memorial hermann greater heights hospital...memorial hermann is a not-for-profit, community-owned,...

2019 Community Health Needs Assessment

MEMORIAL HERMANN GREATER HEIGHTS HOSPITAL

HEALTHINSURANCE

Board Approved June 27, 2019

MemorialHermannGreaterHeightsHospitalCHNA20192

Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Introduction&Purpose...............................................................................................................................4SummaryofFindings...................................................................................................................................4PrioritizedAreas..........................................................................................................................................5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 MemorialHermannGreaterHeightsHospital.............................................................................................6

Vision.......................................................................................................................................................6MissionStatement...................................................................................................................................6MemorialHermannHealthSystem.........................................................................................................6MemorialHermannGreaterHeightsHospitalServiceArea....................................................................7

Consultants..................................................................................................................................................8

Evaluation of Progress Since Prior CHNA .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 PriorityHealthNeedsandImpactfromPriorCHNA....................................................................................9

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Overview....................................................................................................................................................11SecondaryDataSources&Analysis...........................................................................................................11

SecondaryDataScoring.........................................................................................................................11DisparitiesAnalysis................................................................................................................................12

PrimaryDataMethods&Analysis.............................................................................................................12CommunitySurvey.................................................................................................................................12KeyInformantInterviews.......................................................................................................................14

DataConsiderations...................................................................................................................................16Race/EthnicGroupings..........................................................................................................................17ZipCodesandZipCodeTabulationAreas..............................................................................................17

Prioritization..............................................................................................................................................17PrioritizationProcess.............................................................................................................................17

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Population..................................................................................................................................................20

Age.........................................................................................................................................................21Race/Ethnicity........................................................................................................................................22Language...............................................................................................................................................23

SocialandEconomicDeterminantsofHealth............................................................................................24Income...................................................................................................................................................24Poverty...................................................................................................................................................26FoodInsecurity......................................................................................................................................28Unemployment......................................................................................................................................29Education...............................................................................................................................................30Transportation.......................................................................................................................................32

SocioNeedsIndex®.....................................................................................................................................33

Data Synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Priorit ized Signif icant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 PrioritizationResults..................................................................................................................................39AccesstoHealthcare..................................................................................................................................39EmotionalWell-Being................................................................................................................................43FoodasHealth...........................................................................................................................................46ExerciseIsMedicine...................................................................................................................................49

Non-Prioritized Significant Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 OlderAdultsandAging..............................................................................................................................51Cancers......................................................................................................................................................51Education...................................................................................................................................................52Transportation...........................................................................................................................................53Children’sHealth.......................................................................................................................................54Economy....................................................................................................................................................55

Other Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 BarrierstoCare..........................................................................................................................................56Disparities..................................................................................................................................................56

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 AppendixA:EvaluationSincePriorCHNA.................................................................................................60AppendixB.SecondaryDataMethodology...............................................................................................73AppendixC.PrimaryDataMethodology...................................................................................................93AppendixD.PrioritizationTool................................................................................................................108AppendixE.CommunityResources.........................................................................................................111

Executive Summary

Introduction & Purpose MemorialHermannGreaterHeightsHospital(MHGH)ispleasedtopresentits2019CommunityHealthNeedsAssessment(CHNA).ThisCHNAreportprovidesanoverviewoftheprocessandmethodsusedtoidentifyandprioritizesignificanthealthneedsacrossMemorialHermannHealthSystem’sregionalservicearea(includingMHGH),asfederallyrequiredbytheAffordableCareAct.MemorialHermannHealthSystempartneredwithConduentHealthyCommunitiesInstitute(HCI)toconducttheCHNAfor13facilities:

• MemorialHermannKatyHospital• MemorialHermannMemorialCityMedicalCenter• MemorialHermannGreaterHeightsHospital• MemorialHermannNortheastHospital• MemorialHermannSoutheastHospital• MemorialHermannSugarLandHospital• MemorialHermannSouthwestHospital• MemorialHermannTheWoodlandsMedicalCenter• MemorialHermannRehabilitationHospital–Katy• MemorialHermann–TexasMedicalCenter• TIRRMemorialHermann• MemorialHermannSurgicalHospitalKingwood• MemorialHermannSurgicalHospitalFirstColony

ThepurposeofthisCHNAistoofferacomprehensiveunderstandingofthehealthneedsinMHGH’sserviceareaandguidethehospital’splanningeffortstoaddressthoseneeds.Specialattentionhasbeengiventotheneedsofvulnerablepopulations,unmethealthneedsorgapsinservices,andinputfromthecommunity.TostandardizeeffortsacrosstheMemorialHermannHealthSystemandincreasethepotentialforimpactingtophealthneedsinthegreaterHoustonregion,communityhealthneedswereassessedandprioritizedataregional/systemlevel.Findingsfromthisreportwillbeusedtoidentifyanddevelopeffortstoimprovethehealthandqualityoflifeofresidentsinthecommunity.

Summary of Findings TheCHNAfindingsinthisreportresultfromtheanalysisofanextensivesetofsecondarydata(over100indicatorsfromnationalandstatedatasources)andprimarydatacollectedfromcommunityleaders,non-healthprofessionals,andorganizationsservingthecommunityatlarge,vulnerablepopulations,and/orpopulationswithunmethealthneeds.Throughanexaminationoftheprimaryandsecondarydata,thefollowingtophealthneedswereidentified:

Priorit ized Areas InMarch2019,stakeholdersfromthe13hospitalfacilitiesintheMemorialHermannHealthSystemcompletedasurveytoprioritizethesignificanthealthissues,basedoncriteriaincludinghealthimpactandriskaswellasconsiderationofMemorialHermann’sstrategicfocus.Thefollowingfourtopicswereidentifiedasprioritiestoaddress:

MHGHwilldevelopstrategiestoaddresstheseprioritiesinits2019ImplementationStrategy.

MemorialHermannHealthSystem’sSignificantHealthNeeds•AccesstoHealthServices•Cancers•Children’sHealth•Diabetes•Economy

•Education•FoodInsecurity•HeartDisease/Stroke•LackofHealthInsurance•Low-Income/Underserved

•MentalHealth•Obesity•OlderAdults/Aging•SubstanceAbuse•Transportation

MemorialHermannHealthSystem’sCHNAPriorities• AccesstoHealthcare• EmotionalWell-Being• FoodasHealth• ExerciseIsMedicine

Introduction

Memorial Hermann Greater Heights Hospital LocatedintheheartofHoustonadjacenttoTheHoustonHeights,MemorialHermannGreaterHeightsHospitalhasbeencaringforfamiliessince1966.A260-bedfacilitywithmorethan600affiliateddoctors,MHGreaterHeightsprovidesawiderangeofmedicalspecialties,includingheartandvascularcare,orthopedics,cancertreatment,sleeplabs,diagnosticimaging,rehabilitation,women’scare,andwoundcare.

Vision MemorialHermannwillbethepreeminenthealthsystemintheU.S.byadvancingthehealthofthoseweservethroughtrustedpartnershipswithphysicians,employeesandotherstodeliverthebestpossiblehealthsolutionswhilerelentlesslypursuingqualityandvalue.

Mission Statement MemorialHermannisanot-for-profit,community-owned,healthcaresystemwithspiritualvalues,dedicatedtoprovidinghighqualityhealthservicesinordertoimprovethehealthofthepeopleinSoutheastTexas.

Memorial Hermann Health System Oneofthelargestnot-for-profithealthsystemsinthenation,MemorialHermannHealthSystemisanintegratedsystemwithanexceptionalaffiliatedmedicalstaffandmorethan26,000employees.GovernedbyaBoardofcommunitymembers,theSystemservicesSoutheastTexasandtheGreaterHoustoncommunitywithmorethan300caredeliverysitesincluding19hospitals;thecountry’sbusiestLevel1traumacenter;anacademicmedicalcenteraffiliatedwithMcGovernMedicalSchoolatUTHealth;oneofthenation’stoprehabilitationandresearchhospitals;andnumerousspecialtyprogramsandservices.MemorialHermannhasbeenatrustedhealthcareresourceformorethan110yearsandasGreaterHouston’sonlyfull-service,clinicallyintegratedhealthsystem,wecontinuetoidentifyandmeetourregion’shealthcareneeds.AmongourdiverseportfolioisLifeFlight,thelargestandbusiestairambulanceserviceintheUnitedStates;theMemorialHermannPhysicianNetwork,MHMD,oneofthelargest,mostadvanced,andclinicallyintegratedphysicianorganizationsinthecountry;and,theMemorialHermannAccountableCareOrganization,operatingacaredeliverymodelthatgeneratesbetteroutcomesatlowercoststoconsumers,whileprovidingresidentsoftheGreaterHoustonareabroadaccesstohealthinsurancethroughtheMemorialHermannHealthInsuranceCompany.Specialtiesspanburntreatment,cancer,children’shealth,diabetesandendocrinology,digestivehealth,ear,noseandthroat,heartandvascular,lymphedema,neurosurgery,neurology,stroke,nutrition,ophthalmology,orthopedics,physicalandoccupationaltherapy,rehabilitation,roboticsurgery,sleepstudies,transplant,weightloss,women’shealth,maternityandwoundcare.SupportingtheSysteminitsimpactonoverallpopulationhealthistheCommunityBenefitCorporation.Atamarketshareof26.1%inthe‘expanded’greaterHoustonareaof12counties,ourvisionisthatMemorialHermannwillbeapreeminentintegratedhealthsystemintheU.S.byadvancingthehealthofthoseweserve.

Memorial Hermann Greater Heights Hospital Service Area TheserviceareaforMHGHiswithinHarrisCounty,Texas.ThegeographicboundariesoftheserviceareaareshowninFigure1.ThezipcodeswithinMHGH’sprimaryserviceareaarelistedinTable1andrepresentapproximately75%ofinpatientdischarges.

Figure1.MHGHServiceArea

Table1.ProportionofPatientPopulationServedbyZipCodeZIPCode PercentofPatient

Population77088 8.2%77022 7.7%77091 7.5%77092 6.2%77018 5.3%77009 5.1%77076 5.0%77093 4.7%77008 4.2%77026 3.5%77016 3.1%77040 2.6%77028 2.5%77037 1.7%77007 1.6%

ZIPCode PercentofPatientPopulation

77055 1.6%77060 1.5%77038 1.2%77078 1.2%77080 1.2%

Consultants MemorialHermannHealthSystemcommissionedConduentHealthyCommunitiesInstitute(HCI)toconductits2019CommunityHealthNeedsAssessment.HCIworkswithclientsacrossthenationtodrivecommunityhealthoutcomesbyassessingneeds,developingfocusedstrategies,identifyingappropriateinterventionprograms,establishingmonitoringsystems,andimplementingperformanceevaluationprocesses.TolearnmoreaboutConduentHealthyCommunitiesInstitute,pleasevisithttps://www.conduent.com/community-population-health.

Evaluation of Progress Since Prior CHNA TheCHNAprocessshouldbeviewedasathree-yearcycle.AnimportantpartofthatcycleisrevisitingtheprogressmadeonprioritytopicsfrompreviousCHNAs.Byreviewingtheactionstakentoaddresspriorityareasandevaluatingtheimpactoftheseactionsinthecommunity,anorganizationcanbetterfocusandtargetitseffortsduringthenextCHNAcycle.

Priority Health Needs and Impact from Prior CHNA MHGH’slastCHNAwasconductedin2016.ThepriorityareasinFY16-18were:

• HealthyLiving:Encourageandfosterhealthylifestylesthrougheducation,awarenessandearlydetectiontopreventillness.

• HealthcareAccess:Improvecommunityknowledgeabouthealthcareaccesspointsandreduceperceivedbarrierstocare.

• BehavioralHealth:Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

EachoftheabovehealthtopicscorrelateswellwiththeprioritiesidentifiedforthecurrentCHNA(detailedbelow);thusMHGHwillbebuildinguponeffortsofpreviousyears.Adetailed

Figure2.CHNAProcess

AnalyzeData&

CommunityInput

PrioritizeHealthNeeds

CHNAReport&

ImplementationStrategy

Implement

EvaluateActionsTaken 3Year

tabledescribingthestrategies/actionstepsandindicatorsofsuccessforeachoftheprecedingpriorityhealthtopicscanbefoundinAppendixA.MHGH’sprecedingCHNAwasmadeavailabletothepublicviathewebsiteandcommunityfeedbackdirectedtoMemorialHermann’sCommunityBenefitDepartment:http://www.memorialhermann.org/locations/heights/community-health-needs-assessment-greater-heights/.NocommentsorfeedbackwerereceivedontheprecedingCHNAatthetimethisreportwaswritten.

Methodology

Overview Twotypesofdatawereusedinthisassessment:primaryandsecondarydata.Primarydataaredatathathavebeencollectedforthepurposesofthiscommunityassessment.Primarydatawereobtainedthroughacommunitysurveyandkeyinformantinterviews.Secondarydataarehealthindicatordatathathavealreadybeencollectedbypublicsourcessuchasgovernmenthealthdepartments.Eachtypeofdatawasanalyzedusingauniquemethodology.FindingswereorganizedbyhealthtopicsandthensynthesizedforacomprehensiveoverviewofthehealthneedsinMHGH’sservicearea.

Secondary Data Sources & Analysis SecondarydatausedforthisassessmentwerecollectedandanalyzedfromHCI’scommunityindicatordatabase.Thisdatabase,maintainedbyresearchersandanalystsatHCI,includesover100communityindicatorsfromatleast15stateandnationaldatasources.HCIcarefullyevaluatessourcesbasedonthefollowingthreecriteria:thesourcehasavalidatedmethodologyfordatacollectionandanalysis;thesourcehasscheduled,regularpublicationoffindings;andthesourcehasdatavaluesforsmallgeographicareasorpopulations.

Secondary Data Scoring HCI’sDataScoringTool®wasusedtosystematicallysummarizemultiplecomparisonsinordertorankindicatorsbasedonhighestneed.Foreachindicator,thecommunityvaluewascomparedtoadistributionofTexasandUScounties,stateandnationalvalues,HealthyPeople2020,andsignificanttrendswerenoted.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.Thecomparisonscoresweresummarizedforeachindicator,andindicatorswerethengroupedintotopicareasforasystematicrankingofcommunityhealthneeds.PleaseseeAppendixBforfurtherdetailsonthequantitativedatascoringmethodologyaswellassecondarydatascoringresults.

Figure3.SummaryofTopicScoringAnalysis

Disparit ies Analysis Whenagivenindicatorhasdataavailableforsubgroupslikerace/ethnicity,ageorgender–andvaluesforthesesubgroupsincludeconfidenceintervals–significantdifferencesbetweenthesubgroups’valueandtheoverallvaluecanbedetermined.Asignificantdifferenceisdefinedastwovalueswithnon-overlappingconfidenceintervals.Onlysignificantdifferencesinwhichthevalueforasubgroupisworsethantheoverallvalueareidentified.Confidenceintervalsarenotavailableforallindicators.Inthesecases,therearenotenoughdatatodetermineiftwovaluesaresignificantlydifferentfromeachother.

Primary Data Methods & Analysis CommunityinputforMemorialHermannHealthSystemwascollectedtoexpandupontheinformationgatheredfromthesecondarydata.PrimarydatausedinthisassessmentconsistedofacommunitysurveyinEnglishandSpanishaswellaskeyinformantinterviews.SeeAppendixCforthesurveyandinterviewquestions.

Community Survey Inputfromcommunityresidentswascollectedthroughanonlinesurvey.Thissurveyconsistedof11questionsrelatedtotophealthneedsinthecommunity,individuals’perceptionoftheiroverallhealth,andweeklyexercisehabits.ThecommunitysurveywasdistributedonlinethroughSurveyMonkey®fromOctober23rdthroughNovember27thof2018.ThesurveywasmadeavailableinbothEnglishandSpanish.PapersurveyswerealsomadeavailableandanswerstothepapersurveywereenteredintotheSurveyMonkeytool.Atotalof285responseswerecollected.ResultsinthisreportarebasedontheserviceareaforMemorialHermannHealthSystem.Thiswasaconveniencesample,whichmeansresultsmaybevulnerabletoselectionbiasandmakethefindingslessgeneralizabletothepopulationasawhole.

Table2.CommunitySurveyOutreachCommunityEvent DescriptionStepHealthEvent–MoodyPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

StepHealthEvent–CastilloPark,77009

CommunityeventhostedbyMemorialHermannprovidingparkactivation,walkingtours,Zumbainstruction,and(throughapartnershipwithHoustonFoodBank)fooddistributiontolow-income,at-risk,andmostlyuninsuredresidents.

MemorialHermannHealthCentersforSchools

10school-basedhealthclinicsin5schooldistricts(74schools)inHarrisandFortBendCounties,providingmedical,mentalhealth,anddentalcare,alongwithnutrition,navigation,andsummerbootcampprogramstouninsuredandunderinsuredchildrenthroughouttheGreaterHoustonarea.

WestOremYMCA,77085

Acommunity-centeredorganizationthatbringspeopletogethertobridgethegapsincommunityneeds(underservedresidents),nurturesresidents’potentialtolearn,grow,andthrive,andmobilizesthelocalcommunitytoeffectlasting,meaningfulchange.

SpringBranchCommunity

AFederallyQualifiedHealthCenter(FQHC)providingquality,affordablehealthcareservicestotheunderservedanduninsuredcommunitiesofSpring

Therace/ethnicitymake-upofsurveyrespondentsisshowninFigure4.ThelargestproportionofrespondentsidentifiedasHispanic/Latino(47.2%),22.4%asWhite,20.8%asBlack/AfricanAmerican,andtheremaining9.6%ofrespondentsasAsian/PacificIslander,OtherandNativeAmerican.

HealthCenter,77080

BranchandWestHouston.

WesleyCommunityCenter,77009

Amulti-purposesocialserviceagencyprovidingresidentsofHouston:short-termrent,utility,andfoodassistancetopreventhomelessnessandmaintainfamilyfinancialstability;acareerandpersonalfinancialservicecenter;andEarlyHeadStart,achilddevelopmentprogramservinginfantstotoddlerstopromoteschoolreadiness.

CompleteCommunities,Houston

PrograminitiatedbytheMayorofHoustoninfivecommunities-allhistoricallyunder-resourced,eachwithabaselevelofcommunityinvolvementandsupport,andwithdiversepopulations.Theprogramisdesignedtoenhanceaccesstoqualityaffordablehomes,jobs,well-maintainedparksandgreenspace,improvedstreetsandsidewalks,grocerystoresandotherretail,goodschoolsandtransitoptions.Communities:AcresHomes[77018,77088,77091],Gulfton[77056,77057,77081],NearNorthside[77009,77022,77026],SecondWard[77003,77011,77020],andThirdWard[77003,77004,77204].

HealthyLivingMatters

AHouston/HarrisCountyChildhoodObesityCollaborative-Acollaborativeofmulti-sectorleadersthatpromotepolicyaimedatsystem-levelandenvironmentalchangetoreducetheincidenceofchildhoodobesity.Prioritycommunitieswereselectedduetothelackofaccesstohealthyfoodoptionsandopportunitiestoengageinphysicalactivityaswellasfortheircommunityassetsandreadinessforchange.PriorityCommunities:CityofPasadena[77058,77059,77502,77503,77504,77505,77506,77507,77536,77571,77586],NearNorthside[77009,77022,77026],andFifthWard/KashmereGardens[77020,77026,and77028]

GreaterNorthsideHealthCollaborative

Non-profitcollaborativewhosegoalistoexpandactivelivingresourcesandincreaseaccesstoqualityhealthcareandhealthyfoodbypromotingresidentleadershipandcivicparticipation.

Figure4.SurveyRespondentsbyRace/Ethnicity

Surveyrespondentswereaskedtoselecttopissuesmostaffectingthecommunity’squalityoflife.AsshowninFigure5,themajorityofrespondentsidentifiedDiabetes,Obesity/Overweight,SubstanceAbuse,andMentalHealth&MentalDisordersastopissuesinthecommunity.

Figure5.TopIssuesAffectingQualityofLife(Survey)

Key Informant Interviews Communityinputwasalsocollectedthroughkeyinformantinterviews.

MemorialHermannHealthSystemjoinedwiththeEpiscopalHealthFoundation(EHF)intheirkeyinformantinterviewinitiativesupportingfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsofthisinitiativeincludeMemorialHermann,CHISt.Luke’sHealth,HoustonMethodist,andTexasChildren’s(Table3).Throughthispartnership,atotalof53interviewswereconductedwith

47.20%

22.40%

20.80%

4.80%3.60% 1.20%

Hispanic

AfricanAmerican

Asian/PacificIslander

NativeAmerican

10%10%13%13%14%

17%23%26%26%

35%51%54%

64%69%

SexualHealthOralhealth

TeenagePregnancyReproductiveHealth

OtherRespiratory/LungDiseaseInjuries,Violence&Safety

ElderCareHeartDisease&Stroke

CancersMentalHealth&MentalDisorders

SubstanceAbuseObesity/Overweight

Diabetes

stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Communityleaderswithspecificexperienceworkingwithprioritypopulations,suchaswomen,children,peopleofcolor,thedisabled,andmore,werealsointerviewed.

Table3.MemorialHermannCollaborativePartners

Intotal,64keyinformantinterviewswereconductedbyphonefromAugustthroughNovember2018;53keyinformantinterviewswereconductedthroughthecollaborativeand11interviewswereconductedbyHCI.Intervieweeswhowereaskedtoparticipatewererecognizedashavingexpertiseinpublichealth,specialknowledgeofcommunityhealthneedsand/orrepresentedthebroadinterestofthecommunityservedbythehospital,and/orcouldspeaktotheneedsofmedicallyunderservedorvulnerablepopulations.Effortsweremadetoidentifyintervieweesworkinginand/orknowledgeableaboutthecountiesinMemorialHermannHealthSystem’sservicearea.AsseeninTable4,someintervieweeswereidentifiedwithknowledgeofmultiplecounties.

Table4.KeyInformantsbyCountyCounty KeyInformantsAustin IncludedinMultipleCountiesBrazoria 3Chambers 2

EpiscopalHealthFoundation’smissionistoadvancetheKingdomofGodwithspecificfocusonhumanhealthandwell-beingthroughgrants,research,andinitiativesinsupportoftheworkoftheDiocese,spanning57counties.Throughinformedaction,collaboration,empowerment,stewardship,transparency,andaccountabilitythefoundationstrivesforthetransformationofhumanlivesandorganizationswithcompassionforthepoorandpowerless.

CHISt.Luke’sHealth,apartofCatholicHealthInitiatives(CHI),oneofthenation’slargesthealthsystems,isdedicatedtoamissionofenhancingcommunityhealththroughhigh-quality,cost-effectivecare.Throughpartnershipswithphysiciansandcommunitypartners,CHISt.Luke’sHealthservesGreaterHoustonwithitscommitmenttoexcellenceandcompassionincaringforthewholepersonwhilecreatinghealthiercommunities.

HoustonMethodistisanonprofithealthcareorganizationservingGreaterHouston,dedicatedtoexcellenceinresearch,education,andpatientcare.HoustonMethodistbringscompassionandspiritualitytoallitsendeavorstohelpmeetthehealthneedsofthecommunitythroughthesystem’sICAREvalues:integrity,compassion,accountability,respect,andexcellence.

TexasChildren’sHospitalisanot-for-profitorganizationwhosemissionistocreateahealthierfutureforchildrenandwomenthroughoutGreaterHoustonandtheglobalcommunitybyleadinginpatientcare,education,andresearch.TexasChildren’siscommittedtocreatingahealthycommunityforchildrenbyprovidingthebestpediatriccarepossible,throughgroundbreakingresearchandemphasisoneducation,whilealsoofferingafullcontinuumoffamily-centeredcareforwomen,fromobstetricstowell-womancare.

County KeyInformantsFortBend 10Galveston 7Harris 28Liberty 1Montgomery 4SanJacinto IncludedinMultipleCountiesWalker IncludedinMultipleCountiesWaller 2Wharton 2MultipleCounties* 5

Interviewsweretranscribedandanalyzedusingthequalitativeanalytictool,Dedoose1.Interviewexcerptswerecodedbyrelevanttopicareasandkeyhealththemes.Threeapproacheswereusedtoassesstherelativeimportanceoftheneedsdiscussedintheseinterviews.Theseapproachesincluded:thefrequencybywhichahealthtopicwasdiscussedacrossallinterviews;thefrequencybywhichatopicwasdescribedbythekeyinformantasabarrier/challenge;andthefrequencybywhichatopicwasmentionedperinterviewee.

Data Considerations Severallimitationsofdatashouldbeconsideredwhenreviewingthefindingspresentedinthisreport.Althoughthetopicsbywhichdataareorganizedcoverawiderangeofhealthandhealth-relatedareas,dataavailabilityvariesbyhealthtopic.Sometopicscontainarobustsetofsecondarydataindicators,whileothersmayhavealimitednumberofindicatorsorlimitedsubpopulationscoveredbythosespecificindicators.Datascoresrepresenttherelativecommunityhealthneedaccordingtothesecondarydataforeachtopicandshouldnotbeconsideredtobeacomprehensiveresultontheirown.Inaddition,thesescoresreflectthesecondarydataresultsforthepopulationasawhole,anddonotrepresentthehealthorsocioeconomicneedthatismuchgreaterforsomesubpopulations.Moreover,manyofthesecondarydataindicatorsincludedinthefindingsarecollectedbysurvey,andthoughspecificmethodsareusedtobestrepresentthepopulationatlarge,thesemeasuresaresubjecttoinstability,especiallyforsmallerpopulations.TheIndexofDisparityis

1DedooseVersion8.0.35,webapplicationformanaging,analyzing,andpresentingqualitativeandmixedmethodresearchdata(2018).LosAngeles,CA:SocioCulturalResearchConsultants,LLCwww.dedoose.com

*Five(5)oftheKeyInformantInterviewsrepresented2ormorecounties,including:Austin,Brazoria,Chambers,FortBend,Galveston,Harris,Liberty,Montgomery,SanJacinto,Walker,Waller,andWhartoncounties.

alsolimitedbydataavailability,whereindicatordatavariesbasedonthepopulationgroupsandserviceareasbeinganalyzed.

Race/Ethnic Groupings

Thesecondarydatapresentedinthisreportderivefrommultiplesources,whichmaypresentraceandethnicitydatausingdissimilarnomenclature.Forconsistencywithdatasourcesthroughoutthereport,subpopulationdatamayusedifferenttermstodescribethesameorsimilargroupsofcommunitymembers.

Zip Codes and Zip Code Tabulation Areas

ThisreportpresentsbothZIPCodeandZIPCodeTabulationArea(ZCTA)data.ZIPorZoneImprovementPlanCodeswerecreatedbytheU.S.PostalServicetoimprovemaildeliveryservice.Theyarebasedonpostalroutes,whichfactorindelivery-area,mailvolumeandgeographiclocation.Theyarenotdesignedtobeusedforstatisticalreportingandmaychangefrequently.SomeZIPCodesmayonlyincludeP.O.boxesorcoverlargeunpopulatedareas.ZCTAsorZIPCodeTabulationAreaswerecreatedbytheU.S.CensusBureauandaregeneralizedrepresentationsofZIPCodesthathavebeenassignedtocensusblocks.Therefore,ZCTAsarerepresentativeofgeographiclocationsofpopulatedareas.Inmostcases,theZCTAwillbethesameasitsZIPCode.ZCTAswillnotnecessarilyexistforZIPCodeareaswithonlybusinesses,singleormultipleaddresses,orforlargeunpopulatedareas.SinceZCTAsarebasedonthemostrecentCensusdata,theyaremorestablethanZIPCodesanddonotchangeasfrequently.DemographicsforthisreportaresourcedfromtheUnitedStatesCensusBureau,whichpresentsZCTAestimates.TablesandfiguresintheDemographicssectionofthisreportreferenceZIPCodesintitle(forpurposesoffamiliarity)butshowvaluesofZCTAs.DatafromothersourcesisrepresentativebyZIPCodesandarelabeledassuch.

Priorit ization Inordertofocuseffortsonasmallernumberofthemostsignificantcommunityissues,sixteenrepresentativesfromtheMemorialHermannHealthSystem(oneormorerepresentingeachfacility)participatedinanonlineprioritizationprocesstoprioritizethefifteensignificanthealthneedsidentifiedthroughthesecondaryandprimarydataanalyses.Theprioritizedhealthneedswillbeunderconsiderationforthedevelopmentofanimplementationplanthatwilladdresssomeofthecommunity’smostpressinghealthissues.

Priorit ization Process Toprioritizesignificanthealthneeds,MemorialHermannstakeholdersparticipatedinanonlinewebinaronMarch7,2019toreviewdatasynthesisresultsfollowedbycompletionofaprioritizationmatrixlistingsignificanthealthneedsandfourcriteriabywhichtorateeachneed.Participantsscoredeachneedforeachofthecriteriaonascalefrom1-5,with1meaningtherespondentstronglydisagreesto5meaningtherespondentstronglyagreesthatthehealthneedmeetsthecriterion.Respondentswerealsoabletoselect“Don’tKnow/Unsure”foreachhealthneed.

Thecriteriaforprioritizationincludedtowhatextentanissue:• Impactsmanypeopleinthecommunity• Significantlyimpactssubgroupsinthecommunity(gender,race/ethnicity,LGBTQ,etc.)• Hasinadequateexistingresourcesinthecommunity• Hashighriskfordiseaseordeath

CompletionoftheprioritizationmatrixinAppendixDresultedinnumericalscoresforeachhealthneedthatcorrespondedtohowwelleachhealthneedmetthecriteriaforprioritization.Thescoreswererankedfromhighesttolowest(Table5).

Table5.ResultsfromMemorialHermannPrioritizationMatrixSignificantHealthNeed Impacton

CommunityImpactonSubgroups

InadequateResources

HighRisk AverageScore

Obesity(Exercise,NutritionandWeight)

4.69 4.00 3.19 4.50 4.09

MentalHealth 4.44 3.44 4.50 3.75 4.03Diabetes 4.50 4.00 3.25 4.19 3.98LackofHealthInsurance 4.31 4.19 3.38 4.00 3.97Low-Income/Underserved

4.19 4.19 3.44 4.00 3.95

HeartDisease/Stroke 4.44 3.82 2.81 4.44 3.88SubstanceAbuse 3.56 3.88 3.63 4.19 3.81AccesstoHealthServices

4.00 3.94 3.25 3.88 3.77

OlderAdultsandAging 4.38 3.81 3.13 3.75 3.76FoodInsecurity 3.88 4.00 3.44 3.50 3.70Cancers 4.19 3.19 3.00 4.31 3.67Education 3.88 3.81 3.00 3.13 3.45Transportation 4.00 3.88 2.81 3.00 3.42Children'sHealth 4.00 3.50 3.00 3.19 3.42Economy 3.31 3.31 2.69 2.88 3.05Inadditiontoratingeachneedinthematrix,prioritizationparticipantswereaskedtoratethelevelofimportanceofMemorialHermann’s4strategicpillars.

1. ImprovingAccesstoHealthcarethroughprogramming,education,andsocialservicesupport;

2. AddressingEmotionalWell-being(mentalandbehavioralhealth)throughinnovativeaccesspoints;

3. PromotingtheimportanceofahealthydietthroughscreeningandcreatingaccesstonutritiousFoodasHealth;and,

4. FosteringimprovedhealththroughExerciseIsMedicinewithculturallyappropriateactivities.

EachoftheseintersectingpillarsconnecttoeachotherthroughvariouspointsinMemorialHermannprogramsandinitiativesadvancingthehealthofourcommunities(Figure6).

Figure6.MemorialHermann’sFourPillarsforCommunityHealth

Over93%ofparticipantsrespondedthatthe4pillarswereimportantorveryimportant.TheMemorialHermannCommunityBenefitteamreviewedthesefindings,andtakingintoaccountthealignmentoftopneedswithMemorialHermann’sstrategicfocusareas,adecisionwasmadetointegrate:

• LackofHealthInsurance,Low-Income/Underserved,andAccesstoHealthServicesintoPillar1:AccesstoHealthcare

• MentalHealthandSubstanceAbuseintoPillar2:EmotionalWell-Being• Diabetes,FoodInsecurityandHeartDisease/StrokeintoPillar3:FoodasHealth• Obesity(Exercise,NutritionandWeight)intoPillar4:ExerciseIsMedicine

Throughthissystem-wideprioritizationprocess,thefollowingfourprioritiesforMemorialHermannHealthSystemare:

• AccesstoHealthcare(addressingAccesstoHealthServices,LackofHealthInsurance,andLow-Income/Underserved)

• EmotionalWellbeing(addressingMentalHealthandSubstanceAbuse)• FoodasHealth(addressingDiabetes,FoodInsecurity,andHeartDisease/Stroke)• ExerciseIsMedicine(addressingObesity)

ThesefourhealthtopicswillbeexploredfurtherinordertounderstandhowfindingsfromthesecondaryandprimarydataanalysesresultedineachissuebeingahighpriorityhealthneedforMemorialHermannHealthSystem.

Demographics ThefollowingsectionexploresthedemographicprofileofMHGH’sservicearea,consistingofHarrisCounty.Thedemographicsofacommunitysignificantlyimpactitshealthprofile.Differentrace/ethnic,age,andsocioeconomicgroupshaveuniqueneedsandrequiredifferentapproachestohealthimprovementefforts.AlldemographicestimatesaresourcedfromtheU.S.CensusBureau’s2013-2017AmericanCommunitySurveyunlessotherwiseindicated.Furthermore,tablesinthissectionlistindicatorvaluesforthetop75%ofzipcodeswithinMHGH’sserviceareaindescendingorderofinpatientdischargesunlessotherwisenoted.

Population AccordingtotheU.S.CensusBureau’s2013-2017AmericanCommunitySurvey,HarrisCountyhadapopulationof4,652,980.Figure7illustratesthepopulationsizebycountyandTable6byzipcode.AsshowninTable6,themostpopulouszipcodesinMHGH’sserviceareaare77088and77040.

Figure7.HarrisCountyPopulation

Table6.PopulationbyZipCode

ZIPCode TotalPopulationEstimate77088 56,71677022 27,36477091 25,27777092 38,476

ZIPCode TotalPopulationEstimate77018 28,07377009 37,75177076 35,14477093 44,42877008 34,49177026 22,79977016 29,59777040 48,27377028 15,72577037 20,03877007 35,82277055 45,00377060 44,54977038 30,65377078 15,82077080 45,665

AmericanCommunitySurvey,2013-2017

Age Figure8showsMHGH’sserviceareapopulationthatisunder18yearsold.Almost27%ofHarrisCounty’spopulationisunder18.HarrisCountyhasahigherproportionofresidentsunder18comparedtothestateandnationalvalues(26%and22.6%,respectively).

Figure8.PopulationUnder18

AsshowninFigure9,HarrisCountyhasasmallerproportionsofolderadultscomparedtoTexas(12.3%)andtheU.S.(15.6%).InHarrisCounty,10.2%ofresidentsareover65.

Harris Texas U.S.

Figure9.PopulationOver65

Figure10showsthatHarrisCountyhasalargerproportionofresidentsunder5yearsold(7.7%)comparedtobothTexas(7.2%)andtheU.S.(6.1%).

Figure10.PopulationUnder5

Race/Ethnicity Theraceandethnicitycompositionofapopulationisimportantinplanningforfuturecommunityneeds,particularlyforschools,businesses,communitycenters,healthcareandchildcare.Raceandethnicitydataarealsousefulforidentifyingandunderstandingdisparitiesinhousing,employment,income,andpoverty.Figure11showstheracialcompositionofresidentsinHarrisCountywith42.2%ofresidentsidentifyingasHispanicorLatino(ofanyrace);30.6%asWhite;18.5%asBlackorAfrican

Harris Texas U.S.

7.7%7.2%

Harris Texas U.S.

American;6.8%asAsian;and1.9%asAmericanIndianandAlaskaNative,NativeHawaiianandOtherPacificIslander,“Someotherrace”,or“Twoormoreraces”.

Figure11.Race/EthnicityinHarrisCounty

Language Languageisanimportantfactortoconsiderforoutreacheffortsinordertoensurethatcommunitymembersareawareofavailableprogramsandservices.

Figure12.LanguageOtherthanEnglishSpokenatHome

Figure12showstheproportionofresidentsinHarrisCountywhospeakalanguageotherthanEnglishathome.Almost44%ofresidentsinHarrisCountyspeakalanguageotherthanEnglishascomparedto35.3%inTexasand21.3%intheU.S.Thisisanimportantconsiderationfortheeffectivenessofservicesandoutreachefforts,whichmaybemoreeffectiveifconductedinlanguagesotherthanEnglishalone.

18.5%6.8%

1.9%White,non-Hispanic

BlackorAfricanAmerican

HispanicorLatino(ofanyrace)

Harris Texas U.S.

Table7.PopulationwithDifficultySpeakingEnglishbyZipCode

ZIPCode

DifficultySpeakingEnglish

77088 27.3%77022 44.6%77091 22.7%77092 30.3%77018 13.1%77009 22.8%77076 63.9%77093 51.2%77008 5.9%77026 23.0%77016 14.7%77040 25.8%77028 9.2%77037 72.3%77007 4.7%77055 30.2%77060 55.4%77038 52.9%77078 16.9%77080 37.1%Harris 20.4%Texas 14.1%

AsshowninTable7,HarrisCountyhasalargerproportionofresidentswithdifficultyspeakingEnglish(20.4%)comparedtothestateofTexas(14.1%).InHarrisCounty,overhalfofresidentsinzipcodes77076,77093,77037,77060,and77038havedifficultyspeakingEnglish.WithinMHGH’stopzipcodesforinpatientdischarges(77088and77022),overaquarterofcommunitymembershavedifficultyspeakingEnglish.

Social and Economic Determinants of Health Thissectionexplorestheeconomic,environmental,andsocialdeterminantsofhealthinMHGH’sservicearea.Socialdeterminantsaretheconditionsinwhichpeopleareborn,grow,work,live,andage,andthewidersetofforcesandsystemsshapingtheconditionsofdailylife.

Income Medianhouseholdincomereflectstherelativeaffluenceandprosperityofanarea.Areaswithhighermedianhouseholdincomesarelikelytohaveagreatershareofeducatedresidentsandlowerunemploymentrates.Figure13comparesthemedianhouseholdincomevaluesforHarrisCountytothemedianhouseholdincomevalueforTexasandtheU.S.Asshown,HarrisCounty’smedianhousehold

income($57,791)isslightlyhigherthanthestateandnationalvalues($57,051and$57,652,respectively).

Figure13.MedianHouseholdIncome

AsdisplayedinTable8,MHGH’stopzipcodesforinpatientdischargesrevealarelativelylowrangeinmedianhouseholdincome.Thetopfourzipcodesallhavemedianhouseholdincomeslowerthanthestatevalue($57,051),rangingbetween$30,164inzipcode77022and$44,472inzipcode77088.

Table8.MedianHouseholdIncomebyZipCodeZIPCode MedianHousehold

Income77088 $44,47277022 $30,16477091 $32,50077092 $39,92177018 $81,56577009 $49,38377076 $34,84277093 $30,83777008 $97,69077026 $26,64477016 $32,30277040 $55,43877028 $30,233

$57,791

$57,051

$57,652

$56,600

$56,800

$57,000

$57,200

$57,400

$57,600

$57,800

$58,000

Harris Texas U.S.

ZIPCode MedianHouseholdIncome

77037 $41,49177007 $121,45877055 $52,26977060 $28,94877038 $41,34777078 $35,77077080 $44,386Harris $57,791Texas $57,051

Poverty FederalpovertythresholdsareseteveryyearbytheCensusBureauandvarybysizeoffamilyandagesoffamilymembers.Ahighpovertyrateisbothacauseandaconsequenceofpooreconomicconditions.Figure14showstheproportionofresidentslivingbelowthepovertylevelinHarrisCountycomparedtothestateandtheU.S.ThepercentageofresidentslivingbelowthepovertylevelinHarrisCountyis16.8%,whichishigherthanthenationalvalue(14.6%)andslightlyhigherthanthestatevalue(16.0%).

Figure14.PeopleLivingBelowPovertyLevel

Figure15showstheproportionofresidentslivingbelowthepovertylevelbyrace/ethnicity.InHarrisCounty,22.6%ofHispanicorLatinoresidentsand21.8%ofBlackorAfricanAmerican

Harris Texas U.S.

residentslivebelowthepovertylevel,comparedto7%Whiteand11.4%Asianresidents.ThepercentageofBlackandAsianresidentslivingbelowthepovertylevelinHarrisCountyishigherthanthestatevaluesforBlackandAsianresidents.

Figure15.PeopleLivingBelowPovertyLevelbyRace/Ethnicity

Figure16.PeopleLivingBelowPovertyLevelbyZipCode

White,non-Hispanic BlackorAfricanAmerican

Asian HispanicorLatino

Harris Texas U.S.

ThepovertyrateinHarrisCounty(16.8%)issimilartotheTexasvalue(16.0%)(Table9.)AsshowninFigure16andTable9,withinMHGH’sservicearea,over30%ofresidentsinzipcodes77076,77093,77026,and77060arelivingbelowthepovertylevel.MHGH’stopzipcodesforinpatientdischarges,77088and77022,haveover20%ofresidentslivingbelowthepovertylevel.

Table9.PeopleLivingBelowPovertyLevelbyZipCodeZIPCode PeopleLivingBelow

PovertyLevel

77088 21.0%77022 29.6%77091 28.5%77092 26.5%77018 17.5%77009 24.3%77076 33.7%77093 36.6%77008 6.0%77026 38.8%77016 26.1%77040 13.2%77028 28.0%77037 26.3%77007 6.0%77055 22.8%77060 37.1%77038 25.8%77078 21.9%77080 25.1%Harris 16.8%Texas 16.0%

Food Insecurity TheSupplementalNutritionAssistanceProgram(SNAP)isafederalassistanceprogramthatprovideslow-incomefamilieswithelectronicbenefittransfers(EBTs)thatcanbeusedtopurchasefood.Thegoaloftheprogramistoincreasefoodsecurityandreducehungerbyincreasingaccesstonutritiousfood.Table10showsthepercentofhouseholdswithchildrenthatparticipateinSNAPinthezipcodeswithinMHGH’sservicearea.HarrisCountyhasaslightlyhigherproportionofhouseholdswithchildrenreceivingSNAP(67.7%)comparedtothestateofTexas(64.3%).WithinMHGH’stoptenzipcodesforinpatientdischarges,77092,77076,and77093allhaveproportionshigher

than70%.Furthermore,zipcodes77037,77038,and77080allhavemorethan80%ofhouseholdswithchildrenreceivingSNAP.

Table10.HouseholdswithChildrenReceivingSNAPbyZipCodeZIPCode HouseholdswithChildren

ReceivingSNAP77088 67.8%77022 52.7%77091 50.8%77092 71.4%77018 49.0%77009 58.7%77076 77.4%77093 71.6%77008 34.6%77026 49.2%77016 57.4%77040 65.6%77028 41.6%77037 81.7%77007 15.4%77055 72.4%77060 77.3%77038 81.1%77078 74.0%77080 81.3%Harris 67.7%Texas 64.3%

Unemployment Theunemploymentrateisakeyindicatorofthelocaleconomy.Unemploymentoccurswhenlocalbusinessesarenotabletosupplyenoughappropriatejobsforlocalemployeesand/orwhenthelaborforceisnotabletosupplyappropriateskillstoemployers.Ahighrateofunemploymenthaspersonalandsocietaleffects.Duringperiodsofunemployment,individualsarelikelytofeelsevereeconomicstrainandmentalstress.Unemploymentisalsorelatedtoaccesstohealthcare,asmanyindividualsreceivehealthinsurancethroughtheiremployer.Ahighunemploymentrateplacesstrainonfinancialsupportsystems,asunemployedpersonsqualifyforunemploymentbenefitsandfoodstampprograms.Figure17displaystherateofunemploymentinHarrisCountybetweenMay2017andNovember2018.Althoughtheunemploymentratehasexhibitedadecrease,itremainshigher(3.8%)comparedtothestateandnationalrates(both3.5%)inNovember2018.

Figure17.UnemploymentRateperCounty(U.S.BureauofLaborStatistics,2017-2018)

Education Graduatingfromhighschoolisanimportantpersonalachievementandisessentialforanindividual’ssocialandeconomicadvancement.Graduationratescanalsobeanimportantindicatoroftheperformanceofaneducationalsystem.Havingabachelor’sdegreeopensupcareeropportunitiesinavarietyoffieldsandisoftenaprerequisiteforhigher-payingjobs.Figure18displaystheproportionofresidentsinHarrisCountywhoare25yearsandolderwithatleastahighschooldegree.Approximately80%ofresidents25yearsandolderinHarrisCountyhaveatleastahighschooldegree,whichislowerthantheU.S.(87.3%)andTexas(82.8%).

Figure18.People25+withaHighSchoolDegreeorHigher

4.3% 4.3%3.8%

3.7% 3.7% 3.5%

4.1% 3.9%3.6% 3.5%

May2017 November2017 May2018 November2018

Harris Texas UnitedStates

Harris Texas U.S.

Figure19showstheproportionofresidentsinHarrisCountywhoare25yearsandolderwithabachelor’sdegreeorhigher.Theproportionofresidents25andolderwithabachelor’sdegreeinHarrisCounty(30.5%)ishigherthantherateinTexas(28.7%)andsimilartotheratefortheentireU.S.(30.9%).

Figure19.People25+withaBachelor'sDegreeorHigher

Table11displaystheeducationalattainmentindicatorsforresidents25yearsandolderbyzipcodeinMHGH’sservicearea.Forhighschooldegreeattainment,thezipcodewiththehighestrateis77007(95.5%)andthezipcodewiththelowestrateis77037(44.0%).Similarly,forattainmentofabachelor’sdegree,thezipcodewiththehighestrateis77007(74.8%)andthezipcodewiththelowestrateis77037(2.8%).ThezipcodeswithhighestproportionsofMHGHinpatientdischarges,zipcodes77088and77022,havemorethan55%ofpeople25yearsandolderwithahighschooldegree.However,lessthan14%ofresidents25yearsandolderhaveabachelor’sdegreeorhigherinthesetwozipcodes.

Table11.People25+withaHighSchoolDegreeandPeople25+withaBachelor'sDegreebyZipCodeZIPCode HighSchoolDegreeor

HigherBachelor’sDegreeorHigher

77088 70.9% 13.5%77022 55.7% 6.6%77091 74.2% 14.1%77092 73.4% 16.6%77018 85.0% 47.2%77009 70.2% 29.6%77076 52.1% 3.9%77093 48.7% 3.2%77008 93.0% 61.9%77026 62.5% 7.5%77016 71.9% 9.3%77040 78.6% 27.6%

Harris Texas U.S.

ZIPCode HighSchoolDegreeorHigher

Bachelor’sDegreeorHigher

77028 74.5% 7.7%77037 44.0% 2.8%77007 95.5% 74.8%77055 72.5% 33.9%77060 55.1% 6.1%77038 55.7% 8.1%77078 69.6% 9.7%77080 67.6% 17.3%Harris 80.5% 30.5%Texas 82.8% 28.7%

Transportation Therearenumerouswaysinwhichtransportationmayinfluencecommunityhealth.Publictransportationoffersmobility,particularlytopeoplewithoutcars.Transitcanhelpbridgethespatialdividebetweenpeopleandjobs,services,andtrainingopportunities.Publictransportationalsoreducesfuelconsumption,minimizesairpollution,andrelievestrafficcongestion.Walkingtoworkhelpsprotecttheenvironment,whilealsoprovidingthebenefitofdailyexercise.

Figure20.HouseholdsWithoutaVehiclebyZipCode

Figure20showsthepercentageofhouseholdswithoutavehiclewithinMHGH'sservicearea.Asshown,morethan13%ofhouseholdsinzipcodes77022,77026and77091donothaveavehicle.

Table12.ModesofCommutingbyZipCode

ZIPCode CommutebyWalking

CommutebyBiking CommutebyDrivingAlone

CommutebyPublicTransportation

77088 0.5% 0.1% 79.1% 3.9%77022 2.0% 0.6% 78.2% 3.8%77091 0.9% 0.3% 79.8% 6.2%77092 1.7% 0.1% 76.5% 2.5%77018 0.5% 0.5% 82.6% 1.6%77009 3.7% 0.7% 72.9% 3.9%77076 1.3% 0.4% 77.0% 2.5%77093 0.9% 0.2% 76.5% 2.1%77008 1.5% 0.5% 81.8% 2.3%77026 1.9% 0.0% 70.6% 8.1%77016 1.4% 0.0% 80.1% 4.0%77040 1.4% 0.1% 81.8% 1.6%77028 0.9% 0.0% 78.3% 4.8%77037 2.1% 0.2% 80.9% 1.4%77007 0.9% 0.4% 83.9% 2.4%77055 2.9% 0.5% 70.4% 4.0%77060 2.3% 0.2% 71.7% 5.2%77038 0.8% 0.2% 82.6% 1.7%77078 0.2% 0.0% 78.4% 6.0%77080 3.1% 0.7% 71.5% 2.7%Harris 1.5% 0.3% 79.3% 2.7%Texas 1.6% 0.3% 80.5% 1.5%

Table12displaysthedifferentmodesofcommutingusedbyresidentsofHarrisCounty.InHarrisCounty,1.5%ofresidentscommutebywalkingand0.3%commutebybiking.Themajorityofresidents(79.3%)commutebydrivingalone,whichissimilartothestatevalue(80.5%).PublictransportationisusedbyHarrisCountyresidents(2.7%)moresothanthestateofTexasasawhole(1.5%).ConsideringthetoptenzipcodesforinpatientdischargeswithinMHGH’sservicearea,zipcodes77091and77026havethehighestproportionsofresidentscommutingbypublictransportation(6.2%and8.1%,respectively).

SocioNeeds Index® ConduentHealthyCommunitiesInstitutedevelopedtheSocioNeedsIndex®toeasilycomparemultiplesocioeconomicfactorsacrossgeographies.Thisindexincorporatesestimatesforsixdifferentsocialandeconomicdeterminantsofhealth–income,poverty,unemployment,occupation,educationalattainment,andlinguisticbarriers–thatareassociatedwithpoorhealthoutcomesincludingpreventablehospitalizationsandprematuredeath.

Zipcodeswithineachcountyareassignedanindexvaluefrom0(lowneed)to100(highneed),basedonhowthosezipcodescomparetoothersintheU.S.Withineachcounty,thezipcodesarethenrankedfrom1(lowneed)to5(highneed)toidentifytherelativelevelofneed.Zipcodeswithpopulationsunder300personsareexcluded.

Figure21.SocioNeedsIndexbyZipCode

AsshowninFigure21andTable13,themajorityofzipcodes(13outof20)withinMHGH’sserviceareahaveSocioNeedsIndexvaluesgreaterthan95.ThezipcodeswiththelargestproportionofinpatientdischargesatMHGH,zipcodes77088and77022,haveSocioNeedsIndexvaluesof95.6and98.6,respectively.

Table13.SocioNeedsIndexbyZipCode(InOrderofSocioNeedsIndexValue)ZIPCode SocioNeedsIndexValue77060 99.577093 99.3

ZIPCode SocioNeedsIndexValue77076 99.177026 98.977037 98.977022 98.677038 97.677028 96.977078 96.677016 96.377080 95.677088 95.677091 95.577092 93.477009 90.277055 82.677040 71.877018 28.177008 7.877007 4.6

ConduentSocioNeedsIndex,2019

Data Synthesis Allformsofdatahavetheirownstrengthsandlimitations.TogainacomprehensiveunderstandingofthesignificanthealthneedsforMemorialHermannHealthSystem,thefindingsfromboththeprimarydataandthesecondarydatawerecomparedandstudiedtogether.Thesecondarydata,keyinformantinterviewsandcommunitysurveyweretreatedasthreeseparatesourcesofdata.Thesecondarydatawereanalyzedusingdatascoring,whichidentifiedhealthareasofneedbasedonthevaluesofindicatorsforeachtopicarea(AppendixB).Table14displaysthedatascoresforHealthandQualityofLifeTopicsforHarrisCounty.

Table14.HarrisCountyTopicScoresTopic ScoreTransportation 1.82Women'sHealth 1.81Immunizations&InfectiousDiseases 1.78OtherChronicDiseases 1.78PublicSafety 1.65Maternal,Fetal&InfantHealth 1.64Prevention&Safety 1.58SocialEnvironment 1.58Education 1.56Economy 1.55HeartDisease&Stroke 1.54Children'sHealth 1.52OlderAdults&Aging 1.50AccesstoHealthServices 1.48Exercise,Nutrition,&Weight 1.48Wellness&Lifestyle 1.42Men'sHealth 1.38Diabetes 1.34Environment 1.34SubstanceAbuse 1.33Cancer 1.31MortalityData 1.29MentalHealth&MentalDisorders 1.26RespiratoryDiseases 0.99

Thismethodologywasappliedtoeachofthe12countieswithinMemorialHermannHealthSystem’sprimaryserviceareaandthendatascorescalculatedfortheregioninordertodeterminesignificanthealthneedsacrossthesystem.Table15liststheresultingdatascoresforHealth&QualityofLifeTopics.

Table15.MemorialHermannRegionTopicScoresTopic ScoreTransportation 1.84HeartDisease&Stroke 1.82AccesstoHealthServices 1.79OlderAdults&Aging 1.60Exercise,Nutrition,&Weight 1.56OtherChronicDiseases 1.52MentalHealth&MentalDisorders 1.50Children'sHealth 1.47Immunizations&InfectiousDiseases 1.43Education 1.43Women'sHealth 1.42SocialEnvironment 1.42Wellness&Lifestyle 1.41Maternal,Fetal&InfantHealth 1.41RespiratoryDiseases 1.41Economy 1.41Environment 1.40PublicSafety 1.36Cancer 1.31Prevention&Safety 1.26SubstanceAbuse 1.23Men'sHealth 1.21

Theanalysisofkeyinformantinterviewsoccurredusingthequalitativesoftware:Dedoose1.Forthecommunitysurvey,HCIperformedasimplereviewandanalysistoidentifytophealthneeds.Overall,eachmethodproducedindividualresultsthatrepresentthecommunityinputinthisreport.Thisconsolidatedinputleadstotheprioritizedheathneedsinthisreport.ThistriangulatedapproachisshowninFigure22.

Figure22.VisualofDataSynthesisApproach

SignificantHealthNeeds

HealthIndicatorData

(DataScoringAnalysis)

KeyInformantInterviews(Thematic

CodingAnalysis)CommunitySurvey

(ThematicAnalysis)

TheteamusedthetriangulatedapproachtoidentifysignificanthealthneedsforMemorialHermannHealthSystem.Figure23displaystheresultsofthissynthesis.Formanyofthehealthtopicsevidenceofneedwaspresentacrossmultipledatasources,includingObesity,MentalHealth,AccesstoHealthServices,Transportation,andUninsured.Forotherhealthtopicstheevidencewaspresentinjustonesourceofdata,howeveritshouldbenotedthatthismaybereflectiveofthestrengthandlimitationsofeachtypeofdatathatwasconsideredinthisprocess.

Figure23.DataSynthesisResults

Priorit ized Signif icant Health Needs

Priorit ization Results Uponcompletionoftheonlineprioritizationsurvey,fourhealthareaswereidentifiedforsubsequentimplementationplanningbyMemorialHermannHealthSystem.Thesefourhealthprioritiesare:AccesstoCare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.ThefollowingsectionwilldivedeeperintoeachofthesehealthtopicsinordertounderstandhowfindingsfromthesecondaryandprimarydataledtoeachhealthtopicbecomingapriorityhealthissueforMemorialHermannHealthSystem.Foreachprioritizedhealthneed,keyissuesaresummarized;secondarydatascoresarenotedforindicatorsofconcern;andcommunityinputisdescribed.

Access to Healthcare

Secondary Data AccesstoHealthServices,LackofInsuranceandLow-Income/UnderservedwereidentifiedassignificantneedsforMemorialHermannHealthSystem.AsshowninTable16,thereareseveralindicatorsrelatedtoAccesstoHealthServiceswithdatascoresequaltoorgreaterthan1.75.InHarrisCounty,indicatorsofconcerninclude:AdultsUnabletoAffordtoSeeaDoctor,AdultswithHealthInsurance,ChildrenwithHealthInsurance,andPersonswithHealthInsurance.Over22%ofHarrisCountyadultsareunabletoaffordtoseeadoctor,whichishigherthantheproportioninTexas(18.3%)andtheU.S.(12.1%).Moreover,approximately20%ofresidentsinHarrisCountydonothavehealthinsurance.

KeyIssues:• Rangeofbarriers,includingtransportation,accesstospecialtycare,lackofawareness,and

fearorstigma• Lackofhealthinsurance• Lowincomeandvulnerablegroups

SecondaryDataScoringMethodologyForeachindicator,eachcountyinMHGH’sserviceareawasassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariedbyindicatorandwasdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.PleaseseeAppendixBforfurtherinformationonHCIDataScoringmethodology.

Table16.SecondaryDataScoringResults:AccesstoHealthServices

County CountyValueComparedto:

Indicator Name Value DataScore

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

AdultsUnabletoAffordtoSeeaDoctor

[10](2015)Harris

22.12 1.5 3 3 1.5 1.5

percent

[10]TexasBehavioralRiskFactorSurveillanceSystem

AdultswithHealthInsurance:18-64[9]

(2016)Harris

74.71.75 2 2 1.5 3 0

percent

ChildrenwithHealthInsurance[9](2016) Harris

89.41.81 1 2 1.5 3 1

percent

PersonswithHealthInsurance[9](2016)

Harris79.3

1.75 2 2 1.5 3 0percent

[9]SmallAreaHealthInsuranceEstimates

PrimaryCareProviderRate[4](2015) Harris

57.21.61 0 2 3 1.5 2providers/100,000

population[4]CountyHealthRankings

WhenconsideringAccesstoHealthServices,itisimportanttotakeintoaccounttheeconomyandhowfinancialbarriersimpactcommunityresidents’abilitytoaccesscare.AsshowninTable17,thereareseveraleconomicindicatorswithdatascoresgreaterthan2inHarrisCounty.Economicindicatorsofconcern,including:Homeownership,SevereHousingProblems,StudentsEligiblefortheFreeLunchProgram,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,SNAPCertifiedStores,MedianHouseholdGrossRent,FamiliesLivingBelowPovertyLevel,andFoodInsecurityRate.Lessthan50%ofHarrisCountyresidentsownahome.Over20%ofresidentsinHarrisCountyhaveseverehousingproblems.Andmorethan58%ofstudentsareeligibleforthefreelunchprogramcomparedtothenationalvalueof42.6%.InHarrisCounty,thereareover14%offamilieslivingbelowthepovertylevelcomparedto13%inTexasand11%intheU.S.

Table17.SecondaryDataScoringResults:Economy

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

ChildFoodInsecurityRate[5](2016) Harris 23.5

percent 1.67 1 2 3 1.5 0

[5]FeedingAmerica

ChildrenLivingBelowPovertyLevel[1](2012-2016)

Harris 26.0percent 1.67 2 2 3 1.5 0

[1]AmericanCommunitySurveyFamiliesLivingBelowPovertyLevel[1](2012-2016)

Harris 14.4percent

2.06 2 3 3 1.5 1

[1]AmericanCommunitySurvey

FoodInsecurityRate[5](2016) Harris

16.6percent 2.06 2 2 3 1.5 1

[5]FeedingAmerica

Homeownership[1](2012-2016)

Harris 49.6percent

2.44 3 2 3 1.5 2

[1]AmericanCommunitySurveyMedianHouseholdGrossRent[1](2012-

2016)Harris 937

dollars 2.08 3 2 1 1.5 3

[1]AmericanCommunitySurveyMedianMonthlyOwnerCostsfor

HouseholdswithoutaMortgage[1](2012-

Harris 534dollars

2.14 3 3 3 1.5 1

[1]AmericanCommunitySurveyMortgagedOwnersMedianMonthly

HouseholdCosts[1](2012-2016)

Harris1504dollars 1.81 3 2 2 1.5 1

[1]AmericanCommunitySurveyPeople65+Living

BelowPovertyLevel[1](2012-2016)

Harris 11.3percent

1.89 2 2 3 1.5 1

[1]AmericanCommunitySurveyPeopleLivingBelowPovertyLevel[1](2012-2016)

Harris17.4

percent 1.67 2 2 3 1.5 0

[1]AmericanCommunitySurveySevereHousing

Problems[4](2010-2014)

Harris20.9

percent 2.39 3 3 3 1.5 1

[4]CountyHealthRankings

SNAPCertifiedStores[17](2016)

Harris0.6

stores/1,000population

2.11 3 1.5 1.5 1.5 2

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlasStudentsEligiblefor

theFreeLunchProgram[8](2015-

Harris 58.2percent

2.22 2 3 3 1.5 1

Primary Data Duringthekeyinformantinterviewprocess,AccesstoHealthServiceswasdiscussedover160timesandwasraisedbyparticipantsalmost50timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengeswerelimitationstoprocuringspecialtycareservices,transportationtoservicesandhoursofoperation.Inadditiontotheprimarythemes,twoadditionalbarriersorchallengesstoodoutaskeyfactorsimpactingaccesstohealthcareservices,lackofknowledgeandstigmaorfearpreventingpeoplefromseekingcare.Theissuethatinterviewparticipantsweremostconcernedwithwaspatientsbeingabletoaccessfollowupcarewithspecialtycareproviders.Multipleparticipantsraisedconcernsthatevenifpatientsareabletoaccesspreventativeorprimarycareservices,theymaynotbeabletoaccesstheappropriatefollowupcarewithaspecialtycareprovider.Someparticipantsraisedthisconcernincontextofpatientsnotlivingnearaspecialistandothersraisedincontextofpatientsnotbeingabletoaffordthecostoffollowupcare.Aconcernbroughtupbyafewparticipants,thatforseriouschronicconditions,patientswouldultimatelyendupseekingcarefromemergencyservicesinstead.Anothercommonconcernraisedbyinterviewparticipantswastransportationtoservicesandhoursofoperationofserviceslimitingpatients’accesstocare.Participantsdescribedhowthesefactorsdeterminewhetherpatientsdecidetotakeofffromworkandseekservicesinthefirstplace.Afewparticipantsdescribedthemanyservicesandresourcesthatareavailabletothecommunitybutthatmanymaynotbeawarehowtheycanaccessorbenefitfromthem.Oneparticipantdescribedresourcesbeingconcentratedincertaingeographicareasandmoreremotelocationsnotbeingwellconnectedorknowledgeableabouthowtheymayalsobenefitfromtheseresources.Participantsdescribedthepotentialformorecollaborationandpartnershiptoconnectcommunitiestooneanother.Severalparticipantsdescribedadown-turninpeopleseekingpreventativecareserviceandhypothesizedthatoneofthefactorsmayberelatedtotheimmigrantcommunityintheregionexperiencingfearorstigmarelatedtohavingtoshowidentificationorproofofcitizenship.

[8]NationalCenterforEducationStatisticsTotalEmploymentChange[16](2014-

2015)Harris

2.4percent 1.67 1 3 2 1.5 1.5

[16]U.S.Census-CountyBusinessPatternsUnemployedWorkersinCivilianLaborForce

[15](July2018)Harris 4.4

percent 1.94 2 2 2 1.5 2

[15]U.S.BureauofLaborStatistics

“EventhoughweattheHealthDistrictdonotaskforproofofimmigrationstatus,peopledon'tunderstandthat,particularlysincewe'reagovernmentagency,andit'sbeenarealchallengetogetsomeofthesefolkstocomeinforservices.”Therewerealmost80referencestotheuninsuredpopulationinthekeyinformantinterviewsandlackofhealthinsurancewasraisedasabarrierorchallengetoachievinghealthinthecommunity19times.Lackofhealthinsurancewasmostoftenbroughtupincontextofpatientshavinglimitedfinancialresourcesandafactortonotaccessinghealthcareservices.Participantsdiscussedpatientsnothavingtheabilitytopayfeesformultipleappointmentco-paysornotseekingcareduetocompetingfinancialpriorities.Whilehealthcareservicesmaybeavailableinthecommunity,forthosewhoarelackinghealthinsurance,accessinghealthcareservicesisnotnecessarilyanoption.Lackofhealthinsurancecreatesaparticularchallengeforthosewhorequirespecialtycareservices.“Ithinkthosearethebiggesttwo—access,again,withthemajorityofouradultpopulationbeinguninsured,havingthemtrytofindaproviderthat,again,willtakeslidingfeescale,orreducedrates.Oncethey'reabletoaccessthoseservices,thenitbecomesamatterofpayingforthethingsthatareneeded.Thepatientcomesinandwediagnosethemwithdiabetes,thencomesthecostofmedications,andifthatpatientisneedingspecialtycareoutsideofthescopeofprimarycare,accesstospecialists.”Participantsbroughtupissuesrelatedtolowincomeorgroupswhomaybeunderservedinthecommunity115timesduringthekeyinformantinterviewprocess.Particulargroupsthatparticipantsfeltmayexperienceaddedchallengesaccessinghealthcareservicesincludedtheimmigrantpopulation,individualswithdisabilities,familieswithyoungchildren,andtheelderly.Severalparticipantsraisedfeesrelatedtoco-paysoroutofpocketexpensesasabarriertopatientsseekinginitialpreventativeservicesorongoingtreatmentforchronicconditions.Participantsidentifiedseveralgroupstheyfeltwereunderservedinthecommunity.Multipleparticipantsdiscussedtheuniqueandspecificchallengeswithprovidingculturallyappropriatecareforadiverseandrecentimmigrantpopulationinthecommunity.Participantsfeltthatfamilieswithyoungchildrenandtheelderlypopulationareparticularlyvulnerablegroupsinthecommunitythatexperiencebarriersandchallengesaccessinghealthcareservices.Specifically,participantsdiscussedthesegroupsexperiencinghighlevelsofpovertyplacingthemathigherriskforpoorhealthoutcomes.“Mostofthemareextremelylowincomeandtheyfallinthosecategorieswherewehaveasignificantnumberofelderlydisabled,singlemomsandtheirchildren,sovulnerablefolkshereinHouston.”

Emotional Well-Being

KeyIssues:• Mentalhealthaspartofoverallhealth• Needformorebehavioralhealthservicesandproviders• Alcoholandsubstanceabuse• Alzheimer’sanddementia

Secondary Data MentalHealthandSubstanceAbusewereidentifiedassignificantneedsforMemorialHermannHealthSystem.AsshowninTable18,thereareseveralindicatorsrelatedtoMentalHealth&MentalDisorderswithdatascoresgreaterthan1.5.InHarrisCounty,11.4%oftheMedicarePopulationhasAlzheimer’sDiseaseorDementia,whichishigherthantheU.S.value(9.9%).Moreover,80%ofresidentsinHarrisCountyreportedhaving5ormorepoormentalhealthdaysinthepastmonth.

Table18.SecondaryDataScoringResults:MentalHealth&MentalDisorders

Indicator Name ValueDataScore

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

Alzheimer'sDiseaseorDementia:MedicarePopulation[3](2015)

Harris11.4

1.89 2 1 3 1.5 1percent

[3]CentersforMedicare&MedicaidServices

PoorMentalHealth:5+Days[4](2016)

Harris80.0

1.53 1.5 1 1.5 1.5 2percent

SubstanceAbuseisanothertopicofconcerninHarrisCounty.Theproportionofalcohol-impaireddrivingdeathsishigherthanthestateandtheU.S.Therewere37.8%alcohol-impaireddrivingdeathsinHarrisCounty,comparedto28.3%and29.3%inTexasandtheU.S.,respectively(Table19).

Table19.SecondaryDataScoringResults:SubstanceAbuse

TXCounties

TX US HP2020Target

TrendOverTimeValue Value

Alcohol-ImpairedDrivingDeaths[4]

(2012-216)Harris

37.82.17 3 3 3 1.5 0

percent

Primary Data Approximately50%ofcommunitysurveyrespondentscitedMentalHealthasoneofthetopissuesmostaffectingthequalityoflifeintheircommunityand52%ofrespondentsnotedSubstanceAbuse.Ininterviewswithkeyinformants,MentalHealthwasdiscussed113timesandwasraisedbyparticipants33timesasaneedsorconcernforthehealthofthecommunity.TheprimarythemesrelatedtoMentalHealthweretreatingmentalhealthaspartofoverallhealth,addressbehavioralhealthinschool,needforbehavioralhealthprovidersandservicesandolderadultswithAlzheimer’sanddementia.

Someparticipantsdiscussedarecentshiftincaredeliveryandthecontinuedneedtoaddressmentalhealthaspartofaperson’stotalhealthsimilarlytohowchronicdiseaseismanaged.Oneparticularlyvulnerablepopulationthatwouldbenefitfromabroaderapproachtotreatment,inclusiveofmentalhealth,isthehomelesspopulation.Severalparticipantsbroughtupissuesregardinganeedformorebehavioralhealthprovidersandservicesinthecommunity.“(…)Ithinkthereneedstobemoreworkaroundfundingforbehavioralhealthbutalsofundingforrecruitingandtrainingtherapistsandbehavioralhealthspecialiststoaddresssubstanceabuse,anxiety,depressionandsuicidality.”Oneparticipantobservedrecentincreasesandchangeswithinthelocalpopulation.Fromtheparticipant’sperspective,thereshouldbemoreprogramsorservicestoaddressthegrowingneedforaddressingmentalhealthinthecommunity.Anotherparticipantsuggestedsolutionsforaddressingtheneedformorebehavioralhealthprovidersinthecommunitysuchasexpandingresidencyprogramsforpsychiatristsanddevelopingcomprehensivetelemedicineprogramstoprovideservicesmoreefficiently.Furthermore,participantsrecommendedaddressingbehavioralhealthwithyoungerpopulationsintheschools.Schoolsthatprovidebehavioralhealthservicesthroughtelemedicinehavebeenreceivedwellinthecommunityandtheperceptionisthattheyareeffective.Someparticipantsbelievethattheseprogramsshouldbeexpandedandavailableacrossthecommunity.“There[are]thementalhealthunitsthathavegoneoutintotheschools.They'renotschool-basedbutthat’sthevenuetheywilldrivetowiththeirmobileunits.Theyhaveabigimpact.They'reseeingthousandsofkids.They’vedonesometelemedicinewithmentalhealth,behavioralhealth,withsomeofthehighschools.FromwhatI’veheard,(…)it’sbeenprettyeffectiveandwellreceived.”AchallengethathealthcareprovidersidentifiedforthemedicalcommunityisadequatelyaddressingdementiaandAlzheimer’swithinthegeriatricpopulation.“Dementia’saterminalillness.(…)Muchmoreneedstobedonewithhealthcaresystemsaroundroutinescreeningandidentificationofitasanissue.(…)So,thatisthefirstthingthatneedstohappen.Thenthereneedstobeanunderstandingthattherearethings–therearemedicationsthatcanbehelpfultothesystemsofthedementia.(…)Butyoucanaffectitbyaddressingsomeofthesymptoms.”SubstanceAbusewasdiscussed55timesandwasraisedbyparticipants15timesasaneedorconcernforthehealthofthecommunity.MultipleuniquethemesemergedfromthekeyinformantinterviewsrelatedtoSubstanceAbuse:fundingfortreatmentprograms,invisibilityofalcoholism,overcomingstigmaofseekingtreatment,andemergingshiftsinoutreachmodels.Participantsidentifiedfundingforprogramsandavailabilityofservicesforthosewhomaynotbeabletoaffordtreatmentout-of-pocketasissuesthecommunityisfacingtoaddresssubstanceabuse.Oneparticipantraisedalcoholabusespecificallyasanissueinthecommunitythatdoesnotgettheamountofattentionofothersubstanceabusetopicsbutmayinfactbeimpactingalargerproportionofthepopulationandconnectedtomanyotherhealthissues.

Multipleparticipantsidentifiedculturalstigmaasabarrierforthosewhomaybenefitfromseekingtreatment.Stigmaorfearmaybeuniqueandvaryfrompopulationtopopulationinthecommunity.“Withsubstanceabuse,it’scultureandstigma.Nobodygoestosubstanceabusetreatmentontheirown.Theymaynotbeadjudicatedbutsomeoneisreally,reallypushingthem,familymember,boss.Noonegoestotreatmentifthey’renotunderduress.”Afewparticipantsdescribeduniqueapproachestooutreachandsubstanceabusetreatmentinthecommunitythatwouldsupportremovingbarriersforpeoplehavingtotakethefirststepontheirown.“Forinstance,it’sprettynew,butthere’saninitiativethat’scalledtheHeroesProjectthat’slookingatoverdoses,sowhenanoverdosehappens,they’resendingateamtotheER.So,it’sgotapeersupportspecialist,theEMPisinvolved–buttheyactuallygointotheERandtheydoaninterventiontheretotrytohelpwithlinkagetotreatmentsothatwecanassistthepatients.”

Food as Health

Secondary Data ThetopicsofDiabetesandHeartDisease&Strokeemergedassignificanthealthneeds.HeartDisease&StrokerosetothetopofthesecondarydatascoringresultsforMemorialHermannHealthSystem.AlthoughDiabeteswasnotinthetopresultsofthesecondarydatascoring,anindicatorofconcernforHarrisCountyistheproportionofdiabetesintheMedicarepopulation,which,at28.1%,ishigherthanthenationalvalue(26.5%)(Table20).

Table20.SecondaryDataScoringResults:Diabetes

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

Diabetes:MedicarePopulation[3](2015) Harris

28.11.67 2 1 2 1.5 1.5

percent

AsshowninTable21,anotherindicatorofconcernisStrokeintheMedicarePopulationwithaproportionof5.2%inHarrisCounty,comparedto4%intheU.S.

KeyIssues:• Foodinsecurityandlimitedaccesstohealthyfoods• Diabetesandheartdiseaselinkedtosocioeconomicfactors• Sedentarylifestyleanddrivingculture

Table21.SecondaryDataScoringResults:HeartDisease&Stroke

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

HeartFailure:MedicarePopulation

[3](2015)Harris

16.0percent 1.89 1 2 3 1.5 1

Stroke:MedicarePopulation[3](2015)

Harris 5.2percent

2.61 3 3 3 1.5 2

Table22revealsfood-relatedindicatorsofconcern,includingSNAPCertifiedStoresaswellasFoodInsecurityRate.

Table22.SecondaryDataScoringResults:Nutrition

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

ChildFoodInsecurityRate[5](2016) Harris

23.51.67 1 2 3 1.5 0

percent

[5]FeedingAmerica

FastFoodRestaurantDensity[17](2014) Harris

0.71.67 2 1.5 1.5 1.5 1.5restaurants/1,000

population[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

FoodInsecurityRate[5](2016)

Harris16.6

2.06 2 2 3 1.5 1percent

[5]FeedingAmerica

SNAPCertifiedStores[17](2016) Harris

0.62.11 3 1.5 1.5 1.5 2stores/1,000

Primary Data Food-relatedtopicsemergedinthecommunityinputgatheredthroughthesurveyandkeyinformantinterviews.FoodInsecurity,FoodProgramsandFoodKnowledgeissueswerediscussedover170timesduringthekeyinformantinterviewsandwereraisedbyparticipants34timesinrelationtobarriersorchallengestoachievinghealthinthecommunity.Theprimarythemesrelatedtobarriersorchallengesthatemergedintheinterviewswereaccesstohealthyfoodsandaffordability,knowledgegapsandlimitedfoodfamiliarityandprogramlimitations.

Themostcommonissueraisedbykeyinformantparticipantsrelatedtofoodinsecuritywascommunitymembersnotbeingabletoaccesshealthyfoodsintheircommunity.Multipleparticipantsbelievedthatinmanycommunities,healthyfoodoptionswerenotavailabletopeoplewithinafive-mileradiusfromtheirhomeorwork.Participantsdescribed‘fooddeserts’asatopissueaffectinghealthinthecommunityandhowlimitedaccesstohealthyfoodsalsowascloselyassociatedwithpeoplealsobeingnotbeingabletoaffordhealthyfoods.Participantsalsodiscussedtheimbalanceofhealthyfoodoptionsforthosecommunitieswithlowerhousingpricesandingeneral,loweraverageincomes.Oneparticipantdescribedthelinkbetweenpeoplesecuringaffordablehousinginthecommunity,whichmaylimittheiroptionsforaccesstohealthyfoodchoices.

“Wehaveagrocerystoreoneverycornerbutnoteverycornerinthepoorneighborhoods.It’sbeenmypersonalexperiencethateatinghealthyisexpensive.Itcostsmoremoneytobuyhealthyfruitsandvegetablesandmorehealthyfood,ingeneralthanitdoestobuyfoodthat’snotsohealthy,that’shighfat,highcarb,highsugar….Itcostsmoremoney.Ittakeslongertoprepare.Whenyouhaveamomandadadoreitherandthey’retryingtohandletwojobs,ifnotthree.They’vegotkidsofvaryingages.Themechanicsofshoppingandpreparingmealsisprobablyanactivitythatgetsletgo.”

Someparticipantshaddirectexperiencewitheducatingthecommunityabouthealthyfoodsandeating.Theseparticipantssharedthatforsomecommunitymembers,theirknowledgeoffreshfruitsandvegetablesislimitedaswellasproperfoodstorageforfoodswithoutpreservatives.InMemorialHermann’scommunitysurvey,67%ofrespondentsselectedDiabetesasoneofthetopissuesmostaffectingthequalityoflifeintheircommunity.Duringkeyinformantinterviews,Diabeteswasdiscussed64timesandwasraisedbyparticipants32timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedDiabetesasatophealthissueinthecommunity,uniquethemesemergedregardinghowdiabetesisimpactingspecificgroupsinthecommunityandthewayasedentarylifestyleimpactsdiabetes.MultipleparticipantsattributedthesurgeinobesityanddiabetesingeneralintheU.S.toashifttoamoresedentarylifestylewhileothersspecificallyidentifiedthelocalclimateanddrivingcultureaskeyfactorsleadingtoanincreaseinsedentarylifestylesimpactingtheregion.HeartDisease&Strokewasdiscussed34timesduringthekeyinformantinterviewsandwasraisedbyparticipants16timesasahealthneedorconcerninthecommunity.ForthoseparticipantswhoraisedHeartDisease&Strokeasatophealthissueinthecommunity,theuniquethemesthatemergedintheinterviewswerechronicdiseaseriskrelatedtosocioeconomicstatusandchallengeswithmanagingheart-relatedconditions.“Youhavesomanycommunitiesthatarefooddesertsso,ofcourse,Ithinkweareallatriskforthingslikediabetesandhypertension,obesity,stroke–but,Ithinkinadditiontothat,thosethataremostarealreadymarginalized.Peoplewhoarelowincome.Lowsocioeconomicstatus.So,education,andallofthoseindicatorsareprobablyevenmoreatriskforchronicdiseasesthansomeone,forexample,whohasaccesstocareandinsurance.So,theyprobablyaredoublyatrisk.”

Exercise Is Medicine

Secondary Data Exercise,Nutrition&Weightwasthefifthhighest-rankingtopicinthesecondarydatascoringresultsforMemorialHermannHealthSystem.AlthoughExercise,Nutrition&WeightdidnotrisetothetopofthesecondarydatascoringresultsforHarrisCounty,thereareindicatorsofconcern(Table23).Inparticular,anexercise-relatedindicatorwithscoreabove2is:WorkersWhoWalktoWork.

Table23.SecondaryDataScoringResults:Exercise,Nutrition&Weight

TXCounties

TXValue

USValue

HP2020Target

TrendOverTime

ChildFoodInsecurityRate[5](2016)

Harris23.5

1.67 1 2 3 1.5 0percent

[5]FeedingAmerica

Adults(18+Years)WhoAreObese[10](2016)

Harris32.0

1.67 1.5 1 2 2 2percent

[10]TexasBehavioralRiskFactorSurveillanceSystem

FastFoodRestaurantDensity[17](2014) Harris

0.71.67 2 1.5 1.5 1.5 1.5restaurants/1,000

FoodInsecurityRate[5](2016) Harris

16.62.06 2 2 3 1.5 1

percent

[5]FeedingAmerica

SNAPCertifiedStores[17](2016)

Harris0.6

2.11 3 1.5 1.5 1.5 2stores/1,000population

[17]U.S.DepartmentofAgriculture-FoodEnvironmentAtlas

WorkerswhoWalktoWork[1](2012-2016) Harris

1.52.17 2 2 3 3 1.5

percent

[1]AmericanCommunitySurvey

KeyIssues:• Obesity• Walkabilityofcommunities• Safetyofoutdoorspacesandplacestoexercise

Primary Data Over60%ofMemorialHermann’scommunitysurveyrespondentsnotedObesityasatopissueaffectingthequalityoflifeintheircommunity.Inkeyinformantinterviews,Exercise,Nutrition&Weightwasdiscussedalmost170timesandwasraisedbyparticipants42timesasaneedorconcernforachievinghealthinthecommunity.TheprimarybarriersrelatedtoExercise,Nutrition&Weightidentifiedbyparticipantswerewalkability,accesstosafeoutdoorspacesandprogrammingthatmaynotmeettheneedsofcommunitiesfacingfinanciallimitations.Severalparticipantsdiscussedbarrierstohealthylifestylechangesanddescribedcommunitieswheresidewalksarelimitedorpedestrianpathwaysarenotavailable.Theabilityforcommunitymemberstomakesmallshiftsintheirdailylives,suchaswalkingregularly,maybemorefeasiblethanundertakinganexerciseregimen.Thelimitationsofpedestrianpathwaysandsaferwalkingspacespreventthoseinsomesectionsofthecommunityfrommakingtheseshifts.Forindividualswhomaynotbeabletoaffordgymmembershipsnorattendclassesduetoworkschedules,outdooractivitiesandfitnessareasofferafreealternative.Participantsfeltthatinmanyneighborhoods,theseoutdoorspacesarenotavailableduetodisrepairorunsafeenvironments.“Ithinkthebuiltenvironmentishuge,too.Ifyouliveoutinaplannedcommunity,theyusuallyhavewalkingtrails,ortheyhaveaprettyfountainareaforyoutowalkaroundit.Theyhavethoselittleexercisethingsthatyoustoponpartwayaroundthetrailandyoudoyourlittlepush-upsandyoursit-upsandyourpull-ups(…)Yougointothesepoorerareasandthere'snosidewalks.There'snolightsatnight.There'sapark—it'sallrustedequipment.”Participantsalsodescribedprogramsandfacilitiesthatareeitherlimitedorlacking.Theseprogramsincludedfreeexerciseprogramswithchildcareoptions,youthsportsleaguesandrecessintheschoolsandfreeorlow-costoptionsforair-conditionedfacilitiesduringtimesoftheyearwhentheweatherdoesnotpermitoutdooractivities.“InpoorareasofHouston,there’sjustnotalotofparks.There'snolittleleague,andthere'snosoccerleagues,andso,there'snotalotofrecessintheschools.There'sjustnot—thecultureamongthekidsisjustnotbeingcreatedaroundphysicalactivity.”

Non-Prioritized Significant Health Needs Thefollowingadditionalsignificanthealthneedsemergedfromareviewoftheprimaryandsecondarydata.Withtheneedtofocusontheprioritizedhealthneedsdescribedabove,thesetopicsarenotspecificallyprioritizedeffortsinthe2019-2022ImplementationStrategy.However,duetotheinterrelationshipsofsocialdeterminantneedsmanyoftheseareasfall,tangentially,withintheprioritizedhealthneedsandwillbeaddressedthroughtheupstreameffortsoftheprioritizedhealthneeds.Additionally,manyofthemareaddressedwithinongoingprogramsandservices.Examplesoftheseeffortsareprovidedbelowbytopicarea.

Older Adults and Aging

Secondary Data ThesecondarydatascoringresultsrevealedthetopicofOlderAdultsandAgingasasignificanthealthneedforHarrisCounty.OlderAdultsandAgingreceivedatopicscoreof1.5inthesecondarydataresultsforHarrisCounty.Indicatorsofnoteincluded:ChronicKidneyDiseaseandStrokeintheMedicarePopulationaswellasAge-AdjustedDeathRateduetoFalls.

Primary Data KeyinformantsandstakeholdersdiscussedOlderAdultsandAging.Over62%ofparticipantsinMemorialHermannHealthSystem’sprioritizationprocesscitedOlderAdultsasoneofthegroupsmostaffectedbypoorhealthoutcomes.Interviewswithkeyinformantsnotedthegrowingpopulationofolderadultsandneedsrelatedtospecializedcare,financialassistanceandoutreach.“…[W]earegoingtowatchtheliteraldoublingofthenumberofAmericansovertheageof65inthenext25years.Everyday,betweennowand2030,dayafterday,10,000Americanswillturn65,sowearewatchinganextraordinaryexpansionofchallengesofaging.(…)[M]oreandmoreAmericansaregoingtobegettingold,socaringforthismassiveincreaseintheagingpopulationisgoingtobeoneofthegreatchallengesIthink.”

Efforts MemorialHermannHealthSystemincludestwofreestandingRehabilitationHospitals(TIRRandKaty)aswellasaseniorlivingfacility(UniversityPlace),featuringindependentliving,personalassistanceservices,andaseparate,butattached,nursingcenter.Additionalcommunityoutreachincludeshealtheducationon:Alzheimer’sdisease,DiscountedDiabetesEducation,Education/outreachforSeniors,InjuryPrevention,FallPrevention,andsupportgroupsforvariouspopulations,including:Alzheimer’s,Amputees,Cardiacpatients,Chronicdisease,Diabetics,Grief,Parkinson’sdisease,Stroke,Survivorship,andmore.

Cancers

Secondary Data AlthoughCancerwasnotoneofthetoptentopicsinthesecondarydatascoringresultsforHarrisCounty,therearecertainindicatorstonote.Severalindicatorsareofconcernincluding:CervicalCancerIncidenceRateandAge-AdjustedDeathRateduetoBreastCancer(bothwith

indicatorscoresabove2),CancerintheMedicarePopulation,ColonCancerScreening,andAge-AdjustedDeathRateduetoProstateCancer.

Primary Data InMemorialHermann’scommunitysurvey,overonethirdofrespondentsnotedCancerasatopissueaffectingthequalityoflifeintheircommunity.Interviewswithkeyinformantsrevealedtheimportanceofmakingcancerscreeningservicesandspecialtycareavailableandaccessible(e.g.,telehealth,mobilemammography).

Efforts AsleadingprovidersofcancertreatmentinHouston,MemorialHermannCancerCentersarecommittedtocancertreatment,prevention,andresearch.Theirbroadgeographicalcoveragemakescancertreatmentextremelyaccessibleandconvenienttowherepatientsliveorwork.AlleightMemorialHermannCancerCentersareapprovedbytheAmericanCollegeofSurgeonsCommissiononCancer(ACoSCoC);only25percentofhospitalsacrossthecountryhavereceivedthisspecialrecognition.Withguaranteedaccesstocomprehensivecare,collaborativeteamapproachforcoordinatingthebestavailabletreatmentoptions,state-of-the-artequipmentandservices,educationandsupport,andlifelongpatientfollow-upthroughtheCancerRegistry,patientsareabletoaccessafullmenuoftherapiesandtreatmentoptions.Additionaloutreachincludeseducationandsupportgroupsforcancerpatients:Art,Self-guidedArtTherapy,Lymphedema,BrestCancer,OncologyNutritionTherapy,StressRelief,LookGoodFeelBetter,Yoga,Meditation,andHealthyEatingAdvices.

Education

Secondary Data Educationreceivedatopicscoreof1.56inthesecondarydataresultsforHarrisCounty.Thereareseveraleducation-relatedindicatorstoconsider:InfantsBorntoMotherswithLessThan12YearsofEducation(withavalueof27.5%inHarrisCounty,comparedto21.3%inTexasand15.9%intheU.S.),Student-to-TeacherRatio,HighSchoolDropOutRate,andPeople25+withaHighSchoolDegreeorHigher.

Primary Data Duringkeyinformantinterviews,thetopicofEducationcameupfrequentlyandinrelationtodifferentfocusareasandtargetaudiences,includingchildren,generalcommunitymembersaswellasproviders.Thelinkbetweenindividuals’levelofeducationandqualityoflifewasemphasized.Keyinformantsrecommendedfindingopportunitiestoexpandtheavailabilityofeducation(relatedtohealthandnon-healthtopics)aswellasintegratinghealtheducationintoexistingactivitiesinbothclinicalandnon-clinicalsettings,suchasschoolsandchurches.Opportunitieswerealsopointedouttoeducatehealthcareproviders(andprovidecontinuingeducation)onavailablecommunitylinkagesandresourcesandonhowtoinitiateconversationswithpatientsregardingdifferenthealthtopics.

“Wewanttogointodifferentgroupsandeducatethemonwhattheyshouldbedoingorshouldn’tbedoing.(…)Ithinkeducationisahugecomponentbutwe’vegottofigureouthowtointegratethat.Theeducation,withouttheintegrationintosomebody’slifestyle,doesn’tdothemanygood.”

Efforts MemorialHermannoperatestenHealthCentersforSchools,establishedin1996,offeringaccesstoprimarymedical,dentalandmentalhealthservicestounderservedchildrenat82schoolsintheGreaterHoustonArea.Researchshowsthatschool-basedhealthcentersincreaseeducationalsuccessbyprovidingmedicalandmentalhealthcarethatallowsstudentstostayinschoolandlearn.Theprimarygoaloftheprogramistokeepchildrenhealthyandfeelingwellsothattheystayinschoolandcanperformwellacademically,creatingafoundationforabrighterfuture.Byprovidingimprovedaccesstohealthcaretoat-riskchildrenacrosstheregion,MemorialHermannhasdemonstratedsuccessincreatinghealthieroutcomesforkids,includingimprovementsintheirphysicalhealth,theirmentalwellbeing,andeventheirattendancerateatschool.

Transportation

Secondary Data TransportationrosetothetopofthesecondarydatascoringresultsforHarrisCounty,withatopicscoreof1.82.Indicatorsofconcerninclude:SoloDriverswithaLongCommute,MeanTravelTimetoWork,andWorkerswhoWalktoWork.Furthermore,thereexisthighdisparitiesforafewoftheseindicators.

Primary Data ParticipantsraisedthetopicofTransportation59timesinrelationtobarriersorchallengestoachievinghealthinthecommunity–morethananyothertopic.KeyinformantsrepeatedlynotedthattheHoustonregionhassignificanttransportationissues(includingavailability,accessibility)thatimpactcommunitymembers’abilitytoaccesshealthprogramsandservices.Inadditiontolimitedoptionsforpublictransportation,travelcostandtimewerebroughtup.Moreover,forcertainpopulations,likeolderadultsorpeoplewithdisabilities,publictransportationisnotafeasibleoption.“Thisremarkablespread-outcity,thesizeofMassachusetts,istheGreaterHoustonMetropolitanArea.(…)Thisisnotacityandasuburbanymore,it’sametropolitanregionwitheighttotencentersofactivitythatarelargerthandowntownSanDiego,spreadoutoverthismassivearea,butgettingfromoneplacetoanotherisanincreasingchallenge.Povertyalsomeansinadequatetransportation,wehavenoreallygoodtransitsystembecauseit’salmostimpossibletodevelopagoodtransitsystemforacitysolackingindensityandsospreadoutasHoustonis.Wehaven’tsolvedthatproblem,andalotofthehealthcareissuescomebecausepeople[are]withoutacartryingtogettoahospital,ortohealthcare…”

Efforts MemorialHermannprovidesbusandtaxitokensasrequiredfordischargeandcontinuityofcareneeds.

OneMemorialHermannstrategicefforttonotonlyprovidetherightcareattherighttimeintherightplace,butalsoprovidetheopportunitytoaccesshelp/careviathetelephoneistheMemorialHermannNurseHealthLine.Establishedin2014,theNurseHealthLineisafreetelephoneserviceforGreaterHoustonresidentswhoareexperiencingahealthconcernandareunsureofwhattodoorwheretogo.Experienced,bilingualnursesusetheirtrainingandexpertisetoconductassessmentsbyphone,andareavailabletoanswercalls24hoursaday,sevendayaweekforanyresidentlivinginHarrisorsurroundingcounties.Theyhelpcallersdecidewhenandwheretogoformedicalcareandassistwithsocialservicereferralsandtransportationneeds.

Children’s Health

Secondary Data Children’sHealthreceivedatopicscoreof1.52inHarrisCounty.Particularindicatorstonoteinclude:ChildrenwithHealthInsurance,ChildFoodInsecurityRate,andChildrenwithLowAccesstoaGroceryStore.Closeto10%ofchildreninHarrisCountydonothavehealthinsurance.

Primary Data WhendiscussingChildren’sHealth,keyinformantspointedoutspecificissuessuchaschildhoodobesity,accesstoservicesandbeinguninsured.Someparticipantsadvisedeffortstoengagechildren,familiesandcommunitiesmorecomprehensively.“Texasranksverylowindollarsspentonhealthforchildren.Weranklowinourranking,generally,inchildren’shealth.We’renotputtingenoughmoneyandresourcesintoit.Ithinkweneedtoshiftourattentionand(…)givemoreattentiontochildren’shealthandhowimportantitisforearlychildhooddevelopmentandforbraindevelopmentandongoinghealthintherestoftheirlives.Iwouldsayputthatasapriority.Putchildren’shealthasapriority.Notjustsayingtheearlyyears,notjustsayingzerotofivebutalsothroughoutearlyadolescence,pre-adolescence,earlyadolescenceandintotheteens.”

Efforts Children'sMemorialHermannHospital,licensedunderMemorialHermannTexasMedicalCenter,wasfoundedin1986andistheprimaryteachinghospitalforthepediatricandobstetrics/gynecologyprogramsatTheUniversityofTexasMedicalSchoolatHouston.Children'sMemorialHermannofferscareinmorethanthirtypediatricandwomen'srelatedspecialtiesincludingthelatestadvancesinmaternal-fetalmedicineandneonatalcriticalcareservices,andrenownedprogramsinpediatrictrauma,neurosciences,pulmonologyandcardiaccare.Morethan37,000childrencometoChildren'sMemorialHermannHospitaleachyear.InadditiontoMemorialHermann’sschool-basedhealtheffortsdescribedabove,MemorialHermannisanon-goingfinancialcollaboratorwithChildrenatRisk,a501non-profitorganizationthatdriveschangeforchildrenthroughresearch,education,andinfluencingpublicpolicy.

Economy

Secondary Data Withatopicscoreof1.55,EconomywasoneofthetoptentopicsinthesecondarydatascoringresultsforHarrisCounty.Inparticular,eighteconomicindicatorshadscoresabove2:Homeownership,SevereHousingProblems,StudentsEligiblefortheFreeLunchProgram,MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage,SNAPCertifiedStores,MedianHouseholdGrossRent,FamiliesLivingBelowPovertyLevel,andFoodInsecurityRate.Eightadditionalindicatorsreceivedscoresbetween1.5and2.

Primary Data Keyinformantsdiscussedfoodinsecurityandfooddesertsasfactorsrelatedtopoorhealthoutcomes.Theypointedoutthat,althoughindividualsmightunderstandthateatinghealthyfoodsisrecommended,theymaynothaveaccesstogrocerystoresorbeabletoaffordhealthierfoodoptions.Keyinformantsnotedtheimportanceofaddressingsocioeconomicbarrierstoimprovehealthandwellbeing.“(…)That’samatterofmoney.Youcaneducate[a]womanalldaylong,butifshe’sgotacoupleofkidstofeedandshecanfeedthemallforsevendollarsasopposedto25,she’sgoingtogotoMcDonald’s.”

Efforts It’sadauntingtaskinaregionlikeGreaterHouston,whichhasanestimated7millionpeopleandoneofthehighestratesofuninsuredandunderinsuredinthecountry.ButMemorialHermannbelievesthatwecanONLYimpactthehealthofourcommunity,andthehealthofindividuals,byfocusingonthemultipledeterminantsofhealththatplaythegreatestroleininfluencingaperson’soverallhealthandwellbeing.

Other Findings Criticalcomponentsinassessingtheneedsofacommunityareidentifyingbarriersanddisparitiesinhealthcare.Theidentificationofbarriersanddisparitieshelpsinformandfocusstrategiesforaddressingprioritizedhealthneeds.ThefollowingsectionoutlinesbarriersacrossMemorialHermannHealthSystemanddisparitiesastheypertaintoMHGH’sservicearea.

Barriers to Care Communityinputrevealedawiderangeofbarrierstocareandwellbeing.Asdiscussedintheprevioussection,transportationwasthemostfrequentlycitedbarrierinthecommunity,followedbyotherbarrierssuchasaccesstohealthservices,healthyfoodandexerciseoptions,lowincome,andfoodinsecurity.Overall,thesecondaryandprimarydataconfirmedthatsocioeconomicfactorsimpactcommunitymembers’abilitytoachievegoodhealth.“Manythingscomebacktopovertyandlackofdisposableincome.”Keyinformantsdescribedtheinfluenceofsocialdeterminantsofhealth(includingincome,poverty,language,education,employment)onhealthoutcomes.Participantsdiscussedtheimportanceofaddressingsocialandeconomicfactorstogetattherootcausesofpoorhealthandwellbeing.“Ithinkyouhavetounderstandthatalotoffolksworkfrompaychecktopaycheck,soiftheyactuallyendupatoneofthesemedicalcentersandtheyrequireathirtydollarcopayortendollarsorfifteendollars,thenthey’renotgoingtohaveit.So,they’regoingtowalkawayuntiltheydohavethatmoneyandthatcouldbemonthslater.So,iftheyaresick,they’rejustgoingtobecomesicker.So,that’soneofthebigbarriers.”

Disparit ies Significantcommunityhealthdisparitiesareassessedinboththeprimaryandsecondarydatacollectionprocesses.Table24identifiesthenumberofsecondarydatahealthindicatorswithahealthdisparityforMHGH’sservicearea.SeeAppendixBforthespecificindicatorswithsignificantdisparities.

Table24.NumberofHealthDisparitiesIdentifiedinSecondaryDataAnalysis

HarrisCountyBlackorAfricanAmerican(13)

White(8)HispanicorLatino(8)

OtherRace(7)AmericanIndianorAlaskaNative(6)

Male(10)Female(3)

<6yearsofage(2)25-44yearsofage(2)45-64yearsofage(2)65+yearsofage(2)

GeographicdisparitieswereidentifiedusingtheSocioNeedsIndex.AsshownearlierinTable13,themajorityofzipcodeswithinMHGH’sservicearea(includingthetopzipcodesforinpatientdischarges,zipcodes77088and77022)haveSocioNeedsIndexgreaterthan95,potentiallyindicatingpoorerhealthoutcomesforresidentsinthoseareas.

Conclusion TheCommunityHealthNeedsAssessmentforMHGHutilizedacomprehensivesetofsecondarydataindicatorstomeasurethehealthandqualityoflifeneedsforMHGH’sservicearea.Furthermore,thisassessmentwasinformedbyinputfromknowledgeableanddiverseindividualsrepresentingthebroadinterestsofthecommunity.MemorialHermann’ssystem-wideprioritizationprocessresultedinfourfocusareasorpillars:AccesstoHealthcare,EmotionalWell-Being,FoodasHealth,andExerciseIsMedicine.MHGHwillreviewtheseprioritiesmorecloselyduringtheImplementationStrategydevelopmentprocessanddesignaplanforaddressingthesepillarsmovingforward.Inaddition,MHGHinvitesyourfeedbackonthisCHNAreporttohelpinformthenextCommunityHealthNeedsAssessmentprocess.Ifyouhaveanyfeedbackorremarks,pleasesendthemto:Deborah.Ganelin@memorialhermann.org.

Appendix

Appendix A: Evaluation Since Prior CHNA

Appendix B. Secondary Data Methodology

Secondary Data Sources

Secondary Data Scoring

Data Scoring Results

Appendix C. Primary Data Methodology

Community Input Participants

Key Informant Interview Questionnaire (Episcopal Health Foundation)

Key Informant Interview Questionnaire (Conduent Healthy Communities Institute)

Community Survey (English)

Community Survey (Spanish)

Appendix D. Priorit ization Tool

Priorit ization Survey

Appendix E. Community Resources

AppendixA.MHGreaterHeightsImpactReport

EvaluationSincePriorCHNA Priority1:HealthyLiving

Priority1: HealthyLiving

Goal1: Empowerindividualstomanagetheirhealthandbeproactiveintheircaretomaximizehealthylivingforfuturegenerations.

EarlyDetectionandScreeningObjective1.1: IncreaseawarenessandprovideearlydetectionscreeningsforourcommunityOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofscreeningsprovided EstablishBaseline 600 700 5%>Baseline• Numberofeducation/supportgroupeventshostedorparticipatedin 61/year 40 35 75/year

Strategies:Year1Notes Year2Notes Timeline:

Year1,2,31.1.1: Conductfreescreenings(cancer,HIV,HepatitisC,Vascular(screeningforblockedarteriesdiabetes,etc.) 1,2,31.1.2: Conductsupportgroupsondiabetes,cancer,woundcare,amputation,COPD,andstroke(See1.5.1) 1,2,31.1.3: ConductLunchandLearnsforemployers,organizationsandcommunitymembers(See1.3.5) 1,2,31.1.4: Provideinformationonservicesavailableandconducteducationsessionsathealthfairs(See1.2.3and

1.3.5) 1,2,3

Monitoring/EvaluationApproach:• Countsanddataassessedandenteredinadatabaseattheconclusionofeachevent• QuarterlyCommunityBenefitSteeringCommitteeReview

PotentialPartners:• Communityorganizationsthatworkwithat-riskpopulations–churches,countyclinics,safety-netresources• ChambersofCommerce,businessesandemployers

ObesityPreventionObjective1.2: EducatethecommunitytolivehealthierlifestylesthroughnutritionandexerciseOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Poundsofproducedistributedtocommunitypartnersviacommunitygarden EstablishBaselineYear1 500lbs 500 5%>Baseline• Numberoftimesco-opdistributesfoodatfacility EstablishBaselineYear1 12 12 Monthly• Numbereducationaleventsconnectedwithnutritionandexercise 5 5 8 10

Year1,2,31.2.1: Providefinancialsupportandcoordinatevolunteerstoestablishacommunitygardenwithalowerincome

neighborhood(See1.3.3) 1,2,3

1.2.2: Establishaco-opforfreshfruitsandvegetablesatthehospitalforstaffandcommunitymembers(See1.3.4)

1.2.3: Hosteducationalsessionsaboutnutritionandexercise(See1.1.4) 1,2,3 Monitoring/EvaluationApproach:

• Weighingpoundsoffooddonated/distributed• Amountoftimeco-oppick-upisavailableathospital• Countofeducationevents/participantsthathavenutritionfocusaggregatedandenteredinaftereachevent• QuarterlyreviewbyCommunityBenefitSteeringCommittee

PotentialPartners:• Diabetesorganizations• Localschools,churches,civicorganizations,HOAsandemployers• Localfarmer’smarket

AccesstoHealthyFoodObjective1.3: ProvideeducationonhealthyfoodoptionsandhealthierfoodatalowercostforourcommunitymembersOutcomeIndicators:

AnnualBaseline Year1 Year2 FY2020Target

• NumberofERpatientsscreenedforfoodinsecurityviatheMHERNavigationprogram 2,162 3581 3414 2,162

• NumberofCHWreferralstocommunityfoodpantriesviatheMHERNavigationprogram 709 1951 1827 709

• NumberofsupportedcommunityeventshostedbylocalpartnersviatheMHERNavigationprogram 0 1 12 2

• Establishmentofcommunitygarden NotImplemented Identified SupportingGarden Implemented• Poundsofproducedistributedtocommunitypartners EstablishBaselineYear1 500lbs 500lbs 5%>Baseline

Strategies: Year1Notes Year2Notes Timeline:Year1,2,3

1.3.1 ContinuetoparticipateintheMHERNavigationprograminwhichparticipantsarescreenedforfoodinsecurityandreferredtofoodpantriesifnecessary(See2.4.2)

1.3.2: Collectfoodtosupportfoodpantriesorspecialeventshostedbycommunitypartners 1,2,31.3.3: Providefinancialsupportandcoordinatevolunteerstoestablishacommunitygardenwithalowerincome

neighborhood(See1.2.1)

1.3.4: Establishaco-opforfreshfruitsandvegetablesatthehospitalforstaffandcommunitymembers(See1.2.2)

1.3.5: Provideeducationabouthealthyportionsandhealthyfoodchoicestoemployers,organizationsandcommunitymembersviahealthfairsandLunchandLearns(SeestrategiesunderObjective1.1)

Monitoring/EvaluationApproach:• CommunityGardenWorkplanMilestones• Co-opdistributionfrequencyandparticipants• Countofeducationalevents/participants• PatientactivitydocumentedandreportedwithintheMHERNavigationelectronicrecordsystem

PotentialPartners:• Localschools,churches,civicorganizations,HOAsandemployers• Localfarmer’smarket• MinistryAssistanceoftheNewNorthwestAlliance(MANNA)• WesleyCommunityCenter• LINC'sGreenspointPantry• ComunidaddeGracia• MHCommunityBenefitCorporation

Timefor/SafetyDuringPhysicalActivityObjective1.4: EncouragehealthylifestylesthroughsafeexercisepracticesOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofstudentsreachedincoordinationwithfreephysicals 102/year 250 300 150• Partnerwithlocalorganizationstocreatesaferecreationalareas 0locations 2 0 3locations

Year1,2,31.4.1: ProvidefinancialsupporttolocalLittleLeaguetosupportspaceforfields. 1,2,31.4.2: Providefreephysicalexaminationsfortheareaschools(i.e.,Waltripandotherhighschools) 1,2,31.4.3: ProvidefinancialsupportfortherevitalizationofLittleThicketPark,WoodlawnPark,andShadyAcresPark Provided

FinancialsupportforB-CycleProgramatWoodlawn

Monitoring/EvaluationApproach:• Rosterofstudentphysicalsprovided• Dollarsinvestedinrevitalizingparks

PotentialPartners:• Physicians• Localschools,organizationsandemployers• TIRZ5• Sportsassociations

ChronicDiseaseManagementObjective1.5: Providechronicdiseasemanagementservicestoincreaseoverallhealthandwell-beingofhigh-riskpopulationsOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberoftypesofchronicdiseasesupportgroups(Diabetes,COPD) 4 5 5 6• HIVScreeningsinER 561/year 901 1,135 600/year

Year1,2,31.5.1: Maintaincurrentsupportgroupsandestablishnewchronicdiseasesupportgroups(e.g.,diabetes,COPD,

CHF)(See1.1.2)Xreference

1.1.2Xreference

1.1.2 1,2,3

1.5.2: ConductHIVscreeningsintheERthroughtheCDCgrant 1,2,3 Monitoring/EvaluationApproach:

• Countofsupportgroup/participants• CountofHIVscreenings/%testedpositive

PotentialPartners:• Localschools• Churches• Civicorganizations• HOAs• Employers• Vendorswithchronicdiseaseeducationmaterial

Priority2:AccesstoHealthCare

Priority2: HealthCareAccess

Goal2: Helpthepatientgettotherightlocation,attherightcost,attherighttime.

AvailabilityofPrimaryCareandSpecialtyProvidersObjective2.1: ProvidemultipleoptionsandavenuesforpatientstoaccessprimaryandspecialtyprovidersOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• NumberofvisitsatGreaterHeightsaffiliatedMH-UrgentCare 1,209(March–July) 5,883 10,869 9,000/year

• NumberofvisitsatNeighborhoodHealthCenterNorthwest 6,829 6629 6850 7,000• NumberofERreferralstotheNeighborhoodHealthCenter

Northwest 330 601 627 345

• NumberofMemorialHermannMedicalGroupPCPs&NPs 4 5 5 6• Numberoftelemedicineconsultations 187/year 216 149 187/year

Year1,2,32.1.1: RecruitPrimaryandSpecialtyCareProviderstomeetcommunityneed 1,2,32.1.2: EstablishasecondurgentcarecenterintheGreaterHeightscommunity 1,2,32.1.3: Provisionof24/7neurologicalconsultationstoGreaterHeightspatients,

throughtheuseoftelemedicinetechnologiessuchasdigitalimagingandreal-timevideoconferencingprovidingpatientswithcontinuityintreatment,afast-trackedprocess,andthemosteffectivedrugtherapies

Monitoring/EvaluationApproach:• CountofMHMGPCPsandNPs–SizeofPanels• Trackvolumesofunder/uninsuredtreatedatUrgentCare,NeighborhoodHealthCenterandCCC

PotentialPartners:• OtherMHHSentities• Localschools,churches,civicorganizations,HOAsandemployers

HealthInsuranceCoverageandCostsObjective2.2: Provideresourcestoincreaseawareness,education,andhealthinsurancecoverageandreducecostsforuninsuredandunderinsured

populationsOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• NumberofClassDPrescriptionstotheHoggSchool-BasedHealthCenterinsupportofprimarymedicalcareprovidedtouninsuredchildrenandteensatnocost

1,709 165 626 1,709

• NeighborhoodHealthCenterGHvouchersissued 330 666 1222 345

• NeighborhoodHealthCenterGHvouchersused 228 376

627seen

238notseen

(865total)

• %ofpatientsCardonisabletohelpassisttogetmedicalinsurancecoverage 21% 21.82% 21.35% 23%

2.2.1: ProvideClassDPrescriptionstotheHoggSchoolBasedHealthCenterinsupportofprimarymedicalcareprovidedtouninsuredchildrenandteensatnocost

2.2.2: SubsidizethecostforvouchersthatareprovidedforcommunitymemberstoobtainfreeandreducedcostcareattheNeighborhoodHealthCenterGHlocatednexttotheemergencyroom

2.2.3: ContractwithCardontoconsultonallpatientswhoareuninsuredorunderinsuredtoconnectthemwithavailablepayorresources

Cardonisathird-partyeligibilityvendor(paidbyMHSL)toassistpatientswiththe

applicationprocessforMedicaid,CountyIndigent,AffordableCareActInsuranceExchange,andotherthird-partypayors.

2.2.4Contractwithphysicianstoprovidecareforuninsuredpatients 1,2,3 Monitoring/EvaluationApproach:

• Countofvouchersissuedandusedonamonthlybasis• Countofpatientsconsulted/convertedbyCardononamonthlybasis

PotentialPartners:• NeighborhoodHealthCenterGreaterHeights• Localschools,churches,civicorganizations,HOAsandemployers• HarrisHealth(CommunitySafetyNet)• Cardon• MemorialHermannCommunityBenefitCorporation

TransportationObjective2.3: Providepatientsinneedwithjust-in-timetransportationresourcesOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• PatientTransportationFees $48,000/year $355,076 $297,797 $50,000yearStrategies: Year1Notes Year2Notes Timeline:

Year1,2,32.3.1: Providebuspasses,cabvouchers,andambulances,andwheelchairvansforfree

transportationtoandfromappointments

Monitoring/EvaluationApproach:• Numberofvouchersordollarscontributedtosubsidizedtransportationmonthly

PotentialPartners:• Metro,taxi,bussystem• Partnerorganizationswhoprovidefreeorreducedcostfortransportation

HealthCareNavigationObjective2.4: ConnectpatientstoresourcestohelpthemunderstandandnavigatetheirhealthcarejourneytoimprovepatientoutcomesOutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• Numberofhospital'sassociatedcounties'callstoNurseHealthLine(Harris)

28,581 28624 29615 28,581

• NumberofpatientsenrolledintheERNavigationProgram 2,332 3387 3300 2,332• NumberofERNavigationpatientencounters 4,500 8498 9332 4,500• NumberofERNavigationreferralstocommunityresources 5,671 8810 7445 5,671• NumberofERNavigationscheduledappointments 302 470 332 302• Numberofdiseasespecificnursenavigatorsoncampus

(excludingER) 4 4 4 5

• Numberofeducation/supportgroupeventshostedorparticipatedin(Objective1.1) 61/year 6961 XRef.1.1 75/year

2.4.1: Providea24/7freeresourceviatheNurseHealthLinethatcommunitymembers(uninsuredandinsured)withintheMHHScommunitycancalltodiscusstheirhealthconcerns,receiverecommendationsontheappropriatesettingforcare,andgetconnectedtoappropriateresources

2.4.2 ContinuetoparticipateintheMHERNavigationprograminwhichpatientsarereferredtoamedicalhome(See1.3.1)

2.4.3: ProvideNurseNavigatorsfordiseasespecificcareincludingoncology,joint,bariatric,andamputationprevention

2.4.4Providehealthcarescreenings,educationalevents,healthfairs,physicalsandutilizetheappropriateresourcesateacheventtoconnectpatientswiththenecessarytoolstonavigatetheirhealthcarejourney(SeestrategiesunderObjective1.1)

Monitoring/EvaluationApproach:• PatientactivitydocumentedandreportedwithintheERNavigationelectronicrecordsystem• PatientcallsdocumentedwithintheNurseHealthLineelectronicrecordsystem

PotentialPartners:• IbnSinaFoundationClinic• SpringBranchCommunityHealthCenter• St.HopeCommunityHealthCenter• LegacyCommunityHealthCenter• HoustonAreaCommunityServices(HACS)• MemorialHermannCommunityBenefitCorporation

Priority3:BehavioralHealthThefollowingtablesprovidestrategiesandoutcomeindicatorsthatreflectanMHHSsystem-wideapproachtoBehavioralHealth.DataisnotspecifictoMHGreaterHeightsHospitalbuttothecommunityatlargewiththeexceptionofreductioninERencountersthatresultinapsychiatricinpatientstaythroughlinkageswithanetworkofbehavioralpartners.

Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

Objective3.1: Createnontraditionalaccesspointsaroundthecommunity(crisis/ambulatory,acutecare,andcommunity-basedchroniccaremanagement),andlinkthosewhoneedservicestopermanentprovidersandresourcesinthecommunity

OutcomeIndicators: AnnualBaseline

Year1 Year2 FY2020Target

• DecreaseinthenumberofERencountersthatresultinpsychiatricinpatientstay

1,146 1,213 1,135 1,0895%reductionofbaseline

• DecreaseinnumberofERencountersthatresultinpsychiatricinpatientstayatGreaterHeights 114

121 114108

• NumberofMemorialHermannCrisisClinictotalvisits 5,400 5,590 5,154 5%overbaseline• NumberofPsychiatricResponseCareManagementtotalvisits 1,200 1,103 1,259 5%overbaseline

Year1,2,33.1.1: Providementalhealthassessment,care,andlinkagetoservicesinanacute

caresetting,24x7toservicesatGreaterHeightsAnuptickinacutecarevolumeoverthepastfiscalyearhascontributedtoahighernumberofpsychiatrictransfersoverall.

Anincreaseinacutecarevolumeandnumberofacutecaresitesoverthepastfiscalyearhavecontributedtoahighernumberofpsychiatrictransfersoverall.

Priority3: BehavioralHealth

Goal3: Ensurethatallcommunitymemberswhoareexperiencingamentalhealthcrisishaveaccesstoappropriatepsychiatricspecialistsatthetimeoftheircrisis,areredirectedawayfromtheER,arelinkedtoapermanent,communitybasedmentalhealthprovider,andhavethenecessaryknowledgetonavigatethesystem,regardlessoftheirabilitytopay.

3.1.2: Createnontraditionalcommunityaccesstopsychiatricprovidersforindividualsexperiencingamentalhealthcrisis.ClinicalSocialWorkersconnectthetargetpopulationtoon-goingbehavioralhealthcare

Recruitingmentalhealthproviderswillingtocommittoanon-

traditionalscheduleremainsa

challenge.Continuingthisurgentcaremodeloftreatmentremainsapriority,duetolimitedmentalhealthtreatmentaccessinthecommunity

3.1.3: Engageindividualswithachronicmentalillnessandworktomaintainengagementwithtreatmentandstabilityinthecommunityviaenrollmentincommunity-basedmentalhealthcasemanagementprogram

Staffingissuesimpededyearonetarget.Identifyingappropriatelylicensedclinicianswillingtoconsideracareerthatiscommunitybasedwiththerequirementofmakinghomevisitsandworkingnon–traditionalhoursisanongoingchallenge.

CaseManagerspartnerwiththeirclientsto

identifyspecificrecoverygoalsandutilizeevidence-

basedpracticestofacilitateclient

achievement.Wecontinuetopartnerwithcommunityproviderstoaddressthementalhealth

needsoftheGreaterHoustonCommunity.

Monitoring/EvaluationApproach:• EMR/registrationsystem(trackandtrenddaily,weekly,monthly)

PotentialPartners:• Systemacutecarecampuses• MemorialHermannMedicalGroup• Networkofpublicandprivateproviders

Objective3.2: Reducestigmainordertopromotementalwellnessandimprovecommunityawarenessthatmentalhealthispartofphysicalhealthandoverallwell-being

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target• Numberofpresentations/educationalsessionsforhealthcare

professionalswithinMHHS50sessionsperyear 63 71 5%increaseover

baseline• Numberofpresentations/educationalsessionsforcorporations 5 7 8 5%overbaseline• NumberoftrainingsatGHERNursingTrainings(timeincludes

trainingmaterialdevelopmentandimplementation)5trainings(8hours) 0 0 5trainings(8

hours)

• GHMedFloorNursingdebriefing 1training(3hours) 0 0 1training(3hours)

• GHManagementandcommunicationwithdisruptivepatients(timeincludestrainingmaterialdevelopmentandimplementation)

1training(4hours) 0 0 1training(4hours)

• TrainingonAcuteCareConcepts-systemnurseresidentprogram 15trainings(45hourstotal/3hours

each)*18 9

15trainings(45hourstotal/3hourseach)*

• TrainingonCMORoundtable-system-wide 1training(2hours)* 0 4 1training(2hours)*

*Totaltimeincludestrainingmaterialdevelopmentandimplementation

3.2.1: ProvidementalhealtheducationsessionswithintheMHhealthsystemfornursesandphysicians

3.2.2: WorkwithemployersolutionsgrouptoprovideeducationandtrainingwithcorporationsonMHtopics(stress,PTSD)

Monitoring/EvaluationApproach:• Requestsforpresentationsandsessionstrackedviacalendar/excel

PotentialPartners:• Systemacutecarecampuses• SystemMarketingandCommunications• Employersolutionsgroup

Objective3.3: Qualityofmentalhealthandsubstanceabuseservices:access,link,andpracticeutilizingevidence-basedpracticetopromoteoverallwellness

OutcomeIndicators: AnnualBaseline Year1 Year2 FY2020Target

• NumberofMemorialHermannCrisisClinicfollow-upspostdischargewithclinicpatients

7,716 6,431 5,154 5%overbaseline

• PsychiatricResponseCaseManagementreductioninsystemERutilization

54.4% 53.0% 50% 5%increaseoverbaseline

3.3.1: MHCCfollow-upwithdischargedpatientsandtheirfamiliestoassesswell-beingandconnectthemtocommunityresources

3.3.2: PsychiatricResponseCaseManagementProgramutilizesevidence-basedpracticeinterventions(motivationalinterviewing,MHFirstAid,CAMS,etc.)toreduceERutilizationforprogramenrollees

Monitoring/EvaluationApproach:• Socialworklogs(Excelspreadsheet)

PotentialPartners:• Systemacutecarecampuses• Community-basedclinicalproviders• Networkofpublicandprivateproviders

MemorialHermannGreaterHeightsHospitalCHNA2019 73

AppendixB.SecondaryDataMethodology

SecondaryDataSourcesThemainsourceforthesecondarydata,ordatathathavebeenpreviouslycollected,isthecommunityindicatordatabasemaintainedbyConduentHealthyCommunitiesInstitute.ThefollowingisalistofbothlocalandnationalsourcesusedinMemorialHermannGreaterHeights’CommunityHealthNeedsAssessment.

HarrisCounty1. AmericanCommunitySurvey2. AmericanLungAssociation3. CentersforMedicare&MedicaidServices4. CountyHealthRankings5. FeedingAmerica6. InstituteforHealthMetricsandEvaluation7. NationalCancerInstitute8. NationalCenterforEducationStatistics9. SmallAreaHealthInsuranceEstimates10. TexasBehavioralRiskFactorSurveillanceSystem11. TexasDepartmentofFamilyandProtectiveServices12. TexasDepartmentofStateHealthServices13. TexasEducationAgency14. TexasSecretaryofState15. U.S.BureauofLaborStatistics16. U.S.Census-CountyBusinessPatterns17. U.S.DepartmentofAgriculture-FoodEnvironmentAtlas18. U.S.EnvironmentalProtectionAgency

SecondaryDataScoring

Datascoringisdoneinthreestages:

Foreachindicator,eachcountyinMemorialHermannGreaterHeights’serviceareaisassignedascorebasedonitscomparisontoothercommunities,whetherhealthtargetshavebeenmet,andthetrendoftheindicatorvalueovertime.Thesecomparisonscoresrangefrom0-3,where0indicatesthebestoutcomeand3theworst.Availabilityofeachtypeofcomparisonvariesbyindicatorandisdependentuponthedatasource,comparabilitywithdatacollectedforothercommunities,andchangesinmethodologyovertime.

Indicatorsarecategorizedintotopicareasandeachtopicareareceivesascore.Indicatorsmaybecategorizedinmorethanonetopicarea.Topicscoresaredeterminedbythecomparisonsofallindicatorswithinthetopic.

ComparisontoaDistributionofCountyValues:WithinStateandNation

Foreaseofinterpretationandanalysis,indicatordataontheCommunityDashboardisvisuallyrepresentedasagreen-yellow-redgaugeshowinghowthecommunityisfaringagainstadistributionofcountiesinthestateortheUnitedStates.Adistributioniscreatedbytakingallcountyvalueswithinthestateornation,orderingthemfromlowtohigh,anddividingthemintothreegroups(green,yellow,red)basedontheirorder.Indicatorswiththepoorestcomparisons(“inthered”)scoredhigh,whereasindicatorswithgoodcomparisons(“inthegreen”)scoredlow.

Comparisons • Quantitatively

score all possible comparisons

Indicators • Summarize

comparison scores for each indicator

Topics • Summarize

indicator scores by topic area

ComparisontoValues:State,National,andTargets

Eachcountyiscomparedtothestatevalue,thenationalvalue,andtargetvalues.Targetvaluesincludethenation-wideHealthyPeople2020(HP2020)goals.HealthyPeople2020goalsarenationalobjectivesforimprovingthehealthofthenationsetbytheDepartmentofHealthandHumanServices’(DHHS)HealthyPeopleInitiative.Forallvaluecomparisons,thescoringdependsonwhetherthecountyvalueisbetterorworsethanthecomparisonvalue,aswellashowclosethecountyvalueistothetargetvalue.

TrendOverTime

TheMann-Kendallstatisticaltestfortrendwasusedtoassesswhetherthecountyvalueisincreasingovertimeordecreasingovertime,andwhetherthetrendisstatisticallysignificant.Thetrendcomparisonusesthefourmostrecentcomparablevaluesforthecounty,andstatisticalsignificanceisdeterminedatthe90%confidencelevel.Foreachindicatorwithvaluesavailableforfourtimeperiods,scoringwasdeterminedbydirectionofthetrendandstatisticalsignificance.

MissingValues

Indicatorscoresarecalculatedusingthecomparisonscores,availabilityofwhichdependsonthedatasource.Ifthecomparisontypeispossibleforanadequateproportionofindicatorsonthecommunitydashboard,itwillbeincludedintheindicatorscore.Afterexclusionofcomparisontypeswithinadequateavailability,allmissingcomparisonsaresubstitutedwithaneutralscoreforthepurposesofcalculatingtheindicator’sweightedaverage.Wheninformationisunknownduetolackofcomparabledata,theneutralvalueassumesthatthemissingcomparisonscoreisneithergoodnorbad.

IndicatorScoring

Indicatorscoresarecalculatedasaweightedaverageofallincludedcomparisonscores.Ifnoneoftheincludedcomparisontypesarepossibleforanindicator,noscoreiscalculatedandtheindicatorisexcludedfromthedatascoringresults.

TopicScoring

Indicatorscoresareaveragedbytopicareatocalculatetopicscores.Eachindicatormaybeincludedinuptothreetopicareasifappropriate.Resultingscoresrangefrom0-3,whereahigherscoreindicatesagreaterlevelofneedasevidencedbythedata.Atopicscoreisonlycalculatedifitincludesatleastthreeindicators.

DataScoringResults Thefollowing tableslisteachindicatorbytopicareaforMemorialHermannGreaterHeights’servicearea(HarrisCounty).SecondarydataforthisreportareuptodateasofNovember2,2018.

HarrisCounty

SCORE ACCESSTOHEALTHSERVICES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

MEASUREMENTPERIOD HIGHDISPARITY* Source

2.00AdultsUnabletoAffordtoSeeaDoctor percent 22.1 18.3 12.1 2015 10

1.81 ChildrenwithHealthInsurance percent 89.4 100 90.3 2016 9

1.75AdultswithHealthInsurance:18-64 percent 74.7 100 77.4 2016 9

1.75 PersonswithHealthInsurance percent 79.3 100 81.4 2016 9

1.61 PrimaryCareProviderRateproviders/100,000

population 57.2 59.9 75.5 2015 4

1.44 MentalHealthProviderRateproviders/100,000

population 103.7 98.8 214.3 2017 4

1.00Non-PhysicianPrimaryCareProviderRate

providers/100,000population 72.2 66.8 81.2 2017 4

0.50 DentistRatedentists/100,000

population 66.3 55.9 67.4 2016 4

SCORE CANCER UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.53 CervicalCancerIncidenceRatecases/100,000

females 11 7.3 9.2 7.5 2011-2015

2.25Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7

1.94 Cancer:MedicarePopulation percent 7.6 7.1 7.8 2015 3

1.58ColonCancerScreening:SigmoidoscopyorColonoscopy percent 57.6 62.3 2016 10

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7

1.39 BreastCancerIncidenceRatecases/100,000

females 113.2 111.7 124.7 2011-2015 7

1.33 ProstateCancerIncidenceRatecases/100,000

males 102.5 95.4 109 2011-2015 7

1.22Age-AdjustedDeathRateduetoColorectalCancer

deaths/100,000population 14.6 14.5 14.4 14.5 2011-2015 7

1.00 AllCancerIncidenceRatecases/100,000population 402.6 401.3 441.2 2011-2015 7

0.94Age-AdjustedDeathRateduetoCancer

deaths/100,000population 157.8 161.4 156.4 163.5 2011-2015 Black,Male 7

0.94 ColorectalCancerIncidenceRatecases/100,000population 38.8 39.9 38.1 39.2 2011-2015 7

0.89OralCavityandPharynxCancerIncidenceRate

cases/100,000population 10.9 10.9 11.6 2011-2015 7

0.50LungandBronchusCancerIncidenceRate

0.33Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 37.5 45.5 39 43.4 2011-2015 7

SCORE CHILDREN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.81 ChildrenwithHealthInsurance percent 89.4 100 90.3 2016 9

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016 5

1.50ChildrenwithLowAccesstoaGroceryStore percent 5.4 2015 17

1.11 SubstantiatedChildAbuseRatecases/1,000children 5.4 8.5 2017 11

SCORE DIABETES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.67 Diabetes:MedicarePopulation percent 28.1 28.2 26.5 2015

1.44 AdultswithDiabetes percent 10.2 11.2 10.5 2016

0.92Age-AdjustedDeathRateduetoDiabetes

deaths/100,000population 20.2 21.7 21.2 2010-2014

Black,Hispanic,Male 12

SCORE ECONOMY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.44 Homeownership percent 49.6 55 55.9 2012-2016 1

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014 4

2.22StudentsEligiblefortheFreeLunchProgram percent 58.2 52.9 42.6 2015-2016 8

2.14MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 534 467 462 2012-2016 1

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016

2.08 MedianHouseholdGrossRent dollars 937 911 949 2012-2016

2.06FamiliesLivingBelowPovertyLevel percent 14.4 13 11 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,

Other 1

2.06 FoodInsecurityRate percent 16.6 15.4 12.9 2016 5

1.94UnemployedWorkersinCivilianLaborForce percent 4.4 4 4.1 July2018 15

1.89People65+LivingBelowPovertyLevel percent 11.3 10.8 9.3 2012-2016

Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1

1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016

Other,<6 1

1.67 PeopleLivingBelowPovertyLevel percent 17.4 16.7 15.1 2012-2016AmericanIndianorAlaskaNative,Black 1

orAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24

1.67 TotalEmploymentChange percent 2.4 3.2 2.5 2014-2015 16

1.50RentersSpending30%orMoreofHouseholdIncomeonRent percent 46.8 48 47.3 2012-2016 1

1.42PersonswithDisabilityLivinginPoverty(5-year) percent 25.4 25.1 27.6 2012-2016 1

1.33Low-IncomeandLowAccesstoaGroceryStore percent 6.3 2015 17

1.33PeopleLiving200%AbovePovertyLevel percent 61.6 62.8 66.4 2012-2016 1

1.08 MedianHousingUnitValue dollars 145600 142700 184700 2012-2016 1

0.97PersonswithDisabilityLivinginPoverty percent 22.9 24.2 26.6 2016 1

0.94FemalePopulation16+inCivilianLaborForce percent 59.8 57.7 58.3 2012-2016 1

0.94Population16+inCivilianLaborForce percent 68.3 64.2 63.1 2012-2016 1

0.89HouseholdswithCashPublicAssistanceIncome percent 1.5 1.6 2.7 2012-2016 1

0.67 HomeownerVacancyRate percent 1.5 1.6 1.8 2012-2016 1

0.50 MedianHouseholdIncome dollars 55584 54727 55322 2012-2016

Other 1

0.50 PerCapitaIncome dollars 29850 27828 29829 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,NativeHawaiianor

OtherPacific 1

Islander,Other,TwoorMoreRaces

SCORE EDUCATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.92InfantsBorntoMotherswith<12YearsEducation percent 27.5 21.6 15.9 2013

1.89 Student-to-TeacherRatio students/teacher 16.4 15.4 17.7 2015-2016

1.67 HighSchoolDropOutRate percent 2.6 2 2016

1.67People25+withaHighSchoolDegreeorHigher percent 80.2 82.3 87 2012-2016

Male,35-44,45-64,65+ 1

0.67People25+withaBachelor'sDegreeorHigher percent 30.1 28.1 30.3 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1

SCORE ENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014 4

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016 17

1.75 AnnualOzoneAirQuality grade F 2014-2016 2

1.69 AnnualParticlePollution grade C 2014-2016 2

1.67 FastFoodRestaurantDensityrestaurants/1,000

population 0.7 2014 17

1.61RecognizedCarcinogensReleasedintoAir pounds 1962916 2017 18

1.50 FarmersMarketDensitymarkets/1,000population 0 2016 17

1.50 GroceryStoreDensitystores/1,000population 0.2 2014 17

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 17

1.25 DrinkingWaterViolations percent 1.7 6.6 FY2013-14 4

1.17 PBTReleased pounds 210516 2017 18

1.00 FoodEnvironmentIndex 7.2 6 7.7 2018 4

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015 17

1.00People65+withLowAccesstoaGroceryStore percent 1.4 2015 17

0.89 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015 16

0.67 AccesstoExerciseOpportunities percent 90.4 80.6 83.1 2018 4

0.17 HousesBuiltPriorto1950 percent 6.2 7.4 18.2 2012-2016 1

SCORE EXERCISE,NUTRITION,&WEIGHT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1

2.11 SNAPCertifiedStoresstores/1,000population 0.6 2016 17

2.06 FoodInsecurityRate percent 16.6 15.4 12.9 2016 5

1.67 Adults(18+Years)WhoAreObese percent 32 30.5 33.6 29.9 2016 10

1.67 ChildFoodInsecurityRate percent 23.5 23 17.9 2016 5

1.67 FastFoodRestaurantDensityrestaurants/1,000

population 0.7 2014 17

1.50 AdultswhoareOverweightor percent 66.7 68.4 65.2 2016 10

1.50 FarmersMarketDensitymarkets/1,000population 0 2016 17

1.50 GroceryStoreDensitystores/1,000population 0.2 2014 17

1.42AdultFruitandVegetableConsumption percent 18.7 17.2 2015 10

1.33 RecreationandFitnessFacilitiesfacilities/1,000population 0.1 2014 17

1.00 FoodEnvironmentIndex 7.2 6 7.7 2018 4

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015 17

0.67 AccesstoExerciseOpportunities percent 90.4 80.6 83.1 2018 4

SCORE HEARTDISEASE&STROKE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.61 Stroke:MedicarePopulation percent 5.2 4.5 4 2015 3

1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3

1.50AtrialFibrillation:MedicarePopulation percent 7.3 7.4 8.1 2015 3

1.44Hyperlipidemia:MedicarePopulation percent 43.2 46.1 44.6 2015 3

1.42Age-AdjustedDeathRateduetoCerebrovascularDisease(Stroke)

deaths/100,000population 41.5 34.8 42 37.3 2010-2014 Black 12

1.33 IschemicHeartDisease:Medicare percent 28.8 28.8 26.5 2015

Population

1.22Hypertension:MedicarePopulation percent 55.5 57.5 55 2015

0.92Age-AdjustedDeathRateduetoHeartDisease

deaths/100,000population 167.6 173 171.9 2010-2014 Black,White,Male 12

SCOREIMMUNIZATIONS&INFECTIOUSDISEASES UNITS

HARRISCOUNTY HP2020 TEXAS U.S.

2.33 GonorrheaIncidenceRatecases/100,000population 182.1 160.2 2017 12

2.33 SyphilisIncidenceRatecases/100,000population 59.3 40.6 2017 12

2.11 ChlamydiaIncidenceRatecases/100,000population 571.4 511.6 2017 12

1.83 TuberculosisIncidenceRatecases/100,000population 6.6 1 4.5 2013-2017 12

1.78Adults65+withInfluenzaVaccination percent 57.2 57.3 58.6 2016 10

1.67 HIVDiagnosisRatecases/100,000population 26.3 16.1 2016

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016

1.00Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12

SCOREMATERNAL,FETAL&INFANTHEALTH UNITS

2.36 InfantMortalityRatedeaths/1,000live

births 6.8 6 5.8 6 2013 12

1.97MotherswhoReceivedEarlyPrenatalCare percent 56.1 77.9 59.2 74.2 2013 12

1.92InfantsBorntoMotherswith<12YearsEducation percent 27.5 21.6 15.9 2013 12

1.81 BabieswithLowBirthWeight percent 8.6 7.8 8.3 8 2013 12

1.61 BabieswithVeryLowBirthWeight percent 1.5 1.4 1.4 1.4 2013 12

1.25 PretermBirths percent 11.8 9.4 12 11.4 2013 12

0.58 TeenBirths percent 2.5 2.8 4.3 2014 12

SCORE MEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.53Age-AdjustedDeathRateduetoProstateCancer

deaths/100,000males 19.8 21.8 18.1 19.5 2011-2015 7

1.33 ProstateCancerIncidenceRatecases/100,000

males 102.5 95.4 109 2011-2015 7

1.28 LifeExpectancyforMales years 76.4 76.2 76.7 2014 6

SCOREMENTALHEALTH&MENTALDISORDERS UNITS

1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.4 11.7 9.9 2015

1.53 PoorMentalHealth:5+Days percent 80 81.5 2016

1.50PoorMentalHealth:AverageNumberofDays days 3.7 3.4 3.8 2016 4

1.44 MentalHealthProviderRateproviders/100,000

population 103.7 98.8 214.3 2017 4

1.17 FrequentMentalDistress percent 11.2 10.6 15 2016 4

0.94Age-AdjustedDeathRateduetoSuicide

deaths/100,000population 10.3 10.2 11.7 12.5 2010-2014 White,Male 12

0.94 Depression:MedicarePopulation percent 14.8 17 16.7 2015

0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

SCORE OLDERADULTS&AGING UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.67ChronicKidneyDisease:MedicarePopulation percent 20.9 19.9 18.1 2015

2.61 Stroke:MedicarePopulation percent 5.2 4.5 4 2015

2.06Age-AdjustedDeathRateduetoFalls

1.94 Cancer:MedicarePopulation percent 7.6 7.1 7.8 2015 3

1.89Alzheimer'sDiseaseorDementia:MedicarePopulation percent 11.4 11.7 9.9 2015 3

1.89HeartFailure:MedicarePopulation percent 16 15.5 13.5 2015 3

1.89People65+LivingBelowPovertyLevel percent 11.3 10.8 9.3 2012-2016

Asian,BlackorAfricanAmerican,HispanicorLatino,Other,Female,75+ 1

1.72Osteoporosis:MedicarePopulation percent 6.3 6.5 6 2015 3

1.67 Diabetes:MedicarePopulation percent 28.1 28.2 26.5 2015 3

1.50AtrialFibrillation:MedicarePopulation percent 7.3 7.4 8.1 2015 3

1.44Hyperlipidemia:MedicarePopulation percent 43.2 46.1 44.6 2015 3

1.44 People65+LivingAlone percent 24.4 23.9 26.4 2012-2016 1

1.33IschemicHeartDisease:MedicarePopulation percent 28.8 28.8 26.5 2015 3

1.22Hypertension:MedicarePopulation percent 55.5 57.5 55 2015 3

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10

0.94 Asthma:MedicarePopulation percent 7.3 8.2 8.2 2015 3

0.94 Depression:MedicarePopulation percent 14.8 17 16.7 2015 3

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 27.8 31.6 30 2015 3

0.64Age-AdjustedDeathRateduetoAlzheimer'sDisease

deaths/100,000population 17.9 26.6 24.5 2010-2014 White,Female 12

0.39 COPD:MedicarePopulation percent 9.6 11.1 11.2 2015

SCORE OTHERCHRONICDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.67ChronicKidneyDisease:MedicarePopulation percent 20.9 19.9 18.1 2015 3

1.72Osteoporosis:MedicarePopulation percent 6.3 6.5 6 2015 3

RheumatoidArthritisorOsteoarthritis:MedicarePopulation percent 27.8 31.6 30 2015 3

SCORE PREVENTION&SAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.39 SevereHousingProblems percent 20.9 18.3 18.8 2010-2014

2.06Age-AdjustedDeathRateduetoFalls

1.19 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.2 9.8 16.9 2014-2016

0.69Age-AdjustedDeathRateduetoUnintentionalInjuries

SCORE PUBLICSAFETY UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.17 Alcohol-ImpairedDrivingDeaths percent 37.8 28.3 29.3 2012-2016 4

1.67 ViolentCrimeRatecrimes/100,000

population 713.7 407.6 2012-2014 4

SCORE RESPIRATORYDISEASES UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.83 TuberculosisIncidenceRatecases/100,000population 6.6 1 4.5 2013-2017 12

1.17Adults65+withPneumoniaVaccination percent 73.5 90 71.3 73.4 2016 10

1.00Age-AdjustedDeathRateduetoInfluenzaandPneumonia

deaths/100,000population 14 14.2 15.2 2010-2014 Black,Male 12

0.94 Asthma:MedicarePopulation percent 7.3 8.2 8.2 2015 3

0.50LungandBronchusCancerIncidenceRate

0.39 COPD:MedicarePopulation percent 9.6 11.1 11.2 2015 3

0.33Age-AdjustedDeathRateduetoLungCancer

deaths/100,000population 37.5 45.5 39 43.4 2011-2015 7

SCORE SOCIALENVIRONMENT UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.67 MeanTravelTimetoWork minutes 28.6 25.9 26.1 2012-2016 Male 1

2.50 LinguisticIsolation percent 11.8 7.9 4.5 2012-2016 1

2.44 Homeownership percent 49.6 55 55.9 2012-2016 1

2.17 Single-ParentHouseholds percent 36.2 33.3 33.6 2012-2016 1

2.14MedianMonthlyOwnerCostsforHouseholdswithoutaMortgage dollars 534 467 462 2012-2016 1

2.08 MedianHouseholdGrossRent dollars 937 911 949 2012-2016 1

1.81MortgagedOwnersMedianMonthlyHouseholdCosts dollars 1504 1444 1491 2012-2016

1.75 PersonswithHealthInsurance percent 79.3 100 81.4 2016

1.67ChildrenLivingBelowPovertyLevel percent 26 23.9 21.2 2012-2016

Other,<6 1

1.67People25+withaHighSchoolDegreeorHigher percent 80.2 82.3 87 2012-2016

Male,35-44,45-64,65+ 1

1.67 PeopleLivingBelowPovertyLevel percent 17.4 16.7 15.1 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,Other,Female,<6,6-11,12-17,18-24 1

1.67 TotalEmploymentChange percent 2.4 3.2 2.5 2014-2015 16

1.67VoterTurnout:PresidentialElection percent 58.4 58.8 2016 14

1.44 People65+LivingAlone percent 24.4 23.9 26.4 2012-2016 1

1.08 MedianHousingUnitValue dollars 145600 142700 184700 2012-2016 1

0.94FemalePopulation16+inCivilianLaborForce percent 59.8 57.7 58.3 2012-2016 1

0.94Population16+inCivilianLaborForce percent 68.3 64.2 63.1 2012-2016 1

0.67People25+withaBachelor'sDegreeorHigher percent 30.1 28.1 30.3 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,NativeHawaiianor

OtherPacificIslander,Other,45-

64,65+ 1

0.50 MedianHouseholdIncome dollars 55584 54727 55322 2012-2016

Other 1

0.50 PerCapitaIncome dollars 29850 27828 29829 2012-2016

AmericanIndianorAlaskaNative,BlackorAfricanAmerican,HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Other,Two

orMoreRaces 1

SCORE SUBSTANCEABUSE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.17 Alcohol-ImpairedDrivingDeaths percent 37.8 28.3 29.3 2012-2016 4

1.50 AdultswhoDrinkExcessively percent 18.1 25.4 19.4 18 2016 4

Adults(18+Years)ReportingBingeDrinkingWithintheLast12months percent 16.6 24.2 17.9 16.9 2016 10

1.19 DeathRateduetoDrugPoisoningdeaths/100,000

population 10.2 9.8 16.9 2014-2016 4

0.94 AdultswhoSmoke percent 12.1 12 14.3 17.1 2016 10

0.89 LiquorStoreDensitystores/100,000population 6.3 6.8 10.5 2015

SCORE TRANSPORTATION UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.83 SoloDriverswithaLongCommute percent 45.8 36.9 34.7 2012-2016

2.67 MeanTravelTimetoWork minutes 28.6 25.9 26.1 2012-2016 Male 1

2.17 WorkerswhoWalktoWork percent 1.5 3.1 1.6 2.8 2012-2016 White,non-Hispanic 1

1.44 WorkerswhoDriveAlonetoWork percent 79.1 80.3 76.4 2012-2016White,non-

Hispanic,25-44,55- 1

1.33 HouseholdswithoutaVehicle percent 6.4 5.6 9 2012-2016

1.28WorkersCommutingbyPublicTransportation percent 2.8 5.5 1.5 5.1 2012-2016

HispanicorLatino,NativeHawaiianor

OtherPacificIslander,Twoor

MoreRaces,White,non-Hispanic,Male,

25-44 1

1.00HouseholdswithNoCarandLowAccesstoaGroceryStore percent 0.9 2015

SCORE WELLNESS&LIFESTYLE UNITSHARRISCOUNTY HP2020 TEXAS U.S.

1.83Self-ReportedGeneralHealthAssessment:PoororFair percent 18.2 18.2 16 2016 4

1.75 PoorPhysicalHealth:5+Days percent 80.6 81.5 2016 10

1.67 InsufficientSleep percent 33.9 32.7 38 2016 4

1.28 LifeExpectancyforMales years 76.4 76.2 76.7 2014 6

1.17 FrequentPhysicalDistress percent 11.5 10.8 15 2016

1.17PoorPhysicalHealth:AverageNumberofDays days 3.6 3.5 3.7 2016

1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014

SCORE WOMEN'SHEALTH UNITSHARRISCOUNTY HP2020 TEXAS U.S.

2.53 CervicalCancerIncidenceRatecases/100,000

females 11 7.3 9.2 7.5 2011-2015 7

2.25Age-AdjustedDeathRateduetoBreastCancer

deaths/100,000females 23.2 20.7 20.2 20.9 2011-2015 Black 7

1.39 BreastCancerIncidenceRatecases/100,000

females 113.2 111.7 124.7 2011-2015 7

1.06 LifeExpectancyforFemales years 81 80.8 81.5 2014 6

AppendixC.PrimaryDataMethodology

CommunityInputParticipantsAccessHealth(FQHC)(FortBendFamilyHealthCenter)AIDSFoundationofHoustonAssociationfortheAdvancementofMexicanAmericansAvenueCDCCatholicCharities-ArchdioceseofGalvestonCatholicCharities-FortBendChildAdvocatesofFortBendChildrenatRiskChristClinicCityofHouston,DepartmentofParksandRecreationCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceElCentrodeCorazonEpiscopalHealthFoundationFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerce

GulfCoastMedicalFoundationHarrisCountyPublicHealthHealthcarefortheHomeless-HoustonHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictInterfaithCommunityClinicKinderInstituteLegacyCommunityHealthLibertyCountySheriff'sOfficeLoneStarFamilyHealthCenterMidtownArtsandTheaterCenterHoustonMontgomeryCountyWomen'sCenterBaker-RipleyEarlyHeadStartPatientCareInterventionCenter(PCIC)PrairieViewA&MUniversitySantaMariaHostel,Inc.TheArcofFortBendCountyTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeTri-CountyServicesBehavioralHealthcareUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayofHarrisandMontgomeryCountyWestChambersMedicalCenter(FQHC)YMCAofGreaterHouston

KeyInformantInterviewQuestionnaire(EpiscopalHealthFoundation)• Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],

andIamwithHealthResourcesinAction,anon-profitpublichealthorganizationbasedinBoston.Thankyouforspeakingwithmetoday.

• Aswementionedinourinterviewinvitation,theEpiscopalHealthFoundationis

coordinatinganinterviewinitiativetosupportfourGreaterHoustonareahospitalsystemsinpreparingtheircommunityhealthneedsassessments.ThecollaboratinghospitalsincludeCHISt.Luke’s,HoustonMethodistHospital,MemorialHermannHealthSystem,andTexasChildren’sHospital.

• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout70stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthebroaderGreater

Houstoncommunityandthepopulationsyouworkwithasaleaderinyourcommunity.TheFoundationandthefourhospitalswelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,HealthResourcesinActionwillprovideatranscriptofyourinterviewtothefourhospitalsforuseinpreparingtheircommunityhealthneedsassessmentreports.Eachhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.HealthResourcesinActionwillalsobepreparingareportofthegeneralthemesthatemergeacrossalltheinterviewstohelpthehospitalspreparetheirreports.

• TheFoundationhasaskedHealthResourcesinActiontoaskallintervieweeshowtheywish

anyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.

• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW

INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization/agency?

o Hasyourorganization/agencyeverpartneredwithanyofthefourhospitalsinvolvedinthissharedcommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves/theGreaterHoustonpopulationatlarge?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?

§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,whichwould

yourankasyourtopissue?Howdoyouseethisissueaffectingcommunitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbybarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o Whatdoyouseeasthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whatdoyouseeasitslimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfaceinaccessinghealthcareand

socialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofinthecommunitythataddressaccess

tohealthcareandsocialservices?

o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenataddressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesarecurrentlynotavailablethatyouthinkshould

IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)• Whatdoyouthinkneedstohappeninthecommunityyouservetohelpresidentsovercome

oraddressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyaren’tdoingrightnow?Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstothefourhospitals.Eachhospitalwillmaketheircommunityhealthneedsassessmentreportspubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoJenniferMineoattheEpiscopalHealthFoundationwhoiscoordinatingthiseffortonbehalfofthefourhospitals.Thankyouagain.Haveagoodmorning/afternoon.

KeyInformantInterviewQuestionnaire(ConduentHealthyCommunitiesInstitute)Goodmorning/afternoon[NAMEOFINFORMANT].Mynameis[NAMEOFINTERVIEWER],andIamwithConduentHealthyCommunitiesInstitute.Mycolleague[name]isalsoontheline.WeareworkingwithMemorialHermannHealthSystemtoconductaCommunityHealthNeedsAssessment.• Thepurposeofthisinterviewistogainagreaterunderstandingofthehealthstatusand

wellbeingofresidentsintheGreaterHoustonareaanddeterminehowthesehealthneedsarecurrentlybeingaddressed.Interviewslikethisonearebeingconductedwithabout12stakeholdersfromarangeofsectorssuchasgovernment,healthcare,business,andcommunityserviceorganizations.Wearealsointerviewingcommunityleaderswithspecificexperienceworkingwithprioritypopulationssuchaswomen,children,peopleofcolor,andthedisabledtonameafew.

• Weareinterestedinhearingpeople’sfeedbackontheneedsofthecommunityandthe

populationsyouworkwithasaleaderinyourcommunity.MemorialHermannwelcomeyourcriticalfeedbackandsuggestionsforhealthimprovementactivitiesinthefuture.Yourhonestyduringtoday’sinterviewisencouragedandappreciated.

• Aswementionedinourinterviewinvitation,theinterviewwilllastbetween45minutesto

anhouranditwillberecorded.Afteralltheinterviewsarecompleted,wewillanalyzeandsummarizealltheinterviewstoincorporateintothecommunityhealthneedsassessmentreports.EachMHhospitalwillkeepyourinterviewtranscriptconfidentialandaccessibleonlytotheteamthatispreparingthecommunityhealthneedsassessmentreport.

• MemorialHermannhasaskedHCItoaskallintervieweeshowtheywishanyquotesfromtoday’sinterviewtobepresentedinreports.Therearethreeoptions.Quotesmaybepresentedanonymouslywithoutyournameororganization,presentedwithyournameandorganization,orpresentedwithonlythesectoryourepresent.

• Whichoptionwouldyouliketochoose?

• RECORDRESPONSEFROMINTERVIEWEE:rAnonymousrNameandorganizationrSector

• Thankyou.Wewillnoteyourchoiceinthetranscriptthatweprovidetothehospitals.

• IFTHERESPONDENTISUNSUREATTHETIMEOFTHEINTERVIEW:Ok,pleasefeelfreetothinkitoverandwewillfollowupwithyouforyourdecisionbeforewesendthetranscripttothehospitals.

• Doyouhaveanyquestionsbeforewebegin?BEGINRECORDINGTHEINTERVIEW

INTERVIEWQUESTIONNAIRE(55MINUTES)

NOTESTOINTERVIEWER:• INTERVIEWQUESTIONSMAYBEADDEDORTAILOREDTOMEETTHESPECIFIC

POSITION/ROLEOFTHEINTERVIEWEE• THEQUESTIONSINTHEINTERVIEWQUESTIONNAIREAREINTENDEDTOSERVEASAGUIDE,

NOTASCRIPTBACKGROUND(5MINUTES)• Canyoutellmealittlebitaboutyourroleatyourorganization?

o Hasyourorganization/agencyeverpartneredwithMH’scommunityhealthneedsassessmentbefore?IFSO,PROBEINWHATCAPACITY/PROGRAM

• Howwouldyoudescribethecommunityyourepresent/thecommunityyourorganizationserves?Whataresomeofitsdefiningcharacteristicsintermsofdemographics?INTERVIEWER:ESTABLISHWHATTHEINFORMANTCONSIDERSTHECOMMUNITYTOBEFROMTHEIRPERSPECTIVE

COMMUNITYISSUES(20minutes)INTERVIEWER:VARYTHELABELOF‘COMMUNITY’BASEDONTHEINFORMANT’SBACKGROUNDANDHOWHEORSHEDESCRIBESTHECOMMUNITY;BESURETOPROBEONWOMEN’SANDCHILDREN’SISSUESTOENSUREWEADDRESSTHENEEDSOFTHECHILDREN’SHOSPITALSINALLQUESTIONSASRELEVANT• Thinkingaboutthestatusofthecommunitytoday,howwouldyouratetheoverallhealth

statusofresidentsonascaleof1to5with1beingpoorand5beingveryhealthy?

• Ifyouhadtopickyourtop3healthconcernsinthecommunity,whatwouldtheybe?PROBEIN-DEPTHBASEDONINFORMANTAREAOFEXPERTISE

o Whodoyouconsidertobethepopulationsinthecommunitymostvulnerableorat

riskfortheseconditions/issues?§ IFNOTYETMENTIONED,PROBESPECIFICALLYONPRIORITYPOPULATION

RELEVANTTOTHEINFORMANT’SEXPERTISE:Whatdoyouthinkarethemostpressinghealthconcernsinthecommunityfor[PRIORITYPOPULATION]?

§ FORINFORMANTSEXPERTISEWITHWOMENANDCHILDREN:Whatdoyou

thinkarethemostpressinghealthconcernsinthecommunityforchildrenandtheirfamilies?Howaboutforwomen?

§ IFNOTYETDISCUSSED:Ofthetopthreeissuesyoumentioned,which

wouldyourankasyourtopissue?Howdoyouseethisissueaffecting

communitymembers’dailylivesandtheirhealth?PROBEIN-DEPTHINSPECIFICFOCUSAREAS;MAYASKABOUTONEISSUEATTIMEANDFOCUSONPERSON’SAREAOFEXPERTISE.

• Fromyourexperience,whatareresidents’biggestbarrierstoaddressingthetop3health

issuesyouidentified?o PROBE:Socialdeterminantsofhealth?o PROBE:Barrierstoaccessingmedicalcare?o PROBE:Barrierstoaccessingpreventiveservicesorprograms?

FOCUSAREA:HEALTHYLIVING(5MINUTES)• I’dliketoaskyouaboutbarriersaffectinghealthylivingandthepreventionofobesity.

o Whataresomeofthebarrierstohealthyeatingandphysicalactivityamongthecommunitiesyouserve?

§ Whatpopulationsaremostaffectedbythesebarrierstohealthylivingandphysicalactivity?PROBEABOUTFOODINSECURITYANDACCESSTOSAFESPACESFORPHYSICALACTIVITY

o Whateffortsorprogramsareyouawareofthatpromotehealthyliving?PROBEABOUTHEALTHYLIVINGMATTERSCOLLABORATIVE

ACCESSTOHEALTHCAREANDPUBLICHEALTH/PREVENTIONSERVICES(15MINUTES)

• I’dliketoaskyouaboutaccesstohealthcareandsocialservicesinyourcommunity.

o WhatAREthestrengthsofthehealthcareandsocialservicesinyourcommunity?

o Whataresomeoftheirlimitations?• Whatchallenges/barriersdoresidentsinyourcommunityfacewhenaccessinghealthcare

andsocialservices?[PROBEINDEPTHFORBARRIERSTOCARE:INSURANCEISSUES,LANGUAGEBARRIERS,ACCESSTOHEALTHINFORMATION/HEALTHLITERACY,LACKOFTRANSPORTION,CHILDCARE,ETC.]

o Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeoraddressthesechallenges?

• Whatprograms,services,orpoliciesareyouawareofthataddressaccesstohealthcare

andsocialservices?

o Inyouropinion,howeffectivehavetheseprograms,services,orpoliciesbeenataddressingthehealthneedsofresidents?

o Whatprogram,services,orpoliciesnotavailablethatyouthinkshouldbe?

IMPROVINGTHEHEALTHOFTHECOMMUNITY/RESIDENTS(10MINUTES)

• Whatdoyouthinkneedstohappeninthecommunitytohelpresidentsovercomeoraddressthechallengestheyfaceinbeingabletobehealthy?

• Earlierinthisinterview,youmentioned[TOPISSUE]asbeingyourtophealthpriorityforarearesidents.Whatdoyouthinkneedstobedonetoaddress[TOPISSUEHERE]?

o Whatdoyouthinkhospitalscandotoaddressthisissuethattheyarenotdoingrightnow?

o Doyouhaveanysuggestionsabouthowhospitalscanbecreativeorworkoutsidetheirtraditionalroletoaddressthisissueandimprovecommunityhealth?

o Whatkindsofopportunitiesarecurrentlyouttherethatcanbeseizedupontoaddresstheseissues?Forexample,aretheresome“lowhangingfruit”–currentcollaborationsorinitiativesthatcanbestrengthenedorexpanded?

VISIONFORTHECOMMUNITY(5MINUTES)

• Thehospitalsinvolvedinthisinitiativewillbeplanningtheirstrategytoimprovethehealth

ofthecommunitiestheyserve.Whatadvicedoyouhaveforthegroupdevelopingtheplantoaddressthetophealthneedsyou’vementioned?

CLOSING(5MINUTES)

Thankyousomuchforyourtime.That’sitformyquestions.Isthereanythingelsethatyouwouldliketomentionthatwedidn’tdiscusstoday?AsImentioned,afteralloftheinterviewsarecompleted,wewillbesendingyourinterviewtranscriptstoMemorialHermann.Thecommunityhealthneedsassessmentreportswillbepubliclyavailablewhentheyarecomplete.Ifyouhaveanyquestions,pleasefeelfreetoreachouttoDeborahGanelinatMemorialHermannwhoiscoordinatingthiseffort.Thankyouagain.Haveagoodmorning/afternoon.

CommunitySurvey(English)MemorialHermannHealthSystemisconductingaCommunityHealthNeedsAssessmentfortheGreaterHoustonarea.ThisassessmentallowsMemorialHermanntobetterunderstandthehealthstatusandneedsofthecommunityandusetheknowledgegainedtoimplementprogramsthatwillbenefitthecommunity.Wecanbetterunderstandcommunityneedsbygatheringvoicesfromthecommunity.Thissurveyallowscommunitymemberslikeyoutotellusaboutwhatyoufeelareimportantissuesforyourcommunity.Weestimatethatitwilltakeabout5minutestocompletethissurvey.Thankyouverymuchforyourinputandyourtime!1. Pleaselookatthislistofcommunityissues.Inyouropinion,whatarethetop5issuesmost

affectingthequalityoflifeinyourcommunity?o Diabeteso Obesity/Overweighto Respiratory/LungDisease(asthma,COPD,etc.)o Cancerso MentalHealthandMentalDisorderso Injuries,ViolenceandSafetyo SubstanceAbuse(alcohol,tobacco,drugs,etc.)o OralHealtho HeartDiseaseandStrokeo SexualHealth(HIV/AIDS,STDs,etc.)o TeenagePregnancyo ElderCareo ReproductiveHealth(familyplanning)o Other(pleasespecify):______________________________

2. Howwouldyourateyourownpersonalhealth?

o Veryhealthyo Somewhathealthyo Unhealthyo Veryunhealthy

3. Abouthowmanytimesaweekdoyouexerciseorperformaphysicalactivitylikewalking,

running,bicycling,etc.?o Lessthan1timeaweeko 2-3timesaweeko 5ormoretimesaweeko Nevero Other(pleasespecify):______________________________

4. Whataresomeofthebarriersorchallengestoexercisingonaregularbasisforyou?o Noplacestoexerciseo Notimetoexerciseo Idon’tlikeexercisingo Feelunsafeexercisinginthecommunityo Noneofmyfriendsorfamilyexerciseo Nochildcareo Lackoffundstopayforgymorclasseso Notransportationo Other(pleasespecify):______________________________

5. Howmuchdoyouagreeordisagreewitheachofthestatementsbelow. Agree

stronglyAgree Disagree Disagree

stronglyTherearegoodparksforchildren,adultsandpeopleofallabilitiestoenjoyinmycommunity

Inthepast12months,IhadaproblemgettingthehealthcareIneededformeorafamilymemberfromanytypeofhealthcareprovider,dentist,pharmacy,orotherfacility

Idon’tknowwheretogetservicesformyselfwhenIamsad,depressedorneedsomeonetotalkto

IamconfidentIcangetanappointmentwhenIneedtoseemydoctorfairlyquickly

Ihaveaplacetoreceivemedicalcareotherthantheemergencyroom

Withinthepast12months,IworriedwhethermyfoodwouldrunoutbeforeIgotmoneytobuymore

Withinthepast12months,thefoodIboughtjustdidn’tlastandIdidn’thavemoneytogetmore

Therearemanyoptionsforhealthyandaffordablefoodinmycommunity

6. Hasyourdoctorevertoldyouthatyouhaveanyofthefollowing?(Markallthatapply)

o Highbloodpressureo Highcholesterolo Cancero Diabeteso Obesityo Asthmao Heartdiseaseo Other(pleasespecify):______________________________

Now,afewquestionssothatwecanseehowdifferenttypesofpeoplefeelaboutthequestionsasked.7. Zipcodewhereyoulive:______________________________8. Whatisyourage?______________________________

9. Whatisyourrace/ethnicity?o Whiteo Black/AfricanAmericano Hispanic/Latinoo Asian/PacificIslandero NativeAmericano Other(pleasespecify):______________________________

10. Whataretheagesofchildrenlivinginyourhousehold?

o 11andyoungero 12-18yearsoldo 18andoldero None

11. Whatkindofmedicalinsuranceorcoveragedoyouhave?

o Privateo Employer-sponsoredo Medicaido Medicareo Noneo Other(pleasespecify):______________________________

Thankyouforcompletingthissurvey!

CommunitySurvey(Spanish)MemorialHermannHealthSystemestárealizandounaEvaluacióndelasNecesidadesdeSaluddelaComunidadeneláreametropolitanadeHouston.EstaevaluaciónpermiteaMemorialHermann

comprendermejorelestadodesaludylasnecesidadesdelacomunidad,asícomousarlainformaciónobtenidaparaponerenprácticaprogramasquebeneficienalacomunidad.

1.Lealalistadeproblemasdelacomunidad.Ensuopinión¿cuálessonlos5problemasquemásafectanlacalidaddevidaensucomunidad?□ Diabetes□ Obesidad/sobrepeso□ Enfermedadesrespiratorias/pulmonares(asma,enfermedadpulmonarobstructivacrónica[EPOC],etc.)

□ Cáncer□ Saludmentalytrastornosmentales□ Lesiones,violenciayseguridad□ Drogodependencia(alcohol,tabaco,drogas,etc.)

□ Saludbucal□ Enfermedadescardíacasyaccidentescerebrovasculares

□ Saludsexual(VIH/sida,enfermedadesdetransmisiónsexual[ETS],etc.)

□ Embarazosdeadolescentes□ Cuidadodeancianos□ Saludreproductiva(planificaciónfamiliar)

□ Otros,(especifique):_________________________________________________________

2.¿Cómocalificaríasupropiasaludpersonal?□ Muybuena□ Bastantebuena

□ Mala□ Muymala

3.¿Aproximadamente,cuántasvecesporsemanahaceejerciciooalgunaactividadfísica,comocaminar,correr,andarenbicicleta,etc.?□ Menosde1vezporsemana□ De2a3vecesporsemana

□ 5omásvecesporsemana□ Nunca

4.¿Cuálessonalgunasdelasbarrerasodificultadesqueleimpidenhacerejercicioregularmente?□ Notengounlugardondehacerejercicio.□ Notengotiempoparahacerejercicio.□ Nomegustahacerejercicio.□ Nomesientoseguro/ahaciendoejercicioenmicomunidad.

□ Ningunodemisamigosofamiliareshacenejercicio.

□ Notengoconquiéndejaramishijosmientrashagoejercicio.

□ Notengodineroparapagarungimnasiooclases.

□ Notengoaccesoatransporte.

Calculamosqueletomaráunos5minutoscompletarestaencuesta.

5.¿Lehadichosumédicoalgunadelassiguientesafecciones?(Marquetodaslasopcionesquecorrespondan).□ Presiónarterialalta□ Colesterolalto□ Cáncer□ Diabetes

□ Obesidad□ Asma□ Enfermedadcardíaca

6.¿Enquémedidaestádeacuerdooendesacuerdoconcadaunadelassiguientesafirmaciones? Muyde

acuerdoDe

acuerdoEn

desacuerdoMuyen

desacuerdoEnmicomunidad,haybuenosparquesparaniños,adultosypersonascontodotipodecapacidadesparanuestrodisfrute.

Enlosúltimos12meses,tuveunproblemaparaobtenerelcuidadomédicoquenecesitabaparamíoparaunfamiliarporpartedecualquiertipodeproveedordecuidadodelasalud,dentista,farmaciauotrocentrosanitario.

Nosédóndeobtenerserviciosparamícuandoestoytriste,deprimido/a,onecesitohablarconalguien.

Séconseguridadquepuedoobtenerunacitaconmimédicoconciertarapidez.

Tengoamidisposiciónunlugarpararecibircuidadosmédicosquenoseaunasaladeemergencias.

Enlosúltimos12meses,mepreocupédesilacomidaseagotaríaantesdeobtenerdineroparacomprarmásalimentos.

Enlosúltimos12meses,losalimentosquecomprésimplementenoduraronlosuficienteynotuvedineroparacomprarmás.

Enmicomunidadhaymuchasopcionesparacompraralimentossaludablesyasequibles.

7.Códigopostaldesucasa:_________________________8.¿Cuántosañostiene?_________________9.¿Cuálessuraza/origenétnico?□ Blanco/a□ Negro/aoafroamericano/a□ Hispano/aolatino/a

□ Asiático/aoisleño/adelPacífico□ Indígenaamericano/a□ Otro/a,(especifique):______________

10.¿Cuántosañostienenlosniños/asquevivenensucasa?□ 11ymenos□ Entre12y18años

□ Másde18años□ Ninguno

Ahoraleharemosalgunaspreguntasparapodervercómosesientenlosdistintosgruposdepersonasacercadelaspreguntasquelehemoshecho.

11.¿Quétipodeseguromédicoocoberturatiene?□ Privado□ Patrocinadoporunempleador□ Medicaid

□ Medicare□ Ninguno□ Otro,(especifique):________

AppendixD.PrioritizationTool

PrioritizationSurveyThankyouforyourparticipationinthisprioritizationprocess.TheCommunityHealthNeedsAssessment(CHNA)processhasmultiplesteps.Afterthoroughresearchhasbeencompletedtoidentifythesignificanthealthneedsinthecommunity,thesesignificanthealthneedsmustbeprioritizedforfurtherstrategicplanningandimplementation.Prioritizationistheprocessofdeterminingthemostimportantorurgenthealthneedstoaddressincommunities.BelowisadiagramthatshowsthemethodsthatwereusedtoidentifykeyissuesacrossMemorialHermann’sserviceareas.Thesethreemethodsincluded:asecondarydatareview,acommunitysurveyandkeyinformantinterviews.Asyousee,someissuesrevealedthemselvesacrossmultiplemethods.Reviewingthisdiagrammayhelpyoucompletethissurvey.

1. Thefollowinghealthneedsarenotlistedbyorderofimportance.Foreachhealthneed,click

onthearrowonthedropdownboxandselectyouragreementwitheachstatement.Ifyouareonatabletorphone,pleasescrollallthewaytotherightforeachrow.

Theissueimpactsmanypeopleinmycommunity

Thisissuesignificantlyimpactssubgroups

Therearenotenoughexistingandadequateresourcesto

Thisissuehashighriskfordiseaseordeath

(subgroupsbyage,gender,race/ethnicity,LGBTQ,etc.)

addressthisissueinmycommunity

AccesstoHealthServices

HeartDiseaseandStroke

OlderAdultsandAging

Obesity(Exercise,NutritionandWeight)

Transportation MentalHealth Diabetes SubstanceAbuse Cancers LackofHealthInsurance

Education FoodInsecurity Low-Income/Underserved

Children’sHealth Economy 2. IndicatethelevelofimportancethatshouldbegiventowardseachofMemorialHermann’s

4Pillars.Keydefinitionsarelistedbelow.

NotImportant

SomewhatImportant

Important VeryImportant

NotSure

Accesstocare(includinghealthcareaccess,healthcareresourceawareness,healthcarenavigation/literacy)

Foodashealth(includingfoodinsecurity,foodprograms,foodknowledge)

Exerciseasmedicine(includingobesity,accesstoparks,safeplacestoexercise)

Emotionalwell-being(includingemotionalhealth,mentalhealth,substanceabuse)

Keydefinitions:Healthcarenavigation/literacy:needforeducationinnavigatinghealthsystemsFoodinsecurity:lackingreliableaccesstohealthyfoodoptions

Foodprograms:programs,effortsorservicesdesignedtoaddressfoodissuesFoodknowledge:one’sunderstandingofhealthyfoods3. Whoinyourcommunityismostaffectedbypoorhealthoutcomes?(Selectupto5)

o Lesbian,Gay,Bisexual,Transgender,QueerorQuestioning(LGBTQ)o OlderAdultso PersonswithDisabilities(cognitive,sensoryorphysicaldisability)o Racial/EthnicMinorityPopulationso Veteranso Immigrantsorotherundocumentedpersonso Personsexperiencinghomelessnessorprecariouslyhousedo OtherPopulations(pleasespecify):____________________________

4. Pleaseprovideyourname:__________________________________________

5. Pleaseprovideyouremailaddress:__________________________________________

6. Pleaseselectthename(s)ofthehealthcarefacilityorfacilitiesyourepresent.Youmay

choosemorethanone.o MemorialHermannKatyo MemorialHermannMemorialCityo MemorialHermannGreaterHeightso MemorialHermannNortheasto MemorialHermannSoutheasto MemorialHermannSugarLando MemorialHermannSouthwesto MemorialHermannTheWoodlandso KatyRehabo TexasMedicalCentero TIRRMemorialHermanno MemorialHermannSurgicalHospitalKingwoodo MemorialHermannSurgicalHospitalFirstColonyo MemorialHermannFirstColonyHospital(ER)o MemorialHermannTomballHospital(ER)o Other(pleasespecify):_____________________________

ThankyouforyourinputandparticipationintheCommunityHealthNeedsAssessmentprocess.

AppendixE.CommunityResourcesThefollowingisalistofcommunityresourcesmentionedbycommunityinputparticipants.2-1-1TexasA.C.TaylorHealthCenterAccessHealthAcresHomeHealthCenterAIDSFoundationHoustonAldineHealthCenterAmericanHeartAssociationAmericanRedCrossAmistadCommunityHealthCenterAreaAgencyonAgingAssociationfortheAdvancementofMexicanAmericansAvenue360Health&WellnessAvenueCDCBaker-RipleyBastropCommunityHealthCenterBaylorTeenHealthClinicBaysideClinicBaytownHealthCenterBeeBusyWellnessCenterBoatPeopleSOSBo'sPlaceBrighterBitesBrownsvilleCommunityHealthCenterBuffaloBayouPartnershipBurlesonFamilyMedicalCenterBVCAA-HealthPointCanDoHoustonCasadeAmigosHealthCenterCasaElBuenSamaritanoCatholicCharitiesoftheArchdioceseofGalveston-Houston-FortBendCentralCareCommunityHealthChambersCommunityHealthCenterCHISt.Luke'sHealthChildAdvocatesofFortBendChildrenatRiskChristClinicChristianCommunityServicesCenter(CCSC)CHRISTUSHealthSystemCitiesChangingDiabetesCityofHoustonCityofHouston,DepartmentofParksandRecreation

CityofPasadenaCoastalAreaHealthEducationCenters(AHEC)CommunityHealthChoiceCountyIndigentHealthCareProgramCovenantwithChristCommunityServiceCenterCypressHealthCenterDannyJacksonHealthCenterDentalHygieneClinicE.A."Squatty"LyonsHealthCenterElCentroDeCorazonElFrancoLeeHealthCenterEpiscopalHealthFoundationFamilyServices(GalvestonCounty)FortBendConnectFortBendCountyCollaborativeInformationSystemFortBendCountyHealthandHumanServicesFortBendCountySheriff'sOfficeFortBendRegionalCouncilOnSubstanceAbuseFortBendSeniorsMealsonWheelsFortBendWomen'sCenterGalvestonCountyHealthDistrictGalvestonCountyMentalHealthDeputiesGoHealthyHoustonTaskForceGoodRxGreaterHoustonPartnershipGreaterHoustonWomen'sChamberofCommerceGulfCoastCommunityServicesAssociationGulfCoastMedicalFoundationGulfgateHealthCenterHarmonyHouseRespiteCenterHarrisCenterCrisisLineHarrisCountyPublicHealthandEnvironmentalServices(HCPHES)HarrisCountyRidesHarrisCountySocialServicesHarrisHealthSystemHarvestGreen(Development)HEALInitiative

HealthCenterofSoutheastTexasHealthcarefortheHomeless-HoustonHealthyLivingMatters(HarrisCounty)HelpingHandsFoodPantryHOPEClinic(FQHC)HoustonFoodBankHoustonHealthDepartmentHoustonHousingAuthorityHoustonIndependentSchoolDistrictHoustonRyanWhitePlanningCouncilHoustonShifaSynottClinicHuntsvilleMemorialHospitalClinicIbnSinaFoundationIndiaHouseCharityClinicInterfaithCommunityClinicInterfaithMinistriesMealsonWheelsInterfaithofTheWoodlandsKinderInstituteLaNuevaCasaHealthCenterLegacyHealth(FQHC)LeonCountyCommunityHealthCenterLibertyCountySheriff'sOfficeLoneStarFamilyHeathCenter(FQHC)LongBranchHealthCenterLongTermRecoveryGroupLosBarriosUnidosCommunityClinicMagnoliaHealthCenterMamieGeorgeCommunityCenterMartinLutherKingJr.HealthCenterMedicalPlusSuppliesMEHOP-MatagordaEpiscopalHealthOutreachProgramMETHeadStartMethodistHospitalMetroliftMidtownArtsandTheaterCenterHoustonMontgomeryCountyFoodBankMontgomeryCountyWomen’sCenterNeighborhoodHealthCenterNorthwestAssistanceMinistry'sChildren'sClinicNorthwestHealthCenterNuestraClinicadelVallePatMcWatersHealthClinic-SecondMileMissionPatientCareInterventionCenter(PCIC)PearlandCommunityHealthCenterPediatric&AdolescentHealthCenter

PhysiciansatSugarCreekPlannedParenthoodPrairieViewA&MUniversityQuentinMeaseHospitalRegionalAssociationofGrantMakersRegionalMedicalCenterRobertCarrascoHealthClinicRSVPMedSpaSanJoseClinicSantaMariaHostel,Inc.SettegastHealthCenterSevaClinicCharityMedicalFacilityShelteringArmSeniorServicesDivisionofBakerRipleyShifaClinicSmithClinicSocialSecurityAdministrationSpringBranchCommunityHealthCenterSt.HopeFoundationSt.Vincent'sHouseStephenF.AustinCommunityHealthNetworkStrawberryHealthCenterTexanaBehavioralHealthTexasA&MAgriLifeExtensionServiceTexasChildren’sHospitalTexasMedicaidandCHIPMedicalTransportationProgramTheArcofFortBendCountyTheBeaconTheHarrisCenterforMentalHealthandIDD(formerlyMHMRA)TheRoseTheWomen'sHomeThomasStreetHealthCenterTOMAGWAClinicTri-CountyServicesBehavioralHealthcareUberHealthUnitedWayofBrazoriaCountyUnitedWayofGreaterHoustonUnitedWayProjectBlueprintUniversityofHouston-CollegeofOptometryUniversityofTexasHealth-DentalUniversityofTexasHealthServicesUniversityofTexasPhysiciansUrbanHarvestUTMB

ValbonaHealthCenterVCareClinicVecinoHealthCenterWestChambersMedicalCenter(FQHC)WestHoustonAssistanceMinistries(WHAM)WholeLifeServiceCenterWomen'sCareCenterWorkforceSolutionsYMCAofGreaterHouston

memorial hermann greater heights hospital...memorial hermann is a not-for-profit, community-owned,...

Documents

memorial hermann health system

standards of conduct - memorial hermann · pdf filememorial...

2011 annual summary of 2010 memorial hermann cancer ... ·...

memorial hermann health system memorial hermann health...

memorial hermann health system · mh northeast hospital...

children’s memorial hermann | houston children’s...

memorial hermann tower - metronational

memorial hermann surgical hospital first colony Àk …

trang 1 / 19 - memorial hermann health system

memorial hermann advantage hmo y...

memorial hermann health system€¦ · texas medical center...

memorial hermann health...

descripcion general del sistema memorial hermann ·...

memorial hermann: houston, texas - aha.org hermann: houston,...

memorial hermann medical missions 2011...

memorial hermann health system · care, community health...

memorial hermann healthcare€¦ · memorial hermann health...

economic forecast 2014 health care focus: craig cordola, ceo...

2013 circle of life g - memorial hermann · a...

letter to the community - memorial hermann health system ·...