Transcription
Scripps Health02019
Scripps Health 2019 Community Health Needs AssessmentGENERAL INFORMATIONContact Person:Anette BlattDirector, Community Benefits and Advocacy, Officeof the President Community Benefit fitAuthorized governing body that adopted thecommunity Health Needs Assessment (CHNA):Strategic Planning Committee of theScripps Board of TrusteesTax Year in which CHNA was madeavailable to the public:Tax Year 2019 (available onhttp://www.scrippshealth.org/)Name and state license number of HospitalOrganization Operating Hospital Facility: Addressof Hospital Organization:Scripps Mercy Hospital 4077 5thAvenue San Diego, CA 92103090000074*Scripps Mercy Hospital has a second campus in Chula Vista,and they share the same license.Scripps Memorial Hospital La Jolla9888 Genesee AvenueLa Jolla, CA 92037080000050Scripps Green Hospital10666 Torrey Pines RoadSan Diego, CA 92037080000139Scripps Memorial Hospital Encinitas354 Santa Fe DriveLa Jolla, CA 920370800001481 Page
TABLE OF CONTENTSTable of Contents . 2I. Acknowledgements. 10Community Health Needs Assessment Committee . 10Hospital Association of San Diego and Imperial Counties . 11Institute for Public Health, San Diego State University. 11Special Thanks . 12II. Introduction and Purpose of the Community Health Needs Assessment Report . 14III. About Scripps Health . 18A. Service Offerings . 19B. Governance . 23C. Orginizational Foundation . 23D. Mission, Vision, and Values. 24IV. Scripps Health Community Benefit . 25V. Scripps Implementation Plan – Evaluation of Impact Based on the 2016 CHNA . 27A. Cardiovascular Disease. 28B. Diabetes (Type 2). 38C. Behavioral Health . 45D. Obesity . 54Evaluation Plans . 61VI. Building on Previous 2016 Community Health Needs Assessment . 632016 Community Health Needs Assessment – Phase 2 . 632018 Behavioral Health Analysis . 64VII. Executive Summary . 68Introduction and Background. 68Methodology . 68Quantitative . 70Community Engagement. 702019 CHNA Prioritization of the Top Health Needs . 722019 Findings: Top 10 Community Health Needs . 722 Page
Conclusions and Next Steps . 76VIII. Community Defined . 78A. Scripps Health Community Served . 79B. Community Served . 82C. Demographic Profile of San Diego County . 83D. Identifying High-Need Areas . 85E. San Diego County Hospital and Clinic Data . 89IX. Methodology. 92A. Quantitative Data Collection and Analysis . 94B. Community Engagement Activities . 95Methodology for the Community Engagement Process . 95C. 2019 CHNA Prioritization of the Top Health Needs . 100Process and Criteria used for Prioritization of Health Needs . 100D. Data Limitations and Information Gaps . 101X. Findings . 103A. 2019 Findings: Top 10 Community Health Needs . 103Access to Health Care . 104Aging Concerns . 112Behavioral Health . 116Cancer . 122Chronic Conditions . 126Community and Social Support . 133Economic Security . 136Education . 141Homelessness and Housing Instability . 144Unintentional Injury and Violence . 148B. Community Resources and Assets Available to Respond to the Identified Health Needs. 151Community Recommendations. 151Strategies to Increase Knowledge, Improve the Patient Experience, and Enhance Collaboration 152The Development and Expansion of Specific Types of Resources . 153Systemic Change . 1533 Page
C. Next Steps. 155Health Briefs. 157APPENDICES . 159Appendix A: Glossary Terms . 160Appendix B: Acronyms and Abbreviations. 162Appendix C. Secondary Data Sources and Dates . 164Appendix D. Community Input Tracking Form. 169Appendix E: Community Engagement Data Collection Tools . 173Sample Focus Group and Key Informant Questions . 173Appendix F: Survey Findings . 1752019 Community Health Needs Assessment Survey Findings . 175Appendix G: Additional Data Tables . 178Appendix H: Community Need Index Description . 180Appendix I: KFH – San Diego and Zion Analytics . 181KFH-San Diego and Zion - Ranked Health Outcome Comparison Table . 181KFH-San Diego and Zion– Social Factors Linked to Health Outcomes . 182Appendix J: Participating Hospital Locations . 183Appendix K: Legislative Requirements. 1844 Page
FIGURESFigure 1. Mortality Rates for Coronary Heart Disease . 28Figure 2. Hospital Discharge Rates for Coronary Health Disease, 2014—2017. 29Figure 3. Mortality Rates for Stroke, 2014—2016 . 34Figure 4. Hospital Discharge Rates for Stroke. 34Figure 5. Mortality Rate for Diabetes in San Diego County . 38Figure 6. Discharge Rates for Diabetes . 39Figure 7. Age Adjusted Suicide Rates in San Diego County . 45Figure 8. Hospital Discharge Rates for Anxiety . 46Figure 9. Hospital Discharge for Mood Disorders . 46Figure 10. Percent of the Adult Population who are Obese in San Diego County, 2014—2016 . 54Figure 11. 2018 Behavioral Health Analysis, Social Determinants of Health that Limit Patients’ Ability toManage Their Care . 65Figure 12. Post-Care Service Needs Identified by Interviewees . 66Figure 13. 2019 Community Health Needs Assessment Process Map . 70Figure 14. 2019 CHNA Community Engagement Participants . 72Figure 15. 2019 Top 10 Community Health Needs . 73Figure 16. Resources & Opportunities to Address Priority Health Needs . 76Figure 17. San Diego County Health and Human Services Agency Regions . 79Figure 18. Scripps Health Service Area . 83Figure 19. Percentage of San Diego Population by Age Group, 2013—2017 . 84Figure 20. Percentage of San Diego Population without Health Insurance among Civilian Noninstitutionalized Population Ages 18–64 Years in San Diego County, California and the United States,2013—2017. 86Figure 21. Health Places Index (HPI), San Diego County . 87Figure 22. Community Need Index (CNI), San Diego County . 895 Page
Figure 23. 2019 Community Health Needs Assessment Process Map . 94Figure 24. 2019 CHNA Community Engagement Participants . 98Figure 25. 2019 CHNA Top Health Needs . 104Figure 26. Percentage of Population without Health Insurance in San Diego County, California, and theUnited States Ages 18–64 Years, 2013—2017. 106Figure 27. Percentage of Population without Health Insurance in San Diego County and California Ages19–64 Years by Race, 2017 . 106Figure 28. Percentage of Population without Health Insurance in San Diego County and California Ages19–64 Years by Ethnicity, 2017 . 107Figure 29. Preventable Hospital Events for Medicare Beneficiaries in San Diego County, 2015 . 107Figure 30. Percentage of Medicare Beneficiaries who have seen a PCP within Past Year in San DiegoCounty, 2015 . 108Figure 31. Hospital Discharge Rates for Alzheimer’s and Dementia in San Diego County, 2014—2016. 113Figure 32. Hospital Discharge and Mortality Rates for Falls in San Diego County, 2014—2016 . 114Figure 33. Hospital Discharge Rates for Anxiety and Mood Disorders in San Diego County, 2014—2016. 118Figure 34. Suicide Rates in San Diego County by Race/Ethnicity, 2016 . 119Figure 35. Hospital Discharge acute and Chronic Substance Use Rates, 2014—2016 . 120Figure 36. Hospital Discharge Rates for Opioid Misuse, 2014—2016 . 120Figure 37. Incidence Rates for Cancer in San Diego County, 2011—2015 . 123Figure 38. Mortality Rates for Cancer in San Diego County, 2011—2015 . 124Figure 39. Hospital Discharge Rates for Coronary Heart Disease in San Diego County, 2014—2016 . 128Figure 40. Mortality Rates for Coronary Heart Disease in San Diego County, 2014—2016 . 128Figure 41. Hospital Discharge Rates for Stroke in San Diego County, 2014—2016. 129Figure 42. Mortality Rates for Stroke in San Diego County, 2014—2016. 129Figure 43. Hospital Discharge Rates for Diabetes in San Diego County 2014—2016 . 130Figure 44. Mortality Rates for Diabetes in San Diego County 2014—2016 . 1306 Page
Figure 45. Percent of the Adult Population who are Obese in San Diego County, 2014—2017 . 131Figure 46. Percent of the Population below 100% Poverty Level in San Diego County,2013—2017. 137Figure 47. Unemployment Rate in San Diego County, California, and the United States,2014—2018. 138Figure 48. Age-Adjusted ED Discharge and Mortality Rates for Falls in San Diego Count, 2014—2016. 150Figure 49. Age-Adjusted ED Discharge and Mortality Rates for Motor Vehicle Injuries in San Diego County,2014—2016. 150Figure 50. Overall Crime Rates in San Diego County, California, and the United States, 2014—2016 . 151Figure 51. Resources and Opportunities to Address Priority Health Needs . 1557 Page
TABLESTable 1. Results: Eric Paredes Save A Life Foundation. 31Table 2. Results Adult Screenings: Eric Paredes Save a Life Foundation . 32Table 3. Sweetwater Union High School District Pre-Participation Sports Screening Assessment . 33Table 4. Su Corazon, Su Vida – Your Heart, Your Life . 34Table 5. Stroke Risk Factor Program . 37Table 6. Summary of Community Input on Common Diabetes (Type 2) Issues, HASD&IC 2016 CHNA . 41Table 7. The Scripps Diabetes Care Retinal Screening Program . 42Table 8. Project Dulce Care Management Program . 43Table 9. Medical Assistant Health Coaching (MAC) . 45Table 10. Summary of Community Input on Common Behavioral Health Issues, HASD&IC 2016 CHNA. 48Table 11. Psychiatric Liaison Team (PLT) . 50Table 12. Scripps Drug and Alcohol Resource Nurse . 51Table 13. Mi Puente/My Bridge . 52Table 14. Scripps Mercy and Family Health Centers Behavioral Health Partnership . 53Table 15. Behavioral Health Program in Diabetes (BHIP) . 54Table 16. Summary of Community Input on Common Obesity-Related Issues, HASD&IC 2016 CHNA. 56Table 17. Health Living Program . 60Table 18. Promise Neighborhood (Reducing Childhood Obesity in South Bay) . 62Table 19. San Diego County Safety Net Discharges CY17: Safety Net Discharges Include Payer Categories:County Indigent Programs, Medi-Cal and Self Pay . 81Table 20. Scripps OSHPD Safety Net Discharges CY17: Safety Net Discharges Include Payer Categories:County Indigent Programs, Medi-Cal and Self Pay . 81Table 21. Scripps Health Locations . 82Table 22. Scripps Health Inpatient Discharges for Years 2013—2016 from which the Top 70% of ScrippsPatients Originate . 828 Page
Table 23. San Diego County Demographics, 2013—2017 . 84Table 24. Community Need Index Scores by San Diego Count HHSA Regions, 2015 . 89Table 25. Cities with High Need Index Scores by San Diego County HHSA Regions, 2015 . 90Table 26. Demographic Characteristics of all Hospital Emergency Department and Inpatient DiseaseEncounters in San Diego County by San Diego Residents, 2016 . 91Table 27. Clinic Encounters by Diagnosis, Total Encounters in San Diego County, 2016 . 91Table 28. 2019 HASD&IC Community Health Needs Assessment –Overview of Community EngagementParticipants . 97Table 29. Summary of Focus Group and Key Informant Interview Input Related to Access to Care . 112Table 30. Summary of Focus Group and Key Informant Interview Input Related to Aging Concerns. 116Table 31. Summary of Focus Group and Key Informant Input Related to Behavioral Health . 122Table 32. Summary of Focus Group and Key Informant Interview Input related to Cancer . 126Table 33. Summary of Focus Group and Key Informant Interview Input Related to Chronic Conditions. 133Table 34. Federally Qualified Health Centers Rate, Primary Care Provider Rate, Percent of PopulationLiving with Limited English Proficiency, and Linguistically Isolated in San Diego County, California, andthe United States, 2013—2017. 135Table 35. Summary of Focus Group and Key Informant Interview Input Related to Economic Security. 141Table 36. Poverty, Education, Limited English Proficiency, Linguistically Isolated and Unemployed in SanDiego, California and United States, 2013—2017 . 143Table 37. Summary of Focus Group and Key Informant Interview Input Related to Homelessness andHousing Instability. 148Table 38. 2019 Community Health Needs Assessment–Overview of Online Survey Participants . 176Table 39. 2019 HASD&IC CHNA Survey, Trends over Time Question . 1789 Page
I. ACKNOWLEDGEMENTSCOMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEEThis report is based on the collaboration of representatives from seven local San Diego hospitals calledthe Community Health Needs Assessment (CHNA) Committee. The CHNA Committee (listed below)actively participated in the HASD&IC 2019 Community Health Needs Assessment process which isdescribed in detail in this report.Anette Blatt (Chair)Scripps HealthAaron ByzakTri-City Medical CenterLisa LomasRady Children’s Hospital – San DiegoDavid MierUC San Diego HealthJoseph ParkerPalomar HealthJillian Warriner (Vice Chair)Sharp HealthCareLindsey WrightKaiser Foundation Hospital – San Diego and Zion10 P a g e
HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIESDimitrios AlexiouPresident and Chief Executive OfficerLindsey WadeVice President, Public PolicyIvonne VelazquezHealth Policy AssistantINSTITUTE FOR PUBLIC HEALTH, SAN DIEGO STATE UNIVERSITYTanya PennSenior Research Scientist/EpidemiologistMartha CroweResearch ScientistLawrence O. AyersResearch AssistantStephanie PhannResearch AssistantNhat Quang ThaiResearch Assistant11 P a g e
SPECIAL THANKSA heartfelt appreciation goes out to everyone involved in this collaborative process. The expertise andtime were essential for accomplishing a comprehensive, collaborative assessment of the health andsocial needs of San Diego County. The CHNA Committee wishes to thank those who made contributionsand were involved in the focus group participants, key informant interviews, and the San Diego CountyHealth and Human Services Agency for their collaboration in the community survey. It is important toour committee that our Assessment report is valuable to our partners.12 P a g e
INTRODUCTION AND PURPOSE OFTHE COMMUNITY HEALTH NEEDSASSESSMENT REPORT13 P a g e
II. INTRODUCTION AND PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENTREPORTIntroductionThe Scripps Health 2019 CHNA responds to federal tax law requirements set forth in Internal RevenueCode section 501(r) requiring private not-for-profit (tax-exempt) hospitals as described in Code section501 (c)(3) to conduct a community health needs assessment at least once every three years.Although only not-for-profit 501(c)(3) hospitals and health systems are subject to state and IRSregulatory requirements, the 2019 CHNA collaborative process also includes hospitals and healthsystems who are not subject to any CHNA requirements but are deeply engaged in the communitiesthey serve and committed to the goals of a collaborative CHNA. Scripps participates in the collaborativeCHNA process led by the Hospital Association of San Diego and Imperial Counties (HASD&IC).The HASD&IC Board of Directors oversees a standing CHNA Committee that is responsible for theimplementation and oversight of the collaborative 2019 CHNA. HASD&IC's board of directors representsall member sectors and provides policy direction to ensure the interests of member hospitals and healthsystems are preserved and promoted. The CHNA Committee is comprised of representatives from allseven participating hospitals and health care systems. The CHNA Committee includes representativesfrom the following: Kaiser Foundation Hospital – San Diego and ZionPalomar HealthRady Children's Hospital – San DiegoScripps Health (Chair)Sharp HealthCare (Vice Chair)Tri-City Medical CenterUC San Diego HealthScripps Health actively participates in the collaborative CHNA process led by the Hospital Association ofSan Diego & Imperial Counties (HASDIC) and develops a Scripps consolidated CHNA report in accordancewith federal regulatory requirements. Please see Appendix K for further details.CHNA Research PartnerFor the 2019 Community Health Needs Assessment process, HASD&IC contracted with the Institute forPublic Health (IPH) at San Diego
Scripps Memorial Hospital La Jolla 9888 Genesee Avenue . La Jolla, CA 92037 . 080000050 . Scripps Green Hospital . 10666 Torrey Pines Road . San Diego, CA 92037
