Holy Cross Hospital - Chicago

Transcription

Holy Cross Hospital
Community
Health Needs
Assessment
JUNE 2013
Making lives better
Mejorando vidas
Holy Cross Hospital
Community Health
Needs Assessment
June 2013
Contents Executive Summary i Part I. Holy Cross Hospital 1. Introduction to Our Assessment 1 2. Description of Our Communities 8 Part II. Community Health Data 3. Mortality 15 4. Hospitalizations 26 5. Survey Data 40 6. Sexually Transmitted Infections 51 7. Focus Groups 56 Part III. Strategies to Improve Health 8. Implementation Strategy 62 Appendices Appendix A: Additional Mortality Information 73 Appendix B: Additional Hospitalization Information 91 Appendix C: Focus Group Details 102 Executive Summary As part of the Affordable Care Act of 2010, each hospital facility in the U. S. must conduct a Community Health Needs Assessment (CHNA). This very important aspect of that Act mandates that hospitals must assess the health of the communities they serve, not just the patients who walk into their buildings, and that they must make a plan to improve community health. Holy Cross Hospital (HCH), part of the Sinai Health System, is located on the southwest side of the city Communities within the Chicago, serving mostly Black and Latino people from Holy Cross Hospital Primary some of the poorest communities in the U.S. This Service Area CHNA is part of our continual process to not only understand the health-‐related needs of the Archer Heights Gage Park communities we serve, but to work with our Auburn G
resham New City community partners and members to develop and Brighton P
ark West Elsdon implement creative strategies to address them. Chicago Lawn West Englewood Englewood West Lawn This report is heavily evidence-‐based. That is, it is driven by data and shaped by the input and observations of community members, health professionals, and public health practitioners. Together, the data findings and community input helped us determine the most important health issues to address as a health system. Structure of This Report We first describe our assessment and hospital in the Section 1. Then, in Section 2, we present social and demographic data to describe the communities we serve. This is followed by some of the most detailed analyses of causes of death (Section 3) and reasons for hospitalizations (Section 4) that we have ever seen. We then present survey data (Section 5) that help us understand the behaviors and social factors that shape the health of these communities. Next comes information on sexually transmitted infections (Section 6). We follow this data with a very substantial discussion of input into what the data mean to the communities we serve, what issues are of greatest importance, and how the hospital can begin to work with the community to improve health (Section 7). The report culminates with a plan of action and a road map for the implementation of this plan. Findings This assessment is necessarily long and detailed. We certainly do not expect all people to read all of the sections, but we do believe there is something here for everyone. In great brevity, the Primary Service Area of Holy Cross Hospital includes 10 communities, which represent 14% of Chicago’s population with a total of 365,026 people. More than 90% of the population living in this area are either Hispanic or African-‐
American. Although health outcomes vary among these communities, by and large, far too many people are sick and die too early. i “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Dr. Martin Luther King, Jr, 1966 Priority Health Issues for HCH Primary Service Area MORTALITY Diabetes SEXUALLY TRANSMITTED INFECTIONS SURVEY DATA HOSPITALIZATIONS Data Source Heart Disease Stroke Asthma Diabetes Mental Health Chronic Conditions Overweight & Obesity Smoking Mental Health HIV Gonorrhea Syphilis Chlamydia FOCUS GROUPS Chronic Conditions Obesity Mental Health For example, life expectancy, how long we can expect to live, is considered by many to be the single most important measure of health. Life expectancy for Chicago was 77 years but it varied between 69 and 81 years for the 10 communities we serve. A map of life expectancy for the city (in Section 3) shows that low life expectancies are clustered overwhelmingly on the south and west sides, areas which are populated predominantly by Black people. We find the same patterns prevail when we look at various causes of death like heart disease (Section 3), hospitalizations (Section 4), health behaviors like smoking (Section 5), and sexually transmitted infections (Section 6). To guide our efforts, we asked various individuals and organizations within the communities we serve to help us identify priority health issues. We also worked with these community members to brainstorm solutions that the health system could implement, alone or in partnership with community organizations. In Section 7, we describe this input. In general, community members identified problems such as diabetes, high blood pressure, cancer, obesity, mental health, and sexually transmitted infections as the most important health issues to be addressed. They felt that HCH (and other hospitals) could improve the health of the community by providing more health information-‐especially in emergency rooms, collaborating with schools to do outreach and education, and hiring and training culturally competent staff and physicians. Implementation Strategy HIV/STIs The real goal of conducting a Community Health Needs Assessment is to motivate and guide actual changes. We are excited to take the information learned through this assessment and use it to make a plan of action. First, the data described above was used to identify priority health concerns for the communities we serve. These health concerns are as follows: diabetes, obesity, heart disease, stroke, STIs, and mental health. We then examined existing efforts and resources available to improve these conditions. With this information, we were able to map out new programs and policies that we can implement to address the needs identified by the data and community members. This plan, and an overview of its progress to date, is summarized in Section 8. Conclusion HCH has a long history of striving to improve the health of the poor communities on the southwest side of Chicago. This assessment and corresponding plan of action provide an ideal blueprint from which HCH can continue to improve community health through changes inside and outside our walls. We welcome any comments or suggestions you may have to help us on this journey. ii Part I
Holy Cross
Hospital
Section 1: Introduction Health and well-‐being are influenced by many factors ranging from health behaviors (e.g., smoking, physical activity), to access to health care (e.g., health insurance, culturally competent providers), to structural factors in society (e.g., housing, education), to what have been called the fundamental causes of poor health (e.g., poverty, lack of education, racism).1 In order to improve health outcomes within a community, each of these factors needs to be understood and addressed. Conducting a Community Health Needs Assessment (CHNA) is an ideal opportunity for hospitals to do just this. Such assessments allow hospital administrators and health care providers to better understand the health-‐related needs of their community members in order for them to better tailor services and implement interventions. Such an assessment may also be valuable to other organizations and community members. Holy Cross Hospital has recently come under the umbrella of the Sinai Health System (SHS), which will allow us to bring to our community many of the additional resources and expertise that SHS has developed. Sinai Health System is particularly known for its expert knowledge of factors in and around our communities that impact our health, beyond what we traditionally think of as the business of medicine. Attempting to understand and address these factors is a process that Sinai Health System has come to label as “pre-‐primary care©.” For example, as we describe below, one of the highly successful programs of Sinai Health System has consisted of a series of interventions to help children with asthma. Over the past 12 years, we have learned that more was needed than just effective health care. Children with asthma have to be freed from second-‐hand smoke, dust mites, rodent feces, and inadequately ventilated living quarters. This, in turn, requires collaboration with physicians, community health workers, housing experts, and even attorneys. Going beyond traditional health care services is what makes Sinai Health System unique and is one of the ways we are attempting to become the national model for the delivery of urban health care. Figure 1.1 presents a schema for this concept of pre-‐primary care, developed by Sinai Health System and newly available to the Holy Cross Hospital community. Traditional hospital care includes both primary care, which is represented by the cloud in the center, and acute care, which is done by the institutions at the right. However, what makes us truly unique are the activities and institutions shown in the left-‐most column. These are the components of the Sinai Health System that speak most directly to the health of the communities we serve and which will be discussed throughout this assessment. Here we present the 2013 Community Health Needs Assessment of Holy Cross Hospital. This report is consistent with the mission and vision of our health system (see Figure 1.2) and also with the language and spirit of the new federal regulations requiring such assessments. It is hoped that this assessment, like the previous ones we have done, will provide a roadmap to improved health for communities on the west and southwest sides of Chicago. We believe this report is not only critical for guiding the actions of our health system, but also that it may be valuable for members of our community and those organizations who serve them. It is in this spirit that we share this CHNA with the reader. To contact us, please use the following email address: [email protected] or Dennis Ryan, VP of Mission Effectiveness and External Affairs, 773-‐884-‐1605. We would very much appreciate your feedback. 1 Figure 1.1 Pre-‐Primary Care©: Sinai’s Vision of Community-‐Based Health Care We would also be pleased to arrange for a presentation of the main findings of this report to your organization, and/or to provide hard copies. Sinai Health System The Sinai Health System (SHS) is a unique health care delivery system on the west and southwest sides of Chicago. SHS was founded in 1919 to provide care to Eastern European Jewish immigrants in the area as well as to create a place for Jewish doctors to practice. We now serve predominantly African-‐
American and Latino communities, but our mission has remained the same. This mission addresses our desire to make a difference in both the individuals and the communities we serve. As we develop innovative and effective ways to do this, we strive to become the national model for the delivery of urban healthcare (see Figure 1.2). Along with Holy Cross Hospital (HCH), our health care system includes Mount Sinai Hospital, Schwab Rehabilitation Hospital, Sinai Children’s Hospital, Sinai Medical Group, the Sinai Community Institute (SCI), and the Sinai Urban Health Institute (SUHI).  Holy Cross Hospital is a 274-‐bed Catholic community hospital on the southwest side of Chicago, offering intensive care, medical and surgical services, as well as obstetrics, rehabilitation, hospice and an array of diagnostic and therapeutic services. Its Emergency Department receives 50,000 visits per year, and more ambulance runs than any hospital in the state, a function of the hospital’s geographic isolation and local unaddressed health needs. HCH is engaged with its surrounding communities in collaborative efforts to address housing, education, immigration and safety concerns that impact health, particularly in Chicago Lawn and the Englewood communities, in collaboration with Greater Southwest Development Corporation, Southwest Organizing Project, Helping Hands of Englewood, other agencies and federal, state, and local officials. 2 
Mount Sinai Hospital (MSH) is a 319-‐bed teaching hospital with a Level 1 Trauma Center, 60,000 emergency visits, and 4,000 deliveries a year. MSH is a community-‐based hospital that provides exceptional medical, surgical, behavioral health, therapeutic, and diagnostic services. Sinai also trains more than 700 health care professionals a year. Figure 1.2 Mission, Vision and Values of the Sinai Health System Mission Statement
To improve the health of the individuals and communities we serve.
Vision Statement
To be the national model for the delivery of urban healthcare.
Values
We will do this with:
Respect
We create an atmosphere of mutual respect and fairness, treating each person
with dignity, recognizing we all have unique talents.
Integrity
We hold ourselves accountable for our actions and are honest and ethical in all
our dealings.
Quality
We continuously improve our services as measured by the best practices in the
industry.
Safety
We foster an environment that focuses on protecting our patients, visitors and
caregivers from harm or injury.
Teamwork
We celebrate the opportunity to come together as caregivers in an inclusive
workplace where diversity and open communication are valued.

Schwab was the first accredited rehabilitation hospital in the Midwest. Today it serves as a regional 102-‐bed rehabilitation center with innovative therapies including music and horticulture. It is the only rehabilitation facility in the Chicago area accredited by both the Joint Commission and CARF in the disease-‐specific area of stroke. 3 

Sinai Children’s Hospital includes pediatric cardiology, gastroenterology, nephrology, allergy, endocrinology, urology, physical medicine and rehabilitation, and neurology services. In 2010, there were 2,280 admissions to SCH. SCH has a Level III Neonatal Intensive Care Unit Center, which is the highest level of care for fragile newborns, and a Pediatric Intensive Care Unit. Sinai Medical Group includes 295 physicians with 39 medical and surgical specialties who work at Mount Sinai Hospital and other Sinai Health System sites throughout the Chicago area. 
SCI provides education, employment counseling, case management, and nutrition services that address the social and economic factors affecting the health of the community’s most vulnerable members—infants, children, adolescents and older adults. Of the 30,000 annual client visits, approximately 98% are for low-‐income minority women and children.  SUHI is a leading research center focused on eliminating health disparities through social epidemiology, program evaluation, interventions, teaching and consulting. SUHI is currently implementing a wide range of health interventions within the community to address issues such as pediatric asthma, breast cancer screening, and diabetes. Together, these components of the Sinai Health System serve some of the most socio-‐economically challenged neighborhoods in Illinois, providing medical and social services not otherwise available to these diverse communities with a combined population base of 1,500,000 people. The Community We Serve The primary service area of HCH includes: Archer Heights, Auburn Gresham, Brighton Park, Chicago Lawn, Englewood, Gage Park, New City, West Elsdon, West Englewood, and West Lawn. A detailed description of the demographic and socioeconomic characteristics of the individuals living in this community is provided in Section 2. HCH Community Benefits In 2012 Holy Cross Hospital (HCH) provided $20.2 million in community benefits, including charity care, language assistance, government-‐sponsored indigent health services, donations, coverage for bad debts, and volunteer services. Breaking this number down, charity care comprised $8.4 million of that $20.2 million and other community benefits added up to $11.8 million. These benefits provide resources for many unfunded community initiatives that promote health and healing. HCH serves a fragile community. High rates of foreclosure, unemployment, violence, poor educational facilities, and some of the worst health indices in Chicago plague the area. HCH itself has been challenged to stay viable in such a poorly resourced area, however, we work to deploy our limited resources in ways that most appropriately meet the needs of the community. HCH also addresses the needs of the community through a Parish Nurse Program. HCH has designated a nurse to serve three large churches in the area. The nurse conducts blood pressure screenings and health assessments for members and also makes home visits to at-‐risk seniors. The Hospital provides health education workshops, health assessments, and diagnostic testing for members of 30 senior groups. 4 HCH holds membership in several local community organizations, many of which are deeply invested in addressing one or more social determinants of health, such as housing, violence, and youth services. Unpaid Hospital staff persons have become board members of these organizations which has helped HCH identify community needs and in turn communicate to the leadership of these organizations the resources the Hospital has to serve them. HCH’s services for uninsured and underinsured persons represent a vital safety net for community residents totaling to 20.6% of Holy Cross’s annual operating costs. Affordable Care Act of 2010 The Patient Protection and Affordable Care Act (ACA) was recently passed into law and with it the provision (Section 501(r)(3)) which mandates that every hospital facility conduct a needs assessment every three years. The language of the bill emphasizes that this requirement is not just a formality, but a way to ensure that all hospitals are aware of, and are attempting to address, real health needs within the communities they serve. According to the provisions of the act, the assessment must incorporate input from individuals who represent diverse groups within the community, including those with health expertise, and contain an implementation strategy to address the identified needs. Once completed, the report must be made public. Previous Community Health Assessments In order to understand the needs of the communities we serve, the Sinai Health System conducted a health survey between 2002 and 2003. To our knowledge, it was the largest community health assessment ever conducted in Chicago and it resulted in comprehensive analyses of the health and well being of 10 different community areas in the city. These diverse communities included Blacks, Mexicans, Puerto Ricans, Whites, Chinese, Cambodians, Vietnamese, and Orthodox Jews. We have published a book describing this process (Figure 1.4) and the resulting data, entitled Urban Health: Combating Disparities with Local Data. In addition, the results have been disseminated through numerous articles in peer-‐reviewed journals2 and community reports.3,4 All of these articles and reports are available through the Sinai Urban Health Institute website (http://www.suhichicago.org/). Selected findings from this are presented in the Survey Data section. As a result of the data gathered in this health assessment, many grants were written by the SHS and millions of dollars were brought to the various surveyed communities and others like them. 5 Figure 1.4 Sinai’s Recent Book About Community Health Assessments
Most importantly, these grants enabled us to put into place several interventions to improve the health of the communities we serve in such areas as breast health, pediatric asthma, diabetes, pediatric and adult obesity, and smoking cessation. Furthermore, our health system was not the only organization to use the data. Other health agencies across the city employed the data to obtain grants, target programs, and implement new interventions for improved health. Report Methodology To best understand the health of our community, we have collected data from a variety of sources through a variety of methods. For example, we have used both quantitative and qualitative data from both primary and secondary sources. More specifically, this report includes data from surveys, birth and death certificates, program evaluations, and hospital data. We have attempted to interpret the findings in order to make them more accessible to everyone in the community. We have also included information obtained through more personal methods, such as interviews. The knowledge we gathered from community members in this way helps to provide context to the empirical findings. When combined, the overall report offers a great deal of information to help guide our health system’s priorities and the efforts of other community organizations. More specifically, we will begin by describing the communities we serve. Next, in Part II, we examine prominent causes of death in these communities, leading reasons for hospital admissions and readmissions, and what survey data tell us about the health of these communities. Also in Part II, we present discussions of birth outcomes, child and adolescent health, sexually transmitted infections, and disability and violence. In Part III, we present information we obtained from input from the communities we serve through focus groups and town hall meetings. Finally, in Part IV, we describe our strategies for dealing with the health concerns we identified, along with our initial implementation efforts. Contributors Many people have helped write this report. Among these has been the staff of the Sinai Urban Health Institute. These are ALL people trained in public health (most are graduates of schools of public health with MPH or PhD degrees). One of the authors (Dr. Whitman) was the founding member of the Epidemiology Program of the Chicago Department of Public Health. We thus believe that the public health credentials of the authors of this report are substantial and notable. 6 References 1. Link B G and Phelan J. (1995). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior, Extra Issue, 80-‐94. 2. http://www.suhichicago.org/files/publications/P.pdf 3. http://www.suhichicago.org/files/publications/FINALReport2.pdf 4. http://ajph.aphapublications.org/cgi/content/abstract/95/6/1036 7 Section 2: Description of the HCH Communities The HCH Primary Service Area is comprised of 10 communities, representing 14% of Chicago’s population with a total of 365,026 people. These communities are largely made up of minority populations with 92% of the population being either Hispanic (49%) or African-‐American (43%). The HCH Primary Service Area is economically challenged, with n early 28% of the population living below the poverty line and 39% of children living below the poverty line. Unemployment (for adults ages 20-‐64) ranges from 8% to 33% across the HCH communities and median household income ranges from $20,813 to $50,140. Additionally, these communities are young; the population under 18 years of age ranges from 26% to 36% and the percent over 65 years of age ranges from 5% to 16%. Although the demographic and socioeconomic characteristics of the 10 communities within the HCH Primary Service Area vary widely, most are relatively disadvantaged. When we discuss the HCH Primary Service Area, it is necessary to examine data at the community level to truly understand the demographic and health profiles of the communities we serve. What is a community? Chicago has long been known as a city of neighborhoods. The city was officially divided into 75 community areas in the 1920’s, with 2 additional areas added in later years.1,2 These designated areas were loosely related to Chicago’s already established neighborhoods and align with census tracts, giving a unit of measurement that applies to everything from health outcomes to urban planning. Each community in Chicago has a unique history that contributes to its health and well-‐being. Thus, it seems only natural that we begin this report with a description of the communities in the Holy Cross Hospital (HCH) Primary Service Area. For illustrative purposes we also provide a brief history of Chicago Lawn, the community in which the hospital is located, to give insight into how the history of these communities impacts the health and well-‐being of the current residents. The HCH Primary Service Area Box 2.1 Communities within the Holy Cross Hospital Primary Service Area Archer Heights Auburn Gresham Brighton Park Chicago Lawn Englewood Gage Park New City West Elsdon West Englewood West Lawn The HCH Primary Service Area is comprised of 10 communities (Box 2.1). These communities define the area in which approximately 70% of our patients live. Within this area there are approximately 18 clinics that address a range of health needs and one other hospital, St. Bernard’s on the easternmost border. Figure 2.1 presents a map of the HCH Primary Service Area, its corresponding communities, and health resources (hospitals and clinics) located in the area. The 10 communities in the HCH Primary Service Area represent 14% of Chicago’s population with a total of 365,026 people.3 More than 90% of the population living in this area are either Hispanic or African-‐
American, much greater than the percentages in Chicago or the U.S. (61% and 29%, respectively).3 This population remains economically challenged, with 28% living below the poverty line.4 There is, however, 8 Figure 2.1 The Holy Cross Hospital Primary Service Area, Corresponding Community Areas, and Health Resources 9 great economic variation among the communities with poverty rates ranging from 12-‐45%.4 For comparison, 21% of Chicago residents and 14% of U.S. residents live below the poverty line.4 An Historic Perspective5,6 This has not always been the profile of the HCH Primary Service Area. Although each community has a unique history, we examine Chicago Lawn (CL), the community in which HCH is located, as an example of how this area has changed and why it is pertinent to our discussion of the health and overall well-‐being of the current residents. In the early 1900’s, Archbishop Quigley invited both the Augustinian Friars and the Sisters of St. Casimir, a Lithuanian order, to establish schools, churches, a monastery and a convent in the area. Holy Cross Hospital was established in 1928. In the 1920s, the area began rapid growth, attracting Germans and Irish from Back of the Yards and Englewood, as well as immigrants from Eastern Europe. The area was particularly notable for its Lithuanian presence. By the 1950s, the area was fully populated. The area, however, also became a flashpoint for racial strife, as portions of the local population, fearing loss of property values, resisted integration by African-‐Americans moving west or arriving from the south. To make matters worse, the American Nazi Party opened its headquarters near Marquette Park. Because some residents had already experienced the impact of Nazi policies in Europe, their influence in CL was more muted than expected. Dr. Martin Luther King, Jr. chose Marquette Park as the location for his open housing march of 1966. The march culminated in a violent brick-‐throwing clash, during which Dr. King was hit by a rock. To give some perspective on how this area has changed, the population living in CL is now nearly 50% African-‐American and 45% Hispanic/Latino. Many residents of CL know and remember the community’s history and are working to improve things. In the 1980s and 1990s community groups worked intensively to bring diverse groups together, fight redlining and other disinvestment, and increase the effectiveness and stability of neighborhood institutions. The community is home to several highly respected community organizing groups including: Greater Southwest Development Corporation, SouthWest Organizing Project, Local Initiative Support Corporation (LISC), and the New Community Project (NCP). CL is just one example. Each of the communities has a history that impacts the well-‐being of its residents. Understanding the history and dynamics of the communities we serve can help us work more effectively to improve health. Demographic and Economic Profile of the HCH Primary Service Area Demographic and health indicators can and do vary widely from one community to the next. Tables 2.1 (page 6) and 2.2 (page 7) present social, demographic, and economic characteristics of our communities. Five of these are discussed in detail in the text that follows, including: race/ethnicity, age distribution, unemployment, poverty, and household income. Race and Ethnicity The communities in the HCH Primary Service Area are comprised mostly of minority populations. All of the communities served by HCH have minority populations that exceed 75% (Table 2.1).3 Five communities are mostly Hispanic and three are mostly African-‐American (Figure 2.2).3 The remaining two communities that have minority populations that exceed 75% include both Hispanics and African-‐
Americans.3 10 Figure 2.2: Community Areas with Minority Populations that Exceed 75%. 1
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CAs ≥ 75% Population Hispanic/Latino
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Holy Cross Hospital Primary Service Area
Map Source: Sinai Health System, 2012.
11 Age Distribution The communities in the HCH Primary Service Area are young. All have greater proportions of children than the city of Chicago (23%).3 The percentages of the population under 18 years of age range from 26% in Auburn Greshem to 36% in Gage Park (Figure 2.3 and Table 2.1).3 In addition, the percent of the population over 65 years of age is lower than the percentage in Chicago in seven of the 10 communities HCH serves and ranges from 5% in Gage Park to 16% in Auburn Gresham (Figure 2.3 and Table 2.1).3 The data presented in Figure 2.3 are supported by data presented in later sections of this report (Sections 3 and 7) that show that these neighborhoods have more births and lower life expectancy compared to the city of Chicago. 3 20
Chicago: <18 Years (23%)
Chicago: >65 Years (10%)
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% Population <18 Years of Age
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Economic Characteristics Although many of our communities are economically challenged, there is still great variation. Community level unemployment rates (ages 20-‐64) are higher than the rate for the city of Chicago in 8 of the 10 communities HCH serves, ranging from 8% to 33% (Table 2.2).4 Likewise, median household income is lower in 8 of 10 communities HCH serves compared to the city of Chicago and ranges from $20,813 to $50,140.4 Notably, the median household income in Chicago is lower than the median household income in West Elsdon ($50,140). There are marked community level differences in the percent of the population living below the poverty line. Least affected are Archer Heights, West Elsdon, and West Lawn, where less than 20% of the population lives below the poverty line.4 This is less than the reported poverty rate for the city of Chicago. By contrast, 34% – 45% of the residents in New City, West Englewood, and Englewood live below the poverty line (Table 2.2 and Figure 2.4).4 In half of the 12 communities served by HCH, more than one-‐third of all children live below the poverty line, and in two of these communities more than half live below the poverty line (Table 2.2 and Figure 2.4).4 40
Chicago: Child Poverty (31%)
Chicago: Population Poverty (21%)
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Figure 2.4 Percent of Children and Overall Population Living below the Poverty Line in Communities 4 Served by HCH Compared to Percentages for the City of Chicago
% Population Living Below the Poverty Line
% Children Living Below the Poverty Line
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Table 2.1 Demographic Data for the U.S., Chicago, and the HCH Primary Service Area Chicago HCH Service Area Archer Heights Auburn Gresham Brighton Park Chicago Lawn Englewood Gage Park New City West Elsdon West Englewood West Lawn % Population % Population Race/Ethnicity* Population* < 18 Years* > 65 Years* Hispanic White Black (%) (%) (%) (%) (%) 2,695,598 23 10 32 32 29 365,026 32 9 49 7 43 13,393 30 9 76 22 1 48,743 26 16 0.9 0.3 98 45,368 34 6 85 8 1 55,628 32 6 45 4 49 30,654 31 11 1 0.3 97 39,894 36 5 89 5 5 44,377 35 6 57 11 30 18,109 31 8 79 18 1 35,505 30 12 2 0.4 96 33,355 31 8 80 15 4 * Source: U.S. Census (2010) 13 4
Table 2.2 Selected Economic Characteristics for the U.S., Chicago, and the HCH Service Area Chicago HCH Service Area Archer Heights Auburn Gresham Brighton Park Chicago Lawn Englewood Gage Park New City West Elsdon West Englewood West Lawn *
Unemployment Rate (Ages 20-‐64)* 10% 17% 14% 22% 10% 11% 20% 13% 17% 13% 33% 8% Median Household Income* $46,877 $36,521 $44,538 $35,120 $39,737 $39,437 $20,813 $38,674 $35,169 $50,140 $27,174 $47,595 Population Living Children Living Below Below *
the Poverty Line the Poverty Line* 21% 31% 28% 39% 12% 18% 28% 44% 24% 31% 25% 35% 45% 62% 21% 29% 34% 46% 12% 17% 41% 55% 19% 22% Source: American Community Survey (2010), 5-‐year Estimates Conclusion While the majority of the communities discussed in this section are comprised of minority, economically disadvantaged families, this section highlights how the demographic and economic profiles vary among the communities that HCH serves. Likewise, each community has its own unique, relevant history and array of community assets and resources. We use this section to provide context as we go forward in discussing the health of the communities located in the HCH Primary Service Area. It also is a reminder that it is necessary to examine data at the community level to develop effective health care strategies and programs that specifically address the needs of the overall service area and the communities within it. References 1. Seligman A. (2005). Community Areas. The Electronic Encyclopedia of Chicago -‐ Chicago Historical Society. Available online: http://www.encyclopedia.chicagohistory.org/pages/319.html. Accessed on December 13, 2012. 2. The Chicago Fact Book Consortium. (1995). Local Community Fact Book: Chicago Metropolitan Area, 1990. Chicago, Illinois, Academy Chicago Publishers. 3. U.S. Census Bureau. (2010) U.S. Census, 2010. Available online: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t. Accessed on October 2012. 4. U.S. Census Bureau.(2010) American Community Survey 2010, 5-‐year Estimates. Available online: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t. Accessed on October 2012. 5. McMahon EM. (2005). Community Areas. The Electronic Encyclopedia of Chicago -‐ Chicago Historical Society. Available online: http://www.encyclopedia.chicagohistory.org/pages/256.html. Accessed on April 22, 2013. 6. Headly K. (2001). Images of America, Chicago Lawn/Marquette Manor. Chicago, Illinois, Arcadia Publishing. 14 Part II
Community
Health Data
Section 3: Mortality In this section (and the associated Appendix A) we present, for all 10 communities in the Holy Cross Hospital (HCH) Primary Service Area, calculations for each of life expectancy, total death rates, and the death rates for the 10 leading causes of death. In each case we show how these calculations compare to both the City of Chicago and the U.S. as a whole. Life expectancy, how long we can expect to live, is considered by many to be the single most important measure of health. Life expectancy for Chicago was 77 years, but varied from 69 to 81 years across the 10 communities. A map of life expectancy for the city shows that low life expectancies are clustered overwhelmingly on the south and west sides, areas which are populated predominantly by Black p eople. The leading cause of death in Chicago (and the U.S.) is heart disease. The heart disease death rate for Chicago was 242 (per 100,000 population), but ranged from 177 to 328 across the 10 communities. Once again a map showed some of the highest rates on the south and west sides. Many details, tables, and maps for the leading causes of death may be found in this section. What we die from and how old we are when we die tell us a lot about our health and how to go about improving it. With this in mind, we continue our Community Health Needs Assessment (CHNA) in this section by examining life expectancy and mortality data for the city of Chicago and its 77 officially designated community areas (communities). Life expectancy is the number of years a person can expect to live at the time of birth. Mortality data tell us what people are dying from. When a person dies, a physician must determine the cause of death and that cause is recorded on the death certificate. Death certificates can thus be used to determine the leading causes of death for different groups of people. In this case, our population of interest is the city of Chicago and the communities it contains. The following data come from our analysis of the death certificate files for the city of Chicago for the years 2005-‐2007, the most recent data available. We use a report published by the Chicago Department of Public Health to inform us about the 10 leading causes of death in Chicago in 2006. Leading Causes of Death for Chicago Residents, 20061 1. Heart Disease 2. Cancer 3. Accidents 4. Stroke 5. Chronic Lower Respiratory Disease 6. Diabetes 7. Septicemia 8. Nephritis 9. Influenza and Pneumonia 10. Homicide Life Expectancy Let’s start by looking at life expectancy data for Chicago. On average, a baby born in Chicago in 2005-‐
2007 can expect to live to the age of 77 years. However, when we look at life expectancy for the communities within Chicago, we see that where you live changes how long you might expect to live. For instance, let’s say the Smith family has just welcomed a baby into the world and they return to their home in Englewood. At the same time, the Jones family welcomes their first baby and returns to their home in Lake View. If both babies remain in their respective communities, Baby Jones in Lake View can 15 expect to live to the age of 86 years, while Baby Smith in Englewood can expect to live only to the age of 69 years. This means that, on average, people in Lake View live over 17 years longer than people in Englewood. This is not to say that there are not going to be people who live longer in Englewood – it just means that on average, this is how long one can expect to live in each of these communities. Indeed, to offer another example, there is quite a bit of variation in life expectancy across the 77 communities of Chicago, with those in Hyde Park living 84 years on average, and those in Fuller Park living 69 years on average. Figure 3.1 shows the 77 communities of Chicago with light to dark shading for highest to lowest life expectancy. The data are presented in quartiles (see box 3.1 on page 3 for a discussion of quartiles). Box 3.1 Quartiles Throughout this section, data are presented for various health conditions b y Chicago community and the data are presented in quartiles. Quartiles represent a breakdown of the data for the 77 communities into 4 groups such that the first quartile captures the first 25% of the data (the b est off); the second quartile captures the next 25%; the third quartile captures the next 25% and the fourth quartile captures the last 25% (the worst off). Notably, this map reveals that all of the communities with the Life Expectancy lowest life expectancies are on the south and west sides of the U.S. 78 city where the largest concentrations of Non-‐Hispanic Black Chicago 77 (Black) people reside. In fact, of the 20 communities with the Black 71 lowest life expectancy, all but one are primarily Black (70% or White 79 more of the population is Black) and 15 are almost entirely Black Hispanic 84 (90% or more of the population is Black). Given that Blacks in Chicago tend to live in higher poverty areas than Non-‐Hispanic Whites (Whites) and that poverty is associated with poorer health, this finding, while totally unacceptable, is not necessarily surprising. Interestingly, while Chicago’s Hispanic populations also tend to live in higher poverty areas, we actually see higher life expectancy among this group: A brief discussion of why this might be the case is found in Box 3.2. Box 3.2 The Hispanic Health Paradox In almost all parts of the world, lower levels of education and income are associated with worse health and higher death rates. The Hispanic Health Paradox refers to the fact that even though Hispanics in the U.S. tend to have lower levels of education and income than Non-‐Hispanic Whites, they often have health outcomes that are comparable to or, in some cases, better than those of their White counterparts. This includes lower mortality rates and higher life expectancy. The specific causes of this phenomenon are not well understood, but several theories exist that seek to explain it. One of these is the “Acculturation Hypothesis” which proposes that newer arrivals to this country tend to have fewer bad health behaviors like smoking, over-‐eating, and drug use. Another of these is the “Healthy Migrant Effect” which maintains that those who migrate to this country tend to be healthier than the average resident. Finally, the “Salmon Bias Hypothesis” posits that some Hispanic people may return to their countries of origin to retire or when they become chronically ill. In such cases, no U.S. death certificate is ever filed and d eath rates calculated based on these certificates will be artificially low. 16 Figure 3.1 Life Expectancy by Chicago Community Area Life Expectancy (in years)
Fourth Quartile (68 - 73)
Third Quartile (74 - 78)
Second Quartile (79 - 80)
1
9
First Quartile (81 - 84)
2
12
76
10
0
11
HCH Primary Service Area
77
13
Chicago Life Expectancy: 77
4
14
0
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U.S. Life Expectancy: 78
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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Map Source: Sinai Health System, 2012 . Data Source: Chicago Department of Public Health, Vital Records 2005-2007
17 Figure 3.1 also denotes the Holy Cross Hospital (HCH) Primary Service Area, which includes 10 of Chicago’s 77 communities. These data are summarized in Figure 3.2, which presents life expectancy for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area. Within this area, life expectancy ranged from a low of 69 in Englewood to a high of 81 in Brighton Park. Life expectancies below the Chicago average were found in 5 of the 10 HCH communities. Figure 3.2 Life Expectancy (2005-‐2007) 90
80
US = 78
Chicago = 77
70
60
Years
50
40
30
20
10
0
79
72
Archer Heights
Auburn Gresham
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75
69
80
Brighton Chicago Englewood
Park
Lawn
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79
70
Gage New West West Park
City
Elsdon
Englewood
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West Lawn
How Does Place Influence Health? There are several ways in which where a person lives might affect health outcomes such as life expectancy. For instance, affordable healthy foods and a safe place to exercise are not always readily available in every area of Chicago. People who can access healthy foods and exercise may be more likely to lead a healthy lifestyle and thus live longer. In addition to poverty, other societal factors such as racism, low education, and pollution also impact health. It follows then that how many people die and what people die from varies from community to community. All-‐Cause Mortality The all-‐cause mortality rate is a summary measure which tells us how many people will die, on average, in a given year for any reason. In the same way that we see differences across the city in how long people live, we also see differences in the rate at which people die in the various communities. The death certificate contains the decedent’s address, which is used to determine the community for which the death will be counted. In other words, mortality data are based on where the decedent was living, not where s/he was when s/he died. Figure 3.3 presents the all-‐cause mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area. The all-‐cause mortality rate for Chicago was 850. This means that for every 100,000 people in Chicago, an average of 850 of them died in any given year between 2005 and 2007. The rate for the U.S. was 779, much lower than that for Chicago. Within the HCH Primary Service Area, the rates ranged from a low of 640 in Brighton Park to a high of 1218 in Englewood. Rates above the Chicago average were found in 5 of the 10 HCH communities. 18 Figure 3.3 All-‐Cause Mortality (2005-‐2007) 1400
Per 100,000 population
1200
1000
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800
U.S. = 779
600
400
200
0
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1029
Archer Heights
Auburn Gresham
640
915
1218
703
Park
Lawn
1062
757
1160
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Elsdon
Englewood
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West Lawn
Figure 3.4 indicates which community areas are most burdened with mortality. The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest all-‐cause mortality rates. Notably, all of the communities with the highest rates were on the south and west sides of the city. The map also illustrates that four of the communities with the highest all-‐cause mortality rates (those in the 4th quartile) fell within the HCH Primary Service Area. Holy Cross Hospital Primary Service Area
Cause-‐Specific Mortality Above, we focused on how long people in different communities live and how frequently they die. Now we will examine what diseases are causing people to die. In this section, we present data for the top two causes of death – heart disease and cancer. Similar to our discussion of life expectancy and all-‐cause mortality, we continue to provide rates for Chicago, the U.S., and the 10 communities in the HCH Primary Service Area and we present this data in bar charts and maps. This structure is carried over in Appendix 1 where we continue our examination of the other leading causes of death for Chicago and its communities. 19 Figure 3.4 All‐Cause Mortality by Chicago Community Area All-Cause Morality per 100,000
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U.S. All-Cause Mortality: 779
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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20 Heart Disease: #1 Cause of Death in Chicago #1 Cause of Death in the U.S. What is heart disease? Heart disease mainly affects older people and occurs when the heart and blood vessels are not working the way they should. There are several factors that can increase a person’s chance of getting heart disease. Some of these are things we have no control over, like being older or having a family history of heart disease. But there are many things we might be able to change, like smoking, having high blood pressure, being overweight, and not exercising – all of which can increase the likelihood of developing heart disease.2 Death from heart disease includes, among many other categories, heart failure. National data for the U.S. show that heart failure (HF), which accounts for nearly 10% of heart disease mortality, is one of the most common causes of hospitalization and readmission. In 2006, HF was the leading cause of hospitalization for people over 64 years of age in the United States. Furthermore, about 25% of people hospitalized with HF are readmitted within 30 days and 30% within 60 to 90 days.3 More information on hospital discharge and readmissions rates can be found in Sections 4 and 5. • Figure 3.5 presents the heart disease mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The heart disease death rate was: • 242 for Chicago • 201 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 177 for Gage Park to a high of 328 in Englewood • Rates above the Chicago average were found in 5 of the 10 HCH communities Figure 3.5 Heart Disease Mortality (2005-‐2007) 350
300
250
Chicago = 242
200
U.S. = 201
150
100
50
0
206
260
Archer Heights
Auburn Gresham
198
277
328
Park
Lawn
177
304
•
21 309
232
West Lawn
Figure 3.6 displays all 77 of Chicago’s communities with light to dark shading for lowest to highest heart disease death rates • Nearly all of the communities with the highest rates were on the south and west sides of the city • Three of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Heart disease deaths accounted for 23-‐35% of the 77 communities’ total deaths, more than any other cause Holy Cross Hospital Primary Service Area
•
242
City
Elsdon
Englewood
Figure 3.6 Heart Disease Mortality by Chicago Community Area Heart Disease Morality per 100,000
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Chicago Heart Disease Mortality: 242
U.S. Heart Disease Mortality: 201
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Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
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Loop
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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22 Cancer: #2 Cause of Death in Chicago #2 Cause of Death in the U.S. What is Cancer? Cancer refers to a group of diseases, all having to do with abnormal cell growth that can spread quickly throughout the body. A normal cell grows and divides, but it knows when to stop growing and eventually dies. Cancer cells, on the other hand, continue to grow and divide out of control and do not die when they are supposed to. A tumor forms when cancer cells group together. The cancer cells can destroy the normal cells around the tumor and can also damage healthy tissue. The cancer cells can also break away from the original tumor, travel to other parts of the body and continue to grow and form new tumors. This disease process is called metastasis and this is how cancer spreads. Just like with heart disease, there are certain things we have some control over that can help us reduce the risk for developing some cancers, including exercising, eating healthy foods, maintaining a healthy body weight, and abstaining from cigarette smoking and drinking alcohol. However, it is still possible to develop cancer even if we live a very healthy lifestyle. For this reason, cancer screening is important. Screening can help detect cancer early before it has had a chance to spread to other parts of the body. The sooner cancer is found, the sooner treatment can begin, and the better the chances for a full recovery. The type of recommended cancer screening(s) people need depends on their age and gender. • Figure 3.7 presents the cancer mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The cancer death rate was: • 196 for Chicago • 181 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 128 in Brighton Park to a high of 261 in West Englewood • Rates above the Chicago average were found in 4 of the 10 HCH communities Figure 3.7 Cancer Mortality (2005-‐2007) 300
250
200
Chicago = 196
U.S. = 181
150
100
50
0
177
251
Archer Heights
Auburn Gresham
128
180
245
176
Park
Lawn
241
23 182
261
City
Elsdon
Englewood
148
West Lawn
Figure 3.8 Cancer Mortality by Chicago Community Area Cancer Morality per 100,000
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Chicago Cancer Mortality: 196
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West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
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Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
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Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
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Englewood
Ashburn
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Morgan Park
O'Hare
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24 •
Figure 3.8 demonstrates which community areas are most burdened with cancer mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest cancer death rates • Nearly all of the communities with the highest rates were on the south and west sides of the city • Four of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Cancer deaths accounted for 16-‐28% of the 77 communities’ total deaths •
Among the different types of cancer, prostate, lung, breast, and colorectal cancer together accounted for 52% of all cancer deaths in Chicago. Breast cancer death rates above the Chicago average were found in 1 of the 10 HCH communities. Colorectal cancer death rates above the Chicago average were found in 5 of the 10 HCH communities. Prostate and lung cancer death rates above the Chicago average were found in 6 of the 10 HCH communities. Conclusion In this section, we have presented some data about causes of death. More data on this topic is presented in Appendix 1. Although death is, of course, the final step in our journey, it is not nearly the only consideration in determining how healthy our lives are or what the quality of life is like. In the following sections, we address these topics and others as we search for ways in which Holy Cross Hospital can help the communities we serve live healthier and longer lives. References 1. 2006 is the most recent year for which the Chicago Department of Public Health has published these data. See report at: http://www.cityofchicago.org/dam/city/depts/cdph/statistics_and_reports/SR_leading%20causes%
20of%20death%202006.pdf. 2. Kids Health. (2013). Heart Disease. Available online: http://kidshealth.org/kid/grownup/conditions/heart_disease.html#. Accessed on March 7, 2013. 3. Up to Date. (2013). Strategies to reduce hospitalizations in patients with heart failure. Available online: http://www.uptodate.com/contents/strategies-‐to-‐reduce-‐hospitalizations-‐in-‐patients-‐with-‐
heart-‐failure. Accessed on March 7, 2013. 25 Section 4: Hospitalizations Hospitalization data can be a useful tool for measuring poor health and the ways in which individuals utilize the health care system. In this section, we examine hospitalization rates for selected conditions within the HCH Primary Service Area zip codes and compare them to Chicago and national estimates. Hospitalization rates are presented for asthma, diabetes, heart disease, stroke, and mental health disorders, as well as pneumonia, HIV/AIDS, nephritis, cirrhosis, and injury and poisoning in the corresponding appendix (B). Disproportionately high hospitalization rates were seen in several HCH zip codes for all of the conditions listed above. Asthma and mental health hospitalizations were especially noteworthy, with rates almost three times higher than the corresponding Chicago rates in one HCH zip code. Significant racial disparities were seen as shown by hospitalization rates for many conditions being directly correlated to the proportion of non-‐Hispanic Black residents in a given community. Hospitalization data and corresponding disparities in utilization may be particularly important to health care organizations interested in Like information about what causes people to die (described in Section 3), hospitalization data help us to understand the burden of specific diseases and conditions for different groups of people. In this section, we examine hospitalization rates for selected conditions for the city of Chicago and Holy Cross Hospital (HCH) Primary Service Area zip codes. The information comes from hospital discharge diagnoses which are determined by a doctor or another qualified health care provider when a patient is released from the hospital. Hospitals currently use a system called the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-‐9-‐CM) to categorize diagnoses. The hospital records a leading discharge diagnosis, as well as up to 24 secondary diagnoses, for each hospital visit and reports these data to the state. In Illinois, data are also reported to the Illinois Hospital Association, which maintains a discharge database called COMPdata. Discharges in COMPdata can be tabulated by hospital or by the patient’s state, county, or zip code of residence. Hospitalization rates are presented by zip code below. We were not able to organize data by community area since zip code and community area boundaries do not correspond. For example, one zip code may include portions of several community areas that vary greatly in terms of demographics and disease trends. This makes it difficult to extrapolate hospitalization rates to the community level. Table 4.1 provides the racial/ethnic make-‐up of each zip code in the HCH Primary Service Area in an effort to assist with data interpretability. The following results come from Table 4.1 Demographics of HCH Primary Service Area Zip Codes our analyses of hospitalization Hispanic White Black data by zip code from COMPdata Zip Code (%) (%) (%) for the years 2009-‐2011. Conditions were selected based 60609 53 14 28 on a critical assessment of 60620 1 0 98 nationally reported data from the 60621 1 0 97 National Hospital Discharge 60629 67 9 22 Survey1 and the leading causes of 60632 84 11 2 hospitalization for the 60636 3 0 96 communities surrounding HCH. Selected conditions include 26 asthma, diabetes, heart disease, stroke, and mental health. Appendix B also includes information on pneumonia, HIV/AIDS, kidney disease, liver disease, and injury and poisoning. The rates listed below can be interpreted as the average annual number of hospitalizations during 2009-‐2011 for a specific condition per 10,000 people. Rates are based on discharges with a leading diagnosis of the selected condition. Asthma Hospitalizations What is asthma? Asthma is a lung disease that causes breathing difficulties and is especially common in children. Symptoms include wheezing, breathlessness, chest tightness, and coughing.2 Asthma is considered an ambulatory care sensitive condition (ACSC), which means it is potentially preventable with the proper outpatient care. Thus, it is especially important to focus on ACSC conditions from a public health standpoint since they are potentially controllable and preventable. See Box 4.1 for more information on ACSC. Box 4.1 Ambulatory Care Sensitive Conditions (ACSC)3 The Agency for Healthcare Research and Quality (AHRQ) defines Ambulatory Care Sensitive Conditions (ACSC) as “conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease.” The AHRQ developed a set of Prevention Quality Indicators (PQIs) in order to assess q uality of care issues and potential health disparities surrounding preventable hospitalizations. There are currently 16 PQIs, including one or more indicators for diabetes, perforated appendix, COPD or asthma, hypertension, heart failure, low birth weight, dehydration, bacterial pneumonia, urinary tract infection, and angina. In this report we highlight diabetes, asthma, heart disease in general, and p neumonia. •
•
•
Figure 4.1 presents asthma hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area The asthma hospitalization rate (per 10,000) was: • 28 for Chicago • 14 for the U.S. Within the HCH Primary Service Area: • Rates ranged from a low of 12 in 60632 to a high of 76 in 60636 • Rates above the Chicago average were found in 4 of the 6 HCH zip codes 27 Figure 4.1 Asthma Hospitalization Rates for the HCH Primary Service Area 80
Per 1 0,000 Population
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Data source: COMPdata (Chicago, 2009-‐2011); CDC Health Data Interactive (U.S., 2010) •
Figure 4.2 displays 56 zip codes in Chicago with light to dark shading for lowest to highest asthma hospitalization rates • Nearly all the zip codes with the highest rates were on the south and west sides of the city • Three of the six zip codes in the HCH Primary Service Area had asthma hospitalization rates within the highest (4th) quartile (see Box 3.1 in Section 3 for a description of quartiles) Box 4.2 Racial/ethnic trends in hospitalization rates The trends seen in the asthma graph above are consistent throughout this entire section. For every condition p resented here, zip codes 60620, 60621, and 60636 have the highest hospitalization rates. It is informative to examine the racial/ethnic make-‐up of these zip codes when assessing trends. These three zip codes are predominantly Black (>95%), while the zip code with the consistently lowest rate, 60632, is predominantly Hispanic (84%). This disparity in hospitalization rates among predominantly Black zip codes may represent several things, including a higher disease burden, less access to preventive care, or a greater number of readmissions for poorly controlled chronic diseases. Additionally, lower hospitalization rates among predominantly Hispanic zip codes such as 60632 may signify a lower disease burden or lower health care utilization due to a lack of insurance. It is important to keep these factors in mind when interpreting these trends, as the end result of hospitalization may have a multitude of complex and interrelated social causes. 28 Figure 4.2 Asthma Hospitalization Rates by Chicago Zip Code Asthma Hospitalizations per 10,000
60626
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Chicago Asthma Hospitalizations: 28
U.S. Asthma Hospitalizations: 14
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Map Source: Sinai Health System, 2012 . Data Source: Illinois Hospital Association, COMPdata 2009-2011
29 Diabetes Hospitalizations What is Diabetes? 4 Diabetes (known in some communities as “sugar”) is a disease characterized by high blood sugar. Blood sugar is made naturally in our bodies and also comes from the food we eat. We need sugar for energy, but too much sugar in the blood can have negative side effects. Usually, a hormone called insulin helps to regulate the amount of sugar in our blood. However, in people with diabetes, the body either does not make enough insulin or the insulin does not work properly. Diabetes is the result of prolonged high blood sugar and can lead to serious health consequences such as kidney failure and blindness. People with diabetes are also at higher risk for heart disease and stroke. However, diabetes can be controlled with proper diet, exercise, and medication. Since diabetes complications are preventable, it is defined as an ambulatory care sensitive condition by AHRQ (see Box 4.1). • Figure 4.3 presents diabetes hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The diabetes hospitalization rate (per 10,000) was: • 28 for Chicago • 19 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 23 in 60632 to a high of 56 in 60621 • Rates above the Chicago average were found in 5 of the 6 HCH zip codes Figure 4.3 Diabetes Hospitalization Rates for the HCH Primary Service Area 60
Per 10,000 Population
50
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Figure 4.4 displays 56 zip codes in Chicago with light to dark shading for lowest to highest diabetes hospitalization rates • Nearly all the zip codes with the highest rates were on the south and west side of the city • Three of the six zip codes in the HCH Primary Service Area had diabetes hospitalization rates within the highest (4th) quartile 30 Figure 4.4 Diabetes Hospitalization Rates by Chicago Zip Code Diabetes Hospitalizations per 10,000
60626
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Chicago Diabetes Hospitalizations: 28
U.S. Diabetes Hospitalizations: 19
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31 Heart Disease Hospitalizations What is heart disease? Heart disease mainly affects older people and occurs when the heart and blood vessels are not working the way they should. There are several factors that can increase a person’s chance of getting heart disease. Some of these are things we have no control over, like being older or having a family history of heart disease. But there are many things we might be able to change, like smoking, having high blood pressure, being overweight, and not exercising -‐-‐ all of which can increase the chance of developing heart disease.5 Death from heart disease includes, among many other categories, heart failure. National data for the U.S. show that heart failure (HF), which accounts for nearly 10% of heart disease mortality, is one of the most common causes of hospitalization and readmission. In 2006, HF was the leading cause of hospitalization for people over 64 years of age in the United States. Furthermore, about 25% of people hospitalized with HF are readmitted within 30 days and 30% within 60 to 90 days.6 • Figure 4.5 presents heart disease hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The heart disease hospitalization rate (per 10,000) was: • 127 for Chicago • 112 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 94 in 60632 to a high of 217 in 60621 • Rates above the Chicago average were found in 5 of the 6 HCH zip codes Figure 4.5 Heart Disease Hospitalization Rates for the HCH Primary Service Area Per 1 0,000 Population
250
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Chicago = 127
U.S. = 112
100
50
0
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217
128
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Figure 4.6 displays 56 zip codes in Chicago with light to dark shading for lowest to highest heart disease hospitalization rates • Nearly all the zip codes with the highest rates were on the south and west side of the city • Four of the six zip codes in the HCH Primary Service Area had heart disease hospitalization rates within the highest (4th) quartile 32 Figure 4.6 Heart Disease Hospitalization Rates by Chicago Zip Code Heart Disease Hospitalizations per 10,000
60626
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Chicago Heart Disease Hospitalizations: 127
U.S. Heart Disease Hospitalizations: 112
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33 Stroke Hospitalizations What is a stroke? 7 Similar to a heart attack, a stroke can result when a blood vessel is damaged or blocked, denying oxygen-‐rich blood to the brain. When this happens, brain cells begin to die in the region that is not receiving blood, resulting in brain damage. Depending on the location of the stroke, speech, movement, or memory may be affected. People who survive larger strokes may be left with permanent disabilities. The risk factors for stroke, including unhealthy lifestyle factors and conditions such as high blood pressure, may be modified or prevented. For more on these risk factors and the relationship between stroke and other vascular diseases, see Box 4.3 [below]. • Figure 4.7 presents stroke hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The stroke hospitalization rate (per 10,000) was: • 34 for Chicago • 31 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 25 in 60632 to a high of 50 in 60621 • Rates above the Chicago average were found in 5 of the 6 HCH zip codes Figure 4.7 Stroke Hospitalization Rates for the HCH Primary Service Area 60
50
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Chicago = 34
U.S. = 31
30
20
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38
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50
35
25
49
60609
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Figure 4.8 displays 56 zip codes in Chicago with light to dark shading for lowest to highest stroke hospitalization rates • Nearly all the zip codes with the highest rates were on the south and west side of the city • Four of the six zip codes in the HCH Primary Service Area had stroke hospitalization rates within the highest (4th) quartile 34 Figure 4.8 Stroke Hospitalization Rates by Chicago Zip Code Stroke Hospitalizations per 10,000
60626
60645
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Chicago Stroke Hospitalizations: 34
U.S. Stroke Hospitalizations: 31
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35 Box 4.3 Vascular Conditions: Heart Disease, Stroke, and Hypertension8 Heart disease, stroke, and hypertension (high blood pressure) are all conditions that relate to the blood vessels. Having chronic high blood pressure can damage blood vessels, making a heart attack or stroke more likely. The risk factors for all three conditions are similar and include older age, family history, being overweight, living in poverty, and using tobacco. As expected, heart disease and stroke hospitalization rates in the HCH Primary Service Area are directly correlated with hospitalization rates for high blood p ressure. That is, as hospitalization rates for high blood pressure increase among zip codes, so do hospitalization rates for heart disease and stroke. Mental Health Hospitalizations What is mental health? According to the Surgeon General, mental disorders are “health conditions that are characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning.”9 Mental disorders are extremely prevalent in the U.S. and throughout the world. An estimated 83% of U.S. adults are not in a state of optimal mental health, and depression is expected to become the second leading cause of disability worldwide by the year 2020.9,10 Mental health is important not only for our psychological well-‐being, but also because mental disorders can negatively affect our physical health as well. People with mental health problems are more likely to have certain physical health problems, including poor pregnancy outcomes, gastrointestinal disorders, and heart disease.11 Furthermore, even common mental health problems such as stress have the ability to impact our physical health. Substance-‐related disorders, a group of mental health-‐related conditions, are the leading cause of hospitalization at HCH. Therefore, it is especially important to understand the level of the mental health burden in our surrounding communities. • Figure 4.9 presents mental health-‐related hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The mental health hospitalization rate (per 10,000) was: • 203 for Chicago • 68 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 57 in 60632 to a high of 539 in 60621 • Rates above the Chicago average were found in 3 of the 6 HCH zip codes Box 4.4 Caution! Interpreting Rate Magnitude Although the bar charts presented in this section appear to follow the same distribution pattern, it is important to pay attention to the scale (vertical or y-‐axis) of each graph. For example, diabetes hospitalizations in the HCH Primary Service Area range from 23 to 56 per 10,000 population. However, mental health hospitalizations range from 57 to 539 per 10,000 population. This means that hospitalizations for mental health related-‐conditions were much more common during these years than hospitalizations for diabetes. Make sure to look at the scale of each graph when interpreting h ospitalization rates. 36 Figure 4.9 Mental Health-‐Related Hospitalization Rates for the HCH Primary Service Area 600
500
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Chicago = 203
200
100
0
188
279
539
128
57
445
60609
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U.S. = 68
Data source: COMPdata (Chicago, 2009-‐2011); CDC Health Data Interactive (U.S., 2010) Box 4.5 Top 3 Mental Health Discharges in Chicago The following three categories made up over 95% of mental health-‐related hospital discharges in Chicago from 2009-‐2011: 1.Drug and alcohol-‐related (39%) 2.Mood disorders (31%) 3.Psychotic disorders (26%) Mood disorders include diagnoses such as depression, psychosis, manic disorders, and bipolar disorders. Psychotic disorders include d iagnoses such as schizophrenia and delusion. In 60621, the zip code in the HCH Primary Service Area with the greatest burden of mental health hospitalizations, drug and alcohol-‐related discharges made-‐up almost half (48%) of all mental health-‐related hospitalizations. It is important to consider the subcategories that make up mental health-‐related diagnoses in order to understand the risk factors and potential treatment options for d ifferent p opulations. •
Figure 4.10 displays 56 zip codes in Chicago with light to dark shading for lowest to highest mental health hospitalization rates • Nearly all the zip codes with the highest rates were on the south and west side of the city • Three of the six zip codes in the HCH Primary Service Area had mental health hospitalization rates within the highest (4th) quartile 37 Figure 4.10 Mental Health Hospitalization Rates by Chicago Zip Code Mental Health Hospitalizations per 10,000
60626
60645
60631
60646
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60659
Chicago Mental Health Hospitalizations: 203
U.S. Mental Health Hospitalizations: 68
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38 Conclusion In this section, we presented information about some of the reasons that people are hospitalized in the HCH Primary Service Area. Every condition discussed above has disproportionately high rates in several HCH Primary Service Area zip codes. Especially noteworthy conditions include asthma and mental health disorders, in which several zip codes have rates two to three times higher than the corresponding Chicago rate. While hospitalization rates may somewhat reflect the burden of disease in a community, it is important to keep several things in mind when interpreting these rates. First, these data are based on number of hospital visits, not unique patients. Therefore, if a person is hospitalized 10 times for diabetes in a given time period, s/he would be counted as 10 visits when calculating the diabetes hospitalization rate. This may influence the comparability of zip code rates if residents from certain zip codes are more likely to be hospitalized repeatedly for a given condition. Secondly, this is only a measure of people with disease who make it to the hospital for treatment. There may be many people who have a disease and are not hospitalized due to a number of reasons, including insurance status, citizenship, or disease awareness. So while hospitalization rates are an important tool, they are not necessarily a measure of disease prevalence in a community. However, these data, used in combination with other health status indicators, provide another important piece of information to use when assessing the health status of a given community. References 1. Centers for Disease Control and Prevention. (2012). National Hospital Discharge Survey. Available online: http://www.cdc.gov/nchs/nhds.htm. Accessed on February 25, 2013. 2. Centers for Disease Control and Prevention. (2012). Asthma: Basic Information. Available online: http://www.cdc.gov/asthma/faqs.htm. Accessed on March 1, 2013. 3. Agency for Healthcare Research and Quality. (2013). Prevention Quality Indicators Overview. Available online: http://www.qualityindicators.ahrq.gov/Modules/pqi_overview.aspx. Accessed on February 25, 2013. 4. National Institutes of Health. (2012). NIH Senior Health: What is Diabetes? Available online: http://nihseniorhealth.gov/diabetes/diabetesdefined/01.html. Accessed on February 25, 2013. 5. Kids Health. (2013). Heart Disease. Available online: http://kidshealth.org/kid/grownup/conditions/heart_disease.html#. Accessed on March 7, 2013. 6. Up to Date. (2013). Strategies to reduce hospitalizations in patients with heart failure. Available online: http://www.uptodate.com/contents/strategies-‐to-‐reduce-‐hospitalizations-‐in-‐patients-‐with-‐heart-‐failure. Accessed on March 7, 2013. 7. National Stroke Association. (2013). What is Stroke? Available online: http://www.stroke.org/site/PageServer?pagename=stroke. Accessed on March 1, 2013. 8. Mayo Clinic. (2012). High Blood Pressure (Hypertension): Risk Factors. Available online: http://www.mayoclinic.com/health/high-‐blood-‐pressure/DS00100/DSECTION=risk-‐factors. Accessed on February 25, 2013. 9. U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD, U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. 10. Murray CJL, Lopez AD. (1996). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Geneva, Switzerland, World Health Organization. 11. Discovery Fit & Health. (2013). What is mental health? Available online: http://health.howstuffworks.com/mental-‐health/mental-‐disorders/what-‐is-‐mental-‐health1.htm. Accessed on February 25, 2013. 39 Section 5: Survey Data Data about health behaviors and certain health outcomes are available through survey data, often at the state or city level. To supplement this, HCH also conducted its own survey in 2010. Overall, the city data identify chronic conditions, obesity, smoking, and poor mental health as some of the most pressing issues affecting individuals living in Chicago. The Chicago-‐wide data repeatedly revealed that members of racial and ethnic minority groups experience worse levels of health than Whites. Findings from the HCH Community Survey provide insight into the needs, wants, and expectations of our local community and shed light on the opportunities HCH has to improve both access to healthcare and the quality of patient experience. In particular, community members report being dissatisfied with health care mainly due to limited access. And they are interested in improving their health behaviors, specifically those related to diet and exercise. Together, these sources of data are valuable for identifying leading health issues and guiding subsequent interventions or policy decisions. Introduction Health surveys are a valuable source of information to determine how many people are sick, what type of illnesses they have, and what causes their poor health. Without fully understanding these issues, developing long term and sustainable health interventions becomes a serious challenge. There are two ways to get survey data about a particular community or group of people in whom you have interest. One, you can use existing surveys that provide valuable health information for the U.S., each state, and certain big cities. Two, you can collect your own data. To improve our understanding of our community’s health, Holy Cross Hospital (HCH) analyzed data from both of these types of surveys. The methodology and findings are presented in this section. Chicago Data Data for Chicago come from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS collects information from individuals related to their health behaviors, preventive health practices, and use of health care services. BRFSS is the largest telephone health survey in the world, interviewing more than 350,000 adults each year. This data is valuable for health-‐related agencies, researchers, and other groups, which use the data to identify new health problems, make and track health goals, and develop and evaluate relevant policies, programs, and legislation. Although it is a state-‐based system, data are also available for many large metropolitan areas (including Chicago), but not for smaller communities. BRFSS data are collected through monthly telephone interviews with community-‐dwelling adults aged 18 years or older. BRFSS interviewers call both landlines and cell phones. The data were obtained through the Chicago Department of Public Health. The data for “Other” races and ethnicities are not shown here due to small sample sizes, as well as the questionable value of trying to interpret such a 40 category. Observations were analyzed using SAS, version 9.2 (SAS Institute Inc., 2002-‐2003). A sampling weight was applied to survey observations to account for the probability of selection. Chicago Results Findings related to the following topics are discussed here: physical health, mental health, health behaviors, and health care utilization. The Chicago data are available for three race/ethnic groups (NH White, NH Black, and Hispanic). Also, whenever possible, the Chicago results are compared with national data. Physical Health Chronic Conditions. Almost one-‐half of all adults in the U.S. have one or more chronic conditions.1 And, as people continue to live longer, the number suffering from these illnesses will grow. Not only are chronic conditions responsible for the majority of deaths in the U.S., they also are responsible for over 75% of all health care costs in our country.1 Thus, it is critical to have a good understanding of their prevalence in Chicago. To determine this, BRFSS asked respondents whether they had ever been diagnosed with a particular health outcome, such as: “Has your doctor or a health professional ever told you that you have diabetes?” Table 5.1 presents some of the most common health conditions in Chicago, by race/ethnic group. Table 5.1 Selected Findings on Physical Health Outcomes in Chicago All % % 15 5 9 10 30 37 3 36 34 30 18 4 782 17 7 9 15 45 42 3 23 39 38 25 6 250 Chronic Conditions Asthma Cancer Cardiovascular disease Diabetes High blood pressure High cholesterol Stroke Weight Status Normal or underweight Overweight Obese Other Measures of Health Any activity limitations Days poor physical health (in past month) (mean) Sample Size NH Black NH White Hispanic % 9 9 10 6 27 30 3 42 33 25 19 4 398 Source: Chicago and U.S. data from BRFSS, 2009. U.S. cancer estimate from NHIS, 2011. Notes: Data are weighted. a Exact comparison data not found 41 U.S. % % 15 1 6 10 16 46 2 29 39 32 10 3 99 9 8 8 8 29 38 2 36 36 27 19 -‐-‐ a The findings show that levels of chronic conditions were generally slightly higher in Chicago compared to the rest of the U.S. The prevalence of these selected conditions also varied greatly by race and ethnicity. For example, the percent of Black residents with asthma was almost twice as high as the percent of Whites with this condition (17% versus 9%, respectively). Hispanics had higher levels of some diseases compared to Whites (such as asthma, diabetes, and high cholesterol), but lower levels of other conditions compared to both Blacks and Whites (such as cardiovascular disease and high blood pressure). Weight Status. Over one-‐quarter of all adults in the U.S. were currently obese and an additional 36% were overweight (as seen in Figure 6.1). Obesity can lead to many of the chronic conditions discussed above. Weight status is usually categorized according to a person’s body mass index (BMI), which is calculated with his or her weight and height. A BMI between 25 and 29.9 indicates that a person is “overweight.” A BMI greater than or equal to 30 classifies the person as “obese.” Within Chicago, 30% of adults were obese and another 34% were overweight. Thus, the majority of Chicagoans weighed more than doctors recommend for their height. Although being overweight or obese is a problem for all race/ethnic groups, it is more common among Blacks and Hispanics compared to Whites. Other Measures of Health. Having a chronic condition or being obese can limit a person’s activities. In Chicago, 18% of adults report that they were limited in at least one type of activity by their health problems. This percentage was highest among Blacks, followed by Whites, and then Hispanics. Another way to describe the extent of physical health problems in a person’s life is to ask how many days in the past month were they in poor physical health. On average, Chicagoans reported 4 days of poor physical health per month. Hispanics reported half as many poor health days as Blacks (3 versus 6, respectively). Health Behaviors Many health problems, such as the ones discussed above, can be prevented (or at least delayed) by a healthy lifestyle. In fact, 38% of all deaths can be attributed to just four health behaviors: smoking, poor diet, physical inactivity, and alcohol consumption.2 To illustrate levels of these health risk factors in Chicago, information on smoking, drinking, and physical activity behaviors are shown in Table 5.2. Table 5.2 Health Behaviors in Chicago by Race/Ethnicity Tobacco Use Currently smokes Ever smoked Alcohol Use Currently drinks Binge drank past month Physical Activity Ever exercises Moderate activity Vigorous activity Sample Size All % 19 39 56 19 76 86 51 782 NH Black % 23 43 46 14 68 84 45 250 Source: Chicago and US data from BRFSS, 2009 a
Exact comparison data not found 42 NH White % 17 44 70 23 80 92 54 398 Hispanic % 19 28 52 24 78 83 55 99 U.S. % 18 45 54 16 76 -‐-‐ a -‐-‐ Although over one-‐third of Chicago residents have smoked at some point in their lives, only 19% currently do. This percentage was higher for Blacks compared to other groups. According to Healthy People 2020, which documents our nation’s health-‐related targets and progress, the goal for our country is to reduce this number to 12%.3 In contrast, Whites were more likely to drink alcohol. Nearly one-‐quarter of both Whites and Hispanics reported binge drinking in the past month. Both current and binge drinking percentages were slightly above national averages. Finally, the majority of all residents reported at least minimal levels of exercising. Nearly half of Chicago residents reported regular vigorous physical activity, which includes activities like jogging and swimming. Health Care Access and Utilization An individual’s ability to access health care is closely tied to his/her health and well-‐being. The lack of health insurance coverage is at the forefront on our nation’s health agenda today, yet little is known about how local communities utilize services. Findings related to insurance coverage, access to primary care, and use of preventive services are presented in Table 5.3. Overall, 82% of non-‐elderly adults in Chicago had insurance coverage, which is very similar to the national rate of 83% according to BRFSS data. As expected, the percentage of Hispanics with health insurance was substantially lower. In terms of accessing health services, more than half of all individuals had been to the doctor for a check-‐up in the past year and most reported having a health care facility or provider where they generally go for care. Unfortunately, 20% of Chicago residents did not receive the care that they needed in the past year because it cost too much. This percentage was approximately twice as high for minorities compared to Whites. Particularly before the passage of the new health care act (the Affordable Care Act of 2010), a significant consequence of not having health insurance was limited utilization of routine preventive health services. These data show that only about one-‐third of Chicago adults received a flu shot in the past year. The Healthy People 2020 goal for the U.S. is to have 80% of adults aged 18-‐64 receive a flu shot each year.3 Even smaller percentages received a pneumococcal vaccine, and only half of adults had ever been tested for HIV. Table 5.3. Selected Findings on Health Care Access and Utilization in Chicago Has health insurance (18-‐64 yrs) All % 82 Had a check-‐up in past year 62 72 59 54 Has a usual source of care 78 77 82 74 Did not obtain needed medical care in past year because of cost Received flu shot in past year 20 23 12 25 32 33 39 21 Received pneumococcal vaccine in past year 21 21 21 22 Ever Tested for HIV Sample Size 50 782 62 250 47 398 42 99 Source: Chicago BRFSS, 2009 43 NH Black NH White Hispanic % % % 79 91 61 Mental Health and Quality of Life Unfortunately, despite their importance to overall well-‐being, very few measures of mental health or quality of life are available from the BRFSS. Mental Health. One question asked on the BRFSS was related to the number of days in the past month when an individual’s mental health was poor. On average, individuals in Chicago reported just over 4 days per month during which they would rate their mental health as poor. This number was slightly higher for Blacks (5 days) compared to Whites and Hispanics (both 4 days). Individuals were also asked about their overall satisfaction with their lives. As seen in Figure 5.1, most individuals reported that they were very satisfied or satisfied. Less than 10% were dissatisfied. Life satisfaction was fairly similar across race/ethnic groups. Figure 5.1 Overall Life Satisfaction by Race/Ethnicity in Chicago 70 60 Percent 50 Very saysfied 40 Saysfied 30 Dissaysfied 20 Very dissaysfied 10 0 NH White NH Black Hispanic Source: BRFSS, 2009 Social Support. The BRFSS also asks about social support because it has been repeatedly shown to influence health and well-‐being. Specifically, individuals were asked how often they get the social and emotional support that they need (from any source). The majority of respondents reported that they usually or always get enough support (see Figure 5.2). Hispanics were noticeably more likely to report that they never or rarely get enough support, followed by Blacks, and then Whites. 44 Percent Figure 5.2 Frequency of Getting Sufficient Social and Emotional Support 50 45 40 35 30 25 20 15 10 5 0 Always Usually Someyme
s NH White NH Black Hispanic Source: BRFSS, 2009 Self-‐Rated Health. Existing research has demonstrated that an individual’s subjective assessment of his/her own health is a useful measure of their state of complete physical, mental, and social well-‐being. To assess this, respondents were asked, “Would you say that in general your health is excellent, very good, good, fair, or poor?” As seen in Figure 5.3, the majority of Chicago residents said their health was good or better. However, this varies widely by race/ethnicity. Specifically, Whites were more likely than Blacks or Hispanics to say their health is excellent or very good. Similarly, Whites in Chicago were more likely to report excellent or very good health compared to Americans as a whole (data not shown), and less likely to report fair or poor health. The opposite was true for Blacks and Hispanics. Figure 5.3 Self-‐Rated Health Among Adults, by Race/Ethnic Group
40 35 Percent 30 25 NH Black 20 NH White 15 Hispanic 10 U.S. 5 0 Excellent Very Good Good Fair Poor Source: BRFSS, 2009 45 Health Disparities The findings from the Chicago survey data continue to document disparities in health, most often related to race and ethnicity. In other words, we repeatedly find that members of racial and ethnic minority groups experience worse levels of health than Whites. These disparities are caused by numerous factors, from individual determinants (e.g., genetics, health behaviors) to socioeconomic factors (e.g., income, education, insurance) to societal factors (e.g., segregation, discrimination, culture, health care system insufficiencies or inadequacies?). Reducing these inexcusable differences in levels of health is one of the overarching goals of the work at the Sinai Urban Health Institute (SUHI). It is also one of the two main objectives of the Healthy People Initiative (a set of about 500 goals developed by the leading national health agencies that guides much of the public health work in the United States). Yet, despite the effort that we, and our nation at large, are committing to this task, there has been little success. In fact, researchers at SUHI have found that disparities are actually worsening in Chicago, rather than improving.4 Thus, it is critical that researchers continue to highlight differences in health between groups in a population in order to guide future interventions and hopefully eliminate these disparities. HCH Community Survey To better understand community perspectives on health care, HCH devised a survey which asked individuals about where they obtained care, whether their care was satisfactory (and if not, why not), what steps they would take to improve their own health, and their own specific experience with or knowledge about HCH. Surveys were collected surveys 114 respondents. 72% of individuals completed the survey in Spanish. Due to the expense and time needed to collect a scientifically random sample, we choose to use a random sampling procedure instead. Specifically, we used our trained community workers to distribute and collect the surveys among the community groups which they frequented. Findings Most respondents were between the ages of 25-‐44 years and 85% of respondents were female. Most had lived in the neighborhood for more than 5 years (Table 5.4). Table 5.4 How long have you lived in your neighborhood? (n=105) Less than a year 1 to 2 years 3 to 5 years More than 5 years Experiences with Health Care More than half were satisfied with their health care (61% Yes vs 39% No). Among those respondents who were not satisfied with their health care, the most common reason given for this was not having health insurance (see Table 5.6). Percent 3 11 11 74 46 Table 5.6 Reasons for Being Dissatisfied with Health Care (n=39) I don’t have health insurance I don't have a doctor I cannot pay for my medicine I have insurance but it still costs too much My doctor or nurse does not call me with the results of tests Other I can't understand what they say I don't like my doctor I can't miss work to go to a doctor's appointment My doctor is far away or hard to get to Percent 62 31 28 15 10 10 5 5 0 0 Respondents were asked, “When you don’t feel well, where do you go for care?” As seen in Figure 5.4, about half indicated that they go to their doctor and more than one-‐third go to a health center. The remainder of respondents go to an emergency department or do not seek care anywhere. Figure 5.4 When you don't feel well, where do you go for care? My doctor 11% 21% 39% 48% My health center The emergency department of a hospital I don't go anywhere An additional question was asked to allow respondents to characterize various aspects of their health care experiences (Table 5.7). In response to this question, 48% of respondents indicated that “My doctor or nurse talks to me in a language I can understand”; 48% indicated that “My doctor or nurse is nice”; 37% indicated that “My doctor or nurse explains what is wrong”; 34% indicated that “My doctor or nurse tells me how I can better take care of myself”; and 34% indicated that “My doctor or nurse knows me”. Forty-‐three percent indicated that “My doctor’s office is convenient – near my house or job”, and 43% indicated that “I don’t have to wait too long for my appointment”. Twenty-‐eight percent indicated that “My doctor or nurse sends me reminders about tests and appointments,” and 24% indicated that “My doctor or nurse sends me the results of my tests”. 47 Table 5.7 Characteristics of Health Care Experiences (n=114) My doctor or nurse talks to me in language I can understand My doctor or nurse is nice My doctor's office is convenient -‐ near my house or my job I don't have to wait too long for my appointment My doctor or nurse explains what is wrong My doctor or nurse knows me My doctor or nurse tells me how I can take better care of myself My doctor or nurse sends me reminders about tests and appointments My doctor or nurse sends me the results of my tests Percent 48 48 43 43 37 34 34 28 24 About Staying Healthy To understand how a hospital might help individuals in making changes in their health behaviors, respondents were asked, “What things would you like to do to improve your health?” As seen in Table 5.8, 83% of respondents indicated that they would like to eat healthier. Three-‐quarters of the respondents also said that they would like to get more physical activity. More than half indicated that they would like to try to eat less. Other health improvement goals can be seen in Table 5.8. Table 5.8 What things would you like to do to improve your health? (n=114) I would like to eat more vegetables and fruits, and less fat and sugar I would like to exercise more I would like to eat less I have a disease -‐ I would like to learn how to take care of myself better Nothing, my health is fine I would like to stop smoking Nothing, I have other worries that are more important Nothing, I don't think I can change my health Percent 83 75 56 12 10 5 3 0 The next question asked respondents which health-‐related topics interest them the most (Table 5.9). In response to this question, 60% of respondents indicated that they would like to learn more about diet and nutrition and 59% expressed interest in exercise. Thirty-‐two percent of respondents indicated “Disease-‐specific topics”. 48 Table 5.9 What topic interests you the most? (n=114) Healthy food Exercise Disease-‐specific topics Improving health and health care in my neighborhood Healthy aging Stop Smoking Breastfeeding Other Percent 60 59 32 24 21 11 9 3 Perceptions of Holy Cross Hospital Finally, several questions were asked to better understand how community members viewed HCH. To begin, individuals were asked if they had ever been to HCH. Just over half (54%) of respondents replied that they had. For those who had been to HCH, they were then asked to rate their experience. Nearly one-‐quarter said their experience had been “Excellent”. Approximately one-‐third (34%) replied “It was OK”. The remainder said that, “I did not like it”. Some comments referred to recent experiences; others to experiences that were five to ten years old. For those who had not previously been to HCH, Table 5.10 If you would/would not go to Holy they were asked if they knew where HCH is Cross Hospital, why or not? located. To this question, 61% of respondents said Percent “Yes” and 39% said “No”. This same group of individuals was also asked if they would go to HCH Would go to HCH because: if they needed a hospital. Only 37% of respondents Close to my home 50 replied affirmatively. Among respondents who said Heard good things about HCH 7 they would go to HCH if they needed a hospital, Other or b lank 43 some of the reasons for why they would go there included it being close to their home or they had Would not go to HCH because: heard good things about it (Table 5.10). Among Long wait times 8 respondents who said they would not go to HCH if Not h eard good things about HCH 8 they needed a hospital, the vast majority did not Other or b lank 83 list a specific reason. Note: Only 14 respondents had not been to HCH but would go. Only 24 had not been to HCH and said they would not go. 49 Conclusion The data presented here will enable HCH and other community organizations to better direct their scarce resources to the most prevalent health problems. In particular, this section identifies chronic conditions (like asthma), obesity, smoking, and poor mental health as some of the most pressing issues affecting individuals in Chicago. The results of our own community survey give a window into the needs, wants, and expectations of our local community and shed light on the opportunities HCH has to improve both access to healthcare and the quality of patient experience. For example, community members report being dissatisfied with health care mainly due to limited access. And they are interested in improving their health behaviors, specifically those related to diet and exercise. Together, these sources of data are valuable for identifying leading health issues and guiding subsequent interventions or policy decisions. References 1. CDC. The Power of Prevention. (2009). Available online: http://www.cdc.gov/chronicdisease/pdf/2009-‐Power-‐of-‐Prevention.pdf. Accessed on: January 23, 2013. 2. Mokdad AH, Marks JS, et al. (2004). Actual Causes of Death in the United States, 2000. JAMA: The Journal of the American Medical Association. 291(10): 1238-‐1245. 3. Healthy People 2020. (2013). 2020 Topics and Objectives. Available online: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Accessed on January 24, 2013. 4. Orsi JM, Margellos-‐Anast H, Whitman S. (2010). Black:White Health Disparities in the United States and Chicago: A 15-‐Year Progress Analysis. American Journal of Public Health, 100(2): 349-‐
56. 50 Section 6: Sexually Transmitted Infections Sexually transmitted infections (STIs) are a major threat to the health and well-‐being of our communities. In this section, we examine four STIs: HIV, Gonorrhea, Chlamydia, and Syphilis. Since most STIs are transmitted through unprotected sex, they are also an indicator of potential unplanned pregnancies. Data show that the HIV incidence rate (the rate of new infections in a year) is much higher than the rate for the U.S. in almost all of the communities in the HCH Primary Service Area, sometimes by a factor of three or four. Because new therapies are helping keep people with HIV alive much longer, the number of people living with HIV (the prevalence) is increasing quickly. Gonorrhea infection rates are also quite high in the HCH Primary Service Area with rates in some communities as much as seven times higher than the national rate. The same patterns were seen for syphilis and Chlamydia. Overall, the problem of STIs is most severe in African American communities. It is here that a wide-‐spread community campaign could be most effective if we are to h elp improve the health of the communities we serve. Sexually transmitted infections (STIs) are a major problem throughout the world, including in Chicago. These infections are overwhelmingly acquired by having unprotected sex with someone who has the infection. The causes of STIs are bacteria, parasites, and viruses. There are more than 20 types of STIs. In this section we present data for four of the most common STIs in Chicago, focusing on the communities we serve. Data for this section were drawn from a Chicago Department of Public Health Report.1 STIs can lead to both immediate and long-‐term health problems, including an increased risk for HIV. Although most of these conditions affect both men and women, women face additional problems related to their reproductive health. In addition, if a pregnant woman has an STI, it can cause serious health problems for the baby. Most STIs are caused by bacteria or parasites and can be treated with antibiotics or other medicines. If an individual has an STI caused by a virus (like HIV), there is no cure, although medicines can frequently keep the disease under control. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STIs. Some STIs can be spread in ways other than through sexual activity, for example, through blood transfusions or shared needles. If the reader would like to know more about these infections we refer her/him to either of the following excellent websites: http://www.cdc.gov/std/stats11/trends-‐2011.pdf or http://www.cdc.gov/std/healthcomm/fact_sheets.htm. 51 The Problem of Under-‐Estimation The Centers for Disease Control and Prevention (CDC) suggests that only about half of all STIs are ever reported. Thus, disease rates that are discussed below are all under-‐estimates of the true problem. In addition, data about STIs generally come from local public health departments, who collect the information and publish reports about it. Unlike other types of “surveillance” data, for example, birth and death certificate files or hospital discharge data, some STI reports may not be submitted by all clinical facilities. It is widely understood that public facilities are more likely to submit such reports compared to private health providers, which of course biases the data somewhat in still another way. Nonetheless, these are the best population data that exist and they are adequate to inform us about the vulnerable communities served by Holy Cross Hospital. HIV/AIDS Figure 6.1 presents a bar chart illustrating the average annual new HIV infection rate (the incidence rate) for 2009-‐2010 for the 10 community areas in the HCH Primary Service Area. Note that these rates range from a low of 8 new cases (per 100,000 population) in Gage Park to a high of 75 new cases in West Englewood. Note also that three community areas, Archer Heights, West Elsdon, and West Lawn have unreported rates due to a small number of cases. It is informative to compare all of these incidence rates with the rate for the U.S. (17) and Chicago (37). Figure 6.1 Average Annual HIV Infection Rate (2009-‐2010) 80
70
60
50
40
Chicago = 37 30
20
US = 17
10
0
0
43
Archer Heights
Auburn Gresham
15
29
59
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8
27
0
75
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Elsdon
Englewood
0
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Figure 6.2 presents the rate of people living with HIV (the prevalence rate) in these same communities in 2009. Some of these people have progressed to AIDS and some have not. As our effectiveness in treating HIV infections continues to improve, fewer people are dying from the disease, thus increasing the prevalence. We can see from Figure 6.2 that Englewood has the highest prevalence (799 per 100,000 population) while Archer Heights has the lowest prevalence (82). These 10 prevalence rates may be compared with those for the U.S. (277) and Chicago (757). Holy Cross Hospital Primary Service Area
52 Figure 6.2 Prevalence Rate of People Living with HIV Infection (2009) 900
800
Chicago = 757
700
600
500
400
300
U.S. = 277
200
100
0
82
597
Archer Heights
Auburn Gresham
168
365
799
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160
403
105
713
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Elsdon
Englewood
99
West Lawn
Gonorrhea Figure 6.3 presents the Gonorrhea infection rate per 100,000 population in 2010. Once again, Englewood had the highest infection rate (979) followed by West Englewood (777) and Auburn Gresham (636). Chicago Lawn also has a comparatively elevated rate (422). It is interesting to note that the Gonorrhea rate for Chicago is three times higher than the rate for the U.S. but the rate for Englewood is three times higher than that for Chicago and more than nine times higher than that for the U.S. Figure 6.3 Gonorrhea Infection Rate (2010) 1200
1000
800
600
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Chicago = 293
200
U.S. = 101
45
27
636
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Archer Heights
Auburn Gresham
42
422
979
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48
383
777
City
Elsdon
Englewood
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53 Syphilis The 2010 incidence rates for Primary and Secondary Syphilis are shown in Figure 6.4. Since the number of such infections is thankfully small, the rates for several of the community areas have not been calculated and are missing in the figure. Those that have been calculated are much higher than that for the U.S. (5) and some are about the same as for Chicago (25). The one exception to this is Englewood, with a rate (85) that is 3.4 times higher than Chicago’s rate and about 17 times higher than the U.S. rate. Figure 6.4 Primary and Secondary Syphilis Infection Rate (2010) 90
80
70
60
50
40
30
Chicago = 25
20
10
U.S. = 5
0
0
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Archer Heights
Auburn Gresham
11
23
85
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0
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31
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Englewood
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Chlamydia Finally, Figure 6.5 shows the incidence rates for Chlamydia for 2010. Several of these rates are higher than that for the U.S. (426) and some are higher than Chicago’s rate (938). As has been common throughout this section, the rates for Englewood (2316), West Englewood (2129) and Auburn Gresham (1672) are much higher than the rates for both the U.S. and Chicago. Figure 6.5 Chlamydia Infection Rate (2010) 2500
2000
1500
1000
Chicago = 938
500
0
U.S. = 426
284
1672
Archer Heights
Auburn Gresham
406
1271
2316
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526
992
260
2129
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Elsdon
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West Lawn
54 Conclusion It is apparent that the rates for all of these STIs are greatly elevated in several of the communities served by Holy Cross Hospital. It is clear that a concerted effort by the medical centers that serve this area (including Holy Cross), the city, the state, and the federal government is needed. It is interesting and important to note that we of course know how to mitigate these epidemics: condoms, safe sex, needle exchanges and sex education are all known to effectively prevent many of these infections. When we implemented our community survey (see Report 1, Section 9) there was overwhelming support for such measures in a random sample of people living in these communities. The answers are obvious and the needed strategies are there. They are ours to implement if we can find the resources to do so. If we don’t then many lives will be laid to waste needlessly. References 1. Chicago Department of Public Health. STI/HIV Surveillance Report, 2011. Chicago, IL: City of Chicago; November, 2011. 55 Section 7: Focus Groups HCH partnered with community-‐based organizations to facilitate four focus groups with 48 community members. The purpose of these focus groups was to gain insight into the most pressing health conditions affecting each community, the barriers to overcoming those issues, and how a community hospital such as HCH can help improve the community’s health. Across all focus groups, the most important health issues selected by participants generally included diabetes, high blood pressure, cancer, obesity, mental health, and sexually transmitted infections (including HIV/AIDS). According to community members, these health conditions were caused by many things, including genetics, lack of knowledge, lack of exercise, stress, trauma, and poor diet. However, the participants felt that hospitals could improve the health of the community by providing more health information, especially in emergency rooms, collaborating with schools to do outreach and education, and hiring and training bilingual and culturally sensitive and friendly staff and physicians. Community engagement refers to the process of building relationships with community members and community organizations, with the purpose of developing a collective vision to benefit the community. In order to fully understand the complex issues faced by the communities served by Holy Cross Hospital (HCH), community engagement is essential. One way of conducting community engagement is via focus groups, which are guided discussions with a small group of individuals to gain input on a particular topic. Focus groups are effective ways of gaining direct insight from the community about specific health problems as well as ideas for planning and implementing interventions to address these problems. This section of the report will present data on adult health obtained from four focus groups conducted by HCH in its Primary Service Area. There were two focus groups conducted in Chicago Lawn, one in Englewood and another in West Englewood. The purpose of the focus groups was to gain insight on the most pressing health conditions affecting each community, the barriers to overcoming those issues and how a community hospital such as HCH can help improve the community’s health. Methodology Members of community-‐based Box 7.1 Purpose of Focus Groups organizations in each community 1. Gain insight into the most pressing health conditions were contacted to assist in organizing affecting each community the focus groups. A minimum of 10 and a maximum of 15 participants 2. Determine the barriers to overcoming those issues were requested for each group. Participants had to be 18 years of age 3. Gather ideas on how a community hospital such as HCH or older, live or serve residents of the can help improve the community’s health target community, and speak the language of the host group (English or Spanish). It should be noted that some participants in each focus group resided in neighborhoods outside of the target community’s zip code, but were affiliated with the organization where the focus group was held and were thus recruited to participate. 56 A guide was used to facilitate the discussion, which lasted between 60-‐
90 minutes for each focus group. Participants were asked for permission to audio record the conversation before each session began. Each participant who completed the focus group was given a $15 gift card. Basic demographic information was collected by a written survey before the focus group began. Information obtained during the focus groups is presented below. We have provided demographic characteristics of the participants (see Table 7.1), followed by responses to the three main topics discussed during the focus groups. Each conversation was reviewed and analyzed carefully in order to extract main themes within and across groups, as well as to organize and present meaningful quotes and summaries of the topics the participants were most passionate about. Finally, a summary of the three main topics across all three communities is provided, as well as a brief discussion of the similarities and differences among the focus groups. Table 7.1 Demographic C haracteristics of Focus Group Participants Total # of participants 48 18-‐20 – 2% 21-‐30 – 13% 31-‐40 – 15% Age group (years) 41-‐50 – 29% 51-‐60 – 25% 61-‐70+ – 13% No Answer – 4% Yes – 83% Resident of community area? No – 15% No Answer – 2% English– 73% Language Spanish–27% Female – 83% Gender Male – 17% Mexican – 30% Non-‐Hispanic Black – 65% Race/ethnicity Other Hispanic/Latino – 2% Other Race – 4% Public – 40% Insurance Private – 17% No Insurance – 44% Yes – 79% Have a primary care doctor? No – 18% No Answer – 2% If yes, have visited their Yes – 82% primary care doctor within the No – 16% last year? No Answer – 3% Note: Categories may not add to 100% due to rounding and missing data Findings Focus Group Participant Characteristics Forty-‐eight community residents from three community areas participated in four focus groups. Over half of the participants were between the ages of 40 and 60 years old. Almost three-‐fourths of the participants spoke English, while a quarter spoke Spanish. Eighty-‐three percent identified as female. The majority of the participants were non-‐Hispanic Black, with 65% being non-‐Hispanic Black and 30% being Mexican. The sample was almost evenly divided between insured and uninsured (57% and 44% respectively). Although the sample had a high percentage of uninsured (44%), 79% of the sample reported that they have a primary care doctor and 67% had visited their doctor in the last year. 57 Holy Cross Hospital community focus group identified the following health care issues (collated and numbered in descending order) 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Heart Health/High Blood Pressure/Diabetes/Cholesterol 41 Cancer 16 Mental Health 13 Obesity /Healthy Lifestyle 12 Dental/ Vision Care 9 Substance Abuse/Smoking 9 STD/Sexual Health/AIDS 9 Lack of Medical Card 8 Violence 7 Nutrition 4 Lead Poisoning 3 Arthritis 2 Asthma 1 Multiple Sclerosis 1 Holy Cross Hospital senior leadership reviewed and assessed the focus group results. As Holy Cross Hospital is a safety net hospital and has had very few community outreach services, the new partnership with Sinai Health System now allows a significantly greater capacity for community health programs and services to respond to identified needs. Due to the very recent integration of Holy Cross Hospital into the Sinai Health System, the strategy and tactics require a heavy reliance on system wide programs and resources. The Holy Cross Hospital strategy and tactics were formed based on several criteria; •
•
•
The rank order of health issues as identified in the focus groups. The ability of current or new Holy Cross Hospital/Sinai Health System resources and programs that address and could improve community health as identified by community raised health care issues. The financial capacity of Holy Cross Hospital/Sinai Health System to deliver resources and programs that would effectively respond to identified needs. Most Important Health Issues The focus groups began by asking participants to identify the most important health issues affecting them and their community. Each participant was given three votes. In general, the groups had similar concerns. However, they were ranked differently. Across all focus groups, there was no overlap on the top three most important health issues selected. Box 7.2 Box 7.2 Most Important Health Issues Identified in Focus Groups •
•
•
•
•
Violence fd Mental health Diabetes Substance Abuse Unhealthy Living/ Lifestyles •
•
•
•
Cancer High Cholesterol STIs/HIV/AIDS Lack of medical card Access to Dental/Vision Care 58 contains the list of the top health conditions named by the focus groups. It should be noted that the Chicago Lawn-‐English speaking focus group found it difficult to narrow down their choices so they created a category entitled “Unhealthy Living/Lifestyles.” This category included heart disease, obesity, diabetes and high blood pressure. They felt that all of these conditions could be prevented if a person had a healthy lifestyle including eating nutritious foods and exercising. This same group also voted a lack of a medical card as their number one health issue. There was an extensive discussion regarding the eligibility requirements and that there is no help for people without children. In the Englewood focus group, there was a strong concern that violence is the number one health condition affecting their community. However, in West Englewood, the top concerns were high blood pressure and diabetes. Causes of Community Health Conditions When asked about the causes of the most pressing health concerns, participant responses ranged from individual to societal factors. Oftentimes, participants suggested that the community was plagued with many of these health issues due to genetics, lack of knowledge, lack of exercise, stress, and poor diet. One Chicago Lawn participant exclaimed, “If you buy a whole pack of tortillas and eat the whole pack, whose fault is it? Yours!” In almost all of the focus groups, participants discussed the expensive cost and lack of availability of fresh fruits and vegetables in their neighborhoods. There were complaints that the resources had been drained from their communities with relatively no reinvestment. One person in the Englewood focus group described the disparity that exists between North and South side communities as it relates to a lack of major grocery stores selling fresh fruits and vegetables. See Box 7.3 which displays the other causes listed by participants. Box 7.3 Causes of Health Issues as Identified in Focus Groups • Lack of exercise • Stress • Co-‐morbidities like high blood pressure or d iabetes • Poor diet • Lack of knowledge • Genetics • Lack of resources, social support and parenting skills • Drug use-‐both legal and prescription Barriers to Overcoming Health Conditions When the focus group participants were asked about barriers to improving the most prevalent community health issues, many of the suggestions echoed the causes of the problem. For example, lack of knowledge was cited as a reason that community residents have worse health outcomes and it was noted as a barrier to getting better as well. In addition to the causes listed in Table 7.3 above, other barriers were mentioned such as reliance on old fashioned remedies and the lack of classes and seminars (See Box 7.4 below). In Englewood and Chicago Lawn, participants discussed their mistrust of institutions. However, each group discussed a different institution. In Englewood, participants talked about mistrusting medical or social services, as well as the police. Participants recounted stories of police abuse and the police being disrespectful toward the community. The Spanish-‐speaking Chicago Lawn group noted that they do not trust food packaged in China or Canada and even some factories in the United States. There was some disagreement on the safety of food packaged in the United States but the discussion halted when a female participant told the group that the U.S. has better food regulations than many other countries. 59 Fear was a barrier discussed in both the English-‐speaking Chicago Lawn and the Englewood focus groups. In Chicago Lawn, people stated that they are afraid to exercise because they thought that they could hurt themselves. They stated that • Lack of skilled providers they need to be educated on the proper techniques for • Lack of resources exercising. In Englewood, participants were afraid of gangs and • Lack of treatment retaliation after reporting a crime. One man explained that the “No Snitch” rule used to be just among criminals, but the gangs • Fear (i.e., snitches get stitches) now try to enforce this rule as the norm for the entire • Lack of trust in institutions community. (i.e., medical or social services, police, food packaging) Another major barrier was a lack of access to skilled health care • Lack of education providers due to being uninsured or being unable to pay for • Refusal to change prescriptions, treatment, and medical supplies. Participants complained about the lack of convenient, quality mental health • Lack of trauma centers facilities. One participant in the English-‐speaking Chicago Lawn focus group stated that “only gunshot victims are taken care of, not people seeking mental health services. Even if the gunshot was treated, no mental health services are offered.” In Englewood and West Englewood, participants were adamant about the need for more trauma centers in their communities. They discussed how the lack of trauma centers within close distance to their communities greatly contributes to poor health outcomes and a risk of death. One man stated, “Friend of mine got stabbed…died there [in the hospital] because of waiting too long.” Box 7.4 Barriers to Improving Health Community Recommendations: How HCH Can Improve Community Health The focus group participants gave several suggestions for what hospitals can do to improve the numerous health conditions in the community. The most common recommendations are listed in Box 7.5. In all of the groups, participants felt that the hospital should be offering more health education, such as Box 7.5 Recommendations for HCH to culturally appropriate cooking, nutrition, and exercise Improve Community Health classes. Additionally, they recommended interventions • Provide more health education, health that target the entire family and not just the member workshops and sponsor community with diabetes. One Spanish-‐speaking Chicago Lawn events female participant stated that “the whole family needs to be educated because if I am the only one educated • Increase collaboration with schools and I cook a healthy meal, maybe the rest of the family will not eat it.” • Hire and train more bilingual and culturally sensitive staff and physicians In all of the focus groups, participants said that the hospital should serve as a health education resource and be a community partner in combating health issues plaguing these communities. In both of the Chicago Lawn focus groups, people emphasized the need for the hospital to work with the schools to teach children at a young age about mental health and how to maintain a healthy lifestyle by eating well and exercising. The participants also encouraged HCH to 60 invest in pediatric services. They do not want their children to have to be sent out of the community to be treated at hospitals such as Mount Sinai which is far away. In all of the focus groups, the participants thought that HCH needs to hire and train more bilingual staff and physicians. In the Spanish-‐speaking Chicago Lawn focus group, participants want to interact directly with a physician who speaks Spanish. They felt that they could understand and ask questions if they were able to speak for themselves and not through a translator. The English speaking groups also felt that communication between the doctor and patient needs to be improved. They complained that doctors tell you what to do but not how to do it. One woman said, “I was a size 16 about to go up to a size 18. The doctor kept telling me to lose weight every time I saw him but he never told me how to do it.” Conclusion Each focus group held in HCH’s surrounding communities of Chicago Lawn, Englewood and West Englewood provided useful insight on the current state of health among adults in their respective communities. Information on health conditions affecting adults, barriers to improving health, and how a hospital can be more involved in improving community health will greatly assist in informing hospital administration about the development of future community-‐based programs. HCH is committed to continuing to gather direct community input in its efforts to best serve the needs of community members. The efforts of HCH to address the needs of the community presented in these focus groups will be addressed in Section 8. 61 Part III
Strategies
to Improve
Health
Section 8: Implementation Strategy
Holy Cross Hospital Implementation Strategy: DIABETES Issue Diabetes patients may have barriers accessing prompt care due to lack of insurance, lack of assignment to a medical home, or delays for obtaining needed follow-‐
up appointments after an ER visit or hospitalization. Diabetes patients benefit from self-‐
management support. Community outreach Strategy Steps A Diabetes “Bridge” Clinic has been CC Currently accepting established to provide a safety net referrals 2 days weekly. clinic for patients transitioning between ER/hospital and their C Currently reviewing medical home. potential locations and staffing needs. Evaluate and identify a process to respond to co-‐morbidities (e.g., diabetes, obesity, heart disease). Diabetes Learning Circles is a Currently recruiting and program that consists of a series of serving patients for eight classes. Participants benefit English speaking from group support while setting groups. personal goals and receive lifestyle education: knowledge about Planned: Spanish diabetes, meal planning, physical language groups. activity, and problem solving. Participants are incentivized to join a local gym and also participate in cooking demonstrations. Increase awareness of Sinai’s Community health resources for persons with workers and parish diabetes or at risk for diabetes. nurse conduct glucose screenings at local health fairs with follow-‐
up linkages to FQHC’s and social service agencies. Budget (Including personnel) Responsible Fiscal Year Diabetes Service Line $100,000 (SHS) 2013-‐2014 Diabetes Service Line $3,000 (supplies) + $100,000 (personnel) (SHS) 2013-‐2014 Diabetes Service Line $150,000 (SHS) 2013-‐2014 62 Holy Cross Hospital Implementation Strategy: OBESITY Issue Strategy Adult Obesity Assessment of overweight or obese adults at Adult Weight Management Clinic Education and Counseling at Adult Weight Management Clinic Provide healthy lifestyle programs for adults in need that encourage healthy changes. Steps Budget Responsible Fiscal Year Assess overweight and obese adult’s physical health, dietary behaviors and mental health. Provide education and counseling on eating habits, lifestyle choices, physical health, mental health to overweight and obese adults. Develop community based fitness programs in conjunction with other community resources. Evaluate learning circles as a means to develop healthy lifestyles. Part of regular operating budget Adult Weight Management Program Team FY 14 Part of regular operating budget (MSH) Adult Weight Management Program Team FY 14 $30,000 for staff and supplies (SHS) Adult Weight Management Program Team FY 14 63 Holy Cross Hospital Implementation Strategy: HEART DISEASE Issue Strategy Steps Heart disease is the number one cause of death in Chicago and U.S. Alarming rates have been discovered in Mount Sinai Hospital Primary Service Area. Provide comprehensive diagnostic services with an accredited Chest Pain Center -‐ PCI at Mount Sinai Hospital and other accredited chest pain centers where medically appropriate. Screening: All people should receive recommended general preventive screenings (blood pressure, height, weight, waist circumference, pulse, glucose, and cholesterol management). Participate with NCDR-‐ Action Registry Data base and compare our data with other hospitals. Continue to provide outreach activities and screening. Collaborating our efforts and partnering with AHA to develop programming around health disparities. Expand community based cardiology screening outreach program. Chest pain center-‐ $20,000 (SHS) Clinical Director of Operations/Director of Cardiology FY-‐14-‐15 Marketing and Screening activities-‐ $5000 (SHS) Director of Cardiology FY-‐14-‐15 Review best practices, and review data and provide continuous performance improvement strategies. Identify PCP offices within the service area for expansion of specialty care. Action Registry participation-‐ $25,000 (SHS) Medical Director of Cardiology/Director of Cardiology FY-‐14-‐15 $100,000 (SHS) Vice President, Physician Services FY-‐14-‐15 Limited access to limited cardiologists in the community Co-‐locate Sinai Group cardiologists in community based primary care offices to enhance access to care and clinical programs. Budget Responsible Fiscal Year 64 Holy Cross Hospital Implementation Strategy: STROKE Issue Lack of education and knowledge in the community regarding stroke prevention . Strategy Steps Budget Education on stroke signs and symptoms to increase the number of patients who arrive in the treatment window for tPA. F. A. S. T. education to be given at community health fairs, churches, and at Chicago Public Schools. Collaboration with Chicago Region XI QUESTS Initiatives. Provide community education regarding stroke modifiable risks factors. Provide community education regarding how to apply for financial assistance and to access primary care physicians for management of modifiable risks factors. Part of regular operating expense and grant Parish Nurse FY13 Part of regular operating expense and grant Parish Nurse FY13 Education and prevention of Modifiable Risk Factors Responsible Fiscal Year 65 Holy Cross Hospital Implementation Strategy: SEXUALLY TRANSMITTED INFECTIONS Issue HIV Strategy Increase HIV testing in the hospital and the community. Steps Offer HIV testing routinely in all parts of the medical system-‐inpatient, outpatient, and emergency department. Offer HIV testing at community events. Explore grant funding and/or partner with an existing grant funded program to track and provide follow-‐up. Increase the awareness of HIV awareness campaign to make the rates of HIV in our certain people are aware of rates, community. services available and HIV testing sites. Partner with other agencies and community HIV resources (e.g., partnerships with community organizations). Link people who are HIV Working with patient navigators and infected to care. case managers to overcome barriers to enrolling people into HIV care. Treat people who are HIV Explore connections for wrap around infected with HIV services and reporting with referrals to therapy. Sinai Health System. Treat people who are HIV positive for HIV with medication that will prolong life and decrease risk of transmission to others. Explore development of screening and education for HIV positive pregnant women with existing programs to ensure optimal health for mothers and babies. Budget Part of routine medical care and grant funding Responsible Fiscal Year Nursing and physician staff FY13 with follow up by HIV staff to help navigate positives into HIV care. Part of grant funding HIV prevention team. FY13 Grant funding HIV navigators and case managers FY13 Routine medical care HIV clinicians FY13 66 Holy Cross Hospital Implementation Strategy: MENTAL HEALTH Issue Lack of Mental Health counseling and treatment on the HCH campus To expand psychiatric assessments and med management to clinics and hospitals in Illinois without access to psychiatry Strategy Establish outpatient behavioral health counseling and treatment on HCH campus (adult and child). Implement Telepsych Steps Mobile crisis team – community (assessment, education, self care for adults and children, treatment, referral) Budget Responsible David Wilson Loren Chandler Fiscal Year July 2013 Crisis hotline (assessment, education, self care for adults and children, treatment, referral) ED Crisis Stabilization Program (short term observation and crisis care) David Wilson Loren Chandler March 2014 David Wilson Loren Chandler Phase I – October 2013 Substance Abuse Medical Stabilization Program OP therapy and counseling referral post-‐
discharge Explore options for providing telepsych $75,000 Kathy Loeb June 1, 2013 TBD FY13 Decide on an option TBD Obtain, review and execute any partner agreements and fee schedules TBD Identify necessary IT resources and space TBD Purchase resources $800 Psychiatrist Training TBD Setting psychiatrist availability TBD Yogi Ahluwalia, MD, Megha Chadha, M.D. and David Wilson (SHS) Yogi Ahluwalia, MD, Megha Chadha, M.D. and David Wilson (SHS) Yogi Ahluwalia, MD, Megha Chadha, M.D., David Wilson, and Rachel Dvorken (SHS) Neil Doruff (SHS) Neil Doruff (SHS) Neil Doruff (SHS) Dr. Chadha and Neil Doruff (SHS) “Go Live” – Implement the strategy TBD Dr. Ahluwalia and Neil Doruff (SHS) FY13 FY13 FY13 FY13 FY13 FY13 FY13 67 Holy Cross Hospital Implementation Strategy: DISEASE MANAGEMENT Issue Strategy Steps Patients with Chronic Disease have challenges with personal activation resulting in progression of disease, avoidable visits to the Emergency room, and hospitalization. Expand the Disease Management Program for patients with chronic diseases of Diabetes, Heart Failure and Chronic Obstructive Pulmonary Disease (COPD). Team comprised of a nurse disease manager, patient navigator, pharmacist, dietician, social worker, and physical therapist provides targeted education and coaching to the patient on managing their disease, diet, exercise, nutrition, and medication adherence. Reinforce follow-‐up to primary care physician; provide assistance with transportation, and obtaining prescribed medications and other necessary medical equipment. Coach patients on establishing personal goals to identify the warning signs that signal the need to contact their physicians rather than delay care and/or seek care at the emergency room. Assist patients with obtaining appointments with their PCP and other Budget (Including Personnel) $2,000,000 (approximate) which includes $1,400,000 in grants for current program Expansion approximates are an additional $1,500,000 (SHS) Responsible Fiscal Year Vice President of Clinical Integration; Chief Medical Officer, SMG; Vice President, SMG; System Director, Pharmacy; Director of Social Work; Physician Team Disease Management (SHS) FY2013-‐2016 68 Issue Strategy Steps Budget (Including Personnel) Responsible Fiscal Year specialist physicians within five to seven days following discharge from the hospital to minimize the risk of readmission to the inpatient hospital or return visit to the Emergency Room. Extend the Diabetes Disease Management Program to pregnant women who have a diagnosis of gestational diabetes. Continue expansion of Disease Management Program to the ambulatory physician practice sites. Expand access of the interdisciplinary team composed of a Disease Management Nurse, Dietician, Social Worker and Pharmacist to SMG patients; hold individualized sessions with these patients during their appointment with their PCP to assess their need for medication, equipment, and social support; coach on a variety of topics including 69 Issue Strategy Steps Patients at risk for developing chronic disease are not always identified. Administer Health Risk Assessments to Ambulatory Care Patients. Smoking is at high rates in the community. Smoking Cessation Program •
reinforcement of plan of care and healthy lifestyle concepts. Expand Disease Management Team to include Community Health Workers to visit patients in their homes; validate information provided to clinical team; provide additional support to patients to eliminate social determinants interfering with patients’ ability to remain activated. Health Risk Assessments (HRA) are short questionnaires administered to individuals for the purpose of identifying those who may be at risk for the development of a chronic disease. HRA’s are under development; build basic HRAs into Next GEN Develop system of stratification of results to identify patients with greatest need to deploy available resources Develop a basic smoking cessation program for patients with chronic Budget (Including Personnel) Responsible Fiscal Year Operating Budget SHS Disease Management, Physician Team and IS for development; SMG Clinics staff for implementation FY2014-‐FY 2016 $100,000 (SHS) Disease Management specifically Social Worker FY 13-‐14 70 Issue Standardizing care will assure that patients receive the right treatment, at the right time, in the right setting. Strategy Deliver evidence based care to our patients across the continuum. Steps disease and pregnant women Continue development of clinical care guidelines and order sets across the continuum. Budget (Including Personnel) Staff Time; no specific dollars assigned Responsible Disease Management and Disease Management Physician Team Fiscal Year FY 13-‐14 71 Appendices
A. Additional Mortality Information
B. Additional Hospitalization Data
C. Focus Group Details
Appendix A: Additional Mortality Information In Section 3, we summarized the leading causes of death for Chicago residents. We talked about mortality from heart disease and cancer in more detail and presented bar charts and maps to show which communities are most burdened with these particular health problems. In this appendix, we present information on the remaining leading causes of death in a similar format. Recall from Section 3 that the leading causes of death for Chicago residents in 2006 were: Leading Causes of Death for Chicago Residents, 20061 1. Heart Disease 2. Cancer 3. Accidents 4. Stroke 5. Chronic Lower Respiratory Disease 6. Diabetes 7. Septicemia 8. Nephritis 9. Influenza and Pneumonia 10. Homicide Now let’s continue looking at cause-‐specific mortality data for the city of Chicago. In order to understand what people are dying from within Chicago, and also how this varies across the city’s 77 communities, we calculated the 3-‐year average (2005-‐2007) age-‐adjusted mortality rates (rates) for several causes of death for each of Chicago’s 77 communities. Mortality rates are age-‐adjusted in order to allow comparisons across geographic areas (in this case, community areas) which may have very different age distributions. For example, we would expect more deaths from heart disease to occur in communities with a larger elderly population than in communities with more young people. By age-‐
adjusting the rates, we can make comparisons between communities with very old and very young populations and everything in between. We will resume our discussion here with the third leading cause of death – accidents. 73 Accidents: #3 Cause of Death in Chicago #5 Cause of Death in the U.S. What are accidents? Accidents encompass all unintentional injury deaths, including deaths from car accidents, falls, and drug overdoses. Accidents do not include deaths from homicide or suicide. Many fatal injuries are preventable and knowing the characteristics of those at high risk is key to prevention. For instance, falls are the leading mechanism of accidental death for elderly people over 72, while poisoning (drug overdose) is the leading mechanism of accidental death for midlife adults 35-‐53 years of age. For all other age groups (except children under 2 years of age), car accidents are the leading mechanism of injury death.2 • Figure A.1 presents the accident mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The accident death rate was: • 40 for Chicago • 35 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 24 for Gage Park to a high of 81 in Englewood • Rates above the Chicago average were found in 7 of the 10 HCH communities Figure A.1 Accident Mortality (2005-‐2007) 90
80
70
60
50
40
U.S. = 40
Chicago = 35
30
20
10
0
•
•
37
45
Archer Heights
Auburn Gresham
33
39
81
Park
Lawn
24
46
42
64
City
Elsdon
Englewood
26
West Lawn
Figure A.2 helps demonstrate which community areas are most burdened with accident mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest accident death rates • Notably, all of the communities with the highest rates were on the south and west sides of the city • Four of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Accident deaths accounted for 2-‐8% of the 77 communities’ total deaths 74 Figure A.2 Accident Mortality by Chicago Community Area Accident Morality per 100,000
1
9
2
12
76
10
0
11
77
13
Chicago Accident Mortality: 35
4
14
0
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U.S. Accident Mortality: 40
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
40
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72
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
32
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p
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75 Stroke: #4 Cause of Death in Chicago #3 Cause of Death in the U.S. What is a stroke?3 Similar to a heart attack, a stroke can result when a blood vessel is damaged or blocked, denying oxygen-‐rich blood to the brain. When this happens, brain cells begin to die in the region that is not receiving blood, resulting in brain damage. Depending on the location of the stroke, speech, movement, or memory may be affected. People who survive larger strokes may be left with permanent disabilities. The risk factors for stroke, including unhealthy lifestyle factors and conditions such as high blood pressure, may be modified or prevented. • Figure A.3 presents the stroke mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The stroke death rate was: • 46 for Chicago • 44 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 34 for Archer Heights to a high of 78 in Englewood • Rates above the Chicago average were found in 8 of the 10 HCH communities Figure A.3 Stroke Mortality (2005-‐2007) 90
80
70
60
50
Chicago = 46 U.S. = 44
40
30
20
10
0
34
63
Archer Heights
Auburn Gresham
37
65
78
61
Park
Lawn
49
•
•
67
49
West Lawn
Figure A.4 helps demonstrate which community areas are most burdened with stroke mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest stroke death rates • Notably, all of the communities with the highest rates were on the south and west sides of the city • Five of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Stroke deaths accounted for 3-‐9% of the 77 communities’ total deaths 76 47
City
Elsdon
Englewood
Figure A.4 Stroke Mortality by Chicago Community Area Stroke Morality per 100,000
1
9
2
12
76
10
0
11
77
13
Chicago Stroke Mortality: 46
4
14
0
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U.S. Stroke Mortality: 44
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
40
41
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
32
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77 Chronic Lower Respiratory Disease: #5 Cause of Death in Chicago #4 Cause of Death in the U.S. What is Chronic Lower Respiratory Disease (CLRD)? CLRD includes chronic bronchitis, emphysema, asthma, and other illnesses of the lungs. Many of the risk factors for CLRD have been identified and can be prevented, including tobacco smoke, second-‐hand tobacco smoke, and indoor and outdoor air pollutants.4 Most importantly, cigarette smokers are 10 times more likely to die from CLRD than nonsmokers.5 • Figure A.5 presents the CLRD mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The CLRD death rate was: • 29 for Chicago • 42 for the U.S. • Within the SHS Primary Service Area: • Rates ranged from a low of 18 for Gage Park to a high of 41 in Englewood • Rates above the Chicago average were found in 5 of the 10 HCH communities Figure A.5 Chronic Lower Respiratory Disease Mortality (2005-‐2007) 50
45
U.S. = 42
40
35
30
Chicago = 29
25
20
15
10
5
0
34
24
Archer Auburn Heights
Gresham
29
34
41
18
Park
Lawn
24
•
•
38
45
West Lawn
Figure A.6 helps demonstrate which community areas are most burdened with CLRD mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest CLRD death rates • Notably, nearly all of the communities with the highest rates were on the south and west sides of the city • Three of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area CLRD deaths accounted for 2-‐6% of the 77 communities’ total deaths 78 19
City
Elsdon
Englewood
Figure A.6 Chronic Lower Respiratory Disease Mortality by Chicago Community Area Chronic Lower Respiratory Disease
(CLRD) Morality per 100,000
1
9
2
12
76
10
0
77
13
11
4
Chicago CLRD Mortality: 29
14
0
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U.S. CLRD Mortality: 42
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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79 Diabetes: #6 Cause of Death in Chicago #6 Cause of Death in the U.S. What is Diabetes?6 Diabetes (known in some communities as “sugar”) is a disease characterized by high blood sugar. Blood sugar is made naturally in our bodies and also comes from the food we eat. We need sugar for energy, but too much sugar in the blood can have negative side effects. Usually, a hormone called insulin helps sugar enter our cells in order to regulate the amount of sugar in our blood. However, in people with diabetes, the body either does not make enough insulin or the insulin does not work properly. Diabetes is the result of prolonged high blood sugar, and can lead to serious health consequences such as kidney failure and blindness. People with diabetes are also at higher risk for heart disease and stroke. However, diabetes can be controlled with proper diet, exercise, and medication. • Figure A.7 presents the diabetes mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The diabetes death rate was: • 28 for Chicago • 24 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 18 for West Lawn to a high of 41 in Auburn Gresham • Rates above the Chicago average were found in 7 of the 10 HCH communities Figure A.7 Diabetes Mortality (2005-‐2007) 45
40
35
30
Chicago = 28
25
U.S. = 24
20
15
10
5
0
27
41
Gresham
•
•
30
29
40
33
Park
Lawn
20
32
18
West Lawn
Figure A.8 helps demonstrate which community areas are most burdened with diabetes mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest diabetes death rates • Notably, many of the communities with the highest rates were on the south and west sides of the city • Two of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Diabetes deaths accounted for 1-‐6% of the 77 communities’ total deaths 80 34
City
Elsdon
Englewood
Figure A.8 Diabetes Mortality by Chicago Community Area Diabetes Morality per 100,000
1
9
2
12
76
10
0
11
77
13
Chicago Diabetes Mortality: 28
4
14
0
16
15
5
17
6
21
18
19
U.S. Diabetes Mortality: 24
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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81 Septicemia: #7 Cause of Death in Chicago #10 Cause of Death in the U.S. What is Septicemia?7 Septicemia, sometimes referred to as “blood poisoning”, is caused by bacteria entering the bloodstream and triggering an immune response which results in inflammation and a slow shutting down of the body’s systems for handling infection. A person may be vulnerable to septicemia because of age or condition or due to surgery or a latent infection which may spread to the blood. Septicemia is difficult to prevent and can strike unexpectedly. Some measures a person can take to prevent septicemia include: maintain good hygiene and general health; closely monitor the site of any surgical procedures and speak up if you experience any soreness, swelling or discomfort around the site; seek medical attention for deep cuts and puncture wounds so that the site can be adequately flushed and antibiotics can be given if needed. • Figure A.9 presents the septicemia mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The septicemia death rate was: • 25 for Chicago • 11 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 11 for Archer Heights to a high of 39 in New City • Rates above the Chicago average were found in 4 of the 10 HCH communities Figure A.9 Septicemia Mortality (2005-‐2007) 45
40
35
30
25
Chicago = 25
20
15
U.S. = 11
10
5
0
11
34
Gresham
18
25
29
22
Park
Lawn
39
•
•
36
13
West Lawn
Figure A.10 helps demonstrate which community areas are most burdened with septicemia mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest septicemia death rates • Notably, nearly all of the communities with the highest rates were on the south and west sides of the city • Two of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Septicemia deaths accounted for 1-‐5% of the 77 communities’ total deaths 82 16
City
Elsdon
Englewood
Figure A.10 Septicemia Mortality by Chicago Community Area Septicemia Morality per 100,000
1
9
2
12
76
10
0
77
13
11
Chicago Septicemia Mortality: 25
4
14
0
16
15
5
17
6
21
18
19
U.S. Septicemia Mortality: 11
3
20
22
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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83 Nephritis: #8 Cause of Death in Chicago #9 Cause of Death in the U.S. What is Nephritis?8 Nephritis, or kidney disease, is a general term which refers to any damage or inflammation of the kidneys. The kidneys are responsible for filtering the blood, removing extra fluid and unwanted chemicals, and helping the body regulate blood pressure. Therefore, kidney damage can result in a general imbalance in the body, leading to swelling, nausea, and weakness, among other things. Chronic kidney disease is often caused by diabetes and high blood pressure and may be fatal if left untreated. • Figure A.11 presents the nephritis mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The nephritis death rate was: • 23 for Chicago • 14 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 6 for Archer Heights to a high of 45 in Englewood • Rates above the Chicago average were found in 5 of the 10 HCH communities Figure A.11 Nephritis Mortality (2005-‐2007) 50
45
40
35
30
25
Chicago = 23
20
15
U.S. = 14
10
5
0
6
37
Gresham
18
31
45
20
Park
Lawn
36
•
•
38
22
West Lawn
Figure A.12 helps demonstrate which community areas are most burdened with nephritis mortality • The map displays all 77 of Chicago’s communities with light to dark shading for lowest to highest nephritis death rates • Notably, almost all of the communities with the highest rates were on the south and west sides of the city • Four of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Nephritis deaths accounted for 1-‐4% of the 77 communities’ total deaths 84 20
City
Elsdon
Englewood
Figure A.12 Nephritis Mortality by Chicago Community Area Nephritis Morality per 100,000
1
9
2
12
76
10
0
11
77
13
Chicago Nephritis Mortality: 23
4
14
0
16
15
5
17
6
21
18
19
U.S. Nephritis Mortality: 14
3
20
22
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
40
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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85 Influenza and Pneumonia: #9 Cause of Death in Chicago #8 Cause of Death in the U.S. What are influenza and pneumonia? Influenza (flu) is a viral infection that is highly contagious and can affect people of all ages. Seasonal flu can be prevented by receiving a flu shot, which is covered by Medicare and most other health plans, and is widely available – through clinics and pharmacies alike. Pneumonia is an infection of the lungs which causes the air sacs in the lungs to become inflamed and fill with pus and other liquid. It then becomes difficult for the blood to draw oxygen from the air sacs for distribution throughout the body, which prevents the body’s cells from working properly. Lack of oxygen and the spread of infection can lead to death. Vaccination is recommended for certain age groups and those already in poor health. The flu shot can also help prevent pneumonia because of the close relationship between influenza and pneumonia.9 • Figure A.13 presents the influenza and pneumonia mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The influenza and pneumonia death rate was: • 23 for Chicago • 18 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 12 for Gage Park to a high of 33 in West Englewood • Rates above the Chicago average were found in 3 of the 10 HCH communities Figure A.13 Influenza and Pneumonia Mortality (2005-‐2007) 35
30
25
Chicago = 23
20
U.S. = 18
15
10
5
0
20
22
Gresham
17
31
28
Park
Lawn
12
20
•
•
33
15
West Lawn
Figure A.14 displays all 77 of Chicago’s communities with light to dark shading for lowest to highest influenza and pneumonia death rates • Notably, several of the communities with the highest rates were on the south and west sides of the city • Three of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Influenza and pneumonia deaths accounted for 1-‐6% of the 77 communities’ total deaths 86 19
City
Elsdon
Englewood
Figure A.14 Influenza and Pneumonia Mortality by Chicago Community Area Influenza & Pneumonia (I&P)
Morality per 100,000
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9
2
12
76
10
0
77
13
11
4
Chicago I & P Mortality: 23
14
0
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5
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18
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U.S. I & P Mortality: 18
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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87 Homicide: #10 Cause of Death in Chicago #15 Cause of Death in the U.S. What is homicide? Homicide is defined as a human killing another human. Nearly 70% of homicides in the U.S. involve firearms10 and the highest victimization and offending rates are found among young adults.11 Youth homicide is particularly problematic in large urban areas, especially among Black and Hispanic teens. Major factors contributing to the elevated homicide rates among these groups include poverty, easy access to handguns, drug and gang activity, and the failure of the educational system. Violence prevention and reduction strategies are most effective when they can identify high-‐risk children early on and intervene at multiple levels through collaborative community partnerships. • Figure A.15 presents the homicide mortality rates for the U.S., Chicago, and the 10 communities in the HCH Primary Service Area • The homicide death rate was: • 15 for Chicago • 6 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 8 for West Elsdon to a high of 46 in Englewood • Rates above the Chicago average were found in 5 of the 10 HCH communities Figure A.15 Homicide Mortality (2005-‐2007) 50
45
40
35
30
25
20
15
Chicago = 15
10
U.S. = 6
5
0
13
36
Gresham
9
23
46
12
Park
Lawn
27
8
44
City
Elsdon
Englewood
11
West Lawn
•
•
Figure A.16 displays all 77 of Chicago’s communities with light to dark shading for lowest to highest homicide death rates • Notably, all of the communities with the highest rates were on the south and west sides of the city • Three of the communities with the highest rates (those in the 4th quartile) fell within the HCH Primary Service Area Homicide deaths accounted for 0-‐7% of the 77 communities’ total deaths 88 Figure A.16 Homicide Mortality by Chicago Community Area Homicide Morality per 100,000
1
9
2
12
76
10
0
11
77
13
Chicago Homicide Mortality: 15
4
14
0
16
15
5
17
6
21
18
19
U.S. Homicide Mortality: 6
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Rogers Park
West Ridge
Uptown
Lincoln Square
North Center
Lake View
Lincoln Park
Near North Side
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
Portage Park
Irving Park
Dunning
Montclare
Belmont Cragin
Hermosa
Avondale
Logan Square
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Loop
Near South Side
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
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Washington Park
Hyde Park
Woodlawn
South Shore
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
Bridgeport
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
O'Hare
Edgewater
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89 References 1. 2006 is the most recent year for which the Chicago Department of Public Health has published these data. See report at: http://www.cityofchicago.org/dam/city/depts/cdph/statistics_and_reports/SR_leading%20causes%
20of%20death%202006.pdf. 2. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. Hyattsville, MD: National Center for Health Statistics. 2008.National Stroke Association. (2013). 3. National Stroke Association. (2013). What is Stroke? Available online: http://www.stroke.org/site/PageServer?pagename=stroke. Accessed on March 1, 2013. 4. World Health Organization. Risk Factors for Chronic Respiratory Diseases. Available online: http://www.who.int/gard/publications/Risk%20factors.pdf. Accessed on March 8, 2013. 5. American Lung Association. Fact Sheet: Chronic obstructive pulmonary disease (COPD). Available online: http://www.lungusa.org/diseases/copd_factsheet.html. Accessed on March 8, 2013. 6. National Institutes of Health. (2012). NIH Senior Health: What is Diabetes? Available online: http://nihseniorhealth.gov/diabetes/diabetesdefined/01.html. Accessed on February 25, 2013. 7. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. NCHS data brief, no 62. Hyattsville, MD: National Center for Health Statistics. 2011. 8. WebMD. (2013). Understanding Kidney Disease – the Basics. Available online: http://www.webmd.com/a-‐to-‐z-‐guides/understanding-‐kidney-‐disease-‐basic-‐information. Accessed March 7, 2013. 9. American Lung Association. (2010). Influenza and Pneumonia. Available online: http://www.lung.org/assets/documents/publications/solddc-‐chapters/i-‐p.pdf. Accessed March 7, 2010. 10. Centers for Disease Control and Prevention. (2013). Assault or Homicide. Available online at: http://www.cdc.gov/nchs/fastats/homicide.htm. Accessed March 8, 2013. 11. Bureau of Justice Statistics. (2012). Available online at: http://bjs.ojp.usdoj.gov/content/homicide/teens.cfm. Accessed March 8, 2013 90 Appendix B: Additional Hospitalization Data In Section 4, we discussed the hospitalization rates for asthma, diabetes, heart disease, stroke, and mental health disorders. We will continue to present hospitalization data on other conditions here, including pneumonia, HIV/AIDS, kidney disease, liver disease and injury and poisoning. See Section 4 for a description of methods including condition selection, data sources, and rate calculation details. Pneumonia Hospitalizations What is pneumonia?1 Pneumonia is an infection of the lungs which causes the air sacs in the lungs to become inflamed and filled with pus and other fluids. It then becomes difficult for the blood to draw oxygen from the air sacs for distribution throughout the body, which prevents the body’s cells from working properly. Lack of oxygen and the spread of infection can lead to death. Vaccination is recommended for certain age groups and those already in poor health. The flu shot can also help prevent pneumonia because of the close relationship between influenza and pneumonia. •
•
•
Figure B.1 presents the pneumonia hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area The pneumonia hospitalization rate (per 10,000) was: • 34 for Chicago • 35 for the U.S. Within the HCH Primary Service Area: • Rates ranged from a low of 31 in 60629 to a high of 65 in 60621 • Rates above the Chicago average were found in 4 of the 6 HCH zip codes Figure B.1 Pneumonia Hospitalization Rates for the HCH Primary Service Area 70
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Figure B.2 displays 56 zip codes in Chicago with light to dark shading for lowest to highest pneumonia hospitalization rates • Many of the zip codes with the highest rates were on the south and west side of the city • Three of the six zip codes in the HCH Primary Service Area had pneumonia hospitalization rates within the highest (4th) quartile 91 Figure B.2 Pneumonia Hospitalization Rates by Chicago Zip Code Pneumonia Hospitalizations per 10,000
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Chicago Pneumonia Hospitalizations: 34
U.S. Pneumonia Hospitalizations: 35
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92 HIV/AIDS Hospitalizations What is HIV/AIDS?2 The Human Immunodeficiency Virus (HIV) is spread in several ways, including unprotected sexual activity, needle sharing during injection drug use, and mother to child transmission during pregnancy. HIV attacks the immune system, making it difficult for the body to fight off infections. It may take several years for people with HIV to show signs and symptoms of infection. Untreated HIV can lead to a severely damaged immune system, resulting in Acquired Immune Deficiency Syndrome (AIDS). People with AIDS are more likely to develop certain diseases and types of cancer. However, with the proper treatment, people can live with HIV without progressing to AIDS. • Figure B.3 presents the HIV/AIDS hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The HIV/AIDS hospitalization rate (per 10,000) was: • 4 for Chicago • 1 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 0.55 in 60632 to a high of 10 in 60621 • Rates above the Chicago average were found in 4 of the 6 HCH zip codes Figure B.3 HIV/AIDS Hospitalization Rates for the HCH Primary Service Area 12
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Figure B.4 displays 56 zip codes in Chicago with light to dark shading for lowest to highest HIV/AIDS hospitalization rates • Many of the zip codes with the highest rates were on the south and west side of the city • Three of the six zip codes in the HCH Primary Service Area had HIV/AIDS hospitalization rates within the highest (4th) quartile 93 Figure B.4 HIV/AIDS Hospitalization Rates by Chicago Zip Code HIV/AIDS Hospitalizations per 10,000
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Chicago HIV/AIDS Hospitalizations: 4
U.S. HIV/AIDS Hospitalizations: 1
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94 Nephritis Hospitalizations What is nephritis?3 Nephritis, or kidney disease, is a general term which refers to any damage or inflammation of the kidneys. The kidneys are responsible for filtering the blood, removing extra fluid and unwanted chemicals, and helping the body regulate blood pressure. Therefore, kidney damage can result in a general imbalance in the body, leading to swelling, nausea, and weakness, among other things. Chronic kidney disease is often caused by diabetes and high blood pressure and may be fatal if left untreated. • Figure B.5 presents the nephritis hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The nephritis hospitalization rate (per 10,000) was: • 16 for Chicago • 18 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 12 in 60632 to a high of 20 in 60621 • Rates above the Chicago average were found in 4 of the 6 HCH zip codes Figure B.5 Nephritis Hospitalization Rates for the HCH Primary Service Area Per 1 0,000 Population
25
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*Data source: COMPdata (Chicago, 2009-‐2011); CDC Health Data Interactive (U.S., 2010) •
Figure B.6 displays 56 zip codes in Chicago with light to dark shading for lowest to highest nephritis hospitalization rates • Many of the zip codes with the highest rates were on the south and west side of the city • Three of the six zip codes in the HCH Primary Service Area had nephritis hospitalization rates within the highest (4th) quartile 95 Figure B.6 Nephritis Hospitalization Rates by Chicago Zip Code Nephritis Hospitalizations per 10,000
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Chicago Nephritis Hospitalizations: 16
U.S. Nephritis Hospitalizations: 18
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96 Cirrhosis Hospitalizations What is cirrhosis?4 Cirrhosis, or liver disease, is a condition in which scar tissue replaces the soft healthy tissue of the liver. Several risk factors, including alcoholism, chronic hepatitis, and genetic diseases can cause the liver to swell, which may lead to cirrhosis. Treatment is limited and aimed at preventing further damage and reducing complications. Therefore, it is especially important to try to prevent cirrhosis through proper diet, physical activity, limited alcohol intake, vaccination, and safe sex and needle use practices. • Figure B.7 presents the cirrhosis hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The cirrhosis hospitalization rate (per 10,000) was: • 4.3 for Chicago • 3.0 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 3.8 in 60620 to a high of 6.0 in 60632 • Rates above the Chicago average were found in 5 of the 6 HCH zip codes Figure B.7 Cirrhosis Hospitalization Rates for the HCH Primary Service Area 7
6
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Figure B.8 displays 56 zip codes in Chicago with light to dark shading for lowest to highest cirrhosis hospitalization rates • All of the zip codes with the highest rates were on the west side of the city • Five of the six zip codes in the HCH Primary Service Area had cirrhosis hospitalization rates within the highest (4th) quartile 97 Figure B.8 Cirrhosis Hospitalization Rates by Chicago Zip Code Cirrhosis Hospitalizations per 10,000
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Chicago Cirrhosis Hospitalizations: 4
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98 Injury and Poisoning Hospitalizations What is included in injury and poisoning? Hospitalizations for injury and poisoning include fractures, dislocations, sprains, internal injury, wounds, burns, poisoning by drugs, medicinal, and biological substances, and toxic effects of non-‐medicinal substances. • Figure B.9 presents the injury and poisoning hospitalization rates for the U.S., Chicago, and the 6 zip codes in the HCH Primary Service Area • The injury and poisoning hospitalization rate (per 10,000) was: • 57 for Chicago • 60 for the U.S. • Within the HCH Primary Service Area: • Rates ranged from a low of 52 in 60629 and 60632 to a high of 81 in 60636 • Rates above the Chicago average were found in 4 of the 6 HCH zip codes Figure B.9 Injury and Poisoning Hospitalization Rates for the HCH Primary Service Area 90
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Figure B.10 displays 56 zip codes in Chicago with light to dark shading for lowest to highest injury and poisoning hospitalization rates • Many of the zip codes with the highest rates were on the west and south sides of the city • Four of the six zip codes in the HCH Primary Service Area had injury and poisoning hospitalization rates within the highest (4th) quartile 99 Figure B.10 Injury and Poisoning Hospitalization Rates by Chicago Zip Code Injury & Poisoning Hospitalizations per 10,000
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Chicago Injury & Poisoning Hospitalizations: 57
U.S. Injury & Poisoning Hospitalizations: 60
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100 References 1. American Lung Association. (2010). Influenza and Pneumonia. Available online: http://www.lung.org/assets/documents/publications/solddc-‐chapters/i-‐p.pdf. Accessed on March 7, 2013. 2. Centers for Disease Control and Prevention. (2012). Basic Information about HIV and AIDS. Available online: http://www.cdc.gov/hiv/topics/basic/index.htm. Accessed on February 25, 2013. 3. WebMD. (2013). Understanding Kidney Disease – the Basics. Available online: http://www.webmd.com/a-‐to-‐z-‐guides/understanding-‐kidney-‐disease-‐basic-‐information. Accessed on March 7, 2013. 4. American Liver Foundation. (2012). Cirrhosis. Available online: http://www.liverfoundation.org/abouttheliver/info/cirrhosis/. Accessed on March 4, 2013. 101 Appendix C: Focus Group Details In Section 7, we summarized overall findings of the four focus groups conducted in the Holy Cross Hospital (HCH) Primary Service Area. In this appendix, we present detailed information obtained during the focus groups by community, including: • Demographic characteristics of focus group participants • The most important health issues affecting community members • What the barriers are to improving these issues • Suggestions for what a hospital can do to improve community health Each focus group conversation was reviewed and analyzed carefully in order to extract main themes within and across groups, as well as to organize and present meaningful quotes and summaries of the topics about which the participants were most passionate. Englewood and West Englewood Focus group characteristics Two focus groups were conducted in the Englewood area with a total sample size of 22 people. Each took place at area churches: the Gifts of God Ministry in West Englewood and the Englewood Mennonite Church in Englewood. Focus group participants were primarily African American, female, and of middle age (41-‐60). Nearly one in three reported being without health insurance, as Table C.1 Demographic Characteristics for Englewood and West reflected in Table C.1. At the Englewood Focus Groups time of the 2010 Census, Englewood and West Total # of participants 22 Englewood residents were 21-‐30 -‐ 0% primarily African American, 31-‐40 -‐ 18% 97% and 96% respectively. Age Group (years) 41-‐50 -‐ 32% Both neighborhoods have a (N=22) 51-‐60 -‐ 32% small subset of Hispanic 61+ -‐ 9% residents (1-‐2% of the No Answer-‐9% population), who are not Yes – 86% Resident of community area? reflected in either focus group. No – 14% Female – 73% Gender Findings Male – 27% African American – 100% The focus groups began by Race/Ethnicity asking participants to identify the most important health Public – 41% issues affecting them and their Health Insurance No Insurance– 32% community. Diabetes, high Private Insurance– 27% blood pressure, mental health, Yes – 77% Have a primary care doctor? substance abuse, cancer, No – 23% obesity, HIV/STDs, arthritis, Yes – 68% If yes, have visited their primary and respiratory diseases, such No – 18% care doctor within the last year? as asthma and chronic N/A– 14% obstructive pulmonary disease (COPD), were mentioned by 102 both groups. Each participant was then given three votes and asked to select the top three health issues in their community. As seen in Table C.2, each focus group chose different issues. Initially, Focus Group No. 2 (Englewood) emphasized access to dental and vision care as a major issue, ranking it as a tie with violence as their top health concern. However, upon being informed that there cannot be a tie, the group re-‐evaluated which issues were most important and dental/vision was eliminated. The top three concerns for Focus Group No. 2 were violence, obesity, and substance abuse. Table C.2 Top Health Issues Affecting Englewood and West Englewood as Identified by Focus Groups Focus Group No. 1 (votes) -‐ West Englewood Diabetes and High Blood Pressure (10 each) Cancer (7) S Mental Health (5) ST Substance Abuse/Smoking (4) AIDS (4) Sexually Transmitted Infections/Sexual Health (2) Arthritis (2) Obesity (1) Asthma (1) Focus Group No. 2 (votes) -‐ Englewood Violence (7) Obesity (6) Substance Abuse (5) Heart Problems/High Blood Pressure/Cholesterol (4) Nutrition (4) Lead Poisoning (3) Cancer (3) Diabetes (2) Sexually Transmitted Infections/Sexual Health (2) West Englewood Focus Group Diabetes/High Blood Pressure Weight, stress, and lack of exercise, among other issues, were identified by the focus group participants as the cause of diabetes and high blood pressure in West Englewood, as seen in Table C.2. Diet was discussed at length, including the role of personal responsibility and how parents should teach children from a young age how to eat a healthy diet and exercise to maintain a healthy weight. Too much salt, fat, cholesterol, fast food, white foods (e.g., starches, pasta, white flour), and sugar were identified as contributing factors to diabetes. However, the topic of sugar spurred a debate. One woman stated, “Everyone says diabetes is caused by sugar because they used to call it ‘sugar’ back in the day. Everybody relate sugar to diabetes but diabetes is really not caused by sugar… You have to realize a lot of things we eat break down to sugar…” She also explained that her doctor had told her that you can have diabetes in your genes, but if you do all the things you need to like exercise, keep your weight down and eat right, you may not get diabetes. Table C.3 Diabetes/High BP Causes and Barriers as Identified by the West Englewood Focus Group Causes of Diabetes/High Blood Pressure Weight Genetics Stress/Aggravation Poor Diet Lack of Exercise Stress/Aggravation Barriers to Improved Health Lack of Education Reliance on old-‐fashioned remedies Lack of seminars and classes It was suggested that the community would benefit from increased access to dieticians to learn how to use spices and other substitutes to make meals healthier. However, the focus group participants recognized that behavior change can be slow and difficult. One man raised his hand and said he thought 103 that “learning substitutes for healthier foods is a good idea, but it will take a while for people to change because your body is not always used to eating these different flavors.” Another woman used an example of how she once was taught to make mustard and collard greens without meat and fat from meat, and that she actually liked the healthier version better. Additionally, it was recommended that better hospital technology and testing equipment, improved doctor-‐patient communication, offering nutrition classes and healthy cooking demonstrations, increased access to diabetes literature, and better accessibility of hospitals and treatment centers would be beneficial. Cancer West Englewood participants named cancer as the second most important concern for their community, identifying the causes of cancer and barriers to cancer prevention and treatment below in Table C.4. The focus group thought hospitals should have a greater presence in the community in order to elevate their role as a community advocate for persons with cancer. They also suggested that hospitals should work on improving the affordability of cancer treatment and find better ways to engage communities in research. Table C.4 Causes of Cancer and Barriers to Cancer Prevention and Treatment as Identified by the West Englewood Focus Group Causes of Cancer Lack of available screening Environmental toxins (chemicals, pollution, etc.) Smoking and drinking Bad diet Bad diet e xposure Radiation (Exposure to sun, Cell phones) Pride in not getting prostate checked Exposure to sun Barriers to Improved Health Lack of early detection/screening Not having regular doctor check-‐ups Lack of political action Lack of resources for care aftediagnosis didiagnosis In terms of political action, one man said, “People know that we have a lot of pollution problems, yet Too much radiation exposure Cell phones (Lithium there is no challenge against the railroads… no challenges against companies and trucks that pollute our batteries) district. And no one is challenging… all the internal problems within the homes with the exposure to cancer [causing substances].” Englewood Focus Group Violence The Englewood focus group discussed violence as a major health concern, describing domestic problems, mental health, poverty, drugs and alcohol, and a variety of other issues that contribute to violence, as seen in Table C.5, below. In the discussion of gangs, one focus group participant said, “That’s the biggest problem.” The focus group expressed the fear community members have with the gang presence and a fear of retaliation if they report crimes. One man explained that the “No Snitch” rule used to be just among criminals, but the gangs now try to enforce this rule as the norm for the entire community. Englewood residents discussed the lack of safe places and safe havens for people to hang out. For example, churches are locked most of the time and there are little entertainment or social outlets. 104 Table C.5 Causes of Violence and Barriers to Prevention as Identified by the Englewood Focus Group Causes of Violence Gangs Domestic problems Poor Mental health (anger, self-‐esteem) etc.) Poor problem-‐solving and coping skills Poverty/lack of support in meeting needs Teen parenting/poor parenting skills Drugs and alcohol Lack of education Broken families Barriers to Improving Issue of Violence Lack of involvement and leadership Children need better parenting Children need better parenting Lack of education Lack ducation Lack o
of f etrust in institutions (i.e., police abuse, Lack o
f e
ducation Lack o
f t
rust institutions (i.e. police abuse, police d
isrespectful towards community) disrespectful itn owards community) Lack of dtisrespectful rust in institutions (i.e. police abuse, police t
owards c
ommunity) Fear (e.g., “snitches get stitches”) Lack o
f trust in institutions (i.e. police abuse, police t
owards Lack of dsisrespectful afe places and social coommunity) utlets police disrespectful owards cgommunity) No Fear (for example, “tSnitches et stitches”) respect Fear (for example, “Snitches get stitches”) Sometimes there can be lack ogf trust of medical Fear (for example, “Snitches et stitches”) or social services Obesity The second most important health concern in Englewood was obesity. The focus group participants discussed various causes of obesity and barriers to preventing or improving obesity in the community, as outlined below. Table C.6 Causes of Obesity and Barriers to Prevention as Identified By the Englewood Focus Group Causes Children have less physical activity Poor eating habits Psychological factors Lack o
f e
ducation Lack of education Barriers to Preventing and Improving Obesity Food desert/ Lack of grocery stores Too many fast food restaurants in community and Too fast food on many the Southside
restaurants in community and in Southside No sit-‐down family dinners; no time spent with children No sit-‐down family dinners; no time spent with children Frozen food and microwave cooking Political decisions that negatively affect community Frozen food and microwave cooking Political decisions that negatively affect community Participants discussed how there used to be major grocery stores in Englewood with fresh fruits and vegetables, but few, if any, now exist. One resident gave an illustrative example, describing the disparity that exists when comparing North Side to South Side communities. The group discussed lack of physical activity as being a contributing factor to obesity, but the discussion mostly centered on children. For example, one participant discussed how his generation played dodge ball but now children play videogames and eat snacks. He said, “We use to have gym everyday – we would warm up with calisthenics and everything. Now you don’t have gym but once a week and the kids don’t do much.” Another participant stated that parents do not spend time with their kids; instead they give things to their kids because they are not around and they think that will make up for it. There was discussion of bad political decisions made for the community. One participant did not like “Our political system having control over what is put into our families and community. They’re the ones that decided no recess; they’re the ones that decided what foods are brought into our children’s schools… That’s a barrier.” 105 Community Recommendations: How HCH Can Improve Community Health The participants gave several suggestions of what hospitals and health care providers can do to improve the health of the community. The underlying themes of both groups’ responses were: •
•
•
Addressing the lack of medical facilities in the community Improving problems in doctor-‐patient communication Mitigating the influence of mental health on community issues Mental health issues such as verbal and physical abuse, trauma, stress, depression, low self-‐esteem, rejection, and “being sick and tired” play a large part in many of the community’s health concerns, especially substance abuse and violence. Another barrier emphasized during both focus groups was the lack of medical facilities, including clinics that specialize in mental health and sexually transmitted infections, and a lack of access to adequate treatment. The focus groups discussed how the lack of a trauma center within close distance contributes to poor health outcomes and a higher risk of death. One man stated, “Friend of mine got stabbed. Died there because of waiting too long.” Another participant stated, “My uncle was on dialysis and we had to travel very far for his treatment every time, and this was a big problem for my family.” Focus group participants mentioned that there are language barriers with physicians and that doctors do not share enough information with their patients. Doctors tell you what to do, but not how to do it. One woman said, “I was a size 16 about to go up to a size 18. The doctor kept telling me to lose weight every time I saw him but he never ever told me how to do it.” She told us later lost weight through Weight Watchers and the support of her friends and is now down to a size 12 Chicago Lawn–English Speaking Community Focus group characteristics One focus group of 13 English-‐speaking participants was conducted in the southwest community of Chicago Lawn (see Table C.7). This group was recruited to represent the African American population of Chicago Lawn. At the time of the 2010 census, 49% of Chicago Lawn residents were African American. All participants were recruited by a local community organizing group affiliated with the Greater Southwest Development Corporation. The participants were a multigenerational, primarily African American, female group of residents involved in community organizing with the host organization. Multiple pairs of mothers and daughters were present in the focus group. The participants were a health conscious group active in improving the health and well-‐being of their community. 106 Findings Table C.7 Demographic Characteristics for English-‐Speaking Chicago Lawn Focus Group Participants were asked to brainstorm a list of the most Total # of participants 13 important health issues affecting 18-‐20 – 8% them and their community. Mental 21-‐30 – 46% illness, STIs, AIDs, cancer, diabetes, 31-‐40 – 8% homelessness and obesity were some Age Group (years) 41-‐50 – 15% of the many health issues discussed. 51-‐60 – 23% The focus group had a difficult time 61-‐70+ 0% differentiating between health issues Resident of Yes – 92% and health barriers, so their answers community area? No –8% included some of both categories. Female – 92% Participants voted for conditions Gender Male – 8% mentioned earlier. However, the Non-‐Hispanic Black – 69% process took over 20 minutes to Mexican – 8% narrow down the top three. One Race/Ethnicity Other Latino – 8% participant repeatedly interrupted Other (Belizean) –15% the discussion by stating “lack of outreach and education” even after Public – 54% the interviewer pointed out that Insurance Private – 15% those are barriers, not health issues No Insurance – 31% per se. The participants chose lack of Have a primary care Yes – 85% a medical card, mental illness and an doctor? No – 15% umbrella category, i.e. “Unhealthy If yes, have visited Living/Lifestyles” as the top three their primary care Yes – 82% health issues affecting the Chicago doctor within the last No – 9% Lawn community (See Table C8). For year? No Response – 9% purposes of this CHNA, the only health issue clearly identified was mental health and it will be discussed below. Many general health barriers identified by the group were repeated throughout the discussion and will also be outlined. Table C.8 Important Health Issues Affecting the Chicago Lawn Community as Identified by Participants All Issues Obesity Lack of medical card Malnutrition Diabetes Pollution/Germs Cancer Pneumonia Hypertension Kidney Failure STIs Dental AIDS Allergies Arthritis, osteoporosis Out of pocket birth control Lack of vision/hearing tests Teen parents costs Substance abuse Mental illness Heart disease Homelessness Neglect of Children Alzheimer’s disease 107 Most Important (No. of Votes) Lack of medical card (8) Mental Illness (4) Umbrella category (6) “Unhealthy living/lifestyles” Mental Health When asked what were the causes of mental health issues, the group listed lack of testing and screening in schools, educators not knowing the signs of mental illness, public ignorance of mental health issues, lack of resources, genetics and drug use (both illegal and prescription). When asked about barriers to improving mental health, the group suggested lack of treatment, lack of skilled providers and a lack of resources (see Table C.9). Table C.9 Poor Mental Health Causes and Barriers as Identified By Chicago Lawn Focus Group Causes Lack of testing and screening in schools Educators not aware of the signs Ignorance of mental health issues Lack of resources, social support, and parenting skills Stress Genetics Drug use, both illegal and prescription Barriers Lack of treatment Lack of skilled medical providers Lack of resources Weak Parenting The participants gave several suggestions of what hospitals and health care providers can do to improve the mental health of Chicago Lawn residents. A hospital, including HCH, should offer more mental health services and not have a high staff turnover. One participant noted that “only gunshot victims are taken care of, not people seeking mental health services. Even if the gunshot was treated, no mental health services are offered.” HCH must conduct outreach using hospital staff, provide education, have more nurses and social workers, place educational materials in the emergency room, and be a mental health resource for schools. Without prompting from the interviewer, much of the discussion about hospital-‐
led interventions suggested by the participants were aimed at children and schools. One participant shared a story about how her son was diagnosed with ADHD, but that it was not recognized by the school, which just wanted to have him fail his classes. Weak parenting was discussed as a barrier because “parents need to know more about mental health issues” and “become advocates for their children. “ Barriers to Improving the Health of Chicago Lawn Residents As stated above, much of the discussion was focused on barriers to community health versus actual health issues. The group discussed the lack of a medical card and an umbrella category of “Unhealthy Living/Lifestyles”, which included barriers to healthy eating. In terms of lacking a medical card, participants stated that restrictions were too tight due to the requirement of having children. One participant asked, “What about single people?” Another participant said that her brother lost Medicaid at age 50 and would have to wait until age 65 to get Medicare. They suggested that more educational materials should be available about Medicaid in different languages along with more places to sign up, because there are people who qualify and may not even know they are eligible. More free clinics were suggested as a solution to not having a medical card. In terms of unhealthy living/lifestyles, the discussion included the lack of healthy food access and education, fear of exercise, and apathy of community members in Chicago Lawn. One older participant described her difficulty in trying to implement a healthy eating program at a school because the principal would not work with her. This participant also used to work for a healthy living program 108 offered by HCH and stated she would like to see it start up again. Participants felt that patients were left “high and dry” after being diagnosed with such conditions as diabetes, heart disease and AIDs due to the lack of follow up by HCH. Additionally, another younger participant stated that hospitals could inform the public about healthy eating, but “the public needs to take action on their own behalf.” She also stated there should be personal responsibility when it comes to one’s health and “people need to come to their appointments on time and be patient.” Community Recommended Solutions: How HCH Can Improve Community Health As described above, the focus group had many suggestions for how HCH can help improve the health of Chicago Lawn residents. Many were focused on the hospital working with schools to educate children, families, and educators about issues such as mental health and healthy eating habits. The older participants wished for former services to return, such as the healthy living program, follow-‐up calls after diagnosis and pediatric services. The focus on school-‐based interventions may be due to the fact that the group was family oriented, with many three generation families present (grandmother, daughter and young grandchildren). The lack of pediatric services at HCH was mentioned quite often due to the family nature of the group, with participants stating that their children have to be sent out of the community to hospitals such as Mount Sinai in order to be treated. In terms of follow up, a participant shared a story about how a neighbor broke her hip and was so happy to receive a follow up call from HCH to see how she was doing. For the focus group members, these follow up calls are now rare to nonexistent. To improve as a hospital, the participants suggested that HCH should have more bilingual staff, less staff turnover, be more polite, and dress more professionally. In addition, the hospital should serve as a health education resource and be a community partner in combating the health issues plaguing Chicago Lawn. Chicago Lawn–Spanish Speaking Community Focus group characteristics One focus group of 13 Spanish-‐speaking participants was conducted in the southwest community of Chicago Lawn (see Table C.10). This group was recruited to represent the Hispanic population of the community. At the time of the 2010 census, Hispanic/Latinos compromised 45% of the population of Chicago Lawn. All participants were recruited by a local community organizing group affiliated with the Greater Southwest Development Center. The group was conducted entirely in Spanish, with all the participants identifying as Mexican. The participants were mostly uninsured women over the age of 40. Only one participant was male. 109 Table C.10 Demographic Characteristics for Spanish-‐
Speaking Chicago Lawn Focus Group Total # of participants Age Group (years) Resident of community area? Gender Race/Ethnicity (one category) Insurance Have a primary care doctor? Findings 13 18-‐20 – 0% 21-‐30 – 0% 31-‐40 – 15% 41-‐50 – 38% 51-‐60 – 15% 61-‐70+ 31% Yes –62% No –31% No Response–8% Female – 92% Male – 8% Mexican – 100% Public – 23% Private – 0% No Insurance – 77% Yes – 77% No – 15% No Response – 8% If yes, have visited their primary care doctor within Yes – 70% the last year? No – 30% Participants were asked to brainstorm a list of the most important health issues affecting them and their community. Diabetes, poor heart health (high cholesterol/high triglycerides), cancer, obesity, high blood pressure and depression were mentioned by the group, among other issues. The participants were then asked to vote for their top three health issues facing adults; each participant was given three votes. Diabetes, poor heart health (high cholesterol/high triglycerides) and cancer were selected (See Table C.11). The discussion about cancer was limited due to time constraints. Therefore, only findings on diabetes and poor heart health will be described. Table C.11 Health Issues Affecting the Chicago Lawn Community as Identified by Focus Group All Issues Flu Allergies Diabetes ADD/ADHD High blood pressure Kidney problems Cancer Liver problems High cholesterol, triglycerides Heart attacks Obesity Alcoholism Depression Drugs Accidents (e.g. falling in home) Epilepsy Multiple sclerosis Sexually transmitted infections 110 Most Important (No. of Votes) Diabetes (10) High cholesterol/high triglycerides (9) Cancer (6) Obesity (5) High blood pressure (5) Depression (4) Dental problems (2) Heart attacks (1) Multiple sclerosis (1) Sexually transmitted Infections (1) Diabetes Being overweight, lack of exercise, poor nutrition, lack of health information, high cholesterol, high blood pressure, thyroid problems and genetics were identified as causes of diabetes by the participants. When asked about the barriers to decreasing the incidence of diabetes in their communities, the residents listed lack of education, lack of money to buy healthy foods, apathy, language barriers, and people not making a decision to live a healthy life (See Table C.12). Table C.12 Diabetes Causes and Barriers as Identified By Chicago Lawn Focus Group Causes Being overweight Lack of exercise Poor nutrition High cholesterol High blood pressure Thyroid problems Genetics Lack of health Information Barriers Lack of education Lack of money to buy healthy food Language barriers: no bilingual health workers Apathy Not deciding as an individual to be healthier The participants gave several suggestions of what hospitals and health care providers can do to improve both the treatment and prevention of diabetes in the Chicago Lawn community. The participants suggested that hospitals could provide more information on nutrition and portion sizes. Additionally, they recommended interventions that target the entire family and not just the member with diabetes. One female participant stated that, “The whole family needs to be educated because if I am the only one educated and I cook a healthy meal, maybe the rest of the family will not eat it.” Another participant suggested that children should be taught healthy eating habits in school. Poor Heart Health The second most important health issue facing the Chicago Lawn community, as identified by the focus group participants, is poor heart health. In particular, the participants wanted to discuss high cholesterol/high triglycerides. When asked about the causes of poor heart health in their community, participants repeated some of the same causes as diabetes, such as poor nutrition and lack of exercise. Additionally, they also discussed beverage-‐related causes such as excessive alcohol consumption, not drinking enough water and drinking too much juice and soda. When asked about barriers, they also identified the lack of education and people not making a decision to live a healthy life as barriers to improving heart health (See Table C. 13). In particular, one female participant made her argument for taking personal responsibility to improve heart health by stating that “if you buy a whole pack of tortillas and eat the whole pack, whose fault is it? Yours!” Others suggested letting people know they can make better food choices, with another participant using the example of switching to soy chorizo and her family “didn’t even know the difference.” 111 Table C.13. Poor Heart Health Causes and Barriers as Identified by Chicago Lawn Focus Group Causes Barriers Poor nutrition (too much saturated fat) Lack of education Lack of exercise Mistrust of food packaging nutrient-‐poor food and red meat) Excessive alcohol consumption Refusal to change Not drinking enough water Not deciding as an individual to be healthier Drinking too much juice and soda 1
All quotes translated to English from Spanish. The participants gave several suggestions of what hospitals and health care providers can do to improve heart health that were also mentioned in the diabetes discussion. They asked for health care providers and hospitals to educate people about heart health and proper nutrition. Additionally, the participants wanted exercise classes, more medical services and an increase in the number of bilingual staff. They also suggested that hospitals should not overmedicate. The participants wanted the hospital and health care providers to provide incentives/motives for improving heart health. One participant said that community members “don’t know what services the hospital has to offer” because area hospitals do a bad job informing the public about available health services. Community Recommended Solutions: How HCH Can Improve Community Health From both discussions on diabetes and poor heart health, the community members agreed that nutritional education on the individual and family level is needed in order to improve the health of Chicago Lawn residents. Personal responsibility for one’s own lifestyle choices was stressed during both discussions. However, both groups wanted improvements on the hospital level in health education, providing nutrition classes and hiring more bilingual staff. A hospital such as HCH, which is located in the Chicago Lawn community area, would benefit from these suggestions and in turn help community members with health issues. Besides having a lack of bilingual staff and no pediatric services, improving customer service at HCH was another suggestion made by the focus group members after two participants shared poor experiences at HCH. One participant shared how she had to wait three hours at HCH with chest pains and was never seen. She left HCH and was immediately taken in at St. Anthony’s ED. Another participant also shared an unpleasant emergency department experience, where the EMTs expressed disbelief in her level of pain and her friend had to lift her into the ambulance. When she got to the ED, she had to wait a very long time and her friend had to translate because none of the staff spoke Spanish. As stated above, half of the Chicago Lawn community residents are Hispanic/Latino. Training staff in proper customer service practices and Investing in bilingual staff would improve customer service issues at HCH. 112

Holy Cross Hospital - Chicago

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