NYC Health & Hospitals Issues Report Entitled 'Community Health Needs Assessment'

WASHINGTON, Dec. 26 (TNSrep) -- NYC Health and Hospitals, New York, issued a 120-page report in December 2022 entitled "Community Health Needs Assessment."

Here are excerpts:

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TABLE OF CONTENTS

A MESSAGE FROM LEADERSHIP ... 4

EXECUTIVE SUMMARY ... 6

ABOUT NYC HEALTH + HOSPITALS ... 8

THE COMMUNITY NYC HEALTH + HOSPITALS SERVES TODAY ... 12

THE 2022 CHNA PROCESS ... 14

PRIORITY HEALTH NEEDS ... 16

* IMPROVING HEALTH EQUITY ... 18

* FIGHTING CHRONIC DISEASE ... 20

- INEQUITIES RELATED TO PREGNANCY ... 21

- ASTHMA ... 22

- HYPERTENSION ... 23

- DIABETES ... 24

- AGING AND FRAILTY ... 26

- SUBSTANCE USE DISORDER ... 27

- MENTAL HEALTH ... 28

- VIOLENCE ... 29

* FACILITATING ACCESS TO RESOURCES ... 30

THE COVID-19 PANDEMIC ... 32

TOP 10 PERCEIVED RISK FACTORS FOR POOR HEALTH AND DEATH ... 36

STAKEHOLDER INTERVIEWS ... 38

BOROUGH AND FACILITY-SPECIFIC FINDINGS ... 42

* BRONX ... 44

- NYC HEALTH + HOSPITALS/JACOBI ... 46

- NYC HEALTH + HOSPITALS/LINCOLN ... 50

- NYC HEALTH + HOSPITALS/NORTH CENTRAL BRONX ... 54

* BROOKLYN ... 58

- NYC HEALTH + HOSPITALS/CONEY ISLAND ... 60

- NYC HEALTH + HOSPITALS/KINGS COUNTY ... 64

- NYC HEALTH + HOSPITALS/WOODHULL ... 68

* MANHATTAN ... 72

- NYC HEALTH + HOSPITALS/BELLEVUE ... 74

- NYC HEALTH + HOSPITALS/HARLEM ... 78

- NYC HEALTH + HOSPITALS/HENRY J. CARTER ... 82

- NYC HEALTH + HOSPITALS/METROPOLITAN ... 86

* QUEENS ... 90

- NYC HEALTH + HOSPITALS/ELMHURST ... 92

- NYC HEALTH + HOSPITALS/QUEENS ... 96

* STATEN ISLAND ... 100

* NYC HEALTH + HOSPITALS/CORRECTIONAL HEALTH SERVICES ... 102

ACKNOWLEDGMENTS ... 104

APPENDIX ... 107

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Dear New Yorkers:

On behalf of the entire NYC Health + Hospitals system, we are proud to share our 2022 Community Health Needs Assessment (CHNA) with you. The CHNA is a tri-annual Federal legal requirement, but it is much more than that: it is an opportunity to assess our community needs and services with clear eyes and a rededication to our mission.

NYC Health + Hospitals is the largest municipal health care system in the country, serving over one million New Yorkers annually in over 70 locations. Our integrated system includes 11 acute care hospital sites, five post-acute facilities, the Gotham Health network of community health centers across the five boroughs, and MetroPlus Health, our subsidiary health plan. Every day, our 40,000+ employees live our mission of providing high quality health care services with compassion, dignity, and respect to all, regardless of income, gender identity, or immigration status. We are privileged to do this work.

In March of 2020, COVID-19 arrived in New York City and demanded a huge commitment of our energy and resources. Our system became the "epicenter of the epicenter" of COVID-19 in the United States, and NYC Health + Hospitals invested financially, physically, and emotionally to respond to the virus. We are very proud of all of the tremendous life-saving service our public health system has provided to New Yorkers during this horrible pandemic. We have created the nation's largest Test & Trace corps, vaccinated nearly two million New Yorkers at no cost to them, built three new Gotham Health COVID-19 Centers of Excellence to address the long-term impact of the pandemic in hard-hit communities, and treated COVID-19 patients in our hospitals and health centers, without exception. Our performance is due entirely to the unrelenting commitment and focus of our talented workforce members.

With their expertise, we have also continued our essential non-COVID-19 work. In the last year alone, we have taken critical steps including:

* Enrolled 90 percent of uninsured patients in health insurance or financial assistance, up from 70 percent

* Made critical system investments, opening a:

- New emergency department at NYC Health + Hospitals/Woodhull

- New same day surgery suite at NYC Health + Hospitals/Bellevue

- Community-Based Doula Care (HoPE) program at NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Queens

* Established the Maternal Home, which provides case and care management and wraparound services for pregnant people at risk of severe maternal morbidity

* Enrolled 100,000 New Yorkers in NYC Care, expanding access to services for all

* Began expanding our nationally renowned lifestyle medicine service program to six health care sites, building towards making it the most comprehensive expansion of lifestyle medicine programming in the U.S.

* Added new diabetes services for Staten Island

* Continued to integrate best practices in LGBTQ+ affirming care across the system with:

- New Gender Affirming Integrated Services Practice for LGBTQ+ patients opening at NYC Health + Hospitals/Lincoln

- Marking a milestone with 100th gender affirming surgery at NYC Health + Hospitals/Metropolitan

- Opening a new Pride Center to care for LGBTQ+ New Yorkers at NYC Health + Hospitals/Jacobi

As we look towards the future, we remain mindful of the inequities reinforced by COVID-19 and the ongoing importance of accessible, high-quality care for all New Yorkers. To better understand these priorities, we have turned to our community members and partners to gather their perspectives for this CHNA. Our CHNA work has included:

* Twelve community forums, one at each of our hospital facilities, working in coordination with our facility Community Advisory Boards (CABs). This is a new tool added to this year's CHNA process.

* Five borough-based focus groups with local Community Based Organizations (CBOs) and Community Boards. This too is new for this year's CHNA.

* Input from a newly convened CHNA Advisory Board, including the voices of our CAB Chairs, hospital representatives selected by the facility CEOs, the NYC Care director, our facility faith-based leaders, and other community leaders not otherwise accessed. This advisory Board will continue to meet monthly and is, again, a new resource for this year's CHNA.

* Information gathering through written surveys, made available in hard copy, digitally, and through QR code. We received 3,060 completed surveys, which is nearly ten times the response from our 2019 CHNA process. Respondents include our patients, community members, and staff members across New York City.

* Over 30 key informant interviews with NYC Health + Hospitals senior leaders, Board members, and leadership from the New York City Department of Health and Mental Hygiene (DOHMH).

* Supplementary interviews with additional system experts who focus on Correctional Health Services, homelessness, and COVID-19; and

* Intensive primary data review and analysis with our internal NYC Health + Hospitals Data and Analytics team, plus incorporation of secondary data from colleagues at DOHMH.

We are eager to share the outcomes in this CHNA and grateful to the community members who participated in this process. We at NYC Health + Hospitals acknowledge that we alone cannot address all of the forces that shape community health needs, but we must understand them to better serve our patients and neighbors. Thus, while this CHNA is an important project, it is only a step in our ongoing relationships with our communities. We will continue to honor these critical partnerships as we build to a more equitable and healthier future.

Thank you.

Dr. Mitchell Katz, President and CEO

Deborah Brown, JD, MSW, Senior Vice President, External and Regulatory Affairs

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EXECUTIVE SUMMARY

This CHNA takes a systematic approach to better identify, understand, and prioritize the health needs of the communities served by NYC Health + Hospitals, pursuant to the requirements of the Affordable Care Act. As a system, NYC Health + Hospitals is proud to serve all of New York City, and our individual facilities are essential anchors in their specific communities and neighborhoods, which are defined and detailed in this report.

We conducted this CHNA with input from individuals and groups representing the broad interests of our communities, including those with special knowledge of public health needs. This report will form the basis for the strategies that NYC Health + Hospitals and the community will undertake to address these challenges, to be reported in our subsequent Implementation Plan.

Since 2019, New York City communities have faced new public health challenges, including the COVID-19 pandemic, increased behavioral health issues, and widespread concerns about community safety and violence. These challenges have reinforced and exacerbated the health inequities in our communities that NYC Health + Hospitals has long been working to address. The voice of the community is more important than ever to identify these problems and find solutions to them.

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"COVID-19 CLEARED THE LENS TO THE INEQUITIES THAT WERE ALREADY IN OUR COMMUNITY." - NYC Health + Hospitals/Metropolitan Community Forum Participant

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NYC Health + Hospitals, the largest municipal health care system in the U.S., serves over 1.2 million people annually and offers comprehensive, accessible, and affordable health care to all, without exception. The system's 11 acute care hospital sites and its long-term acute care hospital, as well its extensive Gotham Health Federally Qualified Health Center network, provide top-ranked trauma care, offer dozens of inpatient specialties and mental health services, and keep communities healthy. NYC Health + Hospitals facilities have earned numerous special designations for quality and culturally responsive care and have received top ranks by U.S. News and World Report in the 2020-2021 ratings./1

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PRIORITY HEALTH NEEDS

The CHNA process highlighted two priority areas of need: 1) improving health equity and fighting chronic disease and 2) facilitating access to resources. These findings were reflected in the results of 3,060 surveys completed by community members, as outlined in Exhibits A and B, and by months of conversations, focus groups, and interviews with a range of stakeholders. By and large, the major themes of previous needs assessments remain consistent in 2022: the people served by NYC Health + Hospitals still experience large chronic and behavioral disease burdens.

These health outcomes are largely driven by systemic and structural challenges such as inequitable neighborhood income; a lack of quality, affordable housing; inadequate access to healthy affordable food; a limited number of safe places for physical activity; reduced social support; concerns about neighborhood safety; and difficulty accessing mental health treatment.

IMPROVING HEALTH EQUITY AND FIGHTING CHRONIC DISEASE

Health equity is defined as the "absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically."/2

In an equitable society, each person has the same basic access and equal opportunities for healthy living.

Our city and our health care system were impacted seismically in March 2020 when COVID-19 arrived in New York City. The hardest hit communities were those with longstanding health inequities, and the pandemic will have a lasting impact on individual and community health for many of our neighbors.

The populations that NYC Health + Hospitals serves continue to be the most marginalized populations in New York City. Many of our patients face a disproportionate amount of harmful daily stressors and barriers, which contribute to and exacerbate chronic disease and health equity challenges including inequities related to pregnancy, asthma, hypertension, diabetes, aging and frailty, substance use disorder, mental health, and violence.

As we emerge from the COVID-19 pandemic, it is the time to work toward reducing these inequities for all patients across the city. It is more important than ever to engage with community partners, residents, and leadership to gauge the status of each neighborhood. In doing so, NYC Health + Hospitals will work collaboratively with the community to recover from this trauma and continue the important work in achieving health equity for all New Yorkers.

Community stakeholders in the CHNA process identified populations with unique health equity and chronic disease challenges that need additional attention and resources. These include youth, seniors, pregnant people of color, individuals with food insecurity, individuals experiencing homelessness, immigrants and New Yorkers confronting antiAAPI discrimination, individuals living with mental illness, and LGBTQ+ individuals.

FACILITATING ACCESS TO RESOURCES Widespread access to resources is a top priority for residents.

The CHNA review has highlighted that health care access is just one part of the equation to improve and support community health. Our community members also point out the need for additional and accessible resources and community services to improve overall health and wellbeing.

Through surveys, focus groups, community forums, and expert interviews, NYC Health + Hospitals learned that our communities seek help accessing and navigating these resources, specifically:

* Affordable quality housing

* Primary and behavioral health services that are affordable, easy to navigate, and culturally humble

* Community resources (i.e., youth centers, senior services, nutrition events, job fairs)

* Green space or safe places for physical activity

* Affordable quality food

* Violence interruption

FINDING SOLUTIONS AND

BUILDING HEALTHY COMMUNITIES With the completion of the CHNA, NYC Health + Hospitals will work with system and community stakeholders, including other New York City agencies, community partners and providers, and patients to develop an implementation plan responsive to the identified priority needs. The community engagement process revealed that while each hospital and surrounding community has unique disease burdens and needs, major concerns are consistent across neighborhoods, hospitals, patients, and providers. These issues are structural and complex and will require a collective impact approach to hardwire positive, lasting change.

Exhibit A.

Top 10 perceived risk factors for poor health and death by community stakeholders ... Average ranking (Scale 1 to 5)

Housing access, affordability, and quality ... 3.87

Poverty and low-income status ... 3.81

Stress and emotional wellbeing ... 3.78

Community safety and violence ... 3.72

Mental and behavioral health care access ... 3.72

Obesity and high BMI ... 3.71

Hunger, food access, and poor nutrition ... 3.61

Health insurance access ... 3.58

Tobacco, vaping, e-cigarette use ... 3.52

Indoor and outdoor air quality ... 3.52

Exhibit B.

Top 10 perceived causes of poor health and death by community stakeholders ... Average ranking (Scale 1 to 5)

Diabetes and high blood sugar ... 3.88

High blood pressure ... 3.80

Mental health disorders and depression ... 3.80

Obesity and high BMI ... 3.73

Violence and gun violence ... 3.61

Drug use and opioids ... 3.54

Asthma, breathing issues, and lung disease ... 3.53

Heart disease ... 3.52

COVID-19 ... 3.47

Cancer ... 3.47

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ACKNOWLEDGMENTS

* THANK YOU TO THE NYC HEALTH + HOSPITALS AND NYC DOHMH LEADERS AND COMMUNITY MEMBERS WHO CONTRIBUTED TO THIS REPORT

- NYC Health + Hospitals Board of Directors

Jose A. Pagan, Ph.D., Chair of the Board. Chair: Executive and Governance Committees

Freda J. Wang, Vice Chair of the Board. Chair: Finance Committee; HHC Capital Corporation (subsidiary). Member: Capital; Audit; Strategic Planning; Governance; Executive; Equity, Diversity, and Inclusion Committees

Mitchell Katz, MD, Chief Executive Officer, and President. Chair: Quality Assurance/Performance Improvement Committee. Ex-officio Member of all subsidiary Boards and Committees (except Governance)

Anne Williams-Isom, J.D., Deputy Mayor for Health and Human Services. Member: Executive Committee

Ashwin Vasan, M.D., Ph.D., Commissioner, NYC Department of Health and Mental Hygiene. Member: Executive; Governance; Quality Assurance/Performance Improvement; Strategic Planning; Equity, Diversity, and Inclusion Committees

Gary Jenkins, Commissioner of the Human Resources Administration. Member: Executive and Information Technology (I.T.) Committees

Dr. Michael McRae, MD, Acting Executive Deputy Commissioner of Mental Hygiene - NYC Department of Health and Mental Hygiene

Vincent Calamia, MD, Chair: Medical and Professional Affairs Committee; HHC Insurance Company/Physician Purchasing Group. Member: Governance, I.T., and Executive Committees

Sally B. Hernandez Pinero, Chair: Audit Committee; MetroPlus HealthPlan, Inc. Member: Governance; Quality Assurance/Performance Improvement; Equity, Diversity and Inclusion; Finance; Strategic Planning; Capital; Community Relations; Medical and Professional Affairs Committees; HHC Capital Corporation (subsidiary)

Anita Kawatra, Member: Community Relations, Audit, and Strategic Planning Committees

Barbara A. Lowe, RN, MS, Member: Finance; I.T.; Quality Assurance/ Performance Improvement; and Medical and Professionals Affairs Committees Patricia Marthone, MUDr, Member: Community Relations; Finance; Medical and Professional Affairs; Strategic Planning Committees

Robert F. Nolan, Chair: Community Relations Committee. Member: Capital Committee; HHC Capital Corporation (subsidiary)

Feniosky Pena-Mora, Ph.D., Chair: Capital; Strategic Planning; I.T.; Equity, Diversity and Inclusion Committees.

Member: Executive, Finance, and Audit Committees; HHC Capital Corporation (subsidiary)

- NYC Health + Hospitals Leadership

Machelle Allen, MD, Senior Vice President, Chief Medical Officer

Charles Barron, MD, Deputy Chief Medical Officer, Office of Behavioral Health

Deborah Brown, JD, MSW, Senior Vice President, External and Regulatory Affairs

Nichola Davis, MD, MS, Vice President, Chief Population Health Officer

Linda DeHart, MPA, Vice President, Corporate Finance

Danielle DiBari, Pharm.D., Senior Vice President of Business Operations, Chief Pharmacy Officer

Mitchell Katz, MD, President and Chief Executive Officer

Michelle Lewis, Chief Executive Officer, NYC Health + Hospitals/Gotham Health

Theodore G. Long, MD, MHS, Senior Vice President for Ambulatory Care

Khoi Luong, DO, Senior Vice President, Post-Acute Care

Ana Marengo, Senior Vice President, Corporate Communications and Marketing

Kim Mendez, EdD, ANP, RN, Senior Vice President, Corporate Chief Information Officer

Talya Schwartz, MD, Chief Executive Officer and President, MetroPlus Health Plan

Matthew Siegler, Senior Vice President, Managed Care and Patient Growth

John Ulberg, Senior Vice President, Chief Financial Officer

Eric Wei, MD, MBA, Senior Vice President, NYC Health + Hospitals

Patricia Yang, DrPH, Senior Vice President, Correctional Health Services

- NYC Health + Hospitals Facility CEOs

BELLEVUE, William Hicks, MS

CARTER, Floyd R. Long, MBA

COMMUNITY CARE, Nicole Jordan-Martin, MPA

CONEY ISLAND, Svetlana Lipyanskaya, MPA

ELMHURST, Helen Arteaga Landaverde, MPH

HARLEM, Georges H. Leconte, MPA, FAB, RRT

JACOBI | NORTH CENTRAL BRONX Christopher Mastromano, MBA

KINGS COUNTY, Sheldon McLeod

LINCOLN, Christopher Roker, MBA

METROPOLITAN, Cristina Contreras, LMSW, MPA, FABC

QUEENS, Neil J. Moore, MBA, MPA, FACHE

WOODHULL, Gregory Calliste, MBA, MS, FACHE

- NYC Health + Hospitals Facility Leaders

Philip Cooke

Alexis Davis

Thomas Dunn

Cleon Edwards

Ellie Epstein

Evelyn Hernandez, MA

Ross MacDonald, MD

David Margolis, MD

Jeanette Merrill, MPH

Lisa Scott-McKenzie, DHA, CEM, FABC, FACHE

Rohit Sharma, MBA

Ashley Smith, MPA

Philip Wadle, MS

Andrew Wallach, MD

- NYC Department of Health and Mental Hygiene Leadership

K. Torian Easterling, MD, MPH, First Deputy Commissioner/Chief Equity Officer, NYC DOHMH

* 2022 COMMUNITY HEALTH NEEDS ASSESSMENT TEAM LEADS

- Executive Sponsor

Deborah Brown, Senior Vice President, Regulatory and External Affairs

- Project Lead

Okenfe Lebarty, Senior Director, Government and Community Affairs

- Senior Leads

Christopher Philippou, Chief Operating Officer, ExpressCare, Senior Director, Strategic Operations & Development, Office of Quality & Safety

Wilbur Yen, Senior Director, Business Planning and Administration, Office of Patient Growth, Data & Analytics

CHNA CORPORATE ACE LEAD, David Mancher, Director Information Services, Office of Quality & Safety CHNA PROJECT MANAGER

Jenny Kupershtokh, Director of Corporate Reporting, ACE Shared Services, Office of Quality & Safety Stanislav Seleznyov, Senior Director, Executive Administration, Accountable Care Organizations

Angelie Oberoi, Senior Director, Data Sciences and Analytics

Robert Cawlfield, Clinical Business Analyst

Donald Sims, Business Intelligence Consultant

Dhiraj Tripathi, Business Intelligence Developer

- Language Services | Office of Diversity and Inclusion

Margarita Larios, Director of Operations & Language Services | Office of Diversity and Inclusion

Alejandro Cintron Carrasco, Language Support Specialist | Office of Diversity and Inclusion

- Community Affairs

Emaan Moosani, Associate Director, Community Affairs

Amir Abbady, Director, Community Affairs

Manelle Belizaire, Director, Community Affairs

- Marketing & Communications

Ana Marengo, Senior Vice President, Marketing and Communications

Margaret Ramirez, Senior Director, Marketing and Communications

Mario Smith, Director of Marketing and Communications

Gavin So, Webmaster, Marketing and Communications

- Writer

Charlotte Kurz, MPH

- Editors

Allie Nudelman, Senior Director, External and Regulatory Affairs

Rachel Larkin, Assistant Director, External and Regulatory Affairs

- Designer

Karen Psolka, Karen Houser Design

- Borough Focus Groups

BRONX

African, International Collaborative Center, Hadiza Osuji Lasbrey

Bronx Community Board 3, Etta Ritter, Rev. Idus Nunn

Bronx Community Board 8, Ciara Gannon Omar Murray

BronxWorks, Carolina Espinosa

Emerald Isle, Juan Carlos, Grajeda

Public Health Solutions, Gabrielle Miller

BROOKLYN

Academy of Medical and Public Health Services, Inc., Estela Cohetero, Mon Yuck Yu

Alliance for Coney Island, Alexandra Silversmith

Arab American Family Support,.Center of New York, Maha Attieh, Hanna Sheikh

Brighton Neighborhood Association, Pat Singer

Brooklyn Community Board 4, Celeste Lion

For the Better Tomorrow, Rasheedat Ajala, Los Sures, Ralph Perez

India Home, Shaaranya Pillai, Shubhra Datta

Shorefront Y, Larisa Golender, Nancy Kuan

MANHATTAN

Alliance for Positive Change, Arianne Watson, Marcia Deer

Bellevue Program for Survivors of Torture, Caroline Albanese

Children of Bellevue, Nicole Shearman, Sarah Beth Lardie

Dream Charter School, Clarisa Alayeto

East Harlem Tutorial, Maya Vilaplana

Harlem Hospital Center Auxiliary, Inc., Rosalyn Graves

Harlem Outreach, Padmore John

Union Settlement, Ysabel Abreu

QUEENS

CIANA

Emira Habiby, Browne, Joe de Maria

DSI International,.Toyin Omolola

Elmcor, Leyla Bermudez

Emerald Isle, Charlotte Geilman

Grow NYC, Winnifred Lee

Korean Community Services, Sara Soonsik Kim

New York Hall of Science, Delia Meza, Laycca Umer

Public Health Solutions, Deisy Ortiz, Jessica Lozano, Marlene Sierra

Queens Community Board 3, Frank Taylor, Megan Rockwell

Queens Community Board 4, Clara Salas, Rosamond, Gianutsos

Queens World Film Festival, Katha Cato

South Asian Council for Social Services (SACSS), Rehan Mehmood

United Sikhs, Inderjeet Singh, Jagjit Kaur

Voces Latina, Nathaly Rubio-Tori

* STATEN ISLAND

African Refuge, Inc., Min. Joyce Parr, Rev. Judy Brown

Camelot of Staten Island, Luke Nasta

Canvas Institute, Sade Dinkins

Community Board 1, Lisa Crosby

Island Voice, Bobby Digi

Modest Community Service, Timothy Osho

Project Hospitality, Michelle Gassama

United Activities, Inc., Jennifer Colindres

* * *

Facility Community Forums

Harlem Hospital: March 16, 2022 Kings County Hospital: March 17, 2022

Bellevue Hospital: March 23, 2022

Queens Hospital: March 23, 2022

Woodhull Hospital: March 28, 2022

Elmhurst Hospital: April 6, 2022

North Central Bronx: April 6, 2022

Coney Island Hospital: April 7, 2022

Metropolitan Hospital: April 7, 2022

Jacobi Hospital: April 13, 2022

Henry J. Carter Specialty Hospital and Nursing Facility: April 14, 2022

Lincoln Hospital: April 14, 2022

- Advisory Group Meetings

Advisory Group 1: April 12, 2022

Advisory Group 2: May 3, 2022

Advisory Group 3: June 7, 2022

- Focus Groups

Bronx Focus Group: March 24, 2022

Brooklyn Focus Group: March 29, 2022

Manhattan Focus Group: March 29, 2022

Queens Focus Group: April 8, 2022

Staten Island Focus Group: April 7, 2022

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The report is posted at: https://hhinternet.blob.core.windows.net/uploads/2022/07/community-health-needs-asssessment-2022.pdf

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