Community Health Needs Assessment

2013
Community Health Needs Assessment
Kaiser Foundation Hospital – VACAVILLE
License #550001207
To provide feedback about this
Community Health Needs Assessment, email [email protected].
KAISER PERMANENTE NORTHERN CALIFORNIA REGION
COMMUNITY BENEFIT
CHNA REPORT FOR KFH-VACAVILLE
I. Executive Summary
The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, added
new requirements, which nonprofit hospital organizations must satisfy to maintain their taxexempt status under section 501(c) 3 of the Internal Revenue Code. One such
requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to
conduct a community health needs assessment (CHNA) at least once every three years.
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.
While Kaiser Permanente has conducted CHNAs for many years to identify needs and
resources in our communities and to guide our Community Benefit plans, this new
legislation has provided an opportunity to revisit our 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 KFH-Vacaville service area includes the Solano County communities of Dixon, Elmira,
Fairfield, Rio Vista, Suisun City, Vacaville, Winters, and a small portion of Yolo County.. A
collaborative was established in each county to support the CHNA process. The Solano
CHNA workgroup included representatives from Kaiser Foundation Hospital (Vacaville),
Solano County Public Health, Sutter Solano Medical Center (Vallejo), North Bay Medical
Center (Fairfield), Solano Coalition for Better Health, Solano County Public Health
Department, Community Clinic Consortium, and La Clinica in the 2013 CHNA process.
The process included a comprehensive review of secondary data on health outcome
drivers, conditions, and behaviors in addition to the collection and analysis of primary data
through community conversations with members of vulnerable populations in the KFHVacaville service area.
In preparation for the Vacaville Hospital Contributions Committee to better understand the
community health needs, to discuss them, and to prioritize them, the twenty five health
needs were grouped and categorized into broader needs areas, resulting in a total of ten
community health needs. The Vacaville Hospital Contributions Committee reviewed the
identified needs and selected the top four community health needs with particular
relevance for vulnerable populations in the KFH-Vacaville hospital service area (listed in
priority order).
1. Access to culturally appropriate, affordable health care services
2. Access to affordable healthy food
3. Lack of employment and vocational training
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4. Lack of substance abuse treatment and rehabilitation
II.
INTRODUCTION/BACKGROUND
a. Purpose of the Community Health Needs Assessment (CHNA) Report
This report was written in order to comply with federal tax law requirements set
forth in Internal Revenue 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 (KP)*
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, stateof-the-art care delivery, and world-class chronic disease management. Kaiser
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Permanente is dedicated to care innovations, clinical research, health education,
and the support of community health.
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
Community Health, requires equity and social and economic well-being.
Like our approach to medicine, our work in the community takes a preventionfocused, 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 longterm, 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 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.
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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 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. Because data collection, review, and
interpretation are the foundation of the CHNA process, each CHNA includes
a review of secondary and primary data.
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 KP 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
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health. The process and the outcome of the CHNA are described in this
report.
In conjunction with this report, Kaiser Permanente will develop an
implementation strategy for each health need identified. These strategies will
build on Kaiser Permanente’s assets and resources, as well as evidencebased strategies, wherever possible. The Implementation Strategy will be
filed with the Internal Revenue Service using Form 990 Schedule H.
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.
About Kaiser Foundation Hospital Vacaville KEY LEADERSHIP AT KFH‐VACAVILLE Max Villalobos Senior Vice President and Area Manager
Kim Trumbull Kyle Wichelmann Steven Stricker, MD Sandra Rusch Michelle Odell Cynthia Verrett Chief Operating Officer
Area Finance Director Physician in Chief
Medical Group Administrator
Public Affairs Director
CB/CH Manager
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The KFH-Vacaville service area includes the Solano County communities of Dixon, Elmira,
Fairfield, Rio Vista, Suisun City, Vacaville, Winters, and a small portion of Yolo County.
The KFH-Vacaville hospital is centrally located along the Interstate 80 corridor in Solano
County and intersects with Interstate 505.
TABLE 1: DEMOGRAPHIC PROFILE OF THE KAISER FOUNDATION HOSPITAL VACAVILLE SERVICE AREA Total population:
Population: no high school diploma
Uninsured:
Percentage living in poverty:
Percentage unemployed:
Percentage uninsured:
275,396
15.0%
10.74%
9.24%
9.86%
10.74%
Caucasian:
African American
Hispanic/Latinos
Asian
Pacific Islander
Native American
Other Races
Multiple Races
45.7%
12.0%
25.8%
10.3%
0.7%
0.5%
0.7%
4.4%
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The primary focus of our community benefit programs is on the needs of vulnerable
populations. Through a collaborative process with other hospitals and safety net providers
serving KFH-Vacaville hospital service area, we defined vulnerable populations as those
with evidenced-based disparities in health outcomes, significant barriers to care and the
economically disadvantaged. The KFH-Vacaville Communities of Concern include the
cities of East Fairfield, Rio Vista, and parts of Vacaville. The populations at the highest risk
(highest poverty rates, lowest levels of health insurance and lowest rates of high school
degree completion) in these areas are African Americans and Latinos.
IV. WHO WAS INVOLVED IN THE ASSESSMENT
The Solano CHNA collaborative include representatives from Kaiser Foundation Hospital
(Vacaville), Solano County Public Health Department, Sutter Solano Medical Center
(Vallejo), North Bay Medical Center (Fairfield), Solano Coalition for Better Health, Solano
County Public Health Department, Community Clinic Consortium, and La Clinica in the
2013 the Community Health Needs Assessment.
The Solano County collaborative workgroup retained Valley Vision, Inc., to lead the
assessment process. Valley Vision, Inc. (www.valleyvision.org) is a non-profit [501 (c) (3)]
consulting firm serving a broad range of communities across Northern California. The
organization’s mission is to improve quality of life through the delivery of high-quality
research on important topics such as healthcare, economic development, and sustainable
environmental practices. Valley Vision also designed and facilitated primary data collection
as well as a prioritization session that engaged public and community health experts from
across Solano County.
Chris Aguirre, Senior Project Manager, Valley Vision, Inc. Mr. Aguirre joined Valley Vision
in Jan 2006 and holds a master’s degree in Community Development. His fields of study
were economic development, affordable housing, urban design, community participation,
labor and nonprofit organizations. Mr. Aguirre also completed internships with the Senate
Office of Research and the California Legislature’s Select Committee on Economic
Development. Chris supports the many facets of the Youth Development Project, The
Community Needs Assessment, and manages fundraising and stakeholder outreach
projects.
Nancy Shemick, is responsible for consolidating the county processes and writing the
CHNA report. She collected data analysis of the CARES database, and facilitated the
prioritization process. Ms. Shemick holds a Masters Degrees in Public Administration and
has been working with community and public health organizations for 35 years. She
completed the required California SB 697 Community Needs Assessments for other
Northern California Kaiser Foundation hospitals in 2004, 2007, and 2010. Ms. Shemick
has also worked as a consultant to the Solano. Coalition for Better Health and other
community agencies in Solano County. She conducts data analysis, performs strategic
planning for health care nonprofits, leadership development for nonprofit health care
boards of directors and conducts group facilitation
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V. PROCESS AND METHODS USED TO CONDUCT THE CHNA
Solano County (secondary data and community input)
The majority of the secondary data used in this CHNA included health outcomes,
demographic data, behavioral data, and environmental data. A key focus was to show
specific communities (defined geographically) experiencing disparities as they related
to chronic disease and mental health. To this end, ZIP code boundaries were selected
as the unit-of-analysis for most indicators. This level of analysis allowed for
examination of health outcomes at the community level that are often hidden when data
are aggregated at the county level. Some indicators (demographic, behavioral and
environmental in nature) were included in the assessment at the census tract level, the
census block, or point prevalence, which allowed for deeper community level
examination. Once communities of concern were identified, a review of specific
secondary data for Vacaville hospital service area was conducted for presentation to
the Vacaville Community Benefits Advisory Committee. The Kaiser Permanente (KP)
Community Health Needs Assessment (CHNA) Data Platform, powered by the Center
for Applied Research and Environmental Systems (CARES), and the Institute for
People, Places, and Possibility (iP3) were other sources of data used.
Health Outcomes data from the platform were downloaded for KFH-Vacaville and
compared to benchmarks defined either by Healthy People 2020, relevant County-level
rates or State-level rates. After identifying those outcomes indicators for which the
population in the KFH-Vacaville service area were seen to compare poorly to
benchmarks, associated indicators of health (health behaviors, clinical care, physical
environment and social and economic factors) were reviewed and analyzed to see
where these indicators also showed poor performance relative to benchmarks.
Each Community of Concern was determined by health outcomes, and population
characteristics residing in these communities, as well as health behaviors and
environmental conditions.
Primary Data- The Community Voice
Primary data collection included qualitative data gathered in four ways:
1. Meetings with the CHNA workgroup, i.e. Kaiser Permanente, NorthBay
Healthcare, Sutter Health Sacramento Sierra Region, Solano Coalition for Better
Health, Solano County Public Health Department, Community Clinic Consortium,
and La Clinica
2. Key informant interviews with area health and community experts
3. Focus groups with area community members
4. Community health asset collection via phone interviews and website analyses
CHNA Workgroup
The Solano CHNA workgroup was an active contributor to the qualitative data
collection. Using the previously described CBPR approach, regularly scheduled
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meetings were held with the workgroup at each critical stage in the assessment
process. This data (combined with demographical data) informed the location and
selection of key informant interviews for the assessment.
Key Informant Interviews
Key informants are health and community experts familiar with populations and
geographic areas within in the HSA. To gain a deeper understanding of the health
issues pertaining to chronic disease and the populations living in these vulnerable
communities input from 17 key informant interviews were conducted using a
theoretically grounded interview guide. Each interview was recorded and content
analysis was conducted to identify key themes and important points pertaining to each
geographic area. Findings from these interviews were used to identify communities in
which focus groups would most aptly be performed. A list of all key informants
interviewed, including name, professional title, date of interview, and description of
knowledge and experience is detailed below.
Key Informants
Name & Title
Affiliation or
Organization
Dixon Community
Medical Centers
Area of Expertise
Date
Clinical, community health,
medically underserved
persons, low income persons,
populations with chronic
disease needs
6/21/12
Heli Karkkainen
Regional Center
Director
Robin Cox
Health Education
Director
Ivonne Vaughn
Senior Program
Manager
Jacqueline Jones
Site Manager
Planned Parenthood
Clinical, community health, low 6/21/12
income persons, medically
underserved persons
Public Health Expert
6/21/12
Viola Lujan
Director of Business &
Community Relations
La Clinica
Maria Reyes
La Clinica
Minerva Arellano
Clinical Manager
Solano County
Public Health Dept.
City of Vacaville
A.T.O.D. Program
Community and youth
resources
7/9/12
La Clinica
Clinical, community health,
medically underserved
persons, low income persons,
populations with chronic
disease needs
Clinical, community health,
medically underserved
persons, low income persons,
populations with chronic
disease needs
Clinical, community health,
8/16/12
8/16/12
8/16/12
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Health Educator
Margaret Anderson
Executive Director
Rio Vista
CARE/FRC
Adriana Bejarano
Executive Director
Rio Vista
CARE/FRC
Gloria Diaz
Senior MSW
Ana Isabel Montaño
MSW
City of Vacaville
FIRST
City of Vacaville
FRC
Maria Moses
Volunteer Support
Coordinator
Children’s Network
Zoila Perez-Sanchez
Family Resource
Center Director
Cookie Powell
Executive Director
Fairfield-Suisun
Unified School
District and FRC
Dixon Family
Services
Josephine Wilson
Family Resource
Center Director
Halsey Simmons
Mental Health Director
Fighting Back
Partnership/Vallejo
FRC
Solano County
Mental Health Dept.
medically underserved
persons, low income persons,
populations with chronic
disease needs
Family and community
resources, low income
persons
Family and community
resources, low income
persons
Family and community
resources
Family and community
resources, low income
persons
Family and community
resources, low income
persons
Family and community
resources, low income
persons
Family and community
resources, low income
persons
Family and community
resources, low income
persons
Mental health
8/16/12
8/16/12
8/16/12
8/16/12
8/16/12
8/16/12
8/16/12
8/16/12
9/4/12
Focus Group Selection
Selection of locations for focus groups was determined by feedback from key informants,
CHNA team input, and analysis of health outcome indicators (ED visits, hospitalization,
and mortality rates) that pointed to disease severity. Key informants were asked to identify
populations (in demographic subgroups or particular areas of the county) that were most at
risk for chronic health disparities and mental health issues. In addition, analysis of health
outcome indicators by ZIP code, race and ethnicity, age, and gender revealed
communities with high rates that exceeded county benchmarks. This information was
compiled to determine the location of focus groups within the Solano County HSA.
Focus Groups
Members of the community representing demographic subgroups (based on race and
ethnicity, age, or gender) were recruited to participate in focus groups. A standard
protocol was used for all focus groups to understand the lived experience of these
community members as it relates to health disparities and chronic disease. In all, a total of
five focus groups (see chart below) were conducted. Content analysis was performed on
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focus group interview notes and/or transcripts to identify key themes and salient health
issues affecting the community residents.
Focus Groups
Location
Dixon Migrant Center
Date
10/5/12
Age
30s-40s
Mission Solano
10/15/12
20s-50s
Vacaville FRC
10/18/12
20s and 50s
Bayanihan Center
10/19/12
40s-60s
Mt. Calvary Fairfield
10/30/12
30s-50s
Demographic Information
Female; Latino; rural; Spanish
speaking; medically
underserved; low-income
Latino; Black; Caucasian; Asian;
Male; medically underserved;
chronic disease needs group;
low-income
Caucasian; Latino; medically
underserved; low-income
Filipino; female; medically
underserved; low-income
Black; female; low-income,
medically underserved
The Solano residents who participated in the focus groups represented the entire county,
including communities outside the Vacaville hospital service area. As with the health
indicator findings, we learned that the highest areas of community health need include
parts of the Vacaville service area, as identified in the Communities of Concern. The
issues and associated drivers identified by these focus groups were verified by Vacaville
key informants as well as by the Vacaville Contributions Committee.
Secondary Data
Secondary data were collected in three main categories: demographic information, health
outcome data, and behavioral and environmental data (see Appendix B for details).

Demographic Variables Collected from the US Census Bureau (U.S. Census
Bureau, 2013a; U.S. Census Bureau, 2013b)

ZIP Demographic Information (Dignity Health, 2011)

2011 OSHPD Hospitalization and Emergency Department Discharge Data by ZIP
Code

CDPH Birth and Mortality Data by ZIP Code

Behavioral and Environmental Variable Sources
The biggest challenge to the clear analysis and interpretation of data was the difficulties in
acquiring secondary data and assuring community representation via primary data
collection. Emergency Department and hospitalization data used in the assessment are
markets of prevalence, but do not fully represent the prevalence of disease in a given ZIP
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code. Similarly, behavioral data sets at the sub-county level were difficult to obtain and
were not available by race and ethnicity.
Conclusion
Public health researchers have helped expand our understanding of community health by
demonstrating that health outcomes are the result of the interactions of multiple, interrelated variables such as socio-economic status, individual health behaviors, access to
health related resources, cultural and societal norms, the built environment, and
neighborhood characteristics such as crime rate. The results of this assessment help to
shine a light on the relationships of some of these variables that were collected and
analyzed to describe the communities of concern.
Hospital community benefit managers and personnel can use this expanded
understanding of community health, along with the results of these assessments to target
specific interventions and improve health outcomes in some of the area’s more vulnerable
communities. The cities identified with the most vulnerable populations and high-risk
outcomes were East Fairfield, Rio Vista, and parts of Vacaville. By knowing where to focus
community health improvement plans—identified communities of concern—and the
specific conditions and health outcomes experienced by their residents, community benefit
programs can develop plans to address the underlying contributors of negative health
outcomes.
Based on the experience of the expert stakeholders as well as the direct information we
received from members of under-served or at-risk populations, we are confident that the
community health needs we identified have a significant impact of vulnerable populations.
VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY’S HEALTH NEEDS
For the purposes of the CHNA, Kaiser Permanente defines a health need as:
 a poor health outcome and its 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.
Kaiser Foundation Hospital Vacaville identified a list of ten community health needs. The
criteria used to create the list of community health needs are:
o The community health need arises from comprehensive review and interpretation of
a robust set of data;
o More than one indicator and/or data source (i.e., the health need is suggested by
more than one source of secondary and/or primary data) confirms the community
health need;
o Indicator(s) related to the health need perform(s) poorly against a defined
benchmark (e.g., county/state average or HP 2020);
o Poor health outcomes along with their associated drivers (s)
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Community Health Needs for the Kaiser Foundation Hospital Vacaville service area were
defined and prioritized through the following sequential steps:
1. Analysis of secondary data on health outcomes, identifying all of the health outcomes
for which the data showed poor performance relative to benchmark, as described in the
Appendix: Community Health Profiles.
2. For each of the health outcomes showing poor performance, related health drivers,
behaviors and conditions were also analyzed to determine which are of concern in the
Vacaville hospital service area and thus are likely to be factors contributing to health
status.
3. Conversations with Key Informants and with community focus groups to test the data
findings, assess community knowledge about the issue and understand available
community resources.
4. A synthesis of all of the data and community input to define a set of community health
needs.
5. Discussion and prioritization of community health needs with the Vacaville Hospital
Contributions Committee, familiar with issues in the service area (See list of criteria and
prioritized community health needs below).
Valley Vision identified twenty-five detailed community health needs for Solano County.
Again, in each case, the issues identified for the County were identical for Vacaville. In
preparation for the Vacaville Hospital Contributions Committee to better understand the
community health needs, to discuss them, and to prioritize them, the twenty five health
needs were grouped and categorized into broader needs areas, coming to a total of ten
community health needs.
The ten community health needs identified from the Solano process, listed in the table
below, were presented to the Vacaville Hospital Contributions Committee.
Community Health Need Communities Most Affected Access to culturally appropriate, affordable health care services Fairfield, Rio Vista, Vacaville Access to Affordable Healthy Food Fairfield, Rio Vista Lack of safe place to walk, bike, exercise or play Fairfield, Rio Vista, Vacaville Transportation limitations Fairfield, Rio Vista, Vacaville 13
Lack or limited access to dental care Fairfield, Rio Vista, Vacaville Limited places and social space for civic engagement Fairfield, Rio Vista Lack of employment and vocational training Fairfield, Rio Vista, Vacaville Unstable housing and homelessness Fairfield, Rio Vista, Vacaville Lack of substance abuse treatment and rehabilitation Fairfield, Rio Vista, Vacaville Exposure to unclean air, environmental toxins and pesticides Fairfield, Vacaville Using these combined community health needs as a basis for Committee discussion, the
members reviewed the drivers for each community health need, the benchmarks and the
specific neighborhoods and zip codes within the Vacaville service area.
Once the Committee discussed the indicators, community health needs and the drivers
associated with each need, the Committee members agreed on the following criteria to be
used for prioritizing those needs for the Vacaville hospital service area:
•
•
•
•
•
•
Severity of issue/impact of related poor health outcomes
Size of the population affected
Community prioritizes issue over others
Effective and feasible interventions exist
A successful solution/intervention has the potential to solve multiple problems
Opportunity to intervene at the prevention level
Listed below are the top five community health needs as chosen by the Napa-Solano Area
Contributions Committee Meeting attendees on December 18, 2013:
1.
2.
3.
4.
Access to culturally appropriate, affordable health care services
Access to affordable health food
Lack of employment and vocational training
Lack of substance abuse treatment and rehabilitation
Community assets and resources available to respond to the identified health needs
of the community
SIGNIFICANT COMMUNITY ASSETS AND RESOURCES RELATED TO CHNs 14
Community Health Needs Access to culturally
appropriate, affordable health
care services
Existing Community Assets and Resources Kaiser Permanente (Fairfield, Vacaville)
North Bay Medical Center (Fairfield, Vacaville)
Community Medical Center (Vacaville)
Solano County Clinic (Fairfield)
Access to affordable health
food
Fairfield Community Action Council (Fairfield)
Mission Solano (Fairfield)
Fairfield Senior Center (Fairfield)
First 5 Solano (Fairfield)
Food Bank of Contra Costa & Solano County (Fairfield, Rio Vista,
Vacaville)
WIC (Fairfield, Vacaville)
Heather House (Fairfield)
St. Mark’s Lutheran Church (Fairfield)
Rio Vista Community Services (Rio Vista)
Opportunity House (Vacaville)
Vacaville Family Resource Center (Vacaville)
Kaiser Permanente Vacaville Medical Offices (Vacaville)
Crossroads Christian Church (Vacaville)
St. Paul’s United Methodist Church (Vacaville)
Solano County College (Suisun Valley, Vacaville)
The Workforce Investment Board of Solano County (Fairfield-serves county)
MedMark Treatment Center (Fairfield)
Youth & Family Services (Fairfield)
Drug Rehab (Fairfield)
Healthy Partnerships (Fairfield, Rio Vista, Vacaville)
Alcoholics Anonymous (Vacaville)
Rio Vista Abuse Rehab Center (Rio Vista)
Rio Vista Care (Rio Vista)
Lack of employment and
vocational training
Lack of substance abuse
treatment and rehabilitation
15
Appendix A: Community Health Need Profiles 1. Access to culturally appropriate, affordable health care Improved primary care access could have a positive effect on several of the poor health outcomes, particularly diabetes, asthma hospitalizations, heart disease and stroke mortality, and preventable hospital admissions. Rationale: Health care providers indicate that preventive care and specialty care access is limited for low‐income residents parts of Solano County. Vacaville Hospital Service Area Indicators and Health Outcomes
Health Outcomes Benchmarks Diabetes Adult Incidence = 9.65% State average = 7.57% Heart Disease Adult Prevalence = 6.89 Asthma Adult prevalence = 9.65% Adult hospitalization = 6.15/10,000 Related Factors
Insurance rate Access (including transportation access) to culturally /linguistically appropriate prevention services Access to culturally /linguistically appropriate primary care and care management (including medications) State average = 5.87% Access to culturally/linguistically appropriate primary care and care management (including medications) Insurance rate Access (including transportation access) to culturally /linguistically appropriate prevention services State Adult prevalence = 13.12% Adult hospitalization = 8.9/10,000 Access (including transportation access) to culturally /linguistically appropriate prevention services Access to culturally/linguistically appropriate primary care (including medications) 16
2. Access to affordable healthy food is a significant need in order to address several of the poor health outcomes, including obesity and overweight, diabetes, and cancers. Rationale: Several of the poor health outcomes are related to poor eating habits. Many related economic and social factors show that healthy food is less available to vulnerable populations Vacaville Hospital Service Area Indicators and Health Outcomes
Health Outcomes Benchmarks Related Factors Weight (State) Weight Adult Obesity = 26.68% Adult obesity = 26.70% Adult Overweight = 36.13% Adult overweight = 36.20% Youth Obesity = 31.34% Youth overweight = 14.3% Inadequate fruit and vegetable Youth overweight = 14.42%
Youth obesity = 29.82% consumption Diabetes Fruit and veg expenditures Adult Incidence = 9.65% State average = 7.57% Grocery store access WIC authorized food store access
Cancers: Cancers (State) Populations living in food desert
Cervical Cancer incidence = Cervical Cancer incidence = 8.30/100,000 8.50/100,000 Colorectal Cancer incidence = 43.70/100,000 Colorectal Cancer incidence = 48.40/100,000 17
3. Lack of employment and affordable training ‐ The low high school graduation rate is of grave concern, and there are limited training programs, employment placement services and jobs available. Adults recognize the importance of good role modeling, in addition to parenting skills and support were identified as a need by all of the community groups. The need relates to understanding how to raise children in a healthy way, using effective discipline as well as good cooking and eating habits. Parents also wanted skills and support in addressing mental health and substance use/abuse issues with their children. Rationale: Parents felt that improved skills and support is a critical need in families that lack resources, or where parents are struggling to manage jobs, commutes and children Vacaville Hospital Service Area Indicators and Health Outcomes
Mental health ED visits = 172.8/10,000 Substance Abuse ED visits = 312.9/10,000 Homicide = 6.80/100,000 Diabetes Adult Incidence = 9.65% Health Outcomes Benchmarks County – 190.4/10,000 State – 130.9/10,000 County – 407.2/10,000 State – 232.0/10,000 State = 5.15/100,000 State average = 7.57% Youth Obesity = 31.34% Youth overweight = 14.42% Youth overweight = 14.3% Youth obesity = 29.82% Related Factors High school graduation rate Employment rate Youth tobacco expenditures Youth drug and alcohol use Poverty rate High school graduation rate Employment rate 18
4. Lack of substance abuse and rehabilitation Area experts and community members reported the immense struggle the Vacaville has residents had in maintaining positive mental health and accessing treatment for mental illness. Affordable, local mental health services are needed to support families and youth and to limit the negative impact from poor mental health status (including violence). Rationale: Mental health status has an impact through intentional violence (suicide, homicide) as well as general quality of life and ability to be productive. Vacaville Hospital Service Area Indicators and Health Outcomes
Mental health ED visits = 172.8/10,000 Homicide = 6.80/100,000 Health Outcomes Benchmarks County – 190.4/10,000 State – 130.9/10,000 Related Factors Access (including transportation access) to culturally /linguistically appropriate behavioral health services
State = 5.15/100,000 19
5. Lack of limited access to dental care Improved access to oral health services could have a positive effect on several of the poor health outcomes, particularly with student school absenteeism. This indicator is relevant because it indicates lack of access to dental care and/or social barriers to utilization of dental services. Rationale: Focus groups discussed the need for preventive dental services, due to adults having to go to the emergency room with acute oral health disease. Adults commented about the loss of work time to visit the emergency department. Vacaville Hospital Service Area Indicators and Health Outcomes Percent Adults with Poor Dental Health: 11.91%
Percent Adults Without Dental Insurance: 27.21% Hispanic Adults Without Dental Insurance: 48.01%
Percent Adults with No Dental Exam: 28.31%
Health Outcomes Benchmarks Related Factors Percent Adults with Poor Dental Health: 11.27% Percent Adults Without Dental Insurance: 33.72%
Percent Adults with No Dental Exam: 30.51%
Dental Insurance Access to culturally and linguistically appropriate dental care 20
6. Lack of places to walk, bike, exercise or play. These areas are needed to improve multiple health outcomes, including obesity, diabetes, cardiovascular disease, and mental health. In addition, intentional injuries such as assault and homicide, are less likely Rationale: A lack of exercise and physical activity contributes to multiple poor health outcomes. Parents and youth throughout the entire County, including Vacaville indicated that they are concerned about both safety and costs related to having their children in parks and youth sports. Vacaville Hospital Service Area Indicators and Health Outcomes
Youth Weight Youth overweight = 14.42% Diabetes Diabetes discharges = 6.6/10,000
Heart disease mortality =86 /100,000 Stroke mortality = /100,000
Mental Health: Poor mental health = 19.87/100,00 Suicide = /100,000
Homicide: 6.8/100,000 Health Outcomes Benchmarks Adult obesity = 23.25% Youth overweight = 14.3% Youth obesity = 29.82% Related Factors Age‐adjusted diabetes discharge rate = 10.4/10,000
Heart disease mortality = 100.8/100,000
Stroke mortality = 39.46/100,000
Physical inactivity Park access Walkability
Poor mental health =14.21/100,00 Suicide <=10.2/100,000
HP2020 <=5.5/100,00 21
7. Transportation limitations. This is an important community health need, due to its importance in accessing health care, healthy food and exercise for those low income communities who are concerned about safety in their immediate environments. The poor public transportation system restricts access to services and employment in the area. Rationale: Focus group participants stated that the poor public transportation system restricts access to services and employment in the area, and that gasoline prices and costs of maintain a vehicle are prohibitive due to their low‐income situation. Vacaville Hospital Service Area Indicators and Health Outcomes Percent Living in Food Deserts: 5.61%
African Americans, percent Population in Poverty: 20.28% Hispanics, percent Population in Poverty: 14.4% Health Outcomes Benchmarks Related Factors California Percent Living in Food Deserts: 5.71%
Living in Poverty California Percent Population in Poverty: 13.71% 22
8. Limited places and social space for civic engagement. Focus group participants stated that they are not accessing resources available to them in the community due to busy work and parenting schedules, not enough locations to interact with community resource agencies and fear of leaving home due to safety concerns. Rationale: A lack of community connection and social interaction increases isolation, poor mental health outcomes, less information about resources available in the community and fewer social support networks. Vacaville Hospital Service Area Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Poor mental health =19.87 % Poor mental health = 14.21% Suicide <=9.8/100,000 Suicide <=10.2/100,000 Age‐adjusted diabetes discharge rate = Age‐adjusted diabetes discharge rate = 10.4/10,000
6.6/10,000
Physical inactivity Heart disease mortality =86 /100,000
Heart disease mortality = 100.8/100,000
Park access Stroke mortality = 34.5/100,000
Stroke mortality = 39.46/100,000
Walkability Adult obesity = 23.25% Adult obesity = 26.68% Youth overweight = 14.3% Youth overweight =14.42 % Youth obesity = 29.82%
Youth obesity = 31.34%
Homicide death rate = <6.8/100,000 Homicide death rate = <5.5/100,000 Percent Adults Reporting Adequate Reported Nationwide: 80.33% Social or Emotional Support: 76.16% 23
9. Unstable housing and homelessness. Many more families are living in unstable situations such as doubling up with extended family members, living month‐to‐month due to inability to pay the rent or fear of losing their mortgages. These issues are related to economic stability in the area, job availability for low‐income earners and the cost of living in the area. Stable housing is needed because the stress related to housing insecurity plays a significant role in mental health, violence, as well as poor eating and exercise habits (lack of money and time). Rationale: All community focus groups and the key informants stated this would have a meaningful impact across ALL health outcomes. Vacaville Hospital Service Area Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Homelessness: not available Homelessness: not available
High School Graduation rate = 82.4%
High School Graduation rate = 82.05%
th
Student reading proficiency (4 grade) Student reading proficiency (4th grade) Unemployment (Percent not proficient) = <36.04% (Percent not proficient) = <36.3% High School graduation rate Poor Mental Health = 19.87%
Poor Mental Health = 14.21%
Suicide death rate = <=9.8.2/100,000
Suicide death rate = <=10.2/100,000 24
10. Exposure to unclean air, environmental toxins, and pesticides. Air quality affects the overall health of all residents, and particularly affects persons with vulnerable conditions, such as asthma and chronic obstructive pulmonary disease (COPD). In addition those with unmanaged asthma (due to poor access to medical care) are at higher risk of visiting the emergency room and being hospitalized for that condition. In addition, unclear air within the home (tobacco smoke, molds, and other toxins) greatly affects infants, children and the homebound who spend more time inside. Rationale: Focus groups discussed the alarming increase in asthma especially in youth. They pointed to the air quality throughout Solano County and major highway arteries that transect the County (Interstate 80). The expressed concern over the petroleum refineries close to the area, and the predominant winds that sweep through the county. Concern about the exposure of agri‐chemicals not only to the field workers, but the drift into surrounding areas was discussed by community residents in the focus groups. Vacaville Hospital Service Area Indicators and Health Outcomes Health Outcomes Benchmarks Related Factors Asthma prevalence = 19% Asthma prevalence = 13.12% Asthma discharge rate (age‐
Tobacco expenditures Asthma discharge rate (age‐adjusted) = 8.9/10,000 adjusted) = 6.15/10,000 Poor Air Quality (Particulate Matter)
Asthma discharges as % of total discharges = 0.88%
Asthma discharges as % of total discharges = 0.98%
Adult tobacco use: 13.8%
California adult tobacco use: 14% 25
Appendix B Data Dictionary and Processing Introduction The secondary data supporting the 2013 Community Health Needs Assessment was collected from a variety of sources, and was processed in multiple stages before it was used for analysis. This document details those various stages. It begins with a description of the approaches used to define ZIP code boundaries, and the approaches that were used to integrate records reported for PO boxes into the analysis. General data sources are then listed, followed by a description of the basic processing steps applied to most variables. It concludes by detailing additional specific processing steps used to generate a subset of more complicated indicators. ZIP Code Definitions All health outcome variables collected in this analysis are reported by patient mailing ZIP codes. ZIP codes are defined by the US Postal Service as a physical location (such as a PO Box), or a set of roads along which addresses are located. The roads that comprise such a ZIP code may not form contiguous areas. These definitions do not match the approach of the US Census Bureau, which is the main source of population and demographic information in the US. Instead of measuring the population along a collection of roads, the Census reports population figures for distinct, contiguous areas. In an attempt to support the analysis of ZIP code data, the Census Bureau created ZIP Code Tabulation Areas (ZCTAs). ZCTAs are created by identifying the dominant ZIP code for addresses in a given block (the smallest unit of Census data available), and then grouping blocks with the same dominant ZIP code into a corresponding ZCTA. The creation of ZCTAs allows us to identify population figures that, in combination the health outcome data reported at the ZIP code level, allow us to calculate rates for each ZCTA. But the difference in the definition between mailing ZIP codes and ZCTAs has two important implications for analyses of ZIP level data. First, it should be understood that ZCTAs are approximate representations of ZIP codes, rather than exact matches. While this is not ideal, it is nevertheless the nature of the data being analyzed. Secondly, not all ZIP codes have corresponding ZCTAs. Some PO Box ZIP codes or other unique ZIP codes (such as a ZIP code assigned to a single facility) may not have enough addressees residing in a given census block to ever result in the creation of a ZCTA. But residents whose mailing addresses correspond to these ZIP codes will still show up in reported health outcome data. This means that rates cannot be calculated for these ZIP codes individually because there are no matching ZCTA population figures. In order to incorporate these patients into the analysis, the point location (latitude and longitude) of all ZIP codes in California (Datasheer, L.L.C., 2012) were compared to the 2010 ZCTA boundaries (U.S. Census Bureau, 2011). All ZIP codes (whether PO Box or unique ZIP code) that were not included in the ZCTA dataset were identified. These ZIP codes were then assigned to either ZCTA that they fell inside of, or in the case of rural areas that are not 26
completely covered by ZCTAs, the ZCTA to which they were closest. Health outcome information associated with these PO Box or unique ZIP codes were then assigned added to the ZCTAs to which they were assigned. For example, 95609 is a PO Box located in Carmichael. 95609 is not represented by a ZCTA, but it does have patient data reported as outcome variables. Through the process identified above, it was found that 95609 is located within 95608, which does have an associated ZCTA. Health outcome data for ZIP codes 95608 and 95609 were therefore assigned to ZCTA 95608, and used to calculate rates. Data Sources Secondary data were collected in three main categories: demographic information, health outcome data, and behavioral and environmental data. Table B1 below lists demographic variables collected from the US Census Bureau, and lists the geographic level at which they were collected. These demographic variables were collected at the Census block, tract, ZCTA, and state levels. Census blocks are roughly equivalent to city blocks in urban areas, and tracts are roughly equivalent to neighborhoods. Table B2 lists demographic variables at the ZIP code level obtained from Dignity Health (2011). Table B1. Demographic Variables Collected from the US Census Bureau (U.S. Census Bureau, 2013a; U.S. Census Bureau, 2013b) Variable Name Definition Asian Population Hispanic or Latino and Race, Not Hispanic or Latino, Asian alone Black Population Hispanic or Latino and Race, Not Hispanic or Latino, Black or African American alone Hispanic Population Hispanic or Latino and Race, Hispanic or Latino (of any race) Native American Population Pacific Islander Population White Population Total Households Hispanic or Latino and Race, Not Hispanic or Latino, American Indian and Alaska Native alone Hispanic or Latino and Race, Not Hispanic or Latino, Native Hawaiian and Other Pacific Islander alone Hispanic or Latino and Race, Not Hispanic or Latino, White alone Total Households Geographic Level Tract Tract Tract Tract Source 2010 American Community Survey 5 Year Estimates Table DP05 2010 American Community Survey 5 Year Estimates Table DP05 2010 American Community Survey 5 Year Estimates Table DP05 2010 American Community Survey 5 Year Estimates Table DP05 Tract 2010 American Community Survey 5 Year Estimates Table DP05 Tract 2010 American Community Survey 5 Year Estimates Table DP05 2010 American Community Survey 5 Year Estimates Table S1101 Tract 27
Variable Name Married Households Definition Married‐couple family household Tract Single Female Headed Households Single Male Headed Female householder, no husband present, family household Male householder, no wife present, family household Non‐Family Households Nonfamily household Tract Population in Poverty (Under 100% Federal Poverty Level) Population in Poverty (Under 125% Federal Poverty Level) Population in Poverty (Under 200% Federal Poverty Level) Population by Age Group: 0‐4, 5‐14, 15‐24, 25‐34,45‐54, 55‐64, 65‐74, 75‐84, and 85 and over Total Population Total poverty under .50; .50 to .99 Tract Total Population Tract Total poverty under .50; .50 to .99; 1.00 to 1.24 Source 2010 American Community Survey 5 Year Estimates Table S1101 2010 American Community Survey 5 Year Estimates Table S1101 2010 American Community Survey 5 Year Estimates Table S1101 2010 American Community Survey 5 Year Estimates Table S1101 2010 American Community Survey 5 Year Estimates Table C17002 Tract 2010 American Community Survey 5 Year Estimates Table C17002 Total poverty under .50; .50 to .99; 1.00 to 1.24; 1.25 to 1.49; 1.50 to 1.84; 1.85 to 1.99 Tract 2010 American Community Survey 5 Year Estimates Table C17002 Total Population by Age Group Tract 2010 American Community Survey 5 Year Estimates Table DP05 Total Population Tract Total Population Block 2010 American Community Survey 5 Year Estimates Table DP05 2010 Census Summary File 1 Table P1 2010 Census Summary File 1 Table QTP14 Total Population, One Race, Asian/Pacific Islander Population Asian, Not Hispanic or Latino; Total Population, One Race, Native Hawaiian and Other Pacific Islander, Not Hispanic or Latino Black Population Total Population, One Race, Black or African American, Not Hispanic or Latino Hispanic Population Total Population, Hispanic or Latino (of any race) Geographic Level
Tract ZCTA, State ZCTA, State 2010 Census Summary File 1 Table QTP14 ZCTA, State 2010 Census Summary File 1 Table QTP3 28
Variable Name Native American Population Male Population Definition Total Population, One Race, American Indian and Alaska Native, Non Hispanic or Latino Total Population, Once Race, White, Not Hispanic or Latino Total Male Population ZCTA, State Female Population Total Female Population ZCTA, State White Population Population by Age Total Male and Female Group: Population by Age Group Under 1, 1‐4, 5‐14, 15‐24, 25‐34,45‐54, 55‐64, 65‐74, 75‐ 84, and 85 and over Total Population Total Population Geographic Level
ZCTA, State Source 2010 Census Summary File 1 Table QTP14 ZCTA, State 2010 Census Summary File 1 Table QTP14 2010 Census Summary File 1 Table PCT12 2010 Census Summary File 1 Table PCT12 2010 Census Summary File 1 Table PCT12 ZCTA, State ZCTA, State 2010 Census Summary File 1 Table PCT12 Table B2. ZIP Demographic Information (Dignity Health, 2011) Variable Percent Households 65 years or Older In Poverty Percent Families with Children in Poverty Percent Single Female Headed Households in Poverty Percent Population 25 or Older Without a High School Diploma Percent Non‐White or Hispanic Population Population 5 Years or Older who speak Limited English Percent Unemployed Percent Uninsured Percent Renter Occupied Households Collected health outcome data included the number of emergency department (ED) discharges, hospital (H) discharges, and mortalities associated with a number of conditions. ED and H discharge data for 2011 were obtained from the Office of Statewide Healthy Planning and Development (OSHPD). Table B3 lists the specific variables collected by ZIP code. These values report the total number of ED or H discharges that listed the corresponding ICD9 code as either a primary or any secondary diagnosis, or a principle or other E‐code, as the case may be. In addition to reporting the total number of discharges associated with the specified codes per ZIP code, this data was also broken down by sex (male and female), age (under 1 year, 1 to 4 years, 5 to 14 years, 15 to 24 years, 25 to 34 years, 35 to 44 years, 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 84 years, and 85 years or older), and normalized race and ethnicity (Hispanic of any race, non‐Hispanic White, non‐Hispanic Black, non‐Hispanic Asian or Pacific Islander, non‐ Hispanic Native American). Table B3. 2011 OSHPD Hospitalization and Emergency Department Discharge Data by ZIP code 29
Category Chronic Disease
Respiratory
Mental Health
Injuries 21
Cancer
Other Indicators
Variable Name Diabetes Heart Disease Hypertension Stroke Asthma Chronic Obstructive Pulmonary Disease (COPD)
Mental Health Mental Health, Substance Abuse Unintentional Injury
Assault Self Inflicted Injury
Accidents Breast Cancer Colorectal Cancer Lung Cancer Prostate Cancer Hip Fractures Tuberculosis HIV STDs
Oral cavity/dental West Nile Virus Acute Respiratory Infections
Urinary Tract Infections (UTI) Complications related to pregnancy
ICD9/E‐Codes
250
410‐417, 428, 440, 443, 444, 445, 452
401‐405
430‐436, 438
493‐494
490‐496
290, 293‐298, 301‐302, 310‐311
291‐292, 303‐305
E800‐E869, E880‐E929
E960‐E969, E999.1
E950‐E959
E814, E826
174, 175
153, 154
162, 163
185
820
010‐018, 137
042‐044
042‐044, 090‐099, 054.1, 079.4
520‐529
066.4
460‐466
599.0
640‐649
Mortality data, along with the total number of live births, for each ZIP code in 2010 were collected from the California Department of Public Health (CDPH). The specific variables collected are defined in Table B4. The majority of these variables were used to calculate specific rates of mortality for 2010. A smaller number of them were used to calculate more complex indicators of wellbeing. To increase the stability of these more complex measures, rates were calculated using values from 2006 to 2010. These variables include the total number of live births, total number of infant deaths (ages under 1 year), and all cause mortality by age. Table B4 consequently also lists the years for which each variable was collected. Table B4. CDPH Birth and Mortality Data by ZIP Code Variable Name
Total Deaths
Male Deaths
ICD10 Code
Years Collected
2010
2010
21 ICD9 code definitions for the Unintentional Injury, Self Inflicted Injury, and Assault variables were based on definitions given by the Centers for Disease Control and Prevention (CDC, 2011) 30
Female Deaths Population by Age Group: Under 1, 1‐4, 5‐14, 15‐24, 25‐ 34,45‐54, 55‐64, 65‐74, 75‐84, and 85 and over Diseases of the Heart Malignant Neoplasms (Cancer) Cerebrovascular Disease (Stroke) Chronic Lower Respiratory Disease Alzheimer’s Disease Unintentional Injuries (Accidents) Diabetes Mellitus Influenza and Pneumonia Chronic Liver Disease and Cirrhosis Intentional Self Harm (Suicide) Essential Hypertension & Hypertensive Renal Disease Nephritis, Nephrotic Syndrome and Nephrosis All Other Causes Total Births Births with Infant Birthweight Under 1500 Grams, 1500‐2499 Grams 2010 2006‐2010 I00-I09, I11, I13, I20-I51
C00-C97
I60-I69
J40-J47
2010 2010 2010 2010 G30
V01-X59, Y85-Y86
2010 2010 E10-E14
J09-J18
K70, K73-K74
2010 2010 2010 U03, X60-X84, Y87.0
I10, I12, I15
2010 2010 N00-N07, N17-N19, N25-N27
2010 Residual Codes
2010 2006‐2010 2006‐2010 Behavioral and environmental data were collected from a variety of sources, and at various geographic levels. Table B5 lists the sources of these variables, and lists the geographic level at which they were reported. 31
Table B5. Behavioral and Environmental Variable Sources Category
Variable
Year
Definition
Healthy Eating/ Active Living
Overweight and Obese
2003‐ 2005
No 5 a day Fruit and Vegetable Consumption
Modified Retail Food Environment Index (mRFEI)
2003‐ 2005
Percent of population with self‐reported height and weight corresponding to overweight or obese BMIs (BMI greater than 25)
Percent of population age 5 and over not consuming five servings of fruit and vegetables a day
Represents the percentage of all food outlets in an area that are considered healthy
Food Deserts
2011
USDA Defined food desert tracts
Certified Farmers Markets
Parks
2012
Crime
2010
Physical location of certified farmers Location
markets
U.S. Parks, includes local, county, regional, state, and national parks and forests
Major Crimes (Homicide, Forcible Rape, Municipality/ Robbery, Aggravated Assault, Burglary, Jurisdiction
Motor Vehicle theft, Larceny, Arson)
Traffic Accidents Resulting in Fatalities
2010
Locations of traffic accidents resulting in fatalities
Health Professional
2011
Federally designated primary care health
Safe Physical Environments
Other
2011
2010
Reporting Unit
ZIP Code
Data Source
ZIP Code
Healthy Cities/CHIS
Tract
Kaiser Permanente CHNA Data Platform/ Centers for Disease Control and Prevention: Division of Nutrition, Physical Activity, and Obesity
Kaiser Permanente CHNA Data Platform/ US Department of Agriculture
http://www.cafarmersmark ets.com/
Esri
Tract
Location
Healthy Cities/CHIS
State of California Department of Justice, Office of the Attorney General (http://oag.ca.gov/crime/cjs c‐stats/2010/table11)
National Highway Transportation Safety Administration
Kaiser Permanente CHNA
32
Category Variable Indicators
Shortage Areas (Primary Care) Alcohol Availability Year Definition Reporting Unit
professional shortage areas, which may be defined based on geographic areas or distributions of people in specific demographic groups
2012 Number of Active Off‐Sale Retail Liquor Licenses
Data Source Data Platform/ Bureau of Health Professions ZIP Code California Department of Alcoholic Beverage Control
33