), smoking, having HIV or other conditions that cause the immune system to weaken, using birth control
pills for an extended period of time (five or more years), and having given birth to three or more children5. The
table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service
area is performing worse than the comparison area/benchmark. For data on additional indicators please refer to
the KFH-WLA Scorecard in Appendix D.
Page 119
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
HIV/AIDS
HIV prevalence per 100,000 persons
HIV hospitalizations per 100,000 persons
HIV hospitalizations per 100,000 persons
2010
2011
2010
SOCIAL AND ECONOMIC
2010
2010
CLINICAL CARE
Women screened for cervical cancer in last 3 years1
2010
Women screened for cervical cancer in last 3 years
2007
ACCESS TO CARE
2009
2009
2012
2011
Comparison
Level
Avg.
21.8
3.4
35.0
LAC
LAC
CA
14.0
2.2
11.0
16.6%
24.2%
LAC
LAC
15.7%
22.4%
67.6%
86.3%
LAC
LAC
67.6%
84.4%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
1
Healthy People 2020 = >=93%
Community input—What do community stakeholders think about the issue of cervical cancer?
Stakeholders attributed the prevalence of cervical cancer to a lack of access to preventive health care and a lack of
education around cervical cancer.
Numerous assets and resources are available to respond to health needs within a community, including health care
facilities, community organizations and public agencies. The following list includes assets that have been identified as specifically addressing this health need and/or key drivers related to this health need through various
sources including KFH-WLA community partners. Where available, a sampling of community assets specifically
highlighted by stakeholders, during interviews and/or focus groups, is noted as well.
Sample of cervical cancer–specific community assets:
 Planned Parenthood Los Angeles
 South Bay Family Healthcare Center- Inglewood
 UMMA Community Clinic
Stakeholders did not identify community assets specific to cervical cancer.
Page 120
Assessment report.
1
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Cervical Cancer Fact Sheet. Washington,
DC. Available at [http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf]. Accessed [March 4, 2013].
2
Ibid.
3
National Institutes of Health. National Cancer Institute. What you need to know about Cervical Cancer booklet. Bethesda, MD. Available
at [http://www.cancer.gov/cancertopics/wyntk/cervix/page4]. Accessed [March 4, 2013].
4
5
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Cervical Cancer Fact Sheet. Washington,
DC. Available at [http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf]. Accessed [March 4, 2013].
Page 121
Health Need Profile: Asthma
About Asthma—Why is it important?
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of children. Adults
also may suffer from asthma, and the condition is considered hereditary. In most cases, the causes of asthma are
not known, and no cure has been identified. Although asthma is always present in those with the condition,
attacks occur only when the lungs are irritated. Asthma symptoms include wheezing, breathlessness, chest tightness, and coughing. Some asthma triggers include tobacco smoke, dust mites, outdoor air pollution, cockroach
allergen, pet dander, mold, smoke, other allergens, and certain infections known to cause asthma such as the flu,
colds, and respiratory-related viruses. Other contributing factors include exercising, certain medication, bad
weather, high humidity, cold/dry air, and certain foods and fragrances.1
 The asthma hospitalization rate per 10,000 adult admissions was higher (10.0) when compared to Los
 The asthma hospitalizations per 100,000 adults were higher (129.3) when compared to Los Angeles
County (94.3).
 Los Angeles and Inglewood experienced high rates of asthma related hospital discharges.
 Females (1.0%) experienced more asthma related hospital discharges than males (0.9%).
 African-Americans (1.5%) experienced more asthma related hospital discharges.
 Individuals between the ages of one and 19 (4.4%) experienced the most asthma related hospital discharges.
 Asthma hospitalization rates per 100,000 persons were higher in SPA 6 (215.3) and SPA 8 (145.8) when
 Stakeholders2 attributed asthma to smoking, poor air quality, and other environmental factors including
pesticides and chemicals. Stakeholders also mentioned that language was a barrier to access health
services.
 Stakeholders identified youth and adults as the most severely impacted.
 Asthma was mentioned as a major health issue in two out of seven focus groups and four out of 22 interviews and was identified as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 122
Statistical data—How is asthma measured? What is the prevalence/incidence rate of asthma in the community?
 In 2010, the asthma hospitalization
rate per 10,000 admissions was
higher (10.0) when compared to
 In 2010, the asthma hospitalizations per 100,000 adults were
higher (129.3) when compared to
Asthma Indicators
KFH-WLA
Service
Indicators
Year
Area
Asthma prevalence (teens)
2010
11.1%
Asthma hospitalization
2010
10.0
rate per 10,000 admissions
2010
129.3
rate per 100,000 adults
2010
17.0
rate per 10,000 children
Comparison
Level
LAC
Avg.
11.1%
LAC
7.7
LAC
94.3
LAC
19.2
 Females (1.0%) experienced more asthma-related hospital discharges than males (0.9%).
 African-Americans (1.5%) experienced more asthma-related hospital discharges.
 Individuals between the ages of one and 19 (4.4%) experienced the most asthma-related hospital
discharges.
Stakeholders identified youth and adults as the most severely impacted.
 Los Angeles and Inglewood
experienced high rates of
asthma-related hospital discharges.
Asthma Discharge Rate (Per 10,000 Pop.), OSHPD, 2010-11
Over 14.00
10.01 - 14.00
 In Los Angeles, several areas
had high rates of asthma-related
hospital discharges per 10,000
persons, including ZIP Codes
90044 (23.3), 90047 (23.2),
90018 (18.4), 90043 (17.6),
90062 (17.4), 90016 (16.4), and
90008 (14.5).
6.01 - 10.00
2.01 - 6.00
Under 2.0
 In Inglewood, ZIP Codes 90301
(19.0) and 90303 (15.6) experienced high rates of asthma-related hospital discharges per 10,000 persons.
 Asthma hospitalization rates per 100,000 persons were higher in SPA 6 (215.3) and SPA 8 (145.8) when
Page 123
Stakeholders did not identify any geographic areas.
Associated drivers and risk factors—What is driving the high rates of asthma in the community?
Many allergens are also asthma triggers that irritate the lungs, inducing an asthma attack. Allergic reactions are
known to be caused by pollen, dust, food, insect stings, animal dander, mold, medications, and latex.3 Other social
and economic factors have been known to cause or trigger allergic reactions, including poverty, which leads to
poor housing conditions (living with cockroaches, mites, asbestos, mold etc.). Living in an environment or home
with smokers has also been known to exacerbate allergies and/or asthma. The table below includes drivers that
did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the
comparison area/benchmark. For data on additional indicators please refer to the KFH-WLA Scorecard in
Appendix D.
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Indicators
Allergies
Teen with allergies
2007
SOCIAL AND ECONOMIC
2010
2010
ACCESS TO CARE
2009
2009
2012
2011
Comparison
Level
Avg.
27.1%
LAC
24.9%
16.6%
24.2%
LAC
LAC
15.7%
22.4%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
1
Community input—What do community stakeholders think about the issue of asthma?
Stakeholders attributed asthma to smoking, poor air
quality, and other environmental factors, including
pesticides and chemicals. Stakeholders also mentioned
that language was a barrier to access health services.
“The location of schools near freeways causes
students to have higher asthma incidences.”
(community leaders focus group participant)
Sample of asthma-specific community assets:
 American Lung Association (ALA)
 Asthma & Allergy Foundation of America - California Chapter
 Asthma Coalition of Los Angeles County (ACLAC)
Page 124
 BREATHE California of Los Angeles County
Stakeholders did not identify community assets specific to asthma.
Assessment report.
1
Centers for Disease Control and Prevention (CDC). Asthma-Basic Information. Atlanta, GA. Available at
[http://www.cdc.gov/asthma/faqs.htm]. Accessed [March 1, 2013].
2
3
American Academy of Allergy Asthma and Immunology. Allergies. Landover, MD. Available at [http://www.aafa.org/display.cfm?id=9].
Page 125
Health Need Profile: Breast Cancer
About Breast Cancer—Why is it important?
In the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancerrelated death in women. Each year, a small number of men also are diagnosed with and die from breast cancer.
The overall breast cancer death rate has dropped steadily over the past 20 years. However, approximately $16.5
billion is spent in the United States each year on breast cancer treatment.1
The incidence of breast cancer is highest in white women for most age groups, but African-American women
have higher incidence rates before 40 years of age and higher breast cancer mortality rates than women of any
other racial/ethnic groups in the United States at every age. The gap in mortality between African-American and
white women is wider now than in the early 1990s.2
Risk factors for breast cancer include older age, certain inherited genetic alterations, hormone therapy, chest
radiation therapy, alcohol consumption, and obesity. Exercise and maintaining a healthy weight may reduce the
risk of breast cancer.3 Mammograms and clinical breast exams are commonly used to screen for breast cancer.
 The annual rate of incidence of females with breast cancer was 117.9 per 100,000 women in Los Angeles
County and in the KFH-WLA service area. This was lower than the statewide rate of 123.3 per 100,000.
 Within the KFH-WLA service area, African-Americans (123.0) and Whites (121.4) had the highest breast
cancer rates when compared with Asians (97.2), Hispanic/Latinas (84.6) and American Indian/Alaskan
Natives (30.1).
 The breast cancer rates for all four of these racial and ethnic groups were lower than the statewide and
nationwide rates.
 Stakeholders4 indicated South Los Angeles is the most impacted.
 Stakeholders cited the lack of access to preventive care and health care in general as contributing factors
to breast cancer.
 Stakeholders added that there is a need for education around breast cancer.
 Breast cancer is associated with overall cancer mortality, breast cancer screening, obesity, and heavy
alcohol consumption.
 Community stakeholders in two out of 22 interviews and one out of six focus groups identified breast
cancer as a major health issue.
 Breast cancer was identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 126
Statistical data—How is breast cancer measured? What is the prevalence/incidence rate of breast cancer in the
community?
 In 2009, the annual rate of
incidence of females with breast
cancer was 117.9 per 100,000
persons in Los Angeles County
and in the KFH-WLA service
area.
Breast Cancer Indicators
KFHWLA
Service
Indicators
Year
Area
Breast cancer incidence per
2009
117.9
100,000 persons
Comparison
Level
Avg.
LAC
117.9
 Within the KFH-WLA service area, African-Americans (123.0) and Whites (121.4) had the highest breast
cancer rates compared with Asians (97.2), Hispanic/Latinas (84.6) and American Indian/Alaskan Natives
(30.1).
 The breast cancer rates for all four of these groups were lower than the statewide and nationwide rates.
Secondary data for breast cancer geographic disparities were not available on the Kaiser Permanente CHNA data
platform or other secondary sources.
Associated drivers and risk factors—What is driving the high rates of breast cancer in the community?
Risk factors for breast cancer include older age, certain inherited genetic alterations, hormone therapy, having
radiation therapy to the chest, heavy alcohol consumption, and obesity.5 Breast cancer is associated with overall
cancer mortality and access to breast cancer screening. Getting exercise and maintaining a healthy weight may
reduce the chance of getting breast cancer. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison area/benchmark. For
data on additional indicators please refer to the KFH-WLA Scorecard in Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Other Cancers
Cervical cancer incidence rate per 100,000 persons1
Colon/rectum cancer incidence rate per 100,000 persons
Colon/rectum mortality per 100,000 persons (age-adjusted)
Obesity/Overweight
Comparison
Level
Avg.
2009
2009
2008
9.8
45.2
13.5
LAC
LAC
LAC
9.9
45.2
11.2
2009
2009
22.5%
31.3%
LAC
LAC
21.2%
29.7%
Page 127
Indicators
Year
BEHAVIORAL
2011
2010
KFH-WLA
Service Area
1.70%
45.0%
Comparison
Level
Avg.
CA
CA
1.68%
37.5%
CA = California
1
2
Community input—What do community stakeholders think about the issue of breast cancer?
Stakeholders cited the lack of access to preventive care and health care in general as contributing factors of breast
cancer. Stakeholders added that there is a need for education around breast cancer.
Numerous assets and resources are available to
“There is an increase in death rates from breast
respond to health needs within a given commucancer
and an increase in incidences. We… (provide)
nity, including health care facilities, community
200 mammograms per month. We also have an
organizations, and public agencies. The followoutreach program for this.”
ing list includes assets that have been identified
(health care professional, community clinic)
as specifically addressing this health need and/or
key drivers related to this health need through
Sample of breast cancer–specific community assets:
 Inner Images
 Susan G. Komen for the Cure - Los Angeles County Affiliate
 The Saban Free Clinic
 UCLA Medical Center and Orthopedic Hospital - Santa Monica
 UMMA Community Clinic
 Women of Color Breast Cancer Survivors Support Project
 YWCA Santa Monica – Encore Program
Stakeholders identified the following community resources available to address breast cancer:
 Watts Health Care Corporation—a mobile mammography unit provides monthly screenings
Assessment report.
Page 128
1
National Cancer Institute. A Snapshot of Breast Cancer. Available at [http://www.cancer.gov/researchandfunding/snapshots/pdf/BreastSnapshot.pdf]. Accessed [March 6, 2013].
2
Ibid.
3
National Cancer Institute. Breast Cancer: Prevention, Genetics, Causes. Available at [http://www.cancer.gov/cancertopics/preventiongenetics-causes/breast]. Accessed [March 6, 2013].
4
5
National Cancer Institute. Breast Cancer: Prevention, Genetics, Causes. Available at [http://www.cancer.gov/cancertopics/preventiongenetics-causes/breast]. Accessed [March 6, 2013].
Page 129
Health Need Profile: HIV/AIDS
About HIV/AIDS—Why is it important?
More than 1.1 million people in the United States are living with HIV, and almost one in five (18.1%) are
unaware of their infection.1 HIV infection weakens the immune system, making those living with the infection
highly susceptible to a variety of illnesses and cancers, including tuberculosis (TB), cytomegalovirus (CMV),
cryptococcal meningitis, lymphomas, kidney disease, and cardiovascular disease.2 Without treatment, almost all
people infected with HIV will develop AIDS.3 While HIV is a chronic medical condition that can be treated, it
cannot yet be cured.
The risk of acquiring HIV is increased by engaging in unprotected sex, having another sexually transmitted infection, sharing intravenous drugs, having been diagnosed with hepatitis, tuberculosis, or malaria, exchanging sex for
drugs or money, and having been exposed to the virus as a fetus or infant before or during birth, or through
breastfeeding from a mother infected with HIV.4 Racial disparities in HIV prevalence persist; African-Americans
and Hispanics/Latinos are disproportionately affected by HIV and experience the most severe burdens compared
with other races and ethnicities in the United States. Prevention efforts encompass many components, such as
behavioral interventions, HIV testing, and linkage to treatment and care.5
 The KFH-WLA service area has an HIV prevalence rate of 480.3 per 100,000 persons, close to the Los
Angeles County rate of 480.4 and notably higher than the statewide rate of 345.5 and the national rate of
334 per 100,000 persons.
 The HIV hospitalization rate of 3.4 per 1,000 persons in the KFH-WLA service area was higher than the
Los Angeles County rate of 2.2.
 More males (0.6%) in the KFH-WLA service area were discharged from hospitals for HIV-related complications than females (0.1%).
 By race, a larger proportion of African-Americans (0.4%) experienced hospital discharges resulting from
HIV than other racial groups in the KFH-WLA service area.
 By age group, those between the ages of 20 and 44 (0.5%) and 45 and 64 (0.7%) experienced the most
hospitalizations resulting from HIV compared to other age groups.
 High rates of HIV hospital discharges (over 3.0) were concentrated in the eastern side of the KFH-WLA
service area, from West Hollywood (15.2) in the north through south Los Angeles, to Westmont (4.0) in
the south.
 A high discharge rate was also found in the downtown Santa Monica area (7.5).
 The HIV prevalence rate per 100,000 persons was much higher in SPA 4 (46.0) compared with Los
 The HIV hospitalizations rate per 100,000 persons was higher in SPA 4 (60.5) and SPA 6 (48.5) compared to statewide (35.0).
Page 130
 Stakeholders6 identified the aging population, low-income people, and those in the AB109 re-entry of
non-violent offenders as the most impacted.
 Stakeholders identified South Los Angeles as the most impacted.
 Stakeholders indicated positive trends with HIV/AIDS, including more people getting tested, becoming
educated, and obtaining medication. However, stakeholders also noted some challenges, including
transportation, access to healthy food, and a lack of education about sexual health.
 Stakeholders noted links between HIV/AIDS and the sex trade and drug use, and also with the dual-diagnosed aging population.
 HIV was associated with numerous other health factors, including poverty, heavy alcohol consumption,
and access to/use of HIV screenings.
 Stakeholders identified HIV as a major health need in two out of 22 interviews.
 HIV was also a health need in the 2010 KFH-WLA Community Health Needs Assessment.
Statistical data—How is HIV/AIDS measured? What is the prevalence/incidence rate of HIV/AIDS in the
community?
 In 2010, the HIV prevalence
rate per 100,000 persons
(21.8) was higher compared
with Los Angeles County
(14.0).
 In 2010, the HIV
100,000 persons was higher
(35.0) compared with
statewide (11.0).
HIV/AIDS Indicators
KFH-WLA
Service
Indicators
Year
Area
HIV prevalence per 100,000
2008
480.3
persons
HIV prevalence per 100,000
2010
21.8
persons
HIV hospitalizations rate per
2011
2.8
10,000 persons (age-adjusted)
HIV hospitalizations rate per
2010
35.0
100,000 persons
Comparison
Level
Avg.
LAC
480.4
LAC
14.0
LAC
2.8
CA
11.0
CA = California
 More males (0.6%) were discharged from hospitals for HIV-related complications than females (0.1%).
 By race, a larger proportion of African-Americans (0.4%) experienced hospital discharges resulting from
HIV than other racial groups.
 Hispanic/Latinos made up 0.2%, compared with 0.3% of non-Hispanics, of those patients hospitalized as
a result of HIV-related illnesses.
 By age group, those between the ages of 20 and 44 (0.5%) and 45 and 64 (0.7%) experienced the most
hospitalizations resulting from HIV compared to other age groups.
Stakeholders identified the aging population, low-income people, and those in the AB109 re-entry of non-violent
offenders as the most impacted.
Page 131
 High rates of HIV hospital discharges (over 3.0) were concentrated in the eastern side of the
KFH-WLA service area, from
West Hollywood (15.2) in the
north through south Los Angeles,
to Westmont (4.0) in the south.
HIV Discharge Rate (Per 10,000 Pop.), By ZCTA, OSHPD, 2010–11
Over 3.00
2.01 - 3.00
1.01 - 2.00
Under 1.01
 A high discharge rate was also
found in the downtown Santa
Monica area (7.5).
No Hospitalizations
 The HIV prevalence rate per 100,000 persons was much higher in SPA 4 (46.0) compared with Los
 The HIV hospitalization rate per 100,000 persons was higher in SPA 4 (60.5) and SPA 6 (48.5) compared
to statewide (35.0).
Associated drivers and risk factors—What is driving the high rates of HIV/AIDS in the community?
The following factors are associated with HIV/AIDS: injection drug use, risky sexual behaviors,7 poverty, heavy
alcohol consumption, liquor store access, and HIV screenings. HIV prevalence is highest among gay, bisexual,
and other men who have sex with men, and among African-Americans.8
Untreated HIV infection is associated with many diseases, including cardiovascular disease, kidney disease, liver
disease, and cancer.9 Persons with HIV infections are disproportionately affected by viral hepatitis, and those coinfected with HIV and viral hepatitis experience greater liver-related health problems than those who do not have
the HIV infection.10 The table below includes drivers that did not meet the indicated benchmark, indicating that
the KFH-WLA service area is performing worse than the comparison area/benchmark. For data on additional
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Cancers
Cervical cancer incidence rate per 100,000 persons1
Cervical cancer mortality rate per 100,000 persons (ageadjusted)2
Colorectal cancer incidence rate per 100,000 person3
Colorectal cancer mortality rate per 100,000 person (ageadjusted)
Comparison
Level
Avg.
2009
9.8
LAC
9.9
2008
9.5
LAC
3.0
2009
45.2
LAC
45.2
2008
13.5
LAC
11.2
Page 132
Indicators
Heart disease hospitalization per 100,000 persons
Year
2010
2010
2010
BEHAVIORAL
KFH-WLA
Service Area
19.6
1129.9
142.0
Comparison
Level
Avg.
CA
15.6
CA
367.1
LAC
147.1
SOCIAL AND ECONOMIC
2010
Living below 100% of FPL (children and teens)
2010
ACCESS TO CARE
2009
2009
2012
2011
16.6%
24.2%
LAC
LAC
15.7%
22.4%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
CA = California
1
2
3
4
Community input—What do community stakeholders think about the issue of HIV/AIDS?
Stakeholders indicated positive trends with HIV/AIDS, including more people getting tested, becoming educated,
and obtaining medication. However, stakeholders also noted some challenges, including transportation, access to
healthy food, and a lack of education about sexual health. Stakeholders also noted links between HIV/AIDS and
the sex trade and drug use, and also with the dualdiagnosed aging population.
“AIDS has become a chronic illness—people
Assets—What are some examples of community assets
that can address the health need?
are living longer due to better medications,
and developing secondary illnesses.”
(grant writer, community-based organization)
Numerous assets and resources are available to respond to
health needs within a given community, including health care facilities, community organizations, and public
agencies. The following list includes assets that have been identified as specifically addressing this health need
and/or key drivers related to this health need through various sources including KFH-WLA community partners.
Where available, a sampling of community assets specifically highlighted by stakeholders during interviews
and/or focus groups is noted as well.
Sample of HIV/AIDS-specific community assets:
 AIDS Project Los Angeles (APLA)
 Asian American Drug Abuse Program
 Alliance for Housing and Healing
 Being Alive
 Charles Drew University - Community Mobilization Project
Page 133
 Common Ground - The Westside HIV Community Center
 In the Meantime Men’s Group
 Los Angeles Jewish AIDS Services
 Minority AIDS Project
Stakeholders identified the following community resources available to address HIV/AIDS:
 AIDS Drug Assistance Program (ADAP)—insurance program for no/low-cost HIV medications
 Oasis at King-Harbor Campus—community resource for dental care for patients with HIV
 Project Angel Food—provides access to healthy food; gives people the nutrition they need to fight disease
(HIV/AIDS); provides registered dieticians to conduct nutritional counseling
 Watts Health Care Corporation—provides HIV testing and information
Assessment report.
1
Centers for Disease Control and Prevention. Drug-Associated HIV Transmission Continues in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/idu.htm]. Accessed [February 28, 2013].
2
Mayo Clinic. Complications. Available at [http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=complications]. Accessed
[March 1, 2013].
3
National Institutes of Health, HIV Infection. Available at [http://www.nlm.nih.gov/medlineplus/ency/article/000602.htm]. Accessed
[March 1, 2013].
4
National Institute of Allergy and Infectious Diseases. HIV Risk Factors. Available at
[http://www.niaid.nih.gov/topics/hivaids/understanding/pages/riskfactors.aspx]. Accessed [March 6, 2013].
5
Centers for Disease Control and Prevention. CDC’s HIV Prevention Progress in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/cdcprev.htm]. Accessed [February 28, 2013].
6
leaders among others.
7
Centers for Disease Control and Prevention. Drug-Associated HIV Transmission Continues in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/idu.htm]. Accessed [February 28, 2013].
8
Centers for Disease Control and Prevention, HIV in the United States: At A Glance. Available at
[http://www.cdc.gov/hiv/resources/factsheets/us.htm]. Accessed [February 28, 2013].
9
Centers for Disease Control and Prevention. Basic Information about HIV and AIDS. Available at
[http://www.cdc.gov/hiv/topics/basic/index.htm]. Accessed [March 1, 2013].
10
Centers for Disease Control and Prevention. HIV and Viral Hepatitis. Available at
[http://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm]. Accessed [March 1, 2013].
Page 134
Health Need Profile: Vision
About Vision—Why is it important?
People with diabetes are at an increased risk of vision problems, as diabetes can damage the blood vessels of the
eye, potentially leading to blindness. Diabetics are 40% more likely to suffer from glaucoma and 60% more likely
to develop cataracts compared to people without diabetes. People who have had diabetes for a long time or whose
blood glucose or blood pressure is not under control are also at risk of developing retinopathy.1 These kinds of
vision impairment cannot be corrected with glasses and typically require laser therapy or surgery.2 Vision loss
also makes it difficult for people to live independently.
As diabetes rates continue to rise among all age groups, vision complications tied to the disease are expected to
increase as well. Vision care providers should expect to see more complications in the younger population as
more children and adolescents are diagnosed with diabetes.3
Many eye problems are not evident until they are quite advanced, but early detection and treatment can be effective in saving vision. For example, screening for people with diabetes can almost completely eliminate diabetesrelated blindness. However, only about half of diabetics in the United States currently get regular eye exams.4
 The percent of diabetic adults who had their vision checked within the last year was lower in the KFHWLA service area (57.6%) compared to Los Angeles County (63.3%),
 The percent of diabetic adults who had their vision checked within the last year was lower in SPA 4
(37.3%).
 Stakeholders5 identified Latinos, African-Americans, and children as the most impacted.
 Stakeholders indicated a lack of access to specialty care and primary care.
 Diabetes-related vision problems are linked to the length of time one has had diabetes, high blood glucose, and high blood pressure.
 Vision was identified a major health issue in two out of 22 interviews and two out of six focus groups.
 Vision was not identified as a need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 135
Statistical data—How is vision measured? What is the prevalence/incidence rate of vision issues in the
community?
 In 2009, the percent of diabetic
adults who had their vision
checked within the last year was
lower (57.6%) compared to Los
Vision Indicators
KFHWLA
Service
Indicators
Year
Area
Eye examination by diabetic
2009
57.6%
adults (in last year)
Comparison
Level
Avg.
LAC
63.3%
Secondary data for vision disparities among sub-populations were not available on the Kaiser Permanente CHNA
data platform or other secondary sources.
Stakeholders identified Latinos, African-Americans, and children as the most severely impacted.
 Fewer diabetic adults in SPA 4 (37.3%) had had an eye examination in the last year compared to Los
Associated drivers and risk factors—What is driving the high rates of vision problems in the community?
Diabetes-related vision problems are linked to the length of time one has had diabetes, high blood glucose, and
high blood pressure. The table below includes drivers that did not meet the indicated benchmark, indicating that
the KFH-WLA service area is performing worse than the comparison area/ benchmark. For data on additional
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
2009
2010
2010
2010
persons
Hypertension
2009
ACCESS TO CARE
2009
2009
2012
2011
CA = California
Page 136
Comparison
Level
Avg.
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
18.3
CA
9.5
28.5%
LAC
25.5%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
Community input—What do community stakeholders think about the issue of vision?
Stakeholders linked poor vision to a lack of access to specialty care and primary care.
Sample of vision-specific community assets:
 Braille Institute
 Center for the Partially Sighted
 Southside Coalition of Community Health Centers
 UMMA (University Muslim Medical Association) Community Clinic
 Venice Family Clinic
Stakeholders identified the following community resources available to address vision issues:
 MLK Multi-Service Ambulatory Care Center—provides ophthalmology services, especially related to
diabetes
 Vision to Learn—community resource for free vision screenings and eyeglasses
Assessment report.
1
American Diabetes Association. Living with Diabetes. Available at [http://www.diabetes.org/living-with-diabetes/complications/menshealth/serious-health-implications/blindness-or-vision-problems.html]. Accessed [March 5, 2013].
2
Genevra Pittman, Vision Loss Tied to Diabetes on the Rise. Available at [http://www.reuters.com/article/2012/12/11/us-diabetes-visionloss-idUSBRE8BA1AP20121211]. Accessed [March 5, 2013].
3
Ibid.
4
Ibid.
5
Page 137
Health Need Profile: Alcohol and Substance Abuse
About Alcohol and Substance Abuse—Why is it important?
Alcohol and substance abuse has a major impact on individuals, families, and communities. The effects of
substance abuse significantly contribute to costly social, physical, mental, and public health problems, including
teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse, motor vehicle accidents (unintentional
injuries), physical fights, crime, homicide, and suicide. In addition to the considerable health implications,
substance abuse has been a major focal point in discussions about social values: people argue over whether
substance abuse is a disease with genetic and biological foundations or a matter of personal choice.1 Heavy
alcohol consumption is an important determinant of future health needs, including cirrhosis, cancers, and
untreated mental and behavioral health needs.
Alcohol and substance abuse is defined as adults (age 18 and older) who self-report heavy alcohol consumption.
 The alcohol/drug-induced mental disease hospitalization rate in the KFH-WLA service area was 480.0 per
100,000 persons, which was notably higher than the state average of 109.1.
 While the KFH-WLA average rate of hospitalization was 480.0, the rate in SPA 5 was significantly
higher, at 1,549.9 per 100,000 persons.
 Stakeholders2 identified the homeless, low-income and working-class people, and youth as the most
impacted.
 Stakeholders identified South Los Angeles as being the most impacted.
 Stakeholders attributed alcohol and substance abuse to poverty and a lack of access to health care—
specifically, smoking cessation programs and treatment. Stakeholders also cited a close link between substance abuse and mental illness.
 Heavy alcohol consumption is relevant as a behavior and determinant of future health conditions that
include cirrhosis, cancers, and untreated mental and behavioral health issues.
 Alcoholism was identified as a major concern in four out of 22 interviews and one out of six focus
groups.
 Alcohol and substance abuse was not indicated as an area of major need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 138
Statistical data—How is alcohol and substance abuse measured? What is the prevalence/incidence rate of alcohol
and substance abuse in the community?
 In 2010, the alcohol/druginduced mental disease
hospitalization rate in the
KFH-WLA service area was
480.0 per 100,000 adults,
higher than Los Angeles
County (109.1).
Alcohol and Substance Abuse Indicators
KFH-WLA
Comparison
Service
Indicators
Year
Area
Level
Avg.
Alcohol- and drug-induced
mental disease hospitalizations
2010
480.0
LAC
109.1
per 100,000 adults
Secondary data around disparities and sub-populations in relation to alcohol and substance abuse were not available on the Kaiser Permanente CHNA data platform or other secondary sources.
Stakeholders identified the homeless, low-income and working-class people, and youth as the most severely
impacted.
 Alcoholic beverage
expenditures were
highest in the northernmost part of Westwood and in the
Westchester area
(80th percentile).
Ranked Alcoholic Beverage Expenditures (Pct. of Total Expenditures
per Household), Nielsen Site Reports 2011
Top 80th Percentile
(Highest Expenditures)
60th - 80th Percentile
By Service Planning Area
(SPA), the following disparities were found:
 The alcohol- and
Bottom 20th Percentile
drug-induced mental
(Lowest Expenditures)
disease hospitalization rate was much
higher in SPA 5 (1,549.9 per 100,000 adults) when compared to the overall KFH-WLA service area
(480.0).
Stakeholders identified South Los Angeles as being the most impacted.
Associated drivers and risk factors—What is driving the high rates of alcohol and substance abuse in the
community?
Several biological, social, environmental, psychological, and genetic factors are associated with substance abuse
(including alcohol and drug use). These can include gender, race and ethnicity, age, income level, educational
Page 139
attainment, and sexual orientation. Substance abuse is also strongly influenced by interpersonal, household, and
community contexts. Family, social networks, and peer pressure are key influencers of substance abuse among
adolescents.3 As mentioned previously, teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse,
motor vehicle accidents (unintentional injuries), physical fights, crime, homicide (intentional injuries), and suicide
can be attributed to alcohol and substance abuse.4 The table below includes drivers that did not meet the indicated
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Indicators
HIV/AIDS
Rate of HIV hospitalizations per 100,000 persons
Rate of HIV prevalence per 100,00 persons
Intentional Injury
Homicide rate per 100,000 persons1
Homicide rate per 100,000 persons1
Suicide rate per 100,000 persons2
Unemployment rate
2010
2010
2010
2008
2010
BEHAVIORAL
2010
SOCIAL AND ECONOMIC
2009
2010
2010
2012
Comparison
Level
Avg.
35.0
21.8
CA
LAC
11.0
14.0
12.4
13.7
8.7
LAC
LAC
LAC
7.0
8.4
8.0
45.0%
CA
37.5%
72.9
16.6%
24.2%
10.4%
CA
LAC
LAC
LAC
82.3
15.7%
22.4%
10.3%
CA = California
1
2
3
Community input—What do community stakeholders think about the issue of alcohol and substance abuse?
Stakeholders attributed alcohol and
substance abuse to poverty and lack of
access to health care—specifically,
smoking cessation programs and treatment.
Stakeholders also cited a close link between
substance abuse and mental illness.
“Drinking and doing drugs results from stress as a result of
the economy [and] losing jobs and homes.” (lead case
manager, community-based organization)
Sample of alcohol/substance abuse–specific community assets:
 American Health Services - El Dorado Community Service Centers
Page 140
 Asian American Drug Abuse Program
 Community Coalition For Substance Abuse Prevention and Treatment
 Los Angeles County Department of Public Health - Substance Abuse Prevention & Control
 SHARE! The Self-Help and Recovery Exchange
Stakeholders identified the following community resources available to address alcohol and substance abuse:
 Didi Hirsch Mental Health Services—community resource for care
Assessment report.
1
2
3
DC. Available at [http://www.healthypeople.gov/2020/lhi/substanceabuse.aspx?tab=determinants]. Accessed [February 27, 2013].
4
Page 141
Health Need Profile: Colorectal Cancer
About Colorectal Cancer—Why is it important?
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading cause of cancerrelated deaths in the United States and is expected to cause about 50,830 deaths during 2013. The lifetime risk of
developing colorectal cancer is about one in 20 (5.1%), with the risk being slightly lower for women than in men.1
In addition, colorectal cancer is associated with overall cancer mortality, heavy alcohol consumption, obesity, and
diabetes prevalence.
The number of new colorectal cancer cases and the number of deaths from colorectal cancer are decreasing. The
likely causes are regular screenings and improved treatment. Regular screenings can often detect colorectal cancer
early on, when the disease is most likely to be curable. Screenings can also find polyps, which can be removed
before turning into cancer.2 As a result, there are now more than one million survivors of colorectal cancer in the
United States.3
Given the success of colorectal cancer screening, public health organizations are working to increase awareness of
these screenings among the general public and health care providers. Currently, only about half of Americans ages
50 or older have had any colorectal cancer screening.4
 The annual incidence rate of colon and rectum cancer in the KFH-WLA service area was 45.2 individuals
per 100,000 persons, which was the same as the Los Angeles County rate. However, these rates were
above the statewide rate of 43.7 and the national rate of 40.2.
 The KFH-WLA service area average rate for colon/rectum mortality, age-adjusted per 100,000 persons,
was 13.5, which was higher than the Los Angeles County rate of 11.5.
 African-Americans (59.7) residing in the KFH-WLA service area had the highest colorectal cancer incidence rate compared to the other racial groups.
 The colorectal mortality rate was significantly higher in SPA 5 (17.6), SPA 6 (15.4), and SPA 8 (12.7).
 High rates of colorectal cancer are associated with overall cancer mortality, heavy alcohol consumption,
obesity, diabetes prevalence, and colon cancer screening.
 Colorectal cancer was mentioned as a major health issue in one out of 22 interviews with stakeholders5
and was identified as a health need in the 2010 KFH-WLA Community Health Needs Assessment.
Page 142
Statistical data—How is colorectal cancer measured? What is the prevalence/incidence rate of colorectal cancer
in the community?
 In 2009, the colorectal cancer
mortality rate per 100,000
persons was higher (13.5)
when compared to Los
Colorectal Cancer Indicators
KFH-WLA
Service
Indicators
Year
Area
Colorectal cancer mortality rate
2008
13.5
per 100,000 pop. (age-adjusted)
Colorectal cancer incidence per
2009
45.2
100,000 pop.1
Comparison
Level
Avg.
LAC
11.2
LAC
45.2
 In 2009, the colorectal
1
incidence rate per 100,000
persons (45.2) did not meet
the Healthy People 2020 goal (<=38.6).
 African-Americans (59.7) had the highest incidence rate compared to the other racial groups.
 Whites (44.8) and Asians (44.0) had rates that were closest to the KFH-WLA service area rate, whereas
Hispanic/Latinos had an incidence rate of 35.4.
Stakeholders did not identify sub-population disparities.
By Service Planning Area (SPA), the following disparity was found:
 The colon and rectum cancer mortality rate per 100,000 persons was higher in SPA 5 (17.6) and SPA 6
(15.4) when compared to the overall KFH-WLA service area (13.5).
Associated drivers and risk factors—What is driving the high rates of colorectal cancer in the community?
The major factors that can increase the risk of colorectal cancer are increasing age and a family history of colorectal cancer. Other less significant factors include a personal history of inflammatory bowel disease, inherited risk,
heavy alcohol use, cigarette smoking, obesity, diabetes prevalence, and colon cancer screening.6 Regular physical
activity and diets high in vegetables, fruits, and whole grains have been linked with a decreased incidence of
colorectal cancer.7 The table below includes drivers that did not meet the indicated benchmark, indicating that the
KFH-WLA service area is performing worse than the comparison area/benchmark. For data on additional
Page 143
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
persons
Obese/Overweight
Comparison
Level
Avg.
2009
2010
2010
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
2010
18.3
CA
9.5
22.5%
31.3%
LAC
LAC
21.2%
29.7%
45.0%
CA
37.5%
66.5%
LAC
65.5%
75.2%
LAC
75.7%
2009
2009
BEHAVIORAL
2010
CLINICAL CARE
Adults 50 years or older who had a sigmoidoscopy or
2009
colonoscopy in the last 5 years1
Adults 50 years or older who had a sigmoidoscopy,
2009
colonoscopy, or fecal occult blood test
1
Healthy People 2020 = >=70.5%
Community input—What do community stakeholders think about the issue of colorectal cancer?
Stakeholders mentioned colorectal cancer as an issue, but did not make links to drivers or other health issues.
health care facilities, community organizations and public agencies. The following list includes assets that have
Sample of colorectal cancer–specific community assets:
 Crohn's & Colitis Foundation of America - Greater Los Angeles Chapter
 Navigating Cancer Survivorship
 UCLA Colorectal Cancer Treatment Program
Stakeholders did not identify community assets specific to colorectal cancer.
Assessment report.
Page 144
1
American Cancer Society. Colorectal Cancer. Available at
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics]. Accessed [March 4, 2013].
2
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-detection]. Accessed [March 4, 2013].
3
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics]. Accessed [March 4, 2013].
4
Ibid.
5
6
National Cancer Institute. Colorectal Cancer Prevention. Available at
[http://www.cancer.gov/cancertopics/pdq/prevention/colorectal/Patient/page3#Keypoint4]. Accessed [March 4, 2013].
7
American Cancer Society. Colorectal Cancer. Available at Available at
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors]. Accessed [March 4, 2013].
Page 145
Health Need Profile: Chlamydia
About Chlamydia—Why is it important?
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. In 2011,
1,412,791 cases of chlamydia were reported to the Centers for Disease Control and Prevention (CDC) from 50
states and the District of Columbia, but an estimated 2.86 million infections occur annually. A large number of
cases are not reported because most people with chlamydia do not have symptoms and do not seek testing.1
Chlamydial infections can lead to serious health problems. In women, untreated infection can cause pelvic
inflammatory disease (PID), permanently damage a woman’s reproductive tract, and lead to long-term pelvic
pain, the inability to become pregnant and potentially deadly ectopic pregnancies. In men, infection sometimes
spreads to the tube that carries sperm from the testis, causing pain and fever and, rarely, affecting male fertility.
Untreated chlamydia may also increase a person’s chances of acquiring or transmitting HIV.2
 The data represents the incidence rate of chlamydia per 100,000 persons and is an indicator of unsafe sex
practices and a measure of poor health status.
 The rate of chlamydia in the KFH-WLA service area was 538.7 per 100,000 persons, which is higher than
the rate for Los Angeles County (455.1).
 The chlamydia rate per 100,000 persons was higher in SPA 6 (969.6) when compared to the overall KFHWLA service area (538.7).
 Stakeholders3 attributed the prevalence of chlamydia to the lack of education around sexual and reproductive health.
 Chlamydia was not identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Statistical data—How is chlamydia measured? What is the prevalence/incidence rate of chlamydia in the
community?
 In 2010, the chlamydia rate was
538.7, which is higher than the
rate for Los Angeles County
(455.1).
Chlamydia Indicators
KFHWLA
Service
Indicators
Year
Area
Chlamydia rate per 100,000
2009
476.3
persons
Chlamydia rate per 100,000
2010
538.7
persons
Page 146
Comparison
Level
Avg.
LAC
476.3
LAC
455.1
Secondary data was not available and stakeholders did not identify disparities among sub-populations.
 The chlamydia rate per 100,000 persons was higher in SPA 6 (969.6) when compared to the overall KFHWLA service area (538.7).
Associated drivers and risk factors—What is driving the high rates of chlamydia in the community?
Chlamydia is associated with other factors, including poverty, heavy alcohol consumption, sexual activity, and
age (young people are at a higher risk of acquiring chlamydia). Untreated chlamydia may increase a person’s
chances of acquiring or transmitting HIV.4 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison area/benchmark. For
data on additional indicators please refer to the KFH-WLA Scorecard in Appendix D.
Indicators
HIV/AIDS
HIV prevalence rate per 100,000 persons
HIV hospitalization rate per 100,000 persons
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
2010
2010
BEHAVIORAL
2011
SOCIAL AND ECONOMIC
2010
2010
Comparison
Level
Avg.
21.8
35.0
LAC
CA
14.0
11.0
1.70%
CA
1.68%
16.6%
24.2%
LAC
LAC
15.7%
22.4%
CA = California
Community input—What do community stakeholders think about the issue of chlamydia?
Stakeholders attributed the prevalence of chlamydia to the lack of education around sexual and reproductive
health.
Sample of chlamydia-specific community assets:
Page 147
 Charles Drew University
 Common Ground - The Westside HIV Community Center
 Los Angeles Urban League – Neighborhoods at Work
 Minority AIDS Project
Stakeholders identified the following community resources available to address chlamydia:
 Watts Health Care Corporation—provides HIV testing and information
Assessment report.
1
Centers for Disease Control and Prevention. Chlamydia Fact Sheet. Available at [http://www.cdc.gov/std/chlamydia/stdfactchlamydia.htm]. Accessed [February 27, 2013].
2
Ibid.
3
4
Centers for Disease Control and Prevention. Chlamydia Fact Sheet. Available at [http://www.cdc.gov/std/chlamydia/stdfactchlamydia.htm]. Accessed [February 27, 2013].
Page 148
Health Need Profile: Alzheimer’s Disease
About Alzheimer’s Disease—Why is it important?
An estimated 5.4 million Americans have Alzheimer’s disease, which is the sixth leading cause of death in the
U.S.1 Alzheimer’s, an irreversible and progressive brain disease, is the most common cause of dementia among
older people. The disease is characterized by the loss of cognitive functioning and ranges in severity from the
mildest stage of minor cognitive impairment to the most severe stage of complete dependence on others to carry
out the simplest tasks of daily living. People with Alzheimer’s disease and other dementias have more hospital
stays, skilled nursing facility stays, and home health care visits than other older people.2
The likely causes of Alzheimer’s disease include some combination of age-related changes in the brain, a family
history of Alzheimer’s, and genetic, environmental, and lifestyle factors. Some data suggest that cardiovascular
disease risk factors (e.g., physical inactivity, high cholesterol, diabetes, smoking, and obesity) and traumatic brain
injury are associated with a higher risk of developing Alzheimer’s disease.3
Currently, there is no cure for Alzheimer’s disease, although treatment can help manage symptoms and slow the
progression of the disease.4 People with Alzheimer’s can experience a significant improvement in quality of life
with active medical management for the disease. Active management includes: “(1) appropriate use of available
treatment options, (2) effective management of coexisting conditions, (3) coordination of care among physicians,
other health care professionals and lay caregivers, (4) participation in activities and adult day care programs and
(5) taking part in support groups and supportive services such as counseling (p. 12).”5
 The rate of mortality resulting from Alzheimer’s disease per 100,000 persons was lower for the KFHWLA (15.7) service area compared to Los Angeles County (17.6).
 Stakeholders6 identified the aging as experiencing the most impact from this disease.
 Stakeholders identified South Los Angeles as being the most impacted.
 Stakeholders stated that the elderly population was isolated and had a difficult time accessing services for
Alzheimer’s disease.
 Alzheimer’s disease was identified as a major health need in three out of 22 interviews and two out of six
focus groups.
 Alzheimer’s disease was not indicated as a major need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 149
Statistical data—How is Alzheimer’s disease measured? What is the prevalence/incidence rate of Alzheimer’s
disease in the community?
 In 2009, the Alzheimer’s disease
mortality rate per 100,000 persons
was lower (15.7) when compared
to Los Angeles County (17.6).
Alzheimer’s Disease Indicators
KFHWLA
Service
Indicators
Year
Area
Alzheimer’s disease mortality
rate per 100,000 persons (age2009
15.7
adjusted)
Comparison
Level
Avg.
LAC
17.6
Secondary data for Alzheimer’s disease disparities among sub-populations were not available on the Kaiser
Permanente CHNA data platform or other secondary sources.
Stakeholders identified that the aging population is most severely impacted.
Secondary data for Alzheimer’s disease geographic disparities were not available on the Kaiser Permanente
Stakeholders identified South Los Angeles as being the most severely impacted.
Associated drivers and risk factors—What is driving the high rates of Alzheimer’s disease in the community?
The greatest risk factor for Alzheimer’s disease is advancing age. Other risk factors include a family history of
Alzheimer’s, genetic mutations, cardiovascular disease risk factors (e.g., physical inactivity, high cholesterol,
diabetes, smoking, and obesity) and traumatic brain injury.7 The table below includes drivers that did not meet the
indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Heart disease hospitalization per 100,000 persons
Diabetes
Diabetes prevalence
persons
Hypertension
Obesity/Overweight
Comparison
Level
Avg.
2010
2010
2010
19.6
1129.9
142.0
CA
CA
LAC
15.6
367.1
147.1
2009
2010
2010
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
2010
18.3
CA
9.5
2009
28.5%
LAC
25.5%
2009
2009
22.5%
31.3%
LAC
LAC
21.2%
29.7%
Page 150
Indicators
Year
BEHAVIORAL
2010
KFH-WLA
Service Area
45.0%
Comparison
Level
Avg.
CA
37.5%
CA = California
1
Community input—What do community stakeholders think about the issue of Alzheimer’s disease?
Stakeholders stated that the elderly population is isolated and has a difficult time accessing services for
Alzheimer’s disease.
Sample of Alzheimer’s disease–specific community assets:
 Alzheimer's Association, California Southland Chapter
 City of Los Angeles Department of Aging
 Los Angeles County Area Agency on Aging
 OPICA Adult Day Care Center Inc.
 The Saban Free Clinic
 WISE and Healthy Aging
Stakeholders did not identify community assets specific to Alzheimer’s disease.
Assessment report.
1
Alzheimer’s Association. 2012 Alzheimer’s Disease Facts and Figures. Available at
[http://www.alz.org/downloads/facts_figures_2012.pdf]. Accessed [March 6, 2013].
2
National Institutes of Health. About Alzheimer’s Disease: Alzheimer’s Basics. Available at
[http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics]. Accessed [March 5, 2013].
3
Page 151
4
National Institutes of Health. About Alzheimer’s Disease: Alzheimer’s Basics. Available at
[http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics]. Accessed [March 5, 2013].
5
6
7
Page 152
Health Need Profile: Unintentional Injury
About Unintentional Injury—Why is it important?
Unintentional injuries include deaths resulting from motor vehicle accidents and from pedestrians being killed in
accidents. Motor vehicle accidents are one of the leading causes of death in the U.S., with more than 2.3 million
adult drivers and passengers treated in emergency departments as a result of injuries motor vehicle crashes in
2009. The economic impact is also notable: the lifetime costs of accident-related deaths and injuries among
drivers and passengers were $70 billion in 2005.1 In 2007, 4,820 pedestrians were killed in traffic accidents in the
United States, and another 118,278 pedestrians were injured. This averages one accident-related pedestrian death
every two hours, and a pedestrian injury every four minutes. Pedestrians are one and a half times more likely than
passenger vehicle occupants to be killed in a car accident on any given trip.2 Populations most at risk are older
adults, children, and drivers and pedestrians who are under the influence of alcohol and drugs.3
 Unintentional injury is defined as a death resulting from a passenger/driver motor vehicle accident or
pedestrian motor vehicle accident, per 100,000 persons.
 The rate of mortality by motor vehicle accident in the KFH-WLA service area was 7.2 per 100,000
persons, which is slightly higher than the Los Angeles County rate of 7.1; both were lower than the
statewide rate of 8.2.
 The Los Angeles County rate of pedestrian motor vehicle fatality (1.5) was similar to the KFH-WLA service area rate of 1.5 per 100,000 persons.
 According to 2008 data, the percent of pedestrians killed by motor vehicles in Los Angeles County was
25.7%, with a slightly higher rate of 25.9% in the KFH-WLA area.
 The percent of pedestrians killed by motor vehicles was slightly higher in SPA 8 at 26.0% and higher still
in SPA 5 at 30.7%.
 Some health factors associated with unintentional injury are poverty, education, walkability, heavy alcohol consumption, and liquor store access.
 Unintentional injury was not identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 153
Statistical data—How is unintentional injury measured? What is the prevalence/incidence rate of unintentional
injury in the community?
 In 2008, slightly more pedestrians
were killed (25.9%) when
(25.7%).
 In 2010, the motor vehicle
mortality rate per 100,000 persons
was slightly higher (7.2) when
compared to countywide (7.1).
Unintentional Injury Indicators
KFH-WLA
Service
Indicators
Year
Area
Pedestrians killed
2008
25.9%
Motor vehicle mortality rate
2010
7.2
per 100,000 persons1
Pedestrian motor vehicle
mortality rate per 100,000
2010
1.5
persons2
Comparison
Level
LAC
Avg.
25.7%
LAC
7.1
LAC
1.5
1
2
Secondary data for unintentional injury geographic disparities were not available on the Kaiser Permanente
Stakeholders4 did not identify disparities among sub-populations.
 Pedestrian motor vehicle accident mortality rates in KFHWLA service area were highest
within ZIP Code 90232 in Culver
City (7.9) and ZIP Code 90303
in Inglewood (8.0).
Pedestrian Motor Vehicle Accident Mortality Rate
(Per 100,000 Pop.), CDPH, 2008–10
Over 6.00
3.01 - 6.00
1.01 - 3.00
Under 1.01
No Pedestrian Motor
Vehicle Deaths
 The percentage of pedestrians
killed was higher in SPA 5
(30.7%) and SPA 8 (26.0%)
when compared to the overall
KFH-WLA service area (25.9%).
No Data or Data
Suppressed
Associated drivers and risk factors—What is driving the high rates of unintentional injury in the community?
Populations most at risk for unintentional injury include older adults, children, and drivers and pedestrians who
are under the influence of alcohol and drugs.5 The table below includes drivers that did not meet the indicated
Page 154
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Alcohol/drug-induced mental disease hospitalization per
100,000 persons
2010
480.0
Comparison
Level
Avg.
CA
109.1
CA = California
Community input—What do community stakeholders think about the issue of unintentional injury?
Stakeholders did not comment on the issue of unintentional injury.
Sample of unintentional injury–specific community assets:
 Healthy Families
 Healthy Way LA
 Los Angeles County Bicycle Coalition
 Los Angeles Walks
 National Health Foundation
Stakeholders did not identify community assets specific to unintentional injuries.
Assessment report.
1
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Motor Vehicle Safety. Atlanta, GA. Available at
[http://www.cdc.gov/motorvehiclesafety/]. Accessed [March 7, 2013].
2
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Pedestrian Safety. Atlanta, GA. Available at
[http://www.cdc.gov/Motorvehiclesafety/Pedestrian_safety/index.html]. Accessed [March 7, 2013].
Page 155
3
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Pedestrian Safety Fact Sheet. Atlanta, GA.
Available at [http://www.cdc.gov/Motorvehiclesafety/Pedestrian_Safety/factsheet.html]. Accessed [March 7, 2013].
4
5
Ibid.
Page 156
Health Need Profile: Podiatry
About Podiatry—Why is it important?
Foot problems can be caused by arthritis, diabetes, cardiovascular disease, foot and ankle injuries, muscle and
tendon problems, skin disorders, toe joint and nerve disorders, and toenail problems.1 With proper detection,
intervention, and care, most foot and ankle problems can be lessened or prevented.
Complications in the feet are a serious issue for the 26 million diabetics living in the United States. In fact, diabetes is the leading cause of non-traumatic lower-limb amputation.2 Foot examinations can reduce amputation rates
by 45 to 85 percent. The American Podiatric Medical Association (APMA) has campaigned to increase foot
health awareness based on the recent study indicating that nearly 90% of Hispanics in the United States with
diabetes or at risk of diabetes have not visited a podiatrist.3
 A larger portion of adults had their feet checked for sores in Los Angeles County (74.3%) compared to
the KFH-WLA service area (70.5%).
 In SPA 5 (81.7%) and SPA 8 (81.2%), the percentage was higher when compared to Los Angeles County.
 Stakeholders4 identified aging African-Americans with diabetes as the most impacted.
 Stakeholders attributed poor foot health to a lack of access to specialty care. Stakeholders added that there
is a need for education around wound care and ingrown toenails, specifically for diabetics.
 Podiatry was identified as a specialty care need by community stakeholders in two out of 22 interviews.
 Podiatry was not identified as a need in the 2010 KFH-WLA Community Health Needs Assessment.
Statistical data—How is podiatry measured? What is the prevalence/incidence rate of podiatry in the
community?
 In 2009, the portion of adults who
had their feet checked for sores
was lower (70.5%) when
(74.3%).
Podiatry Indicators
KFHWLA
Service
Indicators
Year
Area
Podiatric examination inci2009
70.5%
dence
Comparison
Level
Avg.
LAC
74.3%
Secondary data for podiatry disparities among sub-populations were not available on the Kaiser Permanente
Stakeholders identified aging African-Americans with diabetes as the most severely impacted.
Page 157
 More adults in SPA 8 (81.2%) and SPA 5 (81.7%) had their feet checked for sores when compared to the
overall KFH-WLA service area (70.5%).
Associated drivers and risk factors—What is driving the high rates of podiatry in the community?
Foot problems can be caused by arthritis, diabetes and cardiovascular disease, foot and ankle injuries, muscle and
tendon problems, skin disorders, toe joint and nerve disorders, and toenail problems.5 The table below includes
drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is performing worse
than the comparison area/benchmark. For data on additional indicators please refer to the KFH-WLA Scorecard in
Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Cardiovascular disease per 10,000 persons
2010
2010
2010
Diabetes
Diabetes prevalence
2009
2010
2010
2010
persons
Hypertension
2009
CLINICAL CARE
2009
ACCESS TO CARE
2009
2009
2012
2011
Comparison
Level
Avg.
19.6
1129.9
142.0
CA
CA
LAC
15.6
367.1
147.1
19.1%
200.2
11.1
LAC
CA
CA
10.5%
145.6
9.7
18.3
CA
9.5
28.5%
LAC
25.5%
51.2%
LAC
65.5%
12.0%
7.7%
67.3%
80.6
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
CA = California
1
Community input—What do community stakeholders think about the issue of podiatry?
Stakeholders attributed poor foot health to a lack of access to specialty care. Stakeholders added that there is a
need for education around wound care and ingrown toenails, specifically for diabetics.
Page 158
Sample of podiatry-specific community assets:
 American Diabetes Association
 Kaiser Foundation Hospital - West Los Angeles
 St. John’s Well Child and Family Center
 UMMA (University Muslim Medical Association) Community Clinic
 Watts Healthcare Corporation
 WISE & Healthy Aging
Stakeholders identified the following community resources available to address podiatric issues:
 Watts Healthcare Corporation—provides a podiatrist four days a week and wound care for diabetesrelated foot conditions
 MLK Multi-Service Ambulatory Care Center—provides podiatry services, especially related to diabetes
Assessment report.
1
American Podiatric Medical Association. Foot Health. Available at
[http://www.apma.org/learn/FootHealthList.cfm?navItemNumber=498]. Accessed [March 8, 2013].
2
American Podiatric Medical Association. Diabetes Awareness. Available at
[http://www.apma.org/Learn/content.cfm?ItemNumber=1405&navItemNumber=557]. Accessed [March 8, 2013].
3
American Podiatric Medical Association. APMA Diabetes Survey. Available at
[http://www.apma.org/Media/PRDetail.cfm?ItemNumber=4596]. Accessed [March 8, 2013].
4
5
American Podiatric Medical Association. Foot Health. Available at
[http://www.apma.org/learn/FootHealthList.cfm?navItemNumber=498]. Accessed [March 8, 2013].
Page 159
Health Need Profile: Allergies
About Allergies—Why are they important?
Allergies are an overreaction of the immune system to substances that usually cause no reaction in most individuals. These substances can trigger sneezing, wheezing, coughing, and itching. Allergies have been linked to a variety of common and serious chronic respiratory illnesses such as sinusitis and asthma. Factors such as a family history with allergies, the types and frequency of symptoms, seasonality, duration, and even location of symptoms
(indoors or outdoors, for example) are all taken into consideration in allergy diagnoses. Allergic reactions can be
severe and even fatal. With proper management and patient education, allergic diseases can be controlled and people with allergies can lead normal and productive lives.1 Many allergens are also asthma triggers that irritate the
lungs, inducing an asthma attack. Other social and economic factors have been known to cause or trigger allergic
reactions, including poor housing conditions (living with cockroaches, mites, asbestos, mold, etc.). Living in an
environment or home with smokers has also been known to exacerbate allergies and/or asthma.
 Allergies among teens were higher in the KFH-WLA service area (27.1%) compared to Los Angeles
County (24.9%).
 The percent of teens with allergies were also higher in SPA 5 (45.6%) and SPA 8 (29.5%) when compared to Los Angeles County.
 Within the KFH-WLA service area, female teens were diagnosed with allergies (32.8%) more often than
males (16.1%).
 The percentage of female teens in the KFH-WLA service area diagnosed with allergies was higher than
across Los Angeles County (29%) and statewide (27.6%).
 Stakeholders2 indicated that youth and the aging population were the most impacted.
 Stakeholders associated allergies with poor air quality.
 Allergies were identified as a major health concern in three out of 22 interviews. Allergies were not indicated as a major need in the 2010 KFH-WLA Community Health Needs Assessment.
Statistical data—How are allergies measured? What is the prevalence/incidence rate of allergies in the
community?
 In 2007, the portion of teens that
had allergies was higher (25.8%)
when compared to Los Angeles
County (24.9%).
Allergy Indicators
KFHWLA
Service
Indicators
Year
Area
Allergy prevalence (teens)
2007
25.8%
Page 160
Comparison
Level
LAC
Avg.
24.9%
 Within the KFH-WLA service area, female teens were diagnosed with allergies (32.8%) more often than
males (16.1%).
 The percentage of female teens in the KFH-WLA service area diagnosed with allergies was higher than
across Los Angeles County (29%) and statewide (27.6%).
Stakeholders indicated that youth and the aging population were the most severely impacted.
 More teens in SPA 8 (29.5%) and SPA 5 (45.6%) had allergies when compared to the overall KFH-WLA
service area (25.8%).
Stakeholders did not indicate geographic disparities.
Associated drivers and risk factors—What is driving the high rates of allergies in the community?
Allergic reactions are known to be caused by pollen, dust, food, insect stings, animal dander, mold, medications,
and latex.3 Many allergens are also asthma triggers that irritate the lungs, inducing an asthma attack. Social and
economic factors have been known to cause or trigger allergic reactions, including poverty leading to poor housing conditions (living with cockroaches, mites, asbestos, mold, etc.) and living in an environment or home with
smokers. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFHWLA service area is performing worse than the comparison area/benchmark. For data on additional indicators
please refer to the KFH-WLA Scorecard in Appendix D.
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Comparison
Level
Avg.
Asthma
Asthma hospitalizations per 10,000 adults
Asthma hospitalizations per 100,000 persons
2010
10.0
2010
129.3
Days per year with poor air quality
2008
3.6%
SOCIAL AND ECONOMIC
2010
16.6%
2010
24.2%
CA
CA
7.7
94.3
LAC
2.6%
LAC
LAC
15.7%
22.4%
CA = California
Community input—What do community stakeholders think about the issue of allergies?
Stakeholders associated allergies with poor air quality.
Page 161
Sample of allergy-specific community assets:
 American Lung Association
 Asthma & Allergy Foundation of America - California Chapter
 BREATHE California of Los Angeles County
 Worksite Wellness LA
Stakeholders did not identify community assets specific to allergies.
Assessment report.
1
Asthma and Allergy Foundation of America (AAFA). Allergies. Milwaukee, WI. Available at [http://www.aaaai.org/conditions-andtreatments/allergies.aspx]. Accessed [March 1, 2013].
2
3
American Academy of Allergy Asthma and Immunology. Allergies. Landover, MD. Available at [http://www.aafa.org/display.cfm?id=9].
Page 162
Health Need Profile: Arthritis
About Arthritis—Why is it important?
Arthritis affects one in five adults in the United States and continues to be the most common causes of physical
disability. Arthritis costs more than $128 billion per year currently in the United States, and is projected to
increase over time as the population ages. Interventions such as increased physical activity, education about disease self-management, and weight loss among overweight/obese adults can reduce arthritis pain and functional
limitations; however, these resources are underutilized1.
 Stakeholders2 indicated that the aging, specifically Latinos and African-Americans, were the most
impacted.
 Stakeholders associated arthritis with high blood pressure, cholesterol, and heart disease specifically
among the aging population.
 Arthritis was identified as a major health concern in three out of 22 interviews and two out of six focus
groups.
 Arthritis was not indicated as a major need in the 2010 KFH-WLA Community Health Needs
Assessment.
Statistical data—How is arthritis measured? What is the prevalence/incidence rate of arthritis in the community?
Secondary data for arthritis were not available or the data was not current.
Secondary data for arthritis disparities among sub-populations were not available on the Kaiser Permanente
Stakeholders indicated that the aging, specifically Latinos and African-Americans, were the most severely
impacted.
Secondary data was not available for the geographic disparities on the Kaiser Permanente CHNA data platform or
other secondary sources.
Stakeholders did not identify disparities among sub-populations.
Associated drivers and risk factors—What is driving the high rates of arthritis in the community?
Factors associated with arthritis include being overweight or obese, lack of education around self-management
strategies and techniques, and limited or no physical activity.3 The table below includes drivers that did not meet
the indicated benchmark, indicating that the KFH-WLA service area is performing worse than the comparison
Page 163
Indicators
KFH-WLA
Year
Service Area
HEALTH OUTCOMES
Obesity/Overweight
2009
2009
BEHAVIORAL
2010
Comparison
Level
Avg.
22.5%
31.3%
LAC
LAC
21.2%
29.7%
45.0%
CA
37.5%
CA = California
Community input—What do community stakeholders think about the issue of arthritis?
Stakeholders associated arthritis with high blood pressure, cholesterol, and heart disease specifically among the
aging population.
Sample of arthritis-specific community assets:
 Arthritis Foundation - Los Angeles County Office
 City of Culver City Senior Center
 City of Los Angeles Department of Aging
 Los Angeles County Area Agency on Aging
 OPICA Adult Day Care Center Inc.
Stakeholders did not identify community assets specific to arthritis.
Assessment report.
1
2
3
Ibid.
Page 164
Health Need Profile: Infant Mortality
**Overall Ranking: 23 of 23
About Infant Mortality—Why is it important?
Infant mortality remains a concern in the United States: each year, approximately 25,000 infants die before their
first birthday.1 The leading causes of infant death include congenital abnormalities, pre-term/low birth weight,
Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress
syndrome.2
Infant mortality is associated with factors such as maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. Significant disparities exist among racial and ethnic groups that
impact the infant mortality rate. For example, African-Americans had an infant mortality rate of 14.1 deaths per
1,000 live births in the year 2000, which is more than twice the national average of 6.9 deaths per 1,000 live
births.3
The Centers for Disease Control and Prevention (CDC) have set the goal of eliminating disparities among racial
and ethnic groups with infant mortality rates above the national average. The CDC’s prevention strategy focuses
on modifying behaviors, lifestyles, and conditions that affect birth outcomes, such as smoking, substance abuse,
poor nutrition, lack of prenatal care, medical problems, and chronic illness.
 The rate of infants with low birth weights (8.3%) in the KFH-WLA service area was higher than in Los
 The percent of infants with very low birth weights was also higher (1.4% per 1,000 births) than the Los
Angeles County rate of 1.3% per 1,000 births. This rate was slightly higher in SPA 6 (1.6%) and SPA 8
(1.8%).
 The infant mortality rate per 1,000 live births was much higher among African-Americans (11.5) than
Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3).
 Stakeholders4 identify the Latino and African-American populations as particularly impacted by infant
mortality.
 High rates of infant mortality can indicate broader issues such as access to health care, maternal and child
health, poverty, education, teen births, and a lack of insurance and of prenatal care.
 Infant mortality was not identified as a health need in the 2010 KFH-WLA Community Health Needs
Assessment.
Page 165
Statistical data—How is infant mortality measured? What is the prevalence/incidence rate of infant mortality in
the community?
 In 2009, the infant mortality rate
per 1,000 births (5.1) did not meet
the Healthy People 2020 goal
(<=6.0).
 In 2010, the portion of low-birthweight infants (8.3%) was higher
when compared to California
(6.8%).
Infant Mortality Indicators
KFHWLA
Service
Indicators
Year
Area
Infant mortality rate per 1,000
2009
5.1
births1
Low birth weight infants
2010
8.3%
Very low birth weight infants
2010
1.4%
Comparison
Level
Avg.
LAC
5.1
CA
LAC
6.8%
1.3%
CA = California
1
 In 2010, the portion of very-lowbirth-weight infants (1.4%) was slightly higher when compared with Los Angeles County (1.3%)
 The infant mortality rate per 1,000 live births was much higher among African-Americans (11.5) than
Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3).
Stakeholders identified the Latino and African-Americans populations as most severely impacted.
 The portion of very-low-birth-weight infants was higher in SPA 6 (1.6%) and SPA 8 (1.8%) when compared to the overall KFH-WLA service area (1.4%).
Associated drivers and risk factors—What is driving the high rates of infant mortality in the community?
Factors that affect birth outcomes include smoking, substance abuse, poor nutrition, medical problems, and
chronic illness. Additionally, infant mortality is associated with low birth weight. High rates of infant mortality
can indicate broader issues such as access to health care, maternal and child health, poverty, education rate, lack
of insurance, teen births, and lack of prenatal care. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-WLA service area is doing worse than the comparison area/benchmark.
KFH-WLA
Indicators
Year
Service Area
SOCIAL AND ECONOMIC
2010
16.6%
Living below 100% of FPL (children and teens)
2010
24.2%
Unable to afford food
2009
42.2%
2009
72.9
Page 166
Comparison
Level
Avg.
LAC
LAC
LAC
CA
15.7%
22.4%
38.2%
82.3
Indicators
KFH-WLA
Year
Service Area
ACCESS TO CARE
2009
12.0%
2009
7.7%
2012
67.3%
2011
80.6
Comparison
Level
Avg.
LAC
LAC
CA
LAC
11.6%
7.5%
53.2%
80.7
CA = California
1
Community input—What do community stakeholders think about the issue of infant mortality?
Stakeholders did not comment on the issue of infant mortality.
Sample of infant mortality–specific community assets:
 Black Infant Health Project
 Great Beginnings for Black Babies
 Healthy African American Families II
 Kaiser Foundation Hospital
 LA Best Babies Network
 Los Angeles County Department of Public Health - Maternal, Child and Adolescent Health
 March of Dimes - California Programs
 UCLA Medical Center and Orthopedic Hospital - Santa Monica
 Westside Family Health Clinic
Stakeholders identified the following community resources available to address infant mortality:
 Women, Infants and Children (WIC)—community resource for social services
Assessment report.
1
Centers for Disease Control and Prevention. Infant Mortality. Available at
[http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm]. Accessed [March 5, 2013].
Page 167
2
Centers for Disease Control and Prevention. Infant Health. Available at [http://www.cdc.gov/nchs/fastats/infant_health.htm]. Accessed
[March 5, 2013].
3
Centers for Disease Control and Prevention. Eliminate Disparities in Infant Mortality. Available at
[http://www.cdc.gov/omhd/amh/factsheets/infant.htm#2]. Accessed [March 5, 2013].
4
Page 168
Appendix C:
Secondary Data Sources
from Kaiser Permanente
CHNA Data Platform and
Other Sources
Page 169
Secondary Data Sources from Kaiser Permanente CHNA Data Platform and Other Sources
Category
Indicator
Data
Area
Data Source
Clinical Care
Absence of dental insurance coverage
CA
only
California Health Interview
Survey (CHIS), 2007
Clinical Care
Access to primary care
U.S.
U.S. Health Resources and
Services Administration Area
Resource File, 2011
Health Behaviors
Adequate fruit/vegetable consumption
(youth)
CA
only
Survey (CHIS), 2009
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
(grouping)
State average
Yes
County
State average
No
County
(grouping)
State average
Yes
County
State average
No
Social and
Economic Factors
Adequate social or emotional support
U.S.
Centers for Disease Control and
Prevention, Behavioral Risk
Factor Surveillance System,
2006–2010
Clinical Care
Adults ages 50 and older ever have a
sigmoidoscopy, colonoscopy, or FOBT
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Clinical Care
Adults ages 50 and older have a
sigmoidoscopy, colonoscopy in the last
5 years
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Health Outcomes
Adults taking medicine to lower
cholesterol
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Health Behaviors
Alcohol and substance use
CA
only
Office of Statewide Health and
Planning and Development
(OSHPD), 2010.
County
County
average
No
Health Behaviors
U.S.
Nielsen Claritas Site Reports,
Consumer Buying Power, 2011
Tract
State average
No
Health Outcomes
Allergies (teens)
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Page 170
Category
Indicator
Data
Area
Health Outcomes
Alzheimer's mortality, age-adjusted
CA
only
Health Outcomes
Arthritis prevalence
CA
only
Health Outcomes
CA
only
Health Outcomes
Asthma hospitalizations
CA
only
Health Outcomes
Asthma prevalence
U.S.
Health Outcomes
Breast cancer incidence
U.S.
Clinical Care
Breast cancer screening (mammogram)
U.S.
Health Behaviors
Breastfeeding (any)
CA
only
Data Source
Los Angeles County Department
of Public Health, Office of
Health Assessment and
Epidemiology, 2006
of Public Health, Los Angeles
County Health Survey, 2011
(OSHPD), 2010.
California Office of Statewide
Health, Planning and Development (OSHPD), Patient Discharge Data, 2010
2006–2010
The Centers for Disease Control
and Prevention, and the National
Cancer Institute: State Cancer
Profiles, 2005–2009
Dartmouth Atlas of Healthcare,
Selected Measures of Primary
Care Access and Quality, 2003–
2007
California Department of Public
Health, In-Hospital Breastfeeding Initiation Data, 2011
Page 171
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Geography
Benchmark
SPA
County
average
Yes
SPA
County
average
Yes
ZIP Code
State average
No
ZIP Code
State average
Yes
County
State average
No
County
State average
Yes
County
State average
No
County
State average
Yes
Category
Indicator
Data
Area
Health Behaviors
Breastfeeding (exclusive)
CA
only
Health Outcomes
Cancer mortality
CA
only
Health Outcomes
Cardiovascular disease mortality
CA
only
Health Outcomes
Cervical cancer incidence
U.S.
Health Outcomes
Cervical cancer mortality
CA
only
Clinical Care
Cervical cancer screening in last 3 years
U.S.
Clinical Care
Cervical cancer screening in last 3 years
U.S.
Data Source
Health, In-Hospital Breastfeeding Initiation Data, 2011
Health, Death Statistical Master
File, 2008–2010
(OSHPD), 2010
File, 2008
2004–2010
of Public Health, Office of
Health Assessment and
Epidemiology, Health Assessment Unit, Los Angeles County
Health Survey, 2007
Page 172
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
State average
Yes
ZIP Code
Healthy
People 2020
Yes
ZIP Code
State average
Yes
County
Healthy
People 2020
Yes
ZIP Code
Healthy
People 2020
Yes
County
State average
No
County
County
average
Yes
Category
Indicator
Data
Area
Data Source
U.S. Census Bureau, 2000 Census of Population and Housing,
Summary File 1; U.S. Census
Bureau, 2010 Census of
Population and Housing,
Summary File 1
Geography
Benchmark
Demographics
Change in total population
U.S.
Health Behaviors
Children drinking two or more glasses
of soda
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Health Behaviors
Children eating less than 5 servings of
fruits/vegetables a day
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Address
State average
No
Tract
State average
Yes
SPA
County
average
Yes
County
State average
No
County
Healthy
People 2020
Yes
Social and
Economic Factors
Children eligible for free/reduced-price
lunch
U.S.
Social and
Economic Factors
Children in poverty
U.S.
Clinical Care
Children who have never seen a dentist
CA
only
Health Outcomes
Chlamydia incidence
U.S.
Health Outcomes
Colon and rectum cancer incidence
U.S.
U.S. Department of Education,
National Center for Education
Statistics (NCES), Common
Core of Data, Public School
Universe File, 2010–2011
U.S. Census Bureau, 2006–2010
American Community Survey
Five-Year Estimates
Survey (CHIS), 2009
Prevention and the National
Center for HIV/AIDS, Viral
Hepatitis, STD, and TB
Prevention, 2009
Page 173
County
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
No
Category
Indicator
Data
Area
Data Source
File, 2008
2004–2010
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Geography
Benchmark
ZIP Code
County
average
Yes
County
State average
No
Health Outcomes
Colon cancer mortality
CA
only
Clinical Care
Colon cancer screening (sigmoid/colonoscopy)
U.S.
Clinical Care
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Clinical Care
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Clinical Care
Dental care affordability (youth)
CA
only
Survey (CHIS), 2007
County
(grouping)
State average
Yes
County
State average
No
County
(grouping)
State average
Yes
ZIP Code
State average
Yes
ZIP Code
State average
Yes
ZIP Code
State average
Yes
Clinical Care
Dental care utilization (adult)
U.S.
2006–2010
Clinical Care
Dental care utilization (youth)
CA
only
Survey (CHIS), 2009
Health Outcomes
Diabetes hospitalizations
CA
only
Health Outcomes
Diabetes hospitalizations (adult)
CA
only
Health Outcomes
Diabetes hospitalizations (under 18)
CA
only
(OSHPD), 2010
(OSHPD), 2010
Page 174
Category
Indicator
Data
Area
Data Source
Dartmouth Atlas of Healthcare,
Selected Measures of Primary
Care Access and Quality, 2010
Clinical Care
Diabetes management (hemoglobin a1c
test)
U.S.
Health Outcomes
Diabetes prevalence
CA
only
Survey (CHIS), 2009
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
State average
No
SPA
County
average
Yes
County
State average
Yes
SPA
County
average
Yes
Health Outcomes
Diabetes prevalence
U.S.
Prevention, National Diabetes
Surveillance System, 2009
Clinical Care
Do not have a usual source of care
CA
only
Survey (CHIS), 2009
Clinical Care
Facilities designated as health professional shortage areas
CA
only
Services Administration, Health
Professional Shortage Area File,
2012
HPSA
Physical
Environment
Fast food restaurant access
CA
only
U.S. Census Bureau, ZIP Code
Business Patterns, 2009
ZIP Code
Address
No
State average
No
Clinical Care
Federally Qualified Health Centers
U.S.
Services Administration, Centers
for Medicare and Medicaid
Services, Provider of Service
File, 2011
Health Behaviors
Frequent fast food restaurants
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Health Behaviors
Fruit/vegetable expenditures
U.S.
Tract
State average
No
Physical
Environment
Grocery store access
U.S.
U.S. Census Bureau, County
County
State average
No
Clinical Care
Hard time understanding doctor
CA
only
Survey (CHIS), 2009
SPA
County
average
Yes
Page 175
No
Category
Indicator
Data
Area
Health Outcomes
Heart disease hospitalization
CA
only
Clinical Care
Heart disease management
CA
only
Health Outcomes
Heart disease mortality
CA
only
Health Outcomes
Heart disease prevalence
CA
only
Health Behaviors
Heavy alcohol consumption
U.S.
Health Outcomes
Hepatitis C prevalence
Clinical Care
High blood pressure management
Health Outcomes
High blood pressure prevalence
County
U.S.
County
Data Source
(OSHPD), 2010
Survey (CHIS), 2009
File, 2008–2010
Survey (CHIS), 2009
2004–2010
of Public Health, Acute
Communicable Disease Control
Program, Annual Morbidity
Report and Special Studies
Report, 2011
2006–2010
Survey (CHIS), 2009
Page 176
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
ZIP Code
State average
Yes
SPA
County
average
Yes
ZIP Code
Healthy
People 2020
Yes
County
State average
Yes
County
State average
No
SPA
County
average
Yes
County
State average
No
SPA
County
average
Yes
Category
Indicator
Data
Area
Social and
Economic Factors
High school graduation rate
U.S.
Health Outcomes
HIV hospitalizations
CA
only
Health Outcomes
HIV hospitalizations
CA
only
Health Outcomes
HIV prevalence
U.S.
Health Outcomes
HIV prevalence
U.S.
Clinical Care
HIV Screenings
CA
only
Social and
Economic Factors
Homeless by age
County
Social and
Economic Factors
Homeless count
County
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Data Source
U.S. Department of Education,
National Center for Education
Statistics (NCES), Common
Core of Data, Local Education
Agency (School District) Universe Survey Dropout and Completion Data, 2008–2009
(OSHPD), 2010
Prevention and the National
Center for HIV/AIDS, Viral
Hepatitis, STD, and TB
Prevention, 2008
of Public Health, Annual HIV
Surveillance Report, 2011
Geography
Benchmark
School
district
HP 2020:
On-Time
Graduation
Rate
No
ZIP Code
State average
Yes
ZIP Code
State average
Yes
County
State average
No
County
County
average
Yes
Survey (CHIS), 2005
County
(grouping)
State average
Yes
County
County
average
Yes
County
County
average
Yes
Los Angeles Homeless Services
Authority, Greater Los Angeles
Homeless County Report, 2011
Los Angeles Homeless Services
Authority, Greater Los Angeles
Homeless County Report, 2011
Page 177
Category
Indicator
Data
Area
Health Outcomes
Homicide
CA
only
Health Outcomes
Homicide
CA
only
Health Outcomes
Hospitalizations for uncontrolled
diabetes
CA
only
Health Behaviors
Inadequate fruit/vegetable consumption
(adult)
U.S.
Health Outcomes
Infant mortality
U.S.
Clinical Care
Lack of a consistent source of primary
care
CA
only
Clinical Care
Lack of prenatal care
CA
only
Demographics
Linguistically isolated population
U.S.
Physical
Environment
Liquor store access
CA
only
Health Outcomes
Low birth weight
CA
only
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Data Source
File, 2008–2010
File, 2008
(OSHPD), 2010
2003–2009
Prevention, National Vital
Statistics System, 2003–2009
Geography
Benchmark
ZIP Code
Healthy
People 2020
Yes
ZIP Code
Healthy
People 2020
Yes
ZIP Code
State average
Yes
County
State average
No
County
Healthy
People 2020
Yes
Survey (CHIS), 2009
County
(grouping)
State average
Yes
ZIP Code
State average
No
Tract
State average
Yes
ZIP Code
State average
No
ZIP Code
State average
No
Health, Birth Profiles by ZIP
Code, 2010
Five-Year Estimates
California Department of Alcoholic Beverage Control, Active
License File, April 2012
Code, 2010
Page 178
Category
Indicator
Data
Area
Data Source
Five-Year Estimates
(OSHPD), 2010
(OSHPD), 2010
File, 2008–2010
Health Outcomes
Lung cancer incidence
U.S.
Demographics
Median age
U.S.
Health Outcomes
Mental health hospitalizations (adults)
CA
only
Health Outcomes
Mental health hospitalizations (under
18)
CA
only
Health Outcomes
Motor vehicle crash death
CA
only
Clinical Care
Needed help for mental/emotional/alcohol-drug issues but did
not receive treatment
CA
only
California Health Interview Survey (CHIS), 2009
Health Outcomes
Obesity (adult)
LAC
Only
Health Outcomes
Obesity (adult)
U.S.
Health Outcomes
Obesity (youth)
CA
only
Health Outcomes
Overweight (adult)
LAC
Only
Prevention, National Diabetes
Surveillance System, 2009
California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011
Page 179
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
State average
Yes
Tract
Yes
ZIP Code
County
average
Yes
ZIP Code
County
average
Yes
ZIP Code
Healthy
People 2020
Yes
SPA
County
average
Yes
ZIP Code
Yes
County
State average
Yes
School
district
State average
Yes
ZIP Code
Yes
Category
Indicator
Data
Area
Health Outcomes
Overweight (adult)
U.S.
Health Outcomes
Overweight (youth)
CA
only
Physical
Environment
Park access (within 1/2 mile of park)
U.S.
Health Outcomes
Pedestrian motor vehicle death
CA
only
Health Outcomes
Percent of pedestrians killed
CA
only
Health Behaviors
Physical inactivity (adult)
U.S.
Health Behaviors
Physical inactivity (youth)
CA
only
Clinical Care
Pneumonia vaccinations (age 65+)
U.S.
Data Source
2006–2010
U.S. Census Bureau, 2010 Census of Population and Housing,
Summary File 1; Esri's USA
Parks layer (compilation of Esri,
National Park Service, and TomTom source data), 2012
File, 2008–2010
California Highway Patrol Statewide Integrated Traffic Records
System (CHP— SWITRS), 2008
2004–2010
2004–2010
Page 180
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
State average
No
School
district
State average
Yes
Block
Group
State average
No
ZIP Code
Healthy
People 2020
Yes
SPA
County
average
Yes
County
State average
No
School
district
State average
Yes
County
State average
No
Category
Indicator
Data
Area
Physical
Environment
Poor air quality (particulate matter 2.5)
U.S.
Health Outcomes
Poor dental health
U.S.
Health Outcomes
Poor general health
U.S.
Health Outcomes
Poor mental health
CA
only
Data Source
Prevention, National Environmental Public Health Tracking
Network, 2008
2006–2010
2004–2010
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Tract
State average
No
County
State average
No
County
State average
No
County
(grouping)
State average
Yes
Tract
State average
No
Tract
State average
No
HPSA
State average
No
Five-Year Estimates
Five-Year Estimates
U.S. Health Resources and Services Administration, Health
Professional Shortage Area File,
2012
Social and
Economic Factors
Population below 100% of poverty level
U.S.
Social and
Economic Factors
Population below 200% of poverty level
U.S.
Clinical Care
Population living in a health professional shortage area
U.S.
Physical
Environment
Population living in food deserts
U.S.
U.S. Department of Agriculture,
Food Desert Locator, 2009
Tract
(2000)
State average
No
U.S.
Three-Year Estimates
PUMA
State average
Yes
Social and
Economic Factors
Population receiving Medicaid
Page 181
Category
Indicator
Data
Area
Data Source
Five-Year Estimates
Five-Year Estimates
Prevention, National Vital
Statistics System, 2008–2010
(As Reported in the 2012
County Health Rankings)
Health, Planning and Development (OSHPD), Patient Discharge Data, 2010–2010
U.S. Health Resources and Services Administration Area
Resource File, 2011
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Tract
State average
No
Tract
State average
Yes
Tract
State average
Yes
County
State average
No
ZIP Code
State average
Yes
County
County
average
No
County
State average
Yes
Health Outcomes
Population with any disability
U.S.
Social and
Economic Factors
Population with no high school diploma
U.S.
Social and
Economic Factors
Poverty rate
U.S.
Health Outcomes
Premature death
U.S.
Clinical Care
Preventable hospital events
CA
only
Clinical Care
Primary care provider per 100,000
population
CA
only
Health Outcomes
Prostate cancer incidence
U.S.
Physical
Environment
Protected open space areas in acres per
1,000 people
CA
only
ZIP Code
County
average
No
Clinical Care
Received Pap smear in last 3 years
County
Office of Health Assessment and
Epidemiology, Los Angeles
SPA
Healthy
People 2020
Yes
Page 182
Category
Indicator
Data
Area
County
Data Source
Office of Health Assessment and
Epidemiology, Los Angeles
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Geography
Benchmark
SPA
Healthy
People 2020
No
ZIP Code
State average
No
Clinical Care
Received Pap smear in last 3 years
Physical
Environment
Recreation and fitness facility access
CA
only
U.S. Census Bureau, ZIP Code
Health Behaviors
Serious psychological distress in last
year
CA
only
SPA
County
average
Yes
Health Behaviors
Soft drink expenditures
U.S.
Tract
State average
No
Health Outcomes
Stroke mortality
CA
only
File, 2008–2010
ZIP Code
State average
Yes
Social and
Economic Factors
Student reading proficiency (4th grade)
U.S.
States' Department of Education,
Student Testing Reports, 2011
School
district
Healthy
People 2020
No
Health Outcomes
Suicide
CA
only
ZIP Code
Healthy
People 2020
Yes
Social and
Economic Factors
Supplemental Nutrition Assistance Program (SNAP) recipients
U.S.
County
State average
No
Social and
Economic Factors
Teen births
CA
only
ZIP Code
State average
Yes
Clinical Care
Teens who can’t afford dental care
CA
only
SPA
County
average
No
Health Behaviors
Tobacco expenditures
U.S.
Tract
State average
No
File, 2008–2010
U.S. Census Bureau, Small Area
Income and Poverty Estimates
(SAIPE), 2009
Code, 2010
Page 183
Category
Indicator
Data
Area
Health Behaviors
Tobacco usage (adult)
U.S.
Demographics
Total female population
U.S.
Demographics
Total male population
U.S.
Demographics
Total population
U.S.
Demographics
Total population age 0–4
U.S.
Demographics
U.S.
Demographics
U.S.
Demographics
U.S.
Demographics
U.S.
Data Source
2004–2010
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Page 184
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
County
State average
No
Tract
Yes
Tract
Yes
Tract
Yes
Tract
Yes
Tract
Yes
Tract
Yes
Tract
Yes
Tract
Yes
Category
Indicator
Data
Area
Data Source
Five-Year Estimates
Five-Year Estimates
Five-Year Estimates
Demographics
U.S.
Demographics
U.S.
Demographics
Total population age 65 or older
U.S.
Social and
Economic Factors
Unable to afford enough food (food
insecurity) (adults)
CA
only
(OSHPD), 2009
U.S. Bureau of Labor Statistics,
December, 2012 Local Area
Unemployment Statistics
Health Outcomes
Uncontrolled diabetes hospitalizations
Social and
Economic Factors
Unemployment rate
U.S.
Social and
Economic Factors
Uninsured population
U.S.
Health Outcomes
Very low birthweight
CA
only
Health, 2010
Geography
Tract
Yes
Tract
Yes
Tract
Yes
County
County
average
Yes
ZIP Code
State average
Yes
County
State average
No
PUMA
State average
Yes
ZIP Code
County
average
No
Place,
County
State average
No
County
average
Yes
Social and
Economic Factors
Violent crime
U.S.
U.S. Federal Bureau of
Investigation, Uniform Crime
Reports, 2010
Physical
Environment
Visited park in last month
CA
only
SPA
Physical
Environment
Walkability
U.S.
WalkScore.Com (2012)
City
Page 185
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
Yes
Category
Physical
Environment
Indicator
WIC–authorized food store access
Data Source
Geography
Benchmark
Data Breakout
by Groupings
(including
ethnicity,
gender,
additional
geographies)
U.S. Department of Agriculture,
Food Environment Atlas, 2012
County
State average
No
Data
Area
U.S.
Page 186
Appendix D:
KFH-WLA Scorecard
Page 187
Kaiser Permanente Community Health Needs Assessment
Health Needs and Health Drivers Data Summary – West Los Angeles Service Area
Community Event
Identification of Health Needs and Health Drivers
In 2012, Kaiser Foundation Hospital-West Los Angeles (KFH-WLA) conducted Phase I of the 2013 Community
Health Needs Assessment (CHNA). This included review of data from the Kaiser Permanente CHNA data
platform and other secondary data sources. Additional information was gathered through six (6) focus groups
with providers and residents from across the KFH-WLA service area and interviews with twenty-two (22) key
stakeholders including public health experts, community leaders, and public agency officials.
This process highlighted numerous health needs and health drivers in the West Los Angeles service area. The
document that follows represents a subset of those needs based on set criteria, which included poor
performance against California or Los Angeles County benchmarks or the Healthy People 2020 (HP2020) Target
or repeated mentions in stakeholder interviews and focus groups. The identified health needs and drivers are
summarized in the attached Health Needs and Drivers Summary Scorecard.
Reading the Health Needs & Drivers Data Summary Scorecard
DATA INDICATORS
Indicators, or standard measures of health, are highlighted in the first column
Qualitative data collected in focus groups or interviews is indicated by an italicized indicator
Indicators which did not meet a benchmark, including HP2020 Targets, are highlighted by a black box
When health indicator definitions are consistent across comparison levels, and the HP2020 Target is not
met, the HP2020 Target is noted
The Health Needs and Drivers are listed in alphabetical order, NOT by order of importance
DATA INDICATORS LEGEND
*Data gathered from the Kaiser Permanente CHNA data platform
Data from secondary sources aggregated at the Service Planning Area (SPA)-level reflecting only ZIP codes
represented in the KFH-WLA service area
^Data from secondary sources reflecting the entire Service Planning Area (SPA)
COMPARISON LEVEL
KFH-WLA service area is compared against benchmarks at the State or County-level depending on data
available
o CA: State of California
o LAC: Los Angeles County
Where available, data is also presented for individual Service Planning Areas (SPAs) in the service area
Page 188
Focus Groups (n=#)
Interviews (n=#)
Service Planning Area #
Average
Comparison Average
Comparison Level
Legend
*Data from the Kaiser Permanente CHNA data platform
Data from secondary sources aggregated at the Service Planning Area (SPA)-level
reflecting only zip codes represented in the KFH-WLA service area
^Data from secondary sources reflecting the entire Service Planning Area (SPA)
An italicized indicator denotes qualitative data collected in a focus group or interview
Comparison levels: CA - California LAC - LA County
Year of Data
DATA INDICATOR
Healthy People 2020 Target
The following notes and legend will help you to understand the data presented in the Summary Scorecard.
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Appendix E:
Data Collection Tools and
Instruments
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KP CHNA 2012
Provider Focus Group Protocol
Introduction:
Thank you for participating in this focus group discussion. We are holding discussion groups as
part of a community needs assessment for Kaiser Permanente and their medical centers to help
them better understand community needs and identify the type of support Kaiser Permanente can
provide to its diverse communities. Therefore, we would like get your ideas about the most
important health issues facing your community. In addition, we will talk about what community
members need to be healthier as well as the availability of services to meet those needs. Please
share your honest opinions and experiences and allow other to express theirs freely. Your
responses will not be associated with your name in the report and only to ensure your
confidentiality and anonymity. Does anyone have any questions before we get started?
Note to facilitator: Review health data for appropriate Medical Center Service Area in order to
effectively probe where appropriate.
GENERAL NEEDS (INCLUDING HEALTH AND SOCIAL NEEDS)
1. What are some of the major issues that impact individuals in your service area?
a. Why do you think they’re the most important?
b. What populations are most affected by these needs? Why?
c. What are the social issues that contribute to the health problems? (Such as substance use,
unemployment, etc.)
2. What major trends in needs (positive and negative) are you seeing in your service area?
a. How are today’s trends different from the major trends 5 years ago? Are there any
differences among different communities/geographic areas? What are the differences
(if any)? Why?
3. Are there social or environmental factors that have contributed to these changes? Other
factors?
4. What kind of insurance programs do community members have available to them?
a. How does insurance impact their ability to get the health care they need? Is it different
for their family members by age?
b. If they are uninsured, why? [barriers, etc.]
BARRIERS TO ACCESS
5. What health services are difficult to access in your service area? [For example, this could
include community clinics, healthcare providers for low-income/uninsured, health workshops,
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dental care, vision care, substance abuse services, mental health care, free health fairs,
resources for pregnant women, etc.]
a. Does this affect certain communities/geographic areas more than others? Which? What
factors contribute to this?
6. What health services are lacking in your service area? [For example, this could include
community clinics, healthcare providers for low-income/uninsured, health workshops, dental
care, vision care, substance abuse services, mental health care, free health fairs, resources for
pregnant women, etc.]
a. Does this affect certain communities/geographic areas more than others? Which? What
7. What other challenges keep individuals from seeking help? [For example, this could be a lack
of awareness of available resources, language barriers, lack of bilingual healthcare providers,
immigration status/issues, lack of transportation or childcare, cultural values/beliefs, unsafe
neighborhood, working multiple jobs/lack of time, etc.]
8. Which healthy behavior is the most difficult to promote in your service area?
a. Why?
b. Are there any healthy behaviors that are the hardest to promote for a particular
population? Which? Why?
c. Based on your knowledge of this community, what are some possibilities for addressing
this?
ASSETS (HEALTH AND SOCIAL)
Health services
9. What health-related services are available to you in the community?
a. Where do community members go to receive or obtain information on health services?
b. How do you prefer to receive information about important health issues or available
services? [newspaper, radio, community clinic, flyers, billboards]
c. Does access differ for certain populations or groups?
Social services
10. What social services (non-medical) are available to you in the community? (For example,
senior services, food/nutrition, family support, disability, employment, environmental, homeless,
etc.]
a. Where do community members go to receive or obtain information on social services?
b. Does access differ for certain populations or groups?
c. Which social services are needed in your community?
11. What are the strengths and resources available that have had a positive impact health?
a. What populations are more able to access these resources because of this?
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HEALTH CARE UTILIZATION
12. Are individuals in your service area likely to use preventative healthcare?
a. If no, why?
b. Had this changed in the last 5 years?
c. Do culture or community norms influence the health behaviors of community member?
How?
13. If community members are not feeling well [not an emergency], where do they usually go for
care? [Prompt for other providers: alternative health care including curanderos, traditional
healers, use of herbs and natural medicines]
a. Where are they located? How do you get there?
b. Do you feel that it’s getting easier or harder to obtain healthcare? Why?
HOSPITALS ROLE
14. What role could hospitals play in addressing the service needs of your service area?
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KP CHNA 2012
Resident Focus Group Protocol
Introduction:
Thank you for participating in this focus group discussion. We are holding discussion groups as
part of a community needs assessment for Kaiser Permanente and their medical centers to help
them better understand community needs and identify the type of support Kaiser Permanente can
provide to its diverse communities. Therefore, we would like get your ideas about the most
important health issues facing your community. In addition, we will talk about what community
members need to be healthier as well as the availability of services to meet those needs. Please
share your honest opinions and experiences and allow other to express theirs freely. Your
responses will not be associated with your name in the report and only to ensure your
confidentiality and anonymity. Does anyone have any questions before we get started?
GENERAL HEALTH NEEDS (i.e. CHRONIC DISEASE, COMMUNICABLE DISEASES,
MENTAL HEALTH, ETC.)
1. What are some of the major health issues that affect individuals in your community overall?
a. Why do you think they’re the most important?
b. What populations are most affected by these needs? Why?
c. What are the social/societal issues that contribute to the health problems? (DO NOT
SAY ALOUD: Such as substance use, unemployment, etc.)
2. What major trends in health needs (positive and negative) are you seeing in your community?
d. How are health issues different from 5 years ago? Are there any differences among
different communities/geographic areas? What are the differences (if any)? Why?
e. What factors have contributed to these changes?
3. Are there social or environmental factors that have contributed to health needs or trends?
Which? Other factors?
4. Do you or a family member have a chronic health condition such as asthma, diabetes or heart
disease?
f. If yes, how do you keep your condition under control?
g. How helpful is the support you receive from your health care provider?
h. How helpful is the information that you receive?
5. What kind of insurance programs do you use for yourself? Your spouse? Your children?
i. How does insurance impact/effect your ability to get the health care you need? Is it
different for your other family members?
j. What other kinds of insurance programs are you aware of?
k. If you are uninsured, why?
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BARRIERS TO ACCESS
6. What health services are difficult to access in this community? [DO NOT SAY ALOUD: For
example, this could include community clinics, healthcare providers for low-income/uninsured,
health workshops, dental care, vision care, substance abuse services, mental health care, free
health fairs, resources for pregnant women, etc.]
l. Does this affect certain communities/geographic areas more than others? Which? What
7. What health services are lacking in this community? [DO NOT SAY ALOUD: For example,
this could include community clinics, healthcare providers for low-income/uninsured, health
workshops, dental care, vision care, substance abuse services, mental health care, free health
fairs, resources for pregnant women, etc.]
m. Does this affect certain communities/geographic areas more than others? Which? What
8. What other challenges keep individuals from seeking help/care? [DO NOT SAY ALOUD: For
example, this could be a lack of awareness of available resources, language barriers, lack of
bilingual healthcare providers, immigration status/issues, lack of transportation or childcare,
cultural values/beliefs, unsafe neighborhood, working multiple jobs/lack of time, etc.]
9. Which healthy behavior is the most difficult to encourage in this community? Why?
n. Are there any healthy behaviors that are the hardest to promote for certain
communities/geographic areas? Which? Why?
o. Based on your knowledge of this community, what are some possibilities for addressing
this?
COMMUNITY ASSETS (HEALTH AND SOCIAL)
Health services
10. What health-related services are available to you in the community?
p. Where do community members go to receive or obtain information on health services?
q. How do you prefer to receive information about important health issues or available
services? [newspaper, radio, community clinic, flyers, billboards]
r. Does access differ for certain populations or groups?
Social services
11. What social services (non-medical) are available to you in the community? (DO NOT SAY
ALOUD: For example, senior services, food/nutrition, family support, disability, employment,
environmental, homeless, etc.]
s. Where do community members go to receive or obtain information on social services?
t. Does access differ for certain populations or groups?
u. Which social services are needed in your community?
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12. What does preventative/preventive healthcare mean to you?
a. What do you do to stay healthy?
b. Do culture or community norms influence the health behaviors of community member?
How?
13. If you are not feeling well [not an emergency], where do you usually go for care? [Prompt for
other providers: alternative health care including curanderos, traditional healers, use of herbs
and natural medicines]
a. Where are they located? How do you get there?
b. Do you feel that it’s getting easier or harder to obtain healthcare? Why?
HOSPITALS ROLE
14. What role could hospitals play in addressing the health service needs of this community?
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KP CHNA 2012
Resident Focus Group Protocol
Introducción:
Gracias por participar en esta plática. Estamos hablando con varios grupos en el Condado de Los
Ángeles como parte de un estudio sobre las necesidades de las comunidades en el condado para
mejorar los servicios de Kaiser Permanente y sus centros médicos locales y para identificar los
tipos de apoyo Kaiser Permanente puede proveer a las diversas comunidades. Por eso es
importante que nos digan cuales son los problemas de salud más grandes en su comunidad para
poder identificar arias de necesidad y los servicios disponibles para servir sus necesidades. Por
favor sean honestos y respetosos de los demás. Esto será completamente confidencia. ¿Tienen
preguntas antes de empezar?
NECESIDADES DE SALUD GENERALES (COMO ENFERMEDADES CRÓNICAS Y
TRANSMISIBLES, SALUD MENTAL, ETC.)
1. ¿Cuáles son algunos de los temas más grandes de salud afectando la comunidad?
a. ¿Porque piensan que estos temas son más importantes?
b. ¿Quiénes son los más afectados por esto? ¿Por qué?
c. ¿Hay problemas sociales que contribuyen a estos problemas? [Pueden ser como abuso
de la droga, desempleo, etc.]
2. ¿Cuáles tendencias de salud (positive o negativa) ve en su comunidad?
d. ¿Esas tendencias han cambiado a comparadas a 5 años atrás? ¿Cómo?
e. ¿Que ha contribuido a estos cambios?
3. ¿Existen factores sociales o ambientales que han contribuido a las necesidades de salud o
cambios? ¿Cuáles? ¿Otros factores?
4. ¿Usted o alguien de su familia tiene una condición de salud crónica como asma, diabetes, o
problemas del corazón?
f. ¿Si contesto si, como mantiene su condición bajo control
g. ¿Qué tan útil es el apoyo que recibe de su proveedor medico?
h. ¿Qué tan útil fue la información que recibió?
5. ¿Qué tipo de seguro médico utilizan para usted y su familia?
i. ¿Ha podido utilizar el cuidado médico necesario con su seguro médico? ¿Sus familiares?
j. ¿Cuáles otros seguros médicos conoce?
k. ¿Si no tiene seguro médico, porque?
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LAS BARRERAS AL ACCESO
6. ¿Ahí servicios que son difíciles de utilizar en la comunidad? [Por ejemplo, puede ser clínicas
comunitarias, proveedores de salud para gente con bajos recursos o sin seguro médico, clases
de salud, cuidado dental o de visión, servicios para el abuso de sustancias, servicios de salud
mental, ferias de salud gratuitas, recursos para mujeres embarazadas]
a. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
7. ¿Ahí servicios que faltan en la comunidad? [Por ejemplo, puede ser clínicas comunitarias,
proveedores de salud para gente con bajos recursos o sin seguro médico, clases de salud,
cuidado dental o de visión, servicios para el abuso de sustancias, servicios de salud mental,
ferias de salud gratuitas, recursos para mujeres embarazadas]
b. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
8. ¿Hay otros problemas o situaciones que impiden a la gente buscar ayuda? [Por ejemplo, falta
de conocimiento de recursos disponibles, lenguaje, falta e proveedores bilingües, estate
inmigratorio, falta de transportación cuidado de niño, valores o crianzas de cultura, falta de
seguridad en la comunidad, falta de tiempo, etc.]
9. ¿Cuál comportamiento saludable es más difícil de promover en la comunidad? ¿Por qué?
c. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
d. ¿Cuáles son las mejores formas de tratar de cambiar esto?
SERVICIOS EXISTENTES (SALUD Y SOCIALES)
Servicios de Salud
10. ¿Cuáles servicios de salid están disponibles en su comunidad?
e. ¿A dónde van residentes para obtener información sobre servicios de salud?
f. ¿Cómo prefiere recibir este tipo de información?
g. ¿Hay diferencias en acceso para diferentes grupos?
Servicios Sociales
11. ¿Cuáles servicios sociales (no de salud) están disponibles en su comunidad? [Por ejemplo,
servicios para personas mayores, comida/nutrición, apoyo familiar, deshabilite, empleo,
ambiental, vivienda, etc.]
h. ¿A dónde van residentes para obtener información sobre servicios de salud?
i. ¿Hay diferencias en acceso para diferentes grupos?
j. ¿Cuáles servicios sociales faltan en su comunidad?
USO DE SERVICIOS DE SALUD
12. ¿Para usted que es medicina preventivita?
k. ¿Qué hace para mantenerse saludable?
l. ¿Hay algo que afecta los comportamientos saludables como cultura o costumbres?
¿Cómo?
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13. ¿A dónde van cuando no se sienten bien? [Por ejemplo: curanderos, naturalistas, etc.]
m. ¿En dónde están localizados? ¿Cómo llega a ese lugar?
n. ¿Siente que se está facilitando el uso de servicios médicos? ¿Por qué?
PAPEL DE HOSPITALES
14. ¿Qué pueden hacer los hospitales para corresponder a las necesidades de salud en la
comunidad?
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Organization: _________________________________
KP CHNA 2012
Provider Focus Group Survey
1. Primary service area: ______________________________________________________
2. Primary area of expertise: __________________________________________________
3. Primary service population: ________________________________________________
This survey is confidential, thank you!
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Organization: _________________________________
KP CHNA 2012
Resident Focus Group Survey
1. What ZIP code do you live in? _____________
2. How many years have you lived in this ZIP code? ____________
3. How many children do you have? ____________
4. What year were you born? _________
5. Gender?
 Male
 Female
6. Ethnicity?  African-American  Hispanic/Latino  Asian/Pacific Islander
 Caucasian/While Other _______________
This survey is confidential, thank you!
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Organización: _____________________________
KP CHNA 2012
Resident Focus Group Survey
1. ¿En cuál código postal vive? _____________
2. ¿Cuántos años ha vivido en este código postal? ____________
3. ¿Cuántos hijos tiene? ____________
4. ¿En cuál año nació? _________
5. ¿Sexo?  Masculino  Femenino
6. ¿Etnicidad?  Afro-Americano
 Hispano/Latino  Asiático
 Blanco/Americano Otro _______________
¡Esta encuesta es confidencial, gracias!
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Date:
Interviewer:
Interviewee:
KP CHNA 2012
Stakeholder Interview Protocol
Introduction:
The Center for Nonprofit Management is working with Kaiser Permanente to conduct their 2013
Community Health Needs Assessment. We are talking to health experts to obtain their
perspective on the most important health issues facing the local community and to identify areas
of need as well as the availability of services to meet those needs. All the information collected
will help local medical centers improve and better target their services. The information you
provide will not be associated with your name and will only be reported in an aggregated
manner.
For the interviewer: Review health data to help inform appropriate probing where appropriate.
Area of expertise:
Primary service area:
Population served:
GENERAL ISSUES
1.
What are the primary issues or challenges facing your service population? [e.g., health, socioeconomic, legal]
Have there been any recent events or developments that have had an impact or are likely to
have an impact on the welfare of the community members you serve? [negative or positive]
PRIMARY CONCERNS
2.
What are the most significant concerns among your service population?
Who do they impact the most?
What are the key drivers behind the concerns?
What services are available to address these concerns?
Are there any significant service gaps?
Has there been a significant change in the availability of services over the last few years?
3.
To what extent does your service population utilize basic health care services (including
preventive care) and where do community members access those services? What other community
assets are available to community members?
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To what extent do they utilize dental care and where do they go?
4.
When community members become sick where do they go to receive care? (Doctor’s office,
urgent care, ER, community clinic, etc.)
Where do they tend to obtain information?
5.
Where do community members go if they have chronic health issues?
Where do they go if they need specialized care?
Where do they go if they need mental health care?
BARRIERS TO ACCESS
6.
What kinds of challenges does your service population experience when trying to get the care they
need? [e.g., transportation, language barriers, lack of information, no health insurance, economic
constraints]
Who tends to have the most difficulty?
How might these challenges be addressed?
SERVICE PROVISION
7.
Are there any growing needs/trends among your service population? Explain.
What measures have your organization taken to address this need?
8.
What specifically could hospitals do to help address these needs?
9.
Do you see any potential areas for collaboration or coordination among service providers to better
meet the needs of your service population? Explain.
OUTREACH
10. What would be the most effective way to provide information to your service population about the
availability of health and other services?
Is there a particular message that would appeal to community members?
11. Is there anything else you would like to add?
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Appendix F:
Stakeholder Interviews
Summary for KFH-WLA
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Health Trends and Drivers Impacting Communities
CHNA interviews with stakeholders were conducted via telephone during September and October 2012. Twenty
two interviews representing a broad range of community stakeholders, including health professionals and service
providers, were conducted to gather information and opinions directly from persons who represent the broad
interests of the community served by the Hospital. The interviews were conducted primarily via telephone for
approximately 30 to 45 minutes each. The interview protocol was designed to collect reliable and representative
information about health and other needs and challenges faced by the community, access and utilization of health
care services, and other relevant topics. A summary of key interview findings is noted below.
Health needs
 Diabetes
 Cancer
 Cardiovascular disease
 High cholesterol
 HIV/AIDS
 Hypertension
 Mental health, including depression, anxiety, schizophrenia, bipolar, dementia, Post Traumatic Stress
Disorder, autism
 Obesity
 Substance abuse
 STDs
Drivers of health
 Social and economic factors
 Domestic violence
 Food deserts (no access to fresh fruits and vegetables)
 Food insecurity
 Gang activity
 Interactions with police
 A lack of safe places to exercise
 A lack of transportation
 Language barriers
 Poverty
 Poor educational opportunities (high dropout rate)
 Unemployment
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 Environmental
 Poor air quality
 A lack of access to health insurance
 A lack of education
 A lack of access to information and resources
Interviewees also provided specific insight into these key issues. One interviewee stated that “people are barely
scratching by. They’re only eating what they need to survive.” People are “in survival mode and need jobs to keep
a roof over their heads and food on the table.” Interviewees attributed poor health outcomes to social issues
including poverty and the poor economy, and the family stresses those cause. Another interviewee added, “It’s
difficult to talk about health care reform because it’s still tied to one’s employment status, and the economic
development is just not there.”
The interviewees also added that those affected by chronic diseases are often not aware that they are and don’t
understand the disease. In addition, people don’t know how to manage their disease—for example, the impact of
poor eating and exercising habits on their condition.
Available resources in the community
Interviewees talked about services, programs, and community efforts offered by their own organizations and other
community-based organizations (CBOs) to address the issues identified. All expressed enthusiasm about
participating in partnerships, and several of their programs are described in further detail below (see Ideas for
Collaboration and Cooperation among Service Providers). In addition, interviewees noted that several clinics have
recently received funding to open satellite sites in South Los Angeles, including Saint John’s Child and Family
Care Clinic, T.H.E. Clinic, and others.
The Watts Healthcare Corporation (WHCC) offers classes in English and Spanish on a healthy diet and the
prevention of diabetes and hypertension. The agency guides patients into participation in these classes, and reports
a missed-class rate of 33%. In terms of breast cancer, WHCC is leading the nation in providing mammograms for
women in the high-risk group though their mobile unit, which performs 200 mammograms per month. WHCC
also extended its urgent-care hours from 8:00 a.m. to 8:00 p.m., six days a week. To address transportation,
WHCC operates a fleet of vans for anyone who wants to come in for services, transporting 16,000 patients a year.
Its dental program has seven dentists and 16 clinics. The interviewee noted that the county came to WHCC
because of the shortage of dentists for HIV patients, and gave them funding to hire an additional dentist.
One interviewee praised the “Weight of the Nation” campaign as having great potential. “Many organizations are
involved and word is starting to get out. It doesn’t include a lot of ways to teach people how to change behaviors,
though. Dieticians are promoting the program, but the reach is limited.” This agency teaches the program intensively and is following up with clients as long as their funding permits. It is seeing a substantial lowering of risk
over time and is collecting solid data on the overall effort.
Gaps in services
Interviewees mentioned gaps in services that include not enough service providers to meet the high need, a lack of
specialty care (including inpatient surgery), a lack of interventional radiology, and the lack of free or affordable
programs for smoking cessation, health screenings, and medications. Given these gaps, people often have to seek
treatment outside of their immediate community.
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Health-Related Trends in the Community
Recent developments and trends noted by the interviewees include hospital closures (Martin Luther King Jr./Drew
Medical Center in 2007), the increase in chronic diseases including mental illness, STDs, breast cancer, substance
abuse, co-morbidities associated with diabetes, autism, post-traumatic stress disorder, attention deficit disorder,
attention deficit hyperactivity disorder, and asthma. Other recent changes in the landscape include the passing of
national health care reform—the Affordable Care Act, or ACA—and the passing of AB 109, releasing nonviolent
offenders from prison system.
Interviewees noted positive trends, including:
 Increased HIV/AIDS awareness, testing, and people on medication
 Increased awareness about the connections among diet, obesity, and diabetes
One interviewee anticipates that the reopening of the Martin Luther King Jr. hospital in 2013 will “greatly relieve
the health burden and provide access for people, especially those with transportation issues.” Interviewees also
cited a recently opened public health clinic at 120th and Wilmington, but added, “They didn’t provide enough
information when they moved from their previous location, so people don’t know it’s there or what services are
available.”
Interviewees provided the following comments about the Affordable Care Act, community-based organizations
(CBOs), the passage of AB 109, obesity, and the undocumented:

“There is confusion about the ACA, that it will have a negative impact on seniors’
access to Medicare services and benefits.”

“The ACA could have a positive impact.”

“I’m very concerned that with the ACA, the undocumented population will get all the
charity dollars, or be too scared to access health care.”

“CBOs are scaling back on services and programs due to limited resources, and that
means they’re less able to offer translation services to accommodate non-English
speakers.”

“With the influx of nonviolent offenders into the general population [resulting from
AB 109], especially those diagnosed with AIDS, it will be a challenge to keep
continuity of care and manage the impact on [the] community.”

“Given the high rates of obesity, we’ve got to address the food desert issue and the
inability to afford food.”

“The undocumented are locked out of access to health care even with the advent of
health care reform—they have no way to even buy into low-cost insurance.”
One interviewee observed that Medicare recently made some funding available for people with diabetes to get
counseling about disease management. The interviewee added that her organization was trying to get funding for
similar services for obesity; however, clients would need a referral from a doctor to participate.
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A representative from a local resource center noted that the agency, which provides information and referrals,
started seeing a spike in requests and need in 2008. Over a quarter of requests (27%) were from uninsured people,
and most were for shelter for homeless families, food assistance, and health services.
Fragmented health care system/delivery
The disjointed nature of the current health care system results in “not enough capability to meet demand, with
wait times for appointments averaging eight weeks,” according to an interviewee representing a South Los Angeles CBO. Another participant pointed out that the patchwork nature of the system impacts the uninsured and
underinsured, and provided this example: Young children have health insurance through the many targeted programs for children, while their older siblings and adult parents do not. Consequently, in times of need, this leads
to the sharing of medications and inhalers, which may be expired or empty.
Barriers to Access
Interviewees were asked to identify the kinds of problems or challenges that people face in obtaining health care
and/or social services. The most frequently reported barriers included:
 The biased perception that low-cost care is low-quality care
 Economic constraints
 Homelessness
 The inability to be a responsible partner in health care
 Inadequate capacity (long waits, especially for specialty care)
 A lack of advocacy and access to healthcare
 A lack of health insurance
 A lack of services on weekends and after working hours
 Language barriers
 Limited knowledge/education
 Noncompliance with advice and recommended treatments
 Transportation
Children—who are more likely to be covered through government programs—rely on parents for transportation to
service providers. Transportation for both children and adults remains a major barrier to access in key parts of the
service area.

“Families have only one car to get to work. No taxis come to Watts at any time.”

“Even with good bus service, it’s hard taking a bus with three kids in tow.”

“The new Metro line is helpful, but gentrification is forcing people out of their
homes. The area is in transition [as a result of an agreement with USC for more
affordable housing, and related business opportunities]. This impacts long-term residents who are displaced by students.”
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Interviewees suggested that cultural values, a lack of knowledge, and life challenges could be at the root of the
lack of attention to preventive care.

“It’s a challenge for low-income adults because they’re so wrapped up in day-to-day
survival. It’s just not a priority; they care for their kids before themselves.”

“They tend not to be proactive; they won’t do routine or preventative care, and [they]
only seek medical help when the need gets to [an] emergency level. Of course, the
cost is higher when one waits until it’s an emergency.”

“Our population is not focusing on prevention, and not well informed enough to take
preventative measures for their health.”

“They don’t address health concerns unless someone gets really sick; parents are not
sophisticated in using health care benefits.”

“If there’s a co-pay, no matter how modest, people won’t pay it or seek out care.”
Most Severely Impacted Sub-Populations and Geographic
Disparities
Interviewees identified a number of sub-populations as being the most severely impacted, including the Samoan
community, the African immigrant community, seniors, adult males, the undereducated and illiterate, and families
with children.
Seniors
Describing the substantial challenges facing seniors with mobility and transportation difficulties, one interviewee
observed that, “In some populations, relatives have essentially abandoned their seniors.” One interviewee noted
that seniors between age 60 and 66 do not yet qualify for Medicare. “These ineligible seniors have been relying
on free clinics, but services have been cut there, too.” Chronic disease among the elderly is of great concern to
those interviewed; not only is chronic disease increasing in the current elderly population, the constituency is
increasing with the aging of the baby-boom generation.
Children
Although many targeted programs and services for children exist, a representative of a child care referral service
and resource center (CCRC) pointed out that several interrelated challenges hinder low-income families with
children.
 The increase in need for financial assistance for child care in the last five years
 A decrease of 25% in state-funded child care subsidies
 Impending changes in the Healthy Families program
 Families experiencing contractions in the social service net from all corners
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Women
An interviewee also noted that African-American and Latino young women ages 15 to 25 have 10 to 15 times
higher rates of sexually transmitted infections (STIs) than the general population: “Most women won’t get an
annual Pap smear because of poverty, lack of insurance, survival day-to-day. Women won’t take care of
themselves because they put their children first. It seems it’s just not a priority unless we really discuss it—until
we point out the importance of taking care of themselves.”
Geographic disparities
Interviewees identified South Los Angeles as “a community in crisis.” They added that South Los Angeles lacks
community resources and is often overlooked when resources are distributed.
Health Care Utilization
Interviewees were asked to share the places where they go for health care or health resources in the community.
Many mentioned community-based clinics, hospitals, places of worship, and other community-based
organizations.
 Oasis Clinic
 Saban Free Clinic
 Planned Parenthood
 AIDS Health Foundation
 Kaiser Permanente
 California Wellness
 Black Women for Wellness
 Crenshaw Christian Church
 First Ladies
 Health Care Partners
 Martin Luther King, Jr. Multi-Service Ambulatory Care Center
 Drew University
 USC Dental School
 AIDS Project LA
 Centinela Hospital
 Saint John’s Wellness Child and Family Center
 St. Francis Medical Center
 Eisner Clinic
Interviewees observed that women are the most common users of community health clinics. Those without medical insurance tend to go to the emergency room, but if a co-payment is involved, they won’t go. In addition,
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interviewees mentioned that the lack of preventive care utilization often leads to people waiting until an illness
becomes an emergency. One interviewee added that, often, “Immigrants seek medical care when they visit their
home countries. For chronic and specialized care, including dental services, they go to their home countries where
service and medications are cheaper and access is easier.”
Dental care/oral health
Overall, interviewees with knowledge of dental care provision in the service area agreed that the need is
“overwhelming.” Few clinics offer dental care, and the total is not enough to match the demand. Interviewees
offered the following insights about the challenges to dental care access:

“People don’t have it and can’t get it. Even pro bono dental services at USC are hard
to get. It could be a year’s wait to get an appointment.”

“Oral health is an issue with families receiving financial assistance from us. They
need the knowledge of when to start dental care with their children, and then it’s hard
for families to find dentists.”

“We need to educate parents on the importance of routine dental care [and] how to
qualify for service, and to help them register and enroll.”

“Dental care is not at the forefront of priorities; people just don’t access much routine
dental care—just as with basic health care—until it’s an emergency.”
Mental health
Interviewees described a large gap in available services for the mentally ill. Providers do what they can in urgent
cases to stabilize people, but community facilities are at maximum patient capacity. Because of the stigma associated with mental illness (especially in the Hispanic community), people with mental health issues tend to self-isolate. Referrals occur more often when these individuals are treated for another medical condition. Participants said
more education about mental illness is needed, with the goal of de-stigmatizing the seeking of mental health care.
Patient advocacy
Several interviewees concurred that utilization of available services would increase and produce more effective
outcomes if clients knew how to access and understand what is available to them. They recommended increased
training and the use of patient advocates and system navigators.

“We need more social workers, advocates, and discharge planners who can translate
preventative care practices into people’s real-life needs and capabilities.”

“They need someone to accompany them on medical visits, so two people hear and
learn the key points about the condition. Patients need advocates to guide them in
doing what they should be doing to address their conditions.”

“Train front-line people to provide resources to patients, their caregivers, and [their]
families.”

“Provide someone who can help people pursue the resources, make the calls, and
help them figure out how they can do it.”
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
“A proactive person can ask for what they think should be monitored, but a less
knowledgeable person is at the mercy of the system and health care staff on any
given day to pay attention and do appropriate follow-up.”
Ideas for Collaboration and Cooperation among Service
Providers
Interviewees were asked to reflect on specific actions or initiatives that hospitals could take to help address identified needs. They were also asked to describe potential areas for collaboration and coordination among hospitals
and CBOs to better meet the needs of the communities they serve.
Participants offered a comprehensive list of actionable items for consideration.
 Accept more referrals of patients in need of specialty care
 Create a centralized area for patient health information
 Educate patients about their rights (access to their own medical records, for example)
 Equalize cost structures across Medicare and other insurance plans
 Get involved in local events such as Taste of Soul
 Get promotoras and advocates out into the community
 Help health care providers with less capital get access to the equipment they need
 Identify high utilizers of heath care services for active case management and assessment
 Improve customer service
 Increase the school-based clinic presence
 Initiate more effective public relations
 Make better discharge summaries to primary care providers to reduce re-admission rates
 Offer education programs free or at low cost to the underinsured and uninsured
 Offer more grants to CBOs for outreach and education programs
 Offer more nutrition education and exercise classes
 Partner with local providers and churches to put on health event and community fairs
 Provide information and education about the Affordable Care Act
 Recruit/retain more physicians who want to work with the population of South Los Angeles
 Re-establish a medical residency program with Drew University
 Refer people discharged from the emergency room directly to primary care providers
 Reserve a number of open slots for uninsured patients
 Share information with providers to reduce the duplication of services
 Streamline systems to clinics to get what they need
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 Train system navigators to help low-income, illiterate people through the system
 Treat problems in a timely manner
 Use social media to educate young people on key issues and where to go to get help
 Write prescriptions for social services, not just for medications
One interviewee cited a pilot program in which the ER discharge plan refers the patient directly to the Eisner
Clinic. Another participant suggested that “Kaiser should launch a health plan for undocumented people with a
very low monthly cost—for example, $20.”
Autism
A representative of an autism resources organization noted that the “spike” in diagnosed cases of autism, which
started twenty years ago, has resulted in a large population of adults, now 25 to 30 years old, who contend with
continuing challenges related to autism. It was suggested that Kaiser take a leadership role in investigating the
cause of the rise in autism diagnoses (environmental triggers, genetic issues). Additionally, hospitals can do the
following to address autism at early stages, when intervention is most effective:
 Focus on early intervention and diagnose children correctly
 Conduct annual developmental screenings on every child with a reliable tool
 Build performance standards into regular pediatric care/clinics to ensure that assessments for autism are
being conducted
 Track assessments over time (up to 6 years old)
 Have parents complete assessments in the ER waiting room, and keep them on file for future use
One interviewee offered a number of suggestions for hospitals regarding autism:

“Kaiser does a good job of coordinating, but hospitals need to get better at this, and
not just throw therapies at them, willy nilly.”

“The larger issue is helping help families coordinate the non-medical pieces that also
have implications for the well-being of children with autism.”

“Kaiser can take the lead in helping families navigate not only its system, but other
systems. There’s a cost argument for [the] coordination of complementary services—
they end up making people healthier.”

“If you can’t figure out how to fill out paperwork for your kid with a disability
because you don’t speak English, you can’t get the kid enrolled in early intervention.
If the kid is chronically absent from school and failing, a system navigator can walk
parents through it. Otherwise, families will flounder.”
Hospitals
Other interviewees offered additional suggestions for hospitals:

“Hospitals need to link up with community providers, policy-makers, and officials so
everyone knows what everyone is doing—not reinvent the wheel, but rather enhance
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what each is doing. We really need to find out what is already going on, leverage
that, enhance that, and complement.”

“Offer your spaces to bring people in to do exercise, training and teaching. Turn your
physiotherapy facilities into community-based wellness programs, because people
don’t like going to hospitals for wellness resources. They prefer community-based
programs.”

“Hospitals need to help people have a better experience and feel more supported.
When people come to a hospital, it is a stressful, fear-provoking experience.”
Interviewees suggested additional ideas for collaboration:
 Organizing town hall forums
 Conducting proactive educational outreach
 Partnering with comprehensive family resource centers (e.g., Magnolia Place)
 Making paratransit more accessible through support programs
 Increasing the reach of Meals on Wheels (healthy food for the homebound)
 Giving information about child care resources to pregnant women and new parents
One interviewee suggested that “Mass campaigns around healthy eating and diet would really help. We couldn’t
afford to do that on our own, but in partnership, yes.”
Participants cited the following examples of community coordination and collaboration:
 Healthy Cities project in El Monte
 Crenshaw Christian Church regularly brings in providers to provide health care services to their 18,000
members, and other people in the immediate vicinity may also attend
 First Ladies Initiative organizes health screenings in 30 churches in SPA 6, in collaboration with Health
Care Partners and the County Department of Health
 The BE WELL program has partnered with mental health service providers (possibly the first collaboration of its kind in the nation)
 Some cities have developed internal transportation projects through Community Development Block
Grants
 The South LA Healthcare Leadership Table works to improve health care disparities, bringing people
together to strategize on comprehensive approaches; it is now focusing on diabetes
The interviewees offered additional insight into the dynamics of, and obstacles to, collaboration:

“Let’s not spend time reinventing the wheel. We can accomplish more through
collaboration. Why does Kaiser seek out organizations to advise them on developing
their own patient education programs? Why not partner and have the CBO deliver the
programs for Kaiser patients?”
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
“Many of the issues related to wellness, nutrition, and exercise are behavior
modification issues. There’s potential if all disciplines could work together. We need
to set up task forces [and] develop community-based programs that include hospitals,
cities, and CBOs.”

“Work with established institutions such as Charles Drew, Watts Healthcare, and
other community clinics, come together quarterly, [and] coordinate better in
communicating to the public about services, schedules, and opportunities for health
services.”

“It’s tough when there is no overarching authority mandating that collaboration is
required, but it is still a very competitive model for health care provision.”
Outreach methodologies and message content
Interviewees were asked to share their thoughts about the most effective outreach methods for delivering information to their service populations. They also shared their ideas about messages they thought were particularly
important to convey.
 Cell phones, online platforms, and social media
 Community forums and town hall meetings specific to communities
 Events at schools and libraries
 Faith-based organizations, especially in SPA 6
 Free directories of resources
 Locations where people congregate, local gathering places (e.g., the Mexican consulate)
 Mobile clinics
 Organizations that serve specific populations
 Promotoras
 Providing information in other languages
 Publications specific to communities (Spanish-language, African-American newspapers)
 Radio programs and public service announcements
Interviewees agreed that messaging should be targeted to specific audiences and should be positive, be empowering, and focus on prevention:

“Messages should convey that we have resources to help.”

“Community events get the message out. We have men’s and women’s fairs, with
custom car shows and screenings. We have things for kids. The message is that we
are in the community to help. We pull many people into these events.”

“Kaiser’s Thrive campaign is an amazing message that is on point.”
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
“Make educational resources available in waiting rooms that are appealing and userfriendly. A good example is The People’s Guide to Food and Hunger.”

“We have to handle our message in a more graphic way.”

“Talk about outcomes, but scaring people is not a good idea.”

“Have MDs give written outpatient prescriptions for healthy behaviors.”

“Tell people the how, where, and why of the behavior changes we want them to
make.”

“People are slow to change. Messages have to be relevant for a cultural shift to
occur.”
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Appendix G:
Focus Group Summary
for KFH-WLA
Page 239
Health Needs and Drivers
Six focus groups representing a broad range of community stakeholders, including area residents, were convened
to gather information and opinions directly from persons who represent the broad interests of the community
served by the hospital. Focus group sessions were 60 to 90 minutes each. The focus group topics were designed
to collect representative information about health care utilization, preventive and primary care, health insurance,
access and barriers to care, emergency room use, chronic disease management, and other community issues.
Focus group participants identified chronic diseases and other conditions associated with aging that impact
individuals in the service area, but also mentioned several other concerns relating to mental health and violent or
aggressive behavior in the community. The full list of health needs and drivers mentioned during focus group
discussions is below, along with a summary of key focus group findings.
Health needs
 Alzheimer’s disease
 Arthritis
 Asthma
 Autism
 Cancer
 Chronic pain, including headaches
 Chronic Obstructive Pulmonary Disease (COPD)
 Dementia
 Diabetes
 Emotional distress
 Gall bladder disease
 Hearing problems
 Heart disease
 High blood pressure
 High cholesterol
 Kidney/pancreas transplants
 Lack of prenatal care
 Mental health, including depression, stress, anxiety, and suicide
 Obesity
 Post-Traumatic Stress Disorder (PTSD)
 Substance abuse
Page 240
Drivers of health
 Behavioral
 Poor eating habits
 Lack of exercise
 Teen pregnancy
 Cultural
 Stigmas
 Language
 Drug and alcohol abuse
 Environmental
 Poor air quality
 Family issues
 Family strife
 Single parents
 Housing
 Slum housing
 High rents
 A lack of understanding and knowledge
 The inability to navigate the health system
 A lack of nutritional information
 A lack of resources to buy healthy food
 A denial of their condition
 A lack of awareness of available community services
 Safety
 A lack of safe green spaces
 Community violence
 Social and economic
 Poverty
 Homelessness
 Unemployment
 Unaffordable healthy food options
Homelessness
Community leaders described the effects of increased homelessness on the community. In Culver City, kids are
living in cars with their families. In the 90011 ZIP Code, people are living in parks, which are no longer places for
recreation, and at storefronts. Small colonies of homeless people live near or under freeways. Focus group participants emphasized that these are “regular people” who have lost their homes, not mental health patients or drug
Page 241
addicts. There are also homeless veterans, both men and women. The Health Provider focus group mentioned the
“prison pipeline” and that 20% of students at Fremont High School are in foster care.
Healthy Eating
Focus group participants talked about common misperceptions surrounding diet and healthy eating habits. “People do not know what real obesity is. They think you are obese when you are 400 pounds.” Poor families who get
their food from food banks are consuming a lot of processed foods in the form of packaged and canned goods.
People are consuming high levels of sodium in fast foods. Teens with gall bladder and liver disease are unaware
of their condition. Participants also mentioned the lack of safe parks for exercise and walking; where such places
do exist, the routes to and from the locations are not safe.
Health-Related Trends in the Community
Focus group participants were asked to discuss health-related trends they have noticed in the last five years—
both positive and negative—related to chronic illness, barriers to access, and other factors and issues.
Negative Trends
 An increase in chronic illnesses
 An increase in obesity
 An increase in diabetes
 A lack of access
 Less availability of services despite more money being put into clinics with the Affordable Care Act;
because of the demand, the need for services is very high
 Difficulty accessing specialized care for Alzheimer’s disease
 A lack of professionals
 A lack of cultural competency among providers
 The gatekeepers of the community are retiring and there is a lack of professionals to take their place
 A lack of leadership (CMOs in clinics) [Chief Medical Officers]
 A lack of qualified professionals to identify and treat lupus, but some are trying to teach clinics how to
treat and diagnose it—e.g., Venice Clinic—and will be getting UCLA fellows in July
 Poor health status
Positive trends
Positive trends noted by focus group participants included an increase in a holistic perspective and a better
understanding of health issues and recognition of community-based needs, of connections between drivers and
health issues, and of the need to collaborate. Communities and people are also slowly starting to understand the
importance of fresh fruits and vegetables in the diet (as evidenced by the popularity of farmers markets).
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Sub-Populations Most Affected by These General Health Needs
Focus group participants identified the most affected populations as Hispanics, African-Americans (men and
women), other people of color in lower-income areas, men and boys over age 14, women, single parents, teen parents, the homeless, the aging, low socio-economic populations, and the illiterate.
Social service providers identified specifically affected populations based on the condition: cancer among the elderly; nutrition issues among low-income persons, youth, and the elderly; depression and anxiety among youth and
seniors; PTSD among adults, women, families and caregivers; and diabetes among minorities, women, and young
men.
Barriers to Access
Participants emphasized the lack of information and education about health access and how to navigate the system. People do not know what is available or when they should go to a doctor, and are unable to communicate
with doctors because of language barriers. They do not visit dentists unless they are in pain. There is also a lack of
resources for affordable dental and health screenings and care. In addition, the lack of child care causes difficulty
in attending health classes. Low-income populations need different teaching styles: lectures at Cedars Sinai, for
example, are “over the heads” of patients with low health literacy. Undocumented people are often afraid to seek
care because they are afraid of being deported and “many people do not know how to advocate for themselves.”
Barriers
 Long waiting times—sometimes one to two years for a procedure
 A lack of bilingual doctors
 A lack of child care and day and respite care for seniors
 A lack of eligibility (the working poor are unable to qualify for services)
 A lack of affordable or free health care for the uninsured
 A lack of low-cost/no-cost dental care for children and adults
 A lack of Medi-Cal–accepting health service providers
 A lack of prenatal care
Health services that are lacking or difficult to access
 Health literacy, an awareness of available services; how to qualify, how to navigate systems
 Low-cost, effective/convenient transportation to health clinics and specialty care (often not local)
 Specialty care for vision, dental, and podiatry
 Mental health providers with cultural competence (most are Caucasian) who understand the patient’s
culture
 Outpatient surgery
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Healthy behaviors that are the most difficult to promote
Participants attributed the inability to promote healthy behaviors in the community to the lack of affordable
healthy food options and the lack of safe green spaces in the community. In addition, the following behaviors
were also identified as the most difficult to promote:
 Sobriety
 Condom use
 Preventive health care, including regular medical visits
 Dental hygiene
 Anger management
 Conflict mediation
Health care utilization
Participants believed that people need to be “captured at intake,” when they go into a clinic; if they understand
their condition and the steps required to improve their condition, and can afford to follow these steps, then they
will engage in preventive healthcare. They also mentioned the need for children to be immunized. Participants felt
that simpler messages are needed because people do not understand the term “preventive care.” A representative
from one organization stated that 25% have engaged in preventive care, 50% know about it but cannot afford it,
and 25% don’t know anything about it.
Where community members go for care
When asked where community members went for medical care, participants indicated that most people go to
urgent care or the emergency room, a relative’s house, online resources (i.e., WebMD), or curanderos (or witch
doctors).
Community resources
Participants were also asked to share information about community resources for medical and related health care.
Most mentioned local hospitals, clinics, resource centers, health fairs, senior centers, and other community-based
organizations.
Hospitals
 Kaiser (walk-in medical)
 Cedars Sinai
 Harbor Medical
Community clinics
 Saint John’s (also for behavioral health, dance, nutrition, and support groups on depression, women’s
issues)
 Venice Family Clinic (free medical service)
 Didi Hirsch Mental Health Services (mental health)
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 Vista de Mar (mental health, residential treatment)
 South Bay Family Center (free health care to uninsured)
 LA Free Clinic (medical/mental health) [Note: the LA Free Clinic is now the Saban Free Clinic]
 Culver City Youth Center (free mental health services; a partnership with schools to provide mental
health screenings for students)
Resource centers
 211 (referrals for food stamps and health clinics, information-gathering, behavior/developmental screening over the phone/online)
 Jewish Family Service Center
 NAMI (group/individual counseling)
 The H.E.L.P. Group (autism resources and services)
 Crystal Stairs (child care subsidies, child care resources and referrals, health care enrollment)
Other community-based organizations or resources
 Veterans Affairs
 Vision to Learn (free vision screen, free eyeglasses)
 Food banks, farmers’ markets
 Senior centers that provide computer literacy classes for seniors
 Health fairs
 Access (senior transportation; relatively easy to schedule a doctor visit, more difficult to organize a return
trip)
 Local government representatives (Holly Mitchell and Mike Davis)
 Library, Internet
 Periodical La Opinion, television, radio
 Churches (emergency support, housing, food)
 School parent centers
 Public housing offices, homeless services
 The California Endowment and First 5 (offering Healthy Communities in limited areas)
How Hospitals Can Address the Health Service Needs of This
Community
Focus group respondents had many suggestions for improving services, including preventive health care, improved cultural competency, mental health services, and collaborating with community members to more effectively meet community needs.
Page 245
 VA Hospital: KFH-WLA service area residents wished that more time could be allotted to the doctorpatient consultation, that the wait time for appointments could be shortened, that more facilities would
take insurance, and that there was a better way of disseminating health information to the public (e.g.,
through health classes, programs, and health fairs)
 Kaiser: KFH-WLA service area residents also commented that Kaiser was doing an excellent job with
health/dance classes and the lower costs of care, but wished it could also provide transportation to
appointments
 Free screenings, checkups, mobile units, nutrition classes, free food
 Large health fairs are more effective than local health fairs. Fairs need to be marketed to encourage the
public to attend and should provide incentives for attendees
 Preventive medicine services; community outreach workers should follow up with patients to prevent
their ending up in the ER
 Partner with local agencies (nonprofits, 211, Women, Infants and Children (WIC); either have office
space in the hospital or identify patients who can qualify for services
 Create support groups for people with certain conditions and also provide referrals to other support
groups
 Provide training on how to deal with special needs and how to develop cultural sensitivity
 Learn to deal with mental health patients, to identify their conditions
 Find ways to deal with people like the homeless who are out of the hospital network, and provide a direct
link to appropriate services
 Vision services for children in schools
 Clear messaging about campaigns; target using billboards and other media
 Collaborate with community groups and use community resources to serve residents
 Leverage technology to inform residents, especially youth
Suggestions for promoting healthy behaviors
Participants provided suggestions that might help with promoting healthy behaviors, including incentivizing
healthy behaviors, creating community gardens, advocating for fewer fast food restaurants in the community,
subsidizing local markets to provide affordable healthy food options, using social media networks like Facebook
and Twitter, leveraging existing community resources like Parent Teacher Associations and churches, and using
the promotora model to promote and distribute information.
Communications strategies for some of these recommendations include the use of media outlets such as community newspapers and social media (YouTube, Facebook, etc.), and campaigns that are clear and focused.
Page 246
Appendix H:
Tier Results
Page 247
The following tables include the list of all identified health needs and drivers. Each health need and
driver is presented according to the tier that they fell into during the identification phase, from Tier 1
which was all inclusive to Tier 3 which was the most exclusive. After much discussion between the
consultant and the Collaborative, the list in Tier 2 was taken into the prioritization phase. Please note
that both tables are presented in alphabetical order and not in any ranking order.
KFH-WLA Identified Health Needs 2013, by Tier
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Tier 1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Diabetes
Mental Health
Obesity/Overweight
HIV/AIDS
Alcohol & Substance Use
Allergies
Arthritis
Asthma
Breast Cancer
Cervical Cancer
Colorectal Cancer
Cancer, in General
Cholesterol
Hypertension
Infant Mortality
Intentional Injury
Unintentional Injury
Oral Health
Podiatry
Chlamydia
Vision
Brain Cancer
Chronic Pain
Health, Overall
Hearing
STDs, in General
Transplants
Page 248
Tier 2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Tier 3
X
X
X
X
X
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KFH--WLA Identified Drivers 2013, by Tier
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Tier 1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Healthy Eating
Income
Physical Access
Employment
Language Barrier
Health Care Access
Dental Care Access
Alcohol & Substance Use
Awareness
Nutritional Access
Cancer Screenings
Education
Health Insurance
Homelessness
Natural Environment
Physical Activity
Safety
Transportation
Age
Breastfeeding
Diabetes Management
HIV Screenings
Pneumonia vaccinations
Prenatal Care
Preventive Care Services
Family & Social Support
Immigration Status
Smoking
Teen Birth Rates
Page 250
Tier 2
X
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Tier 3
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Page 251

Community Health Needs Assessment

Transcription

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