2011– 2013
Community Health Needs Assessment
Thank you for taking time to read Advocate South Suburban Hospital’s Community Health Needs Assessment. Meeting the health needs of the patients, families, and communities, we are privileged to serve is at the core of our mission. Before we can support our community, we must first determine its needs. Outreach begins with a careful, comprehensive Community Health Needs Assessment. Every three years, key data is collected to strategically steer our efforts to the people, communities, and health issues where they are most needed, and where we can make a measurable impact. Partnering with local, state, and national organizations and through engagement with community leaders and community assets, we can multiply our effectiveness to create strong, dynamic systems to support the health of our community. Advocate South Suburban Hospital has community health programs that have been developed to address the unique health needs identified for our community. These programs include asthma and diabetes self-management education, and support groups for health issues including Parkinson’s, diabetes, stroke and pulmonary. Other activities include community health screenings as well as community health education and prevention programs. Our goal is for you to have information readily available regarding the assessed health needs of our community so that you can understand and perhaps be a partner with us as we address community health needs. At the end of the report, please find a link to connect with us to express any feedback or ideas you may have to address these health issues in our community. Whether you seek care through our hospital, physician group or home care, or whether you are part of the broader community, we are committed to addressing your health needs. It is indeed a privilege to be entrusted with the health of our community.
Richard Heim President, Advocate South Suburban Hospital
Table of Contents I. Introduction/Mission 2 2 Mission 2 Values 2 Philosophy 3 MVP Integrated
II. Executive Summary 3 III. CHNA Process & Timeline 4 4 Community Health Councils Review Data & Set Priorities 4 Advocate South Suburban Hospital Community Health Council Members
IV. Community Definition 5 5 Community Definition/Service Area 6 Race and Ethnicity 7 Age and Gender 7 Poverty 8 Health Resources
VI. Data Sources 9 9 Information Gaps
VII. CHNA Findings 9 10 Asthma 11 Cardiovascular Disease 12 Diabetes 12 Cancer 13 Teen Pregnancy 13 Key Informant Interviews 13 South Suburban Hospital Patient Utilization Data
VIII. Health Need Priorities 13 13 Prioritization Process 14 Health Need Selected to Address 14 Health Needs Not Selected to Address
VIII. Overview of Planned Program Interventions 15 IX. Vehicle for Community Feedback 15
I. Introduction/Mission Advocate South Suburban Hospital (South Suburban Hospital) is one of eleven hospitals in the Advocate Health Care system. Advocate is the largest health system in Illinois and one of the largest healthcare providers in the Midwest. It operates more than 250 sites of care, including 11 acute care hospitals, the state’s largest integrated children’s network, five Level I trauma centers (the state’s highest designation for trauma care), two Level II trauma centers, one of the area’s largest home health care companies and one of the region’s largest medical groups. Advocate Health Care also trains more primary care physicians and residents at its four teaching hospitals than any other health system in the state. Advocate is a faith-based, not-for-profit system, deeply rooted in its health system affiliations with the Evangelical Lutheran Church in America and the United Church of Christ. In January 1995, these two faith-based, values-driven organizations, joined together to establish Advocate Health Care. A common mission, values and philosophy (MVP) was developed from the similar mission-oriented histories of both organizations.
Mission Advocate’s mission is to serve the health needs of individuals, families and communities through a wholistic philosophy rooted in the fundamental understanding of human beings as created in the image of God. Advocate’s mission permeates all areas of its healing ministry. Advocate Health Care holds its employees, management and Board of Directors accountable to living five core values that guide behavior consistent with its mission.
Values The five values of Advocate Health Care serve as an internal compass to guide relationships and actions: Equality, Compassion, Excellence, Partnership and Stewardship. • Equality – We affirm the worth and spiritual freedom of each person and treat all people with respect, integrity and dignity. • Compassion – We embrace the whole person and respond to emotional, ethical and spiritual concerns, as well as physical needs in our commitment to unselfishly care for others. • Excellence – We empower people to continually improve the outcomes of our service, to advance quality and to increase innovation and openness to new ideas. • Partnership – We collaborate as employees, physicians, volunteers and community leaders to utilize the talents and creativity of all persons. • Stewardship – We are responsible and accountable for all that we are, have and do.
Philosophy Advocate’s philosophy is to provide wholistic care. This philosophy means that Advocate understands people have physical, emotional and spiritual needs, and their relationship to God, themselves, their families and society are vital to health and healing. The philosophy of Advocate is grounded in the principles of human ecology, faith and community-based health care. Through its actions, Advocate affirms the following principles. • We believe each person is created in the image of God. • We respect, include and serve people without regard to race, religion, age, disability, gender, sexual orientation or socio-economic status. • We seek to assure the spiritual freedom of all persons. • We extend our concerns for the whole person to our patients, employees, physicians, volunteers, trustees and their families. • We address clinical, business, corporate and social-ethical issues from a faith perspective and assist individuals, families and professionals in the resolution of these issues. • We are guided by the principles of justice in addressing our social responsibility as a corporate citizen in this society.
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• We are responsible and accountable in the spirit of stewardship for all the resources under our management to assure the accomplishment of our Mission. • We believe in effective collaboration with those individuals and entities interested in addressing the healthcare needs of our region.
MVP Integrated Advocate’s MVP is integrated into every aspect of the organization, strengthening its cultural foundation. The MVP calls for Advocate to extend its services into the community to address access to care issues and to improve the health and well-being of the people in those communities. As an Advocate hospital, South Suburban Hospital embraces the system MVP as its own. South Suburban Hospital is a 289-bed, not-for-profit acute care facility that serves Chicago’s south suburbs. The hospital offers a full range of inpatient and outpatient services, providing nearly 30,000 emergency room visits and welcoming over 1,000 babies into the world over the course of a year. In addition to offering a wide array of hospital services including but not limited to cancer care, diabetes, pulmonary medicine, orthopedics, heart and vascular, pediatrics, sleep disorders, sexual assault nurse examiner and women’s health, South Suburban Hospital also offers free screenings and a variety of other outreach services throughout the community. The hospital has provided outstanding clinical outcomes and compassionate care to the community for more than 60 years.
II. Executive Summary South Suburban Hospital began a community health needs assessment (CHNA) process in 2011, led by the hospital’s Community Health Council. This report describes the assessment process which resulted in the identification of top health needs in South Suburban Hospital’s primary service area (PSA). The assessment process included staff education and study of public health data, demographic data and hospital patient utilization data. The top health needs were prioritized and an action plan was developed to address the selected priority need. During the assessment time frame, existing community outreach and community health initiatives continued. South Suburban Hospital’s PSA is a notably diverse area. According to the 2010 U.S. Census, the hospital’s PSA is 47 percent African American, 38 percent Caucasian and 12 percent Hispanic, with Asian/Pacific Islanders and Native Americans comprising 3 percent of the population. Residents within South Suburban Hospital’s PSA are among the poorest, as well as some of the most affluent, within Cook County and the State of Illinois. Significant disparity exists between the communities in the PSA in relationship to various social conditions and determinants of health, including level of educational attainment, income, race and gender. Additionally, the south district of Cook County, as defined by the Cook County Department of Health, and including South Suburban Hospital’s PSA, experiences some of the highest rates of poor health outcomes within Cook County, attributed to chronic diseases such as asthma, cardiovascular disease, cancer and diabetes. Despite some significant challenges, community members, healthcare providers and faith leaders interviewed as key community informants state that the area also has a strong presence of active community organizations willing to partner to improve social conditions and address health needs. Though it was challenging to prioritize the health needs in this diverse and disparate PSA, asthma (primarily childhood asthma) was chosen as a priority upon which to focus. South Suburban Hospital has a commitment to addressing childhood asthma, particularly based on primary and secondary data analysis which indicates the disparity related to asthma among young black children in the PSA. Nationally, hospitalization for asthma is considered a marker for access to primary care and significantly impacts school attendance and work attendance. Both prior to the formal initiation of the Community Health Needs Assessment process and as a response to findings, a multi-pronged asthma education effort is now in place to combat the magnitude of this health issue.
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III. CHNA Process & Timeline In 2011 South Suburban Hospital and nine other Advocate Health Care hospitals convened a hospital-specific, hospital-based Community Health Council to conduct a comprehensive community health needs assessment (CHNA). The following chart describes the vision and timeline for a three-year process. When complete, South Suburban Hospital will meet the CHNA requirements of the Patient Protection and Affordable Care Act (PPACA).
Long Term Goal – Vision Phase I (2011) Site teams assess data, prioritize needs and establish plans.
Phase II (2012) Strengthen assessment through community engagement.
Phase III (2013) Assessment process in place to address needs and direct programming support, and metrics introduced to measure impact of programming.
Community Health Councils Review Data & Set Priorities In support of this vision and in alignment with Advocate Health Care’s standardized approach, South Suburban Hospital convened a Community Health Council to conduct its comprehensive CHNA. This Council was chaired by the hospital’s Vice President of Mission and Spiritual Care, and was comprised of hospital representatives from business development, community relations, volunteer services, public affairs and marketing, oncology services and respiratory care. Additionally, community members participated on the Community Health Council, including representatives from Aunt Martha’s Community Health Center, a federally qualified health center (FQHC), and faith leaders who are also members of South Suburban Hospital’s Governing Council. The titles and affiliations of the Community Health Council’s members are provided below.
Advocate South Suburban Hospital Community Health Council Members • Director, Nursing, Aunt Martha’s Community Health Center, Hazel Crest Campus • Director, Community Relations, Aunt Martha’s Community Health Center • Associate Pastor, Covenant United Church of Christ- South Holland/Member, South Suburban Hospital Governing Council • Lay Faith Leader, Pilgrim Faith United Church of Christ-Oak Lawn/Member, South Suburban Hospital Governing Council • Intern, Governors State University • VP, Mission and Spiritual Care, South Suburban Hospital • VP, Business Development, South Suburban Hospital • Community Relations Coordinator, South Suburban Hospital 4
• Manager, Volunteer Services, South Suburban Hospital • Breast Health Specialist, South Suburban Hospital • Manager, Respiratory Care, South Suburban Hospital The hospital’s Community Health Council members attended two CHNA workshops hosted by the Advocate system, which were designed to launch the process by educating them on how to conduct an assessment and how to find reliable data sources. Using both primary and secondary community health data, the team identified the hospital service area’s key health needs and then employed a priority-setting process to determine key health needs on which to focus. This process included an examination of both the hospital’s and the community’s issues/ challenges and assets, and discussions with external key informants to determine the potential for partnerships with other organizations and for sharing resources to address community need. South Suburban Hospital’s CHNA results and selected priorities were shared with the hospital’s Governing Council during each of the first two years of the three-year process, with full endorsement of the hospital’s Community Health Plan by its Governing Council on December 5, 2013.
IV. Community Definition Community Definition/Service Area For the purposes of this assessment, the Community Health Council has defined “the community” as South Suburban Hospital’s primary service area (PSA), which includes twenty-two zip codes in south Cook County with parts of Park Forest and Frankfort in Will County. South Suburban Hospital’s PSA is primarily comprised of Cook County residents (with the exception of part of Park Forest and Frankfort), a population which declined by 3.39 percent between 2000 and 2010 (Census Viewer, 2011-2012). According to US Census data, the 2012 population is 499,720 residents. The actual zip codes and corresponding cities, towns or villages are described in Exhibit 1 and a corresponding map of the area is depicted in Exhibit 2. Exhibit 1 – South Suburban Hospital Primary Service Area by Zip Code Zip Code
Corresponding City, Town or Village
60409
Calumet City
60411
Chicago Heights and Ford Heights
60419
Dolton
60422
Flossmoor
60423
Frankfort
60425
Glenwood
60426
Harvey
60428
Markham
60429
Hazel Crest
60430
Homewood
60438
Lansing
60443
Matteson
60445
Midlothian
60452
Oak Forest
60461
Olympia Fields
60466
Park Forest
60471
Richton Park
60473
South Holland 5
Zip Code
Corresponding City, Town or Village
60476
Thornton
60477
Tinley Park
60478
Country Club Hills
60487
Tinley Park
Exhibit 2 – Map of South Suburban Hospital’s Community: Primary Service Area
Race and Ethnicity According to the 2010 U.S. Census, South Suburban Hospital’s primary service area is 47 percent African American (n=235,365), 38 percent Caucasian (n=190,282) and 12 percent Hispanic (n=57,986). Other ethnicities including American Indian, Asian and Native Hawaiian comprising 3.3 percent of the total population. The primary service area has a significantly higher African American population than the average for Cook County (47 percent compared to nearly 25 percent). A small growth in the Hispanic population occurred in the PSA from 2000-2010, compared to the Cook County level where the Hispanic population increased significantly from 2000 to 2010 by 16.1 percent, while the Caucasian and African American populations decreased by 4.2 percent and 8.4 percent, respectively. The following chart compares the top three racial/ethnic group percentages for South Suburban Hospital’s PSA, Cook County, the State of Illinois and the U.S. Exhibit 3 – Race and Ethnicity Comparing Specific Geographic Area Race or Ethnicity
Primary Service Area
Cook County
African American
47%
24.8%
14.5%
12.3%
Caucasian
38%
55.4%
71.5%
62.3%
Hispanic
12%
24%
15.8%
17.3%
Source: U.S. Census Bureau, 2010
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Illinois
U.S.
Age and Gender According to the U.S. Census Bureau (2010) residents’ ages within South Suburban Hospital’s PSA span the life cycle, with 26 percent of the population less than 18 years old, 34 percent 18-44 years old, 27 percent 45-64 years old and 13 percent 65 years old and older. Mirroring the national trend, older adults are among the fastest growing age groups. The areas with the largest percentage of older adults in the primary service area are Tinley Park, Chicago Heights, Midlothian and Lansing.
Poverty According to Community Profiles, South District, Cook County Department of Public Health 2006-2008, 8.5 percent of individuals in suburban Cook County have incomes that are below 100 percent of the poverty level with 23.1 percent living below 200 percent of the poverty level. http://www.cookcountypublichealth.org/files/pdf/data-and-reports/community-profiles-06-08/southdistrict-0608r.pdf (click here) There is significant disparity related to poverty levels among the communities within South Suburban Hospital’s PSA, ranging from 1.3 percent of the total population living below 100 percent of poverty level in Flossmoor to 31.9 percent in Harvey and 47.7 percent below 100 percent of the poverty level in Ford Heights. Nearly 62 percent of Ford Heights’ residents live below 200 percent of the poverty level compared to 56.4 percent in Harvey and only 7.7 percent in Flossmoor. Exhibit 4 shows the percent of people living below 100 and 200 percent of the poverty level by community for the South Suburban Hospital PSA. Exhibit 4 – South Suburban Hospital PSA Poverty Level Percentages by Community City, Town or Village
Percent Living Percent Living Below 100% FPL Below 200% FPL
Calumet City
16.8
37.2
Chicago Heights
23.6
48.8
Ford Heights
47.7
61.9
Dolton
16.1
35.4
Flossmoor
1.3
7.7
Not Available
Not Available
Glenwood
6.1
17.0
Harvey
31.9
56.4
Markham
22.1
45.6
East Hazel Crest
4.4
27.6
Hazel Crest
10.9
31.0
Homewood
2.9
11.6
Lansing
12.2
25.3
Matteson
6.7
18.5
Midlothian
11.0
29.0
Oak Forest
6.7
20.2
Olympia Fields
6.6
16.9
Park Forest
11.5
30.3
Richton Park
8.2
18.1
South Holland
8.4
24.8
Thornton
11.1
22.9
Tinley Park
5.5
13.9
Country Club Hills
8.4
26.8
Frankfort
Source: Community Profile, South District, Cook County Department of Public Health, 2006-2008 http://www.cookcountypublichealth.org/data-reports (click here) 7
Public health literature has identified a link between poverty and disease, as communities considered underprivileged exhibit higher mortality and morbidity rates than wealthier counterparts. For example, the burden of asthma is not borne equally throughout the U.S. Nearly 5,000 people die from asthma each year nationally and the risk of death among African Americans is three times greater than among Caucasians in America, which has been attributed to higher rates of poverty. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602932/ (click here) Additionally, as a social determinant of health, poverty has been linked with lower access to care, being uninsured and a decrease in likelihood to receive medical treatment until disease is exacerbated. Areas with increased poverty often lack policies, systems and environments that promote healthy living and make choosing healthy lifestyles difficult. While residents of some communities within South Suburban Hospital’s PSA are among the poorest in the nation, others are among some of the most affluent within Cook County, the State of Illinois and, in some instances, the U.S. For example, Harvey has an average household income of $43,356, compared to Flossmoor’s average household income of $114,131. Additionally, almost 40 percent of Harvey’s residents make less than $25,000 a year, compared to the 40 percent of Flossmoor’s residents that make $100,000 or more. When comparing educational attainment, 10 percent of Harvey’s residents have a Bachelor’s degree or higher, and Flossmoor’s percentage is slightly more than 50 percent. Approximately 41 percent of the primary service area population has a high school degree or below (including nearly 12 percent that do not have a high school degree). The average household income is $68,343, which is slightly below that of the U.S. and 34 percent of the population is uninsured/ underinsured. Additionally, the south district of Cook County, as defined by the Cook County Department of Public Health, and including South Suburban Hospital’s PSA, experiences some of the highest rates of poor health outcomes within Cook County, including chronic diseases such as asthma, cardiovascular disease and cancer. http://www.cookcountypublichealth.org/files/pdf/data-andreports/community-profiles-06-08/south-district-0608r.pdf (click here) For example, according to the Cook County Department of Public Health, during the combined years of 2005-2007, coronary heart disease mortality was highest among the African American population in the South District at over 250.0 per 100,000 residents, as opposed to the Illinois rate of the same group at slightly less than 150.0 per 100,000 residents.
Health Resources Similar to other providers in the southern suburbs of Chicago, South Suburban Hospital faces challenges in addressing the health needs of the community related to shifting demographics, a broad range of community needs, and limited organizational resources available to meet those needs. However, there is a strong sense of community—churches, social service and community-based organizations, as well as schools, are committed to actively meeting the needs of the community. According to community key informants, this community-wide commitment is viewed as a significant asset. Even though the PSA includes areas that are designated as Medically Underserved Populations (MUP), there are multiple choices for the consumers of healthcare services in the primary service area. Chicago Heights, Ford Heights, Harvey and Robbins are among the areas designated as MUP within Cook County. http://datawarehouse.hrsa.gov/HGDWReports/RT_App. aspx?rpt=MU (click here) Health resources in the area include hospitals, private physician clinics, and safety net providers including free community clinics, federally qualified health centers and a Cook County-based health center. See Exhibit 5 for a summary of health resources in South Suburban Hospital PSA.
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Exhibit 5 – Health Resources Located Within or Serving South Suburban Hospital PSA Name of the Facility
Type of Facility
Location (Service Area)
Ingalls Memorial Hospital
Hospital
Harvey
St. James Olympia Fields
Hospital
Olympia Fields
Silver Cross Hospital
Hospital
New Lenox
St. James Chicago Heights
Hospital
Chicago Heights
Metro South Medical Center
Hospital
Blue Island
Aunt Martha’s Community Health Center
FQHC
Sites in: Harvey, Hazel Crest, Chicago Heights
Access Community Health Network
FQHC
Chicago Heights
Family Christian Health Center
FQHC
Harvey
Oak Forest Health Center
Cook County Outpatient Healthcare Facility
Oak Forest
VI. Data Sources Over the course of the assessment, multiple sources of quantitative and qualitative data were consulted, including key informant interviews with FQHC leaders, school nurses, parish nurses and faith leaders within the PSA. Much of the external quantitative data was supplied by the Cook County Department of Public Health (CCDPH), Illinois Department of Public Health (IDPH) and University of Wisconsin-County Health Rankings. Primary data sources consulted included South Suburban Hospital inpatient and emergency department patient utilization data, key informant interviews with local leaders and the PRC Community Health Report commissioned by the Metropolitan Chicago Health Care Council. Primary data was reviewed using reports from the 2009 PRC Community Health Survey. The PRC Community Health Survey consisted of a telephonic survey of 2,200 households in DuPage, Cook (Chicago), and Lake Counties that solicited information on 131 items that were compared with state and national benchmarked primary and secondary data.
Information Gaps South Suburban Hospital is located in Cook County, the third largest county in the U.S. This is a vast area comprised of over 900 square miles with significantly diverse demographics depending on the city, town, village and neighborhood. Even within the hospital’s primary service area, there is significant demographic range. Granular data at the zip code, neighborhood, or block level was not readily available from many public health sources. Additionally, some data sets and reports spanned different years, which made it challenging to compare certain disease rates and other health indicators. Where granular level data was not available, South Cook County (per the PRC survey) or the South District of Cook County (per Cook County Department of Public Health) is referenced. In an effort to better understand the county level data at a local level, qualitative data was accessed from consulting local faith community leaders and Parish Nurses by the Advocate Health Care Office for Mission and Spiritual Care. Additional qualitative data was obtained by interviewing school nurses and staff at a community-based organizational partner, Aunt Martha’s FQHC.
VII. CHNA Findings This summary of CHNA findings is intended to provide context for planning and implementation of programming efforts, rather than providing comprehensive information on every relevant health indicator. This section provides an overview of significant health needs for the population within South Suburban Hospital’s PSA, as many health issues or diseases have higher incidence rates for specific groups in South Cook County, including asthma, cardiovascular disease and diabetes.
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Asthma Asthma is a significant issue for lower income, primarily black communities in Advocate South Suburban Hospital’s PSA. Note: rather than using the terminology “African American” or “Caucasian” in this section, “black” or “white” will be used in order to be consistent with the IDPH data charts. Children, in particular, bear the burden of disparities in asthma hospitalizations. According to data from the Illinois Department of Public Health, hospitalizations for asthma are higher for the South Suburbs than for Illinois in general and are over two times higher in the black community. According to the American Lung Association (ALA), an estimated 24.7 million people in the United States have asthma. This is a 19 percent increase from 1999 to 2002. According to the Centers for Disease Control (CDC) report, “Summary Health Statistics for U.S. Children,“ 2011, 7.1 million children are diagnosed with asthma, with the highest prevalence found between the ages of five and 17. The CDC reports that asthma accounts for 18 percent of all emergency room visits in the United States, with nearly 40 percent of hospital and emergency department visits occurring for children less than 17. Asthma is the number one cause of avoidable hospitalizations for children and the primary cause of school absenteeism. The CDC reports that, nationally, blacks are three times more likely to be hospitalized than whites. Direct and indirect costs of this chronic condition likely exceed $19 billion per year. Asthma mortality for blacks in Illinois is highest in the city of Chicago, and more than four times the national average. Black children in Chicago have a prevalence rate of 25 percent compared to the national average of approximately 10 percent and Puerto Rican children in Chicago have a prevalence rate of 34 percent compared to the national average of 13 percent. According to a study conducted by the Chicago Department of Public Health from 1999-2001, approximately 50 percent of all asthma hospitalizations are paid for by public funds. Most alarming, however, are the disparity rates for black children aged 6-17 years old. Black children in the South Suburbs have a rate of hospitalization for asthma that is ten times the rate for Illinois in general (57.3 versus 5.7). While there is no data for asthma hospitalizations for children aged 6-17 for the state as a whole, black children are hospitalized at almost twice the rate as white children in the South Suburbs, a rate of 57.3 compared to 29.3. Harvey, a predominantly black, lower income city, has a hospitalization rate of 62.1 for black children aged 6-17. This data clearly indicates a need for intervention around asthma management, particularly in the South Suburban black community. Exhibit 6 – Hospitalizations for asthma as principal diagnosis: Comparison Illinois/South Suburbs – All Races versus Black Populations Area
Year(s)
Race
Count
Rate
Illinois
2009-2010
ALL
39,994
5.7
South Suburban
2009-2010
ALL
2,634
7.7
Illinois
2009-2010
Black
17,095
12.70
South Suburban
2009-2010
Black
1,976
10.6
(Rate Formula: the number of hospitalizations with principal diagnosis of asthma * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010 Exhibit 7 – Hospitalizations for asthma as principal diagnosis Comparing Illinois/South Suburbs – All Ages versus 6-17 year olds Area
Year(s)
Race
Age Range
Count
Rate
Illinois
2009-2010
ALL
ALL
39,994
5.7
South Suburban
2009-2010
ALL
ALL
2,634
7.7
South Suburban
2009-2010
Black
6 to 17
276
57.3
(Rate Formula: the number of hospitalizations with principal diagnosis of asthma * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010
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Exhibit 8 – Hospitalizations for asthma as principal diagnosis – Comparing Illinois/South Suburbs – All, Black and White Races, All Ages versus 6-17 year olds Area
Year(s)
Race
Age Range
Count
Rate
Illinois
2009-2010
ALL
ALL
39,994
5.7
South Suburban
2009-2010
ALL
ALL
2,634
7.7
South Suburban
2009-2010
Black
6 to 17
276
57.3
South Suburban
2009-2010
White
6 to 17
22
29.3
(Rate Formula: the number of hospitalizations with principal diagnosis of asthma * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010 Exhibit 9 – Hospitalizations for asthma as principal diagnosis Comparing Illinois/Harvey All Races versus Black Populations, All Ages versus 6-17 year olds Area
Year(s)
Race
Age Range
Count
Rate
Illinois
2009-2010
ALL
ALL
39,994
5.7
Harvey
2009-2010
ALL
ALL
434
10.3
Harvey
2009-2010
Black
6 to 17
41
62.1
(Rate Formula: the number of hospitalizations with principal diagnosis of asthma * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010
Cardiovascular Disease Cardiovascular disease is the single leading cause of death in both Illinois and the U.S. In Illinois, nearly 25,000 deaths in adults aged 35+ were due to heart disease in 2009. According to the PRC Survey, 5.4 percent of the Cook County sample self-reported a prevalence of heart disease; in South Cook County, that percentage was 7.4 percent. Hypertension is one indicator of cardiovascular disease. IDPH data shows that the hospitalization rate in the south suburbs (2.2) is almost double that of the state (1.4). The state hospitalization rate for blacks is 3.1 compared to .9 for whites. In the south suburbs, rates mirror the state, with blacks being hospitalized at a rate of 3.1, whites at a rate of 1.1 and Hispanics at a rate of 1.6. Exhibit 10 – Hospitalizations for Hypertension Comparing Illinois/South Suburbs – All, Black, White and Hispanic Races Area
Year(s)
Race
Count
Rate
Illinois
2009-2010
ALL
10,069
1.4
South Suburban
2009-2010
ALL
757
2.2
Illinois
2009-2010
Black
4,122
3.10
Illinois
2009-2010
Hispanic
800
1.80
Illinois
2009-2010
White
4,505
0.90
South Suburban
2009-2010
Black
581
3.1
South Suburban
2009-2010
Hispanic
19
1.6
South Suburban
2009-2010
White
145
1.1
(Rate Formula: the number of hospitalizations with principal diagnosis of hypertension * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010
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Diabetes According to the Illinois Department of Public Health, nearly 26 million children and adults (8.3 percent) of the U.S. have diabetes, as compared to 8.2 percent in Illinois and 6.8 percent in Southern Cook County. Among those self reports in the PRC survey, in Cook County, 10.2 percent of the respondents reported having diabetes; in South Cook, the percentage was slightly higher at 13.4 percent. Across racial/ethnic lines, diabetes was reported at higher percentages in the South Cook area for Hispanics at 24.2 percent. The IDPH rate for hospitalizations for diabetes with complications also demonstrates disparities for blacks and Hispanics compared to whites in the south suburbs. In the south suburbs, the overall rate of hospitalization is 8.8 compared to the state rate of 6.6. However, the hospitalization rate in the south suburbs for blacks is 11.5 and for Hispanics is 15, while the rate for whites in the south suburbs is only 4.6. Exhibit 11 – Hospitalizations for chronic diabetes with complications as principal diagnosis Comparing Illinois/South Suburbs – All, Black, White and Hispanic Races Area
Year(s)
Race
Count
Rate
Illinois
2009-2010
ALL
45,793
6.6
South Suburban
2009-2010
ALL
3,028
8.8
Illinois
2009-2010
Black
16,039
11.9
Illinois
2009-2010
Hispanic
5,713
12.8
Illinois
2009-2010
White
21,794
4.6
South Suburban
2009-2010
Black
2,145
11.5
South Suburban
2009-2010
Hispanic
180
15
South Suburban
2009-2010
White
626
4.6
(Rate Formula: the number of hospitalizations with principal diagnosis of diabetes * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010
Cancer Cancer is the second most common cause of death in Illinois and the United States, and the leading cause of death for Illinois citizens aged 45-64. During 2009, the underlying cause of death for 24,182 Illinoisans was cancer. In the same year, new invasive cancer cases totaling 64,135 were diagnosed among Illinois residents. According to the Illinois Department of Public Health, the cancer hospitalization rate for the state is 13.4 for all populations. The South Cook County rate is 13.1. Based on IDPH hospitalization discharge data, cancer seems to be one health issue that is fairly equally distributed across races, with whites actually having a slightly higher rate of hospitalization. Exhibit 12 – Hospitalizations for Cancer – Comparing Illinois/South Suburbs – All, Black, White and Hispanic Races Area
Year(s)
Race
Count
Rate
Illinois
2009-2010
ALL
93,187
13.4
South Suburban
2009-2010
ALL
4,503
13.1
Illinois
2009-2010
Black
15,907
11.8
Illinois
2009-2010
Hispanic
6,076
13.6
Illinois
2009-2010
White
65,000
13.6
South Suburban
2009-2010
Black
2,211
11.9
South Suburban
2009-2010
Hispanic
139
11.6
South Suburban
2009-2010
White
1,975
14.6
(Rate Formula: the number of hospitalizations with principal diagnosis of cancer * 100 / IP Chronic Diseases – All) Source: IDPH Discharge Data, 2009-2010 12
Teen Pregnancy According to the Illinois Department of Public Health, the Cook County and IL percentages of teen pregnancy were 10.2 percent and 9.6 percent, respectively, in 2009. According to the Cook County Department of Public Health, the actual teen birth rate per 1,000 population (15-19 years old during the combined years of 2005-2007) was the following: 40 for the U.S. and about the same for Illinois; however, when comparing across racial/ethnic groups in Illinois, the rate for Hispanic teens was almost 85 and for black teens the rate was slightly below 80. In the South District, the disparity was greater as the Hispanic rate was almost 100 but the black rate was lower than the state level at approximately 70.
Key Informant Interviews Key informant interviews were conducted with local pastors from congregations including, but not limited to Covenant United Church of Christ, St. John Lutheran Church, Hillcrest Baptist Church, St. Emeric Catholic Church, United Christian Church, Jubilee Faith Community Church, Harvey Church of Christ and All Nations Community Church. Interviews were also conducted with leaders of Aunt Martha’s FQHC and selected local school nurses. The community key informants verified the top health needs as asthma, cardiovascular, cancer, diabetes and teen pregnancy. Many of the informants expressed concern related to the significant disparities related to childhood asthma in black populations as well as the need for access to care for uninsured and underinsured individuals and families.
South Suburban Hospital Patient Utilization Data Exhibit 13 shows South Suburban Hospital’s top inpatient admissions with data pulled by Diagnostic Related group (DRG) grouped by service line as well as the top emergency department visits pulled by Current Procedural Technology (CPT) codes also grouped by service lines for 2012. Exhibit 13 – South Suburban Hospital Patient Utilization Data 2012 2012 South Suburban Patient Utilization Data Top 10 Emergency Department Visits Grouped by Service Line
Top 10 Inpatient Admissions Grouped by Service Line
Orthopedics
Cardiac Medicine
General Medicine
Pulmonary
Gastroenterology
Gastroenterology
Cardiac Medicine
Obstetrics
Nephrology/Urology
Nephrology/Urology
Neurology
Neurology
General Surgery
Orthopedics
Pulmonary
General Surgery
Trauma
Infectious Diseases
Infectious Diseases
Endocrinology
Source: South Suburban Hospital (Note: All data and website links within this document were verified as of December 15, 2013.)
VIII. Health Need Priorities Prioritization Process Using both primary and secondary community health data, the Community Health Council, identified the most significant health needs in the hospital’s PSA. The most significant health needs identified included asthma, cardiovascular disease (heart disease and stroke), cancer, diabetes, and teen pregnancy. The Council then engaged in a consensus discussion to determine which priority area would be selected for new community health planning and implementation focus. In selecting the priority for new planning and implementation, the Council considered the following: 13
• Current resources available for design and implementation of new community health programs; • Most prevalent health needs identified based on public health data and South Suburban Hospital patient utilization data; • Health issues where significant disparity exists and • Availability of community partnerships/existing relationships providing the opportunity to work collaboratively to address health needs.
Health Need Selected to Address Asthma Asthma and other respiratory-related diseases within the hospital’s PSA were selected as the top health need to address given the magnitude of this health issue in the primary service area as it relates to severity and prevalence, particularly focused in lower income, minority communities affecting children. The disparities in hospitalization rates for African American children are staggering, making this an urgent issue to address. South Suburban Hospital also has the resources and capacity to potentially have an impact, in partnership with other organizations that are engaged in addressing this issue. The hospital also has a significant history of designing and implementing programs that have impacted asthma. Additional factors for selecting asthma/respiratory health issues a priority focus within the community include the volumes of both inpatient admissions and emergency department visits at South Suburban Hospital for pulmonary health issues. According to hospital patient utilization data, pulmonary admissions were the second most prevalent type of inpatient admission and the eighth most prevalent reason for emergency department visits. Nationally, asthma affects approximately 7.1 million children. Asthma is one of the leading causes of school absenteeism—accounting for more than 14 million missed school days annually (Cook County Department of Public Health, 2010). Children with asthma miss an average of twice as many school days as other children (Centers for Disease Control and Prevention). The burden of asthma in Illinois mirrors national trends. Illinois has one of the highest asthma mortality and morbidity rates in the nation with increasing prevalence, morbidity and mortality rates (Illinois Department of Public Health, 2006). The majority of the state’s asthma deaths occur in Cook County (Chicago and Suburban Cook County). In addition, asthma is the leading cause of missed school days, and as a consequence, missed work days for parents. South Suburban Hospital has historically developed community programs impacting asthma and is currently conducting outreach activities aimed at schools and churches to address asthma, including: continuing medical education for local school nurses, pediatric health fairs, school programs providing asthma screenings, educational materials and peak flow meters, and asthma resource packets including educational materials and a resource directory for local faith communities. These existing outreach activities helped to lay the foundation for the hospital’s expansion of interventions to address asthma in the community.
Health Needs Not Selected to Address Although cardiovascular disease, cancer, diabetes and teen pregnancy were not selected for special focus, South Suburban Hospital remains committed to addressing these health issues as it has done historically. Existing community programs and resources provided by South Suburban Hospital include a Cardiac Rehabilitation Program; various cardiovascular education and prevention programs, including provision of heart risk assessments; a Diabetes Wellness Program including self-management education; selected health screenings; cancer health prevention education and cancer support services. There are a number of local nonprofit organizations currently offering resources to address the health issues of teen pregnancy and sexually transmitted diseases in South Suburban Hospital’s primary service area. These community-based healthcare clinics and centers offer primary care services, including family medicine and OB/GYN physicians, as well as counseling
14
and education aimed at curbing rates of teen birth and STD infection rates within the targeted communities. To best serve those patients most in need of their services, these providers offer free and/or discounted access to uninsured and underinsured patients. The providers include Aunt Martha’s FQHCs in Hazel Crest, Chicago Heights and Harvey; Pregnancy Aid South Suburbs in Tinley Park, Lansing and South Holland; Access Community Health, Chicago Heights; Family Christian Health Center in Harvey, and Bethany Christian Services in Palos Heights.
VIII. Overview of Planned Program Interventions South Suburban Hospital is a vital part of Chicagoland’s southern suburban region, as it works to address the health needs and build upon the resources and assets of the community with a wholistic philosophy of care. The hospital has been and remains an active partner in the public health system. With respect to addressing asthma, one of the first steps was to develop a Community Health Plan for Asthma Initiative to address this health disparity through implementing strategies for improving asthma management in the community. The program primarily targets children with asthma, although the adult population will also be impacted. In 2012, an Asthma Initiative Task Force was formed including representatives of the hospital’s community outreach team, respiratory therapy, the emergency department, nursing, continuing medical education, and the Office of Mission and Spiritual Care. The task force began to articulate a set of strategies and tactics setting the following broad goals: 1. Encourage and enable long-term coordination among stakeholders in order to execute a comprehensive asthma program; 2. Develop a strategy for improving asthma management in the community; 3. Improve access to patient care; and 4. Improve self-management skills for those coping with asthma. Through its work, the Task Force learned that the National Asthma Education and Prevention Program recommend asthma education at all points of care so that individuals have multiple opportunities to learn about asthma and develop selfmanagement skills. In response, the hospital will be developing the following action plan highlights in 2014. • Development of Asthma Learning Center • Increase Emergency Department education via respiratory care practitioner • Development of a school-based asthma education program (especially in areas with disparity in asthma hospitalization rates) • Provision of community health education to teach asthma self-management skills Efforts will be benchmarked against three evaluations of similar initiatives that produced positive results. One initiative was a nurse-led discharge program with a 20-minute education session and a written asthma action plan—a strategy that significantly reduced acute-care utilization over 12 months. A second study of outpatient follow-up education showed similarly positive results. Finally, South Suburban Hospital will benchmark its work against an evidence-based asthma education program for schools.
IX. Vehicle for Community Feedback Thank you for reading this CHNA Report. If you would like to provide comments to us related to the contents of this report, please click on the link below. http://www.advocatehealth.com/chnareportfeedback If you experience any issues with the link to our feedback form or have any other questions, please click below to send an email to us at:
[email protected] A paper copy of this report may be requested by contacting the hospital’s Public Affairs and Marketing department. 15
17800 South Kedzie Avenue Hazel Crest, IL 60429 708.799.8000 advocatehealth.com/ssub
