Online Program

Breaking the code: When access to health care is comparable, socio-economic differences determine health outcomes – A community needs assessment in the Hudson Valley region, NY

Monday, November 2, 2015 : 2:30 p.m. - 2:50 p.m.

Thao Doan, MPH, School of Health Sciences and Practice and Institute of Public Health, New York Medical College, Valhalla, NY
Andrew Maroko, PhD, Lehman College, Department of Health Sciences, City University of New York (CUNY), Bronx, NY
Deborah Viola, PhD, Center for Regional Healthcare Innovation, Westchester Medical Center
Social determinants of health have long been established as critical in the evaluation of population health outcomes. Westchester Medical Center is an applicant to the New York State’s Delivery System Reform Incentive Payment Program, a Medicaid waiver that will restructure health care delivery with the goal of reducing avoidable hospitalizations by 25% over 5 years. This study presents the Community Needs Assessment’s results, conducted during the planning phase. 

Methods: We applied geographic information science and spatial analyses to Medicaid claims data to identify population-based health issues. We identified 9 “hot spot” ZIP codes with high needs and potential gaps in care. Consumer surveys across 8 counties (N=4,952) were also collected. 

Results: Despite significant differences in socio-economic characteristics, respondents from the 9 ZIPs (30%, n=1,464) reported no significant differences in their access to care and rates of health services utilization, compared to the rest of the study group. Respondents from these ZIPs, however, reported a higher ER visit rate (32% vs. 24%) and sought more health behavior-related services (alcohol abuse, substance abuse) and less preventive care (cholesterol testing), commensurate with differences in some health outcomes. 

Conclusions: Identifying “hot spots” is an essential first step in the understanding of health issues experienced by unique sub-populations. Survey results suggest that access alone may still be inadequate to address differences in health outcomes. A more holistic, socially supportive undertaking that seeks to understand the impact of neighborhood determinants, in part by working through community-based organizations, may be a better investment of health care resources.

Learning Areas:

Assessment of individual and community needs for health education
Public health or related research

Learning Objectives:
Describe New York State’s Delivery System Reform Incentive Payment Program (DSRIP), a multi- billion dollar, multi -year program designed to transform healthcare in NYS Define "hot spotting" in the context of a community needs assessment Discuss how addressing the issue of access to care alone is still inadequate in the effort of improving population health

Keyword(s): Health Care Reform, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health professional with an MPH in Maternal and Child Health. I am pursuing my Doctoral degree in Health Policy and Management at New York Medical College. I have worked as a Research Scientist and Project Director at the Research Foundation for Mental Hygiene in New York City. Currently, I am a Research Analyst at the Center for Regional Healthcare Innovation at Westchester Medical Center.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.