Primary Care Initiative Community Health Assessment, Study notes of Public Health

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Primary Care Initiative

Community Health

Assessment

Final Report

August 21, 2008

Acknowledgements

y their very nature community health assessments are a collaborative effort. Accordingly, we at

the New York City Health and Hospitals Corporation (HHC) would like to begin by expressing our

deep appreciation to the numerous individuals and organizations who made the community

health assessment possible, including the thousands of New Yorkers who agreed to participate in

telephone surveys, field interviews and discussion groups. More than 3,000 surveys were conducted

over the telephone or face –to-face. Fourteen (14) community-based organizations and their respective

staff of more than 40 surveyors and discussion group facilitators conducted 1,509 field surveys in 12

languages and conducted 15 community-based discussion groups across all five boroughs of the city to

obtain the community-level feedback for the community health assessment. The community

organizations’ knowledge of the communities and target populations and their ability to engender the

trust of survey and discussion group participants were essential to our success in gathering information

from the people who traditional community health assessments often fail to reach.

We owe a debt of gratitude to the members of the Task Force on Primary Care which was convened by

New York City Council Speaker Christine Quinn’s staff, with the assistance of the Commission on the

Public’s Health System. This task force, comprised of representatives from many diverse community

organizations, community health centers and others, strongly recommended that a community health

assessment was integral to determining need and locations for primary care. Without their emphasis on

the need for the voices of the community to inform planning and program funding processes, the

Primary Care Initiative Community Health Assessment would not have been undertaken.

We extend special thanks to all of the participants of the Primary Care Initiative Workgroup whose

insights were invaluable in identifying the targeted neighborhoods, developing strategies to gather

information from hard-to-reach populations, and designing the assessment tools and methodologies.

We also express our appreciation for the guidance and overall support for this initiative provided by our

government colleagues. Specifically, we thank Rima Cohen and Tamiru Mammo from Deputy Mayor for

Health and Human Services Linda Gibbs’ office; Sarah Brannen, Adira Siman, and David Pristin, staff of

the New York City Council; and Deputy Commissioner Louise Cohen and Hayley Figueroa of the New

York City Department of Health and Mental Hygiene for their efforts.

Tripp Umbach, Inc. provided essential assistance throughout the conduct of the community needs

assessment. In particular, we thank their staff, Nichole Parker, Kenneth Schott, and Ha Pham who were

directly involved in the assessment’s design and implementation, data analysis, and development of this

report.

The generosity of Sue Kaplan, Clinical Associate Professor of Public Policy at New York University’s

Wagner School, and Ninez Ponce, Associate Professor at UCLA’s School of Public Health, in sharing with

members of the workgroup what they have learned from their extensive experience conducting similar

assessments and providing suggestions concerning methodology, is much appreciated.

B

Also, we acknowledge the fine work of Dona Green, Senior Assistant Vice President of Corporate

Planning Services at HHC, and her staff— Kathleen Whyte, David Barnes, and Scott Penn. They

conducted the research, developed materials, provided technical support, and staffed all aspects of this

report’s preparation and production. The project would not have been completed without their

dedication, attention to detail, and good humor.

Finally, we are grateful for the vision and leadership of New York City Mayor Michael R. Bloomberg and

City Council Speaker Quinn for their commitment to improving the health and health care of all New

Yorkers.

To all of you, we offer our heartfelt thanks.

La Ray Brown

Senior Vice President

Corporate Planning, Community

Health and Intergovernmental

Relations

New York City Health and Hospitals

Corporation

Acknowledgments (continued)

PRIMARY CARE INITIATIVE WORKGROUP PARTICIPATING ENTITIES Alianza Dominicana Asian & Pacific Islander Coalition on HIV/AIDS Bedford Stuyvesant Family Health Center Brooklyn Perinatal Network Caribbean Women’s Health Association Commission on the Public’s Health System Community Healthcare Network Community Health Care Association of NY Community Service Society of New York - NYC Managed Care Consumer Assistance Program Hunter College Institute for Urban Family Health Korean Community Services of Metropolitan NY Lehman College Make the Road New York New York City Council, Policy Division and Health Committee New York City Department of Health and Mental Hygiene New York City Health and Hospitals Corporation New York City Office of the Deputy Mayor for Health and Human Services New York Immigration Coalition Primary Care Development Corporation Project Hospitality Ryan/Chelsea-Clinton Community Health Center The Bronx Health Link Urban Health Plan William F. Ryan Community Health Center

COMMUNITY HEALTH EVALUATORS African Refuge Brooklyn Perinatal Network Caribbean Women’s Health Association Hearing Loss Association of America-Manhattan Chapter Korean Community Services of Metropolitan New York League for the Hard of Hearing Make the Road New York Pragati Queens Health Coalition Reconciliation and Culture Cooperative Network (RACCOON) Rockaway Development and Revitalization Corporation (RDRC) The Bronx Health Link The Indochina Sino-American Community Center The Restaurant Opportunities Center of New York (ROC-NY)

ROUNDTABLE KEY INFORMANTS Children’s Defense Fund Esperanza del Barrio Hispanic Federation Safe Space, Inc.

PROJECT CONSULTANT Tripp Umbach, Inc.

Primary Care Initiative

Community Health Assessment Table of Contents

Primary Care Initiative Community Health Assessment

• EXECUTIVE SUMMARY Table of Contents
• OVERVIEW
• METHODOLOGY
• DISCUSSION GROUP FINDINGS
  • ADOLESCENTS (FEMALE AND MALE, AGES 13 – 18) ...........................................................................................................
  • AFRICAN AMERICAN/BLACK MEN (AGES 21 – 50) .............................................................................................................
  • AFRICAN AMERICAN/BLACK MEN (AGES 62 AND OLDER)
  • ALBANIANS IN THE BRONX .............................................................................................................................................
  • CHINESE ELDERS ..........................................................................................................................................................
  • DOMESTIC WORKERS ....................................................................................................................................................
  • ENGLISH SPEAKING WEST AFRICANS IN STATEN ISLAND .......................................................................................................
  • FEMALE VICTIMS OF DOMESTIC VIOLENCE ........................................................................................................................
  • GAY, LESBIAN, BISEXUAL, TRANSGENDER, AND QUESTIONING (GLBTQ) ADOLESCENTS (FEMALE AND MALE, AGES 15 – 20) ..........
  • HEARING IMPAIRED AND DEAF ADULTS ............................................................................................................................
  • KOREAN AMERICANS ..................................................................................................................................................
  • MEXICAN, NICARAGUAN, AND ECUADORIAN MALES (AGES 50 AND OLDER) .........................................................................
  • PARENTS OF CHILDREN WITH PHYSICAL AND DEVELOPMENTAL DISABILITIES...........................................................................
  • PARENTS OF CHILDREN WITH MENTAL ILLNESS.................................................................................................................
  • SOUTH ASIAN ELDERS .................................................................................................................................................
  • HEALTH AND HUMAN SERVICES CBO ROUNDTABLE DISCUSSION.........................................................................................
• TELEPHONE AND FIELD SURVEY FINDINGS
  • BRONX 1 ..................................................................................................................................................................
  • BRONX 2 ..................................................................................................................................................................
  • BROOKLYN 1 .............................................................................................................................................................
  • BROOKLYN 2 .............................................................................................................................................................
  • BROOKLYN 3 .............................................................................................................................................................
  • MANHATTAN 1 ..........................................................................................................................................................
  • MANHATTAN 2 ..........................................................................................................................................................
  • QUEENS 1.................................................................................................................................................................
  • QUEENS 2.................................................................................................................................................................
  • QUEENS 3.................................................................................................................................................................
  • STATEN ISLAND......................................................................................................................................................
• CONCLUSIONS AND RECOMMENDATIONS
• APPENDIX A: KEY SURVEY FINDINGS
  • AGE AND GENDER ......................................................................................................................................................
  • EDUCATIONAL LEVEL ...................................................................................................................................................
  • COUNTRY OF BIRTH .................................................................................................................................................... Table of Contents
  • TOP TEN NON-US COUNTRIES OF BIRTH ........................................................................................................................
  • AVERAGE NUMBER OF YEARS IN THE UNITED STATES/AVERAGE NUMBER OF YEARS IN NEW YORK CITY .....................................
  • RACE .......................................................................................................................................................................
  • ETHNICITY .................................................................................................................................................................
  • LIVING PATTERNS
  • LANGUAGE SPOKEN AT HOME ......................................................................................................................................
  • HOUSEHOLD SIZE AND INCOME .....................................................................................................................................
  • EMPLOYMENT ...........................................................................................................................................................
  • TOP FIVE BARRIERS TO SEEING A DOCTOR OR NURSE IN NEIGHBORHOOD .............................................................................
  • TOP FIVE PROVIDER TYPES DIFFICULT TO ACCESS IN THEIR NEIGHBORHOOD ..........................................................................
  • ACCESSING HEALTH CARE IN THE NEIGHBORHOOD ............................................................................................................
  • TOP FIVE REASONS FOR GETTING HEALTH CARE OUTSIDE OF THE NEIGHBORHOOD .................................................................
  • TOP FIVE MAIN REASONS FOR GETTING HEALTH CARE OUTSIDE OF THE NEIGHBORHOOD ........................................................
  • NEIGHBORHOOD LESS THAN 2 YEARS .............................................................................................................................. RESPONDENTS NOT GETTING HEALTH CARE IN LAST 2 YEARS OR SINCE MOVING TO NEIGHBORHOOD IF RESPONDENT LIVED IN
  • REASONS FOR NOT GETTING HEALTH CARE .....................................................................................................................
  • TOP FIVE REASONS FOR NOT GETTING HEALTH CARE DESPITE THE NEED ..............................................................................
  • MOST CONVENIENT LOCATION FOR GETTING HEALTH CARE................................................................................................
  • AVERAGE TRAVEL TIME TO WORK/OTHER PLACES............................................................................................................
  • HAVING HEALTH INSURANCE ........................................................................................................................................
  • HAVING A MEDICAL HOME ..........................................................................................................................................
  • EMERGENCY ROOM AS MEDICAL HOME .........................................................................................................................
  • BOROUGH OF MEDICAL HOME .....................................................................................................................................
  • TRAVEL TIME TO MEDICAL HOME .................................................................................................................................
  • WHO GOES TO TRADITIONAL HEALERS? .........................................................................................................................
  • REASONS WHY PEOPLE GO TO TRADITIONAL HEALERS .......................................................................................................
• APPENDIX B: STATEN ISLAND COMMUNITY HEALTH ASSESSMENT
  • I. PROJECT INTRODUCTION AND METHODOLOGY ..............................................................................................................
  • II. KEY FINDINGS AND RECOMMENDATIONS ....................................................................................................................
  • III. STATEN ISLAND OVERVIEW ......................................................................................................................................
  • IV. CLARITAS DEMOGRAPHIC PROJECTIONS .....................................................................................................................
• APPENDIX C: PRIMARY CARE INITIATIVE COMMUNITY HEALTH ASSESSMENT SURVEY
• APPENDIX D: PRIMARY CARE INITIATIVE COMMUNITY HEALTH ASSESSMENT SCREENING SHEET
• APPENDIX E: DISCUSSION GROUP DEMOGRAPHIC FORM
• APPENDIX F: GENERAL DISCUSSION GROUP TOPIC GUIDE
• APPENDIX G: TABLES OF FIGURES
  • CHARTS ....................................................................................................................................................................
  • EXHIBITS ...................................................................................................................................................................

Primary Care Initiative Community Health Assessment Table of Contents

FIGURES FROM STATEN ISLAND COMMUNITY HEALTH ASSESSMENT ..................................................................................... MAPS ...................................................................................................................................................................... TABLES .....................................................................................................................................................................

Primary Care Initiative Community Health Assessment Executive Summary

EXECUTIVE SUMMARY

REPORT OVERVIEW

his report summarizes the findings of an assessment of barriers to obtaining health care in

underserved communities in New York City (NYC), with a focus on community residents’

articulation of their experiences accessing primary health care. The stimulus for the

implementation of a community health assessment came from a Task Force on Primary Care convened

by New York City Council Speaker Christine Quinn’s staff, assisted by the Commission on the Public’s

Health System. The diverse group of community organizations, staff from various Council Members’

offices, community health centers, health care advocates, city health agencies, labor organizations, and

academic institutions comprising the Task Force discussed the potential impact of the policy and facility-

specific recommendations of the Commission on Health Care Facilities in the 21st Century on primary

care access and capacity in New York City. The Task Force also identified a pressing need to formulate a

strategy for leveraging funding for primary care expansion through the Health Care Efficiency and

Accountability Law for New Yorkers (HEAL NY) and provisions of New York State’s 1115 Medicaid waiver

(the Federal-State Health Reform Partnership, or F-SHRP). Many Task Force members spoke of the

dissolution of the primary care infrastructure in certain communities as a result of recent hospitals’

closures or retrenchments in primary care operations. Task Force members also strongly recommended

that any determination of need and location for primary care had to emanate from a community health

assessment.

In late fiscal year 2006, Council Speaker Quinn announced a commitment to develop additional primary

care capacity. In the City’s fiscal year 2008 budget, the Mayor provided $745,000 in expense funds to

support the Primary Care Initiative (PCI). The New York City Health and Hospitals Corporation (HHC) was

commissioned to conduct a community health assessment that would inform the use of PCI funding to

expand primary care access and capacity in fiscal years 2008 through 2011. Findings of the community

health assessment would also be shared with the New York State Department of Health to use in its

HEAL NY funding decisions concerning New York City.

HHC established the PCI Workgroup to begin a collaborative effort to determine how community

residents’ perspectives concerning their health care needs and experiences in accessing primary care

services could be assessed. The PCI Workgroup was also asked to advise on the identification of high-

need communities in which initial investments should be made.

The PCI Workgroup agreed that the assessment should use both quantitative and qualitative methods to

capture each targeted community’s concerns. A survey instrument was developed and subsequently

administered over the telephone and in the field (quantitative method) and discussion groups were

conducted to glean more anecdotal and experiential information (qualitative method). As a precursor

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Primary Care Initiative Community Health Assessment Executive Summary

to the survey and discussion group process, a representative array of underserved communities had to

be systematically selected and defined so that Workgroup findings could be reliably used for planning

and program development purposes. To identify these communities, the Workgroup relied on

secondary data (i.e., data that has been previously collected) to measure those factors that typically

influence access to health care in most communities. In addition, a subgroup of the PCI Workgroup was

convened to identify targeted communities through the use of additional data and their own experience

of working in underserved communities.

The Workgroup developed a telephone and field survey tool partly based on surveys successfully used in

other parts of the country by local departments of health, community-based groups, and schools of

public health to reach similar populations. HHC also retained Tripp Umbach, Inc. to conduct telephone

surveys and collaborate with community-based organizations’ (CBOs) staff on the administration of a

face-to-face survey, co-facilitate discussion groups, and analyze the resulting quantitative and

qualitative data. Tripp Umbach has expertise in providing customized market research and community

needs assessment to health care organizations across the country and in New York City. Tripp Umbach

contracted with fourteen CBOs with health care-related backgrounds, which were selected for their

grass-roots expertise and credibility with local residents and health care consumers who are typically

resistant to formal evaluation and survey efforts. Tripp Umbach and the contracted CBOs administered

a 69-question survey over the telephone and via face-to-face field interviews. Of the 3,042 surveys

completed, half were collected over the telephone and half through face-to-face interviews. CBO staff

conducted the face-to-face surveys in the diverse languages spoken by community residents. In

addition, Tripp Umbach and the CBOs co-facilitated 15 discussion groups. Finally, the PCI Workgroup

and a discussion group with health and human services organizations serving New York City were

convened to elicit feedback on survey results and discussion group findings.

To determine which New York City neighborhoods/regions to target for the community health

assessments, all New York City ZIP codes were rated on the following ten variables related to poor

health care access:

1. Percentage of households living in poverty

2. Medicaid-eligible population

3. Medicaid-eligible population per primary care provider

4. Percentage of population that is foreign-born

5. Preventable hospitalization rates – children

6. Preventable hospitalization rates – adults

7. Households living in linguistic isolation

8. Median household income

9. Number of uninsured patients using the New York City public hospital system

10. Located within a Health Professional Shortage Area (HPSA)

Primary Care Initiative Community Health Assessment Executive Summary

In each City ZIP code, each variable was measured on a scale from 1 to 10^1 with lower values reflecting

less need and higher values reflecting more need. ZIP codes were ranked on the basis of their aggregate

score across the ten criteria. Ten geographic clusters or communities were formed from the ZIP codes

that had the highest composite scores, creating the ten targeted regions for the PCI assessment. It was

further determined that surveys would be administered in 27 ZIP codes. In addition, the PCI Workgroup

further refined the list of targeted communities through the use of additional data such as findings from

prior assessments completed for similar areas and their experience of working in underserved

communities. Because HHC and the Community Health Center of Richmond had engaged Tripp Umbach

to conduct a study in 2007 which focused on health care access on Staten Island, it was determined that

the PCI Workgroup could rely on the results of that survey as an essential component of the data for this

report. The data from the 2007 study^2 has been integrated into this report’s recommendations. In

addition, one of the 15 discussion groups was conducted on Staten Island and this qualitative

information is also reported in the study findings. Therefore, targeted communities from all five New

York City boroughs are considered.

Please refer to Table 1: PCI Regions, ZIP Codes, and Neighborhoods below for information about the ten

communities, their ZIP codes, and their associated neighborhoods.

Table 1: PCI Regions, ZIP Codes, and Neighborhoods

Regions ZIP Codes Neighborhoods Brooklyn 1: North Brooklyn 11206, 11237, 11221 East Williamsburg, Bushwick, and Bedford Stuyvesant

Brooklyn 2: Central Brooklyn 11233, 11212, 11207, 11208 Brownsville, Crown Heights, East New York, and NewLots

Brooklyn 3: Flatbush 11226 Flatbush and Ditmas Park Bronx 1: South Bronx 10452, 10456, 10454 Mott Haven, Melrose, Highbridge, and Morrisania

Bronx 2: Central Bronx 10458, 10453, 10457,10460, 10472 University Heights, East Tremont, Fordham, andMorris Heights

Manhattan 1: East Harlem/ Central Harlem 10029, 10039^ East Harlem and Central Harlem Manhattan 2: Lower East Side 10002 Lower East Side and Chinatown

Queens 1: Western Queens 11377, 11373, 11368, 11106 Corona, Jackson Heights, Woodside, Elmhurst, LeFrakCity, Astoria and Long Island City

Queens 2: Southeast Queens 11436, 11435, 11434 South Jamaica, Hollis, St. Albans, and SpringfieldGardens

Queens 3: Far Rockaway 11691 Far Rockaway and Edgemere Staten Island^3 All ZIP codes All Staten Island neighborhoods

(^1) Number of uninsured patients using the NYC public hospital system used a scale of 1 to 20, giving this variable twice the weight of the other variables. 2 Please refer to Appendix B: Staten Island Community Health Assessment on page 239. (^3) This report utilizes the findings and recommendations from the 2007 Staten Island Community Health Assessment, commissioned by the Community Health Center of Richmond County (CHCR), as its main source of quantitative data for Staten Island. (See Footnote 2.)

Primary Care Initiative Community Health Assessment Executive Summary

FINDINGS

here is widespread agreement that easy access to primary care – the main vehicle of preventive

medicine – is good public policy. Inadequate primary care capacity and access worsens health

care status, allows chronic conditions to go unmanaged, and results in more expensive back-end

care. Yet, despite the clear advantages of a health care system that promotes preventive care and

ensures access to effective primary care, evidence from the Primary Care Initiative Community Health

Assessment indicates that the experience of seeking and obtaining primary health care in New York

City’s lower income neighborhoods is often a discouraging experience. Rather than reinforcing health

seeking behavior, the experience is laden with deterrents.

When asked the question about which providers are most difficult to access, 49.7% of all survey

respondents and a majority of discussion group participants reported that their neighborhood had an

acute need for more dentists. In addition, more than one-third of the survey respondents said their

neighborhood needed more primary care doctors. Fifteen percent of survey respondents who answered

this question also identified difficulty accessing mental health services. These findings are not surprising

in light of the fact that the study’s neighborhoods were, in part, chosen because of their designations as

Health Professional Shortage Areas (HPSA). Nevertheless, they are compelling and require action.

Survey and discussion group participants alike consistently reported that they had to wait too long to

get an appointment; they had to wait too long in the waiting room; that doctors and nurses did not

listen to them or spend enough time with them; and that the cost of health care or lack of insurance was

a significant impediment to receiving health care.

Discussion group participants highlighted additional problems. While it is recognized that language

access in health care delivery is critical, many non-English speaking discussion group participants

described barriers to care as a result of the lack of availability of translated forms and culturally

competent interpreters. A common theme across discussion groups was that health care staff, including

doctors, are often not sufficiently respectful of patients who have special needs or who are from a

different demographic. Discussion group participants consistently reported that they experienced

difficulty in navigating the health care system, particularly in obtaining health care coverage and locating

the services they need. Discussion group participants also reported a lack of knowledge about where to

go for reliable sources of health care information. Additionally, discussion group participants expressed

a need for a simpler public health insurance application process and higher income eligibility levels for

adults.

The Elderly find that accessing appropriate and affordable transportation is often challenging,

particularly when they must use several specialists who are not co-located. Parents of children with

physical or developmental disabilities also described the lack of co-located specialists as a significant

barrier to their children receiving quality care. For example, autistic children can have difficulty adapting

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Primary Care Initiative Community Health Assessment Executive Summary

to new environments, which is exactly what they must do when visiting specialists in numerous

locations.

Overall, study participants highlighted a wide range of barriers to accessing high quality primary care in

their neighborhoods. Fortunately, none are insurmountable. However, the creation of an efficient and

effective primary care infrastructure requires investments beyond what the local government can

realistically provide. Therefore, the City and the State must combine resources to address these issues.

RECOMMENDATIONS

We make the following recommendations based on what we have learned from the voices of more than

3,000 community residents.

1. Primary care capacity needs to be expanded in New York City. The PCI Community Health

Assessment findings and other reports show that many communities in New York City lack

access to this basic health care service. Primary Care Initiative and HEAL NY primary care

funding must be allocated to increase staff capacity and capital development in target

neighborhoods. The PCI Community Health Assessment findings should be used to drive these

decisions.

2. Dental and mental health services are sorely lacking in many New York City communities.

City/State task force(s) must be convened and charged with devising creative strategies to

increase the availability of dental services and mental health services in medically underserved

communities. The City’s dental schools must be included as part of the solution to this problem.

New York State’s “Providers Across New York” program must be used to increase dentists and

mental health capacity in targeted communities.

3. New York City and the State of New York must combine resources/leverage the availability of

local (PCI), state (HEAL NY), and federal (F-SHRP) funding to effectively increase primary care

capacity in target communities.

4. PCI funding priority must be given to health centers and other providers that serve low-income

uninsured patients, and have in place fee scale policies that facilitate access and assist patients

to obtain public health insurance.

5. Investments must be made in health centers and other primary care settings to train front-line

and direct care staff in models of patient-centered care. In addition, resources should be made

available to health centers and other primary care practices to re-engineer/redesign the patient

care experience into one that is patient-centered and creates additional capacity with existing

facility and staff resources.

Primary Care Initiative Community Health Assessment Executive Summary

There are proven strategies for re-engineering patient scheduling and patient flow which create

capacity, reduce waiting times, create appointment access, facilitate communication between

provider (teams) and patients, and increase continuity of patient care. Some health

centers/providers may need one-time funding support to implement these strategies.

6. Although low-cost health services, public health insurance, and legal protection through

Manny’s Law (the New York State law that requires hospitals to establish procedures for

providing financial assistance to patients) exist, better efforts must be made to educate

particular communities about these resources. Grass roots community-based organizations

should be supported so they may expand outreach and educational campaigns to target hard-

to-reach groups and promote these resources. PCI and State funding should support these

efforts where they are needed most.

7. Funding incentives must be made available for health centers and other primary care

providers/organizations to develop or strengthen a culturally and linguistically responsive

primary care service infrastructure. Specific incentives could be for:

a. Recruitment and training costs associated with the expansion of a cadre of culturally

and linguistically competent staff and/or interpreters available for face-to-face

interactions with patients.

b. Increased availability of remote telephone and video interpretation resources, if face-to-

face skilled interpretation is not available, within primary care settings.

c. Development of mechanisms to coordinate/integrate language access services into

program operations (e.g. creating flags in the scheduling system that alert staff of the

need of patients requiring language access/interpreter services; embedding in reminder

call mechanisms questions concerning language preference; etc.).

d. Development of curriculum for and skills training of the primary care workforce in

patient centered care, cultural competency, linguistic proficiency and sensitivity to

individuals with special needs (NYC’s 311 system should make information available

concerning providers that have completed the above-referenced skills training

curriculum).

8. Resources must be made available to assist health centers/providers in providing self

management support (e.g. education, care plans, etc.) for patients with special needs and/or

chronic conditions. New funding may support ancillary staff or other means of making self-

management resources available to patients.

Primary Care Initiative Community Health Assessment Executive Summary

9. Start up funding must be provided to expand capacity (e.g., specialists’ hours; multi-specialty

coordinated team practices, mental health consultation services, etc.) within existing primary

care settings to address the service requirements of special needs populations.

10. Funding must be provided to support ancillary expenses associated with the

coordination/integration of services for special needs patients into program operations (e.g.,

patient navigators; peer support; accommodation forms completed at registration or other

methods that alert staff to the special needs of the patients; staff training, etc.)

11. Resources should be made available to health centers and other primary care providers for

technical assistance which helps them maximize earned revenue ( i.e., to obtain all of the

funding they are entitled to from third party payers). Improved financial performance will

enhance centers’/practices’ sustainability thus helping them serve low-income communities.

12. Health centers’ or other providers’ should implement electronic, web-based, or other non-

traditional methods of communicating with patients to increase access and facilitate improved

provider/patient interaction; PCI resources could be used to support this initiative.

13. Funding should be made available for community-based organizations to implement a campaign

that promotes the availability of prescription assistance programs (and how to obtain) to

residents in high-need, underserved communities.

14. Funding should be provided to health centers and other providers for the installation of Assisted

Listening Devices and other forms of technology that facilitate access to effective primary care

by patients who are deaf or hearing impaired.

Primary Care Initiative

DISCUSSION GROUP FINDINGS

Overview

OVERVIEW

his report summarizes the findings of an assessment of barriers to obtaining health care in

underserved communities in New York City (NYC), with a focus on community residents’

articulation of their experiences accessing primary health care. The stimulus for the

implementation of a community health assessment came from a Task Force on Primary Care convened

by New York City Council Speaker Christine Quinn’s staff, assisted by the Commission on the Public’s

Health. The diverse group of community organizations, staff from various Council Members’ offices,

community health centers, health care advocates, city health agencies, labor organizations, and

academic institutions comprising the Task Force discussed the potential impact of the policy and facility-

specific recommendations of the Commission on Health Care Facilities in the 21st Century on primary

care access and capacity in New York City. The Task Force also identified a pressing need to formulate a

strategy for leveraging funding for primary care expansion through the Health Care Efficiency and

Accountability Law for New Yorkers (HEAL NY) and provisions of New York State’s 1115 Medicaid waiver

(the Federal-State Health Reform Partnership, or F-SHRP). Many Task Force members spoke of the

dissolution of the primary care infrastructure in certain communities as a result of recent hospitals’

closures or retrenchments in primary care operations. Task Force members also strongly recommended

that any determination of need and location for primary care had to emanate from a community health

assessment.

In late fiscal year 2006, Council Speaker Quinn announced a commitment to develop additional primary

care capacity. In the City’s fiscal year 2008 budget, the Mayor provided $745,000 in expense funds to

support the Primary Care Initiative (PCI). The New York City Health and Hospitals Corporation (HHC) was

asked to conduct a community health assessment that would inform the use of PCI funding to expand

primary care access and capacity in fiscal years 2008 through 2011. Findings of the community health

assessment would also be shared with the New York State Department of Health to use in its HEAL NY

funding decisions concerning New York City.

HHC established the PCI Workgroup to begin a collaborative effort to determine how community

residents’ perspectives concerning their health care needs and experiences in accessing primary care

services could be assessed. The PCI Workgroup was also asked to advise on the identification of high-

need communities in which initial investments must be made.

The Workgroup developed a telephone and field survey tool partly based on questionnaires used by

local departments of health, community-based groups, and schools of public health to reach similar

populations and HHC subsequently retained consulting firm Tripp Umbach to conduct telephone

surveys, oversee administration of the field surveys and discussion groups, and to complete an analysis

of resulting quantitative and qualitative data. Tripp Umbach has conducted customized market research

and community health assessments across the country and in New York City. Fourteen community-

T

Primary Care Initiative Discussion Group Report

OVERVIEW

based organizations were selected to provide grass-roots expertise; conduct neighborhood based face-

to-face field surveys in the diverse languages spoken by community residents, and to co-facilitate

discussion groups. Finally, the PCI Workgroup and a discussion group with health and human services

organizations serving New York City were convened to elicit feedback on survey results and discussion

group findings.

One constraint regarding the assessment must be noted. A holistic community health assessment

typically attempts to obtain – usually through existing data sources – information on current health care

providers and services. Although this is a plethora of data on health status in New York City, there are

few databases, public or proprietary, which identify both primary care provider and facility resources or

provide that information at a level of detail appropriate/suitable for the present need. Such data would

have added a valuable layer of information about access in the targeted communities. However, to

undertake a complementary study to identify health resources in all of the selected regions would have

been cost prohibitive. Therefore, the assessment did not attempt to identify services nor available

providers in each region. However, an access indicator related to health resources – the number of

physicians per capita in each New York City ZIP code – was one of the criteria used in the selection of the

target neighborhoods/regions.