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UNIVERSITY OF ILLINOIS Community Assessment of Needs CUI-CAN) 2016: Toward Health Equity TIES ag aoe ea eis em Me ReotTe} SMU eines 2 CONTENTS Executive Summary 3 UI Hospital 5 Organization 5 Mission, Vision, and Values 5 Community Served by University of Illinois Hospital & Health Sciences System (UI Health) 7 Community Description 8 Demographic Characteristics 8 Community Assets 10 Development of CHNA 11 UNISON Survey Methodology 11 Community Stakeholder Input 12 Community Health Profile 13 Access to Care 13 Chronic Diseases 14 Physical Health 14 Mental Health 17 Health Behaviors 18 Social Determinants of Health 18 Prioritization of Community Health Needs 22 Prioritization Process 22 Identified High Priority Areas of Focus 23 Evaluation of Impact from 2013 CHNA 24 Appendix A: Additional Health Resources 27 Appendix B: Abbreviations 29 5 UI HOSPITAL Organization UI Health provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois at Chicago (UIC), UI Health comprises a clinical enterprise that includes a 495-bed tertiary care hospital, 22 outpatient clinics, and 12 Mile Square Health Center facilities, which are Federally Qualified Health Centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity. The UI Hospital is inseparable from its broader health system. The collective expertise of UI Health with its seven health science colleges brings a contemporary healthcare workforce to the task of changing healthcare delivery models. An academic environment allows performance of traditional investigation as well as community-based approaches to health identification and health management. And as we move toward community-based and preventive care, our outpatient clinics and community health centers become critical to our ability to manage populations and serve the full continuum of needs. Mission, Vision, and Values A PATIENT CENTERED ORGANIZATION The University of Illinois Hospital and Clinics is a patient centered organization. Providing safe, high-quality and cost-effective care for our patients is our foremost responsibility. The care of our patients and their families will always be at the heart of our mission. OUR MISSION In collaboration with our academic partners, our mission is to advance healthcare to improve the health of our patients and communities, promote health equity and develop the next generations of healthcare leaders. OUR VISION Our vision is to be the preeminent healthcare provider known for improving the health and wellness of our communities, providing exemplary care for our patients and advancing the knowledge to do so. 6 OUR VALUES Compassion We will treat our patients and their families with kindness and compassion and strive to better understand and respond to their needs. Accountability We will hold ourselves accountable as an organization and as individuals to act ethically and responsibly in everything we do, to be excellent stewards of our resources and to be transparent in our actions. Respect We will act with respect, openness and honesty in our dealings with patients, families and coworkers. We will work collaboratively to promote the well-being of the communities we serve and to advance patient care, education and research. Excellence We will work as a team to leverage best practices and innovation in providing the highest-quality care for our patients and families. We will devote ourselves to continuously improve in everything we do. 7 COMMUNITY SERVED BY UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM (UI HEALTH) For the purpose of this CHNA, UI Health focused on its Primary Service Area (PSA). UI Health’s PSA is comprised of 24 neighboring communities. In Chicago these are referred to as community areas. UI Health’s hospital and most of its twelve Federally Qualified Health Centers (FQHCs), Mile Square, are located within this area (Figure 1). In the past, we have generally thought of our PSA in terms of the seven zip codes that account for the largest proportion of UI Health clinical encounters: 60608, 60609, 60612, 60623, 60624, 60629, and 60632. Because community areas tend to be more meaningful for Chicago residents, we have chosen to focus on this geographic unit here. We included every community area that has a significant portion of territory within one of these seven zip codes. Figure 1. UI Health Primary Service Area and Health Facilities 10 Figure 4. Education by Community Area for UI Health’s Primary Service Area Figure 5. Unemployment by Community Area for UI Health’s Primary Service Area Community Assets UI Health recognizes that there are many existing healthcare resources within the community that are available to respond to the needs of its residents. Figure 1 above maps the UI Health clinical resources, including all Mile Square Health Center, school-based health center, and integrated health center locations. Appendix A identifies additional health resources in UI Health’s primary service area, including hospitals, community health centers, school-based health centers, and nursing homes. These health-related assets provide an opportunity for joint efforts to address the needs of the communities we collectively serve. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Pe rc en t w ith H ig h Sc ho ol D eg re e or Le ss Chicago Average - Only High School or Less 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Pe rc en t U ne m pl oy ed Chicago Average - Unemployed (Aged 16+) 11 DEVELOPMENT OF CHNA The 2016 Community Health Needs Assessment was developed by the Office of the Vice Chancellor for Health Affairs (OVCHA), with leadership from Jerry Krishnan, MD, PhD, Associate Vice Chancellor for Population Health Sciences, and Nicole Kazee, PhD, Assistant Vice Chancellor for Strategy. This effort incorporated input from the following groups: • Office of Community Engagement and Neighborhood Health Partnerships o Partner’s Council for Community Health o Healthy City Collaborative • Healthy Chicago Hospital Collaborative • Chicago Department of Public Health Our process focused on incorporating feedback from groups that represent the community and the varied internal stakeholders, and the long term objective of obtaining the appropriate data that will best meet our needs. We will continue to work with these partners and others as we develop and roll out the UI Health Implementation Strategy to impact the health needs that have been identified in this CHNA. UNISON Survey Methodology As described in our first report, UI Health determined in building the 2013 UI-CAN that our commitment to our core mission required that we think bigger about how we could more accurately assess our community’s needs. We believed that the telephone surveys available three years ago left significant gaps in our understanding of our particular communities, and that self- reported data collected via phone had important flaws. As a result, we launched the University of Illinois Survey On Neighborhood Health (UNISON Health), an ambitious, innovative community health needs assessment that involved in-person interviews and biometric testing in our PSA. UNISON Health, conducted in 2013 and 2014 by the Survey Research Laboratory in the University of Illinois at Chicago’s College of Urban Planning and Public Affairs, included a random sample of community members in the 24 community areas in UI Health’s PSA. Utilizing a stratified probability sampling methodology, UNISON Health enrolled 454 adults in Group 1. The community survey included questions on health behaviors, healthcare access and utilization, prevalence of disease conditions, and quality of life indicators. The survey was offered in both English and Spanish. The survey also included collecting biometric data such as blood pressure, height, and weight, in order to measure a small number of actual health indicators. For example, such data could reveal important differences between diagnosed and undiagnosed hypertension in the community, as well as the level of blood pressure control among those with a diagnosis of hypertension. The sample of 454 adults age 18 to 60+ is representative of the 24 community areas, with similar racial and ethnic composition. This was crucial for us, since many surveys underrepresent 12 minorities. Nineteen percent were Non-Hispanic Whites, 34% were Non-Hispanic Blacks, 40% were Hispanic, and 7% indicated an ‘Other’ race/ethnicity. The average age of respondents was 40 years, and 52% were female. Fifty-seven percent of respondents had a high school degree or less. UNISON Health also included modules that focused on a random subset of adults who seek care at UI Health with a diagnosis of hypertension or diabetes, and children with a diagnosis of asthma who live in one the 24 community areas that define our PSA. These portions of the survey included additional questionnaires as well as in-person clinic visits where further biometric data were collected. Findings from these modules will be shared with our communities in other venues, as part of our strategy to develop an Implementation Plan specific to the communities we serve. Community Stakeholder Input To complement the UNISON survey data, the CHNA engaged community stakeholders to solicit input on health needs and priorities. The community members and organizations who provided input were identified through the Office of Community Engagement and Neighborhood Health Partnerships (OCEAN) and included members and organizations representing the interests of medically underserved, low-income, and minority populations in the community. The focus group discussions and specific comments made by participants are included throughout this report, as they relate to other information presented. The first focus group was held on June 2, 2016 and included three community stakeholders. A larger Healthy City Collaborative & Partners Council for Community Health meeting was held on June 14, 2016, and included 20 community stakeholders, including the Chicago Department of Public Health. The community organizations that were represented in either of these events included: • Office of Community Engagement and Neighborhood Health Partnerships • Chicago Department of Public Health • Chicago Hispanic Health Coalition • University of Illinois Cancer Center • UIC Midwest Latino Health Research, Training and Policy Center • Treatment Alternatives for Safe Communities (TASC) • Chicago State University • Brighton Park Neighborhood Council • DePaul University • Rush Alzheimer’s Disease Center • UIC College of Dentistry • UIC Office of Health Literacy • UIC School of Public Health • Unaffiliated community members 15 Figure 7. UI Health Primary Service Area Top Seven Physical Health Conditions UNISON Health asked survey participants to provide self-report weight status and also took in- person measurements of height and weight. Using in-person measurements, 70% of Blacks, 78% of Hispanics, and 63% of Whites were found to be overweight or obese (body mass index 25 kg/m2 or higher). Interestingly, there was a striking difference between self-report and physical measurement of weight status: on average, self-report underestimated overweight or obese body weight when compared to measurements by 19% (Figure 8). Obesity affects many other health conditions, both physical and mental, and therefore has a long-term impact on the health of our communities. 0% 10% 20% 30% 40% 50% 60% 70% 80% Coronary Heart Disease Diabetes Asthma High Cholesterol Joint Pain Disease Hypertension Obese Overall Black Hispanic White U.S. Comparison 16 Figure 8. Self-report vs. Measured Overweight and Obese by Race/Ethnicity for UI Health Primary Service Area Hypertension was another common health condition in the UI Health PSA. The prevalence of hypertension (greater than 140 mm Hg systolic or 90 mm Hg diastolic) in the UI Health PSA is about two-fold that in the U.S. (including the roughly 20% of individuals with undiagnosed hypertention). In addition, among those who reported a diagnosis of hypertension, about two- thirds (68%) did not have blood pressure control when measured at their home (Figure 9). Taken together, these data from UNISON Health indicate a clear need to increase efforts to identify individuals with undiagnosed hypertension, as well as to improve blood pressure control among those who have been diagnosed with hypertension. Figure 9. Hypertension for UI Health Primary Service Area 0 10 20 30 40 50 60 70 80 90 Overall Black Hispanic White Pe rc en t O ve rw ei gh t o r O be se Overweight (self-report) Overweight or Obese (measured) 0 10 20 30 40 50 60 70 80 Prevalence Undiagnosed Uncontrolled Pe rc en t H yp er te ns io n UI Health PSA U.S. 17 Sickle Cell Disease (SCD) is is a rare genetic health condition, affecting about 2% of Blacks in our PSA. Individuals with SCD have painful crises due to sickling of their red blood cells, leading to emergency department visits and hospitalizations. The Sickle Cell Center at UI Health provides comprehensive care across the lifespan for individuals with SCD, which helps to explain why a higher proportion of individuals are seeking care at UI Health for SCD than on average elsewhere in the city of Chicago. Our own utilization data are striking given the low prevalence of SCD. In FY 2015, SCD patients accounted for 1,338 hospitalizations and 761 emergency room visits. Mental Health Three of the ten top health conditions found in UNISON Health were mental health conditions. Diagnoses of depression, anxiety, and attention deficit hyperactivity disorder (ADHD, also known as attention deficit disorder) were found in each racial/ethnic category (Figure 10). Focus group participants cited the importance of addressing both mental and physical health. As described by a participant: “Mental health is a big need. There is such a strong interaction between mental and physical health, which encompasses anxiety, depression, self-medication, overeating, and smoking. Many of these are comfort behaviors that happen as a result of other factors. There is a need to better integrate physical and mental health into one primary care network.” Figure 10. UI Health PSA Top Three Diagnosed Mental Health Conditions The prevalence of violence in the communities we serve, and the trauma that often results from experience with violence, can also have a detrimental effect on mental health. (For example, violent events can trigger posttraumatic stress disorder (PTSD).) The data on homicide rates presented below suggest that the need for mental health services is likely to be disproportionately high in our PSA. 0% 5% 10% 15% 20% 25% Depression Anxiety ADHD/ADD Overall Black Hispanic White 20 Figure 13. Hardship Index by Community Area for UI Health PSA We know that violence plagues our communities, and the issues of violence and safety were brought to our attention by our community members and stakeholders. Half of our communities have homicide rates higher than the city rate (Figure 14). Some of the community areas that are part of the UI Health PSA have homicide rates that are more than three times the average for the city of Chicago. 0 20 40 60 80 100 West Town Near West Side Bridgeport Douglas West Lawn Grand Boulevard McKinley Park Archer Heights West Elsdon Lower West Side Chicago Lawn Armour Square East Garfield Park Brighton Park Humboldt Park North Lawndale Washington Park West Englewood New City West Garfield … Gage Park Englewood South Lawndale Fuller Park CDPH Hardship Index 21 Figure 14. Homicide by Community Area for UI Health PSA Focus group participants cited neighborhood characteristics and a lack of infrastructure in communities as a significant barrier to good health. As described by a participant: “We can’t expect physical activity when people don’t feel safe to go outside or there are no parks or areas of recreation.” A lack of opportunity and high unemployment were also cited by participants as significant issues in their communities. As described by a participant: “Nearly half of young black men in Chicago are unemployed. This is the root cause of many underlying health issues.” 0 10 20 30 40 50 60 Ho m ic id e Ra te p er 1 00 ,0 00 Chicago Average - Homicide Rate 22 PRIORITIZATION OF COMMUNITY HEALTH NEEDS Prioritization Process At the conclusion of each community stakeholder meeting, participants were asked to write down (anonymously) what they individually perceived as the top five health priorities for the community, based on the discussion as well as their own experiences. Their responses were as follows: • Chronic Disease (obesity, hypertension, asthma, diabetes) • Mental health (depression, anxiety, PTSD) • Trauma/violence and community safety • Health education and health literacy • Oral health After reviewing the 2013 UI-CAN data from our community description and health profile, as well as feedback from our community members and the Chicago Department of Public Health, the following additional criteria were used to prioritize the health needs for action in fiscal years 2016 to 2019: • Magnitude. Overall prevalence of chronic diseases and health needs, while paying particular attention to those areas where the needs are greater compared to national, state, and city-level benchmarks. • Disparity. The degree to which the identified need disproportionately impacts certain populations in our PSA. • Impact. The degree to which the condition or issue affects or exacerbates other quality of life and health-related issues, as well as UI Health’s ability to reasonably impact the issue given resources available. • Alignment with UI Health System Mission. How well the health need aligns with the health system's mission to provide high quality care to the people of Illinois and to eliminate health disparities. • Alignment with Healthy Chicago 2.0 and Healthy Illinois 2021. In an effort to collectively make an impact and partner on strategies to improve the health of communities, how well the health need aligns with Healthy Chicago 2.0 and Healthy Illinois 2021 priority areas. 25 o Coordination of HEalthcare for Complex Kids (CHECK) § Deployed a team of highly trained community health workers and Care Coordinators to provide children and families access to extra support services, education about illness, and tools for disease management. § Expanded oral health services through the Mobile Care Chicago dental van, which provides comprehensive services to low income communities. Since January 2016, the dental van has had a goal of hosting at least one monthly event in UI Health communities, providing direct oral health services and linking patients to additional services at the UIC School of Dentistry. o Sickle Cell Center at the University of Illinois Hospital & Health Sciences System § As the only Sickle Cell Center in the state providing comprehensive sickle cell care for adults, the center increased its capacity by expanding service to five days a week. To better integrate care and link patients to these comprehensive services, UI Health pediatric hematologists and a dedicated social worker work with other area hospitals around potential patients being transitioned to UI Health. 3. Increase awareness of UI Health services o UI Health became a Certified Application Counselor organization in 2013. This means that patients and community members can receive in-person enrollment assistance and education for either Medicaid or the Health Insurance Marketplace at six different locations across UI Health. Since the first open enrollment period in 2014, UI Health has assisted community members with over 3700 Medicaid applications and over 320 Marketplace applications. o UI Health marketing developed targeted awareness and education campaigns to improve community knowledge about services and locations of UI Health. Education campaigns provided information and resources around brain aneurysms, stroke, mammography, and sickle cell disease. Follow-up care 1. Provide patient navigators to guide patients through the healthcare system o Emergency Patient Interdisciplinary Care (EPIC) Coordination for Frequent ER Visitors initiative used an interdisciplinary care model to create and activate individualized health management programs to transition frequent ER visitors to a medical home. § The goals of the program were to enhance quality of care, improve outcomes, and lower Illinois Medicaid costs by reducing ER visit and hospitalizations. The program ran for two years, screened over 400 patients and provided care coordination for 230 patients. o The PArTNER program, the CHICAGO Plan, and CHECK aall utilize community health workers to guide patients through the healthcare system. 2. Increase care coordination to ensure patients receive appropriate care o Created an Accountable Care Entity (ACE) called UI Health Plus to provide comprehensive care and care coordination for Medicaid clients across the state. UI Health Plus teamed up with Blue Cross Community Family Health Plan in January 2016. The UI Health Care Coordination team now has 13 care coordinators, coordinating the care of approximately 375 high-risk patients. 26 o Better Health Through Housing, a partnership with the Center for Housing and Health, aims to reduce healthcare costs and provide stability for the chronically homeless by moving individuals directly from hospital emergency rooms into supportive housing, with intensive case management. § In 2016, UI Health committed $250,000 to help launch the initiative, and it is the only Chicago-area hospital working on this type of healthcare-and- housing initiative. Along with housing, individuals are assigned a case manager who helps them with things such as scheduling medical appointments, managing money, and refers them to other needed services. § Early results indicate a 34% reduction in ED and inpatient utilization for these newly housed patients, and a 75% decrease in healthcare costs. Chronic conditions and factors 1. Expand specialty care at FQHCs o Since 2014, psychiatry services have been expanded and breast surgery was added to increase on-site capacity. Mile Square providers are also working with the CHECK program for additional education and patient navigation to specialty care. o In 2016, the Office of Community Engagement and Neighborhood Health Partnership (OCEAN) began implementing the phased introduction of telehealth services at two school-based health centers. The telehealth program supports remote provider consultations and health evaluations for chronic and high-risk patients. 2. Increase focus on patient centered care to provide personalized treatments for chronic conditions o The PARTNER program, the CHICAGO Plan, and the CHECK program all include initiatives to help enrollees manage chronic conditions. 3. Increase education and awareness about chronic conditions through community outreach and screening services o Mile Square takes part in between 12-20 large community events each year, including Corazon Community Health Services, Hope Fest, Fiesta del Sol, Bud Biliken Parade & Picnic, Congressman Davis Back to School Picnic, and the African American Festival for the Arts. o Community health workers from Mile Square clinics and SBHCs regularly attended community health fairs to provide health education and screening. Cancer screening 1. Create a lung cancer screening program o UI Cancer Center and MSHC created the Mi-Quit smoking cessation program to address the high rates of lung cancer in UI Health’s PSA. To date, over 180 patients have been screened and the partnership has resulted in increased early detection of lung cancer in high-risk populations. 2. Leverage existing resources to promote screening for colorectal and prostate cancer o The Mi-Care program goal is to increase colorectal cancer screening in community- based settings through the incorporation of a community-based colorectal cancer screening and navigation program into MSHC. To date, the UI Cancer Center has been able to increase colorectal cancer screening from a baseline rate of 12.7% to over 45% due to evidence-based navigation. 27 APPENDIX A: ADDITIONAL HEALTH RESOURCES Hospitals University of Illinois Hospital 1740 W. Taylor St., Chicago, IL 60612 Holy Cross Hospital 2701 W. 68th St., 60629 Jesse Brown VA Medical Center 820 S. Damen Ave., Chicago, IL 60612 John H. Stroger Jr. Hospital of Cook County 900 W. Polk St., Chicago, IL 60612 Mount Sinai Hospital 1500 S. Fairfield Ave., Chicago, IL 60608 RML Chicago 3435 W. Van Buren St., Chicago, IL 60624 Rush University Medical Center 1653 W. Congress Pkwy., Chicago, IL 60612 Sacred Heart Hospital 3240 W. Franklin Blvd., Chicago, IL 60624 Saint Anthony Hospital 2875 W. 19th St., Chicago, IL 60623 Schwab Rehabilitation Hospital 1401 S. California Blvd., Chicago, IL 60608 Source: http://www.ihatoday.org/hospital-directory.aspx Community Health Centers Mile Square Health Center – Main 1220 S. Wood St., Chicago, IL 60608 Mile Square Health Center – Back of the Yards 4630 S. Bishop St., Chicago, IL 60609 Mile Square Health Center – Cicero 4745-51 W. Cermak Rd., Cicero, IL 60804 Mile Square Health Center – Englewood 641 W. 63rd St., Chicago, IL 60621 Mile Square Health Center – South Shore 7131 S. Jeffery Blvd., Chicago, IL 60649 Mile Square Health Center – Humboldt Park 3240 W. Division St., Chicago, Illinois 60651 Mile Square Health Center – South Clinic/New City 734 W. 47th St., Chicago, IL 60609 ACCESS Servicios Medicos La Villita 3303 W. 26th St., Chicago, IL 60623 ACCESS Madison Family Health Center 3800 W. Madison St., Chicago, IL 60624 ACCESS Centro Medico 3700 W. 26th St., Chicago, IL 60623 ACCESS Westside Family Health Center 3752 W. 16th St., Chicago, IL 60623 ACCESS Centro Medico San Rafael 3204 W. 26th St. , Chicago, IL 60623 ACCESS at Sinai 2653 W. Ogden Ave., 3rd Floor, Chicago, IL 60608 ACCESS Plaza Family Health Center 2533 W. Cermak Rd., Chicago, IL 60608 ACCESS Madison Family Health Center 3800 W. Madison St., Chicago, IL 60624 ACCESS Cabrini Family Health Center 3450 S. Archer Ave., Chicago, IL60608 ACCESS Warren Family Health Center 2409 W. Warren Blvd., Chicago, IL 60612 ACCESS Pilsen Family Health Center 1817 S. Loomis St., Chicago, IL 60608 ACCESS Located at Holy Cross 2701 W. 68th St., 3 South, Chicago, IL 60629 Alivio Medical Center – Morgan Street 966 W. 21st St., Chicago, IL 60608 Alivio Medical Center – Western Avenue 2355 S. Western Ave., Chicago, IL 60608 Esperanza California 2001 S. California Ave., Chicago, IL 60608 Esperanza Little Village 3059 W. 26th St., Chicago, IL 60623 Esperanza Marquette 6550 S. Richmond St., Chicago, IL 60629 Erie Westside Health Center 646 N. Lawndale Ave., Chicago, IL 60624 Friend Family Beethoven Health Center 25 W. 47th St., Chicago, IL 60609 Friend Family Pulaski Health Center 5635 S. Pulaski Rd., 2nd Fl., Chicago, IL 60629 Friend Family Ashland Health Center 4802 S. Ashland Ave., Chicago, IL 60609 Lawndale Christian Health Center – Ogden 3860 W. Ogden St., Chicago, IL 60623 Lawndale Christian Health Center – Homan Square 3517 W. Arthington St., Chicago, IL 60623 Lawndale Christian Health Center – Archer 5122 S. Archer Ave., Chicago, IL 60632 PCC Clinic at The Boulevard 3456 W. Franklin Blvd., Chicago, IL 60624 Source: http://www.iphca.org/Portals/0/Maps/Chicago_All_Sites_And_Legend.pdf