Community Health Needs Assessment

Transcription

2013
Community Health Needs Assessment
Kaiser Foundation Hospital – LOS ANGELES
License #930000077
To provide feedback about this
Community Health Needs Assessment, email [email protected].
Authors
The Center for Nonprofit Management
Maura J. Harrington, Ph.D., MBA
Jessica Vallejo
Brianna Freiheit
Heather Tunis
Malka Fenyvesi
Gigi Nang
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Acknowledgements
The 2013 Community Health Needs Assessment East Metro West Collaborative, composed of Kaiser
Foundation Hospital–Los Angeles (KFH-LA), Kaiser Foundation Hospital–Baldwin Park (KFH-BP),
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA), and Citrus Valley Health Partners (nonKaiser Foundation Hospital), worked in partnership to conduct this needs assessment. The leads at KFHLos Angeles, Catherine Gaughen, Director of Public Affairs and Brand Communications, and Mario
Ceballos, Community Benefit Manager, would like to thank the following for their participation and
assistance.
211 Los Angeles County
A Window Between Worlds
AIDS Project Los Angeles
Alexandria House
Alliance for Housing and Healing
Alzheimer’s Association, California
Southland Chapter
American Heart Association
Angelus Plaza
Ascencia
Asian Pacific Health Care Venture
Aviva Family and Children’s Services
Bienvenidos Children’s Center, Inc.
Boys and Girls Club of Hollywood
Boys and Girls Club of Pasadena
California Children’s Medical Services
CASA of Los Angeles
Center for Oral Health
Center for the Pacific Asian Family
Children’s Hospital Los Angeles
Chinatown Service Center
CoachArt
Coalition for Humane Immigrant Rights of
Los Angeles
Community Clinic Association of Los
Angeles County
Community Health Alliance of Pasadena
Community Health Councils, Inc.
CONTRA-TIEMPO
Covenant House California—Los Angeles
Didi Hirsh Mental Health Services
Early Identification and Intervention Collaborative for Los Angeles County
East Los Angeles Women’s Center
Eisner Pediatric and Family Medical Center
El Centro del Pueblo
Esperanza Community Housing Corporation
(Promotoras)
Familia Unida Living with Multiple Sclerosis
Filipino American Service Group Inc. (FASGI)
Gay Lesbian Elder Housing
Hamburger Home, dba Aviva Family and Children’s Services
Hathaway-Sycamores Child and Family Services
Healthy City
HEAR Center
Heart of Los Angeles Youth, Inc. (HOLA)
Hollywood Community Housing Corporation
Hollywood Sunset Free Clinic
Hollywood Wilshire YMCA
JWCH Institute, Inc.
Kids’ Community Clinic of Burbank
Korean American Family Service Center
Korean Health Education Information & Research
Center
LA Conservation Corps
LACER After-School Programs
Latino Diabetes Association
LAUSD/Student Health and Human Services
Living Advantage
Los Angeles Child Guidance Clinic
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Los Angeles County Department of Health
Services
Los Angeles County Department of
Mental Health (DMH)
Los Angeles County Department of Public
Health, Maternal, Child and Adolescent Health Programs
Los Angeles County Emergency Medical
Services (EMS)
Los Angeles Neighborhood Land Trust
Los Angeles Unified School District
(LAUSD)
Los Angeles Youth Network
Maternal and Child Health Access
P F Bresee Foundation
Pacific Clinics
Planned Parenthood Los Angeles
PROTOTYPES Centers for Innovation in
Health, Mental Health and Social
Services
Proyecto Pastoral at Dolores Mission
Socrates Opportunity Scholarship Foundation
SOS Mentor Shape Up
St. Anne’s
St. Francis Medical Center
Saint John’s Well Child and Family Center, Inc.
St. Vincent Medical Center
The Harmony Project
The Laurel Foundation
The Village Family Services
The Wall-Las Memorias Project
UMMA (University Muslim Medical Association)
Community Clinic
University of Southern California (USC) and USC
School of Dentistry
USC Troy Camp
VIP Community Mental Health Center, Inc.
Worksite Wellness LA
YMCA—Weingart East Los Angeles
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Table of Contents
Authors ........................................................................................................................................................ ii
Acknowledgements .................................................................................................................................... iii
Table of Contents ........................................................................................................................................ v
I.
Executive Summary ........................................................................................................................ 1
a.
b.
II.
Introduction/Background .............................................................................................................. 14
a.
b.
c.
d.
III.
The Center for Nonprofit Management Team .................................................................. 36
East Metro West Collaborative ......................................................................................... 36
East .................................................................................................................................... 36
Metro ................................................................................................................................. 37
West .................................................................................................................................. 38
Process and Methods Used to Conduct the CHNA ...................................................................... 39
a.
b.
c.
VI.
Kaiser Permanente’s definition of community served by hospital facility ....................... 18
Description and map of community served by KFH-Los Angeles ................................... 18
History............................................................................................................................... 18
Service Area ...................................................................................................................... 18
Demographic Profile ......................................................................................................... 22
Chronic diseases in the KFH-LA service area .................................................................. 29
Who Was Involved In The Assessment ........................................................................................ 36
a.
b.
V.
Purpose of the community health needs assessment report .............................................. 14
About Kaiser Permanente ................................................................................................. 14
About Kaiser Permanente community benefit .................................................................. 15
Kaiser Permanente’s approach to the community health needs assessment ..................... 15
About the new federal requirements ................................................................................. 15
SB 697 and California’s history with past assessments .................................................... 15
Kaiser Permanente’s CHNA framework and process ....................................................... 16
Community Served ....................................................................................................................... 18
a.
b.
IV.
Health needs ........................................................................................................................ 3
Drivers............................................................................................................................... 12
Secondary data .................................................................................................................. 39
Community input .............................................................................................................. 41
Data limitations and information gaps .............................................................................. 44
Identification and Prioritization of Community’s Health Needs .................................................. 45
a.
b.
c.
Identifying community health needs ................................................................................. 45
Process and criteria used for prioritization of the health needs ........................................ 47
Community Forums .......................................................................................................... 48
Description of prioritized community health needs .......................................................... 51
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VII.
Community Assets and Resources Available to Respond to the Identified Health Needs of the
Community ................................................................................................................................... 61
a.
b.
Health Care Facilities ........................................................................................................ 61
Hospitals ........................................................................................................................... 61
Community Clinics ........................................................................................................... 62
Dental Care ....................................................................................................................... 63
Mental Health.................................................................................................................... 63
Other Community Resources ............................................................................................ 64
School Districts ................................................................................................................. 64
Community Organizations & Public Agencies ................................................................. 64
Appendix A: Glossary............................................................................................................................... 70
Appendix B: KFH-LA Health Needs Profiles .......................................................................................... 76
Health Need Profile: Mental Health ............................................................................................. 77
Health Need Profile: Obesity/Overweight .................................................................................... 82
Health Need Profile: Oral Health .................................................................................................. 87
Health Need Profile: Diabetes ...................................................................................................... 91
Health Need Profile: Disability..................................................................................................... 96
Health Need Profile: Cardiovascular Disease ............................................................................. 100
Health Need Profile: Hypertension ............................................................................................. 104
Health Need Profile: Cholesterol ................................................................................................ 107
Health Need Profile: Alcohol and Substance Abuse .................................................................. 110
Health Need Profile: Intentional Injury ...................................................................................... 114
Health Need Profile: Cancer ....................................................................................................... 117
Health Need Profile: Breast Cancer ............................................................................................ 120
Health Need Profile: Alzheimer’s Disease ................................................................................. 123
Health Need Profile: Asthma ...................................................................................................... 126
Health Need Profile: Cervical Cancer......................................................................................... 129
Health Need Profile: Hepatitis C ................................................................................................ 132
Health Need Profile: HIV/AIDS ................................................................................................. 135
Health Need Profile: Colorectal Cancer ..................................................................................... 140
Health Need Profile: Unintentional Injury.................................................................................. 144
Health Need Profile: Arthritis ..................................................................................................... 147
Health Need Profile: Allergies .................................................................................................... 150
Health Need Profile: Infant Mortality ......................................................................................... 153
Appendix C: KFH-LA Scorecard ........................................................................................................... 156
Appendix D: Data Collection Tools and Instruments ............................................................................. 165
Appendix E: Tier Results ........................................................................................................................ 192
Appendix F: Focus Group Summary for KFH-LA ................................................................................. 195
Health Needs and Drivers ........................................................................................................... 196
Health-Related Trends in the Community .................................................................................. 197
Sub-Populations Most Affected by These General Health Needs .............................................. 198
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Barriers to Access ....................................................................................................................... 199
Health Care Utilization ............................................................................................................... 201
How Hospitals Can Address the Health Service Needs of This Community ............................. 202
Appendix G: Stakeholder Interviews Summary for KFH-LA ................................................................ 204
Health Trends and Drivers Impacting Communities .................................................................. 205
Health-Related Trends in the Community .................................................................................. 207
Barriers to Access ....................................................................................................................... 209
Most Severely Impacted Sub-Populations .................................................................................. 209
Health Care Utilization ............................................................................................................... 211
Ideas for Collaboration and Cooperation among Service Providers ........................................... 211
Appendix H: Data Sources...................................................................................................................... 216
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I. Executive Summary
The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, included the
requirement, under Section 501(r), that nonprofit hospital organizations must conduct a
Community Health Needs Assessment (CHNA) at least once every three years to maintain taxexempt status under section 501(c)(3) of the Internal Revenue Service Code. As part of the
CHNA, each hospital is required to collect input from designated individuals in the community,
including public health experts as well as members, representatives or leaders of low-income,
minority, and medically underserved populations and individuals with chronic conditions.
Though the CHNA process is a new national mandate within the ACA, nonprofit hospitals in
California have been required to conduct a CHNA every three years following passage of
California Senate Bill 697 (SB697) in 1994.
Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in its
communities and to guide the development of Community Benefit plans. The adoption of ACA
legislation has provided an opportunity to revisit the needs assessment and strategic planning
processes with an eye toward enhanced compliance and transparency and leveraging emerging
technologies. The CHNA process undertaken in 2013 and described in this report was conducted
in compliance with these new federal requirements.
The new legislation guiding the CHNA for nonprofit hospitals requires a greater emphasis on
structured and standardized methodologies in terms of how community needs are identified and
prioritized. The assessment had to balance a strict focus on methodology with the individual
needs of local hospitals and the desire to have an inclusive process, engaging a range of stakeholders and consideration of the diverse needs of the communities served. A glossary of terms
used throughout this report is included in Appendix A.
For the 2013 CHNA, three Kaiser Foundation Hospitals and one non-Kaiser Foundation hospital
in Los Angeles, West Los Angeles and the San Gabriel Valley formed a collaborative to work
with the Center for Nonprofit Management evaluation consulting team in conducting the CHNA.
Known as the East Metro West Collaborative, the four hospitals include: Kaiser Foundation
Hospital–Baldwin Park (KFH-BP) Kaiser Foundation Hospital–Los Angeles (KFH-LA), Kaiser
Foundation Hospital–West Los Angeles (KFH-WLA) and Citrus Valley Health Partners. This
CHNA report was produced for and in collaboration with Kaiser Foundation Hospital-Los
Angeles.
During the initial phase of the CHNA process, community input was collected during seven
focus groups and 19 interviews with key stakeholders selected with the assistance of the KFHLA Community Benefit Manager and recommendations from other key informants, and included
health care professionals, government officials, social service providers, community residents,
leaders and other relevant community representatives with knowledge of the KFH-LA service
area. The interviews were conducted primarily via telephone for approximately 30 to 45 minutes
each; the conversations were confidential and interviewers adhered to standard ethical research
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guidelines. Focus group sessions were 60 to 90 minutes each. As with the interviews, the focus
group topics also were designed to collect representative information about health care utilization, preventive and primary care, health insurance, access and barriers to care, emergency room
use, chronic disease management and other community issues. Concurrently, secondary data
were collected and compared to relevant benchmarks including Healthy People 2020, Los Angeles County or California when possible. The data were also collected at smaller geographies,
when possible, to allow for more in-depth analysis and identification of community health issues.
In addition, previous CHNAs were reviewed to identify trends and ensure that previously identified needs were not overlooked. Primary and secondary data were compiled into a scorecard
presenting health needs and health drivers with highlighted comparisons to the available data
benchmarks. The scorecard was designed to allow for a comprehensive analysis across all data
sources and for use during the prioritization phase of the CHNA process.
After primary and secondary data were analyzed, a process was created in collaboration with the
local medical center’s Community Benefit Manager and the Kaiser Permanente Regional Office
to analyze the identified needs into three levels or tiers, based on the amount of data indicating a
need. The first step involved designing a method for sorting the extensive list of health issues
and drivers identified through the primary and secondary sources described above. The method
developed by the team sorted the identified needs into three levels or tiers, based on the amount
of data indicating a need. The first and most inclusive tier included any need or driver identified
as performing poorly against a set benchmark in secondary data or mentioned at least once in
primary data collection. The second tier included those issues identified as poorly performing
against a set benchmark or mentioned multiple times in primary data collection. The third and
most exclusive tier included those issues identified as poorly performing against a set benchmark
that also received multiple mentions in primary data collection.
After application of the rating method, tier two was deemed as the most appropriate identifier of
a potential prioritized health need (and/or driver) as these criteria provided a stringent yet inclusive approach that would allow for a comprehensive list of 22 health needs to be brought forth
for community input in the prioritization process. A summary of the data related to these identified health needs is included in Appendix B: KFH-LA Health Needs Profiles with summary
detail in Appendix C: KFH-LA Scorecard.
A modified Simplex Method was used to implement the prioritization process, consisting of two
facilitated group sessions engaging participants in the first phase of community input and new
participants in a discussion of the data (as presented in the scorecards and accompanying health
need narratives) and the prioritization process. At the sessions, participants were provided with a
brief overview of the CHNA process, a list of identified needs in the scorecard format and the
brief narrative summary descriptions of the identified health needs described above. Then, in
smaller break-out groups, participants considered the scorecards and health needs summaries in
completing a prioritization grid exercise which was then shared with the larger group. (These
prioritization grids will also serve as supplemental information for the Implementation Strategy
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Phase.) Following this series of discussions, participants completed a brief questionnaire about
health needs, drivers and resources and ranked each health need according to several criteria
including severity, change over time, resources available to address the need or driver and
community readiness to support action on behalf of any health need or driver. After completing
the questionnaires, participants were each given ten (10) sticker dots and invited to place five
dots on any health needs and five dots on any health drivers that were listed in alphabetical order
on large flip chart paper posted around the meeting space. Participants could place the five dots
in each section (health needs and health drivers) in any manner they wished, and each dot
counted as one vote. Data gathered through the survey were analyzed and given an overall score,
ranging from 1 for least need to 12 for highest need. Health needs were also ranked by the criteria including severity, change over time and available resources to address the need.
The following list of 22 prioritized needs resulted from the above described process. Further
indicators and qualitative information about each need is included in Appendix B: KFH-LA
Health Needs Profiles. (See Appendix H for data source reference detail.)
a. Health needs
Data sources for data listed within the health summaries below came from the Kaiser Permanente
CHNA data platform. (see Appendix H for data source reference detail.)
1.
Mental Health
Among adults, mental disorders are common, with approximately one-quarter of adults being
diagnosable for one or more disorders. More than 90 percent of those who die by suicide suffer
from depression or other mental disorders, or a substance-abuse disorder (often in combination
with other mental disorders). In 2009, 14% of the KFH-LA reported poor mental health. In 2010,
suicide was the tenth leading cause of death among Americans. The mental health hospitalization
rate per 100,000 youth in the KFH-LA service area (328.9) is higher when compared to
California (256.4), and highest in SPA 6 (490.6), SPA 3 (343.5.), SPA 4 (340.0), and SPA 7
(292.0). Among adults, the mental health hospitalization rate per 100,000 persons is over double
(1,021.5) in the KFH-LA service area when compared with California (551.7). SPA 4 (2,750.0),
SPA 6 (642.2), SPA 2 (633.7), and SPA 3 (586.4) have higher mental health hospitalization rates
per 100,000 adults than California (551.7). The rate for individuals who needed help for mental,
emotional, alcohol or drug issues but did not receive treatment in the KFH-LA service area was
48.2% compared to a slightly lower rate of 47.3% in Los Angeles County and highest in SPA 6
(56.4%), SPA 4 (52.6%) and SPA 3 (52.2%). In KFH-LA service area, a higher percentage had
serious psychological distress (7.7%) and also in SPA 6 (14.8%), and SPA 4 (10.7%) when
compared to Los Angeles County (7.3%). Poor mental health was highest among Blacks
(19.3%), followed by Whites (17.8%), Latinos (13.0%), and Asians (6.5%). Stakeholders
highlighted mental health as impacting a broad spectrum of populations, including people under
the age of 30, low-income women, the homeless, African-Americans, elderly residents of
Chinatown, and undocumented individuals. Drivers associated with mental disorders include
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chronic diseases, a family history of mental illness, age, substance abuse, and life-event stresses.
Stakeholders identified multiple factors that contributed to poor mental health, including stress
caused by the economic downturn, unemployment, immigration status, abuse (emotional,
physical, and sexual), bullying, and increasing violence (caused by unemployment). Mental
health issues were identified by community stakeholders in nine out of 19 interviews and all
seven focus groups, and mental health was identified as a health need in the 2010 KFH-LA
Community Health Needs Assessment.
2.
Obesity/Overweight
Obesity has risen to epidemic levels in the United States and indicates an unhealthy lifestyle that
influences further health issues. Among U.S. adults age 20 years and older, 68 percent are overweight or obese. Obesity reduces life expectancy and increases the risk of coronary heart disease,
stroke, high blood pressure, diabetes, and a number of other chronic diseases. The portion of
youth who are obese is higher (33.4%) in the KFH-LA service area when compared to California
(29.8%) and 22.5% of adults in KFH-LA as compared to 21.2% in Los Angeles. Similarly,
slightly more youth are overweight in the KFH-LA service area (14.5%) when compared to
California (14.3%). Among adults, a larger percentage of obese individuals live in SPA 6
(30.5%) and SPA 7 (27.6%) when compared to the overall KFH-LA service area (22.5%). The
percentage of overweight adults is greater in KFH-LA (31.3%) than in Los Angeles County
(29.7%). Among adults, a large percentage live in SPA 6 (34.4%), SPA 7 (31.2%) and SPA 2
(32.5%) As well, more adult males (21.5%) in the KFH-LA service area are obese than females
(21.3%). Youth obesity is highest among Hispanics/Latinos (39.9%), African-Americans
(31.7%), and American Indian/Alaskan Native (29.8%). Stakeholders identified obesity as most
severely impacting Latinos, African-Americans, low-income individuals, and youth. Obesity is
associated with factors including poverty, inadequate fruit/vegetable consumption, breastfeeding,
and access to grocery stores, parks, and open space. Stakeholders attributed being obese and
overweight to a lack of access to green space, living in food deserts, a lack of access to healthy
foods such as fruit and vegetables, a lack of safety at parks, and lifestyle choices such as a lack
of physical activity. They also indicated that the link between obesity and diabetes and hypertension is a growing issue in the community. Obesity was identified strongly in focus groups (four
of out of seven) and interviews (nine out of 19) and was identified as a health need in the 2010
KFH-LA Community Health Needs Assessment.
3.
Oral Health
Oral health is essential to overall health and is relevant because engaging in preventive behaviors
decreases the likelihood of developing future health problems. In addition, oral diseases like
cavities and oral cancer cause pain and disability for many Americans. The KFH-LA service area
has an equivalent rate of adults with poor dental health when compared with the statewide rate of
11.6%. Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%) sub-populations lack dental
insurance at higher rates than other ethnic and racial groups living in the KFH-LA service area.
Also, Hispanic/Latino youth or children comprise the largest group of KFH-LA service area
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youth or children who are unable to afford dental care (8.3%), and who have gone without a
dental exam (49.3%). Stakeholders identified low-income individuals, the uninsured, the
homeless (specifically veterans), Latinos, and those living in Chinatown and Skid Row in
downtown Los Angeles as the most severely impacted by poor oral health. Health behaviors that
may lead to poor oral health include tobacco use, excessive alcohol use, and poor dietary
choices. Other factors associated with poor dental health include lower levels (or a lack) of academic education, having a disability, and experiencing other health conditions such as diabetes.
Barriers that prevent or limit a person’s use of preventive intervention and treatments include
limited access to and availability of dental services, a lack of awareness of the need, cost, and
fear of dental procedures. Oral health and dental care was identified by community stakeholders
in all seven focus groups and 11 out of 19 interviews, including an emphasis on new immigrants
who are particularly impacted. Oral health was not identified as a health need in the 2010 KFHLA Community Health Needs Assessment.
4.
Diabetes
Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading
cause of death. A diabetes diagnosis can indicate an unhealthy lifestyle, a risk factor for further
health issues, and is also linked to obesity. Diabetes prevalence is higher in KFH-LA (18.5%)
versus Los Angeles County (10.5%), highest in SPA 7 (23.3%), SPA 6 (23.1%), SPA 4 (17.1%),
SPA 3 (16.9%) and SPA 2 (12.3%). The diabetes hospitalization rate for adults in the KFH-LA
service area is higher (174.3) when compared to the Los Angeles County rate of 145.6 per
100,000 persons. The uncontrolled diabetes hospitalization rate per 100,000 adults is also higher
(17.7) when compared to Los Angeles County (9.5). Diabetes is more common among males
(8.5%) than females (7.1%). In addition, more males (1.1%) have been discharged from hospitals
for diabetes-related incidents than females (0.8%). Also, more African-Americans (1.6%) and
Hispanic/Latinos (1.0) experienced hospital discharges resulting from diabetes. Those between
the ages of 45 and 64 (1.5%) and 65 and over (1.0%) experienced the most diabetes-related
hospital incidents when compared to other age groups. Stakeholders noted that the elderly, adult
Chinatown residents, recent immigrants, the homeless, Latinos, and Latino residents of Skid
Row are particularly impacted by diabetes. Drivers associated with diabetes include being
overweight, high blood pressure, high cholesterol, high blood sugar (or glucose), physical
inactivity, smoking, unhealthy eating, age, race, gender, and having a family history of diabetes.
The lack of access to a usual source of care, medical insurance, and the availability of primary
care providers within a community are also contributing factors. Diabetes was identified as a
major health issue in six out of 19 interviews and six out of seven focus groups. Diabetes was
also identified as a health need in the 2010 KFH-LA Community Health Needs Assessment.
5.
Disability
Disability is an umbrella term for impairments, activity limitations, and participation restrictions.
Over a billion people globally are estimated to live with some form of disability, corresponding
to about 15% of the world population. In California, 5.7 million adults, or 23% of the adult
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population, have a disability. In addition, rates of disability are increasing, in part as a result of
aging populations and an increase in chronic health conditions. Stakeholders identified children
and the aging population as the most severely impacted. Youth with IEPs (Individualized
Education Plans) were also identified by stakeholders as a particularly impacted population.
People with disabilities typically have less access to health care services and often do not have
their health care needs met. They are also more likely to be physically inactive, be in poor
general health, smoke, be overweight or obese, have high blood pressure, experience
psychological distress, receive less social-emotional support, live in poverty, and have high
unemployment rates compared to people without disabilities. Disabilities, defined as
developmental delays and/or as behavior issues, were identified in three out of 19 interviews.
Disabilities were not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
6.
Cardiovascular Disease
Currently, more than one in three adults (81.1 million) lives with one or more types of
cardiovascular disease. Coronary heart disease is a leading cause of death in the United States
and results in serious illness and disability, a decreased quality of life, and hundreds of billions of
dollars in economic loss every year. The KFH-LA service area (379.7) has a higher heart disease
hospitalization rate per 100,000 persons when compared to Los Angeles County (367.1). As
well, the cardiovascular disease mortality rate per 10,000 adults was slightly higher in the KFHLA service area (15.7) when compared to Los Angeles County (15.6) in 2010. More specifically,
the cardiovascular disease mortality rates per 10,000 adults were highest in SPA 3 (21.1), SPA 2
(20.8), and SPA 4 (16.1). Similarly, SPA 2 (485.0), SPA 4 (404.4), and SPA 3 (371.5) had
higher heart disease–related hospitalizations rates per 100,000 persons compared to Los Angeles
County (367.1). Those most often diagnosed with heart disease in the KFH-LA service area
include the White (8.2%) and Hispanic/Latino (5.1%) populations. Cardiovascular disease is
linked to other negative health outcomes including strokes, heart attacks, and diabetes. The leading risk factors for heart disease are high blood pressure, high cholesterol, smoking, poor diet,
physical inactivity, and being overweight or obese. Heart disease/coronary disease was identified
as a major health issue in four of 19 interviews and four of seven focus groups. Cardiovascular
disease was also identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
7.
Hypertension
Hypertension, indicated by high blood pressure, affects one in three adults in the United States. If
left untreated, hypertension can lead to heart failure, blood vessel aneurysms, kidney failure,
heart attack, stroke, and vision changes or blindness. The percent of adults ever diagnosed with
high blood pressure is higher in the KFH-LA service area (27.4%) than in Los Angeles County
(25.5%). In SPA 3 (30.6%), SPA 4 (26.0%), and SPA 7 (26.0%), the percent of adults with high
blood pressure is also higher than in Los Angeles County (25.5%). Stakeholders identified the
uninsured, underinsured, low-income, Latinos, African-Americans, day laborers, and the home-
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less as the most severely impacted. Hypertension is associated with smoking, obesity, eating salt
and fat regularly, drinking excessively, physical inactivity, having had a stroke previously, high
cholesterol, and having heart or kidney disease. As well, those with a family history of hypertension or who are African-American are at an increased risk of having hypertension. Stakeholders
linked hypertension to diabetes, obesity, and stress. They also attributed its prevalence to the lack
of preventive care and people waiting until faced with an emergency to seek treatment. In addition, stakeholders indicated that the lack of access to care—including the high cost of treatment—and poor lifestyles choices also contribute to the prevalence of hypertension. Hypertension was identified as a health issue in three out of 19 interviews and three out of seven focus
groups. Hypertension was identified as a health need in the 2010 KFH-LA Community Health
Needs Assessment.
8.
Cholesterol
High blood cholesterol that builds up on the walls of the arteries can lead to heart disease (the
leading causes of death in the United States) and stroke. About one of every six adult Americans
has high blood cholesterol. The percent of adults who take medicine to lower cholesterol was
higher in SPA 3 (81.4%), and SPA 6 (78.3%) when compared to Los Angeles County (71.2%).
Stakeholders identified Latinos and the aging population as the most severely impacted. Some
health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for
developing high cholesterol. Age is a contributing factor; as people get older, cholesterol levels
rise. Diabetes can also lead to the development of high cholesterol. Some behaviors can lead to
high cholesterol, including a diet high in saturated fats, trans fatty acids (trans fats), dietary
cholesterol, or triglycerides. Also, being overweight and physically inactive can contribute to
high cholesterol. Having high cholesterol can also be hereditary. Cholesterol was identified in
one of 19 interviews and two of seven focus groups. Cholesterol was also identified as a health
need in the 2010 KFH-LA Community Health Needs Assessment.
9.
Alcohol and Substance Abuse
Heavy alcohol consumption is an important determinant of future health needs, including cirrhosis, cancers, and untreated mental and behavioral health needs. The effects of substance abuse
significantly contribute to costly social, physical, mental, and public health problems, including
teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse, motor vehicle crashes
(unintentional injuries), physical fights, crime, homicide, and suicide. The rate of alcohol- and
drug-induced mental disease hospitalization per 100,000 persons is over seven times higher
(838.2) in the KFH-LA service area when compared to Los Angeles County (109.1). The rate of
liquor store access in communities within the KFH-LA service area is high in ZIP Codes 90021
(303.7 per 100,000), and 91210 (914.6 per 100,000). Populations impacted by substance abuse
include youth, women, Latinos, African-Americans, and people with low- and middle-class
income levels. Stakeholders identified the homeless, children, the uninsured, youth in or
transitioning out of the foster care system, and low-income populations as the most severely
impacted sub-populations. Several biological, social, environmental, psychological, and genetic
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factors are associated with alcohol and substance abuse. These factors may include gender, race
and ethnicity, age, income level, educational attainment, and sexual orientation. Family, social
networks, and peer pressure are key influencers of substance abuse among adolescents. Alcoholism was identified as a major concern by four out of 19 interviews and during one out of seven
focus groups. Alcohol and substance abuse was not indicated as a major need in the 2010 KFHLA Community Health Needs Assessment.
10.
Intentional Injury
Intentional injury is defined as homicide or suicide and is a leading cause of premature death.
More than 180,000 people die from injuries each year, and approximately one in ten sustains a
nonfatal injury serious enough to be treated in a hospital emergency department. Beyond their
immediate health consequences, injuries and violence have a significant impact on the wellbeing of Americans by contributing to disability, poor mental health, high medical costs, and lost
productivity. The homicide rate for the KFH-LA service area is 6.8 per 100,000 persons, above
the statewide rate of 5.16. The KFH-LA service area homicide rate does not meet the Healthy
People 2020 goal of <=5.5. Notably high homicide rates are found in SPA 4 (9.2), SPA 6 (14.8),
and SPA 7 (10.8). Homicides rates per 100,000 persons in Los Angeles County are highest
among African-Americans (25.2). Stakeholders identified gay youth, adult men, and adult
women with children as particularly impacted populations. Intentional injury is associated with
several factors, including poverty, unemployment, educational level, heavy alcohol consumption,
violent crime, risk-taking behavior, and social and physical environments that are unsafe. Intentional injury was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
11.
Cancer in General
Cancer is the second leading cause of death in the United States, claiming the lives of more than
half a million Americans every year. The leading causes of cancer deaths among men in the
United States are lung cancer, prostate cancer (22.0), and colorectal cancer (19.1), whereas the
leading causes of cancer deaths among women are lung cancer (38.6), breast cancer (22.2), and
colorectal cancer (13.1). Stakeholders identified children and the homeless as the most severely
impacted populations within the KFH-LA service area. Cancer is associated with growing older,
obesity, tobacco use, heavy alcohol consumption, sunlight exposure, certain chemicals, some
viruses and bacteria, a family history of cancer, poor diet, lacking access to health care, and
being physically inactive. Cancer was identified as a health need in the 2010 KFH-LA
12.
Breast Cancer
In the United States, breast cancer is the most common non-skin cancer and the second leading
cause of cancer-related death in women. The annual incidence rate of breast cancer among
women is 117.9 per 100,000 in the KFH-LA service area and Los Angeles County, which is
lower than the statewide rate of 123.3 per 100,000. Sub-populations most impacted by breast
Page 8
cancer within the KFH-LA service area are African-Americans (122.9) and Whites (121.5).
Breast cancer was identified as a major health issue by community stakeholders in two out of 19
interviews. Risk factors for breast cancer include older age, certain inherited genetic alterations,
hormone therapy, having radiation therapy to the chest, heavy alcohol consumption, and obesity.
Getting exercise and maintaining a healthy weight may reduce the chance of getting breast cancer. Breast cancer is associated with overall cancer mortality and access to breast cancer screening, and was identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
13.
Alzheimer’s Disease
An estimated 5.4 million Americans have Alzheimer’s disease; it is the sixth-leading cause of
death in the U.S. The rate of mortality resulting from Alzheimer’s disease per 100,000 persons
was highest in SPA 2 (21.8) and SPA 3 (17.9) when compared to Los Angeles County. The
greatest risk factor for Alzheimer’s disease is advancing age. Other risk factors include a family
history of Alzheimer’s, genetic mutations, cardiovascular disease risk factors (e.g., physical
inactivity, high cholesterol, diabetes, smoking, and obesity) and traumatic brain injury. Alzheimer’s disease was identified as a major health need in three out of 19 interviews and in one
out of seven focus groups, but was not indicated as a major need in the 2010 KFH-LA Community Health Needs Assessment.
14.
Asthma
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of
children. Adults also may suffer from asthma, and the condition is considered hereditary. The
asthma hospitalization rate per 100,000 adults in the KFH-LA service area is higher (113.4)
when compared to the California average of 94.3. Asthma symptoms include wheezing,
breathlessness, chest tightness, and coughing. Some asthma triggers include tobacco smoke, dust
mites, outdoor air pollution, cockroach allergen, pet dander, mold, smoke, and certain infections
known to cause asthma such as the flu, colds, and respiratory viruses. Other contributing factors
include exercising, certain medication, bad weather, high humidity, cold/dry air, certain foods,
and fragrances. Adult hospitalizations for asthma are particularly high in SPA 6 at 169.8 per
100,000 and in SPA 7 at 134.8 per 100,000 and in SPA 4 at 107.4 per 100,000. Sub-populations
particularly impacted by asthma include low-income women, youth, and homeless individuals.
Asthma was mentioned as a major health issue in two out of seven focus groups and four out of
19 interviews. Asthma was also identified as a health need in the 2010 KFH-LA Community
Health Needs Assessment.
15.
Cervical Cancer
Cervical cancer is a disease in which cells in the cervix—the lower, narrow end of the uterus
connecting the vagina (the birth canal) to the upper part of the uterus—grow out of control. The
cervical cancer death rate in the KFH-LA service area is particularly high at 6.5 individuals per
100,000, more than double the Los Angeles County rate of 3 per 100,000. The highest rates of
Page 9
cervical cancer mortality were in SPA 2 (11.5), SPA 3 (7.2) when compared to the overall KFHLA service area (6.5). Factors associated with cervical cancer are a common virus called the
human papillomavirus (HPV), smoking, having HIV or other conditions that cause the body’s
immune system to weaken, using birth control pills for an extended period of time (five or more
years), and having given birth to three or more children. In the KFH-LA service area, subpopulations most severely impacted are Hispanic/Latina (13.2) and White (10.3) women, based
on cervical cancer–related hospital discharge rates. According to community stakeholders, lowincome women, elderly residents of Chinatown, and the homeless are especially impacted by
cervical cancer, which was identified as a health need in the 2010 KFH-LA Community Health
Needs Assessment.
16.
Hepatitis C
Hepatitis C is a liver disease that results from infection with the Hepatitis C virus, the most common viral hepatitis in the United States. The prevalence rate for Hepatitis C in the KFH-LA service area is slightly higher in SPA 4 (0.2) when compared to Los Angeles County (0.1). Hepatitis
C is most likely to impact current and past injection-drug users; recipients of donated blood,
blood products, and organs; people who receive dialysis; people who receive body piercings or
tattoos with non-sterile instruments; health care workers; HIV-infected persons; children born to
Hepatitis C–infected mothers; people having sexual relations with a Hepatitis C–infected person;
and individuals sharing personal care items with someone infected with Hepatitis C. Hepatitis C
was identified as a major health issue in two out of 19 interviews and one of seven focus groups.
Hepatitis was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
17.
HIV/AIDS
More than 1.1 million people in the United States are living with HIV, and almost one in five
(18.1%) are unaware of their infection. HIV is a life-threatening communicable disease that
disproportionally affects minority communities and may indicate a prevalence of unsafe sex
practices. The KFH-LA service area has an HIV prevalence rate of 480.3 per 100,000 persons,
close to the Los Angeles County rate of 480.4; both rates are notably higher than the statewide
rate of 345.5. The HIV/AIDS hospitalization rate per 10,000 persons in the KFH-LA service area
is 3.2, higher than the Los Angeles County rate of 2.2. HIV/AIDS is associated with numerous
health factors, including poverty, heavy alcohol consumption, HIV screenings, and liquor store
access. HIV prevalence per 100,000 persons is higher in SPA 4 (46.0) and SPA 6 (16.0) than in
Los Angeles County (14.0) and the entire KFH-LA service area (15.5). Untreated HIV infection
is associated with many diseases, including cardiovascular disease, kidney disease, liver disease,
and cancer. Persons with HIV infections are disproportionately affected by viral hepatitis, and
those co-infected with HIV and viral hepatitis experience greater liver-related health problems
than those who do not have HIV infections. Sub-populations particularly impacted by HIV/AIDS
include males, African-Americans, Hispanics/Latinos, and homeless individuals. HIV/AIDS was
identified as a health concern in two out of 19 interviews and one out of seven focus groups.
Page 10
HIV/AIDS was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment, though HIV prevention was identified as a health need in that study.
18.
Colorectal Cancer
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading
cause of cancer-related death in the United States and is associated with overall cancer mortality,
heavy alcohol consumption, obesity, diabetes prevalence, and colon-cancer screening. It is
expected to cause about 50,830 deaths during 2013. The annual incidence rate of colorectal cancer in the KFH-LA service area is 45.1 individuals per 100,000, very close to the Los Angeles
County rate of 45.2. Both rates are above the national rate of 40.2 per 100,000. Colon cancer
mortality rates per 100,000 persons were highest in SPA 2 (14.7) and SPA 3 (14.5) when
compared to Los Angeles County (11.2). Sub-populations that are most severely impacted within
the KFH-LA service area are African-Americans (59.9) with the highest incidence rate, followed
by Whites (44.9) and Asians (44.0). Colorectal cancer was identified as a major health issue in
one out of 19 interviews, and was identified as a health need in the 2010 KFH-LA Community
19.
Unintentional Injury
Unintentional injuries include those resulting from motor vehicle crashes resulting in death and
pedestrians being killed in crashes. The rate of mortality by motor vehicle accident in the KFHLA service area is 7.2 per 100,000 persons, which is slightly higher than the Los Angeles County
rate of 7.1. The most at risk for unintentional injuries include older adults, children, and drivers
and pedestrians who are under the influence of alcohol and drugs. While sub-population data
were not available for the KFH-LA service area, motor vehicle mortality rates are highest among
the White (10.0) and Black (9.2) populations in Los Angeles County, and pedestrian motor vehicle mortality rates are highest among the White (2.0), Hispanic/Latino (2.0), and Black (1.85)
populations in Los Angeles County. Health factors associated with unintentional injury include
poverty, education, and heavy alcohol consumption. Unintentional injury was not identified as a
health need in the 2010 KFH-LA Community Health Needs Assessment.
20.
Arthritis
Arthritis affects one in five adults and continues to be the most common cause of physical
disability. Arthritis data available for the KFH-LA service area indicate the same rate as Los
Angeles County (17.4%), the highest rates were in SPA 3 (20.1%), SPA 7 (18.2%) and SPA 5
(17.7%), although it was identified as a major health concern in two out of 19 interviews and in
one out of seven focus groups. Factors associated with arthritis include being overweight or
obese, a lack of education around self-management strategies and techniques, and limited or no
physical activity. Interventions that can reduce arthritis pain and functional limitations include
increased physical activity, education about disease self-management, and weight loss among
overweight/obese adults. Stakeholders identified the aging and Asian populations as being the
Page 11
most impacted by arthritis. Arthritis was not indicated as a major need in the 2010 KFH-LA
21.
Allergies
Allergies are an overreaction of the immune system to substances that usually cause no reaction
in most individuals. These substances can trigger sneezing, wheezing, coughing, and itching.
Allergies have been linked to a variety of common and serious chronic respiratory illnesses (such
as sinusitis and asthma). Allergies among teens were higher in the KFH-LA service area (25.8%)
when compared to Los Angeles County (24.9%). The percent of teens with allergies was also
higher in SPA 3 (36.8%) when compared to Los Angeles County. Female teens were more often
diagnosed with allergies (27.3%) in the KFH-LA service area than males (20.6%). Allergies
were identified as a major health concern in three out of 19 interviews and in one out of seven
focus groups. Allergies were not indicated among major needs in the 2010 KFH-LA Community
22.
Infant Mortality
Infant mortality remains a concern in the United States, as each year approximately 25,000
infants die before their first birthday. Infant mortality is associated with rates of low birth weight;
6.9% of the infants born in the KFH-LA service area have a low birth weight, which is higher
than the state rate of 6.8%. More infants were born with very low birth weights in SPA 7 (1.5%)
when compared to Los Angeles County (1.3%). Factors that affect birth outcomes include smoking, substance abuse, poor nutrition, medical problems, and chronic illness. High rates of infant
mortality can indicate broader issues, such as access to health care, maternal and child health,
poverty, education rate, a lack of insurance, teen births, and a lack of prenatal care. Within the
KFH-LA service area, sub-populations with a high infant mortality rate per 1,000 live births
include African-Americans (11.5), Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3). Infant
mortality was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
b. Drivers
Drivers such as poverty and behaviors are very much linked and are often the root or cause of
many health problems. For this reason, drivers were put through the same rigorous process of
identification and prioritization as health needs. The following list includes the prioritized list of
drivers:
1.
Employment
2.
Income
3.
Health insurance
4.
Homelessness
5.
Alcohol and substance use
Page 12
6.
Health care access
7.
Dental care access
8.
Healthy eating
9.
Physical activity
10.
Transportation
11.
Family and social supports
12.
Awareness and education
13.
Cardiovascular disease management
14.
Education
15.
Safety
16.
Nutritional access
17.
Preventive care services
18.
Language barriers
19.
Cancer screenings
20.
Smoking
21.
Prenatal care
Page 13
II. Introduction/Background
a. Purpose of the community health needs assessment report
Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The
findings from this CHNA report will serve as a foundation for understanding the health needs
found in the community and will inform the Implementation Strategy for Kaiser Foundation
Hospitals as part of their Community Benefit planning. This report complies with federal tax law
requirements set forth in Internal Revenue Service Code section 501(r) requiring hospital
facilities owned and operated by an organization described in Code section 501(c)(3) to conduct
a community health needs assessment at least once every three years. The required written plan
of Implementation Strategy is set forth in a separate written document. At the time that hospitals
within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal
Revenue Service provided the most recent guidance on how to conduct a CHNA. This written
plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52
regarding conducting the CHNA for the hospital facility.
b. About Kaiser Permanente
Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945,
Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit
health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go
to a doctor. Since our beginnings, we have been committed to helping shape the future of health
care. Among the innovations Kaiser Permanente has brought to U.S. health care are:
Prepaid health plans, which spread the cost to make it more affordable
A focus on preventing illness and disease as much as on caring for the sick
An organized coordinated system that puts as many services as possible under one roof—all
connected by an electronic medical record
Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation
Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups.
Today we serve more than 9 million members in nine states and the District of Columbia. Our
mission is to provide high-quality, affordable health care services and to improve the health of
our members and the communities we serve.
Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered
and supported by industry-leading technology advances and tools for health promotion, disease
prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser
Permanente is dedicated to care innovations, clinical research, health education, and the support
of community health.
Page 14
c. About Kaiser Permanente community benefit
For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we
serve. We believe good health is a fundamental right shared by all and we recognize that good
health extends beyond the doctor’s office and the hospital. It begins with healthy environments:
fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks,
and safe playgrounds. These are the vital signs of healthy communities. Good health for the
entire community, which we call Total Health, requires equity and social and economic wellbeing.
Like our approach to medicine, our work in the community takes a prevention-focused, evidence-based approach. We go beyond traditional corporate philanthropy or grantmaking to pair
financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—health access, healthy communities, and
health knowledge—to address critical health issues in our communities.
For many years, we’ve worked side-by-side with other organizations to address serious public
health issues such as obesity, access to care, and violence. And we’ve conducted Community
Health Needs Assessments to better understand each community’s unique needs and resources.
The CHNA process informs our community investments and helps us develop strategies aimed at
making long-term, sustainable change—and it allows us to deepen the strong relationships we
have with other organizations that are working to improve community health.
d. Kaiser Permanente’s approach to the community health needs
assessment
About the new federal requirements
Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that
hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is
conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires
nonprofit hospitals to: collect and take into account input from public health experts as well as
community leaders and representatives of high need populations—this includes minority groups,
low-income individuals, medically underserved populations, and those with chronic conditions;
identify and prioritize community health needs; document a separate CHNA for each individual
hospital; and make the CHNA report widely available to the public. In addition, each nonprofit
hospital must adopt an Implementation Strategy to address the identified community health
needs and submit a copy of the Implementation Strategy along with the organization’s annual
Form 990.
SB 697 and California’s history with past assessments
For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our
allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill
Page 15
697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA
every three years. As part of SB 697 hospitals are also required to annually submit a summary of
their Community Benefit contributions, particularly those activities undertaken to address the
community needs that arose during the CHNA. Kaiser Permanente has designed a process that
will continue to comply with SB 697 and that also meets the new federal CHNA requirements.
Kaiser Permanente’s CHNA framework and process
Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked
together to establish an approach for implementing the new federally legislated CHNA. From
data collection and analysis to the identification of prioritized needs and the development of an
implementation strategy, the intent was to develop a rigorous process that would yield meaningful results.
Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and
the Center for Applied Research and Environmental Studies (CARES), developed a web-based
CHNA data platform to facilitate implementation of the CHNA process. More information about
the CHNA platform can be found at http://www.CHNA.org/kp/. Because data collection, review,
and interpretation are the foundation of the CHNA process, each CHNA includes a review of
secondary and primary data.
Page 16
To ensure a minimum level of consistency across the organization, Kaiser Permanente included a
list of roughly 100 indicators in the data platform that, when looked at together, help illustrate
the health of a community. California data sources were used whenever possible. When California data sources weren’t available, national data sources were used. Once a user explores the data
available, the data platform has the ability to generate a report that can be used to guide primary
data collection and inform the identification and prioritization of health needs.
In addition to reviewing the secondary data available through the CHNA data platform, and in
some cases other local sources, each Kaiser Permanente hospital collected primary data through
key informant interviews, focus groups, and surveys. They asked local public health experts,
community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources.
Each hospital/collaborative used a set of criteria to determine what constituted a health need in
their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized
community health. The process and the outcome of the CHNA are described in this report.
In conjunction with this report, Kaiser Permanente will examine the list of prioritized health
needs and develop an implementation strategy for those health needs it will address. These
strategies will build on Kaiser Permanente’s assets and resources, as well as evidence-based
strategies, wherever possible. The Implementation Strategy will be filed with the Internal
Revenue Service using Form 990 Schedule H.
Page 17
III. Community Served
a. Kaiser Permanente’s definition of community served by hospital
facility
Kaiser Permanente defines the community served by a hospital as those individuals residing
within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations.
b. Description and map of community served by KFH-Los Angeles
History
Kaiser Permanente evolved from industrial health care programs for construction, shipyard and
steel mill workers during World War II. Its founders were Sidney Garfield, M.D., and Henry J.
Kaiser, who became partners in advancing the concept of pre-paid health care.
Kaiser Foundation Hospital–Los Angeles (KFH-LA) was established in 1953 as a medical clinic
to serve the members of the retail clerks union, Local 770. The KFH-LA Medical Center ensures
that underserved persons living in the overall service area receive coordinated high-quality
prevention and medical care services. KFH-LA provides primary and specialty health care services, in addition to health education, training, public health, and community services, and
ensures that underserved persons living in the overall service area receive coordinated highquality prevention and medical care services.
Service Area
The KFH-LA service area is presented below by city or community, ZIP Code and Service
Planning Area.
KFH-LA Service Area
Service
Planning
Area (SPA)*
SPA 3
SPA 3
SPA 3
SPA 3
City/Community
Alhambra
Altadena
Arcadia
Bradbury
Burbank
ZIP Code
91801, 91802, 91803, 91804, 91841, 91896, 91899
91001, 91002, 91003
91006, 91007, 91066, 91077
91008, 91010
91502, 91503, 91504, 91505, 91506, 91507, 91508, 91510,
91520, 91521, 91522, 91523, 91501, 91526
Duarte
91008, 91009, 91010
91201, 91202, 91203, 91204, 91205, 91206, 91207, 91208,
91209, 91221, 91222, 91225, 91226, 91210
SPA 3
91010
SPA 3
Glendale
Irwindale
Page 18
SPA 2
SPA 2
City/Community
La Canada Flintridge,
Flintridge, La Canada
La Crescenta, Glendale
Los Angeles
Los Angeles
Los Angeles
Los Angeles
Monrovia
Monterey Park
Montrose
Mount Wilson
Pasadena
San Gabriel
San Marino
Sierra Madre
South Pasadena
Temple City
Verdugo City
ZIP Code
91011, 91012
91214, 91224
90004, 90005, 90006, 90010, 90012, 90013, 90014,90015,
90017, 90020, 90021, 90023, 90026, 90027, 90028, 90029,
90030,90031, 90032, 90033, 90038, 90039, 90041, 90042,
90046, 90050, 90051, 90053, 90054, 90055, 90057, 90065,
90068, 90070, 90071, 90072, 90074, 90075, 90076, 90078,
90079, 90081, 90084, 90086, 90087, 90088, 90090, 90093,
90097, 90099, 90102
90060
90011, 90037, 90082, 90089
90007, 90022, 90063, 90096
91016, 91017
91754, 91756
91020, 91021
91023
91050, 91051, 91101, 91102, 91103, 91104, 91105, 91106,
91107, 91108, 91109, 91110, 91114, 91115, 91116, 91117,
91118, 91121, 91122, 91123, 91124, 91125, 91126, 91127,
91128, 91129, 91131, 91175, 91182, 91184, 91185, 91186,
91187, 91188, 91189, 91191, 91199
91775
91108, 91118
91024, 91025
91030, 91031
91780
91046
Service
Planning
Area (SPA)*
SPA 3
SPA 2
SPA 4
SPA 5
SPA 6
SPA 7
SPA 3
SPA 3
SPA 2
SPA 3
SPA 3
SPA 3
SPA 3
SPA 3
SPA 3
SPA 3
SPA 2
Note: One ZIP Code, 90060, is listed as part of the service area and located in SPA 5, but no data are available as the population
is 0.
*Los Angeles County Department of Public Health Service Planning Area (SPA): SPA 2–San Fernando Valley; SPA 3–San
Gabriel and Pomona Valleys; SPA 4–Metro Los Angeles; SPA 5–West; SPA 6–South; SPA 7–East
Page 19
KFH-LA Service Area Map
Page 20
KFH-LA Service Area Map with SPA Boundaries
Page 21
A description of the community served by KFH-LA is provided in the following data tables and
narrative. Depending upon the available data sources for each variable, KFH-LA information are
presented as representing the entirety of the service areas when possible or by Service Planning
Areas 2, 3, 4, 6 and 7, portions of which are served by KFH-LA. Data are organized in the
following sections: Demographic Profile, Access to Health Care and Chronic Disease Prevalence
and Incidence.
Demographic Profile
Population
In 2010, the total population within the KFH-LA service was 2,246,237, making up 22.9% of the
population in Los Angeles County (U.S. Census, 2010, U.S. Census Bureau Decennial Census,
2010). Nearly half (43.1%) of the population in the KFH-LA service area resides in SPA 4. Over
a quarter (27.9%) resides in SPA 3 (U.S. Census Bureau Decennial Census, 2010). The service
area is nearly 280 square miles and has a high population density of 7,842.97 persons per square
mile, compared to 235.19 in California.
Total Population, 2010
SPA 2–San Fernando Valley
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
Number
318,585
627,111
967,299
166,168
167,074
2,246,237
9,818,605
Percent
14.2%
27.9%
43.1%
7.4%
7.4%
22.9%
100.0%
Source: U.S. Census Bureau Decennial Census, 2010
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in KFH-LA service area)
Gender
In the KFH-LA service area, the population is nearly evenly divided, with males being 49.6%
and females 50.4%. In Los Angeles County, the situation is similar—49.7% are males and 50.3%
are females (U.S. Census Bureau Decennial Census, 2010).
Gender, 2010
Male
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
#
152,085
275,153
504,540
81,566
82,419
1,095,763
4,839,654
Female
%
47.9%
48.0%
51.7%
50.3%
50.2%
49.6%
49.7%
#
165,218
298,056
471,802
80,498
81,724
1,097,298
18,736,126
%
52.1%
52.0%
48.3%
49.7%
49.8%
50.4%
50.3%
Page 22
Age
By age, over a quarter of those in the KFH-LA service area (30.2%) are between the ages of 25
and 44 years compared to 29.6% in Los Angeles County (U.S. Census Bureau Decennial Census,
2010). Another quarter (23.3%) is between the ages of 0 and 17 years, slightly less than in Los
Angeles County (24.5%) (U.S. Census Bureau Decennial Census, 2010).
Age, 2010
85 years and over
75-84 years
65-74 years
60-64 years
55-59 years
50-54 years
45-49 years
1.5%
1.5%
KFH-LA
3.5%
3.6%
LA County
5.6%
5.8%
4.3%
4.6%
5.4%
5.7%
6.3%
6.7%
6.9%
7.2%
14.5%
14.6%
15.7%
35-44 years
25-34 years
21-24 yrars
18-20 years
15-17 years
10-14 years
5-9 years
0-4 years
0.0%
15.0%
6.8%
6.1%
5.1%
4.8%
4.5%
4.5%
6.7%
6.9%
6.4%
6.5%
5.7%
6.6%
5.0%
10.0%
15.0%
20.0%
Race and Ethnicity
In the KFH-LA service area, nearly half (47.7%) of the population are Hispanic or Latino consistent with the population in Los Angeles County (47.7%) (U.S. Census Bureau Decennial Census,
2010). The second largest ethnic group is Caucasian, making up over a quarter (27.8%) of the
population in the KFH-LA service area—consistent with the demographics of Los Angeles
County (27.8%) (U.S. Census Bureau Decennial Census, 2010).
Page 23
Race and Ethnicity, 2010
Hispanic/Latino
Caucasian
African-American
American Indian/Alaskan Native
Asian/Pacific Islander
Other
Two or more races
KFH-LA service area Los Angeles County
(1,081,351) 47.7%
(4,687,889) 47.7%
(594,062) 27.8%
(2,728,321) 27.8%
(104,295) 8.3%
(815,086) 8.3%
(3,615) 0.2%
(18,886) 0.2%
(83,394) 13.7%
(1,348,135) 13.5%
(5,439) 0.3%
(25,367)0.3%
(40,503) 2.0%
(194,921) 2.0%
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in the KFH-LA service area)
Language Spoken At Home
A larger portion of the population in KFH-LA service area speaks Spanish in the home (42.2%)
when compared to Los Angeles County (39.7%). Another third speak English only (33.0%) at
home, a smaller portion when compared to Los Angeles County (42.9%). A slightly larger portion of the population speaks an Asian/Pacific Island language (16.0%) at home when compared
to Los Angeles County (10.9%).
Language Spoken At Home, 2013
Language
English Only
Asian/Pacific Island
Indo-European
Spanish
Other
Total
KFH-LA service area
#
%
686,597
33.0%
332,388
16.0%
168,168
8.1%
877,633
42.2%
16,364
0.8%
2,081,150
100.0%
Los Angeles County
#
%
3,998,524
42.9%
1,016,304
10.9%
494,736
5.3%
3,699,298
39.7%
102,818
1.1%
9,311,680
100.0%
Data source: Nielson Claritas, 2013
Source geography: ZIP code
Educational Attainment
Over a third (32.5%) of the population in the KFH-LA service has less than a ninth-grade education, slightly higher than Los Angeles County (26.9%) (U.S. Census Bureau Decennial Census,
2010). Another 13.7% in the KFH-LA service area have a ninth- to twelfth-grade education, but
did not obtain a high school diploma—slightly higher when compared to Los Angeles County
(12.7%) (U.S. Census Bureau Decennial Census, 2010).
Page 24
Less than
9th Grade
SPA 2–San Fernando
Valley
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
Educational Attainment, 2010
9th to 12th High School
Some
Grade
Graduate
College
(no
(includes
(no
diploma) Equivalency) degree)
Associate’s
Degree
Bachelor’s
Degree
Graduate or
Professional
Degree
20.1%
9.0%
15.7%
19.3%
6.6%
20.6%
8.7%
20.5%
28.5%
54.3%
39.0%
32.5%
26.9%
9.5%
12.9%
21.2%
16.1%
13.7%
12.7%
14.4%
16.6%
13.5%
18.5%
15.7%
16.9%
16.2%
16.1%
7.2%
16.7%
15.1%
18.0%
5.7%
4.4%
1.5%
2.4%
4.1%
5.0%
20.2%
15.6%
2.2%
5.5%
12.8%
13.6%
13.6%
5.9%
0.0%
1.8%
7.5%
7.0%
Source: U.S. Census Bureau Public Use Microdata Statistics (PUMS), 2010
Household Income
In 2009, nearly a quarter of residents in the KFH-LA service area (24.1%) had an annual household income between $20,001 and $40,000. A slightly smaller proportion of Los Angeles County
(23.8%) reported the same income range (California Health Interview Survey, 2009). Nearly a
quarter (22.8%) have an annual household income of $20,000 or below, which is slightly less
when compared to Los Angeles County (25.1%) (California Health Interview Survey, 2009).
Annual Household Income, 2009
12.1%
12.2%
<=$135,000
$100,001-…
$90,001-$100,000
$80,001-$90,000
$70,001-$80,000
$60,001-$70,000
4.2%
3.2% 4.6%
3.5%
4.4%
5.0%
4.6%
4.7%
6.5%
7.1%
KFH-LA
LA County
6.8%
6.8%
7.2%
7.4%
$50,001-$60,000
$40,001-$50,000
10.9%
10.4%
$30,001-$40,000
$20,001-$30,000
6.3%
$15,001-$20,000
$5,001-$10,000
0.0%
9.0%
7.4%
7.4%
$10,001-$15,000
>=$5,000
13.2%
13.4%
3.5%
3.5%
5.6%
5.2%
5.0%
10.0%
Source: California Health Interview Survey, 2009
Source Geography: SPA (data not available at the ZIP Code level)
Page 25
15.0%
Poverty
Poverty thresholds are used for calculating all official poverty population statistics and are
updated by the Census Bureau on an annual basis. For 2010, the federal poverty level for one
person was $10,830 and $22,050 for a family of four.
Poverty level in the KFH-LA service area is more severe when compared to Los Angeles
County. The population in the KFH-LA service area living below 100% of the Federal Poverty
Level (FPL) is larger (19.5%) when compared to Los Angeles County (15.7%). Similarly, more
of the population in the KFH-LA service area is living below 200% of the FPL (42.8%) than in
Los Angeles County (37.6%). In addition, more children in the KFH-LA service area (28.1%)
live below 100% of the FPL when compared to Los Angeles County (22.4%).
Poverty Level, 2010
KFH-LA
service area
Population living below 100% of the
Federal Poverty Level
Population living below 200% of the
Federal Poverty Level
Children (0-17 years) living below 100% of
the Federal Poverty Level
Los Angeles
County
19.5%
15.7%
42.8%
37.6%
28.1%
22.4%
Data source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates
Source geography: Tract
Homeless Persons
In the KFH-LA service area most of the homeless population is within Service Planning Area
(SPA) 4 (31.1%) and SPA 6 (23.5%). Another 12.8% of the homeless population in KFH-LA
service area is within SPA 7, SPA 2 (12.7%), and SPA 3 (10.5%).
Homeless Persons, 2011
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA service area
Los Angeles County
Number
4,727
3,918
11,571
8,735
4,759
37,222
45,422
Percent
12.7%
10.5%
31.1%
23.5%
12.8%
100%
Data source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless County Report, 2011
Source geography: SPA
Homeless Persons by Age
Most of the homeless population in the KFH-LA service area are between the ages of 25 and 54
(57.1%), similar to Los Angeles County (57.4%). Another 13.6% are between the ages of 55 and
61 in the KFH-LA service area and another 13.1% are under the age of 18, followed by those 62
Page 26
years of age and older (8.2%). Finally, 8.0% of the population in the KFH-LA service area is
under the age of 18.
Homeless Persons by Age, 2011
Age group
Under 18
18-24
25-54
55-61
62 and Older
KFH-LA
service area
13.1%
8.0%
57.1%
13.6%
8.2%
Los Angeles County
13.4%
7.9%
57.4%
14.1%
7.2%
Data source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless County Report, 2011
Source geography: SPA
Employment Status
In 2012, the U.S. Bureau of Labor Statistics reported an unemployment rate of 10.2 in the KFHLA service area, slightly higher when compared to Los Angeles County (9.7). In 2010, the
percent of the unemployed population averaged 5.74% in the KFH-LA service area, the same as
Los Angeles County (American Community Survey Five-Year Estimates, 2010).
Over a third of the population in the KFH-LA service area (34.9%) were not in the labor force, a
rate that is slightly higher when compared to Los Angeles County (34.8%) (American Community Survey Five-Year Estimates, 2010). However, over half of the population (59.3%) in the
KFH-LA service area was employed—slightly less when compared to Los Angeles County
(59.5%).
Employment Status, 2010
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Employed
61.8%
58.6%
60.7%
53.4%
57.8%
59.3%
59.5%
58.5%
Unemployed
5.5%
5.0%
6.6%
6.9%
5.5%
5.7%
5.7%
5.8%
Armed
Forces
0.0%
0.0%
0.0%
0.0%
0.1%
0.2%
0.1%
0.5%
Not in Labor
Force1
32.7%
36.4%
32.7%
39.7%
36.6%
34.9%
34.8%
35.3%
Source: American Community Survey Five-Year Estimates, 2006–2010
1
All people 16 years and over who are not classified as members of the labor force, including students, retired
workers, seasonal workers, individuals taking care of home or family, etc.
Medical Insurance
Nearly a quarter (23.4%) of the population in the KFH-LA service area does not have medical
insurance compared to 17.0% of the population in Los Angeles County (California Health Interview Survey, 2009). SPA 6 (28.4%) and SPA 7 (26.9) have the largest portion of the population
Page 27
without medical insurance (California Health Interview Survey, 2009). Another 16.3% of the
population in the KFH-LA service area does not have a usual source of care, and 22.6% in SPA 6
(22.3%) are without a usual source of care (California Health Interview Survey, 2009). In the
KFH-LA service area, 603,677 individuals are eligible for and enrolled in Medi-Cal, with the
largest portion living in SPA 4 (295,097).
Medical Insurance Status, 2009 and 2011
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Percent of population (0 to 64 years)
without insurance1
13.8%
13.6%
24.6%
28.4%
26.9%
23.4%
17.0%
14.5%
Percent of population (0 to 64) who do
not have a usual
source of care1
16.0%
15.0%
19.3%
22.3%
17.2%
16.3%
16.2%
14.2%
Number of
individuals who are
eligible for and
enrolled in MediCal
63,760
86,146
295,097
91,214
67,460
603,677
2,444,850
7,790,828
Source: California Health Interview Survey (CHIS), 2009 1, California Department of Health Care Services (DHCS), 2011
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in the KFH-LA service area)
Population Without a Usual Source of Care
A slightly larger portion of the population in the KFH-LA service area (16.3%) do not have a
usual source of care (a place they go when they get sick such as primary doctor) when compared
to Los Angeles County (16.2%). A larger portion without a usual source of care is within SPA 6
(22.3%), SPA 4 (19.3%), and SPA 7 (17.2%).
Population Without a Usual Source of Care, 2009
Percent
16.0%
15.0%
19.3%
22.3%
17.2%
16.3%
16.2%
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA service area
Los Angeles County
Data source: California Health Interview Survey (CHIS), 2009
Source geographic: SPA
Health Professional Shortage Areas
Nearly half (48.2%, n=66) of facilities in Los Angeles County (n=137) that are designated as
health professional shortage areas (HPSAs) are within the KFH-LA service area. In addition, less
than half (44.6%) of the population live in a HPSA. Please refer to Section VII of the
Page 28
Community Health Needs Assessment report for a comprehensive list of community assets
including facilities designated as health professional shortage areas.
Health Professional Shortage Areas, 2012
Facilities designated as health professional shortage areas
Population living in a health professional shortage area
KFH-LA
service area
66
44.6%
Los Angeles
County
137
53.2%
Data source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, 2012
Source geographic: HPSA
Federally Qualified Health Centers (FQHC) in Service Area
Over a third (41.6%, n=42) of Federally Qualified Health Centers in Los Angeles County
(n=101) are located in the KFH-LA service area. Please refer to Section VII of the Community
Health Needs Assessment report for a comprehensive list of community assets including
federally qualified health centers.
Federally Qualified Health Center (FQHC), 2011
Number of federally qualified health centers
KFH-LA
service area
42
Los Angeles
County
101
Data source: U.S. Health Resources and Services Administration, Centers for Medicare & Medicaid Services, Provider of
Service File, 2011
Source geographic: Address
Chronic diseases in the KFH-LA service area
Diabetes Prevalence and Hospitalizations
Diabetes is a very common disease in the general population. In 2009, 18.5% of the population
45 years old and above in the KFH-LA service area were diagnosed with diabetes, compared to
only 10.5% in Los Angeles County. SPA 6 and SPA 7 experienced the largest portion of
individuals diagnosed with diabetes (23.1% and 23.3%, respectively). The rate of hospitalizations resulting from uncontrolled diabetes per 100,000 population in the KFH-LA service area is
nearly double (17.7) the California statewide rate (9.5). The rates of hospitalization for uncontrolled diabetes are higher in SPA 6 (23.9), SPA 4 (21.6), and SPA 7 (19.9) when compared to
the KFH-LA service area overall (17.7).
Diabetes Prevalence, 2009 and 2010
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
Percent Diagnosed
with Diabetes (Adults
age 45 and over)1
12.3%
16.9%
17.1%
23.1%
23.3%
18.5%
10.5%
Number of Hospitalizations for Uncontrolled
Diabetes2
27
66
179
39
37
348
No data
Page 29
Rate of Hospitalizations
for Uncontrolled Diabetes (per 100,000 pop.)2
10.1
13.1
21.6
23.9
19.9
17.7
No data
California
8.5%
3,581
9.5
Source: California Health Interview Survey (CHIS), 2009 1, Office of Statewide Health and Planning and Development (OSHPD), 20102
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in KFH-LA service area)2
Adults in the KFH-LA service area experience more diabetes-related hospitalizations per
100,000 population (174.3) in comparison with youth (24.0). Specifically, SPA 6 (227.9), SPA 7
(207.2), and SPA 4 (186.2) experienced high rates of diabetes-related hospitalizations when
compared to the overall KFH-LA service area (174.3).
Diabetes Hospitalizations, 2010
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Number of
Hospitalizations
(adults)
320
770
1,742
368
348
3,548
No data
54,244
Number of
Hospitalizations
(Youth under
18)
7
14
43
10
10
84
No data
3,247
Hospitalization Hospitalization
Rate for
Rate for Youth
Adults (per
(per 100,000
100,000 pop.)
pop.)
130.6
23.4
119.6
20.6
186.2
31.7
227.9
21.3
207.2
23.2
174.3
24.0
No data
No data
145.6
34.9
Source: Office of Statewide Health Planning and Development (OSHPD), 2010
The prevalence of cardiovascular disease (also referred to as heart disease) in the KFH-LA service area is slightly higher (5.8%) when compared to Los Angeles County (5.7%). The rate of
heart disease–related hospitalizations per 100,000 persons is higher in the KFH-LA service
(379.7) when compared to California (367.1). Specifically, in SPA 2 (485.0) and SPA 4 (404.4),
rates were higher when compared to the overall rate for the KFH-LA service area (379.7). Over
half (64.4%) of the population diagnosed with heart disease receives heart disease management
services, similar to those in the Los Angeles County (65.5%). In SPA 3 (75.1%) three quarters of
the population are receiving heart disease management services. However, the rate of heart disease mortality per 10,000 is slightly higher (15.7) when compared to California (15.6). SPA 3
(21.1), SPA 2 (20.8), and SPA 4 (16.1) have higher rates than the KFH-LA service area overall
(15.7).
Page 30
Cardiovascular Disease Prevalence, 2009 and 2010
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Hospitalization
Rate (per 100,000
pop.)1
485.0
371.5
404.4
286.1
351.6
379.7
No data
367.1
Percent Diagnosed with Heart
Disease2
5.1%
5.4%
6.2%
5.0%
6.2%
5.8%
5.7%
5.9%
Health Professional Provided
Heart Disease
Management
Plan2
65.7%
75.1%
44.7%
51.7%
76.1%
64.4%
65.5%
70.9%
Death Rate for
Heart Disease
(per 10,000 pop.)
20.8
21.1
16.1
9.7
10.7
15.7
No data
15.6
Source: Office of Statewide Health and Planning and Development (OSHPD), 2010 1, California Health Interview Survey (CHIS), 20092
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in KFH-LA service area)1, SPA data not available at
the ZIP Code level)2
Cervical Cancer
The percentage of women who received a Pap smear in the last three years and resided in the
KFH-LA service area (85.0%) did not meet the Healthy People 2020 benchmark of >=93%, and
was slightly higher when compared to Los Angeles County (84.4%). SPA 6 (88.3%), and SPA 7
(85.0%) had larger portions of women who received Pap smears in the last three years when
compared to the KFH-LA service area (85.0%). The morality rate for cervical cancer per
100,000 was double (6.5) in the KFH-LA service area when compared to Los Angeles County,
and did not meet the Healthy People 2020 benchmark of <=2.2. SPA 2 (11.5) and SPA 3 (7.2)
have much higher rates of cervical cancer mortalities when compared to the KFH-LA service
area overall (6.5).
Cervical Cancer, 2007 and 2008
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
HP 2020
Received Pap Smear in the
Last 3 Years2
83.7%
81.3%
84.6%
88.3%
85.0%
85.0%
84.4%
No data
>=93%
Death Rate (age-adjusted
per 100,000 pop.)1
11.5
7.2
5.2
4.4
4.2
6.5
3.0
2.3
<=2.2
Source: California Department of Public Health, Death Statistical Master File, 2008 1; Los Angeles County Department of Public Health,
Office of Health Assessment and Epidemiology, Los Angeles County Health Survey, 20072
Source Geography: SPA (data not available at the ZIP Code level)2, ZIP Code (each SPA aggregated to include only those ZIP Codes in
KFH-LA service area)1
** If <20 deaths, a reliable rate cannot be calculated.
Page 31
Colorectal Cancer
The portion of men over the age of 50 who had a sigmoidoscopy or colonoscopy was lower
(74.2%) in the KFH-LA service area when compared to Los Angeles County (75.7%), but higher
than the Healthy People 2020 benchmark >=70.5%. Similarly, the percentage of men over the
age of 50 who had the same tests done in the last five years was lower (64.9%) in the KFH-LA
service area when compared to Los Angeles County (65.5%) and did not meet the Healthy People 2020 benchmark >=70.5%. The mortality rate of colorectal cancer per 100,000 persons is
slightly lower in the KFH-LA service area overall (10.9) when compared to Los Angeles County
(11.2). The rate is also much higher in SPA 2 (14.7) and SPA 3 (14.5).
Colorectal Cancer Incidence, 2008 and 2009
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
HP 2020
Death Rate (ageadjusted per 100,000
pop.)1
14.7
14.5
9.7
7.7
7.9
10.9
11.2
11.1
n/a
Percent of Adults Ages
50 or Older Ever
Having a Sigmoidoscopy, Colonoscopy or
FOBT2
75.8%
76.9%
73.1%
67.1%
71.1%
74.2%
75.7%
78.0%
>=70.5%
Percent of Adults Ages
50 or Older Who Had a
Sigmoidoscopy or
Colonoscopy in the
Last 5 Years2
67.0%
67.4%
64.4%
57.9%
59.2%
64.9%
65.5%
68.1%
>=70.5%
Source: California Department of Public Health, Death Statistical Master File, 2008 1, California Health Interview Surveys, 20092
Source Geography: ZIP Code (each SPA aggregated to include only those ZIP Codes in KFH-LA service area)1, SPA data not available at
the ZIP Code level)2
Mental Health
Mental health-related hospitalization rates for per 100,000 persons in the KFH-LA service area is
nearly double (1,021.5) that of California (551.7). In SPA 4, the rate is twice that of the KFH-LA
service area overall (1,021.5). The rate of mental health–related hospitalizations per 100,000
youth under the age of 18 is higher for the KFH-LA service area (328.9) when compared to
California (256.4). In SPA 6 (490.6), SPA 3 (343.5), and SPA 4 (340.0), the rates are higher than
the KFH-LA service area overall (328.9).
Page 32
Mental Health Hospitalizations, 2010
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Hospitalizations
(adult)
2,011
3,312
6,786
1,379
696
14,184
No data
205,526
Hospitalizations
(youth under 18)
110
388
651
258
141
1,548
No data
28,836
Hospitalization
Rate (adult) per
100,000 pop.
633.7
586.4
2,750.0
642.2
495.3
1,021.5
No data
551.7
Hospitalization
Rate (youth
under 18) per
100,000 pop.
178.4
343.5
340.0
490.6
292.0
328.9
No data
256.4
The portion of the population in the KFH-LA service area that experienced the most alcohol- or
drug-induced mental disease hospitalizations reside in SPA 4 (51.0%). Another quarter lives in
SPA 3 (22.9%).
Alcohol/Drug Induced Mental Health Hospitalizations, 2010
Number
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
413
608
1,355
153
129
2,658
No data
40,651
Percent
15.5%
22.9%
51.0%
5.8%
4.9%
20.0%
No data
No data
On average, 7.7% of the population in the KFH-LA service area had serious psychological distress, and another 48.2% needed help for mental, emotional, or alcohol or drug issues but did not
receive assistance. Particularly in SPA 6 (56.4%), SPA 4 (52.6%), and SPA 3, over half of the
population did receive help when needed.
Page 33
Mental Health—Psychological Distress, 2009
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Likely had serious
psychological
distress in past year
#
%
82,000
5.3%
85,000
6.1%
101,000 10.7%
101,000 14.8%
55,000
5.5%
442,000
7.7%
541,000
7.3%
1,785,000
6.5%
Needed help for
Needed help for
mental/emotional/alcohol- mental/emotional/alcoholdrug issues but did not
drug issues and received
receive treatment
treatment
#
%
#
%
92,000
41.0%
133,000
59.0%
88,000
52.2%
81,000
47.8%
96,000
52.6%
87,000
47.4%
51,000
56.4%
39,000
43.6%
54,000
45.7%
64,000
54.3%
414,000
48.2%
451,000
51.8%
495,000
47.3%
550,000
52.7%
1,741,000
44.5%
2,173,000
55.5%
Source: California Health Interview Surveys, 2009
Obesity/Overweight
A third (31.3%) of the population in the KFH-LA service area is overweight, with a BMI or
Body Mass Index between 26 and 29. Another 22.5% are considered obese, with a BMI of 30
and above. SPA 6 (34.4%), and SPA 2 (32.5%) had larger portions of those who are overweight
when compared to the KFH-LA service area overall (31.3%). However, SPA 6 (30.5%) and SPA
7 (27.6%) had larger portions of the population designated as obese.
Obesity/Overweight, 2009
SPA 3–San Gabriel
SPA 4–Metro
SPA 6–South
SPA 7–East
KFH-LA Service Area
Los Angeles County
California
Percent Overweight (BMI 26-29)
32.5%
29.3%
29.2%
34.4%
31.2%
31.3%
29.7%
31.5%
Percent Obese (BMI >=30)
15.4%
18.1%
20.8%
30.5%
27.6%
22.5%
21.2%
21.1%
Source: California Health Interview Survey (CHIS), 2009
When compared to Los Angeles County, the same proportion of adults in the KFH-LA service
area are obese (21.4%); however, a larger portion of youth are obese in the KFH-LA service area
(33.4%) compared to Los Angeles County (29.8%). A larger portion of adults are overweight
(36.4%) in the KFH-LA service area when compared to Los Angeles County (26.4%). Similarly,
more youth are overweight in the KFH-LA service area (14.5%) when compared to Los Angeles
County (14.3%).
Page 34
Obesity/Overweight—Adults and Youth, 2010
KFH-LA Service Area
Los Angeles County
Percent of
adults who are
obese
21.4%
21.4%
Percent of
youth who are
obese
33.4%
29.8%
Percent of
adults who are
overweight
36.4%
26.4%
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010
Source Geography: County
Page 35
Percent of
youth who are
overweight
14.5%
14.3%
IV. Who Was Involved In The Assessment
a. The Center for Nonprofit Management Team
The Center for Nonprofit Management (CNM) Evaluation Consulting team conducted the 2013
Community Health Needs Assessment for KFH-LA one of three Kaiser Foundation Hospitals
and the Citrus Valley Medical Center, also known as the East Metro West Collaborative. CNM is
the leading management assistance organization in Southern California, providing training,
technical assistance, capacity-building resources and services, and customized counsel to the
nonprofit sector since 1979.
The principal members of the CNM evaluation team—Dr. Maura Harrington and Ms. Jessica
Vallejo—have extensive experience with SB 697 community health needs assessments and public health data. The team was involved in conducting the 2004, 2007, and 2010 CHNAs for the
Metro Hospital Collaborative (California Hospital Medical Center, Children’s Hospital Los
Angeles, Good Samaritan Hospital, Kaiser Foundation Hospital Los Angeles, QueensCare, and
St. Vincent Medical Center) and has participated in other CHNAs in the region. Dr. Harrington
has worked on projects with the Pasadena Public Health Department and California Wellness
Foundation and many other health-related projects. The CNM team has extensive experience
with a broad range of evaluation projects involving qualitative and quantitative data collection
and analysis and the preparation of reports and documentation appropriate for diverse audiences
and constituencies.
b. East Metro West Collaborative
The Collaborative includes the following partners:
Kaiser Foundation Hospital–Baldwin Park (KFH-BP)
Gloria R. Bañuelos, Community Benefit Manager
Kaiser Foundation Hospital–Los Angeles (KFH-LA)
Mario P. Ceballos, Community Benefit Manager
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA)
Celia A. Brugman, Community Benefit Manager
Citrus Valley Health Partners
Maria Peacock, Community Benefit Department
East
Kaiser Foundation Hospital–Baldwin Park
Kaiser Foundation Hospital–Baldwin Park (KFH-BP) is a 272 licensed-bed hospital offering
comprehensive services including primary care and specialty services. KFH-BP serves 246,000
members in the San Gabriel Valley through a network of more than 3,300 employees and 498
Page 36
physicians at its medical center campus, four outlying medical office buildings, a behavioral and
addiction medicine facility, and three retail Vision Essentials offices.
KFH-BP’s service area includes the Southern California communities of Azusa, Baldwin Park,
Covina, Diamond Bar, El Monte, Glendora, Hacienda Heights, Irwindale, Industry, La Puente,
Montebello, Rosemead, Rowland Heights, San Dimas, San Gabriel, South El Monte, Valinda,
Walnut, and West Covina.
Citrus Valley Health Partners
Citrus Valley Health Partners, through its three hospital campuses (Citrus Valley Medical Center—Inter-Community Campus in Covina; Citrus Valley Medical Center—Queen of the Valley
Campus in West Covina; and Foothill Presbyterian Hospital in Glendora) and hospice (Citrus
Valley Hospice in West Covina), serves a community of nearly one million people in the San
Gabriel Valley. Its mission is lived through the work of its 3,000+ staff members and nearly
1,000 physicians. Each hospital campus offers different areas of specialty, including cardiac care,
family-centered maternity services, a Level IIIB Newborn Intensive Care Unit (NICU), the
Geleris Family Cancer Center, a Robotic Surgery Program, a full range of rehabilitation services,
and an Outpatient Diabetes Education Program. Citrus Valley Hospice has an extensive home
care program as well as a 10-bed inpatient hospice facility. Associated with Hospice, Citrus
Valley Home Health provides physician-supervised nursing and rehabilitation care to individuals
recovering at home from accidents, surgery, or illness.
Metro
Kaiser Foundation Hospital–Los Angeles
The Kaiser Foundation Hospital–Los Angeles (KFH-LA) is Kaiser Permanente’s tertiary center
of excellence in Southern California. KFH-LA offers a wide range of specialty care services,
featuring 39 Centers of Excellence—including complex neurosurgery, pediatrics, comprehensive
cancer care—and has the largest cardiac surgery program in the western United States. KFH-LA
is also a medical learning institution where highly trained doctors mentor and teach new generations of physicians and caregivers. KFH-LA is home to The Center for Medical Education
(CME) which includes an extensive graduate medical education program with more than 250
interns, residents, and fellows in 22 different specialties and subspecialties. KFH-LA currently
hosts approximately 300 active medical research projects across a range of disciplines. More
than 750,000 patients visit KFH-LA a year. For more information, visit www.kp.org/losangeles.
The KFH-Los Angeles service area includes the communities of Alhambra, Altadena, Arcadia,
Burbank, Glendale, La Cãnada Flintridge, La Crescenta, Los Angeles (primarily SPA 4), Monrovia, Monterey Park, Montrose, Pasadena, San Gabriel, San Marino, Sierra Madre, South Pasadena, and West Hollywood (East). City of Los Angeles neighborhoods include Atwater Village,
Boyle Heights, Chinatown, City Terrace, Downtown Los Angeles, Eagle Rock, East Los Angeles, Echo Park, El Sereno, Glassell Park, Hancock Park, Highland Park, Hollywood, Hollywood
Hills, Laurel Canyon, Los Feliz, Montecito Heights, and Silverlake.
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West
Kaiser Foundation Hospital–West Los Angeles
Kaiser Foundation Hospital–West Los Angeles (KFH-WLA) is a 305 licensed-bed hospital
offering comprehensive services including primary care and specialty services. KFH-WLA
serves 189,013 members and has a staff of 2,916 employees and 517 physicians. Four outlying
medical offices, two retail Vision Service offices, and a Health Education Center expand KFHWLA services throughout the West Los Angeles service area—in Playa Vista, Culver Marina,
Inglewood, and South Los Angeles. KFH-WLA is home to six award-wining centers of expertise
that provide innovative treatments and surgical procedures.
The WLA Service Area includes the cities of Beverly Hills, Culver City, El Segundo, Inglewood,
Malibu, Santa Monica, West Hollywood, and the City of Los Angeles, including the communities of Baldwin Hills, Cheviot Hills, Crenshaw, Hyde Park, Jefferson Park, La Tijera, Leimert
Park, Mar Vista, Mid City, Miracle Mile, Ocean Park, Pacific Palisades, Palms, Playa Del Rey,
Rancho Park, Rimpau, University Park, Venice, Vermont Knolls, West Adams, Westchester,
Westwood, Wilshire, and unincorporated areas such as Ladera Heights, Lennox, Marina del Rey,
View Park, Westmont, and Windsor Hills, among others.
Page 38
V. Process and Methods Used to Conduct the CHNA
a. Secondary data
Secondary data were collected from a wide range of local, county and state sources to present
demographics, mortality, morbidity, health behaviors, clinical care, social and economic factors
and physical environment. These categories are based on the Mobilizing Action Toward
Community Health (MATCH) framework which illustrates the inter-relationships among the elements of health, and their relationship to each other: social and economic factors, health behaviors, clinical care, physical environmental, and health outcomes.
To promote consistency across the organization, Kaiser Permanente identified a minimum set of
required indicators for each of the data categories to be used by all Kaiser Permanente Regions
for the Community Health Needs Assessments. Kaiser Permanente partnered with the Center for
Applied Research and Environmental Systems (CARES) at the University of Missouri to develop
a web-based data platform to provide the common indicators across service areas. The secondary
data for this report was obtained from the Kaiser Permanente CHNA data platform from October
Page 39
2012 through February 2013. The data platform is undergoing continual enhancements and certain data indicators may have been updated since the data were obtained for this report. As such,
the most updated data may not be reflected in the tables, graphs, and/or maps provided in this
report. For the most recent data and/or additional health data indicators, please visit
CHNA.org/kp.
The Kaiser Permanente common indicator data were calculated to obtain unique service area
rates. In most cases, the service area values represent the aggregate of all data for geographies
(ZIP Codes, counties, tracts, etc.), which fall within the service area boundary. When one or
more geographic boundaries are not entirely encompassed by a service area, the measure is
aggregated proportionally. The options for weighting “small area estimations” are based upon
total area, total population, and demographic-group population. The specific methodology for
how service area rates are calculated for each indicator can be found on the CHNA.org/kp
website.
Additional data sets were accessed to supplement the minimum required data sets. These data
were selected from local sources that were not offered on the common indicators database. The
data sets were accessed electronically and the data for the KFH–LA service area were collected
and documented in data tables. The tables present the data indicator, the geographical area the
data represented, the data measurement (e.g. rate, number, percent), and the data source and year.
When data from supplemental sources were available by ZIP code, the data from the ZIP codes
of the service area were compiled for a medical service area indicator. For geographic comparisons across SPAs within the medical service area, if the source provided data by ZIP codes, then
ZIP codes were aggregated to calculate medical service area rates in respective SPAs; when the
data were not available by ZIP code, then the data for the entire SPA was utilized.
Secondary data for KFH-LA were downloaded from the Kaiser Permanente CHNA data platform
as well as from the supplementary resources, and were input into tables to be included in the
analysis. Data are presented based on the data source and geographic level of available data.
When possible, these data are presented in the context of larger geographies such as county or
state for comparison.
To allow for a comprehensive analysis across data sources, and to assist with the identification of
a health need, a matrix (Appendix C: KFH-LA Scorecard) was created listing all identified
secondary indicators and primary issues in one location. The matrix included medical service
area–level secondary data (averaged), primary data counts (number of times an issue was
mentioned) for both interviews and focus groups and sub-populations noted as most severely
impacted. The matrix also included benchmark data in the form of Healthy People 2020
(HP2020) benchmarks which are nationally recognized when the indicator matched the data on
hand. If, however, an appropriate HP2020 indicator was not available, then the most recent
county or state data source was used as a comparison.
Page 40
Each data indicator for the medical center area was first compared to the HP2020 benchmark if
available and then to the geographic level for benchmark data to assess whether the medical center area performance was better or worse than the benchmark. When more than one source (from
the primary or secondary data) identified an issue, the issue was designated as a health need or
driver.
Two additional steps of analysis were conducted. The first reviewed data in smaller relevant
geographies, repeating the process described above to identify areas in which needs were more
acute. In the second step, the previous Community Health Needs Assessment was reviewed to
identify trends and ensure that a previously identified need had not been overlooked.
b. Community input
Information and opinions were gathered directly from persons who represent the broad interests
of the community served by the Hospital. Between September and December 2012, the consultants convened seven focus groups and conducted nineteen telephone interviews with a broad
range of community stakeholders, including area residents. The purpose for the primary data
collection component of the Community Health Needs Assessment is to identify broad health
needs and key drivers, as well as assets and gaps in resources, through the perceptions and
knowledge of varied and multiple stakeholders.
Focus group and interview candidates were selected with the assistance of the KFH-LA Community Benefit Manager and recommendations from other key informants, and included representation from a range of health and social service providers and other community based organizations and agencies as well as community residents.
The interviews were conducted primarily via telephone for approximately 30 to 45 minutes each;
the conversations were confidential and interviewers adhered to standard ethical research guidelines. The interview protocol was designed to collect reliable and representative information
about health and other needs and challenges faced by the community, access and utilization of
health care services, and other relevant topics. (See Appendix D for data collection tools and
instruments used in primary data collection.)
Focus groups took place in a range of locations throughout the service area, with translation and
interpretation services provided when appropriate. Focus group sessions were 60 to 90 minutes
each. As with the interviews, the focus group topics also were designed to collect representative
information about health care utilization, preventive and primary care, health insurance, access
and barriers to care, emergency room use, chronic disease management and other community
issues. Participants included groups that the hospital identified as prioritized stakeholders for the
needs assessment including residents from major ethnic groups, geographic areas and service
providers in the service area. Ethnic groups represented included residents from African-American, Latino and Asian-Pacific Islander communities. Interpretation services were provided in
Spanish and Mandarin. A focus group of individuals representing the geography of downtown
Page 41
Los Angeles were engaged as were two focus groups that included representatives of community
agencies and service providers who interact with residents on issues related to health care.
The stakeholders engaged through the seven focus groups and nineteen interviews represent a
broad range of individuals from the community, including health care professionals, government
officials, social service providers, local residents, leaders, and other relevant community
representatives, as per the IRS requirement. The charts below demonstrate this broad diversity,
highlighting the expertise/perspective, key categories and geographies represented by the participants in interviews and focus groups. Please see Appendix F for a summary of the focus group
responses and Appendix G for a summary of the stakeholder interview responses.
Individuals with Special Knowledge of or Expertise in Public Health
Name
1.
Anderson,
Margot
Title
Affiliation
Description of Public
Health
Knowledge/Expertise
Business management,
camp management, serving
youth and families with
HIV/AIDS
FQHC, primary care,
mental health care for
homeless and dual-diagnosis, HIV services
Serving Asian Pacific
immigrant and Latino communities (family resource
center, clinics, workforce
development)
Date of
Consult
Type of
Consult
9/25/12
Interview
10/19/12
Interview
10/22/12
Interview
CEO
The Laurel
Foundation
2.
Ballesteros,
Al
CEO
JWCH Institute
(John Wesley
Community
Health)
3.
Blakeney,
Karen
Executive
Director
Chinatown
Service Center
4.
Bryan,
Cynthia
Vice President,
Human
Resources
Didi Hirsh Mental
Health Services
Human resource
management
10/2/12
Interview
5.
Coan, Carl
Executive
Director
Eisner Pediatric
and Family
Medical Center
Public health, human genetics, health care administration, and management
10/3/12
Interview
6.
Cox, Debra
Senior Director
Foundation
Relations
American Heart
Association
Health equity, research, and
funding
10/5/12
Interview
Maternal, child, and adolescent health
10/2/12
Interview
Domestic violence, sexual
assault, and HIV
10/19/12
Interview
Clinical management and
administration
10/3/12
Interview
7.
8.
9.
Donovan,
Kevin
Kappos,
Barbara
Mandel,
Susan,
Ph.D.
Executive
Director
Los Angeles
County Department of Public
Health, Maternal,
Child and Adolescent Health
Programs
East Los Angeles
Women’s Center
President, CEO
Pacific Clinics
Staff Analyst
Page 42
Name
10.
Marin,
Maribel
11.
Martinez,
Margie
Title
Los Angeles
Executive
Director
Affiliation
Description of Public
Health
Knowledge/Expertise
Date of
Consult
Type of
Consult
211
Information and referral
service serving LA County
10/15/12
Interview
CEO
Community
Health Alliance of
Pasadena
Public health
10/22/12
Interview
12.
Munoz,
Randy
Vice Chair
Latino Diabetes
Association
10/22/12
Interview
13.
Nathason,
Niel, DDS
Associate Dean
USC School of
Dentistry
9/12/12
Interview
14.
Rayfield,
Beth
Director of
Development
International labor union;
organizing, working conditions, and contractual rights
10/2/12
Interview
15.
Schiffer,
Wendy
MSPH
Director of
Planning and
Evaluation
Public health and health
services
10/3/12
Interview
Coalition for
Humane Immigrant Rights of
Los Angeles
California
Children’s Medical Services
Diabetes, preventive medicine, low-income, undocumented, and
un/underinsured
Low-income dental care
services including children,
youth, and adults, both in
mobile and clinical contexts. Primary populations
are low-income, disadvantaged and/or indigent.
Individuals Consulted from Federal, Tribal, Regional, State or Local Health Departments or Other Departments or
Agencies with Current Data or Other Relevant Information
Name
Title
1.
Chidester,
Cathy MSN
Director of
EMS
2.
Donovan,
Kevin
Staff Analyst
3.
Murata,
Dennis
Deputy
Director
Affiliation
Los Angeles
County Emergency Medical
Services (EMS)
Los Angeles
County Department of Public
Health– Maternal,
Child and Adolescent Health
Programs
Los Angeles
County Department of Mental
Health
Page 43
Date of
Consult
Type of
Consult
10/17/12
Interview
Local health department
10/2/12
Interview
Local health department
10/22/12
Interview
Type of Department
Coordinating emergency
services, including fire
department, hospitals, and
ambulance companies
Leaders, Representatives, or Members of Medically Underserved Persons, Low-Income Persons,
Minority Populations, and Populations With Chronic Disease Needs
Group Size
Description of
Leadership,
Representative,
or Member Role
Health care
providers
1.
6 participants
2.
6 participants
3.
10 participants
4.
4 participants
5.
6 participants
6.
16 participants
Social service
providers
7.
3 participants
Business and
education leaders
Promotoras
Residents and
clients
Residents and
clients
Residents and
clients
What Group(s) Do They Represent?
Health access, children, youth and families,
minority populations
Minority populations, underserved, dental
care, reproductive care, outreach
Latino, minority, and underserved populations
Pilipino, Tagalog-speaking, minority, and
underserved populations
Chinese/Mandarin-speaking, minority, and
underserved populations
Social service providers serving lowincome, minority, chronic disease
populations
Serving youth, business development, and
land use
Date of
Consult
10/12/12
10/12/12
10/30/12
9/26/12
9/26/12
Type of
Consult
Focus
Group
Focus
Group
Focus
Group
Focus
Group
Focus
Group
9/18/12
Focus
Group
10/3/12
Focus
Group
c. Data limitations and information gaps
The Kaiser Permanente common data set includes a robust set of nearly 100 secondary data
indicators that, when taken together, enable an examination of the broad health needs within a
community. However, there are some limitations with regard to this data, as is true with any
secondary data. Some data were available only at a county level, making an assessment of health
needs at a neighborhood level challenging. Moreover, disaggregated data for age, ethnicity, race,
and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. At time, when stakeholders identified a health issue it
may not have been reflected by the secondary data indictors. In addition, data are not always collected on an annual basis, meaning that some data are several years old. Lastly, the project timeframe did not allow for additional data collection or data requests to other sources.
The goal of primary data collection is to gather information from a broad, relevant selection of
stakeholders, from government officials to health care professionals and service providers to
community members. Given busy schedules, stakeholders were offered several different ways in
which to participate. Again, given the project timeframe, focus groups and interviews were
organized with relatively short lead time. In each medical hospital, the local community benefit
manager actively participated in outreach through personalized invitations and reminders.
Page 44
VI. Identification and Prioritization of Community’s Health
Needs
a. Identifying community health needs
For the purposes of the CHNA, Kaiser Permanente defines a health need as a poor health outcome and associated health driver(s) or a health driver associated with a poor health outcome
where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive
identification, interpretation, and analysis of a robust set of primary and secondary data. Please
refer to Appendix A for additional definitions.
Primary data were analyzed, by service area, by inputting all interviews and focus groups into
Microsoft Excel. The data were then reviewed using content analysis to identify themes and
determine a comprehensive list of codes; the data were coded and the number of times an issue
was identified was tallied. In addition, sub-populations mentioned as being most affected by a
specific issue were noted.
Secondary data were input into tables to be included in the analysis. When possible, benchmark
data were included (Healthy People 2020, Los Angeles County, or California). Each medical
hospital agreed to use county levels as the benchmark, when available. However, if the data
source was not available at the county level, state-level data was used.
Health needs and drivers were identified from both primary and secondary data sources using the
size of the problem relative to the portion of population affected by the problem as well as the
seriousness of the problem (impact at the individual, family or community levels). To examine
the size and seriousness of the problem, the indicators from the secondary data were compared to
the available benchmark (HP2020, County, or State). Those indicators that performed poorly
against a benchmark were considered to have met the size and seriousness criterion and were
added to the master list of health needs and drivers. Concurrently, health needs and drivers that
were identified by stakeholders in the primary data collection were also added to the master list
of health needs and drivers.
After primary and secondary data were analyzed, a process was created in collaboration with the
local medical center’s Community Benefit Manager and the Kaiser Permanente Regional Office
to analyze the identified needs into three levels or tiers, based on the amount of data indicating a
need.
The identification of a community health need was conducted through a multi-tiered process,
using results from primary and secondary data analysis. This tiered system serves to document
the process of analyzing health issues identified by both primary and secondary data. The
following criteria were used for the tiers:
Page 45
Tier 1: Health issues that were identified in secondary data as poorly performing against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) or mentioned once
in either primary data source (focus group or interview).
Tier 2: Health issues that were identified in secondary data as performing poorly against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) or received
repeated mentions in either primary data source (focus group or interview).
Tier 3: Health issues that were identified in secondary data as performing poorly against a
benchmark (HP 2020, California state rates, or Los Angeles County rates) and received
repeated mentions in primary data sources (focus group or interview).
Tier
1
2
3
Secondary Data:
Poorly Performing Indicators
Single
Single
Single
Or/And
Or
Or
And
Primary Data: Mentions
Single
Multiple
Multiple
Upon application of the tiers, a number of observations were made by the CNM team. First, use
of the most inclusive criteria (tier one) resulted in a very long list. Furthermore, the use of the
most stringent criteria, requiring identification by both a quantitative indicator as well as a
qualitative indicator, yielded what was regarded as too few needs and drivers—in one case, five
needs and eight drivers. Thus, the decision was made to use tier two, identification by a
quantitative indicator and/or qualitative indicator, for the list of needs used in the prioritization
process.
After application of this process, the tier-two designation was determined as most appropriate,
providing a stringent yet inclusive approach that would allow for a comprehensive list of 22
health needs and 21 drivers to be brought forth in the second phase or prioritization process for
the KFH-LA service area. The results of the application of this tiered approach can be found in
Appendix E.
Health Needs and Drivers Carried Into Prioritization Phase
Health Need
Health Driver
Allergies
Alzheimer's Disease
Arthritis
Asthma
Breast Cancer
Cancer, in General
Cervical Cancer
Cholesterol
Colorectal Cancer
Diabetes
Alcohol and Substance Use
Awareness and Education
Cancer Screening
Cardiovascular Disease Management
Dental Care Access
Education
Employment
Family and Social Supports
Health Care Access
Health Insurance
Healthy Eating
Homelessness
Page 46
Disability
Hepatitis
HIV/AIDS
Hypertension
Infant Mortality
Intentional Injury
Mental Health
Obesity/Overweight
Oral Health
Unintentional injury
Income
Language Barrier
Nutritional Access
Physical Activity
Prenatal Care
Preventive Care Services
Safety
Smoking
Transportation
Note: Presented in alphabetical order
A matrix (or scorecard) was created listing Tier 2 health needs and drivers (listed above) to be
carried into the prioritization phase which included secondary and primary data related to the 22
health needs and 21 drivers (see Appendix C). To allow for a comprehensive analysis, and to
assist with the prioritization of health needs identified in Tier 2, the matrix lists health issues
correlated with secondary data indicators and primary data results. For example, the secondary
indicators for adult hospitalizations due to mental health and reported serious psychological
distress as well as primary data results that identified specific mental health-related issues found
in the community are grouped under ‘mental health’.
This matrix included benchmark data from Healthy People 2020 (HP2020) benchmarks when the
indicator matched the data on hand. If an appropriate HP2020 indicator was not available, the
most recent county or state rate was used. The matrix also included medical center–level
secondary data (averaged), primary data counts (number of times an issue was mentioned) for
interviews and focus groups, and sub-populations noted as most severely impacted. Each data
indicator for the medical center was first compared to the HP2020 benchmark, if available, and
then to the geographic level for benchmark data to assess whether the medical center
performance was better or worse than the benchmark. When the process identified an issue from
more than one source (from primary or secondary data), the issue was designated as a health
need or driver.
b. Process and criteria used for prioritization of the health needs
After a series of discussions about possible approaches, all medical centers in the collaborative
agreed to use the same method for prioritization and selected the Simplex Method as a guide. A
Simplex Method is the process in which input is gathered through a close-ended survey where
respondents rate each health need and driver using a set of criterion. After surveys are
completed, the surveys are scored for each health need and driver. The health needs and drivers
are then ranked in order of highest priority. Preferences for the approach included:
•
To be inclusive of stakeholders
•
That the method involve a moderate amount of rigor but not with so much
math/statistics as to be difficult to use and to communicate
Page 47
•
That the rigor be balanced by a relatively easy-to-use methodology
Community Forums
1.
Facilitated Group Discussion. Community forums were designed to provide the
opportunity for a range of stakeholders to engage in a discussion of the data and participate in the prioritization process. In order to provide stakeholders an opportunity to
participate, two community forums were held in each medical center area. Community
representatives (stakeholders) were invited to participate in one of the two forums,
according to their availability. A maximum of two representatives from an organization
were invited to participate, drawing a total of 70 participants. In addition, all individuals
who were invited to take part in the primary data collection (Phase I: focus groups and
interviews, irrespective of whether or not they actually participated in that phase) were
invited to attend a community forum.
Each forum included a brief presentation that provided an overview of the CHNA data
collection and prioritization processes, and a review of the documents to be used in the
facilitated discussion. Participants were provided with a list of identified health needs and
drivers in the scorecard format, developed from the matrix described previously in this
report, and a narrative document of brief summary descriptions of the identified health
needs using data from secondary data sources noted in Appendix G. Participants then
engaged in a facilitated group discussion about the findings as presented in the scorecard
and the narrative document, and a prioritization of the identified health needs and drivers.
Participants completed a group prioritization grid exercise to share back with the larger
group and to be used as supplemental information for the implementation strategy phase.
The following questions were addressed in the grid exercise:

Which health needs/drivers most severely impact the community (communities)
you serve?

For which health needs/drivers are there the most community assets/gaps in
resources?

What are the drivers that can be addressed?
At the end of each forum participants were asked to complete a questionnaire and to rank
each health need and drivers according to several criteria, as described below.
2.
Administration of the questionnaire. Community forum participants were asked to
complete a questionnaire after the forum rating each health need and driver according to
severity, change over time, resources available to address the needs and/or drivers, and
the community’s readiness to support initiatives to address the needs and/or drivers.
Appendix D provides a description of the scale used for each criterion to rank each health
issue and driver.
Page 48
3.
Secondary ranking of health needs and drivers. After completing the questionnaires,
participants were given 10 sticker dots and asked to place five dots on the health needs
and five dots on the health drivers—listed in alphabetical order on flipchart paper—
placed in a designated area in the meeting space. Each sticker dot counted as one vote;
participants were able to place the dots in any manner they wished. For example, a
participant could place all five of their health-need dots on diabetes. These counts served
as a way to validate questionnaire findings and to serve as additional information that
may be carried into the implementation strategy phase.
Analysis of Survey Scores
After the community forums, the 65 completed questionnaires (the net completed questionnaires
received from the 70 participants) were entered and analyzed using Microsoft Excel. Each
participant’s scores for each health need and driver by each criterion (severity, change over time,
resources, and community’s readiness to support) were totaled. Scores were then averaged using
the criterion severity, change over time, and resources responses across all participants, for a
final overall score (or rating) for each health need and driver. (The “community readiness to
support” criterion was not used in the calculation because this would better serve as
supplementary information for the implementation strategy phase.) Health needs and drivers
were sorted by each criterion, including overall average (or rating), and placed in a grid to allow
each medical center to weigh the information by criterion or overall. Please see the health need
and driver prioritization process tables below for more information.
The overall average was calculated by adding the total across severity (total possible score equals
4), change over time (total possible equals 4), and resources (total possible equals 4) for each
survey (with a total possible score of 12). The total scores were divided by the total number of
surveys for which data was provided, resulting in an overall average per health need.
Overall Averages by Health Need and Criteria Resulting from Prioritization Process, n=65
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Health Need
Mental health
Obesity/overweight
Oral health
Diabetes
Disability
Cardiovascular disease
Hypertension
Cholesterol
Alcohol and substance abuse
Intentional injury
Cancer, in general
Severe
impact on
the
community
3.77
3.79
3.61
3.67
3.38
3.50
3.43
3.43
3.41
3.39
3.18
Gotten
worse
over time
3.47
3.48
3.46
3.55
3.22
3.33
3.35
3.26
3.04
2.93
2.88
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Shortage of
resources in
the
community
3.18
3.03
3.33
2.88
3.06
2.93
2.81
2.80
3.16
2.91
2.63
Community
unable to
address/support
2.61
3.05
2.94
2.93
2.73
2.96
2.76
2.95
2.80
2.75
2.90
Overall
rating
10.08
10.02
10.00
9.61
9.04
9.00
8.96
8.83
8.69
8.57
8.44
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Health Need
Breast cancer
Alzheimer’s disease
Asthma
Cervical cancer
Hepatitis
HIV/AIDS
Colorectal cancer
Unintentional injury
Arthritis
Allergies
Infant mortality
Severe
impact on
the
community
3.31
2.97
3.02
3.11
2.88
3.21
3.04
3.03
2.56
2.34
2.57
Gotten
worse
over time
2.79
3.15
3.07
3.07
2.91
2.49
3.00
2.79
2.83
2.91
2.28
Shortage of
resources in
the
community
2.63
2.74
2.79
2.81
2.83
2.46
2.68
2.59
2.73
2.50
2.50
Community
unable to
address/support
3.14
2.80
2.71
2.90
2.13
2.80
2.65
2.74
2.53
2.52
2.92
Overall
rating
8.23
8.22
8.19
8.06
8.04
7.69
7.50
7.49
7.45
6.67
6.63
Note: Health needs are in prioritized order. The overall rating was calculated by averaging the variables “severe
impact on the community,” “gotten worse over time,” and “shortage of resources in the community.”
Page 50
Overall Averages by Driver and Criteria Resulting from Prioritization Process, n=65
Severe impact
on the
community
3.67
3.67
3.76
3.64
3.72
3.63
3.64
3.66
3.50
3.36
3.45
3.48
Gotten
worse over
time
3.46
3.50
3.12
3.42
3.47
3.02
3.49
3.07
3.11
2.98
2.94
2.77
Shortage of
resources in the
community
3.27
3.25
3.24
3.24
3.19
3.02
3.25
2.82
2.86
2.93
2.95
2.77
Community
unable to
address/support
3.17
3.00
3.06
2.78
2.80
3.00
2.92
2.93
2.98
2.91
3.02
3.03
Overall
rating
10.15
10.05
9.78
9.74
9.67
9.55
9.42
9.34
9.30
9.02
8.98
8.88
13. Cardiovascular Disease
Management
3.50
3.00
2.71
2.87
8.85
14.
15.
16.
17.
18.
19.
20.
21.
3.46
3.46
3.41
3.45
3.34
3.46
3.10
2.77
2.93
3.09
2.83
2.75
2.79
2.84
2.15
2.36
2.76
2.88
2.71
2.78
2.86
2.82
2.24
2.36
2.96
2.96
2.86
2.88
2.80
2.91
2.93
3.15
8.84
8.74
8.66
8.62
8.51
8.47
7.14
6.69
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Health Driver
Employment
Income
Health Insurance
Homelessness
Alcohol and Substance Use
Health Care Access
Dental Care Access
Healthy Eating
Physical Activity
Transportation
Family and Social Supports
Awareness and Education
Education
Safety
Nutritional Access
Language Barrier
Cancer Screening
Smoking
Prenatal Care
Note: Health drivers are in prioritized order. The overall rating was calculated by averaging the variables “severe
impact on the community,” “gotten worse over time,” and “shortage of resources in the community.”
c. Description of prioritized community health needs
The following list of 22 prioritized needs resulted from the above described process. Further
details are included in Appendix B: KFH-LA Health Needs Profiles. See Appendix H for data
source reference information.
1.
Mental Health
Among adults, mental disorders are common, with approximately one-quarter of adults being
diagnosable for one or more disorders. More than 90 percent of those who die by suicide suffer
from depression or other mental disorders, or a substance-abuse disorder (often in combination
with other mental disorders). In 2009, 14% of the KFH-LA reported poor mental health. In 2010,
suicide was the tenth leading cause of death among Americans. The mental health hospitalization
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rate per 100,000 youth in the KFH-LA service area (328.9) is higher when compared to
California (256.4), and highest in SPA 6 (490.6), SPA 3 (343.5.), SPA 4 (340.0), and SPA 7
(292.0). Among adults, the mental health hospitalization rate per 100,000 persons is over double
(1,021.5) in the KFH-LA service area when compared with California (551.7). SPA 4 (2,750.0),
SPA 6 (642.2), SPA 2 (633.7), and SPA 3 (586.4) have higher mental health hospitalization rates
per 100,000 adults than California (551.7). The rate for individuals who needed help for mental,
emotional, alcohol or drug issues but did not receive treatment in the KFH-LA service area was
48.2% compared to a slightly lower rate of 47.3% in Los Angeles County and highest in SPA 6
(56.4%), SPA 4 (52.6%) and SPA 3 (52.2%). In KFH-LA service area, a higher percentage had
serious psychological distress (7.7%) and also in SPA 6 (14.8%), and SPA 4 (10.7%) when
compared to Los Angeles County (7.3%). Poor mental health was highest among Blacks
(19.3%), followed by Whites (17.8%), Latinos (13.0%), and Asians (6.5%). Stakeholders
highlighted mental health as impacting a broad spectrum of populations, including people under
the age of 30, low-income women, the homeless, African-Americans, elderly residents of
Chinatown, and undocumented individuals. Drivers associated with mental disorders include
chronic diseases, a family history of mental illness, age, substance abuse, and life-event stresses.
Stakeholders identified multiple factors that contributed to poor mental health, including stress
caused by the economic downturn, unemployment, immigration status, abuse (emotional,
physical, and sexual), bullying, and increasing violence (caused by unemployment). Mental
health issues were identified by community stakeholders in nine out of 19 interviews and all
seven focus groups, and mental health was identified as a health need in the 2010 KFH-LA
2.
Obesity/Overweight
Obesity has risen to epidemic levels in the United States and indicates an unhealthy lifestyle that
influences further health issues. Among U.S. adults age 20 years and older, 68 percent are overweight or obese. Obesity reduces life expectancy and increases the risk of coronary heart disease,
stroke, high blood pressure, diabetes, and a number of other chronic diseases. The portion of
youth who are obese is higher (33.4%) in the KFH-LA service area when compared to California
(29.8%) and 22.5% of adults in KFH-LA as compared to 21.2% in Los Angeles. Similarly,
slightly more youth are overweight in the KFH-LA service area (14.5%) when compared to
California (14.3%). Among adults, a larger percentage of obese individuals live in SPA 6
(30.5%) and SPA 7 (27.6%) when compared to the overall KFH-LA service area (22.5%). The
percentage of overweight adults is greater in KFH-LA (31.3%) than in Los Angeles County
(29.7%). Among adults, a large percentage live in SPA 6 (34.4%), SPA 7 (31.2%) and SPA 2
(32.5%) As well, more adult males (21.5%) in the KFH-LA service area are obese than females
(21.3%). Youth obesity is highest among Hispanics/Latinos (39.9%), African-Americans
(31.7%), and American Indian/Alaskan Native (29.8%). Stakeholders identified obesity as most
severely impacting Latinos, African-Americans, low-income individuals, and youth. Obesity is
associated with factors including poverty, inadequate fruit/vegetable consumption, breastfeeding,
and access to grocery stores, parks, and open space. Stakeholders attributed being obese and
Page 52
overweight to a lack of access to green space, living in food deserts, a lack of access to healthy
foods such as fruit and vegetables, a lack of safety at parks, and lifestyle choices such as a lack
of physical activity. They also indicated that the link between obesity and diabetes and hypertension is a growing issue in the community. Obesity was identified strongly in focus groups (four
of out of seven) and interviews (nine out of 19) and was identified as a health need in the 2010
KFH-LA Community Health Needs Assessment.
3.
Oral Health
Oral health is essential to overall health and is relevant because engaging in preventive behaviors
decreases the likelihood of developing future health problems. In addition, oral diseases like
cavities and oral cancer cause pain and disability for many Americans. The KFH-LA service area
has an equivalent rate of adults with poor dental health when compared with the statewide rate of
11.6%. Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%) sub-populations lack dental
insurance at higher rates than other ethnic and racial groups living in the KFH-LA service area.
Also, Hispanic/Latino youth or children comprise the largest group of KFH-LA service area
youth or children who are unable to afford dental care (8.3%), and who have gone without a
dental exam (49.3%). Stakeholders identified low-income individuals, the uninsured, the
homeless (specifically veterans), Latinos, and those living in Chinatown and Skid Row in
downtown Los Angeles as the most severely impacted by poor oral health. Health behaviors that
may lead to poor oral health include tobacco use, excessive alcohol use, and poor dietary
choices. Other factors associated with poor dental health include lower levels (or a lack) of academic education, having a disability, and experiencing other health conditions such as diabetes.
Barriers that prevent or limit a person’s use of preventive intervention and treatments include
limited access to and availability of dental services, a lack of awareness of the need, cost, and
fear of dental procedures. Oral health and dental care was identified by community stakeholders
in all seven focus groups and 11 out of 19 interviews, including an emphasis on new immigrants
who are particularly impacted. Oral health was not identified as a health need in the 2010 KFHLA Community Health Needs Assessment.
4.
Diabetes
Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading
cause of death. A diabetes diagnosis can indicate an unhealthy lifestyle, a risk factor for further
health issues, and is also linked to obesity. Diabetes prevalence is higher in KFH-LA (18.5%)
versus Los Angeles County (10.5%), highest in SPA 7 (23.3%), SPA 6 (23.1%), SPA 4 (17.1%),
SPA 3 (16.9%) and SPA 2 (12.3%). The diabetes hospitalization rate for adults in the KFH-LA
service area is higher (174.3) when compared to the Los Angeles County rate of 145.6 per
100,000 persons. The uncontrolled diabetes hospitalization rate per 100,000 adults is also higher
(17.7) when compared to Los Angeles County (9.5). Diabetes is more common among males
(8.5%) than females (7.1%). In addition, more males (1.1%) have been discharged from hospitals
for diabetes-related incidents than females (0.8%). Also, more African-Americans (1.6%) and
Hispanic/Latinos (1.0) experienced hospital discharges resulting from diabetes. Those between
Page 53
the ages of 45 and 64 (1.5%) and 65 and over (1.0%) experienced the most diabetes-related
hospital incidents when compared to other age groups. Stakeholders noted that the elderly, adult
Chinatown residents, recent immigrants, the homeless, Latinos, and Latino residents of Skid
Row are particularly impacted by diabetes. Drivers associated with diabetes include being
overweight, high blood pressure, high cholesterol, high blood sugar (or glucose), physical
inactivity, smoking, unhealthy eating, age, race, gender, and having a family history of diabetes.
The lack of access to a usual source of care, medical insurance, and the availability of primary
care providers within a community are also contributing factors. Diabetes was identified as a
major health issue in six out of 19 interviews and six out of seven focus groups. Diabetes was
also identified as a health need in the 2010 KFH-LA Community Health Needs Assessment.
5.
Disability
Disability is an umbrella term for impairments, activity limitations, and participation restrictions.
Over a billion people globally are estimated to live with some form of disability, corresponding
to about 15% of the world population. In California, 5.7 million adults, or 23% of the adult
population, have a disability. In addition, rates of disability are increasing, in part as a result of
aging populations and an increase in chronic health conditions. Stakeholders identified children
and the aging population as the most severely impacted. Youth with IEPs (Individualized
Education Plans) were also identified by stakeholders as a particularly impacted population.
People with disabilities typically have less access to health care services and often do not have
their health care needs met. They are also more likely to be physically inactive, be in poor
general health, smoke, be overweight or obese, have high blood pressure, experience
psychological distress, receive less social-emotional support, live in poverty, and have high
unemployment rates compared to people without disabilities. Disabilities, defined as
developmental delays and/or as behavior issues, were identified in three out of 19 interviews.
Disabilities were not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
6.
Currently, more than one in three adults (81.1 million) lives with one or more types of
cardiovascular disease. Coronary heart disease is a leading cause of death in the United States
and results in serious illness and disability, a decreased quality of life, and hundreds of billions of
dollars in economic loss every year. The KFH-LA service area (379.7) has a higher heart disease
hospitalization rate per 100,000 persons when compared to Los Angeles County (367.1). As
well, the cardiovascular disease mortality rate per 10,000 adults was slightly higher in the KFHLA service area (15.7) when compared to Los Angeles County (15.6) in 2010. More specifically,
the cardiovascular disease mortality rates per 10,000 adults were highest in SPA 3 (21.1), SPA 2
(20.8), and SPA 4 (16.1). Similarly, SPA 2 (485.0), SPA 4 (404.4), and SPA 3 (371.5) had
higher heart disease–related hospitalizations rates per 100,000 persons compared to Los Angeles
County (367.1). Those most often diagnosed with heart disease in the KFH-LA service area
include the White (8.2%) and Hispanic/Latino (5.1%) populations. Cardiovascular disease is
Page 54
linked to other negative health outcomes including strokes, heart attacks, and diabetes. The leading risk factors for heart disease are high blood pressure, high cholesterol, smoking, poor diet,
physical inactivity, and being overweight or obese. Heart disease/coronary disease was identified
as a major health issue in four of 19 interviews and four of seven focus groups. Cardiovascular
disease was also identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
7.
Hypertension
Hypertension, indicated by high blood pressure, affects one in three adults in the United States. If
left untreated, hypertension can lead to heart failure, blood vessel aneurysms, kidney failure,
heart attack, stroke, and vision changes or blindness. The percent of adults ever diagnosed with
high blood pressure is higher in the KFH-LA service area (27.4%) than in Los Angeles County
(25.5%). In SPA 3 (30.6%), SPA 4 (26.0%), and SPA 7 (26.0%), the percent of adults with high
blood pressure is also higher than in Los Angeles County (25.5%). Stakeholders identified the
uninsured, underinsured, low-income, Latinos, African-Americans, day laborers, and the homeless as the most severely impacted. Hypertension is associated with smoking, obesity, eating salt
and fat regularly, drinking excessively, physical inactivity, having had a stroke previously, high
cholesterol, and having heart or kidney disease. As well, those with a family history of hypertension or who are African-American are at an increased risk of having hypertension. Stakeholders
linked hypertension to diabetes, obesity, and stress. They also attributed its prevalence to the lack
of preventive care and people waiting until faced with an emergency to seek treatment. In addition, stakeholders indicated that the lack of access to care—including the high cost of treatment—and poor lifestyles choices also contribute to the prevalence of hypertension. Hypertension was identified as a health issue in three out of 19 interviews and three out of seven focus
groups. Hypertension was identified as a health need in the 2010 KFH-LA Community Health
Needs Assessment.
8.
Cholesterol
High blood cholesterol that builds up on the walls of the arteries can lead to heart disease (the
leading causes of death in the United States) and stroke. About one of every six adult Americans
has high blood cholesterol. The percent of adults who take medicine to lower cholesterol was
higher in SPA 3 (81.4%), and SPA 6 (78.3%) when compared to Los Angeles County (71.2%).
Stakeholders identified Latinos and the aging population as the most severely impacted. Some
health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for
developing high cholesterol. Age is a contributing factor; as people get older, cholesterol levels
rise. Diabetes can also lead to the development of high cholesterol. Some behaviors can lead to
high cholesterol, including a diet high in saturated fats, trans fatty acids (trans fats), dietary
cholesterol, or triglycerides. Also, being overweight and physically inactive can contribute to
high cholesterol. Having high cholesterol can also be hereditary. Cholesterol was identified in
one of 19 interviews and two of seven focus groups. Cholesterol was also identified as a health
need in the 2010 KFH-LA Community Health Needs Assessment.
Page 55
9.
Heavy alcohol consumption is an important determinant of future health needs, including cirrhosis, cancers, and untreated mental and behavioral health needs. The effects of substance abuse
significantly contribute to costly social, physical, mental, and public health problems, including
teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse, motor vehicle crashes
(unintentional injuries), physical fights, crime, homicide, and suicide. The rate of alcohol- and
drug-induced mental disease hospitalization per 100,000 persons is over seven times higher
(838.2) in the KFH-LA service area when compared to Los Angeles County (109.1). The rate of
liquor store access in communities within the KFH-LA service area is high in ZIP Codes 90021
(303.7 per 100,000), and 91210 (914.6 per 100,000). Populations impacted by substance abuse
include youth, women, Latinos, African-Americans, and people with low- and middle-class
income levels. Stakeholders identified the homeless, children, the uninsured, youth in or
transitioning out of the foster care system, and low-income populations as the most severely
impacted sub-populations. Several biological, social, environmental, psychological, and genetic
factors are associated with alcohol and substance abuse. These factors may include gender, race
and ethnicity, age, income level, educational attainment, and sexual orientation. Family, social
networks, and peer pressure are key influencers of substance abuse among adolescents. Alcoholism was identified as a major concern by four out of 19 interviews and during one out of seven
focus groups. Alcohol and substance abuse was not indicated as a major need in the 2010 KFHLA Community Health Needs Assessment.
10.
Intentional Injury
Intentional injury is defined as homicide or suicide and is a leading cause of premature death.
More than 180,000 people die from injuries each year, and approximately one in ten sustains a
nonfatal injury serious enough to be treated in a hospital emergency department. Beyond their
immediate health consequences, injuries and violence have a significant impact on the wellbeing of Americans by contributing to disability, poor mental health, high medical costs, and lost
productivity. The homicide rate for the KFH-LA service area is 6.8 per 100,000 persons, above
the statewide rate of 5.16. The KFH-LA service area homicide rate does not meet the Healthy
People 2020 goal of <=5.5. Notably high homicide rates are found in SPA 4 (9.2), SPA 6 (14.8),
and SPA 7 (10.8). Homicides rates per 100,000 persons in Los Angeles County are highest
among African-Americans (25.2). Stakeholders identified gay youth, adult men, and adult
women with children as particularly impacted populations. Intentional injury is associated with
several factors, including poverty, unemployment, educational level, heavy alcohol consumption,
violent crime, risk-taking behavior, and social and physical environments that are unsafe. Intentional injury was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
11.
Cancer in General
Cancer is the second leading cause of death in the United States, claiming the lives of more than
half a million Americans every year. The leading causes of cancer deaths among men in the
Page 56
United States are lung cancer, prostate cancer (22.0), and colorectal cancer (19.1), whereas the
leading causes of cancer deaths among women are lung cancer (38.6), breast cancer (22.2), and
colorectal cancer (13.1). Stakeholders identified children and the homeless as the most severely
impacted populations within the KFH-LA service area. Cancer is associated with growing older,
obesity, tobacco use, heavy alcohol consumption, sunlight exposure, certain chemicals, some
viruses and bacteria, a family history of cancer, poor diet, lacking access to health care, and
being physically inactive. Cancer was identified as a health need in the 2010 KFH-LA
12.
Breast Cancer
In the United States, breast cancer is the most common non-skin cancer and the second leading
cause of cancer-related death in women. The annual incidence rate of breast cancer among
women is 117.9 per 100,000 in the KFH-LA service area and Los Angeles County, which is
lower than the statewide rate of 123.3 per 100,000. Sub-populations most impacted by breast
cancer within the KFH-LA service area are African-Americans (122.9) and Whites (121.5).
Breast cancer was identified as a major health issue by community stakeholders in two out of 19
interviews. Risk factors for breast cancer include older age, certain inherited genetic alterations,
hormone therapy, having radiation therapy to the chest, heavy alcohol consumption, and obesity.
Getting exercise and maintaining a healthy weight may reduce the chance of getting breast cancer. Breast cancer is associated with overall cancer mortality and access to breast cancer screening, and was identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
13.
An estimated 5.4 million Americans have Alzheimer’s disease; it is the sixth-leading cause of
death in the U.S. The rate of mortality resulting from Alzheimer’s disease per 100,000 persons
was highest in SPA 2 (21.8) and SPA 3 (17.9) when compared to Los Angeles County. The
greatest risk factor for Alzheimer’s disease is advancing age. Other risk factors include a family
history of Alzheimer’s, genetic mutations, cardiovascular disease risk factors (e.g., physical
inactivity, high cholesterol, diabetes, smoking, and obesity) and traumatic brain injury. Alzheimer’s disease was identified as a major health need in three out of 19 interviews and in one
out of seven focus groups, but was not indicated as a major need in the 2010 KFH-LA Community Health Needs Assessment.
14.
Asthma
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of
children. Adults also may suffer from asthma, and the condition is considered hereditary. The
asthma hospitalization rate per 100,000 adults in the KFH-LA service area is higher (113.4)
when compared to the California average of 94.3. Asthma symptoms include wheezing,
breathlessness, chest tightness, and coughing. Some asthma triggers include tobacco smoke, dust
mites, outdoor air pollution, cockroach allergen, pet dander, mold, smoke, and certain infections
Page 57
known to cause asthma such as the flu, colds, and respiratory viruses. Other contributing factors
include exercising, certain medication, bad weather, high humidity, cold/dry air, certain foods,
and fragrances. Adult hospitalizations for asthma are particularly high in SPA 6 at 169.8 per
100,000 and in SPA 7 at 134.8 per 100,000 and in SPA 4 at 107.4 per 100,000. Sub-populations
particularly impacted by asthma include low-income women, youth, and homeless individuals.
Asthma was mentioned as a major health issue in two out of seven focus groups and four out of
19 interviews. Asthma was also identified as a health need in the 2010 KFH-LA Community
15.
Cervical Cancer
Cervical cancer is a disease in which cells in the cervix—the lower, narrow end of the uterus
connecting the vagina (the birth canal) to the upper part of the uterus—grow out of control. The
cervical cancer death rate in the KFH-LA service area is particularly high at 6.5 individuals per
100,000, more than double the Los Angeles County rate of 3 per 100,000. The highest rates of
cervical cancer mortality were in SPA 2 (11.5), SPA 3 (7.2) when compared to the overall KFHLA service area (6.5). Factors associated with cervical cancer are a common virus called the
human papillomavirus (HPV), smoking, having HIV or other conditions that cause the body’s
immune system to weaken, using birth control pills for an extended period of time (five or more
years), and having given birth to three or more children. In the KFH-LA service area, subpopulations most severely impacted are Hispanic/Latina (13.2) and White (10.3) women, based
on cervical cancer–related hospital discharge rates. According to community stakeholders, lowincome women, elderly residents of Chinatown, and the homeless are especially impacted by
cervical cancer, which was identified as a health need in the 2010 KFH-LA Community Health
Needs Assessment.
16.
Hepatitis C
Hepatitis C is a liver disease that results from infection with the Hepatitis C virus, the most common viral hepatitis in the United States. The prevalence rate for Hepatitis C in the KFH-LA service area is slightly higher in SPA 4 (0.2) when compared to Los Angeles County (0.1). Hepatitis
C is most likely to impact current and past injection-drug users; recipients of donated blood,
blood products, and organs; people who receive dialysis; people who receive body piercings or
tattoos with non-sterile instruments; health care workers; HIV-infected persons; children born to
Hepatitis C–infected mothers; people having sexual relations with a Hepatitis C–infected person;
and individuals sharing personal care items with someone infected with Hepatitis C. Hepatitis C
was identified as a major health issue in two out of 19 interviews and one of seven focus groups.
Hepatitis was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
17.
HIV/AIDS
More than 1.1 million people in the United States are living with HIV, and almost one in five
(18.1%) are unaware of their infection. HIV is a life-threatening communicable disease that
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disproportionally affects minority communities and may indicate a prevalence of unsafe sex
practices. The KFH-LA service area has an HIV prevalence rate of 480.3 per 100,000 persons,
close to the Los Angeles County rate of 480.4; both rates are notably higher than the statewide
rate of 345.5. The HIV/AIDS hospitalization rate per 10,000 persons in the KFH-LA service area
is 3.2, higher than the Los Angeles County rate of 2.2. HIV/AIDS is associated with numerous
health factors, including poverty, heavy alcohol consumption, HIV screenings, and liquor store
access. HIV prevalence per 100,000 persons is higher in SPA 4 (46.0) and SPA 6 (16.0) than in
Los Angeles County (14.0) and the entire KFH-LA service area (15.5). Untreated HIV infection
is associated with many diseases, including cardiovascular disease, kidney disease, liver disease,
and cancer. Persons with HIV infections are disproportionately affected by viral hepatitis, and
those co-infected with HIV and viral hepatitis experience greater liver-related health problems
than those who do not have HIV infections. Sub-populations particularly impacted by HIV/AIDS
include males, African-Americans, Hispanics/Latinos, and homeless individuals. HIV/AIDS was
identified as a health concern in two out of 19 interviews and one out of seven focus groups.
HIV/AIDS was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment, though HIV prevention was identified as a health need in that study.
18.
Colorectal Cancer
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading
cause of cancer-related death in the United States and is associated with overall cancer mortality,
heavy alcohol consumption, obesity, diabetes prevalence, and colon-cancer screening. It is
expected to cause about 50,830 deaths during 2013. The annual incidence rate of colorectal cancer in the KFH-LA service area is 45.1 individuals per 100,000, very close to the Los Angeles
County rate of 45.2. Both rates are above the national rate of 40.2 per 100,000. Colon cancer
mortality rates per 100,000 persons were highest in SPA 2 (14.7) and SPA 3 (14.5) when
compared to Los Angeles County (11.2). Sub-populations that are most severely impacted within
the KFH-LA service area are African-Americans (59.9) with the highest incidence rate, followed
by Whites (44.9) and Asians (44.0). Colorectal cancer was identified as a major health issue in
one out of 19 interviews, and was identified as a health need in the 2010 KFH-LA Community
19.
Unintentional injuries include those resulting from motor vehicle crashes resulting in death and
pedestrians being killed in crashes. The rate of mortality by motor vehicle accident in the KFHLA service area is 7.2 per 100,000 persons, which is slightly higher than the Los Angeles County
rate of 7.1. The most at risk for unintentional injuries include older adults, children, and drivers
and pedestrians who are under the influence of alcohol and drugs. While sub-population data
were not available for the KFH-LA service area, motor vehicle mortality rates are highest among
the White (10.0) and Black (9.2) populations in Los Angeles County, and pedestrian motor vehicle mortality rates are highest among the White (2.0), Hispanic/Latino (2.0), and Black (1.85)
populations in Los Angeles County. Health factors associated with unintentional injury include
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poverty, education, and heavy alcohol consumption. Unintentional injury was not identified as a
health need in the 2010 KFH-LA Community Health Needs Assessment.
20.
Arthritis
Arthritis affects one in five adults and continues to be the most common cause of physical
disability. Arthritis data available for the KFH-LA service area indicate the same rate as Los
Angeles County (17.4%), the highest rates were in SPA 3 (20.1%), SPA 7 (18.2%) and SPA 5
(17.7%), although it was identified as a major health concern in two out of 19 interviews and in
one out of seven focus groups. Factors associated with arthritis include being overweight or
obese, a lack of education around self-management strategies and techniques, and limited or no
physical activity. Interventions that can reduce arthritis pain and functional limitations include
increased physical activity, education about disease self-management, and weight loss among
overweight/obese adults. Stakeholders identified the aging and Asian populations as being the
most impacted by arthritis. Arthritis was not indicated as a major need in the 2010 KFH-LA
21.
Allergies
Allergies are an overreaction of the immune system to substances that usually cause no reaction
in most individuals. These substances can trigger sneezing, wheezing, coughing, and itching.
Allergies have been linked to a variety of common and serious chronic respiratory illnesses (such
as sinusitis and asthma). Allergies among teens were higher in the KFH-LA service area (25.8%)
when compared to Los Angeles County (24.9%). The percent of teens with allergies was also
higher in SPA 3 (36.8%) when compared to Los Angeles County. Female teens were more often
diagnosed with allergies (27.3%) in the KFH-LA service area than males (20.6%). Allergies
were identified as a major health concern in three out of 19 interviews and in one out of seven
focus groups. Allergies were not indicated among major needs in the 2010 KFH-LA Community
22.
Infant Mortality
Infant mortality remains a concern in the United States, as each year approximately 25,000
infants die before their first birthday. Infant mortality is associated with rates of low birth weight;
6.9% of the infants born in the KFH-LA service area have a low birth weight, which is higher
than the state rate of 6.8%. More infants were born with very low birth weights in SPA 7 (1.5%)
when compared to Los Angeles County (1.3%). Factors that affect birth outcomes include smoking, substance abuse, poor nutrition, medical problems, and chronic illness. High rates of infant
mortality can indicate broader issues, such as access to health care, maternal and child health,
poverty, education rate, a lack of insurance, teen births, and a lack of prenatal care. Within the
KFH-LA service area, sub-populations with a high infant mortality rate per 1,000 live births
include African-Americans (11.5), Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3). Infant
mortality was not identified as a health need in the 2010 KFH-LA Community Health Needs
Assessment.
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VII. Community Assets and Resources Available to Respond to
the Identified Health Needs of the Community
Numerous community assets and resources are available to respond to the health needs of the
KFH-LA community. These include health care facilities as well as community organizations
and public agencies that provide health services, health promotion activities, social services, and
referrals. A sampling of these programs and KFH-LA partners is below. Community assets
identified that address specific health needs are included in this list and noted in the individual
KFH-LA Health Needs Profiles in Appendix B.
a. Health Care Facilities
Hospitals
Alhambra Hospital Medical Center
Barlow Respiratory Hospital
California Hospital Medical Center—LA
Children’s Hospital of Los Angeles
Cigna Hospital of Los Angeles Inc.—Silver Lake Medical Center
City of Angels Medical Center
City of Hope Helford Clinic Research Hospital
City View Hospital
East Los Angeles Doctors Hospital
Edgemont Hospital
Doheny Eye Institute
Garfield Medical Center
Glendale Adventist Medical Center
Glendale Memorial Hospital and Health Center
Good Samaritan Hospital
Hollywood Community Hospital of Hollywood
Hollywood Presbyterian Medical Center
Huntington Memorial Hospital
Kaiser Permanente Los Angeles Medical Center
LAC+USC Medical Center
Las Encinas Hospital
Linda Vista Community Hospital
Los Angeles Community Hospital
Methodist Hospital of Southern California
Monrovia Community Hospital
Monterey Park Hospital
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Orthopedic Hospital
Pacific Alliance Medical Center
Pasadena Community Hospital
Promise Hospital—East Los Angeles Campus
Providence Saint Joseph Medical Center
Queen of Angels Medical Center
Saint Luke Medical Center
Saint Vincent Medical Center
Santa Teresita Hospital
Shriners Hospitals for Children—Los Angeles
St. Francis Medical Center
St. Vincent Medical Center
Temple Community Hospital
University of Southern California (USC)—Kenneth Norris Jr. Cancer Hospital; University
Hospital
Verdugo Hills Hospital
White Memorial Medical Center
Community Clinics
All for Health, Health for All, Inc.
AltaMed Health Services Corporation
Arroyo Vista FHC (El Sereno, Lincoln Heights, Loma Drive)
Asian Pacific Health Care Venture, Inc.
California Family Care
Central City Community Health Center
Clínica Monseñor Oscar A. Romero
Clínica Para Las Mujeres
Community Health Foundation of East LA
Comprehensive Community Health Center (Eagle Rock, Highland Park)
Hollywood Sunset Free Clinic
JWCH Institute, Inc.
LA Gay and Lesbian Center
Los Angeles Christian Health Centers
Mission City Community Network, Inc.
Northeast Community Clinic
QueensCare Family Clinic (Eagle Rock, Echo Park, Hollywood, Lee Wilshire CT, Mobile
Unit, Eastside)
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St. Anthony Medical Center (Hollywood Clinic, Pico Clinic)
Saint John’s Well Child and Family Center (Abraham Lincoln High, Dr. Louis, Magnolia
Place)
T.H.E. Clinic, Inc.
The Saban Free Clinic
Dental Care
AIDS Project Los Angeles
AltaMed Medical and Dental Group
Kids’ Community Dental Clinic
Los Angeles County Department of Health Services
Saint John’s Well Child and Family Center
The Saban Free Clinic
University of Southern California (USC) School of Dentistry
Mental Health
Amanecer Community Counseling Services
Asian Pacific Counseling Treatment Centers
Didi Hirsch Mental Health Services
ENKI Health and Research Systems (ENKI), East LA Mental Health
Exodus
Gateways Hospital Mental Health Center
Hope Street Family Center Behavioral Health Clinic at California Hospital Medical Center
Kaiser Foundation Hospital–Mental Health Center
Kedren Community Mental Health Center
Los Angeles County Department of Mental Health
Pacific Clinics
South Central Los Angeles Ministry Project (LAMP)
Special Service for Groups (SSG)
VIP Community Mental Health Center, Inc.
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b. Other Community Resources
A partial list of community resources available to address identified community health needs is
listed below. Additional resources can be found at:
www.211LA.org
www.HealthyCity.org
School Districts
Alhambra Unified School District
Arcadia Unified School District
Burbank Unified School District
Duarte Unified School District
Glendale Unified School District
La Canada Unified School District
Los Angeles Unified School District
Monrovia Unified School District
Pasadena Unified School District
South Pasadena Unified School District
Temple City Unified School District
Community Organizations & Public Agencies
A Window Between Worlds
AADAP (Asian American Drug Abuse Program)
Aguilar House
AIDS Healthcare Foundation
AIDS Project Los Angeles (APLA)
AIDS Research Alliance
AIDS Service Center
Alcoholics Anonymous (AA) and Al-Anon
Alcoholism Center for Women
Alexandria House
Alliance for Housing and Healing
Alzheimer’s Association, California Southland Chapter
Amanecer Community Counseling Services
American Cancer Society
American Heart Association
American Liver Foundation, Greater Los Angeles Chapter
American Lung Association, California
Angelus Plaza
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Area 10 Disabilities Board
Armenian American Chamber of Commerce
Armenian Relief Society of Western U.S.A., Inc.
Arthritis Foundation, Los Angeles County Office
Ascencia
Asian Pacific Counseling Treatment Centers
Asian Pacific Liver Center at St. Vincent Medical Center
Asian Rehabilitation Services
Assistance League of Southern California
Asthma and Allergy Foundation of America, California Chapter
Asthma Coalition of Los Angeles County (ACLAC)
Bienestar Human Services
Boys and Girls Club of Burbank and Greater East Valley
Boys and Girls Club of Hollywood
Boys and Girls Club of Pasadena
Boys and Girls Club of the Foothills
BREATHE California of Los Angeles County
California Wellness Foundation
CARECEN
California Certified Farmers Markets
Casa de Amigos Youth Center
CASA of Los Angeles
Center for Oral Health
Center for the Pacific Asian Family
Center for the Partially Sighted
Central City Association
Charles Drew University Of Medicine & Science
CHCADA (California Hispanic Commission on Alcohol and Drug Abuse)
Children’s Bureau of Southern California
Churches/congregations—general
City of Glendale—City Council
City of Los Angeles Department of Aging
CoachArt
Coalition for Humane Immigrant Rights of Los Angeles
Community Clinic Association of Los Angeles County (CCALAC)
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Community Health Alliance of Pasadena
Community Health Councils, Inc.
CONTRA-TIEMPO
Covenant House California, Los Angeles
Create Now
Crohn’s and Colitis Foundation of America, Greater Los Angeles Chapter
CSULA Auxiliary Services, Inc
Disability Rights Center California
Downtown Homeowners Association
Early Identification and Intervention Collaborative for Los Angeles County
East Los Angeles Women’s Center
East Valley Boys and Girls Club
Eisner Pediatric and Family Medical Center
El Centro del Pueblo
Esperanza Community Housing Corporation
Familia Unida Living with Multiple Sclerosis
Family Resource Network
Farmers markets—general
Filipino American Service Group Inc. (FASGI)
Five Acres, The Boys’ and Girls’ Aid Society of Los Angeles County
Friends of Expo Center
Friends of Micheltorena Street School, Project of Community Partners
Garfield Health Center
Gay Lesbian Elder Housing
Girls on the Run of Los Angeles County
Girls Today Women Tomorrow
Giving Back Hope
Glendale Community Free Health Clinic
Glendale Healthy Kids
Habitat for Humanity of Greater Los Angeles
Harugee
Hathaway-Sycamores Child and Family Services
Healthy African American Families
Healthy Families
Healthy Way LA
HEAR Center
Heart of Los Angeles Youth, Inc. (HOLA)
Hollywood Community Housing Corporation
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Hollywood Police Activities League (Hollywood PAL)
Hollywood Presbyterian
Hollywood Wilshire YMCA
Homeless Health Care Los Angeles (HCCLA)
Hope Street Family Center Behavioral Health Clinic at California Hospital Medical Center
Human Impact Program
Immanuel Presbyterian Church
Impact Drug and Alcohol Treatment Center
Inner Images
Inside Out Community Arts, Inc.
Kids’ Community Clinic of Burbank
Korean American Family Service Center
Korean Health Education Information & Research Center (KHEIR)
LA Best Babies Network
LA Conservation Corps
LA Voice PICO
LAC+USC Healthcare Network
LAC+USC Medical Center—Breathemobile
LACER After-school Programs
Lanterman Regional Center
Latino Diabetes Association
Legacy LA
Living Advantage
Los Angeles Child Guidance Clinic
Los Angeles Christian Health Centers
Los Angeles Community Garden Council
Los Angeles County Area Agency on Aging
Los Angeles County Bicycle Coalition
Los Angeles County Department of Children and Family Services (Metro)
Los Angeles County Department of Health Services
Los Angeles County Department of Mental Health
Los Angeles County Department of Public Health—Maternal, Child and Adolescent Health
Programs; Substance Abuse, Prevention and Control
Los Angeles County Education Coordinating Council (ECC)
Los Angeles County Emergency Medical Services (EMS)
Los Angeles Neighborhood Land Trust
Los Angeles Unified School District (LAUSD) Student Health and Human Services
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Los Angeles Youth Network
Los Angeles Walks
Magnolia Place
March of Dimes, California Programs
Maternal and Child Health Access
Minority AIDS Project
Mission City Community Network
My Friend’s Place
Neighborhood Legal Services
New Economics for Women
New Horizons Family Center
Operation USA
P F Bresee Foundation
Pacific Asian Medical Center
Para Los Niños
Parents of Developmentally Disabled Children (CHLA)
Parents of Hope Street Family Center
Parents of St. Vincent Youth Center
Pasadena Council on Alcoholism and Drug Dependence (Pasadena)
Peace First Los Angeles
People Assisting The Homeless (PATH)
Pico Union Family Preservation Network
Planned Parenthood Los Angeles
Planned Parenthood of Pasadena
Project Angel Food
PROTOTYPES—Community Assessment Services Center
PROTOTYPES Centers for Innovation in Health, Mental Health, and Social Services
Proyecto Pastoral at Dolores Mission
Ronald McDonald House Charities of Southern California—Los Angeles
Rosemary Children’s Services
Search to Involve Pilipino Americans (SIPA)
SERRA Ancillary Care Corporation
Shelter Partnership
Social Justice Learning Institute
Socrates Opportunity Scholarship Foundation
SOS Mentor Shape Up
South Central Los Angeles Ministry Project (LAMP)
Special Service for Groups (SSG)
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St. Anne’s
St. Barnabas Senior Center of Los Angeles
St. Vincent Health Benefit Resource Center
St. Vincent Multicultural Health Awareness and Prevention Center
Step Up on Second Street Inc.—Step Up on Vine Permanent Supportive Housing
Students Run LA
Susan G. Komen for the Cure, Los Angeles County Affiliate
Thai Community Development Center
Thai Health and Information Services
The Harmony Project
The Trevor Project
The Village Family Services
The Wall—Las Memorias Project
Traveler’s Aid Society of Los Angeles
UCLA School of Public Health
UNITE-LA
UMMA (University Muslim Medical Association) Community Clinic
University of Southern California (USC)
University of Southern California (USC) School of Dentistry Community Dentistry Program
University of Southern California (USC) Troy Camp
Weingart Center Association
Wellness Works Community Health Center
Worksite Wellness LA
YMCA–Weingart East Los Angeles
YMCA of West San Gabriel Valley
YWCA–Glendale
YWCA–Pasadena-Foothill Valley
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Appendix A: Glossary
Page 70
This glossary has been developed to provide definitions for key terms and terminology used throughout the East
Metro West Kaiser Foundation Hospitals 2013 Community Health Needs Assessments (CHNA). The terms with
footnotes have been adapted from the Kaiser CHNA Toolkit, developed “in order to standardize the [CHNA] process across the region and to ensure compliance with the Affordable Care Act (ACA) regulations,” as well as to
create a shared understanding of the terms within the CHNA consultants and Kaiser Foundation Hospitals
Community Benefit Managers.
Age-adjusted rate
The incidence or mortality rate of a disease can depend on age distribution within a community. Because chronic
diseases and some cancers affect older adults disproportionately, a community with a higher number of older
adults might have a higher mortality or incidence rate for some diseases than another community with a higher
percentage of population of younger people. An age-adjusted incidence or mortality rate allows for taking the
proportion of persons in corresponding age groups into consideration when reviewing statistics, which allows for
more meaningful comparisons between communities with different age distributions.
Benchmark1
A benchmark is a measurement that serves as a standard by which other measurements and/or statistics may be
measured or judged. In the case of the CHNA reports, the term “benchmark” indicates a standard by which a
community can determine how well or not well the community is performing in comparison to the standard for
specific health outcomes. For the purpose of the Kaiser Foundation Hospitals CHNA reports, one of three benchmarks has been used to make comparisons with the medical center area. These include statistics published by
Healthy People 2020, Los Angeles County and California.
Community assets
Those people, places, and relationships that provide resources, individually or in the aggregate, to bring about the
maximal functioning of a community. (Example: Federally Qualified Health Care Centers, primary care physicians, hospitals and medical clinics, community-based organizations, social service and other public agencies,
parks, community gardens, etc.)
Community Health Needs Assessment2
Abbreviated as CHNA, a systematic process involving the review of public data and input from a broad cross-section of community resources and participants to identify and analyze community health needs and assets.
Community served
Based on Affordable Care Act (ACA) regulations, the “community served” is to be determined by each individual
hospital. The community served is generally defined by a geographical location such as a city, county, or
metropolitan region. A community served may also take into consideration certain hospital focus areas (i.e., cancer, pediatrics) though is not defined so narrowly as to intentionally exclude high-need groups such as the elderly
or low-income individuals.
Consultant
Individuals or firms with specific expertise in designing, conducting, and managing a process on behalf of the
client.
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Data set
A data set refers to a set or grouping of secondary, usually quantitative, data.
Data source
Data source refers to the original source (i.e., database, interview, focus group, etc.) from which quantitative or
qualitative data were collected.
Disease burden
Disease burden refers to the impact of a health issue not only on the health of the individuals affected by the disease, but also on the financial cost of addressing the health issue, such as public expenditures. The burden of disease can also refer to the disproportionate impact of a disease on certain populations, which may negatively affect
quality of life, socioeconomic status, and other factors.
Drivers of health
Drivers of health are risk factors that may positively or negatively impact a health outcome. For the purposes of
the Kaiser Foundation Hospitals CHNA, drivers have been separated into four categories: social and economic
factors, physical environment, health behaviors, and clinical care access and delivery.
FQHC3
Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the
federal Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. Certain tribal organizations and FQHC look-alikes (organizations that meet PHS Section 330 eligibility
requirements but do not receive grant funding) also may receive special Medicare and Medicaid reimbursements.
Focus group
A gathering of people (also referred to as stakeholders) for the purpose of sharing and discussing a specific
topic—in this case, community health.
Health disparity
Diseases and health problems do not affect all populations in the same way. Health disparity refers to the
disproportionate impact of a disease or a health problem on specific populations. Much health disparity research
literature focuses on racial and ethnic differences—as to how these communities experience specific diseases—
however, health disparity can also be correlated with gender, age, and other factors, such as veteran, disability,
and housing status.
Health driver
Health drivers are behavioral, environmental, social, economic, and clinical-care factors that positively or negatively impact health. For example, smoking (behavioral) is a health driver for lung cancer, and access to safe
parks (environmental) is a health driver for obesity/overweight. Some health drivers, such as poverty or lack of
insurance, impact multiple health issues.
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Health indicator4
A characteristic of an individual, population, or environment that is subject to measurement (directly or indirectly)
and can be used to describe one or more aspects of the health of an individual or population. (Example: Percent of
children overweight in Los Angeles County, incidence of breast cancer in Los Angeles County)
Health need
Kaiser Permanente uses the Mobilizing Action Toward Community Health (MATCH) framework to understand
population health, and defines a health need as any of the following that arise from a comprehensive review and
interpretation of a robust data set: a) a poor health outcome and its associated health driver and/or b) a health
drive/factor associated with poor health outcome(s), where the outcome itself has not yet arisen as a need. (Example: breast cancer, obesity and overweight, asthma, physical inactivity, access to healthcare)
Health outcomes5
Snapshots of diseases in a community that can be described in terms of both morbidity and mortality. (Example:
breast cancer prevalence, lung cancer mortality, homicide rate)
Healthy People 20206
Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to
encourage collaborations across communities and sectors, empower individuals toward making informed health
decisions, and measure the impact of prevention activities.
Implementation strategy7
The nonprofit hospital’s plan for addressing the health needs identified through the CHNA.
Incidence8 rate
Incidence is a measure of the occurrence of new disease or health problem in a population of people at risk for the
disease within a given time period. (Example: 1,000 new cases of breast cancer in 2011) Incidence rate is
expressed either as a fraction (e.g., percentage) or a density rate (e.g., x number of cases per 10,000 people) to
allow for comparison between different communities. Incidence rate should not be confused with prevalence rate,
which measures the proportion of people found to have a specific disease or health problem (see prevalence rate).
Morbidity rate
Morbidity rate refers to the prevalence of a disease. Morbidity rate is usually expressed as a density rate (e.g. x
number of cases per 10,000 people). Prevalence is often used to measure the level of morbidity in a population.9
Mortality rate
Mortality rate refers to the number of deaths in a population resulting from a disease. Mortality rate is usually
expressed as a density rate (e.g., x number of cases per 10,000 people).
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Percent
A percent is the portion of the total population that currently has a given disease or health problem. Percent is
used to communicate prevalence, for example, and to give an idea of the severity (or lack thereof) of a disease or
health problem.
Prevalence10
Prevalence is the proportion of total population that currently has a given disease. (Example: 1,000 total cases of
lung cancer in 2011)
Prevalence rate
Prevalence rate is the proportion of total population that currently has a given disease or health problem. Prevalence rate is expressed either as a fraction (e.g., percentage) or a density rate (e.g., x number of cases per 10,000
people) to allow for comparison between different communities. Prevalence rate is distinct from incidence rate,
which focuses on new cases. For instance, a community may experience a decrease in new cases of a certain disease (incidence) but an increase in the total number of people suffering that disease (prevalence) because people
are living longer as a result of better screening or treatment for that disease.
Primary data
Primary data are new data collected or observed directly from first-hand experience. They are typically qualitative
(not numerical) in nature. For this CHNA, primary data were collected through focus groups and interviews with
key stakeholders. Primary data describes what is important to the people who provide the information and is useful in interpreting secondary data (see qualitative data, quantitative data, secondary data). (Example: Focus
groups, key informant interviews)
Qualitative data11
These are typically descriptive in nature and not numerical; however, qualitative data can be coded into numeric
categories for analysis. Qualitative data is considered to be more subjective than quantitative data, but they provide information about what is important to the people (see stakeholder) who provide the information. (Example:
focus group data)
Quantitative data12
Data that has a numeric value. Quantitative data is considered to be more objective than qualitative data (Example: State or National survey data)
Risk factor13
Characteristics (genetic, behavioral, and environmental exposures and sociocultural living conditions) that
increase the probability that an individual will experience a disease (morbidity) or specific cause of death (mortality). Some risk factors can be changed through behavioral or external changes or influences (e.g., smoking) while
others cannot (e.g., family history).
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Secondary data
Data that has already been collected and published by another party. Typically, secondary data collected for
CHNAs is quantitative (numerical) in nature (Example: California Health Interview Survey [CHIS], Behavioral
Risk Factor Surveillance System [BRFSS]) Secondary data are useful in highlighting in an objective manner
health outcomes that significantly impact a community.
Stakeholder
Stakeholders are people who represent and provide informed, interested perspectives regarding an issue or topic.
In the case of CHNAs, stakeholders include health care professionals, government officials, social service providers, community residents, and community leaders, among others.
1
Merriam-Webster Dictionary. Retrieved from [http://www.merriam-webster.com/dictionary/benchmark]
2
World Health Organization (WHO). Retrieved from [http://www.who.int/hia/evidence/doh/en/]
3
U.S. Department of Health and Human Services. Rural Health IT Toolbox. Retrieved from
[http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/qualified.html] Accessed [April 30, 2013].
4
“Health Promotion Glossary,” World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health
Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998.
5
“Health Promotion Glossary,” World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health
Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998.
6
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington,
DC. Available at [http://healthypeople.gov/2020/default.aspx] Accessed [April 30, 2013]
7
Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft.
Retrieved from [http://www.chausa.org/Assessing_and_Addressing_Community_Health_Needs.aspx]
8
Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett
Publishers.
9
New York State Department of Health. Basic Statistics: About Incidence, Prevalence, Morbidity, and Mortality—Statistical Teaching
Tools. Retrieved from [http://www.health.ny.gov/diseases/chronic/basicstat.htm] Accessed on [May 1, 2013].
10
Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett
Publishers.
11
Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft.
Retrieved from [http://www.chausa.org/Assessing_and_Addressing_Community_Health_Needs.aspx]
12
Ibid.
13
Adapted from: Green L. & Kreuter M. (2005). Health program planning: An educational and ecological approach. 4th edition. New
York, NY: McGraw Hill.
Page 75
Appendix B:
KFH-LA
Health Needs Profiles
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Health Need Profile: Mental Health
**Overall Ranking Resulting from Prioritization: 1 of 22
About Mental Health—Why is it important?
Among adults, mental disorders are common, with approximately one-quarter of adults being diagnosable for one
or more disorders. Mental illness is a common cause of disability. Untreated disorders may leave individuals atrisk for substance abuse, self-destructive behavior, and suicide. Additionally, mental health disorders can have a
serious impact on physical health and are
“People who have lost their jobs recently and the newly
associated with the prevalence, progression and
1
homeless are the most affected. There is also a stigma about
outcome of chronic diseases . Suicide is
mental health and some people won’t seek help, don’t know
considered a major preventable public health
about resources, how to get on Medicare or Medi-Cal, or
problem. In 2010, suicide was the tenth leading
get access to other health resources.”
cause of death among Americans of all ages,
(vice president of human resources,
and the second leading cause of death among
community-based organization)
people between the ages of 25 to 34.2 An estimated 11 attempted suicides occur per every suicide death.
Research shows that more than 90 percent of those who die by suicide suffer from depression or other mental
disorders, or a substance-abuse disorder (often in combination with other mental disorders).3 Among adults,
mental disorders are common, with approximately one-quarter of adults being diagnosable for one or more disorders.4 Mental disorders are not only associated with suicide, but also with chronic diseases, a family history of
mental illness, age, substance abuse, and life-event stresses.5
Interventions to prevent suicide include therapy, medication, and programs that focus both on suicide risk and
mental or substance-abuse disorders. Another intervention is improving primary care providers’ ability to recognize and treat suicide risk factors, given the research showing that older adults and women who die by suicide are
likely to have seen a primary care provider in the year before death.6
Major Findings in the Kaiser Foundation Hospital—Los Angeles Service Area (KFH-LA)
 The percentage of adults who self-report poor mental health in the past year was the same (14.0%) in the
KFH-LA service area and for Los Angeles County.
 The mental health hospitalization rate per 100,000 youth in the KFH-LA service area (328.9) is higher
when compared to California (256.4).
 The mental health hospitalization rate per 100,000 adults is over double (1,021.5) in the KFH-LA service
area when compared to California (551.7).
 Mental health hospitalization rates per 100,000 adults are highest in SPA 4 (2,750.0), SPA 6 (642.2), SPA
2 (633.7), and SPA 3 (586.4) when compared to California (551.7).
 Mental health hospitalization rates per 100,000 youth are highest in SPA 6 (490.6), SPA 3 (343.5.), SPA
 More people had serious psychological distress in SPA 6 (14.8%), and SPA 4 (10.7%) when compared to
Los Angeles County (7.3%).
Page 77
 Downtown Los Angeles (32.2) is experiencing a high suicide rate.
 African-Americans (19.3%) had the highest rates of poor mental health, followed by Whites (17.8%),
Latinos (13.0%), and Asians (6.5%).
 Stakeholders7 highlighted mental health as impacting a broad spectrum of populations, including people
under the age of 30, low-income women, the homeless, African-Americans, elderly residents of Chinatown, and undocumented individuals.
Statistical data—How is mental health measured? What is the prevalence/incidence rate of mental health in the
community?
In the KFH-LA service area:
 In 2010, the mental health hospitalization rate per 100,000 adults
was double (1,021.5) that of
California (551.7).
 In 2010, the mental health hospitalization rate per 100,000 youth
was higher (328.9) than California
(256.4).
 In 2009, a larger portion (48.2%)
needed treatment for mental illness and did not receive assistance
when compared to Los Angeles
County (47.3%).
Mental Health Indicators
KFHLA
Service
Indicators
Year
Area
Mental health hospitalization rate
2010
1021.5
per 100,000 adults
Mental health hospitalization rate
2010
328.9
per 100,000 youth
Mental health treatment not
2009
48.2%
received
Poor mental health
2009
14.0%
Serious psychological distress
2009
7.7%
Suicide rate per 100,00 persons1
2010
7.8
Comparison
Level
Avg.
CA
551.7
CA
256.4
LAC
47.3%
LAC
LAC
LAC
14.0%
7.3%
8.0
LAC=Los Angeles County
CA=California
1
Healthy People 2020 - <=10.2
 In 2009, more people (7.7%) had serious psychological distress than in Los Angeles County (7.3%).
Sub-populations experiencing greatest impact (disparities)
Within the KFH-LA service area, the following sub-populations are the most severely impacted:
 African-Americans (19.3%) had the highest rates of poor mental health, followed by Whites (17.8%),
Latinos (13.0%), and Asians (6.5%).
Stakeholders identified the homeless, low-income people, veterans, the undocumented, men in gangs, and youth
(foster youth aging out of the foster system and high school youth) as the most severely impacted.
Page 78
Geographic areas of greatest impact (disparities)
Communities experiencing high suicide
rates include (see map):
Suicide Mortality, Rate (Per 100,000 Pop.), CDPH, 2008–10
Over 30.0
 Downtown Los Angeles (32.2)
20.1 - 30.0
By SPA, the following disparities were
found:
10.1 - 20.0
 Mental health hospitalization
rates per 100,000 adults are
highest in SPA 4 (2,750.0), SPA
6 (642.2), SPA 2 (633.7), and
SPA 3 (586.4) when compared to
California (551.7).
Under 10.1
No Suicide
Deaths
No Data or Data
Suppressed
 Mental health hospitalization rates per 100,000 youth are highest in SPA 6 (490.6), SPA 3 (343.5.), SPA
 Larger portions of people had serious psychological distress in SPA 6 (14.8%), and SPA 4 (10.7%) when
compared to Los Angeles County (7.3%).
 More people have gone without mental health treatment in SPA 6 (56.4%), SPA 4 (52.6%), and SPA 3
(52.2%) than in Los Angeles County (47.3%).
Stakeholders identified certain geographic areas, including Skid Row in downtown Los Angeles and Chinatown.
Associated drivers and risk factors—What is driving the high rates of mental health in the community?
Mental health is associated with many other health factors, including poverty, heavy alcohol consumption, poverty, and unemployment. Chronic diseases such as cardiovascular disease, diabetes, and obesity are also associated with mental health disorders such as depression and suicide8. The table below includes drivers that did not
meet the indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison
area/benchmark. For data on additional indicators, please refer to the KFH-LA Scorecard in Appendix C.
Poor-Performing Drivers
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Cardiovascular disease mortality per 10,000 persons
Heart disease hospitalizations per 100,000 persons
Heart disease mortality per 100,000 persons1
Diabetes
Diabetes prevalence
Diabetes hospitalizations per 100,000 adults
Hospitalizations for uncontrolled diabetes per 100,000 persons
Obesity/Overweight
Overweight adults
Overweight youth
Obese youth
Page 79
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
2010
2010
2010
18.5%
174.3
10.5
17.7
LAC
CA
CA
CA
10.5%
145.6
9.7
9.5
2010
2011
2011
36.4%
14.5%
33.4%
LAC
CA
CA
26.4%
14.3%
29.8%
KFH-LA
Year
Service Area
BEHAVIORAL
Alcohol expenditures
2011
1.7%
Heavy drinkers
2010
15.4%
Tobacco expenditures
2011
1.1%
PHYSICAL ENVIRONMENT
Fast food restaurants per 100,000 persons
2009
78.7
SOCIAL AND ECONOMIC
Living below 100% of FPL
2010
19.5%
Living below 200% FPL
2010
43.8%
Living below 100% FPL (children and teens)
2010
28.1%
CLINICAL CARE
Receiving heart disease management
2009
64.4%
ACCESS TO CARE
Do not have a usual source of care
2009
16.3%
Primary care provider per 100,000 persons
2011
80.6
Uninsured
2010
27.9%
Indicators
Comparison
Level
Avg.
CA
LAC
CA
1.7%
15.4%
1.1%
LAC
72.5
LAC
LAC
LAC
15.7%
37.6%
22.4%
LAC
65.5%
LAC
LAC
LAC
16.2%
80.7
22.6%
LAC = Los Angeles County
1
Healthy People 2020 = <=100.8
Community input—What do community stakeholders think about the issue of mental health?
Stakeholders stated that community members had a difficult time
obtaining treatment for mental health issues because of strict
insurance guidelines and the cost of treatment and medication.
Transportation was also a barrier. Stakeholders identified multiple factors that contributed to poor mental health, including stress
caused by the economic downturn, unemployment, immigration
status, abuse (emotional, physical, and sexual), bullying, and
increasing violence.
“Mental and emotional health is the
most difficult to promote because most
are either in denial or embarrassed
about having a health issue and so do
not speak up or do anything about it.”
(resident focus group participant)
Assets—What are some examples of community assets that can address the health need?
Numerous assets and resources are available to respond to health needs within a given community, including
health care facilities, community organizations, and public agencies. The following list includes assets that have
been identified as specifically addressing this health need and/or key drivers related to this health need through
various sources including KFH-LA community partners. Where available, a sampling of community assets
specifically highlighted by stakeholders during interviews and/or focus groups is noted as well.
Some examples of mental health–specific community assets:
 Amanecer Community Counseling Services
 Asian Pacific Counseling Treatment Centers
 Cigna Hospital of Los Angeles Inc.—Silver Lake Medical Center
 Community Clinic Association of Los Angeles County (CCALAC)
 Kaiser Foundation Hospital Mental Health Center
 Kedren Community Mental Health Center
Page 80
 Los Angeles County Department of Mental Health
 Pacific Clinics
 Special Service for Groups (SSG)
 VIP Community Mental Health Center, Inc
Stakeholders identified the following community resources available to address mental health:
 Didi Hirsch Mental Health Services (DHMS)—has instituted a 24/7 suicide help hotline
 Exodus—has partnered with a hospital to provide a 23-hour-a-day open clinic for mental health services
 The Laurel Foundation—tele-mental health program provides online face-time with a social worker and
peers using monitored half-hour online meetings
For information on other assets in the community, please refer to Section VII of the Community Health Needs
Assessment report.
1
DC. Available at [http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=28]. Accessed [April 30, 2013].
2
Centers for Disease Control and Prevention. 10 Leading Causes of Death by Age Group, United States – 2010. Available at
[http://www.cdc.gov/injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf]. Accessed [March 12, 2013].
3
National Institute of Mental Health. Suicide in the U.S.: Statistics and Prevention. Available at
[http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml]. Accessed [March 12, 2013].
4
National Institute of Mental Health. Any Disorder Among Adults. Available at
[http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml]. Accessed [March 12, 2013].
5
Public Health Agency of Canada. Mental Illness. Available at [http://www.phac-aspc.gc.ca/cd-mc/mi-mm/index-eng.php]. Accessed
[March 12, 2013].
6
National Institute of Mental Health. Suicide in the U.S.: Statistics and Prevention. Available at
[http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml]. Accessed [March 12, 2013].
7
Stakeholders included health care professionals, government officials, social service providers, community residents, and community
leaders, among others.
8
Centers for Disease Control and Prevention. Mental Health and Chronic Diseases. Available at
[http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf]. Accessed [May 1, 2013].
Page 81
Health Need Profile: Obesity/Overweight
About Obesity/Overweight—Why is it important?
Obesity, a condition in which a person has an abnormally high and unhealthy proportion of body fat, has risen to
epidemic levels in the United States; 68 percent of adults age 20 years
and older are overweight or obese.1
“Obesity is escalating at its highest
Obesity reduces life expectancy and causes devastating and costly
rate, which causes other chronic
health problems, increasing the risk of coronary heart disease, stroke,
diseases and ailments that shorten a
high blood pressure, diabetes, and a number of other chronic diseases.
person’s lifespan”
(foundation relations director,
Findings suggest that obesity also increases the risks for cancers of the
national health organization)
esophagus, breast (postmenopausal), endometrium, colon and rectum,
kidney, pancreas, thyroid, gallbladder, and possibly other cancer
types.2
Excess weight is a significant national problem and indicates an unhealthy lifestyle that influences further health
issues. Obesity is associated with factors including poverty, inadequate fruit/vegetable consumption, breastfeeding, and lack of access to grocery stores, parks, and open space.
 The portion of adults who are obese is the same (21.4%) in the KFH-LA service area and Los Angeles
County.
 The portion of adults who are overweight in the KFH-LA service area is the same (36.4%) when compared to Los Angeles County.
 In the KFH-LA service area, the portion of youth who are obese is higher (33.4%) when compared to
California (29.8%).
 Slightly more youth are overweight in the KFH-LA service area (14.5%) when compared to California
(14.3%).
 Stakeholders3 attributed being obese and overweight to a lack of access to green space, living in food
deserts, a lack of access to healthy foods such as fruit and vegetables, a lack of safety at parks, and lifestyle choices such as lack of physical activity.
 Stakeholders linked obesity and being overweight to diabetes and hypertension, indicating that these are a
growing issue.
 Stakeholders identified Latinos, African-Americans, low-income people, and youth as the most severely
impacted.
Page 82
Statistical data—How is obesity/overweight measured? What is the prevalence/incidence rate of
obesity/overweight in the community?
 The portion of adults who are
obese is the higher (22.5%) when
compared to Los Angeles County
(21.2%).
 There is higher percent of adults
who are overweight (31.3%) when
compared to Los Angeles County
(29.7%).
Obesity/Overweight Indicators
KFHComparison
LA
Service
Indicators
Year
Area
Level
Avg.
Adults who are obese
2009
22.5%
LAC
21.2%
Adults who are overweight
2010
31.3%
LAC
29.7%
Youth who are obese
2011
33.4%
CA
29.8%
Youth who are overweight
2011
14.5%
CA
14.3%
CA=California
 The portion of youth who are obese is higher (33.4%) when compared to California (29.8%).
 Slightly more youth are overweight (14.5%) when compared to California (14.3%).
 More adult males (21.5%) are obese than females (21.3%).
 More Hispanic/Latino (39.9%), African-American (31.7%), and American Indian/Alaskan Native
(29.8%) youth are obese.
 More African-American (15.2%) and Hispanic/Latino (15.1%) youth are overweight.
Stakeholders identified Latinos, African-Americans, low-income people, and youth as the most severely
impacted.
Communities with the highest portion of youth who are overweight include (see map):
 East Los Angeles (27.6%)
 Monterey Park (27.6%)
Students in the 'Needs Improvement' Body Composition Zone
(Overweight), CA Dept. of Education, 2011
found:
Over 19.0%
16.1 - 19.0%
 Greater percentages of adults in
the KFH-LA service area who
are overweight live in SPA 6
(34.4%), SPA 2 (32.5%), and
SPA 7 (31.2%) when compared
to the overall KFH-LA service
area (31.3%)
13.1 - 16.0%
10.1 - 13.0%
Under 10.1%
Page 83
 Larger portions of adults in the KFH-LA service area who are obese live in SPA 6 (30.5%) and SPA 7
(27.6%) when compared to the overall KFH-LA service area (22.5%).
Associated drivers and risk factors—What is driving the high rates of obesity/overweight in the community?
Obesity is associated with factors such as poverty, inadequate fruit/vegetable consumption, physical inactivity,
and lack of access to grocery stores, parks, and open space. Obesity increases the risk of coronary heart disease,
stroke, high blood pressure, diabetes, and a number of other chronic diseases. The condition also increases the
risks of cancers of the esophagus, breast (postmenopausal), endometrium, colon and rectum, kidney, pancreas,
thyroid, gallbladder, and possibly other cancer types.4 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Colorectal Cancer
Colon/rectum cancer incidence rate per 100,000
persons2
Diabetes
Diabetes prevalence
Hospitalizations for uncontrolled diabetes per 100,000
persons
Hypertension
Adults ever diagnosed with high blood pressure
Obesity/Overweight
Overweight adults
Overweight youth
Obese youth
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
45.1
LAC
45.2
2009
2010
2010
18.5%
174.3
10.5
LAC
CA
CA
10.5%
145.6
9.7
2010
17.7
CA
9.5
2009
27.4%
LAC
25.5%
36.4%
14.5%
33.4%
LAC
CA
CA
26.4%
14.3%
29.8%
LAC
18.1%
LAC
CA
CA
CA
12.5%
37.5%
0.5%
1.1%
LAC
72.5
LAC
LAC
LAC
15.7%
37.6%
22.4%
LAC
65.5%
2010
2011
2011
BEHAVIORAL
Drinking two or more glasses of soda yesterday
2009
18.8%
(youth)
Eat fast food 4 times a week or more
2009
12.7%
Not physically active (youth)
2010
41.9%
Soft drink expenditures
2010
0.5%
2011
1.1%
2009
78.7
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
CLINICAL CARE
2009
64.4%
Page 84
Indicators
Uninsured
KFH-LA
Year
Service Area
ACCESS TO CARE
2009
16.3%
2011
80.6
2010
27.9%
Comparison
Level
Avg.
LAC
LAC
LAC
16.2%
80.7
22.6%
1
2
Community input—What do community stakeholders think about the issue of obesity/overweight?
Stakeholders attributed being obese and overweight to a lack
of access to green space, living in food deserts, a lack of
access to healthy foods such as fruit and vegetables, a lack of
safety at parks, and lifestyle choices such as a lack of physical
activity. Stakeholders added that obesity and being
overweight was closely linked to diabetes and hypertension,
indicating that these are a growing issue.
“There aren’t enough places to get healthy
foods. There are more fast food and liquor
stores in low-income neighborhoods.”
(business and education leader
focus group participant)
Some examples of obesity/overweight-specific community assets:
 American Diabetes Association—Los Angeles Office
 California Certified Farmers Markets
 Glendale Adventist Medical Center
 Huntington Memorial Hospital
 JWCH Institute, Inc.
 Latino Diabetes Association
 Providence St. Joseph Medical Center
 White Memorial Medical Center
Stakeholders identified the following community resources available to address obesity/overweight issues:
 Clínica Monseñor Oscar A. Romero (all locations)—has worked to provide a community garden,
information on how to harvest fresh vegetables, and exercise activities
 Esperanza Community Housing Corporation—provides education classes on health care promotion, nutrition and diabetes; a community resource for care
Page 85
 Los Angeles Unified School District (LAUSD)—started Healthy Lunch and the ‘Walk to School’
monthly program and activities
 St. John’s Well Child and Family Center—provides educational classes on nutrition, disease management, and ways to support a healthy lifestyle
Assessment report.
1
National Cancer Institute. Obesity and Cancer Risk. Available at [http://www.cancer.gov/cancertopics/factsheet/Risk/obesity]. Accessed
[March 10, 2013].
2
Ibid.
3
4
National Cancer Institute. Obesity and Cancer Risk. Available at [http://www.cancer.gov/cancertopics/factsheet/Risk/obesity]. Accessed
[March 10, 2013].
Page 86
Health Need Profile: Oral Health
About Oral Health—Why is it important?
Oral health is essential to overall health and is relevant because engaging in preventative behaviors decreases the
likelihood of developing future oral health and related health problems. In addition, oral diseases such as cavities
and oral cancer cause pain and disability for many Americans.1
Behaviors that may lead to poor oral health include tobacco use, excessive alcohol consumption, and poor dietary
choices. Barriers that prevent or limit a person’s use of preventative intervention and treatments for oral health
include limited access to and availability of dental services, a lack of awareness of the need, cost, and fear of dental procedures. Social factors associated with poor dental health include lower levels or lack of education, having
a disability, and other health conditions such as diabetes.2
 The portion of youth unable to afford dental care is between 6.1% and 8.0% throughout the KFH-LA service area.
 The portion of adults without a dental exam in the last year is between 30.1% and 40.0% throughout the
KFH-LA service area.
 Poor oral health is more common among the Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%)
sub-populations, specifically because of a lack of dental insurance.
 Hispanic/Latino youth (or children) are the largest portion (8.3%) among other youth who are unable to
afford dental care and have not had a dental exam (49.3%).
 Stakeholders identified low-income people, uninsured, the homeless (specifically veterans), and Latinos
as the most severely impacted.
 Stakeholders identified Chinatown and Skid Row in Downtown Los Angeles as the most severely
impacted.
Statistical data—How is oral health measured? What is the prevalence/incidence rate of dental health in the
community?
 In 2010, an equal portion of adults
had poor dental health when compared to Los Angeles County
(11.6%).
Oral Health Indicators
KFHLA
Year
Service
Indicators
Area
Poor dental health (adults)
2010
11.6%
Page 87
Comparison
Level
Avg.
LAC
11.6%
 Poor oral health is more common among the Hispanic/Latino (43.7%) and Asian/Pacific Islander (40.6%)
sub-populations, specifically because of a lack of dental insurance.
 Hispanic/Latino youth (or children) are the largest portion (8.3%) of youth who are unable to afford dental care and have not had a dental exam (49.3%).
Stakeholders identified low-income people, the uninsured, the homeless (specifically veterans), and Latinos as the
most severely impacted.
In the KFH-LA service area (see
maps):
Youth Unable to Afford Dental Care (Age 2–17), CHIS 2009
 The portion of youth unable
to afford dental care is
between 6.1% and 8.0%
throughout.
Over 10.0%
8.1 - 10.0%
6.1 - 8.0%
 The portion of adults without
a dental exam in the last year
is between 30.1% and 40.0%
throughout
4.1 - 6.0%
Under 4.1%
Stakeholders identified Chinatown
and Skid Row in downtown Los Angeles as the most severely impacted.
Population (Age 18 ) without Dental Exam within Past 1 Year,
CDC BRFSS 2006–2010
Over 50.0%
40.1 - 50.0%
30.1 - 40.0%
20.1 - 30.0%
Under 20.1%
Page 88
Associated drivers and risk factors—What is driving the high rates of poor oral health in the community?
Poor oral health can be prevented by decreasing sugar intake and eating well to prevent tooth decay and premature
tooth loss; eating more fruits and vegetables to protect against oral cancer; smoking cessation; decreased alcohol
consumption to reduce the risk of oral cancers, periodontal disease, and tooth loss; using protective gear when
playing sports; and living in a safe physical environment.3 In addition, oral health conditions such as periodontal
(gum) disease has been linked to diabetes, heart disease, stroke, and premature, low-eight births4.The table below
includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA service area is performing
worse than the comparison area/benchmark. For data on additional indicators, please refer to the KFHLA Scorecard in Appendix C.
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
persons
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
2010
2010
18.5%
174.3
10.5
LAC
CA
CA
10.5%
145.6
9.7
2010
17.7
CA
9.5
18.8%
LAC
18.1%
12.7%
41.9%
0.5%
1.1%
LAC
CA
CA
CA
12.5%
37.5%
0.5%
1.1%
19.5%
43.8%
28.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
64.4%
LAC
65.5%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
6.3%
11.5%
LAC
LAC
6.2%
10.5%
BEHAVIORAL
(youth)
Uninsured
Dental Care Access
Dental care affordability (children and teens)
Never seen a dentist (children)
2009
2009
2010
2010
2011
SOCIAL AND ECONOMIC
2010
2010
2010
CLINICAL CARE
2009
ACCESS TO CARE
2009
2011
2010
2007
2009
1
Page 89
Community input—What do community stakeholders think about the issue of oral health?
Stakeholders attributed poor oral health to the lack of affordable dental services, a lack of access to dental services, and a
lack of education about health oral health behaviors such as
brushing habits, when to visit doctors, etc.
“I needed two root canals so I visited a private
dentist, but the cost was double what USC
charges, so I went to USC.”
(focus group participant)
Some examples of oral health–specific community assets:
 AIDS Project Los Angeles
 AltaMed Medical and Dental Group
 Arroyo Vista Family Health Center
 Kids’ Community Dental Clinic
 Los Angeles County Department of Health Services
 The Saban Free Clinic
 University of Southern California (USC) School of Dentistry
Stakeholders identified the following community resources available to address oral health:
 Esperanza Community Housing Corporation—provides classes on dental hygiene; a community resource
for care
 St. John’s Well Child and Family Center—provides classes on dental hygiene; a community resource for
care
Assessment report.
1
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32]. Accessed [February 26, 2013].
2
Ibid.
3
World Health Organization, Oral health Fact Sheet. Geneva, Switzerland. Available at
[http://www.who.int/mediacentre/factsheets/fs318/en/index.html]. Accessed [February 26, 2013].
4
Centers for Disease Control and Prevention. Mental Health and Chronic Diseases. Available at
[http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Oral-Health-AAG-PDF-508.pdf]. Accessed [May 1, 2013].
Page 90
Health Need Profile: Diabetes
About Diabetes—Why is it important?
Diabetes affects an estimated 23.6 million people and is the seventh leading cause of death in the United States.
Diabetes lowers life expectancy by up to 15 years, increases the risk of heart disease by two to four times, and is
the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness.1 A diabetes diagnosis can
also indicate an unhealthy lifestyle—a risk factor for further health issues—and is also linked to obesity.
Given the steady rise in the number of people with diabetes,
“Community members do not realize
and earlier onset of Type 2 diabetes, there is growing concern
they
have to change their habits in order
about substantial increases in diabetes-related complications
to live a healthier life.”
and their potential to impact and overwhelm the health care
system. There is a clear need to take advantage of recent
discoveries about the individual and societal benefits of improved diabetes management and prevention by bringing life-saving findings into wider practice, and complementing those strategies with efforts in primary prevention
among those at risk for developing diabetes2.
In addition, evidence is emerging that diabetes is associated with other co-morbidities including cognitive impairment, incontinence, fracture risk, and cancer risk and prognosis3.
 Diabetes prevalence is higher in KFH-LA (18.5%) versus Los Angeles County (10.5%)
 The diabetes hospitalization rate for adults in the KFH-LA service area is higher (174.3) than the Los
Angeles County rate of 145.6 per 100,000 persons.
 Diabetes prevalence is higher among males (8.5%) compared to females (7.1%), and more males (1.1%)
have been discharged from hospitals for diabetes-related incidents than females (0.8%).
 More African-Americans (1.6%) and Hispanic/Latinos (1.0) experienced hospital discharges resulting
from diabetes than other groups.
 Those between the ages of 45 and 64 (1.5%) and 65 and over (1.0%) experienced the most hospital incidents resulting from diabetes compared to other age groups.
 Stakeholders4 noted that the elderly, adult Chinatown residents, recent immigrants, the homeless, Latinos,
and Latino residents of Skid Row are particularly impacted by diabetes.
Page 91
Statistical data—How is diabetes measured? What is the prevalence/incidence rate of diabetes in the
community?
 In 2010, the diabetes
hospitalization rate was
higher at 174.3 adults per
100,000 persons when compared to the Los Angeles
County rate of 145.6 per
100,000 persons.
Diabetes Indicators
Indicators
Diabetes prevalence among adults
Diabetes hospitalizations per 100,000
adults
adults
Uncontrolled diabetes hospitalizations per 100,000 persons
children
 In 2010–2011, the diabetes
hospitalization rate for adults
was higher at 10.5 adults per
10,000 persons when compared to the Los Angeles County rate of 9.7 per 10,000 persons.
Year
2009
KFH-LA
Service
Area
7.7%
Comparison
Level
LAC
Avg.
7.7%
2010
174.3
LAC
145.6
2010
10.5
LAC
9.7
2010
17.7
LAC
9.5
2010
2.3
LAC
4.8
 In 2009, the uncontrolled diabetes hospitalization rate was higher at 17.7 adults per 100,000 persons,
above the Los Angeles County rate of 9.5 per 100,000 persons.
Within the KFH-LA service area, the following sub-populations are most severely impacted:
 Diabetes prevalence is higher among males (8.5%) compared to females (7.1%).
 More males (1.1%) have been discharged from hospitals for diabetes-related incidents than females
(0.8%).
 More African-Americans (1.6%) and Hispanic/Latinos (1.0) experienced hospital discharges resulting
from diabetes than other groups.
 Those between the ages of 45 and 64 (1.5%) and 65 and over (1.0%) experienced the most hospital incidents resulting from diabetes compared to other age groups.
Stakeholders also identified Latinos, Asians, women, the aging population, the uninsured, and the undocumented
as the most impacted sub-populations.
Page 92
Communities experiencing the highest hospital diabetes-related discharge rates include (see map):
 The northwest side of Pasadena
(19.0)
Diabetes Discharge Rate (Per 10,000 Pop.), OSHPD, 2010–11
Over 14.00
 The City Terrace area (ranging
between 14.6 and 17.2)
10.01 - 14.00
 The west part of East Los
Angeles (20.3)
6.01 - 10.00
2.01 - 6.00
 Los Angeles (ranging between
14.6 and 19.1)
Under 2.01
found:
 Diabetes prevalence highest in
SPA 7 (23.3%), SPA 6 (231%), SPA 4 (17.1%), SPA 3 (16.9%), SPA 2 (12.3%)
 Diabetes hospitalization rates per 100,000 persons in SPA 6 (227.9), SPA 7 (207.2), and SPA 4 (186.2)
were higher when compared to Los Angeles County (145.6).
 Uncontrolled diabetes hospitalization rates per 100,000 persons were higher than Los Angeles County
(9.5) across all SPAs, but specifically in SPA 6 (23.9), SPA 4 (21.6), and SPA 7 (19.9), where rates were
more than double that of Los Angeles County.
Associated drivers—What is driving the high rates of diabetes in the community?
Factors associated with diabetes include being overweight; having high blood pressure, high cholesterol, high
blood sugar (or glucose); physical inactivity, smoking, unhealthy eating, age, race, gender, and having a family
history of diabetes.5 The table below includes drivers that did not meet the indicated benchmark, indicating that
the KFH-LA service area is performing worse than the comparison area/ benchmark. Drivers performing significantly worse include the percentage of youth who are not physically active (41.9%) compared to California
(37.5%). The number of fast food restaurants per 100,000 persons is significantly higher in the KFH-LA service
area (78.7) compared to Los Angeles County (72.5). For data on additional indicators, please refer to the KFHLA Scorecard in Appendix C.
Indicators
Overweight youth
Obese youth
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2011
14.5%
2011
33.4%
Comparison
Level
Avg.
CA
CA
14.3%
29.8%
BEHAVIORAL
(youth)
2009
18.8%
LAC
18.1%
2009
12.7%
LAC
12.5%
2010
41.9%
CA
37.5%
Page 93
Indicators
KFH-LA
Service Area
0.5%
1.1%
Year
2010
2011
Comparison
Level
CA
CA
Avg.
0.5%
1.1%
LAC
72.5
LAC
15.7%
43.8%
28.1%
LAC
LAC
37.6%
22.4%
CLINICAL CARE
2009
64.4%
LAC
65.5%
ACCESS TO CARE
2009
16.3%
LAC
16.2%
80.6
LAC
80.7
2009
78.7
SOCIAL AND ECONOMIC
2010
19.5%
2010
2010
2011
“The main issue is families and
culture. They tend to eat the same kind
of food as in the past even if it’s
unhealthy.”
“There aren’t enough places to get healthy foods.
There are more fast food and liquor stores in lowincome neighborhoods.”
(business and education focus group participant)
Uninsured
2010
27.9%
LAC
22.6%
Community input—What do community stakeholders think about the issue of diabetes?
Stakeholders linked diabetes to obesity and hypertension. They also attributed the prevalence of diabetes to a
number of factors, including the high cost of and lack of access to healthy food, as well as living in a food desert
and lifestyle choices. Other factors include a lack of access to health services, language barriers, and transportation. Stakeholders also stated that diabetes is a growing issue.
Page 94
Some examples of diabetes-specific community assets:
 American Diabetes Association—Los Angeles Office
 Children’s Hospital of Los Angeles
 JWCH Institute, Inc.
 Latino Diabetes Association
 Providence St. Joseph Medical Center
Stakeholders identified the following community resources available to address diabetes:
 Esperanza Community Housing Corporation—provides education classes on health care promotion, nutrition, and diabetes; a community resource for care
 St. John’s Well Child and Family Center—provides education classes on health care promotion, nutrition,
and diabetes; a community resource for care
 University of Southern California (USC)—provides services such as health screenings and education to
parents about nutrition and diabetes prevention
Assessment report.
1
2
Ibid.
3
Ibid.
4
Page 95
Health Need Profile: Disability
About Disability—Why is it important?
An umbrella term for impairments, activity limitations, and participation restrictions, disability is the interaction
between individuals with a health condition (e.g., cerebral palsy, Down syndrome, and depression) and personal
and environmental factors (e.g., negative attitudes, inaccessible transportation and public buildings, and limited
social supports).1 Examples of disabilities include impairment of hearing, vision, movement, thinking, remembering, learning, communication, and/or mental health and social relationships. Disabilities can affect a person at any
point in the life cycle.2
Over a billion people—corresponding to about 15% of the world population—are estimated to live with some
form of disability. Between 110 million (2.2%) and 190 million (3.8%) people 15 years and older have significant
difficulties functioning. In addition, rates of disability are increasing, in part as a result of aging populations and
increases in chronic health conditions. People with disabilities typically have less access to health care services
and often do not have their health care needs met.3
In California alone, 5.7 million adults, or 23 percent of the adult population, have a disability. The proportion of
the population with disabilities increases with age and among females and African American, whites, or American
Indian/ Alaskan native populations. People with disabilities are also more likely than others to be poorly educated,
unemployed, and living below the poverty level. 4
 Disability rates in the KFH-LA service area and Los Angeles County are the same, at 9.38%.
 Stakeholders5 identified youth with IEPs (Individualized Education Plans) and the aging as the most
severely impacted populations.
Statistical data—How is disability measured? What is the prevalence/incidence rate of disability in the
community?
 In 2010, disability was equally
prevalent when compared to Los
Angeles County (9.4%).
Indicators
Disability prevalence in
adults
Disability Indicator
KFH-LA
Service
Year
Area
2010
9.4%
Comparison
Level
Avg.
LAC
9.4%
Within the KFH-LA service area, secondary data did not indicate disparities among sub-populations.
Stakeholders identified children and the aging as the most severely impacted populations.
Neither secondary data nor stakeholders identified geographic disparities.
Page 96
Associated drivers and risk factors—What is driving the high rates of disability in the community?
Disabilities may occur to anyone at any point in time; however, disability rates are increasing in part as a result of
aging populations and increases in chronic health conditions. People with disabilities typically have less access to
health care services and often do not have their health care needs met.6 People with disabilities are more likely to
experience difficulties or delays in getting the health care they need in a timely manner, including visiting a dentist and getting mammograms and Pap smear tests, among other important diagnostic and preventative resources.
In addition, they are likely to not engage in physical activity, to smoke, to be overweight or obese, to have high
blood pressure, to experience psychological distress, to receive less social/emotional support, and to have high
unemployment rates.7 The table below includes drivers that did not meet the indicated benchmark, indicating that
the KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional indicators, please refer to the KFH-LA Scorecard in Appendix C.
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Heart disease hospitalization per 100,000 persons
Colorectal Cancer
Colon/rectum cancer incidence rate per 100,000
persons2
Diabetes
Diabetes prevalence
persons
Hypertension
Mental Health
Needed help for mental/emotional/alcohol-drug issues
but did not receive treatment
Serious psychological distress in the last year
Mental health hospitalizations per 100,000 adults
Mental health hospitalizations per 100,000 youth
Obesity/Overweight
Overweight youth
Obese youth
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
45.1
LAC
45.2
2009
2010
2010
18.5%
174.3
10.5
LAC
CA
CA
10.5%
145.6
9.7
2010
17.7
CA
9.5
2009
27.4%
LAC
25.5%
2009
48.2%
LAC
47.3%
2009
2010
2010
7.7%
1,021.5
328.9
LAC
CA
CA
7.3%
551.7
256.4
14.5%
33.4%
CA
CA
14.3%
29.8%
LAC
18.1%
LAC
CA
CA
CA
12.5%
37.5%
0.5%
1.1%
LAC
LAC
72.5
1.5%
2011
2011
BEHAVIORAL
2009
18.8%
(youth)
2009
12.7%
2010
41.9%
2010
0.5%
2011
1.1%
2009
78.7
Living in a food desert
2009
1.5%
Page 97
KFH-LA
Year
Service Area
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
Social and emotional support
2010
71.1%
CLINICAL CARE
Adults receiving a sigmoidoscopy, colonoscopy in the
2009
64.9%
last 5 years2
Adults who received a sigmoidoscopy, colonoscopy, or
2009
74.2%
fecal occult blood test
3
Cervical cancer screenings in last 3 years
2010
67.6%
2009
64.4%
ACCESS TO CARE
Children who have never seen a dentist
2009
11.5%
Dental care affordability (children and teens)
2007
6.3%
2009
16.3%
Preventable hospital admission (ACSC) per 1,000 total
2010
101.5
admissions
2011
80.6
Uninsured
2010
27.9%
Indicators
Comparison
Level
Avg.
LAC
LAC
LAC
LAC
15.7%
37.6%
22.4%
71.1%
LAC
65.5%
LAC
75.7%
LAC
LAC
67.6%
65.5%
LAC
LAC
LAC
10.5%
6.2%
16.2%
CA
88.5
LAC
LAC
80.7
22.6%
1
2
Healthy People 2020 = >=70.5%
3
Healthy People 2020 = >=93%
Community input—What do community stakeholders think about the issue of disability?
Stakeholders identified specific cognitive and physical disabilities as being prevalent, including autism and Down
Syndrome.
been identified as specifically addressing this health need, and/or key drivers related to this health need, through
Some examples of disability-specific community assets:
 Area 10 Disabilities Board
 Asian Rehabilitation Services
 California Children’s Medical Services
 Center for the Partially Sighted
 Disability Rights Center California
 Family Resource Network
Page 98
 Lanterman Regional Center
 Parents of Developmentally Disabled Children (CHLA)
 Providence Saint Joseph Medical Center
Stakeholders did not identify community assets specific to disabilities.
Assessment report.
1
World Health Organization. Disability and Health Fact Sheet. Geneva, Switzerland. Available at
[http://www.who.int/mediacentre/factsheets/fs352/en/index.html]. Accessed [March 5, 2013].
2
Center for Disease Control and Prevention. Atlanta, GA. Available at [http://www.cdc.gov/ncbddd/disabilityandhealth/types.html].
Accessed [March 5, 2013].
3
4
California Department of Public Health’s Living Healthy with a Disability Program and Living Healthy Advisory Committee. Planning
for Today, Thinking of Tomorrow – California’s 2011-2016 Strategic Directions for Promoting the Health of People with Disabilities
Sacramento, CA. Available at [http://www.cdph.ca.gov/HealthInfo/injviosaf/Documents/Planning_for_Today.pdf]. Accessed [April 30,
2013].
5
6
7
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=9 Accessed [March 5, 2013].
Page 99
Health Need Profile: Cardiovascular Disease
About Cardiovascular Disease—Why is it important?
Cardiovascular disease—also called heart disease and coronary heart disease—includes several problems related
to plaque buildup in the walls of the arteries, or atherosclerosis. As the plaque builds up, the arteries narrow,
restricting blood flow and creating a risk for heart attack. Currently, more than one in three adults (81.1 million)
in the United States lives with one or more types of cardiovascular disease. In addition to being one of the leading
causes of death in the United States, heart disease results in serious illness and disability, decreased quality of life,
and hundreds of billions of dollars in economic loss every year.1
Cardiovascular disease encompasses and/or is closely linked to a number of health conditions that includes
arrhythmia, atrial fibrillation, cardiac arrest, cardiac rehab, cardiomyopathy, cardiovascular conditions of childhood, high cholesterol, congenital heart effects, diabetes, heart attack, heart failure, high blood pressure, HIV,
heavy alcohol consumption, metabolic syndrome, obesity, pericarditis, peripheral artery disease (PAD), and
stroke.2
 The rate of heart disease in Los Angeles County and the KFH-LA service area is the same, at 5.83%.
 The heart disease hospitalization rate per 100,000 persons is higher (379.7) in the KFH-LA service area
when compared to Los Angeles County (367.1).
 Those most often diagnosed with heart disease in the KFH-LA service area include White (8.2%) and
Hispanic/Latino (5.1%) populations.
 Stakeholders3 identified low-income populations as the most impacted by cardiovascular disease.
Statistical data—How is cardiovascular disease measured? What is the prevalence/incidence rate of cardiovascular disease in the community?
 In 2009, the prevalence rate of heart
disease was the same as in Los
 In 2010, the cardiovascular disease
mortality rate per 10,000 adults was
slightly higher in the KFH-LA service area (15.7) when compared to
Los Angeles County (15.6).
Cardiovascular Disease Indicators
KFH-LA
Service
Indicators
Year
Area
Heart disease prevalence
2009
5.8%
Cardiovascular disease
mortality rate per 10,000
2010
15.7
adults
Heart disease hospitalization
2010
379.7
rate per 100,000 adults
Heart disease mortality rate
2010
130.8
per 100,000 adults1
Stroke mortality per 100,000
2010
34.3
persons
1 Healthy People 2020 = <=100.8
Page 100
Comparison
Level
LAC
Avg.
5.8%
LAC
15.6
LAC
367.1
LAC
147.1
LAC
37.6
 In 2010, hospitalization rates resulting from heart disease per 100,000 persons were higher in the KFHLA service area (379.7) when compared to Los Angeles County (367.1).
The burden of cardiovascular disease is disproportionately distributed across the population. Significant disparities are evident based on gender, age, race/ethnicity, geographic area, and socioeconomic status with regard to the
prevalence of risk factors, access to treatment, appropriate and timely treatment, treatment outcomes, and
mortality.4
In the KFH-LA service area, the following sub-populations are the most severely impacted:
 Those most often diagnosed with heart disease include the White (8.2%) and Hispanic/Latino (5.1%)
populations.
Stakeholders also identified low-income populations as the most severely impacted by cardiovascular disease.
Within the KFH-LA service area, the following geographic disparities were identified (see maps):
 The percent of adults diagnosed
with cardiovascular diseases is
evenly spread, ranging between
5.1% and 6.0%.
Percentage of Adults Ever Diagnosed with Cardiovascular Disease,
CHIS 2009
Over 8.0%
 Mortality rates are the highest in
ZIP code 90021 (205.0).
7.1 - 8.0%
6.1 - 7.0%
found:
5.1 - 6.0%
Under 5.1%
 Cardiovascular disease mortality
rates per 10,000 persons in SPA
3 (21.1), SPA 2 (20.8), and SPA
4 (16.1) were higher when compared to Los Angeles County
(15.6).
Cardiovascular Disease Mortality, Rate (Per 100,000 Pop.),
By ZCTA, CDPH, 2008-10
Over 200.0
 Heart disease–related
hospitalization rates per 100,000
persons in SPA 2 (485.0), SPA 4
(404.4), and SPA 3 (371.5) were
higher when compared to Los
Angeles County (367.1).
160.1 - 200.0
120.1 - 160.0
80.1 - 120.0
Under 80.1
Data Suppressed
or No Data
Stakeholders did not identify geographic
disparities.
Page 101
Associated drivers and risk factors—What is driving the high rates of cardiovascular disease in the community?
The leading risk factors for heart disease are high blood pressure, high cholesterol, smoking, diabetes, poor diet,
physical inactivity, and overweight and obesity. Cardiovascular disease is closely linked with and can often lead
to stroke.5 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFHLA service area is performing worse than the comparison area/benchmark. For data on additional indicators,
please refer to the KFH-LA Scorecard in Appendix C.
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Indicators
Diabetes
Uncontrolled diabetes hospitalizations per 100,000
persons
Diabetes prevalence
Comparison
Level
Avg.
2010
2010
174.3
10.5
CA
CA
145.6
9.7
2010
17.7
CA
9.5
2009
18.5%
LAC
10.5%
Hypertension
Adults diagnosed with high blood pressure
2009
27.4%
LAC
25.5%
Obesity/Overweight
Overweight youth
Obese youth
2011
2011
14.5%
33.4%
CA
CA
14.3%
29.8%
2009
18.8%
LAC
18.1%
2009
2010
2010
2011
12.7%
41.9%
0.5%
1.1%
LAC
CA
CA
CA
12.5%
37.5%
0.5%
1.1%
LAC
72.5
LAC
LAC
LAC
15.7%
37.6%
22.4%
64.4%
LAC
65.5%
101.5
LAC
88.5
16.3%
80.6
20.9%
27.9%
LAC
LAC
LAC
LAC
16.2%
80.7
19.9%
22.6%
BEHAVIORAL
(youth)
2009
78.7
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
Preventable hospital admission (ACSC) per 1,000
admission
Population with Medicaid
Uninsured
CLINICAL CARE
2009
2010
ACCESS TO CARE
2009
2011
2010
2010
Page 102
Community input—What do community stakeholders think about the issue of cardiovascular disease?
Stakeholders linked cardiovascular disease to obesity, diabetes, and hypertension. They attributed high rates of
cardiovascular disease to the lack of access to healthy foods, living in food deserts, living an unhealthy lifestyle, a
lack of access to medical care, and the lack of transportation to obtain medical care.
Some examples of cardiovascular-disease–specific community assets:
 AltaMed Health Services Corporation
 American Heart Association
 California Hospital Medical Center—LA
 Central City Community Health Center
 Glendale Memorial Hospital
 LAC+USC Medical Center
 Los Angeles Community Garden Council
Stakeholders did not identify community assets specific to cardiovascular disease.
Assessment report.
1
2
Ibid.
3
4
Ibid.
5
Ibid.
Page 103
Health Need Profile: Hypertension
About Hypertension—Why is it important?
Hypertension, defined as a blood pressure reading of 140/90 or higher, affects one in three adults in the United
States.1 With no symptoms or warning signs and the ability to cause serious damage to the body, the condition has
been called a silent killer. High blood pressure, if untreated, can lead to heart failure, blood vessel aneurysms, kidney failure, heart attack, stroke, and vision changes or blindness.2 High blood pressure can be controlled through
medicines and lifestyle change; however, patient adherence to treatment regimens is a significant barrier to
controlling high blood pressure.3
High blood pressure is associated with smoking, obesity, the regular consumption of salt and fat, excessive drinking, and physical inactivity. Those at higher risk of developing hypertension include people who have previously
had a stroke and those who have high cholesterol or heart or kidney disease. African-Americans and people with a
family history of hypertension are also at an increased risk of having hypertension.4
 The portion of adults diagnosed with high blood pressure is higher in the KFH-LA service area (27.4%)
when compared to Los Angeles County (25.5%).
 In the KFH-LA service area, SPA 3 (30.6%), SPA 4 (26.0%), and SPA 7 (26.0%) have higher portions of
adults with high blood pressure when compared to Los Angeles County (25.5%).
 Stakeholders5 linked hypertension to diabetes, obesity, and stress. They also attributed its prevalence to
the lack of preventive care and people waiting until an emergency to seek treatment. Lack of access to
care, the high cost of treatment, and poor lifestyles choices also contribute to the prevalence of hypertension.
 Stakeholders identified the uninsured, underinsured, low-income, Latinos, African-Americans, day laborers, and the homeless as the most severely impacted.
 Stakeholders identified Los Angeles as the most severely impacted geographic area.
Statistical Data—How is hypertension measured? What is the prevalence/incidence rate of hypertension in the
community?
 In 2009, the incidence rate for hypertension was higher (27.4%) when compared
to Los Angeles County (25.5%).
Indicators
Hypertension incidence rate
Hypertension Indicator
KFH-LA
Service
Year
Area
Page 104
2009
27.4%
Comparison
Level
Avg.
LAC
25.5%
Sub-Populations Experiencing Greatest Impact (disparities)
Stakeholders indicated that hypertension mostly impacts Latinos, African-Americans, the homeless, uninsured,
underinsured, and day laborers.
Geographic Areas of Greatest Impact (disparities)
Within the KFH-LA service area, the following geographic disparities were identified:
 The incidence rate for hypertension was highest in SPA 6 (34.1%), SPA 3 (30.6%), SPA 4 (26.0%), and
SPA 7 (26.0%) when compared to Los Angeles County (25.5%).
Stakeholders indicated that Los Angeles is the most severely impacted geographic area.
Associated Drivers and Risk Factors—What is driving the high rates of hypertension in the community?
Smoking, obesity, the regular consumption of salt and fat, excessive drinking, and physical inactivity are risk factors for hypertension. People who have previously had a stroke, have high cholesterol, or have heart or kidney
disease are also at higher risk of developing hypertension. The table below includes drivers that did not meet the
indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2010
2010
2010
BEHAVIORAL
Drinking two or more glasses of soda yesterday (youth)
2009
2009
2010
2010
2011
2009
SOCIAL AND ECONOMIC
2010
2010
2010
CLINICAL CARE
2009
ACCESS TO CARE
2009
2011
Uninsured
2010
1
Page 105
Comparison
Level
Avg.
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
18.8%
12.7%
41.9%
0.5%
1.1%
LAC
LAC
CA
CA
CA
18.1%
12.5%
37.5%
0.5%
1.1%
78.7
LAC
72.5
19.5%
43.8%
28.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
64.4%
LAC
65.5%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of hypertension?
Stakeholders indicated that hypertension is
“Hypertension is going up because people are not getting it
closely related and linked to diabetes, obesity,
checked,
they not aware have it, they not going to [a] doctor on
stress, and lifestyle choices. Stakeholders
a regular basis, and, as the population ages, they have a
added that people were not getting regular
tendency to have higher blood pressure.”
medical check-ups and were waiting until an
(foundation relations director, health organization)
emergency, often because the cost of seeking
treatment is high and there is a lack of access to health care.
Some examples of hypertension-specific community assets:
 Chinatown Service Center
 Kaiser Foundation Hospital – Los Angeles
Stakeholders did not identify community assets specific to hypertension.
Assessment report.
1
National Institutes of Health. Hypertension (High Blood Pressure). Available at
[http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=97]. Accessed [March 12, 2013].
2
National Heart, Lung, and Blood Institute. Blood Pressure: Signs & Symptoms. Available at [http://www.nhlbi.nih.gov/health/healthtopics/topics/hbp/signs.html]. Accessed [March 12, 2013].
3
National Institutes of Health. Hypertension (High Blood Pressure). Available at
[http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=97]. Accessed [March 12, 2013].
4
The Patient Education Institute. Essential Hypertension. Available at
[http://www.nlm.nih.gov/medlineplus/tutorials/hypertension/hp039105.pdf]. Accessed [March 12, 2013].
5
Page 106
Health Need Profile: Cholesterol
About Cholesterol—Why is it important?
Cholesterol is a waxy, fat-like substance necessary in the body. However, if too much cholesterol is present in the
blood, this can build up on artery walls, leading to heart disease—one of the leading causes of death in the United
States—and stroke. About one of every six adult Americans has high blood cholesterol. In addition, 2,200 Americans die of heart disease each day, an average of one death every 39 seconds.1
Some health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for developing high
cholesterol. Age is a contributing factor; as people get older, cholesterol levels rise. Diabetes can also lead to the
development of high cholesterol. Some behaviors can also lead to high cholesterol, including a diet high in saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. Being overweight and physical inactivity can also contribute to high cholesterol. Finally, high cholesterol can be hereditary.2
 In the KFH-LA service area, the percent of adults who take medicine to lower cholesterol was slightly
higher in SPA 3 (81.4%), SPA 6 (78.3%), and SPA 5 (75.8%) when compared to Los Angeles County
(71.2%).
Statistical data—How is cholesterol measured? What is the prevalence/incidence rate of cholesterol in the
community?
 In 2009, the portion of adults who
take medication to lower their cholesterol was slightly lower (70.5%)
County (71.2%).
Indicators
Adults who take medication to lower their
cholesterol
Cholesterol Indicators
KFH-LA
Service
Year
Area
2009
70.5%
Comparison
Level
Avg.
LAC
71.2%
Sub-Populations Experiencing Greatest Impact (disparities)
Stakeholders3 identified Latinos and the aging population as the most severely impacted.
Within the KFH-LA service area, the following disparities were found by SPA:
 Larger portions of adults who take medication to lower cholesterol live in SPA 3 (81.4%), SPA 6
(78.3%), and SPA 5 (75.8%) when compared to Los Angeles County (71.2%).
Stakeholders did not identify geographic disparities.
Page 107
Associated drivers and risk factors—What is driving the high rates of cholesterol in the community?
Some health conditions, as well as lifestyle and genetic factors, can put people at a higher risk for developing high
cholesterol. Age is a contributing factor; as people get older, cholesterol level tends to rise. Diabetes can also lead
to the development of high cholesterol. Some behaviors can also lead to high cholesterol, including a diet high in
saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. Being overweight and physical
inactivity can also contribute to high cholesterol. Finally, high cholesterol can be hereditary.4 The table below
Indicators
Year
BEHAVIORAL
(youth)
Uninsured
KFH-LA
Service Area
Comparison
Level
Avg.
2009
18.8%
LAC
18.1%
2009
2010
2010
12.7%
41.9%
0.5%
LAC
CA
CA
12.5%
37.5%
0.5%
2011
1.1%
CA
1.1%
LAC
72.5
LAC
LAC
15.7%
37.6%
28.1%
LAC
22.4%
CLINICAL CARE
2009
64.4%
LAC
65.5%
ACCESS TO CARE
2009
2011
16.3%
80.6
LAC
LAC
16.2%
80.7
27.9%
LAC
22.6%
2009
78.7
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
2010
Community input—What do community stakeholders think about the issue of cholesterol?
Stakeholders linked high cholesterol to poor nutrition and poor lifestyle choices.
Page 108
Some examples of cholesterol-specific community assets:
 Central City Community Health Center
Stakeholders did not identify community assets specific to cholesterol.
Assessment report.
1
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. High Cholesterol. Atlanta, GA.
Available at [http://www.cdc.gov/cholesterol/index.htm]. Accessed [March 4, 2013].
2
Ibid.
3
4
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. High Cholesterol. Atlanta, GA.
Available at [http://www.cdc.gov/cholesterol/index.htm]. Accessed [March 4, 2013].
Page 109
Health Need Profile: Alcohol and Substance Abuse
About Alcohol and Substance Abuse—Why is it important?
Substance abuse has a major impact on individuals, families, and communities. The effects of substance abuse
significantly contribute to costly social, physical, mental, and public health problems, including teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse, motor vehicle accidents (unintentional injuries), physical fights, crime, homicide, and suicide. In addition to the considerable health implications, substance abuse has
been a major focal point in discussions about social values: people argue over whether substance abuse is a disease with genetic and biological foundations or a matter of personal choice.1 Heavy alcohol consumption is an
important determinant of future health needs, including cirrhosis, cancers, and untreated mental and behavioral
health needs.
 The alcohol/drug-induced mental disease hospitalization rate is higher at 838.2 per 100,000 persons in the
KFH-LA service area than in Los Angeles County (109.1)
 The rate of liquor store access per 100,000 persons in communities within the KFH-LA service area is
high in ZIP Codes 90021 (303.7), and 91210 (914.6).
 Stakeholders2 identified Los Angeles as generally impacted by alcohol and substance abuse.
 Populations impacted by substance abuse include youth, women, Latinos, African-Americans, and people
with low- and middle-class income levels.
Statistical data—How is alcohol and substance abuse measured? What is the prevalence/incidence rate of alcohol
and substance abuse in the community?
 The rate of alcohol and drug– induced
mental disease hospitalization per
100,000 persons is six times higher
(838.2) when compared to Los Angeles County (109.1).
Alcohol and Substance Abuse Indicator
KFH-LA
Comparison
Service
Indicators
Area
Level
Avg.
Alcohol and drug induced
mental disease hospitalization
838.2
LAC
109.1
per 100,000 adults
Secondary data did not indicate disparities among sub-population on the Kaiser Permanente CHNA data platform
or other secondary sources.
Stakeholders identified the homeless, children, the uninsured, youth in or transitioning out of the foster care system, and low-income populations as the most severely impacted sub-populations.
Page 110
 Communities experiencing the highest alcoholic beverages expenditures include the southernmost part
Percentile of Alcohol Expenditures (Pct. of Total Expenditures per Household),
of the KFH-LA service area.
Nielsen Site Reports 2011
 Throughout the KFH-LA service area, the percentage of
adults that drink heavily ranges
between 14.1% and 18.0%.
Top 80th Percentile
(Highest Expenditures)
60th - 80th Percentile
 The rate of liquor store access
in communities within the
KFH-LA service area is high in
ZIP Codes:
Bottom 20th Percentile
(Lowest Expenditures)
Percent of Adults (Age 18+) Drinking Alcohol Heavily, CDC BRFSS 2004-2010
 90021 (303.7 per 100,000
persons)
 91210 (914.6 per 100,000
persons)
Over 22.0%
18.1 - 22.0%
14.1 - 18.0%
10.1 - 14.0%
Stakeholders also identified Los Angeles is generally impacted by alcohol
and substance abuse.
Under 10.1%
Active Retailer License Rate (Per 100,000 Pop.),
CA Dept. of Alcoholic Beverage Control, 2012
Over 300.0
100.1 - 300.0
50.1 - 100.0
Under 50.0
No Active Licenses
Page 111
Associated drivers and risk factors—What is driving the high rates of alcohol and substance abuse in the
community?
Several biological, social, environmental, psychological, and genetic factors are associated with alcohol and substance abuse. These factors may include gender, race and ethnicity, age, income level, educational attainment, and
sexual orientation. Substance abuse is also strongly influenced by interpersonal, household, and community factors. Family, social networks, and peer pressure are key influencers of substance abuse among adolescents.3 As
mentioned earlier, teenage pregnancy, HIV/AIDS, STDs, domestic violence, child abuse, motor vehicle accidents
(unintentional injuries), physical fights, crime, homicide (intentional injuries), and suicide can be attributed to
alcohol and substance abuse.4 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional indicators, please refer to the KFH-LA Scorecard in Appendix C.
Indicators
KFH-LA SerYear
vice Area
HEALTH OUTCOMES
Comparison
Level
Avg.
HIV/AIDS
HIV prevalence rate per 100,000 adults
HIV hospitalization rate per 10,000 adults
2010
2011
2010
15.5
3.2
67.1
LAC
LAC
CA
14.0
2.2
11.0
Intentional Injury
Homicide rate per 100,000 adults
2008
9.1
LAC
8.4
41.9%
CA
37.5%
Not physically active (children)
Adults with no high school diploma
Unemployment rate
Uninsured
BEHAVIORAL
2010
SOCIAL AND ECONOMIC
2010
19.5%
2010
2010
2010
2010
2012
ACCESS TO CARE
2009
2011
2010
LAC
15.7%
43.8%
28.1%
27.0%
71.1%
10.4%
LAC
LAC
LAC
LAC
LAC
37.6%
22.4%
24.1%
71.1%
10.3%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of alcohol and substance abuse?
Stakeholders indicated that alcohol and substance abuse are often associated with mental illness and poverty, and
attribute the prevalence of alcohol and substance abuse to the lack of access to treatment.
Page 112
Some examples of alcohol- and substance-abuse–specific community assets:
 AADAP (Asian American Drug Abuse Program)
 Alcoholics Anonymous (AA) and Al-Anon
 Alcoholism Center for Women
 CHCADA (California Hispanic Commission on Alcohol and Drug Abuse)
 Children’s Hospital Los Angeles
 Good Samaritan Hospital
 Impact Drug and Alcohol Treatment Center
 Los Angeles County Department of Public Health’s Substance Abuse Prevention & Control Unit
 Pacific Clinics
 Pasadena Council on Alcoholism and Drug Dependence, Pasadena
 PROTOTYPES—Community Assessment Services Center
Stakeholders did not identify community assets related to alcohol or substance abuse.
Assessment report.
1
2
3
DC. Available at [http://www.healthypeople.gov/2020/lhi/substanceabuse.aspx?tab=determinants]. Accessed [February 27, 2013].
4
Page 113
Health Need Profile: Intentional Injury
About Intentional Injury—Why is it important?
Intentional injuries and violence are widespread in society and are among the top 15 causes of death of Americans
of all ages. Injuries are the leading cause of death for Americans ages 1 to 44, and a leading cause of disability for
all ages, regardless of sex, race/ethnicity, or socioeconomic status. More than 180,000 people die from injuries
each year, and approximately one in 10 sustains a nonfatal injury serious enough to be treated in a hospital emergency department. Beyond the immediate health consequences, injuries and violence have a significant impact on
well-being, contributing to premature death, disability, poor mental health, high medical costs, and lost productivity, among other issues.1 In addition, violence erodes communities by reducing productivity, decreasing property
values, and disrupting social services.2
 In 2008, in the KFH-LA service area, homicide rates per 100,000 persons are 9.2 in SPA 4, 14.8 in SPA 6
and 10.8 in SPA 7 when compared to Los Angeles County (8.4). In 2010, rates per 100,000 persons were
6.8 in KFH-LA versus 7.0 in Los Angeles County.
 Homicides rates per 100,000 persons in Los Angeles County are highest among African-Americans
(25.2).
 Stakeholders3 identified gay youth, adult males, and adult women with children as particularly impacted
populations.
Statistical data—How is intentional injury measured? What is the prevalence/incidence rate of intentional injuries in the community?
 In 2010, the homicide rate per 100,000
persons (6.8) was lower when compared to Los Angeles County (7.0) but
did not meet the Healthy People 2020
goal (<=5.5).
Intentional Injury Indicators
KFH-LA
Service
Indicators
Year
Area
Homicide rate per 100,000
2010
6.8
persons
Homicide rate per 100,000
2008
9.1
Comparison
Level
Avg.
LAC
7.0
LAC
8.4
 In 2008, the homicide rate per 100,000
Healthy People 2020: <=5.5
persons (9.8) was higher when
compared to Los Angeles County (8.4), and did not meet the Healthy People 2020 goal (<=5.5).
 Homicides rates per 100,000 persons in Los Angeles County are highest among African-Americans (25.2)
followed by Whites (8.7), Hawaiian/Pacific Islanders (2.8), and Hispanic/Latino (3.9).
Stakeholders identified gay youth, adult males, and adult women with children as particularly impacted populations.
Page 114
Communities with the highest homicide
rates per 100,000 persons in the KFH-LA
service area include:
Homicide Mortality, Rate (Per 100,000 Pop.), CDPH, 2008–2010
Over 12.0
 Los Angeles and East Los
Angeles
6.1 - 12.0
3.1 - 6.0
 In Los Angeles, ZIP Codes
90017 (15.2), 90013 (25.7),
90014 (19.4), 90011 (18.0), and
90037 (14.4) experienced high
rates of homicide per 100,000
persons.
Under 3.1
No Homicide
Deaths
Data Suppressed
or No Data
 In East Los Angeles, ZIP Codes
90033 (15.7), 90023 (14.3), and 90063 (13.2) experienced high rates of homicide per 100,000 persons.
By SPA, the following disparities were found:
 High homicide rates per 100,000 persons were reported in SPA 6 (14.8), SPA 7 (10.8), and SPA 4 (9.2).
Associated drivers and risk factors—What is driving the high rates of intentional injury in the community?
Factors associated with intentional injuries include high-risk behaviors such as alcohol use, risk-taking, socializing in unsafe and violent physical environments, as well as economic factors including poverty and unemployment.4 The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA
service area is performing worse than the comparison area/benchmark. For data on additional indicators, please
refer to the KFH-LA Scorecard in Appendix C.
KFH-LA
Indicators
Year
Service Area
HEALTH OUTCOMES
Alcohol/drug induced mental disease hospitalization
2010
838.2%
per 100,000 persons
BEHAVIORAL
2011
1.7%
Heavy drinkers
2010
15.4%
2011
1.1%
2009
1.5%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
Unemployment
2012
10.4%
Page 115
Comparison
Level
Avg.
CA
109.1%
CA
LAC
CA
1.7%
15.4%
1.1%
LAC
1.5%
LAC
LAC
LAC
LAC
15.7%
37.6%
22.4%
10.3%
Indicators
Uninsured
KFH-LA
Year
Service Area
ACCESS TO CARE
2010
71.1%
2011
80.6
2010
27.9%
Comparison
Level
Avg.
LAC
LAC
LAC
71.1%
80.7
22.6%
Community input—What do community stakeholders think about the issue of intentional injuries?
Stakeholders identified intentional injury as an issue commonly found in gay youth, adult males, and adult women
with children as particularly impacted populations.
Some examples of intentional-injury–specific community assets:
 Bienvenidos Children’s Center, Inc.
 Center for the Pacific Asian Family
 East Los Angeles Women’s Center
 Peace First Los Angeles
 St. Vincent Medical Center—Casa de Amigos de San Vicente program
 The Trevor Project
Stakeholders did not identify community assets specific to intentional injuries.
Assessment report.
1
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=24]. Accessed [March 6, 2013].
2
Centers for Disease Control and Prevention. Injury Center: Violence Prevention. Atlanta, GA. Available at
[http://www.cdc.gov/ViolencePrevention/index.html]. Accessed [March 6, 2013].
3
4
DC. Available at [http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=24]. Accessed [March 6, 2013].
Page 116
Health Need Profile: Cancer
About Cancer—Why is it important?
Cancer is the second leading cause of death in the United States, claiming the lives of more than half a million
Americans every year.1 Cancer incidence rates per 100,000 persons show that the three most common cancers
among American men are prostate cancer (137.7), lung cancer (78.2), and colorectal cancer (49.2). Likewise, the
leading causes of cancer death among men are lung cancer (62.0), prostate cancer (22.0), and colorectal cancer
(19.1). Among women, the three most common cancers are breast cancer (123.1), lung cancer (54.1), and colorectal cancer (37.1). Lung (38.6), breast (22.2), and colorectal (13.1) cancers are also the leading causes of cancerrelated deaths among women.2
The number of new cancer cases can be reduced, and many cancer deaths can be prevented. Research shows that
screening for cervical and colorectal cancers, as recommended, helps prevent these diseases by finding precancerous lesions so they can be treated before they become cancerous. Screening for cervical, colorectal, and breast
cancers also helps find these diseases at an early, often highly treatable stage.3 The most common risk factors for
cancer are growing older, obesity, tobacco, alcohol, sunlight exposure, certain chemicals, some viruses and bacteria, a family history of cancer, poor diet, and lack of physical activity.4
 Stakeholders5 identified children and the homeless as the populations most severely impacted by cancer
within the KFH-LA service area.
Statistical data—How is cancer measured? What is the prevalence/incidence rate of cancer in the community?
 In 2010, the cancer mortality rate
per 100,000 persons was lower
(136.7) when compared to Los
Angeles County (156.5), and met
the Healthy People 2020 goal
(<=160.6).
Indicators
Cancer mortality rate per
100,000 persons
Cancer Indicators
KFHLA
Service
Year
Area
2010
136.7
Comparison
Level
LAC
Avg.
156.5
Secondary data for cancer disparities among sub-populations was not identified.
Stakeholders identified children and the homeless as the most severely impacted.
Secondary data and stakeholders did not identify geographic disparities.
Associated drivers and risk factors—What is driving the high rates of cancer in the community?
A primary method of preventing cancer is screening for cervical, colorectal, and breast cancers.6 The most common risk factors for cancer are growing older, obesity, tobacco, alcohol, sunlight exposure, certain chemicals,
Page 117
some viruses and bacteria, a family history of cancer, poor diet, and lack of physical activity.7 The table below
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Indicators
Cervical Cancer
Cervical cancer rate per 100,000 women1
Colorectal Cancer
Colorectal cancer incidence rate per 100,000 persons2
Comparison
Level
Avg.
2009
9.9
LAC
9.9
2009
45.1
LAC
45.2
2009
18.8%
LAC
18.1%
2009
2010
2010
12.7%
41.9%
0.5%
LAC
CA
CA
12.5%
37.5%
0.5%
2011
1.1%
CA
1.1%
LAC
72.5
LAC
LAC
15.7%
37.6%
28.1%
LAC
22.4%
67.6%
85.0%
LAC
LAC
67.6%
84.4%
64.9%
LAC
65.5%
74.2%
LAC
75.7%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
BEHAVIORAL
(youth)
2009
78.7
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
CLINICAL CARE
Women screened for cervical cancer in last 3 years3
2010
Women screened for cervical cancer in last 3 years
2007
Adults 50 years and older who received a sigmoido2009
scopy, colonoscopy in last 5 years4
Adults 50 years and older who received a sigmoido2009
scopy, colonoscopy, or fecal occult blood test (FOTB)
ACCESS TO CARE
2009
2011
Uninsured
2010
1
2
3
Healthy People 2020 = >=93%
4
Community input—What do community stakeholders think about the issue of cancer?
Stakeholders indicated a lack of education around cancer and a limited availability of prevention services.
Page 118
Some examples of cancer-specific community assets:
 American Cancer Society
 City of Hope National Medical Center—Cancer Center
 QueensCare Family Clinics
 St. Vincent Medical Center Cancer Treatment Center
 University of Southern California (USC)/Kenneth Norris Jr. Cancer Hospital—USC Norris Comprehensive Cancer Center
Stakeholders did not identify community assets specific to cancer.
Assessment report.
1
Centers for Disease Control and Prevention. Using Science to Reduce the Burden of Cancer. Available at
[http://www.cdc.gov/Features/CancerResearch/]. Accessed [March 7, 2013].
2
Ibid.
3
Centers for Disease Control and Prevention. Cancer Prevention. Available at [http://www.cdc.gov/cancer/dcpc/prevention/index.htm].
4
National Cancer Institute. Risk Factors. Available at [http://www.cancer.gov/cancertopics/wyntk/cancer/page3]. Accessed [March 7,
2013].
5
6
Centers for Disease Control and Prevention. Cancer Prevention. Available at [http://www.cdc.gov/cancer/dcpc/prevention/index.htm].
7
National Cancer Institute. Risk Factors. Available at [http://www.cancer.gov/cancertopics/wyntk/cancer/page3]. Accessed [March 7,
2013].
Page 119
Health Need Profile: Breast Cancer
About Breast Cancer—Why is it important?
In the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancerrelated death in women. Each year, a small number of men also are diagnosed with and die from breast cancer.
The overall breast cancer death rate has dropped steadily over the past 20 years. However, it is estimated that
approximately $16.5 billion is spent in the U.S. each year on breast cancer treatment.1
The incidence of breast cancer is highest in White women for most age groups, but African-American women
have higher incidence rates before 40 years of age and higher breast cancer mortality rates than women of any
other racial/ethnic group in the United States at every age. The gap in mortality between African-American and
White women is wider now than in the early 1990s.2
Risk factors for breast cancer include older age, certain inherited genetic alterations, hormone therapy, having
chest radiation therapy, drinking alcohol, and obesity. Exercise and maintaining a healthy weight may reduce the
chance of breast cancer.3 Mammograms and clinical breast exams are commonly used to screen for breast cancer.
 Breast cancer incidence rates per 100,000 persons are the same when compared to Los Angeles County
(117.9)
 Within the KFH-LA service area, African-Americans (122.9) and Whites (121.5) have the highest breast
cancer rates.
 Breast cancer is associated with overall cancer mortality, access to breast cancer screening, obesity, and
heavy alcohol consumption.
Statistical data—How is breast cancer measured? What is the prevalence/incidence rate of breast cancer in the
community?
 Breast cancer incidence rates
per 100,000 persons are the
same as in Los Angeles County
(117.9)
Breast Cancer Indicator
KFH-LA
Service
Indicators
Year
Area
Breast cancer incidence per
2009
117.9
100,000 persons
Comparison
Level
Avg.
LAC
 Breast cancer incidence rates per 100,000 persons are highest among African-Americans (122.9) and
Whites (121.5).
Stakeholders4 indicated that low-income women were the most severely impacted by breast cancer.
Page 120
117.9
Secondary data and stakeholders did not indicate geographic disparities.
Associated drivers and risk factors—What is driving the high rates of breast cancer in the community?
Risk factors for breast cancer include older age, certain
“Mammograms for women under 40 years of
inherited genetic alterations, hormone therapy, having
age— mammograms are very expensive and
chest radiation therapy, heavy alcohol consumption, and
difficult to obtain. Even if cancer has been
5
obesity. Breast cancer is associated with overall cancer
detected, it is very hard to obtain services.”
mortality and access to breast cancer screening. Exercise
(focus group participant)
and maintaining a healthy weight may reduce the chance
of breast cancer. The table below includes drivers that did not meet the indicated benchmark, indicating that the
KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional indicators,
Indicators
Overweight adults
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2010
36.4%
Comparison
Level
Avg.
LAC
26.4%
BEHAVIORAL
2009
2009
2010
2010
18.8%
12.7%
41.9%
0.5%
LAC
LAC
CA
CA
18.1%
12.5%
37.5%
0.5%
1.1%
CA
1.1%
LAC
72.5
16.3%
80.6
LAC
LAC
16.2%
80.7
27.9%
LAC
22.6%
Uninsured
2011
2009
78.7
ACCESS TO CARE
2009
2011
2010
Community input—What do community stakeholders think about the issue of breast cancer?
Stakeholders attributed the high rates of breast cancer to a lack of education around health and a lack of access to
health care, including mammograms.
Page 121
Some examples of breast-cancer–specific community assets:
 California Hospital Medical Center—Donald P. Loker Cancer Center
 Clínica Monseñor Oscar A. Romero
 Huntington Memorial Hospital—Constance G. Zahorik Breast Center
 Inner Images
 JWCH Institute
 Korean Health, Education, Information and Research (KHEIR) Center
 Susan G. Komen for the Cure, Los Angeles County Affiliate
 The Saban Free Clinic
Stakeholders did not identify community assets related to breast cancer.
Assessment report.
1
National Cancer Institute. A Snapshot of Breast Cancer. Available at [http://www.cancer.gov/researchandfunding/snapshots/pdf/BreastSnapshot.pdf]. Accessed [March 6, 2013].
2
National Cancer Institute. A Snapshot of Breast Cancer. Available at [http://www.cancer.gov/researchandfunding/snapshots/pdf/BreastSnapshot.pdf]. Accessed [March 6, 2013].
3
National Cancer Institute. Breast Cancer: Prevention, Genetics, Causes. Available at [http://www.cancer.gov/cancertopics/preventiongenetics-causes/breast]. Accessed [March 6, 2013].
4
5
National Cancer Institute. Breast Cancer: Prevention, Genetics, Causes. Available at [http://www.cancer.gov/cancertopics/preventiongenetics-causes/breast]. Accessed [March 6, 2013].
Page 122
Health Need Profile: Alzheimer’s Disease
About Alzheimer’s Disease—Why is it important?
An estimated 5.4 million Americans have Alzheimer’s disease, which is the sixth leading cause of death in the
U.S.1 Alzheimer’s, an irreversible and progressive brain disease, is the most common cause of dementia among
older people. The disease is characterized by the loss of cognitive functioning, and ranges in severity from the
mildest stage of minor cognitive impairment to the most severe stage, when the person with Alzheimer’s must
depend completely on others for tasks of daily living. People with Alzheimer’s disease and other dementias have
more hospital stays, skilled nursing facility stays, and home health care visits than other older people.2
The likely causes of Alzheimer’s disease include some combination
of age-related changes in the brain, a family history of Alzheimer’s,
and genetic, environmental, and lifestyle factors. Some data suggest
that cardiovascular disease risk factors (e.g., physical inactivity,
high cholesterol, diabetes, smoking, and obesity) and traumatic
brain injury are associated with a higher risk of developing Alzheimer’s disease.3
“There is an increasing need for
services for older adults, especially with
the anticipated increase in the number
of people with Alzheimer’s.”
(health professional, community-based
organization)
Currently there is no cure for Alzheimer’s disease, although treatment can help manage symptoms and slow the
progression of the disease.4 People with Alzheimer’s can experience a significant improvement in their quality of
life with active medical management for the disease. Active management includes: “(1) appropriate use of available treatment options, (2) effective management of coexisting conditions, (3) coordination of care among physicians, other health care professionals and lay caregivers, (4) participation in activities and adult day care programs
and (5) taking part in support groups and supportive services such as counseling.”5
 Mortality rates as a result of Alzheimer’s disease were higher in SPA 2 (21.8) and SPA 3 (17.9) when
compared to Los Angeles County (17.6).
 Stakeholders identified people over the age of 85 years of age who are uninsured, low-income, Latinos,
and Asians as the most severely impacted.
Statistical data—How is Alzheimer’s disease measured? What is the prevalence/incidence rate of Alzheimer’s
disease in the community?
Alzheimer’s Disease Indicator
KFH-LA
Service
Year
Area
 In 1009, the Alzheimer’s disease
mortality rate per 100,000 persons
was lower (16.6) when compared
to Los Angeles County (17.6).
Indicators
Alzheimer’s disease
persons (age-adjusted)
2009
16.6
Comparison
Level
Avg.
LAC
17.6
Page 123
Stakeholders identified people over the age of 85 years of age who are uninsured, low-income, Latinos, and
Asians as the most severely impacted.
In the KFH-LA service area, the following geographic disparities were identified:
 The Alzheimer’s disease mortality rate per 100,000 persons in SPA 2 (21.8) and SPA 3 (17.9) were
higher when compared to Los Angeles County (17.6).
Stakeholders identified Chinatown and Los Angeles as the most severely impacted.
Associated drivers and risk factors—What is driving the high rates of Alzheimer’s disease in the community?
The greatest risk factor for Alzheimer’s disease is advancing age. Other risk factors include a family history of
Alzheimer’s, genetic mutations, cardiovascular disease risk factors (e.g., physical inactivity, high cholesterol,
diabetes, smoking, and obesity) and traumatic brain injury.6 The table below includes drivers that did not meet the
indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
persons
Hypertension
Uninsured
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
2010
2010
18.5%
174.3
10.5
LAC
CA
CA
10.5%
145.6
9.7
2010
17.7
CA
9.5
27.4%
LAC
25.5%
1.1%
CA
1.1%
19.5%
43.8%
28.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
64.4%
LAC
65.5%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
2009
BEHAVIORAL
2011
SOCIAL AND ECONOMIC
2010
2010
2010
CLINICAL CARE
2009
ACCESS TO CARE
2009
2011
2010
1
Page 124
Community input—What do community stakeholders think about the issue of Alzheimer’s disease?
Stakeholders attributed the prevalence of Alzheimer’s disease to the increase in the aging population. Stakeholders identified an increased need for
Alzheimer’s disease-related services including
diagnosis.
“Submitting to the inevitable (old age)—they feel there is
nothing they can do about getting old and the health
issues that comes with old age.”
Some examples of Alzheimer’s-disease–specific community assets:
 AltaMed Health Services Group
 Alzheimer’s Association, California Southland Chapter
 City of Los Angeles Department of Aging
 Korean Health, Education, Information and Research (KHEIR) Center
 Los Angeles County Area Agency on Aging
 Northeast Community Clinic
 St. Vincent Medical Center
Stakeholders did not identify community assets specific to Alzheimer’s disease.
Assessment report.
1
Alzheimer’s Association. 2012 Alzheimer’s Disease Facts and Figures. Available at
[http://www.alz.org/downloads/facts_figures_2012.pdf]. Accessed [March 6, 2013].
2
National Institutes of Health. About Alzheimer’s Disease: Alzheimer’s Basics. Available at
[http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics]. Accessed [March 5, 2013].
3
4
National Institutes of Health. About Alzheimer’s Disease: Alzheimer’s Basics. Available at
[http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics]. Accessed [March 5, 2013].
5
6
Ibid.
Page 125
Health Need Profile: Asthma
**Overall Ranking: 14 of 22
About Asthma—Why is it important?
Asthma is a disease that affects the lungs and is one of the most common long-term diseases of children. Adults
also may suffer from asthma, and the condition is considered hereditary. In most cases, the causes of asthma are
not known, and no cure has been identified. Although asthma is always present in those with the condition,
attacks occur only when the lungs are irritated. Asthma symptoms include wheezing, breathlessness, chest tightness, and coughing. Some asthma triggers include tobacco smoke, dust mites, outdoor air pollution, cockroach
allergen, pet dander, mold, smoke, other allergens, and certain infections known to cause asthma such as the flu,
colds, and respiratory-related viruses. Other contributing factors include exercising, certain medication, bad
weather, high humidity, cold/dry air, and certain foods and fragrances.1
 The adult asthma hospitalization rates in the KFH-LA service area are higher (113.4) when compared to
California (94.3).
 The hospitalization rate per 100,000 adults is higher in SPA 6 (169.8), SPA 7 (134.8), and in SPA 4
(107.4)
 Subpopulations particularly impacted by asthma include low-income women, youth, and homeless
individuals.
 More females (0.9%) experienced asthma-related hospital discharges than males (0.8%).
 African-Americans (1.6%) experienced more asthma-related hospital discharges than other ethnic groups.
 Individuals between the ages of 1 and 19 (3.3%) experienced the most asthma-related hospital discharges.
 Stakeholders identified children as the most severely impacted sub-population.
Statistical data—How is asthma measured? What is the prevalence/incidence rate of asthma in the community?
 In 2010, the asthma hospitalization rate per 100,000 adults was
higher (113.4) when compared to
Los Angeles County (94.3).
Asthma Indicators
KFHLA
Service
Indicators
Year
Area
Asthma prevalence (teens)
2010
11.1%
Asthma hospitalization
2010
8.8
2010
113.4
2010
18.4
rate per 10,000 children
Page 126
Comparison
Level
LAC
Avg.
11.1%
LAC
7.7
LAC
94.3
LAC
19.2
 More females (0.9%) experienced asthma-related hospital discharges than males (0.8%).
 African-Americans (1.6%) experienced more asthma-related hospital discharges followed by multi-raced
(1.0%), and Hispanic/Latinos (0.9%).
 Individuals between the ages of 1 and 19 (3.3%) experienced the most asthma-related hospital discharges.
Stakeholders identified children as the most severely impacted sub-population.
Communities with the highest asthma-related hospital discharges include:
 Pasadena, Los Angeles, and East
Los Angeles.
Asthma Discharge Rate (Per 10,000 Pop.), OSHPD, 2010-11
 In Pasadena, ZIP Code 91103
experienced 14.1 asthma-related
hospital discharges per 10,000
persons.
Over 14.00
 In Los Angeles, ZIP Codes
90013 (23.1), 90037 (21.9),
90011 (17.7), 90004 (15.4),
90014 (14.9), and 90029 (14.4)
experienced the highest rates of
asthma-related hospital
discharges.
2.01 - 6.00
10.01 - 14.00
6.01 - 10.00
Under 2.01
 In East Los Angeles, ZIP Code 90023 experienced 18.6 asthma-related hospital discharges per 10,000
persons.
By SPA, the following disparities were identified:
 Higher rates of asthma hospitalizations per 100,000 adults lived in SPA 6 (169.8), SPA 7 (134.8), and
SPA 4 (107.4).
Associated drivers and risk factors—What is driving the high rates of asthma in the community?
Many allergens are also asthma triggers that irritate the lungs, inducing an asthma attack. Allergic reactions are
known to be caused by pollen, dust, food, insect stings, animal dander, mold, medications, and latex2. Other social
and economic factors have been known to cause or trigger allergic reactions, including poverty, which leads to
poor housing conditions (living with cockroaches, mites, asbestos, mold, etc.). Living in an environment or home
with smokers has also been known exacerbate allergies and/or asthma. The table below includes drivers that did
not meet the indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional indicators, please refer to the KFH-LA Scorecard in Appendix C.
Page 127
Indicators
Allergy prevalence (teens)
Uninsured
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2007
36.4%
BEHAVIORAL
2011
1.1%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
ACCESS TO CARE
2009
16.3%
2011
80.6
2010
27.9%
Comparison
Level
Avg.
LAC
26.4%
CA
1.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of asthma?
Stakeholders linked poor air quality, lack of access to medical care, and patients’ inability to obtain the needed
asthma medication to asthma prevalence.
Some examples of asthma-specific community assets:
 American Lung Association, California
 Asthma & Allergy Foundation of America, California Chapter
 Asthma Coalition of Los Angeles County (ACLAC)
 BREATHE California of Los Angeles County
 Children’s Hospital Los Angeles Community Asthma Project
 LAC+USC Medical Center’s Breathemobile
Stakeholders did not identify community assets specific to asthma.
Assessment report.
1
Centers for Disease Control and Prevention (CDC). Asthma-Basic Information. Atlanta, GA. Available at
[http://www.cdc.gov/asthma/faqs.htm]. Accessed [March 1, 2013].
2
American Academy of Allergy Asthma and Immunology. Allergies. Landover, MD. Available at
[http://www.aafa.org/display.cfm?id=9]. Accessed [March 1, 2013].
Page 128
Health Need Profile: Cervical Cancer
About Cervical Cancer—Why is it important?
Cervical cancer is a disease in which cells in the cervix—the lower, narrow end of the uterus connecting the
vagina (the birth canal) to the upper part of the uterus1—grow out of control. All women are at risk for cervical
cancer, which occurs most often in women over the age of 30. Each year, approximately 12,000 women in the
United States are diagnosed with cervical cancer. The human papillomavirus (HPV), a common virus that is
passed from one person to another during sex, is the main cause of cervical cancer. At least half of sexually active
people will have HPV at some point in their lives, but fortunately, fewer women will get cervical cancer2.
Most adults have been infected with HPV at some time in their lives, though most infections clear up on their
own. An HPV infection that doesn’t go away can cause cervical cancer in some women. Other risk factors, such
as smoking, can increase the risk of cervical cancer among women infected with HPV. A woman’s risk of cervical
cancer can be reduced by having regular cervical cancer screening tests. Cervical cancer can be prevented, if
abnormal cervical cell changes are found early on, by removing or destroying the cells before they become
cancerous. Women can also reduce the risk of cervical cancer by getting an HPV vaccine before becoming sexually active (between the ages of 9 and 26). Even women who have had an HPV vaccine need regular cervical cancer screening tests.3
 The incidence rate of cervical cancer per 100,000 women is the same (9.9) in the KFH-LA service area
and Los Angeles County.
 The cervical cancer death rate per 100,000 women in the KFH-LA service area is more than double (6.5)
that of Los Angeles County (3.0).
 Stakeholders linked cervical cancer to sexually transmitted diseases (STDs). Stakeholders also attributed
its prevalence to a lack of education about women’s health and a lack of access to health care.
 Stakeholders4 identified elderly residents of Chinatown and the homeless as the most severely impacted.
Statistical data—How is cervical cancer measured? What is the prevalence/incidence rate of cervical cancer in
the community?
 In 2009, the cervical cancer incidence rate per 100,000 women
was the same (9.9) when compared to Los Angeles County.
 In 2008, the cervical cancer mortality rate per 100,000 women
was more than double (6.5) that
of Los Angeles County (3.0).
Cervical Cancer Indicators
KFH-LA
Service
Indicators
Year
Area
Cervical cancer incidence
2009
9.9
Rate per 100,000 women1
Cervical cancer mortality
2008
6.5
rate per 100,000 women2
1
Healthy People 2020 target= <=7.1
2
Healthy People 2020 target= <=2.2
Page 129
Comparison
Level
Avg.
LAC
9.9
LAC
3.0
 Cervical cancer–related hospital discharge rates are higher among Hispanic/Latino (13.2) and White
(10.3) women.
Stakeholders identified low-income women as being the most severely impacted.
Cervical cancer prevalence is generally
widespread across the KFH-LA service
area, with rates ranging between 8.1 and
10.0 per 100,000 women.
Cervical Cancer Incidence Age Adjusted Rate (Per 100,000 Pop.),
NCI 2005–2009
Over 12.0
10.1 - 12.0
found:
8.1 - 10.0
 Cervical cancer mortality rates
per 100,000 women were generally higher than Los Angeles
County (3.0)
6.1 - 8.0
Under 6.0
 The highest rates of cervical cancer mortality were in SPA 2
(11.5), and SPA 3 (7.2) when compared to the overall KFH-LA service area (6.5).
Associate drivers and risk factors—What is driving the high rates of cervical cancer in the community?
The factors associated with cervical cancer include the human papillomavirus (HPV), smoking, having HIV or
other conditions that cause the immune system to weaken, using birth control pills for an extended period of time
(five or more years), and giving birth to three or more children.5 The table below includes drivers that did not
Indicators
HIV/AIDS
HIV hospitalization per rate 100,000 adults
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2010
2011
2010
BEHAVIORAL
2011
SOCIAL AND ECONOMIC
2010
2010
2010
Page 130
Comparison
Level
Avg.
15.5
3.2
67.1
LAC
LAC
CA
14.0
2.2
11.0
1.1%
CA
1.1%
19.5%
43.8%
28.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
Indicators
Uninsured
KFH-LA
Year
Service Area
ACCESS TO CARE
2009
16.3%
2011
80.6
2010
27.9%
Comparison
Level
Avg.
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of cervical cancer?
Stakeholders linked cervical cancer to sexually transmitted diseases (STDs). Stakeholders also attributed its
prevalence to a lack of education about women’s health and lack of access to health care.
Some examples of cervical cancer–specific community assets:
 Planned Parenthood of Pasadena
 Planned Parenthood Los Angeles
 St. Vincent Medical Center Cancer Treatment Center
 University of Southern California (USC)/Kenneth Norris Jr. Cancer Hospital—USC Norris Comprehensive Cancer Center
Stakeholders did not identify community assets specific to cervical cancer.
Assessment report.
1
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Cervical Cancer Fact Sheet. Washington,
DC. Available at [http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf]. Accessed [March 4, 2013].
2
Ibid.
3
National Institutes of Health. National Cancer Institute. What you need to know about Cervical Cancer booklet. Bethesda, MD. Available
at [http://www.cancer.gov/cancertopics/wyntk/cervix/page4]. Accessed [March 4, 2013].
4
5
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Cervical Cancer Fact Sheet. Washington,
DC. Available at [http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf]. Accessed [March 4, 2013].
Page 131
Health Need Profile: Hepatitis C
About Hepatitis C—Why is it important?
Hepatitis C is a liver disease that results from infection with the Hepatitis C virus, the most common viral hepatitis in the United States. The disease can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the
body of someone who is not infected. The most common cause of transmission through the blood occurs during
blood transfusions (medical, piercings, and tattoos) and drug use involving needles and the sharing of needles.
The virus can also be sexually transmitted, transmitted between mother and child during birth, and transmitted
through outbreaks caused by blood contamination in health care settings.1
Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs
within the first six months after exposure. For most people, acute infection leads to chronic infection, which often
leads to liver problems including liver damage, cirrhosis, liver failure, or liver cancer.2
 The prevalence rate for Hepatitis C in the KFH-LA service area and Los Angeles County are the same
(0.1).
 Hepatitis C prevalence rates are higher in SPA 4 (0.2) when compared to Los Angeles County (0.1).
 Stakeholders3 linked Hepatitis C with other chronic diseases including HIV and diabetes, and attributed
its prevalence to the lack of access to health care.
 Stakeholders identified the homeless, especially the older population, as the most severely impacted.
Statistical data—How is Hepatitis C measured? What is the prevalence/incidence rate of Hepatitis C in the
community?
 In 2011, the Hepatitis C prevalence rate was the same (0.1) when
compared to Los Angeles County.
Hepatitis C Indicator
KFHLA
Service
Indicators
Year
Area
Hepatitis C prevalence per
2011
0.1
100,000 adults
Secondary data for Hepatitis C disparities among sub-populations was not identified.
Stakeholders identified the older or aging homeless population as the most severely impacted.
Page 132
Comparison
Level
Avg.
LAC
0.1
In the KFH-LA service area, the following geographic disparities were identified:
 The prevalence rate of adults with Hepatitis C is highest in SPA 4 (0.2) when compared to Los Angeles
County (0.1).
Associated drivers and risk factors—What is driving the high rates of Hepatitis C in the community?
Hepatitis C is most likely to impact current and past injection-drug users; recipients of donated blood, blood products, and organs; people who receive dialysis; people who receive body piercings or tattoos with non-sterile
instruments; health care workers; HIV-infected persons; children born to Hepatitis C–infected mothers; people
having sexual relations with a Hepatitis C–infected person; and those sharing personal care items with someone
infected with Hepatitis C.4 The table below includes drivers that did not meet the indicated benchmark, indicating
that the KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional
indicators, please refer to the KFH-LA Scorecard in Appendix C.
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Diabetes
Diabetes prevalence
2009
2010
2010
2010
persons
HIV/AIDS
2010
2011
2010
SOCIAL AND ECONOMIC
2010
2010
2010
ACCESS TO CARE
2009
2011
Uninsured
2010
Comparison
Level
Avg.
18.5%
174.3
10.5
LAC
CA
CA
10.5%
145.6
9.7
17.7
CA
9.5
15.5
3.2
67.1
LAC
LAC
CA
14.0
2.2
11.0
19.5%
43.8%
28.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of Hepatitis C?
Stakeholders associated Hepatitis C with HIV and diabetes, and attributed its prevalence to the lack of health care
access.
Page 133
Some examples of hepatitis C–specific community assets:
 AIDS Project Los Angeles (APLA)
 American Liver Foundation, Greater Los Angeles Chapter
 Asian Pacific Liver Center at St. Vincent Medical Center
 JWCH Institute
Stakeholders did not identify community assets specific to Hepatitis C.
Assessment report.
1
Centers for Disease Control and Prevention. Know More Hepatitis. Atlanta, GA. Available at
[http://www.cdc.gov/knowmorehepatitis/LearnMore.htm]. Accessed [March 6, 2013].
2
Ibid.
3
4
Centers for Disease Control and Prevention. Know More Hepatitis. Atlanta, GA. Available at
[http://www.cdc.gov/knowmorehepatitis/LearnMore.htm]. Accessed [March 6, 2013].
Page 134
Health Need Profile: HIV/AIDS
About HIV/AIDS—Why is it important?
More than 1.1 million people in the United States are living with HIV, and almost one in five (18.1%) are
unaware of their infection.1 HIV infection weakens the immune system, making those living with
“It is like what it was 20 years ago: clients are facing
HIV highly susceptible to a variety of illnesses
discrimination; living in secrecy among peers, in the
and cancers, including tuberculosis (TB),
community, and now back to family as well. As a result,
they are facing emotional issues and mental issues, in
cytomegalovirus (CMV), cryptococcal meningiaddition to physical issues.”
tis, lymphomas, kidney disease, and cardiovas2
(CEO,
community-based foundation)
cular disease. Without treatment, almost all people infected with HIV will develop AIDS.3 While
HIV is a chronic medical condition that can be treated, the disease cannot yet be cured.
The risk of acquiring HIV is increased by engaging in unprotected sex, having another sexually transmitted infection, sharing intravenous drugs, having been diagnosed with hepatitis, tuberculosis, or malaria, and having been
exposed to the virus as a fetus or infant before or during birth, or through breastfeeding from a mother infected
with HIV.4 Racial disparities in HIV prevalence persist; African-Americans and Hispanics/Latinos are
disproportionately affected by HIV and experience the most severe burden of HIV compared with other races and
ethnicities in the United States. Prevention efforts to reduce the spread of HIV in the United States encompass
many components, such as behavioral interventions, HIV testing, and linkage to treatment and care.5
 The HIV/AIDS hospitalization rate per 10,000 persons in the KFH-LA service area is higher (3.2) when
 More males (0.6%) have been discharged from hospitals for HIV-related complications than females
(0.1%).
 A larger proportion of African-Americans (0.8%) experienced hospital discharges resulting from HIV
than other racial groups.
 Hispanic/Latino patients made up 0.2% of those hospitalized as a result of HIV-related illnesses.
 Those between the ages of 20 and 44 (0.5%) and 45 and 64 (0.7%) experienced the most hospitalizations
resulting from HIV compared to other age groups.
 Stakeholders6 identified the homeless, GLBTQ (gays, lesbians, bisexuals, transgenders, and queer culture), teens, low-income women, and teens transitioning into adults as the most severely impacted subpopulations.
 Communities with the highest rates of HIV-related hospital discharges include Atwater Village (3.1) to
the east, Universal City (5.3) to the north, Hollywood (5.8) to the west, and northern parts of downtown
Los Angeles (3.4) to the south. Areas closer to West Hollywood have higher rates, which range from 10.1
to 12.6.
Page 135
 HIV prevalence per 100,000 persons is highest in SPA 4 (46.0) and SPA 6 (16.0) in comparison to KFHLA service area (15.5) and to Los Angeles County (14.0).
 HIV hospitalization rates per 100,000 persons are highest in SPA 4 (285.1), SPA 6 (17.0), and SPA 2
(15.6) when compared to California (11.0).
 Stakeholders identified a need for more education and prevention services and measures around
HIV/AIDS, including family-based programming and services, mental health services (to alleviate the
depression and anxiety experienced by those with HIV/AIDS), and more collaboration from hospitals.
Statistical data—How is HIV/AIDS measured? What is the prevalence/incidence rate of HIV/AIDS in the
community?
 In 2010, HIV prevalence per 100,000
persons is higher (15.5) when compared to Los Angeles County (14.0).
 In 2011, the HIV hospitalization rate
per 10,000 persons is higher (3.2)
County (2.2).
HIV/AIDS Indicators
KFH-LA
Service
Indicators
Year
Area
HIV prevalence per 100,000
2010
15.5
persons
HIV hospitalization rate per
2011
3.2
10,000 persons (age-adjusted)
HIV hospitalization rate per
2010
67.1
100,000 persons
Comparison
Level
Avg.
LAC
14.0
LAC
2.2
CA
11.0
CA=California
 In 2010, the HIV hospitalization rate
per 100,000 persons is higher (67.1) than California (11.0).
 More males (0.6%) have been discharged from hospitals for HIV-related complications than females
(0.1%).
 A larger proportion of African-Americans (0.8%) experienced hospital discharges resulting from HIV
than other racial groups.
 Hispanic/Latino patients made up 0.2% of those hospitalized as a result of HIV-related illnesses.
 Those between the ages of 20 and 44 (0.5%) and 45 and 64 (0.7%) experienced the most hospitalizations
resulting from HIV compared to other age groups.
Stakeholders identified the homeless, GLBTQ (gays, lesbians, bisexuals, transgenders, and queer culture), teens,
low-income women, and teens transitioning into adults as the most severely impacted sub-populations.
Page 136
Communities with the highest rates of
HIV-related hospital discharges
include (see map):
HIV Discharge Rate (Per 10,000 Pop.), OSHPD, 2010-11
 Atwater Village (3.1) to the east,
Universal City (5.3) to the north,
Hollywood (5.8) to the west, and
northern parts of downtown Los
Angeles (3.4) to the south.
Over 3.00
2.01 - 3.00
1.01 - 2.00
Under 1.01
 Areas closer to West Hollywood
have higher rates, which range
from 10.1 to 12.6.
No
Hospitalizations
found:
 HIV prevalence per 100,000 persons is highest in SPA 4 (46.0) and SPA 6 (16.0) in comparison to KFHLA service area (15.5) and to Los Angeles County (14.0).
 HIV hospitalization rates per 100,000 persons are highest in SPA 4 (285.1), SPA 6 (17.0), and SPA 2
(15.6) when compared to California (11.0).
Associated drivers and risk factors—What is driving the high rates of HIV/AIDS in the community?
The following factors are associated with HIV/AIDS: injection drug use, risky sexual behaviors,7 poverty, heavy
alcohol consumption, liquor store access, and HIV screenings. HIV prevalence is highest among gay, bisexual,
and other men who have sex with men, and among African-Americans.8
Untreated HIV infection is associated with many diseases, including cardiovascular disease, kidney disease, liver
disease, and cancer.9 Persons with HIV infections are disproportionately affected by viral hepatitis, and those coinfected with HIV and viral hepatitis experience greater liver-related health problems than those who do not have
HIV infections.10 The table below includes drivers that did not meet the indicated benchmark, indicating that the
KFH-LA service area is performing worse than the comparison area/benchmark. For data on additional indicators,
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Cervical Cancer
Cervical cancer incidence rate per 100,000 women2
Colorectal Cancer
Colon/rectum cancer incidence rate per 100,000 persons3
Comparison
Level
Avg.
2010
2010
2010
15.7
379.7
130.8
CA
CA
LAC
15.6
367.1
147.1
2009
9.9
LAC
9.9
2009
45.1
LAC
45.2
Page 137
KFH-LA
Year
Service Area
BEHAVIORAL
2011
1.1%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
CLINICAL CARE
2009
64.4%
ACCESS TO CARE
2009
16.3%
2011
80.6
Uninsured
2010
27.9%
Indicators
Comparison
Level
Avg.
CA
1.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
LAC
65.5%
LAC
LAC
LAC
16.2%
80.7
22.6%
1
2
3
Community input—What do community stakeholders think about the issue of HIV/AIDS?
Stakeholders identified a need for more
“There is a different group being identified. Women find out
education and prevention services and
that they are HIV-positive after their partner becomes ill or dies
measures around HIV/AIDS including
of the disease. We do workshops and use a promotora model to
family-based programming and services,
enter the community and break the silence and isolation.”
mental health services (to alleviate the
(executive director, community-based organization)
depression and anxiety experienced by
those with HIV/AIDS), and more collaboration from hospitals.
Some examples of HIV/AIDS-specific community assets:
 AIDS Healthcare Foundation
 AIDS Project Los Angeles (APLA)
 AIDS Service Center – Pasadena
 Alliance for Housing and Healing
 Bienestar Human Services
Page 138
 Minority AIDS Project
 Project Angel Food
Stakeholders identified the following community resources available to address HIV/AIDS:
 AIDS Healthcare Foundation—provides free STD (sexually-transmitted disease) testing and treatment all
year round, regardless of the individual’s ability to pay
 AIDS Project Los Angeles (APLA)—provides free STD testing several times a year
 East Los Angeles Women’s Center—provides free STD testing several times a year; provides HIV testing
at agency, eliminating resident’s fear of going into a clinic or doctor’s office to get tested
 Planned Parenthood—provides free STD testing several times a year
Assessment report.
1
Centers for Disease Control and Prevention. Drug-Associated HIV Transmission Continues in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/idu.htm]. Accessed [February 28, 2013].
2
Mayo Clinic. Complications. Available at [http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=complications]. Accessed
[March 1, 2013].
3
National Institutes of Health, HIV Infection. Available at [http://www.nlm.nih.gov/medlineplus/ency/article/000602.htm]. Accessed
[March 1, 2013].
4
National Institute of Allergy and Infectious Diseases. HIV Risk Factors. Available at
[http://www.niaid.nih.gov/topics/hivaids/understanding/pages/riskfactors.aspx]. Accessed [March 6, 2013].
5
Centers for Disease Control and Prevention. CDC’s HIV Prevention Progress in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/cdcprev.htm]. Accessed [February 28, 2013].
6
7
Centers for Disease Control and Prevention. Drug-Associated HIV Transmission Continues in the United States. Available at
[http://www.cdc.gov/hiv/resources/factsheets/idu.htm]. Accessed [February 28, 2013].
8
Centers for Disease Control and Prevention, HIV in the United States: At A Glance. Available at
[http://www.cdc.gov/hiv/resources/factsheets/us.htm]. Accessed [February 28, 2013].
9
Centers for Disease Control and Prevention. Basic Information about HIV and AIDS. Available at
[http://www.cdc.gov/hiv/topics/basic/index.htm]. Accessed [March 1, 2013].
10
Centers for Disease Control and Prevention. HIV and Viral Hepatitis. Available at
[http://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm]. Accessed [March 1, 2013].
Page 139
Health Need Profile: Colorectal Cancer
About Colorectal Cancer—Why is it important?
Colorectal cancer, defined as cancer that starts in the colon or the rectum, is the second leading cause of cancerrelated deaths in the United States and is expected to cause about 50,830 deaths during 2013. The lifetime risk of
developing colorectal cancer is about one in 20 (5.1%), with the risk being slightly lower for women than in men.1
In addition, colorectal cancer is associated with overall cancer mortality, heavy alcohol consumption, obesity,
diabetes prevalence, and colon cancer screening.
The number of new colorectal cancer cases and the number of deaths from colorectal cancer are decreasing. The
likely causes are regular screenings and improved treatment. Regular screenings can often detect colorectal cancer
early on, when the disease is most likely to be curable. Screenings can also find polyps, which can be removed
before turning into cancer.2 As a result, there are now more than one million survivors of colorectal cancer in the
United States.3
Given the success of colorectal cancer screening, public health organizations are working to increase awareness of
these screenings among the general public and health care providers. Currently, only about half of Americans ages
50 or older have had any colorectal cancer screening.4
 The annual incidence rate of colon and rectum cancer in the KFH-LA service area is 45.1 individuals per
100,000 persons, slightly lower than the Los Angeles County rate (45.2).
 Within the KFH-LA service area, African-Americans (59.9) have the highest colorectal incidence rate
compared to the other racial groups.
Statistical data—How is colorectal cancer measured? What is the prevalence/incidence rate of colorectal cancer
in the community?
 In 2009, the colorectal cancer incidence rate was slightly lower
(45.1) when compared to Los
Angeles County (45.2), though the
rate did not meet the Healthy People 2020 goal <=38.6.
Colorectal Indicators
KFH-LA
Year
Service
Indicators
Area
Colorectal cancer incidence
2009
45.1
per 100,000 persons1
Colon cancer mortality rate
per 100,000 persons (age 2008
10.9
adjusted)
Comparison
Level
Avg.
LAC
45.2
LAC
11.2
 In 2008, the colon cancer mortality 1
rate per 100,000 persons was
slightly lower in the KFH-LA service area (10.9) when compared to Los Angeles County (11.2).
Page 140
 African-Americans (59.9) have the highest incidence rate, followed by Whites (44.9), Asians (44.0), and
Hispanic/Latino (35.3).
Stakeholders5 did not identify disparities among sub-populations.
Within the KFH-LA service area, the following disparities were found by SPA:
 Colon cancer mortality rates per 100,000 persons were highest in SPA 2 (14.7) and SPA 3 (14.5) when
Associated drivers and risk factors—What is driving the high rates of colorectal cancer in the community?
The major factors that can increase the risk of colorectal cancer are increasing age and a family history of colorectal cancer. Other less significant factors include a personal history of inflammatory bowel disease, inherited risk,
heavy alcohol use, cigarette smoking, obesity, diabetes prevalence, and colon cancer screening.6 Regular physical
activity and diets high in vegetables, fruits, and whole grains have been linked with a decreased incidence of
colorectal cancer.7 The table below includes drivers that did not meet the indicated benchmark, indicating that the
KFH-LA area is performing worse than the comparison area/benchmark. For data on additional indicators, please
Indicators
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Diabetes
persons
Diabetes prevalence
Comparison
Level
Avg.
2010
2010
174.3
10.5
CA
CA
145.6
9.7
2010
17.7
CA
9.5
2009
18.5%
LAC
10.5%
BEHAVIORAL
Drank two or more glasses of soda yesterday (youth)
2009
2009
18.8%
12.7%
LAC
LAC
18.1%
12.5%
41.9%
0.5%
1.1%
CA
CA
CA
37.5%
0.5%
1.1%
LAC
LAC
15.7%
37.6%
LAC
22.4%
2010
2010
2011
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
Page 141
28.1%
CLINICAL CARE
Adults 50 years or older who had a sigmoidoscopy or
2009
colonoscopy in last 5 years1
Adults 50 years or older who had a sigmoidoscopy,
2009
colonoscopy, or fecal occult blood test
ACCESS TO CARE
2009
2011
Uninsured
2010
64.9%
LAC
65.5%
74.2%
LAC
75.7%
16.3%
80.6
LAC
LAC
16.2%
80.7
27.9%
LAC
22.6%
1
Community input—What do community stakeholders think about the issue of colorectal cancer?
Stakeholders mentioned colorectal cancer as an issue that was affecting the community.
Some examples of colorectal cancer–specific community assets:
 Crohn’s & Colitis Foundation of America - Greater Los Angeles Chapter
 Huntington Hospital—Colorectal Cancer Program
 QueensCare Family Clinic
Stakeholders did not identify community assets specific to colorectal cancer.
Assessment report.
1
American Cancer Society. Colorectal Cancer. Available at
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics]. Accessed [March 4, 2013].
2
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-detection]. Accessed [March 4, 2013].
3
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics]. Accessed [March 4, 2013].
4
Ibid.
Page 142
5
6
National Cancer Institute. Colorectal Cancer Prevention. Available at
[http://www.cancer.gov/cancertopics/pdq/prevention/colorectal/Patient/page3#Keypoint4]. Accessed [March 4, 2013].
7
American Cancer Society. Colorectal Cancer. Available at Available at
[http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors]. Accessed [March 4, 2013].
Page 143
Health Need Profile: Unintentional Injury
About Unintentional Injury—Why is it important?
Unintentional injuries include deaths resulting from motor vehicle accidents and from pedestrians being killed in
accidents. Motor vehicle accidents are one of the leading causes of death in the U.S., with more than 2.3 million
adult drivers and passengers treated in emergency departments as a result of injuries motor vehicle crashes in
2009. The economic impact is also notable: the lifetime costs of accident-related deaths and injuries among drivers and passengers were $70 billion in 2005.1 In 2007, 4,820 pedestrians were killed in traffic accidents in the
United States, and another 118,278 pedestrians were injured. This averages one accident-related pedestrian death
every two hours, and a pedestrian injury every four minutes. Pedestrians are one and a half times more likely than
passenger vehicle occupants to be killed in a car accident on any given trip. 2 Populations most at risk are older
adults, children, and drivers and pedestrians who are under the influence of alcohol and drugs.3
 The mortality rate for motor vehicle accidents in the KFH-LA service area is 7.2 per 100,000, slightly
higher than the Los Angeles County rate of 7.1.

Health factors associated with unintentional injury include poverty, lack of education, and heavy alcohol
consumption.
Statistical data—How is unintentional injury measured? What is the prevalence/incidence rate of unintentional
injuries in the community?
 In 2010, the motor vehicle mortality
rate per 100,000 persons was higher
(7.2) when compared to Los Angeles County (7.1).
 In 2010, the pedestrian motor vehicle mortality rate per 100,000 persons was higher (1.6) when compared to Los Angeles County (1.5).
Sub-populations experiencing greatest
impact (disparities)
Unintentional Injury Indicators
KFH-LA
Service
Indicators
Year
Area
Pedestrians killed
2008
18.1%
Motor vehicle mortality rate
2010
7.2
per 100,000 persons1
Pedestrian motor vehicle
2010
1.6
persons2
Comparison
Level
LAC
Avg.
25.7%
LAC
7.1
LAC
1.5
1
HealthyPeople 2020: <=12.4
2
HealthyPeople 2020: <=1.3
 Motor vehicle mortality rates are highest among the White (10.0) and African-American (9.2) populations
in Los Angeles County.
 Pedestrian motor vehicle mortality rates are highest among the White (2.0), Hispanic/Latino (2.0), and
African-American (1.85) populations in Los Angeles County.
Stakeholders4 did not identify disparities among sub-populations.
Page 144
Communities with the highest motor
vehicle accident mortality rates include
(see map):
Pedestrian Motor Vehicle Accident Mortality, Rate (Per 100,000 Pop.),
CDPH, 2008-10
Over 6.00
 Motor vehicle accident mortality
rates in the KFH-LA service area
are highest within ZIP Code
90068 at 31.2 per 100,000 persons.
3.01 - 6.00
1.01 - 3.00
Under 1.01
No Pedestrian
Motor Vehicle
Deaths
 Pedestrian motor vehicle accident mortality rates are highest
(between 3.0 and 6.0 per 100,000
population) in parts of Hollywood, Glendale, Los Angeles,
and East Los Angeles.
No Data or Data
Suppressed
 In Hollywood, ZIP Code 90028 had a rate of 4.9 per 100,000 persons. In Glendale, ZIP Code 91203 had a
rate of 1.0 per 100,000 persons.
 In Los Angles, ZIP Codes 90037 (4.6), 90011 (4.0), 90017 (3.3), and 90020 (3.0) had the highest rates of
pedestrian motor vehicle accident deaths.
 In East Los Angeles, ZIP Code 90023 had a 4.3 rate per 100,000 persons.
Associated drivers and risk factors—What is driving the high rates of unintentional injury in the community?
Populations most at risk for unintentional injuries include older adults, children, and drivers and pedestrians who
are under the influence of alcohol and drugs.5 The table below includes drivers that did not meet the indicated
benchmark, indicating that the KFH-LA service area is performing worse than the comparison area/benchmark.
For data on additional indicators, please refer to the KFH-LA Scorecard in Appendix C.
KFH-LA
Year
Service Area
HEALTH OUTCOMES
Alcohol/drug-induced mental disease hospitalization
2010
838.2%
per 100,000 persons
BEHAVIORAL
2011
1.7%
Heavy drinkers
2010
15.4%
2011
1.1%
2009
1.5%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
Indicators
Page 145
Comparison
Level
Avg.
CA
109.1%
CA
LAC
CA
1.7%
15.4%
1.1%
LAC
1.5%
LAC
LAC
LAC
15.7%
37.6%
22.4%
Uninsured
ACCESS TO CARE
2010
2011
2010
71.1%
80.6
27.9%
LAC
LAC
LAC
71.1%
80.7
22.6%
Community input—What do community stakeholders think about the issue of intentional injuries?
Stakeholders did not make connections between unintentional injuries and other factors.
Numerous assets and resources are available to respond to health needs within the community, including health
care facilities, community organizations, and public agencies. The following list includes assets that have been
identified as specifically addressing this health need and/or key drivers related to this health need through various
sources including KFH-LA community partners. Where available, a sampling of community assets specifically
highlighted by stakeholders during interviews and/or focus groups is noted as well.
Some examples of unintentional injury–specific community assets:
 AADAP (Asian American Drug Abuse Program)
 Impact Drug and Alcohol Treatment Center
 Los Angeles County Bicycle Coalition
 Los Angeles Walks
 SHARE! Self Help and Recovery Exchange
Stakeholders did not identify community assets specific to unintentional injuries.
For information on other assets in the community, please refer to Section VII of the Community Health
Needs Assessment report.
1
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Motor Vehicle Safety. Atlanta, GA. Available at
[http://www.cdc.gov/motorvehiclesafety/]. Accessed [March 7, 2013].
2
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Pedestrian Safety. Atlanta, GA. Available at
[http://www.cdc.gov/Motorvehiclesafety/Pedestrian_safety/index.html]. Accessed [March 7, 2013].
3
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Pedestrian Safety Fact sheet. Atlanta, GA.
Available at [http://www.cdc.gov/Motorvehiclesafety/Pedestrian_Safety/factsheet.html]. Accessed [March 7, 2013].
4
5
Centers for Disease Control and Prevention. Injury Center: Injury Prevention & Control: Pedestrian Safety Fact sheet. Atlanta, GA.
Available at [http://www.cdc.gov/Motorvehiclesafety/Pedestrian_Safety/factsheet.html]. Accessed [March 7, 2013].
Page 146
Health Need Profile: Arthritis
About Arthritis—Why is it important?
Arthritis affects one in five adults in the United States and continues to be the most common causes of physical
disability. Arthritis costs more than $128 billion per year currently in the United States, and is projected to
increase over time as the population ages. Interventions such as increased physical activity, education about disease self-management, and weight loss among overweight/obese adults can reduce arthritis pain and functional
limitations; however, these resources are underutilized. 1
 More was diagnosed with arthritis in SPA 3 (20.1%) and SPA 7 (18.2%).
 Stakeholders2 identified the aging and Asian populations as being the most impacted.
Statistical data—How is arthritis measured? What is the prevalence/incidence rate of arthritis in the community?
 In 2011, the same portion was diagnosed with arthritis (17.4%) when
compared to Los Angeles County.
Sub-populations experiencing greatest
impact (disparities)
Unintentional Injury Indicators
KFH-LA
Service
Indicators
Year
Area
Ever diagnosed with arthritis
2011
17.4%
Comparison
Level
LAC
Avg.
17.4%
Secondary data for arthritis disparities among sub-populations were not available through the Kaiser Permanente
CHNA data platform or other secondary sources.
Stakeholders identified the aging and Asian population as being the most severely impacted.
By SPA the following disparities were found:
 More was diagnosed with arthritis in SPA 3 (20.1%) and SPA 7 (18.2%).
Associated drivers and risk factors—What is driving the high rates of arthritis in the community?
The factors associated with arthritis include being overweight or obese, a lack of education around self-management strategies and techniques, and limited or no physical activity.3 The table below includes drivers that did not
Page 147
Indicators
Year
BEHAVIORAL
2009
2010
2010
2010
2011
Not physically active (children)
Uninsured
ACCESS TO CARE
2009
2011
2010
KFH-LA
Service Area
Comparison
Level
Avg.
12.7%
41.9%
41.9%
0.5%
1.1%
LAC
CA
CA
CA
CA
12.5%
37.5%
37.5%
0.5%
1.1%
16.3%
80.6
27.9%
LAC
LAC
LAC
16.2%
80.7
22.6%
Community input—What do community stakeholders think about the issue of arthritis?
Stakeholders indicated that the aging populations were the most impacted by arthritis.
Some examples of arthritis-specific community assets:
 Arthritis Foundation, Los Angeles County Office
 Chinatown Service Center
 Hollywood Presbyterian Medical Center
 Los Angeles County Area Agency on Aging
 St. Vincent Medical Center
Stakeholders did not mention community assets related to arthritis.
For information on other assets in the community, please refer to Section VII of the Community Health
Needs Assessment report.
1
Page 148
2
3
Page 149
Health Need Profile: Allergies
About Allergies—Why are they important?
Allergies are an overreaction of the immune system to substances that usually cause no reaction in most individuals. These substances can trigger sneezing, wheezing, coughing, and itching. Allergies have been linked to a variety of common and serious chronic respiratory illnesses such as sinusitis and asthma. Factors such as a family history with allergies, the types and frequency of symptoms, seasonality, duration, and even location of symptoms
(indoors or outdoors, for example) are all taken into consideration in allergy diagnoses. Allergic reactions can be
severe and even fatal. With proper management and patient education, allergic diseases can be controlled and people with allergies can lead normal and productive lives.1 Many allergens are also asthma triggers that irritate the
lungs, inducing an asthma attack. Other social and economic factors have been known to cause or trigger allergic
reactions, including poor housing conditions (living with cockroaches, mites, asbestos, mold, etc.). Living in an
environment or home with smokers has also been known to exacerbate allergies and/or asthma.
 Allergies among teens were higher in the KFH-LA service area (25.8%) compared to Los Angeles County
(24.9%).
 The percent of teens with allergies was higher in SPA 3 (36.8%) when compared to Los Angeles County.
 Female teens were diagnosed with allergies (27.3%) in the KFH-LA service area more often than males
(20.6%).
 Stakeholders2 added that Asian populations were the most affected by allergies.
Statistical data—How are allergies measured? What is the prevalence/incidence rate of allergies in the
community?
 In 2007, more teens (25.8%) had
allergies when compared to Los
Allergy Indicator
KFH-LA
Indicators
Year
Service
Area
Allergy prevalence in teens
2007
25.8%
Comparison
Level
LAC
Avg.
24.9%
Within the KFH-LA service area, female teens were more often diagnosed with allergies (27.3%) than males
(20.6%). Stakeholders added that Asian populations seemed to be the most affected by allergies.
By SPA, the following disparities were found:
 Greater percentages of teens with allergies are present in SPA 3 (36.8%).
Page 150
Associated drivers and risk factors—What is driving the high rates of allergies in the community?
Allergic reactions are known to be caused by pollen, dust, food, insect stings, animal dander, mold, medications,
and latex.3 Many allergens are also asthma triggers that irritate the lungs, inducing an asthma attack. Social and
economic factors have been known to cause or trigger allergic reactions, including poverty leading to poor housing conditions (living with cockroaches, mites, asbestos, mold, etc.) and living in an environment or home with
smokers. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA
service area is performing worse than the comparison area/benchmark. For data on additional indicators, please
Indicators
Asthma hospitalizations per 10,000 adults
Asthma hospitalizations per 100,000 adults
KFH-LA
Year
Service Area
HEALTH OUTCOMES
2010
8.8
2010
113.4
BEHAVIORAL
2011
Level
Avg.
CA
CA
7.7
94.3
CA
1.1%
LAC
LAC
LAC
15.7%
37.6%
22.4%
16.3%
LAC
16.2%
80.6
27.9%
LAC
LAC
80.7
22.6%
1.1%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
ACCESS TO CARE
2009
Uninsured
2011
2010
Comparison
Community input—What do community stakeholders think about the issue of allergies?
Stakeholders indicated that allergies were associated with poor air quality and other environmental factors.
Some examples of allergy-specific community assets:
 Alhambra Hospital Medical Center
 Asthma & Allergy Foundation of America, California Chapter
Page 151
 Esperanza Community Housing Corporation
 Worksite Wellness LA
Stakeholders did not identify community assets related to allergies.
Assessment report.
1
Asthma and Allergy Foundation of America (AAFA). Allergies. Milwaukee, WI. Available at [http://www.aaaai.org/conditions-andtreatments/allergies.aspx]. Accessed [March 1, 2013].
2
3
American Academy of Allergy Asthma and Immunology. Allergies. Landover, MD. Available at [http://www.aafa.org/display.cfm?id=9].
Page 152
Health Need Profile: Infant Mortality
About Infant Mortality—Why is it important?
Infant mortality remains a concern in the United States: each year, approximately 25,000 infants die before their
first birthday.1 The leading causes of infant death include congenital abnormalities, pre-term/low birth weight,
Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress
syndrome.2
Infant mortality is associated with factors such as maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. Significant disparities exist among racial and ethnic groups that
impact the infant mortality rate. For example, African-Americans had an infant mortality rate of 14.1 deaths per
1,000 live births in the year 2000, which is more than twice the national average of 6.9 deaths per 1,000 live
births.3
The Centers for Disease Control and Prevention have set the goal of eliminating disparities among racial and ethnic groups with infant mortality rates above the national average. The CDC’s prevention strategy focuses on
modifying behaviors, lifestyles, and conditions that affect birth outcomes, such as smoking, substance abuse, poor
nutrition, lack of prenatal care, medical problems, and chronic illness.
 The infant mortality rate per 1,000 births is the same (5.1) in the KFH-LA service area and Los Angeles
County.
 The portion of infants born with low birth weights in the KFH-LA service area (6.9%) is higher when
compared to California (6.8%).
 Within the KFH-LA service area, the infant mortality rate per 1,000 live births is much higher among
African-Americans (11.5) than Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3).
Statistical data—How is infant mortality measured? What is the prevalence/incidence rate of infant mortality in
the community?
 In 2009, the infant mortality rate
per 1,000 births was the same (5.1)
County.
 Slightly more infants were born
with low birth weights in the
KFH-LA service area (6.9%)
when compared to California
(6.8%).
Infant Mortality Indicators
KFH-LA
Service
Indicators
Year
Area
Infant mortality rate per
2009
5.1
1,000 births1
Low birth weight infants
2010
6.9%
Very low birth weight
2010
1.2%
infants
CA=California
1 Healthy People 2020 = <=6.0
Page 153
Comparison
Level
Avg.
LAC
5.1
CA
6.8%
LAC
1.3%
 Slightly fewer infants were born with very low birth weights in the KFH-LA service area (1.2%) when
compared to Los Angeles County (1.3%).
 The infant mortality rate per 1,000 live births is much higher among African-Americans (11.5) than
Hispanics/Latinos (4.8), Whites (4.5), and Asians (3.3).
Stakeholders did not identify disparities among sub-populations.
In the KFH-LA service area, the following disparities were identified:
 More infants were born with very low birth weights in SPA 7 (1.5%) when compared to Los Angeles
County (1.3%).
Associated drivers and risk factors—What is driving the high rates of infant mortality in the community?
Factors that affect birth outcomes include smoking, substance abuse, poor nutrition, medical problems, and
chronic illness. Additionally, infant mortality is associated with low birth weight. High rates of infant mortality
can indicate broader issues such as access to health care, maternal and child health, poverty, education rate, lack
of insurance, teen births, and lack of prenatal care. The table below includes drivers that did not meet the indicated benchmark, indicating that the KFH-LA service area is performing worse than the comparison
KFH-LA
Year
Service Area
BEHAVIORAL
2009
18.8%
2009
12.7%
2010
41.9%
2010
0.5%
2011
1.1%
SOCIAL AND ECONOMIC
2010
19.5%
2010
43.8%
2010
28.1%
Population with no high school diploma
2010
27.0%
High school graduation rate1
2009
77.2
CLINICAL CARE
Mothers who obtain late or no prenatal care
2009
12.9%
ACCESS TO CARE
2009
16.3%
2011
80.6
Population receiving Medicaid
2010
20.9%
Uninsured
2010
27.9%
Indicators
1
Healthy People 2020 = >82.4
Page 154
Comparison
Level
Avg.
LAC
LAC
CA
CA
CA
18.1%
12.5%
37.5%
0.5%
1.1%
LAC
LAC
LAC
LAC
CA
15.7%
37.6%
22.4%
24.1%
82.3
LAC
7.5%
LAC
LAC
LAC
LAC
16.2%
80.7
19.9%
22.6%
Community input—What do community stakeholders think about the issue of infant mortality?
Stakeholders4 indicated that more women are experiencing difficult pregnancies, though specific reasons were not
mentioned.
Some examples of infant mortality specific community assets:
 California Hospital Medical Center—Los Angeles
 East Los Angeles Women’s Center
 Eisner Pediatric and Family Medical Center
 Hathaway-Sycamores Child and Family Services
 Hollywood Presbyterian Medical Center
 LA Best Babies Network
 Los Angeles County Department of Public Health’s Maternal, Child & Adolescent Health Unit
 Magnolia Place
 March of Dimes—California Programs
 Maternal and Child Health Access
 Planned Parenthood Los Angeles
Stakeholders did not identify community assets specific to infant mortality.
Assessment report.
1
Centers for Disease Control and Prevention. Infant Mortality. Available at
[http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm]. Accessed [March 5, 2013].
2
Centers for Disease Control and Prevention. Infant Health. Available at [http://www.cdc.gov/nchs/fastats/infant_health.htm]. Accessed
[March 5, 2013].
3
Centers for Disease Control and Prevention. Eliminate Disparities in Infant Mortality. Available at
[http://www.cdc.gov/omhd/amh/factsheets/infant.htm#2]. Accessed [March 5, 2013].
4
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Appendix C:
KFH-LA Scorecard
Page 156
Kaiser Permanente Community Health Needs Assessment
Health Needs and Health Drivers Data Summary - Los Angeles Service Area
Community Event
Identification of Health Needs and Health Drivers
In 2012, Kaiser Foundation Hospital-Los Angeles (KFH-LA) conducted Phase I of the 2013 Community Health
Needs Assessment (CHNA). This included review of data from the Kaiser Permanente CHNA data platform and
other secondary data sources. Additional information was gathered through seven (7) focus groups with
providers and residents from across the KFH-LA service area and interviews with nineteen (19) key stakeholders
including public health experts, community leaders, and public agency officials.
This process highlighted numerous health needs and health drivers in the Los Angeles service area. The
following document represents a subset of those needs based on set criteria, which included poor performance
against California or Los Angeles County benchmarks or the Healthy People 2020 (HP2020) Target or repeated
mentions in stakeholder interviews and focus groups. The identified health needs and drivers are summarized in
the attached Health Needs and Drivers Summary Scorecard. In all, the CHNA process has engaged 70 individuals
in sharing their insight and expertise to identify key needs in the Los Angeles service area.
Reading the Health Needs & Drivers Data Summary Scorecard
DATA INDICATORS
Indicators, or standard measures of health, are highlighted in the first column
Qualitative data collected in focus groups or interviews is indicated by an italicized indicator
Indicators which did not meet a benchmark, including HP2020 Targets, are highlighted by a black box
When health indicator definitions are consistent across comparison levels, and the HP2020 Target is not
met, the HP2020 Target is noted
The Health Needs and Drivers are listed in alphabetical order, NOT by order of importance
DATA INDICATORS LEGEND
*Data gathered from the Kaiser Permanente CHNA data platform
Data from secondary sources aggregated at the Service Planning Area (SPA)-level reflecting only zip codes
represented in the KFH-LA service area
^Data from secondary sources reflecting the entire Service Planning Area (SPA)
COMPARISON LEVEL
KFH-LA service area is compared against benchmarks at the State or County-level depending on data
available
o CA: State of California
o LAC: Los Angeles County
Where available, data is also presented for individual Service Planning Areas (SPAs) in the service area
Page 157
Focus Groups (n=#)
Interviews (n=#)
Service Planning Area #
KFH-LA Service Area Average
Comparison Average
Comparison Level
Legend
*Data from the Kaiser Permanente CHNA data platform
Data from secondary sources aggregated at the Service Planning Area (SPA)-level
reflecting only zip codes represented in the KFH-LA service area
^Data from secondary sources reflecting the entire Service Planning Area (SPA)
An italicized indicator denotes qualitative data collected in a focus group or interview
Comparison levels: CA - California LAC - LA County
Year of Data
DATA INDICATOR
Healthy People 2020 Target
The following notes and legend will help you to understand the data presented in the Summary Scorecard.
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Page 164
Appendix D:
Data Collection Tools and
Instruments
Page 165
KP CHNA 2012
Provider Focus Group Protocol
Introduction:
Thank you for participating in this focus group discussion. We are holding discussion groups as
part of a community needs assessment for Kaiser Permanente and their medical centers to help
them better understand community needs and identify the type of support Kaiser Permanente can
provide to its diverse communities. Therefore, we would like get your ideas about the most
important health issues facing your community. In addition, we will talk about what community
members need to be healthier as well as the availability of services to meet those needs. Please
share your honest opinions and experiences and allow other to express theirs freely. Your
responses will not be associated with your name in the report and only to ensure your
confidentiality and anonymity. Does anyone have any questions before we get started?
Note to facilitator: Review health data for appropriate medical center service area in order to
effectively probe where appropriate.
GENERAL NEEDS (INCLUDING HEALTH AND SOCIAL NEEDS)
1. What are some of the major issues that impact individuals in your service area?
a. Why do you think they’re the most important?
b. What populations are most affected by these needs? Why?
c. What are the social issues that contribute to the health problems? (Such as substance use,
unemployment, etc.)
2. What major trends in needs (positive and negative) are you seeing in your service area?
a. How are today’s trends different from the major trends 5 years ago? Are there any
differences among different communities/geographic areas? What are the differences
(if any)? Why?
3. Are there social or environmental factors that have contributed to these changes? Other
factors?
4. What kind of insurance programs do community members have available to them?
a. How does insurance impact their ability to get the health care they need? Is it different
for their family members by age?
b. If they are uninsured, why? [barriers, etc.]
BARRIERS TO ACCESS
5. What health services are difficult to access in your service area? [For example, this could
include community clinics, healthcare providers for low-income/uninsured, health workshops,
Page 166
dental care, vision care, substance abuse services, mental health care, free health fairs,
resources for pregnant women, etc.]
a. Does this affect certain communities/geographic areas more than others? Which? What
factors contribute to this?
6. What health services are lacking in your service area? [For example, this could include
community clinics, healthcare providers for low-income/uninsured, health workshops, dental
care, vision care, substance abuse services, mental health care, free health fairs, resources for
pregnant women, etc.]
7. What other challenges keep individuals from seeking help? [For example, this could be a lack
of awareness of available resources, language barriers, lack of bilingual healthcare providers,
immigration status/issues, lack of transportation or childcare, cultural values/beliefs, unsafe
neighborhood, working multiple jobs/lack of time, etc.]
8. Which healthy behavior is the most difficult to promote in your service area?
a. Why?
b. Are there any healthy behaviors that are the hardest to promote for a particular
population? Which? Why?
c. Based on your knowledge of this community, what are some possibilities for addressing
this?
ASSETS (HEALTH AND SOCIAL)
Health services
9. What health-related services are available to you in the community?
a. Where do community members go to receive or obtain information on health services?
b. How do you prefer to receive information about important health issues or available
services? [newspaper, radio, community clinic, flyers, billboards]
c. Does access differ for certain populations or groups?
Social services
10. What social services (non-medical) are available to you in the community? (For example,
senior services, food/nutrition, family support, disability, employment, environmental, homeless,
etc.]
a. Where do community members go to receive or obtain information on social services?
b. Does access differ for certain populations or groups?
c. Which social services are needed in your community?
11. What are the strengths and resources available that have had a positive impact health?
a. What populations are more able to access these resources because of this?
HEALTH CARE UTILIZATION
12. Are individuals in your service area likely to use preventative healthcare?
a. If no, why?
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b. Had this changed in the last 5 years?
c. Do culture or community norms influence the health behaviors of community member?
How?
13. If community members are not feeling well [not an emergency], where do they usually go for
care? [Prompt for other providers: alternative health care including curanderos, traditional
healers, use of herbs and natural medicines]
a. Where are they located? How do you get there?
b. Do you feel that it’s getting easier or harder to obtain healthcare? Why?
HOSPITAL’S ROLE
14. What role could hospitals play in addressing the service needs of your service area?
Page 168
KP CHNA 2012
Resident Focus Group Protocol
Introducción:
Gracias por participar en esta plática. Estamos hablando con varios grupos en el Condado de Los
Ángeles como parte de un estudio sobre las necesidades de las comunidades en el condado para
mejorar los servicios de Kaiser Permanente y sus centros médicos locales y para identificar los
tipos de apoyo Kaiser Permanente puede proveer a las diversas comunidades. Por eso es
importante que nos digan cuales son los problemas de salud más grandes en su comunidad para
poder identificar arias de necesidad y los servicios disponibles para servir sus necesidades. Por
favor sean honestos y respetosos de los demás. Esto será completamente confidencia. ¿Tienen
preguntas antes de empezar?
NECESIDADES GENERALES (DE SALUD O SOCIALES)
1. ¿Cuales son algunos de los temas más grandes afectando a la comunidad?
a. ¿Porque piensan que estos temas son más importantes?
b. ¿Quiénes son los más afectados por esto? ¿Por qué?
c. ¿Hay problemas sociales que contribuyen a estos problemas? [Pueden ser como abuso
de la droga, desempleo, etc.]
2. ¿Cuales tendencias (positivas o negativas) ve en la comunidad?
a. ¿Esas tendencias han cambiado en los últimos 5 años? ¿Cómo?
b. ¿Que ha contribuido a estos cambios?
3. ¿Existen factores sociales o ambientales que han contribuido a estos cambios? ¿Cuáles? ¿Otros
factores?
4. ¿Qué tipo de seguro médico son más utilizados en la comunidad?
a. ¿Han podido utilizado el cuidado médico necesario con los seguro médico? ¿Sus
familiares?
b. ¿Si no tienen seguro médico, porque?
LAS BARRERAS AL ACCESO
5. ¿Ahí servicios que son difíciles de utilizar en la comunidad? [Por ejemplo, puede ser clínicas
comunitarias, proveedores de salud para gente con bajos recursos o sin seguro médico, clases
de salud, cuidado dental o de visión, servicios para el abuso de sustancias, servicios de salud
mental, ferias de salud gratuitas, recursos para mujeres embarazadas]
a. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
6. ¿Ahí servicios que faltan en la comunidad? [Por ejemplo, puede ser clínicas comunitarias,
proveedores de salud para gente con bajos recursos o sin seguro médico, clases de salud,
Page 169
cuidado dental o de visión, servicios para el abuso de sustancias, servicios de salud mental,
ferias de salud gratuitas, recursos para mujeres embarazadas]
b. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
7. ¿Hay otros problemas o situaciones que impiden a la gente buscar ayuda? [Por ejemplo, falta
de conocimiento de recursos disponibles, lenguaje, falta e proveedores bilingües, estate
inmigratorio, falta de transportación cuidado de niño, valores o crianzas de cultura, falta de
seguridad en la comunidad, falta de tiempo, etc.]
8. ¿Cuál comportamiento saludable es más difícil de promover en la comunidad? ¿Por qué?
c. ¿Cuáles comunidades son las más afectadas? ¿Por qué?
d. ? Cuáles son las mejores formas de tratar de cambiar esto?
SERVICIOS EXISTENTES (SALUD Y SOCIALES)
Servicios de Salud
9. ¿Cuáles servicios de salid están disponibles en su comunidad?
e. ¿A dónde van residentes para obtener información sobre servicios de salud?
f. ¿Cómo prefiere recibir este tipo de información?
g. ¿Hay diferencias en acceso para diferentes grupos?
Servicios Sociales
10. ¿Cuáles servicios sociales (no de salud) están disponibles en su comunidad? [Por ejemplo,
servicios para personas mayores, comida/nutrición, apoyo familiar, deshabilite, empleo,
ambiental, vivienda, etc.]
h. ¿A dónde van residentes para obtener información sobre servicios de salud?
i. ¿Hay diferencias en acceso para diferentes grupos?
j. ¿Cuáles servicios sociales faltan en su comunidad?
11. ¿Cuáles recursos o servicios en la comunidad están disponibles y han contribuido al
mejoramiento de salud en la comunidad?
a. ¿Quién es más probable de tener acceso a esos recursos o servicios?
USO DE SERVICIOS DE SALUD
12. ¿Qué es medicina preventivita para la gente de la comunidad?
k. ¿Qué hace para mantenerse saludable?
l. ¿Hay algo que afecta los comportamientos saludables como cultura o costumbres?
¿Cómo?
13. ¿A dónde van miembros de la comunidad cuando no se sienten bien? [Por ejemplo: curanderos,
naturalistas, etc.]
m. ¿En dónde están localizados? ¿Cómo llega a ese lugar?
n. ¿Siente que se está facilitando el uso de servicios médicos? ¿Por qué?
PAPEL DE HOSPITALES
14. ¿Qué pueden hacer los hospitales para corresponder a las necesidades de la comunidad?
Page 170
KP CHNA 2012
Resident Focus Group Protocol
Introduction:
Thank you for participating in this focus group discussion. We are holding discussion groups as
part of a community needs assessment for Kaiser Permanente and their medical centers to help
them better understand community needs and identify the type of support Kaiser Permanente can
provide to its diverse communities. Therefore, we would like get your ideas about the most
important health issues facing your community. In addition, we will talk about what community
members need to be healthier as well as the availability of services to meet those needs. Please
share your honest opinions and experiences and allow other to express theirs freely. Your
responses will not be associated with your name in the report and only to ensure your
confidentiality and anonymity. Does anyone have any questions before we get started?
GENERAL HEALTH NEEDS (i.e. CHRONIC DISEASE, COMMUNICABLE DISEASES,
MENTAL HEALTH, ETC.)
15. What are some of the major health issues that affect individuals in your community overall?
a. Why do you think they’re the most important?
b. What populations are most affected by these needs? Why?
c. What are the social/societal issues that contribute to the health problems? (DO NOT
SAY ALOUD: Such as substance use, unemployment, etc.)
16. What major trends in health needs (positive and negative) are you seeing in your community?
a. How are health issues different from 5 years ago? Are there any differences among
different communities/geographic areas? What are the differences (if any)? Why?
b. What factors have contributed to these changes?
17. Are there social or environmental factors that have contributed to health needs or trends?
Which? Other factors?
18. Do you or a family member have a chronic health condition such as asthma, diabetes or heart
disease?
a. If yes, how do you keep your condition under control?
b. How helpful is the support you receive from your health care provider?
c. How helpful is the information that you receive?
19. What kind of insurance programs do you use for yourself? Your spouse? Your children?
a. How does insurance impact/effect your ability to get the health care you need? Is it
different for your other family members?
b. What other kinds of insurance programs are you aware of?
c. If you are uninsured, why?
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BARRIERS TO ACCESS
20. What health services are difficult to access in this community? [DO NOT SAY ALOUD: For
example, this could include community clinics, healthcare providers for low-income/uninsured,
health workshops, dental care, vision care, substance abuse services, mental health care, free
health fairs, resources for pregnant women, etc.]
21. What health services are lacking in this community? [DO NOT SAY ALOUD: For example,
this could include community clinics, healthcare providers for low-income/uninsured, health
workshops, dental care, vision care, substance abuse services, mental health care, free health
fairs, resources for pregnant women, etc.]
22. What other challenges keep individuals from seeking help/care? [DO NOT SAY ALOUD: For
example, this could be a lack of awareness of available resources, language barriers, lack of
bilingual healthcare providers, immigration status/issues, lack of transportation or childcare,
cultural values/beliefs, unsafe neighborhood, working multiple jobs/lack of time, etc.]
23. Which healthy behavior is the most difficult to encourage in this community? Why?
a. Are there any healthy behaviors that are the hardest to promote for certain
communities/geographic areas? Which? Why?
b. Based on your knowledge of this community, what are some possibilities for addressing
this?
COMMUNITY ASSETS (HEALTH AND SOCIAL)
Health services
24. What health-related services are available to you in the community?
a. Where do community members go to receive or obtain information on health services?
b. How do you prefer to receive information about important health issues or available
services? [newspaper, radio, community clinic, flyers, billboards]
c. Does access differ for certain populations or groups?
Social services
25. What social services (non-medical) are available to you in the community? (DO NOT SAY
ALOUD: For example, senior services, food/nutrition, family support, disability, employment,
environmental, homeless, etc.]
a. Where do community members go to receive or obtain information on social services?
b. Does access differ for certain populations or groups?
c. Which social services are needed in your community?
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26. What does preventative/preventive healthcare mean to you?
a. What do you do to stay healthy?
b. Do culture or community norms influence the health behaviors of community member?
How?
27. If you are not feeling well [not an emergency], where do you usually go for care? [Prompt for
other providers: alternative health care including curanderos, traditional healers, use of herbs
and natural medicines]
a. Where are they located? How do you get there?
b. Do you feel that it’s getting easier or harder to obtain healthcare? Why?
HOSPITALS ROLE
28. What role could hospitals play in addressing the health service needs of this community?
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Organization: _________________________________
KP CHNA 2012
Provider Focus Group Survey
1. Primary service area: ______________________________________________________
2. Primary area of expertise: __________________________________________________
3. Primary service population: ________________________________________________
This survey is confidential, thank you!
Page 174
Organization: _________________________________
KP CHNA 2012
Resident Focus Group Survey
1. What ZIP code do you live in? _____________
2. How many years have you lived in this ZIP code? ____________
3. How many children do you have? ____________
4. What year were you born? _________
5. Gender?
 Male
 Female
6. Ethnicity?  African-American  Hispanic/Latino  Asian/Pacific Islander
 Caucasian/While Other _______________
This survey is confidential, thank you!
Organización: _____________________________
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KP CHNA 2012
Resident Focus Group Survey
1. ¿En cuál código postal vive? _____________
2. ¿Cuántos años ha vivido en este código postal? ____________
3. ¿Cuántos hijos tiene? ____________
4. ¿En cuál año nació? _________
5. ¿Sexo?  Masculino  Femenino
6. ¿Etnicidad?  Afro-Americano
 Hispano/Latino  Asiático
 Blanco/Americano Otro _______________
¡Esta encuesta es confidencial, gracias!
Page 176
Date:
Interviewer:
Interviewee:
KP CHNA 2012
Stakeholder Interview Protocol
Introduction:
The Center for Nonprofit Management is working with Kaiser Permanente to conduct their 2013
Community Health Needs Assessment. We are talking to health experts to obtain their
perspective on the most important health issues facing the local community and to identify areas
of need as well as the availability of services to meet those needs. All the information collected
will help local medical centers improve and better target their services. The information you
provide will not be associated with your name and will only be reported in an aggregated
manner.
For the interviewer: Review health data to help inform appropriate probing where appropriate.
Area of expertise:
Primary service area:
Population served:
GENERAL ISSUES
1.
What are the primary issues or challenges facing your service population? [e.g., health, socioeconomic, legal]
Have there been any recent events or developments that have had an impact or are likely to
have an impact on the welfare of the community members you serve? [negative or positive]
PRIMARY CONCERNS
2.
What are the most significant concerns among your service population?
Who do they impact the most?
What are the key drivers behind the concerns?
What services are available to address these concerns?
Are there any significant service gaps?
Has there been a significant change in the availability of services over the last few years?
3.
To what extent does your service population utilize basic health care services (including
preventive care) and where do community members access those services? What other community
assets are available to community members?
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To what extent do they utilize dental care and where do they go?
4.
When community members become sick where do they go to receive care? (Doctor’s office,
urgent care, ER, community clinic, etc.)
Where do they tend to obtain information?
5.
Where do community members go if they have chronic health issues?
Where do they go if they need specialized care?
Where do they go if they need mental health care?
BARRIERS TO ACCESS
6.
What kinds of challenges does your service population experience when trying to get the care they
need? [e.g., transportation, language barriers, lack of information, no health insurance, economic
constraints]
Who tends to have the most difficulty?
How might these challenges be addressed?
SERVICE PROVISION
7.
Are there any growing needs/trends among your service population? Explain.
What measures have your organization taken to address this need?
8.
What specifically could hospitals do to help address these needs?
9.
Do you see any potential areas for collaboration or coordination among service providers to better
meet the needs of your service population? Explain.
OUTREACH
10. What would be the most effective way to provide information to your service population about the
availability of health and other services?
Is there a particular message that would appeal to community members?
11. Is there anything else you would like to add?
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Appendix E:
Tier Results
Page 192
The following tables include the list of all identified health needs and drivers. Each health need and driver is presented according to the tier that they fell into during the identification phase, from Tier 1 which was all inclusive
to Tier 3 which was the most exclusive. After much discussion between the consultant and the Collaborative, the
list in Tier 2 was taken into the prioritization phase. Please note that both tables are presented in alphabetical
order and not in any ranking order.
KFH-LA Identified Health Issues 2013, by Tier
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Alcohol & Substance Use
Allergies
Arthritis
Asthma
Brain Cancer
Breast Cancer
Cancer, in General
Cervical Cancer
Chlamydia
Cholesterol
Chronic Pain
Colorectal Cancer
Common Cold
COPD
Diabetes
Disability
Gastritis
Gonorrhea
Health, Overall
Hepatitis
HIV/AIDS
Hypertension
Infant Mortality
Intentional Injury
Lung Cancer
Mental Health
Metabolic Syndrome
Mortality, Overall
Obesity/Overweight
Oral Health
Ovarian Cancer
Sexually Transmitted Infections
STDs, in General
Vision
Page 193
Tier 1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Tier 2
X
X
X
X
X
X
X
X
X
Tier 3
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
KFH-LA Identified Drivers 2013, by Tier
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Tier 1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Age
Alcohol & Substance Use
Awareness
Breastfeeding
Cancer Screening
Dental Care Access
Education
Employment
Family & Social Supports
Health Care Access
Health Insurance
Healthy Eating
HIV Screenings
Homelessness
Income
Language Barrier
Natural Environment
Nutritional Access
Physical Activity
Physical Activity
Pneumonia Vaccinations
Prenatal Care
Safety
Smoking
Teen Birth Rates
Transportation
Page 194
Tier 2
Tier 3
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Appendix F:
Focus Group Summary
for KFH-LA
Page 195
Health Needs and Drivers
Seven focus groups representing a broad range of community stakeholders, including area residents, were convened to gather information and opinions directly from persons who represent the broad interests of the community served by the Hospital. Focus groups took place in a range of locations throughout the service area, with
translation and interpretation services provided when appropriate. Focus group sessions were 60 to 90 minutes
each. The focus group topics were designed to collect representative information about health care utilization,
preventive and primary care, health insurance, access and barriers to care, emergency room use, chronic disease
management and other community issues. A summary of key focus group findings is noted below.
Health needs
 Abuse, including sexual, physical, emotional, or neglect
 Allergies, asthma
 Attention Deficit Hyperactivity Disorder (ADHD)
 Cancer
 Chronic pain
 Dental disease (youth and adults)
 Developmental disorders, including autism
 Gastritis
 Heart disease
 High blood pressure
 High cholesterol
 HIV/AIDS
 Mental health, including depression, anxiety, and stress
 Metabolic syndrome
 Post-Traumatic Stress Disorder (PTSD)
 Sexually transmitted diseases (STDs)
 Sexually transmitted infections (STIs)
 Substance abuse
 Suicide
Drivers of health
 Environmental
 A lack of green space
 Poor air quality
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 Healthy behaviors
 Junk food epidemic, coupled with a lack of access to affordable healthy foods, a belief that junk food is
cheaper, and misleading food health campaigns (such as corn syrup vs. sugar)—more fast food and liquor stores in these neighborhoods
 Food is influenced by family culture; people continue to eat the same kinds of food even if this is
known to be unhealthy
 Housing
 People have been displaced by increased commercial development and the demolition of older apartment buildings, resulting in more expensive rental housing and an increase in the number of families
living together in a single residence.
 The criteria for affordable housing have changed. A family with a household income of $45,000 used
to be able to qualify for affordable housing; the cutoff has been reduced to $20,000
 A lack of low-income housing—new affordable housing buildings have only three units per 99 units
designated for low-income families
 A lack of education about healthy behaviors
 A lack of understanding about the importance of good nutrition
 A lack of awareness about wellness, healthy behaviors, and healthy habits (such as brushing teeth)
 A lack of access
 A lack of insurance
 People do not apply because they do not have IDs and will be denied services.
 A lack of trust in providers
 Fear about asking questions
 Poverty
 Low income
 Unemployment
 Single mothers are more likely to focus on obtaining food than seeking medical services
Health-Related Trends in the Community
Focus group participants were asked to discuss health-related trends they have noticed in the last five years.
Participants noted both positive and negative trends having to do with the worsening economy, poor health status,
barriers to access, and others.
Negative trends
 Continued barriers to access
 A lack of transportation
 The effects of deportation (of illegal immigrants)—more single parents/grandparents/older siblings are
caring for younger children, which also leads to violence and depression
 Fragmented health care system
 The criteria/requirements are getting harder, more rigorous
 Funding cuts to United Way and Healthy Families
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 Poor economic outlook
 Increased unemployment
 An increase in hazardous living conditions
 Overcrowded living conditions
 Displacement, changes in neighborhoods resulting from the bad economy
 Cuts in social support services for the elderly
 Cuts in women’s health services (abortion, breast care)
 The closing of many adult day care facilities
 Cuts in autism funding, the reallocation of HIV testing funding
 A worsening health status for many, including an increase in chronic illnesses
 An increase in number of sick patients going to emergency rooms (ER) for care
 An increase in teen pregnancy
 An increase in mental health issues, including suicide, depression, substance abuse, post-partum
depression
 An increase in diabetes
 An increase in HIV in the Latino community (both men and women)
 Drug abuse (an increase in the use of marijuana resulting from easy access at dispensaries; an increase
in the use of prescription drugs, and even Tylenol)
Positive trends
Focus group participants noted positive trends, including increased awareness around bullying and the early
detection and diagnosis of autism. There has also been more collaboration among social and health service
providers to create community gardens, exercise programs, and educational programs around healthy eating and
shopping habits. For example, the Los Angeles Unified School District has created a healthy lunch program and
started a walk to school program. In addition, community-based organizations such as CARACEN and Clínica
Monseñor Oscar A. Romero have increased the availability of health and dental screenings in the community.
Despite some of these challenges, participants learned how to manage their conditions and develop healthy behaviors from nutrition classes and their health care providers, as well taking appropriate medications, exercising, and
eating more healthily.
Sub-Populations Most Affected by These General Health Needs
The most affected populations were identified as Hispanics, African-Americans, single parents, the homeless,
undocumented immigrants, new immigrants, parolees, and the elderly. Focus group participants suggested that
these groups might be particularly vulnerable because of a lack of information, their economic status, a lack of
education, illiteracy, racism, language barriers, and a failure to seek their rights.
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Barriers to Access
Participants spoke of a number of barriers and challenges. Many circled back to a lack of awareness and confusion about the cost and availability of health services. One participant stated that she did not know where an
undocumented immigrant would go to seek medical services. Another shared that Mission Hospital, one of the
two hospitals in Southeast Los Angeles, was shut down, and that the remaining hospital sees about 200 patients a
day. A participant in the Filipino focus group shared that she experienced discrimination when she made an
appointment for a clinic visit, and had to wait for two hours. In the meantime, another patient (without an appointment but of the same race as the receptionist) walked in and was seen immediately by the doctor.
Barriers
 Authorization for referrals takes a long time
 Cost—even with insurance, co-pays can be prohibitively expensive
 Eligibility process—paperwork to be filled out with month-to-month eligibility requirements
 Immigration status—unsure of consequences when seeking health care
 A lack of affordable child care
 A lack of insurance coverage
 A lack of senior care
 A lack of transportation—a participant in the Mandarin focus group mentioned a community member
who provides transportation for senior citizens
 Language issues—inability to communicate with doctor
 Low-cost clinics might not provide comprehensive services—a participant in the Social Service Provider
focus group shared how a client’s sprain was misdiagnosed when the provider did not take an X-ray
because of a lack of insurance coverage
 Many nonprofits were unable to fundraise to meet patient needs and have gone out of business
 People get confused when they are moved from the emergency room to community clinics/hospitals
 A shortage of physicians
 Some locations are not easily accessible geographically
 Inability to miss work—loss of income, lack of job security
 USC requires patients to complete a form and some people resist this requirement
 Wait times
Health services that are lacking or difficult to access
 Affordable housing services
 Asthma
 Child care services/youth centers
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 Comprehensive case management
 Dementia care
 Dental services—not enough providers will accept Denti-Cal
 Diabetes management
 Eating disorders
 Mammograms for women under age 40
 Mental health services, particularly culturally accessible (e.g., for the Latino population)
 Prenatal care
 Preventive care
 Senior services
 Services for undocumented immigrants
 Social services and/or vocational centers
 Specialty care
 Substance abuse for teens
 Vision services
Healthy behaviors that are the most difficult to promote
Participants noted that old habits are hard to break. One person remarked that it is “harder to change behavior than
to have health care providers . . . teach.” Another commented, “It is easier for some families and mothers to fill a
bottle with soda than with milk.”
Healthy behaviors that are most difficult to promote include:
 The appropriate use of prescribed medication
 Condom use in the GLBTQ community
 Eating together as a family at the dinner table (without distractions)
 Exercise (safety and fear of dangerous environments)
 Getting early diagnosis (preventive care)
 Mental/emotional health (people are in denial or embarrassed and don’t speak up)
 Healthy eating habits (it’s difficult to break old habits such as consuming soda and fast food, but programs that teach how to harvest healthy foods do help)
 Healthy food shopping
 Healthy relationships
 Preventive dental care—brushing, flossing; even with insurance, only 25% of children are visiting the
dentist
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 Smoking cessation
Suggestions for promoting healthy behaviors
One participant described the use of “promotoras” in schools as a way to promote and provide health care information to parents. In fact, at Miguel Contreras High School, 400 flyers were distributed inviting parents to attend
a preventive health care event, although only 50 attended. The participant commented that this reflected a lack of
involvement in the community: “Sometimes it is because there are too many promises made by the politicians that
are not delivered [on].” She also believed that parents might be unwilling to invest the time necessary for the
meetings.
Specific suggestions for promoting healthy behaviors included:
 Creating community spaces as a way to promote healthy behaviors (for example, community exercise
groups held in parks have encouraged many people to start exercising)
 Finding ways to change community norms and behaviors; if something is seen as a norm, it is difficult to
change the behavior
 Having a case manager go shopping with a client to teach them about buying health foods
 Motivating the population to help them solve their own problems (e.g., ward off hopelessness by using
positive reinforcement and messaging)
 Providing financial incentives to motivate people (e.g., compensation for time lost at work)
 Starting healthy eating campaigns—for example, Carl’s Jr. promoted healthy food choices by using a
celebrity, which worked well with young people
 Targeting middle-aged men who think they know everything
 Using religion to target the Latino population, who tend to rely on religion to solve their problems
 Using social media in a culturally appropriate way
Health Care Utilization
Participants pointed out that many people are still unfamiliar with preventive health care and do not know the
term “preventive health care” even when they might be seeking out green spaces or eating healthy foods. One
participant defined the term as “ways to avoid having health problems” such as diabetes. Another recognized that
sometimes “we do not eat to live, we live to eat,” and noted the role of tobacco and second-hand smoke in causing
cancer.
The role of culture and community norms can also influence healthy behaviors, such as the tradition of not wasting food and the notion that “You cannot leave the table until you have finished all the food.” Similarly, one’s
religious beliefs might prohibit the use of contraceptives. One participant shared that people wait to go to the dentist “until they experience pain.” People do not visit the dentist even if they have insurance (i.e., Denti-care).
Another stated that there is a lack of understanding of the “prevention paradigm,” and this even extends to policymakers and school board members.
When asked about what participants do to stay healthy, participants said they “pay more attention to what they
eat,” engage in “proper exercise,” and schedule “regular doctor visits.” Participants also stated that the people
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most likely to engage in preventive health care include those who have access to transportation and health insurance, are educated, and are third- or fourth-generation immigrants.
Where community members go for care
When participants are not feeling well, they most often go to their regular doctor and clinics including Clínica
Monseñor Oscar A. Romero, Hawthorne Clinic, and Saint John’s Well Child and Family Center. Other participants mentioned the use of the emergency room (ER), curanderos (or witch doctors), churches (for social support,
food drives, etc.), the fire department, pharmacies (to self-prescribe medication), using other people’s medications, and more holistic forms of medicine, including acupuncture and Chinese medicine. Participants added that
incentives would help to encourage preventive care—e.g., providing free stuff for dental care. It would also help
if people were better informed about the benefits of a preventive care visit.
Community resources
Participants were also asked to share information about community resources available in their community. Most
were aware of local school-based clinics, community clinics, health fairs, and health and legal advocates. Others
named the Medical and Legal Partnership (NLS), an organization called Victims of Crime (support for crime victims), Al-Anon Family Groups (alcohol abuse center), USC Dental Care Services, and Care Harbor LA (a health
resource for the uninsured).
There is still a need for support services in the community, such as nurse-based clinics, mental health services
(including counseling and peer education), health education, care transition services, free vaccination services
(i.e., flu shots), family caregiver support services, culturally sensitive providers, and other social services like
those provided by FAGSI (Filipino American Service Group, Incorporated) and SIPA (Search to Involve Pilipino
Americas).
How Hospitals Can Address the Health Service Needs of This
Community
Participants emphasized the importance of offering health services and health care workshops within the community. They also talked about the need for culturally sensitive and bilingual medical staff and wrap-around services
that could guide the patient through the process from medical treatment to ongoing disease management, and to
preventive medicine and the development of more healthy behaviors. One participant talked about how Kaiser
Permanente’s Thrive campaign emphasizes the concept of “being well” and to “not wait until you get sick.” Other
suggestions include:
 Adding preventive medicine at schools and community centers, including topics such as sex education
and birth control for teens
 Creating a list of resources and then following up with an open dialogue
 Creating wrap-around services (case/care management) that help families receive needed social services—e.g., Magnolia Place has a great process that integrates a county worker who assesses family needs
and guides them in following up
 Enabling private hospitals to provide care and not just referrals
 Establishing formal linkages between laboratory and radiology departments at hospitals
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 Having open house events in hospitals—e.g., explaining what they do in radiology—and orientation
events, introducing the community to services offered at the hospital
 Incorporating pre-assessments by case managers to help guide patients through a treatment process and
also help determine urgency of care
 Kaiser Permanente’s hiring more personnel to assist with promotoras’ group activities
 Leveraging technical (clinical/management) expertise in community organizations
 Organizing health care workshops at community centers with a cultural focus and in the language of the
community
 Providing access to space for agencies and partnering with nonprofit organizations to staff and volunteer
and to serve on the boards of those organizations
 Providing bereavement support groups open to all members of the community
 Providing grants and funding more places for people to access health care; creating wellness centers
within the community
 Providing volunteer opportunities and mentoring programs for teens
 Reducing costs for patient visits
 Reducing waiting times (one participant has a brother with a heart condition who has to wait six months
to see the cardiologist; she is afraid he might die during the long wait)
 Taking on an advocacy role, bringing people together, creating patient advocates
 Working with community-based organizations (CBOs) and providing spaces within hospitals for clinics
(triage ER visits), an approach that has worked in Houston; also training CBOs to collaborate and work
together, increasing and appreciating the value of community-based work including education and
preventive care
Communications strategies for some of these recommendations include the use of radio and television, brochures
in all languages, social media (YouTube, Facebook, etc.), community-based health fairs, and telenovelas (or soap
operas), as well as using promotoras and providing incentives.
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Appendix G:
Stakeholder Interviews
Summary for KFH-LA
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Health Trends and Drivers Impacting Communities
CHNA interviews with stakeholders were conducted via telephone during September and October 2012. Nineteen
interviews representing a broad range of community stakeholders, including health professionals and service
providers, were conducted to gather information and opinions directly from persons who represent the broad
interests of the community served by the Hospital. The interviews were conducted primarily via telephone for
approximately 30 to 45 minutes each. The interview protocol was designed to collect reliable and representative
information about health and other needs and challenges faced by the community, access and utilization of health
care services, and other relevant topics. A summary of key interview findings is noted below.
Interviewees identified several issues of primary concern related to all population groups, as well as issues of
greater concern to specific communities and sub-populations in the KFH-LA service area. The broader, community-wide issues most frequently mentioned are listed below.
Health needs
 Diabetes
 Obesity
 Hypertension
 Cardiovascular disease
 Cancer (lung, breast, cervical, ovarian)
 Chronic respiratory conditions
 Mental illness
 HIV/AIDS
 Substance abuse
 Dental care/oral health
Drivers of health
 Social and economic factors
 Poverty
 Unemployment
 Homelessness
 Immigration status
 Domestic and community violence (gang activity)
 Substandard housing
 Language barriers
 The impact of the economic downturn on the funding of community-based programs
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 A lack of access to:
 High-quality prevention and self-management programs
 Health care, including the difficulty of navigating the patchwork of clinics and community-based
organizations that offer services; problems with the fragmentation of available health care providers
and treatment options
 High-quality food and fresh food choices
 A lack of education regarding:
 Eligibility for services and/or where to go to access available services
 Healthy food choices, mental health, substance abuse, and HIV/AIDS
 A lack of transportation, resulting in a diminished access to health care and employment opportunities
Interviewees also provided insight into these key issues. One interviewee noted chronic diseases as coming “from
multiple interacting issues, including the economy and family stresses.” Another pointed out, “Even if insured,
people often don’t take advantage of the health care services they have because they don’t understand them.”
On immigration status, a provider of legal services to the undocumented observed that “anti-immigrant sentiment
is pretty high, although California is better. Work force raids and virtual raids are a constant source of stress and
anxiety.” This interviewee also noted that “Mixed-status families want to get services for their kids, but are concerned about being in the system (and identified as illegal). There’s a lot of misinformation around this.”
Interviewees offered the following observations about the fragmented nature of the current health care system
(Medi-Cal/HMOs) and lack of primary care:

“When people have multiple issues or conditions, they can only be treated for one
condition at a time at the clinic and need to come back repeatedly, rather than getting
all or most addressed at one time.”

“Siloed payment systems don’t treat for positive outcomes, just symptom treatment.”

“Only 30% to 40% get primary care. Very few have Medicare; they just don’t live
long enough to qualify for it. Many are on SSI and can’t see private physicians.”

“There is overuse of the ER and 911 because people don’t have primary care or
insurance coverage.”
Additionally, interviewees pointed to the difficulty of navigating the health insurance maze for those with coverage who face language barriers:

“When they try making an appointment, they get an automated answering machine.”

“Language is an important issue in the Latino community. Not everyone speaks
English, and materials and services need to be bilingual.”
Several interviewees agreed that preventive care and healthy lifestyle choices have not been a priority in the
populations they serve, and highlighted the inter-related reasons why:

“Parents work two jobs, and it takes so much time trying to get to places at the times
they are open to get services.”
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
“Parents are dealing with working and supporting their families. They just can’t fit it
in, or just don’t see it as important.”

“Latino communities don’t have the money to be able to feed a family and always
buy the best types of food.”

“A lot of fast food restaurants are inexpensive, so people go there. There’s no real
emphasis on healthy eating.”

“People are not motivated to be active. In some of our communities, it’s not convenient and there are no places to go for recreation.”

“They often fear going outside after dark [because of gang violence and/or the risk of
deportation].”
Health-Related Trends in the Community
Decreased funding has decreased access
Since 2008, community-based organizations (CBOs) have taken several hits as a result of the economy, and are
hard-pressed to keep pace with the increased need for services. With decreased reimbursement rates for physicians and cuts to emergency services, facilities, and providers, actual programs and services have vanished.
Interviewees say their organizations are struggling to stay afloat. Some are focused on building strategic partnerships with like agencies as a way to survive and deliver on their mission:

“Services have become fewer. So many organizations have gone under, or cut back.
They’ve changed into little programs.”

“We are trying to do our core work and still cover other areas.”

“Trying to partner with organizations to meet this changed availability.”
Cuts to dental care programs
State cuts since 2009 in the Denti-Cal program resulted in a substantial number of adults losing dental coverage at
clinics and private offices. (Dental coverage for children remained in place). Providers have seen an increase in
adults without coverage neglecting routine dental care, resulting in more emergency care and tooth extractions.
One person mentioned the significance of the Veterans Administration policy to provide only for tooth extractions
and not preventive or routine care for veterans. One interviewee whose agency provides dental services to lowincome people, veterans, the National Guard, and the homeless said, “We have become the safety net they come
to, as we try to avoid extracting teeth.” In the last two years, the agency has become involved with groups focusing on deployment readiness, as soldiers with bad oral health cannot be deployed.
HIV/AIDS
Interviewees noted several positive developments with the campaign against HIV/AIDS.
 An increased awareness of HIV/AIDS at all levels of society, especially among youth
 Increased testing
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 A decreased rate of infection transmission through blood
 More people on medication, making them less infectious
While HIV-related illness has decreased and the number of infected children (under age 10) is also decreasing,
providers are seeing an increase in infected teens. They are also now serving many more affected children (children of infected parents).
Interviewees expressed concern about the continued ignorance about the disease, and the alienation that people
with HIV/AIDS continue to face.

“People still don’t understand the disease. They’re still asking questions like, ‘Can
you get HIV/AIDS from mosquitoes?’ It’s like it was 20 years ago.”

“Clients are facing discrimination, living in secrecy among peers and family. So they
have emotional and mental issues, in addition to the physical problems.”

“We are seeing many situations where parents aren’t telling their kids about their
infection until they have to go into the clinic. Kids find it difficult to process.”
Like other CBOs, several HIV/AIDS service providers started a collaborative network to support each other and
“stay alive” during the economic downturn. One of the interviewees has joined a collaborative network that meets
regularly and on LinkedIn.
Mental health
Interviewees cited three recent developments impacting the delivery of mental health services.

AB109—Early Release Program
 More returning veterans needing treatment for PTSD and substance abuse
 More newly homeless as a result of unemployment and the economic downturn
Regarding the recently initiated Early Release Program, one interviewee observed that, “incarcerated individuals
are coming out of jails with no place to go, and they don’t know where to get (health, mental health or other) services or referrals.”
Undocumented/immigration issues
Interviewees offered the following developments as significantly impacting the undocumented and CBO efforts to
assist them:
 An increase in the number of deportations, seen as “excessive” by many
 Increased fears among the undocumented resulting from SB 1070 in Arizona and copycat laws in other
states
They added these observations about the current situation for the undocumented:

“People are afraid to leave home. They come from countries where the threat of
prosecution or death is real if they are returned home.”
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
“The undocumented are locked out of access to health care, even with the advent of
the new health care laws.”
Positive trends include:
 Working on legislation to improve health—such as strengthening the Clean Water Act—particularly in
schools, and increasing taxes on cigarettes
 More people becoming conscious of their weight; patients are making the connections among diet,
weight, diabetes, and hypertension.
 California’s efforts to meet the Health Care Challenge–Healthy Way Initiative is getting health care
providers to “start talking to each other”
Barriers to Access
Interviewees were asked to identify the kinds of problems or challenges that people face in obtaining health care
and/or social services. The most frequently reported barriers included:
 A lack of education about or an understanding of the severity of their conditions
 People wait until their symptoms becomes an emergency
 Food deserts, the lack of access to fresh fruit and vegetables
 A lack of safety while walking in the community, so kids stay inside, watching TV or using the computer
 Not enough community clinics
 Not enough supportive and/or affordable housing
 Language barriers in navigating the system and ascertaining eligibility to enroll in services
 Uninsured or uninsurable
 Expensive to get care
 Challenging for the mentally ill to navigate even no-cost services
Most Severely Impacted Sub-Populations
Interviewees were asked to comment on issues of special concern to specific sub-populations within the
communities their agencies serve. Among all the subgroups identified below, one interviewee pointed out that
each group can be further distinguished in terms of how individuals in that group process and act on information:
“We have two groups—the savvy and [the] isolated.” This is relevant in that those who are isolated have different
needs than those who know how to use technology and language to make connections.
Interviewees noted a number of underserved sub-populations and gaps in service.
People with chronic diseases (including mental illness) and the disabled
 The need to reduce recidivism and high use of ER
 Compliance--lack of follow-up
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
“Without someone to help manage chronic disease, it’s a burden on the patient and
caregivers, who usually don’t have the skills or wherewithal to care for a condition.”

“Not enough resources or attention is being given to adult males in terms of health
management. Also [we] need to focus on adult women who tend to put health concerns on the back burner to take care of their families.”
Children
 With the closing of pediatric clinics, families have to go farther to find care
 Children affected by (but not infected with) HIV/AIDS
One interviewee whose agency provides services to children affected by HIV/AIDS said, “Some are suicidal.
They need social workers, but they don’t have any. The parents are oblivious, absorbed their own issues and fears.
These children have no access to support because they aren’t sick and they aren’t insured. Infected children are
covered, but children affected [by a family member with HIV/AIDS] are not.”
Youth/young adults
 High suicide rate among people under 30
 The need for ongoing mental health, educational, and social supports
 The need for groups targeted to support heterosexual youth (group services to support homosexual youth
are plentiful)
One interviewee pointed out that when teens transition from pediatric to adult status at the provider level, many
are left in a kind of limbo. “The paperwork is confusing and some youth find themselves in a period without
coverage. They get frustrated and call us and we refer them to someone who can help.” This confusing gap in
coverage “has resulted in some young adults with HIV/AIDS who can’t get their medication.”
The following observations were offered in terms of support groups for youth:

“Youth like support groups, but aren’t attending. It’s not a transportation issue. They
have transportation. This is a new generation of youth, and we need to figure out how
to serve their needs.”

“Many youth nowadays aren’t good at communicating. A lot come from gangs, are
missing school. They don’t communicate with [their] families, yet they do have
goals.”

“They need a safe space to share, to feel good about themselves, and [to] feel
empowered. We are about helping them develop steps toward their goals and [to]
rebuild relationships with their families.”

“Let’s keep them out of jail and on the right track. They need help, support, and guidance. They are in a spiral they can’t get out of without help.”
Seniors
 In-home mobility, adaptable public transportation
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 The need for more services for older adults, in light of the anticipated increase in number of people with
Alzheimer’s
 The need for assistance in navigating the health care system and managing chronic conditions
 The need to train psychiatric social workers in geriatric services
Health Care Utilization
Interviewees were asked to name places where people go to access services and information to help them deal
with mental and physical health care issues, family challenges, and personal concerns. Community members
access services, information, and education in varied settings and across many communication platforms.
Community resources mentioned during the interviews are included in the compiled list of community assets in
Section VII of the Community Health Needs Assessment report.
Ideas for Collaboration and Cooperation among Service
Providers
Interviewees were asked to reflect on specific actions or initiatives that hospitals could take to help address identified needs. They were also asked to describe potential areas for collaboration and coordination among hospitals
and CBOs to better meet the needs of the communities they serve.
Develop patient advocates and patient advocate training programs

“Someone to accompany a person to a medical visit, so two people hear and learn
key points about the condition and can provide the patient with guidance and support
to do what they have to do to address their condition.”

“Someone who can help people pursue resources, make the call for them, help them
understand what they should do, and figure out how they can do it.”

“Have more patient advocates and discharge planners who can translate preventive
care practices into people’s real-life needs and capabilities.”

“Train these front-line people to provide these resources to patients and their caregivers and families.”

“Have more engagement specialists so [that] when people show up in [the] ER, people on staff can link them to community health resources.”

“Advocates can help with the HIV/AIDS pediatric to adult transition, sitting down
with them and helping get them into the next program.”
Interviewees provided examples of advocacy programs that are working:
 Pacific Clinics’ peer-based health navigator program trains clients to help other clients navigate services.
Advocates remind clients to take meds, of scheduled appointments, and accompany clients on office visits, etc.)
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 Didi Hirsch Mental Health Services has an outcomes-based approach that begins with a patient assessment at the first visit and the assignment of “engagement specialists” and “outcomes assistants,” with
health coaches and links to services. They accompany patients through the treatment process, help them
to navigate services and maintain compliance between appointments, etc.
One interviewee commented on the need for a health care advocate as a Kaiser patient. “I found the care to be less
than comprehensive and thorough in tracking and monitoring a chronic disease. A proactive person can ask for
what they think should be monitored and attended to, but a less knowledgeable person is at the mercy of the system and the health care staff’s ability on any given day to give quality attention and appropriate follow-up in
managing the health issue.”
Support groups

“Hospitals need to think out of the box, because the support groups aren’t working as
they are formatted now. Kids are calling saying they need this, but they won’t go to
the hospital/clinic for it.”

“This is a different generation of youth. They are on computers. We need to collaborate on new ways to reach them [on the digital and electronic platforms] where they
congregate and feel most comfortable.”
Community-based clinics and mobile clinics

“Establish open clinics such as Exodus, which has partnered with a hospital to provide a 23-hour-a-day mental health services. It would be great to have something like
this for primary care services, as an alternative to the ER.”

“Make presentations to health care agency staff so they can knowledgeably share
information.”

“Kaiser can partner with wellness centers for diabetes or nutrition classes.”

“Bring back art therapy and education programs—it’s a shared responsibility.”
One interviewee described a community education program in collaboration with Los Angeles County that
encourages patients to participate in a community garden project located at the hospital, that is tied to a nutrition
program.
Another interviewee—representing one of the founding agencies of the Los Angeles County Coalition of Mobile
Units—described how mobile providers get together to strategize, maintain, and enhance services: “It’s very ad
hoc, without any funding, and needs to be strengthened. Our mobile clinics got stimulus money to buy the van
and tools, but no money to run it.”
A dental care provider interviewee described his organization as involved in many collaborative coalitions, and
emphasized the importance of “operational funding for community clinics. Also, collaborative strategizing is not
enough, because being able to actually run things is critical.” This interviewee was eager to “brainstorm with
community partners to look at oral health insertions in operating programs.”
Another example of a working partnership—First 5 LA provides more information through the promotoras who
go to WIC centers and Head Start programs with key messages about oral health and preventive dental care.
Page 212
Maximize use of public health data in planning and service delivery
An interviewee from an agency serving all Los Angeles County noted how the agency has used public health data
to develop proactive measures in response to major causes of trauma and death. In partnership with other providers, it established a network of locations to take people to for specific emergencies (e.g., cardiac centers, ST Segment Elevation Myocardial Infarction (STEMI) centers, stroke, pediatric services). This interviewee noted that
Kaiser hospitals have not participated in the development of this network and do not serves as sites for any of
these services. The interviewee identified Kaiser’s non-participation as a service gap, emphasizing that Kaiser
participation would generate mutual benefit. “Kaiser has so much data, information about health needs, conditions, trends, etc.—they can identify areas of need, share with 911 and other key services and providers to inform
[the] development of policies [and] programs [and] leverage resources.”
Immigration
An interviewee representing a provider of legal services to the undocumented said that the agency started a
relationship with the Human Impact Program to help immigrant family members left behind to deal with the
impact of a loved one’s deportation. This interviewee said it was preferable to have “those most immersed in the
communities provide help, but Kaiser has been good by providing us funding to be able to do the work we do.
CBOs are over extended and understaffed, so it’s not just a partnership, but funding to increase capacity that is
needed.”
Hospital certification

“Hospitals should come together to embrace the concept of becoming certified stroke
centers, adopting guidelines and improvement initiatives so that they have that higher
quality-of-care standards and the resources that go along with that.” (Fewer than half
of all hospitals are certified.)
All representatives of the organizations interviewed for this report expressed enthusiasm about the idea of
participating in additional partnerships.
Outreach methodologies and message content
Interviewees were asked to share their thoughts about the most effective outreach methods for delivering information to their service populations. They also shared their ideas about messages they thought were particularly
important to convey.
 Adapt the method and message to targeted populations (generic does not fit all)
 Create mass campaigns promoting healthy eating and diet
 Redesign support-group delivery to fit youth preferences and lifestyles
 Provide educational resources in waiting rooms
 Organize more informational events, garden projects in the schools
 Offer more free informational and screening events at convenient times
 Address multiple health issues at a single event to save time and resources
 Emphasize preventive practices
Page 213
 Make follow-up phone calls
 Make home visits to hard-to-reach individuals
 Expand the promotoras model
Expanding on the above methods and messages, interviewees offered the following commentary on outreach
methods and formats:

“House-to-house outreach is most effective.”

“One-on-one outreach is the way to go.”

“Phone calls are more effective than e-mail. People don’t have time to make calls any
more, but that’s what they need. You hear their story and at the same time provide
social support. Each call takes about 20 minutes, but it shows we care. They will
show up at something we host because they know we’re listening to them and working as a team.”

“Our organizers go where our demographic is.”

“Go where people congregate as part of daily life, at health fairs, food distribution
centers, etc. Expecting organizations to disseminate information doesn’t seem to
work, People just don’t connect.”

“Take into account culture and beliefs “(i.e., Hispanics at community centers and
schools, African-American at churches).

“Place more people in communities who can facilitate connection to resources and
care and identify risks in the home.”

“Most of our clients don’t drive and [do] work long hours, so address multiple needs
at one time/event.”
In terms of message content, interviewees offered these suggestions:

“Help people at around age 30 to realize that they will benefit by learning about and
practicing healthy behaviors now to impact how they’ll look and feel as they get
older—life expectancy, quality of life, things like that.”

“The Kaiser Thrive ads are making an impact—great message.”

“Talk about outcomes, but scaring them is not good.”

“With garden programs, you can’t expect to just put one in and have them use it. It
has to be incorporated into the school curriculum so they get it.”
Three examples of educational materials/campaigns considered effective:
 “People’s Guide to Food and Hunger” (from the now defunct Coalition to End Hunger and Homelessness
in Los Angeles)
Page 214
 The “methadone calendar” concept in which a photo of one person looks normal in January and gets
progressively worse over each of the successive 12 months
 “My Kitchen—My Rules” ad campaign
To meet the needs of teens and deliver messages to them effectively, interviewees concurred that the Internet is a
viable avenue to explore.

“Online is a new solution. They like it. It’s social media. They like online.”

“For HIV/AIDS prevention, teens aren’t interested in traditional behavioral solutions
or groups, but they still need social support time.”
One example of this new online support format was described as “tele-mental health,” which provides face-time
with peers and a facilitating social worker in monitored online meetings. Currently, this is offered for groups, not
one-on-one, and only locally, but the agency is looking to implement the model nationally in the future.
Page 215
Appendix H:
Data Sources
Page 216
Secondary Data Sources from Kaiser Permanente CHNA Data Platform and other Sources
Category
Clinical Care
Indicator
Absence of Dental
Insurance Coverage
Clinical Care
Access to Primary Care
Clinical Care
Adults ages 50 and older
ever have a
sigmoidoscopy,
colonoscopy, or FOBT
Clinical Care
Adults ages 50 and older
have a sigmoidoscopy,
colonoscopy in the last 5
years
Clinical Care
Breast Cancer Screening
(Mammogram)
Data
Area
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Geograph
y
Benchmark
CA
Only
California
Health
Interview
Survey (CHIS),
2007
County
(Grouping)
State
Average
Yes
U.S.
U.S. Health
Resources and
Services
Administration
Area Resource
File, 2011
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
U.S.
Dartmouth
Atlas of
Healthcare,
Selected
Measures of
Primary Care
Access and
Quality, 2003–
2007
County
State
Average
No
Data Source
Page 217
Category
Clinical Care
Clinical Care
Clinical Care
Indicator
Cervical Cancer
Screening in last 3 years
Cervical Cancer
Screening in last 3 years
Children who have
never seen a dentist
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
U.S.
Los Angeles
County
Department of
Public Health,
Office of
Health
Assessment
and
Epidemiology,
Health
Assessment
Unit, Los
Angeles
County Health
Survey, 2007
County
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
Page 218
Category
Clinical Care
Clinical Care
Clinical Care
Clinical Care
Indicator
Colon Cancer Screening
(Sigmoid/Colonoscopy)
Delayed or didn’t get
medical care
Delayed or didn’t get
prescriptions
Dental Care
Affordability (Youth)
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2007
County
(Grouping)
State
Average
Yes
Page 219
Category
Clinical Care
Clinical Care
Clinical Care
Clinical Care
Indicator
Dental Care Utilization
(Adult)
Dental Care Utilization
(Youth)
Diabetes Management
(Hemoglobin A1c Test)
Do Not Have a Usual
Source of Care
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
(Grouping)
State
Average
Yes
U.S.
Dartmouth
Atlas of
Healthcare,
Selected
Measures of
Primary Care
Access and
Quality, 2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
Page 220
Category
Clinical Care
Clinical Care
Clinical Care
Clinical Care
Indicator
Facilities designated as
health professional
shortage areas
Federally Qualified
Health Centers
Hard Time
Understanding Doctor
Heart Disease
Management
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
U.S. Health
Resources and
Services
Administration,
HPSA
Health
Professional
Shortage Area
File, 2012
No
U.S.
U.S. Health
Resources and
Services
Administration,
Centers for
Medicare &
Address
Medicaid
Services,
Provider of
Service File,
2011
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
Page 221
Category
Clinical Care
Clinical Care
Clinical Care
Indicator
High Blood Pressure
Management
HIV Screenings
Lack of a Consistent
Source of Primary Care
Clinical Care
Lack of Prenatal Care
Clinical Care
Needed help for
mental/emotional/alcoho
l-drug issues but did not
receive treatment
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2005
County
(Grouping)
State
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
(Grouping)
State
Average
Yes
CA
Only
California
Department of
Public Health,
Birth Profiles
by ZIP Code,
2010
ZIP Code
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
Page 222
Category
Clinical Care
Clinical Care
Clinical Care
Indicator
Pneumonia Vaccinations
(Age 65+)
Population Living in a
Health Professional
Shortage Area
Preventable Hospital
Events
Data
Area
Data Source
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
State
Average
No
U.S.
U.S. Health
Resources and
Services
Administration,
HPSA
Health
Professional
Shortage Area
File, 2012
State
Average
No
CA
Only
California
Office of
Statewide
Health,
Planning and
Development
(OSHPD),
Patient
Discharge
Data, 2010–
2010
State
Average
Yes
Page 223
County
ZIP Code
Category
Clinical Care
Clinical Care
Clinical Care
Clinical Care
Indicator
Primary care provider
per 100,000 Population
Received Pap smear in
last 3 years
Received Pap smear in
last 3 years
Teens who can’t afford
dental care
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
U.S. Health
Resources and
Services
Administration
Area Resource
File, 2011
County
County
Average
No
Count
y
Office of
Health
Assessment
and
Epidemiology,
Los Angeles
County Health
Survey, 2007
SPA
Healthy
People 2020
Yes
Count
y
Office of
Health
Assessment
and
Epidemiology,
Los Angeles
County Health
Survey, 2010
SPA
Healthy
People 2020
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
No
Page 224
Category
Demographic
s
Demographic
s
Demographic
s
Demographic
s
Indicator
Change in Total
Population
Linguistically Isolated
Population
Median Age
Total Female Population
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
U.S. Census
Bureau, 2000
Census of
Population and
Housing,
Summary File
1; U.S. Census
Bureau, 2010
Census of
Population and
Housing,
Summary File
1
County
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Survey FiveYear Estimates
Tract
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
Page 225
No
State
Average
Yes
Category
Demographic
s
Demographic
s
Demographic
s
Demographic
s
Demographic
s
Indicator
Total Male Population
Total Population
Total Population Age 0–
4
Total Population Age
18–24
25–34
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
Page 226
Category
Demographic
s
Demographic
s
Demographic
s
Demographic
s
Demographic
s
Indicator
35–44
45–54
Total Population Age 5–
17
55–64
Total Population Age 65
or Older
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
Yes
Page 227
Category
Health
Behaviors
Health
Behaviors
Health
Behaviors
Health
Behaviors
Indicator
Adequate
Fruit/Vegetable
Consumption (Youth)
Alcohol & Substance
Use
Alcohol Expenditures
Breastfeeding (Any)
Data
Area
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Geograph
y
Benchmark
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
(Grouping)
State
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010.
County
County
Average
No
U.S.
Nielsen
Claritas
SiteReports,
Consumer
Buying Power,
2011
Tract
State
Average
No
CA
Only
California
Department of
Public Health,
In-Hospital
Breastfeeding
Initiation Data,
2011
County
State
Average
Yes
Data Source
Page 228
Category
Health
Behaviors
Health
Behaviors
Health
Behaviors
Health
Behaviors
Health
Behaviors
Indicator
Breastfeeding
(Exclusive)
Children drinking two or
more glasses of soda
Children eating less than
5 servings of
Fruit/Vegetable a Day
Frequent Fast Food
Restaurants
Fruit/Vegetable
Expenditures
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
California
Department of
Public Health,
In-Hospital
Breastfeeding
Initiation Data,
2011
County
State
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
U.S.
Nielsen
Claritas
SiteReports,
Consumer
Buying Power,
2011
Tract
State
Average
No
Page 229
Category
Health
Behaviors
Health
Behaviors
Health
Behaviors
Indicator
Heavy Alcohol
Consumption
Inadequate
Fruit/Vegetable
Consumption (Adult)
Physical Inactivity
(Adult)
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2003–
2009
County
State
Average
No
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
Page 230
Category
Health
Behaviors
Health
Behaviors
Health
Behaviors
Health
Behaviors
Indicator
Physical Inactivity
(Youth)
Serious Psychological
Distress in Last Year
Soft Drink Expenditures
Tobacco Expenditures
Data
Area
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Geograph
y
Benchmark
CA
Only
California
Department of
Education,
Fitnessgram
Physical
Fitness Testing
Results, 2011
School
District
State
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
U.S.
Nielsen
Claritas
SiteReports,
Consumer
Buying Power,
2011
Tract
State
Average
No
U.S.
Nielsen
Claritas
SiteReports,
Consumer
Buying Power,
2011
Tract
State
Average
No
Data Source
Page 231
Category
Health
Behaviors
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Tobacco Usage (Adult)
Adults Taking Medicine
to Lower Cholesterol
Allergies (teens)
Alzheimer's mortality
age-adjusted
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
Los Angeles
County
Department of
Public Health,
Office of
Health
Assessment
and
Epidemiology,
2006
SPA
County
Average
Yes
Page 232
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Arthritis Prevalence
Asthma Hospitalization
Asthma Hospitalizations
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
Los Angeles
County
Department of
Public Health,
Los Angeles
County Health
Survey, 2011
SPA
County
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010.
Zip Code
State
Average
No
CA
Only
California
Office of
Statewide
Health,
Planning and
Development
(OSHPD),
Patient
Discharge
Data, 2010
ZIP Code
State
Average
Yes
Page 233
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Asthma Prevalence
Breast Cancer Incidence
Cancer Mortality
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
U.S.
The Centers for
Disease
Control and
Prevention, and
the National
Cancer
Institute: State
Cancer
Profiles, 2005–
2009
County
State
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
Page 234
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Mortality
Cervical Cancer
Incidence
Cervical Cancer
Mortality
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
Zip Code
State
Average
Yes
U.S.
The Centers for
Disease
Control and
Prevention, and
the National
Cancer
Institute: State
Cancer
Profiles, 2005–
2009
County
Healthy
People 2020
Yes
CA
only
California
Department of
Public Health,
Death
Statistical
Master File,
2008
ZIP Code
Healthy
People 2020
Yes
Page 235
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Chlamydia Incidence
Colon and Rectum
Cancer Incidence
Colon Cancer Mortality
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention and
the National
Center for
HIV/AIDS,
Viral Hepatitis,
STD, and TB
Prevention,
2009
County
State
Average
No
U.S.
The Centers for
Disease
Control and
Prevention, and
the National
Cancer
Institute: State
Cancer
Profiles, 2005–
2009
County
Healthy
People 2020
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008
ZIP Code
County
Average
Yes
Page 236
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Diabetes
Hospitalizations
Diabetes
Hospitalizations (adult)
Diabetes
Hospitalizations (under
18)
Diabetes Prevalence
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
California
Office of
Statewide
Health,
Planning and
Development
(OSHPD),
Patient
Discharge
Data, 2010
ZIP Code
State
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
ZIP Code
State
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
ZIP Code
State
Average
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
Page 237
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Diabetes Prevalence
Heart Disease
Hospitalization
Heart Disease Mortality
Heart Disease
Prevalence
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
National
Diabetes
Surveillance
System, 2009
County
State
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
ZIP Code
State
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
State
Average
Yes
Page 238
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Hepatitis C Prevalence
High Blood Pressure
Prevalence
HIV Hospitalizations
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Count
y
Los Angeles
County
Department of
Public Health,
Acute
Communicable
Disease
Control
Program,
Annual
Morbidity
Report and
Special Studies
Report, 2011
SPA
County
Average
Yes
Count
y
California
Health
Interview
Survey (CHIS),
2009
SPA
County
Average
Yes
CA
Only
California
Office of
Statewide
Health,
Planning and
Development
(OSHPD),
Patient
Discharge
Data, 2010
ZIP Code
State
Average
Yes
Page 239
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
HIV Hospitalizations
HIV Prevalence
HIV Prevalence
Homicide
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
ZIP Code
State
Average
Yes
U.S.
Centers for
Disease
Control and
Prevention and
the National
Center for
HIV/AIDS,
Viral Hepatitis,
STD, and TB
Prevention,
2008
County
State
Average
No
U.S.
Los Angeles
County
Department of
Public Health,
Annual HIV
Surveillance
Report, 2011
County
County
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
Page 240
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Homicide
Hospitalizations for
Uncontrolled Diabetes
Infant Mortality
Low Birth Weight
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008
ZIP Code
Healthy
People 2020
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
ZIP Code
State
Average
Yes
U.S.
Centers for
Disease
Control and
Prevention,
National Vital
Statistics
System, 2003–
2009
County
Healthy
People 2020
Yes
CA
Only
California
Department of
Public Health,
Birth Profiles
by ZIP Code,
2010
ZIP Code
State
Average
No
Page 241
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Lung Cancer Incidence
Mental Health
Hospitalizations (adults)
Mental Health
Hospitalizations (under
18)
Motor Vehicle Crash
Death
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
The Centers for
Disease
Control and
Prevention, and
the National
Cancer
Institute: State
Cancer
Profiles, 2005–
2009
County
State
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
Zip Code
County
Average
Yes
CA
Only
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2010
Zip Code
County
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
Page 242
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Obesity (Adult)
Obesity (Adult)
Obesity (Youth)
Overweight (Adult)
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
LAC
Only
California
Health
Interview
Survey (CHIS),
2009
Zip Code
U.S.
Centers for
Disease
Control and
Prevention,
National
Diabetes
Surveillance
System, 2009
County
State
Average
Yes
CA
Only
California
Department of
Education,
Fitnessgram
Physical
Fitness Testing
Results, 2011
School
District
State
Average
Yes
LAC
Only
California
Health
Interview
Survey (CHIS),
2009
Zip Code
Page 243
Yes
Yes
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Overweight (Adult)
Overweight (Youth)
Pedestrian Motor
Vehicle Death
Percent of Pedestrians
Killed
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
CA
Only
California
Department of
Education,
Fitnessgram
Physical
Fitness Testing
Results, 2011
School
District
State
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
CA
Only
California
Highway Patrol
Statewide
Integrated
SPA
Traffic Records
System (CHP–
SWITRS),
2008
County
Average
Yes
Page 244
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Poor Dental Health
Poor General Health
Poor Mental Health
Population with Any
Disability
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2004–
2010
County
State
Average
No
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
(Grouping)
State
Average
Yes
U.S.
U.S. Census
Bureau, 2008–
2010 American
Community
Survey ThreeYear Estimates
Tract
State
Average
No
Page 245
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Indicator
Premature Death
Prostate Cancer
Incidence
Stroke Mortality
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
National Vital
Statistics
System, 2008–
2010 (As
Reported in the
2012 County
Health
Rankings)
County
State
Average
No
U.S.
The Centers for
Disease
Control and
Prevention, and
the National
Cancer
Institute: State
Cancer
Profiles, 2005–
2009
County
State
Average
Yes
CA
Only
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
State
Average
Yes
Page 246
Category
Health
Outcomes
Health
Outcomes
Health
Outcomes
Physical
Environment
Physical
Environment
Indicator
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
California
Department of
Public Health,
Death
Statistical
Master File,
2008–2010
ZIP Code
Healthy
People 2020
Yes
Uncontrolled Diabetes
Hospitalizations
Office of
Statewide
Health and
Planning and
Development
(OSHPD),
2009
Zip Code
State
Average
Yes
Very Low Birthweight
CA
Only
California
Department of
Public Health,
2010
Zip Code
County
Average
No
CA
Only
U.S. Census
Bureau, ZIP
Code Business
Patterns, 2009
ZIP Code
State
Average
No
U.S.
U.S. Census
Bureau,
County
Business
Patterns, 2009
County
State
Average
No
Suicide
Fast Food Restaurant
Access
Grocery Store Access
CA
Only
Page 247
Category
Physical
Environment
Physical
Environment
Physical
Environment
Indicator
Liquor Store Access
Park Access (Within 1/2
mile of park)
Poor Air Quality
(Particulate Matter 2.5)
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
California
Department of
Alcoholic
Beverage
Control, Active
License File,
April 2012
ZIP Code
State
Average
No
U.S.
U.S. Census
Bureau, 2010
Census of
Population and
Housing,
Summary File
1; ESRI's USA
Parks layer
(compilation of
ESRI, National
Park Service,
and TomTom
source data),
2012
Block
Group
State
Average
No
U.S.
Centers for
Disease
Control and
Prevention,
National
Environmental
Public Health
Tracking
Network, 2008
Tract
State
Average
No
Page 248
Category
Physical
Environment
Indicator
Population Living in
Food Deserts
Data
Area
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Geograph
y
Benchmark
U.S.
U.S.
Department of
Agriculture,
Food Desert
Locator, 2009
Tract
(2000)
State
Average
No
ZIP Code
County
Average
No
Data Source
Physical
Environment
Protected Open Space
Areas in Acres per 1,000
People
CA
Only
California
Health
Interview
Survey (CHIS),
2009
Physical
Environment
Recreation and Fitness
Facility Access
CA
Only
U.S. Census
Bureau, ZIP
Code Business
Patterns, 2009
ZIP Code
State
Average
No
SPA
County
Average
Yes
Physical
Environment
Visited park in last
month
CA
Only
California
Health
Interview
Survey (CHIS),
2009
Physical
Environment
Walkability
U.S.
WalkScore.Co
m (2012)
City
U.S.
U.S.
Department of
Agriculture,
Food
Environment
Atlas, 2012
County
Physical
Environment
WIC-Authorized Food
Store Access
Page 249
Yes
State
Average
No
Category
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Indicator
Adequate Social or
Emotional Support
Children Eligible for
Free/Reduced Price
Lunch
Children in Poverty
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
Centers for
Disease
Control and
Prevention,
Behavioral
Risk Factor
Surveillance
System, 2006–
2010
County
State
Average
No
U.S.
U.S.
Department of
Education,
National
Center for
Education
Statistics
(NCES),
Common Core
of Data, Public
School
Universe File,
2010–2011
Address
State
Average
No
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
State
Average
Yes
Page 250
Category
Social &
Economic
Factors
Social &
Economic
Factors
Indicator
High School Graduation
Rate
Homeless by Age
Data
Area
Data Source
U.S.
U.S.
Department of
Education,
National
Center for
Education
Statistics
(NCES),
Common Core
of Data, Local
Education
Agency
(School
District)
Universe
Survey
Dropout and
Completion
Data, 2008–
2009
Count
y
Los Angeles
Homeless
Services
Authority,
Greater Los
Angeles
Homeless
County Report,
2011
Page 251
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
School
District
HP 2020:OnTime
Graduation
Rate:>82.
4
No
County
County
Average
Yes
Category
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Indicator
Homeless Count
Population Below 100%
of Poverty Level
Population Below 200%
of Poverty Level
Population Receiving
Medicaid
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
Count
y
Los Angeles
Homeless
Services
Authority,
Greater Los
Angeles
Homeless
County Report,
2011
County
County
Average
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
State
Average
No
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
State
Average
No
U.S.
U.S. Census
Bureau, 2008–
2010 American
Community
PUMA
State
Average
Yes
Page 252
Category
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Indicator
Population with No
High School Diploma
Poverty Rate
Student Reading
Proficiency (4th Grade)
Supplemental Nutrition
Assistance Program
(SNAP) Recipients
Teen Births
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
State
Average
Yes
U.S.
U.S. Census
Bureau, 2006–
2010 American
Community
Tract
State
Average
Yes
U.S.
States'
Department of
School
Education,
District
Student Testing
Reports, 2011
Healthy
People 2020
No
U.S.
U.S. Census
Bureau, Small
Area Income
and Poverty
Estimates
(SAIPE), 2009
County
State
Average
No
CA
Only
California
Department of
Public Health,
Birth Profiles
by ZIP Code,
2010
ZIP Code
State
Average
Yes
Page 253
Category
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Social &
Economic
Factors
Indicator
Unable to Afford
Enough Food (Food
Insecurity) (Adults)
Unemployment Rate
Uninsured Population
Violent Crime
Data
Area
Data Source
Geograph
y
Benchmark
Data
Breakout
by
Groupings
(including
ethnicity,
gender,
additional
geographies
)
CA
Only
California
Health
Interview
Survey (CHIS),
2009
County
County
Average
Yes
U.S.
U.S. Bureau of
Labor
Statistics,
December,
2012 Local
Area
Unemployment
Statistics
County
State
Average
No
U.S.
U.S. Census
Bureau, 2008–
2010 American
Community
PUMA
State
Average
Yes
U.S.
U.S. Federal
Bureau of
Investigation,
Uniform Crime
Reports, 2010
Place,
County
State
Average
No
Page 254
Page 255

Community Health Needs Assessment

Transcription

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