holy cross hospital
Post on 17-Apr-2022
10 Views
Preview:
TRANSCRIPT
HOLY CROSS HOSPITAL
Community Health Needs Assessment FY 2015
TABLE OF CONTENTS
PageiHolyCrossHospital
ListofFigures_____________________________________________________________________________________________ii
ListofTables_____________________________________________________________________________________________ iv
Executivesummary ______________________________________________________________________________________v
Introduction ______________________________________________________________________________________________1
ApproachandMethodology_____________________________________________________________________________5
TheCommunityWeServe_______________________________________________________________________________9
SocialDeterminantsofHealth_________________________________________________________________________ 12
HealthIndicators_______________________________________________________________________________________ 18
DataGapsIdentified____________________________________________________________________________________ 44
ResponsetoFindings___________________________________________________________________________________ 45
References______________________________________________________________________________________________ 48
PageiiHolyCrossHospital
LIST OF FIGURES
Figure1:TheCNIoftheprimaryserviceareaofHolyCrossHospital............................................6
Figure2:PrimaryandsecondaryserviceareaforHolyCrossHospital.........................................9
Figure3:Marylandforeign‐bornpopulationdistributionbycounty...........................................10
Figure4:65+PopulationprojectionsforMontgomeryandPrinceGeorge'sCounties........11
Figure5:TotalnumberenrolledinaMedicaidplanbycounty......................................................13
Figure6:MarylandQualifiedHealthPlanEnrollmentsbycounty,asofMay31,2014........13
Figure7:Percentageoftotaluninsuredpersonspercounty...........................................................13
Figure8:Thepercentageofthetotalciviliannon‐institutionalizedpopulationwithouthealthinsurancecoverage...............................................................................................................................14
Figure9:Unemploymentrateforpopulationaged16andoverbyraceandethnicity........14
Figure10:Civilians,16yearsofageandover,whomareunemployed.......................................15
Figure11:Percentageofrentersspendingmorethan30%ofincomeonrent.......................15
Figure12:Medianhouseholdincomebyrace........................................................................................16
Figure13:Percentageofthepopulationaged25yearsandolderwithnohighschooldiploma....................................................................................................................................................................17
Figure14:Age‐adjusteddeathrateper100,000populationduetocancer..............................19
Figure15:YearlypercentageofMedicarebeneficiarieswhoweretreatedforcancer.........19
Figure16:Age‐adjustedincidencerateforbreastcancerincasesper100,000females....20
Figure17:Age‐adjusteddeathrateper100,000femalesduetobreastcancer......................20
Figure18:Thepercentageofadultsaged50andoverwhohaveeverhadasigmoidoscopyorcolonoscopyexam.........................................................................................................................................21
Figure19:Theage‐adjustedincidencerateforcolorectalcancer.................................................22
Figure20:Theage‐adjusteddeathrateduetocolorectalcancer..................................................22
Figure21:Thepercentageofwomenaged18andoverwhohavehadaPapsmearinthepastthreeyears....................................................................................................................................................23
Figure22:Theage‐adjustedincidencerateforcervicalcancer.....................................................23
Figure23:Theage‐adjustedincidencerateforprostatecancer....................................................24
Figure24:Theage‐adjusteddeathrateduetoprostatecancer.....................................................24
Figure25:Theage‐adjusteddeathrateduetolungcancer.............................................................26
Figure26:Theage‐adjustedincidencerateforlungandbronchuscancers.............................26
PageiiiHolyCrossHospital
Figure27:Theage‐adjusteddeathrateduetolungcancer.............................................................26
Figure28:Percentageofdeathsfromheartdiseasebyrace...........................................................27
Figure29:Thepercentageofadultswhohavebeentoldtheyhavehighbloodpressure..28
Figure30:Thepercentageofadultswhohaveeverbeendiagnosedwithdiabetes.............30
Figure31:Theaverageannualage‐adjustedemergencyroomvisitrateduetodiabetes..31
Figure32:Thepercentageofadultswhoareoverweightorobese..............................................32
Figure33:Thepercentageofmaleandfemaleadultswhoareoverweightorobese...........32
Figure34:Thepercentageofadultswhoengageinmoderatephysicalactivity.....................32
Figure35:Healthyfoodindexscores.........................................................................................................33
Figure36:Percentageofadultswhoreporttheyhavebeendiagnosedwithadepressivedisorder...................................................................................................................................................................34
Figure37:Marylandsuicidedeathsbyraceandsex...........................................................................35
Figure38:Averageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabusebyageandsex.........................................................................................................................36
Figure39:Averageannualage‐adjustedemergencyroomvisitratebyrace/ethnicity......36
Figure40:PercentageofLBWbirthsbyageandrace/ethnicityofmother..............................38
Figure41::LeadingcausesofdeathintheMontgomeryCountypopulationaged65andover............................................................................................................................................................................40
Figure42::LeadingcausesofdeathinthePrinceGeorge'sCountypopulationaged65andover...................................................................................................................................................................40
Figure43:DeathsfromaccidentsinMontgomeryCountyfrom2000‐2010............................41
Figure44:DeathsfromaccidentsinPrinceGeorge'sCountyfrom2000‐2010......................42
Figure45:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbyrace.................................................................................................................................43
Figure46:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbypayer..............................................................................................................................43
Figure47:HealthyMontgomeryprioritiesandoverarchingthemes...........................................45
Figure48:HowHolyCrossHealthalignstargetedprogramswiththemissionandstrengthsofthehospitalandunmetcommunityneeds.....................................................................47
PageivHolyCrossHospital
LIST OF TABLES
Table1:DemographicbreakdownofHolyCrossHospital'sserviceareabyraceandethnicity.....................................................................................................................................................................9
Table2:TopfiveleadingcausesofdeathforMontgomeryandPrinceGeorge'sCounties.18
Table3:HealthyMontgomeryBreastCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................21
Table4:HealthyMontgomeryColorectalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................22
Table5:HealthyMontgomeryCervicalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................24
Table6:HealthyMontgomeryProstateCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................25
Table7:Numberofadults,aged18+,whoself‐reportedcurrentlysmokingcigarettessomedaysoreveryday................................................................................................................................................25
Table8:HealthyMontgomeryLungCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................27
Table9:HealthyMontgomeryCardiovascularDiseaseIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................................29
Table10:Costofdiabetes................................................................................................................................30
Table11:HealthyMontgomeryDiabetesIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD)............................................................................................31
Table12:BodyMassIndexchart..................................................................................................................31
Table13:HealthyMontgomeryObesityIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD)............................................................................................33
Table14:HealthyMontgomeryBehavioralHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................................37
Table15:HealthyMontgomeryMaternalandChildHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................39
Table16:HolyCrossHospital'sAmbulatoryCareSensitiveConditiondischarges................43
PagevHolyCrossHospital
EXECUTIVE SUMMARY
In2010,CongressenactedthePatientProtectionandAffordableCareActthatrequiresnon‐profithospitalstoconductacommunityhealthneedsassessmentandadoptanimplementationstrategyeverythreeyears.HolyCrossHealth,aCatholicnot‐for‐profithealthsystembasedinMontgomeryCounty,Maryland,hasbeenconductingneedsassessmentsfor15years.Beginningin2009,HolyCrossHealthpartneredwithHealthyMontgomery,MontgomeryCounty'sCommunityHealthImprovementProcesstodeterminethesignificantunmetneedsofthecommunity,consistentwiththenewIRSrequirements.HolyCrossHealthalsoreviewedandanalyzeddatafrommultiplesourcesincludingDignityHealth'sCommunityHealthNeedIndex,UniversityofWisconsinPopulationHealthInstitute'sCountyHealthRankingsData,andotheravailableneedsassessmentsandreports.
ThiscommunityhealthneedsassessmentfocusesonthegeographicareasHolyCrossHospitalserves.Itprovidesthefoundationfortheorganization'seffortstoguidecommunitybenefitplanningtoimprovethehealthstatusofthecommunityserved.HolyCrossHospitalservesalargeportionofMontgomeryandPrinceGeorge’sCountiesresidents,oneofthemostculturallyandethnicallydiversecommunitiesinthenation.MontgomeryandPrinceGeorge'sCountiesarefairlyaffluentintermsofwealthandcommunityresources,however,thecomplexityofthecommunitychallengesthehospital,thecountyhealthdepartments,community‐basedorganizationsandotherorganizationstounderstandandaddressunmetneeds.
Althoughaccesstoquality,affordablehealthcareplaysasignificantroleinthehealthofindividuals,healthisalsoaffectedbyothersocialdeterminants.Understandingsocialdeterminantsofhealth,suchaseconomicsandeducation,canalsoleadtoreductionsinhealthdisparitiesandimprovementsinhealthindicators.
Healthindicators,suchascausesofdeath,breastcancerrates,obesityandfruitconsumption,canbeusedtodescribetheoverallhealthofapopulationanddetermineunmetcommunityneed.Whereavailable,themostcurrentandup‐to‐datedatawasusedtodeterminethehealthneedsofthecommunity.However,datagapsexist.Forexample,manydataarenotavailablebygeographicareaswithinMontgomeryorPrinceGeorge'sCountyandhealthriskdataonsubpopulationssuchasHispanic/Latinopopulationsaredifficulttomeasure.
PageviHolyCrossHospital
TheHealthyMontgomerySteeringCommitteeanalyzedavailabledataonmorethan100indicatorstodeterminethetop‐rankedpriorityareasforthecounty:BehavioralHealth,Obesity,Cancers,MaternalandInfantHealth,Diabetes,andCardiovascularHealth.Inadditiontoselectingthesixbroadprioritiesforaction,theHealthyMontgomerySteeringCommitteeselectedthreeoverarchingthemesforallpriorities:lackofaccess,healthinequities,andunhealthybehaviors.
BuildingupontheHealthyMontgomerytop‐rankedprioritiesandthreeoverarchingthemes,HolyCrossHealthaddedmeetingtheneedsofthegrowingseniorpopulationasapriority.HolyCrossHealthalsorankedtheprioritiesbasedonseverity,feasibility,potentialtoachieveoutcomesandprevalenceinthepopulation.Usingscoresfromeachofthecategorieslisted,thefollowingisaprioritizedlistofthesignificantunmetneedsidentified:
1. Maternal&InfantHealth2. Seniors3. CardiovascularHealth4. Obesity5. Diabetes6. BehavioralHealth7. Cancers
Withthisinformation,HolyCrossHealthwilladdresstheunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.HolyCrossHealthwillfocusourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniorsandracial,ethnicandlinguisticminorities.
ForfurtherinformationonhowHolyCrossHealthplanstoaddresseachidentifiedunmetneedpleasereviewourMulti‐YearCommunityBenefitImplementationPlanathttp://www.holycrosshealth.org/community‐benefit‐implementation‐plan.
Page1HolyCrossHospital
INTRODUCTION
In2010,CongressenactedthePatientProtectionandAffordableCareAct(TheAffordableCareAct),whichputsinplacecomprehensivehealthinsurancereformtoenhancethequalityofhealthcareforallAmericans.Inanefforttoenhancethequalityofhealthcare,theAffordableCareActalsorequiresnon‐profithospitalstoconductacommunityhealthneedsassessmentandadoptanimplementationstrategy,aplandescribinghowthehospitalwilladdresstheneedsidentified,everythreeyears.
HolyCrossHealthhasevaluatedtheneedsofitscommunitytosupportitscommunitybenefitplansfor15years.Doingsoisconsistentwiththeorganization'smissionandvalues.ItalsocloselyalignswithadvancingHolyCrossHealth'sstrategicprinciples.
MissionStatement
We,HolyCrossHealthandCHETrinityHealth,servetogetherinthespiritoftheGospelasacompassionateandtransforminghealingpresencewithinourcommunities.Wecarryoutthismissioninourcommunitiesthroughourcommitmenttobethemosttrustedproviderofhealthcareservices.
HolyCrossHealth'steamwillachievethistrustthrough:
Innovative,high‐qualityandsafehealthcareservicesforallinpartnershipwithourphysiciansandothers
Accessibilityofservicestoourmostvulnerableandunderservedpopulations Outreachthatrespondstocommunityhealthneedandimproveshealthstatus Ongoinglearningandsharingofnewknowledge Ourfriendly,caringspirit
CoreValues
Reverence:Wehonorthesacrednessanddignityofeveryperson Commitmenttothosewhoarepoor:Westandwithandservethosewhoarepoor,
especiallythosemostvulnerable Justice:Wefosterrightrelationshipstopromotethecommongood,including
sustainabilityofEarth
Page2HolyCrossHospital
Stewardship:Wehonorourheritageandholdourselvesaccountableforthehuman,financialandnaturalresourcesentrustedtoourcare
Integrity:Wearefaithfultowhowesayweare
HolyCrossHealth'sfiscal2015‐2018strategicplanidentifiesthreestrategicprinciplesthatareresponsivetoourmissioncommitmentsandtheenvironmentinwhichweoperate.
Attractmorepeople,serveeveryone Managequality,costsandrevenueeffectively
Improveandsustainindividualandcommunityhealththroughinnovation,alignment,andpartnership.
ThesestrategicprinciplesguideHolyCrossHealth'soveralldevelopmentandinparticular,advanceourpopulationhealthefforts,whichincludeourcommunityhealthneedsassessmentandtheassociatedcommunitybenefitplan.
Duringthelastseveralyears,theterm"populationhealth"hasbeenusedtodescribeeffortstoimprovepatientoutcomesandcommunityhealthstatuswhilemanagingcosts.Asanemergingterm,thereisnooneanswertohow"population"shouldbedefined.Forinstance,publichealthagenciestypicallydefineapopulationbasedongeographicareasstratifiedbydemographiccharacteristicssuchasrace,ethnicityorincome.Healthcaredeliverysystemsdefinepopulationsbasedonindividualpatientstheyservesuchasdiabeticorcongestiveheartfailurepatients(Gourevitch,Cannell,Boufford,&Summers,2012).Populationscanalsobedefinedasgroupsforwhichanentitysuchasaninsureroremployerbearsfinancialriskforhealthcareutilization.Althoughthedefinitiondiffersbetweenpolicy,publichealth,healthcare,andotherhealthfields,apopulationhealthorientationprovidestheopportunityfororganizationsfocusedonhealthimprovement,includinghealthcaredeliverysystems,toworktogethertoachievepositiveoutcomesinthecommunitiestheyserve(Stoto,2013).
ThiscommunityhealthneedsassessmentfocusesonthegeographicareasHolyCrossHospitalserves.Itprovidesthefoundationfortheorganization'seffortstoguidecommunitybenefitplanningtoimprovethehealthstatusofthepeopleinHolyCrossHospital'sservicearea.
Page3HolyCrossHospital
OVERVIEW OF HOLY CROSS HEALTH
HolyCrossHealthisaCatholicnot‐for‐profithealthsystembasedinMontgomeryCounty,Maryland,thathasnearly200,000patientvisitseachyear.Weofferafullrangeofinpatient,outpatientandinnovativecommunity‐basedservices,andaretheregion'sonlythree‐timewinnerofTheJointCommission’shighestqualityaward.HolyCrossHealthhasa1,500membermedicalstaff,employsnearly4,000people,hasalmost600volunteersandistheonlyhealthcareproviderinMarylandtoreceivetheWorkplaceExcellenceSealofApprovalAwardeachyearsince1999fromthegreaterWashington,D.C.,AllianceforWorkplaceExcellence.HolyCrossHealthiscomprisedofHolyCrossHospital,HolyCrossGermantownHospitalandHolyCrossHealthNetwork.
HolyCrossHospital:LocatedinSilverSpring,HolyCrossHospitalisoneofthelargesthospitalsinMaryland.Foundedmorethan50yearsagoin1963bytheCongregationoftheSistersoftheHolyCross,todayHolyCrossHospitalisateachinghospitalwith391adultandpediatriclicensedbeds,aneonatalunitwith159bassinets,andanon‐siteobstetrics/gynecologyoutpatientclinicforuninsuredwomen.Thehospitaloffersafullrangeofinpatientandoutpatientservices,withspecializedexpertiseinseniorservices,womenandinfantservices,surgery(particularlygynecological),neuroscience,andcancer.
HolyCrossGermantownHospital:InOctober2014,HolyCrossHealthopenedHolyCrossGermantownHospital,thefirstnewhospitalinMontgomeryCountyin35years.Thehospitalservesthemostrapidlygrowingregioninthecountyandprovidesaccesstohigh‐qualitycareinanareathathadpreviouslybeen,byfar,thelargestconcentrationofpeoplewithoutahospitalinthestate.HolyCrossGermantownHospitalhas93adultlicensedbedsandaneonatalunitwitheightlicensedbassinets.Thehospitaloffersemergency,medical,surgical,obstetric,neonatalandpsychiatriccaretomeetafullrangeofcommunityneeds.Allpatientroomsareprivatetoenhancepatientsafetyandsatisfaction,aswellaspatient,familyandvisitorcomfort.ThehospitalisequippedwiththelatesttechnologytoenhancepatientcareandmeetstheLEEDGoldstandardsforenvironmentalsustainability.
HolyCrossHealthNetwork:Establishedin2012,HolyCrossHealthNetworkisanoperatingdivisionwithinHolyCrossHealththatisfocusedoncreatingtherelationshipsandprogramsthatwillhelpHolyCrossHealthbettermanagecareinthecommunitiesitserves.HolyCrossHealthNetworkoperatesHolyCrossHealthCentersinSilverSpring,GaithersburgandAspenHill.Theseprimarycaresitesservelow‐incomepatientswhoareuninsuredorareenrolledinMedicaid.HolyCrossHealthNetworkalsooperatesallofHolyCrossHealth'scommunityhealthprogramsandoutreach.
Page4HolyCrossHospital
Beyondourcampuses,weprovideserviceatmultiplelocations,includingavitalagingcenterforseniors.Wehaveestablishedgeographicpresenceat23sitesthathostourseniorexerciseprogramandin63churchesthroughourfaithcommunitynurseprogram.
Page5HolyCrossHospital
APPROACH AND METHODOLOGY
HolyCrossHealthhasbeenconductingneedsassessmentsformorethan15yearsandidentifiesunmetcommunityhealthcareneedsinourcommunityinavarietyofways.WecollaboratewithotherhealthcareproviderstosupportHealthyMontgomery,MontgomeryCounty'scommunityhealthimprovementprocess.WeusetheCommunityHealthNeedIndexandotheravailablereportsandassessments.Wealsoconductanextensiveanalysisofdemographics,healthindicatorsandsocialdeterminantsofhealthofthecommunitiesweserve.Finally,weseekexpertguidancefromapanelofexternalparticipantswithexpertiseintheneedsofourcommunity.
HEALTHY MONTGOMERY
HealthyMontgomeryisMontgomeryCounty'shealthimprovementprocessandservesasthebaseforHolyCrossHealth'sneedsassessment.Ithasfourobjectives:(1)Toidentifyandprioritizehealthneedsinthecountyasawholeandinthediversecommunitieswithinthecounty;(2)Toestablishacomprehensivesetofindicatorsrelatedtohealthprocesses,healthoutcomesandsocialdeterminantsofhealthinMontgomeryCountythatincorporateawidevarietyofcountyandsub‐countyinformationresourcesandutilizemethodsappropriatetotheircollection,analysisandapplication;(3)Tofosterprojectstoachievehealthequitybyaddressinghealthandwell‐beingneeds,improvinghealthoutcomesandreducingdemographic,geographic,andsocioeconomicdisparitiesinhealthandwell‐being;and(4)TocoordinateandleverageresourcestosupporttheHealthyMontgomeryinfrastructureandimprovementprojects.
HealthyMontgomerybeganin2010whenHolyCrossHospitalandtheotherthreehospitalsystemsinMontgomeryCountyeachgave$25,000,foratotalof$100,000,totheUrbanInstitutetoprovidesupportfortheHealthyMontgomerywork.Thisincludedcoordinatingtheenvironmentalscan,whichlookedatalltheexistingsourcesofdata(e.g.,vitalstatistics,DepartmentofHealthandMentalHygiene)andneedsassessmentsandimprovementplansfromorganizationsinMontgomeryCounty(manyofthesedocumentsarenowavailablethroughtheHealthyMontgomerywebsite),supportoftheefforttoselectthe100indicatorstoincludeintheimprovementprocess,preparationofindicatorsandmapsthatshowthesocialdeterminantsofhealthforthecountyasawholeandforPublicUseMicrodataAreas(PUMAs)thatwillbeincludedintheHealthyMontgomeryNeedsAssessmentdocument.
Page6HolyCrossHospital
Since2011,HolyCrossHospitalandthefourotherindividualhospitals(MedStarMontgomeryMedicalCenter,ShadyGroveAdventistHospital,SuburbanHospital,andWashingtonAdventistHospital)haveeachgiven$25,000,foratotalof$125,000peryear,totheInstituteforPublicHealthInnovation.ThesefundscontinuetosupporttheHealthyMontgomerySteeringCommitteemeetings,preparationandpresentationofallofthecommunityconversations,preparationoftheNeedsAssessmentReport(quantitativedataandinformationfromthecommunityconversations),supportoftheSteeringCommitteeindeterminingselectioncriteriathatwillbeusedtochoosetheprioritiesforcommunityhealthimprovement,andsupportforthepriorityselectionprocess.
HealthyMontgomeryisundertheleadershipoftheHealthyMontgomerySteeringCommittee,whichincludesplanners,policymakers,healthandsocialserviceprovidersandcommunitymembers(seeAppendixA).Itisanongoingprocessthatincludesperiodicneedsassessments,developmentandimplementationofimprovementplansandmonitoringoftheresultingachievements.Theprocessisdynamic,thusgivingthecountyanditscommunitypartnerstheabilitytomonitorandactonthechangingconditionsaffectingthehealthandwell‐beingofcountyresidents.ThematerialpresentedinthisdocumentisbasedonMontgomeryCounty’sCommunityHealthNeedsAssessmentconductedduring2015‐2018.
PrinceGeorge’sCountydoesnothaveasimilarcounty‐widedataprogramsoHolyCrossHealthusedthedatasourcesfoundinHealthyMontgomerytoextractdatathatwasspecifictoPrinceGeorge’sCountysothathealthinformationcouldbeanalyzedforbothcounties.TheUniversityofWisconsinPopulationHealthInstitute'sCountyHealthRankingsData(seeAppendixB),andHolyCrossHospital'sEmergencyDepartmentanddischargereadmissionsdatawerealsoanalyzedtodetermineunmetneedsofthepopulationweserveresidinginMontgomeryandPrinceGeorge'sCounties.
COMMUNITY NEED INDEX
TheCommunityNeedIndex(seeFigure1)identifiestheseverityofhealthdisparitiesforeveryZIPcodeintheUnitedStatesanddemonstratesthelinkbetweencommunityneed,accesstocare,andpreventablehospitalizations(DignityHealth,2011).ForeachZIPcodeintheUnitedStates,theCommunityNeedIndex Figure1:TheCNIoftheprimaryserviceareaofHoly
CrossHospitalis3.2,however,severalZIPcodesthroughoutthecountyrankashighneedareas.Source:DignityHealth,2014Mapdata:2014©Google.
Page7HolyCrossHospital
aggregatesfivesocioeconomicindicators/barrierstohealthcareaccessthatareknowntocontributetohealthdisparitiesrelatedtoincome,education,culture/language,insuranceandhousing.WeusetheCommunityNeedIndextoidentifycommunitiesofhighneedanddirectarangeofcommunityhealthandfaith‐basedcommunityoutreacheffortstotheseareas.
EXTERNAL REVIEW
Eachyearsince2005,wehaveinvitedinputandobtainedadvicefromagroupofexternalparticipantsthatrepresentthebroadinterestofthecommunityweserve.Thegroupreviewsourcommunitybenefitplan,annualworkplan,foundation/keybackgroundmaterial,anddatasupplementstoadviseusonprioritycommunityneedsandthedirectiontotakeforthenextyear.
ExternalgroupparticipantsincludethepublichealthofficerandthedirectorofMontgomeryCountyDepartmentofHealthandHumanServices;avarietyofindividualsfromlocalandstategovernmentalagencies;andleadersfromcommunity‐basedorganizations,foundations,churches,colleges,coalitions,andassociations(seeAppendixC).Theseparticipantsareexpertsinarangeofareasincludingpublichealth,minoritypopulationsanddisparitiesinhealthcare,socialdeterminantsofhealth,healthcare,andsocialservices.Throughgroupdiscussion,theyprovideinputthathelpstoensurethatwehaveidentifiedandrespondedtothemostpressingcommunityhealthcareneeds.Onanongoingbasisweparticipateinavarietyofcoalitions,commissions,committees,partnershipsandpanelsandourcommunityhealthworkersspendtimeinthecommunityascommunityparticipantsandbringbackfirst‐handknowledgeofcommunityneeds.
READMISSION DATA AND PREVENTION QUALITY INDICATORS
HolyCrossHospitalreadmissiondataisusedtotrackthenumberofpatientswhoarereadmittedtothehospitalwithin30daysofdischarge.CentersforMedicare&MedicaidServices(CMS),defineshospitalreadmissionasapatientadmissiontoahospitalwithin30daysafterbeingdischargedfromanearlierhospitalstayandthedatacanbeusedtoevaluatethequalityofhospitalcare.PreventionQualityIndicators(PQI)areasetofmeasuresthatareusedwithinpatientdischargedatatoidentifyqualityofcareforambulatorycaresensitiveconditions,conditionsthatevidencesuggestscouldhavebeenpotentiallyavoidedthroughbetteroutpatientcare(AgencyforHealthcareResearchandQuality,2014).AnanalysisofhospitalreadmissionsandPQIallowustoidentifyselect
Page8HolyCrossHospital
indicatorsrelatedtocommunityhealthneedsanddevelopmethodologiesandprogramsthatwillimprovehealthoutcomes.
NEEDS ASSESSMENTS AND REPORTS
Asavailable,wealsousearangeofotherspecificneedsassessmentsandreportstoidentifyunmetneeds,especiallyforunderservedminorities,seniors,andwomenandchildren.Ourworkisbuiltonpastavailableneedsassessments,andweusethesedocumentsasreferencetools,includingthefollowingkeyresourcesthatbecameavailablemorerecently:
MarylandStateHealthImprovementProcess PrinceGeorge'sCountyHealthImprovementPlan2011‐2014 AfricanAmericanHealthProgramStrategicPlanTowardHealthEquity,2009‐
2014; BlueprintforLatinoHealthinMontgomeryCounty,Maryland,2008‐2012; AsianAmericanHealthPriorities,AStudyofMontgomeryCounty,Maryland,
Strengths,Needs,andOpportunitiesforAction,2008.
OTHER AVAILABLE DATA
Wealsoreviewourowninternalpatientdataandreviewpurchasedandpubliclyavailabledataandanalysesonthemarket,demographicsandhealthserviceutilization,healthindicatorsandsocialdeterminantsofhealth.Thesedataprovideamoredetailedlookatthecommunityweservebyidentifyingpotentialdisparitiesthatmightnotsurfacewhenlookingatonlycountyorstatedata.Thisinformationthenassistsusindevelopingprogramstomeetthecomplexneedsofthecommunity;payingspecialattentiontovulnerablepopulations.
Page9HolyCrossHospital
Race
Primary Service Area
(641,761)
Total Service Area
(1.7 Million)
White, Non‐Hispanic
212,388 (33.1%)
533,623 (31.4%)
Black, Non‐Hispanic
173,751 (27.1%)
625,033 (36.8%)
Hispanic 168,264 (26.2%)
319,042 (18.8%)
Asian/Pacific Islander, Non‐ Hispanic
68,361 (10.7%)
169,507 (10.0%)
All Others 18,997 (3.0%)
49,850 (2.9%)
Table1:DemographicbreakdownofHolyCrossHospital'sserviceareabyraceandethnicity.©2013TheNielsenCompany,©2013TruvenHealthAnalyticsInc.
THE COMMUNITY WE SERVE
HOLY CROSS HOSPITAL
HolyCrossHospitalservesalargeportionofMontgomeryandPrinceGeorge’sCountiesresidents(seeFigure2).Our21ZIPcodeprimaryservicearea(seeAppendixD)includes641,761people,ofwhom66.9%areminorities.Anestimated1.7millionpeoplein60ZIPcodesmakeupourtotalservicearea,ofwhom68.6%areminorities(seeTable1).OurprimaryserviceareaisderivedfromtheMarylandZIPcodeareasfromwhichthetop60%ofourFY13 dischargesoriginated.Thenext15%contributetoour secondaryservicearea.Wedraw69%ofourinpatients andoutpatientsfromMontgomeryCounty.
Intheearly1990'sPrinceGeorge'sCountybecameamajority‐minoritycounty,wheretheminoritypopulationsurpassesthewhitenon‐Hispanicpopulation,(Fox,
1996).Duringthelastcensus,MontgomeryCountyjoinedPrinceGeorge'sCountyasoneofonly336"majority‐minority"countiesinthecountry(MontgomeryCountyPlanningDepartment,2011).Theforeign‐bornpopulationofbothcountiesisalsohigherthanthenationalaverageof12.9%withanaveragepopulationof31.9%and20.0%inMontgomeryCountyandPrinceGeorge'sCounty,respectively(CommunityCommons,2014).Thecommunityweserveremainstobeoneofthemostculturallyandethnicallydiverseinthenation,challengingthehospital,thecountyhealthdepartments,community‐basedorganizationsandotherorganizationstounderstandandmeettheirvariedneeds.Figure2:Primaryandsecondaryserviceareafor
HolyCrossHospital
Page10HolyCrossHospital
FluencyinEnglishisveryimportantwhennavigatingthehealthcaresystemaswellasfindingemployment.MontgomeryandPrinceGeorge'sCountyhavethehighestshareofforeign‐bornresidentsinMaryland(seeFigure3).Foreign‐bornresidentsaccountfor72.6%ofthecounty'spopulationincreasebetween2000and2012(MontgomeryCountyCircuitCourt,2013).Morethan328,000,ornearlyonethird,ofMontgomeryCountyresidentsareforeign‐born.Approximately40%ofthoseforeign‐bornspeakEnglishlessthan“verywell”(U.S.CensusBureau,2012)and7.8%ofthepopulationagedfiveandoverarelinguisticallyisolated(CommunityCommons,2014).ThehighestratesoflinguisticisolationareamongLatinoAmericansandAsianAmericans.
PrinceGeorge’sCountyalsoexperiencedalargeinfluxofforeign‐bornresidentsduringthelasttwodecades.Foreign‐bornresidentsaccountedfor91.7%ofthecounty'spopulationincreasebetween2000and2012(U.S.CensusBureau,2012).Morethan183,000PrinceGeorge'sCountyresidents,approximately20%ofthetotalpopulation,areforeign‐born.InPrinceGeorge'sCounty,39%offoreign‐bornresidentsspeakEnglishlessthan“verywell”(U.S.CensusBureau,2012)and4.8%ofthepopulationagedfiveandoverislinguisticallyisolatedwiththemostlinguisticisolationoccurringinnorthernPrinceGeorge'sCounty(CommunityCommons,2014).
Figure3:Marylandforeign‐bornpopulationdistributionbycounty.Theforeign‐bornpopulationincludesanyonewhowasnotaU.S.citizenoraU.S.nationalatbirth.PreparedbyMarylandDepartmentofLegislativeServices,2013.Source:U.S.CensusBureau.
Page11HolyCrossHospital
MontgomeryCountyisalsorapidlyaging.Thepopulationaged65+isestimatedtoincreasefrom119,769in2010to243,940in2040,morethandoubling.Asaresult,thepercentageofthepopulationage65andolderwillincreasefrom12.3%to16.8%.ThesamepatternisexpectedinPrinceGeorge'sCounty.Thepopulationage65+andolderisprojectedtoincreasefrom81,513in2010to174,110in2040,increasingfrom9.4%ofthepopulationto18.0%(seeFigure4).Increasingtheneedforseniorservicessuchhashousingandhealthcareinbothcounties.
Figure4:65+PopulationprojectionsforMontgomeryandPrinceGeorge'sCounties.Source:MarylandDepartmentofAging,2014.
0
50000
100000
150000
200000
250000
300000
2010 2020 2030 2040
Persons
Year
65+PopulationProjectionsbyCounty
MontgomeryCounty65+ PrinceGeorge'sCounty65+
Page12HolyCrossHospital
SOCIAL DETERMINANTS OF HEALTH
Accesstoquality,affordablehealthcareplaysasignificantroleinthehealthofindividuals.However,clinicalcarecannotaddressallthefactorsthatshapebothhealthbehaviorsandhealthitself(Braveman,Egerter,&Mockenhaupt,2011).Understandingsocialdeterminantsofhealth,suchaseconomicsandeducationcanalsoleadtoimprovementsinhealthandreductionsinhealthdisparities(Williams,Costa,Odunlami,&Mohammed,2008).
INSURANCE COVERAGE
Despiteitsrelativewealthintermsofincome,educationandsupportforpublicservicesmorethan600,000MarylandresidentswereuninsuredpriortotheimplementationoftheAffordableCareAct.Themajorityofuninsuredresidentswereminorities,withthelargestpercentageofuninsuredpertotalracial/ethnicpopulationbeingAmericanIndian/AlaskanNative(U.S.CensusBureau,2012).Lackofinsuranceisaprimarybarriertohealthcareaccessincludingregularprimarycare,specialtycare,andotherhealthservicesthatcontributestopoorhealthstatus.
TheimplementationoftheAffordableCareAct'sexpandedinsurancecoverageinJanuaryof2014madeinsuranceaccessibletothousandsofresidentsinMontgomeryandPrinceGeorge'sCountypossiblyforthefirsttime.Inthelastsixmonthsoffiscalyear2014,MedicaidenrollmentinMontgomeryandPrinceGeorge'sCountyincreased30%and35%,respectively(seeFigure5).AsofMay31,2014,MarylandHealthBenefitExchangeenrolled300,310individualsinMedicaidand72,207individualsinaqualifiedhealthplan(MarylandHealthBenefitExchange,2014).Ofthe72,207individualsenrolledinaqualifiedhealthplan,28%resideinMontgomeryCountyand17%resideinPrinceGeorge'sCounty(seeFigure6).Althoughthemajorityoftheuninsuredresidents(seeFigure7andFigure8)areeligibleforhealthinsurance,thousandswillremainuninsuredduetoineligibility.HealthyMontgomery,thecounty'scommunityhealthimprovementprocess,hasrankedaccesstocareforthoseuninsuredandunderinsuredasanoverarchingthemethataffectsalloftheselectedtophealthpriorities.
Page13HolyCrossHospital
MontgomeryCounty
PrinceGeorge'sCounty
Figure6:MarylandQualifiedHealthPlanEnrollmentsbycounty,asofMay31,2014.Source:MarylandHealthConnection,2014.
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
NumberofPersons
Month
FY2013‐2014TotalMedicadEnrollmentbyCounty
MontgomeryCounty PrinceGeorge'sCounty
Figure5:TotalnumberenrolledinaMedicaidplanbycountyforeachmonthoffiscalyear2014.Source:MarylandMedicaideHealthStatistics.
Figure7:Percentageoftotaluninsuredpersonspercounty.Source:CommunityCommons,2014.
Page14HolyCrossHospital
0 5 10 15
Total
Other
White
Hispanic
AfricanAmerican/Black
Asian
PercentUnemployed
2012ACSSurvey,UnemploymentRate
PrinceGeorge'sCounty MontgomeryCounty Maryland
Figure9:Unemploymentrateforpopulationaged16andoverbyraceandethnicityforMaryland,MontgomeryCounty,andPrinceGeorge'sCounty.Source:U.S.CensusBureau,2012ACS,1‐yearestimates.
Figure8:Thepercentageofthetotalciviliannon‐institutionalizedpopulationwithouthealthinsurancecoverage.Source:CommunityCommons,2014.
ECONOMICS
MontgomeryCounty,Maryland’smostpopulousjurisdictionwithapopulationof1,004,709(U.S.CensusBureau,PopulationDivision,2012),hasamedianhouseholdincomeof$94,965comparedtothestatewidemedianhouseholdincomeof$71,122(U.S.CensusBureau,2012).Thecounty’sincomelevelispositivelycorrelatedtoitslevelofeducation;morethanhalfofthecounty’sresidentsaged25andover(56.9%)holdabachelor’sdegreeorhighercomparedto36.9%statewide(U.S.CensusBureau,2012).
PrinceGeorge’sCounty,likeMontgomeryCounty,isoneofthestate'smostpopulousjurisdictionswithapopulationofmorethan863,420residentsandamedianhouseholdincomeof$69,879,slightlylowerthanthestateaverage.TheunemploymentrateforthecountyisslightlyhigherthanthestatewiththehighestpercentageofunemployedamongtheAfricanAmerican/BlackandHispanicpopulations(seeFigure9)andlessthanonethird(30.3%)ofthecounty’sresidentsholdabachelor’sdegreeorhigher(U.S.CensusBureau,2012).
Page15HolyCrossHospital
Legend
≤47.4%
47.5-52.8% >52.8% Montgomery
County
PrinceGeorge'sCounty
Figure11:Percentageofrentersspendingmorethan30%ofincomeonrentbyZIPcode.Source:HealthyCommunitiesInstitute.
5.44.4
7.46.0
0
2
4
6
8
10
Jan‐12
Mar‐12
May‐12
Jul‐12
Sep‐12
Nov‐12
Jan‐13
Mar‐13
May‐13
Jul‐13
Sep‐13
Nov‐13
Jan‐14
Mar‐14
Percent
UnemployedWorkersinCivilianLaborForce
MontgomeryCounty PrinceGeorge'sCounty
Figure10:Civilians,16yearsofageandover,whomareunemployedasapercentageoftheU.S.civilianlaborforce.Source:U.S.BureauofLaborStatistics.
Unemploymentrateisakeyindicatorofthelocaleconomyandoccurswhenlocalbusinessesareunabletosupplyenoughjobsforlocalemployeesorwhenthelaborforceisnotabletosupplyappropriateskillstoemployers(HealthyCommunitiesInstitute,2014).Duringperiodsofunemployment,individualsarelikelytofeelsevereeconomicstrainandmentalstress.Unemploymentisalsorelatedtoaccesstohealthcare,asmanyindividualsreceivehealthinsurancethroughtheiremployer.Ahighunemploymentrateplacesstrainonfinancialsupportsystems,asunemployedpersonsqualifyforunemploymentbenefitsandfoodstampprograms.TheunemploymentratesofbothMontgomeryandPrinceGeorge'sCountyhavebeensteadilydecliningannuallysinceFY11.
Duetothelargenumberoffederalagenciesandcontractors,bothcountiesgenerallyenjoylowunemploymentwhencomparedtotheU.S.InMarch,2014theunemploymentratewas4.4%inMontgomeryCountyand6.0%inPrinceGeorge'sCountycomparedto7.0%fortheU.S.(U.S.BureauofLaborStatistics,2014);showingimprovementfromwhatwasreportedinpreviousyears(seeFigure10).
Anotherindicatorofthelocaleconomyisthepercentageofhouseholdsspendingahighpercentageofincomeonrent.Payingahighrentcancreateafinancialhardship,especiallyforthosewithalimitedincome,leavinglittlemoneyforotherexpensessuchasfood,transportationandmedicalservices(HealthyCommunitiesInstitute,2014).
Moreover,highrentreducestheproportionofincomeahouseholdcanallocatetosavingseachmonth.Onaverage,51.7%ofrentersinMontgomeryCountyand51.9%ofrentersinPrinceGeorge'sCountyspendmorethan30%oftheirincomeonrent.However,asshowninthemapinFigure11,thehighestpercentageofresidentsspendingmorethan30%oftheirincomeonrentresideinZIPcodessurroundingHolyCrossHospitalandHolyCrossGermantownHospital.
Page16HolyCrossHospital
$‐ $40,000 $80,000 $120,000
OtherTwoorMoreRaces
WhiteAlone(notHispanic/Latino)HispanicLatino(ofanyrace)
Black/AfricanAmericanAsian
AmericanIndian/AlaskaNativeCountyaverage
2012Self‐SufficiencyIncome*
MedianIncomeinPast12MonthsMontgomeryandPrinceGeorge'sCounty
PrinceGeorge'sCounty MontgomeryCounty
Figure12:MedianhouseholdincomebyraceforMontgomeryandPrinceGeorge’sCounty.Source:U.S.CensusBureau,2012ACS,1‐yearestimates;TheSelf‐SufficiencyStandardforMaryland,2012.*Annualself‐sufficiencystandardforoneadult,onepreschooler,andoneschool‐agechild.
DespitetherelativeaffluenceandfairlylowunemploymentratesofbothMontgomeryandPrinceGeorge'sCounty,disparitiesexist.Forexample,inMontgomeryCounty,keyminoritypopulationsaveragelowermedianincomethantheincomeleveldeterminedforself‐sufficiency(seeFigure12)andinPrinceGeorge’sCounty,higherincomelevelsdonothelplowertheAfricanAmericaninfantmortalityrate.
EDUCATION
Kindergartenscreeningmeasuresthereadinessofeachstudenttobeginkindergartenbasedoneducationstandards.ThereadinessstandardsaresetbytheMarylandModelforSchoolReadinessandmeasureseventeenexpectationsforschoolreadiness,includingimmunizationstatus,physicaldevelopment,compliancewithrules,communicationskills,interactionswithpeersandadults,demonstrationofcuriosity,abilitytopayattention,andabilitytofollowdirections(HealthyCommunitiesInstitute,2014).Forthe2011‐2012schoolyear,81%ofincomingMontgomeryCountyKindergartenersand77%ofincomingPrinceGeorge'sCountykindergartnersmetthereadinessstandards,fallingshortoftheStateHealthImprovementProcessgoalof85%(MarylandDepartmentofHealthandMentalHygiene,2014).
Highschoolgraduationratesalsohaveahighimpactonthehealthofanindividual.Individualswhodonotfinishhighschoolaremorelikelythanpeoplewhofinishhighschooltolackthebasicskillsrequiredtofunctioninanincreasinglycomplicatedjob
Page17HolyCrossHospital
marketandsociety.Adultswithlimitededucationlevelsaremorelikelytobeunemployed,ongovernmentassistance,orinvolvedincrime(HealthyCommunitiesInstitute,2014).ThegoalfortheMarylandStateHealthImprovementProcessistohaveagraduationrateof88.6%by2014.During2012‐2013,bothMontgomeryCountyandPrinceGeorge'sCountyfellbelowthisgoalwith88.3%and74.1%countygraduationrates,respectively.Inourservicearea,censustractsnearWheaton‐Glenmont,AspenHill,GaithersburginMontgomeryCountyandUniversityParkandRiverdaleinPrinceGeorge'sCountyhavethelargestpercentagesofresidentsovertheageof25withlessthanahighschooldiploma(seeFigure13).
Figure13:Percentageofthepopulationaged25yearsandolderwithnohighschooldiploma.Source:CommunityCommons,2014.
Page18HolyCrossHospital
HEALTH INDICATORS
Healthindicators,suchascausesofdeath(seeTable2),breastcancerrates,obesityandfruitconsumption,canbeusedtodescribethehealthofapopulation,healthdifferenceswithinapopulationorusedtodetermineifprogramobjectivesdesignedtoimprovehealtharebeingmet.HealthyMontgomeryselectedapproximately100indicatorstomonitorforimprovement.Inthissection,selectindicatorsrelatedtothesixHealthyMontgomeryprioritiesandselectindicatorsrelatedtotheseniorpopulationhavebeengraphedtoshowavisualrepresentationofhealthdifferenceswithinapopulation.EachHealthyMontgomeryindicatorislistedinatableattheendofasectionandmeasuresarecolor‐codedbasedondistributionofvaluesfromthereportingregions(e.g.countiesinthestate);sometimeslowervaluesarebetterandinothercaseshighervaluesarebetter.Fromthedistribution,thegreenrepresentsthetop50thpercentile,theyellowrepresentsthe25th‐50thpercentile,andtheredrepresentsthe25thpercentile.EachindicatorisalsocomparedtotheindicatorsfromtheFY12CHNAwithagreenorredarrowtoindicateimprovement(green)ordecline(red)(HealthyCommunitiesInstitute,2014).
PrinceGeorge'sCountyAge‐adjustedDeathRate/100,000
HeartDisease 191.2
Cancer 165.2
Stroke 35.2
Diabetes 27.6
ChronicLowerRespiratoryDisease 22.7
MontgomeryCounty Age‐adjustedDeathRate/100,000
Cancer 126.7
HeartDisease 119.7
Stroke 27.5
ChronicLowerRespiratoryDisease 18.2
Accidents 16.7
Table2:TopfiveleadingcausesofdeathforMontgomeryandPrinceGeorge'sCounties.Source:MarylandVitalStatisticsAdministration,2012.
Page19HolyCrossHospital
CANCER
Advancesinresearch,detectionandtreatmenthaveslowedthecancerdeathrate;however,cancerremainsaleadingcauseofdeathintheUnitedStates(U.S.DepartmentofHealthandHumanServices,2010).ItistheleadingcauseofdeathinMontgomeryCountyandthesecondleadingcauseofdeathinPrinceGeorge’sCounty(VitalStatistics,2012).Theburdenofbattlingcancerswithinourcommunityvaries;withdisparitiesclearlypresent(DHHS,2011).Forexample,inMontgomeryCountythebreastcancerincidencerateforWhitewomenishigherthanforAfricanAmerican/Blackwomen,however,thedeathrateforAfricanAmerican/Blackwomenismorethan50%higher.
TheNationalCancerInstitute(NCI)definescancerasatermusedtodescribediseasesinwhichabnormalcellsdividewithoutcontrolandareabletoinvadeothertissues.Thereareover100differenttypesofcancer,however,lung,colorectal,breast,pancreatic,andprostatecancerleadtothegreatestnumberofdeathseachyear.
116.8
148.0
128.4
0 50 100 150 200 250
Overall
Male
Female
Deaths/100,000population
Age‐AdjustedDeathRateduetoCancerMontgomeryCounty
186.7
234.0
158.2
0 50 100 150 200 250
Overall
Male
Female
Deaths/100,000population
Age‐AdjustedDeathRateduetoCancerPrinceGeorge'sCounty
Figure14:Age‐adjusteddeathrateper100,000populationduetocancer.Source:NationalCancerInstitute,2006‐2010.
7.5
8.0
8.5
9.0
9.5
2008 2009 2010 2011 2012
Percent
MedicareBeneficiariesTreatedforCancer
UnitedStates Maryland
MontgomeryCounty PrinceGeorge'sCounty
Figure15:YearlypercentageofMedicarebeneficiarieswhoweretreatedforcancer(Breast,colorectal,lungandprostate).Source:CentersforMedicaidandMedicareServices,2012.
Page20HolyCrossHospital
122.8
131.9
127.5
0 50 100 150
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Cases/100,000females
BreastCancerIncidenceRateMontgomeryCounty
108.0
123.6
118.5
0 50 100 150
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Cases/100,000females
BreastCancerIncidenceRatePrinceGeorge'sCounty
Figure16:Age‐adjustedincidencerateforbreastcancerincasesper100,000females.Source:NationalCancerInstitute,2006‐2010.
19.6
19.2
30.3
0 10 20 30 40
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Deaths/100,000females
Age‐AdjustedDeathRateduetoBreastCancerMontgomeryCounty
27.8
22.3
31.8
0 10 20 30 40
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Deaths/100,000females
Age‐AdjustedDeathRateduetoBreastCancerPrinceGeorge'sCounty
Figure17:Age‐adjusteddeathrateper100,000femalesduetobreastcancer.Source:NationalCancerInstitute,2006‐2010.
Breast Cancer
BreastcanceristhesecondmostcommontypeofcanceramongwomenintheU.S.followingbehindskincancerandaccordingtotheAmericanCancerSociety,breastcanceristhesecondleadingcauseofcancerdeathamongwomenintheU.S.Thegreatestriskfactorindevelopingbreastcancerisage.Since1990,breastcancerdeathrateshavedeclinedprogressivelyduetoadvancementsintreatmentanddetection.
Page21HolyCrossHospital
Table3:HealthyMontgomeryBreastCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Colorectal Cancer
Colorectalcancer,cancerofthecolonorrectum,isthesecondleadingcauseofcancer‐relateddeathsintheUnitedStates.Earlydetectionplaysasignificantroleindecreasingthedeathrateforthosediagnosed,ifadultsaged50orolderhadregularscreeningtests,asmanyas60%ofthedeathsfromcolorectalcancercouldbeprevented(HealthyCommunitiesInstitute,2014).InbothMontgomeryandPrinceGeorge'sCounty,thescreeningrateforcolorectalcancerishighat72.9%and71.7%ofthepopulation50andovergettingscreenedbutracialdisparitiesarepresent(seeFigure18).Therearealsoracialdisparitiesintheincidenceanddeathrates(seeFigure19).AfricanAmerican/BlackshaveahigherincidenceanddeathratewhencomparedtotheratesofWhites,AsiansorPacificIslandersandHispanics.
BreastCancerIndicators CHNA2012 Current
MC PGC MD MC PGC MD
Age‐adjusteddeathrateduetobreastcancer(deaths/100,000population) 20.2 30.3 25.8 19.6 27.8 24.5
Range ≤22.9 23.0‐25.9 ≥26.0
Breastcancerincidencerate(cases/100,000population) 129.6 116.7 123.8 127.5 118.5 128.0
Range ≤115.6 115.7‐126.5 ≥126.5
Mammogramhistory82.6% 81.7% 80.5% 84.7% 85.7% 62.4%
Range ≥83.9% 83.8‐80.3% ≤80.4%
72.9
78.9
57.4
71.9
60.7
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
ColorectalScreeningRateMontgomeryCounty
71.7
78.0
47.1
70.4
100.0
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
ColorectalCancerScreeningRatePrinceGeorge'sCounty
Figure18:Thepercentageofadultsaged50andoverwhohaveeverhadasigmoidoscopyorcolonoscopyexam.Source:MarylandBRFSS,2012.
Page22HolyCrossHospital
33.2
31.8
20.3
38.4
0.0 10.0 20.0 30.0 40.0 50.0
Overall
White
Hispanic
Black
Cases/100,000population
ColorectalCancerIncidenceRateMontgomeryCounty
39.9
37.2
27.4
41.4
0 10 20 30 40 50
Overall
White
Hispanic
Black
Cases/100,000population
ColorectalCancerIncidenceRatePrinceGeorge'sCounty
Figure19:Theage‐adjustedincidencerateforcolorectalcancerincasesper100,000population.Source:NationalCancerInstitute,2006‐2010.
11.0
10.0
16.2
11.0
0.0 5.0 10.0 15.0 20.0
Overall
White
Black
Asian
Deaths/100,000population
ColorectalCancerDeathRateMontgomeryCounty
18.8
15.6
21.0
14.4
0 5 10 15 20 25
Overall
White
Black
Asian
Deaths/100,000population
ColorectalCancerDeathRatePrinceGeorge'sCounty
ColorectalCancerIndicatorsCHNA2012 Current
MC PG MD MC PG MD
Age‐adjusteddeathrateduetocolorectalcancer(deaths/100,000
population) 12.2 21.0 18.6 11.0 18.8 16.8
Range ≤17.4 17.5‐20.2 ≥20.3
Coloncancerscreening72.1% 73.9% 71.3% 72.9% 71.7% 72.4%
Range ≥69.8% 69.7‐64.0% ≤64.1%
Colorectalcancerincidencerate(cases/100,000population) 38.1 46.9 46.9 33.2 39.9 41.5
Range ≤46.6 46.7‐52.5 ≥52.6
Table4:HealthyMontgomeryColorectalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Figure20:Theage‐adjusteddeathrateper100,000populationduetocolorectalcancer.Source:NationalCancerInstitute,2006‐2010.
Page23HolyCrossHospital
Cervical Cancer
CervicalcancerisacommoncancerthathasaveryhighcureratewhencaughtearlyandtheAmericanCollegeofObstetriciansandGynecologistsrecommendsthatallwomengetregularPapteststoincreaseearlydetectionofcervicalcancer(seeFigure21).InMontgomeryCounty,Hispanicwomen'sincidencerateofcervicalcancerisabouttwicethatofWhitewomen(seeFigure22).
83.0
85.4
86.4
83.3
71.9
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
PapTestHistoryMontgomeryCounty
81.9
75.1
84.8
86.4
32.9
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
PapTestHistoryPrinceGeorge'sCounty
Figure21:Thepercentageofwomenaged18andoverwhohavehadaPapsmearinthepastthreeyears.Source:MarylandBRFSS,2012.
5.8
4.9
8.9
7
0 2 4 6 8 10
Overall
White
Hispanic
Black
Cases/100,000females
CervicalCancerIncidenceRateMontgomeryCounty
7.3
7.2
7.1
7.2
0 2 4 6 8 10
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Cases/100,000females
CervicalCancerIncidenceRatePrinceGeorge'sCounty
Figure22:Theage‐adjustedincidencerateforcervicalcancerincasesper100,000females.Source:NationalCancerInstitute,2006‐2010.
Page24HolyCrossHospital
Prostate Cancer
ProstatecanceristhemostcommonformofcanceramongmenintheUnitedStatesandisonlysecondtolungcancerasacauseofcancer‐relateddeathamongmen(HealthyCommunitiesInstitute,2014).ProstatecancerusuallyoccursinoldermenandAfricanAmerican/Blackmen'sincidencerateismorethan50%higherthanWhitemeninMontgomeryCountyand78%higherinPrinceGeorge'sCounty.Theirdeathrateisalsomorethan70%higher(seeFigure23andFigure24).
CervicalCancerIndicatorsCHNA2012 Current
MC PG MD MC PG MD
Cervicalcancerincidencerate(cases/100,000population) 8.0 7.0 7.6 5.8 7.3 6.8Range ≤8.2 8.3‐10.0 ≥10.1
PapTestHistory87.4% 82.2% 84.1% 83.5% 90.5% 94.3%
Range ≥86.4% 86.3‐84.0% ≤83.9%
Table5:HealthyMontgomeryCervicalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
162.6
155.7
116.8
238.7
0 100 200
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Cases/100,000males
ProstateCancerIncidenceRateMontgomeryCounty
187.6
105.6
130.1
187.6
0 100 200
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Cases/100,000males
ProstateCancerIncidenceRatePrinceGeorge'sCounty
Figure23:Theage‐adjustedincidencerateforprostatecancerincasesper100,000males.Source:NationalCancerInstitute,2006‐2010.
17.0
16.9
29.1
0 10 20 30 40 50
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Deaths/100,000males
Age‐AdjustedDeathRateduetoProstateCancerMontgomeryCounty
37.5
27.0
49.2
0 10 20 30 40 50
Overall
White,Non‐Hispanic
Black,Non‐Hispanic
Deaths/100,000males
Age‐AdjustedDeathRateduetoProstateCancerPrinceGeorge'sCounty
Figure24:Theage‐adjusteddeathrateper100,000malesduetoprostatecancer.Source:NationalCancerInstitute,2006‐2010.
Page25HolyCrossHospital
ProstateCancerIndicatorsCHNA2012 Current
MC PG MD MC PG MD
Age‐adjusteddeathrateduetoprostatecancer(deaths/100,000population) 19.7 37.7 27.5 17.0 37.5 25.0Range ≤24.0 24.1‐28.0 ≥28.1
Prostatecancerincidencerate(cases/100,000population) 158.2 178.8 159.4 162.6 187.6 157.2Range ≤138.1 138.2‐159.7 ≥159.8
Lung Cancer
AccordingtotheAmericanLungAssociation,morepeoplediefromlungcancerannuallythananyothertypeofcancer,exceedingthetotaldeathscausedbybreastcancer,colorectalcancer,andprostatecancercombined.Howlongapersonsmokesandhowoftenisthegreatestriskfactorforlungcancer.AsshowninTable7,thesmokingrateinMontgomeryandPrinceGeorge'sCountiesislowerthanthestateandthecountry.Whilethelungcancermortalityrateishigherformen(seeFigure25)thanforwomentherateformenhasreachedaplateau,themortalityrateduetolungcanceramongwomencontinuestoincrease.InMontgomeryandPrinceGeorge'sCounty,AfricanAmerican/Blackshavethehighestlungcancerincidencerates(seeFigure26).However,WhitemenhaveahigherdeathrateinPrinceGeorge'sCounty(seeFigure27).
ReportArea TotalPopulation
Age18+
Est.Population
RegularlySmoking
Cigarettes
Age‐Adjusted
Percentage
MontgomeryCounty 728,670 57,565 7.9%
PrinceGeorge'sCounty 650,433 90,410 13.5%
Maryland 4,380,821 674,646 15.4%
UnitedStates 232,556,016 41,491,223 18.1%
Table7:Numberofadults,aged18+,whoself‐reportedcurrentlysmokingcigarettessomedaysoreveryday.Source:CentersforDiseaseControlandPrevention,BehavioralRiskFactorSurveillanceSystem:2006‐12.
Table6:HealthyMontgomeryProstateCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Page26HolyCrossHospital
28.329.1
9.732.4
20.0
0 10 20 30 40 50 60
OverallWhite,Non‐Hispanic
HispanicBlack,Non‐Hispanic
Asian/PacificIslander
Deaths/100,000population
Age‐AdjustedDeathRateduetoLungCancerMontgomeryCounty
45.855.1
10.941.4
23.1
0 10 20 30 40 50 60
OverallWhite,Non‐Hispanic
HispanicBlack,Non‐Hispanic
Asian/PacificIslander
Deaths/100,000population
Age‐AdjustedDeathRateduetoLungCancerPrinceGeorge'sCounty
Figure27:Theage‐adjusteddeathrateper100,000populationduetolungcancer.Source:NationalCancerInstitute,2006‐2010.
40.0
40.0
20.9
47.6
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
Overall
White
Hispanic
Black
Cases/100,000population
LungandBronchuscancerIncidenceRatebyRace/EthnicityMontgomeryCounty
51.7
28.1
48.2
59.6
0 10 20 30 40 50 60 70
Overall
White
Hispanic
Black
Cases/100,000population
LungandBronchusCancerIncidenceRatebyRace/Ethnicity
PrinceGeorge'sCounty
Figure26:Theage‐adjustedincidencerateforlungandbronchuscancersincasesper100,000population.Source:NationalCancerInstitute,2006‐2010.
28.3
32.3
25.6
0 10 20 30 40 50 60 70
Overall
Males
Females
Deaths/100,000population
LungCancerAge‐AdjustedDeathRatebyGenderMontgomeryCounty
45.8
60.7
36.0
0 10 20 30 40 50 60 70
Overall
Males
Females
Deaths/100,000population
LungCancerAge‐AdjustedDeathRatebyGenderPrinceGeorge'sCounty
Figure25:Theage‐adjusteddeathrateper100,000populationduetolungcancer.Source:NationalCancerInstitute,2006‐2010.
Page27HolyCrossHospital
LungCancerIndicatorsCHNA2012 Current
MC PG MD MC PG MD
Age‐adjusteddeathrateduetolungcancer(deaths/100,000population) 30.6 49.5 53.8 28.3 45.8 49.6
Range ≤55.4 55.5‐64.9 ≥65.0
Lungandbronchuscancerincidencerate(cases/100,000population) 42.6 54.4 67.6 40.0 51.7 63.5
Range ≤72.0 72.1‐82.9 ≥83.0
Table8:HealthyMontgomeryLungCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Cardiovascular Disease
Together,heartdiseaseandstrokeareamongthemostwidespreadandcostlyhealthproblemsfacingthenationtoday,theyarealsoamongthemostpreventable.InMontgomeryCountyandPrinceGeorge'sCounty,heartdiseaseandstrokeareinthetopfiveleadingcausesofdeath(seeTable2).In2012,heartdiseasewasthesecondleadingcauseofdeathinMontgomeryCounty,withthemajorityofdeathsoccurringinWhites(seeFigure28).ItisthefirstleadingcauseofdeathforWhitesandAsian/PacificIslandersandthesecondleadingcauseofdeathforAfricanAmericans/BlacksandHispanics(MarylandDepartmentofHealthandMentalHygiene,2014).InPrinceGeorge'sCountyitistheleadingcauseofdeathforallracesandethnicitieswiththemajorityofdeathsoccurringinAfricanAmerican/Blacks.
Deaths from Heart Disease Montgomery County
Figure28:PercentageofdeathsfromheartdiseasebyraceforMontgomeryandPrinceGeorge'sCounty.Source:MarylandDHMH,2010‐2012.
Page28HolyCrossHospital
Cerebrovascular Disease
InMontgomeryandPrinceGeorge'sCountystroke,whichcanbecausedbycerebrovasculardisease,isthethirdleadingcauseofdeath.Astrokeoccurswhenthebrainisdeprivedofoxygenandthisusuallyoccurswhenbloodvesselscarryingoxygentothebrainbecomeblockedorburst.Ageisalargeriskfactorforstroke,withtheriskdoublingforeachdecadeafter55,however,thelargestmodifiableriskfactorsforstrokearehighbloodpressure,highcholesterolanddiabetesmellitus(HealthyCommunitiesInstitute,2014).
High Blood Pressure and Cholesterol
Highbloodpressure(140/90mmHgorhigher)isariskfactorformanydiseasesincludingheartdisease,kidneyfailureandstroke.Highbloodpressureisoftencalledthe"silentkiller"becausehighbloodpressurecanbeasymptomaticandgoundetected.Highbloodpressurecanoccurinpeopleofanyageorsex;however,itismorecommonamongthoseoverage35.InMontgomeryandPrinceGeorge'sCountythehighestratesofhighbloodpressureareBlack,Non‐HispanicsandWhites,Non‐Hispanics(seeFigure29).Highcholesterolisalsoamajorriskfactorforheartdiseaseandcangoundetected.Itisimportantforbothmenandwomentomaintainlowcholesterollevelsandreducetheirchanceofdevelopingheart(HealthyCommunitiesInstitute,2014).
21.6
25.4
14.4
23.1
5.8
0 10 20 30 40
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
HighBloodPressurePrevalenceMontgomeryCounty
36.3
40.4
22.3
38.6
13.3
0 10 20 30 40 50
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
HighBloodPressurePrevalencePrinceGeorge'sCounty
Figure29:Thepercentageofadultswhohavebeentoldtheyhavehighbloodpressure.Source:MarylandBRFSS,2011.
Page29HolyCrossHospital
CardiovascularDiseaseIndicatorsCHNA2012 Current
MC PGC MD MC PGC MD
Age‐adjusteddeathrateduetocerebrovasculardisease/100,000population 29.2 35.7 38.7 27.5 35.2 37.4
Range ≤37.8 37.9‐41.4 ≥41.5
Age‐adjusteddeathrateduetoheartdisease131.0 225.4 197.8 119.7 191.2 174.9
Range ≤184.1 184.2‐205.4 ≥205.5
Highbloodpressureprevalence24.5% 34.2% 30.1% 21.6% 36.3% 32.0%
Range ≤34.4% 34.5‐37.1% ≥37.2%
Highcholesterolprevalence38.7% 34.7% 37.4% 31.8% 34.6% 35.4%
Range ≤37.7 37.8‐41.4% ≥41.5%
AtrialFibrillation:MedicarePopulation 8.1% 5.4% 8.1%
Range ≤7.5% 7.6‐8.4% ≥8.5%
ERRateduetoHypertension/10,000population 126.2 238.4 222.2
Range ≤215.5 215.6‐265.6 ≥265.5
HeartFailure:MedicarePopulation 12.3% 15.3% 14.6%
Range ≤15.4% 15.5‐17.5% ≥17.6%
Hyperlipidemia:MedicarePopulation 47.5% 46.1% 49.8%
Range ≤41.5% 41.6‐46.9% ≥47%
Hypertension:MedicarePopulation 54.0% 60.7% 60.6%
Range ≤56.0% 56.1‐60.4% ≥60.5%
IschemicHeartDisease:MedicarePopulation 26.6% 28.8% 30.1%
Range ≤29.1% 29.2‐33% ≥33.1%
Stroke:MedicarePopulation 3.4% 5.1% 4.5%
Range ≤3.5% 3.6‐3.9% ≥4%
Table9:HealthyMontgomeryCardiovascularDiseaseIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Page30HolyCrossHospital
Diabetes
In2012,29.1millionAmericans,or9.3%ofthepopulation,haddiabetesupfrom25.8millionand8.3%in2010(NationalDiabetesStatisticsReport,2014).DiabetesdisproportionatelyaffectsminoritypopulationsandtheelderlyanditsincidenceislikelytoincreaseasminoritypopulationsgrowandtheU.S.populationbecomesolder.Personswithdiabetesarealsoatincreasedriskforischemicheartdisease,neuropathy,andstroke.Diabetesisalsoacostlydisease(seeTable10).Itisestimatedthattheaveragemedicalexpendituresforapersondiagnosedwithdiabetesis2.3timeshigherthanitwouldbeifthatpersondidnothavediabetes(NationalDiabetesStatisticsReport,2014).
In2012,diabeteswastheseventhleadingcauseofdeathinMontgomeryCountyandthefifthleadingcauseofdeathinPrinceGeorge'sCounty.Diabetescanlowerlifeexpectancybyupto15yearsandincreasestheriskofheartdiseaseby2to4times.Itisalsotheleadingcauseofkidneyfailure,lowerlimbamputations,andadult‐onsetblindness(U.S.DepartmentofHealthandHumanServices,2010).
7.0
6.2
5.1
9.8
7.5
0 5 10 15
Overall
White, Non‐Hispanic
Hispanic
Black, Non‐Hispanic
Asian
Percent
Adults with Diabetes by Race/EthnicityMontgomery County
10.4
9.5
7.3
13.7
6.4
0 5 10 15
Overall
White, Non‐Hispanic
Hispanic
Black, Non‐Hispanic
Asian
Percent
Adults with Diabetes by Race/EthnicityPrince George's County
CostofDiabetes $245billion:Total
costsofdiagnoseddiabetesintheUnitedStatesin2012
$176billionfordirectmedicalcosts
$69billioninreducedproductivity
Table10:Costofdiabetes.Source:AmericanDiabetesAssociation,2014.
Figure30:Thepercentageofadultswhohaveeverbeendiagnosedwithdiabetes,notincludingwomenwhowerediagnosedwithdiabetesonlyduringpregnancy.Source:MarylandBRFSS,2012.
Page31HolyCrossHospital
DiabetesIndicatorsCHNA2012 Current
MC PGC MD MC PGC MD
AdultswithDiabetes 7.1% 10.9% 9.4% 5.1% 11.0% 9.6%Range ≤9.7% 9.8‐11.8% ≥11.9%
Age‐AdjustedDeathRateduetoDiabetesdeaths/100,000population 12.7 31.4 21.9 13.2 27.6 19.9
Range ≤19.7 19.8‐23.9 ≥24.0
Diabetes:MedicarePopulation 24.7% 34.8% 29.2%Range ≤26.9% 27.0‐29.6% ≥29.7%
ERRateduetoDiabetes/10,000population 163.5 300.3 314.6
Range ≤294.7 294.7‐391.9 ≥392.0
Obesity
Duringthepasttwentyyears,obesityrateshaveincreasedintheUnitedStates;doublingforadultsandtriplingforchildren.Morethan50%ofMontgomeryCountyresidentsandmorethan70%ofPrinceGeorge’sCountyresidentsareoverweightorobese(BRFSS,2012).Obesityaffectsallpopulations,regardlessofage,sex,race,
Table11:BodyMassIndexchart.
0 5 10 15 20 25
18‐19
20‐24
25‐44
45‐64
65‐84
85+
MontgomeryCountyERrateduetodiabetesbyage
Figure31:Theaverageannualage‐adjustedemergencyroomvisitrateduetodiabetesper10,000populationaged18yearsandolder.Casesofgestationaldiabeteswereexcluded;PrinceGeorge'sCountydataisnotavailable.Source:MarylandHSCRC,2009‐2011.
Table12:HealthyMontgomeryDiabetesIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Page32HolyCrossHospital
55.2
60.9
47.3
71.4
74.9
68.0
0 20 40 60 80
Overall
Male
Female
Percent
AdultswhoareOverweightorObese
PrinceGeorge'sCounty MontgomeryCounty
Figure33:ThepercentageofmaleandfemaleadultswhoareoverweightorobeseaccordingtotheBMI.Source:MarylandBRFSS,2012.
0 20 40
Asian
Black,Non‐Hispanic
Hispanic
White,Non‐Hispanic
Overall
Percent
AdultsEngaginginPhysicalActivity
PrinceGeorge'sCounty MontgomeryCounty
Figure34:Thepercentageofadultswhoengageinmoderatephysicalactivityatleast30minutesonfivedaysperweek.PrinceGeorge'sCountydataforHispanicsandAsianswasnotavailable.Source:MarylandBRFSS,2012.
2010),however,disparitiesdoexistandratesareaffectedbyrace/ethnicity,sexandage.
InPrinceGeorge'sCountysevenoutoftenHispanicadultsandAfricanAmerican/Blackadultsareeitheroverweightorobese.Inbothcounties,obesitylevels(BodyMassIndex(BMI)atorabove30.0seeTable12)arelowestamongtheAsian/PacificIslanderadultsandhighestamongAfricanAmerican/BlackandHispanicadults(seeFigure32).Inbothcounties,menaremorelikelytobeoverweightorobese(seeFigure33).Menandadultsaged45‐64arealsolesslikelytoengagein30minutesofmoderateactivityfor30minutesormoreperday.Hispanic/LatinoadultsandWhiteadultsaremorelikelythanAsian/PacificIslanderandAfricanAmerican/Blackadultstoengageinatleastlight‐to‐moderatephysicalactivity(seeFigure34).
55.2
52.4
70.5
61.7
40.3
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
AdultswhoareOverweightorObeseMontgomeryCounty
71.6
64.5
76.4
74.2
47.0
0 20 40 60 80 100
Overall
White,Non‐Hispanic
Hispanic
Black,Non‐Hispanic
Asian
Percent
AdultswhoareOverweightorObesePrinceGeorge'sCounty
Figure32:ThepercentageofadultswhoareoverweightorobeseaccordingtotheBMI.Source:MarylandBRFSS,2012.
Page33HolyCrossHospital
Fruitandvegetableconsumptionisanindicatorofhealthbecauseunhealthyeatinghabitscanleadtoobesity,diabetesandotherhealthissues.Approximately70%ofMontgomeryCountyadultsandapproximately68%ofPrinceGeorge'sCountyadultsconsumelessthanfiveservingsoffruitsandvegetableseachday.InMontgomeryandPrinceGeorge'sCountymorethanhalfofthecountyislocatedinanareawithloworpooraccesstohealthyfoods(seeFigure35).
Exercise,Nutrition,&WeightIndicatorsCHNA2012 Current
MC PG MD MC PG MD
AdolescentswhoareObese 8.40% 15.40% 11.60%Range ≤12.0% 12.1‐15.1% ≥15.2%
AdultFruitandVegetableConsumption 32.1% 30.1% 27.6% 29.6% 32.4% 27.1%Range ≥25.2% 25.1‐21.1% ≤21.0%
AdultsEngaginginModeratePhysicalActivity 33.9% 28.3% 34.1% 34.9% 23.0% 31.9%Range ≥34.0% 33.9‐31.3% ≤31.2%
AdultsEngaginginRegularPhysicalActivity 52.6% 50.2% 45.6%Range ≥47.9% 47.8‐45.3% ≤45.2%
AdultswhoareObese 17.5% 33.8% 26.8% 17.1% 31.3% 28.3%Range ≤30.5% 30.6‐34.3% ≥34.4%
AdultswhoareOverweightorObese 51.6% 67.9% 62.9% 55.2% 69.8% 64.4%Range ≤67.0% 67.1‐69.7% ≥69.8%
Figure35:HealthyfoodindexscoresforcensustractsinMontgomeryandnorthernPrinceGeorge'sCounty.Afooddesertisdefinedasalow‐incomecensustract(whereasubstantialnumberorshareofresidentshaslowaccesstoasupermarketorlargegrocerystore.Source:CommunityCommons,2014.
Table13:HealthyMontgomeryObesityIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Page34HolyCrossHospital
Behavioral Health
Adequatesocialandemotionalsupporthasbeenshowntohaveapositiveinfluenceonhealthduringtimesofstressbydecreasingstresshormonesandreducingbloodpressure.Researchhasshownthatindividualswithsocialandemotionalsupport(i.e.thesubjectivesensationoffeelinglovedandcaredforbythosearound)experiencebetterhealthoutcomescomparedtoindividualswholacksuchsupport(HealthyCommunitiesInstitute,2014).OneineverysixadultsinMontgomeryCountyandoneinfiveadultsinPrinceGeorge'sCountyreporttheyarenotgettingtheadequatesocialandemotionalsupporttheyneed.
Likeinadequatesocialandemotionalsupport,psychologicaldistresscanalsohaveanegativeeffectonhealth.Itisimportanttobeabletorecognizepotentialissuesbeforetheyelevatetocriticallevels.InMontgomeryandPrinceGeorge'sCounties80.0%and74.8%ofthepopulation,respectively,saidthattheyexperiencedtwoorfewerdaysofpoormentalhealthinthepastmonth.
Depressivedisordersgobeyondfeelingblueorsadforafewdaysandcaninterferewithfamilylife,workhabitsanddailyfunctioningandmanyindividualssufferingfromdepressivedisordersneverseektreatment.Examplesofdepressivedisordersincludedepression,majordepression,dysthymia,andminordepressionandcanoftenoccurwithotherillnessessuchasanxietydisorders,substanceabuse,andcancer.Majordepressivedisordersaccountformorethantwo‐thirdsofallsuicides(HealthyCommunitiesInstitute,2014).TenpercentofMontgomeryCountyresidentsand9.1%ofPrinceGeorge'sCountyresidentsself‐reportedthattheyhavebeendiagnosedwithadepressivedisorderwithWhitesself‐reportinghigherratesofdiagnoses(seeFigure36).
0 5 10 15
Overall
White
Hispanic
Black
Percent
DepressiveDisorderMontgomeryCounty
0 5 10 15
Overall
White
Hispanic
Black
Percent
DepressiveDisorderPrinceGeorge'sCounty
Figure36:Percentageofadultswhoreporttheyhavebeendiagnosedwithadepressivedisorder.Source:MarylandBRFSS,2012.
Page35HolyCrossHospital
Suicideisamajor,preventablepublichealthproblemandcanbecloselylinkedtomajordepressivedisorders.In2012,suicidewasthe12thleadingcauseofdeathinMontgomeryCountyandthe14thleadingcauseofdeathinPrinceGeorge'sCounty.InthestateofMaryland,menweremorethanfourtimesmorelikelytodiefromsuicidethanwomenandWhiteindividualsweremorethanfourtimesmorelikelytodieofsuicidethanAfricanAmerican/BlacksandHispanicindividualscombined(seeFigure37).
Mentaldisorders,likedepression,anxiety,post‐traumaticstressandpanicdisorders,arecommonacrosstheUnitedStates.Althoughmentaldisordersarecommon,fewreceivetreatment.Nationally,ofthosethatdoreceivetreatment,asignificantproportionofindividualsusingemergencydepartmentshavepsychiatricneeds;between1992and2003mentalhealthrelatedemergencydepartmentvisitsincreased75%(Bazelon,2012).In2011therewere2,569.1mentalhealthrelatedemergencydepartmentvisitsper100,000populationinMontgomeryCountyand2,930.9mentalhealthrelatedemergencydepartmentvisitsper100,000populationinPrinceGeorge'sCounty.Bothcountieswerewellbelowthestatetargetof5,028.3per100,000visitsbutthenumberofvisitsinbothcountiesincreasedcomparedtothenumberof2010visitsrelatedtomentalhealthconditions(SHIP,2014).
Emergencydepartment(ED)visitsrelatedtobehavioralhealthconditionscanalsoinvolvesubstanceabuseandviceversa.AmongEDvisitsinvolvingmentalhealthandsubstanceusedisorders,42.7%wereformooddisorders,26.1%foranxietydisordersand22.9%foralcohol‐relatedconditions(AHRQ,2012).InMontgomeryCounty,236per100,000visitswereduetoacuteorchronicalcoholabuse."Alcoholabuse"includesalcoholdependence
0 100 200 300 400 500
White
Hispanic
Black
Persons
SuicideDeathsbyRaceMaryland
0 100 200 300 400 500
White
Hispanic
Black
Persons
SuicideDeathsbySexMaryland
Female Male
Figure37:Marylandsuicidedeathsbyraceandsex.Source:MarylandDHMH,2010‐2012.
Page36HolyCrossHospital
syndrome,nondependentalcoholabuse,alcoholicpsychoses,excessivebloodlevelofalcohol,andfetalalcoholsyndrome.Disproportionateratesareseeninthoseaged18‐19,malesandAmericanIndians/AlaskanNatives.
0 100 200 300 400 500
Overall85+
65‐8445‐6425‐4420‐2418‐19
EDvisits/100,000
ERRateduetoAlcoholAbusebyAgeMontgomeryCounty
0 100 200 300 400 500
Overall
Male
Female
EDvisits/100,000
ERRateduetoAlcoholAbusebySexMontgomeryCounty
236
263
453
64
965
0 500 1000
Overall
White
Black/AfricanAmerican
Asian/PacificIslander
AmericanIndian/AlaskaNative
ERvisits/100,000
ERRateduetoAlcoholAbusebyRace/EthnicityMontgomeryCounty
Figure38:Theaverageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabuseper100,000populationaged18yearsandolderbyageandsex.Source:MarylandHSCRC,2009‐2011.
Figure39:Theaverageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabuseper10,000populationaged18yearsandolderbyrace/ethnicity.Source:MarylandHSCRC,2009‐2011.
Page37HolyCrossHospital
BehavioralHealthIndicatorsCHNA2012 Current
MC PG MD MC PG MD
Age‐AdjustedDeathRateduetoSuicidedeathrate/100,000population 7.3 6.1 8.9 7.0 5.7 8.8MarylandStateComparison 8.8
Depression:MedicarePopulation 12.0% 8.70% 13.20%
Range ≤14.2% 14.3‐16.1% ≥16.2%
ERRateRelatedtoBehavioralHealthConditions/100,000population 2569.1 2930.9 5521.7Range ≤6378.8 6378.9‐7347.9 ≥7348.0
Self‐ReportedDiagnosisofAnxiety10.6% 8.7% 12.4% 9.9% 8.9% 12.7%
Range ≤11.1% 11.2‐15.2% ≥15.3%
Self‐ReportedDiagnosisofDepression16.8% 12.1% 15.9% 10.6% 9.0% 14.2%
Range ≤14.2% 14.3‐16.8% ≥16.9%
Self‐ReportedMentalHealth76.7% 80.0% 76.9% 79.9% 74.9% 75.4%
Range ≥77.3% 77.2‐71.0% ≤70.9%
SocialandEmotionalSupport78.0% 77.5% 78.0% 83.3% 78.7% 82.9%
Range ≥84.4% 84.3‐81.7% ≤81.6%
YouthwhohadaMajorDepressiveEpisode7.3% 7.5% 7.5% 7.6% 7.5%
MarylandStateComparison 7.5%
Maternal/Child Health
Thehealthandwell‐beingofwomen,infantsandchildrendeterminesthehealthofthenextgenerationandcanhelppredictfuturepublichealthchallengesforfamilies,communitiesandthehealthcaresystem(U.S.DepartmentofHealthandHumanServices,2010).
Between2009and2012MontgomeryCounty'slowbirth‐weight(LBW)percentagedroppedfrom8.2%to7.4%.OverallitisbelowtheHealthyPeople20201targetof7.8%.However,therateforAfricanAmerican/Blackbirthsisabovethetarget,especiallyfor18‐19yearoldwomen(seeFigure40).Thepercentageofverylowbirth‐weight(VLBW)birthshasremainedconstantat1.4%,whichequalstheHealthyPeople2020target.TheLBWbirthsinPrinceGeorge'sCountyhavealsodeclinedfrom11.2%in2009to10.0%in2012.TheVLBWbirthshaverisenslightlyfrom2.4%in2009to2.5%in2012.
1HealthyPeopleprovidesscience‐based,10‐yearnationalobjectivesforimprovingthehealthofallAmericans.
Table14:HealthyMontgomeryBehavioralHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.
Page38HolyCrossHospital
MontgomeryCountyhasaninfantdeathrateof5.1deathsper1,000livebirths,whichisbelowtheHealthyPeople2020targetof6.0per1,000livebirths.TheAfricanAmerican/Blackinfantmortalityrateissignificantlyhigherthanthecountyrateat8.2deathsper1,000livebirths.
Babiesborntomotherswhodonotreceiveprenatalcarearethreetimesmorelikelytobebornatalowbirthweightandfivetimesmorelikelytodiewhencomparedtomotherswhodoreceiveprenatalcare.Increasingthenumberofwomenwhoreceiveprenatalcare,andwhodosoearlyintheirpregnancies(withinthefirsttrimester),canimprovebirthoutcomesandreducethelikelihoodofcomplicationsduringpregnancyandchildbirth.
Teenmothersandmothersunder25yearsofagearemostlikelynottohaveenteredcarewithintheirfirsttrimester.Only69.6%ofMontgomeryCountyteenmothersand54.2%ofPrinceGeorge'sCountyteenmothersenteredcareintheirfirsttrimesterin20092,bothcountiesarebelowtheHealthyPeople2020targetof77.9%.
2Lateornoprenatalcaredataaresuppressedfor2010and2011formonthprenatalcarebegan.Revisedbirthcertificatesin2010ledtodatacollectionissuesandmissingvaluesonprenatalcare.Uponadequatereportingonthemonthprenatalcarebegan,thesedatawillbeupdated(HealthyCommunitiesInstitute,2014).
024681012141618
AllAges <18 18‐19 20‐24 25‐29 30‐34 35‐39 ≥40
Percent
Ageattimeofbirth
LowbirthWeightbyAgeandRace/EthnicityMontgomeryCounty
Asian/PacificIslander AfricanAmerican/Black Hispanic
White Overall HP2020Target
* * * * *
Figure40:PercentageofLBWbirthsbyageandrace/ethnicityofmother.2012MarylandDHMHVitalStatisticsReport*Percentagesbasedon<5eventsinthenumeratorarenotpresentedsincepercentagesbasedonsmallnumbersareunstable.Source:MarylandDHMH,2012.
Page39HolyCrossHospital
Seniors
TheseniorpopulationofbothMontgomeryandPrinceGeorge'sCountiesisgrowingmorethan4%peryear(comparedtolessthan1%peryearfortheyoungerpopulation).Seniorsusehospitaldaysataratesixtimeshigherthanthose<65.TheaveragelifeexpectancyforMontgomeryCountyis84.9yearsforfemalesand81.6yearsformales;higherthanthenationalaverageof80.9yearsforfemalesand76.3yearsformales.TheaveragelifeexpectancyinPrinceGeorge'sCountyisslightlylowerthanthenationalaveragewithanaveragelifeexpectancyof79.8yearsforfemalesand74.8yearsformales.Theagingpopulationaffectseveryaspectofsociety,withthelargesteffectsoccurringinpublichealth,socialservices,andhealthcaresystems(CentersforDiseaseControlandPrevention,2013).
TwooutofeverythreeolderAmericanshavemultiplechronicconditionsandexperiencedisproportionateratesofheartdisease,cancer,diabetes,congestiveheartfailure,arthritisanddementia(includingAlzheimer’s)(CentersforDiseaseControlandPrevention,2013).TheleadingcausesofdeathintheMontgomeryandPrinceGeorge'sCountypopulationaged65andoveraresimilartotheleadingcausesofthetotalpopulationbuttherearesomedifferences(seeTable2,Figure41andFigure42).
MaternalandChildHealthIndicatorsCHNA2012 Current
MC PG MD MC PG MD
BabieswithLowBirthWeight 8.2% 11.2% 10.0% 7.4% 10% 8.8%Range ≤7.9% 8.0‐8.9% ≥9.0%
BabieswithVeryLowBirthWeight 1.4% 2.4% 1.8% 1.4% 2.5% 1.7%Range ≤1.4% 1.5‐1.8% ≥1.9%
InfantMortalityRate 5.5 8.7 7.2 5.1 8.6 6.3MarylandStateComparison 6.3
MotherswhoReceivedEarlyPrenatalCare2 81.0% 65.7% 80.2% 81.0% 65.7% 80.2%Range ≥83.6% 80.4‐83.6% ≤80.3%
MotherswhoReceivedLateorNoPrenatalCare 4.6% 11.1% 4.6% 4.6% 11.1% 4.6%MarylandStateComparison 4.6%
Table15:HealthyMontgomeryMaternalandChildHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).HealthyCommunitiesInstitute,2014.
Page40HolyCrossHospital
0 200 400 600 800 1000 1200
Accidents
Nephritis
Septicemia
Diabetes
InfluenzaandPneumonia
ChronicLowerRespiratoryDisease
Alzheimers
Stroke
Cancer
HeartDisease
CausesofDeathforthePopulationAged65+MontgomeryCounty
0 200 400 600 800 1000 1200
InfluenzaandPneumonia
Accidents
Nephritis
Septicemia
Alzheimers
Diabetes
ChronicLowerRespiratoryDisease
Stroke
Cancer
HeartDisease
CausesofDeathforthePopulationAged65+PrinceGeorge'sCounty
Inthe65andoverpopulationofMontgomeryandPrinceGeorge'sCounties,deathsfrominfluenzaandpneumoniaanddeathsfromaccidentsarelistedinthetop10causesofdeathandarehighlypreventable.Influenzacanbedangerousforpeoplewithheartor
Figure41:LeadingcausesofdeathintheMontgomeryCountypopulationaged65andover.Source:MarylandAssessmentToolforCommunityHealth,2010.
Figure42:LeadingcausesofdeathinthePrinceGeorge'sCountypopulationaged65andover.Source:MarylandAssessmentToolforCommunityHealth,2010.
Page41HolyCrossHospital
breathingconditionsandcanleadtopneumoniaanddeaths,especiallyintheelderly(HealthyCommunitiesInstitute,2014).Theinfluenzavaccinecanpreventseriousillnessanddeath,however,only64.5%ofMontgomeryCountyresidentsand55.9%ofPrinceGeorge'sCountyresidentssaidtheyreceivedaninfluenzavaccinationin2012(CentersforDiseaseControlandPrevention,2012).
Pneumococcalpneumoniaistheleadingcauseofvaccine‐preventabledeathandillnessintheUnitedStates.Thepneumoniavaccineisveryeffectiveatpreventingseveredisease,hospitalization,anddeath.InMontgomeryandPrinceGeorge'sCounty70.5%and58.3%,respectively,saidtheyreceivedapneumococcalpneumoniavaccinationin2012(CentersforDiseaseControlandPrevention,2012).
Deathsfromaccidentsarethe10thleadingcauseofdeathinMontgomeryCountyandthe9thleadingcauseofdeathinPrinceGeorge'sCountyforseniors.Between2000and2010fallsaccountedfor65.3%ofthedeathsfromaccidentsinMontgomeryCountywith54.7%offallsoccurringinresidents85andover(seeFigure43)and46.6%ofthedeathsfromaccidentsinPrinceGeorge'sCountywithalmostequalamountsoffalldeathsoccurringinresidentsaged75‐84and85andover(seeFigure44).
MotorVehicle18.0%
AllOtherTransport0.7%
Drowing1.1%
ExposuretoSmoke/Fire/Flame
1.9%
Poison0.7%
AllOther12.3%
65‐7411.2%
75‐8434.1% 85+
54.7%
Falls65.3%
DeathsfromAccidentsAged65+,2000‐2010MontgomeryCounty
AgeofFall
Figure43:DeathsfromaccidentsinMontgomeryCountyfrom2000‐2010.Source:MarylandAssessmentToolforCommunityHealth,2010
Page42HolyCrossHospital
Hospital Readmissions and Preven on Quality Indicators
Hospitalreadmissionscanbeindicatorsofpoorcareormissedopportunitiestobettercoordinatecare(HSCRC,2014).Asresearchsuggests,monitoringthenumberofpatientswhoexperienceunplannedreadmissionscanimprovequalityofcarethroughthedevelopmentofhospital‐basedinitiativesdesignedtoimprovecommunicationwithpatientsandtheircaregiversandpotentiallyavertmanyreadmissions(HSCRC,2014).Ananalysisofhospitalreadmissionsallowsustoidentifyselectindicatorsrelatedtocommunityhealthneedsanddevelopmethodologiesandprogramsthatwillimprovehealthoutcomes.
HolyCrossHealth,inalignmentwiththeCentersforMedicare&MedicaidServices(CMS),definesahospitalreadmissionasapatientadmissiontoahospitalwithin30daysafterbeingdischargedfromanearlierhospitalstay.FromApril2010‐June2013,HolyCrossHospitaldischarged111,135patients.Ofthis,5,883patientswerereadmittedwithin30days(allcause,including1‐dayLOS)accountingfor8,596readmissions(7.73%30‐dayreadmissionrate)and147(2.5%)patientswereadmittedfiveormoretimeswithin30daysaccountingfor1,110(12.91%)ofreadmissions.AdisproportionatepercentageofreadmissionswereAfricanAmericans(43.1%)andMedicarerecipients.
MotorVehicle27.2%
AllOtherTransport2.4%
Drowing1.1%
ExposuretoSmoke/Fire/Flame
3.3%
Poison1.8%
AllOther17.6%
65‐7412.6%
75‐8416.8%
85+17.2%
Falls46.6%
DeathsfromAccidentsAged65+,2000‐2010PrinceGeorge'sCounty
AgeofFall
Figure44:DeathsfromaccidentsinPrinceGeorge'sCountyfrom2000‐2010.Source:MarylandAssessmentToolforCommunityHealth,2010
Page43HolyCrossHospital
Preventionqualityindicators(PQI)areasetofmeasuresthatcanbeusedwithhospitalinpatientdischargedatatoidentifyambulatorycaresensitiveconditions(ACSCs).ACSCsareconditionsforwhichhospitalizationcouldhavebeenpotentiallypreventedinthepresenceofgoodoutpatientcareorforwhichanearlyinterventioncouldpossiblypreventcomplicationsormoreseveredisease(DepartmentofHealthandHumanServicesAgencyforHealthcareResearchandQuality,2007).
ThePQIsconsistofthefollowing16ambulatorycaresensitiveconditions,whicharemeasuredasratesofadmissiontothehospital(topfiveHolyCrossHealthPQIsinbold):
Bacterialpneumonia Hypertension Dehydration Adultasthma Pediatricgastroenteritis Pediatricasthma Urinarytractinfection Chronicobstructivepulmonarydisease Perforatedappendix Diabetesshort‐termcomplication Lowbirthweight Diabeteslong‐termcomplication Anginawithoutprocedure Uncontrolleddiabetes Congestiveheartfailure Lower‐extremityamputation(diabetes)
0 20 40 60
Uninsured
Medicaid
Medicare
Private
Percent
30‐dayAllCauseReadmissionsbyPayerHolyCrossHealth
0 20 40 60
Other
NativeAmerican
Asian
Black
White
Percent
30‐dayAllCauseReadmissionsbyRaceHolyCrossHealth
Figure45:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbyrace,datafromApril2010‐June2013.
Figure46:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbypayer,datafromApril2010‐June2013.
Table16:HolyCrossHospital'sAmbulatoryCareSensitiveConditiondischarges.
Page44HolyCrossHospital
DATA GAPS IDENTIFIED
Whereavailable,themostcurrentandup‐to‐datedatawasusedtodeterminethehealthneedsofthecommunity.Althoughthedatasetavailableisrichwithinformationandmoreinformationisavailabletodaywhencomparedtotheneedsassessmentconductedthreeyearsago,datagapsstillexist.
Datasuchashealthinsurancecoveragedataandcancerscreening,incidenceandmortalityratesarenotavailablebygeographicareaswithinMontgomeryorPrinceGeorge’sCounties.
Dataarenotavailableonalltopicstoevaluatehealthneedswithineachrace/ethnicitybyage‐genderspecificsubgroups.
Diabetesprevalenceisnotavailableforchildren,agroupthathashadanincreasingriskfortype2diabetesinrecentyearsduetoincreasingoverweight/obesityrates.
Healthriskbehaviorsthatincreasetheriskfordevelopingchronicdiseases,likediabetes,aredifficulttomeasureaccuratelyinsubpopulations,especiallytheHispanic/Latinopopulations,duetoBRFSSmethodologyissues.
County‐widedatathatcharacterizehealthriskandlifestylebehaviorslikenutrition,exercise,andsedentarybehaviorsarenotavailableforchildren.
Analysisoflinkedbirth‐deathrecordswouldprovidedetailedinformationaboutcharacteristicsandriskfactorsthatcontributetofetalandinfantlossesinMontgomeryandPrinceGeorge’sCountiesamongthosepopulationsthatcouldbeatelevatedriskforpoorbirthoutcomes.
AnongoingsourceofPregnancyRiskAssessmentMonitoringSystem(PRAMS)dataatthecountylevelatleasteverythreeyearswouldimprovepolicyandplanningeffortsinmaternal,fetalandinfanthealth.
DataarenotasavailableinPrinceGeorge’sCountywhencomparedtoMontgomeryCounty.
Datafromcommunityconversationswasunavailableforthe2015CHNA,howeverdatafromconversationsheldduringfiscalyear2015willbeaddedasanaddenduminfiscal2016.
Page45HolyCrossHospital
RESPONSE TO FINDINGS
Throughmulti‐votingandconsensusdiscussion,theHealthyMontgomerySteeringCommittee,whichincludesrepresentationfromaHolyCrossHealthexecutiveteammember,analyzedavailabledataonmorethan100indicatorstodeterminethefollowingtop‐rankedpriorityareas(moredetailedinformationontheprioritysettingprocesscanbefoundinAppendixE):
BehavioralHealth, Obesity, Cancers, MaternalandInfantHealth, Diabetes,and CardiovascularHealth
Inadditiontoselectingthesixbroadprioritiesforaction,theHealthyMontgomerySteeringCommitteeselectedthreeoverarchingthemes:lackofaccess,healthinequities,andunhealthybehaviors(seeFigure47).
BuildingupontheworkofHealthyMontgomery,HolyCrossHealth'sneedsassessmentrevealsparticularareasthathavealargenumberofpeoplewhoarepoor,ofchild‐bearingage,elderly,raciallyandethnicallydiverse,andoflimitedEnglishspeakingability.Wefocusourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniorsandracial,ethnicandlinguisticminorities.
DemographicanalysisfromHolyCrossHealth'sneedsassessmentalsorevealsthattheseniorpopulationofMontgomeryandPrinceGeorge’sCountiesisgrowingatanunprecedentedrate,increasingtheneedforseniorservicessuchashousingandhealthcare.InanefforttobeproactiveinmeetingthegrowingneedsofthispopulationwehaveincludedseniorsasapriorityfocusinadditiontotheprioritiessetbyHealthyMontgomery.
Figure47:HealthyMontgomeryprioritiesandoverarchingthemes.
Page46HolyCrossHospital
GUIDING PRINCIPLES
HolyCrossHealth'smulti‐yearcommunitybenefitimplementationplanaddressesthepriorityareasandoverarchingthemesbyfocusingourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniors,andracial,ethnicandlinguisticminorities.Toselectoutreachprioritiesfortheimplementationplan,HolyCrossHealthlinkedcommunityhealthcareneedstoourmissionandstrategicpriorities.Wedevelopedasetofprinciplestohelpdetermineourhighestprioritiesandguideourdecision‐makingaboutcommunitybenefit:
BetheMontgomeryCountyleaderandastate/nationalmodel Takeprudentrisksandensuresoundfinancialstewardshipandsustainability Befocusedontheprimaryservicearea Prioritizeneedsthatareconsistentwiththeorganization'sstrengths
o Women/children(particularlyinfantmortalityandobesity)o Seniors(particularlycardiovasculardisease,diabetes,andobesity)o Cancer(particularlybreastcancer)
MeetHolyCrossHealth'soverallcommitmenttoimprovingaccesstocareandaddressingidentifiedcommunityneed
o Access,especiallyforvulnerableandunderservedpopulations(racialandethnicpopulationsubgroups;uninsuredresidents;primarycareaccess,especiallyforchronicconditionsincludingdiabetesandheartfailure)
o Outreachtotargetedpopulations(especiallyforcancerpreventioninAfricanAmerican,African/CaribbeanAmerican,LatinoAmerican,AsianAmerican,NativeAmericanpopulations)
o Demonstratedimprovementsinhealthstatus(reductionininfantmortality;reductioninpercentageofchildrenandadultswithobesity;reductioninrateofbreastcancerdeaths;reductioninpreventablehospitaladmissionsforchronicdisease)
o Ongoinglearningandsharingofnewknowledge(publiceducation) Havemeasurableoutcomesandbeintegratedwithplanningandbudgeting Reflectpartnership.
PRIORITIZING SIGNIFICANT UNMET NEEDS
Withthisinformation,HolyCrossHealthwilladdressunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.WerecognizethatweareequippedtoaddresseachsignificantunmetneedidentifiedbyHealthyMontgomeryandHolyCrossHealth;however,prioritizingtheneedswillallowustoutilizeourresourcesandexpertisetoensurewehavethebiggestimpactontheunmetneedsinourcommunity.
Page47HolyCrossHospital
documentedunmet community
health needs
missioncommitments and
key strengths
this intersectiondetermines
rigorous monitoring and evaluation
supportive management and governance
resource allocation
targeted programs
supportive infrastructure is needed to improve and sustain
documentedunmet community
health needs
missioncommitments and
key strengths
this intersectiondetermines
rigorous monitoring and evaluation
supportive management and governance
resource allocation
targeted programs
supportive infrastructure is needed to improve and sustain
Figure48:HowHolyCrossHealthalignstargetedprogramswiththemissionandstrengthsofthehospitalandunmetcommunityneeds.
Toprioritizethetoprankedhealthpriorities,membersoftheCEOReviewonPopulationHealthandCommunityBenefitwereaskedtorateeachpriorityonthefollowingcriteria:severityoftheneed,feasibilityofourorganizationtoaddresstheneed,andthepotentialeachneedhasforachievableandmeasurableoutcomes.Eachneedwasalsoscoredonitsprevalenceinthepopulation.Thefollowingprioritizationwasdeterminedbytallyingallthescoresreceivedforeachunmetneed:
1. Maternal&InfantHealth2. Seniors3. CardiovascularHealth4. Obesity5. Diabetes6. BehavioralHealth7. Cancers
Community Benefit Implementa on Strategy
Asthecounty’scommunityhealthimprovementprocessevolves,prioritieswillbedetermined,andwiththisinformation,HolyCrossHospitalwilladdressunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.
Keyfindingsfromalldatasources,includingdataprovidedbyHealthyMontgomery,ourexternalreviewgroup(seeAppendixCforhighlights)andhospitalavailabledatawerereviewedandthemostpressingneedswereincorporatedintoourannualcommunitybenefitplan.ThecommunitybenefitplanreflectsHolyCrossHospital’soverallapproachtocommunitybenefitbytargetingtheintersectionbetweentheidentifiedneedsofthecommunityandthekeystrengthsandmissioncommitmentsoftheorganization(seeFigure48)tohelpbuildthecontinuumofcare.Wehaveestablishedleadershipaccountabilityandanorganizationalstructureforongoingplanning,budgeting,implementationandevaluationofcommunitybenefitactivities,whichareintegratedintoourmulti‐yearstrategicandannualoperatingplanningprocesses.HolyCrossHospital’sCommunityBenefitImplementationStrategyispresentedinaseparatedocument.
Page48HolyCrossHospital
REFERENCES
AgencyforHealthcareResearchandQuality.(2014).AHRQQualityIndicators.Retrieved112014,June,fromAgencyforHealthcareResearchandQuality(AHRQ):http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx
Braveman,P.A.,Egerter,S.A.,&Mockenhaupt,R.E.(2011,January).Broadeningthefocus:Theneedtoaddressthesocialdeterminantsofhealth.AmericanJournalofPreventiveMedicine,40(1S1),pp.S4‐S18.
CentersforDiseaseControlandPrevention.(2012).MarylandBehavioralRiskFactorSurveillanceSystemSurveyData.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.
CentersforDiseaseControlandPrevention.(2013).TheStateofAgingandHealthinAmerica.Atlanta,GA:CentersforDiseaseControladnPrevention,USDepartmentofHealthandHumanServices.
DepartmentofHealthandHumanServicesAgencyforHealthcareResearchandQuality.(2007,March12).GuidetoPreventionQualityIndicators:HospitalAdmissionforAmbulatoryCareSensitiveConditions.RetrievedApril15,2014,fromAHRQ‐QualityIndicators:http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V31/pqi_guide_v31.pdf
DignityHealth.(2011,January20).ImprovingPublicHealth&PreventingChronicDisease‐CHWsCommunityNeedIndex.RetrievedApril23,2014,fromDignityHealth:http://www.dignityhealth.org/stellent/groups/public/@xinternet_con_sys/documents/webcontent/212782.pdf
Fox,L.(1996,April19).PrinceGeorge'sCounty:Hitting300.WashingtonPost,p.WW6.
Gourevitch,M.N.,Cannell,T.,Boufford,J.,&Summers,C.(2012).TheChallengeofAttribution:ResponsiblityforPopulationHealthintheContextofAccountableCare.AmericanJournalofPublicHealth,102(No.S3),pp.S322‐S324.doi:10.2105/AJPH.2011.300642
HealthyCommunitiesInstitute.(2014,May).HealthyMontgomery::CommunityDashboard::UnemployedWorkersinCivilianLaborForce.RetrievedJune17,2014,fromHealthyMontgomery:TheCommunityHealthImprovementProcessforMontgomeryCounty,Maryland:http://www.healthymontgomery.org
Page49HolyCrossHospital
HealthyCommunitiesInstitute.(2014,January).HealthyMontgomery:CommunityDashboard.RetrievedApril16,2014,fromHealthyMontgomery:TheCommunityHealthImprovementProcessforMontgomeryCounty,Maryland:http://www.healthymontgomery.org/modules.php?op=modload&name=NS‐Indicator&file=index
MarylandDepartmentofHealthandMentalHygiene.(2014,August5).ReportsandVitalStatistics.Retrieved88,2014,fromMaryland.gov:http://dhmh.maryland.gov/vsa/SitePages/reports.aspx
MarylandDepartmentofHealthandMentalHygiene.(2014,May21).SHIP‐Measures.RetrievedJune20,2014,fromMarylandStateHealthImprovementProcess(SHIP):http://dhmh.maryland.gov/ship/SitePages/measures.aspx
MarylandHealthBenefitExchange.(2014,July3).ReportfromtheMarylandHealthBenefitExchangeaboutMarylandHealthConnection,thestate‐basedhealthinsurancemarketplace.RetrievedJuly11,2014,fromLatestNews&UpcomingEventsforMarylandHealthConnection|MarylandHealthConnection℠:
http://marylandhealthconnection.gov/latest‐news‐upcoming‐events/
MontgomeryCountyCircuitCourt.(2013).MontgomeryCountyCircuitCourt:FY2013AnnualStatisticalDigest.Rockville.
MontgomeryCountyPlanningDepartment.(2011,August21).MontgomeryPlanning:Research&TechnologyCenter‐Census2010:MontgomeryCountyData.RetrievedApril30,2014,fromMontgomeryCountyPlanningDepartment:http://www.montgomeryplanning.org/research/data_library/census/2010/
Stoto,M.A.(2013,February21).PopulationHealthintheAffordableCareActEra.RetrievedApril22,2014,fromAcademyHealth:AdvancingResearch,Policy,andPractice:http://www.academyhealth.org/files/AH2013pophealth.pdf
U.S.BureauofLaborStatistics.(2014).BureauofLaborStatisticsData.RetrievedMarch20,2014,fromU.S.BureauofLaborStatistics:http://data.bls.gov/pdq/querytool.jsp?survey=la
U.S.CensusBureau.(2012,December).2012AmericanCommunitySurvey1‐YearEstimates.RetrievedApril30,2014,fromAmericanFactFinder:http://factfinder2.census.gov/
Page50HolyCrossHospital
U.S.CensusBureau,PopulationDivision.(2012,December).AnnualEstimatesoftheResidentPopulation:April1,2010toJuly1,2012.RetrievedApril30,2014,fromAmericanFactFinder‐Results:2014
Williams,D.R.,Costa,M.V.,Odunlami,A.O.,&Mohammed,S.A.(2008,November).Movingupstream:Howinterventionsthataddresstehsocialdeterminantsofhealthcanimprovehealthandreducedeisparities.JournalofPublicHealthManagementandPractice(14(Suppl)),pp.S8‐17.doi:10.1097/01.PHH.0000338382.36695.42.
Mr. George Leventhal Ms. Sharan London
Councilmember, Montgomery County Council Vice President, ICF InternationalAffiliation: Homeless Issues
Ms. Uma Ahluwalia Ms. Beatrice MillerDirector, Montgomery County DHHS Assistant Director, Adult Medicine DC‐SM, Kaiser Permanente
Affiliation: African American Health Program
Mr. Ron Bialek Dr. Seth MorganPresident, Public Health Foundation PhysicianAffiliation: Commission on Health Affiliation: Commission on People with Disabilities
Ms. Tara Clemons Dr. Cesar Palacios
Community Benefits Outreach Coordinator, Executive Director, Proyecto Salud Health Center MedStar Montgomery Medical Center Affiliation: Latino Health Initiative
Ms. Mary Dolan Ms. Monique Sanfuentes
Chief, Functional Planning and Policy Division, Director, Community Health and Wellness, Suburban Hospital Montgomery County Department of Planning Affiliation: Suburban Hospital
Ms. Tanya Edelin Dr. Wendy ShiauSr. Project Manager for Community Benefit,
Kaiser Permanente
Affiliation: Asian American Health Initiative
Ms. Wendy Friar Mr. Jon SminkVice President, Community Health,
Holy Cross Health
Recreation Specialist, Montgomery County
Recreation Department
Dr. Carol Garvey Dr. Michael StotoVice President for Health Policy, Garvey
Associates
Professor of Health Systems Admin & Population Health,
Georgetown University School of Nursing & Health Studies
Affiliation: Montgomery County Collaboration
Council for Children, Youth and Families
Affiliation: Academia
Mr. Thomas Harr Dr. Ulder J. Tillman
Executive Director, Family Services, Inc. Montgomery County Health Officer and Chief,
Public Health Services
Ms. Lorrie Knight‐Major Dr. Deidre WashingtonMember, Commission on Veterans Affairs Research Associate, Center for Health Equity & Wellness,
Adventist HealthCare
Dr. Samuel P. Korper Ms. Sharon Zalewski
Affiliation: Commission on Aging Vice President, Primary Care Coalition of Montgomery County
Ms. Kathy McCallum Dr. Andrew ZuckermanController, Ronald D. Paul Companies Chief of Staff, Montgomery County Public SchoolsAffiliation: Mental Health Association of
Montgomery County
Healthy Montgomery Steering Committee Members
Co‐Chairs:
Members:
AppendixA:2014HealthyMontgomerySteeringCommitteeMembers
Rank County
1 Montgomery
2 Howard
3 Frederick
4 Queen Anne's
5 Carroll
6 Talbot
7 St. Mary's
8 Calvert
9 Anne Arundel
10 Harford
11 Worcester
12 Charles
13 Washington
14 Baltimore
15 Garrett
16 Kent
17 Prince George's
18 Wicomico
19 Cecil
20 Somerset
21 Dorchester
22 Allegany
23 Caroline
24 Baltimore City
AppendixB:MarylandCountyHealthRankingsandHealthModel
TheRankingsarebasedonamodelofpopulationhealththatemphasizesthemanyfactorsthat,ifimproved,canhelpmakecommunitieshealthierplacestolive,learn,workandplay.CommunityHealthRankings,2014
AppendixC:KeyhighlightsfromHolyCrossHealth'sCommunityBenefitExternalReview
On June 9th, 2014 the following organizations were represented at the External Review Meeting:
• Montgomery County Department of Health & Human Services • American Heart Association • American Cancer Society • Holy Cross Health Mission and Population Health Board Committee • Kaiser Permanente • Primary Care Coalition of Montgomery County, Maryland • Montgomery County Upcounty Regional Services Center • University of Maryland School of Nursing • Institute for Public Health Innovation • Montgomery County Recreation Department • Montgomery County African American Health Program
Suggestions made for our FY15 Annual Community Benefit Plan Increase evaluation and track and measure outcomes to show programs are making a
difference • Coordinate with 5 hospitals and county government to look at collective impact for the
county; think about achieving population health goals for the county in conjunction with other systems
Obesity prevention in both children and adults; including engagement with schools Implement active learning and skills building across all programs to engage participants
instead of just teaching them • Develop workplace wellness programs Focus on population health by working with dual eligibles (Medicaid and Medicare) in
the county • Work with and support small non‐profits in the community Engage more with patients in the home environment; wrap services around housing to
help people age in place Create cultural competence that is sensitive to various ethnic groups and religious
communities, including those that are well‐educated with good jobs, etc. but may have barriers to accessing services
Enhance role and training of community health workers • Monitor outcomes for children born through Maternity Partnership through age four
Key Accomplished or in process • Still considering
ZIPCode City HCHDischarges HCHCumulative
%ofDischarges20904 SilverSpring 2,871 10.6%20902 SilverSpring 2,349 19.3%20906 SilverSpring 2,059 26.9%20910 SilverSpring 1,549 32.6%20901 SilverSpring 1,393 37.8%20903 SilverSpring 762 40.6%20783 Hyattsville 652 43.0%20853 Rockville 600 45.2%20705 Beltsville 549 47.2%20895 Kensington 490 49.0%20912 TakomaPark 483 50.8%20707 Laurel 407 52.3%20852 Rockville 370 53.7%20905 SilverSpring 367 55.0%20782 Hyattsville 350 56.3%20866 Burtonsville 310 57.5%20770 Greenbelt 306 58.6%20740 CollegePark 264 59.6%20851 Rockville 210 60.4%20742 CollegePark 1 60.4%20868 Spencerville 16 60.4%
AppendixD:HolyCrossHospital21ZIPCodePrimaryServiceArea
AppendixE:HealthyMontgomeryPrioritySettingProcess
The Montgomery County Community Health Improvement Process launched in June 2009 with a comprehensive scan of all existing and past planning processes. Past assessment, planning, and evaluation processes were compiled that related to health and well-being focus and social determinants of health across a multitude of sectors, populations, and communities within Montgomery County. By 2010, the focus was on establishing a core set of indicators that could be examined through a comprehensive needs assessment that resulted in approximately 100 indicators being released at the launch of the Healthy Montgomery website on February 2011. During 2011, this information was compiled into the Healthy Montgomery Needs Assessment, which was sent to the Healthy Montgomery Steering Committee (HMSC) in September 2011. In October 2011, the HMSC held a half-day retreat to choose the strategic priority areas for improvement activities. The priority setting process utilized an online survey tool that the Steering Committee members completed prior to the retreat to enable them to independently evaluate potential priority areas by five criteria:
1. How many people in Montgomery County are affected by this issue? 2. How serious is this issue? 3. What is the level of public concern/awareness about this issue? 4. Does this issue contribute directly or indirectly to premature death? 5. Are there inequities associated with this issue? (Health inequities are differences in health
status, morbidity, and mortality rates across populations that are systemic, avoidable, unfair, and unjust.)
The survey results were compiled for each member and for the entire HMSC. The results were ranked and provided at the retreat to initiate the group process. Through multi-voting and consensus discussion, the Steering Committee narrowed the top-ranked priority areas to be the following:
Behavioral Health; Cancers; Cardiovascular Health; Diabetes; Maternal and Infant Health; and Obesity In addition to selecting the six broad priorities for action, the HMSC selected three overarching themes (lenses) that Healthy Montgomery should address in the health and well-being action plans for each of the six priority areas.
The themes are:
Lack of access; Health inequities; and Unhealthy behaviors.
CONTACT INFORMATION
ForquestionsorcommentsregardingtheCommunityHealthNeedsAssessment,pleasecontact:
KimberleyMcBrideCommunityBenefitOfficerHolyCrossHealth10720ColumbiaPikeSilverSpring,MD20904Phone‐(301)754‐7149mcbrik@holycrosshealth.org
AnelectronicversionofthisCommunityHealthNeedsAssessmentispublicallyavailableathttp://www.holycrosshealth.org/community‐health‐needs‐assessmentandprintversionsareavailableuponrequest.AfullversionoftheHealthyMontgomeryCommunityHealthNeedsAssessmentispublicallyavailableathttp://www.healthymontgomery.org/.
1500ForestGlenRdSilverSpring,MD20886www.holycrosshealth.org
top related