BARNES-JEWISH HOSPITAL 2016 COMMUNITY …...implementation plan every three years. Barnes-Jewish...

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BARNES-JEWISH HOSPITAL

2016 COMMUNITY HEALTH NEEDS

ASSESSMENT & IMPLEMENTATION PLAN

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TABLE OF CONTENTS

Executive Summary ................................................................................................................................. 3

Community Description ........................................................................................................................... 4

Geography .................................................................................................................................... 4

Population Trends ......................................................................................................................... 5

Income........................................................................................................................................... 7

Education .................................................................................................................................... 10

Previous CHNA Measurement and Outcomes Results ...................................................................... 16

Conducting the 2016 CHNA .................................................................................................................. 18

Primary Data Collection .............................................................................................................. 18

Secondary Data Analyses ........................................................................................................... 21

Internal Work Group Prioritization Meetings ............................................................................... 74

Appendices ............................................................................................................................................. 82

Barnes-Jewish Hospital: Who We Are ........................................................................................ 83

Community Focus Group ............................................................................................................ 84

Focus Group Report .................................................................................................................... 85

Internal Work Group .................................................................................................................... 94

Internal Work Group Worksheet 1 .............................................................................................. 95



Implementation Plan .............................................................................................................................. 98

Community Health Needs to be Addressed ................................................................................ 98

Community Health Needs Identified that will not be addressed ............................................... 104

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EXECUTIVE SUMMARY

Barnes-Jewish Hospital, a member of BJC HealthCare, is a 1,315-bed, academic medical center located

in the city of St. Louis, Missouri. Situated on Washington University Medical Campus, Barnes-Jewish

Hospital provides inpatient, outpatient, emergency/trauma and ambulatory clinic services. Barnes-Jewish

Hospital was created by the 1996 merger of Barnes Hospital and The Jewish Hospital of St. Louis. What

began more than 100 years ago as two separate hospitals has evolved into a nationally recognized

medical center delivering high quality health care services to patients across the St. Louis region. Barnes-

Jewish Hospital has also established effective partnerships towards the goals of improving the health of

the community. (See Appendix A for more information about Barnes-Jewish Hospital)

Like all nonprofit hospitals, Barnes-Jewish Hospital is required by the Patient Protection and Affordable

Care Act (PPACA) to conduct a community health needs assessment (CHNA) and create an

implementation plan every three years. Barnes-Jewish Hospital completed its first CHNA and

implementation plan on Dec. 31, 2013. The report was posted to the hospital’s website to ensure easy

access to the public.

As part of the CHNA process, each hospital is required to define its community. Barnes-Jewish Hospital

defined its community as St. Louis City. Once the community is defined, input must be solicited from

those who represent the broad interests of the community served by the hospital, as well as those who

have special knowledge and expertise in the area of public health.

Barnes-Jewish Hospital conducted its 2016 assessment in two phases. The first phase consisted of a

focus group discussion with key leaders and stakeholders representing the community. This group

reviewed the primary data and community health need findings from 2013 and discussed changes that

had occurred since 2013. Additionally, the focus group reviewed gaps in meeting needs, as well as

identified potential community organizations for Barnes-Jewish Hospital to collaborate with in addressing

needs.

During phase two, findings from the focus group meeting were reviewed and analyzed by a hospital

internal work group of clinical and non-clinical staff. Using multiple sources, including but not limited to

Healthy Communities Institute and the Centers for Disease Control and Prevention (CDC), a secondary

data analysis was conducted to further assess the identified needs. This data analysis identified some

unique health disparities and trends evident in St. Louis City when compared against data for the state

and country.

At the conclusion of the comprehensive assessment process, Barnes-Jewish Hospital identified four

health needs where focus is most needed to improve the health of the community it serves: 1) Access to

Services; 2) Healthy Lifestyles: Obesity; 3) Mental and Behavioral Health: Substance Abuse; and 4)

Public Safety: Violence.

The analysis and conclusions were presented, reviewed and approved by the Barnes-Jewish Hospital

board of directors.

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COMMUNITY DESCRIPTION

GEOGRAPHY

Barnes-Jewish Hospital is the largest of the 15 BJC HealthCare hospitals that comprise the system. BJC

HealthCare hospitals serve urban, suburban and rural community locations primarily in the greater St.

Louis, southern Illinois and mid-Missouri regions. Barnes-Jewish Hospital and St. Louis Children’s

Hospital are the two BJC HealthCare hospitals located in St. Louis City.

Barnes-Jewish Hospital is the largest hospital in Missouri. Seventy-five percent of the hospital’s patients

come from the hospital’s primary service area, including eight counties in Missouri and eight counties in

Illinois. The remaining 25 percent of patients come from the surrounding 250 miles of St. Louis.

As the major safety net provider, Barnes-Jewish Hospital serves a larger community; however, for the

purpose of the CHNA, Barnes-Jewish Hospital defined its community as St. Louis City. The shaded area

in the map below represents St. Louis City.

This area includes the following ZIP codes:

63101 63102 63103 63104 63106 63107 63108 63109 63110 63111 63112

63113 63115 63116 63118 63120 63139 63147 63164 63166 63196 63199

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POPULATION TREND

Population and demographic data is necessary to understand the health of the community and plan for

future needs. In 2015, St. Louis City reported a total population estimate of 315,685 compared to the

state population of 6,083,672. St. Louis City comprised five percent of Missouri’s total population.

Since the 2010 census, the population of the city declined 1.2 percent while the state population

increased 1.6 percent.

Table 1: Population Trend, St. Louis City vs. Missouri

St. Louis City Missouri

Total Population: 315,685 6,083,672

Percent Number Percent Number

Female 51.70 163,209 50.9 3,096,590

Male 48.30 152,476 49.1 2,987,082

White 46.60 149,224 83.50 5,079,866

African American 47.27 147,109 1.8 717,873

Hispanic or Latino 3.93 12,406 4.0 243,347

Two or More Races 2.28 7,198 2.1 127,757

Asian 3.01 9,502 1.9 115,590

The table on the following page further details the city’s demographics as compared to the state.

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Table 2: Demographics, St. Louis City vs. Missouri


Geography

Land area in square miles, 2010 61.91 68,741.52

Persons per square miles, 2010 5,157.50 87.1

Population

Population, July 1, 2015 estimate 315,685 6,083,672

Population, April 1, 2010 estimate base 319,365 5,988,923

Population, percent change – April 1, 2010 to July 1, 2015 -1.2% 1.6%

Population, 2010 317,294 5,988,927

Race / Ethnicity

White alone, percent, 2015 47.1% 83.3%

Black or African American alone, percent, 2015 46.9% 11.8%

American Indian and Alaska Native alone, percent, 2015 0.3% 0.6%

Asian alone, percent, 2015 3.3% 2.0%

Native Hawaiian and Other Pacific Islander alone, percent 2015 0.0% 0.1%

Two or more races, percent, 2015 2.4% 2.2%

Hispanic or Latino, percent, 2015 3.9% 4.1%

White alone, not Hispanic or Latino, percent, 2015 44.0% 79.8%

Foreign born persons, percent, 2010-2014 6.8% 3.9%

Age

Persons under 5 years, percent, 2015 6.7% 6.2%

Persons under 18 years, percent, 2015 20.1% 22.9%

Persons 65 years and over, percent, 2015 11.6% 15.7%

Language

Language other than English spoken at home, percent of age 5 years+, 2015

9.6% 6.1%

Gender

Female persons, percent, 2015 51.6% 51.0%

Male persons, percent, 2015 48.4% 49.0%

Source: United States Census Bureau

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INCOME

St. Louis City’s median household income for the five-year period ending 2014 was 27 percent lower than

the state overall. Persons living below the poverty level in

St. Louis City totaled 28.8 percent compared to 15.5 percent in the state. Home ownership was higher in

St. Louis City (70.8 percent) than Missouri (67.9 percent).

Table 3: Education, Income & Housing, St. Louis City vs. Missouri


Education

High school graduate or higher, percent of persons age 25+, 2010-2014

83.2% 88.0%

Bachelor’s degree or higher, percent of persons age 25+, 2010-2014

30.4% 26.7%

Income

Per capita money income in the past 12 months (2011 dollars), 2010-2014

$23,244 $26,006

Median household income (2014 dollars), 2010-2014 $34,800 $47,764

Persons in poverty, percent, 2010-2014 28.8% 15.5%

Housing

Housing units, July 1, 2014 175,355 2,735,742

Home ownership rate, 2010-2014 70.8% 67.9%

Housing units in multi-unit structures, percent, 2010-2014 22.7% 19.7%

Median value of owner-occupied housing units, 2010-2014 118,600 136,700

Households, 2010-2014 139,594 2,361,232

Persons per household, 2010-2014 2.2 2.48

Source: United States Census Bureau

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Chart 1: St. Louis City Families Living Below Poverty Level by Race / Ethnicity, 2010-2014

Source: Healthy Communities Institute

The rate of families living below the poverty level in St. Louis City was 22.0 percent. The rate of African

American families living below the poverty level in the city was higher than any other race at 34.4 percent.

22

8.6

25

25.6

23.1

34.4

14.4

5.6

0 5 10 15 20 25 30 35 40

OVERALL

WHITE, NON-HISPANIC

TWO OR MORE RACES

OTHER

HISPANIC OR LATINO

AFRICAN AMERICAN

ASIAN

AMERICAN INDIAN OR ALASKA NATIVE

PERCENT

RA

CE

/ ET

HN

ICIT

Y

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Chart 2: People Living Below Poverty Level by Age, 2010-2014


The overall rate of people living in poverty in St. Louis City was 27.8 percent, 78 percent higher than in

the state. The 6-11 age group had the highest rate of poverty in the city followed by the under 6 age

group.

15.6

10.6

7.7

10.9

14.8

27.4

17.6

21.5

25.6

27.8

18.4

16.6

22.5

22.7

39.2

37.1

46.9

42

0 5 10 15 20 25 30 35 40 45 50

OVERALL

75 & OVER

65-74 YEAR

45-54 YEAR

25-44 YEAR

18-24 YEAR

12-17 YEAR

6-11 YEAR

UNDER 6 YEAR

PERCENT

AG

E


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EDUCATION

Chart 3: People 25+ with a High School Degree or Higher by Age, 2010-2014


In St. Louis City, 83.2 percent of the population 25 and older had a high school diploma compared to

Missouri at 88 percent.

The Healthy People 2020 national health target is to increase the proportion of students who graduate

high school within four years of their first enrollment in 9th grade to 82.4 percent.

Individuals who do not finish high school are more likely than people who finish high school to lack the

basic skills required to function in an increasingly complicated job market and society. Adults with limited

education levels are more likely to be unemployed, on government assistance, or involved in crime.

(Healthy Communities Institute).

90.3 90.2 89.9

80.8

8889.2

84.4 84.1

69.9

83.2

0

10

20

30

40

50

60

70

80

90

100

25-34 35-44 45-64 65 & OVER OVERALL

PER

CEN

T

AGE

Missouri St. Louis City

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Chart 4: People 25+ with a High School Degree or Higher by Race / Ethnicity, 2010-2014


Whites had the highest rate of individuals with a high school degree or higher in St. Louis City, followed

by American Indian or Alaska Native. Those who identify as Other had the lowest rate of individuals with

a high school degree or higher followed by Native Hawaiian or Other Pacific Islander. In Missouri, Whites

also had the highest rate of individuals with a high school degree or higher, followed by Native Hawaiian

or Other Pacific Islander. Those who identify as Other had the lowest rate of individuals with a high school

degree or higher followed by Hispanics.

88

89.4

83.6

60.8

87.9

68.5

83.1

86.2

84

83.2

90

78.7

59.1

65.4

70.1

77.1

77.3

85.2

0 10 20 30 40 50 60 70 80 90 100

OVERALL

WHITE, NON-HISPANIC

TWO OR MORE RACES

OTHER

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

HISPANIC OR LATINO

AFRICAN AMERICAN

ASIAN


PERCENT

RA

CE

/ ET

HN

ICIT

Y


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Chart 5: People 25+ with a High School Degree or Higher by Gender, 2010-2014


St. Louis City had a 5.5 percent lower rate of individuals with a high school degree or higher than

Missouri. Rates among females and males in St. Louis City and the state were similar.

88.4 87.6 8883.1 83.4 83.2

0

10

20

30

40

50

60

70

80

90

100

FEMALE MALE OVERALL

PER

CEN

T

GENDER


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Chart 6: People 25+ with a Bachelor’s Degree or Higher by Age, 2010-2014


In St. Louis City, 30.4 percent of the population 25 and older had a bachelor’s degree when compared to

Missouri at 26.7 percent.

For many, having a bachelor's degree is the key to a better life. The college experience develops

cognitive skills, and allows learning about a wide range of subjects, people, cultures, and communities.

Having a degree also opens up career opportunities in a variety of fields, and is often the prerequisite to a

higher-paying job. It is estimated that college graduates earn about $1 million more per lifetime than their

non-graduate peers. (Healthy Communities Institute).

31.7 31.3

26.3

18.9

26.7

44.6

32.2

24.1

18.5

30.4

0

5

10

15

20

25

30

35

40

45

50

25-34 35-44 45-64 65 & OVER OVERALL

PER

CEN

T

AGE


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Chart 7: People 25+ with a Bachelor’s Degree or Higher by Race / Ethnicity, 2010-2014


Asians had the highest rate of individuals with a bachelor’s degree or higher both in St. Louis City and

Missouri. African Americans had the lowest rate in St. Louis City and Native Hawaiian or Other Pacific

Islander had the lowest rate in Missouri.

26.7

27.7

22.4

12.5

11.6

18.2

16.8

56.3

17.5

30.4

45

25.2

24.5

16.7

28.4

12.9

54.3

20.3

0 10 20 30 40 50 60

OVERALL

WHITE, NON-HISPANIC

TWO OR MORE RACES

OTHER

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

HISPANIC OR LATINO

AFRICAN AMERICAN

ASIAN


PERCENT

RA

CE

/ ET

HN

ICIT

Y


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Chart 8: People 25+ with a Bachelor’s Degree or Higher by Gender, 2010-2014


St. Louis City had 13.9 percent higher rate of individuals with a bachelor’s degree than the state. The

rates among females and males in St. Louis City and Missouri were similar.

26.9 26.4 26.7

30.2 30.6 30.4

0

5

10

15

20

25

30

35

FEMALE MALE OVERALL

PER

CEN

T

GENDER


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PREVIOUS (2013) CHNA MEASUREMENT AND OUTCOMES RESULTS

At the completion of the 2013 CHNA, Barnes-Jewish Hospital outlined goals for meeting eight broad

categories of health needs in St. Louis City. Mission-core priorities were identified as aligning with the

strategic priorities of the hospital in order to ensure dedicated resources. These included Health Literacy

and Education and Chronic Conditions. The additional needs were included as supporting priorities:

Access to Health Care; Behavioral Health; Financial Barriers; Safety from Violence; Lack of Service

Coordination; and Training of Health Care Professionals.

Rather than choosing one program on which to focus for each of the priorities in the implementation plan,

Barnes-Jewish Hospital included all programs that were being conducted under each category. This was

done with the hopes of highlighting all the work being done for the community, even though it was not

necessary to do so. Due to the length of the listing of programs, the table below includes a selection of

major programs under mission-core priorities that outlines the details results, goals and current status of

these community health needs.

Table 4A: 2013 CHNA Outcomes, Barnes-Jewish Hospital

Health Literacy & Education Chronic Conditions

Goals Goals

Provide health education and free screenings to 4,000 community members.

Provide free flu shots to a minimum of 30,000 individuals in the broader Barnes-Jewish Hospital community.

Results of program impact evaluation will average a score of 4 on a scale of 1-5

Reserve a minimum of 15 percent of free flu shots to be provided in key underserved regions as identified by the CHNA.

Current Status Current Status

2014: 5,644 community members attended health education and screening events. The average impact score for these events was 4.25 out of 5. 2015: 7,870 community members attended health education and screening events. The average impact score for these events was 4.42 out of 5.

2014: 24,415 free flu shots were administered to members of the community. Of the 22,954 participants who provided ZIP codes, 5,576 (24 percent) were from St. Louis City and another 2,968 (13 percent) were from underserved areas in north St. Louis County as defined by the Christian Hospital CHNA. 2015: The number of shots available to give to the community was reduced because it was determined that Barnes-Jewish Hospital would provide the best vaccine available. The hospital offered quadrivalent doses instead of trivalent doses at an approximate 50 percent cost increase. 19,236 free flu shots were administered to members of the community. Of the 18,904 participants who provided ZIP codes, 4,968 (26 percent) were from St. Louis City and another 2,286 (12 percent) were from underserved areas in north St. Louis County as defined by the Christian Hospital CHNA.

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Table 4B: 2013 CHNA Outcomes, OASIS

Chronic Disease & Diabetes Self-Management Physical Activity and Functional Fitness

Goals Goals

Increase enrollment in self-management programs by 5% annually.

Increase physical activity participation and functional fitness in adults ages 60 and older by 10% annually.

After establishing a baseline, increase knowledge of blood pressure management terms and tools, and positive medication management behaviors by 5%.

At least 50% of participants will see improvement in strength, flexibility, and balance and agility, as measured by the Senior Fitness Test (SFT).

Current Status Current Status

2014: Participation in OASIS self-management programs was inflated due to participation in a research study. 2015: Participation decreased by 41% from 2014 due to the previously inflated participation rates. In 2015, efforts to recruit participants was more evenly distributed among health programs. Increased knowledge in blood pressure management increased by 19%. Increased knowledge in medication management increased by 24%.

2015: 1859 participants was 20% increase from 2014. 68% of participants improved aerobic endurance; 61% of participants improved agility and balance; 60% of participants improved lower body strength; 50% of participants improved upper body flexibility.

For the 2013 CHNA, Barnes-Jewish Hospital chose to address all needs identified by the stakeholders

and confirmed by the secondary data. Regrettably, there was a lack of focus on particular areas. The

team was not able to show outcomes in all areas selected. Therefore, the team decided to limit priorities

and use resources wisely in order to show outcomes in 2016. Barnes-Jewish Hospital will continue with

all the programs from the 2013 CHNA and focus the implementation plan on fewer priorities and

demonstrate greater impact.

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CONDUCTING THE 2016 CHNA

PRIMARY DATA COLLECTION: FOCUS GROUP

Barnes-Jewish Hospital conducted a focus group to solicit feedback from community stakeholders, public

health experts and those with a special interest in the health needs of residents located in St. Louis City.

Ten of 16 invited participants representing various St. Louis County organizations participated in the

focus group (See Appendix B for Community Focus Group list). The focus group was held March 28,

2015, at the Chase Park Plaza Hotel with the following objectives identified:

1. Determine whether the needs identified in the 2013 CHNA remain the correct focus areas.

2. Explore whether any needs on the list should no longer be a priority.

3. Determine where gaps exist in the plan to address the prioritized needs.

4. Identify other potential organizations for collaboration.

5. Discuss how the community had changed since 2013 when Barnes-Jewish Hospital first identified

these needs and whether there are new issues to consider.

6. Evaluate what issues the stakeholders anticipate becoming a greater concern in the future to

consider now.

2016 FOCUS GROUP SUMMARY

A general consensus was reached that needs identified in the previous assessment should remain as

focus areas for the hospital. A few participants suggested that mental health and behavioral health should

be rated higher in priority due to the effect these concerns have on contributing to violence in the

community (See Appendix C for complete Focus Group Report).

Needs that Should Be Removed

There was discussion about why training of health professionals and service coordination was not present

in the revised list of needs. The law now requires that any prioritized need must be measured so as to

determine the impact of any implementation tactics. These items were removed because there was a lack

of measures associated with them. Stakeholders from the Regional Health Commission indicated that

they have some metrics for Barnes-Jewish Hospital to consider around these needs.

Gaps in Implementation Strategies

Financial access to coverage continues to be an issue for St. Louis City residents who are low-income.

There was much discussion around the role that technology could play in improving access to services.

Other comments around access to services included care coordination. Discussion also took place

regarding increasing health provider awareness of trauma (post-traumatic stress disorder) and how

recognition can ultimately impact the treatment of chronic conditions along with behavioral health issues.

Special Populations

The homeless population was identified as one that may require additional consideration, particularly

following discharge, as no appropriate place currently exists. Additionally, several points were made in

regard to those who are deaf and blind.

Potential Partner Organizations

Barnes-Jewish Hospital was positively recognized for its numerous collaborative efforts with a variety of

organizations on various levels. The hospital was also noted for its excellent work on emergency

preparedness and responsiveness as well as for collaborating with the St. Louis Integrated Health

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Network on placing referring coordinators in the facility. There was one suggestion to examine the

relationships the hospital has with homeless providers in the city to identify additional ways to address the

needs of the homeless upon discharge.

Needs of Increasing Importance

Safety from Violence – Although violence was identified in the 2013 CHNA, with the events that

occurred in Ferguson in 2014 and 2015, many see violence as an issue that will continue to exist

in St. Louis City.

Access: Coverage – The lack of Medicaid expansion will continue to affect access, as well as

disparities in access related to low-income populations.

Sexually Transmitted Disease (STD) – There continues to be concern about STDs including

gonorrhea as well as HIV/AIDs, especially within the African American community. Education is

needed on these issues and information should be made available especially at community

health fairs.

Behavioral Health –The spread of heroin and prescription drug abuse is a continued concern.

Chronic Conditions – Sickle cell anemia continues to be an issue among African Americans.

RATING OF NEEDS

Participants were given the list of the needs identified in the 2013 assessment and directed to re-rank

them on a scale of 1 (low) to 5 (high), based on their perceived level of community concern and the ability

of community organizations to address them collaboratively. The table on the following page shows the

results of this ranking.

Access to Coverage and Access to Services rated highest in terms of level of concern and ability to

collaborate. Childbirth and Breastfeeding Education rated lowest on ability to collaborate and the level of

concern.

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Chart 9: Focus Group Ranking of Health Needs

3.6

4

3.8

4

4

4.3

4.2

4.2

4.3

4.3

4.5

4.5

4.3

4.3

4.5

4.7

4.5

4.5

4.5

4.2

4.6

4.8

4.5

4.5

4.5

4.8

4.8

4.8

3.3

4

4.3

4.3

4.3

4

4.2

4.2

4.2

4.3

4.2

4.2

4.5

4.5

4.5

4.3

4.5

4.5

4.5

4.8

4.5

4.3

4.7

4.7

4.7

4.7

5

5

0 1 2 3 4 5 6

Childbirth & Breastfeeding Education

Respiratory Disease: COPD

Cancer: Lung

Injury & Violence: Fatal Injuries

Oral Health

Immunizations and Infectious Disease

Cancer: Skin

Cancer: Head & Neck

Respiratory Disease: Asthma

Cancer: GYN

Nutrition

Reproductive & Sexual Health

Injury & Violence: Crime

Access: Transportation

Cancer: Prostate

Cancer: Colon & Rectal

Heart Disease & Stroke: Stroke

Heart Disease & Stroke: Congestive Heart Failure

Heart Disease & Stroke: Heart Health

Health Literacy

Smoking & Tobacco Education

Cancer: Breast

Substance Abuse

Mental Health & Disorders

Diabetes

Obesity

Access: Services

Access: Coverage

Level of Concern Ability to Collaborate

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SECONDARY DATA ANALYSES

Based on the primary data reviewed by focus group members (see graph on previous page), key areas

were identified by the internal workgroup (see internal workgroup process beginning on page 66) for

secondary data analysis. These areas represent the most prevailing issues identified by the focus group.

DATA SOURCES

Healthy Communities Institute (HCI), an online community dashboard of health indicators for St. Louis

County as well as the ability to evaluate and track the information against state and national data and

Healthy People 2020 goals. This online dashboard of health indicators for St. Louis County evaluates and

tracks information against state and national data and Healthy People 2020 goals. Sources of data

include the National Cancer Institute, Environmental Protection Agency, US Census Bureau, US

Department of Education, and other national, state, and regional sources.

Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all

Americans. For three decades, Healthy People has established benchmarks and monitored progress over

time in order to encourage collaborations across communities and sectors, empower individuals toward

making informed health decisions and measure the impact of prevention activities.

Hospital Industries Data Institute (HIDI, 2014) is a data source provides insight into the patterns and

frequency of health care utilization in the hospital.

Missouri Information for Community Assessment (MICA) is an online system that helps to prioritize

diseases using publicly available data. The system also provides for the subjective input of experts to

rank their perceived seriousness of each issue.

Centers for Disease Control and Prevention (CDC)/State Cancer Profiles is a web site that provide

data, maps, and graphs to help guide and prioritize cancer control activities at the state and local levels. It

is a collaboration of the National Cancer Institute and the Centers for Disease Control and Prevention.

https://statecancerprofiles.cancer.gov

Missouri Department of Mental Health provides numerous comprehensive reports and statistics on

mental health diseases, alcohol and drug abuse.

http://dmh.mo.gov/ada/countylinks/saint_louis_county_link.html

In addition to the resources listed above, while not directly cited in this report, Barnes-Jewish Hospital

utilized information from the following organizations during internal work group discussions:

The Commonwealth Fund

County Health Rankings and Roadmaps

Kaiser Family Foundation

Robert Wood Johnson Foundation

http://health.mo.gov/data/mica/MICA/

https://statecancerprofiles.cancer.gov/

http://dmh.mo.gov/ada/countylinks/saint_louis_county_link.html

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HEALTH NEEDS

In order to provide a comprehensive analysis of disparities and trends, the most up-to-date secondary

data was included on the following needs determined by the internal work group (see internal workgroup

process beginning on page 74):

Access: Coverage

Access: Services


Cancer

Diabetes

Healthy Lifestyles

Heart Health

Maternal & Child Health

Mental & Behavioral Health: Mental Illness

Mental & Behavioral Health: Substance Abuse

Public Safety: Violence

Reproductive & Sexual Health

Respiratory Disease: Asthma

We acknowledge that, like most cities, tremendous variation exists in demographic and health

characteristics between neighborhoods in the City of St. Louis. Some areas have multiple, high-risk

factors clustered together. However, most data is not available at a more granular level than by county.

For this reason, the analysis was completed comparing St. Louis City, Missouri and the U.S. When

necessary during implementation, more specific data will be used when available.

Following the secondary data analysis, a summary is provided that outlines observations noted in the

disparities and trends for each of the above needs. (See page 73).

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ACCESS: COVERAGE

Individuals without medical insurance are more likely to lack a traditional source of medical care, such as

a Primary Care Provider (PCP), and are more likely to skip routine medical care due to costs, therefore,

increasing the risk for serious and debilitating health conditions. Those who access health services are

often burdened with large medical bills and out-of-pocket expenses. Increasing access to both routine

medical care and medical insurance are vital steps in improving the health of the community. (Healthy

Communities Institute).

Chart 10: Adults with Health Insurance by Age, 2014


The overall rate of adults in St. Louis City with health insurance in 2014 was 80.3 percent, 4.3 percent

lower than Missouri. Of the total number of insured adults, the 55-64 age group had the most adults with

health insurance in St. Louis City; the 18-24 age group and the 45-54 age group had the second highest

percentage of insured adults in St. Louis City. The 25-34 age group had the lowest number of insured

adults in St. Louis City. The Healthy People 2020 national health target is to increase the proportion of

people with health insurance to 100 percent.

83.9

91.1

86.5

82.4

77.5

80.8

80.3

89.2

81.7

76.1

75.6

81.7

0 10 20 30 40 50 60 70 80 90 100

OVERALL

55-64

45-54

35-44

25-34

18-24

PERCENT

AG

E


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Chart 11: Adults with Health Insurance by Race / Ethnicity, 2014


The overall rate of adults with health insurance was higher in the state than in St. Louis City. When

comparing the rate by race/ethnicity, the city had higher rates of adults with health insurance than the

state except for African Americans and those with two or more races.

83.9

86

81

66.9

75.3

83.2

80.3

89

78

69.2

71.6

87

0 10 20 30 40 50 60 70 80 90 100

OVERALL

WHITE, NON-HISPANIC

TWO OR MORE RACES

HISPANIC OR LATINO

AFRICAN AMERICAN

ASIAN

PERCENT

RA

CE

/ ET

HN

ICIT

Y


25

Chart 12: Adults with Health Insurance by Gender, 2014


The health insurance rate among females in St. Louis City was lower than Missouri, but higher than the

rate of males in the city. Males in St. Louis City also had a lower health insurance rate than the state.

Chart 13: Adults 18-64 with Health Insurance: Time Series


The graph above shows the rate of adults in St. Louis City with health insurance coverage from 2010 until

2014. A decline occurred in the city between 2010 and 2011 followed by an increase from 2012 to 2014.

This increase could have resulted from the ACA, which mandates that all residents should be covered

under some form of health insurance. The rate in Missouri was statistically the same from 2010 to 2013,

with an increase noted in 2014.

85.1 82.6 83.983.377.2 80.3

0

20

40

60

80

100

FEMALE MALE OVERALL

PER

CEN

T

GENDER


81.4 80.7 80.9 81.7 83.9

74 72.675.3 76.8

80.3

0

10

20

30

40

50

60

70

80

90

2010 2011 2012 2013 2014

PER

CEN

T


26

The ability of an individual to access health services has a profound and direct effect on every aspect of

health. Beginning in 2010, nearly 1 in 4 Americans lacked a primary care provider or health center to

receive ongoing medical services.

Table 5: Access to Health Care, St. Louis City vs. Missouri

Health Indicators St. Louis City Missouri

Adults with health insurance, percent of age 18-64, 2014 80.3 83.9

Children with health insurance, percent, 2014 93.5 92.8

Primary care providers rate / 100,000, 2013 84 71

Dentist rate / 100,000, 2014 46 54

Mental health providers rate / 100,000, 2015 271 167

Non-physician primary care provider rate / 100,000, 2015 143 66

Preventable hospital stays, discharges / 1,000 enrollees, 2013 57 59

Source: Healthy Communities Institute/County Health Ranking

The rate of primary care providers and mental health providers was higher in the city than the rate of

providers in the state. Further, the rate of non-physician primary care providers was more than double the

rate in the city than in the state. However, the rate of dental providers was lower in the city than the rate

of dentists in the state.

27

ACCESS: TRANSPORTATION

Owning a car has a direct correlation with the ability to travel. Individuals with no car in the household

make fewer than half the number of trips compared to those with a car and have limited access to

essential local services such as supermarkets, post offices, doctors' offices and hospitals. Most

households with above-average income own a car while only half of low-income households have a car.

(Healthy Communities Institute).

Table 6: Access: Transportation, St. Louis City vs. Missouri, 2010-2014


Households without a vehicle, percent 21.9 7.4

Workers commuting by public transportation, percent 9.7 1.5

Mean travel time to work, age 16+ in minutes 23.8 23.1


St. Louis City had three times the number of households without a vehicle when compared to the state.

28

CANCER

Cancer is a leading cause of death in the United States, with more than 100 different types of the

disease. According to the National Cancer Institute, lung, colon and rectal, breast, pancreatic and

prostate cancer lead in the greatest number of annual deaths.

Chart 14: Death and Incidence Rates due to Cancer

Source: CDC State Cancer Profile

Overall, death and incidence rates of cancer in St. Louis City were higher than the respective rates in

Missouri and in the U.S.

Chart 15: Age-Adjusted Incidence Rate Compared to Age-Adjusted Death Rate Due to All Cancer: Time Series


485.1454.8 453.8

220.6184.1 171.2

0

100

200

300

400

500

600

ST. LOUIS CITY MISSOURI U.S.

CA

SES

/ 1

00

,00

0 P

OP

ULA

TIO

N

Incidence Rate Death Rate

438.9 435.4 439.8

488.3 490.2 485.1

221.5 217.4 210.7231.4 224 220.6

0

100

200

300

400

500

2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012

CA

SES

/ 1

00

,00

0

Incidences Deaths

29

Between the period ending 2007 and the period ending 2012, the incidence rate from cancer increased

10.5 percent in the city. The highest incidence rate occurred the period ending 2011. The death rate

remained relatively flat except for the period ending 2010 when the rate increased to 231.4.

Chart 16: Age-Adjusted Death Rate Due to Cancer by Race, 2008-2012


The overall cancer age-adjusted death rate in St. Louis City was higher than the rate in Missouri and in

the U.S. Of the overall rate, African Americans had the highest rate of cancer in the city, state and in the

country.

Chart 17: Age-Adjusted Death Rate by Cancer Type, 2008-2012


20

3.7

24

4.7

10

0.6

22

0.6

18

2.2

21

8.9

93

.5

18

4.1

17

0.9 2

02

10

6.6

17

1.2

0

50

100

150

200

250

300

WHITE AFRICAN AMERICAN ASIAN PACIFIC ISLANDER OVERALL

DEA

THS

/ 1

00

,00

0

St. Louis City Missouri US

27

.2

67

.1

28

.4

12

.8

22

.6

3.7

23

.4

57

19

.9

11

.1 16

.8

2.6

21

.9

47

.2

21

.4

10

.9 15

.5

2.3

0

10

20

30

40

50

60

70

80

BREASTCANCER

LUNGCANCER

PROSTATECANCER

PANCREATICCANCER

COLORECTALCANCER

CERVICALCANCER

DEA

THS

/ 1

00

,00

0


30

The age-adjusted death rates of breast, lung and bronchus, prostate, pancreatic, colon and cervical

cancer in the city were higher than the rates in the state and the country. The highest death rate of cancer

in the city was reported in lung and bronchus cancer and prostate cancer. In Missouri, the highest death

rate occurred in lung and bronchus cancer and breast cancer.

According to Healthy Communities Institute:

Breast Cancer

Breast cancer is a leading cause of cancer death among women in the United States. According to the

American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 36 women will

die from breast cancer. Breast cancer is associated with increased age, hereditary factors, obesity and

alcohol use. Since 1990, breast cancer death rates have declined progressively due to advancements in

treatment and detection. The Healthy People 2020 national health target is to reduce the breast cancer

death rate to 20.7 deaths per 100,000 females.

Lung Cancer

According to the American Lung Association, more people die from lung cancer annually than any other

type of cancer, exceeding the total deaths caused by breast cancer, colorectal cancer, and prostate

cancer combined. The greatest risk factor for lung cancer is duration and quantity of smoking. While the

mortality rate due to lung cancer among men has reached a plateau, the mortality rate due to lung cancer

among women continues to increase. African Americans have the highest risk of developing lung cancer.

The Healthy People 2020 national health target is to reduce the lung cancer death rate to 45.5 deaths per

100,000 population.

Prostate Cancer

Prostate cancer is a leading cause of cancer death among men in the United States. According to the

American Cancer Society, about 1 in 7 men will be diagnosed with prostate cancer. And about 1 in 36 will

die from prostate cancer. The two greatest risk factors for prostate cancer are age and race, with men

over the age of 65 and men of African descent possessing the highest incidence rates of prostate cancer

in the U.S.

The Healthy People 2020 national health target is to reduce the prostate cancer death rate to 21.8 deaths

per 100,000 males.

Colorectal Cancer

Colorectal cancer—cancer of the colon or rectum—is a leading cause of cancer-related deaths in the

United States. The Centers for Disease Control and Prevention estimates that if all adults aged 50 or

older had regular screening tests for colon cancer, as many as 60 percent of the deaths from colorectal

cancer could be prevented. While 90 percent of colorectal cancer cases occur in adults aged 50 or older,

it is essential for individuals with risk factors (those with a family history of colorectal cancer, inflammatory

bowel disease, or heavy alcohol use) to seek regular screening earlier.

The Healthy People 2020 national health target is to reduce the colorectal cancer death rate to 14.5

deaths per 100,000 population.

31

Chart 18: Age-Adjusted Incidence Rate Comparison Due to Cancer, 2008-2012


The breast cancer incidence rate in the city was similar to the rate in the state and in the country. The

prostate cancer incidence rate in the city and the rate in the country were similar while the rate was lower

in the state. The rate of lung and bronchus cancer, pancreatic cancer, colon and rectum cancer and

cervical cancer was higher in the city than Missouri and the country.

Chart 19: Age-Adjusted Death Rate Due to Cancer Type by Race / Ethnicity


12

4.5

89

.7

13

2.3

14

.6

50

.5

11

.8

12

4.7

76

.2

11

3.6

12

.1

44

.5

8.4

12

3

63

.7

13

1.7

12

.3

41

.9

7.7

0

20

40

60

80

100

120

140

160

BREASTCANCER

LUNG &BRONCHUS

CANCER

PROSTATECANCER

PANCREATICCANCER

COLORECTALCANCER

CERVICALCANCER

CA

SES

/ 1

00

,00

0


34.2

26.7

71.1

40.3

21.818.3

66.1

19.9

0

10

20

30

40

50

60

70

80

BREASTCANCER

COLORECTALCANCER

LUNGCANCER

PROSTATECANCER

DEA

THS

/ 1

00

,00

0

African American White

32

The age-adjusted death rate due to breast, colorectal, lung and prostate cancers among African

Americans in St. Louis City was higher than the rate among Whites in the city. The rate of breast cancer

among African Americans was one-and one-half times higher than the rate of Whites. The death rate of

prostate cancer among African Americans was twice the rate of Whites.

Chart 20: All Cancer Incidence Rate by Race / Ethnicity


The incidence rate of all cancer was 6.7 percent higher in the city than in the state. The incidence of

cancer among African Americans in St. Louis City was 2.7 percent higher when compared to the state.

The incidence of cancer among Whites in St. Louis City was 3.8 percent higher when compared to the

state.

As noted in the previous graph regarding breast cancer, African American women lead the way in both

incidence and mortality. Some of the social determinants of health that play into cancer are similar to

many of the other issues in terms of influences on health behaviors that are risk factors for cancer, such

as nutrition or tobacco use, as well as barriers to access. In this case, barriers to access may result in

delays not just in screening and early detection, but throughout the entire process of cancer care.

506.5

268.3

468.5485.14493.2

299.1

451.4 454.8

0

100

200

300

400

500

600

AFRICAN AMERICAN HISPANIC WHITE OVERALL

DEA

THS

/ 1

00

,00

0


33

Chart 21: Age-Adjusted Incidence Rates Due to Cancer by Gender, 2008-2012


The overall rate of cancer incidence among both genders in the city was higher than the rate in the state

and in the country.

Chart 22: Age-Adjusted Death Rates Due to Cancer by Gender, 2008-2012


Even though the death rate due to cancer by both genders was higher in the city than in the state and in

the country, the death rate due to cancer among females was lower in the city than the rate in the state

and in the country. Males had a 76 percent higher death rate in the city when compared to the state and

an 89 percent higher death rate when compared to the country.

43

5.1

56

1.2

48

5.1

42

1.5 5

02

.9

45

4.8

41

2.3

51

2.6

45

3.8

0

100

200

300

400

500

600

700

FEMALE MALE BOTH

CA

SES

/ 1

00

,00

0


18

7.3

27

4.4

22

0.6

22

2.7

15

6 18

4.120

7.9

14

5.4 17

1.2

0

50

100

150

200

250

300

350

FEMALE MALE BOTH

CA

SES

/ 1

00

,00

0


34

Chart 23: Age-Adjusted Death Rates Due to Cancer by Gender, 2008-2012


The age-adjusted incidence rate due to cancer was higher in the city among Whites and African

Americans, but lower among Hispanics.

46

8.5 50

6.5

26

8.3

48

5.1

45

1.4 49

3.2

29

9.1

45

4.8

45

4.1

46

5.8

35

4.6

45

3.8

0

100

200

300

400

500

600

WHITE AFRICAN AMERICAN HISPANIC ALL RACES

DEA

THS

/ 1

00

,00

0


35

DIABETES

Diabetes is a leading cause of death in the United States. According to the Centers for Disease

Prevention and Control, more than 25 million people have diabetes, including both individuals already

diagnosed and those who have gone undiagnosed.

This disease can have harmful effects on most of the organ systems in the human body. It is a frequent

cause of end-stage renal disease, non-traumatic lower-extremity amputation, and a leading cause of

blindness among working-age adults. Persons with diabetes are also at increased risk for coronary heart

disease, neuropathy and stroke.

Diabetes disproportionately affects minority populations and the elderly, and its incidence is likely to

increase as minority populations grow and the U.S. population becomes older. (Healthy Communities

Institute).

Chart 24: Age-Adjusted Death Rates Due to Diabetes by Gender, 2010-2014


The age-adjusted death rate of adults due to diabetes in the city was 57.4 percent higher than the state.

The rate of females in the county was 55.8 percent higher than the rate of females in the state. The rate

of males in the state was 37.0 percent higher than the rate of males in the county.

26.8

38

31.8

17.2

24

20.2

0

5

10

15

20

25

30

35

40

45

FEMALE MALE BOTH

PER

CEN

T


36

Chart 25: Adults with Diabetes, 2013


The rate of adults with diabetes was 25 percent higher in the city when compared to the state. The rate of

females in the city was 33.3 percent higher than the state. The rate of males was 15.5 percent higher

than the state.

Chart 26: Age-Adjusted Death Rate Due to Diabetes by Race / Ethnicity


The age-adjusted death rate due to diabetes was 57.4 percent higher in the city than the state. African

Americans in the city had a 9.1 percent higher death rate when compared to the state. Whites in St. Louis

City had a 22.7 percent higher death rate than the state.

14.4

12.613.5

10.8 10.9 10.8

0

2

4

6

8

10

12

14

16

18

20

FEMALE MALE BOTH

PER

CEN

T


41.9

22.7

31.8

38.4

18.520.2

0

5

10

15

20

25

30

35

40

45

50

AFRICAN AMERICAN WHITE OVERALL

DEA

THS

/ 1

00

,00

0 P

OP

ULA

TIO

N


37

Chart 27: Adults with Diabetes: Time Series


From 2011 to 2013, the rate of adults with diabetes increased 9.8 percent. The rate in Missouri remained

relatively flat.

Chart 28: Age-Adjusted Death Rate Due to Diabetes, 2010-2014


The age-adjusted death rate due to diabetes for St. Louis City and Missouri remained relatively flat during

the period ending 2011 to the period ending 2014.

12.3 12.413.5

10.6 10.7 10.8

0

2

4

6

8

10

12

14

16

18

20

2011 2012 2013

PER

CEN

T


32 31.332.7 31.8

20.8 20.2 20.3 20.2

0

5

10

15

20

25

30

35

2007-2011 2008-2012 2009-2013 2010-2014

DEA

THS

/ 1

00

,00

0 P

OP

ULA

TIO

N


38

Chart 29: Medicare Population with Diabetes: Time Series


For the period ending 2010 to the period ending 2014, diabetes in the Medicare population in St. Louis

City and Missouri remained largely unchanged.

Chart 30: Medicare Population with Diabetes by Age, 2014


St. Louis City had a 15.4 percent higher rate of adults with diabetes than the state. The Under 65

Medicare population had a 14.1 percent higher rate than state. The 65 and Over Medicare population had

a 13.3 percent higher rate than the state.

29.4 29.8 30.1 30.1 29.9

25.9 26.1 26.1 26.1 25.9

0

5

10

15

20

25

30

35

2010 2011 2012 2013 2014

PER

CEN

T


28.430.7 29.9

24.927.1

25.9

0

5

10

15

20

25

30

35

UNDER 65 65 & OVER OVERALL

PER

CEN

T


39

HEALTHY LIFESTYLES

Obesity increases the risk of many diseases and health conditions including heart disease, type 2

diabetes, cancer, hypertension, stroke, liver and gallbladder disease, respiratory problems and

osteoarthritis. Losing weight and maintaining a healthy weight help to prevent and control these diseases.

Being obese also carries significant economic costs due to increased healthcare spending and lost

earnings. (Healthy Communities Institute).

Chart 31: Adult Fruit and Vegetable Consumption by Race / Ethnicity, 2011


African Americans had a higher fruit and vegetable consumption rate in the city than the state and a 9

percent higher rate compared to White, non-Hispanic.

Numerous studies have shown a clear link between the amount and variety of fruits and vegetables

consumed and rates of chronic diseases, especially cancer. According to the World Cancer Research

Fund International, about 35 percent of all cancers can be prevented through increased fruit and

vegetable consumption. (Healthy Communities Institute).

Chart 32: Adults Who are Obese by Race / Ethnicity, 2011


12.411.1

12.212 12.3 12.5

0

5

10

15

AFRICAN AMERICAN WHITE, NON-HISPANIC OVERALL


37.7

27.431.1

41.1

29 30

0

5

10

15

20

25

30

35

40

45


PER

CEN

T


40

African Americans in the city had an 8.3 percent lower rate of obesity when compared to the state. Whites

also had a 5.5 percent lower rate of obesity when compared to the state.

Chart 33: Adults Who are Obese vs. HealthyPeople 2020, 2011


The Healthy People 2020 national health target is to reduce the proportion of adults age 20 and older who

are obese to 30.5 percent. In the graph above, St. Louis City and the state slightly exceeded the target.

31.1 31 30.5

0

5

10

15

20

25

30

35

ST. LOUIS CITY MISSOURI HP2020 TARGET

PER

CEN

T

41

HEART HEALTH

Heart disease is a term that encompasses a variety of different diseases affecting the heart and is the

leading cause of death in the United States accounting for 25.4 percent of total deaths.

Chart 34: Age-Adjusted Death Rate Due to Heart Disease by Race / Ethnicity, 2010-2014


The age-adjusted death rate due to heart disease in St. Louis City was 23.5 percent higher than the rate

in the state. African Americans in the city had a 16.4 percent higher death rate from heart disease in the

city when compared to the rate in the state.

Chart 35: High Cholesterol Prevalence in Adults 35+ by Race / Ethnicity, 2011


The overall high cholesterol prevalence was 4 percent lower in the city when compared to the state.

African Americans in the city had a 4 percent higher rate when compared to the state. White, Non-

Hispanics in the city had a 5.8 percent lower rate than the state.

267.6

220.4241

229.9

191.6 195

0

50

100

150

200

250

300



39.7 40.8 41.238.1

43.3 42.9

0

10

20

30

40

50


PER

CEN

T


42

Chart 36: Age-Adjusted Death Rate Due to Stroke by Race / Ethnicity, 2010-2014


The age-adjusted death rate due to stroke in the city was 11.7 percent higher when compared to the

state. African Americans in the city had a 5.1 percent lower age-adjusted death rate due to stroke when

compared to the state. Whites in the city had a 9.8 percent higher age-adjusted death rate due to stroke

than the state.

Table 7: Heart Health & Stroke, St. Louis City vs. Missouri; Age-Adjusted Rate

Health Topics St. Louis City Missouri

Heart Disease

Deaths / 100,000, 2003-2013 279.10 216.8

Hospitalizations / 10,000, 2009-2013 154.9 123.1

ER visits / 1,000, 2009-2013 16.20 14.7

Ischemic Heart Disease

Deaths / 100,000, 2003-2013 185.1 144.7


ER visits / 1,000, 2009-2013 0.3 0.6

Stroke / Other Cerebrovascular Disease

Deaths / 100,000, 2003-2013 53.8 47.8


ER visits / 1,000, 2009-2013 0.4 0.8

Source: Missouri Department of Health and Senior Services

49.7

44.746.8

52.4

40.7 41.9

0

10

20

30

40

50

60


DEA

THS

/ 1

00

,00

0 P

OP

ULA

TIO

N


43

For heart disease, ischemic heart disease and stroke, the death rate for the city was higher than in the

state. The city was lower than the state in hospitalizations and ER Visits for ischemic heart disease and in

ER Visits for stroke.

Table 8: Heart Health & Stroke by Race/Ethnicity, St. Louis City vs. Missouri


Heart Disease White African

American White

African American

Deaths / 100,000, 2003-2013 263.5 298.8 212.7 264.6

Hospitalizations / 10,000, 2009-2013 109.7 203.5 115.4 180.8

ER visits / 1,000, 2009-2013 8.6 24 13.1 24.7


Deaths / 100,000, 2003-2013 189.2 182.4 143.1 168.6


ER visits / 1,000, 2009-2013 0.2 0.4 0.6 0.4


Deaths / 100,000, 2003-2013 48.3 59.2 46.4 60.9


ER visits / 1,000, 2009-2013 0.2 0.5 0.8 0.7


Like in the state, African Americans had a higher death rate compared to Whites for heart disease (+13.4

percent) and stroke (+22.6 percent). For ischemic heart disease in the city, African Americans had a 3.6

percent lower death rate compared to Whites.

44

Table 9: Heart Disease & Stroke, St. Louis City vs. Missouri Three-Year Moving Average Rates

Health Indicators 2009-2011 2010-2012 2011-2013

Heart Disease St. Louis

City Missouri

St. Louis City

Missouri St. Louis

City Missouri

Death / 100,000 population 257.21 200.75 247.12 196.22 235.88 194.11

Hospitalizations / 10,000 population

176.39 151.84 172.90 142.91 170.34 136.57

ER Visits / 1,000 population

13.68 13.06 14.10 13.07 14.84 13.63




45.49 55.14 42.60 49.38 39.90 45.21


0.33 0.84 0.34 0.73 0.32 0.67




36.58 30.42 36.18 29.55 37.86 29.51


0.48 0.81 0.49 0.79 0.47 0.77


For the period ending 2011 to the period ending 2013, the city had a decline in the heart disease death

rate of 8.5 percent; a decline of 11.6 percent in the ischemic heart disease death rate; and a decline of

4.9 percent in the stroke/other cerebrovascular disease death rate. While all three heart conditions had

experienced a decline, the rates were above the death rates in the state.

45

MATERNAL & CHILD HEALTH

Babies born with low birth weight are more likely than babies of normal weight to have health problems

and require specialized medical care in the neonatal intensive care unit. Low birth weight is typically

caused by premature birth and fetal growth restriction, both of which are influenced by a mother's health

and genetics. The most important thing an expectant mother can do to prevent low birth weight are to

seek prenatal care, take prenatal vitamins, stop smoking, and stop drinking alcohol and using drugs.

(Healthy Communities Institute)

Chart 37: Babies with Low Birth Weight by Gender, 2014


The overall rate of babies with low birth weight for both genders in St. Louis City was 12.3 percent, 50

percent higher than Missouri. The percent of female babies with low birth weight in St. Louis City was

35.2 percent higher than the birth weight of male babies.

The Healthy People 2020 national health target is to reduce the proportion of infants born with low birth

weight to 7.8 percent.

14.2

10.5

12.3

8.9

7.58.2

0

2

4

6

8

10

12

14

16

FEMALE MALE BOTH

PER

CEN

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46

Chart 38: Babies with Very Low Birth Weight by Maternal Race / Ethnicity, 2014


The rate of babies with very low birth weight in St. Louis City was nearly nine times higher than Missouri.

The rate of African Americans in St. Louis City was five times higher than the state.

The Healthy People 2020 national health target is to reduce the proportion of infants born with very low

birth weight to 1.4 percent.

Infant mortality rate continues to be one of the most widely used indicators of the overall health status of a

community. The leading causes of death among infants are birth defects, pre-term delivery, low birth

weight, Sudden Infant Death Syndrome (SIDS), and maternal complications during pregnancy. (Healthy


1.4

1.1

1.5

1.2

2.9

1

1.6

12.3

8.1

11.7

8.3

15.6

9.4

10

0 2 4 6 8 10 12 14 16 18

OVERALL

WHITE, NON-HISPANIC

OTHER

HISPANIC

AFRICAN AMERICAN

ASIAN/HAWAIIAN/PACIFIC ISLANDER

AMERICAN INDIAN/ALASKAN NATIVE

RA

CE

/ ET

HN

ICIT

Y


47

Chart 39: Infant Mortality Rate by Race / Ethnicity, 2002-2012


The infant mortality rate by race was 11.2 percent, 53.4 percent higher than the state. The rate of infant

mortality among African Americans in the city was nearly three times higher than the rate of Whites.

The Healthy People 2020 national health target is to reduce the infant mortality rate to 6 deaths per 1,000

live births.

Babies born to mothers who do not receive prenatal care are three times more likely to have a low birth

weight and five times more likely to die than those born to mothers who do get care. Early prenatal care

(i.e. care in the first trimester of a pregnancy) allows women and their health care providers to identify

and, when possible, treat or correct health problems and health-compromising behaviors that can be

particularly damaging during the initial stages of fetal development. Increasing the number of women who

receive prenatal care, and who do so early in their pregnancies, can improve birth outcomes and lower

health care costs by reducing the likelihood of complications during pregnancy and childbirth. (Healthy


15.3

5.1

11.2

14.4

6.1

7.3

0

2

4

6

8

10

12

14

16


PER

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48

Chart 40: Mothers Who Received Early Prenatal Care by Age, 2010-2014


The rate of mothers who received early prenatal care in St. Louis City was 73.2 percent, 1.9 points below

the state rate. The 30-34 age group had the highest rate among all age groups in St. Louis City and

Missouri followed by the 35-39 age group. The 10-14 age group received the lowest rate of early prenatal

care in both St. Louis City and Missouri.

The Healthy People 2020 national health target is to increase the proportion of pregnant women who

receive prenatal care in the first trimester to 77.9 percent.

75.1

75.6

80.9

83

78.4

68.9

61.9

55.2

37.3

73.2

76

82.3

83.2

76

64.5

59.4

48.2

33.3

0 10 20 30 40 50 60 70 80 90

OVERALL

40+

35-39

30-34

25-29

20-24

18-19

15-17

10-14A

GE

IN Y

EAR

S


49

Chart 41: Mothers Who Received Early Prenatal Care by Race / Ethnicity, 2010-2014


Among all races residing in the city, Whites received the highest percentage of early prenatal care both in

the city and the state. African Americans had the lowest rate in the city and the state.

Smoking during pregnancy poses risks for both mother and fetus. A baby born to a mother who has

smoked during her pregnancy is more likely to have less developed lungs and a lower birth weight, and is

more likely to be born prematurely. It is estimated that smoking during pregnancy causes up to 10 percent

of all infant deaths. Even after a baby is born, secondhand smoking can contribute to SIDS (Sudden

Infant Death Syndrome), asthma onset, and stunted growth.

The Healthy People 2020 national health target is to decrease the percentage of women who gave birth

and who smoked cigarettes during pregnancy to 1.4 percent.

75.1

77.8

65.5

63.1

62.5

73.6

63.4

73.2

87

67.7

72.2

63.5

77.6

67.8

0 10 20 30 40 50 60 70 80 90 100

OVERALL

WHITE

OTHER

HISPANIC

AFRICAN AMERICAN


AMERIAN INDIAN/ALASKA NATIVE


50

Chart 42: Mothers Who Smoked During Pregnancy by Race / Ethnicity, 2014


The rate of mothers who smoke during pregnancy in the city was 13.5 percent, 18.7 percent lower than

the state. African Americans had the highest rate in St. Louis City and American Indian/Alaska Native had

the highest rate in the state.

Babies born premature are likely to require specialized medical care, and oftentimes must stay in

intensive care nurseries. While there have been many medical advances enabling premature infants to

survive, there is still risk of infant death or long-term disability. The most important things an expectant

mother can do to prevent prematurity and low birth weight are to take prenatal vitamins, stop smoking,

stop drinking alcohol and using drugs, and get prenatal care. (Healthy Communities Institute).

16.6

17.9

2.4

6.3

13.6

2.6

27.1

13.5

10.9

3.6

4.9

16.7

3.9

5

0 5 10 15 20 25 30

OVERALL

WHITE

OTHER

HISPANIC

AFRICAN AMERICAN



PERCENT


51

Chart 43: Preterm Births by Maternal Race / Ethnicity, 2014


The rate of preterm births is 12.5 percent in St. Louis City, 28.9 percent higher than in Missouri. Preterm

births among African Americans had the highest rate in the city and the state.

The Healthy People 2020 national health target is to reduce the proportion of infants who are born

preterm to 11.4 percent.

9.7

8.9

8.2

8.8

14.2

9.2

10.1

12.5

9.3

12.6

10.8

15

11.6

0

0 2 4 6 8 10 12 14 16

OVERALL

WHITE

OTHER

HISPANIC

AFRICAN AMERICAN



PERCENT


52

Chart 44: Age of Mother at Birth by Race / Ethnicity, 2009-2013


The percent of birth by age of mother was highest among the African American 20-24 age group in the

city followed closely by the White 30-34 age group in the city. In the state, the percent of birth by age of

mother was highest in the African American 20-24 age group followed by the White 25-29 age group.

0.1

2

6.1

25.4

31.5

24

9

1.9

0.3

4.7

10.9

35.8

25.7

14.8

6.3

1.5

0

0.7

2.6

13.6

30.2

35.9

14.2

2.8

0.4

6.1

12

37.6

24.6

13

5.2

1.2

0 5 10 15 20 25 30 35 40

UNDER 15

15-17

18-19

20-24

25-29

30-34

35-39

40 & OVER

PERCENT

St. Louis City: African American St. Louis City: White Missouri: African American Missouri: White

53

Chart 45: Births by Age of Mother, 2009-2013


The birth by age of mother in the city was highest among the 20-24 age group followed closely by the 25-

29 age group. In the state, the birth by age of mother was highest in the 25-29 age group.

1.89

8.84

22.75

30.54

26.67

6.77

2.45

0.08

1.9

9.1

22.6

27

27.4

7.9

3.9

0.2

0 5 10 15 20 25 30 35

40 & OVER

35-39

30-34

25-29

20-24

18-19

15-17

UNDER 15A

GE


54

MENTAL AND BEHAVIORAL HEALTH: MENTAL ILLNESS

In 2014, there were an estimated 9.8 million adults age 18 or older in the U.S. with serious mental illness.

This number represented 4.2 percent of all U.S. adults. (Source: National Institute of Mental Health).

Suicide is a leading cause of death in the United States, presenting a major, preventable public health

problem. More than 33,000 people kill themselves each year according to the Centers for Disease Control

and Prevention, but suicide deaths only account for part of the problem. An estimated 25 attempted

suicides occur per every suicide death, and those who survive suicide may have serious injuries, in

addition to having depression and other mental problems. Men are about four times more likely than

women to die from suicide, but three times more women than men report attempting suicide. Suicide

occurs at a disproportionately higher rate among adults 75 years and older (Healthy Communities

Institute).

Chart 46: Age-Adjusted Death Rate Due to Suicide: Time Series

Source: Missouri Department of Mental Health

From the period ending 2011 to 2013, the age-adjusted death rate in the state due to suicide increased

by 8.6 percent while the rate in city decreased slightly.

12.7 12.3 12.5

13.9 14.214.7

0

2

4

6

8

10

12

14

16

2007-2011 2008-2012 2009-2013

DEA

THS

/ 1

00

,00

0 P

OP

ULA

TIO

N


55

Chart 47: Age-Adjusted Death Rate Due to Suicide by Gender, 2010-2014


The age-adjusted death rate from suicide in the city was 23.8 percent lower than the state. Males both in

the city and the state had a death rate more than four times higher the rate of females.

Chart 48: Age-Adjusted Death Rate Due to Suicide by Race / Ethnicity, 2010-2014


The age-adjusted death rate due to suicide among Whites in the city was nearly three times higher when

compared to the rate of African Americans. The age-adjusted death rate due to suicide among Whites in

the state was two and one-half times the rate of African Americans.

4.3

19.5

11.5

6

24.9

15.1

0

5

10

15

20

25

30

FEMALE MALE BOTH

DEA

THS

/ 1

00

,00

0 P

OP

ULA

TIO

N


5.8

17

11.5

6.4

16.415.1

0

2

4

6

8

10

12

14

16

18

20


DEA

THS

/ 1

00

,00

0


56

Chart 49: Depression in Medicare Population: Time Series


The rate of depression in the Medicare population in St. Louis City and Missouri increased from the

period ending 2010 to the period ending 2014.

Depression is a chronic disease that negatively affects a person's feelings, behaviors and thought

processes. Depression has a variety of symptoms, the most common being a feeling of sadness, fatigue

and a marked loss of interest in activities that used to be pleasurable. Many people with depression never

seek treatment; however, even those with the most severe depression can improve with treatments

including medications, psychotherapies and other methods. According to the National Comorbidity Survey

of mental health disorders, people over the age of 60 have lower rates of depression than the general

population — 10.7 percent in people over the age of 60 compared to 16.9 percent overall. (Healthy


19.621 21.6 22.2 22.5

16.918.1 18.6 19.1 19.7

0

5

10

15

20

25

2010 2011 2012 2013 2014

PER

CEN

T


57

Chart 50: Depression in Medicare Population by Age, 2014


The rate of depression among the Medicare population in the city was higher than in the state. The rate of

depression among the Under 65 Medicare population was 12.5 percent lower than in the state. The rate

of depression among the 65 & Over Medicare population was 12.1 percent higher than the state.

Medicare is the federal health insurance program for persons aged 65 years or older, persons under age

65 years with certain disabilities, and persons of any age with end-stage renal disease (ESRD).

31.6

17.6

22.5

36.1

15.7

19.7

0

5

10

15

20

25

30

35

40


PER

CEN

T


58

Chart 51: Comprehensive Psychiatric Services Numbers Served in St. Louis City


The graph above indicates the number of clients seen with each diagnosis per year. An individual client

may have more than one admission within a year. Mood and psychotic disorders led among all conditions

during the three-year-period. (Missouri Department of Mental Health, 2014).

632

142

11

2429

274

3156

701

23

6

567

79

548

186

14

2521

322

3440

699

27

10

675

54

608

279

16

2736

387

3676

819

31

352

893

85

0 500 1000 1500 2000 2500 3000 3500 4000

DIAGNOSIS UNKNOWN

OTHER DIAGNOSIS

SEXUAL DISORDER

PSYCHOTIC DISORDER

PERSONALITY DISORDER

MOOD DISORDER

IMPULSE CONTROL DISORDER

DEVELOPMENT DISORDER

DIMENTIA

ANXIETY DISORDER

ADJUSTMENT DISORDER

2015 2014 2013

59

MENTAL AND BEHAVIORAL HEALTH: SUBSTANCE ABUSE

The availability of county/city-level data on substance use and abuse is limited. According to the Missouri

Department of Mental Health, there were 3,370 individuals in St. Louis City admitted into substance

abuse treatment programs in 2014. A total of 672 were primarily due to alcohol while 727 were due to

marijuana. There were a total of 143 alcohol-related and 422 drug-related hospitalizations. In addition,

there were 1,845 alcohol-related and 1,052 drug-related emergency room visits that did not include a

hospital stay.

Chart 52: Current 30-Day Substance Use for Ages 19+, 2010-2012


Alcohol was the substance most used in the Eastern Region and in Missouri followed by cigarettes and

binge drinking. Binge drinking is considered five or more drinks in a single day.

1.89

8.84

22.75

30.54

26.67

6.77

2.45

0.08

1.9

9.1

22.6

27

27.4

7.9

3.9

0.2

0 5 10 15 20 25 30 35

ILLICIT DRUG USEEXCLUDING MARIJUANA

PAIN RELIEVER ABUSE

MARIJUANA

BINGE DRINKING

ALCOHOL

CIGARETTES

15-17

UNDER 15

Eastern Region Missouri

60

Chart 53: Primary Drug Problem in St. Louis City Substance Abuse Treatment Programs Per Total Individuals: Time Series


The graph above shows that heroin was the drug of choice among individuals admitted to substance

abuse treatment programs in the city for the past three years. From 2012 to 2014, heroin treatment use

among those admitted increased 17.1 percent.

In 2012, the average age for first-time drug use was 20.6 years; 20.5 years in 2013 and 21.1 years in

2014. (Missouri Department of Mental Health).

8

6

17

111

1220

46

376

695

684

10

10

32

114

1338

62

403

727

672

8

15

26

130

1436

93

358

699

691

0 200 400 600 800 1000 1200 1400 1600

OTHER MEDICATION/ILLICIT DRUG

TRANQUILIZER

PCP/LSD/OTHERHALLUCINOGEN

ANALGESIC EXCEPTHEROIN

HEROIN

STIMULANT TOTAL

COCAINE TOTAL

MARIJUANA/HASHISH

ALCOHOL

2015 2014 2013

61

Chart 54: Primary Drug Problem in St. Louis City Substance Abuse Treatment Programs Per Total Individuals


The 45-54 age group had the highest admissions for substance abuse treatment from 2012-2015,

followed by the 30-34 age group. The under 18 age group had the least number of admissions all three

years.

14

9

36

4

48

0 53

2

40

7

33

7

64

1

25

6

14

3

36

3

49

6

56

0

45

7

34

0

67

0

34

1

11

4

35

4

49

5

59

5

51

1

40

6

65

1

33

3

0

100

200

300

400

500

600

700

800

UNDER 18 18-24 25-29 20-34 35-39 40-44 45-54 55 & OVER

TOTA

L N

UM

BER

OF

IND

IVID

UA

LS

2013 2014 2015

62

Chart 55: Total Number of Individuals Who Attended Substance Abuse Treatment Programs by Education Level: Time Series


Individuals with a bachelor or advanced degree had the lowest number of individuals in substance abuse

treatment followed by those with an associate degree or some college.

13

31

12

83

53

1

21

14

33

13

62

55

5

20

14

91

14

91

54

2

24

0

200

400

600

800

1000

1200

1400

1600

LESS THANHIGH SCHOOL

HIGH SCHOOLGRADUATE OR G.E.D.

ASSOCIATE DEGREEOR SOME COLLEGE

BACHELOR ORADVANCED DEGREE

TOTA

L N

UM

BER

OF

IND

IVID

UA

LS

2013 2014 2015

63

Chart 56: Total Number of Individuals Who Attended Substance Abuse Treatment Programs by Race / Ethnicity: Time Series


African Americans had the highest number of individuals who attended substance abuse treatment

programs. While the number of individuals had not substantially changed across most groups, an

increase occurred for the number of Whites in substance abuse treatment programs. (Missouri

Department of Mental Health).

91

6

21

46

32 81

98

6

22

70

33 8

7

10

43

22

91

41 9

2

0

500

1000

1500

2000

2500

AFRICAN AMERICAN WHITE HISPANIC OTHER RACE/TWOOR MORE RACES

TOTA

L N

UM

BER

OF

IND

IVID

UA

LS

2013 2014 2015

64

PUBLIC SAFETY: VIOLENCE

A violent crime is a crime in which the offender uses or threatens to use violent force upon the victim.

Violence negatively impacts communities by reducing productivity, decreasing property values, and

disrupting social services. (Healthy Communities Institute).

Chart 57: Age-Adjusted Death Rate Due to Assault Injury, 2003-2013


The age-adjusted death rate due to assault injury in St. Louis City was four times higher than the rate in

the state. The death rate due to firearms was nearly four and one-half times higher in the city than the

state.

1.2

0.1

0.1

5.1

0.06

7.2

3

0.2

0.1

23.3

2.2

28.8

0 5 10 15 20 25 30 35

OTHER ASSAULTINJURIES

BLUNT OBJECT

CHILD ABUSE

FIREARMS

CUT-PIERCE

TOTAL ASSAULTINJURIES


65

Chart 58: Assault Injury Visits to the ER, 2003-2013


There were more visits to the emergency room due to fights in St. Louis City than any other assault injury,

one and one-half times higher than the rate in the state.

Child abuse was the second highest emergency room visit in the city, four times the rate of the state.

1

1.8

0.4

0.2

0.5

0.1

0.2

2

3

1.5

0.7

2.1

0.6

0.8

0 0.5 1 1.5 2 2.5 3 3.5


FIGHTS

BLUNT OBJECT

ADULT ABUSE

CHILDE ABUSE

FIREARMS

CUT-PIERCE

CASES / 1,000


66

Chart 59: Assault Injury Hospitalizations, 2003-2013


Hospitalization rate due to firearms in the city was more than five times the rate of hospitalization in the

state. Child abuse was the second highest rate in the city, two and one-half times the rate in the state.

0.5

0.6

0.4

0.1

0.8

0.8

0.5

1.6

1.3

1.2

0.1

2.1

4.2

1.7

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5


FIGHTS

BLUNT OBJECT

ADULT ABUSE

CHILDE ABUSE

FIREARMS

CUT-PIERCE

CASES / 1,000


67

Table 10: Assault Injury & Firearm, St. Louis City vs. Missouri Three-Year Moving Average Rates


Assault Injury St. Louis

City Missouri

St. Louis City

Missouri St. Louis

City Missouri

Deaths / 100,000 population 257.21 200.75 247.12 196.22 235.88 194.11

Hospitalizations / 10,000 population 176.39 151.84 172.90 142.91 170.34 136.57

ER visits / 1,000 population 13.68 13.06 14.10 13.07 14.84 13.63

Firearm

Deaths / 100,000 population 166.54 132.55 158.66 128.05 147.17 122.38

Hospitalizations / 10,000 population 45.49 55.14 42.60 49.38 39.90 45.21

ER visits / 1,000 population 0.33 0.84 0.34 0.73 0.32 0.67


Based on the three-year moving assault injury average rates from 2009-2013, a slight decline occurred in

the total number of assault deaths, injury hospitalizations and ER Visits, firearm deaths and firearm

hospitalizations in the city as well as in the state. An increase occurred in firearm ER Visits in St. Louis

City.

Table 11: Assault Injury & Firearm by Race/Ethnicity, St. Louis City vs. Missouri 2003-2013


Assault Injury White African

American White

African American

Deaths / 100,000 population 6.13 53.21 3.29 32.63

Hospitalizations / 10,000 population 3.35 17.60 1.62 10.80

ER visits / 1,000 population 3.89 13.59 2.93 9.78

Firearm

Deaths / 100,000 population 3.24 45.16 1.79 26.53

Hospitalizations / 10,000 population 0.35 8.06 0.15 4.65

ER visits / 1,000 population 0.06 1.10 0.02 0.59


The total number of assault injury deaths among African Americans was more than 8 times the rate of

Whites in the city and 16 times the rate of Whites in the state. Death due to firearms among African

Americans in the city was nearly 14 times the rate of death among Whites in the city and just over 25

times the rate of death of Whites in the state.

68

REPRODUCTIVE & SEXUAL HEALTH

The Centers for Disease Control and Prevention (CDC) estimates that there are approximately 20 million

new STD infections each year—almost half of them among young people ages 15 to 24. The cost of

STDs to the U.S. health care system is estimated to be as much as $16 billion annually. Because many

cases of STDs go undiagnosed—and some common viral infections, such as human papillomavirus

(HPV) and genital herpes, are not reported to the CDC at all—the reported cases of chlamydia,

gonorrhea, and syphilis represent only a fraction of the true burden of STDs in the U.S.

Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and

young women. The CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women

in the U.S. each year to become infertile. (Healthy People 2020).

Chart 60: Infectious Diseases Incidence: Time Series


While there has been a decline in the rate of incidence/cases of Hepatitis C from 2011-2013, Hepatitis C

had the highest rate of incidence/cases in St. Louis City when compared to HIV/AIDS and Hepatitis B

over the three years.

12

2

53

82

3

12

7

68

78

0

11

3

73

77

4

0

100

200

300

400

500

600

700

800

900

HIV/AIDS HEPATITIS B(CHRONIC, ACUTE & PRENATAL)

HEPATITIS C(CHRONIC & ACUTE)

TOTA

L C

ASE

S

2011 2012 2013

69

Chart 61: Sexually Transmitted Diseases: Females 15-19, 2010-2014


The rate of chlamydia in St. Louis City was more than three times the rate in the state. The rate of

gonorrhea in the city was more than five times the rate in the state.

Chart 62: Chlamydia Incidence: Females 15-19 by Race / Ethnicity, 2010-2014


The rate of chlamydia among females age 15 to 19 in the city was three times higher than the rate in the

state. African American females age 15 to 19 in the city were nine times higher than the rate of Whites in

the city. African American females age 15-19 in the state were six times higher than the rate of Whites in

the state.

11362

33133607

642

0

2000

4000

6000

8000

10000

12000

CHLAMYDIA GONORRHEA

CA

SES

/ 1

00

,00

0


13891.5

1424.6

11362.210205.3

1648.2

3607

0

2000

4000

6000

8000

10000

12000

14000


INC

IDEN

CES

/ 1

00

,00

0


70

RESPIRATORY DISEASE: ASTHMA

Asthma is a chronic lung disease characterized by periods of wheezing, chest tightness, and shortness of

breath and coughing. Symptoms often occur or worsen at night or in the early morning. These

occurrences, often referred to as “asthma attacks,” are the result of inflammation and narrowing of the

airways due to a variety of factors or “triggers.”

Chart 63: Asthma in Medicare Population by Age, 2014


The overall rate of asthma in St. Louis City was 7.7 percent, 60.4 percent higher than the state. The

under 65 population had a 125 percent higher rate when compared to the state and the 65 and over

population had a 50 percent higher rate than the state.

Table 12: Asthma by Race/Ethnicity, St. Louis City vs. Missouri


White African

American White

African American

Death / 100,000, 2003-2013 0.89 4.92 0.87 3.02


ER visits / 1,000, 2009-2013 3.37 22.98 3.11 17.39


Asthma hospitalization rates in the city among African Americans were more than five times the rate of whites. The death, hospitalization and ER Visit rates in the city were higher than the rates in the state, especially among African Americans.

10.8

6

7.7

4.8

4

4.8

0

2

4

6

8

10

12


PER

CEN

T


71

Table 13: Asthma, St. Louis City vs. Missouri; Three-Year Moving Average Rates


St. Louis

City Missouri

St. Louis City

Missouri St. Louis

City Missouri

Asthma death / 100,000 population

2.62 1.08 2.08 1.03 2.22 0.9

Asthma hospitalizations / 10,000 population

35.77 13.38 37.54 13.5 38.72 13.64

Asthma ER visits / 1,000 population

13.91 5.15 14.06 5.2 14.31 5.22


The asthma death rate in St. Louis City declined from the period ending 2011 to 2012, but increased in

the period ending in 2013. The death rate in Missouri decreased over the three-year-period. The

hospitalization and ER Visit rates in the city and the state increased over the three-year-period.

Table 14: Asthma Rates, St. Louis City vs. Missouri


Asthma deaths, 2003-2013 2.90 1.11

Asthma hospitalizations, 2009-2013 36.20 12.45

Asthma ER visits, 2009-2013 14.50 5.32


Among asthma health indicators, St. Louis City had higher rates than Missouri. Asthma hospitalizations in

St. Louis City were nearly three times the rate in the state and asthma ER Visits were more than double

the rate in Missouri.

72

Chart 64: Adults with Current Asthma by Race / Ethnicity, 2011


The rate of adults with asthma in the city in 2011 was 11.7 percent, 15.8 percent higher than the rate in

Missouri, and 10.1 percent, as noted in table 9 below. The rate of African American is twice the rate of

White, Non-Hispanic and higher than the overall rate.

Table 15: Respiratory Disease Rates, St. Louis City vs. Missouri


Adults with current asthma, percent, 2011 11.7 10.1

Age-adjusted death rate due to chronic lower respiratory disease / 100,000 population, 2010-2014

45.5 51.7

Asthma: Medicare population, percent, 2014 7.7 4.8

COPD: Medicare population, percent, 2014 11.9 13.2


St. Louis City had higher rates than the state in the Medicare population including adults with asthma,

asthma in the Medicare population and COPD. St. Louis City had a 12.0 percent lower rate than the state

for age-adjusted death rate due to Chronic Lower Respiratory Disease.

15.3

7.6

11.7

0

2

4

6

8

10

12

14

16

18

20


PER

CEN

T

73

SECONDARY DATA SUMMARY

The collection of secondary data presented on the preceding pages revealed a number of findings:

The overall rate of adults in St. Louis City with health insurance in 2014 was 80.3 percent, 4.3

percent lower than Missouri.

St. Louis City had three times the number of households without a vehicle when compared to the

state.

The overall rate of asthma in St. Louis City was 7.7 percent, 60.4 percent higher than the state.

The under 65 population had a 125 percent higher rate when compared to the state and the 65

and over population had a 50 percent higher rate than the state.

Between the period ending 2007 and the period ending 2012, the incidence rate from cancer

increased 10.5 percent in the city. The incidence rate of all cancer was 6.7 percent higher in the

city than in the state.

Even though the death rate due to cancer by both genders was higher in the city than in the state

and in the country, the death rate due to cancer among females was lower in the city than the

rate in the state and in the country. Males had a 76 percent higher death rate in the city when

compared to the state and an 89 percent higher death rate when compared to the country.

The age-adjusted death rate due to heart disease in St. Louis City was 23.5 percent higher than

the rate in the state.

The age-adjusted death rate due to stroke in the city was 11.7 percent higher when compared to

the state.

The age-adjusted death rate of adults due to diabetes in the city was 57.4 percent higher than the

state. The rate of females in the county was 55.8 percent higher than the rate of females in the

state. The rate of males in the state was 37.0 percent higher than the rate of males in the county.

The overall rate of babies with low birth weight for both genders in St. Louis City was 12.3

percent, 50 percent higher than Missouri The rate of babies with very low birth weight in St. Louis

City was nearly nine times higher than Missouri. Missouri.

The rate of chlamydia in St. Louis City was more than three times the rate in the state. The rate of

chlamydia among females age 15 to 19 in the city was three times higher than the rate in the

state. The rate of gonorrhea in the city was more than five times the rate in the state.

Heroin was the drug of choice among individuals admitted to substance abuse treatment

programs in the city for the past three years. From 2012 to 2014, heroin treatment use among

those admitted increased 17.1 percent.

There were more visits to the emergency room due to fights in St. Louis City than any other

assault injury, one and one-half times higher than the rate in the state.

Child abuse was the second highest emergency room visit in the city, four times the rate of the

state.

Hospitalization rate due to firearms in the city was more than five times the rate of hospitalization

in the state. Child abuse was the second highest rate in the city, two and one-half times the rate

in the state.

The age-adjusted death rate due to assault injury in St. Louis City was four times higher than the

rate in the state. The death rate due to firearms was nearly four and one-half times higher in the

city than the state.

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INTERNAL WORK GROUP MEETINGS

Barnes-Jewish Hospital chose 18 employees to participate on an internal CHNA work group representing

various hospital departments including Ambulatory Services, Case Management and Social Work, Center

for Diversity and Cultural Competence, Emergency Services, Hospitality Services, Marketing and

Communications, Outpatient Clinics, Patient Access, Pharmacy, Siteman Cancer Center, and

Washington University School of Medicine (See Appendix D for Internal Work Group List).

The CHNA internal work group met three times to analyze the primary and secondary data, to complete

the priority ranking for the hospital’s CHNA and to determine the community’s most critical needs.

Members reviewed data provided by the external focus group as well as information collected through the

secondary data analyses.

MEETING 1

The work group first met as a team on Dec. 1, 2015 to review the purpose for the CHNA, role of the work

group and goals for the project. The team reviewed the key findings from the 2013 report and the current

findings from the 2015 focus group. The 2015 focus group perceptions were then reviewed and

discussed.

After the discussion, the team was asked to complete a worksheet (Appendix E) to prioritize the 28 health

needs identified by the focus group. The following table includes the results of this initial ranking in rank

order.

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Table 16: Barnes-Jewish Hospital CHNA Internal Work Group: Ranking of health needs identified by focus group

Rank Health Need Total Score

1. Access: Coverage 66

2. Access: Services 67

3. Health Literacy 82

4. Mental & Behavioral Health 97

5. Obesity 123

6. Diabetes 132

7. Heart Disease & Stroke: Heart Health 141

8. Nutrition 149

9. Respiratory Disease: Asthma 151

10. Access: Transportation 153

11. Substance Abuse 171

12. Heart Disease & Stroke: Stroke 172

13. Childbirth & Breastfeeding Education 178

14. Public Safety: Violence 182

15. Heart Disease & Stroke: CHF 186

16. Reproductive & Sexual Health 189

17. Smoking & Tobacco Education 192

18. Immunizations & Infectious Disease 211

19. Public Safety: Fatal Injuries 212

20. Respiratory Disease: COPD 215

21. Cancer: Breast 238

22. Cancer: Colon & Rectal 255

23. Oral Health 256

24. Cancer: GYN 275

25. Cancer: Prostate 279

26. Cancer: Lung 288

27. Cancer: Head & Neck 300

28. Cancer: Skin 319

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MEETING 2

The work group met Jan. 11, 2016. The results of the ranking on the previous page were presented and

compared to the focus group ranking as well as to secondary data from the Healthy Communities

Institute.

The Healthy Communities Institute (HCI) Data Scoring Tool compares data from similar communities in

the nation. The tool provides a systematic ranking of indicators for St. Louis City and helps prioritize the

needs. The scoring is based on how a city compared to other similar cities within the state, U.S. and

Healthy People 2020 targets.

The team reviewed the scores by indicators.

Table 17: Primary & Secondary Data Comparison

Rank Stakeholders Focus Group BJH CHNA Work Group Healthy Communities

Institute

1. Access: Coverage Access: Coverage Asthma: Medicare Population

2. Access: Services Access: Services Chronic Kidney Disease: Medicare Population

3. Obesity Health Literacy Depression: Medicare Population

4. Diabetes Mental & Behavioral Health Diabetes: Medicare Population

5. Mental & Behavioral Health Obesity Homeownership

6. Substance Abuse Diabetes Lung and Bronchus Cancer Incidence Rate

7. Cancer: Breast Heart Disease & Stroke: Heart Health

People Living 200% Above Poverty Level

8. Smoking & Tobacco Education

Nutrition Cervical Cancer Incidence Rate

9. Health Literacy Respiratory Disease: Asthma Age-Adjusted Death Rate due to Cancer

10. Heart Disease & Stroke: Heart Health

Access: Transportation Age-Adjusted Death Rate due to Colorectal Cancer

11. Heart Disease & Stroke: CHF Substance Abuse Renters Spending 30% or More of Household Income on Rent

12. Heart Disease & Stroke: Stroke

Heart Disease & Stroke: Stroke

Age-Adjusted Death Rate due to Lung Cancer

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Rank Stakeholders Focus Group BJH CHNA Work Group Healthy Communities

Institute

13. Cancer: Colon & Rectal Childbirth & Breastfeeding Education

Children Living Below Poverty Level

14. Cancer: Prostate Public Safety: Violence Families Living Below Poverty Level

15. Access: Transportation Heart Disease & Stroke: CHF Households with Cash Public Assistance Income

16. Public Safety: Violence Reproductive & Sexual Health

Households without a Vehicle

17. Reproductive & Sexual Health

Smoking & Tobacco Education

People 65+ Living Alone

18. Nutrition Immunizations & Infectious Disease

People Living Below Poverty Level

19. Cancer: GYN Public Safety: Fatal Injuries Young Children Living Below Poverty Level

20. Respiratory Disease: Asthma Respiratory Disease: COPD Adults who Drink Excessively

21. Cancer: Head & Neck Cancer: Breast Age-Adjusted Death Rate due to Breast Cancer

22. Cancer: Skin Cancer: Colon & Rectal Babies with Very Low Birth Weight

23. Immunizations & Infectious Disease

Oral Health Colorectal Cancer Incidence Rate

24. Oral Health Cancer: GYN Food Insecurity Rate

25. Public Safety: Fatal Injuries Cancer: Prostate High School Graduation

26. Cancer: Lung Cancer: Lung Heart Failure: Medicare Population

27. Respiratory Disease: COPD Cancer: Head & Neck Median Household Income

28. Childbirth & Breastfeeding Education

Cancer: Skin People 65+ Living Below Poverty Level

Through discussion and group consensus, the team narrowed the list of health needs from 28 to 12. In

addition to using secondary data, the team made their decision based on their expertise in the field and

their experiences in the hospital. The following table lists the 12 health needs and corresponding

indicators.

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Table 18: Barnes-Jewish Hospital CHNA Internal Work Group: Top 12 community healthy needs based on ranking and considerations

Health Need Indicators

Access: Coverage Insurance coverage and ability to pay

Access: Services Availability of primary care physicians, specialty care, clinics, mental health services, etc.

Access: Transportation Access to transportation, including owned and public

Cancer Breast, colorectal, prostate, gynecological (GYN), head & neck, skin and lung

Healthy Lifestyles

Adults who are overweight, adults who are obese, adults 20+ who are sedentary, adult fruit and vegetable consumption, food insecurity rate, physical inactivity, access to exercise opportunities, food environment index

Health Literacy Education level, English proficiency, language spoken at home

Maternal & Child Health Birth weight, infant mortality, prenatal care, childbirth and breastfeeding education

Mental & Behavioral Health: Mental Illness

Suicide, depression and other mental health issues and disorders

Public Safety: Violence Violence and violence prevention

Reproductive & Sexual Health HIV, Syphilis, Gonorrhea, Chlamydia, birth control

Respiratory Disease: Asthma Asthma and contributing risk factors including smoking, environmental risk factors, etc.


Adults who drink excessively, adults who smoke, death rate due to drug poisoning, etc.

After consensus, the work group members were asked to complete a second worksheet (Appendix F) to

determine the ranking of these top 12 needs. The criteria (below) for prioritizing the needs was agreed

upon by the Barnes-Jewish Hospital internal team.

How many people are affected by the problem?

What are the consequences of not addressing the problem?

Are existing programs addressing the issue?

How important is the problem to community members?

How does this problem affect vulnerable populations?

For each health need, each of these criteria was given a rank from 1-5 and a weight of importance from

1-3. Based on the total scores, the following rank was given to the top 12 needs.

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Table 19: Barnes-Jewish Hospital’s CHNA Work Group: Ranking of Top 12 Community Health Needs

Rank Health Need Score

1. Access: Services 58.36

2. Public Safety: Violence 58.18

3. Health Literacy 57.00

4. Access: Coverage 55.27

5. Mental & Behavioral Health: Mental Illness 53.36

6. Mental & Behavioral Health: Substance Abuse 45.73

7. Healthy Lifestyles 45.00

8. Reproductive & Sexual Health 43.73

9. Access: Transportation 43.00

10. Maternal & Child Health 42.82

11. Respiratory Disease: Asthma 41.27

12. Cancer 40.00

In an effort to facilitate group discussion on determining the implementation plan, the work group was

asked to complete a third worksheet (Appendix G) prior to the final meeting. This final ranking was based

on the following considerations:

Ability to collaborate

Special populations

Ability to measure impact

Hospital priority, budget, resources

Based on the total scores, the following rank was given to the top 12 needs.

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Table 20: Barnes-Jewish Hospital’s CHNA Work Group: Ranking of Top 12 Community Health Needs

Rank Health Need Score

1. Access: Services 2.000

2. Maternal & Child Health 2.667

3. Cancer 3.333

4. Access: Coverage 4.333

5. Reproductive & Sexual Health 5.333

6. Health Literacy 6.333

7. Respiratory Disease: Asthma 6.667

8. Healthy Lifestyles (tie) 7.000

8. Mental & Behavioral Health: Mental Illness (tie) 7.000

10. Mental & Behavioral Health: Substance Abuse 8.000

11. Public Safety: Violence 9.333

12. Access: Transportation 9.667

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MEETING 3

The internal work group’s final meeting took place on Jan. 21, 2016. The final ranking of the top 11 needs

was presented. The internal work group engaged in conversation around each area of need. While the

group recognized the great need to address all areas of need, focusing on a select few would allow for

greater impact. The following key points helped determine the needs which will be addressed.

Access: Services – While the group recognized the great need around mental health, the availability of

services was determined the most important and immediate issue. Therefore, this issue will be included in

access to services.

Healthy Lifestyles – The activities to address healthy lifestyles are similar to activities to address many

health conditions, such as heart and vascular diseases, lung diseases, cancer prevention, etc. Therefore,

because the impact of such programs will directly improve the health of the community, it was decided

focus will include healthy lifestyles rather than specific diseases.

Mental & Behavioral Health: Substance Abuse – Addressing substance abuse is an immediate need in

our community, so we will focus on this area in our implementation plan.

Public Safety: Violence – It is known that violence, trauma, poverty, and other adverse experiences and

chronic stressors have both short and long-term effects on the health and wellbeing of individuals. Toxic

stress contributes to regional health disparities, particularly when these same communities have trouble

accessing medical and supportive services in the aftermath of trauma. Therefore, we will address

violence in our implementation plan.

At the conclusion of the comprehensive assessment process to determine the most critical needs in St.

Louis City, the group concluded that Barnes-Jewish Hospital will focus on:

Access to Services

Healthy Lifestyles



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O

APPENDICES

A. Barnes-Jewish Hospital: Who We Are B. Community Focus Group C. Focus Group Report D. Internal Work Group E. Internal Work Group: Worksheet 1 F. Internal Work Group: Worksheet 2 G. Internal Work Group: Worksheet 3

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APPENDIX A: BARNES-JEWISH HOSPITAL: WHO WE ARE

Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and

the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington

University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who

are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in

addition to nurses, technicians and other health-care professionals.

Recognizing its excellent nursing care, Barnes-Jewish Hospital was the first adult hospital in Missouri to

be certified as a "Magnet Hospital" by the American Nurses Credentialing Center (ANCC). The Magnet

Award is the highest honor awarded for hospital nursing by the ANCC.

Barnes-Jewish Hospital was created by the 1996 merger of Barnes Hospital and The Jewish Hospital of

St. Louis. Each hospital brought a rich tradition of excellence. Barnes Hospital opened in 1914 and

became one of the first medical teaching centers in the United States. Jewish Hospital opened in 1902 to

care for St. Louis’ growing immigrant population. Barnes-Jewish Hospital is a member of BJC HealthCare,

one of the nation’s leading health-care organizations.

Exceptional quality and unmatched experience has earned Barnes-Jewish Hospital a place on the U.S.

News & World Report honor roll of America’s Best Hospitals for 24 consecutive years, with 12 nationally

ranked medical specialties recognized in 2016.

Our patients have access to leading-edge treatments as a result of research from one of the top-ranked

medical schools in the nation. As one of the leading recipients of National Institutes of Health grant

money for medical research funding, Washington University School of Medicine and Barnes-Jewish

Hospital are proud of advancements they’ve developed through bench-to-bedside research and

treatment.

Barnes-Jewish Hospital’s care extends into the community. Our refugee health department supports new

immigrants, assisting patients in 33 different languages and dialects. Our AWARE program counsels

victims of domestic violence. The Siteman Cancer Center focuses on outreach including providing

mammograms, prostate PSA screenings and colonoscopy screening to the indigent. The hospital also

provides more than 100 community education events annually.

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APPENDIX B: COMMUNITY FOCUS GROUP

Name Organization Attended

Focus Group Participants

Judy Bentley President, CHIPS X

Larry Bonds Patient X

Barbara Bowman Urban League of Greater St. Louis

Web Brown Missouri Foundation for Health

Colleen Burdis Paraquad X

Ariel Burgess International Institute

Marlene Davis Alderwoman, Ward 19 X

Susan DiSario Regional Health Commission X

Alan Freeman Affinia Healthcare, formerly Grace Hill Health Centers

Rob Fruend Regional Health Commission X

Kelly Hall St. Louis Area Food Bank

Joyce Hoth Gateway Region YMCA X

Dr. Jade James St. Louis County Health Department

Dr. Katherine Mathews Casa de Salud X

Michael McMillan Urban League of Greater St. Louis

Melba Moore City of St. Louis Health Commissioner X

Amanda Stoermer St. Louis Integrated Health Network X

Hospital Observers

Jennifer Arvin Communications & Marketing X

Robin Bonn Interpreter, American Sign Language X

Bob Cannon President X

Angela Chambers Market Research X

Erin Curran Center for Diversity & Cultural Competence X

Elizabeth Kalicak Community Outreach / Community Benefit X

Karley King BJC HealthCare, Community Benefit X

Susan Kraenzle Siteman Cancer Center X

Dr. John Lynch Chief Medical Officer & Vice President X

Dale Peluso Communications & Marketing X

Jacqueline Randolph Ambulatory Services X

Pat Rekart Outpatient Clinics X

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APPENDIX C: FOCUS GROUP REPORT

PERCEPTIONS OF THE HEALTHCARE NEEDS

OF ST. LOUIS CITY RESIDENTS

FROM THE VIEWPOINT OF COMMUNITY LEADERS

Prepared by:

Angela Ferris Chambers

Manager, Market Research

BJC HealthCare

Prepared for:

Elizabeth Kalicak

Team Lead

Barnes-Jewish Hospital

May 25, 2015

Updated August 10, 2015

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TABLE OF CONTENTS

BACKGROUND ............................................................................................. 2

RESEARCH OBJECTIVES .......................................................................... 2

METHODOLOGY.......................................................................................... 2

KEY FINDINGS ............................................................................................. 5

NEXT STEPS .................................................................................................. 8

APPENDIX A (PARTICIPANT/OBSERVER LISTS) ............................... 9

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BACKGROUND

The Patient Protection and Affordable Care Act (PPACA, March 2010) requires that non-profit

hospitals conduct a community health needs assessment (CHNA) every three years. As part of

that process, each hospital is required to solicit input from those who represent the broad

interests of the community served by the hospital as well as those who have special knowledge

and expertise in the area of public health.

Barnes-Jewish Hospital completed its first needs assessment in December 2013, implementing a

plan to address those prioritized needs between January 1, 2014 and December 31, 2016. It is

now in the process of preparing the next needs assessment, including an evaluation of progress

made in achieving the objectives identified in the first plan.

RESEARCH OBJECTIVES

The main objective for this research is to solicit input from healthcare experts and those who

have a special interest in the healthcare needs of the St. Louis City population served by Barnes-

Jewish Hospital. Specifically, the discussion identified the following objectives:

1) Determine whether the needs identified in the 2013 CHNA are still the right areas on which to

focus

2) For the purposes of the cancer needs assessment required by the Commission on Cancer,

discuss whether the barriers to access are different for cancer

3) Explore whether there is there anything on the list that should no longer be a priority

4) Determine where there are the gaps in the plan to address the prioritized needs

5) Identify other organizations addressing these needs with whom we should consider

collaborating

6) Discuss how the world has changed since 2013 when BJH first identified these needs and

whether there are there new issues we should consider addressing

7) Evaluate what issues the stakeholders anticipate becoming a greater concern in the future that

we need to consider now

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METHODOLOGY

To fulfill the PPACA requirements, Barnes-Jewish Hospital conducted a single focus group with

public health experts and those with a special interest in the healthcare needs of St. Louis City

residents. It was held on March 28, 2015 at the Chase Park Plaza Hotel in the city of St. Louis.

The group was facilitated by Angela Ferris Chambers, Manager of Market Research & CRM for

BJC HealthCare. The discussion lasted ninety minutes.

10 individuals representing various St. Louis City organizations participated in the discussion.

Eight additional individuals were invited, but were unable to attend (Appendix A).

Dr. John Lynch, BJH Vice President and Chief Medical Officer, welcomed participants at the

beginning of the evening and introduced Mr. Bob Cannon, BJH President. Those who were

observing on behalf of Barnes-Jewish Hospital were also introduced to the group (Appendix A).

During the group, the moderator reminded the community leaders why they were invited - that

their input is needed to help the hospital move forward in this next phase of the needs assessment

process.

The moderator shared the needs prioritized by BJH in the first assessment and discussed where

the hospital is in its implementation plan. She also mentioned that as a system, BJC is working to

standardize the language for identifying prioritized needs across all of its hospitals so that impact

can be measured consistently. This will allow the sharing of best practices among all BJC

hospitals.

The “mission core priorities” that were identified in the 2013 BJH CHNA are Health Literacy &

Education and Chronic Conditions. In the revised nomenclature, we anticipate that these needs

may be classified as follows, although they may be subject to further revision before the 2016

CHNA is finalized.

Health Literacy & Education:

Childbirth and Breastfeeding Education

Health Literacy (general health education)

Immunizations and Infectious Diseases

Oral Health

Reproductive and Sexual Health

Smoking/Tobacco Education

Chronic Conditions:

Cancer

o Breast Cancer

o Colon & Rectal Cancer

o GYN Cancer

o Head & Neck Cancer

o Lung Cancer

o Prostate Cancer

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o Skin Cancer

Diabetes

Heart Disease/Stroke

o Heart Health

o Congestive Heart Failure

o Stroke

Nutrition

Obesity

Respiratory Disease

o Asthma

o COPD

The “supporting priorities” were identified as access to health care, behavioral health, financial

barriers, safety from violence, lack of service coordination, and training of health care

professionals. In the revised nomenclature, these are the suggested categories for classification:

Access to Health Care, Financial Barriers to Access

Access: Coverage

Access: Services

o Health Care Services

o Physician Need


Behavioral Health

Behavioral & Mental Health

o Mental Health & Mental Disorders

o Substance Abuse

Safety from Violence

Injury and Violence

o Fatal Injuries

o Crime

Lack of Service Coordination and Training of Health Care Professionals will be removed due to

an inability to quantify need and measure impact.

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KEY FINDINGS

PERCEPTION OF 2013 PRIORITIES:

There was general consensus that the needs identified in the previous assessment are still those

on which BJH should focus. A few suggested that the issues of mental health and behavioral

health should be rated higher in priority due to the impact they have on contributing to violence

in our community.

NEEDS THAT SHOULD BE REMOVED: There was some discussion about why training of health professionals and service coordination

were not present in the revised list of needs. The law now requires that any prioritized needs be

able to be measured so as to determine the impact of any implementation tactics. These items

were removed because there was a lack of measures associated with them. Stakeholders from the

Regional Health Commission indicated that they have some metrics for BJH to consider around

these needs.

GAPS IN IMPLEMENTATION STRATEGIES:

ACCESS: COVERAGE Financial access to coverage continues to be an issue for St. Louis

City residents who are low-income.

The fact that the Medicaid program was not expanded in Missouri has created large gaps

in access for those in low income categories.

When ConnectCare closed, access was reduced. Those who are referred to BJH found

that they were expected to pay a $50 co-pay to receive services. For some, this is an

insurmountable financial barrier.

The differences between BJH and WU financial aid policies also create a lot of confusion

for patients, and may act as a psychological barrier to care.

ACCESS: SERVICES: There was much discussion around the role that technology could

play in improving access to services. These are some of the ideas that were mentioned:

Use technology to share information among all of a patient’s different health providers,

regardless of with which hospital or health system they are affiliated. Access to test

results and medications via a common electronic medical record can reduce unnecessary

utilization and improve continuity of care.

Use of “Facetime” and telemedicine capabilities can improve physician access to those

who might not otherwise see one. For example, incorporating this technology at health

fairs would give those who are identified with extremely high blood pressure or blood

sugar an opportunity to immediately interact with a physician and address the issue.

Otherwise, the condition may go untreated and end up becoming more severe.

Technology can also be used for the communication of health messages to educate

patients and encourage them to be pro-active about their health. It can positively impact

the health literacy of those at high risk for certain conditions.

Technology could be used to identify someone who missed an appointment and flag him

to be contacted for follow-up.

A medical card that contains all of your health history would be useful when a person

enters the health system. Caregivers would immediately have access to previous health

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information, be made aware of the person’s issues and how they have been treated.

Although this use of technology could improve access and continuity, a few expressed

concern about privacy breaches.

ACCESS: SERVICES: Other comments around access to services revolved more around

care coordination.

We need to examine how patients transition from primary care to specialty care and how

we can seamlessly make that happen, especially for low-income patients.

The relationship that BJH has with the Integrated Health Network (IHN) and their

community health referral coordinators has helped to improve access for patients. BJH

should take more credit than they do for putting this program into place.

Working in teams that include both medical and mental health experts will help to better

identify whether issues are physical, mental, social and/or environmental and improve

our plans to address them.

Access to services is impacted by the cultural sensitivity of those who are providing

them. BJH should explore their patient satisfaction data by race, and especially the

attributes related to feeling listened to and respected. There may be opportunities for the

hospital to change behavior and improve performance on these metrics.

There was a specific question about perceptions of access to cancer services. Due to a

change in the Medicaid law in 2001, access to some cancer screening services is actually

better than for other services. However, this does not necessarily mean that once a condition

is identified through the screening, that access to treatment is readily accessible.

BEHAVIORAL/MENTAL HEALTH ISSUES: Increasing health providers’ awareness of

trauma (post-traumatic stress disorder) and how to recognize/assess it can ultimately impact

the treatment of chronic conditions along with behavioral health issues.

SPECIAL POPULATIONS:

HOMELESS: The homeless population was identified as one that may require additional

consideration. There is concern about where a homeless person would go when s/he is

released from the hospital as there is currently no appropriate place to release them.

THOSE WHO ARE DEAF/BLIND: Several points were made in regard to these

populations.

These individuals may not attend health fairs; often, there are no interpreters available.

We need to remember them when planning these events.

A law passed in 2014 requires that all videos be close-captioned/subtitled so that

members of these communities can easily access the information.

In the St. Louis community, there is a large need for a deaf psychologist who is not

personally familiar with members of the deaf community.

According to new legislation that is anticipated to soon be passed, a deaf/blind person

will be accompanied by a support person to all medical visits. This person cannot be

asked to leave the room. We need to make members of the medical profession aware of

these situations.

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When a deaf patient is being seen by a health provider, they may indicate that they

understand what they are being told, even when they don’t, and have an interpreter

present. Having close-captioned videos available to explain a health condition would

help. Also asking the health provider ask the patient to explain their understanding if the

issue would also help establish their level of comprehension.

OTHER ORGANIZATIONS WITH WHOM BJH SHOULD CONSIDER PARTNERING: BJH was positively recognized as already collaborating with many different organizations on

many different levels. Several mentioned that the hospital often does not take enough credit for

committing to these relationships. The hospital was recognized for having done an excellent job

on its emergency preparedness and responsiveness, and for collaborating with the IHN on

placing referring coordinators in the facility.

There was one suggestion to examine the relationships the hospital has with homeless

providers in the city to identify additional ways to address the needs of the homeless once

they have been released from the hospital.

NEEDS OF INCREASING IMPORTANCE: Community leaders were asked to reflect on

how the world has changed since 2013 and to identify other needs that they see becoming

increasingly important in the future.

SAFETY FROM VIOLENCE: Although violence was identified in the 2013 CHNA, with

the events that took place in Ferguson in 2014 and 2015, many see violence as an issue that

will continue to loom large in the city of St. Louis.

It is important to begin to address violence in childhood and to educate our children about

what it means to be safe; that it is not normal to know about guns and murder. Children

who learn violence grow up to be adults who think that violence in normal.

Several identify violence as being the end-result of issues that are rooted in mental and

behavioral health. If we are able to provide services to address mental and behavioral

health issues, we may be able to reduce the threat of violence in our communities.

ACCESS: COVERAGE: The lack of Medicaid expansion will continue to affect access, as

well as disparities in access related to low-income populations.

SEXUALLY TRANSMITTED DISEASES: There continues to be concern about STDs

including gonorrhea as well as HIV/AIDs, especially within the African American

community. There continues to be a need for education on these issues, and information

should be made available especially at community health fairs.

BEHAVIORAL HEALTH: There is continued concern about the spread of heroin and

prescription drug abuse.

CHRONIC CONDITIONS: Sickle cell anemia continues to be an issue among African

Americans.

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NEXT STEPS

Based on the input the hospital received from community stakeholders, Barnes-Jewish will

examine secondary data for St. Louis City to explore the size of the needs that have been

identified.

The hospital has established an internal stakeholder group to assess this information and evaluate

whether the priorities should change.

The needs assessment and associated implementation plan must be revised and updated for

release by December 31, 2016.

The community stakeholder group will continue to be updated as to the progress of the internal

work group as they work to meet this deadline.

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APPENDIX D: INTERNAL WORK GROUP

Department Representative

Ambulatory Services Jacqueline Randolph

Center for Diversity & Cultural Competence Erin Curran

Center for Diversity & Cultural Competence Carmel Hannah

Center for Diversity & Cultural Competence Erin Stampp

Community Outreach / Community Benefit Elizabeth Kalicak

Emergency Department Dr. Robert Poirier, Washington University Physician

Hospitality Services Gail Watkins

Outpatient Clinics Pat Rekart

Patient Access Esther Moonier

Siteman Cancer Center Susan Kraenzle

Ad Hoc Members

Chief Medical Office Dr. John Lynch

Center for Diversity & Cultural Competence Katrina Farmer

Center for Diversity & Cultural Competence Steven Player

Communications & Marketing Jennifer Arvin

Respiratory Care Darnetta Clinkscale

Stay Healthy Outpatient Program Kelly Dodds

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APPENDIX E: INTERNAL WORK GROUP: WORKSHEET 1

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APPENDIX F: INTERNAL WORK GROUP: WORKSHEET 2

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APPENDIX G: INTERNAL WORK GROUP: WORKSHEET 3

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IMPLEMENTATION PLAN

The purpose of an implementation plan is to identify the goals, objectives, rationale, activities, outcomes

and evaluation strategy to meet the community health needs identified through the community health

needs assessment.

Barnes-Jewish Hospital prioritized the needs based on the ranking of each health topic and a variety of

other factors. The hospital chose four needs on which to focus:

Access to Services

Healthy Lifestyles



COMMUNITY HEALTH NEEDS TO BE ADDRESSED

ACCESS TO SERVICES:

.Rationale

Access to healthcare is an ongoing and national concern. Access to comprehensive, quality health care

services is important for the achievement of health equity and for increasing the quality of a healthy life for

everyone. It allows individuals to gain entry into the health care system, access a health care location

where needed services are provided and find a health care provider with whom the patient and

community can trust.

Additionally, access to mental health services in particular is a great need in St. Louis City. The burden of

mental illness is among the highest of all diseases, and mental disorders are among the most common

cause of disability. Mental health is essential to a person’s well-being, healthy family and interpersonal

relationships, and the ability to live a full and productive life.

Program Goal

To improve access to comprehensive, quality health care services

Program Objectives

After baseline studies are completed, we will:

Reduce avoidable Emergency Department utilization for patients who visit most often.

Increase coordination of community resources to assist in reducing access challenges for

patients.

Identify methods for successful management of frequent and complex patients in the emergency

department.

Action Plan

As healthcare evolves, it is increasingly important patients are cared for in the most effective location for

quality, continuity or care, and total cost of care management. Recognizing the social challenges many

residents of St. Louis City face, a team at Barnes-Jewish Hospital has increased efforts to understand the

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complex reasons patients utilize the Emergency Room for non-emergent needs. In partnership with BJC’s

Center for Clinical Excellence, the Barnes-Jewish team is analyzing barriers to accessing healthcare in

the most appropriate setting for the patient. While some conditions may be better treated in a primary

care physician’s office, financial, transportation and many other resource challenges lead to increase

potentially avoidable visits to the Emergency Room. By regularly gathering a multi-disciplinary team to

discuss patient’s care on an individual basis, the Barnes-Jewish team will work to improve the continuity

of care for its patients and identify barriers that may be preventing the individual from being as healthy as

they can be.

Expected Outcomes

Access to health services affects a person’s health and well-being. Regular and reliable access to health

services can:

Prevent disease and disability

Detect and treat illnesses or other health conditions

Increase quality of life

Reduce the likelihood of premature (early) death

Increase life expectancy

Outcomes Measurement

After baseline studies are completed, the following will be used to measure impact:

Total number of visits from top 100 utilizers of the BJH Emergency Department

30-day ED revisit rate

Follow-up appointment success rate

100

HEALTHY LIFESTYLES

Goal

Improve knowledge and skill in leading a healthy lifestyle.

Rationale

Good nutrition, physical activity and a healthy body weight are essential parts of a person’s overall health

and well-being. Together, these can help decrease a person’s risk of developing serious health

conditions, such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer. A

healthful diet, regular physical activity, and achieving and maintaining a healthy weight also are

paramount to managing health conditions so they do not worsen over time. (HealthyPeople 2020)

The health impact of eating a healthful diet and being physically active cannot be understated. Together,

a healthful diet and regular physical activity can help people:

Achieve and maintain a healthy weight

Reduce the risk of heart disease, stroke and diabetes

Reduce the risk of certain forms of cancer

Improve mood and energy level

Chief among the benefits of a healthful diet and physical activity is reduction in the risk of obesity. Obesity

is a major risk factor for several of today’s most serious health conditions and chronic diseases, including

high blood pressure, high cholesterol, diabetes, heart disease and stroke, and osteoarthritis. Obesity also

has been linked to many forms of cancer. (HealthyPeople 2020)

Objectives

Once phase one of tool development is complete, provide Your Disease Risk assessments to 100

community members each year.

Improve knowledge of the importance of a healthful diet, physical activity and healthy weight in a

minimum of 50% of participants who complete an assessment, as measured by pre- and post-

tests.

Improve the health of the people we serve as measured by the pre- and post-tests conducted

after phase two of tool development is completed.

Action Plan

Your Disease Risk is an assessment tool developed over the past ten years by world-renowned experts.

It collects the latest scientific evidence on disease risk factors into one easy-to-use tool. Each participant

who completes the assessment can learn their risk for various diseases and get personalized tips for

preventing them.

Barnes-Jewish Hospital and Siteman Cancer Center will redevelop the comprehensive online Your

Disease Risk tool, as well as develop a more simplified assessment for use at community events.

Beginning in 2017, both Barnes-Jewish and Siteman will conduct opportunities for community members

to take the Your Disease Risk Assessment.

A second phase of tool development will be conducted by 2019. This will allow us to record risk by

individual participant and measure change in risk over time.

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Expected Outcomes

For those who participate in the program:

Improvement in knowledge of healthy lifestyles, as measured by score from pre- to post- test with

average improvement being a minimum of 10%

Once phase two of tool development is complete:

o Average risk of heart disease, stroke and diabetes will be reduced by a minimum of 3%

o Average BMI improvement will be at least 3%


After the first phase of tool development, this program will be evaluated by measuring the

increase in knowledge of the importance of a healthful diet, physical activity and healthy weight in

preventing disease by comparing post-test results to pre-tests.

After the second phase of tool development, this program will be evaluated by measuring

improvements in Your Disease Risk Assessment scores for each participant over time.

102

MENTAL & BEHAVIORAL HEALTH: SUBSTANCE ABUSE

Goal

Increase awareness of prescription drug misuse.

Rationale

Although progress has been made in substantially lowering rates of substance abuse in the United

States, the use of mind- and behavior-altering substances continues to take a major toll on the health of

individuals, families and communities nationwide.

Substance Abuse – involving drugs, alcohol, or both – is associated with a range of destructive social

conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic

violence, child abuse and crime. (HealthyPeople 2020)

Substance abuse continues to be one of the most complex public health issues:

As the numbers of prescribed opioids rise, there is an increase in overdoses and death.

Prescription opioid drugs are a gateway to heroin, an illegal substance that is easier to get and

less expensive than prescription opioids.

If diagnosed on time, opioid overdoses can be reversed with the administration of naloxone by a

healthcare professional. Assistance into a treatment program should be provided to patient.

Objectives

In 2017, baseline percentage change from pre- and post- tests will be taken to show impact of education.

By 2019, increase knowledge test scores of prescription drug misuse in 8 percent of the patients who participate as compared to 2017.

Action Plan

Beginning in 2017, Barnes-Jewish Hospital will require online training to educate health care providers on standards of care when reviewing opioid prescriptions with emergency room patients.

Before a patient is discharged, the provider will review all instructions including but not limited to, dosage, home safety, risks of misuse and proper disposal.

Provide web-based and print materials to health care providers so they can offer immediate assistance to a patient who presents with a chemical dependency disorder (drug or alcohol) or classified as high risk.

Raise awareness of resources through social media, and internal communications to physicians and clinical staff on the campus of Barnes-Jewish West County Hospital and Barnes-Jewish Hospital.

Expected Outcomes

Preventing prescription drug misuse will improve quality of life, lower health care costs and promote a

safer community.


Record the total number of Barnes-Jewish Hospital health care providers who complete the online competency training in Saba.

Conduct pre- and post-tests to 100 emergency room patients who are discharged with an opioid

prescription.

Measure pre- and post-test results to measure awareness and confidence in addressing prescription drug misuse and illicit drug use.

103

PUBLIC SAFETY: VIOLENCE

Goal

Support the regional effort to make St. Louis a trauma-informed community and reduce the impacts of

violence on patient care and outcomes by training Barnes-Jewish Hospital team members in trauma-

informed care.

Rationale

The impacts of stress and trauma are a harmful and pervasive public health problem. The effects of

traumatic events and chronic stress place a heavy burden on individuals, families, communities and

create challenges for the public organizations that work to serve them. Trauma results from things such

as violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. The science

and information about trauma is growing rapidly as is the work to promote more trauma informed

communities and institutions.

St. Louis has one of the highest crimes rates in the country and with that comes citizens experiencing

high levels of trauma. As we learn more about trauma, we understand that childhood trauma and chronic

stress can lead to destructive behaviors include participating in criminal activities. As the city’s safety net

hospital and a level one trauma center, we face the challenges of serving a community that is impacted

by trauma and need to have the tools to navigate those challenges. As a hospital we can be actively

engaged in reducing crime and minimizing its long term effects on our patients by becoming a trauma

informed organization.

Objectives

75% of all Barnes-Jewish Hospital team members will be trained in trauma-informed care.

50% improvement in patient post-test scores compared to pre-tests.

Action Plan

Beginning in 2017, Barnes-Jewish Hospital team members will be required to participate in

training designed for trauma-informed communities.

Team members will be given access to resources for recognizing and addressing traumatic and

toxic stress.

Expected Outcomes

As a trauma informed hospital, we can be better equipped to meet our patients and families where they

are and therefore provide care that better meets their needs.

With team members who have been trained to identify and address issues related to trauma, we

will improve the patient experience and give them the best chance for improving their health.

The impact of violence on patient care and outcomes will be reduced.


Through the BJC Learning Management System, team member training will be offered and

tracked for completion.

Pre- and post-tests will be conducted in priority areas of the hospital, including the Emergency

Department.

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COMMUNITY HEALTH NEEDS NOT TO BE ADDRESSED

Following the 2013 Community Health Needs Assessment process, the Barnes-Jewish Hospital internal

work group decided that with too many areas of focus, minimal impact would be made. While the

following needs are important to the hospital and our community, they are not included in the

implementation plan so that we can dedicate necessary resources to fewer focus areas. Programs will

continue to be conducted for each of these needs, but they will not be the hospital’s primary focus.

ACCESS TO COVERAGE

Barnes-Jewish Hospital provides financial assistance to the patients and community we serve.

This includes help in applying for health insurance through the new Marketplace, applying for

Medicaid assistance and determining if you qualify for financial assistance from BJC.

Other organizations addressing this need include, but are not limited to:

o Cover Missouri

o St. Louis Regional Health Commission

ACCESS TO TRANSPORTATION

Barnes-Jewish Hospital provides transportation assistance to qualified patients via cab vouchers.


o Metro Transit – St. Louis

o Organized Alternative Transportation Services (OATS)

CANCER

Siteman Cancer Center provides a variety of health education and screening events for the

community, as well as through the Program for the Elimination of Cancer Disparities (PECaD).


o American Cancer Society

o Cancer Support Community

DIABETES

Barnes-Jewish Hospital provides diabetes education and services through the Diabetes Center.


o American Diabetes Association

o St. Louis County Department of Health

HEALTH LITERACY

All patient education materials provided by Barnes-Jewish Hospital are reviewed by the Center

for Practice Excellence to ensure they meet health literacy standards.


o Health Literacy Missouri

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HEART DISEASE & STROKE

Barnes-Jewish Hospital offers various opportunities for education and screenings for heart

disease and stroke.


o American Heart Association

o American Stroke Association

IMMUNIZATIONS & INFECTIOUS DISEASE

Each year, Barnes-Jewish Hospital offers 20,000 free flu shots to members of our community

who would otherwise not have access to one.


o City of St. Louis Department of Health


MATERNAL & CHILD HEALTH

Barnes-Jewish Hospital’s OB-GYN Clinic and Women & Infants programs provide health

education, classes, etc. for expecting and new mothers.


o St. Louis Maternal, Child & Family Health Coalition

o Annie Malone Children & Family Service Center

MENTAL HEALTH & DISORDERS

BJC Behavioral Health offers a continuum of services including early intervention services,

school-based services, outpatient services, comprehensive children’s services and adult

psychiatric rehabilitation services.

To support much-needed regional acute mental health care delivery, Barnes-Jewish Hospital

assumed operations and ownership of the St. Louis Regional Psychiatric Stabilization Center, a

25-bed adult impatient acute psychiatric program in St. Louis. Barnes-Jewish Hospital operates

the facility, with medical staffing by physicians of the Department of Psychiatry at Washington

University School of Medicine. It is now called the Barnes-Jewish Hospital Psychiatric Support

Center.


o Mental Health America of Eastern Missouri

o Missouri Department of Mental Health

o St. Louis Mental Health Board

NUTRITION

Barnes-Jewish Hospital will include nutrition education when addressing healthy lifestyles.




106

OBESITY

Barnes-Jewish Hospital will include obesity education when addressing healthy lifestyles.



o Missouri Foundation for Health


ORAL HEALTH

The Foundation for Barnes-Jewish Hospital funds dental and oral assistance programs at Barnes-

Jewish Hospital.


o Affinia Healthcare

PUBLIC SAFETY: FATAL INJURIES

Barnes-Jewish Hospital’s trauma center provides various opportunities for public safety and fatal

injuries education.


o American Trauma Society

o ThinkFirst Saint Louis

o Trauma Survivors Network

REPRODUCTIVE & SEXUAL HEALTH

Organizations addressing this need include, but are not limited to:

o Family Care Health Centers

o La Leche League, Gateway Area

o Myrtle Hilliard Davis Comprehensive Health Centers, Inc.

o People’s Health Center, Inc.

o ThriVe St. Louis

RESPIRATORY DISEASE: ASTHMA & COPD

Barnes-Jewish Hospital offers respiratory disease education through various programs.


o American Lung Association

o Asthma & Allergy Foundation of America, St. Louis Chapter

SMOKING & TOBACCO EDUCATION

Barnes-Jewish Hospital offers smoking and tobacco education through various programs.


o American Heart Association

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American Lung Association

108

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