Simi Valley Hospital by wuzhenguang

VIEWS: 4 PAGES: 48

									"#$#!%&''()!*+,-#.&'!               !

Community Health Needs Assessment




August 2010

MELISSA BIEL, DPA, RN




                                        0
                                                               Contents
Introduction ................................................................................................................................... 3
      Background and Purpose ...................................................................................................... 3
Methods ........................................................................................................................................ 3
      Primary Data Collection ......................................................................................................... 3
      Secondary Data Collection .................................................................................................... 3
      Map........................................................................................................................................ 4
Overview of Key Findings and Community Needs ....................................................................... 5
Community Profile ........................................................................................................................ 7
      Population.............................................................................................................................. 7
      Race/Ethnicity........................................................................................................................ 7
      Unemployment ...................................................................................................................... 9
      Poverty .................................................................................................................................. 9
      Housing and Households .................................................................................................... 10
      Language............................................................................................................................. 10
      Education............................................................................................................................. 11
Birth and Death Characteristics .................................................................................................. 12
      Births ................................................................................................................................... 12
      Teen Pregnancy .................................................................................................................. 12
      Prenatal Care ...................................................................................................................... 12
      Low Birth Weight and Infant Mortality .................................................................................. 13
      Breastfeeding ...................................................................................................................... 14
      Deaths ................................................................................................................................. 14
      Heart Disease Mortality ....................................................................................................... 15
      Cancer Mortality .................................................................................................................. 15
      Diabetes Mortality ................................................................................................................ 16
      Pneumonia Mortality ............................................................................................................ 16
      Unintentional Injury Death Rate........................................................................................... 17
        Suicide Rate ...................................................................................................................... 17
Access to Health Care ................................................................................................................ 19
      ER Admissions .................................................................................................................... 19
Chronic Disease ......................................................................................................................... 21
      Chronic Diseases among Adults.......................................................................................... 21
      Childhood Asthma ............................................................................................................... 21
      HIV/AIDS Infection............................................................................................................... 21
      STD Cases .......................................................................................................................... 22
      Tuberculosis ........................................................................................................................ 22

                                                                                                                                                 1
      Preventive Practices ............................................................................................................ 23
Social Issues............................................................................................................................... 24
      Adult and Childhood Obesity ............................................................................................... 24
      Youth Social Issues ............................................................................................................. 24
      Alcohol, Tobacco and Drug Use .......................................................................................... 25
      Mental Health ...................................................................................................................... 26
      Homelessness ..................................................................................................................... 26
      Crime ................................................................................................................................... 27
School and Student Characteristics............................................................................................ 28
      Free and Reduced Price Lunch Program ............................................................................ 28
      English Learners.................................................................................................................. 28
      Computers in Schools ......................................................................................................... 29
      High School Graduation Rate .............................................................................................. 30
Key Stakeholder Interviews ........................................................................................................ 31
      Biggest Issues or Concerns in the Simi Valley Community ................................................. 31
      Demographic Trends ........................................................................................................... 32
      Trends in the Economy and its Impact ................................................................................ 32
      Trends in the Health Care Provider Community .................................................................. 32
      Trends in Community Health Status .................................................................................... 33
      Problems or Barriers to Obtaining Health Care ................................................................... 34
      Where People Go for Assistance with Health or Social Problems....................................... 35
      Where People Access Preventive Care............................................................................... 36
      Services that are Lacking to Meet Community Need........................................................... 36
      Barriers to Care and Treatment for Chronic Diseases......................................................... 37
      What People do to Prevent Chronic Conditions from Worsening ........................................ 37
      Services that are lacking for Chronic Disease Prevention, Management, or Treatment ..... 38
      Past or Present Partnerships with Simi Valley Hospital....................................................... 39
      Opportunities to Increase the Partnership with Simi Valley Hospital ................................... 39
      Role(s) that Simi Valley Hospital Currently Plays in the Community ................................... 40
      Role(s) that Simi Valley Hospital Could or Should Play in the Community.......................... 41
      Recommendations for Improving Access to Care and Community Health Status............... 41
Benchmark Comparisons ........................................................................................................... 43
Attachment 1. Simi Valley Hospital Service Area Zip Code Map................................................ 44




                                                                                                                                                2
                                     Introduction
Background and Purpose
Simi Valley Hospital is part of Adventist Health, a not-for-profit, faith-based health care
system founded on the Seventh-day Adventist heritage of Christian health care. Simi
Valley Hospital has undertaken a community health needs assessment as required by
California law. As well, the recent passage of the Patient Protection and Affordable
Care Act requires tax exempt hospitals to conduct needs assessments and develop
community benefit plans every three years. The needs assessment is a primary tool
used by the Hospital to determine its community benefit plan, which outlines how the
Hospital will give back to the community in the form of health care and other community
services to address unmet community health needs. This assessment incorporates
components of primary data collection and secondary data analysis that focus on the
health and social needs of the service area.
The primary Simi Valley Hospital service area is located in Ventura County, California
and encompasses the cities of Moorpark and Simi Valley covering 3 Zip codes:
Moorpark      93021
Simi Valley   93063
Simi Valley   93065

                                        Methods
Primary Data Collection
Targeted interviews were used to gather information and opinions from persons who
represent the broad interests of the community served by the Hospital. For the
interviews, community stakeholders, identified by Simi Valley Hospital, were contacted
and asked to participate in the needs assessment. Twenty-two interviews were
completed for the Simi Valley Hospital Community Health Needs Assessment during
June and July, 2010. Participants in the interviews included five public organizations, six
nonprofit organizations, two religious organizations, and nine private businesses. A list
of the key stakeholder interview respondents can be found in Attachment 1. A summary
of the primary data collection findings begins on page 32.

Secondary Data Collection
Secondary data were collected from a variety of local, county, and state sources to
present a community profile, birth and death characteristics, access to health care,
chronic diseases, social issues, and school and student characteristics. When
pertinent, these data sets are presented in the context of Ventura County and the State,
framing the scope of an issue as it relates to the broader community.
Analyses were conducted at the most local level possible for the Simi Valley Hospital
primary service area, given the availability of the data. For example:
• U.S. Census 2000 data and California State data available by Zip code
• Ventura County Homeless & Housing Coalition for city and county
• Office of Statewide Health Planning and Development for hospital data

                                                                                          3
•   Employment Development Department statistics for city data
•   California Department of Education data for school district data

This report presents a summary that highlights the data findings, presents key needs
and opportunities for action. What follows is a detailed narrative that examines each of
the data sets. The report concludes with benchmark comparison data. Simi Valley
Hospital community data findings are compared to accepted benchmarks that reference
recognizable state and national resources.

Map
A map of the Simi Valley Hospital service area is presented in the report Attachment 1.




                                                                                          4
             Overview of Key Findings and Community Needs
This overview summarizes some of the significant findings drawn from an analysis of
the data. Full data descriptions, findings, and data sources follow in the full report.

Community Profile
  ! The residents of the Simi Valley Hospital services area are primarily
    White/Caucasians (61%) and Latinos (26.5%).
  ! The area has higher percentages of adults ages 40-64 and lower rates of seniors
    than found in Ventura County and the State.
  ! There are relatively low levels of poverty and unemployment, when compared to
    the County and the State.
  ! The residents are well educated, with high rates of high school and college
    graduates.
  ! English is the primary language among residents; Spanish is spoken in 14.3% of
    resident households.

Birth and Death Characteristics
   !   Among pregnant women, 87.5% obtain prenatal care in the recommended first
       trimester; this rate drops to 85.1% of pregnant women in Moorpark entering early
       into prenatal care.
   !   Simi Valley (93063) has a troubling high rate of infant mortality of 10.0 per 1,000
       live births. In comparison, the infant death rate in the County is 5.7 and the State
       is 5.3 deaths per 1,000 live births.
   !   Simi Valley (93063) also has a high rate of low birth weight babies at 72.0 per
       1,000 live births.
   !   When adjusted for age, the Simi Valley Hospital service area has a considerably
       higher death rate (1016.6 per 100,000) than that of the County (803.9) and the
       State (650.1).
   !   Heart disease, cancer and chronic lung disease are the top three leading causes
       of death.
   !   Simi Valley (93063) has high mortality rates from cardiac disease, cancer,
       diabetes and pneumonia.
   !   Moorpark and Simi Valley have high death rates due to unintentional injuries and
       suicide.

Access to Health Care
  !  The area has low rates of uninsured with 88% of the adult population and 94% of
     children and teens having access to health insurance.
  !  Simi Valley Hospital ER admissions rose to 22,869 in 2009, an increase of 10.5%
     from the previous year.
Chronic Disease
  !  Adults in Ventura County have high rates of blood cholesterol, heart disease and
     asthma.
  !  11.4% of children have been diagnosed with asthma.

                                                                                          5
   !   Teens, adults and seniors have high rates of TB.
   !   Seniors are not receiving flu shots and pneumonia vaccines at the recommended
       rates.

Social Issues
  !   In Ventura County, 34.0% of adults are overweight and 20.1% are obese.
      Among teens, 13.1% are overweight and 9.8% of children are overweight.
  !   12.5% of adults and teens smoke.
  !   Over 10% of adults experienced mental illness/psychological distress.
  !   In Simi Valley the number of homeless is increasing.

Student and School Characteristics
   ! The percentage of students eligible for the free and reduced price lunch program
     ranges from 1.9% to 72.9% at Simi Valley Unified schools.
   ! Teachers, school administrators and staff feel that student alcohol and drug use,
     disruptive behavior and truancy are severe problems in the District’s schools.
   ! Simi Valley Unified has high rates of students per computer – 5.3 students per
     computer.

Community Stakeholder Interview Findings
  ! The issue of greatest concern was the failing economy, loss of jobs and
    unemployment.
  ! Access to health, dental, vision, mental health and behavioral health services is a
    serious problem in the community due to lack of available low-cost services
    (particularly for mental health services, dental care and vision care) and lack of
    insurance or financial resources.
  ! There has been an increase in the homeless population.
  ! At least one-third of the interviewees identified an increase in childhood obesity
    as a negative trend in the community. An increase in adult obesity was also
    noted.
  ! Barriers to accessing health care include: lack of transportation, lack of insurance
    as a result of changes in employment, inadequate number of physician
    specialists to serve the area, insurance coverage limitations and high co-pays.
  ! There have been huge cuts in mental health services.
  ! The Simi Valley Free Clinic and Sierra Vista Clinic are trusted community
    resources for the uninsured and under-insured to obtain health services.
  ! The services that are lacking in the community include: dental care, vision care,
    mental health/substance abuse services, safety net services for those without
    insurance, services for the homeless, and services for seniors.
  ! People are eating healthier and exercising more, becoming more health
    conscious and aware, and making more thoughtful lifestyle choices.
  ! The Hospital is perceived as doing more now than ever before in the community.
  ! The hospital has a good presence in the community and a positive image.
  ! Simi Valley Hospital has come a long way in improving their reputation and
    status in the community.


                                                                                       6
                                     Community Profile
Population
The population for the Simi Valley Hospital primary service area is 167,603. Children
and youth, ages 0-19 make up 30.2% of the population; 25.1% are 20-39 years of age;
36.1% are 40-64; and 8.7% of the population are seniors, 65 years of age and older.
The area has higher percentages of adults ages 40-64 than found in Ventura County
and the State.

Population by Age
                   SVH Service Area          Ventura County              California
                   Number       Percent    Number     Percent        Number       Percent
Age 0-4             12,054       7.2 %       61,048      7.3 %       2,644,549     7.0 %
Age 5-19            38,465      23.0 %     189,459       22.8 %      8,235,179    21.8 %
Age 20-39           42,065      25.1 %     217,530       26.2 %    10,964,743     29.1 %
Age 40-64           60,482      36.1 %     273,564       32.9 %    11,799,750     31.3 %
Age 65+             14,537       8.7 %       89,783      10.8 %      4,050,214    10.7 %
     Total         167,603      100.0 %    831,384    100.0 %      37,694,435     100.0 %
Source: ESRI 2008 Projections


When the population is examined by Zip code, Moorpark has higher a concentration of
children and youth, and a lower percentage of seniors when compared to Simi Valley.

Population by Age and Zip Code
                    Zip 93021             Zip 93063               Zip 93065
               Number Percent Number            Percent     Number      Percent
Age 0-4          3,008       7.7 %   3,718       6.6 %       5,328       7.3 %
Age 5-19         9,836      25.2 %   12,089     21.6 %      16,540       22.8 %
Age 20-39        9,933      25.5 %   13,538     24.2 %      18,594       25.6 %
Age 40-64       13,817      35.4 %   20,989     37.5 %      25,676       35.3 %
Age 65+          2,386       6.1 %   5,619      10.0 %       6,532       9.0 %
    Total       38,980     100.0 %   55,953     100.0 %     72,670      100.0 %
Source: ESRI 2008 Projections


Race/Ethnicity
The population of the service area consists primarily of White/Caucasians (61%) and
Latinos (26.5%). Asian/Pacific Islanders comprise 7.3% of the population, and African
Americans, Native Americans, and other races combined total only 5.2% of the
population. The area has a notably larger percentage of Whites, and a smaller

                                                                                            7
percentage of Latinos when compared to Ventura County.

Population by Race and Ethnicity
                        SVH Service Area       Ventura County           California
                        Number Percent Number Percent               Number       Percent
White                   102,248       61.0 %   404,098   48.6 %    15,118,817     39.9 %
Hispanic or Latino       44,396       26.5 %   334,094   40.2 %    14,322,256     37.8 %
Black or African
                          2,206       1.3 %    14,920     1.8 %    2,257,918      6.0 %
American
American Indian
                           623        0.4 %     3,184     0.4 %     184,930       0.5 %
and Alaska Native
Asian                    12,237       7.3 %    50,508     6.1 %    4,490,571      11.9 %
Native Hawaiian
and Pacific                221        0.1 %     1,572     0.2 %     116,028       0.3 %
Islander
Other or Multiple         5,672       3.4 %    23,607     2.8 %    1,382,887      3.7 %
Total                   167,603 100.0 % 831,983 100.0 % 37,873,407               100.0 %
Source: ESRI 2008 Projections


When examined by Zip code, Moorpark has a higher concentration of Latinos and fewer
Whites and Asians when compared to Simi Valley.

Population by Race and Ethnicity and Zip Code
                                Zip 93021         Zip 93063            Zip 93065
                        Number Percent Number Percent              Number       Percent
White                    19,808       50.8 %   36,896    65.9 %     45,544      62.7%
Hispanic or Latino       14,828       38.0 %   11,852    21.2 %     17,716      24.4 %
Black or African
                           549        1.4 %     726       1.3 %      931         1.3 %
American
American Indian
                           98         0.3 %     186       0.3 %      339         0.5 %
and Alaska Native
Asian                     2,440       6.3 %     4,267     7.6 %     5,530        7.6 %
Native Hawaiian
and Pacific                40         0.1 %      88       0.2 %       93         0.1 %
Islander
Other or Multiple         1,217       3.1 %     1,938     3.5 %     2,517        3.5 %
Total                    38,980      100.0 %   55,953    100.0 %    72,670      100.0 %
Source: ESRI 2008 Projections


                                                                                           8
Unemployment
The cities that make up the Simi Valley Hospital primary service area have relatively low
unemployment rates when compared to the County and the State. Simi Valley’s
unemployment rate in 2009 was 8.2% and in Moorpark, unemployment was 9.3%.

12-Month Average Unemployment Rate, 2009
                               Unemployment Rate
City of Simi Valley                                   8.2 %
City of Moorpark                                      9.3 %
SVH Service Area                                      8.4 %
Ventura County                                       10.0 %
California                                           11.4 %
Source: California Employment Development Department, 2009

Poverty
Poverty thresholds are used for calculating all official poverty population statistics. They
are updated each year by the Census Bureau. For 2000, the federal poverty threshold
for one person was $8,794 and for a family of four $17,603. The poverty rates paint an
important picture of the population within the Simi Valley Hospital primary service area.
Poverty rates show 6% of the population living at or below 100% of the Federal Poverty
Level (FPL) and 15.2% at 200% of FPL. Importantly, the data indicate that poverty rates
are the highest in Moorpark.

Ratio of Income to Poverty Level
                         Below 100% Poverty          Below 200% Poverty
                         Number           Percent    Number      Percent
Zip Code 93021                2,198          6.7 %       6,129    18.6 %
Zip Code 93063                2,886          6.0 %       6,943    14.3 %
Zip Code 93065                3,665          5.7 %       9,830    15.2 %
SVH Service Area              8,749          6.0 %      22,902    15.7 %
Ventura County              68,540           9.2 %     182,017    25.0 %
California               4,706,130          14.2 % 10,943,136     33.1 %
Source: U.S. Bureau of the Census, 2000


Data on the percent of children in poverty paint a more concerning picture as children in
the Hospital service area tend to suffer with higher rates of poverty than the general
population.




                                                                                           9
Children in Poverty
                              Zip 93021              Zip 93063           Zip 93065
                         Number Percent Number Percent                Number    Percent
Ages 0-4                       180        7.0 %       261     7.6 %       204      4.2 %
Age 5                           45        6.8 %        52     7.5 %        97      7.5 %
Ages 6-11                      366        8.4 %       263     5.4 %       524      7.8 %
Ages 12-17                     320        9.1 %       285     6.4 %       378      6.4 %
Source: U.S. Bureau of the Census, 2000


Housing and Households
There are over 50,000 housing units in the area. Most of the housing in the service
area consists of single family dwellings. The high percentage of single family housing
(over 80%) exceeds the rates found in the County and the State.

Types of Housing Units
                                                                                            Total
                                                                      Mobile Homes,
                         Single Family            Multiple Family                          Housing
                                                                      RVs, Vans, Etc.
                                                                                            Units
                       Number        Percent      Number    Percent Number      Percent    Percent
City of Simi                                                                                 100.0 %
                          33,854      80.6 %        7,277   17.3 %      892       2.1 %
Valley
City of Moorpark           8,967      83.4 %        1,487   13.8 %      298       2.8 %      100.0 %
SVH Service                                                                                  100.0 %
                          42,821      81.1 %        8,764   16.6 %     1,190      2.3 %
Area
Ventura County          205,749       73.8 %       60,640   21.8 %    12,362      4.4 %      100.0 %
California            8,747,293       64.4 % 4,247,635      31.3 % 596,938        4.4 %      100.0 %
Source: California Department of Finance, 2010


Section 8 is a federally funded program that provides rental assistance in the form of
vouchers to low and very-low income families, singles, senior citizens, disabled and
handicapped individuals. The Area Housing Authority of the County of Ventura handles
the public housing program. In the Simi Valley Hospital service area, less than 1% of
the population lives in Section 8 housing. The wait time in Ventura County for public
housing ranges from 365 to 1,825 days (1-5 years).

Language
In the overall Hospital service area, Spanish is spoken in 14.3% of the homes; this is
less than the number of Spanish speaking households in the County (26.2%) and the
State (25.8%). The service area has noticeably fewer households that speak other
Indo-European (4.0%) or Asian/Pacific Island languages (3.4%).

                                                                                                10
Language Spoken at Home for the Population 5 Years and Over
                                 Spanish               Other Indo-European            Asian or Pac. Is.
                          Number           Percent      Number          Percent    Number          Percent
Zip Code 93021                 6,820         22.4 %           1,086        3.6 %           607       2.0 %
Zip Code 93063                 4,949         10.9 %           1,865        4.1 %        1,829        4.0 %
Zip Code 93065                 7,728         12.8 %           2,555        4.2 %        2,205        3.7 %
SVH Service Area             19,497          14.3 %           5,506        4.0 %        4,641        3.4 %
Ventura County              182,412          26.2 %          18,358        2.6 %       25,412        3.6 %
California                8,105,505          25.8 %    1,145,002           4.3 %   2,709,179         8.6 %
Source: U.S. Bureau of the Census, 2000


Education
Of the population age 25 and over, 13.3% have less than a high school diploma, which
is better than County and State completion rates. Additionally, the area has higher high
school graduation rates than the County or State, as well as Associate degree and
Bachelor’s degree college attainment. In comparison, the residents show slightly lower
rates of graduate or professional degrees than in the County or State.

Education Levels
                           Service Area               Ventura                 California
                        Number Percent Number Percent                     Number       Percent
No Schooling
                            1,146         1.3 %    12,132       2.6 %       691,925        3.2 %
completed
Non-High School
                          11,276       12.3 %      81,740      17.3 %     4,250,818      20.0 %
Graduate
High School
                          20,396       22.3 %      92,936      19.7 %     4,288,452      20.1 %
Graduate
Some College              26,299       28.7 %     120,471      25.5 %     4,879,336      22.9 %
Associate Degree            7,967         8.7 %    37,341       7.9 %     1,518,403        7.1 %
Bachelor’s Degree         17,229       18.8 %      82,179      17.4 %     3,640,157      17.1 %
Master’s Degree             4,788         5.2 %    28,845       6.1 %     1,287,844        6.0 %
Professional
                            1,767         1.9 %    10,794       2.3 %       492,504        2.3 %
School Degree
Doctorate Degree              793         0.9 %      5,318      1.1 %       249,461        1.2 %
Total                     91,661 100.0 %          471,756 100.0 % 21,298,900            100.0 %
Source: U.S. Bureau of the Census, 2000




                                                                                                          11
                               Birth and Death Characteristics
Birth characteristics and major causes of death for residents of the Simi Valley Hospital
service area follow.

Births
In 2008, there were 1,997 births in the area. The majority of the births were to mothers
who are White (48.9%) and Latino (37.4%).

Teen Pregnancy
In 2008, teen pregnancy rates occurred at a rate of 49.1 per 1,000 births (or 4.9% of
total births). This rate is considerably less than the teen pregnancy rate found in the
County and the State.

Births to Teenage Mothers (Under Age 20)
                          Births to
                                            Live       Rate per 1,000
                            Teen
                                           Births       Live Births
                          Mothers
Zip Code 93021                     23            475             48.4
Zip Code 93063                     30            598             50.2
Zip Code 93065                     45            924             48.7
SVH Service Area                   98          1,997             49.1
Ventura County                 1,101         12,007              91.7
California                    52,328        551,567              94.9
Source: California Department of Public Health, 2008


Prenatal Care
In 2008, pregnant women in the service area entered prenatal care late - after the first
trimester - at a rate of 124.7 per 1,000 live births. This rate of late entry into prenatal
care translates to 87.5% of women entering prenatal care within the first trimester. It is
lower in Moorpark where 85.1% of women are entering early into prenatal care. The
area rate of early entry into prenatal care does not meet the Healthy People 2010
benchmark of 90% of women entering prenatal care in the first trimester.




                                                                                          12
Late Entry into Prenatal Care (After First Trimester)
                           Birth With
                                                  Live         Rate per 1,000
                          Late Prenatal
                                                 Births         Live Births
                              Care
Zip Code 93021                           71             475             149.5
Zip Code 93063                           63             598             105.4
Zip Code 93065                          115             924             124.7
SVH Service Area                        249            1,997            124.7
Ventura County                       2,398          12,007              199.7
California                          94,870        551,567               172.0
Source: California Department of Public Health, 2008


Low Birth Weight and Infant Mortality
Low birth weight is a negative birth indicator. Babies born at a low birth weight are at
higher risk for disease, disability and possibly death. The Simi Valley Hospital service
area has a slightly lower rate of low birth weight babies (63.6 per 1,000 live births) when
compared to the County (65.2 per 1,000 live births) and the State (68.3 per 1,000 live
births). However, Simi Valley (93063) has a higher rate of low birth weight babies at
72.0 per 1,000 live births.

Low Birth Weight (Under 2,500 g)
                            Low
                                            Live         Rate per 1,000
                           Weight
                                           Births         Live Births
                           Births
Zip Code 93021                     30            475                63.2
Zip Code 93063                     43            598                72.0
Zip Code 93065                     54            924                58.4
SVH Service Area                 127           1,997                63.6
Ventura County                   783          12,007                65.2
California                    37,663        551,567                 68.3
Source: California Department of Public Health, 2008


Simi Valley (93063) has a troubling high rate of infant mortality of 10.0 per 1,000 live
births. In comparison, the infant death rate in the County is 5.7 and the State is 5.3
deaths per 1,000 live births.




                                                                                           13
Infant Mortality Rate
                           Infant           Live        Rate per 1,000
                           Deaths          Births        Live Births
Zip Code 93021                       2           475                  4.2
Zip Code 93063                       6           598                 10.0
Zip Code 93065                       6           924                  6.5
SVH Service Area                   14          1,997                  7.0
Ventura County                     68        12,007                   5.7
California                     2,806        551,567                   5.1
Source: California Department of Public Health, 2008


Breastfeeding
Breastfeeding has been proven to have considerable benefits to baby and mother. The
California Department of Public Health (CDPH) highly recommends babies be fed only
breast milk for the first six months of life. Data on breastfeeding are collected by
hospitals on the Newborn Screening Test Form. Of the 7 hospitals in Ventura County
documenting in-hospital breastfeeding rates, Simi Valley Hospital ranks 6th for any
breastfeeding and 5th for exclusive breastfeeding (1=best ranking, 7=worst ranking).

In-Hospital Breastfeeding, 2007
                                 Any Breastfeeding                  Exclusive Breastfeeding
                              Number            Percent            Number         Percent
Simi Valley Hospital                 485               88.5%                246      44.9 %
Ventura County                   10,165                90.0%             5,019       44.4 %
California                      438,806                86.6%          216,426        42.7 %
Source: California Department of Public Health, Hospital of Occurrence, 2007


Deaths
There were 854 deaths among residents of the Simi Valley Hospital service area in
2008. Heart disease, cancer and chronic lung disease were the top three leading
causes of death. The percentage of deaths for heart disease and cancer are higher in
the area than when compared to County and State death rates. Deaths from diabetes
stand out at a higher percentage of the overall deaths when compared to County and
State death rates from diabetes.
Age-adjusted death rates are an important factor to examine when comparing mortality
data. The crude death rate is a ratio of the number of deaths to the entire population.
The Hospital service area has a lower death rate than the County or the State. Age-
adjusted death rates eliminate the bias of age in the makeup of the populations being
compared. And because the area does not have a large percentage of seniors, it would
be assumed that the crude death rate will be low. However, when adjusted for age, the

                                                                                              14
Simi Valley Hospital service area has a considerably higher death rate than that of the
County and the State.

     Age-Adjusted Death Rate, 2008
                                             Rate per 100,000 Persons
                              SVH Service
                                                     Ventura County            California
                                 Area
Crude                                     581.5                    669.4                611.9
Age-Adjusted                            1,016.6                    803.9                650.1
Source: California Department of Public Health, 2008, U.S. Bureau of the Census, 2000, and
Center for Economic Development at California State University, Chico


A more complete picture of disease risk and mortality is seen when the service area is
examined by Zip code.

Heart Disease Mortality
The Simi Valley community of Zip code 93063, an area with a high socioeconomic base,
has the highest rate of death by heart disease among the Hospital service area
communities.

Heart Disease Mortality
                                                           Rate per
                           Deaths       Population         100,000
                                                           Persons
Zip Code 93021                     34        33,009                103.0
Zip Code 93063                     91        48,814                186.4
Zip Code 93065                     96        65,030                147.6
SVH Service Area                 221        146,853                150.5
Ventura County                 1,337        831,983                160.7
California                   60,739 37,871,509                     160.4
Source: California Department of Public Health, 2008, ESRI 2008 Projections


Cancer Mortality
The cancer death rate shows an interesting picture with Moorpark (93021)
demonstrating a low rate of death by cancer (87.9 per 100,000 persons). This is in
contrast to Simi Valley (93063), which has a cancer mortality rate of 157.7 (per 100,000
persons) – a rate that exceeds both County and State cancer death rates.




                                                                                                15
Cancer Mortality
                                                           Rate per
                           Deaths       Population         100,000
                                                           Persons
Zip Code 93021                     29        33,009                  87.9
Zip Code 93063                     77        48,814                157.7
Zip Code 93065                     92        65,030                141.5
SVH Service Area                 198        146,853                134.8
Ventura County                 1,169        831,983                141.5
California                   54,579 37,871,509                     144.1
Source: California Department of Public Health, 2008, ESRI 2008 Projections


Diabetes Mortality
The death rate due to diabetes also shows Simi Valley (93063) with a high death rate
from diabetes. This Zip code area has a diabetes death rate (18.4) that is higher than
the County rate (17.1 per 100,000 persons).

Diabetes Mortality
                                                           Rate per
                           Deaths       Population         100,000
                                                           Persons
Zip Code 93021                      4        33,009                  12.1
Zip Code 93063                      9        48,814                  18.4
Zip Code 93065                      8        65,030                  12.3
SVH Service Area                   21       146,853                  14.3
Ventura County                   142        831,983                  17.1
California                     7,349 37,871,509                      19.4
Source: California Department of Public Health, 2008, ESRI 2008 Projections


Pneumonia Mortality
While the service area has a relatively low pneumonia death rate, a careful look at the
deaths by Zip code reveals that Simi Valley (93063) has a high rate of death by
pneumonia. This rate is more than double the other rates of death for pneumonia by
Zip code in the service area.




                                                                                          16
Pneumonia Mortality
                                                           Rate per
                           Deaths       Population         100,000
                                                           Persons
Zip Code 93021                      1        33,009                   3.1
Zip Code 93063                      8        48,814                  16.4
Zip Code 93065                      5        65,030                   7.7
SVH Service Area                   14       146,853                   9.5
Ventura County                     98       831,983                  11.8
California                     6,576 37,871,509                      17.4
Source: California Department of Public Health, 2008, ESRI 2008 Projections


Unintentional Injury Death Rate
Deaths due to unintentional injuries are primarily caused by motor vehicle accidents,
poisoning, falls and drowning. These deaths account for injuries among children and
adults. Moorpark and Simi Valley have higher death rates due to unintentional injuries
than the County and the State.

Unintentional Injury Death Rate
                                                            Rate per
                           Deaths       Population          100,000
                                                            Persons
Zip Code 93021                     14         33,009                 42.4
Zip Code 93063                     25         48,814                 51.2
Zip Code 93065                     27         65,030                 41.5
SVH Service Area                   66        146,853                 45.0
Ventura County                    253        831,983                 30.4
California                    10,667     37,871,509                  28.2
Source: California Department of Public Health, 2008, ESRI 2008
Projections


Suicide Rate
All of the communities in the service area have higher rates of death attributed to
suicide (11.6 per 100,000 persons) than the rates found in the County (10.1) and the
State (9.8).




                                                                                       17
Suicide Rate
                                                           Rate per
                           Deaths       Population         100,000
                                                           Persons
Zip Code 93021                      4        33,009                  12.1
Zip Code 93063                      5        48,814                  10.2
Zip Code 93065                      8        65,030                  12.3
SVH Service Area                   17       146,853                  11.6
Ventura County                     84       831,983                  10.1
California                     3,729 37,871,509                       9.8
Source: California Department of Public Health, 2008, ESRI 2008 Projections




                                                                              18
                                       Access to Health Care
Health insurance coverage is considered a key component to accessing health care.
While place specific data on access to health care is not available, County level data is
examined to gain a picture of the availability of insurance and a source of care for area
residents.

In Ventura County, 88% of the adult population and 94% of children and teens have
health insurance, a rate higher than the State. Among uninsured adults under 65 years
old, 6.5% are eligible for Medi-Cal. Over 80% of the population in the County has
visited a doctor within the last year. Less than 20% of the population in Ventura County
has visited the ER, less than the State rate of ER use.

Access to Health Care
                                          Ventura County   California
                                               Percent      Percent
Adults who have insurance
                                               87.9 %       83.9 %
coverage
Children and Teens who have
                                               93.9 %       92.7 %
insurance coverage
Eligibility of Uninsured under 65
                                               6.5 %        9.0 %
for Medi-Cal
Adults who visited a doctor in
                                               84.4 %       81.7 %
the past 12 months
Children and Teens who visited
                                               89.5 %       88.3 %
a doctor in the past 12 months
Adults who visited ER in the past
                                               17.9 %       18.7 %
12 months
Children and Teens who visited
                                               18.2 %       19.5 %
ER in the past 12 months
Source: California Health Interview Survey, 2007


ER Admissions
Simi Valley Hospital ER admissions were examined over a three year period from 2007
to 2009. ER admissions grew by 5.3% from 2007 to 2008. In 2009, ER admissions
rose to 22,869. From 2008 to 2009 this was an increase of 10.5%: double the increase
from the previous year.




                                                                                        19
Source: State of California, OSHPD, Emergency Department Data, 2007-2009




                                                                           20
                                          Chronic Disease
Chronic Diseases among Adults
The data on chronic diseases are available by County. Among adults, over one-quarter
of the population (25.8%) has been diagnosed with high blood cholesterol. Adults have
slightly higher rates of heart disease and asthma when compared to the State.

Chronic Diseases among Adults
                                          Ventura County    California
                                               Percent       Percent
Adults diagnosed with Arthritis                19.1 %        19.5 %
Adults diagnosed with Asthma                   14.1 %        13.0%
Adults diagnosed with Heart
                                               7.4 %         7.0 %
Disease
Adults diagnosed with High
                                               25.8 %        22.1 %
Blood Cholesterol
Source: California Health Interview Survey, 2007


Childhood Asthma
Among children and teens in Ventura County, the rates of asthma are lower than found
among youth statewide, but still exceed the Healthy People 2010 benchmark rate of
5%.

Asthma among Children and Teens
                             Ventura County                 California
                                               Percent       Percent
Children Diagnosed with Asthma                     11.4 %    13.5%
Teens Diagnosed with Asthma                        13.1 %    19.5%
Source: California Health Interview Survey, 2007


HIV/AIDS Infection
Ventura County has a 29.4 prevalence rate of HIV/AIDS per 100,000 persons. This
prevalence is considerably lower than the State rate of 92.4. The rate of AIDS at 129.1
per 100,000 persons is also considerably less than the State rate of 402.2.




                                                                                     21
HIV/AIDS Cases as of December 2008
                                      HIV                                          AIDS
                                                     Rate
                                                                                                     Rate per
                   Living                     Total  per         Living                   Total
                              Deceased                                     Deceased                  100,000
                   Cases                     Cases 100,000       Cases                    Cases
                                                                                                     Persons
                                                    Person

Ventura                243             2       245      29.4        486          588         1,074     129.1
County
California         34,006          1,006    35,012      92.4    66,360       85,958 152,318            402.2
Source: California Department of Public Health, The Office of AIDS, 2008, ESRI 2008 Projections


STD Cases
Ventura County has low rates of Chlamydia, Gonorrhea and Syphilis as compared to
the State.

STD Cases, 2009
                             Ventura County                        California
                        Cases         Rate per            Cases            Rate per
                                      100,000                              100,000
                                      Persons                              Persons
Chlamydia                2,322                 276.1      146,476                  380.6
Gonorrhea                    147                17.5        23,876                   62.0
Primary &
Secondary                     16                  1.9        2,005                     5.2
Syphilis
Early Latent
                               7                  0.8        1,709                     4.4
Syphilis
Late/Late Latent
                              34                  4.0        2,456                     6.4
Syphilis
Source: California Department of Public Health, STD Control Branch, 2009


Tuberculosis
The overall rate of tuberculosis in Ventura County is 7.8 per 100,000 cases. This is
higher than the rate of TB in the State. When examined by age group, there is little
infection among children. However, teens and adults, ages 15-44, have high rates of
TB, as do seniors.




                                                                                                                22
Tuberculosis Cases by Age Group
                        Ventura County                              California
                              Rate per 100,000                        Rate per 100,000
                 Number                                  Number
                                  Persons                                 Persons
Age 0-4                   1                        1.6         87                   3.1
Age 5-14                  1                        0.8         68                   1.3
Age 15-24                 9                        7.6       280                    4.9
Age 25-44               21                         9.3       812                    7.4
Age 45-64               17                         8.0       825                    9.1
Age 65+                 16                     17.8          623                  15.4
Total                   65                         7.8     2,695                    7.1
Source: California Department of Public Health, 2008, ESRI 2008 Projections


Preventive Practices
Health screenings and immunizations are two widely accepted methods to help identify
and prevent disease.
Seniors are particularly vulnerable to communicable respiratory diseases, and are
recommended to obtain yearly flu shots. Over a year period, 67.5% of seniors in
Ventura County had obtained a flu shot. And 58.4% of seniors had a pneumonia
vaccine sometime in their lives.
Pap smears screen for cervical cancer. Among adult women, 88% had received a Pap
smear in the last three years; and 70.5% received a mammogram in the last two years.
Blood stool tests, and sigmoidoscopy and colonoscopy are screening measures for
colon cancer. For adults 50 and over in Ventura County, 76.8% had received the
recommended screening measures.
Preventive Practices
                                          Ventura County             California
                                               Percent                Percent
Senior flu shot                                67.5%                   68.8%
Senior pneumonia vaccine                       58.4%                   63.1%
Pap smear in last 3 years                      88.0%                   84.1%
Mammogram in the last 2 years                  70.5%                   63.6%
Screening for colorectal cancer                76.8%                   74.5%
Source: California Health Interview Survey, 2007




                                                                                          23
                                              Social Issues
A variety of social issues face the residents of the communities in the Simi Valley
Hospital service area.

Adult and Childhood Obesity
In Ventura County, 34.0% of adults are overweight and 20.1% are obese. Among
teens, 13.1% are overweight and 9.8% of children are overweight. The percentage of
overweight and obese adults, youth and children is slightly less than in the State.
Overweight and Obesity
                                          Ventura County      California
                                               Percent         Percent
Adults who are Obese                               20.1 %      22.7%
Adults who are Overweight                          34.0 %      34.4%
Teens who are Overweight                           13.1 %      13.3%
Children who are Overweight                         9.8 %      11.2%
Source: California Health Interview Survey, 2007

Youth Social Issues
The California Healthy Kids Survey is a tool used by school districts to collect data on
youths’ nutritional and activity habits, alcohol, tobacco and drug use, school safety, and
strengths and assets. The following table shows the results of the 2008 Healthy Kids
survey for the Simi Valley Unified School District.

These data were collated from surveys completed by 558 teachers, administrators and
staff at Simi Valley Unified schools. Respondents were asked to rate the level of
problems they have observes among students from Insignificant to Severe. When
moderate and severe problem issues were combined, the problems identified as of
most concern were:
• Disruptive student behavior
• Student drug use
• Student alcohol use
• Cutting classes or truant
• Student tobacco use
• Harassment or bullying among students
• Vandalism




                                                                                        24
Youth Social Issues in Simi Valley Unified
                                                  Insignificant     Mild Problem        Moderate     Severe
                                 Responses          Problem                             Problem     Problem
                                                    #         %        #         %      #    %      #       %
Student Drug Use                          531           83   16 %     214        40 % 185    35 %   49      9%
Disruptive Student
                                          538           36    7%      244        45 % 211    39 %   47      9%
Behavior
Student Alcohol Use                       530        100     19 %     213        40 % 173    33 %   44      8%
Cutting Classes or Being
                                          532           90   17 %     244        46 % 158    30 %   40      8%
Truant
Vandalism (Including
                                          539        121     22 %     258        48 % 118    22 %   42      8%
Graffiti)
Student Tobacco Use                       530        105     20 %     223        42 % 171    32 %   31      6%
Harassment or Bullying
                                          535           62   12 %     298        56 % 153    29 %   22      4%
Among Students
Racial/Ethnic Conflict
                                          537        140     26 %     272        51 % 106    20 %   19      4%
Among Students
Verbal or Physical Abuse of
                                          533        224     42 %     216        41 %   74   14 %   19      4%
School Staff by Students
Physical Fighting Between
                                          538        118     22 %     310        58 %   99   18 %   11      2%
Students
Student Depression or
Other Mental Health                       529        102     19 %     307        58 % 112    21 %       8   2%
Problems
Gang-Related Activity                     533        185     35 %     256        48 %   82   15 %   10      2%
Theft                                     534        166     31 %     265        50 %   95   18 %       8   2%
Weapons Possession                        528        351     66 %     156        30 %   18   3%         3   1%
Source: California Healthy Kids Survey, California School Climate Survey, 2008


    Alcohol, Tobacco and Drug Use
    The California Health Interview Survey asked teens and adults about their use of
    alcohol, tobacco and drugs. In Ventura County 12.5% of teens and adults are current
    smokers. Binge drinking is measured as consuming a certain amount of alcohol in a
    designated period of time. For males this is 5 or more drinks per occasion and for
    females 4 or more drinks per occasion. Over one-quarter of adults (26.9%) engaged in
    binge drinking in the last year. Among teens, over 11% have experimented with illegal
    drugs.




                                                                                                                 25
Alcohol, Tobacco and Drug Use
                                          Ventura County   California
                                               Percent      Percent
Adults and teens who smoke                     12.5%        13.3%
Adults who engaged in binge
                                               26.9 %       29.7 %
drinking in the past year
Teens who have tried marijuana,
cocaine, sniffing glue, other                  11.3%        10.8%
drugs
Source: California Health Interview Survey, 2007


Mental Health
Among adults in Ventura County, 10.4% experienced some type of psychological
distress in the past year; 13.8% of adults saw a health care provider for mental health or
drug/alcohol related issues, and 12.8% have taken medicine for more than two weeks
for mental health issues. These mental health indicators are more frequent among
residents of Ventura County than compared to the State overall.
Mental Health Indicators
                                          Ventura County   California
                                               Percent      Percent
Adults who had psychological
                                               10.4 %       8.5 %
distress during past year
Adults who saw a health care
provider for emotional-mental
                                               13.8 %       12.4 %
and/or alcohol-drug issues in
past year
Has taken prescription medicine
for emotional/mental health                    12.8%        10.0%
issue in past year
Source: California Health Interview Survey, 2007


Homelessness
In 2007 and in 2010 the Ventura County Homeless & Housing Coalition conducted the
Ventura County Homeless Count and Homeless Survey. From 2007 to 2010, the
number of homeless in Ventura County fell by 146 persons. However, in Simi Valley,
the number of homeless increased by 40% from 163 to 229 persons.




                                                                                       26
Homeless Population
                                              Moorpark                    Simi Valley
                                         2007         2010              2007            2010
Number of homeless                        13             1               163            229
Percent seniors                          7.7%            0%             0.7%            6%
Percent youth, ages 18-24                0%              0%             2.8%            11%
Percent children, under 18               0%              0%             10.5%           4%
Percent women                            7.7%            0%             32.8%           29.%
Number of families                        0              0               13              7
Source: Ventura County Homeless & Housing Coalition, 2007 and 2010


Detailed information on homelessness in Ventura County can be found at
www.vchhc.org/HomelessCounts.html.

Crime
Crime statistics indicate that while crime rates are higher in Simi Valley than Moorpark,
the rates of crime in the Simi Valley Hospital service area are noticeably lower when
compared to Ventura County and the State. The highest rates of crime are for larceny
and theft.

Crime
                              Violent Crimes                  Property Crimes                Larceny-Theft
                                           Rate per                      Rate per                     Rate per
                           Number          100,000           Number      100,000        Number        100,000
                                           Persons                       Persons                      Persons
City of Moorpark                    52           133.4           281            720.9          410     1,051.8
City of Simi Valley               183            142.3          1,066           828.8         1,437    1,117.2
SVH Service Area                  235            140.2          1,347           803.7         1,847    1,102.0
Ventura County                  2,137            256.9          8,413         1,011.2        11,459    1,377.3
California                   185,233             489.1        656,744         1,734.1    650,653       1,718.0
Source: California Department of Justice, 2008, ESRI 2008 Projections




                                                                                                             27
                            School and Student Characteristics
The schools in the Simi Valley Unified School District were examined for selected
demographic and performance characteristics. The school district consists of 21
Elementary Schools, 3 Middles Schools, and 4 High Schools. In the 2008/2009 school
year the school enrollment for the district was 20,855 students.

Free and Reduced Price Lunch Program
The number of students eligible for the free and reduced price lunch program is one
indicator of the socioeconomic status of a school district’s student population. At 24.2%,
the District has considerably lower rates of low-income eligible students than the County
or State averages. It is important to note that while examining District totals provides an
overview of the student population; this is an average among all the schools. Within the
District there are a number of schools with much higher rates of eligible low-income
children. The range of low income program-eligible children ranges from a low of 1.9%
to a high of 72.9%.

Free and Reduced Price Lunch Program
                                                            Simi Valley School       Ventura
                                                                                               California
                                                                  District           County
Students eligible for Free and Reduced Price
                                                                             24.2%     42.0%       53.7%
Lunch Program
Source: California Department of Education, Simi Valley Unified, 2008-2009


English Learners
The percentage of English learners ranges from 23% among First Graders to 2.3%
among High School seniors. The data do reveal that the percentage of students who
are English learners decreases as students move to middle school and high school,
indicating an improvement in language skills and increased English fluency as they
progress to higher grade levels. Overall, Simi Valley Unified has less than half the rate
of English learners when compared to the County and the State.




                                                                                                       28
Number of English Learners
                    Simi Valley School
                                                    Ventura County                     California
                          District
                                                                                                % of
                               % of Grade                    % of Grade
                 Number                         Number                             Number      Grade
                               Enrollment                    Enrollment
                                                                                             Enrollment
Kindergarten           307           21.7 %        3,999           38.4 %          184,770         40.1 %
Grade 1                347           22.9 %        3,977           38.4 %          186,337         39.7 %
Grade 2                315           21.3 %        3,893           37.6 %          179,892         38.6 %
Grade 3                210           13.4 %        3,395           31.8 %          149,641         31.9 %
Grade 4                194           12.5 %        2,991           28.4 %          127,604         27.5 %
Grade 5                162           10.3 %        2,535           23.8 %          106,370         22.8 %
Grade 6                118             7.7 %       2,261           21.4 %           96,063         20.5 %
Grade 7                100             6.3 %       2,003           18.6 %           90,058         18.8 %
Grade 8                 77             4.6 %       1,708           15.3 %           80,436         16.5 %
Grade 9                 87             5.1 %       1,867           16.1 %           92,571         17.2 %
Grade 10                73             4.3 %       1,724           14.8 %           78,147         15.3 %
Grade 11                51             2.9 %       1,381           12.1 %           64,980         13.3 %
Grade 12                50             2.8 %       1,158           10.0 %           57,447         12.1 %
Total               2,091            10.0 %       32,892           23.2 %      1,494,316           23.9 %
Source: California Department of Education, Simi Valley Unified, 2008-2009


Computers in Schools
Simi Valley Unified has high rates of students per computers (5.3) as compared to the
County (4.0) and State (4.1) averages. To get a clear view of computer availability, it is
necessary to examine students per computer by school. Disparities can be found to
exist among the schools, with some schools having over five times the number of
students per computer than other schools.

Computers in Simi Valley Unified District Schools
                                                              Simi Valley
                                                                                     Ventura
                                                                School                              California
                                                                                     County
                                                                District
Students Per Computer                                                        5.3             4.0               4.1
Students Per Internet Connected Computer                                     5.2             4.8               4.6
Percent of Computers Connected to the
                                                                      93.7 %            88.1 %              89.6 %
Internet
Source: California Department of Education, Simi Valley Unified, 2007, 2008-2009



                                                                                                                 29
High School Graduation Rate
In the Simi Valley Unified School District, the high school dropout rate from Grades 7-12
is on average only 1.0%. The highest rate of dropouts is in Grade 12 at 9.8% of total
students enrolled. This rate is less than found in Ventura County (10.3%) but higher
than the State rate (9.1%).

Dropout Rate
                Simi Valley School District             Ventura County                       California
                             Drop                              Drop                              Drop
                Enrolled               Percent Enrolled                   Percent     Enrolled            Percent
                             outs                              outs                              outs
Grade 7             1,676          1     0.1 %      10,892          47        0.4 %    487,331    4,149     0.9 %

Grade 8             1,597          1     0.1 %      10,542          50        0.5 %    490,054    4,755     1.0 %
Grade 9             1,694          2     0.1 %      12,117        282         2.3 %    541,650    9,737     1.8 %
Grade 10            1,781          6     0.3 %      11,664        235         2.0 %    513,707   10,995     2.1 %
Grade 11            1,805          9     0.5 %      11,550        196         1.7 %    488,227   14,657     3.0 %
Grade 12            1,879       185      9.8 %      11,303      1,159        10.3 %    468,281   42,794     9.1 %
Ungraded
                         0         0     0.0 %           50           2       4.0 %      3,855     186      4.8 %
Secondary
Total              21,137       204      1.0 %    141,260       1,971         1.4 % 6,275,469    87,273     1.4 %
Source: California Department of Education, Simi Valley Unified, 2007-2008




                                                                                                             30
                            Key Stakeholder Interviews
The community stakeholders who participated in this needs assessment represented a
cross-section of agencies serving the Simi Valley Hospital service area. They provide a
broad continuum of services to all segments of the population.
Interview participants were asked to share their perspectives on a number of topics,
including:
    • Biggest issues or concerns in the community
    • Trends relative to demographics, the economy, the health care provider
       community, and community health status
    • Problems people face in obtaining health care and/or social services and where
       they go when they need assistance in these areas
    • Where people access preventive care
    • Services lacking in the community
    • Barriers and services related to chronic health conditions
    • Partnership experiences and opportunities with Simi Valley Hospital
    • Current roles of the Hospital in addressing the needs of low-income people in the
       community and possible future roles
    • Recommendations for improving access to care and the health of the community

Below is a summary of responses and trends in responses to each of these topics.

Biggest Issues or Concerns in the Simi Valley Community
By far, the issue of greatest concern to the interview participants was the economy and
its impact in the community. Aspects of this concern included:
     • Job losses and unemployment
     • Lack of job security
     • Cut backs in wages and hours
     • Loss of personal wealth and assets, including homes and home values
     • Difficulty in securing basic needs among formerly middle class families
     • Lack of adequate money needed to retire
     • People are spending less and prioritizing their spending more carefully
     • Increased stress and depression within families as a result of the economy

Other issues of concern to the interview participants included:
   • Access to health, dental, vision, mental health and behavioral health services
       due to lack of available low-cost services (particularly for mental health services,
       dental care and vision care) and lack of insurance or financial resources
   • Increase in homeless population
   • Maintaining high level of public safety services and quality education in the City
       of Simi Valley




                                                                                         31
Demographic Trends
Demographic trends reported by the participants were sometimes inconsistent. For
example, several people said there are more young people, including families with
children, while others said that there are fewer children and the birth rate and school
enrollments are declining. Several participants noted an increase in the senior
population and their related needs, while others reported that the population has been
stable with no significant demographic changes.

Some consistent trends that were reported included:
  • Increase in homeless population, including families and older people
  • Growing Hispanic population
  • The income level of Simi Valley residents had been increasing with an influx of
     more affluent people for the five years before the economic downturn

Trends in the Economy and its Impact
A number of these issues are summarized above in the “Biggest Issues or Concerns”
question. Some additional trends that were identified included:
   • People moving out of the area due to job losses and early retirement
   • People under-housed, i.e., living in inadequate situations. Because of house
       foreclosure, families are living in cars
   • Families of older people less able to help their aging parents as they are afraid of
       losing their jobs
   • Family members of older people living with their parents who are on fixed
       incomes
   • People more cautious about their financial spending and have less disposable
       income – this has become the “new normal”
   • Decrease in local jobs
   • Sales are down for all businesses, including local retail stores
   • People losing health insurance with their loss of jobs and unable to afford
       COBRA
   • Young people cannot afford housing

Trends in the Health Care Provider Community
Two resources were identified most frequently that serve lower-income and uninsured
individuals and families.
Sierra Vista Clinic – This is a new county clinic in Simi Valley that provides urgent care,
primary care, and behavioral health services. As a new resource, it is still becoming
known in the community. Moorpark is hoping to also have a similar clinic open there.
Free Clinic of Simi Valley – This clinic has long history in the community and has
partnerships with Simi Valley Hospital and Ventura County Health for services, supplies
and medications. It offers a weekly homeless clinic with volunteer doctors from Kaiser
Permanente. The clinic also offers a dental clinic with a long wait list. The Free Clinic is
being called upon to serve more and more people each year.




                                                                                          32
Both these resources were well regarded by the interview participants who were familiar
with their services. It was noted that both are accessible on major transportation/bus
lines.
Other resources for the uninsured that were identified include:
   • Ventura County Health Care Agency is a source of help to people in need, but is
       located in Ventura and requires transportation
   • A large community clinic, Clinicas del Camino Real, is planning to open a site in
       Simi Valley
   • Simi Valley Hospital provides a lot of care to lower-income and uninsured people
       that the hospital is not reimbursed for, including care through their emergency
       room
   • STAR program is available for homeless people through Ventura County
       Behavioral Health Department

A number of people commented on trends in health care that people with insurance are
experiencing. These include:
   • Extended medical community in Simi Valley is small and many people go out of
      the area for specialty care. There is a need to develop medical professional pool
      locally
   • It has become very difficult to find doctors who take various types of insurance,
      this is probably because of low reimbursement rates offered by insurance
      companies
   • People are being referred out of the area for services that are available locally
      but not covered on insurance plans (e.g., one woman was referred to a breast
      center in Thousand Oaks and was unable to use the local breast center she had
      used previously).

Trends in Community Health Status
The most frequently reported trend was the increase in childhood obesity. At least one-
third of the interviewees identified this as a negative trend in the community. An
increase in adult obesity was also identified.

Other negative trends in community health status included increases in:
   • People without health insurance
   • Fewer people accessing preventive care or screenings due to lack of insurance,
      higher deductibles, or bigger co-pays
   • Hypertension
   • Diabetes
   • Stress and depression
   • Drug use among homeless, including heroine and methamphetamines
   • Alcohol use
   • Skin cancers
   • Teen/youth exposure to and use of prescription drugs (particularly Vicodin),
      accessible from parents and illegally on the street
   • Teen smoking


                                                                                      33
   •   Attention Deficit Disorders and autism
   •   Allergies and related complications (e.g., eye and sinus infections)

Some positive trends in community health status include:
  • People are eating healthier and exercising more, becoming more health
     conscious and aware, and making more thoughtful lifestyle choices
  • Fewer cavities in teeth among Latino kids

Problems or Barriers to Obtaining Health Care
The most frequent problem related to obtaining health care is lack of health insurance or
ability to pay for care and/or medications.
    • Young adults often cannot afford health insurance so they go without. As a
         result, they do not get preventive care
    • Lack of health insurance is particularly an issue for those who are trying to
         manage with a chronic diseases
    • People don’t have insurance and do not get preventive care or they wait to obtain
         health care until their problems are very serious. This sometimes results in
         needing emergency care
    • Insurance companies are covering less and becoming more expensive for
         individuals due to increases in premiums, non-covered visits, procedures, and
         medications.
    • People don’t see the providers they want to see because of insurance limitations;
         it is hard to find doctors that take insurance
    • Middle class people are making drastic changes to their coverage. As people
         select plans with higher co-pays, they avoid preventive care and wait until
         problems are severe
    • It is more difficult for employers to provide health care at subsidized rates, this is
         a burden for small businesses
    • There is a lack of information and communication about available, free/low-cost
         services

Transportation to medical services was also identified as a barrier by several
participants, though it was noted that Simi Valley Free Clinic, Sierra Vista Clinic and
Simi Valley Hospital are all on major bus routes. Some concerns about medical
transportation include:
    • There are no public health services and no hospital in Moorpark. It is a long bus
        ride to services in Simi Valley. There is a need for a public health clinic in
        Moorpark
    • Transportation to Ventura County Medical Center is very difficult given the long
        distance to travel
    • It is difficult for seniors with Kaiser insurance to get to the Woodland Hills hospital
    • The Simi Valley Free Clinic is only open in the evening, limiting use by seniors
        who rely on Dial-a-Ride, which stops service at 8:00 p.m.




                                                                                          34
Barriers for seniors include transportation issues and also the difficulty in accessing
care due to:
   • Cost of care
   • Cost of medications
   • Lack of assistance for coordinating care and helping to manage medications

Cuts in funding and services were also identified as barriers, including:
   • Huge cuts in mental health services. Schools are trying to find mental health
       services for families in need.
   • ACE program (state-funded medical care program) will start charging a co-pay
       and annual fee in September, so it won’t be feasible for homeless to use this
       program
   • Funding for nonprofits is down, as are CDBG (Community Development Block
       Grant) dollars

Where People Go for Assistance with Health or Social Problems
It was noted that many people do not know where to go when they need help. However,
the most frequently identified places where people go include:
    • The Emergency Room
    • Simi Valley Free Clinic
    • Sierra Vista Clinic
    • Personal doctor (for those with insurance)
    • Internet

Comments about use of the emergency room include:
  • “Everybody goes to the ER; it’s the final safety net. People go to the ER until they
    find out about Simi Valley Free Clinic, then they go to the clinic.”
  • People call the ER for referrals, but they cannot give out referrals on the phone.
  • People like it at the ER, even if it needs to be remodeled
  • More convenient to go to the ER than wait for a doctor’s appointment in some
    cases
  • The ER provides services to out of town visitors who don’t know where to go.
  • The ER is the place to go for mental health crises

Other places where people go for assistance were identified to include:
   • Samaritan Center for homeless services
   • Ventura County Human Services – makes referrals for many health and social
      services; e.g., food stamps, General Relief, housing assistance, applications for
      Medi-Cal
   • County-run mobile medical unit with nurses and Physician Assistants does
      intakes, provides exams and can write prescriptions when needed.
   • Ventura County Medical Center/Public Health – will take anyone irrespective of
      insurance – but is far away and poses transportation barriers
   • Family and friends, social service agencies, churches
   • Seniors go to the Senior Center, which has an advocate to work with seniors on
      problem solving and some case management

                                                                                          35
Where People Access Preventive Care
Several participants said that uninsured/under-insured people often do not obtain
preventive health services because they do not even think about it, do not know where
to go, or it is not a priority. This population will often only access the health care system
when they have a serious health problem or are diagnosed with a serious health
condition. However, frequently identified locations used by this population to access
preventive care include:
    • Simi Valley Free Clinic (also for dental care)
    • Sierra Vista Clinic

Simi Valley Hospital was cited by a number of the participants as a source for
preventive care. Hospital offerings include:
   • Health education on diabetes and other health topics
   • Flu clinics
   • Health fairs with preventive screenings (offered in the past but has been cut)
   • One person said, “Simi Valley Hospital puts on several events per year, including
      Hats Off to Women to support women’s health programs, and other free things in
      town that people can do episodically. Simi Valley Hospital gets an ‘A’ in this.
      They are very proactive.”

Other locations where people seek preventive care include:
   • Internet
   • Drug stores
   • Health fairs
   • Senior Center
   • Mobile clinic at Samaritan Center (for homeless)

It was noted that it is most effective to provide preventive care at trusted sites where
people congregate for other purposes, as this will help to reduce transportation and
other barriers. This is particularly an issue for seniors and others who use public
transportation.

Services that are Lacking to Meet Community Need
The services most frequently identified as lacking in the community include:
   • Dental care
   • Vision care
   • Mental health services
   • Safety net services for those without insurance
   • Services for people with addictive disorders
   • Services for the homeless, including transitional housing, addiction management,
      self-esteem training, shelter program in summer months, respite services
      following hospitalizations
   • Services for parents raising children with behavioral problems, addictions, etc.
   • Housing services for seniors, including down payment assistance, senior
      apartments, and application process assistance
   • Activities for teens that are healthy and fun

                                                                                           36
   •   Services are available for those who can pay, but there’s a lack of services for
       the uninsured
   •   County health care services for uninsured in Moorpark
   •   24-hour urgent care services
   •   An “under one roof” center to provide all the social/human services in one place.
       Currently services are scattered all around, and are hard to find.
   •   The need for better coordination among agencies and a more comprehensive
       approach to address local problems. Many services are available but people
       don’t know about them. Communication is done by individual agencies, but a
       more coordinated approach would be more effective

Services lacking at Simi Valley Hospital were identified to include:
   • Heart trauma services (available only in Thousand Oaks)
   • Upgraded emergency room. The ER is too small and old to meet community
      needs
   • Nurse advice line that could provide more credible information than the Internet
      (Hospital had this service in the past, but it was cut).
   • Some services are provided at Los Robles or Northridge Hospitals that are not
      available at Simi Valley Hospital that may result in loss of some business
   • Trauma center (though there is one in Thousand Oaks, so it is probably not
      financially justified)

Barriers to Care and Treatment for Chronic Diseases
Lack of health insurance coverage and/or money was identified by nearly half the
interview participants as a barrier to chronic disease treatment. A related issue is the
high cost of medications for all, including seniors and those with share of cost Medicare.
While transportation to services within Simi Valley is not necessarily a huge barrier for
local residents, it is a barrier for residents of Moorpark and for anyone who needs to
travel the long distance to Ventura for county medical services. Specialty care services
for the uninsured are only available at Ventura County Medical Center, so transportation
and waits for appointments are barriers to these services for under-served populations.

Some specialties do not exist within Simi Valley; e.g., people travel outside the
community, usually to Los Angeles, for cancer treatment including chemo, support, and
radiation. Insurance companies are covering less and less while becoming more and
more expensive and people are cutting back their coverage. Employers are finding it
more difficult to provide adequate health insurance coverage for their employees.

What People do to Prevent Chronic Conditions from Worsening
The most frequently identified activities include:
   • Increase exercise/physical activity
   • Change diet to eat healthier food
   • Visit doctor regularly and follow the advice of the doctor, including taking
     prescribed medications
   • Cut back on smoking and other addictive behaviors
   • Take vitamin supplements

                                                                                        37
   •   Take advantage of the chronic disease self-management classes for all patients
       diagnosed with diabetes and hypertension at the Simi Valley Free Clinic
   •   Take advantage of the numerous programs offered at the Senior Center, such as
       balance classes, chronic disease self-management, nutritious meals, flu shots,
       bone density screenings, etc.

Health Services, Education and Materials for People with Chronic Conditions
The most frequently mentioned resource for information for people with chronic
conditions was the Internet (mentioned by nearly half the interviewees).

Simi Valley Hospital programs were also noted, including:
   • Excellent referral program and resources through Simi Valley Hospital and Sierra
      Vista Center
   • Educational presentations and information on chronic disease and lifestyle
      changes needed for self-management and referrals to support groups
   • Free diabetes classes including information on healthy eating
   • Nurse advice line, offered by the Hospital in the past

Other resources were identified to include:
   • Medications available through Simi Valley Free Clinic to help stop smoking
   • Free seminars on nutrition offered to parents at elementary school
   • Information from personal doctors
   • Disease management programs through insurance company
   • Tests offered through the mail by some providers to pre-screen for conditions
       that might need more investigation
   • Alzheimer’s support group and nurse that does blood pressure checks and other
       screenings at Senior Center
   • County “blue book;” a list of resources in Ventura County
   • City of Simi Valley’s social services referral booklet

Services that are lacking for Chronic Disease Prevention, Management, or
Treatment
Services lacking for chronic disease prevention, management and treatment were:
    • Emergency cardiac services at Simi Valley Hospital. One person said, “Everyone
       knows that if there’s a cardiac emergency, you will need to go to Los Robles
       Hospital in Thousand Oaks.”
    • Free or low-cost health care services and medications
    • Low-cost testing and screening services for blood pressure, cholesterol, etc.
    • Shelter (housing) for homeless with chronic diseases
    • Medication management assistance for seniors and the homeless, including
       when to take what, how to refill, etc.
    • Services for thyroid problems, which has seen a recent increase at the Simi
       Valley Free Clinic
Some respondents felt that there are a lot of services available but that more
marketing/promotion is needed to inform people how to take care of themselves or to
direct people to the sources of information and/or services

                                                                                   38
Past or Present Partnerships with Simi Valley Hospital
A number of interviewees identified Simi Valley Hospital contributions to partnership
activities, such as:
    • Provide used blankets, pillows and bed linens
    • Provide lab work for patients for free and medications for free in conjunction with
        a local pharmacy
    • Provide supplies or equipment
    • Identify opportunities for their doctors and nurses to serve as volunteers
    • Support fundraisers
    • Staff serve as a keynote speakers for community presentations
    • Service on Boards of Directors
    • Demonstrate healthy cooking and healthy snacks for youth
    • Provide screenings for youth (in past)

Local organizations have contributed to these partnerships in ways that include:
   • Host community events and workshops for Hospital
   • Promote events – health fairs, flu shots, cancer screenings, etc.
   • Provide case management services for homeless patients in the Hospital
   • Support Hospital fundraisers, such as Hats Off to Women

Opportunities to Increase the Partnership with Simi Valley Hospital
A number of ideas for partnership activities were suggested. Several positive comments
were also made about the Hospital, including:
   • “While there are always opportunities for more partnership activity, there is
      satisfaction that relationship is as good as it is and we can explore more
      opportunities in the future.”
   • “The Hospital has made great strides in being more available and more open to
      discussion. In the past, the Hospital was its own entity – now it is more involved
      in the services of the community.”

Several participants commented on improvements to the reputation of Simi Valley
Hospital in recent years. These comments include:
   • Employees who recently got services there (both inpatient and outpatient) were
      very pleased with the services
   • Hospital has made a clear attempt to improve its image and structure in the
      community, and has done a good job
   • Hospital opened new wing/building, which has improved the reputation of the
      Hospital
   • The Hospital is now recognizing that it’s in everyone’s best interest for everyone
      to be healthy. New leadership at Hospital is probably the biggest reason for this
      philosophical change
   • The Hospital has been making changes for the greater good
   • Hospital is doing more now than ever before in the community
   • The Hospital has a good presence in the community and a positive image



                                                                                       39
   •   Simi Valley Hospital has come a long way in improving their reputation and
       status in the community. The new tower (modernization) has been a great help,
       because the other facilities were so old
   •   Relationship between us and the Hospital is terrific and nothing like it used to be.
       Used to be virtually nonexistent. Now there’s such a difference, and I’m a huge
       supporter
   •   Leadership now is vastly different from leadership that was there before. The
       leadership now gets it – that we are all in this together!
   •   It is great that the Hospital is doing outreach. This is important. It seems that they
       are trying to promote the new things available at the Hospital. The number one
       positive focus has been on newborns. They have modernized these facilities and
       are promoting them
   •   Just happy to see the direction the Hospital is going, and it is noted in the
       community
   •   Hospital doing a good job and moving in the right direction and we appreciate
       their work in the community

Suggestions for ways that the Hospital and community can partner together include:
  • Private businesses in town can support Hospital fundraisers
  • Local businesses and nonprofit organizations could offer space for classes or
     community outreach
  • Hospital could provide flu shots through school districts
  • Hospital could provide some services for low-income and uninsured patients that
     are not otherwise available (e.g., x-rays, mammograms) and maybe some
     surgeries or procedures that patients need but cannot afford
  • Hospital nurses could administer medications for diabetic children at the schools,
     as nurses are now required for this but are not on staff at the schools
  • Provide support groups for diabetes onsite at community organizations
  • Provide community health education at schools and community organizations

Role(s) that Simi Valley Hospital Currently Plays in the Community
The Hospital contributions that were noted by the participants include:
   • Provide uncompensated care through emergency room and don’t turn people
     away based on inability to pay
   • Participate in a lot of functions in town (e.g., health fairs, street fairs, health
     expos) and offer free screenings and information
   • Flu clinics
   • Offer one day of salary per year to all employees to volunteer for any nonprofit in
     the community
   • Free lectures/presentations/speaking engagements in the community
   • Send a nice mailer out to community that includes their offerings
   • Participate in community organizations that help low-income people
   • New patient tower is a symbol of rededication of the Hospital’s commitment to
     serving the community
   • Hospital getting involved with the community and wanting to find out what they
     can do and how they can do it

                                                                                          40
   •   Prostate cancer clinic
   •   Give away a lot of free services
   •   Inform the public about their services and upgrade quality of services

Role(s) that Simi Valley Hospital Could or Should Play in the Community
The roles that the Hospital could or should play included:
   • Offer education classes to prevent/manage diabetes and heart disease and other
      chronic diseases, as well as on prevention (include a focus on heart health and
      danger signs among women)
   • Provide free cholesterol testing, blood pressure checks, cancer screening,
      carotid artery testing as well as other free screenings
   • Provide education in schools about nutrition and exercise, including ideas for
      school lunches and education on how to order when you go out to eat
   • Support and promote primary and urgent care health services for very low-
      income, working people. It was noted that this would benefit the hospital by
      reducing unneeded emergency department visits
   • Provide lab work to patients who cannot afford the tests
   • Involve Hospital staff on boards of directors of nonprofits
   • Support health fairs and career days to teach young kids about career options.
      Also teach young kids how to talk to their doctors and how to use the health care
      system
   • Serve as a leader in community-wide initiatives and partnerships in all aspects of
      prevention
   • Provide flu shots onsite at community agencies where transportation is a barrier
   • Sponsor a farmer’s market on the Hospital grounds and use the fresh foods in
      the cafeteria

Recommendations for Improving Access to Care and Community Health
Status
   •   Provide prevention and wellness services, health care exams and consultations,
       prenatal care for those who can’t afford it, and provide for children who need
       access to care
   •   Help the uninsured by providing the full spectrum of services (preventive, primary
       care, specialty, dental services, vision care, etc.)
   •   Reduce inappropriate emergency room (ER) use:
          o Upgrade ER or start urgent care center for uninsured so people don’t use
              ER inappropriately
          o Institute 24-hour “Ask a Doctor/Nurse” line to help determine who needs
              ER services
   •   Improve and update facilities of local nonprofits to provide more services with
       current equipment and resources
   •   Create transitional housing with comprehensive services for homeless as well as
       respite care as homeless people recover from medical conditions
   •   Embark on a healthy lifestyles, healthy living, self-care program
   •   Provide comprehensive community health education for all people in the
       community:

                                                                                       41
        o Educate kids in the schools so they learn about health issues while they
            are young
        o Educate adults about chronic disease prevention (all languages needed)
        o Promote vaccines. Educate people on how they protect the public’s
            health and that they are safe
•   Provide community outreach and services in the community (e.g., immunization
    clinics, medical screenings, preventive services)
•   Contribute to Simi Valley Community Foundation because the Foundation knows
    the community’s needs and priorities
•   Develop a one-stop human services center
•   Develop an information/education campaign to help people find services that are
    relevant for their needs




                                                                                 42
                                     Benchmark Comparisons
Where data are available, health and social indicators in the Simi Valley Hospital
service area are compared to established goals or benchmarks. The bolded items are
indicators in the Hospital service are that do not meet established benchmarks; non-
bolded items meet or exceed benchmarks.

Service Area Data                               Goal/Benchmark                            Source
Heart disease deaths                            Heart disease deaths                      Healthy People 2010
150.5 per 100,000                               166 per 100,000
Diabetes deaths                                 Diabetes deaths                           Healthy People 2010
14.3 per 100,000                                45 per 100,000
Cancer deaths                                   Cancer deaths                             Healthy People 2010
134.8 per 100,000                               159.9 per 100,000
Unintentional injury deaths                     Unintentional injury deaths               Healthy People 2010
45.0 per 100,000                                17.5 per 100,000
Suicides                                        Suicides                                  Healthy People 2010
11.6 per 100,000                                5.0 per 100,000
Early prenatal care                             Early prenatal care                       Healthy People 2010
87.5% of women                                  90% of women
Low birth weight infants                        Low birth weight infants                  Healthy People 2010
6.4% of live births                             5.0% of live births
Infant death rate                               Infant death rate                         Healthy People 2010
7.0 per 1,000 live births                       4.5 per 1,000 live births
Child health insurance rate                     Child health insurance rate               Healthy People 2010
93.9%                                           100%
Adult health insurance rate                     Adult health insurance rate               Healthy People 2010
87.9%                                           100%
Adult obese                                     Adult obese                               Healthy People 2010
20.1%                                           15%
Youth overweight or obese                       Youth overweight or obese                 Healthy People 2010
13.1%                                           5%
Childhood asthma                                Childhood asthma                          Healthy People 2010
11.4%                                           5%
Violent crime rate                              Violent crime rate                        State of California
140.2 per 100,000                               469.0 per 100,000
Property crime rate                             Property crime rate                       State of California
803.7 per 100,000                               1677.0 per 100,000
Annual adult influenza vaccination              Annual adult influenza vaccination        Healthy People 2010
67.5%                                           90%
Adults who have received                        Adults who have received                  Healthy People 2010
pneumococcal vaccination                        pneumococcal vaccination
58.4%                                           90%
Adults engaging in binge drinking               Adults engaging in binge drinking         Healthy People 2010
26.9%                                           6%
Cigarette smoking by adults                     Cigarette smoking by adults               Healthy People 2010
13.7%                                           12%
Adults 50+ who have had a                       Adults 50+ who have had a                 Healthy People 2010
sigmoidoscopy or colonoscopy in the last        sigmoidoscopy or colonoscopy in the
5 years and/or blood stool test in the last 2   last 5 years and/or blood stool test in
years                                           the last 2 years
76.8%                                           50%
Adult women who have had a Pap                  Adult women who have had a Pap            Healthy People 2010
smear in the last three years                   smear in the last three years
88.0%                                           90%




                                                                                                                43
Attachment 1. Simi Valley Hospital Service Area Zip Code
Map




                                                           44
     The mission of Simi Valley Hospital is to demonstrate
   God’s love by providing exceptional service and quality care
to meet the physical, mental and spiritual needs of our community.



Simi Valley Hospital • 2975 N. Sycamore Drive • Simi Valley, CA 93065
                      www.SimiValleyHospital.com

								
To top