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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.

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.

• 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