holy cross hospital

HOLY CROSS HOSPITAL

Community Health Needs Assessment FY 2015

TABLE OF CONTENTS

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ListofFigures_____________________________________________________________________________________________ii

ListofTables_____________________________________________________________________________________________ iv

Executivesummary ______________________________________________________________________________________v

Introduction ______________________________________________________________________________________________1

ApproachandMethodology_____________________________________________________________________________5

TheCommunityWeServe_______________________________________________________________________________9

SocialDeterminantsofHealth_________________________________________________________________________ 12

HealthIndicators_______________________________________________________________________________________ 18

DataGapsIdentified____________________________________________________________________________________ 44

ResponsetoFindings___________________________________________________________________________________ 45

References______________________________________________________________________________________________ 48

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LIST OF FIGURES

Figure1:TheCNIoftheprimaryserviceareaofHolyCrossHospital............................................6

Figure2:PrimaryandsecondaryserviceareaforHolyCrossHospital.........................................9

Figure3:Marylandforeign‐bornpopulationdistributionbycounty...........................................10

Figure4:65+PopulationprojectionsforMontgomeryandPrinceGeorge'sCounties........11

Figure5:TotalnumberenrolledinaMedicaidplanbycounty......................................................13

Figure6:MarylandQualifiedHealthPlanEnrollmentsbycounty,asofMay31,2014........13

Figure7:Percentageoftotaluninsuredpersonspercounty...........................................................13

Figure8:Thepercentageofthetotalciviliannon‐institutionalizedpopulationwithouthealthinsurancecoverage...............................................................................................................................14

Figure9:Unemploymentrateforpopulationaged16andoverbyraceandethnicity........14

Figure10:Civilians,16yearsofageandover,whomareunemployed.......................................15

Figure11:Percentageofrentersspendingmorethan30%ofincomeonrent.......................15

Figure12:Medianhouseholdincomebyrace........................................................................................16

Figure13:Percentageofthepopulationaged25yearsandolderwithnohighschooldiploma....................................................................................................................................................................17

Figure14:Age‐adjusteddeathrateper100,000populationduetocancer..............................19

Figure15:YearlypercentageofMedicarebeneficiarieswhoweretreatedforcancer.........19

Figure16:Age‐adjustedincidencerateforbreastcancerincasesper100,000females....20

Figure17:Age‐adjusteddeathrateper100,000femalesduetobreastcancer......................20

Figure18:Thepercentageofadultsaged50andoverwhohaveeverhadasigmoidoscopyorcolonoscopyexam.........................................................................................................................................21

Figure19:Theage‐adjustedincidencerateforcolorectalcancer.................................................22

Figure20:Theage‐adjusteddeathrateduetocolorectalcancer..................................................22

Figure21:Thepercentageofwomenaged18andoverwhohavehadaPapsmearinthepastthreeyears....................................................................................................................................................23

Figure22:Theage‐adjustedincidencerateforcervicalcancer.....................................................23

Figure23:Theage‐adjustedincidencerateforprostatecancer....................................................24

Figure24:Theage‐adjusteddeathrateduetoprostatecancer.....................................................24

Figure25:Theage‐adjusteddeathrateduetolungcancer.............................................................26

Figure26:Theage‐adjustedincidencerateforlungandbronchuscancers.............................26

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Figure27:Theage‐adjusteddeathrateduetolungcancer.............................................................26

Figure28:Percentageofdeathsfromheartdiseasebyrace...........................................................27

Figure29:Thepercentageofadultswhohavebeentoldtheyhavehighbloodpressure..28

Figure30:Thepercentageofadultswhohaveeverbeendiagnosedwithdiabetes.............30

Figure31:Theaverageannualage‐adjustedemergencyroomvisitrateduetodiabetes..31

Figure32:Thepercentageofadultswhoareoverweightorobese..............................................32

Figure33:Thepercentageofmaleandfemaleadultswhoareoverweightorobese...........32

Figure34:Thepercentageofadultswhoengageinmoderatephysicalactivity.....................32

Figure35:Healthyfoodindexscores.........................................................................................................33

Figure36:Percentageofadultswhoreporttheyhavebeendiagnosedwithadepressivedisorder...................................................................................................................................................................34

Figure37:Marylandsuicidedeathsbyraceandsex...........................................................................35

Figure38:Averageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabusebyageandsex.........................................................................................................................36

Figure39:Averageannualage‐adjustedemergencyroomvisitratebyrace/ethnicity......36

Figure40:PercentageofLBWbirthsbyageandrace/ethnicityofmother..............................38

Figure41::LeadingcausesofdeathintheMontgomeryCountypopulationaged65andover............................................................................................................................................................................40

Figure42::LeadingcausesofdeathinthePrinceGeorge'sCountypopulationaged65andover...................................................................................................................................................................40

Figure43:DeathsfromaccidentsinMontgomeryCountyfrom2000‐2010............................41

Figure44:DeathsfromaccidentsinPrinceGeorge'sCountyfrom2000‐2010......................42

Figure45:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbyrace.................................................................................................................................43

Figure46:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbypayer..............................................................................................................................43

Figure47:HealthyMontgomeryprioritiesandoverarchingthemes...........................................45

Figure48:HowHolyCrossHealthalignstargetedprogramswiththemissionandstrengthsofthehospitalandunmetcommunityneeds.....................................................................47

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LIST OF TABLES

Table1:DemographicbreakdownofHolyCrossHospital'sserviceareabyraceandethnicity.....................................................................................................................................................................9

Table2:TopfiveleadingcausesofdeathforMontgomeryandPrinceGeorge'sCounties.18

Table3:HealthyMontgomeryBreastCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................21

Table4:HealthyMontgomeryColorectalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................22

Table5:HealthyMontgomeryCervicalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................24

Table6:HealthyMontgomeryProstateCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................25

Table7:Numberofadults,aged18+,whoself‐reportedcurrentlysmokingcigarettessomedaysoreveryday................................................................................................................................................25

Table8:HealthyMontgomeryLungCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).............................................................................27

Table9:HealthyMontgomeryCardiovascularDiseaseIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................................29

Table10:Costofdiabetes................................................................................................................................30

Table11:HealthyMontgomeryDiabetesIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD)............................................................................................31

Table12:BodyMassIndexchart..................................................................................................................31

Table13:HealthyMontgomeryObesityIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD)............................................................................................33

Table14:HealthyMontgomeryBehavioralHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................................37

Table15:HealthyMontgomeryMaternalandChildHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).................................................39

Table16:HolyCrossHospital'sAmbulatoryCareSensitiveConditiondischarges................43

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EXECUTIVE SUMMARY

In2010,CongressenactedthePatientProtectionandAffordableCareActthatrequiresnon‐profithospitalstoconductacommunityhealthneedsassessmentandadoptanimplementationstrategyeverythreeyears.HolyCrossHealth,aCatholicnot‐for‐profithealthsystembasedinMontgomeryCounty,Maryland,hasbeenconductingneedsassessmentsfor15years.Beginningin2009,HolyCrossHealthpartneredwithHealthyMontgomery,MontgomeryCounty'sCommunityHealthImprovementProcesstodeterminethesignificantunmetneedsofthecommunity,consistentwiththenewIRSrequirements.HolyCrossHealthalsoreviewedandanalyzeddatafrommultiplesourcesincludingDignityHealth'sCommunityHealthNeedIndex,UniversityofWisconsinPopulationHealthInstitute'sCountyHealthRankingsData,andotheravailableneedsassessmentsandreports.

ThiscommunityhealthneedsassessmentfocusesonthegeographicareasHolyCrossHospitalserves.Itprovidesthefoundationfortheorganization'seffortstoguidecommunitybenefitplanningtoimprovethehealthstatusofthecommunityserved.HolyCrossHospitalservesalargeportionofMontgomeryandPrinceGeorge’sCountiesresidents,oneofthemostculturallyandethnicallydiversecommunitiesinthenation.MontgomeryandPrinceGeorge'sCountiesarefairlyaffluentintermsofwealthandcommunityresources,however,thecomplexityofthecommunitychallengesthehospital,thecountyhealthdepartments,community‐basedorganizationsandotherorganizationstounderstandandaddressunmetneeds.

Althoughaccesstoquality,affordablehealthcareplaysasignificantroleinthehealthofindividuals,healthisalsoaffectedbyothersocialdeterminants.Understandingsocialdeterminantsofhealth,suchaseconomicsandeducation,canalsoleadtoreductionsinhealthdisparitiesandimprovementsinhealthindicators.

Healthindicators,suchascausesofdeath,breastcancerrates,obesityandfruitconsumption,canbeusedtodescribetheoverallhealthofapopulationanddetermineunmetcommunityneed.Whereavailable,themostcurrentandup‐to‐datedatawasusedtodeterminethehealthneedsofthecommunity.However,datagapsexist.Forexample,manydataarenotavailablebygeographicareaswithinMontgomeryorPrinceGeorge'sCountyandhealthriskdataonsubpopulationssuchasHispanic/Latinopopulationsaredifficulttomeasure.

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TheHealthyMontgomerySteeringCommitteeanalyzedavailabledataonmorethan100indicatorstodeterminethetop‐rankedpriorityareasforthecounty:BehavioralHealth,Obesity,Cancers,MaternalandInfantHealth,Diabetes,andCardiovascularHealth.Inadditiontoselectingthesixbroadprioritiesforaction,theHealthyMontgomerySteeringCommitteeselectedthreeoverarchingthemesforallpriorities:lackofaccess,healthinequities,andunhealthybehaviors.

BuildingupontheHealthyMontgomerytop‐rankedprioritiesandthreeoverarchingthemes,HolyCrossHealthaddedmeetingtheneedsofthegrowingseniorpopulationasapriority.HolyCrossHealthalsorankedtheprioritiesbasedonseverity,feasibility,potentialtoachieveoutcomesandprevalenceinthepopulation.Usingscoresfromeachofthecategorieslisted,thefollowingisaprioritizedlistofthesignificantunmetneedsidentified:

1. Maternal&InfantHealth2. Seniors3. CardiovascularHealth4. Obesity5. Diabetes6. BehavioralHealth7. Cancers

Withthisinformation,HolyCrossHealthwilladdresstheunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.HolyCrossHealthwillfocusourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniorsandracial,ethnicandlinguisticminorities.

ForfurtherinformationonhowHolyCrossHealthplanstoaddresseachidentifiedunmetneedpleasereviewourMulti‐YearCommunityBenefitImplementationPlanathttp://www.holycrosshealth.org/community‐benefit‐implementation‐plan.

HolyCrossHospital

INTRODUCTION

In2010,CongressenactedthePatientProtectionandAffordableCareAct(TheAffordableCareAct),whichputsinplacecomprehensivehealthinsurancereformtoenhancethequalityofhealthcareforallAmericans.Inanefforttoenhancethequalityofhealthcare,theAffordableCareActalsorequiresnon‐profithospitalstoconductacommunityhealthneedsassessmentandadoptanimplementationstrategy,aplandescribinghowthehospitalwilladdresstheneedsidentified,everythreeyears.

HolyCrossHealthhasevaluatedtheneedsofitscommunitytosupportitscommunitybenefitplansfor15years.Doingsoisconsistentwiththeorganization'smissionandvalues.ItalsocloselyalignswithadvancingHolyCrossHealth'sstrategicprinciples.

MissionStatement

We,HolyCrossHealthandCHETrinityHealth,servetogetherinthespiritoftheGospelasacompassionateandtransforminghealingpresencewithinourcommunities.Wecarryoutthismissioninourcommunitiesthroughourcommitmenttobethemosttrustedproviderofhealthcareservices.

HolyCrossHealth'steamwillachievethistrustthrough:

Innovative,high‐qualityandsafehealthcareservicesforallinpartnershipwithourphysiciansandothers

Accessibilityofservicestoourmostvulnerableandunderservedpopulations Outreachthatrespondstocommunityhealthneedandimproveshealthstatus Ongoinglearningandsharingofnewknowledge Ourfriendly,caringspirit

CoreValues

Reverence:Wehonorthesacrednessanddignityofeveryperson Commitmenttothosewhoarepoor:Westandwithandservethosewhoarepoor,

especiallythosemostvulnerable Justice:Wefosterrightrelationshipstopromotethecommongood,including

sustainabilityofEarth

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Stewardship:Wehonorourheritageandholdourselvesaccountableforthehuman,financialandnaturalresourcesentrustedtoourcare

Integrity:Wearefaithfultowhowesayweare

HolyCrossHealth'sfiscal2015‐2018strategicplanidentifiesthreestrategicprinciplesthatareresponsivetoourmissioncommitmentsandtheenvironmentinwhichweoperate.

Attractmorepeople,serveeveryone Managequality,costsandrevenueeffectively

Improveandsustainindividualandcommunityhealththroughinnovation,alignment,andpartnership.

ThesestrategicprinciplesguideHolyCrossHealth'soveralldevelopmentandinparticular,advanceourpopulationhealthefforts,whichincludeourcommunityhealthneedsassessmentandtheassociatedcommunitybenefitplan.

Duringthelastseveralyears,theterm"populationhealth"hasbeenusedtodescribeeffortstoimprovepatientoutcomesandcommunityhealthstatuswhilemanagingcosts.Asanemergingterm,thereisnooneanswertohow"population"shouldbedefined.Forinstance,publichealthagenciestypicallydefineapopulationbasedongeographicareasstratifiedbydemographiccharacteristicssuchasrace,ethnicityorincome.Healthcaredeliverysystemsdefinepopulationsbasedonindividualpatientstheyservesuchasdiabeticorcongestiveheartfailurepatients(Gourevitch,Cannell,Boufford,&Summers,2012).Populationscanalsobedefinedasgroupsforwhichanentitysuchasaninsureroremployerbearsfinancialriskforhealthcareutilization.Althoughthedefinitiondiffersbetweenpolicy,publichealth,healthcare,andotherhealthfields,apopulationhealthorientationprovidestheopportunityfororganizationsfocusedonhealthimprovement,includinghealthcaredeliverysystems,toworktogethertoachievepositiveoutcomesinthecommunitiestheyserve(Stoto,2013).

ThiscommunityhealthneedsassessmentfocusesonthegeographicareasHolyCrossHospitalserves.Itprovidesthefoundationfortheorganization'seffortstoguidecommunitybenefitplanningtoimprovethehealthstatusofthepeopleinHolyCrossHospital'sservicearea.

HolyCrossHospital

OVERVIEW OF HOLY CROSS HEALTH

HolyCrossHealthisaCatholicnot‐for‐profithealthsystembasedinMontgomeryCounty,Maryland,thathasnearly200,000patientvisitseachyear.Weofferafullrangeofinpatient,outpatientandinnovativecommunity‐basedservices,andaretheregion'sonlythree‐timewinnerofTheJointCommission’shighestqualityaward.HolyCrossHealthhasa1,500membermedicalstaff,employsnearly4,000people,hasalmost600volunteersandistheonlyhealthcareproviderinMarylandtoreceivetheWorkplaceExcellenceSealofApprovalAwardeachyearsince1999fromthegreaterWashington,D.C.,AllianceforWorkplaceExcellence.HolyCrossHealthiscomprisedofHolyCrossHospital,HolyCrossGermantownHospitalandHolyCrossHealthNetwork.

HolyCrossHospital:LocatedinSilverSpring,HolyCrossHospitalisoneofthelargesthospitalsinMaryland.Foundedmorethan50yearsagoin1963bytheCongregationoftheSistersoftheHolyCross,todayHolyCrossHospitalisateachinghospitalwith391adultandpediatriclicensedbeds,aneonatalunitwith159bassinets,andanon‐siteobstetrics/gynecologyoutpatientclinicforuninsuredwomen.Thehospitaloffersafullrangeofinpatientandoutpatientservices,withspecializedexpertiseinseniorservices,womenandinfantservices,surgery(particularlygynecological),neuroscience,andcancer.

HolyCrossGermantownHospital:InOctober2014,HolyCrossHealthopenedHolyCrossGermantownHospital,thefirstnewhospitalinMontgomeryCountyin35years.Thehospitalservesthemostrapidlygrowingregioninthecountyandprovidesaccesstohigh‐qualitycareinanareathathadpreviouslybeen,byfar,thelargestconcentrationofpeoplewithoutahospitalinthestate.HolyCrossGermantownHospitalhas93adultlicensedbedsandaneonatalunitwitheightlicensedbassinets.Thehospitaloffersemergency,medical,surgical,obstetric,neonatalandpsychiatriccaretomeetafullrangeofcommunityneeds.Allpatientroomsareprivatetoenhancepatientsafetyandsatisfaction,aswellaspatient,familyandvisitorcomfort.ThehospitalisequippedwiththelatesttechnologytoenhancepatientcareandmeetstheLEEDGoldstandardsforenvironmentalsustainability.

HolyCrossHealthNetwork:Establishedin2012,HolyCrossHealthNetworkisanoperatingdivisionwithinHolyCrossHealththatisfocusedoncreatingtherelationshipsandprogramsthatwillhelpHolyCrossHealthbettermanagecareinthecommunitiesitserves.HolyCrossHealthNetworkoperatesHolyCrossHealthCentersinSilverSpring,GaithersburgandAspenHill.Theseprimarycaresitesservelow‐incomepatientswhoareuninsuredorareenrolledinMedicaid.HolyCrossHealthNetworkalsooperatesallofHolyCrossHealth'scommunityhealthprogramsandoutreach.

HolyCrossHospital

Beyondourcampuses,weprovideserviceatmultiplelocations,includingavitalagingcenterforseniors.Wehaveestablishedgeographicpresenceat23sitesthathostourseniorexerciseprogramandin63churchesthroughourfaithcommunitynurseprogram.

HolyCrossHospital

APPROACH AND METHODOLOGY

HolyCrossHealthhasbeenconductingneedsassessmentsformorethan15yearsandidentifiesunmetcommunityhealthcareneedsinourcommunityinavarietyofways.WecollaboratewithotherhealthcareproviderstosupportHealthyMontgomery,MontgomeryCounty'scommunityhealthimprovementprocess.WeusetheCommunityHealthNeedIndexandotheravailablereportsandassessments.Wealsoconductanextensiveanalysisofdemographics,healthindicatorsandsocialdeterminantsofhealthofthecommunitiesweserve.Finally,weseekexpertguidancefromapanelofexternalparticipantswithexpertiseintheneedsofourcommunity.

HEALTHY MONTGOMERY

HealthyMontgomeryisMontgomeryCounty'shealthimprovementprocessandservesasthebaseforHolyCrossHealth'sneedsassessment.Ithasfourobjectives:(1)Toidentifyandprioritizehealthneedsinthecountyasawholeandinthediversecommunitieswithinthecounty;(2)Toestablishacomprehensivesetofindicatorsrelatedtohealthprocesses,healthoutcomesandsocialdeterminantsofhealthinMontgomeryCountythatincorporateawidevarietyofcountyandsub‐countyinformationresourcesandutilizemethodsappropriatetotheircollection,analysisandapplication;(3)Tofosterprojectstoachievehealthequitybyaddressinghealthandwell‐beingneeds,improvinghealthoutcomesandreducingdemographic,geographic,andsocioeconomicdisparitiesinhealthandwell‐being;and(4)TocoordinateandleverageresourcestosupporttheHealthyMontgomeryinfrastructureandimprovementprojects.

HealthyMontgomerybeganin2010whenHolyCrossHospitalandtheotherthreehospitalsystemsinMontgomeryCountyeachgave$25,000,foratotalof$100,000,totheUrbanInstitutetoprovidesupportfortheHealthyMontgomerywork.Thisincludedcoordinatingtheenvironmentalscan,whichlookedatalltheexistingsourcesofdata(e.g.,vitalstatistics,DepartmentofHealthandMentalHygiene)andneedsassessmentsandimprovementplansfromorganizationsinMontgomeryCounty(manyofthesedocumentsarenowavailablethroughtheHealthyMontgomerywebsite),supportoftheefforttoselectthe100indicatorstoincludeintheimprovementprocess,preparationofindicatorsandmapsthatshowthesocialdeterminantsofhealthforthecountyasawholeandforPublicUseMicrodataAreas(PUMAs)thatwillbeincludedintheHealthyMontgomeryNeedsAssessmentdocument.

HolyCrossHospital

Since2011,HolyCrossHospitalandthefourotherindividualhospitals(MedStarMontgomeryMedicalCenter,ShadyGroveAdventistHospital,SuburbanHospital,andWashingtonAdventistHospital)haveeachgiven$25,000,foratotalof$125,000peryear,totheInstituteforPublicHealthInnovation.ThesefundscontinuetosupporttheHealthyMontgomerySteeringCommitteemeetings,preparationandpresentationofallofthecommunityconversations,preparationoftheNeedsAssessmentReport(quantitativedataandinformationfromthecommunityconversations),supportoftheSteeringCommitteeindeterminingselectioncriteriathatwillbeusedtochoosetheprioritiesforcommunityhealthimprovement,andsupportforthepriorityselectionprocess.

HealthyMontgomeryisundertheleadershipoftheHealthyMontgomerySteeringCommittee,whichincludesplanners,policymakers,healthandsocialserviceprovidersandcommunitymembers(seeAppendixA).Itisanongoingprocessthatincludesperiodicneedsassessments,developmentandimplementationofimprovementplansandmonitoringoftheresultingachievements.Theprocessisdynamic,thusgivingthecountyanditscommunitypartnerstheabilitytomonitorandactonthechangingconditionsaffectingthehealthandwell‐beingofcountyresidents.ThematerialpresentedinthisdocumentisbasedonMontgomeryCounty’sCommunityHealthNeedsAssessmentconductedduring2015‐2018.

PrinceGeorge’sCountydoesnothaveasimilarcounty‐widedataprogramsoHolyCrossHealthusedthedatasourcesfoundinHealthyMontgomerytoextractdatathatwasspecifictoPrinceGeorge’sCountysothathealthinformationcouldbeanalyzedforbothcounties.TheUniversityofWisconsinPopulationHealthInstitute'sCountyHealthRankingsData(seeAppendixB),andHolyCrossHospital'sEmergencyDepartmentanddischargereadmissionsdatawerealsoanalyzedtodetermineunmetneedsofthepopulationweserveresidinginMontgomeryandPrinceGeorge'sCounties.

COMMUNITY NEED INDEX

TheCommunityNeedIndex(seeFigure1)identifiestheseverityofhealthdisparitiesforeveryZIPcodeintheUnitedStatesanddemonstratesthelinkbetweencommunityneed,accesstocare,andpreventablehospitalizations(DignityHealth,2011).ForeachZIPcodeintheUnitedStates,theCommunityNeedIndex Figure1:TheCNIoftheprimaryserviceareaofHoly

CrossHospitalis3.2,however,severalZIPcodesthroughoutthecountyrankashighneedareas.Source:DignityHealth,2014Mapdata:2014©Google.

HolyCrossHospital

aggregatesfivesocioeconomicindicators/barrierstohealthcareaccessthatareknowntocontributetohealthdisparitiesrelatedtoincome,education,culture/language,insuranceandhousing.WeusetheCommunityNeedIndextoidentifycommunitiesofhighneedanddirectarangeofcommunityhealthandfaith‐basedcommunityoutreacheffortstotheseareas.

EXTERNAL REVIEW

Eachyearsince2005,wehaveinvitedinputandobtainedadvicefromagroupofexternalparticipantsthatrepresentthebroadinterestofthecommunityweserve.Thegroupreviewsourcommunitybenefitplan,annualworkplan,foundation/keybackgroundmaterial,anddatasupplementstoadviseusonprioritycommunityneedsandthedirectiontotakeforthenextyear.

ExternalgroupparticipantsincludethepublichealthofficerandthedirectorofMontgomeryCountyDepartmentofHealthandHumanServices;avarietyofindividualsfromlocalandstategovernmentalagencies;andleadersfromcommunity‐basedorganizations,foundations,churches,colleges,coalitions,andassociations(seeAppendixC).Theseparticipantsareexpertsinarangeofareasincludingpublichealth,minoritypopulationsanddisparitiesinhealthcare,socialdeterminantsofhealth,healthcare,andsocialservices.Throughgroupdiscussion,theyprovideinputthathelpstoensurethatwehaveidentifiedandrespondedtothemostpressingcommunityhealthcareneeds.Onanongoingbasisweparticipateinavarietyofcoalitions,commissions,committees,partnershipsandpanelsandourcommunityhealthworkersspendtimeinthecommunityascommunityparticipantsandbringbackfirst‐handknowledgeofcommunityneeds.

READMISSION DATA AND PREVENTION QUALITY INDICATORS

HolyCrossHospitalreadmissiondataisusedtotrackthenumberofpatientswhoarereadmittedtothehospitalwithin30daysofdischarge.CentersforMedicare&MedicaidServices(CMS),defineshospitalreadmissionasapatientadmissiontoahospitalwithin30daysafterbeingdischargedfromanearlierhospitalstayandthedatacanbeusedtoevaluatethequalityofhospitalcare.PreventionQualityIndicators(PQI)areasetofmeasuresthatareusedwithinpatientdischargedatatoidentifyqualityofcareforambulatorycaresensitiveconditions,conditionsthatevidencesuggestscouldhavebeenpotentiallyavoidedthroughbetteroutpatientcare(AgencyforHealthcareResearchandQuality,2014).AnanalysisofhospitalreadmissionsandPQIallowustoidentifyselect

HolyCrossHospital

indicatorsrelatedtocommunityhealthneedsanddevelopmethodologiesandprogramsthatwillimprovehealthoutcomes.

NEEDS ASSESSMENTS AND REPORTS

Asavailable,wealsousearangeofotherspecificneedsassessmentsandreportstoidentifyunmetneeds,especiallyforunderservedminorities,seniors,andwomenandchildren.Ourworkisbuiltonpastavailableneedsassessments,andweusethesedocumentsasreferencetools,includingthefollowingkeyresourcesthatbecameavailablemorerecently:

MarylandStateHealthImprovementProcess PrinceGeorge'sCountyHealthImprovementPlan2011‐2014 AfricanAmericanHealthProgramStrategicPlanTowardHealthEquity,2009‐

2014; BlueprintforLatinoHealthinMontgomeryCounty,Maryland,2008‐2012; AsianAmericanHealthPriorities,AStudyofMontgomeryCounty,Maryland,

Strengths,Needs,andOpportunitiesforAction,2008.

OTHER AVAILABLE DATA

Wealsoreviewourowninternalpatientdataandreviewpurchasedandpubliclyavailabledataandanalysesonthemarket,demographicsandhealthserviceutilization,healthindicatorsandsocialdeterminantsofhealth.Thesedataprovideamoredetailedlookatthecommunityweservebyidentifyingpotentialdisparitiesthatmightnotsurfacewhenlookingatonlycountyorstatedata.Thisinformationthenassistsusindevelopingprogramstomeetthecomplexneedsofthecommunity;payingspecialattentiontovulnerablepopulations.

HolyCrossHospital

Race

Primary Service Area

(641,761)

Total Service Area

(1.7 Million)

White, Non‐Hispanic

212,388 (33.1%)

533,623 (31.4%)

Black, Non‐Hispanic

173,751 (27.1%)

625,033 (36.8%)

Hispanic 168,264 (26.2%)

319,042 (18.8%)

Asian/Pacific Islander, Non‐ Hispanic

68,361 (10.7%)

169,507 (10.0%)

All Others 18,997 (3.0%)

49,850 (2.9%)

Table1:DemographicbreakdownofHolyCrossHospital'sserviceareabyraceandethnicity.©2013TheNielsenCompany,©2013TruvenHealthAnalyticsInc.

THE COMMUNITY WE SERVE

HOLY CROSS HOSPITAL

HolyCrossHospitalservesalargeportionofMontgomeryandPrinceGeorge’sCountiesresidents(seeFigure2).Our21ZIPcodeprimaryservicearea(seeAppendixD)includes641,761people,ofwhom66.9%areminorities.Anestimated1.7millionpeoplein60ZIPcodesmakeupourtotalservicearea,ofwhom68.6%areminorities(seeTable1).OurprimaryserviceareaisderivedfromtheMarylandZIPcodeareasfromwhichthetop60%ofourFY13 dischargesoriginated.Thenext15%contributetoour secondaryservicearea.Wedraw69%ofourinpatients andoutpatientsfromMontgomeryCounty.

Intheearly1990'sPrinceGeorge'sCountybecameamajority‐minoritycounty,wheretheminoritypopulationsurpassesthewhitenon‐Hispanicpopulation,(Fox,

1996).Duringthelastcensus,MontgomeryCountyjoinedPrinceGeorge'sCountyasoneofonly336"majority‐minority"countiesinthecountry(MontgomeryCountyPlanningDepartment,2011).Theforeign‐bornpopulationofbothcountiesisalsohigherthanthenationalaverageof12.9%withanaveragepopulationof31.9%and20.0%inMontgomeryCountyandPrinceGeorge'sCounty,respectively(CommunityCommons,2014).Thecommunityweserveremainstobeoneofthemostculturallyandethnicallydiverseinthenation,challengingthehospital,thecountyhealthdepartments,community‐basedorganizationsandotherorganizationstounderstandandmeettheirvariedneeds.Figure2:Primaryandsecondaryserviceareafor

HolyCrossHospital

HolyCrossHospital

FluencyinEnglishisveryimportantwhennavigatingthehealthcaresystemaswellasfindingemployment.MontgomeryandPrinceGeorge'sCountyhavethehighestshareofforeign‐bornresidentsinMaryland(seeFigure3).Foreign‐bornresidentsaccountfor72.6%ofthecounty'spopulationincreasebetween2000and2012(MontgomeryCountyCircuitCourt,2013).Morethan328,000,ornearlyonethird,ofMontgomeryCountyresidentsareforeign‐born.Approximately40%ofthoseforeign‐bornspeakEnglishlessthan“verywell”(U.S.CensusBureau,2012)and7.8%ofthepopulationagedfiveandoverarelinguisticallyisolated(CommunityCommons,2014).ThehighestratesoflinguisticisolationareamongLatinoAmericansandAsianAmericans.

PrinceGeorge’sCountyalsoexperiencedalargeinfluxofforeign‐bornresidentsduringthelasttwodecades.Foreign‐bornresidentsaccountedfor91.7%ofthecounty'spopulationincreasebetween2000and2012(U.S.CensusBureau,2012).Morethan183,000PrinceGeorge'sCountyresidents,approximately20%ofthetotalpopulation,areforeign‐born.InPrinceGeorge'sCounty,39%offoreign‐bornresidentsspeakEnglishlessthan“verywell”(U.S.CensusBureau,2012)and4.8%ofthepopulationagedfiveandoverislinguisticallyisolatedwiththemostlinguisticisolationoccurringinnorthernPrinceGeorge'sCounty(CommunityCommons,2014).

Figure3:Marylandforeign‐bornpopulationdistributionbycounty.Theforeign‐bornpopulationincludesanyonewhowasnotaU.S.citizenoraU.S.nationalatbirth.PreparedbyMarylandDepartmentofLegislativeServices,2013.Source:U.S.CensusBureau.

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MontgomeryCountyisalsorapidlyaging.Thepopulationaged65+isestimatedtoincreasefrom119,769in2010to243,940in2040,morethandoubling.Asaresult,thepercentageofthepopulationage65andolderwillincreasefrom12.3%to16.8%.ThesamepatternisexpectedinPrinceGeorge'sCounty.Thepopulationage65+andolderisprojectedtoincreasefrom81,513in2010to174,110in2040,increasingfrom9.4%ofthepopulationto18.0%(seeFigure4).Increasingtheneedforseniorservicessuchhashousingandhealthcareinbothcounties.

Figure4:65+PopulationprojectionsforMontgomeryandPrinceGeorge'sCounties.Source:MarylandDepartmentofAging,2014.

0

50000

100000

150000

200000

250000

300000

2010 2020 2030 2040

Persons

Year

65+PopulationProjectionsbyCounty

MontgomeryCounty65+ PrinceGeorge'sCounty65+

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SOCIAL DETERMINANTS OF HEALTH

Accesstoquality,affordablehealthcareplaysasignificantroleinthehealthofindividuals.However,clinicalcarecannotaddressallthefactorsthatshapebothhealthbehaviorsandhealthitself(Braveman,Egerter,&Mockenhaupt,2011).Understandingsocialdeterminantsofhealth,suchaseconomicsandeducationcanalsoleadtoimprovementsinhealthandreductionsinhealthdisparities(Williams,Costa,Odunlami,&Mohammed,2008).

INSURANCE COVERAGE

Despiteitsrelativewealthintermsofincome,educationandsupportforpublicservicesmorethan600,000MarylandresidentswereuninsuredpriortotheimplementationoftheAffordableCareAct.Themajorityofuninsuredresidentswereminorities,withthelargestpercentageofuninsuredpertotalracial/ethnicpopulationbeingAmericanIndian/AlaskanNative(U.S.CensusBureau,2012).Lackofinsuranceisaprimarybarriertohealthcareaccessincludingregularprimarycare,specialtycare,andotherhealthservicesthatcontributestopoorhealthstatus.

TheimplementationoftheAffordableCareAct'sexpandedinsurancecoverageinJanuaryof2014madeinsuranceaccessibletothousandsofresidentsinMontgomeryandPrinceGeorge'sCountypossiblyforthefirsttime.Inthelastsixmonthsoffiscalyear2014,MedicaidenrollmentinMontgomeryandPrinceGeorge'sCountyincreased30%and35%,respectively(seeFigure5).AsofMay31,2014,MarylandHealthBenefitExchangeenrolled300,310individualsinMedicaidand72,207individualsinaqualifiedhealthplan(MarylandHealthBenefitExchange,2014).Ofthe72,207individualsenrolledinaqualifiedhealthplan,28%resideinMontgomeryCountyand17%resideinPrinceGeorge'sCounty(seeFigure6).Althoughthemajorityoftheuninsuredresidents(seeFigure7andFigure8)areeligibleforhealthinsurance,thousandswillremainuninsuredduetoineligibility.HealthyMontgomery,thecounty'scommunityhealthimprovementprocess,hasrankedaccesstocareforthoseuninsuredandunderinsuredasanoverarchingthemethataffectsalloftheselectedtophealthpriorities.

HolyCrossHospital

MontgomeryCounty

PrinceGeorge'sCounty

Figure6:MarylandQualifiedHealthPlanEnrollmentsbycounty,asofMay31,2014.Source:MarylandHealthConnection,2014.

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

NumberofPersons

Month

FY2013‐2014TotalMedicadEnrollmentbyCounty

MontgomeryCounty PrinceGeorge'sCounty

Figure5:TotalnumberenrolledinaMedicaidplanbycountyforeachmonthoffiscalyear2014.Source:MarylandMedicaideHealthStatistics.

Figure7:Percentageoftotaluninsuredpersonspercounty.Source:CommunityCommons,2014.

HolyCrossHospital

0 5 10 15

Total

Other

White

Hispanic

AfricanAmerican/Black

Asian

PercentUnemployed

2012ACSSurvey,UnemploymentRate

PrinceGeorge'sCounty MontgomeryCounty Maryland

Figure9:Unemploymentrateforpopulationaged16andoverbyraceandethnicityforMaryland,MontgomeryCounty,andPrinceGeorge'sCounty.Source:U.S.CensusBureau,2012ACS,1‐yearestimates.

Figure8:Thepercentageofthetotalciviliannon‐institutionalizedpopulationwithouthealthinsurancecoverage.Source:CommunityCommons,2014.

ECONOMICS

MontgomeryCounty,Maryland’smostpopulousjurisdictionwithapopulationof1,004,709(U.S.CensusBureau,PopulationDivision,2012),hasamedianhouseholdincomeof$94,965comparedtothestatewidemedianhouseholdincomeof$71,122(U.S.CensusBureau,2012).Thecounty’sincomelevelispositivelycorrelatedtoitslevelofeducation;morethanhalfofthecounty’sresidentsaged25andover(56.9%)holdabachelor’sdegreeorhighercomparedto36.9%statewide(U.S.CensusBureau,2012).

PrinceGeorge’sCounty,likeMontgomeryCounty,isoneofthestate'smostpopulousjurisdictionswithapopulationofmorethan863,420residentsandamedianhouseholdincomeof$69,879,slightlylowerthanthestateaverage.TheunemploymentrateforthecountyisslightlyhigherthanthestatewiththehighestpercentageofunemployedamongtheAfricanAmerican/BlackandHispanicpopulations(seeFigure9)andlessthanonethird(30.3%)ofthecounty’sresidentsholdabachelor’sdegreeorhigher(U.S.CensusBureau,2012).

HolyCrossHospital

Legend

≤47.4%

47.5-52.8% >52.8% Montgomery

County


Figure11:Percentageofrentersspendingmorethan30%ofincomeonrentbyZIPcode.Source:HealthyCommunitiesInstitute.

5.44.4

7.46.0

0

2

4

6

8

10

Jan‐12

Mar‐12

May‐12

Jul‐12

Sep‐12

Nov‐12

Jan‐13

Mar‐13

May‐13

Jul‐13

Sep‐13

Nov‐13

Jan‐14

Mar‐14

Percent

UnemployedWorkersinCivilianLaborForce


Figure10:Civilians,16yearsofageandover,whomareunemployedasapercentageoftheU.S.civilianlaborforce.Source:U.S.BureauofLaborStatistics.

Unemploymentrateisakeyindicatorofthelocaleconomyandoccurswhenlocalbusinessesareunabletosupplyenoughjobsforlocalemployeesorwhenthelaborforceisnotabletosupplyappropriateskillstoemployers(HealthyCommunitiesInstitute,2014).Duringperiodsofunemployment,individualsarelikelytofeelsevereeconomicstrainandmentalstress.Unemploymentisalsorelatedtoaccesstohealthcare,asmanyindividualsreceivehealthinsurancethroughtheiremployer.Ahighunemploymentrateplacesstrainonfinancialsupportsystems,asunemployedpersonsqualifyforunemploymentbenefitsandfoodstampprograms.TheunemploymentratesofbothMontgomeryandPrinceGeorge'sCountyhavebeensteadilydecliningannuallysinceFY11.

Duetothelargenumberoffederalagenciesandcontractors,bothcountiesgenerallyenjoylowunemploymentwhencomparedtotheU.S.InMarch,2014theunemploymentratewas4.4%inMontgomeryCountyand6.0%inPrinceGeorge'sCountycomparedto7.0%fortheU.S.(U.S.BureauofLaborStatistics,2014);showingimprovementfromwhatwasreportedinpreviousyears(seeFigure10).

Anotherindicatorofthelocaleconomyisthepercentageofhouseholdsspendingahighpercentageofincomeonrent.Payingahighrentcancreateafinancialhardship,especiallyforthosewithalimitedincome,leavinglittlemoneyforotherexpensessuchasfood,transportationandmedicalservices(HealthyCommunitiesInstitute,2014).

Moreover,highrentreducestheproportionofincomeahouseholdcanallocatetosavingseachmonth.Onaverage,51.7%ofrentersinMontgomeryCountyand51.9%ofrentersinPrinceGeorge'sCountyspendmorethan30%oftheirincomeonrent.However,asshowninthemapinFigure11,thehighestpercentageofresidentsspendingmorethan30%oftheirincomeonrentresideinZIPcodessurroundingHolyCrossHospitalandHolyCrossGermantownHospital.

HolyCrossHospital

$‐ $40,000 $80,000 $120,000

OtherTwoorMoreRaces

WhiteAlone(notHispanic/Latino)HispanicLatino(ofanyrace)

Black/AfricanAmericanAsian

AmericanIndian/AlaskaNativeCountyaverage

2012Self‐SufficiencyIncome*

MedianIncomeinPast12MonthsMontgomeryandPrinceGeorge'sCounty

PrinceGeorge'sCounty MontgomeryCounty

Figure12:MedianhouseholdincomebyraceforMontgomeryandPrinceGeorge’sCounty.Source:U.S.CensusBureau,2012ACS,1‐yearestimates;TheSelf‐SufficiencyStandardforMaryland,2012.*Annualself‐sufficiencystandardforoneadult,onepreschooler,andoneschool‐agechild.

DespitetherelativeaffluenceandfairlylowunemploymentratesofbothMontgomeryandPrinceGeorge'sCounty,disparitiesexist.Forexample,inMontgomeryCounty,keyminoritypopulationsaveragelowermedianincomethantheincomeleveldeterminedforself‐sufficiency(seeFigure12)andinPrinceGeorge’sCounty,higherincomelevelsdonothelplowertheAfricanAmericaninfantmortalityrate.

EDUCATION

Kindergartenscreeningmeasuresthereadinessofeachstudenttobeginkindergartenbasedoneducationstandards.ThereadinessstandardsaresetbytheMarylandModelforSchoolReadinessandmeasureseventeenexpectationsforschoolreadiness,includingimmunizationstatus,physicaldevelopment,compliancewithrules,communicationskills,interactionswithpeersandadults,demonstrationofcuriosity,abilitytopayattention,andabilitytofollowdirections(HealthyCommunitiesInstitute,2014).Forthe2011‐2012schoolyear,81%ofincomingMontgomeryCountyKindergartenersand77%ofincomingPrinceGeorge'sCountykindergartnersmetthereadinessstandards,fallingshortoftheStateHealthImprovementProcessgoalof85%(MarylandDepartmentofHealthandMentalHygiene,2014).

Highschoolgraduationratesalsohaveahighimpactonthehealthofanindividual.Individualswhodonotfinishhighschoolaremorelikelythanpeoplewhofinishhighschooltolackthebasicskillsrequiredtofunctioninanincreasinglycomplicatedjob

HolyCrossHospital

marketandsociety.Adultswithlimitededucationlevelsaremorelikelytobeunemployed,ongovernmentassistance,orinvolvedincrime(HealthyCommunitiesInstitute,2014).ThegoalfortheMarylandStateHealthImprovementProcessistohaveagraduationrateof88.6%by2014.During2012‐2013,bothMontgomeryCountyandPrinceGeorge'sCountyfellbelowthisgoalwith88.3%and74.1%countygraduationrates,respectively.Inourservicearea,censustractsnearWheaton‐Glenmont,AspenHill,GaithersburginMontgomeryCountyandUniversityParkandRiverdaleinPrinceGeorge'sCountyhavethelargestpercentagesofresidentsovertheageof25withlessthanahighschooldiploma(seeFigure13).

Figure13:Percentageofthepopulationaged25yearsandolderwithnohighschooldiploma.Source:CommunityCommons,2014.

HolyCrossHospital

HEALTH INDICATORS

Healthindicators,suchascausesofdeath(seeTable2),breastcancerrates,obesityandfruitconsumption,canbeusedtodescribethehealthofapopulation,healthdifferenceswithinapopulationorusedtodetermineifprogramobjectivesdesignedtoimprovehealtharebeingmet.HealthyMontgomeryselectedapproximately100indicatorstomonitorforimprovement.Inthissection,selectindicatorsrelatedtothesixHealthyMontgomeryprioritiesandselectindicatorsrelatedtotheseniorpopulationhavebeengraphedtoshowavisualrepresentationofhealthdifferenceswithinapopulation.EachHealthyMontgomeryindicatorislistedinatableattheendofasectionandmeasuresarecolor‐codedbasedondistributionofvaluesfromthereportingregions(e.g.countiesinthestate);sometimeslowervaluesarebetterandinothercaseshighervaluesarebetter.Fromthedistribution,thegreenrepresentsthetop50thpercentile,theyellowrepresentsthe25th‐50thpercentile,andtheredrepresentsthe25thpercentile.EachindicatorisalsocomparedtotheindicatorsfromtheFY12CHNAwithagreenorredarrowtoindicateimprovement(green)ordecline(red)(HealthyCommunitiesInstitute,2014).

PrinceGeorge'sCountyAge‐adjustedDeathRate/100,000

HeartDisease 191.2

Cancer 165.2

Stroke 35.2

Diabetes 27.6

ChronicLowerRespiratoryDisease 22.7

MontgomeryCounty Age‐adjustedDeathRate/100,000

Cancer 126.7

HeartDisease 119.7

Stroke 27.5

ChronicLowerRespiratoryDisease 18.2

Accidents 16.7

Table2:TopfiveleadingcausesofdeathforMontgomeryandPrinceGeorge'sCounties.Source:MarylandVitalStatisticsAdministration,2012.

HolyCrossHospital

CANCER

Advancesinresearch,detectionandtreatmenthaveslowedthecancerdeathrate;however,cancerremainsaleadingcauseofdeathintheUnitedStates(U.S.DepartmentofHealthandHumanServices,2010).ItistheleadingcauseofdeathinMontgomeryCountyandthesecondleadingcauseofdeathinPrinceGeorge’sCounty(VitalStatistics,2012).Theburdenofbattlingcancerswithinourcommunityvaries;withdisparitiesclearlypresent(DHHS,2011).Forexample,inMontgomeryCountythebreastcancerincidencerateforWhitewomenishigherthanforAfricanAmerican/Blackwomen,however,thedeathrateforAfricanAmerican/Blackwomenismorethan50%higher.

TheNationalCancerInstitute(NCI)definescancerasatermusedtodescribediseasesinwhichabnormalcellsdividewithoutcontrolandareabletoinvadeothertissues.Thereareover100differenttypesofcancer,however,lung,colorectal,breast,pancreatic,andprostatecancerleadtothegreatestnumberofdeathseachyear.

116.8

148.0

128.4

0 50 100 150 200 250

Overall

Male

Female

Deaths/100,000population

Age‐AdjustedDeathRateduetoCancerMontgomeryCounty

186.7

234.0

158.2

0 50 100 150 200 250

Overall

Male

Female


Age‐AdjustedDeathRateduetoCancerPrinceGeorge'sCounty

Figure14:Age‐adjusteddeathrateper100,000populationduetocancer.Source:NationalCancerInstitute,2006‐2010.

7.5

8.0

8.5

9.0

9.5

2008 2009 2010 2011 2012

Percent

MedicareBeneficiariesTreatedforCancer

UnitedStates Maryland


Figure15:YearlypercentageofMedicarebeneficiarieswhoweretreatedforcancer(Breast,colorectal,lungandprostate).Source:CentersforMedicaidandMedicareServices,2012.

HolyCrossHospital

122.8

131.9

127.5

0 50 100 150

Overall

White,Non‐Hispanic

Black,Non‐Hispanic

Cases/100,000females

BreastCancerIncidenceRateMontgomeryCounty

108.0

123.6

118.5

0 50 100 150

Overall




BreastCancerIncidenceRatePrinceGeorge'sCounty

Figure16:Age‐adjustedincidencerateforbreastcancerincasesper100,000females.Source:NationalCancerInstitute,2006‐2010.

19.6

19.2

30.3

0 10 20 30 40

Overall



Deaths/100,000females

Age‐AdjustedDeathRateduetoBreastCancerMontgomeryCounty

27.8

22.3

31.8

0 10 20 30 40

Overall



Deaths/100,000females

Age‐AdjustedDeathRateduetoBreastCancerPrinceGeorge'sCounty

Figure17:Age‐adjusteddeathrateper100,000femalesduetobreastcancer.Source:NationalCancerInstitute,2006‐2010.

Breast Cancer

BreastcanceristhesecondmostcommontypeofcanceramongwomenintheU.S.followingbehindskincancerandaccordingtotheAmericanCancerSociety,breastcanceristhesecondleadingcauseofcancerdeathamongwomenintheU.S.Thegreatestriskfactorindevelopingbreastcancerisage.Since1990,breastcancerdeathrateshavedeclinedprogressivelyduetoadvancementsintreatmentanddetection.

HolyCrossHospital

Table3:HealthyMontgomeryBreastCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

Colorectal Cancer

Colorectalcancer,cancerofthecolonorrectum,isthesecondleadingcauseofcancer‐relateddeathsintheUnitedStates.Earlydetectionplaysasignificantroleindecreasingthedeathrateforthosediagnosed,ifadultsaged50orolderhadregularscreeningtests,asmanyas60%ofthedeathsfromcolorectalcancercouldbeprevented(HealthyCommunitiesInstitute,2014).InbothMontgomeryandPrinceGeorge'sCounty,thescreeningrateforcolorectalcancerishighat72.9%and71.7%ofthepopulation50andovergettingscreenedbutracialdisparitiesarepresent(seeFigure18).Therearealsoracialdisparitiesintheincidenceanddeathrates(seeFigure19).AfricanAmerican/BlackshaveahigherincidenceanddeathratewhencomparedtotheratesofWhites,AsiansorPacificIslandersandHispanics.

BreastCancerIndicators CHNA2012 Current

MC PGC MD MC PGC MD

Age‐adjusteddeathrateduetobreastcancer(deaths/100,000population) 20.2 30.3 25.8 19.6 27.8 24.5

Range ≤22.9 23.0‐25.9 ≥26.0

Breastcancerincidencerate(cases/100,000population) 129.6 116.7 123.8 127.5 118.5 128.0

Range ≤115.6 115.7‐126.5 ≥126.5

Mammogramhistory82.6% 81.7% 80.5% 84.7% 85.7% 62.4%

Range ≥83.9% 83.8‐80.3% ≤80.4%

72.9

78.9

57.4

71.9

60.7

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

ColorectalScreeningRateMontgomeryCounty

71.7

78.0

47.1

70.4

100.0

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

ColorectalCancerScreeningRatePrinceGeorge'sCounty

Figure18:Thepercentageofadultsaged50andoverwhohaveeverhadasigmoidoscopyorcolonoscopyexam.Source:MarylandBRFSS,2012.

HolyCrossHospital

33.2

31.8

20.3

38.4

0.0 10.0 20.0 30.0 40.0 50.0

Overall

White

Hispanic

Black

Cases/100,000population

ColorectalCancerIncidenceRateMontgomeryCounty

39.9

37.2

27.4

41.4

0 10 20 30 40 50

Overall

White

Hispanic

Black


ColorectalCancerIncidenceRatePrinceGeorge'sCounty

Figure19:Theage‐adjustedincidencerateforcolorectalcancerincasesper100,000population.Source:NationalCancerInstitute,2006‐2010.

11.0

10.0

16.2

11.0

0.0 5.0 10.0 15.0 20.0

Overall

White

Black

Asian


ColorectalCancerDeathRateMontgomeryCounty

18.8

15.6

21.0

14.4

0 5 10 15 20 25

Overall

White

Black

Asian


ColorectalCancerDeathRatePrinceGeorge'sCounty

ColorectalCancerIndicatorsCHNA2012 Current

MC PG MD MC PG MD

Age‐adjusteddeathrateduetocolorectalcancer(deaths/100,000

population) 12.2 21.0 18.6 11.0 18.8 16.8

Range ≤17.4 17.5‐20.2 ≥20.3

Coloncancerscreening72.1% 73.9% 71.3% 72.9% 71.7% 72.4%

Range ≥69.8% 69.7‐64.0% ≤64.1%

Colorectalcancerincidencerate(cases/100,000population) 38.1 46.9 46.9 33.2 39.9 41.5

Range ≤46.6 46.7‐52.5 ≥52.6

Table4:HealthyMontgomeryColorectalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

Figure20:Theage‐adjusteddeathrateper100,000populationduetocolorectalcancer.Source:NationalCancerInstitute,2006‐2010.

HolyCrossHospital

Cervical Cancer

CervicalcancerisacommoncancerthathasaveryhighcureratewhencaughtearlyandtheAmericanCollegeofObstetriciansandGynecologistsrecommendsthatallwomengetregularPapteststoincreaseearlydetectionofcervicalcancer(seeFigure21).InMontgomeryCounty,Hispanicwomen'sincidencerateofcervicalcancerisabouttwicethatofWhitewomen(seeFigure22).

83.0

85.4

86.4

83.3

71.9

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

PapTestHistoryMontgomeryCounty

81.9

75.1

84.8

86.4

32.9

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

PapTestHistoryPrinceGeorge'sCounty

Figure21:Thepercentageofwomenaged18andoverwhohavehadaPapsmearinthepastthreeyears.Source:MarylandBRFSS,2012.

5.8

4.9

8.9

7

0 2 4 6 8 10

Overall

White

Hispanic

Black


CervicalCancerIncidenceRateMontgomeryCounty

7.3

7.2

7.1

7.2

0 2 4 6 8 10

Overall


Hispanic



CervicalCancerIncidenceRatePrinceGeorge'sCounty

Figure22:Theage‐adjustedincidencerateforcervicalcancerincasesper100,000females.Source:NationalCancerInstitute,2006‐2010.

HolyCrossHospital

Prostate Cancer

ProstatecanceristhemostcommonformofcanceramongmenintheUnitedStatesandisonlysecondtolungcancerasacauseofcancer‐relateddeathamongmen(HealthyCommunitiesInstitute,2014).ProstatecancerusuallyoccursinoldermenandAfricanAmerican/Blackmen'sincidencerateismorethan50%higherthanWhitemeninMontgomeryCountyand78%higherinPrinceGeorge'sCounty.Theirdeathrateisalsomorethan70%higher(seeFigure23andFigure24).

CervicalCancerIndicatorsCHNA2012 Current

MC PG MD MC PG MD

Cervicalcancerincidencerate(cases/100,000population) 8.0 7.0 7.6 5.8 7.3 6.8Range ≤8.2 8.3‐10.0 ≥10.1

PapTestHistory87.4% 82.2% 84.1% 83.5% 90.5% 94.3%

Range ≥86.4% 86.3‐84.0% ≤83.9%

Table5:HealthyMontgomeryCervicalCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

162.6

155.7

116.8

238.7

0 100 200

Overall


Hispanic


Cases/100,000males

ProstateCancerIncidenceRateMontgomeryCounty

187.6

105.6

130.1

187.6

0 100 200

Overall


Hispanic


Cases/100,000males

ProstateCancerIncidenceRatePrinceGeorge'sCounty

Figure23:Theage‐adjustedincidencerateforprostatecancerincasesper100,000males.Source:NationalCancerInstitute,2006‐2010.

17.0

16.9

29.1

0 10 20 30 40 50

Overall



Deaths/100,000males

Age‐AdjustedDeathRateduetoProstateCancerMontgomeryCounty

37.5

27.0

49.2

0 10 20 30 40 50

Overall



Deaths/100,000males

Age‐AdjustedDeathRateduetoProstateCancerPrinceGeorge'sCounty

Figure24:Theage‐adjusteddeathrateper100,000malesduetoprostatecancer.Source:NationalCancerInstitute,2006‐2010.

HolyCrossHospital

ProstateCancerIndicatorsCHNA2012 Current

MC PG MD MC PG MD

Age‐adjusteddeathrateduetoprostatecancer(deaths/100,000population) 19.7 37.7 27.5 17.0 37.5 25.0Range ≤24.0 24.1‐28.0 ≥28.1

Prostatecancerincidencerate(cases/100,000population) 158.2 178.8 159.4 162.6 187.6 157.2Range ≤138.1 138.2‐159.7 ≥159.8

Lung Cancer

AccordingtotheAmericanLungAssociation,morepeoplediefromlungcancerannuallythananyothertypeofcancer,exceedingthetotaldeathscausedbybreastcancer,colorectalcancer,andprostatecancercombined.Howlongapersonsmokesandhowoftenisthegreatestriskfactorforlungcancer.AsshowninTable7,thesmokingrateinMontgomeryandPrinceGeorge'sCountiesislowerthanthestateandthecountry.Whilethelungcancermortalityrateishigherformen(seeFigure25)thanforwomentherateformenhasreachedaplateau,themortalityrateduetolungcanceramongwomencontinuestoincrease.InMontgomeryandPrinceGeorge'sCounty,AfricanAmerican/Blackshavethehighestlungcancerincidencerates(seeFigure26).However,WhitemenhaveahigherdeathrateinPrinceGeorge'sCounty(seeFigure27).

ReportArea TotalPopulation

Age18+

Est.Population

RegularlySmoking

Cigarettes

Age‐Adjusted

Percentage

MontgomeryCounty 728,670 57,565 7.9%

PrinceGeorge'sCounty 650,433 90,410 13.5%

Maryland 4,380,821 674,646 15.4%

UnitedStates 232,556,016 41,491,223 18.1%

Table7:Numberofadults,aged18+,whoself‐reportedcurrentlysmokingcigarettessomedaysoreveryday.Source:CentersforDiseaseControlandPrevention,BehavioralRiskFactorSurveillanceSystem:2006‐12.

Table6:HealthyMontgomeryProstateCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

HolyCrossHospital

28.329.1

9.732.4

20.0

0 10 20 30 40 50 60

OverallWhite,Non‐Hispanic

HispanicBlack,Non‐Hispanic

Asian/PacificIslander


Age‐AdjustedDeathRateduetoLungCancerMontgomeryCounty

45.855.1

10.941.4

23.1

0 10 20 30 40 50 60

OverallWhite,Non‐Hispanic

HispanicBlack,Non‐Hispanic



Age‐AdjustedDeathRateduetoLungCancerPrinceGeorge'sCounty

Figure27:Theage‐adjusteddeathrateper100,000populationduetolungcancer.Source:NationalCancerInstitute,2006‐2010.

40.0

40.0

20.9

47.6

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

Overall

White

Hispanic

Black


LungandBronchuscancerIncidenceRatebyRace/EthnicityMontgomeryCounty

51.7

28.1

48.2

59.6

0 10 20 30 40 50 60 70

Overall

White

Hispanic

Black


LungandBronchusCancerIncidenceRatebyRace/Ethnicity


Figure26:Theage‐adjustedincidencerateforlungandbronchuscancersincasesper100,000population.Source:NationalCancerInstitute,2006‐2010.

28.3

32.3

25.6

0 10 20 30 40 50 60 70

Overall

Males

Females


LungCancerAge‐AdjustedDeathRatebyGenderMontgomeryCounty

45.8

60.7

36.0

0 10 20 30 40 50 60 70

Overall

Males

Females


LungCancerAge‐AdjustedDeathRatebyGenderPrinceGeorge'sCounty

Figure25:Theage‐adjusteddeathrateper100,000populationduetolungcancer.Source:NationalCancerInstitute,2006‐2010.

HolyCrossHospital

LungCancerIndicatorsCHNA2012 Current

MC PG MD MC PG MD

Age‐adjusteddeathrateduetolungcancer(deaths/100,000population) 30.6 49.5 53.8 28.3 45.8 49.6

Range ≤55.4 55.5‐64.9 ≥65.0

Lungandbronchuscancerincidencerate(cases/100,000population) 42.6 54.4 67.6 40.0 51.7 63.5

Range ≤72.0 72.1‐82.9 ≥83.0

Table8:HealthyMontgomeryLungCancerIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

Cardiovascular Disease

Together,heartdiseaseandstrokeareamongthemostwidespreadandcostlyhealthproblemsfacingthenationtoday,theyarealsoamongthemostpreventable.InMontgomeryCountyandPrinceGeorge'sCounty,heartdiseaseandstrokeareinthetopfiveleadingcausesofdeath(seeTable2).In2012,heartdiseasewasthesecondleadingcauseofdeathinMontgomeryCounty,withthemajorityofdeathsoccurringinWhites(seeFigure28).ItisthefirstleadingcauseofdeathforWhitesandAsian/PacificIslandersandthesecondleadingcauseofdeathforAfricanAmericans/BlacksandHispanics(MarylandDepartmentofHealthandMentalHygiene,2014).InPrinceGeorge'sCountyitistheleadingcauseofdeathforallracesandethnicitieswiththemajorityofdeathsoccurringinAfricanAmerican/Blacks.

Deaths from Heart Disease Montgomery County

Figure28:PercentageofdeathsfromheartdiseasebyraceforMontgomeryandPrinceGeorge'sCounty.Source:MarylandDHMH,2010‐2012.

HolyCrossHospital

Cerebrovascular Disease

InMontgomeryandPrinceGeorge'sCountystroke,whichcanbecausedbycerebrovasculardisease,isthethirdleadingcauseofdeath.Astrokeoccurswhenthebrainisdeprivedofoxygenandthisusuallyoccurswhenbloodvesselscarryingoxygentothebrainbecomeblockedorburst.Ageisalargeriskfactorforstroke,withtheriskdoublingforeachdecadeafter55,however,thelargestmodifiableriskfactorsforstrokearehighbloodpressure,highcholesterolanddiabetesmellitus(HealthyCommunitiesInstitute,2014).

High Blood Pressure and Cholesterol

Highbloodpressure(140/90mmHgorhigher)isariskfactorformanydiseasesincludingheartdisease,kidneyfailureandstroke.Highbloodpressureisoftencalledthe"silentkiller"becausehighbloodpressurecanbeasymptomaticandgoundetected.Highbloodpressurecanoccurinpeopleofanyageorsex;however,itismorecommonamongthoseoverage35.InMontgomeryandPrinceGeorge'sCountythehighestratesofhighbloodpressureareBlack,Non‐HispanicsandWhites,Non‐Hispanics(seeFigure29).Highcholesterolisalsoamajorriskfactorforheartdiseaseandcangoundetected.Itisimportantforbothmenandwomentomaintainlowcholesterollevelsandreducetheirchanceofdevelopingheart(HealthyCommunitiesInstitute,2014).

21.6

25.4

14.4

23.1

5.8

0 10 20 30 40

Overall


Hispanic


Asian

Percent

HighBloodPressurePrevalenceMontgomeryCounty

36.3

40.4

22.3

38.6

13.3

0 10 20 30 40 50

Overall


Hispanic


Asian

Percent

HighBloodPressurePrevalencePrinceGeorge'sCounty

Figure29:Thepercentageofadultswhohavebeentoldtheyhavehighbloodpressure.Source:MarylandBRFSS,2011.

HolyCrossHospital

CardiovascularDiseaseIndicatorsCHNA2012 Current

MC PGC MD MC PGC MD

Age‐adjusteddeathrateduetocerebrovasculardisease/100,000population 29.2 35.7 38.7 27.5 35.2 37.4

Range ≤37.8 37.9‐41.4 ≥41.5

Age‐adjusteddeathrateduetoheartdisease131.0 225.4 197.8 119.7 191.2 174.9

Range ≤184.1 184.2‐205.4 ≥205.5

Highbloodpressureprevalence24.5% 34.2% 30.1% 21.6% 36.3% 32.0%

Range ≤34.4% 34.5‐37.1% ≥37.2%

Highcholesterolprevalence38.7% 34.7% 37.4% 31.8% 34.6% 35.4%

Range ≤37.7 37.8‐41.4% ≥41.5%

AtrialFibrillation:MedicarePopulation 8.1% 5.4% 8.1%

Range ≤7.5% 7.6‐8.4% ≥8.5%

ERRateduetoHypertension/10,000population 126.2 238.4 222.2

Range ≤215.5 215.6‐265.6 ≥265.5

HeartFailure:MedicarePopulation 12.3% 15.3% 14.6%

Range ≤15.4% 15.5‐17.5% ≥17.6%

Hyperlipidemia:MedicarePopulation 47.5% 46.1% 49.8%

Range ≤41.5% 41.6‐46.9% ≥47%

Hypertension:MedicarePopulation 54.0% 60.7% 60.6%

Range ≤56.0% 56.1‐60.4% ≥60.5%

IschemicHeartDisease:MedicarePopulation 26.6% 28.8% 30.1%

Range ≤29.1% 29.2‐33% ≥33.1%

Stroke:MedicarePopulation 3.4% 5.1% 4.5%

Range ≤3.5% 3.6‐3.9% ≥4%

Table9:HealthyMontgomeryCardiovascularDiseaseIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

HolyCrossHospital

Diabetes

In2012,29.1millionAmericans,or9.3%ofthepopulation,haddiabetesupfrom25.8millionand8.3%in2010(NationalDiabetesStatisticsReport,2014).DiabetesdisproportionatelyaffectsminoritypopulationsandtheelderlyanditsincidenceislikelytoincreaseasminoritypopulationsgrowandtheU.S.populationbecomesolder.Personswithdiabetesarealsoatincreasedriskforischemicheartdisease,neuropathy,andstroke.Diabetesisalsoacostlydisease(seeTable10).Itisestimatedthattheaveragemedicalexpendituresforapersondiagnosedwithdiabetesis2.3timeshigherthanitwouldbeifthatpersondidnothavediabetes(NationalDiabetesStatisticsReport,2014).

In2012,diabeteswastheseventhleadingcauseofdeathinMontgomeryCountyandthefifthleadingcauseofdeathinPrinceGeorge'sCounty.Diabetescanlowerlifeexpectancybyupto15yearsandincreasestheriskofheartdiseaseby2to4times.Itisalsotheleadingcauseofkidneyfailure,lowerlimbamputations,andadult‐onsetblindness(U.S.DepartmentofHealthandHumanServices,2010).

7.0

6.2

5.1

9.8

7.5

0 5 10 15

Overall


Hispanic


Asian

Percent

Adults with Diabetes by Race/EthnicityMontgomery County

10.4

9.5

7.3

13.7

6.4

0 5 10 15

Overall


Hispanic


Asian

Percent

Adults with Diabetes by Race/EthnicityPrince George's County

CostofDiabetes $245billion:Total

costsofdiagnoseddiabetesintheUnitedStatesin2012

$176billionfordirectmedicalcosts

$69billioninreducedproductivity

Table10:Costofdiabetes.Source:AmericanDiabetesAssociation,2014.

Figure30:Thepercentageofadultswhohaveeverbeendiagnosedwithdiabetes,notincludingwomenwhowerediagnosedwithdiabetesonlyduringpregnancy.Source:MarylandBRFSS,2012.

HolyCrossHospital

DiabetesIndicatorsCHNA2012 Current

MC PGC MD MC PGC MD

AdultswithDiabetes 7.1% 10.9% 9.4% 5.1% 11.0% 9.6%Range ≤9.7% 9.8‐11.8% ≥11.9%

Age‐AdjustedDeathRateduetoDiabetesdeaths/100,000population 12.7 31.4 21.9 13.2 27.6 19.9

Range ≤19.7 19.8‐23.9 ≥24.0

Diabetes:MedicarePopulation 24.7% 34.8% 29.2%Range ≤26.9% 27.0‐29.6% ≥29.7%

ERRateduetoDiabetes/10,000population 163.5 300.3 314.6

Range ≤294.7 294.7‐391.9 ≥392.0

Obesity

Duringthepasttwentyyears,obesityrateshaveincreasedintheUnitedStates;doublingforadultsandtriplingforchildren.Morethan50%ofMontgomeryCountyresidentsandmorethan70%ofPrinceGeorge’sCountyresidentsareoverweightorobese(BRFSS,2012).Obesityaffectsallpopulations,regardlessofage,sex,race,

Table11:BodyMassIndexchart.

0 5 10 15 20 25

18‐19

20‐24

25‐44

45‐64

65‐84

85+

MontgomeryCountyERrateduetodiabetesbyage

Figure31:Theaverageannualage‐adjustedemergencyroomvisitrateduetodiabetesper10,000populationaged18yearsandolder.Casesofgestationaldiabeteswereexcluded;PrinceGeorge'sCountydataisnotavailable.Source:MarylandHSCRC,2009‐2011.

Table12:HealthyMontgomeryDiabetesIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

HolyCrossHospital

55.2

60.9

47.3

71.4

74.9

68.0

0 20 40 60 80

Overall

Male

Female

Percent

AdultswhoareOverweightorObese


Figure33:ThepercentageofmaleandfemaleadultswhoareoverweightorobeseaccordingtotheBMI.Source:MarylandBRFSS,2012.

0 20 40

Asian


Hispanic


Overall

Percent

AdultsEngaginginPhysicalActivity


Figure34:Thepercentageofadultswhoengageinmoderatephysicalactivityatleast30minutesonfivedaysperweek.PrinceGeorge'sCountydataforHispanicsandAsianswasnotavailable.Source:MarylandBRFSS,2012.

2010),however,disparitiesdoexistandratesareaffectedbyrace/ethnicity,sexandage.

InPrinceGeorge'sCountysevenoutoftenHispanicadultsandAfricanAmerican/Blackadultsareeitheroverweightorobese.Inbothcounties,obesitylevels(BodyMassIndex(BMI)atorabove30.0seeTable12)arelowestamongtheAsian/PacificIslanderadultsandhighestamongAfricanAmerican/BlackandHispanicadults(seeFigure32).Inbothcounties,menaremorelikelytobeoverweightorobese(seeFigure33).Menandadultsaged45‐64arealsolesslikelytoengagein30minutesofmoderateactivityfor30minutesormoreperday.Hispanic/LatinoadultsandWhiteadultsaremorelikelythanAsian/PacificIslanderandAfricanAmerican/Blackadultstoengageinatleastlight‐to‐moderatephysicalactivity(seeFigure34).

55.2

52.4

70.5

61.7

40.3

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

AdultswhoareOverweightorObeseMontgomeryCounty

71.6

64.5

76.4

74.2

47.0

0 20 40 60 80 100

Overall


Hispanic


Asian

Percent

AdultswhoareOverweightorObesePrinceGeorge'sCounty

Figure32:ThepercentageofadultswhoareoverweightorobeseaccordingtotheBMI.Source:MarylandBRFSS,2012.

HolyCrossHospital

Fruitandvegetableconsumptionisanindicatorofhealthbecauseunhealthyeatinghabitscanleadtoobesity,diabetesandotherhealthissues.Approximately70%ofMontgomeryCountyadultsandapproximately68%ofPrinceGeorge'sCountyadultsconsumelessthanfiveservingsoffruitsandvegetableseachday.InMontgomeryandPrinceGeorge'sCountymorethanhalfofthecountyislocatedinanareawithloworpooraccesstohealthyfoods(seeFigure35).

Exercise,Nutrition,&WeightIndicatorsCHNA2012 Current

MC PG MD MC PG MD

AdolescentswhoareObese 8.40% 15.40% 11.60%Range ≤12.0% 12.1‐15.1% ≥15.2%

AdultFruitandVegetableConsumption 32.1% 30.1% 27.6% 29.6% 32.4% 27.1%Range ≥25.2% 25.1‐21.1% ≤21.0%

AdultsEngaginginModeratePhysicalActivity 33.9% 28.3% 34.1% 34.9% 23.0% 31.9%Range ≥34.0% 33.9‐31.3% ≤31.2%

AdultsEngaginginRegularPhysicalActivity 52.6% 50.2% 45.6%Range ≥47.9% 47.8‐45.3% ≤45.2%

AdultswhoareObese 17.5% 33.8% 26.8% 17.1% 31.3% 28.3%Range ≤30.5% 30.6‐34.3% ≥34.4%

AdultswhoareOverweightorObese 51.6% 67.9% 62.9% 55.2% 69.8% 64.4%Range ≤67.0% 67.1‐69.7% ≥69.8%

Figure35:HealthyfoodindexscoresforcensustractsinMontgomeryandnorthernPrinceGeorge'sCounty.Afooddesertisdefinedasalow‐incomecensustract(whereasubstantialnumberorshareofresidentshaslowaccesstoasupermarketorlargegrocerystore.Source:CommunityCommons,2014.

Table13:HealthyMontgomeryObesityIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

HolyCrossHospital

Behavioral Health

Adequatesocialandemotionalsupporthasbeenshowntohaveapositiveinfluenceonhealthduringtimesofstressbydecreasingstresshormonesandreducingbloodpressure.Researchhasshownthatindividualswithsocialandemotionalsupport(i.e.thesubjectivesensationoffeelinglovedandcaredforbythosearound)experiencebetterhealthoutcomescomparedtoindividualswholacksuchsupport(HealthyCommunitiesInstitute,2014).OneineverysixadultsinMontgomeryCountyandoneinfiveadultsinPrinceGeorge'sCountyreporttheyarenotgettingtheadequatesocialandemotionalsupporttheyneed.

Likeinadequatesocialandemotionalsupport,psychologicaldistresscanalsohaveanegativeeffectonhealth.Itisimportanttobeabletorecognizepotentialissuesbeforetheyelevatetocriticallevels.InMontgomeryandPrinceGeorge'sCounties80.0%and74.8%ofthepopulation,respectively,saidthattheyexperiencedtwoorfewerdaysofpoormentalhealthinthepastmonth.

Depressivedisordersgobeyondfeelingblueorsadforafewdaysandcaninterferewithfamilylife,workhabitsanddailyfunctioningandmanyindividualssufferingfromdepressivedisordersneverseektreatment.Examplesofdepressivedisordersincludedepression,majordepression,dysthymia,andminordepressionandcanoftenoccurwithotherillnessessuchasanxietydisorders,substanceabuse,andcancer.Majordepressivedisordersaccountformorethantwo‐thirdsofallsuicides(HealthyCommunitiesInstitute,2014).TenpercentofMontgomeryCountyresidentsand9.1%ofPrinceGeorge'sCountyresidentsself‐reportedthattheyhavebeendiagnosedwithadepressivedisorderwithWhitesself‐reportinghigherratesofdiagnoses(seeFigure36).

0 5 10 15

Overall

White

Hispanic

Black

Percent

DepressiveDisorderMontgomeryCounty

0 5 10 15

Overall

White

Hispanic

Black

Percent

DepressiveDisorderPrinceGeorge'sCounty

Figure36:Percentageofadultswhoreporttheyhavebeendiagnosedwithadepressivedisorder.Source:MarylandBRFSS,2012.

HolyCrossHospital

Suicideisamajor,preventablepublichealthproblemandcanbecloselylinkedtomajordepressivedisorders.In2012,suicidewasthe12thleadingcauseofdeathinMontgomeryCountyandthe14thleadingcauseofdeathinPrinceGeorge'sCounty.InthestateofMaryland,menweremorethanfourtimesmorelikelytodiefromsuicidethanwomenandWhiteindividualsweremorethanfourtimesmorelikelytodieofsuicidethanAfricanAmerican/BlacksandHispanicindividualscombined(seeFigure37).

Mentaldisorders,likedepression,anxiety,post‐traumaticstressandpanicdisorders,arecommonacrosstheUnitedStates.Althoughmentaldisordersarecommon,fewreceivetreatment.Nationally,ofthosethatdoreceivetreatment,asignificantproportionofindividualsusingemergencydepartmentshavepsychiatricneeds;between1992and2003mentalhealthrelatedemergencydepartmentvisitsincreased75%(Bazelon,2012).In2011therewere2,569.1mentalhealthrelatedemergencydepartmentvisitsper100,000populationinMontgomeryCountyand2,930.9mentalhealthrelatedemergencydepartmentvisitsper100,000populationinPrinceGeorge'sCounty.Bothcountieswerewellbelowthestatetargetof5,028.3per100,000visitsbutthenumberofvisitsinbothcountiesincreasedcomparedtothenumberof2010visitsrelatedtomentalhealthconditions(SHIP,2014).

Emergencydepartment(ED)visitsrelatedtobehavioralhealthconditionscanalsoinvolvesubstanceabuseandviceversa.AmongEDvisitsinvolvingmentalhealthandsubstanceusedisorders,42.7%wereformooddisorders,26.1%foranxietydisordersand22.9%foralcohol‐relatedconditions(AHRQ,2012).InMontgomeryCounty,236per100,000visitswereduetoacuteorchronicalcoholabuse."Alcoholabuse"includesalcoholdependence

0 100 200 300 400 500

White

Hispanic

Black

Persons

SuicideDeathsbyRaceMaryland

0 100 200 300 400 500

White

Hispanic

Black

Persons

SuicideDeathsbySexMaryland

Female Male

Figure37:Marylandsuicidedeathsbyraceandsex.Source:MarylandDHMH,2010‐2012.

HolyCrossHospital

syndrome,nondependentalcoholabuse,alcoholicpsychoses,excessivebloodlevelofalcohol,andfetalalcoholsyndrome.Disproportionateratesareseeninthoseaged18‐19,malesandAmericanIndians/AlaskanNatives.

0 100 200 300 400 500

Overall85+

65‐8445‐6425‐4420‐2418‐19

EDvisits/100,000

ERRateduetoAlcoholAbusebyAgeMontgomeryCounty

0 100 200 300 400 500

Overall

Male

Female

EDvisits/100,000

ERRateduetoAlcoholAbusebySexMontgomeryCounty

236

263

453

64

965

0 500 1000

Overall

White

Black/AfricanAmerican


AmericanIndian/AlaskaNative

ERvisits/100,000

ERRateduetoAlcoholAbusebyRace/EthnicityMontgomeryCounty

Figure38:Theaverageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabuseper100,000populationaged18yearsandolderbyageandsex.Source:MarylandHSCRC,2009‐2011.

Figure39:Theaverageannualage‐adjustedemergencyroomvisitrateduetoacuteorchronicalcoholabuseper10,000populationaged18yearsandolderbyrace/ethnicity.Source:MarylandHSCRC,2009‐2011.

HolyCrossHospital

BehavioralHealthIndicatorsCHNA2012 Current

MC PG MD MC PG MD

Age‐AdjustedDeathRateduetoSuicidedeathrate/100,000population 7.3 6.1 8.9 7.0 5.7 8.8MarylandStateComparison 8.8

Depression:MedicarePopulation 12.0% 8.70% 13.20%

Range ≤14.2% 14.3‐16.1% ≥16.2%

ERRateRelatedtoBehavioralHealthConditions/100,000population 2569.1 2930.9 5521.7Range ≤6378.8 6378.9‐7347.9 ≥7348.0

Self‐ReportedDiagnosisofAnxiety10.6% 8.7% 12.4% 9.9% 8.9% 12.7%

Range ≤11.1% 11.2‐15.2% ≥15.3%

Self‐ReportedDiagnosisofDepression16.8% 12.1% 15.9% 10.6% 9.0% 14.2%

Range ≤14.2% 14.3‐16.8% ≥16.9%

Self‐ReportedMentalHealth76.7% 80.0% 76.9% 79.9% 74.9% 75.4%

Range ≥77.3% 77.2‐71.0% ≤70.9%

SocialandEmotionalSupport78.0% 77.5% 78.0% 83.3% 78.7% 82.9%

Range ≥84.4% 84.3‐81.7% ≤81.6%

YouthwhohadaMajorDepressiveEpisode7.3% 7.5% 7.5% 7.6% 7.5%

MarylandStateComparison 7.5%

Maternal/Child Health

Thehealthandwell‐beingofwomen,infantsandchildrendeterminesthehealthofthenextgenerationandcanhelppredictfuturepublichealthchallengesforfamilies,communitiesandthehealthcaresystem(U.S.DepartmentofHealthandHumanServices,2010).

Between2009and2012MontgomeryCounty'slowbirth‐weight(LBW)percentagedroppedfrom8.2%to7.4%.OverallitisbelowtheHealthyPeople20201targetof7.8%.However,therateforAfricanAmerican/Blackbirthsisabovethetarget,especiallyfor18‐19yearoldwomen(seeFigure40).Thepercentageofverylowbirth‐weight(VLBW)birthshasremainedconstantat1.4%,whichequalstheHealthyPeople2020target.TheLBWbirthsinPrinceGeorge'sCountyhavealsodeclinedfrom11.2%in2009to10.0%in2012.TheVLBWbirthshaverisenslightlyfrom2.4%in2009to2.5%in2012.

1HealthyPeopleprovidesscience‐based,10‐yearnationalobjectivesforimprovingthehealthofallAmericans.

Table14:HealthyMontgomeryBehavioralHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).Source:HealthyCommunitiesInstitute,2014.

HolyCrossHospital

MontgomeryCountyhasaninfantdeathrateof5.1deathsper1,000livebirths,whichisbelowtheHealthyPeople2020targetof6.0per1,000livebirths.TheAfricanAmerican/Blackinfantmortalityrateissignificantlyhigherthanthecountyrateat8.2deathsper1,000livebirths.

Babiesborntomotherswhodonotreceiveprenatalcarearethreetimesmorelikelytobebornatalowbirthweightandfivetimesmorelikelytodiewhencomparedtomotherswhodoreceiveprenatalcare.Increasingthenumberofwomenwhoreceiveprenatalcare,andwhodosoearlyintheirpregnancies(withinthefirsttrimester),canimprovebirthoutcomesandreducethelikelihoodofcomplicationsduringpregnancyandchildbirth.

Teenmothersandmothersunder25yearsofagearemostlikelynottohaveenteredcarewithintheirfirsttrimester.Only69.6%ofMontgomeryCountyteenmothersand54.2%ofPrinceGeorge'sCountyteenmothersenteredcareintheirfirsttrimesterin20092,bothcountiesarebelowtheHealthyPeople2020targetof77.9%.

2Lateornoprenatalcaredataaresuppressedfor2010and2011formonthprenatalcarebegan.Revisedbirthcertificatesin2010ledtodatacollectionissuesandmissingvaluesonprenatalcare.Uponadequatereportingonthemonthprenatalcarebegan,thesedatawillbeupdated(HealthyCommunitiesInstitute,2014).

024681012141618

AllAges <18 18‐19 20‐24 25‐29 30‐34 35‐39 ≥40

Percent

Ageattimeofbirth

LowbirthWeightbyAgeandRace/EthnicityMontgomeryCounty

Asian/PacificIslander AfricanAmerican/Black Hispanic

White Overall HP2020Target

* * * * *

Figure40:PercentageofLBWbirthsbyageandrace/ethnicityofmother.2012MarylandDHMHVitalStatisticsReport*Percentagesbasedon<5eventsinthenumeratorarenotpresentedsincepercentagesbasedonsmallnumbersareunstable.Source:MarylandDHMH,2012.

HolyCrossHospital

Seniors

TheseniorpopulationofbothMontgomeryandPrinceGeorge'sCountiesisgrowingmorethan4%peryear(comparedtolessthan1%peryearfortheyoungerpopulation).Seniorsusehospitaldaysataratesixtimeshigherthanthose<65.TheaveragelifeexpectancyforMontgomeryCountyis84.9yearsforfemalesand81.6yearsformales;higherthanthenationalaverageof80.9yearsforfemalesand76.3yearsformales.TheaveragelifeexpectancyinPrinceGeorge'sCountyisslightlylowerthanthenationalaveragewithanaveragelifeexpectancyof79.8yearsforfemalesand74.8yearsformales.Theagingpopulationaffectseveryaspectofsociety,withthelargesteffectsoccurringinpublichealth,socialservices,andhealthcaresystems(CentersforDiseaseControlandPrevention,2013).

TwooutofeverythreeolderAmericanshavemultiplechronicconditionsandexperiencedisproportionateratesofheartdisease,cancer,diabetes,congestiveheartfailure,arthritisanddementia(includingAlzheimer’s)(CentersforDiseaseControlandPrevention,2013).TheleadingcausesofdeathintheMontgomeryandPrinceGeorge'sCountypopulationaged65andoveraresimilartotheleadingcausesofthetotalpopulationbuttherearesomedifferences(seeTable2,Figure41andFigure42).

MaternalandChildHealthIndicatorsCHNA2012 Current

MC PG MD MC PG MD

BabieswithLowBirthWeight 8.2% 11.2% 10.0% 7.4% 10% 8.8%Range ≤7.9% 8.0‐8.9% ≥9.0%

BabieswithVeryLowBirthWeight 1.4% 2.4% 1.8% 1.4% 2.5% 1.7%Range ≤1.4% 1.5‐1.8% ≥1.9%

InfantMortalityRate 5.5 8.7 7.2 5.1 8.6 6.3MarylandStateComparison 6.3

MotherswhoReceivedEarlyPrenatalCare2 81.0% 65.7% 80.2% 81.0% 65.7% 80.2%Range ≥83.6% 80.4‐83.6% ≤80.3%

MotherswhoReceivedLateorNoPrenatalCare 4.6% 11.1% 4.6% 4.6% 11.1% 4.6%MarylandStateComparison 4.6%

Table15:HealthyMontgomeryMaternalandChildHealthIndicatorsforMontgomeryCounty(MC),PrinceGeorge'sCounty(PGC)andMaryland(MD).HealthyCommunitiesInstitute,2014.

HolyCrossHospital

0 200 400 600 800 1000 1200

Accidents

Nephritis

Septicemia

Diabetes

InfluenzaandPneumonia

ChronicLowerRespiratoryDisease

Alzheimers

Stroke

Cancer

HeartDisease

CausesofDeathforthePopulationAged65+MontgomeryCounty

0 200 400 600 800 1000 1200

InfluenzaandPneumonia

Accidents

Nephritis

Septicemia

Alzheimers

Diabetes

ChronicLowerRespiratoryDisease

Stroke

Cancer

HeartDisease

CausesofDeathforthePopulationAged65+PrinceGeorge'sCounty

Inthe65andoverpopulationofMontgomeryandPrinceGeorge'sCounties,deathsfrominfluenzaandpneumoniaanddeathsfromaccidentsarelistedinthetop10causesofdeathandarehighlypreventable.Influenzacanbedangerousforpeoplewithheartor

Figure41:LeadingcausesofdeathintheMontgomeryCountypopulationaged65andover.Source:MarylandAssessmentToolforCommunityHealth,2010.

Figure42:LeadingcausesofdeathinthePrinceGeorge'sCountypopulationaged65andover.Source:MarylandAssessmentToolforCommunityHealth,2010.

HolyCrossHospital

breathingconditionsandcanleadtopneumoniaanddeaths,especiallyintheelderly(HealthyCommunitiesInstitute,2014).Theinfluenzavaccinecanpreventseriousillnessanddeath,however,only64.5%ofMontgomeryCountyresidentsand55.9%ofPrinceGeorge'sCountyresidentssaidtheyreceivedaninfluenzavaccinationin2012(CentersforDiseaseControlandPrevention,2012).

Pneumococcalpneumoniaistheleadingcauseofvaccine‐preventabledeathandillnessintheUnitedStates.Thepneumoniavaccineisveryeffectiveatpreventingseveredisease,hospitalization,anddeath.InMontgomeryandPrinceGeorge'sCounty70.5%and58.3%,respectively,saidtheyreceivedapneumococcalpneumoniavaccinationin2012(CentersforDiseaseControlandPrevention,2012).

Deathsfromaccidentsarethe10thleadingcauseofdeathinMontgomeryCountyandthe9thleadingcauseofdeathinPrinceGeorge'sCountyforseniors.Between2000and2010fallsaccountedfor65.3%ofthedeathsfromaccidentsinMontgomeryCountywith54.7%offallsoccurringinresidents85andover(seeFigure43)and46.6%ofthedeathsfromaccidentsinPrinceGeorge'sCountywithalmostequalamountsoffalldeathsoccurringinresidentsaged75‐84and85andover(seeFigure44).

MotorVehicle18.0%

AllOtherTransport0.7%

Drowing1.1%

ExposuretoSmoke/Fire/Flame

1.9%

Poison0.7%

AllOther12.3%

65‐7411.2%

75‐8434.1% 85+

54.7%

Falls65.3%

DeathsfromAccidentsAged65+,2000‐2010MontgomeryCounty

AgeofFall

Figure43:DeathsfromaccidentsinMontgomeryCountyfrom2000‐2010.Source:MarylandAssessmentToolforCommunityHealth,2010

HolyCrossHospital

Hospital Readmissions and Preven on Quality Indicators

Hospitalreadmissionscanbeindicatorsofpoorcareormissedopportunitiestobettercoordinatecare(HSCRC,2014).Asresearchsuggests,monitoringthenumberofpatientswhoexperienceunplannedreadmissionscanimprovequalityofcarethroughthedevelopmentofhospital‐basedinitiativesdesignedtoimprovecommunicationwithpatientsandtheircaregiversandpotentiallyavertmanyreadmissions(HSCRC,2014).Ananalysisofhospitalreadmissionsallowsustoidentifyselectindicatorsrelatedtocommunityhealthneedsanddevelopmethodologiesandprogramsthatwillimprovehealthoutcomes.

HolyCrossHealth,inalignmentwiththeCentersforMedicare&MedicaidServices(CMS),definesahospitalreadmissionasapatientadmissiontoahospitalwithin30daysafterbeingdischargedfromanearlierhospitalstay.FromApril2010‐June2013,HolyCrossHospitaldischarged111,135patients.Ofthis,5,883patientswerereadmittedwithin30days(allcause,including1‐dayLOS)accountingfor8,596readmissions(7.73%30‐dayreadmissionrate)and147(2.5%)patientswereadmittedfiveormoretimeswithin30daysaccountingfor1,110(12.91%)ofreadmissions.AdisproportionatepercentageofreadmissionswereAfricanAmericans(43.1%)andMedicarerecipients.

MotorVehicle27.2%

AllOtherTransport2.4%

Drowing1.1%

ExposuretoSmoke/Fire/Flame

3.3%

Poison1.8%

AllOther17.6%

65‐7412.6%

75‐8416.8%

85+17.2%

Falls46.6%

DeathsfromAccidentsAged65+,2000‐2010PrinceGeorge'sCounty

AgeofFall

Figure44:DeathsfromaccidentsinPrinceGeorge'sCountyfrom2000‐2010.Source:MarylandAssessmentToolforCommunityHealth,2010

HolyCrossHospital

Preventionqualityindicators(PQI)areasetofmeasuresthatcanbeusedwithhospitalinpatientdischargedatatoidentifyambulatorycaresensitiveconditions(ACSCs).ACSCsareconditionsforwhichhospitalizationcouldhavebeenpotentiallypreventedinthepresenceofgoodoutpatientcareorforwhichanearlyinterventioncouldpossiblypreventcomplicationsormoreseveredisease(DepartmentofHealthandHumanServicesAgencyforHealthcareResearchandQuality,2007).

ThePQIsconsistofthefollowing16ambulatorycaresensitiveconditions,whicharemeasuredasratesofadmissiontothehospital(topfiveHolyCrossHealthPQIsinbold):

Bacterialpneumonia Hypertension Dehydration Adultasthma Pediatricgastroenteritis Pediatricasthma Urinarytractinfection Chronicobstructivepulmonarydisease Perforatedappendix Diabetesshort‐termcomplication Lowbirthweight Diabeteslong‐termcomplication Anginawithoutprocedure Uncontrolleddiabetes Congestiveheartfailure Lower‐extremityamputation(diabetes)

0 20 40 60

Uninsured

Medicaid

Medicare

Private

Percent

30‐dayAllCauseReadmissionsbyPayerHolyCrossHealth

0 20 40 60

Other

NativeAmerican

Asian

Black

White

Percent

30‐dayAllCauseReadmissionsbyRaceHolyCrossHealth

Figure45:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbyrace,datafromApril2010‐June2013.

Figure46:HolyCrossHospitalpercentageofpatientadmissionswithin30daysafterbeingdischargedbypayer,datafromApril2010‐June2013.

Table16:HolyCrossHospital'sAmbulatoryCareSensitiveConditiondischarges.

HolyCrossHospital

DATA GAPS IDENTIFIED

Whereavailable,themostcurrentandup‐to‐datedatawasusedtodeterminethehealthneedsofthecommunity.Althoughthedatasetavailableisrichwithinformationandmoreinformationisavailabletodaywhencomparedtotheneedsassessmentconductedthreeyearsago,datagapsstillexist.

Datasuchashealthinsurancecoveragedataandcancerscreening,incidenceandmortalityratesarenotavailablebygeographicareaswithinMontgomeryorPrinceGeorge’sCounties.

Dataarenotavailableonalltopicstoevaluatehealthneedswithineachrace/ethnicitybyage‐genderspecificsubgroups.

Diabetesprevalenceisnotavailableforchildren,agroupthathashadanincreasingriskfortype2diabetesinrecentyearsduetoincreasingoverweight/obesityrates.

Healthriskbehaviorsthatincreasetheriskfordevelopingchronicdiseases,likediabetes,aredifficulttomeasureaccuratelyinsubpopulations,especiallytheHispanic/Latinopopulations,duetoBRFSSmethodologyissues.

County‐widedatathatcharacterizehealthriskandlifestylebehaviorslikenutrition,exercise,andsedentarybehaviorsarenotavailableforchildren.

Analysisoflinkedbirth‐deathrecordswouldprovidedetailedinformationaboutcharacteristicsandriskfactorsthatcontributetofetalandinfantlossesinMontgomeryandPrinceGeorge’sCountiesamongthosepopulationsthatcouldbeatelevatedriskforpoorbirthoutcomes.

AnongoingsourceofPregnancyRiskAssessmentMonitoringSystem(PRAMS)dataatthecountylevelatleasteverythreeyearswouldimprovepolicyandplanningeffortsinmaternal,fetalandinfanthealth.

DataarenotasavailableinPrinceGeorge’sCountywhencomparedtoMontgomeryCounty.

Datafromcommunityconversationswasunavailableforthe2015CHNA,howeverdatafromconversationsheldduringfiscalyear2015willbeaddedasanaddenduminfiscal2016.

HolyCrossHospital

RESPONSE TO FINDINGS

Throughmulti‐votingandconsensusdiscussion,theHealthyMontgomerySteeringCommittee,whichincludesrepresentationfromaHolyCrossHealthexecutiveteammember,analyzedavailabledataonmorethan100indicatorstodeterminethefollowingtop‐rankedpriorityareas(moredetailedinformationontheprioritysettingprocesscanbefoundinAppendixE):

BehavioralHealth, Obesity, Cancers, MaternalandInfantHealth, Diabetes,and CardiovascularHealth

Inadditiontoselectingthesixbroadprioritiesforaction,theHealthyMontgomerySteeringCommitteeselectedthreeoverarchingthemes:lackofaccess,healthinequities,andunhealthybehaviors(seeFigure47).

BuildingupontheworkofHealthyMontgomery,HolyCrossHealth'sneedsassessmentrevealsparticularareasthathavealargenumberofpeoplewhoarepoor,ofchild‐bearingage,elderly,raciallyandethnicallydiverse,andoflimitedEnglishspeakingability.Wefocusourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniorsandracial,ethnicandlinguisticminorities.

DemographicanalysisfromHolyCrossHealth'sneedsassessmentalsorevealsthattheseniorpopulationofMontgomeryandPrinceGeorge’sCountiesisgrowingatanunprecedentedrate,increasingtheneedforseniorservicessuchashousingandhealthcare.InanefforttobeproactiveinmeetingthegrowingneedsofthispopulationwehaveincludedseniorsasapriorityfocusinadditiontotheprioritiessetbyHealthyMontgomery.

Figure47:HealthyMontgomeryprioritiesandoverarchingthemes.

HolyCrossHospital

GUIDING PRINCIPLES

HolyCrossHealth'smulti‐yearcommunitybenefitimplementationplanaddressesthepriorityareasandoverarchingthemesbyfocusingourcommunitybenefitactivitiesonthemostvulnerableandunderservedindividualsandfamilies,includingwomen/children,seniors,andracial,ethnicandlinguisticminorities.Toselectoutreachprioritiesfortheimplementationplan,HolyCrossHealthlinkedcommunityhealthcareneedstoourmissionandstrategicpriorities.Wedevelopedasetofprinciplestohelpdetermineourhighestprioritiesandguideourdecision‐makingaboutcommunitybenefit:

BetheMontgomeryCountyleaderandastate/nationalmodel Takeprudentrisksandensuresoundfinancialstewardshipandsustainability Befocusedontheprimaryservicearea Prioritizeneedsthatareconsistentwiththeorganization'sstrengths

o Women/children(particularlyinfantmortalityandobesity)o Seniors(particularlycardiovasculardisease,diabetes,andobesity)o Cancer(particularlybreastcancer)

MeetHolyCrossHealth'soverallcommitmenttoimprovingaccesstocareandaddressingidentifiedcommunityneed

o Access,especiallyforvulnerableandunderservedpopulations(racialandethnicpopulationsubgroups;uninsuredresidents;primarycareaccess,especiallyforchronicconditionsincludingdiabetesandheartfailure)

o Outreachtotargetedpopulations(especiallyforcancerpreventioninAfricanAmerican,African/CaribbeanAmerican,LatinoAmerican,AsianAmerican,NativeAmericanpopulations)

o Demonstratedimprovementsinhealthstatus(reductionininfantmortality;reductioninpercentageofchildrenandadultswithobesity;reductioninrateofbreastcancerdeaths;reductioninpreventablehospitaladmissionsforchronicdisease)

o Ongoinglearningandsharingofnewknowledge(publiceducation) Havemeasurableoutcomesandbeintegratedwithplanningandbudgeting Reflectpartnership.

PRIORITIZING SIGNIFICANT UNMET NEEDS

Withthisinformation,HolyCrossHealthwilladdressunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.WerecognizethatweareequippedtoaddresseachsignificantunmetneedidentifiedbyHealthyMontgomeryandHolyCrossHealth;however,prioritizingtheneedswillallowustoutilizeourresourcesandexpertisetoensurewehavethebiggestimpactontheunmetneedsinourcommunity.

HolyCrossHospital

documentedunmet community

health needs

missioncommitments and

key strengths

this intersectiondetermines

rigorous monitoring and evaluation

supportive management and governance

resource allocation

targeted programs

supportive infrastructure is needed to improve and sustain

documentedunmet community

health needs

missioncommitments and

key strengths

this intersectiondetermines

rigorous monitoring and evaluation

supportive management and governance

resource allocation

targeted programs

supportive infrastructure is needed to improve and sustain

Figure48:HowHolyCrossHealthalignstargetedprogramswiththemissionandstrengthsofthehospitalandunmetcommunityneeds.

Toprioritizethetoprankedhealthpriorities,membersoftheCEOReviewonPopulationHealthandCommunityBenefitwereaskedtorateeachpriorityonthefollowingcriteria:severityoftheneed,feasibilityofourorganizationtoaddresstheneed,andthepotentialeachneedhasforachievableandmeasurableoutcomes.Eachneedwasalsoscoredonitsprevalenceinthepopulation.Thefollowingprioritizationwasdeterminedbytallyingallthescoresreceivedforeachunmetneed:

1. Maternal&InfantHealth2. Seniors3. CardiovascularHealth4. Obesity5. Diabetes6. BehavioralHealth7. Cancers

Community Benefit Implementa on Strategy

Asthecounty’scommunityhealthimprovementprocessevolves,prioritieswillbedetermined,andwiththisinformation,HolyCrossHospitalwilladdressunmetneedswithinthecontextofouroverallapproach,missioncommitmentsandkeyclinicalstrengthsandwithintheoverallgoalsofHealthyMontgomery.

Keyfindingsfromalldatasources,includingdataprovidedbyHealthyMontgomery,ourexternalreviewgroup(seeAppendixCforhighlights)andhospitalavailabledatawerereviewedandthemostpressingneedswereincorporatedintoourannualcommunitybenefitplan.ThecommunitybenefitplanreflectsHolyCrossHospital’soverallapproachtocommunitybenefitbytargetingtheintersectionbetweentheidentifiedneedsofthecommunityandthekeystrengthsandmissioncommitmentsoftheorganization(seeFigure48)tohelpbuildthecontinuumofcare.Wehaveestablishedleadershipaccountabilityandanorganizationalstructureforongoingplanning,budgeting,implementationandevaluationofcommunitybenefitactivities,whichareintegratedintoourmulti‐yearstrategicandannualoperatingplanningprocesses.HolyCrossHospital’sCommunityBenefitImplementationStrategyispresentedinaseparatedocument.

HolyCrossHospital

REFERENCES

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Braveman,P.A.,Egerter,S.A.,&Mockenhaupt,R.E.(2011,January).Broadeningthefocus:Theneedtoaddressthesocialdeterminantsofhealth.AmericanJournalofPreventiveMedicine,40(1S1),pp.S4‐S18.

CentersforDiseaseControlandPrevention.(2012).MarylandBehavioralRiskFactorSurveillanceSystemSurveyData.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.

CentersforDiseaseControlandPrevention.(2013).TheStateofAgingandHealthinAmerica.Atlanta,GA:CentersforDiseaseControladnPrevention,USDepartmentofHealthandHumanServices.

DepartmentofHealthandHumanServicesAgencyforHealthcareResearchandQuality.(2007,March12).GuidetoPreventionQualityIndicators:HospitalAdmissionforAmbulatoryCareSensitiveConditions.RetrievedApril15,2014,fromAHRQ‐QualityIndicators:http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V31/pqi_guide_v31.pdf

DignityHealth.(2011,January20).ImprovingPublicHealth&PreventingChronicDisease‐CHWsCommunityNeedIndex.RetrievedApril23,2014,fromDignityHealth:http://www.dignityhealth.org/stellent/groups/public/@xinternet_con_sys/documents/webcontent/212782.pdf

Fox,L.(1996,April19).PrinceGeorge'sCounty:Hitting300.WashingtonPost,p.WW6.

Gourevitch,M.N.,Cannell,T.,Boufford,J.,&Summers,C.(2012).TheChallengeofAttribution:ResponsiblityforPopulationHealthintheContextofAccountableCare.AmericanJournalofPublicHealth,102(No.S3),pp.S322‐S324.doi:10.2105/AJPH.2011.300642

HealthyCommunitiesInstitute.(2014,May).HealthyMontgomery::CommunityDashboard::UnemployedWorkersinCivilianLaborForce.RetrievedJune17,2014,fromHealthyMontgomery:TheCommunityHealthImprovementProcessforMontgomeryCounty,Maryland:http://www.healthymontgomery.org

HolyCrossHospital

HealthyCommunitiesInstitute.(2014,January).HealthyMontgomery:CommunityDashboard.RetrievedApril16,2014,fromHealthyMontgomery:TheCommunityHealthImprovementProcessforMontgomeryCounty,Maryland:http://www.healthymontgomery.org/modules.php?op=modload&name=NS‐Indicator&file=index

MarylandDepartmentofHealthandMentalHygiene.(2014,August5).ReportsandVitalStatistics.Retrieved88,2014,fromMaryland.gov:http://dhmh.maryland.gov/vsa/SitePages/reports.aspx

MarylandDepartmentofHealthandMentalHygiene.(2014,May21).SHIP‐Measures.RetrievedJune20,2014,fromMarylandStateHealthImprovementProcess(SHIP):http://dhmh.maryland.gov/ship/SitePages/measures.aspx

MarylandHealthBenefitExchange.(2014,July3).ReportfromtheMarylandHealthBenefitExchangeaboutMarylandHealthConnection,thestate‐basedhealthinsurancemarketplace.RetrievedJuly11,2014,fromLatestNews&UpcomingEventsforMarylandHealthConnection|MarylandHealthConnection℠:

http://marylandhealthconnection.gov/latest‐news‐upcoming‐events/

MontgomeryCountyCircuitCourt.(2013).MontgomeryCountyCircuitCourt:FY2013AnnualStatisticalDigest.Rockville.

MontgomeryCountyPlanningDepartment.(2011,August21).MontgomeryPlanning:Research&TechnologyCenter‐Census2010:MontgomeryCountyData.RetrievedApril30,2014,fromMontgomeryCountyPlanningDepartment:http://www.montgomeryplanning.org/research/data_library/census/2010/

Stoto,M.A.(2013,February21).PopulationHealthintheAffordableCareActEra.RetrievedApril22,2014,fromAcademyHealth:AdvancingResearch,Policy,andPractice:http://www.academyhealth.org/files/AH2013pophealth.pdf

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U.S.CensusBureau.(2012,December).2012AmericanCommunitySurvey1‐YearEstimates.RetrievedApril30,2014,fromAmericanFactFinder:http://factfinder2.census.gov/

HolyCrossHospital

U.S.CensusBureau,PopulationDivision.(2012,December).AnnualEstimatesoftheResidentPopulation:April1,2010toJuly1,2012.RetrievedApril30,2014,fromAmericanFactFinder‐Results:2014

Williams,D.R.,Costa,M.V.,Odunlami,A.O.,&Mohammed,S.A.(2008,November).Movingupstream:Howinterventionsthataddresstehsocialdeterminantsofhealthcanimprovehealthandreducedeisparities.JournalofPublicHealthManagementandPractice(14(Suppl)),pp.S8‐17.doi:10.1097/01.PHH.0000338382.36695.42.

Mr. George Leventhal Ms. Sharan London

Councilmember, Montgomery County Council Vice President, ICF InternationalAffiliation: Homeless Issues

Ms. Uma Ahluwalia Ms. Beatrice MillerDirector, Montgomery County DHHS Assistant Director, Adult Medicine DC‐SM, Kaiser Permanente

Affiliation: African American Health Program

Mr. Ron Bialek Dr. Seth MorganPresident, Public Health Foundation PhysicianAffiliation: Commission on Health Affiliation: Commission on People with Disabilities

Ms. Tara Clemons Dr. Cesar Palacios

Community Benefits Outreach Coordinator, Executive Director, Proyecto Salud Health Center MedStar Montgomery Medical Center Affiliation: Latino Health Initiative

Ms. Mary Dolan Ms. Monique Sanfuentes

Chief, Functional Planning and Policy Division, Director, Community Health and Wellness, Suburban Hospital Montgomery County Department of Planning Affiliation: Suburban Hospital

Ms. Tanya Edelin Dr. Wendy ShiauSr. Project Manager for Community Benefit,

Kaiser Permanente

Affiliation: Asian American Health Initiative

Ms. Wendy Friar Mr. Jon SminkVice President, Community Health,

Holy Cross Health

Recreation Specialist, Montgomery County

Recreation Department

Dr. Carol Garvey Dr. Michael StotoVice President for Health Policy, Garvey

Associates

Professor of Health Systems Admin & Population Health,

Georgetown University School of Nursing & Health Studies

Affiliation: Montgomery County Collaboration

Council for Children, Youth and Families

Affiliation: Academia

Mr. Thomas Harr Dr. Ulder J. Tillman

Executive Director, Family Services, Inc. Montgomery County Health Officer and Chief,

Public Health Services

Ms. Lorrie Knight‐Major Dr. Deidre WashingtonMember, Commission on Veterans Affairs Research Associate, Center for Health Equity & Wellness,

Adventist HealthCare

Dr. Samuel P. Korper Ms. Sharon Zalewski

Affiliation: Commission on Aging Vice President, Primary Care Coalition of Montgomery County

Ms. Kathy McCallum Dr. Andrew ZuckermanController, Ronald D. Paul Companies Chief of Staff, Montgomery County Public SchoolsAffiliation: Mental Health Association of

Montgomery County

Healthy Montgomery Steering Committee Members

Co‐Chairs:

Members:

AppendixA:2014HealthyMontgomerySteeringCommitteeMembers

Rank County

1 Montgomery

2 Howard

3 Frederick

4 Queen Anne's

5 Carroll

6 Talbot

7 St. Mary's

8 Calvert

9 Anne Arundel

10 Harford

11 Worcester

12 Charles

13 Washington

14 Baltimore

15 Garrett

16 Kent

17 Prince George's

18 Wicomico

19 Cecil

20 Somerset

21 Dorchester

22 Allegany

23 Caroline

24 Baltimore City

AppendixB:MarylandCountyHealthRankingsandHealthModel

TheRankingsarebasedonamodelofpopulationhealththatemphasizesthemanyfactorsthat,ifimproved,canhelpmakecommunitieshealthierplacestolive,learn,workandplay.CommunityHealthRankings,2014

AppendixC:KeyhighlightsfromHolyCrossHealth'sCommunityBenefitExternalReview

On June 9th, 2014 the following organizations were represented at the External Review Meeting:

• Montgomery County Department of Health & Human Services • American Heart Association • American Cancer Society • Holy Cross Health Mission and Population Health Board Committee • Kaiser Permanente • Primary Care Coalition of Montgomery County, Maryland • Montgomery County Upcounty Regional Services Center • University of Maryland School of Nursing • Institute for Public Health Innovation • Montgomery County Recreation Department • Montgomery County African American Health Program

Suggestions made for our FY15 Annual Community Benefit Plan Increase evaluation and track and measure outcomes to show programs are making a

difference • Coordinate with 5 hospitals and county government to look at collective impact for the

county; think about achieving population health goals for the county in conjunction with other systems

Obesity prevention in both children and adults; including engagement with schools Implement active learning and skills building across all programs to engage participants

instead of just teaching them • Develop workplace wellness programs Focus on population health by working with dual eligibles (Medicaid and Medicare) in

the county • Work with and support small non‐profits in the community Engage more with patients in the home environment; wrap services around housing to

help people age in place Create cultural competence that is sensitive to various ethnic groups and religious

communities, including those that are well‐educated with good jobs, etc. but may have barriers to accessing services

Enhance role and training of community health workers • Monitor outcomes for children born through Maternity Partnership through age four

Key Accomplished or in process • Still considering

ZIPCode City HCHDischarges HCHCumulative

%ofDischarges20904 SilverSpring 2,871 10.6%20902 SilverSpring 2,349 19.3%20906 SilverSpring 2,059 26.9%20910 SilverSpring 1,549 32.6%20901 SilverSpring 1,393 37.8%20903 SilverSpring 762 40.6%20783 Hyattsville 652 43.0%20853 Rockville 600 45.2%20705 Beltsville 549 47.2%20895 Kensington 490 49.0%20912 TakomaPark 483 50.8%20707 Laurel 407 52.3%20852 Rockville 370 53.7%20905 SilverSpring 367 55.0%20782 Hyattsville 350 56.3%20866 Burtonsville 310 57.5%20770 Greenbelt 306 58.6%20740 CollegePark 264 59.6%20851 Rockville 210 60.4%20742 CollegePark 1 60.4%20868 Spencerville 16 60.4%

AppendixD:HolyCrossHospital21ZIPCodePrimaryServiceArea

AppendixE:HealthyMontgomeryPrioritySettingProcess

The Montgomery County Community Health Improvement Process launched in June 2009 with a comprehensive scan of all existing and past planning processes. Past assessment, planning, and evaluation processes were compiled that related to health and well-being focus and social determinants of health across a multitude of sectors, populations, and communities within Montgomery County. By 2010, the focus was on establishing a core set of indicators that could be examined through a comprehensive needs assessment that resulted in approximately 100 indicators being released at the launch of the Healthy Montgomery website on February 2011. During 2011, this information was compiled into the Healthy Montgomery Needs Assessment, which was sent to the Healthy Montgomery Steering Committee (HMSC) in September 2011. In October 2011, the HMSC held a half-day retreat to choose the strategic priority areas for improvement activities. The priority setting process utilized an online survey tool that the Steering Committee members completed prior to the retreat to enable them to independently evaluate potential priority areas by five criteria:

1. How many people in Montgomery County are affected by this issue? 2. How serious is this issue? 3. What is the level of public concern/awareness about this issue? 4. Does this issue contribute directly or indirectly to premature death? 5. Are there inequities associated with this issue? (Health inequities are differences in health

status, morbidity, and mortality rates across populations that are systemic, avoidable, unfair, and unjust.)

The survey results were compiled for each member and for the entire HMSC. The results were ranked and provided at the retreat to initiate the group process. Through multi-voting and consensus discussion, the Steering Committee narrowed the top-ranked priority areas to be the following:

Behavioral Health; Cancers; Cardiovascular Health; Diabetes; Maternal and Infant Health; and Obesity In addition to selecting the six broad priorities for action, the HMSC selected three overarching themes (lenses) that Healthy Montgomery should address in the health and well-being action plans for each of the six priority areas.

The themes are:

Lack of access; Health inequities; and Unhealthy behaviors.

CONTACT INFORMATION

ForquestionsorcommentsregardingtheCommunityHealthNeedsAssessment,pleasecontact:

KimberleyMcBrideCommunityBenefitOfficerHolyCrossHealth10720ColumbiaPikeSilverSpring,MD20904Phone‐(301)754‐[email protected]

AnelectronicversionofthisCommunityHealthNeedsAssessmentispublicallyavailableathttp://www.holycrosshealth.org/community‐health‐needs‐assessmentandprintversionsareavailableuponrequest.AfullversionoftheHealthyMontgomeryCommunityHealthNeedsAssessmentispublicallyavailableathttp://www.healthymontgomery.org/.

1500ForestGlenRdSilverSpring,MD20886www.holycrosshealth.org

holy cross hospital

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