The Comprehensive Community Needs Assessment (CCNA) assesses Glendale’s changing community needs to help prioritize health and wellness initiatives. Utilized by organizations throughout the community, the project is led by representatives of our three area three hospitals: Glendale Adventist Medical Center, Glendale Memorial Medical Center, and Verdugo Hills Hospital. CCNA serves as the basis of multiple population health initiatives and community collaborations.
The Comprehensive Community Needs Assessment is designed to provide an evaluation of the major health and social needs and strengths in the greater Glendale area and neighboring communities. This comprehensive assessment provides a synthesis of detailed community-wide demographic and health status data from primary qualitative research and secondary data sources. The assessment was conducted by Center for Nonprofit Management, on behalf of the three not-for-profit hospitals serving the Glendale community:
- Glendale Adventist Medical Center
- Glendale Memorial Hospital and Health Center
- Verdugo Hills Hospital
The overall objectives of the project are as follows:
- To evaluate and prioritize health needs within the City of Glendale and neighboring communities by conducting a community-wide assessment, customized to each hospital’s defined service area, which measures key health indicators.
- To assure that the statutory requirements of Senate Bill 697 are met through the proposed community-wide assessment project.
- To design an assessment that is intended for use by the three hospitals in preparing an annual community benefit plan over the next three years in accordance with Senate Bill 697, with the potential to:
- Engage community partners in an ongoing community health priority-setting process and dialogue
- Increase awareness and utilization of existing resources
- Facilitate coordination and collaboration among the hospitals, community based organizations, and the Los Angeles County Department of Public Health to implement needed health improvement projects that address unmet community health needs.
- Primary and secondary data analyzed.
- Surveys sent to 200 organizations.
- Twenty one agencies (public and private) provided data.
- Assets mapping completed for SPA-2.
- Data collected around four target groups:
- Children (age 0 to 17)
- Adults (age 18 to 64)
- Seniors (age 65+)
- Low Income and Uninsured
The Hospital Community Benefit Program (HCBP), defined in the Health and Safety Code, Division 107, Part 2, Chapter 2, Section 127340 – 127360, is commonly referred to as “SB 697”. Passage of Senate Bill 697 in 1994 aided in refocusing attention on a collaborative approach to identifying and addressing community health needs. The enabling legislation states that private not-for-profit hospitals “assume a social obligation to provide community benefits in the public interest” in exchange for their tax-exempt status. Therefore, under the community benefit legislation, a private not-for-profit hospital in California is required to:
Conduct a community needs assessment every three years to identify unmet community health care needs,
Develop a community benefit plan in consultation with the community, and
Annually submit a copy of its plan to the Office of Statewide Health Planning and Development (OSHPD).
As not-for-profit hospitals, Glendale Adventist Medical Center, Glendale Memorial Hospital and Health Center, and Verdugo Hills Hospital are subject to the provisions of California Senate Bill 697, community benefits legislation. The community health needs assessment is envisioned to serve as a foundation for greater community cooperation to meet health needs. Through use of a common assessment, non-profit hospitals will be able to better coordinate and target their community benefit programs avoiding duplication of services with others. The identified needs, and their prioritization, will provide direction to the City of Glendale and other community and county entities as it determines deployment of public health resources. This will, in turn, result in a more coordinated allocation of both public and private health resources in Glendale. In addition, it is hoped that the community-wide health needs assessment will also stimulate greater collaboration between and among healthcare providers, government agencies, and community organizations.
Assets mapping is a strategy for “asset-based community development” and is based on the recognition of a unique combination of assets that exists in each community. Historically, the approach has been to focus on a community’s needs, deficiencies and problems. By comparison, assets mapping focuses on a community’s capacities and assets. The proposed SB 697 needs assessment combines the two approaches into a single strategy that links needs to community assets.
The main objective of assets mapping is to provide communities with a geographically oriented database of community assets. The intent of assets mapping is to identify what resources already exist in the community, how the resources are networked, and how these existing resources could be utilized to address priority needs and issues in the community. This, in combination with measurements of health status indicators should provide not only a method for constructing networks to address community health needs, but also a mechanism for understanding community well-being. Assets mapping will also provide information that the hospitals could use to build collaborations with other institutions providing similar services, complementary services, or serving similar populations.
- Income disparities are growing in Los Angeles County and the service area of interest. In the densely populated SPA 4, one in four households are (25%) living 100% below federal poverty line (FPL) which is greater than both the neighboring SPA 2 (14.2%) and the entire county (20.6%). In both AHG and GMHHC service areas, income power varies greatly but close to one in five households have incomes below $25,000 despite a mean household income rate nearing $100,000 and respective employment rates (58.4% & 60.3%) greater than that of the County (58.9%). Nearly half of residents in the coalition communities struggle financially with monthly housing costs exceeding 30% of their income. Not surprisingly, the homelessness rate is highest in SPA 4 (27%) of Los Angeles County. The area lacks sufficient shelters and social service providers to connect the homeless with needed resources. The heavy reliance on emergency services fails to meet the long term health care needs of the homeless.
Mental Health/Substance Abuse
- Coalition stakeholders identified poor mental health as one of the top health concerns in their service area, adding that it affects everyone, regardless of age. Though close to one in ten adults, primarily White or African-American and between the ages of 50-64, has depression, a third lack adequate social and emotional support. But, suicide rates are lower in the service planning areas 2 and 4 than in the rest of the County or State. In the AHG and GMHHC target areas, more than 1 in 10 adults engage in binge drinking (15.7 & 16.2% respectively). In the Glendale community, core to the coalition’s service area, 4 alcohol outlets are available per 1,000 persons on average, a rate nearly triple that of the County (0.6). Other adults in both service areas smoke (close to 1 in 4), try e-cigarettes (more than 1 in 6), or misuse any form of prescription drugs (5.2% & 7% respectively) or marijuana (15.1% in GMHHC) at a higher rate than County peers. In SPA 4 particularly, fewer than 1 in 3 adults (27.7%) sought help for self-reported mental/emotional and/or alcohol-drug Issues. Community stakeholders frequently mentioned lack of fit between service delivery models and community needs, and stigma surrounding mental health issues, as barriers to obtaining care.
Access to Care
- Health coverage among adults was significantly lower than coverage among children under 18 with a coverage gap measuring at least 10% in Los Angeles County between the two population groups. Among the insured, the majority carried employment based insurance (39.8%) or Medi-Cal (29.4%). At least 24% of adults in both hospital service areas faced challenges in accessing medical care slightly higher than the Los Angeles County rate (23.6%). In the broader SPA 4 community, more than half (55.5%) delayed care due to cost or lack of insurance, a rate significantly higher than the State rate (46%). Over 10% of adults in Service Planning Area 2 and 4 (which includes service areas for both hospitals) carry no insurance. More than one in five people in the coalition target communities lacked a consistent source of primary care, a high rate compared to Los Angeles County (19.7%).
- In Los Angeles County, the rate of adults diagnosed with heart disease has increased moderately year-over-year, from 5.4% in 2015 to 5.6% in 2016 and 6.6% in 2017. Almost one in ten White adults (9.5%) had heart disease compared to 5.6% of Latinos, 8.2% of African-Americans, and 2.8% of Asians. A large percentage of the population in SPA 2–San Fernando (94.7%) received assistance from a care provider to manage their disease. The rate is higher than that of Los Angeles County by 18% margin. Among diagnosed adults managing their condition, more than half in the county (53.5%) appeared confident to control their condition. In the coalition service area, at least a quarter of the population is diagnosed with high cholesterol. Among individuals with cholesterol, two-thirds receive disease management services for that condition. The SPA 2 and 4 reveal a population that is less prone to hypertension (29.9% and 24.4%) than its counterpart in Los Angeles County (30.0%). Nevertheless, for hypertension, the average annual age adjusted rates in emergency room visits for the AHG and GMHHC service areas were 33.6 and 32.9 respectively.
- Good prevention includes regular source of medical care and timely physical and medical tests. The rate at which AHG and GMHHC service area residents visit a doctor, nurse, or other health care professional is slightly lower (70.1% & 68.7% respectively) than the State (70.7%). The gap in care between medical and dental is significant, with fewer residents accessing dental care by a 6% margin. Screenings play an important role in prevention though only a few specific data measurements, such as those for colorectal and breast cancers, are readily reported. While not meeting 81.1% benchmark rate set in Healthy People 2020 Objective, mammogram screenings among women 30 years and older over a two year period were moderately higher in Los Angeles County (78.2%) though much better than 5 years prior.
- A majority of people do not carry dental insurance, though rates in SPA 2 (60.8%) and 4 (56.1%) fare better than the rest of Los Angeles (61.1%). While enough dentists appear available for oral care, 13% of all dentists in the County were newly licensed, and a larger portion (22%) were nearing retirement indicating a possible shortage of services in the near future. Problems with routine access persist particularly among minorities: one in five children in SPA 2 have no access. The rate of adults visiting a dentist in a year was 62.0% in SPA 4, which was the lowest rate in the range compared to the county (70%). In both of these service areas, over 10% of adults reported poor dental health or no natural teeth. Affordability of care is particularly noticeable among the youth particularly in SPA 4 with more than half of teens (54.2%) and 15% of children cannot afford care.
- Close to a third of the adult population in the County is overweight regardless of age. Adults 65 and over had the highest proportion of overweight people (40.7%), while adults between 50-59 years of age had the highest obesity rate (27.7%) in the county. The African American population had the highest combined rate for both overweight and obese (74.4%) adults. Trends suggest the rate decreased for overweight adults in the regions of interest to both hospitals, but increased among the adult obese population, as well as among overweight and obese youth. Disaggregated data at the local level are not currently available.
- The AHG service area has a greater proportion (17.6%) of it population 65 years of age or older than the GMHHC service area (15.6%). Rates of hospitalization due to falls was also higher in AHG community (17.6%) than GMHHC community (16.5%) but significantly lower than the rest of the County (28%) or State (28.5%). Among those seniors who fell in the coalition target communities, 4 out of 5 medical professionals recommended physical therapy /exercise, and one out of 3 reviewed medications. Broader county trends suggest a larger percentage of the 65+ population were diagnosed with diabetes (21.2%), hypertension (54.2%) or high cholesterol (47.5%) than the whole population (9.8%, 23.5% and 25.2%, respectively). Additionally, 47.7% of the 65+ population reported participating in low or no physical activity, compared to 34.8% of the general population. Seven out of California’s 10 most populous counties showed an Alzheimer’s death rate increase of over 20 percent from the prior period.
- Unlike the 2016 CHNA report, stakeholders did not identify diabetes as one of the top three important health problems in the community. The rates appear to be decreasing in these communities even while they increase significantly in Los Angeles County and the State. For instance, 9.6% of adults in SPA 2 were diagnosed with diabetes though the rate has decreased by 9.4% in a two year period. 16.7% of adults identified as pre or borderline diabetic with a declining rate (by 7.2%) from two years prior. These trends are assessed in greater detail in each hospital’s Community Health Needs Assessments which provide extensive data and supportive information regarding the assessment process as well as relevant data and analysis of these identified community needs and health determinants.