Mission Community Hospital`s 2013 Community Needs Assessment

Transcription

GFI GOLDBERG & FACKTOR
MISSION COMMUNITY HOSPITAL
COMMUNITY HEALTH NEEDS ASSESSMENT
Prepared for Mission Community Hospital
Published: June 24, 2013
GFI Goldberg & Facktor, Inc.
LOS ANGELES, ORANGE COUNTY, SAN FRANCISCO, SACRAMENTO & CHICAGO
Table of Contents
1. Organization Profile
2. Background, Purpose, & Design
3. Demographics
4. Barriers to Health Care Access
5. Disease Prevalence and Mortality
6. Risk Behaviors
7. Results from Focus Groups & Key Informant Interviews
8. Conclusion
9. APPENDIX A: Primary Data (Focus Groups & Interviews)
1. Organization Profile
a. Mission, Vision, and Values
Mission Community Hospital’s (MCH) doctors, nurses and hospital staff are dedicated to
providing the best-possible care within a compassionate environment that meets each
patient’s physical, social, and emotional needs.
MCH staff knows that many of the individuals and families in the surrounding community
face socioeconomic, language and cultural barriers to accessing healthcare. MCH is
dedicated to meeting patient needs with multilingual and multicultural understanding. MCH
has partnered with neighboring hospitals, as well as community organizations and agencies,
in order to ensure patients have access to the full range of services needed, including health
education and disease prevention.
MCH is guided by its values that include respect, compassion, leadership, teamwork,
excellence, quality, honesty, accountability, and continued growth.
b. History
MCH is a private not-for-profit safety net hospital that has been providing high-quality,
affordable healthcare to the surrounding community for close to 90 years. MCH is an acute
care hospital owned and operated by San Fernando Community Hospital, Inc., a not-forprofit California Charitable Corporation. MCH is committed to the health and wellness of
north-central and northeast San Fernando Valley (SFV) residents. As such, MCH dedicates
itself to being a center of excellence in delivering a full range of medical, surgical, and
mental health care, including 24-hour emergency services of the highest quality. MCH
pledges compassionate care with services delivered by highly qualified caregivers reflective
of the ethnic and linguistic diversity of the SFV. In 2010, MCH entered into an agreement
with Deanco Healthcare, LLC that will lead to a transfer of ownership by the end of June
2013. In 2011, MCH, under the new management group, purchased new hospital equipment,
including advanced surgical navigation equipment and the only Robotic Surgery System
located in a community hospital in the entire Western United States. The hospital is fully
accredited by The Joint Commission (TJC) and fully certified to participate in Medicare and
Medicaid. As a State of California designated Medi-Cal Disproportionate Share Hospital
(DSH), 89 percent of MCH services are to Medi-Cal or Medicare beneficiaries and to
uninsured individuals.
Licensed for 85 medical/surgical beds and 60 acute psychiatric beds, MCH provides a full
range of medical, surgical, psychiatric and emergency care. MCH recently completed
renovations and became one of the first hospitals in Los Angeles (LA) County to fully meet
all SB 1953 seismic requirements for new facility construction. In addition to the new
medical-surgical and psychiatric facility, MCH also houses a Psychiatric Outpatient Day
Treatment service for adults. A satellite Outpatient Treatment Center opened in 2011 in Santa
Clarita, providing mental health services to a community that has, historically, been
underserved. MCH’s commitment to the mental health of the community has led to the
creation of a mobile Psychiatric Evaluation Team which serves persons in crisis at MCH,
satellite locations, other hospitals’ emergency departments, as well as community agencies,
group homes and families. Since 2012, MCH has been in the process of upgrading the North
Tower to include 25 additional licensed beds. MCH pledges to continue providing an array
of health education and outreach services to prevent and reverse the threat to health and
quality-of life faced by individuals from two of the most serious chronic life threatening
diseases: unchecked diabetes and obesity.
The Governing Board consists of local leaders, including doctors and business professionals
who live and work in the community. These dedicated individuals approve all major hospital
decisions, including long-range strategic plans, capital allocations, service programs, and
major acquisitions and sales.
c. Governance
The 12-member Board of Directors (Board) is representative of the communities MCH
serves. The Board has fiduciary, quality assurance and policy-making responsibilities.
Members of the Board of Directors are elected for staggered three-year terms and limited to
three consecutive terms. The Chief Executive Officer of the Hospital is an ex-officio, nonvoting member and the Chief of the Hospital’s Medical Staff is also ex-officio, but voting
member of the Board. The Board consists of local leaders, including doctors and business
professionals who live and work in the community. The affiliations of officers and directors
are as follows:
William Josephson, M.D., Chairman
Internal Medicine, member of the MCH Medical Staff since 1988
Cesar De La Cruz, Vice-Chairman
Property Manager, Agora Realty & Management, Inc.
Sunghee Myung-Koziol, Treasurer
Senior Vice President/District Manager, Premier Business Bank
Louise Oliver, Secretary
Director of Government & Community Contracts, Valley Operations, Goodwill of Southern
California
Piyush Jogani, M.D., Director
Gastroenterologist, member of the MCH Medical Staff since 1993
Troy Halpern, Director
Owner, Halpern Industries
Staci Harrison, Director
Director of Clinical Nursing, Critical Care Services
Shirley Friedman, Director
Founder, President/CEO, The Attentive Group, Inc.
Jeffrey Silverman, M.D., Director
Landmark Imaging Medical Group, Inc.
Andrew Ratzky, Director
Area Mortgage Manager, HSBC Bank
Bassam Bejjani, M.D., Ex-Officio
Chief of Staff, member of the MCH Medical Staff since 1993
James Theiring, CEO, Ex-Officio
Chief Executive Officer, Mission Community Hospital (non-voting)
d. Hospital Services
MCH employs over 800 culturally and linguistically appropriate clinical and support
professionals to meet the needs of the community. MCH has over 350 medical staff
including primary care providers as well as specialists and sub-specialists. MCH offers
medical/surgical, surgical, cardio pulmonary, ICU/CCU, inpatient psychiatric and outpatient
day treatment programs, medical detoxification, physical therapy, industrial medicine, and
24-hour emergency services. Outpatient services include physical therapy, mammography,
laboratory, ultrasound, X-ray and other diagnostics, and outpatient day treatment services.
MCH is licensed by the State of California, LA County Department of Public Health and
accredited by The Joint Commission.
The following hospitals are also located within MCH’s service area:
• Kaiser Permanente Panorama City
• Providence Holy Cross Medical Center, Mission Hills
• Valley Presbyterian Hospital, Van Nuys
• Providence Tarzana Medical Center, Tarzana
• Rinaldi Convalescent Hospital, Granada Hills
• Northridge Hospital Medical Center, Northridge
The following Federally Qualified Health Centers are located within MCH’s service area:
• Glendale Health Center
• North Hollywood Health Center
• Pacoima Health Center
• Northeast Valley Health Center
e. Community Benefit Programs
MCH defines Community Benefit as services and activities that address community health
needs primarily through disease prevention, health promotion and education, improved
access to services and working with others to improve individual and community health
status. MCH operates seven core Community Benefit functions. Each is briefly described
below.
1. Hospital Charity (Uncompensated) Care
MCH treats all patients, regardless of age, sex, lifestyle, creed, race, national origin or source
of payment. All patients are treated equally with regard to charges, bed assignments and
medical care, regardless of their ability to pay. MCH provides care without charge, or at
discounted rates, to patients who meet MCH charity care eligibility criteria.
2. Emergency Department Services
The MCH Emergency Department (ED) has nine patient care bays. The ED serves a wide
spectrum of medical, surgical, age, ethnic and linguistic groups. The Level III service is fully
accredited and staffed by board certified emergency medicine physicians supported by
registered nurses, nurse practitioners, emergency medical technicians, and patient advocates.
The ED responds to the needs of an average of 1600 patients monthly. It is the point-of-entry
for about 2/3 of MCH inpatient medical/surgical admissions. ED operates 24/7 responding to
the immediate care needs of adult, senior and child gunshot victims, behavioral crisis,
asthmatics and others in respiratory crisis, persons in heart failure, auto accident victims and
high-risk pregnant women and teens presenting in labor but without prior prenatal care.
3. San Fernando Community Health Center
MCH is supporting the construction of a new comprehensive primary care facility in the San
Fernando Valley (SFV). The San Fernando Community Health Center (SFCHC) is the new
15-exam room primary care clinic comprising 8400 square feet, which will include the
Dental Clinic, Project ALTO-D™, and the Community Diabetes Center, which will house
the Diabetes Testing Kitchen.
4. The Community Diabetes Center
The Community Diabetes Center provides preventive healthcare to medically underserved
people in the northeast SFV, with a special focus on the needs of the Latino community. To
ensure services are provided in a culturally appropriate environment, a majority of the staff is
bilingual and all understand and respect cultural differences. The Center combines an
intensive patient education program with each visit to help reduce acute illness and promote
healthy lifestyles in an at-risk population. The Diabetes Testing Kitchen, opened in
November 2010, focuses on diabetes, obesity and chronic disease prevention. Kitchen
educational programs are designed to reduce the danger from escalating rates of diabetes and
obesity in MCH service communities by teaching residents at risk for or living with these
conditions, caregivers and other family members, how to prepare nutritious, and culturally
appropriate foods. The emphasis is on the selection and healthy preparation of low fat, low
starch, and low sugar fresh foods that reduce risk of diabetes, heart failure and other serious
medical complications.
5. Project ALTO-Diabetes/Obesity Prevention and Self-Management
MCH has sponsored Project ALTO-D™ for six years. ALTO-D™ is an acronym for
“Alerting Latinos to Overcome Diabetes and Obesity.” The project offers a free 18-hour
Estilo de Vida Saludable con Diabetes (EVS) course that translates to “Healthier Lifestyles
with Diabetes.” EVS consists of 2-hour workshops delivered by highly qualified Spanishspeaking health educators and held weekly for eight consecutive weeks.
6. Dental Teaching Clinic
Since its opening in 2005, the Dental Teaching Clinic offers dental services delivered by bilingual Spanish/English faculty members of the UCLA School of Dentistry and advanced
students in community dentistry. The Dental Clinic provides patient diagnosis, treatment
planning, treatment and follow-up to patients.
7. Community Psychiatric Evaluation & Counseling Services (PECC)
PECC has the following four aims: 1) Create a point-of-service for the psychiatric evaluation
of persons presenting to the ED in apparent behavioral health crisis, 2) Reduce ED waiting
times for ED patients presenting with apparent emerging medical need by triaging behavioral
health patients to the PECC and away from the hospital patient waiting room, 3) Assess
behavioral health patients referred to the hospital for immediate or deferrable psychiatric
need and 4) Provide Psychiatric Emergency Team (PET) mobile evaluation of persons with
behavioral health challenge unable to travel to the PECC for evaluation.
f. Collaborations
MCH programs are developed in collaboration with community residents, physicians,
dentists, mental health professionals, health and human service organizations, businesses,
churches, schools, and fraternal organizations.
MCH develops services and strategies for overcoming community health disparities in
collaboration with the UCLA School of Dentistry, UCLA School of Nursing, and the
California State University, Northridge (CSUN) Marilyn Magaram Center for Food Science,
Nutrition, and Dietetics. MCH is a proud community partner in the recently established
Clinical and Translational Science Institute at UCLA, which works to bring cutting edge
scientific research into the community setting.
MCH conducts community outreach and educational information sessions routinely with the
following community organizations:
•
•
•
•
•
El Cariso Park, Sylmar
Noble Elementary School
St. Ferdinand Catholic Church
Hansen Dam Recreation Center
Japanese Gardens St. Health Fair
•
•
•
•
Plaza del Valle
Los Angeles Mission College
Vaughn Next Century Learning
Center
Saticoy Elementary School
Project ALTO-D™ Diabetes Classes are offered in collaboration with the following local
educational institutions:
•
•
•
•
MEND
O’Melveny Elementary School
San Fernando Middle School
Bird Middle School
•
•
•
Vaughn Next Century Learning
Center
Roscoe Elementary School
Dyer Elementary School
In addition, MCH collaborates with the following community organizations on a variety of
community benefit programs:
•
•
•
•
•
Girl Scouts of America
Panorama City Neighborhood
Council
Neighborhood Watch Meeting
Family to Family- NAMI
Pierce College
•
•
•
•
•
West Coast University
Annenberg School of Nursing
Project ALTO Diabetes Class
Latinas in Action
First Time Homeowners
Workshop
•
•
CES College
Valley College of Allied Health
•
American Career College
2. Background, Purpose, and Design of the 2013 Needs Assessment
In 1994, the California State Legislature enacted Senate Bill 697 (SB 697) requiring nonprofit hospitals to conduct a needs assessment every three years. Based on the needs and
priorities identified in the tri-annual needs assessment, the hospital would develop a
community benefits plan. The purpose of the community benefits plan is to propose activities
based on the identified community needs and designed around disease prevention efforts and
improvement of health status. The seven projects identified previously developed as a result
of previous community needs assessments published by local community based
organizations.
For this community health needs assessment, primary data were collected through key
informant interviews and focus groups. The report includes data from 4 focus groups
conducted in various settings throughout the hospital catchment area. There were eight key
informant interviews conducted with social service, health, mental health, dental, public
health, and clinic service providers.
Secondary data are helpful in highlighting, in an objective manner, health outcomes that
significantly impact a community. MCH reviewed and analyzed secondary data sources
including the United States Census 2010, American Community Survey (ACS), Los Angeles
County Department of Health Services, Key Indicators of Health and Recent Health trends in
Los Angeles, and UCLA’s California Health Interview Survey (CHIS). In addition,
information from other resources including online resources and health care foundations
were utilized as needed. Data gathered were grouped according to the health conditions, comorbidities, age, gender, and ethnicity. Zip code level data collected was used to compare
how areas within the catchment area compare to each other. Feedback collected from primary
data collection was then used to determine if community perception of health needs aligned
with the secondary data.
The types of indicators provided for use in the MCH Needs Assessment include:
demographics, social and economic factors, health behaviors, physical environment, and
health outcomes.
3. Demographics
a. Service Area
Los Angeles County’s health delivery system is divided into eight geographic regions called
Service Planning Areas (SPA). The SPAs combined contain 26 distinct Health Districts.
Designated boundaries for MCH are aligned with SPA 2 in LA County, California. As a
whole, SPA 2 spans over 999.24 square miles and contains 2,136,581 residents, representing
the largest SPA in LA County, as detailed in Table 1 below. SPA 2 is larger in population
than the states of New Mexico, West Virginia and Nebraska.
Table 1: SPA Population Counts (listed from highest to lowest)1
Los Angeles County
SPA 2 San Fernando
SPA 3 San Gabriel
SPA 8 South Bay
SPA 7 East
SPA 4 Metro
SPA 6 South
SPA 5 West
SPA 1 Antelope Valley
9,866,194
2,136,581
1,752,126
1,528,363
1,295,828
1,120,091
1,009,550
637,129
386,526
SPA 2 as a whole consists of thirty-six communities, ten of which are incorporated cities, and
is further divided into four distinct health districts identified as East Valley, Glendale, San
Fernando, and West Valley. MCH is located within the San Fernando health district, however
patients served represent all health districts. It is important to note that some of the data
reported in this report could only be narrowed down to the district level. This will not always
reflect the true nature of the zip codes in the San Fernando district because those zip codes in
the Santa Clarita Valley fare much better than those located in the Northeast San Fernando
Valley which is part of the San Fernando health district.
Figure 1: Service Planning Area (SPA) 2
1
LA County Department of Public Health, Key Indicators of Health, March 2013, accessed at
http://publichealth.lacounty.gov/ha/docs/kir_2013_finals.pdf, accessed on May 20, 2013.
MCH’s primary service area is defined as a 30-square mile urban and suburban area in the
north central and northeast SFV within SPA 2. MCH’s service area, with a population of
approximately 969,213 includes the cities of Arleta, Canoga Park, Chatsworth, Granada
Hills, Mission Hills, North Hills, North Hollywood, Panorama City, Pacoima, Sepulveda,
Sylmar, Sun Valley, Van Nuys, and the City of San Fernando. MCH’s service area
geographic boundary consists of Sherman Way to the south, the 405 freeway to the west, the
118 freeway to the north, and the 5 freeway to the east. Six neighborhoods in Pacoima and
San Fernando are designated federal Empowerment Zones because of pervasive poverty.
MCH’s primary service area, which accounts for over 85 percent of patient volume, consists
of the following 12 zip codes:
91331 Arleta, Pacoima
91342 Sylmar
91343 North Hills
91344 Granada Hills
91352 Sun Valley
91401 Van Nuys
91402 Panorama City, Sepulveda
91405 Van Nuys
91406 Van Nuys
91411 Van Nuys
91605 North Hollywood
MCH’s secondary service area consists of the following eight zip codes:
91304 Canoga Park
91306 Canoga Park
91311 Chatsworth
91324 Northridge
91325 Northridge
91340 San Fernando, Sylmar
91345 Mission Hills
b. Population count
In 2012, MCH’s total service area population consisted of 969,219 individuals. The highest
populated zip code within MCH’s service area was 91331 with 10 percent of the service area
population, followed by 91342 and 91402 at 9 percent and 7.3 percent respectively. In
contrast, the least populated zip code was 91345 with less than 2 percent of the service area
population, followed by 91411 and 91324 with 2.43 and 2.77 percent respectively.
Table 2: MCH Service Area – population count
ZIP CODE
91304
91306
91311
91324
91325
91331
91340
91342
91343
CITY NAME
Canoga Park
Canoga Park
Chatsworth
Northridge
Northridge
Arleta, Pacoima
San Fernando, Sylmar
Sylmar
North Hills
TOTAL
POPULATION
52,249
47,235
37,504
26,853
32,497
97,523
34,516
87,707
59,886
% POPULATION
5.39%
4.87%
3.87%
2.77%
3.35%
10.06%
3.56%
9.05%
6.18%
91344
91345
91352
91401
91402
91405
91406
91411
91601
91605
91606
Granada Hills
Mission Hills
Sun Valley
Van Nuys
Panorama City/Sepulveda
Van Nuys
Van Nuys
Van Nuys
North Hollywood
North Hollywood
North Hollywood
MCH TOTAL
53,134
18,629
46,561
38,600
70,676
53,395
52,955
23,520
35,830
54,052
45,897
969,219
5.48%
1.92%
4.80%
3.98%
7.29%
5.51%
5.46%
2.43%
3.70%
5.58%
4.74%
100.00%
c. Gender and Age Distribution
In MCH’s service area, gender distribution is quite equal with females accounting for 49.8
percent and males 51.2 percent of the population. As shown in figure 2 below, MCH’s
service area boasts a young population with more than one third of residents (36 percent)
under the age of 24.
Figure 2: Population Pyramid for MCH service area
d. Race and ethnicity
As shown in table 3 below, the majority of the population in MCH’s service area is Hispanic/
Latino (58 percent), similar to the last two needs assessments. The second largest portion of
the population is White (26 percent), followed by Asian (10 percent), and African American
(4 percent).
Zip code 91340 has the highest percentage of Hispanic/ Latino residents (90.96 percent) and
the lowest percentages of African American (1.22 percent) and Asian (1.00 percent). Zip
code 91311 is the only one where the majority of the population is White (56 percent) and
has the lowest percentage of Hispanic/ Latino residents (20.63 percent).
Table 3: MCH Service Area - Population by Race/ Ethnicity
Zip
code
91304
91306
91311
91324
91325
91331
91340
91342
91343
91344
91345
91352
91401
91402
91405
91406
91411
91601
91605
91606
City Name
2011 Total
population
Hispanic
/ Latino
White
Canoga Park
Canoga Park
Chatsworth
Northridge
Northridge
Arleta, Pacoima
Sylmar
North Hills
Granada Hills
Mission Hills
Sun Valley
Van Nuys
Van Nuys
Van Nuys
Van Nuys
North Hollywood
North Hollywood
North Hollywood
Total
52,249
47,235
37,504
26,853
32,497
97,523
34,516
87,707
59,886
53,134
18,629
46,561
38,600
70,676
53,395
52,955
23,520
35,830
54,052
45,897
969,219
43.42%
44.86%
20.63%
35.76%
28.91%
87.80%
90.96%
73.52%
59.94%
28.63%
60.16%
69.35%
42.23%
71.67%
59.57%
53.43%
53.22%
41.74%
63.56%
57.63%
57.99%
36.05%
29.27%
55.83%
39.70%
43.71%
4.39%
5.81%
13.98%
19.78%
48.15%
22.74%
19.64%
46.16%
9.64%
26.03%
31.03%
34.23%
41.54%
22.04%
31.42%
26.01%
Black/
African
American
4.10%
4.77%
3.38%
5.57%
6.91%
3.13%
1.22%
4.50%
4.02%
3.58%
3.59%
1.56%
4.05%
3.51%
4.65%
4.53%
4.49%
8.09%
3.12%
2.80%
3.96%
Asian
Other
13.97%
18.40%
17.25%
16.93%
17.89%
4.06%
1.00%
6.41%
14.58%
16.13%
11.13%
8.90%
4.96%
13.00%
7.17%
8.25%
5.99%
5.69%
10.29%
5.69%
10.03%
2.47%
2.70%
2.92%
2.04%
2.58%
0.62%
1.00%
1.59%
1.68%
3.52%
2.38%
0.55%
2.60%
2.17%
2.57%
2.76%
2.07%
2.94%
0.99%
2.47%
2.02%
4. Barriers to Health Care Access
a. Poverty
While impoverished households can be found in virtually every tract throughout the County,
it is unmistakable that a majority of these households are located in specific geographic
areas. The growth in concentrated poverty in the Los Angeles region was accompanied by
changes in the racial/ethnic composition and the geographical concentration of the poor.
Concurrent with national trends, by 2000, Latinos in the region increased their representation
of the growing population in tracts with concentrated poverty from 20 percent in 1970 to 65
percent in 2000.2 This growth is largely explained by immigration, as the share of the
region’s population made up of foreign-born residents grew from 13 to 44 percent during the
same time period.3 Changes in LA County also paralleled the geographic reorganization of
poverty that was taking place at the national level during the 1990s. Poverty - which was
once limited to the inner city - now expanded into the suburbs. In SPA 2 as a whole, 10.64
percent or 67,806 of households have total annual income levels less than $15,000.
Approximately 25,413 of those households include a child under the age of 13.
U.S. Census Bureau ACS 2007-2011 5-year estimates show that more than one quarter of a
million people (29 percent) in MCH’s service area is low income, living at or below 200
percent of the Federal Poverty Level (FPL), which in 2012 corresponds to $23,050 for a
family of four.4,5
In the MCH service area, as shown in table 4, Arleta/Pacoima has the largest concentration of
the population below 200 percent of the Federal Poverty Level (FPL) with 51.5 percent,
followed by San Fernando/Sylmar with 48.4 percent, and North Hills at 44.6 percent.
Table 4: Population below 200% of the FPL
Zip
City Name
Population for
whom poverty
status is
determined
%
Population
Below 200%
FPL
91304
91306
Canoga Park
Canoga Park
51,744
47,064
38.0%
37.1%
91311
Chatsworth
36,935
17.7%
91324
Northridge
26,771
31.3%
91325
91331
Northridge
Arleta, Pacoima
32,253
96,739
29.5%
51.5%
91340
34,340
48.4%
91342
91343
Sylmar
North Hills
86,042
59,339
37.2%
44.6%
91344
Granada Hills
52,690
20.4%
91345
91352
Mission Hills
Sun Valley
18,629
46,561
8.6%
16.7%
91401
Van Nuys
38,600
19.0%
2
Paul Jargowsky, “Stunning Progress, Hidden Problems: The Dramatic Decline of Concentrated Poverty in the 1990s,” The
Brookings Institution (2003); Paul Ong, “The Trajectory of Poor Neighborhoods in Southern California, 1970-2000,” The Ralph
and Goldy Lewis Center for Regional Policy Studies (2003).
3
Ibid.
4
U.S. Census Bureau. 2007-2011 American Community Survey 5 year estimates. “Ratio of income to poverty level in the past 12
months” C17002.
5
Federal Register Volume 77, Number 17 (Thursday, January 26, 2012), pp. 4034-4035
91402
91405
Van Nuys
70,676
53,395
24.2%
26.1%
91406
Van Nuys
52,955
17.0%
91411
Van Nuys
23,520
17.0%
91601
North Hollywood
35,830
16.8%
91605
North Hollywood
54,052
19.7%
91606
North Hollywood
45,897
18.3%
964,032
29.36%
MCH Total
Living in a poverty-stricken community, in addition to being poor, subject’s residents to
other costs and limitations. Research has shown the wide-ranging social and economic
effects that result when the poor are concentrated in economically segregated and
disadvantaged communities such as these. Concentrated poverty can limit educational
opportunities, lead to increased crime rates and poorer health outcomes. Faced with the stress
and marginalization of poverty, residents of very poor communities demonstrate a higher
incidence of poor physical and mental health outcomes, like asthma, depression, diabetes,
and heart ailments.6
b. Health insurance
Within a healthcare system that relies upon employment to provide health insurance
coverage, unemployment is inextricably linked to healthcare access. Indeed, almost one
quarter (22 percent) of MCH’s service area is uninsured, compared to 14.5 percent in
California. Without a regular source of health care, the uninsured are less likely to receive
important preventive services or treatments for chronic conditions such as asthma, diabetes,
or hypertension, making them more likely to develop severe yet preventable health
conditions and to be diagnosed at more advanced disease stages. Once diagnosed, the
uninsured often receive less, or inadequate medical care and are more likely to experience
premature death than those who are insured.
Over one quarter (27.5 percent) of MCH’s service area is receiving Medi-Cal or Medicare
services. The remaining 50 percent has private commercial insurance, mostly through their
employer. In contrast, more than 89 percent of MCH patients for medical/surgical and
behavioral services are Medicare or Medi-Cal beneficiaries. At MCH, all persons receiving
community-benefit services are low-to-very-low income medically indigent and with limited
ability to pay for care.
Table 5: Percentage of Insurance Type in the MCH Service Area
Zip
City Name
91304
Canoga Park
91306
Canoga Park, Winnetka
Population
%
MediCal
%
Medicare
103,747
16.6%
4.8%
49,523
14.4%
7.0%
%
Dual
Eligible
%
Private
insurance
%
Uninsured
2.5%
55.8%
20.2%
3.6%
57.3%
17.5%
6
Cohen Deborah et al. Neighborhood Physical Conditions and Health. Journal of American Public Health 93(3): 467-71, 2003.
91311
Chatsworth
46,553
14.7%
6.8%
3.5%
57.1%
17.8%
91324
Northridge
36,818
9.4%
10.3%
5.2%
63.6%
11.4%
91325
Northridge
51,414
8.8%
9.4%
4.8%
66.5%
10.6%
91331
Arleta, Pacoima
18,895
12.6%
8.8%
4.5%
58.9%
15.3%
91340
60,773
19.7%
6.3%
3.2%
46.9%
23.9%
91342
Sylmar
37,921
23.1%
4.9%
2.6%
41.4%
28.1%
91343
North Hills
56,416
24.9%
5.4%
2.8%
36.7%
30.2%
91344
Granada Hills
44,930
25.0%
5.8%
3.0%
35.8%
30.4%
91345
Mission Hills
26,860
16.2%
9.1%
4.6%
50.4%
19.7%
91352
Sun Valley
35,248
14.2%
8.3%
4.3%
55.9%
17.2%
91401
Van Nuys
69,925
22.7%
4.2%
2.2%
43.2%
27.6%
91402
Panorama City, Sepulveda
34,801
17.0%
4.6%
2.4%
55.3%
20.7%
91405
Van Nuys
47,016
19.3%
5.5%
2.9%
48.9%
23.4%
91406
Van Nuys
93,100
13.0%
6.0%
3.1%
62.2%
15.7%
91411
Van Nuys
39,064
21.2%
6.6%
3.4%
43.0%
25.8%
91601
North Hollywood
50,804
27.4%
5.4%
2.8%
30.9%
33.4%
91605
North Hollywood
53,444
20.7%
5.4%
2.8%
45.8%
25.2%
91606
North Hollywood
24,199
19.3%
5.3%
2.8%
49.1%
23.5%
981,451
18.1%
6.2%
3.2%
50.5%
22.0%
MCH Total
d. Educational attainment
On the education front, over 28.6 percent of residents in the U.S. graduated from high school
as compared with California as a whole where 33.6 percent have a high school diploma. This
disparity is particularly pronounced when looking at residents in MCH’s service area, where
only 22.8 percent of residents graduated high school. More than one quarter of the population
started college but did not finish or only completed an Associate’s degree. Only 15 percent of
persons 25 years and older in MCH’s service area have a Bachelor’s degree.
Table 6: MCH Service Area - Educational Attainment
Zip
Code
City Name
2011
Population
25 and
older
% < 9th
Grade
% High
School
Graduate
% Some
College or
Associate
Degree
%
Bachelor
Degree
%
Graduate
Degree
91304
Canoga Park
34,284
12.8%
22.2%
30.1%
17.6%
9.8%
91306
30,427
14.3%
24.1%
27.3%
17.6%
6.4%
91311
Chatsworth
26,966
3.9%
21.3%
32.2%
24.7%
13.1%
91324
Northridge
16,854
9.5%
19.0%
28.3%
25.0%
12.8%
91325
Northridge
20,918
6.0%
17.5%
32.5%
26.2%
12.1%
91331
Arleta, Pacoima
56,150
33.0%
24.2%
15.7%
6.2%
1.6%
91340
19,306
29.3%
24.8%
19.1%
5.4%
2.4%
91342
Sylmar
52,810
18.1%
24.1%
26.9%
12.0%
4.0%
91343
North Hills
36,719
17.1%
20.1%
27.7%
17.8%
6.0%
91344
Granada Hills
36,603
4.9%
24.0%
30.6%
22.5%
11.5%
91345
Mission Hills
12,279
11.2%
28.4%
29.2%
13.8%
5.4%
91352
Sun Valley
28,597
23.1%
25.8%
22.6%
11.5%
3.6%
91401
Van Nuys
26,689
13.9%
22.2%
27.5%
18.7%
9.2%
91402
40,981
25.5%
23.3%
22.1%
11.6%
2.4%
91405
Van Nuys
32,304
17.0%
25.1%
25.4%
13.4%
5.6%
91406
Van Nuys
34,274
13.1%
26.1%
27.9%
14.9%
6.8%
91411
Van Nuys
16,271
16.1%
19.3%
28.6%
20.2%
7.0%
91601
North Hollywood
24,730
9.7%
16.4%
29.6%
25.7%
9.5%
91605
North Hollywood
33,987
24.3%
21.0%
25.5%
12.0%
3.5%
91606
North Hollywood
30,390
17.9%
22.7%
26.0%
16.0%
5.2%
MCH Total
611,539
17.2%
22.8%
26.1%
15.7%
6.4%
As education impacts health literacy, it, in turn, affects health access. As defined by Healthy
People 2020, health literacy is, “The degree to which individuals have the capacity to obtain,
process and understand basic health information and services needed to make appropriate
health decisions.” Health literacy is considered a more significant predictor of health status
than income level, ethnicity, age, education or employment.7 Not surprising, low-income,
minority, and immigrant groups have the poorest health literacy. Nationally, annual costs
associated with low health literacy are about $73 billion due to hospitalizations resulting
from the ineffective use of prescriptions or misunderstandings about treatment plans.8 Low
health literacy results in less preventive care, which leads to more chronic conditions, more
emergency care, higher costs, and poorer health status.
e. Cultural and Ethnic Factors
Socioeconomic status contributes greatly to health disparities in access to healthcare. A
recent Institute of Medicine report documented racial/ethnic disparities in the diagnosis and
treatment of several conditions, even when analyses were controlled for socioeconomic
status, insurance status, co-morbidity, and age, among other potential confounders.9 These
disparities are due, in part, in variations in patients’ health beliefs, values, preferences, and
behaviors. These include variations in patient recognition of symptoms; thresholds for
seeking care; the ability to communicate symptoms to a provider who understands their
meaning; the ability to understand the prescribed management strategy; expectations of care;
7
National Network of Libraries of Medicine. (2007). Health Literacy, Consumer Health Manual. Retrieved on July 19, 2012 from
http://nnlm.gov/outreach/consumer/hlthlit.html
8
Sullivan, Eileen and Glassman, Penny. (1998). Health Literacy Fact Sheet. From the National Academy on an Aging Society.
Retrieved on July 19, 2012 from http://www.agingsociety.org/agingsociety/publications/fact/fact_low.html
9
Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington: National
Academies Press; 2002.
and adherence to preventive measures and medications.10 These factors influence patient and
physician decision-making and the interactions between patients and the health care delivery
system, thus contributing to health disparities.
MCH’s service area suffers from a myriad of complex health issues, which are often rooted
in complex socio-economic factors. Recently arrived Latinos have characteristics that impact
access to and the delivery of traditional health care services. These include immigration
status, language and literacy, distrust of the system and its institutions, lack of knowledge
and awareness of available resources, lack of personal resources to meet basic needs, lack of
ability to navigate government sponsored health programs, such as Medi-Cal and Healthy
Families, lack of transportation to healthcare providers, lack of after-school child care, lack
of effective programs to address housing issues, and culture from their homeland. The latter
presents divergent issues for each sub-culture.
For Mexican nationals or other Latino sub-groups, the issue is the cultural unacceptability of
seeking preventive care until it is no longer an option and medical intervention of some form
is required. Further, new immigrants see abundant and rich foods as a sign of achievement.
Large food tables laden with low-cost, high-calorie, low-nutrition foods such as deep-fried
tortillas, beans prepared with lard, and fatty pork and beef are everyday events. With families
only able to afford and find sporadic and episodic health care visits, true intervention in the
form of consistent and long-term case and disease management is rare, and what programs do
exist are full with long waiting lists. This prompts unexpected emergency room visits, taxing
already over-burdened and dwindling resources.
Linguistic barriers can have a harmful effect on health outcomes by creating obstacles to
health care access and utilization. Difficulties with English can hamper a person’s ability to
seek medical services or understand the health care they are given. Persons with Limited
English Proficiency (LEP) are also less likely to have a regular source of medical care or
follow their doctor’s instructions. According to the latest Census Bureau numbers, 56.6
percent of LA County households speak a language other than English at home, compared to
19 percent of the total U.S. population. Over one quarter (26.8 percent) of households in LA
County are linguistically isolated, meaning no member of the household aged 14 or older
spoke English “very well.”11
Within MCH’s service area, 66.9 percent of the population over 5 years of age speaks a
language other than English, with 51 percent speaking Spanish. Language and culture play an
important role in health care access and utilization. Many individuals who do not speak
English as their primary language may hesitate to seek health care due to a lack of health care
providers who share a similar culture or speak the same language. Cultural competence
(including language skills, translation services, and understanding of cultural perspectives) is
therefore a necessity in providing appropriate services to low-income individuals in this
10
Betancourt JR et al. Defining Cultural Competence: A Practical Framework for Addressing Racial// Ethnic Disparities in
Health and Healthcare. Public Health Reports, July-Aug 2003; 118, 293-302.
11
Asian Pacific American Legal Center, L.A. Speaks Language Diversity and English Proficiency by Los Angeles County
Service Planning Area, accessed at http://apalc.org/sites/default/files/LASpeaksLanguageDiversity.pdf, accessed on February 25
2013.
service area. However, there is a shortage of bilingual, bicultural medical providers in the
community that accept Medi-Cal patients.
Table 7: Percent of the Population who speak a language other than English
2011 Total
population 5
yrs. and Older
% Who Speak
Language Other
than English
91304 Canoga Park
48,728
55.3%
91306 Canoga Park, Winnetka
43,628
63.3%
91311 Chatsworth
35,810
37.2%
91324 Northridge
25,375
50.4%
91325 Northridge
30,566
41.9%
89,667
84.6%
31,040
78.9%
91342 Sylmar
80,913
68.2%
91343 North Hills
54,593
67.7%
91344 Granada Hills
50,945
50.2%
91345 Mission Hills
17,782
59.1%
91352 Sun Valley
43,308
80.0%
91401 Van Nuys
36,340
61.6%
91402 Panorama City/Sepulveda
64,090
82.5%
91405 Van Nuys
48,938
75.5%
91406 Van Nuys
48,869
63.7%
91411 Van Nuys
21,916
60.7%
33,810
51.8%
50,450
79.8%
42,611
72.2%
899,379
66.9%
Zip
City Name
MCH Total
Table 8: Percent of the Population who are Spanish Speakers
Zip
City Name
2011 Total
population 5
yrs. and Older
% Who Speak
Spanish
91304
Canoga Park
48,728
38.3%
91306
43,628
39.6%
91311
Chatsworth
35,810
14.8%
91324
Northridge
25,375
28.6%
91325
Northridge
30,566
21.8%
91331
Arleta, Pacoima
89,667
80.0%
91340
31,040
77.8%
91342
Sylmar
80,913
61.6%
91343
North Hills
54,593
51.2%
91344
Granada Hills
50,945
21.5%
91345
Mission Hills
17,782
44.7%
91352
Sun Valley
43,308
64.9%
91401
Van Nuys
36,340
39.4%
91402
64,090
66.6%
91405
Van Nuys
48,938
55.9%
91406
Van Nuys
48,869
47.3%
91411
Van Nuys
21,916
49.0%
91601
North Hollywood
33,810
36.8%
91605
North Hollywood
50,450
58.6%
91606
North Hollywood
42,611
52.3%
MCH Total
899,379
51.0%
With over one in three residents born outside the U.S., LA County faces unique challenges in
delivering services to a disproportionately LEP population. Nearly one in three persons
countywide are LEP, or face some difficulty communicating in English that impacts their
ability to access critical services delivered only in English. Latino residents are more likely
than other residents to face language barriers; 48 percent of Latinos in LA County are LEP
followed by 43 percent of the Asian population.12 More specifically, 53 percent of Latinos
between the ages of 18-64 and 57 percent of Latinos over 65 years of age are LEP.
In the MCH Service Area, 409,610 or 42.3 percent of the population was born in another
country. The largest concentration of the foreign born population is in Panorama
City/Sepulveda with 53.3 percent of the population foreign born followed by North
Hollywood with 52.2 percent, and Van Nuys with 47.6 percent.
Table 9: MCH Service Area - Percent of Population Foreign Born
Zip
Code
91304
91306
91311
91324
91325
91331
City Name
Canoga Park
Canoga Park
Chatsworth
Northridge
Northridge
Arleta, Pacoima
2011 Total
Population
52,249
47,235
37,504
26,853
32,497
97,523
Foreign Born
% Foreign Born
19,865
20,881
10,242
9,547
11,260
44,297
38.0%
44.2%
27.3%
35.6%
34.6%
45.4%
12
Ibid.
91340
91342
91343
91344
91345
91352
91401
91402
91405
91406
91411
91601
91605
91606
Sylmar
North Hills
Granada Hills
Mission Hills
Sun Valley
Van Nuys
Van Nuys
Van Nuys
Van Nuys
North Hollywood
North Hollywood
North Hollywood
MCH Total
34,516
87,707
59,886
53,134
18,629
46,561
38,600
70,676
53,395
52,955
23,520
35,830
54,052
45,897
969,219
13,318
31,404
26,819
18,902
6,927
21,579
16,938
37,635
25,404
21,975
9,797
12,528
28,214
22,078
409,610
38.6%
35.8%
44.8%
35.6%
37.2%
46.3%
43.9%
53.3%
47.6%
41.5%
41.7%
35.0%
52.2%
48.1%
42.3%
f. Means of Transportation
Los Angeles County is the largest county in the nation, defined as a sprawling urban and
suburban area encompassing almost 4,084 square miles. Known for its many freeways and
highways, it is a county where having a vehicle is a necessity to get around. For those
without a car, public transportation is available through the metropolitan bus service but is
often inconvenient and unreliable. Other issues include safety concerns about riding public
transportation and having to care for several children during long waits for buses. The City of
Los Angeles Transportation Profile Report of 2009 estimates that over 10 percent of
households in LA County must rely on public transportation to get around.13
Transportation has been cited in numerous studies as a commonly perceived access barrier to
health care.14 Flores and colleagues found that transportation problems are the most common
reason that Latino parents delay their children’s medical visits.15 In LA County, individuals
with disabilities qualify for “Access” Paratransit services, a complimentary service to
individuals with disabilities offered by the Los Angeles County Transportation Services
Agency. However, the 2007 Los Angeles County Health Survey found that 17.6 percent of
individuals with disabilities found transportation as a barrier to accessing health care.
In the 2010 Community Needs Assessment, conducted by the Valley Care Community
Consortium (VCCC) for SPA 2, residents identified concerns for those living in poverty as
more likely to have health care disparities, lower levels of education resulting in limited job
opportunities, lack of health and mental health coverage and lack of transportation to get to
13
The City of Los Angeles Transportation Profile, 2009, LA DOT Moving Los Angeles Forward, accessed at
http://ladot.lacity.org/pdf/PDF10.pdf, accessed on February 25, 2013.
14
Yang, S et al. Transportation Barriers to Accessing Health Care for Urban Children. Journal of Health Care for the
Poor and Underserved 17 (2006): 928–943
15
Flores G, Abreu M, Olivar MA, et al. Access barriers to health care for Latino children. Arch Pediatr Adolesc
Med. 1998 Nov;152(11):1119–25
needed medical, mental health, and social services appointments.16 According to Table 11
below, 4.0 percent of the population do not have access to a vehicle for transportation and
must rely on public transport.
Table 10: Means of Transportation
Zip
Code
City Name
Workers
16 Years
and Over
% No
Vehicle
Available
Vehicles Available
% 3 or
%1
%2
more
Vehicle
vehicles
vehicles
20.1%
39.2%
36.9%
91304
Canoga Park
23,949
3.7%
91306
Canoga Park
22,337
3.6%
19.2%
36.8%
40.3%
91311
Chatsworth
18,658
1.1%
15.8%
49.7%
32.9%
91324
Northridge
12,539
3.1%
20.4%
40.0%
36.1%
91325
Northridge
15,438
2.9%
23.6%
41.3%
31.6%
91331
Arleta, Pacoima
39,302
3.2%
12.9%
29.7%
54.2%
91340
14,239
3.2%
12.7%
35.1%
48.5%
91342
Sylmar
37,255
1.1%
12.9%
37.4%
48.4%
91343
North Hills
26,524
5.1%
19.8%
34.3%
40.6%
91344
Granada Hills
24,270
0.9%
14.3%
39.3%
45.2%
91345
Mission Hills
8,364
2.0%
10.2%
34.5%
53.3%
91352
Sun Valley
20,049
4.3%
17.1%
35.8%
42.9%
91401
Van Nuys
19,399
6.0%
33.1%
41.6%
19.3%
91402
30,286
7.3%
28.0%
36.3%
28.4%
91405
Van Nuys
23,379
6.2%
35.3%
34.9%
23.7%
91406
Van Nuys
24,793
5.4%
22.9%
37.2%
34.5%
91411
Van Nuys
12,034
8.1%
37.0%
39.9%
15.0%
91601
North Hollywood
18,861
4.8%
34.0%
41.6%
19.6%
91605
North Hollywood
24,184
5.4%
22.2%
33.5%
38.9%
91606
North Hollywood
21,544
3.9%
30.6%
35.2%
30.2%
437,404
4.0%
21.6%
37.1%
37.1%
MCH Total
According to Table 11 below, 6.7 percent of residents in the service area must rely on public
transportation. Panorama City/Sepulveda had the largest percentage of residents relying on
public transport in the service area at 12.3 percent, followed by Van Nuys at 10.3 percent,
and North Hollywood at 9.5 percent.
16
Community Needs Assessment 2010, Valley Community Consortium.
Table 11: Means of Transportation
Workers
16 Years
and
Over
Car, Truck, or
Van
% Using
Public
Transport
%
Walked
to
Work
%
Worked
at
Home
91304
Canoga Park
23,949
70.8%
10.9%
6.6%
3.1%
% Used
Taxi,
bike or
other
means
4.2%
91306
Canoga Park
22,337
72.3%
15.2%
5.8%
1.5%
2.3%
3.1%
91311
Chatsworth
18,658
79.7%
9.8%
2.8%
0.6%
1.2%
5.9%
91324
Northridge
12,539
71.4%
10.7%
5.4%
3.7%
3.5%
5.3%
91325
Northridge
15,438
75.4%
11.1%
4.2%
3.6%
1.9%
3.9%
91331
Arleta, Pacoima
39,302
66.5%
21.2%
6.3%
2.2%
1.0%
2.8%
91340
14,239
68.7%
22.7%
3.6%
1.7%
1.0%
2.3%
91342
Sylmar
37,255
72.1%
17.8%
3.6%
1.0%
1.6%
3.8%
91343
North Hills
26,524
70.8%
13.5%
7.5%
2.3%
2.3%
3.6%
91344
Granada Hills
24,270
82.0%
9.0%
2.1%
0.7%
1.1%
5.0%
91345
Mission Hills
8,364
80.0%
14.4%
1.9%
0.7%
0.2%
2.7%
91352
Sun Valley
20,049
70.3%
14.6%
6.6%
1.7%
3.8%
3.0%
91401
Van Nuys
19,399
72.0%
9.7%
10.3%
2.0%
1.2%
4.8%
91402
30,286
58.3%
20.5%
12.3%
3.9%
1.7%
3.3%
91405
Van Nuys
23,379
71.1%
12.5%
9.4%
2.8%
1.7%
2.5%
91406
Van Nuys
24,793
75.7%
8.5%
7.5%
1.2%
3.0%
4.2%
91411
Van Nuys
12,034
69.8%
12.5%
8.0%
3.7%
1.6%
4.4%
91601
North Hollywood
18,861
71.4%
9.6%
9.5%
1.8%
3.3%
4.4%
91605
North Hollywood
24,184
71.0%
11.5%
7.8%
2.9%
4.3%
2.5%
91606
North Hollywood
21,544
67.9%
13.4%
8.4%
2.8%
2.8%
4.7%
MCH Total
437,404
71.2%
14.0%
6.7%
2.2%
2.2%
3.8%
Zip
Code
City Name
%
Drove
alone
%
Carpool
4.4%
A Community Need Index (CNI) developed by Catholic Healthcare West in joint partnership
with Solucient, LLC devised the first scoring that includes underlying economic and
structural barriers that impact access to health care. The CNI aggregates socioeconomic
indicators known to contribute to health disparity and applies that data to hospital
admissions. The CNI score is based on barriers related to income, culture/language,
education, insurance, and housing in order to quantify health care access in communities
across the nation. Dignity Health’s research has shown that residents of communities with the
highest CNI scores (4.2 to 5) are twice as likely to be hospitalized for manageable conditions
such as pneumonia or congestive heart failure as communities with the lowest CNI scores.
The scoring is from 1.0 to 5.0, with those scoring 4.2 to 5.00 being those with the highest
need. According to the CNI, approximately 35.3 percent of zip codes located within SPA 2
are designated as high need areas. The figure below shows that 75% of the zip codes in the
hospital’s catchment area are considered high need areas above 4.2. Additionally, eight of
the zip codes have gotten worse between 2012 and 2013.
Figure 3: Community Needs Index for MCH Service Area
5. Disease Prevalence and Mortality
According to Table 12 below, there were over 5,076 deaths in the MCH service area in 2010.
The largest number of deaths occurred in Sylmar (zip code 91342) with 481 deaths, followed
by Chatsworth with 409.
Table 12: Deaths by Zip Codes
91304
Total
Deaths
280
91345
Total
Deaths
128
91306
236
91352
224
91311
271
91401
204
91324
175
91402
271
91325
221
91405
281
91331
409
91406
257
91340
114
91411
163
91342
481
91601
165
91343
311
91605
279
91344
374
91606
232
TOTAL
5,076
Zip Codes
Zip Codes
The communities of the SFV lead the County in deaths due to coronary heart disease, stroke
and lung cancer. In SPA 2, the leading cause of death is Coronary Heart Disease (3,081
deaths), followed by stroke, lung cancer, Alzheimer’s disease, and Emphysema/COPD. The
leading cause of premature death is Coronary Heart Disease; improved prevention services
are critically needed.17 In SPA 2, infant mortality is at a rate of 5.3 per 1,000 live births;
compared to LA County as a whole at a rate of 5.0 per 1,000 live births. Rates for mortality
of breast cancer, cancer, cervical cancer, and cardiovascular disease are also high. The 58
percent of adults in LA County who were diagnosed with diabetes were also diagnosed with
hypertension, 56 percent were diagnosed with high cholesterol, and 41 percent suffered from
obesity; a large proportion of these individuals living in SPA 2. In addition, 20.4 percent of
youth in grades 5, 7 and 9 are obese.
The leading causes of death in the MCH service area are: Diseases of the Heart, Cancer, and
Chronic Lower Respiratory Disease. To address the unique needs of this population, health
care services should include culturally sensitive medical interventions, preventative health
education, and knowledge of the importance of a “medical health home.” Other issues
include high rates of crystal meth drug and alcohol addictions.
17
County of Los Angeles Public Health, “ Mortality in Los Angeles County 2008: Leading Causes of Death and Premature Death
with Trends for 1999-2008”, < http://publichealth.lacounty.gov/docs/mortality2008-dec2011.pdf>, accessed on June 20, 2013.
!
Table 13: Causes of Death
Zip
Codes
Total
Deaths
Cause of Death
Disease
of the
Heart
Cancer
Stroke
Chronic
Lower
Respiratory
Disease
Alzheimer’s
Disease
Accidents
Diabetes
Mellitus
Influenza &
Pneumonia
Chronic
Liver
Disease &
Cirrhosis
Suicide
HTN
Nephritis,
Nephrotic
Syndrome
&
Nephrosis
Other
91304
280
85
66
16
14
17
5
7
11
2
8
5
2
42
91306
236
68
43
12
19
15
13
7
9
7
3
2
4
34
91311
271
80
80
11
17
13
5
9
7
3
3
2
3
38
91324
175
48
52
10
8
7
6
6
5
3
1
1
-
28
91325
221
79
60
12
7
11
10
4
5
1
3
1
1
27
91331
409
111
83
21
7
18
19
21
10
8
3
1
17
90
91340
114
29
26
3
4
4
4
7
5
4
3
-
2
23
91342
481
141
115
31
15
27
15
22
12
10
5
4
10
74
91343
311
103
84
11
11
12
19
7
11
7
5
2
3
36
91344
374
111
96
18
13
18
10
13
11
5
2
7
8
62
91345
128
39
34
5
4
4
7
3
4
2
3
2
2
19
91352
224
69
51
9
8
11
13
9
10
5
1
4
2
32
91401
204
50
46
14
8
6
6
11
16
-
1
3
4
39
91402
271
78
66
13
10
10
9
12
9
9
1
5
2
47
91405
281
85
66
13
10
10
6
11
14
6
3
6
3
48
91406
257
90
48
17
13
6
9
8
8
5
8
2
4
39
91411
163
68
26
4
8
6
5
4
9
3
3
2
3
22
91601
165
51
38
6
7
4
9
2
8
4
2
1
3
30
91605
279
83
57
13
13
10
12
12
7
9
3
4
5
51
91606
232
64
57
15
11
5
11
8
6
7
2
4
5
37
TOTAL
5,076
1,532
1,194
254
207
214
193
183
177
100
63
58
83
818
!
!
a. Diabetes
In 2008, Diabetes Mellitus was the seventh leading cause of death in SPA 2 with 405 deaths,
which calculates to 3.34 percent of all SPA 2 deaths. This remains similar to 2004 where
there were 395 deaths in SPA 2 due to Diabetes Mellitus. The 58 percent of adults in Los
Angeles County who were diagnosed with diabetes were also diagnosed with hypertension,
56 percent were diagnosed with high cholesterol, and 41 percent suffered from obesity; a
large proportion of these individuals living in SPA 2. In MCH’s service area, 6.5 percent of
the population was diagnosed with Diabetes.
Table 14: Percent of population by zip code that has been diagnosed with diabetes
Zip
City Name
Diabetes
%
Diabetes
91304 Canoga Park
49,523
3,259
6.6%
46,553
3,137
6.7%
91311 Chatsworth
36,818
2,897
7.9%
91324 Northridge
26,860
1,935
7.2%
91325 Northridge
35,248
2,425
6.9%
103,747
6,700
6.5%
34,801
2,222
6.4%
91342 Sylmar
93,100
6,286
6.8%
91343 North Hills
60,773
3,900
6.4%
91344 Granada Hills
51,414
3,837
7.5%
91345 Mission Hills
18,895
1,441
7.6%
91352 Sun Valley
47,016
2,981
6.3%
91401 Van Nuys
39,064
2,429
6.2%
69,925
4,032
5.8%
91405 Van Nuys
50,804
2,981
5.9%
91406 Van Nuys
53,444
3,281
6.1%
91411 Van Nuys
24,199
1,490
6.2%
37,921
2,218
5.8%
56,416
3,417
6.1%
44,930
2,757
6.1%
981,451
63,625
6.5%
MCH Total
!
Population
!
!
b. Heart Disease
Table 15: Percent of Service Area diagnosed with Coronary Heart Disease
91304 Canoga Park
49,523
Coronary
Heart
Disease
1,432
91306 Canoga Park
46,553
1,248
2.7%
91311 Chatsworth
36,818
1,418
3.9%
91324 Northridge
26,860
895
3.3%
91325 Northridge
35,248
1,129
3.2%
103,747
1,983
1.9%
34,801
647
1.9%
91342 Sylmar
93,100
2,151
2.3%
91343 North Hills
60,773
1,164
1.9%
91344 Granada Hills
51,414
1,790
3.5%
91345 Mission Hills
18,895
553
2.9%
91352 Sun Valley
47,016
1,048
2.2%
91401 Van Nuys
39,064
1,090
2.8%
69,925
1,314
1.9%
91405 Van Nuys
50,804
1,172
2.3%
91406 Van Nuys
53,444
1,270
2.4%
91411 Van Nuys
24,199
591
2.4%
37,921
895
2.4%
56,416
1,267
2.2%
44,930
1,084
2.4%
981,451
24,141
2.5%
Zip
City Name
MCH Total
Population
%
Coronary
Heart Disease
2.9%
c. Cancer
Table 16: Percent of Service Area diagnosed with Breast Cancer
Population
Breast Cancer
91304 Canoga Park
49,523
451
%
Breast
Cancer
0.9%
46,553
397
0.9%
91311 Chatsworth
36,818
464
1.3%
91324 Northridge
26,860
276
1.0%
91325 Northridge
35,248
344
1.0%
Zip
Code
!
City Name
!
!
103,747
550
0.5%
34,801
173
0.5%
91342 Sylmar
93,100
634
0.7%
91343 North Hills
60,773
472
0.8%
91344 Granada Hills
51,414
579
1.1%
91345 Mission Hills
18,895
171
0.9%
91352 Sun Valley
47,016
309
0.7%
91401 Van Nuys
39,064
341
0.9%
91402 Panorama
City/Sepulveda
91405 Van Nuys
69,925
406
0.6%
50,804
362
0.7%
91406 Van Nuys
53,444
387
0.7%
91411 Van Nuys
24,199
181
0.7%
37,921
266
0.7%
56,416
384
0.7%
44,930
334
0.7%
981,451
7,480
0.8%
MCH Total
Table 17: Percent of Population Diagnosed with Cervical Cancer
91304
Canoga Park
49,523
190
%
Cervical
Cancer
0.4%
91306
46,553
154
0.3%
91311
Chatsworth
36,818
171
0.5%
91324
Northridge
26,860
101
0.4%
91325
Northridge
35,248
144
0.4%
91331
Arleta, Pacoima
103,747
280
0.3%
91340
34,801
98
0.3%
91342
Sylmar
93,100
290
0.3%
91343
North Hills
60,773
186
0.3%
91344
Granada Hills
51,414
220
0.4%
91345
Mission Hills
18,895
62
0.3%
91352
Sun Valley
47,016
146
0.3%
91401
Van Nuys
39,064
171
0.4%
91402
69,925
177
0.3%
91405
Van Nuys
50,804
170
0.3%
91406
Van Nuys
53,444
189
0.4%
Zip
!
City Name
Population
Cervical
Cancer
!
!
91411
Van Nuys
24,199
94
0.4%
91601
North Hollywood
37,921
158
0.4%
91605
North Hollywood
56,416
181
0.3%
91606
North Hollywood
44,930
170
0.4%
981,451
3,352
0.3%
MCH Total
Table 18: Percent of Population Diagnosed with Colon Rectal Cancer
91304
Canoga Park
49,523
Colon
Rectal
Cancer
159
91306
46,553
135
0.3%
91311
Chatsworth
36,818
166
0.5%
91324
Northridge
26,860
101
0.4%
91325
Northridge
35,248
126
0.4%
91331
Arleta, Pacoima
103,747
174
0.2%
91340
34,801
55
0.2%
91342
Sylmar
93,100
212
0.2%
91343
North Hills
60,773
162
0.3%
91344
Granada Hills
51,414
207
0.4%
91345
Mission Hills
18,895
60
0.3%
91352
Sun Valley
47,016
102
0.2%
91401
Van Nuys
39,064
121
0.3%
91402
69,925
128
0.2%
91405
Van Nuys
50,804
125
0.2%
91406
Van Nuys
53,444
132
0.2%
91411
Van Nuys
24,199
63
0.3%
91601
North Hollywood
37,921
94
0.2%
91605
North Hollywood
56,416
128
0.2%
91606
North Hollywood
44,930
114
0.3%
981,451
2,565
0.3%
Zip
Code
City Name
MCH Total
!
Population
%
Colon Rectal
Cancer
0.3%
!
!
Table 19: Percent of Population Diagnosed with Lung Cancer
91304
Canoga Park
49,523
63
%
Lung
Cancer
0.1%
91306
46,553
54
0.1%
91311
Chatsworth
36,818
65
0.2%
91324
Northridge
26,860
40
0.1%
91325
Northridge
35,248
50
0.1%
91331
Arleta, Pacoima
103,747
77
0.1%
91340
34,801
24
0.1%
91342
Sylmar
93,100
90
0.1%
91343
North Hills
60,773
66
0.1%
91344
Granada Hills
51,414
80
0.2%
91345
Mission Hills
18,895
24
0.1%
91352
Sun Valley
47,016
42
0.1%
91401
Van Nuys
39,064
48
0.1%
91402
69,925
53
0.1%
91405
Van Nuys
50,804
51
0.1%
91406
Van Nuys
53,444
54
0.1%
91411
Van Nuys
24,199
26
0.1%
91601
North Hollywood
37,921
38
0.1%
91605
North Hollywood
56,416
52
0.1%
91606
North Hollywood
44,930
46
0.1%
MCH Total
981,451
1,043
0.1%
Zip Code
City Name
Population
Lung
Cancer
Table 20: Percent of Population Diagnosed with Prostate Cancer
91304
Canoga Park
49,523
303
%
Prostate
Cancer
0.6%
91306
46,553
253
0.5%
91311
Chatsworth
36,818
314
0.9%
91324
Northridge
26,860
201
0.7%
91325
Northridge
35,248
251
0.7%
91331
Arleta, Pacoima
103,747
355
0.3%
91340
34,801
114
0.3%
91342
Sylmar
93,100
421
0.5%
Zip Code
!
City Name
Population
Prostate
Cancer
!
!
91343
North Hills
60,773
313
0.5%
91344
Granada Hills
51,414
397
0.8%
91345
Mission Hills
18,895
111
0.6%
91352
Sun Valley
47,016
200
0.4%
91401
Van Nuys
39,064
229
0.6%
91402
69,925
235
0.3%
91405
Van Nuys
50,804
229
0.5%
91406
Van Nuys
53,444
253
0.5%
91411
Van Nuys
24,199
120
0.5%
91601
North Hollywood
37,921
180
0.5%
91605
North Hollywood
56,416
249
0.4%
91606
North Hollywood
44,930
213
0.5%
981,451
4,940
0.5%
MCH Total
Table 21: Percent of Population diagnosed with Skin Cancer
Zip Code
City Name
Skin
Cancer
% Across
Skin Cancer
91304
Canoga Park
49,523
184
0.4%
91306
46,553
134
0.3%
91311
Chatsworth
36,818
196
0.5%
91324
Northridge
26,860
110
0.4%
91325
Northridge
35,248
146
0.4%
91331
Arleta, Pacoima
103,747
100
0.1%
91340
34,801
34
0.1%
91342
Sylmar
93,100
174
0.2%
91343
North Hills
60,773
154
0.3%
91344
Granada Hills
51,414
236
0.5%
91345
Mission Hills
18,895
48
0.3%
91352
Sun Valley
47,016
95
0.2%
91401
Van Nuys
39,064
154
0.4%
91402
69,925
100
0.1%
91405
Van Nuys
50,804
133
0.3%
91406
Van Nuys
53,444
148
0.3%
91411
Van Nuys
24,199
75
0.3%
91601
North Hollywood
37,921
123
0.3%
91605
North Hollywood
56,416
132
0.2%
91606
North Hollywood
44,930
131
0.3%
981,451
2,607
0.3%
MCH Total
!
Population
!
!
Table 22: Percent of Population diagnosed with Uterine Cancer
91304
Canoga Park
49,523
121
%
Uterine
Cancer
0.2%
91306
46,553
107
0.2%
91311
Chatsworth
36,818
118
0.3%
91324
Northridge
26,860
72
0.3%
91325
Northridge
35,248
92
0.3%
91331
Arleta, Pacoima
103,747
134
0.1%
91340
34,801
43
0.1%
91342
Sylmar
93,100
155
0.2%
91343
North Hills
60,773
124
0.2%
91344
Granada Hills
51,414
148
0.3%
91345
Mission Hills
18,895
39
0.2%
91352
Sun Valley
47,016
79
0.2%
91401
Van Nuys
39,064
89
0.2%
91402
69,925
118
0.2%
91405
Van Nuys
50,804
96
0.2%
91406
Van Nuys
53,444
104
0.2%
91411
Van Nuys
24,199
49
0.2%
91601
North Hollywood
37,921
75
0.2%
91605
North Hollywood
56,416
103
0.2%
91606
North Hollywood
44,930
86
0.2%
981,451
1,951
0.2%
Zip Code
City Name
MCH Total
!
Population
Uterine
Cancer
!
!
6. Risk Behaviors
a. Dental Care
In SPA 2, approximately 51.0 percent of residents have dental insurance compared to 49.0
percent who do not have dental insurance. 29.0 percent of adults self reported that they could
not afford dental insurance, while 9.6 percent of children in SPA 2 did not have access to
dental insurance.
b. Fitness and Nutrition
In SPA 2, 61.3 percent of adult residents get the recommended amount of aerobic physical
activity per week while 25.9 percent do not. In contrast, 28.4 percent of adult residents get
the recommended amount of aerobic and strengthening physical activity exercise weekly
compared to 60.4 percent who do not. In addition, 36.3 percent of adult residents get the
recommended amount of muscle strengthening activities weekly.
c. Obesity
Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and Type 2
diabetes. Over one quarter (23.8 percent) of California adults are obese, according to CDC
Behavioral Risk Factor Surveillance System (BRFSS) surveys conducted in 2011.18 In Los
Angeles County, 40.6 percent of Latinos are overweight and 31.6 percent obese. 38.9
percent of African Americans are overweight compared with 31.0 percent being obese. The
58 percent of adults in LA County who were diagnosed with diabetes were also diagnosed
with hypertension, 56 percent were diagnosed with high cholesterol, and 41 percent suffered
from obesity; a large proportion of these individuals living in SPA 2. In addition, 20.4
percent of youth in grades 5, 7 and 9 are obese. In SPA 2, 21.1 percent of adults are
considered obese while 36.4 percent are considered overweight. In addition, those LA
County residents who live below 200 percent of the FPL, 55.9 percent are obese and 73.1
percent are overweight.
There are several reasons that might account for the differences in the prevalence of obesity
among these different populations. First, racial/ethnic populations differ in behaviors that
contribute to weight gain. For instance, compared with non-Hispanic whites, non-Hispanic
blacks and Hispanics are less likely to engage in regular physical activity. In addition,
differences exist in attitudes and cultural norms regarding body weight. Also, certain
populations have less access to affordable, healthy foods and safe locations for physical
activity. Evidence suggests that neighborhoods with large minority populations – such as
those in MCH’s service area – have fewer chain supermarkets and produce stores. Evidence
also suggests that healthy foods are relatively more expensive than energy-dense foods,
especially in minority and low-income communities. These populations also have less access
to physical activity facilities and resources.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
18
Centers for Disease Control and Prevention. Office of Surveillance, Epidemiology, and Laboratory Services.
Behavioral Risk Factor Surveillance System. California. Available at:
http://apps.nccd.cdc.gov/BRFSS/display.asp?cat=OB&yr=2011&qkey=8261&state=CA
!
!
!
d. Smoking
The leading cause of preventable death nationally is cigarette smoking. Smokers are at higher
risk for lung cancer and respiratory diseases. In SPA 2, 13.8 percent of residents are current
smokers while 20.6 percent are former smokers.
Table 23: Smokers by SPA
Service Planning Area
Antelope Valley
San Fernando
San Gabriel
Metro
West
South
East
South Bay
!
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
Current Smoker
Non-Regular Smoker
Former Smoker
Non-Smoker
15.6%
2.0%
20.9%
61.6%
13.8%
1.0%
20.6%
64.6%
10.9%
1.2%
19.0%
68.9%
14.9%
1.9%
22.6%
60.6%
9.7%
24.5%
65.5%
13.3%
2.7%
15.2%
68.8%
14.4%
1.2%
17.8%
66.6%
13.0%
2.1%
17.3%
67.5%
!
!
e. Alcohol use
Table 24: Binge Drinking by Race/Ethnicity in LA County
Race/Ethnicity
Latino
White
African American
Asian/Pacific Islander
American Indian/Alaskan Native
18.1%
14.7%
11.2%
12.0%
-
Table 25: Alcoholic Beverage Drinking by SPA
Antelope Valley
San Fernando
San Gabriel
Metro
West
South
East
South Bay
Binge
Drinking
15.1%
14.9%
11.7%
19.2%
16.5%
16.9%
15.7%
16.3%
Heavy
Drinking
3.1%
3.8%
2.5%
4.6%
3.4%
2.5%
3.2%
4.6%
f. Drug use
Table 26: Percent of Adults Who Reported They Needed or Wanted Treatment for Alcohol or
Drug Problem (excluding tobacco) in the past 5 years.
Antelope Valley
San Fernando
San Gabriel
Metro
West
South
East
South Bay
!
2.2%
3.1%
2.1%
3.3%
1.4%
2.3%
1.8%
2.5%
!
!
7. Results from Focus Groups and Key Informant Interviews
Primary data for this community health needs assessment were collected through key
informant interviews and focus groups, which took place between September, 2012 and June,
2013. The report includes data from 4 focus groups conducted in various settings throughout
the hospital catchment area. The focus groups included participants from a wide sample of
stakeholders including experts in public health, health administration, kinesiology, social
services and public policy in addition to low-income, medically underserved minority
populations living with diabetes and hypertension, and finally Los Angeles County
Department of Health Services, Olive View- UCLA Medical Center Primary Care clinicians.
The 8 key informant interviewees included experts in public health, social services, mental
health, Primary Care clinicians, dental, public health, and clinic service providers. Since the
data collected for this Needs Assessment were qualitative, an analysis of word frequencies
related to each question was performed by generating a list of all the unique key responses to
each question. After the list was generated using Excel, we then counted the number of times
each word or theme occurred.
Detailed primary data from each focus group and key informant interview can be found
enclosed in Appendix A. Below is a summary of the main findings, which are consistent with
the secondary, quantitative data from MCH’s service area.
a. Focus group demographics*
* Demographic information was not provided for Key Informants
Focus Group n = 53
Key Informants n = 8
Total n = 61
Ethnicity
White
25% (13)
Latino/
Latina
47% (25)
African
American
4% (2)
Native
American
0% (0)
Asian
15% (8)
Pacific
Islander
0% (0)
Other
9% (5)
Age
18-65
96% (51)
!
Over 65
4% (2)
!
!
b. Perceptions of Health Needs, Behavior Risks, and Resources
Between September 2012 and June 2013, the Valley Care Community Consortium conducted
a series of focus groups and key informant interviews which involved 61 participants in the
Mission Community Hospital Service Area.
The top 3 identified health problems identified in Focus Groups and Key Informant interviews
were diabetes, obesity and Mental Health. Participants identified alcoholism, drug abuse and
poor nutrition as the 3 most risky behaviors affecting the community. The most significant
educational, environmental or socio-economic factors participants identified affecting he
community were access to higher education, access to resources and food security.
Respondents identified transportation, lack of child/elder care and lack of personnel and
resources at sites as the 3 top barriers to accessing resources.
Table 27: The Most Significant Health Problems in the Community
Identified Health Issue
Diabetes
Obesity
Mental Health
Alcoholism
Asthma (Children)
Frequency of responses
12
10
8
5
5
Table 28: Significant Educational/ Environmental/ Socio-Economic Factors Affecting the
Community
Identified Factors
Access to Higher Education/Classes
Access to resources
Food security
Unemployment
Access to clean air and water
13
5
4
3
3
Table 29: Most Risky Behaviors Affecting the Community
Identified Risk Behaviors
Alcoholism
Drug abuse
Poor nutrition
Smoking
Lack of physical activity
!
6
6
6
5
4
!
!
Table 30: Community Resources to Address These Issues
Identified Community Resources
MEND (Meet Each Need with Dignity)
American Cancer Society
Church
Non-profit hospitals
YMCA
4
2
2
2
2
Table 31: Barriers to Accessing Resources
Identified Barriers
Transportation
Lack of child care or elder care
Lack of personnel at sites/resources
Communication
Cost
Fear (undocumented status)
Literacy issues
Lack of access
Dental care
6
4
4
3
3
3
3
3
3
Table 32: Solutions to These Issues/ Barriers
Identified Solutions
Education
Coordination of services
Transportation tokens
Classes (ESL and ‘how to access services’)
Cultural competency (bilingual staff)
5
2
2
2
3
Table 33: Prioritization of Concerns
!
Identified Priorities
Accessibility
Affordability
Collective approach to problems
Cost-benefit analysis
Early intervention and prevention
2
2
1
1
1
!
!
6. Conclusion
The 2013 Community Needs Assessment has been compiled for Mission Community
Hospital as an information resource. The data collected identifies common needs, issues, and
priorities across various segments of the population, as well as those unique to particular
ages, genders, and socioeconomic groups within the hospital’s primary and secondary service
areas. This information provides a foundation for program development and strategic
planning activities in the future.
!
!
!
APPENDIX A:
Primary Data
(Focus Groups & Interviews)
!
!
!
California State University Northridge Focus Group Summary Sheet
Date
Location
Group Facilitator
Meeting Type
October 1, 2012
California State University Northridge, 18111 Nordhoff Street, Northridge, CA 91330
Joni Novosel
Community Meeting/Focus group (e.g. Service Provider Group (public and/or
PTA, Chamber, Service Club,
private service provider: educators/
Advisory, Boards, etc.)
teachers, counselors, health providers,
etc.)
(Place “X” in the
appropriate box)
Tribal Council
Meeting
Other (describe)
X (CSUN Professors, Assistant
Professors, Students)
Meeting Attendance
Total
Service Providers
Other Stakeholders
10
Family Members
Consumers/Clients
PhDs. in Health Field
Participant Demographics
Total
White
Adults
(18-65)
8
Seniors
(65+)
2
7
Hispanic
Black/ African
American
2
Native American
Asian
Pacific Islander
Other
1
Were incentives used? No ____
Yes __X__ If yes, please number and types of incentives
Number Provided
Child Care
Food
Other
10
Lunch
!
5!
!
!
California State University Northridge Focus Group Data
What are the most significant health problems in the community? What ages?
•
•
•
•
•
•
•
Asthma (children)
Autism
Breast Cancer
Cancer (18-25 and 50 and above)
Cholesterol
Colon Cancer
Depression
•
•
•
•
•
•
•
Depression and suicide (mental health)
Depression and suicide (young adults and adults)
Developmental disability
Diabetes (adult and children, adult and juvenile)
Domestic Violence (women and children)
Heart Disease (50 and up)
Lung and Breast Cancer
•
•
•
•
•
•
Lupus
Mental health (young and adults)
Obesity ( all Latino children and
lower income)
Oral health (all ages)
Prostate Cancer
Stroke (50 and up)
What are the most significant educational/environmental/ socio-economic factors affecting the community? What ages are most impacted?
•
•
•
•
•
•
•
•
Access to classes (in colleges)
Access to clean air and water
Access to higher education
Access to resources, budget cuts and state
funds
Affordable housing (homelessness)
Food security (South LA's meals on wheels
sign up has a 4 month wait)
Furlough
Homelessness (students, youth, adults)
•
•
•
•
•
•
•
•
Jobs
Lack of connecting environmental justice to quality
of health
Lack of dental care for uninsured
Lack of mentors
Lack of nutrition
Lack of nutritional education
Lack of transportation
Lack or green space and under parked
•
•
•
•
•
•
•
Lack or knowledge of resources
and ability to educate community
on those resources
lack or resources due to budget
cuts
Lack or workers, promotoras
Language barrier/ cultural
competency
Opportunity to recreation
Safe parks, recreation
Teacher evaluation
What are the most risky health behaviors affecting the community?
•
•
•
•
•
•
•
•
•
Ability to maintain independence
Adolescent drug abuse
Alcoholism
Bullying
Children and obesity
Crime and safety
Distracted driving
Driving beyond capability
Gangs
•
•
•
•
•
•
•
•
•
Gangs victims and perpetrators
Isolation
Junk food/ poor nutrition
Lack of finances
Lack of quality care for elderly
Lack of time
Lack or access to outdoor natural environment
Lack or physical activity
Not accessing health care on a regular basis
•
•
•
•
•
•
•
•
Overwork and stress
Road rage
Safe sex
Smoking (youth)
Substance abuse
Technology as a risk for isolation,
texting, bullying, sexting, social
abuse
Texting
Underage drinking
6!
!
!
What are the community resources that we have to support the community to address the issues?
•
•
•
•
•
•
•
•
•
•
Adult day center
Alzheimer's association
American Cancer Society
Churches
CSUN
FQHC
Inst. For health and wellbeing
JFS
Med centers
MEND
•
•
•
•
•
•
•
•
•
•
NLS
Non-profit hospital
OPCC
Regional center
Retail clinics and pharmacy
SFVDS
Tattoo Removal
Urgent care clinic
VA
Valley Trauma Center
•
•
•
•
•
•
•
•
•
•
VCC
YMCA
Cancer centers
Mental health centers
LAC DPH
Chrysalis
Boys and girls club
Home health orgs
Hospice care
Traditional medicine
patient beliefs
Patient compliance
Practitioner's understanding of
what they are dealing with
Providing care that culturally
Reliance on traditional medicine,
home remedies
Stigma in mental health
Transportation
What are some of the barriers to accessing these resources?
•
•
•
•
•
•
•
•
Communication
Cost
Cultural competency on both sides
Fear (illegal immigrants and
undocumented)
Gender and memory issues
health literacy
Health literacy
Health navigation
•
•
•
•
•
•
•
•
Hours of operation
Lack of access to assistive devices
Lack of childcare
Lack of coordinated care
Lack of parody
Lack of trust
Language
Literacy
•
•
•
•
•
•
Education
Having the right metrics for impact
Identify what is appropriate amount to
community benefit by hospitals
Increase in baby friendly hospitals
Make a care for better worksite wellness
Navigation
One door policy
•
•
•
•
•
•
•
•
•
•
Solutions to these issues?
•
•
•
•
•
•
•
6 aims: accessible, equitable
Access to quality child care services
Affective time management of the
providers
Capacity building
Collaboration
Coordination or services
Corporate responsibility
•
•
•
•
•
Patient center care
Preventative services
School based health care services
Service centered care
Sustainable built environment
Systems management
(communication)
Worksite wellness
Prioritization of concerns and solution?
•
Accessibility and affordability
•
Early intervention, early prevention
•
Realistic assessment
7!
!
!
•
•
•
Avoid concentrating on the low hanging fruit
Collective approach to problems
Cost/benefit analysis (RLI)
•
•
•
Insurance and private consumers
Maslow's hierarchy
Prevention in services for children
•
•
SMART
Under promise over deliver
8!
!
!
Project ALTO Diabetes Education Class Focus Group Summary Sheet
Meeting Date
Location
Group Facilitator
Meeting Type
appropriate box)
June 6, 2013
Mission Community Hospital-Diabetes Kitchen, 700 Chatsworth Drive, Sand Fernando, CA 91340
Maribel A.
Community Meeting/Focus group
Service Provider Group (public
Tribal Council Meeting
(e.g. PTA, Chamber, Service Club,
and/or private service provider:
Advisory, Boards, etc.)
educators/ teachers, counselors,
health providers, etc.)
Other
X Chronic Disease Diabetes Group
Meeting Attendance
Total
Service Providers
Other Stakeholders
Family Members
Consumers/Clients
11
X
Total
Adults
(18-65)
11
Seniors
(65+)
0
White
Hispanic
Black/ African
American
Native American
Asian
Pacific Islander
Other
11
Other (List)
Number Provided
Child Care
Food
Other
11
11
Lunch
Gift Cards
9!
!
!
Project ALTO Diabetes Education Class Focus Group!
n=11
What are the most significant health problems in the community and what ages and ethnicities are affected? Please rank in order of priority
1. Mental Health Problems (Everyone)
• Bipolar
• Drugs (Children)
• Depression (Everyone)
2.
Chronic Disease
• Cholesterol (Everyone)
• High Blood Pressure (Everyone)
3. Cancer (Everyone) & Lupus (Everyone)
• Skin Cancer
• Lung Cancer
• Breast Cancer
4. Obesity (Adults & Children)
5. Asthma
6. Stroke (35+)
7. Bullying (Children)
8. Domestic Violence (Children & Adults)
9. Hyperactive Children (2-14) & Autism (1+)
10. Enlargement of the heart (40+)
•
•
•
Suicide (Teens 13-18)
Stress
Alcoholism (Adolescents & Adults)
•
•
Diabetes (Everyone: Hispanic and African American)
Problems with Kidneys (Everyone)
•
•
•
Colon Cancer
Throat Cancer
Ovaries Cancer
What is the most significant educational/environmental/socio-economic factors affecting the community. Who is most impacted?
Education:
1.
2.
3.
4.
5.
Many cannot pay to continue school
They do not finish high school
The adolescents would rather work
Many do not consume enough nourishment and that affects their education and perform poorly in school (Mal-nutrition)
Problems of the parents
• They leave their children alone because they have to work
• The technology in the house (Television=babysitter)
10!
!
!
•
•
There is more good than bad (Entertaining and no education)
More using technology for fun and not educationally constructive
Environment:
•
•
•
•
Paint from the body shop
Freeways
19 landfills in Pacoima
Cars that produce a lot of smoke
o Cars do not pass the smog test but pay the fee
• Marijuana (A lot of dispenser shops)
Socioeconomic:
•
•
•
•
•
Second hand smoke
Pesticides
Rapists
Prostitution on San Fernando Road
Motels and bars are close to schools and residents
Jobs
o Lack of jobs
o Lack of preparation (Technology)
o Minimum payment
o Undocumented people
o Age, most are older than 50 and it makes it harder to
find a job
• Rent is too expensive
• Transportation for everyone
• Healthy food is more expensive now
What are the most risky health behaviors affecting the community? What age and ethnicity are most impacted?
•
•
•
•
•
•
Malnutrition
Stress
Eating the wrong food…
Prostitution
Drugs among the adolescents (Alcoholism)
•
•
•
•
•
•
•
•
•
•
Reviewing the list of problems what are some community resources to support the community to address the issues?
Counselors in schools
• Church-Food, Health, Youth Group
Sports
• NLS
Participation of parents (More Involvement)
• Neighborhood Watch
Mission Community Hospital
• AA
El Nido
• American Cancer Society
Alanon
• Hermandad Mexicana
MEND
• Radio Guadalupe FM (54.3 & in television)
UNIC
• YPI (Jobs for adolescents in the summer 14-21)
Parks
• YMCA
Pacoima Beautiful
• Girls & Boy scouts
•
•
Graffiti
Violence (Among adolescents that show videos on the computer)
o Lack of respect (Exhibitionism)
o Promotion in pages that demonstrate triple x videos
o Exhibitionism in social media
11!
!
!
•
•
There is more good than bad (Entertaining and no education)
More using technology for fun and not educationally constructive
Environment:
•
•
•
•
Paint from the body shop
Freeways
19 landfills in Pacoima
Cars that produce a lot of smoke
o Cars do not pass the smog test but pay the fee
• Marijuana (A lot of dispenser shops)
Socioeconomic:
•
•
•
•
•
Second hand smoke
Pesticides
Rapists
Prostitution on San Fernando Road
Motels and bars are close to schools and residents
Jobs
o Lack of jobs
o Lack of preparation (Technology)
o Minimum payment
o Undocumented people
o Age, most are older than 50 and it makes it harder to
find a job
• Rent is too expensive
• Transportation for everyone
• Healthy food is more expensive now
What are the most risky health behaviors affecting the community? What age and ethnicity are most impacted?
•
•
•
•
•
•
Malnutrition
Stress
Eating the wrong food…
Prostitution
Drugs among the adolescents (Alcoholism)
•
•
•
•
•
•
•
•
•
•
Reviewing the list of problems what are some community resources to support the community to address the issues?
Counselors in schools
• Church-Food, Health, Youth Group
Sports
• NLS
Participation of parents (More Involvement)
• Neighborhood Watch
Mission Community Hospital
• AA
El Nido
• American Cancer Society
Alanon
• Hermandad Mexicana
MEND
• Radio Guadalupe FM (54.3 & in television)
UNIC
• YPI (Jobs for adolescents in the summer 14-21)
Parks
• YMCA
Pacoima Beautiful
• Girls & Boy scouts
•
•
Graffiti
Violence (Among adolescents that show videos on the computer)
o Lack of respect (Exhibitionism)
o Promotion in pages that demonstrate triple x videos
o Exhibitionism in social media
11!
!
!
•
•
•
•
Boys & Girls Club
Families helping families (MEND/ Holy Cross)
Proyecto del Barrio
NEVHC
What are some of the Barriers to accessing these resources?
•
•
•
•
•
•
Lack of information
Do not speak English (Language)
o Discrimination (Physical appearance)
o Long waiting time when on the phone
Transportation
No one else can take care of children or elders
Access to health care
Cutting benefits for third generations
•
•
•
They do not attend to people fast enough & lack of personnel (Olive
View) (10+ HES)
o Lack of beds
o Lack of good service
Negligence of hospitals
Services offered by county are limited
o Do not approach resources
o Lack of interest from parents
Suggest some possible solutions to the issues
•
•
•
•
•
•
•
•
•
•
More personal
Interpreters
Tokens (to help for transportation)
More conscious/ more friendly and nice
English classes (Before you to be free, $30 for each semester)
Free classes
Center for parents in schools (Resource)
o Give a lot of information
Vote
Support to prevent abortion
Continuing tutoring/ reach the level that is appropriate
12!
!
!
ValleyCare Clinician Focus Group Summary Sheet
Meeting!Date!
Location!
Group!Facilitator!
Meeting!Type!
!
!
(Place!“X”!in!the!
appropriate!box)!
!
September!5,!2012!
Olive!View!Medical!Center!!14445!Olive!View!Drive,!Sylmar,!CA!91342!
Joni!Novosel!
Community!Meeting/Focus!group!(e.g.!PTA,! Service!Provider!Group!(public!and/or! Tribal!Council!
Chamber,!Service!Club,!Advisory,!Boards,!
private!service!provider:!!educators/!
Meeting!
etc.)!
teachers,!counselors,!health!providers,!
etc.)!
!
X!(Physicians,!Physician!Assistants,!and! !
Nurse!Practioners!in!the!safety[net!
community!hospital)!
Other!!
!
Meeting!Attendance!
Total!
Service!Providers!
Other!Stakeholders!
24!
X!24!health!care!providers!
!
!
Adults!
(18[65)!
Seniors!
(65+)!
Total!
White!
Hispanic!
Family!Members!
Consumers/Clients!
!
Participant!Demographics!
Black/!African!
American!
Native!American!
!
Asian!
Pacific!Islander!
Other!
24!
6!
4!
1!
!
8!
!
5!
0!
!
!
!
!
!
!
!
Were!incentives!used?!!No!____!!!!Yes!__X__!!If!yes,!please!number!and!types!of!incentives!
!
Child!Care!
Food!
Other!
Number!Provided!
!
24!
!
!
!
Lunch!
!
!
13!
!
!
ValleyCare Physicians Focus Group Data
VCCC conducted this large group focus group using Turning Point Automated Response System technology. Questions for this group were more detailed and the copy of the
computer generated report is provided. These groups of primary care clinicians are part of the Los Angeles County Department of Health Services ValleyCare Safety net
system. The system includes Olive View UCLA Medical Center in Sylmar, Mid Valley Comprehensive Health Center in Van Nuys, San Fernando Health Center in the City of
San Fernando, and Glendale Health Center.
LACDHS Doctor Focus Group
9/5/12
Turning Results by Question
Session Name: New Session 9-5-2012 11-51 AM
Created: 11/9/2012 1:05 PM
1.) Physician’s Age (multiple choice)
Responses
(percent)
25 – 34 years
35 – 44 years
45 – 54 years
55 – 64 years
65 +
(count)
17.39%
39.13%
30.43%
8.70%
4.35%
100%
Totals
4
9
7
2
1
23
2.) Physician Specialty (fill in the blank)
Responses
(percent)
0%
100%
Totals
100%
3.) Physician Office Location – choose all that apply (multiple choice)
Responses
(percent)
(count)
Keywords:
Response Other:
0
23
23
(count)
14!
!
!
Olive View
MVCHC
Glendale HC
SFHC
Totals
21.05%
42.11%
13.16%
23.68%
100%
4.) What is your perception of the health of your patients? (multiple choice)
Responses
(percent)
Very Poor
4.17%
Poor
25%
Fair
54.17%
Average
8.33%
Good
4.17%
Excellent
4.17%
Totals
100%
8
16
5
9
38
(count)
5.) What percentage of your patients do you think are uninsured? (multiple choice)
Responses
(percent)
(count)
0–5%
27.27%
5 – 10 %
22.73%
10 – 25%
22.73%
25 – 50 %
18.18%
50 – 75 %
9.09%
More than 75%
0%
Totals
100%
1
6
13
2
1
1
24
6
5
5
4
2
0
22
15!
!
!
6.) What do you think are the risky behaviors of your patients? (multiple choice)
Responses
(percent)
Smoking
4.55%
Alcoholism
0%
Narcotics
4.55%
RX drug abuse
4.55%
OTC drug abuse
0%
Poor diet
27.27%
Sedentary lifestyle
40.91%
Other
18.18%
Totals
100%
(count)
1
0
1
1
0
6
9
4
22
7.) What is the chronic diseases you see in the low-income communities? Choose all that may apply
(multiple choice)
Responses
(percent)
(count)
Diabetes
17.39%
4
Hypertension
8.70%
2
Cardiovascular Diseases
4.35%
1
Stroke
4.35%
1
Cancers
13.04%
3
Other
52.17%
12
Totals
100%
23
16!
!
!
8.) In the 2010 CHNA we identified the following areas as greatest need - Rank the top Four (priority
ranking)
Responses
(percent)
(count)
Affordable Housing
13.62%
61
Home/long term care
1.56%
7
Dental care:
6.25%
28
Affordable/Portable Health
Insurance
13.39%
60
Mental Health Services:
15.62%
70
Transportation
2.23%
10
Access to primary care
22.10%
99
Chronic Disease
management
7.37%
33
Case management
1.34%
6
Wellness, screening and
prevention
16.52%
74
Totals
100%
448
9.) How many years of experience do you have working with vulnerable population? (multiple
choice)
Responses
(percent)
(count)
0 – 1 years
4.17%
1 – 2 years
4.17%
2 – 3 years
4.17%
3 – 4 years
0%
4 – 5 years
8.33%
5+
79.17%
Totals
100%
1
1
1
0
2
19
24
17!
!
!
Chronic Disease Diabetes and Hypertension Focus Group
Meeting Date
Location
Group Facilitator
October 25, 2012
Northeast Valley Health Corporation, 1600 San Fernando Road, San Fernando, CA 91340
Maribel Aguilar
Meeting Type
Community Meeting/Focus group (e.g.
PTA, Chamber, Service Club, Advisory,
Boards, etc.)
appropriate box)
Service Provider Group (public and/or
private service provider: educators/
teachers, counselors, health providers,
etc.)
Tribal Council Meeting
Other
X (Patients or
clients of the
clinic)
Meeting Attendance
Total
Service Providers
Other Stakeholders
Family Members
8
Consumers/Clients
X (Patients, Clients)
Total
White
Hispanic
Black/ African
American
Native American
Asian
Pacific Islander
Other
Children/
Youth
Adults
(18-65)
8
8
Seniors
(65+)
Number Provided
Child Care
18!
!
!
Food
Other
8
$10 Gift card to Subway
Focus!Group!Responses@!NEVHC!
!What!are!the!most!significant!educational/environmental/!socio@economic!factors!affecting!the!community?!
What!ages!are!most!impacted?!
• Trash!(neighborhood,!streets)!
• Adults!needs!orientation!
• Cannot!afford!rent!
• Cannot!afford!to!pay!for!health!insurance!
• Contaminated!air!due!to!smoking!
What!are!the!most!risky!health!behaviors!affecting!the!community?!
•
•
•
•
•
Language!barriers!
Not!a!lot!of!lighting!in!the!neighborhood!
Not!enough!teachers!
Traffic!all!around!
Unemployment!
• Driving!and!texting!
• Robbery!
• Drugs!
• Shootings!!
• Road!rage!
• Violence!(domestic,!child!abuse,!gang!rivalry)!
What!are!the!community!resources!that!we!have!to!support!the!community!to!address!the!issues?!
• Hospitals!
• Northeast!Valley!Health!Corp!
What!are!some!of!the!barriers!to!accessing!these!resources?!
•
•
ORSA!(health!coverage!to!low!income!families)!
Rehabilitation!Centers!
• Cannot!communicate!
• Cost!too!much!money!
• Lack!of!health!support!from!the!government!
Solutions!to!these!issues?!
•
•
•
Transportation!
Undocumented!are!scared!to!seek!help!
Wait!time!
• Depends!on!one!self!to!find!resources!
• Orientation/coordination!or!services!
• Group!support!to!be!heard!
Prioritization!of!concerns!and!solution?!
•
•
Need!a!program!such!as!Meal!on!Wheels!in!the!San!Fernando!Valley!!
MEND!
•
•
Obesity!(more!health!programs)!
Support!group!(when!issues!are!raised!people!need!to!come!together!to!
make!change)!
•
•
!
Education!(for!adults!to!be!aware!of!their!children's!school!and!what!
programs!are!offered!in!the!school.!
Also,!when!seeking!research!in!health!and!how!to!obtain!that!help)!
!
Key Informant Interviews:
A total of 8 key informant interviews were conducted for Mission Community Hospital catchment area. Each interview lasted between 30 to 45 minutes. The key informants
included individuals from Los Angeles County health, mental health and public health departments, academia, community clinics, hospitals, and community based
organization leaders with public health expertise or a provider of services for low-income, uninsured families.
What group do they represent?
Key Informant
Description of leadership,
Consult
Type of
Names
representative or member role
Date
consult
Aguila, Ismael
Operation Manager, City of San
Fernando
City of San Fernando residents many are Low-income, minority population.
11/2/2012
Key Informant
Interview
Dunn, Jody
Vice President, Service Integration for
Partners in Care Foundation
Medically underserved, low-income, senior population
11/6/2012
Key Informant
Interview
Mayen-Cho,
Marie
Director of Providence Access to CareHealth Education Outreach
Medically underserved, low-income, minority population.
11/5/2012
Key Informant
Interview
Nino, Carla
L.A. DHS ValleyCare Mid Valley
Comprehensive Health Center
Medically underserved, low-income, minority population, with chronic
disease access safety-net
11/7/2012
Key Informant
Interview
Ozols, Andy
Executive Director, San Fernando
Valley Dental Society
Association for area DDS servicing all ethnicities and income levels with
special events and programs for low-income minority children and veterans
5/28/2013
Key Informant
Interview
Soto, Tania
Field Representative Assembly Member
Fuentes
Constitutions of all income levels. Many are minority population.
5/31/2013
Key Informant
Interview
Valencia, Yanira
Program manager, Chronic Disease
Department
Medically underserved, low-income, minority population.
5/28/2013
Key Informant
Interview
Vigdorchik,
Olga
Los Angeles County Department of
Public Health, Health Educator
SPA 1 and 2 Low income, underserved.
5/29/2013
Key Informant
Interview
Summary of Common Themes:
Common themes identified as community health needs among the 8 Key Informant Interview’s included: diabetes, lack of access to care, and lack of access to dental care.
20!
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Key Informant Detail Sheets
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Name: Ismael Aguila
City, Zip code where they work: San Fernando, 91340
Degree: MA in Exercise
Email: IAguila@ci.san-fernando.ca.us
Title: Operation Manager
Phone: (213)663-3603
Agency: City of San Fernando
Experience and expertise in public health or working with low-income, indigent population: Yes
1. What are the most significant health problems in the community you serve? What ages are affected by the issue?
• Food security, obesity, diabetes and air pollution are some of the health problems I observe in the San Fernando area. All age
groups are affected by these health problems. Children are the ones most affected by Obesity
2. What are the most significant educational/environmental & socio-economic factors affecting the community? What ages are
impacted?
• The economy being a big factor affecting the community, social norm regarding smoking, health access to healthy food, lack of
green space. All age groups are impacted.
3. What are the most risky behaviors affecting the community? What age groups most impacted?
•
Having liquor stores, junk food for kids, we have a gang problem with children, parents not being there for their children, leaving
them unsupervised, teen pregnancy. Teenagers and Middle School students
4. What problems affect the health of your clients? If you could prioritize the issues, what are the top 5 issues, what age groups?
Please rank the issues 1 being the most important and 5 being the least important.
Issues:
Diabetes, physical inactivity, high sugar foods.
1. Diabetes
3. Lack of food security – all ages
2. obesity –children in 5th and 6th grade
4. Air pollution -all ages
22!
!
5.
How often do you see the above list in the communities you serve?
•
All the issues above are seen on a daily basis in this community.
6. To address the list of concerns, what are some of the community resources that you could think of that could help address the
issues?
Did not respond
7. What are some of the barriers? Income and resources
8. Could you please suggest some solutions? Not sure more education
Name: Jody Dunn
Degree: BS
Title: Vice President Service Integration for Partners in Care Foundation
Agency: Partners in Care Foundation
City, Zip code where they work: San Fernando, 91343
Email: jodyadunn@hotmail.com
Phone: 818-837-3775 ext. 138
Experience and expertise in public health or working with low-income, indigent population:
Help create access to care collaborative along with key partners being MEND and set up a free care clinic for working poor uninsured
individuals. Help oversee a contract with LA Care Health Plan serving seniors and persons with disabilities and medical recipients
only.
• Multi-Morbidity (many chronic disease)
• High blood pressure/hypertension
• Diabetes
50 years and over
• Congestive heart failure
• Depression/Mental illness
•
2. What are the most significant educational/environmental and socio-economic factors affecting the community? What are ages are
impacted?
All are ages 50 and up
Educational
• Low literacy (all ages)
• Lack of access to good programs and better take care of themselves (all ages- young and older)
22!
!
!
Environmental
• Have older adult safety in home environment to prevent falls
• Outside environment - to be able to go outside safely and walk safely
• Side-walks are not in good conditions
• Community not conducive to be safe
Socio-economic
• Poor
• To many health conditions that prevent them from working
• No skills
3. What are the risky behaviors affecting the community? What age groups are most impacted?
• Not taking care of their health
• Do not understand the information they need
• Cannot manage the disease stage they are have
4. What problems affect the health of your clients? If you could prioritize the issues, what are the top five issues, what age groups?
• High blood pressure/Hypertension -3
• Diabetes- 2
• Congestive heart failure- 4
• Depression/Mental Illness- 1
5. After we collected primary and secondary data, the following health issues came up to be the top concerns. If you could rank the top
5 of these issues what would they be?
• Mental health
• Obesity
• Asthma
these are young problems
• Infant Health
• Homicide
6. What are the most common issues that you hear about from the list above in the communities you serve?
• Depression
• Mental health
seen in older adults
• Obesity (affect all)
23!
!
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issues?
• Expand mental health access
• Reimburse to providers to provide health education
• Community Safety
• Side walk repair
• Gang intervention to keep community safe
8. What are some barriers?
• Lack of access to mental health
• It is not easy to accept mental health problem
• To keep a community safe is costly
• Have to allocate resources from somewhere else
9. Could you please suggest some solutions?
•
•
Access to mental health
Education
• Patients goes with their physician and the physician might not have the expertise to help the patient
The physician does not have the resources to refer the patient
Name: Marie Mayen-Cho
Degree: Master in Public Health
Title: Director of Providence Access to Care-Health Education Outreach
Agency: Providence Health and Services
City, Zip code where they work: North Hollywood, 91605
Email: marie.mayen-cho@providence.org
Phone: 818-847-3909
24!
!
!
• Chronic diseases continue to be a serious concern (heart disease, diabetes, asthma, obesity) in this community (North Hollywood).
There has been an increase mental health issues. Chronic diseases such as heart disease, diabetes, and hypertension are prevalent in
older populations (40-65). Asthma and obesity and currently affects all ages in North Hollywood.
impacted?
• All age groups 0-100 are afflicted by poverty and lack access to information, educational opportunities, and housing. The community also
lacks resources.
• Obesity affects all ages because there is too much access to sugar and fast food especially in underserved communities. Teen
pregnancy (12-18) has overall decreased but remains a problem for the Latino community. Alcohol use among Latino men also remains
a problem which leads accidents.
• Poverty lack of resources-1
• Lack of access to medical care-2
• Lack of culturally appropriate information about resources (not being culturally sensitive, poor translation, cultural and beliefs are not
being considered when developing information about resources)-3
• Lack of good mental health services-4
• Access Dental care-5
5. After we collected primary and secondary data, the following health issues came up to be the top concerns. If you could rank the top
• Health care access-1
• Mental health-2
• Obesity-3
• Homicide-4
• Asthma-5
6. What are the most common issues that you hear about from the list above in the communities you serve?
• Lack of access to resources (physical, mental, or dental) or they don’t know about community resources (access to health care).
• Mental health issues
• Economic problems (poverty); unemployment.
issues?
25!
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!
• Access to Care- helps patients that come to ER and links patients to clinics for further services
• Promotora programs that outreach to the Latino community.
• More funding/Grant funding for programs
• Provide resources and information to clients who work closely with clinics in order to provide good info to patients.
• Access to care
• Lack of programs (dental care; such a big problem; no longer covered my medical)
• Lack of resources for dental care
• Transportation
• Child care
• Poverty
• Addressing the economy
• Be able to have access to employment opportunities. Good policies and changes in government to create jobs
• Funding from grants to address bigger needs to develop appropriate informational guides
• Have people that are best suited to serve the community when implementing health programs such promotoras; they more culturally
sensitive and appropriate and have more experience working with the community
• Better research
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Name: Carla Nino
Date Conducted: 11/7/12
Title: Administrator
Degree: Anthropology
Department: LA Department Services
City: 7515 Van Nuys, Van Nuys CA 91406
Email: Cnino@ dhs.lacounty.gov
• Low income, uninsured chronic disease individuals
• The primary diagnosis for our patients is Type 2 Diabetes. Many have accompanying issues of hypertension and hyperlipidemia. We
predominately see adults between the ages of 18-64.
2. What are the most significant educational/environmental & socio-economic factors affecting the community? What ages are
impacted?
• Our patients are un-or-underinsured. With the establishment of primary care medical homes, most of our patients are in a managed care
plan through LA Care or eligible to/receiving Healthy Way LA.
• Their educational level is basically at a 6th grade level.
3. What are the most risky behaviors affecting the community? What age groups most impacted?
• The primary risky behaviors we see in our patients is smoking and overeating.
4. What other problems or concerns affect the health of your clients/patients/people you serve? What age group most impacted?
• Patients express they are anxious and/or depressed. We primarily serve adults
5. What are the common issues do you hear from your patients/clients?
The primary concern is access to health care and a payment method.
6. If you could prioritize the issues in your community, what are the top 5 issues, what age groups? Please rank the issues 1 being the
most important and 5 being the least important.
1) Access to primary care; adults
2) Access to mental health services; adults
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7. To address the list of concerns, what are some of the community resources that you could think of that could help address the issues
1) Additional primary care medical homes throughout the community to enhance access
2) Co-location of mental health services within the primary care setting
8. What are some of the barriers
1) Resources
2) Clinic capacity
3) Staffing
9. Could you please suggest some solutions? No response
Name Andy Ozols, MA, MBA
Title: Executive Director
Agency: San Fernando Dental Association
Date conducted: May 28, 2013 @ 11am
Email: exec.sfvbs@sbcglobal.net
Phone Number: 818-576-1006
Address: 9205 Alabama Ave. Unit B Chatsworth CA, 91311
1.
What are the most significant health problems in the community you serve? What ages are what are the most significant
educational/environmental and socio-economic factors affecting the community? What are ages are impacted?
Educational
Educational (across the board): Low income indigent people are not as well educated and lack the ability to read self-help guides.
Socioeconomic: Poorer populations eat poorly and have diets that consist of junk food and consume food high in sugar such as soda and
candy. When we attempt to educate the population on oral health care they do not seem to comprehend. Socioeconomic status affects all
ages and is one of the biggest factors affecting the community.
Socio-economic
2.
Lack of healthcare coverage for the adult and senior population. Federal insurance coverage has been cut and people over 18 years of age
can only receive dental services in emergency rooms that only cover extractions.
What are the risky behaviors affecting the community? What age groups are most impacted?
28!
!
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Across the board
a. Risky behaviors are primarily nutritional. There are many adults and children consuming high quantities of soda and junk food.
Due to the lack of knowledge and/or education many parents put infants to bed with bottles of milk (sugar) which contain high
quantities of sugar. Additionally, parents misunderstand the importance of caring for primary teeth and often do not take proper
care of their infant’s primary teeth.
b. Behavioral factors such as not brushing or flossing are also risky behaviors for bad oral health
3.
What problems affect the health of your clients? If you could prioritize the issues, what are the top five issues, what age groups?
The list below affects all age groups
1. Lack of concern about oral health until they are in pain.
2. Cultural barriers
3. Lack of education
There is a high lack of concern for oral health care amongst the adult population that they pass down to their children. Cultural and
educational reasons have been noted due to the fact that many cultures do not place emphasis on good oral health care. For some cultures
it’s quite the opposite. Some cultures take pride in the amount of metal in their mouth as it signifies that they have more money.
4.
What are the most common issues that you hear about from the list above in the communities you serve?
Common issues mentioned include: lack of transportation, no health care coverage, no money, and fear of seeing a dentist. Some people
simply do not see the dentist because they believe primary teeth are not important.
5.
To address the list of concerns, what are some of the community resources that you could think of that could help address the
issues?
Health Fairs (once or twice a month), free-clinics, Kids Community Dental, MEND, NEVHC (treat kids but not adults), Children’s Dental
Foundation, Glendale Healthy Kids, and members who volunteer their time.
6.
What are some barriers?
Cultural factors are the biggest barriers, lack of oral health, language, and transportation. Specifically, for adults and seniors the state has
removed coverage for oral health care. If they restore the funding, that will open room for more potential providers. They would be able to go
to practitioners and private practice. Under the federal Medi-Care program, recipients are only covered for extractions in emergency rooms
not crowns or fillings.
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7.
Could you please suggest some solutions?
The San Fernando Dental Society tries to educate the community as best we can in different environments such as in school with teachers
and parents where we distribute pamphlets flyers. A higher emphasis needs to be placed on educating the community during health fairs so
that people come to be educated not just take the freebies. It would be great to be able to get public services announcements on billboards
and television to increase oral health awareness.
Name: Tania Soto
Degree: B.S in Public Health at CSUN
Title: Field Representative
Agency: California State Assembly
City, Zip code where they work: 9300 Laurel Canyon 1St Floor Arleta
Email: Tania.Soto@asm.ca.gov
Phone: 818-504-3911
I have very high experience and expertise. Having a degree has enabled me to work with all sorts of people: the people we serve are low
income and we educate about process and local level government. Having background as a health educator is helpful and allows me teach
basics and provide resources.
• From people that come into the office, from our events , we come across with issues such as diabetes, high blood pressure, childhood
obesity, dental care, lack of access to care, breathing and asthma problems, and cancer
• Childhood obesity and asthma and breathing problems (Age Impacted: 5-12)
• Cancer (Age Impacted-varies on age because it depends on cancer, but more Adults)
• Diabetes (Age Impacted: Adults)
• High Blood Pressure: (Age Impacted: Seniors)
• Dental Care: (Age Impacted: Adults)
•
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impacted?
Educational
• Adults are lacking healthcare access males adults (especially males)
o Don’t have health coverage or cannot get to clinic because are they overloaded
o Unaware of state help
Environmental
o Lack of open space, especially in areas that are heavily populated with apartments, children don’t have place to play, it is
unsafe environment, (Age impacted: Children )
Socio-economic
o Not enough housing and not able to afford home, or if they buy a home 2-3 families live in that home ((Age Impacted:
Everyone)
In some cases they lose those homes
Some houses do not have a back area to play in
Some have front yard, but parents do not want them to play there and therefore may play in the streets which parents do not
want to see happen either. As a result, they do not have anywhere to play
o Places like Pacoima, areas in Sylmar, and along foothill are all apartments and is very congested, but it is easier to afford for
a lot of people
 Nowhere for kids to go
• Budget cuts are cutting physical education time in k-12 which is the main source of activity for these children
• Eating out rather than walking to farmers market that has fresh food
• Poor eating habits (Age Impacted: Everyone)
• A lot of alcohol and drug abuse among teens and adults especially among homeless population-everyone (Age Impacted:
Everyone (Teens, Adults, Homeless)
• Low graduation rates among high school students/high dropout rate (Age Impacted: Teens)
• Tobacco use
• Apartments want to convert to smoke free, but we are working on legislation (Age Impacted: Adults)
#1 Employment
Not enough jobs
o
o
o
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5.
6.
7.
8.
#2 Educations
Need more early education programs
We have to make sure kids are prepared in life and not only about making sure they graduate high school and college
#3 Dental
Don’t have access to dental care
#4Diabetes
#5 Land Use Issues
People living next to dump sites,
After we collected primary and secondary data, the following health issues came up to be the top concerns. If you could rank the top
• Combine from what they call our office, what are resources they are asking, in the field, health fair-show up for dental services
• #1 Access to health
• Because it is our first choice
• #2 Obesity
• #3 Cancer
• #4 Asthma
• #5 Infant Health
• Have not come up in our office, our community provides a lot of infant health through different non- profits and hospitals
• Unemployment/disable
o So many cases not receiving benefits after being laid off
• Lack of veteran services
o Physical and mental services
• Dental care
o Many come to our health fairs just to seek dental care
issues?
• Suggest people to engage more with local elected officials in regards to issues they may have so in the end they can receive the help
they need
• If they knew we were available to help them to get these services and know about all the partners we have with clinics, more
people would be able to seek health they need
• Getting engaged with parks and schools
32!
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People don’t know a lot about how the government works
• Low education about government leads to not knowing they have someone who represents them
• They are unaware of the government system and believe when they call our office they are going to speak about Obama
• Language barrier
• Latinos believe they are not able to seek help because of their immigration status as well as because they believe if they do not
vote, they are unable to ask for help or speak to their representatives
• We want to expose ourselves more with events, we want to do more outreach, and want people to know an assembly official is here to
help them
• Some people come to the office to ask to repair pot holes instead of asking for state medical help or child care services,
• More education
• We would like to go to parent centers and teach them about “government 101” and teach that they have representation
• Want to educate them what is happening in government and among their city
• We want them to know if they are a resident or not they are still allowed to call and be able to push for what they are advocating
•
33!
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Name: Yanira Valencia
Degree: BA
Title: Program Manager, Chronic Disease Department
Agency: Northeast Valley Health Corporation
City, Zip code where they work: 531 5th Street, Suite A, San Fernando, CA 91340
Email: yaniravalencia@nevhc.org
Phone: 818-270-9700 Ext 50158
• Diabetes
• Hypertension
• Asthma (pediatric)
• obesity
impacted?
Educational
• Reseda high number of India, Pakistan and Pacoima is Latino (language barriers)
• Low literacy levels in places like Pacoima
• Inability to understand instructions in English and follow treatment regimen
Environmental
• Parks access
• Safety of the community
• Weather
• Air pollution
Socio-economic
• Lack of income households with both, one or none employed
34!
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3.
4.
5.
6.
7.
• Singer parents
• Lack of insurance
What are the risky behaviors affecting the community? What age groups are most impacted?
• Smoking
• Noncompliance of medication
• Broken appointment
• Unsanitary conditions they live in
What problems affect the health of your clients? If you could prioritize the issues, what are the top five issues, what age groups?
• Access to care
• Communication provider and patient
• Cost of care for uninsured and people who are unmatched with the healthy way la
• Transportation
1. Access to care
2. Mental health
3. Obesity
4. Parent education
5. Community safety
Obesity – patients not having support from families and relatives to help with behavior change
“Those that are diabetic have problem with their diet as the rest of the family wants regular food, so they prepare it to feed others but can’t
consume it themselves, so sometimes self-control can become an issue.” Diabetics also lack the understanding of the need for modifying
diet to control their diabetes. So, some patients with diabetes feel that they do not have support of their family in this regard.
issues?
• Places communities can go to exercise classes
• Grocery stores like Tresierras, Food 4 Less etc. for cheaper foods that are healthier
• Mental health agencies
• Legal services
• Placement and skill centers (get certified)
• Scholarship programs/schools/promote skill buildings
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• Language
• Health literacy
• Even the doctor is speaking the same language, understanding is a big problem
• Patients being able to access their records electronically and not tech savvy
• Bilingual staff at every facility
• Kiosk in every department and clinic and readily available to the patients
• To access records, appoints, etc.
• Transportation available from agencies
• Educational classes with physical activity for staff and patients. For the staff to walk with patients and be involved.
• Increase accessibility to care.
• One stop job placement agencies
Name: Olga Vigdorchik
Wednesday, May 29, 2013
Agency: LAC DPH
Phone Number: 818-766-3920
Email: ovigdorchik@ph.lacounty.gov
Address:
•
The new key indicator report has just come out so if you look at that particular health outcome report one significant problem would be
overweight and obesity although children are faring a bit better than adults. Higher percentages have been reported among adults and
diagnosed with diabetes and high cholesterol; specifically in the West End of the San Fernando Valley. Additionally, higher rates of stoke
mortality can be seen in the West End of the San Fernando Valley. Mental health and Alzheimer’s mortality rates have been rising with
the growing aging population. This can be seen in older adults in this SPA than other SPA’s.
36!
!
!
• Mortality of people of all ages: mortality coronary heart disease, death from stroke, COPD, Alzheimer’s. Folks under age 75 are
most impacted by heart disease, suicide, drug overdose (combination of both prescription and OTC drugs), motor vehicle
crashes, and finally liver disease.
• Specific to the West Valley: The leading health problems are overall coronary heart disease, all lung cancers, stroke, Alzheimer’s,
and COPD.
• Under 75 for West San Fernando Valley: suicide, drug overdose, motor vehicle accidents, and homicide (probably related to
gangs).
impacted?
• Educational factors:
• If you look at the breakdown we seem to have about 30 percent of folks that have at least some college and 20 percent of have
less than high school education. Based on the indicators there in no real indication that education is a factor that is significantly
affecting the community.
• Socio-economic:
• Have had a significant increase since more than 30 percent do not have money to cover other expenses such as healthy food.
Low federal poverty level close to being homeless. Ninety percent of the population reports that it is easy to get healthy food so
access in not an issue. Currently 1 in 10 people receive food stamps. Thirty percent of the population in the San Fernando Valley
report having food security.
• Environmental:
• Based on the Key Indicator Health report, SPA 2 has less of the population reporting adequate lighting, walking, playgrounds
(built environment) which affect physical health, mental health, and physical activity. People who live here (SPA 2) do not use
them as much as they should. Some just report that they do not have (recreational facilities) them in their neighborhood.
• Risky behaviors-physical inactivity (children fair better). Percent of obese adults has increased and it has not leveled off. The San
Fernando District has higher obese adults compared to other SPA’s. 1 in 5 adults 18 years of age and older is obese. West LA has
the lowest amount of obese and we are close 2nd and even then we have 20 percent which is still high.
• High sugar and sodium consumption –high sugar consumption leads to overweight and high sodium intake causes high blood pressure.
• Smoking- and that is clearly reflected in death rates for emphysema, lung cancer, and COPD.
• Drug use (Overdose).
• These are some of the risky behaviors affecting community
37!
!
!
We have several components such as clinics, patients who are served by public health nurses for communicable diseases, in SPA 2
there are Health Educators and Community Liaisons for the community at large.
• Clinics: for patients with STD’s
• For patients with communicable diseases many of them do not health care coverage. When they (Nurses) go into the home there may
be more issues. [The nurses] help people get into the system to get health care coverage and work with the homeless population as well.
• For the overall community, please refer to the answer previously covered in question #1.
1. Please refer to question #4 (LADPH has several different components; please provide clarification as to what population to provide
information for (patient? Or Clients? Or People?)
2. 1. Overweight/Obesity (Children and adults)
3. 2. Diabetes (no age group can be provided from data that we are looking at)(Geographically higher in the West Valley area)
4. 3. Heart Disease, Mental Health, Injury/Violence (suicide, motor vehicle causes of premature death)
• Department of Public Health, VCCC, other LA County departments such as: county parks, parks and recreation, school districts (LAUSD
as they implement physically activity programs) Hospitals, YMCA, Private funders, 211 an all-inclusive county service.
• Lack knowledge. People don’t know what is available to them .They are not knowledgeable of what Affordable Health Care Act will
cover,
• Do not having healthcare coverage,
• Do not having time.
• Exercising risky behaviors mentioned in question #3
• Programs that lack cultural sensitivity will not be successful
• Built environment that is not conducive of healthy behaviors. Not having access to health exercise and walking.
• Continue working together collaboratively to minimize duplication of programs/efforts and maximize efforts and see where the gaps are.
We can fill in the gaps where communities are not receiving services. Making sure that organizations are not duplicating efforts. Working
more on policies and that they are enforced and if there are not policies currently in place bringing them to light to bring about health
change.
Could you please suggest some solutions? No response needed
•
5.
6.
7.
8.
9.
38!
!
!
GFI Goldberg & Facktor, Inc.
LOS ANGELES, ORANGE COUNTY, SAN FRANCISCO, SACRAMENTO & CHICAGO
!

Mission Community Hospital`s 2013 Community Needs Assessment

Transcription

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