2013
Community Health Needs Assessment Kaiser Foundation Hospital – SAN FRANCISCO License #220000188
To provide feedback about this Community Health Needs Assessment, email
[email protected].
I. EXECUTIVE SUMMARY Kaiser Foundation Hospital San Francisco submits this Community Health Needs Assessment (CHNA) in response to the federal requirements described in section 501(r)(3) of the Internal Revenue Code and related excise tax and reporting obligations, applicable to hospital organizations that are (or seek to be) recognized as described in section 501(c)(3) of the Code. Kaiser Foundation Hospital San Francisco has long valued a systematic approach for identifying community health needs in order to guide thoughtful and effective community benefit investment for years to come. Kaiser Foundation Hospital San Francisco has conducted community health needs assessments on a three‐year cycle under the requirements of California Senate Bill 697, enacted in 1994. This 2013 CHNA continues Kaiser Foundation Hospitals’ long‐standing commitment to the communities we serve by understanding their needs and assets in order to define where and how Kaiser Foundation Hospital San Francisco community investments can have the greatest impact. In coordination with academic partners, the San Francisco Department of Public Health, other nonprofit hospitals as well as the broader San Francisco community, Building a Healthier San Francisco built on years of successful collaboration to work on this community health needs assessment (CHNA). Serving California’s only consolidated city and county and a diverse population of 805,235 residents, the partners made every effort to create a community‐oriented process aligned with community values. With a long history of successful collaboration, the partners agreed to work together once again to tackle the requirement under the Affordable Care Act (ACA): to identify and prioritize community health needs. This effort is not unfamiliar to San Francisco’s nonprofit hospitals, as they have undergone a similar process every three years since California Senate Bill 697 was passed in 1994. For many years this collaborative (Building a Healthier San Francisco) has conducted collective community needs assessments. Helpful to this year’s process was the number of similar efforts being undertaken to assess community health needs to design improvement strategies such as accreditation for the San Francisco Public Health Department and the Health Care Services Master Plan. To leverage resources required for these endeavors Building a Healthier San Francisco made use of a community‐driven process that engaged more than 160 community residents and local public health system partners who identified the following key health priorities for action: Safe and Healthy Living Environments Healthy Eating and Physical Activity Access to Quality Health Care and Services
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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 the hospital collaborative conducted this CHNA, 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. Approach to Community Health Needs Assessment From July 2011 until February 2013 the partners engaged in a process to collaboratively assess the community’s health needs. The partners decided to 1) agree on data elements and indicators to be collected, 2) identify the parties responsible to collect those data, 3) identify the methods to solicit and incorporate community input, 4) share findings, 5) identify prioritization criteria to be used, 6) conduct the prioritization process, and 6) obtain community stakeholders’ input on strategies to address the health needs. i. 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. ii. SB 697 and California’s history with past assessments For many years, the partner hospitals have conducted needs assessments to guide 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
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a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. iii. CHNA framework and process The CHNA takes a comprehensive look at the health status of San Francisco and helps identify priority community health needs. It will serve many purposes including but not limited to planning community benefits strategies for nonprofit hospitals, planning health services in San Francisco, informing decision makers about San Franciscans’ health status, identifying key health priorities for the City/County and gaining a better understanding of health disparities and inequities. Between mid‐2011 and late 2012, similar assessments were taking place in San Francisco. Representatives of these projects agreed to collaborate to leverage their assessment work and to incorporate grassroots community participation. These intersecting initiatives, all of which share common aims, are described below: Health Care Services Master Plan (HCSMP): The HCSMP was created by local ordinance and requires SFDPH and the San Francisco Planning Department to create a plan that identifies the current and projected needs for health care services in San Francisco and makes recommendations on how to achieve and maintain an equitable and appropriate distribution of health care services in the city. Nonprofit Hospital Community Needs Assessment: Building a Healthier San Francisco is a citywide collaborative of nonprofit hospitals, SFDPH, local foundations, health plans and a variety of health organizations and philanthropic foundations that conducts a community health needs assessment for San Francisco every three years as required by state and now federal law. Public Health Department Accreditation: Public health department accreditation seeks to advance quality and performance within public health departments nationwide. Accreditation is conferred by the national Public Health Accreditation Board and documents the capacity of a public health department to perform the core functions of public health and the 10 Essential Public Health Services. Accreditation signifies that the health department has an appropriate mission and purpose and the ability to meet the needs of the community it serves. SFDPH is pursuing public health department accreditation for which a community health assessment is a prerequisite. The Public Health Department is also undergoing an integration of its Population Health and Prevention divisions as part of this process.
San Francisco Health Improvement Partnerships (SFHIP): A program of UCSF to improve the health of the community by integrating the interests, assets, and expertise of UCSF, community and civic stakeholders to address the most compelling public health issues in San Francisco.
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The process and timeframes for key components of this collaborative project include the following: From July 2011 to April 2012, the Health Care Services Master Plan Task Force met in a series of nine meetings, including neighborhood‐based community forums. Augmenting that work from February to April 2012 the data‐consulting firm, Harder + Company conducted focus groups to learn more about their perspective on community health needs. As part of the Public Health Department’s Population Health and Prevention Integration, focus groups were conducted from March to May 2012. The visioning process with grassroots community participants included attendees from 21 San Francisco neighborhoods. Culminating in July 2012 Harder + Company completed the Community Health Status Assessment that includes 150 indicators. In late May and early June 2012 the Leadership Council reviewed different criteria options, and chose the Hanlon method to prioritize the community health needs. The Leadership Council along with members of the Building a Healthier San Francisco coalition identified priority needs using these criteria in early August 2012. In late August 2012, about 60 community participants attended a meeting to understand the three priority areas, and were asked to generate strategies for each priority. In September and October 2012, small community groups were convened to further hone the strategies, described later in this report. Although the Affordable Care Act requirements stipulate that this report only identify the community health needs, it is important to note that this grassroots, transparent course of action respected the interests of the neighborhood participants who were interested in moving towards implementation as soon as feasible. In the last quarter of 2012, the partners developed goals and objectives for each priority as well as related measures and strategies to address the needs. III. COMMUNITY SERVED The hospital service area includes all populations residing in the City and County of San Francisco. Historically underserved and vulnerable populations residing in San Francisco continue to demonstrate poor health outcomes. The primary focus of Kaiser Foundation Hospital San Francisco’s community benefit programs is on the needs of vulnerable populations. We define vulnerable populations as those with evidence‐based disparities in health outcomes, significant barriers to care and the economically disadvantaged. In the map and description below, the indicators and associated factors identify the
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Bayview, Chinatown, Downtown/Civic Center, Visitacion Valley and Excelsior neighborhoods with those characteristics. Reviewing the demographic profile, these neighborhoods experience poverty, low educational achievement and are linguistically isolated. These factors, described in this report as “social determinants of health” are defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age, including the health system.”
Table 1: Demographic Profile Total population: Median age: Average household income: Percentage living in poverty: Children living in poverty Living under 200% poverty Percentage unemployed: Percentage uninsured:
805,235 38.2 $ 73,127 11.86% 15% 27.59% 9.5% 11.53%
White: Latino: African American: Asian and Pacific Islander: Native American: Other: Linguistically Isolated No high school diploma:
48.5% 15.1% 6.1% 33.7% 0.5% 3.72% 23.78% 14.29%
Sources: http://www.countyhealthrankings.org; http://www.CHNA.org/kp; http://www.sfdph.org/dph/files/reports/PolicyProcOfc/CHSA_10162012.pdf To demonstrate the disparities rooted in social determinants of health, the exhibit below reveals high school non‐graduation, unemployment, poverty and inadequate
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social support by race/ethnicity in San Francisco. These measures have critical and studied links to health status: Educational attainment has an important impact on health as years of formal education correlates strongly with improved work and economic opportunities, reduced psychosocial stress, and healthier lifestyles. Unemployment may lead to physical health responses ranging from self‐ reported physical illness to mortality, especially suicide. It has also been shown to lead to an increase in unhealthy behaviors related to alcohol and tobacco consumption, diet, exercise and other health‐related behaviors which in turn can lead to increased risk for disease or mortality. Because employee‐sponsored health insurance is the most common source of health insurance coverage, unemployment can also limit access to health care. Poverty can result in negative health consequences, such as increased risk of mortality, increased prevalence of medical conditions and disease incidence, depression, intimate partner violence and poor health behaviors. Poor family support, minimal contact with others, and limited involvement in community life are associated with increased morbidity and early mortality. Furthermore social support networks have been identified as powerful predictors of health behaviors, suggesting that individuals without a strong social network are less likely to participate in healthy lifestyle choices. The disproportionately high rates for Black/African American residents for every one of these socioeconomic factors underscores the significant health equity issues that exist for Black/African American San Franciscans. Table 2: Social and Economic Factors in San Francisco by Race/Ethnicity
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The exhibit below displays these same socioeconomic factors by San Francisco neighborhood. Only those neighborhoods consistently worse than the citywide average appear on the chart. Please note that it is primarily the same four to five neighborhoods that have the highest disparities among these social and economic determinants of health: Bayview, Chinatown, Downtown/Civic Center, Visitacion Valley and Excelsior. The Financial District also shows significant disparities, but these data are less reliable due to the relatively small population living in this area. Table 3: Social and Economic Factors in San Francisco by Neighborhood
IV. Who Was Involved In The Assessment a. Identity of hospitals and other partner organizations who collaborated on the assessment During 2012 a number of other community‐based needs assessments were underway at the same time as the CHNA. In order to reduce duplication of effort, leverage resources and to respect community members’ time commitment to the process, the CHNA was combined with the Health Care Services Master Plan process, the Department of Public Health’s process to achieve accreditation that requires the completion a Community Health Assessment (CHA) and a Community Health Improvement Plan (CHIP) and the work of the San Francisco Health Improvement Partnerships. This fortuitous combination of efforts brought together a number of additional partners beyond the members of Building a Healthier San Francisco who are tasked with producing the hospital community needs assessment every three years. Following is a list of Building a Healthier San Francisco members who are responsible for guiding this and every triennial nonprofit hospital community health needs assessment:
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Building a Healthier San Francisco Membership 1. Anthem Blue Cross 2. California Pacific Medical Center 3. Chinese Hospital 4. Hospital Council of Northern and Central California 5. Kaiser Foundation Hospital 6. McKesson Foundation 7. Mount Zion Health Fund 8. NICOS Chinese Health Coalition 9. Saint Francis Memorial Hospital 10. San Francisco Community Clinic Consortium 11. San Francisco Department of Human Services 12. San Francisco Department of Public Health 13. San Francisco Foundation 14. San Francisco Medical Society 15. San Francisco Unified School District 16. St. Mary's Medical Center 17. UCSF Medical Center 18. United Way of the Bay Area Below is description of collaborating organizations and individuals that enriched the input through a variety of perspectives and contributions to the combined efforts: Nearly 30 community stakeholders – including representatives from San Francisco’s nonprofit hospitals, academic institutions, health plans, the African American Health Disparities Project, San Francisco Human Services Agency and SFDPH. Close to 70 community residents and members of the local public health system – including representatives from K‐12 education, higher education, philanthropy, nonprofit agencies, minority health equity coalitions, government (including the San Francisco Mayor’s Office and Health Commission), hospitals and more. Hospital and academic partners, who continued to partner with SFDPH on San Francisco’s CHA/CHIP Leadership Council, which has guided the development and will guide the implementation of San Francisco’s CHIP. The CHA/CHIP Leadership Council was responsible for steering the multiple processes that intersected during this community health needs assessment process. A representative from each of the initiatives met on a regular basis to ensure that each project’s requirements were being met. The Leadership Council members are listed in the table below:
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CHA/CHIP Leadership Council Program/Project
Organization/ Department
Lead
Health Care Services Master Plan and DPH Public Health Accreditation
San Francisco Department of Public Health
Barbara Garcia, SFDPH, Director of Health
Community Transformation Grant
San Francisco Health and Prevention, Department of Public Health
Patricia Erwin SFDPH, Program Manager, Newcomers Health Program
Population Health Assessment
SF PHP Population Health & Prevention Department of Public Health
Tomas Aragon, MD, MPH Director, SFDPH Population Health & Prevention (PHP)
BHSF (Building a Healthier San Francisco)
Abbie Yant, Vice President Mission, Advocacy and Community Health Saint Francis Memorial Hospital Lara Sallee, Community Benefit Manager Kaiser Foundation Hospital ‐ San Francisco Medical Center
San Francisco Health Improvement Partnerships
University of California San Francisco
Kevin Grumbach, MD Department of Family and Community Medicine, UCSF Wylie Liu, Director of University Community Partnerships, UCSF
Health Development Measurement Tool
San Francisco Department of Public Health
Rajiv Bhatia, MD Director of Occupational and Environmental Health
Community Health Needs Assessment
b. Identity and qualifications of consultants used to conduct the assessment A number of consulting firms and consultants were involved throughout this process including 1) Heart Beets for community engagement; 2) Circle Point for ongoing communication with stakeholders; 3) Harder and Company for data collection and analysis; and 4) Nancy Shemick for meeting facilitation and report writing. HeartBeets Director Laura Critchfield brings more than 20 years’ experience in the health and education fields, with a focus on ensuring the voices of those most affected by policies and programs play a lead role in designing and implementing them. David Fernandez has extensive experience around diversity and systems integration. HeartBeets facilitators are trained in the Institute for Cultural Affairs’ techniques that ensure focus groups build trust among diverse participants, highlight common interests in an efficient way and lay the groundwork for tangible community‐centered action. SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
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As Project Manager at Circle Point, Ms. Daniels provides administrative support, communications outreach and facilitation of the partnership efforts. She coordinates CBP, BHSF and Champions meetings as well as helps execute the tasks including management of the Building a Healthier San Francisco website and Facebook page, coordination of public outreach events and correspondence, management of public health indicator data and maintenance of the stakeholder contact database. She was instrumental in recruiting and organizing community input. She holds a Masters of Science Degree in Community Development. Harder + Company is a consulting firm specializing in research, strategic planning, evaluation, and facilitation services with offices in Davis, San Francisco, San Diego and Los Angeles. Its mission is to provide health, social service and advocacy organizations with the information and tools they need to do their work effectively. Since 1986, they have worked with public and private human service agencies throughout California and the country to plan services and evaluate programs that improve the health and well being of diverse populations. In particular, they have developed short and long‐range strategic plans for philanthropy, government agencies, nonprofit organizations, and community groups, as well as for numerous advocacy organizations. Ms. Shemick holds a Masters Degree in Public Administration and has been working with community and public health organizations for over 35 years. She completed the required California SB 697 Community Needs Assessments for Kaiser Foundation Hospital in San Francisco in 2010. Ms. Shemick has also worked as a consultant to the San Francisco Department of Public Health as well as several community health centers in San Francisco. She uses her skills in strategic planning, Board development, project management and group facilitation. V. Process and Methods Used To Conduct the CHNA Both qualitative data as well as quantitative data were collected as part of this process. To honor community members’ substantive contributions of time and energy devoted to generating qualitative data for MAPP (Mobilizing for Action through Planning and Partnerships, whose components are described in the exhibit), San Francisco’s CHA/CHIP Leadership Council – consisting of representatives from the numerous assessment initiatives – took initial responsibility for synthesizing the data. A graphic description of data sources and their purposes for each assessment is noted in the exhibit below.
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Exhibit 1: San Francisco CHNA Data Sources
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a. Secondary Data Community Health Status Assessment An analysis of over 150 data indicators (see Appendix II for a listing of the indicators) was conducted by Harder + Company who was engaged specifically for the Community Health Needs Assessment process. To ensure that all the Kaiser Foundation Hospital required indicators in this assessment were included, a comparison of these 150 data indicators was made with those available on the CARES database. In a few cases, the CARES indicators yielded different or small variations from the Harder + Company results, but they were not significant. The Leadership Council (please see page 10 for a table of Leadership Council members) agreed to the final list of 150 indicators. The indicators and each data source is located in Appendix II. Harder + Company conducted a comprehensive review of secondary data sources to obtain the most current and reliable data for the CHSA. Secondary data sources and resources include but are not limited to the US Census 2000 and 2010, the American Community Survey 2009 and 2010, the California Department of Public Health (CDPH), the California Department of Finance (DOF), the California Office of Statewide Health Planning and Development (OSHPD), the California Department of Education (CDE), SFDPH, SFDPH Healthy Development Measurement Tool (HDMT), Health Matters in San Francisco, the California Health Interview Survey (CHIS), the Behavior Risk Factor Survey and Surveillance (BRFSS), Health Resources and Services Administration (HRSA), Healthy People 2020 (HP 2020), the 2012 County Health Rankings and Community Health Status Indicators. In all cases, Harder + Company used the most current data available to complete the current CHSA (i.e., data that were considered preliminary were not used). These data were exported in database formats, cleaned and basic statistical techniques were applied to analyze trends. Where applicable, benchmark or target data were included. All data were carefully reviewed and analyzed to ensure that they accurately address and respond to each of the indicators and category areas. Sample sizes for datasets were examined to ensure that they were large enough for analyses, particularly for sub‐ populations. If sample sizes were not large enough, results were either aggregated over several years, were not presented, or the indicator was presented as “statistically unstable.”
The data compiled from OSHPD to examine health care utilization throughout San Francisco describes individuals who access some kind of health service based on patient discharge data or patient registration data.
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Therefore, these data does not capture those who did not access health services or who access health services at a health agency whose data is not collected or reported to OSHPD. In addition, neither OSHPD nor any other source provides comprehensive data regarding the distribution of private sector health professionals and the patients they serve. This information gap reflects the fragmented nature of the health care system and illustrates the difficulty of health service planning for optimal community health. Also, although US census 2010 data were released between the end of 2011 and early 2012, all of the data required for this report were not yet available, such as the descriptive breakdown of poverty status in San Francisco. In those instances, data from the American Community Survey (ACS) 2009 and 2010, an ongoing sample survey calculated by the US Census Bureau, were used and cited as such. Additionally, certain demographic data is no longer available through the US Census but rather comes through the ACS. A limitation of the cross‐sectional data currently available is that it does not allow for examination of the cumulative or interactive effects of various factors that may impact health status. (e.g., being poor, female, Latino, and living in a certain neighborhood may have cumulative effects on the risk of disease and illness that are not reflected in individual indicators). In addition, while neighborhood boundaries do not necessarily reflect residents’ lived experiences or their personal definitions of neighborhood, geographic data are presented in the format in which they are available (i.e., planning neighborhood, zip code, County supervisorial district). b. Community Input As part of the collaborative community health needs assessment, numerous focus groups were convened, ranging from the goal to create a vision for a Healthy San Francisco to learning about health issues and needs that informed the health care services master plan. In addition to sessions to create a vision for a healthy San Francisco, six consumer focus groups were conducted for the health care services master plan. In these sessions, the participants were asked about the community’s health needs. The focus group sessions were organized in groupings that included persons with low‐incomes, those who are medically underserved, minority populations, and individuals with chronic conditions. The focus groups were titled 1) Older adults and the disabled, 2) Lesbian/gay/ bisexual/transgender, 3) Monolingual Spanish, 4) Excelsior District families, 5) the Richmond/Sunset neighborhood areas, 6) Youth. Recruitment for the focus groups was community based, and local health and social service providers also assisted with the recruitment. Recruitment techniques included posting flyers at community locations where potential participants may visit and placing calls to service providers with instructions for face‐to‐face recruitment. All potential
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participants were screened for eligibility based on the eligibility criteria for each focus group. Each group consisted of up to 12 participants. Elderly – Disabled group participants were either elderly (60 years or older) and/or living with a disability. They are also medically underserved and suffer from chronic conditions. Their ages ranged from 40 to 78. Of the eleven total participants, ten were male and one was female. Most participants reported residing in the San Francisco neighborhoods of South of Market or Tenderloin, and live on low incomes. The Lesbian, Gay, Bisexual, and Transgender focus group members—although intended to be diverse—all identified as being transgender. All five focus group participants identified themselves as female (male‐to female transgender). Three were African‐ Americans, one was Asian, and one was White. All reported living in the Market/Tenderloin/Civic Center area. They are medically underserved. Participants in the Richmond or Sunset districts focus group all lived in the Richmond or Sunset districts and identified as being Asian or Asian American. Five were female and one was male, and they ranged in age from 28 to 69 years. All are members of minority groups. Participants in the Excelsior district neighborhood focus group live in that neighborhood, with ages ranging from 37 to 61. Four of the nine participants self‐identified as female and members of Asian/Pacific Islander minority groups. The others did not self‐identify. In the monolingual Spanish focus group, there were twelve participants, nine of whom were female and three were male, ranging in age from 49 to 81 years. They are also medically underserved and live on low incomes.
The teen focus group included eleven teenage participants of the Mo’ MAGIC program, a San Francisco neighborhood‐based nonprofit organization whose mission is to transform the community and youth through collaboration. The teens represented a variety of San Francisco neighborhoods: seven participants were female and four were male. In addition to the input from the community residents described above, experts in health care, public health, issues that affect community health and health inequities gathered on August 28, 2012 to review the health needs and to share their perspectives. A list of these public health and related experts, their organizations and titles as well as the groups that they represent is located in a table as Appendix III. VI. Identification and Prioritization of Community Health Needs a. Identifying Community Health Needs
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In May 2012, a review of the outcomes of each assessment was conducted to determine the common community health needs. Not surprisingly, each assessment’s outcomes generated common community health needs, as described by poor health outcomes and their associated drivers. The process first grouped results of the Mobilizing for Action through Planning and Partnerships (MAPP, whose sources are described in Exhibit 1 on page 12) and Community Vital Signs (also described in Exhibit 1, page 12) health indicators into common health needs, using a grid to group like data points. The community health needs were then placed in a grid format to facilitate presenting them in easy‐to‐understand high‐level data concepts by data source and overarching theme. Then members of the CHA/CHIP Leadership Council reviewed the grouped poor health outcomes and their associated drivers, to ensure all data were considered and grouped correctly. Staff made revisions based on input from the Leadership Council. b. Prioritized Description of all community health needs identified through the CHNA The staff then presented the process and findings to experts and others from of the broader San Francisco health system, including members of the Building a Healthier San Francisco coalition and the CHA/CHIP Leadership Council. Following an in‐depth discussion of the data, they then reviewed the data synthesis grid with common health needs. They were given the opportunity to comment and suggest revisions. Participants felt that the community health needs were accurate—based on the numerous data sources used for the assessments, the process to find commonalities, as well as their professional experience. The seven community health needs are: 1. Safe and healthy living environments 2. Behavioral health 3. Access to quality health care and services 4. Physical activity and healthy eating 5. Spread of infectious disease 6. Early childhood development 7. Seniors/persons with disabilities’ access to care and services SAFE AND HEALTHY LIVING ENVIRONMENTS NEED
a. Safety and crime prevention
INDICATOR (Source)
Annual SFGH violent injury incident rate per 100,000 population (SFGH Trauma Registry)
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SF BASELINE EQUITY
Black/African American: 453.8 Latino: 121.1 Best-performing: Asian: 18.9
CITYWIDE
75.1 (606/year = actual number)
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NEED
INDICATOR (Source)
Perceived safety at night among adult residents (SF City Survey)
Five-year average annual rate of severe and fatal pedestrian injuries per 100,000 population (SCI) b. Exposure to environmental hazards
Proportion of population living in area with 10 ug/m3 or higher 2.5 concentration (SFDPH and Bay Area Air Quality Management District via SCI)
Percent of population living within an area with average daytime and nighttime noise levels greater than 60 decibels (SFDPH via SCI)
SF BASELINE EQUITY
94107: 33.9% 94112: 32.8% 94102: 31.4% 94134: 22.9% 94124: 13.1 % Best-performing: 94114: 75%
CITYWIDE
51.1%
Age 65+: 16.75 Best-performing: Age < 18: 8.4 Mission Bay: 15.80% Financial District: 7.10% SOMA: 6.10% Bayview: 4.40% Excelsior: 4.00% Best-performing: Several neighborhoods are at 0%
Downtown/Civic Center: 99% Western Addition: 98% Financial District: 97% Haight Ashbury: 96% SOMA: 95%
11.60
1.20%
70%
Best-performing: Seacliff: 1% Annual number of housing violations per 1,000 residents (SFDPH and Department of Building Inspection via SCI)
Downtown/Civic Center: 24.5 Nob Hill: 13.2 SOMA: 11.5 Mission: 10.3 Russian Hill: 9.8
5.4
Best-performing: Pacific Heights: 1.2 Percent of adults who smoke (CHIS)
c. Safe, green, “active” public spaces
Black/African American: 28.5%* Adults 18-24: 26.7%* Best-performing: Asian: 6%* Seniors: 2.3%*
11.5%
Complete subpopulation disparity data unavailable.
72.4%*
Percent of teens feeling that their local park/playground is safe during the day (CHIS)
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NEED
INDICATOR (Source)
Percent of land that is open space (SF Planning Department via SCI)
SF BASELINE EQUITY
Treasure Island + Yerba Buena Island: 0.0% Crocker Amazon: 0.6% SOMA + Nob Hill: 1.3% Mission + Presidio Heights: 2.0% Outer Richmond: 2.9% Best-performing: Seacliff: 70.4%
CITYWIDE
22.8%
BEHAVIORAL HEALTH NEED
Mental health, smoking, alcohol abuse
INDICATOR (Source)
SF BASELINE CITYWIDE
Age-adjusted death rate due to suicide
Current: 10.7/100,000 Target: 5.0/100,000 Current: 12.5% Target: 12% Current: 51.6/100,000 Target: 48.7/100,000 Current: 14.8/100,000 Target: 5.5/100,000
Adults who smoke Lung & Bronchus Cancer Incidence Rate Liver & bile duct cancer incidence rate
ACCESS TO HEALTH CARE SERVICES NEED
INDICATOR (Source)
Preventable emergency room visits: Health insurance or enrolled in a comprehensive access program
Hospitalization rate due to congestive heart failure Hospitalization rate due to uncontrolled diabetes Hospitalization rate due to immunization-preventable pneumonia or flu
SPREAD OF INFECTIOUS DISEASE NEED
Access to care for Hep B patients Access to caremedical home
SF BASELINE CITYWIDE
Current: 237.8/10,000 Target: 234.6/10,000 Current: 30.9/10,000 Target: 18.3/10,000 Current: 0.40/10,000 Target: 0.40/10,000 Current: 7.1/10,000 Target: 2.6/10,000
INDICATOR (Source)
SF BASELINE CITYWIDE
Number of clinicians on the SF Hep B Free Clinician’s Honor Roll (DPH) Liver and bile duct cancer incidence rate Infants fully immunized at 24 months
Current: 702 clinicians Target: 1,350 clinicians
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Current: 14.8/100,000 Target: 5.5/100,000 Current: 79% Target: 90 %
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HIV/AIDS death rate among Black/African American men nearly three times that of the city overall.
HIV incidence estimate
Current: 621 new infections Target: 467 new infections Current: 530.4/100,000 Target: 314.6/100,000 Current: 258.6/100,000 Target: 47.5/100,000 Current: 44.0/100,000 Target: 2.1/100,000
Chlamydia incidence rate Access to prevention and treatment
Gonorrhea incidence rate Primary and secondary syphilis rate
EARLY CHILDHOOD DEVELOPMENT NEED
INDICATOR (Source)
SF BASELINE CITYWIDE
Access to prenatal care Access to care and education
Mothers who received early prenatal care Hospitalization rate due to pediatric asthma
Current: 87.3% Target: 90% Current: 11.9/10,000 Target: 3.3/10,000
HEALTHY EATING + PHYSICAL ACTIVITY NEED
a. Physical activity
b. Healthy eating
INDICATOR (Source)
Percentage of physically fit children within the San Francisco Unified School District who score 6 of 6 on the California Fitness-gram test (CDE and SFUSD)
Minutes per day residents spend walking and/or biking for nonleisure, utilitarian trips (SFCTA via SCI) Food Market Access Score (SCI)
SF BASELINE EQUITY
5th Grade (African American): 11.5% 7th Grade (African American): 12.9% 9th Grade (Native Hawaiian/Pacific Islander): 5.1% Best-performing: 5th Grade (White): 27.3% 7th Grade (Asian): 41.5% 9th Grade (Asian): 44.2% Outer Mission, Bayshore, Hill Districts, and Sunset: < 20 min. Best-performing: SOMA: 43.3 min. Treasure Island: 0 Visitacion Valley: 25 Lakeshore: 29 Bayview: 33 Ocean View: 45
CITYWIDE
5th grade: 20.3% 7th grade: 30.4% 9th grade: 34.8%
27.6 min.
56
Best-performing: Downtown/Civic Center: 93
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NEED
SF BASELINE EQUITY
INDICATOR (Source)
Percent of children and teens (ages 2-17) who consume five or more servings of fruits and vegetables daily (CHIS)
c. Number of residents who maintain a healthy weight
Percent of children and adolescents who consumed two or more glasses of soda or sugary drink yesterday (CHIS) Percent of youth (San Francisco students in Grades 5, 7, and 9) who score within the “High Risk” category (obese) for body composition on the Fitnessgram physical fitness test (CDE via Kaiser Permanente) Percent of adults that report a BMI ≥ 30 (CHIS)
Black/African American: Not Available1 White: 17.6%* Asian: 17.2%* Best-performing: Latino: 26.7%* Asian: 24.2%* Latino: 33.9%* Best-performing: White: 4.4%* American Indian/Alaska Native: 42.6% Latino: 37.7% Black/African American: 32.8%
CITYWIDE
18.3%*
17.2%
24.2
Best-performing: Asian: 15.3% Latino: 56.9% Black/African American: 33.4%*
17.2%
Best-performing: Asian: 7.1%*
ACCESS TO HIGH QUALITY HEALTH CARE AND SERVICES NEED
a. Integration + coordination of services across the continuum of care b. Connection of individuals to the health services they need
c. Services are culturally + linguistically appropriate
SF BASELINE EQUITY
INDICATOR (Source)
Percent of currently insured (CHIS) + percent enrolled in Healthy San Francisco (HSF) Percent of persons who delayed or did not obtain medical care (CHIS) Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees (CHR) Percent of adults who speak a language other than English at home who have difficulty understanding their doctor (CHIS)
Subpopulation data unavailable White: 23.5% Black/African American: 19.7%* Best-performing: Asian: 2.5%*
CITYWIDE
94%
15.1%
Subpopulation data unavailable
49
Spanish: 29.9%* English & Spanish: 9.9%* Chinese: 5%*
2.7%
Best-performing: English: 0.6%
1
Please note that Black/African Americans and other racial/ethnic groups may be underrepresented among children and teens who consume 5+ servings of fruits and vegetables daily; CHIS does not provide estimates for samples smaller than 500 people.
SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
PAGE 20
NEED
INDICATOR (Source)
d. Access to a health care home
Percent of persons who have a usual place to go when sick or need health advice (CHIS)
SF BASELINE EQUITY
Asian: 85.4% Latino: 86.8%* White: 88.1%* Best-performing: Black/African American: 97.8%*
CITYWIDE
86.8%
c. Process and criteria used for prioritization of the health needs To help frame its thinking about the definition of health and health needs this process built on the work by the Bay Area Regional Health Inequities Initiative (BARHII). Members of this forward‐thinking group created a Conceptual Framework for Understanding and Measuring Health Inequities that helped the partners frame their work beyond the concept of medical care. A clear implication of this framework is that vulnerable populations and communities often experience health disparities; that is, they have poorer health outcomes than other segments of the population. Health disparities that are avoidable, associated with social disadvantages that create barriers to opportunity and are considered ethically unfair are called health inequities. This framework encouraged the decision to define “health need” as “A poor health outcome and its associated health driver(s).” The framework also supported what type of data were collected as well as the populations involved in the community input, along with the public health experts who contributed to identifying the health needs and the prioritization process. To prepare for the prioritization session, the Leadership Council agreed that this important process is best accomplished through agreeing on a set of the criteria that consider not only the importance of the health issue (quantitative and qualitative aspects) but also the effectiveness and feasibility of potential interventions. The Leadership Council reviewed approaches used by other organizations and health departments, and took into account criteria that emphasize equity and community sentiment—two values brought forth by the community. The Leadership Council came to consensus and agreed to use a modified “Hanlon Method.” On August 3, 2012 members of the Leadership Council and Building a Healthier San Francisco met and used these priority‐selection criteria: 1. Magnitude/Size of the Public Health Issue 2. Other Factors Related to Importance of the Public Health Issue 3. Effectiveness of Interventions 4. Feasibility and Sustainability of Intervention Implementation 5. Equity (some groups are more affected by the issue/a health inequity exists for the issue)
SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
PAGE 21
Please note that San Francisco elected to highlight equity as a priority‐selection criterion to uphold the collaborative’s fundamental value of reducing disparities in health access and outcomes for San Francisco’s diverse communities. (Please see Appendix I for a more detailed explanation of San Francisco’s priority‐selection criteria.)
Once agreement was reached about the seven community health needs, the participants individually ranked the seven needs against health priority‐selection criteria with “1” indicating highest rank and “7” indicating lowest rank. Facilitators totaled individual scores for each data theme and criterion to identify San Francisco’s top three health priorities for action. These priorities, as well as some assets available to address them (see Appendix IV for a full list of assets), include: Priority 1: Ensure Safe and Healthy Living Environment Some community assets and resources available to respond to this need: Strong interagency and community collaboration (e.g., SFHIP, CBP, Community Transformation Grant Team, Healthy Homes Project) Sustainable Communities Index, which facilitates health impact assessment in land use planning Strong existing programs that address these issues such as SF Tobacco Free Project and Bayview Safe Haven after school program (Effective Practice) Strong network of existing and well‐maintained parks Priority 2: Increase Healthy Eating and Physical Activity Some community assets and resources available to respond to this need: Strong interagency and community collaboration to improve nutrition (e.g., SFHIP, Southeast Food Access Network, SF Food Security Task Force) Strong interagency and community collaboration to improve opportunities for physical activity (e.g., Sunday Streets, Walk First, Bayview HEAL Zone, Safe Routes to School, SFHIP) Current Assessment Efforts: Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3) Priority 3: Increase Access to Quality Health Care and Services Some community assets and resources available to respond to this need: Health Reform as driver toward primary care home as well as integration and Coordination Healthy San Francisco + SFPATH (provides affordable medical care to people living in San Francisco) SF system of care (SFDPH, nonprofit hospitals, community clinics, private providers) Session participants reviewed the identified priorities and agreed that all selected priority issues were reasonable and appropriate for San Francisco. On August 23, 2012
SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
PAGE 22
the priority areas were presented at a meeting of over 60 community members, nonprofit organization leaders and public health experts interested in improving the health status of all San Franciscans. The participants were asked to contribute their ideas on the best strategies to address each of the three areas. The partners will unveil their work to community, business and other partners in the second quarter of 2013. A goal is to identify collaborative strategies to increase the likelihood of having a greater impact on the health needs. In conjunction with this report, each hospital will develop an implementation strategy for each health need identified. These strategies will build on assets and resources, as well as evidence‐based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. Appendices: Appendix I: Criteria for Prioritizing Community Health Needs Appendix II: Data Indicators and Sources Appendix III: Public Health Experts Involved in Community Health Needs Identification Appendix IV: Community Assets for CHNA Priorities
SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
PAGE 23
Appendix I: San Francisco Criteria for Prioritizing Key Health Issues + Related Considerations Criteria A: Magnitude/Size of the Public Health Issue
Percent of population at risk
Mortality rate, premature death rate, prevalence, incidence, or other measure of issue’s impact on population
Degree of disparity between various groups (e.g., county versus other county, state, or federal comparisons; intra‐county comparisons between groups)
Criteria B: Other Factors Related to Importance of the Public Health Issue
Importance to the community; degree of public concern on the issue
Level of support from community members and other stakeholders
Alignment with national, state, and/or local health objectives
Work on the issue is “mandated” by statute or other authority
The local public health system has a clearly established role to address the issue
Legal or ethical concerns related to the issue
Linkage to an environmental concern, including safety
Criteria C: Effectiveness of Interventions
Interventions have been successfully applied to the issue
Level of evidence supporting the interventions
Other rationale for use of interventions
Preventability of the issue or condition
Extent to which interventions will address root causes
Criteria D: Feasibility and Sustainability of Intervention Implementation
Within the power of the local public health system to control
Cost‐effectiveness of the interventions
Interventions are culturally appropriate and acceptable to community members
Size of the gap between community resources currently addressing the issue and need
Needed resources are available
Timeliness of implementation and expected benefits
Ease of implementation
Ease and likelihood of sustainability/maintenance of effort
Legal or ethical concerns that may arise as a result of the intervention
Criteria E: Equity
Some groups are more affected by the issue/a health inequity exists for the issue (e.g., by race/ethnicity, gender, age, other social determinant of health)
Definitions
Health Disparity: Difference in the distribution of disease and illness across populations.
Health Equity: Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
Health Inequity: Systemic, unfair, avoidable, and unjust differences in health status and mortality rates
Intervention: Action intended to improve a specific public health issue
Social Determinant of Health: Economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole
Appendix II: CHNA Data Indicators and Sources
#
Needs Assessment Indicator
Origin
Variable(s)
Data Source(s)
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
Notes / Questions
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
National Prevention Strategy
Demographic Characteristics, Category 1 1
net change in population/population density
NACCHO
2 3 4 5
age sex race ethnicity
NACCHO NACCHO NACCHO NACCHO
6 7 8 9 10
Socioeconomic Characteristics, Category 2 employment % below poverty level - sex % below poverty level - age % below poverty level - race/ethnicity % below poverty level - children
NACCHO SF DPH SF DPH SF DPH NACCHO
11 % below poverty level - families
Census/ACS, CHSI Report
N
Census/ACS, HDMT Census/ACS, HDMT Census/ACS, HDMT Census/ACS, HDMT
N N N N
percent unemployed, percent unemployed by race count and percent below poverty by sex count and percent below poverty by age count and percent below poverty by race/ethnicity count and percent below poverty by children count and percent below poverty by families, fmailies with realted children under 18, maried couples, maried couples with children under 18, female householder, no husband, female householder, no husband with children under 18 household income, total number of households median household income, median household income by neighborhood graduation rate for cohort who entered 9th grade 3 yrs prior by race/ethnicity, by socioeconomically disadvantaged, by ELL, by special educatio, by migrant education immigration status, immigration status by age groups number of homeless people by SF District language(s) spoken at home by population 5 and over, language spoken by Kindergarten ELL educational attainment for population over 25, by selected neighborhoods household composition - married couples, female no husband, male no wife, same breakdowns with children where medical facilities (hospitals and clinics) are located by neighborhood
BLS ACS 2010 ACS 2010 ACS 2010 Census/ACS, CA DoF
N
N
neighborhood level
x
Census/ACS, CA DoF
N
neighborhood level
x
Census/ACS, CA DoF
N
neighborhood level
x
Census/ACS, CA DoF
N
neighborhood level
x
California Department of Education
N
Census/ACS SF-HSA Homeless Count
N N
district level level
x x
Census/ACS
N
neighborhood level
x
SFMTA, SFDPH EHS
N
x
HCSMP Ordinance
percent of commute trips made by biking/walkding
SFMTA, SFDPH EHS
N
x
HCSMP Ordinance
charity care applications by supervisorial district, by zip Health Reform, OSHPD; Charity Care code of residents and hospital visited report
NACCHO
12 % below poverty level - total
NACCHO
13 median household income
NACCHO
14
ratio of students graduating who entered 9th grade 3 years prior
NACCHO
15 migrant persons 16 homeless persons
NACCHO NACCHO
17 non-English speaking persons
NACCHO
18 persons 25+ with less than a high school education
NACCHO
19 single parent families
NACCHO
20 transit and infrastructure availibility
HCSMP Ordinance
21
traffic characteristics - incl. mode split among cars, public transit, bicycles, and pedestrians
22 community obligations of providers
"pre-" population/population density numbers, population density by neighborhood age sex race, breakdown by neighborhood ethnicity, breakdown by neighborhood
x neighborhood level neighborhood level neighborhood level neighborhood level
x x x x
x
x
Census/ACS, CHSI Report
N
x
Census/ACS
N
x
N
neighborhood/dsitrict level
X
x
Health Resource Availibility, Category 3 23 persons without health insurance
NACCHO
24 health coverage in San Francisco
SF DPH
25 Healthy San Francisco use
H+C, SF DPH
26 preventable emergency room use
H+C, SF DPH
27 intensity of use
HCSMP Ordinance
28 payment for services
HCSMP Ordinance
29 rate: Medicaid eligibles to participating physicians 30 rate: licensed dentists to total population
NACCHO NACCHO
31 rate: licensed general practice PCPs to total population
NACCHO
32 rate: licensed family practice PCPs to total population
NACCHO
33 rate: licensed internal medicine PCPs to total population
NACCHO
34 rate: licensed ob/gyn PCPs to total population
NACCHO
uninsured by race health coverage status, breakdown of health coverage types, health coverage types for children, health coverage types for 65 and older HSF participation by age, race/ethnicity/income, neighborhood; HSF participating hospitals and medical homes rate of preventable emergency use per 10,000in SF and by neighborhood where medical facilities (hospitals and clinics) are located by neighborhood, rate of hospital utilization, rate of PCHC use
OSHPD Patient Discharge Data, CHIS, Health Matters in SF
N
Health Matters in SF, ACS 2009, Healthy San Francisco Annual Report
N
Healthy San Francisco Annual Report
N
X
N OSHPD, Planning Dept - Dunn & Bradstreet
Emergency Dept Data, Health policy sources of payment for health services by neighborhood, research (KFF, RWJF, CHCA), OSHPD primary care health center utilization by payment source Patient Discharge medicaid eligibles, participating physicians number of licensed dentists, and total population CHSI Report number of licensed general practice PCPs, and total CHSI Report population number of licensed family practice PCPs, and total CHSI Report population number of licensed internal medicine PCPs, and total CHSI Report population number of licensed ob/gyn PCPs, and total population CHSI Report
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x
N
N
x
trend assessment; neighborhood level
? N
x x x
N
CHSI collapses all PCPs into one number
x
?
CHSI collapses all PCPs into one number
x
?
CHSI collapses all PCPs into one number
x
?
CHSI collapses all PCPs into one number
x
Page 1 of 6 9/24/2013 11:52 AM
Appendix II: CHNA Data Indicators and Sources
#
Needs Assessment Indicator
Origin
Variable(s)
Data Source(s)
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
35 rate: licensed pediatrics PCPs to total population
NACCHO
number of licensed pediatraic PCPs, and total population CHSI Report
?
36 rate: licensed PCPs (total) total population
NACCHO NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance
number of licensed PCPs (total), and total population number of licensed acute hospital beds, and total population number of occupied acute hospital beds, and number of licensed acute hospital beds number of licensed specialty hospital beds, and total population number of occupied specialty hospital beds, and number of licensed specialty hospital beds number of licensed hospital beds (total), and total population number of occupied hospital beds (total), and number of licensed hospital beds (total)
CHSI Report
N
OSHPD
37 rate: licensed acute hospital beds to total population 38 rate: occupied acute hospital beds to total available 39 rate: licensed specialty hospital beds to total population 40 rate: occupied specialty hospital beds to total available 41 rate: licensed hospital beds (total) to total population 42 rate: occupied hospital beds (total) to total available acute hospital services, including those that require 43 specialized facility accomodations
HCSMP Ordinance
44 rate: visiting nurse / IHSS to total population
NACCHO
45
proportion of population w/o regular source of primary care (incl. dental)
46 Medicare adjusted average per capita cost
NACCHO NACCHO
rate: local health department full-time equivalents to total NACCHO population dollars in local health department operating budget per 48 NACCHO total population 47
49 neighborhood primary care health centers
Harder+Co
50 health centers/clinics that target specific populations
Harder+Co
51 governmental policy
HCSMP Ordinance
52 use of health care services by patients from outside SF
HCSMP Ordinance
x
N
SFDPH wants current and projected capacity
x
x
OSHPD
N
current and projected capacity
x
x
OSHPD
N
SFDPH wants current and projected capacity
x
x
OSHPD
N
current and projected capacity
x
x
OSHPD
N
current and projected capacity
x
x
OSHPD
N
current and projected capacity
x
x
OSHPD
?
current and projected capacity
per capita health care spending for Medicare beneficiaries
N
x
N
x
SFDPH
N
SFDPH
N
OSHPD, SFDPH, SFCCC
N
SFDPH, OSHPD Healthy Kids, Healthy SF, & Healthy Workers, (Colleen); Health policy research (KFF, RWJF, CHCA) OSHPD
x x
number of SFDPH FTEs, and total population
X
x do they mean per person? What is the "total population"?
x
N Y - DPH (Colleen)
related to distribution, access, quality, and cost of health care services; trends assessment at national, state, regional levels
x
N
x
referral of patients from SF to medical institutions 53 outside SF 54 sources and uses of capital for investment in services
HCSMP Ordinance
N/A
HCSMP Ordinance
?
trends assessment
x
55 emergency services including trauma services
HCSMP Ordinance
OSHPD, SFDEM
?
current and projected capacity
x
56 57 58 59 60
ambulatory care services including primary care hospital-based and free-standing urgent care services rehabilitation services long-tem care services home health services behavioral health services, including psychiatric 61 emergency services
HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance
OSHPD OSHPD OSHPD OSHPD OSHPD SFDPH Community Behavioral Health Services
? ? ? ? ?
current and projected capacity current and projected capacity current and projected capacity current and projected capacity current and projected capacity
x x x x x
?
current and projected capacity
x
62 medically underserved areas for particular services
HCSMP Ordinance
N
will also come out of HCSMP Task Force community meetings
x
HCSMP Ordinance
63 waiting times
Listing of all health services/facilities in SF along with map
Listing of all health services/facilities in SF along with map geography, transportation/communication options, unique barriers to accessing care (cultural competence, lanugage, HRSA MUA, HRSA race, immigration status, gender identity, substance abuse, public assistance SF DPH
National Prevention Strategy
x
?
total SFDPH operating budget, and total population
Percent of patients discharged from SF hospitals that were residents outside of SF
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
could not find on CHSI
number of visiting nurse / IHSS providers, and total SFHSA (DAAS)? population number of people without regular source of primary care, HRSA Health Professional Shortage Areas and total population and Medically Underserved Areas
map with listing of all PCHC, number of pts. Seen, number of services provided in fiscal year, sources of payment for services narrative, listings on map of PCHC
Notes / Questions
Y - DPH
cannot get data, only available through interviews
x
brought up at 7/1 meeting
Quality of Life, Category 4 64 Perception of health and wellness
H+C, SF DPH
65 social support
H+C, SF DPH
66 perception of safety
H+C, SF DPH
67 satisfaction with quality of physical environment
H+C, SF DPH
proportion of persons satisfied with quality of life in 68 community
NACCHO
Percent of adults who reported poor or fair health; average number of self-reported physically unhealthy days and mentally unhealthy days Receiving social support: availability of others for understanding problems; someone to health with daily chores; others for relaxation purposes percent of SF residents who feel safe walking alone during day and night percent of SF residents who are satisfied with phisical environment in which they live SEE INDCATORS ABOVE
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BRFSS, County Health Rankings
N
CHIS
N
SF City Survey
N
SF City Survey
N N
X
SEE ABOVE INDICATORS
x
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Appendix II: CHNA Data Indicators and Sources
#
69
Needs Assessment Indicator
proportion of adults satisfied with health care system in the community
Origin
NACCHO
70 proportion of parents in Parent Teachers Association
NACCHO
70 school quality
H+C, SF DPH
number of openings in child care facilities for low-income NACCHO families 72 number of neighborhood crime watch areas NACCHO civic organization/association members per 1,000 73 NACCHO population 71
Variable(s)
proportion of adults satisfied with health care system in the community number of parents in Parent Teachers Association, and number of SFUSD parents percent of parents who gave a grade of good or excellent when rating child's school number of openings in child care facilities for low-income families number of neighborhood crime watch areas number of civic organization/association members, and total population
S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All
Data Source(s)
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
Notes / Questions
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
Focus Groups
N
Will use focus groups to get at this
x
SFUSD; CDE Dataquest
X
Data does not exist in SF
x
City Survey State Licensing; State Child Care Resource and Referral HDMT
National Prevention Strategy
N N
number occupied and available
x
X
Will not use this indicator
x
total population? adults only?
x
in progress
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Appendix II: CHNA Data Indicators and Sources
#
Needs Assessment Indicator
74 percent of regisgered voters who vote 75 neighborhood empowerment
Origin
NACCHO
Variable(s)
number of voters, and number of registered voters
Data Source(s)
HDMT Neighborhood Empowerment Network
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
Notes / Questions
N Y - Megan
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
National Prevention Strategy
x
Behavioral Risk Factors, Category 5 76 substance use and abuse - tobacco use
NACCHO
77 substance use and abuse - illegal drug use
NACCHO
78 substance use and abuse - binge drinking
NACCHO
79 lifestyle - nutrition
NACCHO
80 lifestyle - obesity (adults and kids)
NACCHO
81 lifestyle - exercise and sedentary lifestyle
NACCHO
Pecent of adults who reported smoking, percent of high school students who reported smoking percent illicit drug use, marijuana use, cocaine use, nonmedical use of pain relievers, trend data percent binge drinking among madults and high school students
CDC-BRFSS and YRBS
N
NACCHO groups into youth (< 18), adult, and older adult (>64)
x
X
National Surveys on Drug Use and Health, 2006-2008
N
same as above
x
X
CDC-BRFSS and YRBS
N
same as above
x
X
X
N
same as above
x
N
same as above
x
X
X
N
same as above
x
X
X
x
CDC-BRFSS, CA data in CHSI Report, percent of high school students who consumed soda; fruit CHIS, Pediatric Nutrition Surveillance and vegetable consumption; fast food consumption System obesity rate among adults and chidlren overall and by CDC-BRFSS, CA data in CHSI Report; race/ethnicity CHIS percent of adults who reported doing no leisure time exercise or physical activity; percent high school students CDC-BRFSS, CA data in CHSI Report; who report no physical activity; percent of students who CHIS; California Department of Education did not pass the physical fitness challenge percent who use a seat belt, percetn of high schol students CDC-BRFSS and YRBS who reported not using seat belt
82 protective factors - seatbelt use
NACCHO
N
same as above
83 protective factors - child safety seat use
NACCHO
number of conviction for improper child car seat restraint CA DMV
N
same as above
x
84 protective factors - bicycle helmet use
NACCHO
percent of Sf residents who wear a bike helmet percent of high school students who resported not using a condom percent of Medicare pts who received a screening % or men 40+ who had a PSA women 18+ who have had apap in last 3 yrs % of woment 40+ AND 50+ who have had amammogram in last 2 yrs
City of San Francisco Bicycle Count
N
same as above
x
CDC-BRFSS and YRBS
N
same as above
x
85 protective factors - condom use
NACCHO
86 screening - diabetes 87 screening - prostate cancer 88 screening - pap smear
H+C, SF DPH H+C, SF DPH NACCHO
89 screening - mammography
NACCHO
CDC-BRFSS, CA data in CHSI Report
N
percent of age-specific female population
x
CDC-BRFSS, CA data in CHSI Report
N
percent of age-specific female population
x
Behavioral Risk Factors by Special Population, Category 5 continued 90 substance use and abuse - tobacco use (adult)
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
X
91 substance use and abuse - illegal drug use
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
X
substance use and abuse - binge drinking (adults; alcohol 92 NACCHO use also captured for teens)
see above where applicable
CDC-BRFSS
N
see above where applicable
x
X
93 lifestyle - nutrition
see above where applicable
CDC-BRFSS, CA data in CHSI Report, CHIS
N
see above where applicable
x
NACCHO
94 lifestyle - obesity
NACCHO
see above where applicable
CDC-BRFSS, CA data in CHSI Report
N
see above where applicable
x
95 lifestyle - exercise
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
96 lifestyle - sedentary lifestyle
NACCHO
see above where applicable
CDC-BRFSS, CA data in CHSI Report
N
see above where applicable
x
97 protective factors - seatbelt use
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
98 protective factors - child safety seat use
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
99 protective factors - bicycle helmet use
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
100 protective factors - condom use
NACCHO
see above where applicable
CDC-BRFSS
N
see above where applicable
x
101 screening - pap smear
NACCHO
see above where applicable
CDC-BRFSS, CA data in CHSI Report
N
percent of age-specific female population
x
102 screening - mammography
NACCHO
see above where applicable
CDC-BRFSS, CA data in CHSI Report
N
percent of age-specific female population
x
?
burden of illness, trends assessment
x
in progress- address when Master Plan is redone in 3 years trends assessment
x
Health System Trends (from Ordinance) 103 disease and population health status
HCSMP Ordinance
SFDPH, Health Matters in SF, Healthy People 2020, 2011 County Health Rankings, phpartners.org, CHIS
104 disaster planning, surge capacity needs
HCSMP Ordinance
SFDEM, NERT
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N/A
Page 4 of 6 9/24/2013 11:52 AM
X
Appendix II: CHNA Data Indicators and Sources
#
Needs Assessment Indicator
Origin
Variable(s)
Data Source(s)
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
105 clinical technology
HCSMP Ordinance
phpartners.org
?
106 communications technology
HCSMP Ordinance
phpartners.org
?
Notes / Questions
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
advances that help deliver care (e.g., VMI, electronic medical records), health information technology and standards trends assessment trends assessment
National Prevention Strategy
x x
Environmental Health Indicators, Category 6 107 air quality
NACCHO
number and type of US EPA air quality standards not met CHSI Report
N
x
108 109 110 111
NACCHO NACCHO NACCHO NACCHO
SF Policy of monitoring of waters and flouridation SF Policy on indoor air percent of OSHA violations rate of food-borne disease per total population number of children under 5 who have blood levels exceeding 10mcg/dL, and total number of children under 5 who are tested
SF PUC SF Policy OSHA CHSI Report
N N ? N
x x x x
Joe Walseth
N
water quality + waterborne disease indoor clean air workplace hazards food safety
percentage of what?
112 lead exposure
NACCHO
113 waterborne disease
NACCHO
rate of waterborne disease per total population
2009 Annual Report of Communicable Diseases in SF
N
x
114 fluoridated water
NACCHO
number of people (households?) with fluoridated water supplies, and total population
SF PUC
N
x
115 rabies in animals
NACCHO
total number of cases of rabies in animals
2009 Annual Report of Communicable Diseases in SF
N
x
HDMT
N
HDMT
N
HDMT
N
116 violent crime (homicide and physical assault)
H+C, SF DPH
117 community noise
H+C, SF DPH
118 overcrowding
H+C, SF DPH
119 120 121 122 123 124 125 126
Social and Mental Health, Category 7 During the past 30 days, average number of days adults report poor mental health Number and rate of confirmed child abuse and neglect among children Homicide rate Suicide rate Domestic violence Psychiatric admissions Alcohol related motor vehicle mortality Drug-related mortality Maternal and Child Health, Category 8
NACCHO
average number of self-reported mentally unhealthy days BRFSS
N
NACCHO
Number of child abuse and neglect cases
RAND, HDMT
N
NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO
Homicides per 1000 by neighborhood Number of suicides countywide and by neighborhood rate per total population Number of admissions
HDMT OSHPD OSHPD
N N Y N
number of drug-related mortality
OSHPD
N
SFDPH
N
127 birth rate (by subgroup)
Harder+Co
128 prenatal care in 1st trimester
NACCHO
129 births to adolescents as a proportion of live births 130 Adolescent pregnancy rate
NACCHO NACCHO
131 Very low birthrate
NACCHO
132 Child mortality 133 neonatal mortality 134 post-neonatal mortality Death, Illness and Injury, Category 9 135 General health status 136 Average number of sick days within past month 137 causes of death / death rate 138 All Cancers 139 Breast cancer 140 Lung cancer 141 cervical cancer 142 colorectal cancer 143 Unintentional Injuries 144 Years of Productive Life Lost
NACCHO NACCHO NACCHO
145 Causes of Premature death
homicites per 1000 by neighborhood; physical assoults per 1000 by neighborhoods; rape or sexual assault per 1000 by neighborhood Average decibel of daytime and nighttime outdoor noise by neighborhood proportion of households living in overcrowded conditions by neighborhood
NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO H+C, SF DPH
birth rates by ageof mother, by race of mother, by neighborhood number of mothers who did not receive 1st trimester prenatal care, by neighborhood births to mother under 20 years, by nieghborhood
X
X
X
X
X
X
x
x
N N N
percent of babies born under 1,500 grams, 1500 to 2499 grams, 2500 grams or more
N N N N
percent of respondents reporting health status; percent of self-reported physically unhealthy days rates for all causes number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of unintentional injuries by type number of YPLL under age 75 per population causes of premature death by sex and zip code/neighborhood; average age at death
BRFSS BRFSS CA State death rates CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CDIC HDMT
N N N N N N N N N N
SF DPH
N
Communicable Disease, Category 10
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Appendix II: CHNA Data Indicators and Sources
#
Needs Assessment Indicator
Proportion of children at kindergarten entry who have receive dall age-appropriate vaccines Proportion of adults aged 65 and older who have been 147 immunized for pneumonia Proportion of adults aged 65 and older who have been 148 immunized for influenza 146
Origin
NACCHO NACCHO NACCHO
149 Syphillis cases
NACCHO
150 Gonorrhea cases
NACCHO
151 Chlamydia cases
NACCHO
152 Tubueculosis
NACCHO
153 AIDS
NACCHO
154 Bacterial meningitis
NACCHO
155 Hepatitis A cases
NACCHO
156 Hepatits B cases
NACCHO
157 Hepatitis C cases
NACCHO
Variable(s)
Proportion of children at kindergarten entry who have receive dall age-appropriate vaccines Proportion of adults aged 65 and older who have been immunized for pneumonia Proportion of adults aged 65 and older who have been immunized for influenza
Data Source(s)
California Department of Health Services
Sentinel Events, Category 11 State SF County protocol and referece mobidity data 158 above
Notes / Questions
NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM
National Prevention Strategy
N
SF DPH
In Progress
SF DPH
In Progress
SF DPH 2009 Communicable Disease Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease Tuburculosis case rates by age groups, by race/ethnicity Annual Report; Tuburculosis Control Section AIDS case by gender, race/ethnicity, exposure categories, 2010 HIV/AIDS Epidemiology Annual neighborhoods Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report
rates by age, sex, race/ethnicity
Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)
N N N N N N N N N
In Progress x
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Appendix III: Public Health Experts Involved in Community Health Needs Identification Name Adrian Nunez Aine Casey Amor Santiago Anne Quaintance Anni Chung Beverly Upton Bill Hirsh Brenda Storey Brian Basinger Carlina Hansen Christina Shea David Pating, MD
Estela Garcia
Gina Fromer Gloria Thornton Jessica Flintoft John Gressman Karen Gruneisen
Organization
Category of Expertise
Healthy Kids, SF Health Plan Health care for uninsured children Independent Living Resource Center Services for persons with disabilities APA Family Support Services Services for Asian populations Deputy Director, Meals on Wheels of SF; Services for seniors, persons with Long‐term Care Coordinating Council disabilities Exec. Dir., Self Help for the Elderly Services for seniors Exec. Dir., SF Domestic Violence Services for victims of domestic Consortium violence Exec. Dir., AIDS Legal referral Panel Services for persons with HIV/AIDS Exec. Dir., Mission Neighborhood Health Health care for Latinos, uninsured Center Exec. Dir., AIDS Housing Alliance Services for persons with HIV/AIDS Executive Director, Women’s Community Health care for women, uninsured Clinic Richmond Area Multi‐Services; Asian‐ Health care for Asian Pacific Pacific Islander Health Parity Coalition Islanders Dir., Chemical Dependency Recovery Behavioral health care Program, Kaiser Permanente San Francisco Health care for Latinos, uninsured Exec. Dir., Instituto Familiar de la Raza; Chicano/Latino/Indigena Health Equity Coalition Director, Bayview YMCA Services for African American and Asian populations Community resource Center, Anthem Health care for the uninsured Blue Cross Reentry Policy Director , Office of the Services for ex‐offender populations Public Defender Exec. Dir., San Francisco Community Clinic Health care for the uninsured, Consortium minorities Associate Director, Episcopal Community Services for homeless populations Services
Kevin Grumbach, MD Dir., Clinical Translational Science Institute, University of California San Francisco Kevin Truitt Asst. Superintendent, Director of Wellness Programs, SF Unified School District Le Tim Ly Chinese Progressive Association Lucy Johns Health Care Policy consultant
PUBLIC HEALTH EXPERTS INVOLVED IN COMMUNITY HEALTH NEEDS IDENTIFICATION, PAGE 2
Population health and prevention
School‐based health care services
Services for the Chinese population Health care policy and planning
Name Margy Baran
Organization
Category of Expertise Community support for seniors and persons with disabilities Health care for children, uninsured Physician services Services for uninsured minorities Services for transgender populations Health care for African Americans
Roma Guy
Exec. Dir., IHSS Consortium; Long‐term Care Coordinating Council Children’s Council of SF Exec. Dir., SF Medical Society Exec. Dir., Portola Family Connections Exec. Dir., Transgender Law Center Exec. Dir., African American Health Disparities Project Exec, Dir., Black Coalition on AIDS; African American Community Health Equity Council Former President, SF Health Commission
Sherilyn Adams
Exec. Dir., Larkin St. Youth Services
Steve Fields
Exec. Dir., Progress Foundation
Tavi Baker Tomas Aragon, MD
Boys and Girls Club City Health Officer; Dir., Population Health & Prevention, SF Dept. of Public Health Dir. Of Community Partnerships, UCSF
Maria Luz Torre Mary Lou Licwinko Maryann Flemming Masen Davis Michael Huff Perry Lang
Wylie Liu
PUBLIC HEALTH EXPERTS INVOLVED IN COMMUNITY HEALTH NEEDS IDENTIFICATION, PAGE 2
Health care for African Americans, persons with HIV/AIDS Population health and prevention, public health Services for youth, homeless, uninsured Mental health services, uninsured, homeless Services for youth Population health & prevention, public health Public health, population health & prevention, health care for the uninsured
Appendix IV: Assets for Community Health Need Priorities Increase Access to Quality Health Care and Services Organization Project Name (if applicable) SFGH Health Reform as driver toward primary care home as well as integration and Coordination SFDPH Healthy San Francisco + SFPATH San Francisco Community Clinic Consortium Operation Access Women’s Community Clinic Project Homeless Connect SFGH Foundation SFDPH, nonprofit hospitals, community SF system of care clinics, private providers On Lok 30th Street Falls Prevention Maintenance Exercise Program Asian & Pacific Islander Wellness Center The Wellness Clinic serving A&PI & LGBT population Healthcare Foundation of Northern and African American Health Disparity Project Central California Health Initiatives for Youth Middle Schools Go Healthy Dimensions Clinic Brief Intervention, Education, and Engagement for Transgender Youth Women's Community Clinic UCSF AIDS Health Project Reducing Mental Health Treatment Waitlist for People with HIV/AIDS Increase Healthy Eating and Physical Activity Organization Project Name (if applicable) Strong interagency and community collaboration to improve nutrition (e.g., SFHIP, Southeast Food Access Network, SF Food Security Task Force) Strong interagency and community collaboration to improve opportunities for physical activity (e.g., Sunday Streets, Walk First, Bayview HEAL Zone, Safe Routes to School, SFHIP) Current Assessment Efforts: Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3) Urban Sprouts Garden Based Education Nutrition Enhancement Project San Francisco Green Schoolyard Alliance 2013 Grounds for Healthy Kids Project Family Service Agency of San Francisco Healthy Families, Healthy Lives Wellness Program
Family Service Agency of San Francisco Community Grows Boys & Girls Clubs of San Francisco Shape Up San Francisco Sunday Streets Gateway to Fitness Program
Healthy Families, Healthy Lives Wellness Program Seed‐to‐Mouth Cooking Classes Power Play Expansion
Ensure Safe and Healthy Living Environment Organization Project Name (if applicable) Strong interagency and community collaboration (e.g., SFHIP, CBP, Community Transformation Grant Team, Healthy Homes Project) Strong existing programs that address these issues such as SF Tobacco Free Project and Bayview Safe Haven after school program (Effective Practice) Strong network of existing and well‐ maintained parks Sustainable Communities Index, which facilitates health impact assessment in land use planning Straight Forward Club LEAP (Look to End Abuse Permanently) 3rd Street Youth Center & Clinic Fellas Sunset Youth Services Comprehensive Juvenile Delinquency and Violence Prevention Program Kidpower Vaccine Against Community Violence Insituto Familiar de la Raza, Peace Dialogues Community Matters Whole School Climate Initiative to Reduce Community Violence
