2013

Community Health Needs Assessment Kaiser Foundation Hospital – VACAVILLE License #550001207

To provide feedback about this Community Health Needs Assessment, email [email protected].

KAISER PERMANENTE NORTHERN CALIFORNIA REGION COMMUNITY BENEFIT CHNA REPORT FOR KFH-VACAVILLE I. Executive Summary The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their taxexempt status under section 501(c) 3 of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a community health needs assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low-income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance and transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report was conducted in compliance with these new federal requirements. The KFH-Vacaville service area includes the Solano County communities of Dixon, Elmira, Fairfield, Rio Vista, Suisun City, Vacaville, Winters, and a small portion of Yolo County.. A collaborative was established in each county to support the CHNA process. The Solano CHNA workgroup included representatives from Kaiser Foundation Hospital (Vacaville), Solano County Public Health, Sutter Solano Medical Center (Vallejo), North Bay Medical Center (Fairfield), Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica in the 2013 CHNA process. The process included a comprehensive review of secondary data on health outcome drivers, conditions, and behaviors in addition to the collection and analysis of primary data through community conversations with members of vulnerable populations in the KFHVacaville service area. In preparation for the Vacaville Hospital Contributions Committee to better understand the community health needs, to discuss them, and to prioritize them, the twenty five health needs were grouped and categorized into broader needs areas, resulting in a total of ten community health needs. The Vacaville Hospital Contributions Committee reviewed the identified needs and selected the top four community health needs with particular relevance for vulnerable populations in the KFH-Vacaville hospital service area (listed in priority order). 1. Access to culturally appropriate, affordable health care services 2. Access to affordable healthy food 3. Lack of employment and vocational training

 

1

4. Lack of substance abuse treatment and rehabilitation II.

INTRODUCTION/BACKGROUND a. Purpose of the Community Health Needs Assessment (CHNA) Report This report was written in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52 regarding conducting the CHNA for the hospital facility. b. About Kaiser Permanente (KP)* Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: 

Prepaid health plans, which spread the cost to make it more affordable



A focus on preventing illness and disease as much as on caring for the sick



An organized coordinated system that puts as many services as possible under one roof—all connected by an electronic medical record

Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, stateof-the-art care delivery, and world-class chronic disease management. Kaiser

 

2

Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. c. About Kaiser Permanente Community Benefit* For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor’s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Community Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a preventionfocused, evidence-based approach. We go beyond traditional corporate philanthropy or grantmaking to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—Health Access, Healthy Communities, and Health Knowledge—to address critical health issues in our communities. For many years, we’ve worked side-by-side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we’ve conducted Community Health Needs Assessments to better understand each community’s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making longterm, sustainable change—and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. d. Kaiser Permanente’s approach to Community Health Needs Assessment About the new federal requirements* Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations— this includes minority groups, low-income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization’s annual Form 990.

 

3

SB 697 and California’s history with past assessments* For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente’s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources weren’t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each KP hospital collected primary data through key informant interviews, focus groups, and surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized community

 

4

health. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will develop an implementation strategy for each health need identified. These strategies will build on Kaiser Permanente’s assets and resources, as well as evidencebased strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. III. COMMUNITY SERVED  a. Kaiser Permanente’s definition of community served by hospital facility* Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations.   About Kaiser Foundation Hospital Vacaville    KEY LEADERSHIP AT KFH‐VACAVILLE  Max Villalobos 

Senior Vice President and Area Manager

Kim Trumbull  Kyle Wichelmann  Steven Stricker, MD  Sandra Rusch  Michelle Odell  Cynthia Verrett   

Chief Operating Officer Area Finance Director  Physician in Chief Medical Group Administrator Public Affairs Director CB/CH Manager

 

5

The KFH-Vacaville service area includes the Solano County communities of Dixon, Elmira, Fairfield, Rio Vista, Suisun City, Vacaville, Winters, and a small portion of Yolo County. The KFH-Vacaville hospital is centrally located along the Interstate 80 corridor in Solano County and intersects with Interstate 505. TABLE 1: DEMOGRAPHIC PROFILE OF THE KAISER FOUNDATION HOSPITAL VACAVILLE SERVICE  AREA  Total population: Population: no high school diploma Uninsured: Percentage living in poverty: Percentage unemployed: Percentage uninsured:

275,396 15.0% 10.74% 9.24% 9.86% 10.74%

Caucasian: African American Hispanic/Latinos Asian Pacific Islander Native American Other Races Multiple Races

45.7% 12.0% 25.8% 10.3% 0.7% 0.5% 0.7% 4.4%

 

 

6

The primary focus of our community benefit programs is on the needs of vulnerable populations. Through a collaborative process with other hospitals and safety net providers serving KFH-Vacaville hospital service area, we defined vulnerable populations as those with evidenced-based disparities in health outcomes, significant barriers to care and the economically disadvantaged. The KFH-Vacaville Communities of Concern include the cities of East Fairfield, Rio Vista, and parts of Vacaville. The populations at the highest risk (highest poverty rates, lowest levels of health insurance and lowest rates of high school degree completion) in these areas are African Americans and Latinos. IV. WHO WAS INVOLVED IN THE ASSESSMENT The Solano CHNA collaborative include representatives from Kaiser Foundation Hospital (Vacaville), Solano County Public Health Department, Sutter Solano Medical Center (Vallejo), North Bay Medical Center (Fairfield), Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica in the 2013 the Community Health Needs Assessment. The Solano County collaborative workgroup retained Valley Vision, Inc., to lead the assessment process. Valley Vision, Inc. (www.valleyvision.org) is a non-profit [501 (c) (3)] consulting firm serving a broad range of communities across Northern California. The organization’s mission is to improve quality of life through the delivery of high-quality research on important topics such as healthcare, economic development, and sustainable environmental practices. Valley Vision also designed and facilitated primary data collection as well as a prioritization session that engaged public and community health experts from across Solano County. Chris Aguirre, Senior Project Manager, Valley Vision, Inc. Mr. Aguirre joined Valley Vision in Jan 2006 and holds a master’s degree in Community Development. His fields of study were economic development, affordable housing, urban design, community participation, labor and nonprofit organizations. Mr. Aguirre also completed internships with the Senate Office of Research and the California Legislature’s Select Committee on Economic Development. Chris supports the many facets of the Youth Development Project, The Community Needs Assessment, and manages fundraising and stakeholder outreach projects. Nancy Shemick, is responsible for consolidating the county processes and writing the CHNA report. She collected data analysis of the CARES database, and facilitated the prioritization process. Ms. Shemick holds a Masters Degrees in Public Administration and has been working with community and public health organizations for 35 years. She completed the required California SB 697 Community Needs Assessments for other Northern California Kaiser Foundation hospitals in 2004, 2007, and 2010. Ms. Shemick has also worked as a consultant to the Solano. Coalition for Better Health and other community agencies in Solano County. She conducts data analysis, performs strategic planning for health care nonprofits, leadership development for nonprofit health care boards of directors and conducts group facilitation

 

7

V. PROCESS AND METHODS USED TO CONDUCT THE CHNA Solano County (secondary data and community input) The majority of the secondary data used in this CHNA included health outcomes, demographic data, behavioral data, and environmental data. A key focus was to show specific communities (defined geographically) experiencing disparities as they related to chronic disease and mental health. To this end, ZIP code boundaries were selected as the unit-of-analysis for most indicators. This level of analysis allowed for examination of health outcomes at the community level that are often hidden when data are aggregated at the county level. Some indicators (demographic, behavioral and environmental in nature) were included in the assessment at the census tract level, the census block, or point prevalence, which allowed for deeper community level examination. Once communities of concern were identified, a review of specific secondary data for Vacaville hospital service area was conducted for presentation to the Vacaville Community Benefits Advisory Committee. The Kaiser Permanente (KP) Community Health Needs Assessment (CHNA) Data Platform, powered by the Center for Applied Research and Environmental Systems (CARES), and the Institute for People, Places, and Possibility (iP3) were other sources of data used. Health Outcomes data from the platform were downloaded for KFH-Vacaville and compared to benchmarks defined either by Healthy People 2020, relevant County-level rates or State-level rates. After identifying those outcomes indicators for which the population in the KFH-Vacaville service area were seen to compare poorly to benchmarks, associated indicators of health (health behaviors, clinical care, physical environment and social and economic factors) were reviewed and analyzed to see where these indicators also showed poor performance relative to benchmarks. Each Community of Concern was determined by health outcomes, and population characteristics residing in these communities, as well as health behaviors and environmental conditions. Primary Data- The Community Voice Primary data collection included qualitative data gathered in four ways: 1. Meetings with the CHNA workgroup, i.e. Kaiser Permanente, NorthBay Healthcare, Sutter Health Sacramento Sierra Region, Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica 2. Key informant interviews with area health and community experts 3. Focus groups with area community members 4. Community health asset collection via phone interviews and website analyses CHNA Workgroup The Solano CHNA workgroup was an active contributor to the qualitative data collection. Using the previously described CBPR approach, regularly scheduled

 

8

meetings were held with the workgroup at each critical stage in the assessment process. This data (combined with demographical data) informed the location and selection of key informant interviews for the assessment. Key Informant Interviews Key informants are health and community experts familiar with populations and geographic areas within in the HSA. To gain a deeper understanding of the health issues pertaining to chronic disease and the populations living in these vulnerable communities input from 17 key informant interviews were conducted using a theoretically grounded interview guide. Each interview was recorded and content analysis was conducted to identify key themes and important points pertaining to each geographic area. Findings from these interviews were used to identify communities in which focus groups would most aptly be performed. A list of all key informants interviewed, including name, professional title, date of interview, and description of knowledge and experience is detailed below. Key Informants Name & Title

Affiliation or Organization Dixon Community Medical Centers

Area of Expertise

Date

Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs

6/21/12

Heli Karkkainen Regional Center Director Robin Cox Health Education Director Ivonne Vaughn Senior Program Manager Jacqueline Jones Site Manager

Planned Parenthood

Clinical, community health, low 6/21/12 income persons, medically underserved persons Public Health Expert 6/21/12

Viola Lujan Director of Business & Community Relations

La Clinica

Maria Reyes

La Clinica

Minerva Arellano Clinical Manager

 

Solano County Public Health Dept. City of Vacaville A.T.O.D. Program

Community and youth resources

7/9/12

La Clinica

Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs Clinical, community health,

8/16/12

8/16/12

8/16/12 9

Health Educator

Margaret Anderson Executive Director

Rio Vista CARE/FRC

Adriana Bejarano Executive Director

Rio Vista CARE/FRC

Gloria Diaz Senior MSW Ana Isabel Montaño MSW

City of Vacaville FIRST City of Vacaville FRC

Maria Moses Volunteer Support Coordinator

Children’s Network

Zoila Perez-Sanchez Family Resource Center Director Cookie Powell Executive Director

Fairfield-Suisun Unified School District and FRC Dixon Family Services

Josephine Wilson Family Resource Center Director Halsey Simmons Mental Health Director

Fighting Back Partnership/Vallejo FRC Solano County Mental Health Dept.

medically underserved persons, low income persons, populations with chronic disease needs Family and community resources, low income persons Family and community resources, low income persons Family and community resources Family and community resources, low income persons Family and community resources, low income persons Family and community resources, low income persons Family and community resources, low income persons Family and community resources, low income persons Mental health

8/16/12

8/16/12

8/16/12 8/16/12

8/16/12

8/16/12

8/16/12

8/16/12

9/4/12

Focus Group Selection Selection of locations for focus groups was determined by feedback from key informants, CHNA team input, and analysis of health outcome indicators (ED visits, hospitalization, and mortality rates) that pointed to disease severity. Key informants were asked to identify populations (in demographic subgroups or particular areas of the county) that were most at risk for chronic health disparities and mental health issues. In addition, analysis of health outcome indicators by ZIP code, race and ethnicity, age, and gender revealed communities with high rates that exceeded county benchmarks. This information was compiled to determine the location of focus groups within the Solano County HSA. Focus Groups Members of the community representing demographic subgroups (based on race and ethnicity, age, or gender) were recruited to participate in focus groups. A standard protocol was used for all focus groups to understand the lived experience of these community members as it relates to health disparities and chronic disease. In all, a total of five focus groups (see chart below) were conducted. Content analysis was performed on  

10

focus group interview notes and/or transcripts to identify key themes and salient health issues affecting the community residents. Focus Groups Location Dixon Migrant Center

Date 10/5/12

Age 30s-40s

Mission Solano

10/15/12

20s-50s

Vacaville FRC

10/18/12

20s and 50s

Bayanihan Center

10/19/12

40s-60s

Mt. Calvary Fairfield

10/30/12

30s-50s

Demographic Information Female; Latino; rural; Spanish speaking; medically underserved; low-income Latino; Black; Caucasian; Asian; Male; medically underserved; chronic disease needs group; low-income Caucasian; Latino; medically underserved; low-income Filipino; female; medically underserved; low-income Black; female; low-income, medically underserved

The Solano residents who participated in the focus groups represented the entire county, including communities outside the Vacaville hospital service area. As with the health indicator findings, we learned that the highest areas of community health need include parts of the Vacaville service area, as identified in the Communities of Concern. The issues and associated drivers identified by these focus groups were verified by Vacaville key informants as well as by the Vacaville Contributions Committee. Secondary Data Secondary data were collected in three main categories: demographic information, health outcome data, and behavioral and environmental data (see Appendix B for details). 

Demographic Variables Collected from the US Census Bureau (U.S. Census Bureau, 2013a; U.S. Census Bureau, 2013b)



ZIP Demographic Information (Dignity Health, 2011)



2011 OSHPD Hospitalization and Emergency Department Discharge Data by ZIP Code



CDPH Birth and Mortality Data by ZIP Code



Behavioral and Environmental Variable Sources

The biggest challenge to the clear analysis and interpretation of data was the difficulties in acquiring secondary data and assuring community representation via primary data collection. Emergency Department and hospitalization data used in the assessment are markets of prevalence, but do not fully represent the prevalence of disease in a given ZIP

 

11

code. Similarly, behavioral data sets at the sub-county level were difficult to obtain and were not available by race and ethnicity. Conclusion Public health researchers have helped expand our understanding of community health by demonstrating that health outcomes are the result of the interactions of multiple, interrelated variables such as socio-economic status, individual health behaviors, access to health related resources, cultural and societal norms, the built environment, and neighborhood characteristics such as crime rate. The results of this assessment help to shine a light on the relationships of some of these variables that were collected and analyzed to describe the communities of concern. Hospital community benefit managers and personnel can use this expanded understanding of community health, along with the results of these assessments to target specific interventions and improve health outcomes in some of the area’s more vulnerable communities. The cities identified with the most vulnerable populations and high-risk outcomes were East Fairfield, Rio Vista, and parts of Vacaville. By knowing where to focus community health improvement plans—identified communities of concern—and the specific conditions and health outcomes experienced by their residents, community benefit programs can develop plans to address the underlying contributors of negative health outcomes. Based on the experience of the expert stakeholders as well as the direct information we received from members of under-served or at-risk populations, we are confident that the community health needs we identified have a significant impact of vulnerable populations. VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY’S HEALTH NEEDS For the purposes of the CHNA, Kaiser Permanente defines a health need as:  a poor health outcome and its associated health driver(s) or  a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Kaiser Foundation Hospital Vacaville identified a list of ten community health needs. The criteria used to create the list of community health needs are: o The community health need arises from comprehensive review and interpretation of a robust set of data; o More than one indicator and/or data source (i.e., the health need is suggested by more than one source of secondary and/or primary data) confirms the community health need; o Indicator(s) related to the health need perform(s) poorly against a defined benchmark (e.g., county/state average or HP 2020); o Poor health outcomes along with their associated drivers (s)

 

12

Community Health Needs for the Kaiser Foundation Hospital Vacaville service area were defined and prioritized through the following sequential steps: 1. Analysis of secondary data on health outcomes, identifying all of the health outcomes for which the data showed poor performance relative to benchmark, as described in the Appendix: Community Health Profiles. 2. For each of the health outcomes showing poor performance, related health drivers, behaviors and conditions were also analyzed to determine which are of concern in the Vacaville hospital service area and thus are likely to be factors contributing to health status. 3. Conversations with Key Informants and with community focus groups to test the data findings, assess community knowledge about the issue and understand available community resources. 4. A synthesis of all of the data and community input to define a set of community health needs. 5. Discussion and prioritization of community health needs with the Vacaville Hospital Contributions Committee, familiar with issues in the service area (See list of criteria and prioritized community health needs below). Valley Vision identified twenty-five detailed community health needs for Solano County. Again, in each case, the issues identified for the County were identical for Vacaville. In preparation for the Vacaville Hospital Contributions Committee to better understand the community health needs, to discuss them, and to prioritize them, the twenty five health needs were grouped and categorized into broader needs areas, coming to a total of ten community health needs. The ten community health needs identified from the Solano process, listed in the table below, were presented to the Vacaville Hospital Contributions Committee.

Community Health Need 

 

Communities Most Affected 

Access to culturally appropriate, affordable  health care services  

Fairfield, Rio Vista, Vacaville 

Access to Affordable Healthy Food 

Fairfield, Rio Vista 

Lack of safe place to walk, bike, exercise or  play 

Fairfield, Rio Vista, Vacaville 

Transportation limitations 

Fairfield, Rio Vista, Vacaville 

13

Lack or limited access to dental care 

Fairfield, Rio Vista, Vacaville 

Limited places and social space for civic  engagement 

Fairfield, Rio Vista 

Lack of employment and vocational training 

Fairfield, Rio Vista, Vacaville 

Unstable housing and homelessness 

Fairfield, Rio Vista, Vacaville 

Lack of substance abuse treatment and  rehabilitation 

Fairfield, Rio Vista, Vacaville 

Exposure to unclean air, environmental  toxins and pesticides 

Fairfield, Vacaville 

Using these combined community health needs as a basis for Committee discussion, the members reviewed the drivers for each community health need, the benchmarks and the specific neighborhoods and zip codes within the Vacaville service area. Once the Committee discussed the indicators, community health needs and the drivers associated with each need, the Committee members agreed on the following criteria to be used for prioritizing those needs for the Vacaville hospital service area: • • • • • •

Severity of issue/impact of related poor health outcomes Size of the population affected Community prioritizes issue over others Effective and feasible interventions exist A successful solution/intervention has the potential to solve multiple problems Opportunity to intervene at the prevention level

Listed below are the top five community health needs as chosen by the Napa-Solano Area Contributions Committee Meeting attendees on December 18, 2013: 1. 2. 3. 4.

Access to culturally appropriate, affordable health care services Access to affordable health food Lack of employment and vocational training Lack of substance abuse treatment and rehabilitation

Community assets and resources available to respond to the identified health needs of the community SIGNIFICANT COMMUNITY ASSETS AND RESOURCES RELATED TO CHNs 

 

14

Community Health Needs  Access to culturally appropriate, affordable health care services

Existing Community Assets and Resources  Kaiser Permanente (Fairfield, Vacaville) North Bay Medical Center (Fairfield, Vacaville) Community Medical Center (Vacaville) Solano County Clinic (Fairfield)

Access to affordable health food

Fairfield Community Action Council (Fairfield) Mission Solano (Fairfield) Fairfield Senior Center (Fairfield) First 5 Solano (Fairfield) Food Bank of Contra Costa & Solano County (Fairfield, Rio Vista, Vacaville) WIC (Fairfield, Vacaville) Heather House (Fairfield) St. Mark’s Lutheran Church (Fairfield) Rio Vista Community Services (Rio Vista) Opportunity House (Vacaville) Vacaville Family Resource Center (Vacaville) Kaiser Permanente Vacaville Medical Offices (Vacaville) Crossroads Christian Church (Vacaville) St. Paul’s United Methodist Church (Vacaville) Solano County College (Suisun Valley, Vacaville) The Workforce Investment Board of Solano County (Fairfield-serves county) MedMark Treatment Center (Fairfield) Youth & Family Services (Fairfield) Drug Rehab (Fairfield) Healthy Partnerships (Fairfield, Rio Vista, Vacaville) Alcoholics Anonymous (Vacaville) Rio Vista Abuse Rehab Center (Rio Vista) Rio Vista Care (Rio Vista)

Lack of employment and vocational training Lack of substance abuse treatment and rehabilitation

 

 

15

Appendix A: Community Health Need Profiles  1. Access to culturally appropriate, affordable health care  Improved primary care access could have a positive effect on several of the poor health outcomes, particularly diabetes, asthma  hospitalizations, heart disease and stroke mortality, and preventable hospital admissions.   Rationale: Health care providers indicate that preventive care and specialty care access is limited for low‐income residents parts of Solano  County.   Vacaville Hospital Service Area  Indicators and Health Outcomes

Health Outcomes Benchmarks 

Diabetes  Adult Incidence = 9.65% 

State average = 7.57% 

 

Heart Disease  Adult Prevalence = 6.89  Asthma  Adult prevalence = 9.65%  Adult hospitalization =  6.15/10,000     

 

Related Factors Insurance rate  Access (including transportation access) to culturally  /linguistically appropriate prevention services   Access to culturally /linguistically appropriate primary  care and care management (including medications) 

State average = 5.87% 

Access to culturally/linguistically appropriate primary  care and care management (including medications)  Insurance rate  Access (including transportation access) to culturally  /linguistically appropriate prevention services 

State  Adult prevalence = 13.12%  Adult hospitalization = 8.9/10,000 

 Access (including transportation access) to culturally  /linguistically appropriate prevention services  Access to culturally/linguistically appropriate primary  care (including medications) 

 

16

2. Access to affordable healthy food is a significant need in order to address several of the poor health outcomes, including obesity and  overweight, diabetes, and cancers.     Rationale: Several of the poor health outcomes are related to poor eating habits. Many related economic and social factors show that healthy  food is less available to vulnerable populations  Vacaville Hospital Service Area  Indicators and Health Outcomes Health Outcomes Benchmarks  Related Factors  Weight (State)  Weight  Adult Obesity = 26.68%  Adult obesity = 26.70%  Adult Overweight = 36.13%  Adult overweight = 36.20%   Youth Obesity = 31.34%  Youth overweight = 14.3%  Inadequate fruit and vegetable  Youth overweight = 14.42% Youth obesity = 29.82%  consumption  Diabetes  Fruit and veg expenditures  Adult Incidence = 9.65%  State average = 7.57%  Grocery store access    WIC authorized food store access Cancers:  Cancers (State)  Populations living in food desert Cervical Cancer incidence =  Cervical Cancer incidence = 8.30/100,000  8.50/100,000  Colorectal Cancer incidence = 43.70/100,000  Colorectal Cancer incidence =    48.40/100,000   

 

17

3. Lack of employment and affordable training ‐ The low high school graduation rate is of grave concern, and there are limited training  programs, employment placement services and jobs available. Adults recognize the importance of good role modeling, in addition to parenting  skills and support were identified as a need by all of the community groups. The need relates to understanding how to raise children in a healthy  way, using effective discipline as well as good cooking and eating habits.  Parents also wanted skills and support in addressing mental health and  substance use/abuse issues with their children.   Rationale: Parents felt that improved skills and support is a critical need in families that lack resources, or where parents are struggling to  manage jobs, commutes and children    Vacaville Hospital Service Area  Indicators and Health Outcomes   Mental health ED visits =  172.8/10,000    Substance Abuse ED visits =  312.9/10,000  Homicide = 6.80/100,000  Diabetes  Adult Incidence = 9.65% 

Health Outcomes Benchmarks  County – 190.4/10,000  State – 130.9/10,000  County – 407.2/10,000  State – 232.0/10,000  State = 5.15/100,000  State average = 7.57% 

  Youth Obesity = 31.34%  Youth overweight = 14.42% 

Youth overweight = 14.3%  Youth obesity = 29.82% 

Related Factors  High school graduation rate   Employment rate   Youth tobacco expenditures  Youth drug and alcohol use        Poverty rate   High school graduation rate   Employment rate     

                  

 

18

4.  Lack of substance abuse and rehabilitation Area experts and community members reported the immense struggle the Vacaville has  residents had in maintaining positive mental health and accessing treatment for mental  illness. Affordable, local mental health services are  needed to support families and youth and to limit the negative impact from poor mental health status (including violence).      Rationale: Mental health status has an impact through intentional violence (suicide, homicide) as well as general quality of life and ability to be  productive.    Vacaville Hospital Service Area  Indicators and Health Outcomes   Mental health ED visits =  172.8/10,000    Homicide = 6.80/100,000   

Health Outcomes Benchmarks  County – 190.4/10,000  State – 130.9/10,000 

Related Factors  Access (including transportation access) to  culturally /linguistically appropriate  behavioral health services

State = 5.15/100,000 

               

 

 

19

      5. Lack of limited access to dental care Improved access to oral health services could have a positive effect on several of the poor health  outcomes, particularly with student school absenteeism. This indicator is relevant because it indicates lack of access to dental care and/or  social barriers to utilization of dental services.  Rationale: Focus groups discussed the need for preventive dental services, due to adults having to go to the emergency room with acute oral  health disease. Adults commented about the loss of work time to visit the emergency department.  

Vacaville Hospital Service Area  Indicators and Health Outcomes  Percent Adults with Poor Dental  Health: 11.91% Percent Adults Without Dental  Insurance: 27.21%  Hispanic Adults Without Dental  Insurance: 48.01% Percent Adults with No Dental  Exam: 28.31%    

 

Health Outcomes Benchmarks 

Related Factors 

Percent Adults with Poor Dental Health: 11.27%  Percent Adults Without Dental Insurance: 33.72%

Percent Adults with No Dental Exam: 30.51%

Dental Insurance   Access to culturally and  linguistically appropriate dental  care   

 

20

 

  6. Lack of places to walk, bike, exercise or play. These areas are needed to improve multiple health outcomes, including obesity, diabetes,  cardiovascular disease, and mental health. In addition, intentional injuries such as assault and homicide, are less likely   Rationale:  A lack of exercise and physical activity contributes to multiple poor health outcomes. Parents and youth throughout the entire  County, including Vacaville indicated that they are concerned about both safety and costs related to having their children in parks and youth  sports.    Vacaville Hospital Service Area  Indicators and Health Outcomes Youth Weight  Youth overweight = 14.42%  Diabetes  Diabetes discharges = 6.6/10,000 Heart disease mortality =86 /100,000  Stroke mortality = /100,000 Mental Health:  Poor mental health = 19.87/100,00  Suicide = /100,000 Homicide: 6.8/100,000         

 

Health Outcomes Benchmarks  Adult obesity = 23.25%  Youth overweight = 14.3%  Youth obesity = 29.82% 

Related Factors 

Age‐adjusted diabetes discharge rate = 10.4/10,000 Heart disease mortality = 100.8/100,000 Stroke mortality = 39.46/100,000

Physical inactivity  Park access  Walkability

Poor mental health =14.21/100,00  Suicide