Panorama City CHNA_2013 - Kaiser Permanente

2013

Community Health Needs Assessment Kaiser Foundation Hospital – PANORAMA CITY License #9300000358

To provide feedback about this Community Health Needs Assessment, email [email protected].

Authors Valley Care Community Consortium was contracted to prepare a Community Health Needs Assessment for the Kaiser Permanente Panorama City Medical Center Service Area. Joni Novosel, MS Health Administration Surekha Vasant, MS Public Health VCCC contributing authors (health profiles, data tables, and asset mapping) Kenia Alcaraz, BS Public Health Maribel Aguilar, BS Health Education

Belen Arangure, BS Health Education Ines Herrera, BS Public Health

Shivani Ponnambalavan, Dual MS Human Resources and Health Administration VCCC subcontracted with Antelope Valley Partners for Health for the portions of the report pertaining to Antelope Valley including the cities of Lancaster and Palmdale. Michelle Kiefer, MBA

Tiara Sigaran, BS Public Health Trish Bogna, BS Business Management

Valley Care Community Consortium 7515 Van Nuys Blvd., Fifth Floor Van Nuys, CA 91405 Telephone: 818-947-4040 Website: www.valleyccc.org

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Acknowledgements Conducting a community health needs assessment is no small task and would not be possible without the contributions of VCCC staff, Antelope Valley Partners for Health (AVPH), Los Angeles County Department of Public Health, our VCCC partner agencies including KFHPanorama City, and community residents. We would like to give a special thanks to the graduate and undergraduate health administration and public health interns working with us from California State University Northridge and Los Angeles. We would like to extend a special acknowledgement to AVPH, who as a sub-contractor with VCCC provided primary and additional local secondary data. VCCC acknowledges and honors AVPH’s contribution of time, dedication, and expertise in identifying the community health needs in the Antelope Valley including the cities of Lancaster and Palmdale. We would like to recognize and acknowledge our local KFH- Panorama City Public Affairs Director and her Community Benefits staff for their ongoing guidance and support. In addition we appreciate the technical assistance and leadership from the Kaiser Permanente Regional Office. Their efforts have been instrumental in completing this report. The list of individuals representing multiple agencies are too many to name individually, however we want to express our gratitude to those agencies that supported VCCC and AVPH through participation in key informant interviews, focus groups, community forums, and prioritization meetings. Agencies represented include: Children’s Bureau Church on The Way City of San Fernando Community Synergy for Children and Families CSUN El Nido Family Center Friends of the Family Lancaster Department of Children and Family Services Lancaster School District Los Angeles Community Development Commission Los Angeles County Department of Mental Health SA 1 and SA 2 Los Angeles County Department of Public Health

All 4 Children Antelope Valley Community Clinic Antelope Valley Healthcare District Antelope Valley Hospital Antelope Valley Partners for Health Antelope Valley Pregnancy Counseling Center Asian Youth Center AV Chess House AV Mobility Management Project Bartz-Altadona Community Health Center Black Infant Health California State University, Northridge Catalyst Foundation Child and Family Guidance Center Children Center of the Antelope Valley

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Los Angeles County Office of Education Los Angeles County, High Desert Health System Los Angeles County, ValleyCare Health System Los Angeles Department of Children and Family Services Los Angeles Unified School District MEND Menfolk Mental Health America Mid Valley Comprehensive Health Center Mission Community Hospital National Alliance for Mental Illness (NAMI)

Neighborhood Legal Services New Directions for Youth Northeast Valley Health Corporation Olive View UCLA Medical Center Open Arms Foster Age Palmdale School District Partners in Care Foundation Protective Science Dynamics Providence Access to Care PSD Head Start SCAN Tarzana Treatment Center Two Life Styles Valley Trauma Center Yes 2 Kids

We would also like to thank the data committee. The data committee consists of area academic, health and public health service providers that meet on a monthly basis to provide guidance throughout all stages of the needs assessment process.

H-sin Chen, MSHA – Tarzana Treatment Center Regan Mass, Ph.D – California State University Northridge, Geography Dept. Gigi Mathew, Dr.PH – Research Analyst III Los Angeles County Department of Public Health Office of Health Assessment and Epidemiology Marie Mayen-Cho, MPH – Providence Access to Care Collaborative Douglas Melnick, MD, MPH – Los Angeles County Department of Public Health Ronald Sorensen, MSHA – Providence Health & Services Center for Community Health

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Table of Contents AUTHORS ............................................................................................................................................. I ACKNOWLEDGEMENTS ................................................................................................................ II GLOSSARY OF TERMS ..................................................................................................................... 4 I. EXECUTIVE SUMMARY ............................................................................................................... 8 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) BACKGROUND ............................................. 8 SUMMARY OF NEEDS ASSESSMENT METHODOLOGY AND PROCESS ................................................ 8 SUMMARY OF PRIORITIZED NEEDS ............................................................................................... 10 II.

INTRODUCTION/BACKGROUND ....................................................................................... 13 PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT ......................................... 13 ABOUT KAISER PERMANENTE ....................................................................................................... 13 ABOUT KAISER PERMANENTE COMMUNITY BENEFIT ................................................................... 14 KAISER PERMANENTE’S APPROACH TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ............. 14 About the new federal requirements ......................................................................................... 14 SB 697 and California’s history with past assessments............................................................ 14 Kaiser Permanente’s CHNA framework and process .............................................................. 15

III. COMMUNITY SERVED .......................................................................................................... 16 KAISER PERMANENTE’S DEFINITION OF COMMUNITY SERVED BY HOSPITAL FACILITY .................. 16 DESCRIPTION AND MAP OF COMMUNITY SERVED BY KFH-PANORAMA CITY .......................... 16 Geographic Description............................................................................................................ 19 Socio-demographic Profile ....................................................................................................... 20 Access to Health Care ............................................................................................................... 29 Chronic Disease Prevalence and Incidence ............................................................................. 34 IV. WHO WAS INVOLVED IN THE ASSESSMENT ................................................................... 43 V. PROCESS AND METHODS USED TO CONDUCT THE CHNA ......................................... 44 A.

SECONDARY DATA................................................................................................................. 44 B. COMMUNITY INPUT ................................................................................................................ 46 C. DATA LIMITATIONS AND INFORMATION GAPS ........................................................................ 60 VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY’S

HEALTH NEEDS 60

A.

IDENTIFYING COMMUNITY HEALTH NEEDS ............................................................................. 60 B. PROCESS AND CRITERIA USED FOR PRIORITIZATION OF THE HEALTH NEEDS ........................... 62 C. PRIORITIZED DESCRIPTION OF COMMUNITY HEALTH NEEDS ................................................... 62 VII. COMMUNITY ASSETS AND RESOURCES AVAILABLE TO RESPOND TO THE IDENTIFIED HEALTH NEEDS OF THE COMMUNITY ........................................................... 66 2|Page

APPENDIX A: HEALTH NEED PROFILES ................................................................................ 72 Health Need Profile: Access to Primary Care .......................................................................... 73 Health Need Profile: Asthma .................................................................................................... 78 Health Need Profile: Breastfeeding .......................................................................................... 81 Health Need Profile: Cardiovascular Disease ......................................................................... 83 Health Need Profile: Cervical Cancer ..................................................................................... 87 Health Need Profile: Dental Health Services ........................................................................... 91 Health Need Profile: Diabetes .................................................................................................. 93 Health Need Profile: Mental Health ......................................................................................... 97 Health Need Profile: Obesity/Overweight for Adult and Youth ............................................. 101 Health Need Profile: Physical Environment/Transportation ................................................. 106 Health Need Profile: Poverty Rates ........................................................................................ 109 Health Need Profile: Prenatal Care ....................................................................................... 113 Health Need Profile: Unemployment ...................................................................................... 117 Health Need Profile: Uninsured Population .......................................................................... 121 APPENDIX B: PRIMARY DATA COLLECTION TOOLS AND INSTRUMENTS ............... 124 APPENDIX C: COMMUNITY RESOURCES BY CATEGORY ............................................... 138 APPENDIX D: REFERENCES/BIBLIOGRAPHY ...................................................................... 182

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Glossary of Terms The following are definitions of key CHNA terms referenced in this report. In order to standardize the process across the Region and to ensure compliance with the ACA regulations a shared understanding of these terms is important. Age-adjusted Rate The incidence or mortality rate of a disease can depend on the age distribution of a community. Because chronic diseases and some cancers affect older adults disproportionately, a community with a higher number of older adults might have a higher mortality or incidence rate of some diseases than another community that may have younger people. An incidence or mortality rate that is ageadjusted takes into the consideration of the proportions of persons in corresponding age groups, which allows for more meaningful comparison between communities with different age distributions. Benchmarks4 Something that serves as a standard by which others may be measured or judged (Example: Healthy People 2020). Community Assets Those people, places and relationships that can conceivably be used in acting to bring about the most equitable functioning of a community (Example: FQHC’s, primary care physicians, parks). Community Health Needs Assessment5 (CHNA) A systematic process involving the community to identify and analyze community health needs and assets. Community Served Based on ACA regulations, the community served is to be determined by each individual hospital. It is generally defined by a geographical location such as a city, county or metropolitan region. A community may also take into consideration certain hospital focus area (i.e., cancer, pediatrics) but should not be denied so narrowly as to intentionally exclude high needs groups such as the elderly or low income individuals. Disease Burden Disease burden refers to the impact of a health issue not only on the health of the individuals affected by it, but also the financial cost in addressing this health issue, such as public expenditures in addressing a health issue. The burden of disease can also refer to the disproportionate impact of a disease on certain populations, which may negatively affect their quality of life and socioeconomic status.

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Drivers of Health Risk factors are issues that may positively or negatively impact a health outcome. For the purposes of KP’s CHNA they have been divided into four categories: social and economic factors, physical environment, health behaviors and clinical care access and delivery. Health Indicator6 A characteristic of an individual, population, or environment which is subject to measurement (directly or indirectly) and can be used to described one or more aspects of health of an individual or population ( Examples: Percent of children overweight in Santa Clarita County, Incidence of breast cancer in Santa Clara County). Health Disparity Diseases and health problems do not affect all populations in the same way. Health disparity refers to the disproportionate impact of a disease or a health problem on specific populations. Much of research literature on health disparity focuses on racial and ethnic differences in how these communities experience the diseases, but health disparity can be correlated with gender, age, and other factors, such as veteran, disability, and housing status. Health Needs Health outcomes that are disproportionately impacting a particular population. They are identified through interpretation and analysis of secondary data as well as primary data. (Example: breast cancer, obesity and overweight, asthma) Health Outcomes7 Health Outcomes are snapshots of diseases in a community that can be described in terms of both morbidity and mortality. They are measureable health indicators that may be used to identify and prioritize health needs. (Example: breast cancer prevalence, lung cancer mortality, homicide rate) Immediate Needs Immediate needs are health needs that the community felt needs an immediate intervention. Implementation Strategy8 The non-profit hospital’s plan for addressing the health needs identified through the community health assessment. (CHNA) Incidence9 A measure of the occurrence of new disease in a population of people at risk for the disease, (Example: 1,000 new cases of breast cancer in 2011).

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Intermediate Needs Intermediate needs are the health needs that the community felt needs attention once the immediate needs have been addressed. Mortality Rate Mortality rate refers to the number of deaths in a population due to a disease. It is usually expressed as a density rate (e.g. x number of cases per 10,000 people). Prevalence10 The proportion of total population that currently has a given disease (Example: 1,000 total cases of lung cancer in 2011). Primary Data New data that is collected or observed directly from first-hand experience; typically, primary data collected for CHNA is qualitative in nature. (Example: Focus groups, key informants interviews) Qualitative Data11 Typically descriptive in nature and not numerical; however, it can be coded into numeric categories for analysis. Qualitative data is considered to be more subjective than quantitative data but describes what is important to people who provide the information. (Example: Focus group data) Quantitative Data12 Data that has numeric value. Quantitative data is considered to be more objective than qualitative data. (Example: State or National survey data) Risk Factor13 Characteristics (genetic, behavioral, and environmental exposures and sociocultural living conditions) that increase the probability that an individual will experience a disease (morbidity) or specific cause of death (mortality). Some risk factors can be changed (e.g., smoking) while others cannot (e.g., family history) Secondary Data Data that has already been collected and published by another party. Typically, secondary data collected for CHNA is quantitative in nature (Example: California Health Interview Survey (CHIS), Behavioral Risk Factor Surveillance System (BRFSS)) Source: 4

Merriam – Webster Dictionary. Retrieved from http://www.meriam-webter.com/dictionary/benchmark World Health Organization (WHO). Retrieved from http://www.who.int/hia/evidence/doh/en/ 6 “Health Promotion Glossary,” World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998. 5

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Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from http://www.chausa.org/Assessing_and_Addressing _Community_Health_Need.aspx 8 Ibid 9 Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett Publishers. 10 Ibid. 11 Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from http:// www.chausa.org/Assessing_and_Addressing _Community_Health_Need.aspx 12 Ibid 13 Adapted from: Green L. & Kreuter M. (2005). Health program planning: An educational and ecological approach. 4th edition. New York, NY: McGrawhill.

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I. Executive Summary Community Health Needs Assessment (CHNA) Background The Patient Protection and Affordable Care Act (ACA) enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their tax-exempt status under section 501(c) 3 of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low-income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance, transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report is conducted in compliance with these new federal requirements.

Summary of Needs Assessment Methodology and Process VCCC’s overarching aim and main objective in creation of this report is to identify and prioritize unmet community health needs. More importantly this report will act as the foundation to create an implementation strategy to plan coordinated and potential collaborative efforts and activities to promote and improve the health of all individuals residing in the KFH - Panorama City Medical Center Service Area. The area consists of 3,668 sq. miles that spans two Service Planning Areas (SPA), SPA1 and SPA 2 that are distinctly different. The CHNA team collected data on common indicators from the Kaiser Permanente CHNA data platform which is being used by all of its regions. The national common indicators included data in the following categories: demographics, social and economic factors, health behaviors, physical environment, clinical care, and health outcomes. In addition the team utilized the Dignity Health’s Community Need IndexTM(CNI) to determine areas of highest need. The CNI aggregates socioeconomic indicators known to contribute to health disparity. Additional secondary data sources included The Nielson Company & Thomson Reuter’s disease prevalence data at the zip code level to provide a comprehensive epidemiologically-based health profile of the area. The CHNA team also conducted local literature review. A data resource list can be located under Appendix D. Primary data are new data collected directly from first-hand experience. They are typically qualitative (not numerical) in nature. For this community health needs assessment, primary data were collected through key informant interviews, focus groups and community forums with community

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stakeholders. These primary data describe what is important to the people who provide the information and are useful in interpreting secondary data. Secondary data are data that have been collected and published by another entity. They are typically quantitative (numerical) in nature. Secondary data are helpful in highlighting in an objective manner health outcomes that significantly impact a community. Between September and December 2012, 5 focus groups and 8 community forums were conducted in various settings throughout the region. There were 17 key informant interviews conducted with social service, health, public health and clinic service providers. Additionally, 346 surveys were collected and analyzed for common themes. Secondary data was reviewed for validity and appropriateness. The numeric values were then benchmarked against the state, national and HP 2020 targets. Health and socio-economic related issues not meeting benchmarks were compiled into a list of identified health needs. Feedback collected from primary data collection was then used to determine if community perception of health needs aligned with the secondary data. Following the identification of health needs, the CHNA team brought together health care experts and community residents to prioritize the list into 10 most immediate health needs for KFH- Panorama City Medical Center Service Area. A total of two meetings were conducted: one in Panorama City and one in Antelope Valley. Those that participated in prioritization received a copy of the health need profiles created for the identified health needs. Through a multi-voting approach the participants were asked to reach a consensus on the most immediate needs. In addition to the health need profiles the following main criteria were considered during the prioritization process: 1. 2. 3. 4. 5.

Does the issue impact both the Antelope Valley and Panorama City? How severe is the problem (i.e. meeting benchmarks state, nation or Healthy People)? Is the issue getting worse over time? Has the community ranked the issue over other issues? Are there reasonable resolutions to the problems?

Please note that the KFH – Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley’s individual top 10 immediate needs did differ as you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey. Please note that the KFH – Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley’s individual top 10 immediate needs did differ as 9|Page

you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey.

Summary of Prioritized Needs The 10 most immediate and significant health needs that rose to the top for the KFH - Panorama City Medical Center Service Area based on prioritization process are listed below (from highest to lowest priority): 1. Access to Primary Care 2. Obesity/Overweight for Adult and Youth 3. Mental Health 4. Dental Health Services 5. Uninsured Population 6. Physical Environment/Transportation 7. Poverty Rates 8. Diabetes 9. Prenatal Care 10. Breastfeeding The health of the community is the result of many inter-related factors. A key concern for a majority of the community residents and some of the experts has been the impact on the community due to poor economy, unemployment, reduced hours, reduced pay, and in many instances the loss of employer based health care. The overall consensus was that many issues such as obesity, chronic disease, and depression could be the result of stress that comes from being part of the “working poor” population. The following information provides a summary for each of the prioritized health needs. Data in the following descriptions was retrieved from the CHNA data platform, L.A. Department of Public Health, and The Nielson Company, Thomson Reuters, 2012 unless otherwise noted. Access to Primary Care - Over 55% of respondents identified access to primary care as an immediate need. There are 20 Federally Qualified Health Centers (FQHC) located in the 3,668 square miles that make up the KFH-Panorama City Medical Center Service Area. However 15 of the FQHC’s are located in the Panorama City area (856 sq. miles) and 5 FQHC’s are located in the Antelope Valley area (2,812 sq. miles). “Limited English Proficiency” also poses a barrier to healthcare services. This is especially relevant in Panorama City where 26.74% of the population speak English less than “very well” and speak another language at home. This issue is not as relevant in the Antelope Valley (14.47%) which brings the area average to 23.53% which fares worse than the state (19.85%) and the nation (8.70%). Additionally the high volume of preventable hospitals events in the Antelope Valley (138.38 per 10,000 population compared to Panorama City (105.73) and California (83.17)) shows a need for 10 | P a g e

improved disease management. Preventable hospital events include diabetes and other events that could have been prevented if there were adequate primary care resources. Obesity/Overweight for Adult and Youth – The 2012 Los Angeles County Department of Public Health article on “Trends in Obesity: Adult Obesity Continues to Rise” states that “Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation.” The report went on to state obesity is an issue with youth as well. A large majority of those that participated in focus groups and community forums felt obesity is a major health issue. Adults and youth living in low-income minority communities are at a higher risk for obesity and overweight with greater risk of developing chronic disease. In KFH – Panorama City Medical Center Service Area, the percentage of obese children (33.75%) is higher than the state (29.82%) and is not meeting the benchmark. Mental Health - Mental health issues inclusive of dual diagnosis (mental health with substance abuse and/or mental health with chronic disease) were a topic of discussion in many of the community forums and focus groups. According to 2012 Thomson Reuter’s Depression/Anxiety Estimates for KFH – Panorama City Medical Center Service Area, 135,961 cases or 8.5% of the population is dealing with depression or anxiety. The majority of the estimated cases affect those adults 18 to 64 years of age. Major depression has been linked to higher suicide rates which is a huge problem in Antelope Valley (12.4 Per 100,000 Population). The Antelope Valley rate is much higher than Panorama City (7.4 Per 100,000 Population) which creates an average 8.7 per 100,000 population rate for the entire KFH – Panorama City Medical Center Service Area. While the area overall falls within California (9.79 Per 100,000 Population) rates, and Healthy People 2020 goal of ≤ 10.2 per 100,000 Pop, when looking at each of the two areas there is a noticeable problem in the Antelope Valley. A key informant shared that “There is no real infrastructure for adult mental health. Resources and services in our area are very sparse.” Dental Health Services - Adults who self-reported having poor dental health in KFH – Panorama City Medical Center Service Area (11.66%) faring slightly worse than California (11.27%). Stakeholders shared that the problem is worse for seniors because Medicare does not provide coverage for preventative (cleaning and x-rays) care. In addition, Medi-Cal stopped providing DentiCal for adults while retaining services for children. A major concern is the high percentage of adults (34.65%) who self-report they have not visited a dental professional in the past year is worse than the state average of (30.51%). In addition, 12.22% of teens have not had a dental visit in the past year again faring worse than the state average (10.07%). These numbers are in alignment with the numbers of adults without dental insurance in the area (37.36%) which is also worse than the state (33.72%). Many stakeholders were concerned that people underestimate how vital good dental health is to a person’s overall general health. Uninsured Population - The lack of health insurance is considered a key driver of health status. KFH – Panorama City Medical Center Service Area stakeholders felt it should be addressed as an immediate need. While many felt that the Patient Protection Affordable Care Act (ACA) will help to reduce the burden of uninsured in 2014, concerns remain high especially in the Panorama City area 11 | P a g e

where the majority of the population is Latino. A percentage of this population may be undocumented and ineligible for ACA coverage. In KFH – Panorama City Medical Center Service Area, Panorama City (22.37%) has the higher percentage of uninsured population compared to Antelope Valley (16.47%). However, the overall KFH - Panorama City Medical Center Service Area (20.81%) is not meeting the state (17.92%) or the U.S. (15.05%) benchmark. Physical Environment/Transportation - Stakeholders brought up the physical environment in both Panorama City and Antelope Valley areas. Community members brought up issues such as public safety, access to parks, and green space. Another major concern that was often brought up by the community was transportation. Transportation as a barrier to accessing health care services was noted to affect the low-income, homeless, chronically ill, disabled and senior population more adversely then others. One key informant shared “Primarily in this area, it’s the distances between residential areas and key health services. In the Antelope Valley and Palmdale most of the health services are located in the same area. Some folks who live in areas such as Lake Los Angeles, Acton, and Little Rock face the greatest transportation barriers.” Poverty Rates - The KFH – Panorama City Medical Center Service Area with 15.04% of population living below 100% Federal Poverty Level (FPL) exceeds the state percentage of 13.71%. The Antelope Valley in KFH – Panorama City Medical Center Service Area is higher (18.68%) compared to Panorama City (13.74%). Diabetes - Nationally there is an increase in the incidence of Type II Diabetes in both adults and youth. This has been directly associated with the rising rates of overweight and obesity in the United States. Diabetes prevalence rate in the overall KFH – Panorama City Medical Center Service Area (7.71%) is slightly higher than the state (7.57%). Antelope Valley is slightly higher (7.73%) than Panorama City (7.70%). This indicator represents the percentage of the population over 20 years old that have been told by a doctor they have diabetes. It is interesting to note that while the prevalence of diabetes is only slightly higher than the state, the rate of diabetes hospitalizations and deaths in the area especially Antelope Valley is extremely high. Prenatal Care - There is grave disparities in the KFH – Panorama City Medical Center Service Area between the Antelope Valley and Panorama City related to prenatal care. The percentage of mothers with late or no prenatal care in the Antelope Valley (32.05%), Panorama City (10.75%) and the combined area rate of (16.84%) is much higher than the state (3.14%). This indicator highlights a lack of access to primary care and health knowledge. Lack of prenatal care can also lead to low birth weight infants. Breastfeeding - Greater emphasis and legislation has been put forth on the importance of breastfeeding to improve the health of infants. Research shows that breastfeeding can lead to reduced rates of childhood obesity. The combined rate of exclusive breastfeeding in KFH – Panorama City Medical Center Service Area (46.98%) is much lower than the state (60.63%). With similar low rates of breastfeeding in Antelope Valley (46.88%) and Panorama City (47.02%), both areas are not meeting the state (60.63%) benchmark. 12 | P a g e

II. Introduction/Background Purpose of the Community Health Needs Assessment Report Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The findings from this CHNA report will serve as a foundation for understanding the health needs found in the community and will help with forming the Implementation Strategy for Kaiser Foundation Hospitals as part of their Community Benefit planning. This report complies with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52 regarding conducting the CHNA for the hospital facility.

About Kaiser Permanente Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof—all connected by an electronic medical record Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. 13 | P a g e

About Kaiser Permanente Community Benefit For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor’s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a prevention-focused, evidencebased approach. We go beyond traditional corporate philanthropy or grantmaking to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—Health Access, Healthy Communities, and Health Knowledge—to address critical health issues in our communities. For many years, we’ve worked side-by-side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we’ve conducted Community Health Needs Assessments to better understand each community’s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long-term, sustainable change—and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health.

Kaiser Permanente’s Approach to the Community Health Needs Assessment About the new federal requirements Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c) (3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations—this includes minority groups, low-income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization’s annual Form 990.

SB 697 and California’s history with past assessments For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three 14 | P a g e

years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements.

Kaiser Permanente’s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results.

Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. More information about the CHNA platform can be found at http://www.CHNA.org/kp/. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources 15 | P a g e

weren’t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each Kaiser Permanente hospital collected primary data through key informant interviews, focus groups, and surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once the community health needs were identified, they were prioritized based on a second set of criteria. This process resulted in a complete list of prioritized community health needs. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will examine the list of prioritized health needs and develop an implementation strategy for those health needs it will address. These strategies will build on Kaiser Permanente’s assets and resources, as well as evidence-based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H.

III. Community Served Kaiser Permanente’s definition of community served by hospital facility Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations.

Description and map of community served by KFH-Panorama City KFH - Panorama City Medical Center serves the communities of the East San Fernando Valley, Santa Clarita Valley, and Antelope Valley, as depicted in the map below. Although many residents of the Antelope Valley seek hospital services from closer community hospitals, KFH - Panorama City Medical Center Service Area includes the Antelope Valley service area in the "community" for purposes of this CHNA because KFH - Panorama City Medical Center is part of an integrated delivery system that serves this broader area. This broader area will be referred to as the KHF Panorama City Medical Center Service Area for purposes of this report. The broad communities served by KFH - Panorama City Medical Center Service Area have diverse geography, topography and vary across levels of socio-economic status. As such, in addition to information about the health 16 | P a g e

needs of the broader KFH - Panorama City Medical Center Service Area, this report will also include information about Panorama City and Antelope Valley service areas separately to capture both the commonalities and well as the unique problems that exists across these geographies. This will enhance understanding of the significant health needs of KFH - Panorama City Medical Center communities to form more targeted implementation strategies. KFH - Panorama City Medical Center Service Area has two very uniquely characterized areas; Panorama City and the Antelope Valley with diverse geography, topography and large geographic land area with varied levels of socioeconomic status. The residents in the KFH – Panorama City Medical Center Service Area share some commonalities and some very unique problems that exist in their individual communities.

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Geographic Description The KFH – Panorama City Medical Center Service Area includes the San Fernando, Santa Clarita, and Antelope Valleys. The San Fernando Valley includes Arleta, Granada Hills, Lakeview Terrace, Mission Hills, North Hills, North Hollywood, Northridge, Pacoima, Panorama City, San Fernando, Sepulveda, Sherman Oaks, Studio City, Sunland, Sun Valley, Sylmar, Toluca Lake, Tujunga, Universal City, Valley Village, and Van Nuys. The Santa Clarita Valley includes Canyon Country, Castaic, Newhall, Santa Clarita, Saugus, Stevenson Ranch, Val Verde, and Valencia. The Antelope Valley includes Acton, California City, Lake Hughes, Lancaster, Littlerock, Llano, Mojave, Palmdale, Pearblossom, Rosamond and Valyermo. The following table summarizes the KFH- Panorama City Medical Center Service Area: Communities of KFH - Panorama City Medical Center Service Area City/Community Acton California City

Zip Codes 93510 93505

County Los Angeles, SPA 1 Kern

Cantil, Mojave Canyon Country Castaic, Val Verde Granada Hills Lake Hughes Lancaster Littlerock Llano Mission Hills Mojave Newhall North Hills, Northridge, Sepulveda North Hollywood, Studio City, Toluca Lake Pacoima, Arleta, Lakeview Terrace Palmdale Panorama City Pearblossom Rosamond San Fernando Santa Clarita, Saugus Sherman Oaks Stevenson Ranch Studio City Sun Valley Sunland Sylmar

93519 91351, 91387 91384 91344 93532 93534, 93535, 93536 93543 93544 91345 93501 91321 91343 91601, 91602, 91605, 91606 91331 93552, 93550, 93551, 93591 91402 93553 93560 91340 91350, 91390 91423 91381 91604 91352 91040 91342

Kern Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 1 Los Angeles, SPA 1 Los Angeles, SPA 1 Los Angeles, SPA 1 Los Angeles, SPA 2 Kern Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 1 Los Angeles, SPA 2 Los Angeles, SPA 1 Kern Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2

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Tujunga Valencia, Santa Clarita Valley Village Valyermo Van Nuys Universal City

91042 91354, 91355 91607 93563 91401, 91405, 91411 91608

Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 2 Los Angeles, SPA 1 Los Angeles, SPA 2 Los Angeles, SPA 2

Source: Health Cities

Socio-demographic Profile Population In the KFH - Panorama City Medical Center Service Area, Panorama City area is more densely populated with 1,126,736 people living in 855.53 Sq. miles compared to Antelope Valley with 403,158 people living in 2,812.45 Sq. miles. Overall, KFH - Panorama City Medical Center Service Area is more densely populated compared to the state of California and the U.S. High population density could possibly contribute to more communicable health issues. Table 1: Total Population Density Report Area KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Los Angeles County California United States

Total Population 1,529,894

Total Land Area (Square Miles) 3,667.98

Population Density (Per Square Mile) 417.09

403,158

2,812.45

143.35

1,126,736 9,758,256 36,637,288 303,965,271

855.53 4,057.88 155,779.20 3,531,905.50

1,317 2,404.77 235.19 86.06

Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract.

Population by Gender Table 2: Population by Gender Report Area KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Los Angeles County California United States

Male 765,111

Female 764,782

% Male 50.01%

% Female 49.99%

200,159 564,952 4,811,964 18,223,156 149,398,720

202,997 561,785 4,946,292 18,414,132 154,566,544

49.65% 50.14% 49.31% 49.74% 49.15%

50.35% 49.86% 50.69% 50.26% 50.85%


The total population of KFH - Panorama City Medical Center Service Area (1,529,893) is equally distributed with 49.99% females and 50.01% males. 20 | P a g e

Population by Ethnicity Los Angeles County includes socially, culturally and economically diverse populations. KFH Panorama City Medical Center Service Area is home to multi-ethnic, multi-lingual populations that require health care services that are innovative and culturally appropriate. The ethnic distribution of the population in KFH – Panorama City Medical Center Service Area is Hispanics (49.50%), followed by White (33.81%) , Asians (7.36%) and Blacks (6.65%). A total of (2.68%) of the population falls under multiple and other races which could include smaller groups of people from various ethnic backgrounds. Graph 1: Population by Ethnicity KFH – Panorama City Medical Center Service Area 100

Lancaster

Palmdale

Van Nuys

White %

Black %

Asian %

Pacoima

Sylmar

Panorama City

Percentages

80 60 40 20 0

Hispanic %

All Other %

Data Source: The Nielsen Company., Thomson Reuters, 2012

The six most populated cities in KFH - Panorama City Medical Center Service Area are Lancaster (186,865), followed by Palmdale (176,204), Van Nuys (167,511), Pacoima (103,747), and Sylmar (93,100) and Panorama City (69,925). Of the most densely populated cities Pacoima has the highest percent of Hispanic population (88.46%) compared to other cities in KFH - Panorama City Medical Center Service Area (2012 The Nielsen Company, 2012 Thomson Reuters). Population by Age Graph 2: Population by Age Distribution 9%

7%

9% 19% 14% 10% 16%

16%

Age 0-4 Age 5-17 Age 18-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65+


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About 26% of the total population in KFH - Panorama City Medical Center Service Area is children and youth between the ages of 0-17 years; 65% are adults between the ages of 18 to 64 years and 9% are older adults ages 65 plus. In general, older population use more health care services compared to younger population. Table 3: Population Change between 2000 and 2010 U.S. Census Report Area Total Population, Total Population, 2010 Census 2000 Census KFH - Panorama City Medical 1,573,307 1,518,346 Center Service Area Antelope Valley (Service Area) 420,603 400,776 Panorama City (Service Area) 1,152,704 1,117,570 Los Angeles County 9,818,605 9,519,338 California 37,253,956 33,871,648 United States 308,745,538 281,421,906

Percent Change from 2000-2010 Census 3.62% 4.95% 3.14% 3.14% 9.99% 9.71%

Note: No breakout data available. Data Source: U.S. Census Bureau, 2000 Census of Population and Housing, Summary File 1; U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1. Source geography: County.

The percentage of growth in Antelope Valley (4.95%) exceeded Panorama City (3.14%). Overall growth in KFH - Panorama City Medical Center Service Area between 2000 and 2010 was 3.62%. A positive or negative shift in the total population over time impacts health care providers, and the utilization of health care services and resources. Limited English Proficiency The inability to speak English can create barriers to healthcare access, provider communications, and health literacy/education. KFH - Panorama City Medical Center Service Area has a higher percent (23.53%) of population that has limited English proficiency compared to the state (19.85%) and the U.S. (8.70%). Antelope Valley (14.47%) is lower than the state and the U.S benchmarks; however, Panorama City (26.74%) and the L.A. County (26.97%) have a higher percentage of people not speaking English proficiently and therefore not meeting the state and the national benchmarks. This could likely be due to the higher percentages of Latino, Asian and other multiple ethnicities in KFH – Panorama City Medical Center Service Area speaking a language other than English at home. The Nielson Company and Thomson Reuters report estimates that communities such as Pacoima (80%), San Fernando (77.8%), and Panorama City (66.6%) have the highest monolingual Spanish population in KFH - Panorama City Medical Center Service Area. Community feedback from focus groups, community forums, and key informant interviews identified language as one of the major barriers for not seeking or acquiring appropriate medical care. Lack of effective communication between health care providers and community members increases the probability of patient noncompliance with prescribed treatment and pharmaceuticals, which could negatively affect the health outcomes. Language was also identified as a contributing factor for the 22 | P a g e

lack of health literacy, understanding the importance of seeking preventative services and lack of awareness regarding the available health care resources in the community. Table 4: Percent of Population With Limited English Proficiency Report Area Total Population Total (For Whom Limited English English Proficiency is Proficiency Determined) Population KFH - Panorama City Medical 1,419,753 334,101 Center Service Area Antelope Valley (Service Area) 371,609 53,776 Panorama City (Service Area) 1,048,144 280,325 Los Angeles County 9,098,454 2,453,700 California 34,092,224 6,768,923 United States 283,833,856 24,704,752

Percent Limited English Proficiency Population 23.53% 14.47% 26.74% 26.97% 19.85% 8.70%

Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract.

Poverty