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Research Questions

  1. What is the health status of the population served by the District of Columbia Healthy Communities Collaborative and are there disparities by age, gender, race/ethnicity, and ward?
  2. What do inpatient and emergency department hospitalization rates indicate about patterns of health care use among residents of the District of Columbia?
  3. What are some barriers and facilitators to health service use in the District of Columbia according to community stakeholders?
  4. What recommendations do community stakeholders have for health program and policy improvement in the District of Columbia?

The District of Columbia Healthy Communities Collaborative (DCHCC) represents a unique collaboration among D.C.-area hospitals and federally qualified health centers. In response to its community commitment and Affordable Care Act requirements, DCHCC set forth to conduct a community health needs assessment (CHNA) that can guide decisions about where and how to allocate resources and implement appropriate health interventions for the population it serves. The CHNA described in this report includes analysis of existing demographic, health status, and hospital service use data, as well as hospital and emergency department discharge data. The analysis of this quantitative data is complemented by an analysis of current stakeholder perspectives regarding health needs, as well as health policy and investment priorities. This CHNA demonstrates the persistence of many issues identified in prior CHNAs: asthma, obesity, mental health, and sexual health. Despite high insurance rates, health care services are not evenly distributed by ward, creating significant challenges to access. There is a need to expand these services, as well as improve care coordination between health and social services to help residents navigate the system and obtain the services they need. In addition to these intervention pathways by priority health condition, we identified emerging issues that require further investigation, including declines in coronary atherosclerosis discharges and a spike in stress-related diagnoses (headaches and back pain) and associated alcohol-related issues. This may be related to a host of factors, including economic downturn and demographic transitions in the District.

Key Findings

Many Issues Identified in Prior CHNAs Persist, Including Those Related to Asthma, Obesity, Mental Health, and Sexual Health

  • Asthma is the cause of many avoidable hospitalizations and emergency department visits.
  • Rates of obesity and overweight remain high in the District, but these rates cannot be explained solely by a lack of physical activity.
  • Mental health issues continue to concern District stakeholders, particularly heavy drinking among young adults and poor access to behavioral health services.
  • In general, sexual health issues (beyond high HIV testing rates and reductions in teen pregnancy) have remained a significant challenge in the District.

Despite a High Insurance Rate in the District, There Were Several Access-to-Care Issues Noted

  • Health care services are not evenly distributed by ward. In particular, specialty services such as oncology and pain management are lacking in Wards 7 and 8.
  • Case management issues impede access to health and related social services.
  • Hospitals and clinics do not offer many colocated services, and there is limited linkage across hospital sites.

Recommendations

  • Better integration of health and social services may help facilitate the timely use of preventive health services by creating new access points for individuals to obtain primary care.
  • Improvements in care coordination may facilitate more timely asthma management, particularly among those 17 years old and younger.
  • Developing methods of disseminating exercise opportunities to adults aged 40 years and older should be a priority.
  • More education about the co-occurrence of HIV and hepatitis B and C, as well as education about the long-term sequelae of gonorrhea and chlamydia among District youth is needed.
  • In terms of mental health and substance use, more attention should be given to alcohol-related discharges among those 18 to 39 years old; access to behavioral health services among vulnerable populations, including the homeless and non-English-speaking residents; and stress-related discharges.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Sociodemographic Characteristics and Trends in the District

  • Chapter Three

    Health and Health Risk Behaviors in the District

  • Chapter Four

    Access to and Use of Health Services

  • Chapter Five

    Stakeholder Perspectives

  • Chapter Six

    Conclusions

  • Appendix A

    Top 20 Primary Conditions for Inpatient and ED Discharges (2007-2011 rankings)

  • Appendix B

    Health and Social Determinants Focus Group Protocols

  • Appendix C

    District of Columbia Hospitals and Community Health Centers

Research conducted by

The research described in this report was sponsored by the DC Healthy Communities Collaborative, and was conducted in RAND Health, a division of the RAND Corporation.

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