Introduction and Background Chapter One
Charting the Course: A San Diego County Health Needs Assessment outlines health needs information intended to be used by health and human service professionals to navigate a course of community benefit planning and health improvement. The research, tables, charts, graphs, calculations, percentages, rates and other measurements included in this document serve as coordinates on our San Diego County map. By pinpointing the health problems of our people -- our communities, our youth, our parents, ourselves -- we can set our bearings for a healthier San Diego.
This needs assessment is the product of a collaborative response to Senate Bill 697 (SB 697), Chapter 812, Statutes of 1994, which requires not-for-profit, private hospitals to perform community health needs assessments, develop community benefit plans, and submit the plans to the State of California, Office of Statewide Health Planning and Development (OSHPD). The report itself provides a summary of health information that was extrapolated from a variety of sources locally, statewide, and nationally.
A secondary benefit of assessing San Diego's health needs was that the process also provided a forum for health care professionals, who were from organizations that oftentimes compete in the marketplace, to work together to improve the health of the community in a coordinated and meaningful way. Coalition members taught each other and learned from each other how various health delivery organizations, foundations, social services, universities, government agencies and others, could share resources to achieve a mutual goal. In the long term, it is the multiple benefits of these newly forged relationships based upon similar missions and goals that will steer the course to improved community health.
Senate Bill 697 was passed into law and signed by Governor Pete Wilson in September, 1994. It was co-authored by Senator Art Torres (D-Los Angeles) and Assemblyman Phil Isenberg (D-Sacramento) and co-sponsored by the California Association of Hospitals and Health Systems (CAHHS) and the California Association of Catholic Hospitals (CACH). CAHHS and CACH were interested in supporting legislation which would acknowledge the full range of charitable services the hospitals provide rather than limiting recognition to merely "charity care." Until this law, hospitals had no formal reporting mechanism which advised their communities about the full scope of benefits they provide in fulfilling their obligations as tax-exempt institutions.
The San Diego County SB 697 Coalition first met on June 1, 1995. The group was called together at the invitation of William H. Moseley, President/CEO of the Hospital Council of San Diego and Imperial Counties; Robert K. Ross, MD, Director of the Department of Health Services for the County of San Diego; and F. Douglas Scutchfield, MD, Director of the Graduate School of Public Health at San Diego State University. These three individuals felt strongly about the potential gain for San Diego which could be realized through a proactive, collaborative approach to completing the requirements of SB 697.
The first meeting was attended by representatives from over 25 health care-related organizations, the majority of whom were not obligated by law to complete SB 697's directives. Since the first meeting, the coalition's membership grew further to include a broad representation of San Diego County's health care industry. No formal membership structure was established: any health care organization could elect to send delegates to the meetings and participate. No dues were assessed. Project work was accomplished primarily through coalition members donating their staff time. In addition, a modest internship was funded jointly by the Alliance Healthcare Foundation, the Hospital Council, the County Department of Health Services and the Graduate School of Public Health at San Diego State University.
The catalyst for forming the coalition was the requirement that hospitals perform a community health needs assessment. Public health models clearly point towards collaboration as the key ingredient in conducting useful needs assessments, and SB 697 language encouraged hospitals to work together on this phase. To this end, the coalition formed task forces out of its membership to determine how it would proceed.
Initially, two task forces met. The Model Task Force selected a model and format for the community health needs assessment. The Assessment Protocol for Excellence in Public Health (APEX-PH) model, developed by the National Association of County Health Officials, was adopted and customized to the coalition's needs. The second task force, the Data Task Force, was charged with identifying the data elements to include in the community health needs assessment. They developed a detailed list of health indicators to be collected, using APEX-PH worksheets as a starting point. The arduous work of tracking down this information was completed in just three months by seeking out secondary data sources from local, state and federal public agencies, local university libraries, and private research foundations, among others.
At the Data and Model Task Forces' joint recommendation, the coalition decided that efforts to collect primary data would be prohibitive in the short six month period which they had to complete the needs assessment. Instead, they agreed efforts would focus on collecting and analyzing the ample amount of health data which existed for San Diego County. Overall, the emphasis on collecting secondary data embodied one major premise of the coalition: that they share existing work and not duplicate what has already been done.
Despite the short time period, however, the Violence and Emergency Services team decided to conduct an informal survey of hospital emergency room injury-related visits. Six participating hospitals provided primary data for this study which is described in more detail in the Violence and Emergency Services chapter.
To complete the actual work of analysis necessary for a community health needs assessment, nine Community Health Assessment Task Teams (CHATTs) were established to look at the specific health topics constituted by logical groupings of the data. Coalition membership knew they needed additional experts with in-depth public health knowledge. A brainstorming session was held where coalition members discussed who some of the San Diego experts were in each health topic area. Letters inviting these "intellectual health resources" of San Diego County were sent asking that they help. Nearly 40 non-hospital affiliated individuals responded and donated their time and expertise to analyze data. These individuals came from many diverse non-hospital health and community benefit organizations such as Planned Parenthood, United Way, Center for the Blind, and the Department of Environmental Health, among others.
The nine CHATTs developed reports on their assigned topic area, as well as a brief narrative describing any findings of the data. Each of the CHATTs' reports is a chapter in this health needs assessment. Every participant on the CHATT is named at the beginning of the chapter under the heading, "Contributors." Although a common format was followed by all of the CHATTs, the uniqueness of each group is reflected in the writing style and content of each chapter. The integrity of the chapter was maintained, even if more than one chapter described different aspects of the same topic. Suicide, for example, is discussed in both the Violence and Emergency Services chapter, as well as in the Mental Health and Chemical Dependency chapter.
Two specific areas of future collaboration were identified during the needs assessment process. First, it was agreed that a needs assessment would not be complete without receiving input from key community leaders regarding their views of health needs in the communities they serve. As "Chapter Ten, Community Input: Process and Pretest Results" describes, a survey process was initiated to receive input from leaders in various agencies and communities. Preliminary results from a pretest of two groups are discussed in Chapter Ten. Results of the complete survey will be available in the Spring of 1996. Recognizing the importance of input from the community members who are utilizing health care services, the coalition also began discussing ways to receive feedback from the consumers regarding health needs, and to use that feedback to tailor benefit plans.
Secondly, the coalition agreed to work together beyond January 1, 1996 to develop a coordinated community benefit plan. This "second phase" of the coalition's work provides a logical continuity to assure that the benefit plans of individual hospitals do not duplicate each other, and that identified community needs do not go unaddressed. The health needs that emerged through this document will be evaluated by stakeholders of the coalition to develop a prioritized listing of health problems. The plan will include quantifiable regionwide objectives and specific implementation strategies which will be monitored and periodically reassessed. It will provide a strategic framework that hospitals can use as a guide to develop their own plans based upon a number of factors including their target populations, their abilities to impact a problem, and a supply of adequate resources. The plan itself should be available in the Fall of 1996.
It became clear through the process of drafting, revising, and rewriting chapters that as health issues surfaced within the chapters, there were many opportunities, met with great enthusiasm, to branch out and collect more in-depth data or background information. For example, when looking at issues related to growing older in San Diego, it was tempting to explore some of the social and political issues associated with aging. The CHATT groups made a deliberate effort, however, to focus on data that pointed to health needs for the purpose of this document, rather than exploring content areas.
Because SB 697 required the needs assessment to be completed by January 1, 1996, there was some urgency to summarize and finalize the data at hand. Although at times more data were available to expand upon a particular subject, we regretfully had to set a target date to complete our data collection efforts so that we could finalize our booklet in a timely manner. As a result, this booklet is intended to be a first effort to compile disparate needs assessment data, rather than a final, comprehensive analysis.
In many cases, health data for San Diego County were compared to state or national standards. Healthy People 2000: National Health Promotion and Disease Prevention Objectives (1991), set national health objectives for the year 2000. Whenever possible, these benchmarks were included for comparison within the text. In July of 1995, the State of California issued Healthy California 2000: California's Experience in Achieving the National Health Promotion and Disease Prevention Objectives. This informative reference compares California's health indicators with the national objectives. Information from this report was also included when possible.
For consistency, every chapter is introduced with an executive summary which identifies key needs or highlights of the data. Most of the specific needs that emerged in each chapter have all been compiled in "Chapter Two: Executive Summary of Needs." At the end of each chapter is a "References" section, which lists a bibliography of references that were cited in the text as sources for statements of fact and for the tables and figures. Finally, when there was a table or figure that contained relevant information, but was too detailed to include in the body of the chapter, it was made part of an "Appendix" placed at the end of the chapter.
This needs assessment is intended to be used by any individual or organization who requires health needs data to meet a particular objective. It will no doubt be useful not only for members of the health care community, but also for schools, civic groups, religious organizations, social services, service organizations, and anyone else who is interested in improving the health of our population.
needintr.htm 4/13/96