Community Health Needs Assessments: The Role of Hospitals

Community Health Needs Assessments: The Role of Hospitals

Community Health Needs Assessments: The Role of Hospitals in Addressing Specific Community Health Needs Yesmina Zavala MPH Candidate 2016 University of San Francisco Overview 1. Problem/Unmet Needs of the Population of Interest 2. Background 3. Scope of the Project 4. Summary of Findings 5. Significance and Implications

6. Next Steps 7. Conclusion A real life example... ...28 year old male with schizophrenia is admitted through the ED for renal failure... Scope of Project Kaiser Permanente Overview One of the nations largest not-for-profit health plans, serving 10.6 million members; 186,497 employees serving in 8 states.

In Northern California: 3,969,733 members, 21 hospitals, 238 medical offices, 14 service areas 52 place-based collaboratives to improve community health for over 636,000 community members. 850,461 people served by Medicaid and CHIP. 87,875 people served by Charitable Health Coverage. 200,000+ medical financial assistance individuals approved Mission: to provide high-quality, affordable health care services and to improve the health of our members and the communities served.

Brand: We stand for total health. Impact in Communities Community Health Initiatives reached 665,000 people in more than 50 communities across KP regions in 2015 and 209,000 children Retrieved from https://share.kaiserpermanente.org/static/kp_annualreport_2015/ Scope of Project NCAL CHNA Collation & Standardization of Reports Richmond Community Behavioral Health Needs Assessment - Behavioral health profile, data analysis on indicators, KP ED specific data analysis - Richmond community organizations, policy-makers, etc.

- SWOT analysis - Recommendations list Lean Methodology to Improve Patient Flow from ED Richmond Mental Health Profile % of adults needing mental health professional 2013-14 & of Medicare Population

with Depression 2016 Average of Mentally Unhealthy Days (last 30 days) 2006-12 Suicide Mortality Rate - Age adjusted (per

100,000) 2010-12 Access to Mental Health Care Provider Rate (per 100,000) 2006 RCH Total 11.57 13.83

3.4 9.28 na CA Total 15.9 13.9 3.6 9.8

280.6 Community Health Needs Assessment (CHNA) reports: Findings from the extensive health assessments conducted in partnership with other organizations Implementation Strategy (IS) reports: Details describing KPs planned

response to the needs identified through the CHNA process Behavioral Health Needs in the U.S. 1 in 4 individuals experience mental illness in a given year The World Health Organization states that nearly 50% of individuals will develop at least one mental illness during their lifetime. - Depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease.

CA has the highest number of adults with mental illness (4.9 million) National Alliance on Mental Illness noted that nearly 60% of adults with mental illness did not receive mental health services in the previous year. More than of counties in the U.S. have a serious shortage of mental health professionals While the California population rises...

Population Data Source: U.S. Census Bureau Richmond CA: Behavioral Health Needs Psych Data Source: OSHPD Richmond Behavioral Health Needs 15% self-reported having poor mental health in RCH Significant increase in behavioral health related emergencies in the ED in RCH KP Disconnect between operational strategy for BH and Community Benefit Significance and Implications Opportunity to use resources at KP to follow patients through the continuum of care (from prevention through treatment) Shortages in mental health services lead to hospitals being unable to

place patients Delay in placement can cause patients state of health to escalate Hospitals must play an active role in patient disposition and follow up Next Steps/ Recommendations Bridge the KP Behavioral Health Strategy with Community Health Needs Assessments. This means that CHNAs must continue to be conducted. Consider implementation of outpatient psychiatric emergency services Consider implementation of the Alameda Model for Contra Costa County. Partner with a psychiatric emergency room specifically to transfer patients (Contra Costa Regional Center). Leverage the use of the crisis stabilization coding in order to receive adequate reimbursement from Medical (up to 20 hours) Reduce the stigma associated with mental health through campaigns like Find your words

Conclusion Community Health Needs Assessment Reports have true value in hospital operational strategy Clear understanding of community needs drives patient care improvements, better connection to community resources, etc. KP is committed to Community Health Needs Assessments Community health is engrained in the mission and brand Senior leadership understand that high-quality care can only be achieved when considering and addressing social determinants of health. Thank You! Yesmina L Zavala MPH Candidate 2016 University of San Francisco E-mail: [email protected]

References American Hospital Association. (2012). Managing Population Health: The Role of the Hospital. Retrieved from http://www.hpoe.org/Reports-HPOE/managing_population_health.pdf Californias Acute Psychiatric Bed Loss October 25, 2016. (n.d.). Retrieved November 10, 2016, from http://www.calhospital.org/sites/main/files/file-attachments/6__psychbeddata.pdf California Healthcare Foundation. (2015) Locally Sourced: The Crucial Role of Counties in the Health of Californians. Retrieved November 10, 2016, from http://www.chcf.org/publications/2015/10/locally-sourced-crucial-role-counties

County, H. A., (n.d.). Healthy Alameda County :: Better health through community. Retrieved November 19, 2016, from http://www.healthyalamedacounty.org/ Hazlett, S. B., (2004). Epidemiology of Adult Psychiatric Visits to U.S. Emergency Departments. Academic Emergency Medicine, 11(2), 193-195. doi:10.1197/j.aem.2003.09.014 Kaiser Permanente. (n.d.) Community Commons. Retrieved November 18, 2016 from http://www.communitycommons.org Kaiser Permanente. (2013) Community Health Needs Assessment. Retrieved November 18, 2016 from https://share.kaiserpermanente.org/wp-content/uploads/2013/09/Richmond-CHNA-2013.pdf

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Retrieved November 20, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/15939837 Lippert, S., Nesper, A., Jain, N., Fahimi, J., Pirrotta, E., & Wang, N. (2016). 142 Mental Health Emergency Department Visits: 24 Hours and Counting, Characteristics Associated With Prolonged Length of Stay. Annals of Emergency Medicine, 68(4). doi:10.1016/j.annemergmed.2016.08.154 Mapping the Gaps. (n.d.). Retrieved November 10, 2016, from http://www.chcf.org/publications/2013/07/data-viz-mental-health

Mental Health America. (2015) Parity or Disparity The State of Mental Health in America 2015. (n.d.). Retrieved November 20, 2016, from http://www.mentalhealthamerica.net/sites/ default/files/Parity or Disparity 2015 Report.pdf National Alliance on Mental Illness. (n.d.). Retrieved November 20, 2016, from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers Nesper, A. C., Morris, B. A., Scher, L. M., & Holmes, J. F. (2016). Effect of Decreasing County Mental Health Services on the Emergency Department. Annals of Emergency Medicine, 67(4), 525-530. doi:10.1016/j.annemergmed.2015.09.007 Online Journal of Public Health Informatics. (2011-2013). California EpiCenter data platform for Overall Injury Surveillance. Retrieved November 19, 2016, from

http://journals.uic.edu/ojs/index.php/ojphi/gateway/plugin/WebFeedGatewayPlugin/rss2 Promoting Mental Health - World Health Organization. (n.d.). Retrieved November 20, 2016, from http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf Robeznieks, A., Mental health workforce shortage a worldwide issue. Retrieved November 18, 2016, from http://www.modernhealthcare.com/article/20150715/NEWS/150719943 Soumya Sahoo. (2015, March 14). Socio-Ecological Model. [Image]. Retrieved from http://www.slideshare.net/drswaroopsoumya/public-health-model.

Weiss, A. P., Chang, G., Rauch, S. L., Smallwood, J. A., Schechter, M., Kosowsky, J., Orav, E. J. (2012). Patient- and Practice-Related Determinants of Emergency Department Length of Stay for Patients With Psychiatric Illness. Annals of Emergency Medicine, 60(2). doi:10.1016/j.annemergmed.2012.01.037 Zeller, S., Calma, N., & Stone, A. (2014). Effect of a Regional Dedicated Psychiatric Emergency Service on Boarding and Hospitalization of Psychiatric Patients in Area Emergency Departments. Western Journal of Emergency Medicine, 15(1), 1-6. doi:10.5811/westjem.2013.6.17848

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