2016

Northwest Hospital & Medical Center Community Health Needs Assessment

UW Medicine

Table of Contents Executive Summary ....................................................................................................................4 Introduction ...............................................................................................................................10 Background and Purpose...................................................................................................10 Collaborative Process ........................................................................................................10 Service Area ......................................................................................................................10 Map of the Northwest Hospital Service Area ......................................................................11 Information Gaps ...............................................................................................................12 Consultant..........................................................................................................................12 Methods ....................................................................................................................................13 Secondary Data Collection.................................................................................................13 Primary Data Collection .....................................................................................................13 Public Comment.................................................................................................................14 Identification of Significant Health Needs ..................................................................................15 Collaborative Effort ............................................................................................................15 Review of Primary and Secondary Data .............................................................................15 Resources to Address Significant Needs ...........................................................................15 Priority Health Needs ................................................................................................................16 Impact Evaluation ..............................................................................................................17 Community Demographics ........................................................................................................18 Population ..........................................................................................................................18 Race/Ethnicity ....................................................................................................................20 Language ...........................................................................................................................22 Social and Economic Factors ....................................................................................................23 Social and Economic Factors Ranking ...............................................................................23 Unemployment ...................................................................................................................23 Poverty ..............................................................................................................................23 Free or Reduced Price Meals.............................................................................................24 Households ........................................................................................................................25 Households by Type ..........................................................................................................26 Educational Attainment ......................................................................................................26 High School Graduation Rates ...........................................................................................26 Northwest Hospital

Page 1

Homelessness ...................................................................................................................27 Community Input – Social and Economic Factors ..............................................................27 Health Access ...........................................................................................................................29 Health Insurance Coverage ...............................................................................................29 Medical Assistance Programs ............................................................................................29 Unmet Medical Need .........................................................................................................30 Primary Care Physicians ....................................................................................................30 Access to Primary Care Community Clinics .......................................................................31 Dental Care........................................................................................................................32 Mental Health Providers .....................................................................................................32 Community Input - Access to Care .....................................................................................33 Birth Characteristics ..................................................................................................................34 Births .................................................................................................................................34 Teen Birth Rate ..................................................................................................................34 Prenatal Care.....................................................................................................................34 Low Birth Weight ................................................................................................................35 Maternal Smoking during Pregnancy .................................................................................35 Infant Mortality ...................................................................................................................35 Mortality/Leading Causes of Death ...........................................................................................37 Death Rates .......................................................................................................................37 Mortality Rates ...................................................................................................................37 Cancer Mortality .................................................................................................................38 King County Regional Mortality Rates ................................................................................39 Chronic Disease........................................................................................................................40 Fair or Poor Health.............................................................................................................40 Diabetes ............................................................................................................................40 Heart Disease and Stroke ..................................................................................................40 High Blood Pressure and High Cholesterol ........................................................................41 Community Input – Heart Disease .....................................................................................41 Cancer ...............................................................................................................................42 Community Input – Cancer ................................................................................................42 Asthma ..............................................................................................................................43 Tuberculosis ......................................................................................................................44 Northwest Hospital

Page 2

Disability ............................................................................................................................45 Health Behaviors.......................................................................................................................46 Health Behaviors Ranking..................................................................................................46 Overweight and Obesity .....................................................................................................46 Physical Activity .................................................................................................................47 Exercise Opportunities .......................................................................................................47 Community Walkability .......................................................................................................48 Soda Consumption ............................................................................................................48 Community Input – Overweight and Obesity ......................................................................49 STD/HIV....................................................................................................................................50 Youth Sexual Behaviors .....................................................................................................50 Sexually Transmitted Diseases ..........................................................................................50 HIV.....................................................................................................................................51 Community Input – Sexually Transmitted Diseases and HIV ..............................................51 Substance Abuse ......................................................................................................................52 Tobacco Use......................................................................................................................52 Alcohol and Drug Use ........................................................................................................52 Community Input – Substance Abuse ................................................................................53 Mental Health ............................................................................................................................55 Frequent Mental Distress ...................................................................................................55 Community Input – Mental Health ......................................................................................56 Preventive Practices .................................................................................................................58 Flu and Pneumonia Vaccines.............................................................................................58 Mammograms ....................................................................................................................58 Pap Smears .......................................................................................................................59 Colorectal Cancer Screening .............................................................................................59 Community Input – Preventive Practices ............................................................................60 Attachment 1. King County HCC Interviewees ..........................................................................61 Attachment 2. Community Stakeholder Interviewees ................................................................65 Attachment 3. Community Resources .......................................................................................66 Attachment 4. Impact Evaluation ..............................................................................................67

Northwest Hospital

Page 3

Executive Summary Northwest Hospital & Medical Center has undertaken a Community Health Needs Assessment (CHNA) as required by federal law. The Patient Protection and Affordable Care Act and IRS section 501(r)(3) direct tax exempt hospitals to conduct a community health needs assessment and develop an Implementation Strategy every three years. The Community Health Needs Assessment is a primary tool used by Northwest Hospital to determine its community benefit plan, which outlines how it will give back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the service area. Service Area Northwest Hospital & Medical Center is located at 1550 N. 115th Street Seattle, Washington 98133. The service area comprises portions of King County and Snohomish County and includes 18 zip codes, representing 6 cities or communities. Northwest Hospital & Medical Center Service Area City Zip Code Bothell 98021 Bothell - Bothell/Mill Creek 98012 Edmonds 98020 Edmonds 98026 Kenmore 98028 Lynnwood 98036 Lynnwood 98037 Lynnwood 98087 Mountlake Terrace 98043 Seattle - Ballard 98107 Seattle - Ballard/Crown Hill 98117 Seattle - Broadview/Richmond Beach 98177 Seattle - Greenlake/Greenwood/Wallingford 98103 Seattle - Haller Lake/Shoreline 98133 Seattle - Lake Forest Park 98155 Seattle - Maple Leaf/Wedgewood/Roosevelt/ SandPoint 98115 Seattle - Pinehurst/Northgate/Lake City 98125 Seattle - University District 98105

County Snohomish Snohomish Snohomish Snohomish King Snohomish Snohomish Snohomish Snohomish King King King King King King King King King

Data Collection This community health needs assessment includes collection and analyses of secondary and primary data. Northwest Hospital

Page 4

Secondary Data This report examines up-to-date data sources for the service area to present community profile, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, and health behaviors. When applicable, these data sets are presented in the context of King County and Washington, framing the scope of an issue as it related to the broader community. Analyses were conducted at the most local level possible for the hospital primary service area, given the availability of the data. The report includes benchmark comparison data, comparing Northwest Medical Center community data findings to the Healthy People 2020 objectives. Additional data for King County are available from the King County Community Health Needs Assessment www.kingcounty.gov/healthservices/health/data/kchhc.aspx. Primary Data Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by the Hospital. Seventeen (17) interviews were completed between December 2015 and February 2016. Interviewees included individuals who are leaders and representatives of medically underserved, lowincome, minority and chronic disease populations. Additionally, input was obtained from the King County Public Health Department. Overview of Key Findings This overview summarizes significant findings drawn from an analysis of the data from each section of the report. Full data descriptions, findings, and data sources follow in the full report. Community Profile  The population of the Northwest Hospital service area is 598,493.  Children and youth, ages 0-19, make up 21.9% of the population; 66.3% are adults, ages 20-64; and 11.8% of the population are seniors, ages 65 and over. The population in the Northwest Hospital service area tends to have a higher percentage of adults ages 20-24 and 25-44, and a lower percentage of children than found in the state or county.  71.4% of the residents are White; 13% are Asian; 7% are Hispanic/Latino; 3% are African American; and 1.1% are American Indian/Alaskan Native/Native Hawaiian or other race/ethnicity, while 4.5% identify as multiracial.  English is spoken in the home among 78.6% of the service area population. Spanish is spoken at home among 4.8% of the population; 9.6% of the Northwest Hospital

Page 5

population speak an Asian language; and 5% of the population speaks an IndoEuropean language at home. Social and Economic Factors  Among the residents in the Northwest Hospital service area, 10.9% are at or below 100% of the federal poverty level (FPL) and 22.2% are at 200% of FPL or below. These rates of poverty are lower than found in the state where 13.4% of residents are at poverty level and 30% are at 200% of FPL or below.  In the service area, 11.4% of children, under age 18 years, are living in poverty.  The median household income in the area is $71,021.  The five year average (2009-2013) unemployment rate of in the service area is 5.4%, which is lower than the state rate of 6%.  In the hospital service area, only 5.7% of adults lack a high school diploma. Over half the population (58.7%), ages 25 and older, have a college degree.  The 2015 point-in-time count estimated 10,122 homeless individuals in King County and 829 homeless in Snohomish County. Health Access  Health insurance coverage is considered a key component to access health care. 89.1% of the total population in the Northwest Hospital service area has health insurance.  95.4% of children under age 18 have health insurance coverage in the service area. Mountlake Terrace has the highest health insurance rate among children (97.4%), and Lynnwood has the lowest percentage of children with health insurance (94.6%).  14% of adults in the Seattle region and 8% of adults in North County had an unmet medical need because they were not able to afford care. These rates are compared to those found in King County (10%). Snohomish County has a rate of 13% of adults not accessing medical care due to cost. Birth Characteristics  In 2013, the total number of births in King County was 25,057 and in Snohomish County it was 9,237. The race and ethnicity of mothers in the service area was primarily White in King County (64.6%) and Snohomish County (78.3%).  Teen births occurred in King County at a rate of 26.1 per 1,000 births (or 2.6% of total births) and in Snohomish County at a rate of 38.3 per 1,000 births (3.8%). This rate is lower than the teen birth rate found in the state (5.1%).  82.7% of women in King County and 80.4% in Snohomish County enter prenatal care within the first trimester. The area rate of early entry into prenatal care exceeds the Healthy People 2020 objective of 78% of women entering prenatal Northwest Hospital

Page 6





care in the first trimester. The infant mortality rate (defined as deaths to infants more than 27 days old, and under 1 year of age) in King County was 4.3 deaths and in Snohomish County was 3.0 per 1,000 live births. Among pregnant women, 96.3% in King County and 93.6% in Snohomish County did not smoke during pregnancy. These rates are lower than the Healthy People 2020 objective of 98.6% of women to abstain from cigarette smoking during pregnancy.

Leading Causes of Death  The age-adjusted death rate in King County (6.2 per 1,000 persons) is less than the state rate of 6.8. Snohomish County has an age-adjusted death rate of 7.0 per 1,000 persons.  The top two leading causes of death in the Northwest Hospital service area are cancer and heart disease.  Alzheimer’s disease, unintentional injury and stroke are in the top five causes of death in King County. None of the causes of death in King County exceed state rates.  In Snohomish County, Alzheimer’s disease, lung disease and unintentional injury are in the top five causes of death. Of note, all of the top seven causes of death in Snohomish County exceed state rates, including: cancer, heart disease, Alzheimer’s disease, unintentional injury, lung disease, stroke, and diabetes.  Mortality rates for female breast cancer in King County (21.0 per 100,000 persons) exceed the state rate of 18.2. The rate of death from colorectal cancer in Snohomish County (13.9 per 100,000 persons) exceeds the state rate of 12.9. Chronic Disease  In King County, 26.4% of adults have been diagnosed with high blood pressure and 36.4% have high cholesterol. 31.3% of adults in Snohomish County have high blood pressure and 39.5% have high cholesterol.  Cardiovascular disease prevalence includes adults who have been told by a health care professional that they have had a heart attack, angina, coronary heart disease or stroke. Reported rates of cardiovascular disease are lower for King County than for Snohomish County, which in turn are slightly lower than statewide rates.  In King County, the age-adjusted cancer incidence rate is 542.5 per 100,000 persons. In Snohomish County it is 567.4 per 100,000 persons. These rates of cancer are higher than the state rate of 528.8. Breast cancer and prostate cancer occur at higher rates in King County than the state rates for these types of cancer. Breast, prostate and lung cancer rates are higher in Snohomish County Northwest Hospital

Page 7



than state rates. Among adults in King County, 12.6% have been diagnosed with asthma. 15.2% of adults in Snohomish County have been diagnosed with asthma, which is about the same as the state rate of 15%. 8% of children in Seattle and 6% of children in North County have been diagnosed with asthma. 7% of children in King County have asthma.

Health Behaviors  Over one-quarter of adults (28.4%) are obese in Snohomish County and 22.4% of adults in King County are obese.  In King County, 19% of 8th graders, 20% of 10th graders and 19% of 12 grade students are overweight and obese. Rates of overweight and obesity are slightly higher among students in Snohomish County. 26% of 8th graders, 23% of 10th grade students, and 26% of 12th graders in Snohomish County are overweight and obese.  In King County, 44.2% of adults do not meet the national physical activity recommendation. In Snohomish County 48.8% of adults obtain inadequate amounts of physical activity.  81% of King County youth in grade 10 do not meet the national physical activity recommendation. 78% of 10th graders in Snohomish County do not meet the physical activity recommendation.  72% of adults in King County and 75% of Snohomish County adults do not meet the recommendation daily consumption of five or more fruits and vegetables.  King County has higher rates of the sexually transmitted diseases of gonorrhea and syphilis than found in the state, while Snohomish County's rate of genital herpes is higher than King County's or the state's.  The King County rate of newly-diagnosed HIV cases (14.3 per 100,000 persons) is more than twice the state rate (6.4) and almost three times the rate found in Snohomish County (5.0). Substance Abuse  In King County, 13.6% of adults are current smokers, while in Snohomish County the rate is 19.2% of adults.  7% of 10th grade youth in both King and Snohomish Counties smoked cigarettes in the prior 30 days. Rates of smokeless tobacco use in the prior 30 days were 2% of 10th graders in King County and 3% in Snohomish County.  Among adults, 17.6% in King County had engaged in binge drinking in the past 30 days; and 19% of adults in Snohomish County had engaged in binge drinking. Among youth, binge drinking increases from 10 th to 12th grade. 18% of 12th graders in King County and 19% in Snohomish County had engaged in binge drinking in the previous two weeks. Northwest Hospital

Page 8

Mental Health  The average number of poor mental health days experienced by adults in King County in the last 30 days was 2.9 days. Adults in Snohomish County experienced 3.6 mentally unhealthy days in the past 30 days.  Among 10th grade youth, 31% in King County and 36% in Snohomish County had experienced depression.  18% of 10th graders in King County and 21% in Snohomish County had considered suicide in the past year. 9% of King County 10th graders and 10% of 10th graders in Snohomish County had attempted suicide in the past year. Preventive Practices  78% of seniors in the Seattle area and 69% of seniors in North County had obtained a pneumonia vaccine. This does not meet the Healthy People 2020 objective of 90%.  The Healthy People 2020 objective for mammograms is that 81.1% of women between 50 and 74 years of age have a mammogram in the past two years. This translates to a maximum of 18.9% of who lack screening. In King County, 22.3% of women lack breast cancer screening and 25.3% of women in Snohomish County lack breast cancer screening.

Northwest Hospital

Page 9

Introduction Background and Purpose Northwest Hospital & Medical Center is affiliated with the UW Medicine Health System. Established in 1960, Northwest Hospital & Medical Center is licensed for 281 beds. It is a full-service, nonprofit community hospital that offers comprehensive medical, surgical and therapeutic services. The hospital mission is to raise the long-term health status of our community by providing personalized, quality care with compassion, dignity, and respect. The passage of the Patient Protection and Affordable Care Act requires tax-exempt hospitals to conduct Community Health Needs Assessments every three years, and adopt Implementation Strategies to meet the priority health needs identified through the assessment. A Community Health Needs Assessment identifies unmet health needs in the service area, provides information to select priorities for action and target geographical areas, and serves as the basis for community benefit programs. This assessment incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the service area. Collaborative Process Northwest Hospital & Medical Center participated in a collaborative process for the Community Health Needs Assessment as part of the King County Hospitals for a Healthier Community (HHC). HHC is a collaborative of 12 hospitals and health systems in King County and Public Health-Seattle & King County. The HHC members joined together to identify important health needs and assets in the communities they serve. This shared approach avoids duplication and focuses available resources on a community's most important health needs. Partnerships between hospitals, public health, community organizations and communities are key to successful strategies to address common health needs. The full report and list of assessment partners can be accessed at: www.kingcounty.gov/healthservices/health/data/kchhc.aspx. Service Area Northwest Hospital & Medical Center is located at 1550 N. 115th Street Seattle, Washington 98133. The service area comprises portions of King County and Snohomish County and includes 18 zip codes, representing 6 cities or communities. Northwest Hospital determines the service area by assigning zip codes based on patient discharges. The top 76% of inpatient discharges based on the zip codes of patient origin constitutes the primary service area. The Northwest Hospital service area is presented below by community, zip code and county.

Northwest Hospital

Page 10

Northwest Hospital & Medical Center Service Area City Zip Code Bothell 98021 Bothell - Bothell/Mill Creek 98012 Edmonds 98020 Edmonds 98026 Kenmore 98028 Lynnwood 98036 Lynnwood 98037 Lynnwood 98087 Mountlake Terrace 98043 Seattle - Ballard 98107 Seattle - Ballard/Crown Hill 98117 Seattle - Broadview/Richmond Beach 98177 Seattle - Greenlake/Greenwood/Wallingford 98103 Seattle - Haller Lake/Shoreline 98133 Seattle - Lake Forest Park 98155 Seattle - Maple Leaf/Wedgewood/Roosevelt/ SandPoint 98115 Seattle - Pinehurst/Northgate/Lake City 98125 Seattle - University District 98105

County Snohomish Snohomish Snohomish Snohomish King Snohomish Snohomish Snohomish Snohomish King King King King King King King King King

Map of the Northwest Hospital Service Area

Northwest Hospital

Page 11

Information Gaps Information gaps that impact the ability to assess health needs were identified. Some of the secondary data are not always collected on a regular basis, meaning that some data are several years old. Some data resources are only available at the county level so community level information is not available for all data indicators. Disaggregated data around age, ethnicity, race, and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. Consultant Melissa Biel of Biel Consulting, Inc. conducted the Community Health Needs Assessment. Biel Consulting, Inc. is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. She was joined by Sevanne Sarkis, JD, MHA, MEd, and Denise Flanagan, BA. Biel Consulting, Inc. has extensive experience conducting hospital Community Health Needs Assessments and working with hospitals on developing, implementing, and evaluating community benefit programs. www.bielconsulting.com

Northwest Hospital

Page 12

Methods Secondary Data Collection Secondary data were collected from a variety of local, county, and state sources to present community profile, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, health behaviors, STD/HIV, substance abuse, mental health and preventive practices. Analyses were conducted at the most local level possible for the hospital primary service area, given the availability of the data. For example, some demographic and economic data are based on zip codes. Most of the Community Health Needs Assessment data are only available by county. In limited cases, King County data are made available by region; for Northwest Hospital these were the Seattle and North County regions. Sources of data include the U.S. Census Bureau American Community Survey, Washington State Department of Health, Behavioral Risk Factor Surveillance System, Washington State Health Care Authority, Public Health – Seattle and King County, County Health Rankings, Washington State Healthy Youth Survey, Uniform Data Set, CDC National Health Statistics, and others. When pertinent, these data sets are presented in the context of Washington State, framing the scope of an issue as it relates to the broader community. The report includes benchmark comparison data that measures Northwest Hospital community data findings with Healthy People 2020 objectives. Healthy People 2020 objectives are a national initiative to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels. Primary Data Collection The Community Health Needs Assessment conducted with the King County Hospitals for a Healthier Community (HHC) collaborative took into account input from people who represent the broad interests of the communities served by HHC hospitals and health systems. As noted in the King County Community Health Needs Assessment www.kingcounty.gov/healthservices/health/data/kchhc.aspx, three methods of gathering information on identified health needs and assets were used. 1. Interviews were conducted by Public Health-Seattle & King County staff between January and July of 2014 with stakeholder coalitions with broad representation. This method maximized the number and diversity of stakeholders who could provide input. Coalitions were identified that have expertise on identified health needs, have diverse membership, and have a regional or sub-regional focus. Northwest Hospital

Page 13

Stakeholders included those who represented the broad interests of the community, representatives of medically underserved, low-income and minority populations, and populations with chronic disease needs, as well as representatives from the local health department. Stakeholder groups included human service providers, community health centers, behavioral health providers, state, county, and local government staff, fire departments, law enforcement, advocacy organizations, hospital staff, groups focused on health disparities in communities of color, faith communities, labor, and managed care organizations. A total of 11 coalitions and 99 individual organizations or key informants provided information. The list of the stakeholder interview respondents from the King County Hospitals for a Healthier Community Collaborative can be found in Attachment 1. 2. An online survey was made available for those who were unable to attend the coalition meeting and wished to provide input in writing. Thirty-one individuals responded to the survey. 3. Recent reports on health needs were also reviewed for themes and relevant assets and resources. In addition, Northwest Hospital also conducted targeted interviews to gather information and opinions from persons who represent the broad interests of the community served by the Hospital. Seventeen (17) interviews were completed between December 2015 and February 2016. For the interviews, community stakeholders identified by Northwest Hospital were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, and minority populations, and regional, State or local health or other departments or agencies that have “current data or other information relevant to the health needs of the community served by the hospital facility.” A list of the stakeholder interview respondents, their titles, organizations and leadership roles can be found in Attachment 2. Public Comment In compliance with IRS regulations 501r for charitable hospitals, a hospital Community Health Needs Assessment (CHNA) is to be made widely available to the public and public comment on the CHNA is to be solicited. The previous Community Health Needs Assessment was made widely available to the public on the website http://nwhospital.org/aboutus/community-health-needs-assessment.asp. Public comment was solicited on the assessment report, however, to date, no written comments have been received.

Northwest Hospital

Page 14

Identification of Significant Health Needs Collaborative Effort A committee of representatives from Hospitals for a Healthier Community (HHC), facilitated by Public Health-Seattle & King County (PHSKC) staff, used a community health framework and population-based approach to identify significant health needs and develop criteria for indicators used to measure health needs. The group finalized the selection of indicators with feedback from public health and hospital staff. HHC and other representatives were subject matter experts who helped identify population-level health needs. The group reached consensus to focus particularly on:  Access to care  Preventable causes of death  Maternal and child health  Behavioral health  Violence and injury prevention Review of Primary and Secondary Data Based on the results of the primary and secondary data collection, significant health needs were identified. The health needs were based on the size of the problem (relative portion of population afflicted by the problem); or the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of a problem, the health needs identified in the secondary data were measured against benchmark data, specifically county or state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. Community stakeholders were asked to identify community and health issues based on the perceived size or seriousness of a problem. The significant health needs included:  Access to health care  Cancer  Heart disease  Mental health  Overweight/obesity  Preventive practices  Smoking  STD/HIV Resources to Address Significant Needs Through the interview process, community stakeholders identified community resources to address the significant health needs. The identified community resources are presented in Attachment 3. Northwest Hospital

Page 15

Priority Health Needs The identified significant health needs were prioritized with input from the community. Interviews with community stakeholders were used to gather input on the identified health needs. The following criteria were used to prioritize the health needs:  Severity – the perceived impact of the health need on the community.  Change over time – determination if the health need has improved, stayed the same or worsened.  Resources – availability of resources in the community to address the health need. The stakeholder interviewees were sent a link to an electronic survey (Survey Monkey) in advance of the interview. They were asked to rank each identified health need. The percentage of responses were noted as those that identified the need as having severe or very severe impact on the community, had worsened over time, and had a shortage of absence of resources available in the community. Not all survey respondents answered every question, therefore, the response percentages were calculated based on respondents only and not on the entire sample size. Mental health, access to health care, and overweight/obesity had the highest scores in the survey. This indicated severe impact in the community, a worsening of the issues over time and a shortage or absence of resources available in the community to address these needs. These results are listed in the table below.

Significant Health Needs

Severe and Very Severe Impact on the Community

Worsened over Time

Insufficient or Absent Resources in the Community

Access to health care

75%

50%

87.5%

Cancer

25%

0%

12.5%

Heart disease

25%

12.5%

25%

Mental health

100%

100%

88.9%

Overweight and obesity

55.5%

44.4%

62.5%

25%

25%

37.5%

Smoking

37.5%

0%

25%

STD/HIV

12.5%

12.5%

12.5%

Preventive practices

The community stakeholders were also asked to rank order the health needs according to highest level of importance in the community. The total score for each health need (possible score of 4) was divided by the total number of surveys for which data were provided, resulting in an overall average for each health need. The calculations resulted in the following prioritization of the significant health needs: Northwest Hospital

Page 16

Significant Health Needs

Priority Ranking (Total Possible Score of 4)

Mental health Access to health care Preventive practices Overweight and obesity Heart disease Cancer Smoking STD/HIV

4.00 3.67 3.56 3.44 3.11 3.00 3.00 3.00

Community input on these health needs is detailed throughout the CHNA report. Impact Evaluation In 2013, Northwest Hospital conducted their previous Community Health Needs Assessment (CHNA). Significant health needs were identified from issues supported by primary and secondary data sources gathered for the Community Health Needs Assessment. In developing the hospital’s Implementation Strategy associated with the 2013 CHNA, Northwest Hospital chose to address access to care, cancer and heart disease through a commitment of community benefit programs and resources. The evaluation of the impact of actions the hospital used to address these significant health needs can be found in Attachment 4.

Northwest Hospital

Page 17

Community Demographics Population The population of the Northwest Hospital service area is 598,493. Population, 5-Year Estimates, 2009-2013 ZCTA

Population

Bothell

98021

27,547

Bothell - Bothell/Mill Creek Edmonds Edmonds

98012 98020 98026

52,351 18,561 36,370

Kenmore Lynnwood Lynnwood

98028 98036 98037

20,896 36,597 27,546

Lynnwood Mountlake Terrace

98087 98043

31,120 20,195

Seattle - Ballard Seattle - Ballard/Crown Hill Seattle - Broadview/Richmond Beach

98107 98117 98177

21,996 30,719 18,642

Seattle - Greenlake/Greenwood/Wallingford Seattle - Haller Lake/Shoreline Seattle - Lake Forest Park Seattle - Maple Leaf/Wedgewood/Roosevelt/SandPoint Seattle - Pinehurst/Northgate/Lake City

98103 98133 98155 98115 98125

47,019 46,405 32,942 47,611 36,644

Seattle - University District Northwest Hospital Service Area

98105

45,332 598,493

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05.http://factfinder.census.gov

The hospital service area population is 51% female and 49% male. 49.9% of the residents in King County are male and 50.1% are female, while in Snohomish County the proportions are reversed. Population by Gender

Male Female

NW Hospital Service Area 49.0% 51.0%

49.9%

Snohomish County 50.1%

50.1%

49.9%

King County

Washington 49.9% 50.1%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05.http://factfinder.census.gov

Children and youth, ages 0-19, make up 21.9% of the population; 66.3% are adults, ages 20-64; and 11.8% of the population are seniors, ages 65 and over. The population in the Northwest Hospital service area tends to have a higher percentage of adults, and a lower percentage of children than found in the state or county.

Northwest Hospital

Page 18

Population by Age Northwest Hospital Service Area Number Percent

King County Number

Percent

Snohomish County Number Percent

Washington Number

Percent

Age 0-4 Age 5-19 Age 20-24 Age 25-44

34,769 96,270 47,077 192,096

5.8% 16.1% 7.9% 32.1%

122,921 344,104 131,782 625,434

6.2% 17.4% 6.7% 31.7%

47,177 144,103 46,217 205,944

6.5% 441,534 19.9% 1,325,537 6.4% 477,368 28.4% 1,869,737

6.5% 19.4% 7.0% 27.4%

Age 45-64

157,614

26.3%

527,630

26.7%

202,568

28.0% 1,834,084

26.9%

Age 65+ Total

70,667 598,493

11.8% 222,696 100% 1,974,567

11.3% 100%

78,618 724,627

10.8% 871,319 100% 6,819,579

12.8% 100%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05. http://factfinder.census.gov

When the service area is examined by community, Bothell/Mill Creek (26.9%) has the highest percentage of youth, ages 0-19, followed closely by Lynnwood zip 98087 (26.7%). Seattle Ballard (12.0%) and Seattle - Greenlake/Greenwood/Wallingford (14.4%) have the lowest percentage of youth in the service area. Youth, Ages 0-19, as a Percent of Population ZCTA

Percent

Bothell Bothell - Bothell/Mill Creek

98021 98012

25.4% 26.9%

Edmonds

98020

20.3%

Edmonds Kenmore

98026 98028

24.2% 25.5%

Lynnwood Lynnwood

98036 98037

24.3% 25.0%

Lynnwood Mountlake Terrace Seattle - Ballard

98087 98043 98107

26.7% 22.6% 12.0%

Seattle - Ballard/Crown Hill Seattle - Broadview/Richmond Beach Seattle - Greenlake/Greenwood/Wallingford Seattle - Haller Lake/Shoreline

98117 98177 98103 98133

20.0% 21.7% 14.4% 18.9%

Seattle - Lake Forest Park Seattle - Maple Leaf/Wedgewood/Roosevelt/SandPoint

98155 98115

22.0% 20.2%

Seattle - Pinehurst/Northgate/Lake City Seattle - University District

98125 98105

17.7% 25.7%

Northwest Hospital Service Area Washington

21.9% 25.9%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05. http://factfinder.census.gov

Northwest Hospital

Page 19

The percent of the population 65 years and older in the service area is 11.8%, which is lower than the state rate of 12.8%. Nearly one-quarter of the population of Edmonds 98020 (23.5%) is 65 years old and over. The Seattle-University District has the lowest percentage of seniors in the service area at 6.5%. Seniors as a Percent of Population ZCTA

Percent

Bothell

98021

11.5%

Bothell - Bothell/Mill Creek Edmonds

98012 98020

10.0% 23.5%

Edmonds Kenmore Lynnwood

98026 98028 98036

13.4% 13.3% 11.8%

Lynnwood

98037

12.1%

Lynnwood Mountlake Terrace Seattle - Ballard Seattle - Ballard/Crown Hill Seattle - Broadview/Richmond Beach

98087 98043 98107 98117 98177

7.5% 11.8% 9.4% 10.1% 20.1%

Seattle - Greenlake/Greenwood/Wallingford Seattle - Haller Lake/Shoreline

98103 98133

8.1% 15.8%

Seattle - Lake Forest Park Seattle - Maple Leaf/Wedgewood/Roosevelt/SandPoint Seattle - Pinehurst/Northgate/Lake City

98155 98115 98125

13.7% 11.3% 13.6%

Seattle - University District Northwest Hospital Service Area Washington

98105

6.5% 11.8% 12.8%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05. http://factfinder.census.gov

Race/Ethnicity The majority population (71.4%) in the Northwest Hospital service area identifies as White/Caucasian, with 13.0% of the population identifying as Asian, 7.0% of the population as Hispanic/Latino, and 3% of the population is Black/African American. The remaining racial/ethnic groups make up less than 1.1% of the population, with the exception of multiracial (two-or-more races) at 4.5% of the population.

Northwest Hospital

Page 20

Population by Race and Ethnicity Race/Ethnicity White Asian Hispanic or Latino Black/African American Multiracial All other

Northwest Hospital Service Area 71.4% 13.0% 7.0% 3.0% 4.5% 1.1%

King County 64.2% 14.7% 9.0% 6.0% 4.5% 1.6%

Snohomish County 73.7% 9.1% 9.2% 2.3% 4.1% 1.6%

Washington 71.9% 7.3% 11.5% 3.5% 3.9% 1.9%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05. http://factfinder.census.gov

When race/ethnicity is examined by place, Lynnwood 98087 has the highest percentage of Asians (21.8%) and Mountlake Terrace has the highest percentage of Latinos (12.7%) in the service area. The Haller Lake/Shoreline area of Seattle has the highest percentage of Blacks (6.6%) in the service area, while Ballard/Crown Hill has the highest percentage of Whites (87%). Race/Ethnicity by Place

Bothell

98021

75.8%

14.6%

Hispanic Latino 4.3%

Bothell - Bothell/Mill Creek Edmonds

98012 98020

67.3% 82.8%

18.8% 6.8%

6.7% 4.0%

1.5% 1.9%

Edmonds Kenmore Lynnwood

98026 98028 98036

77.5% 72.0% 62.7%

9.1% 11.6% 14.4%

4.8% 9.9% 11.4%

3.2% 1.7% 4.2%

Lynnwood Lynnwood Mountlake Terrace Seattle - Ballard Seattle - Ballard/Crown Hill

98037 98087 98043 98107 98117

58.5% 53.0% 67.0% 81.9% 87.0%

19.0% 21.8% 11.9% 6.2% 4.7%

12.0% 11.7% 12.7% 6.8% 3.8%

4.8% 5.2% 3.3% 1.7% 0.4%

Seattle - Broadview/Richmond Beach Seattle - Greenlake/Greenwood/ Wallingford Seattle - Haller Lake/Shoreline Seattle - Lake Forest Park Seattle - Maple Leaf/Wedgewood/ Roosevelt/SandPoint Seattle - Pinehurst/Northgate/Lake City Seattle - University District Northwest Hospital Service Area Washington

98177

83.2%

8.2%

4.6%

1.5%

98103

78.5%

8.2%

5.8%

1.5%

98133 98155

62.6% 70.6%

14.4% 10.9%

9.1% 7.3%

6.6% 5.8%

98115

81.0%

8.6%

3.7%

1.9%

98125 98105

65.6% 68.9% 71.4% 71.9%

16.0% 19.2% 13.0% 7.3%

7.3% 3.8% 7.0% 11.5%

5.7% 1.7% 3.0% 3.5%

ZCTA

White

Asian

Black 0.8%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP05. http://factfinder.census.gov

Northwest Hospital

Page 21

Language The languages spoken at home by area residents mirror the racial/ethnic make-up of the Northwest Hospital service area communities, with more Asian-language speakers and fewer Spanish-speakers than seen statewide. Language Spoken at Home for the Population 5 Years and Over

Population 5 years and older English only Speaks Spanish

Northwest King Snohomish Hospital Washington County County Service Area 563,724 1,851,646 677,450 6,378,045 78.6% 74.1% 81.3% 81.5% 4.8% 6.6% 6.1% 8.2%

Speaks other Indo-European languages Speaks Asian and Pacific Islander languages

5.0% 9.6%

6.2% 11.0%

4.3% 6.9%

3.8% 5.6%

Speaks other languages

2.0%

2.1%

1.4%

1.0%

Source: U.S. Census Bureau, American Community Survey, 2009-2013, DP02. http://factfinder.census.gov

Northwest Hospital

Page 22

Social and Economic Factors Social and Economic Factors Ranking The County Health Rankings ranks counties according to health factors data. Social and economic indicators are examined as a contributor to the health of a county’s residents. Washington’s 39 counties are ranked according to social and economic factors with 1 being the county with the best factors to 39 for that county with the poorest factors. This ranking examines: high school graduation rates, unemployment, children in poverty, social support, and others. King County is ranked first, and Snohomish County second out of all Washington counties, according to social and economic factors, an improvement from 6th and 12th place, respectively, from 3 years ago. Social and Economic Factors Ranking County Ranking (out of 39) King County Snohomish County

1 2

Source: County Health Rankings, 2016 http://www.countyhealthrankings.org

Unemployment The unemployment rate in the hospital service area averaged over 5 years was 5.4%, the same as for King County, and lower than Snohomish (6.3%) and the state rate of 6%. Employment Status for the Population 16 and Over, 2009-2013 Northwest Hospital Service Area King County Snohomish County Washington

Civilian Labor Force 350,848 1,117,065 388,068 3,476,885

Unemployed 26,957 86,550 36,021 327,155

Unemployment Rate 5.4% 5.4% 6.3% 6.0%

Source: U.S. Census Bureau, 2009-2013 American Community Survey, 5-year estimates, DP03. http://factfinder.census.gov

Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2013, the federal poverty level (FPL) for one person was $11,490 and for a family of four $23,550. Among the residents in the Northwest Hospital service area, 10.9% are at or below 100% of the federal poverty level (FPL) and 22.2% are at 200% of FPL or below. These rates of poverty are lower than found in the state where 13.4% of residents are at poverty level and 30% are at 200% of FPL or below.

Northwest Hospital

Page 23

Poverty Levels