community needs assessment report

USC Norris Cancer Hospital Community Needs Assessment Report December 2015

Introduction:USC Norris Comprehensive Cancer Hospital is a private, non-profit service clinic affiliated with the University Of

Southern California Keck School Of Medicine. Although this is a research hospital, until recently little attention has been paid to the satisfaction of its patients in relation to care. Biel Consulting completed a Community Needs Assessment in 2013 to evaluate the geographic community surrounding Keck Medical Center of USC. A section of this assessment did address which was included into the data analysis and collection. However, this data was limited in the scope of analyzing barriers to care for the patients served at USC Norris Cancer Hospital.

The American College of Surgeons Commission on Cancer is implementing new standards that must be in place by 2015, requiring a community needs assessment to be implemented to monitor the barriers to care endemic in the hospital to be reviewed as part of the re-accreditation survey in March 2016. The recognized challenges observed will be utilized as the foundation in the planning, implementation and evaluation of the patient navigation program, ultimately promoting best practices for the services provided to USC patients. Authors:Ozivefueshe Dimowo, Master of Public Health students of Keck School of Medicine of the University of Southern California gathered and reviewed data for the Community Needs Assessment as part of their practicum hours. They were under the supervision of Gwendolyn Lynch, MBA, CTR, CCRP, Cancer Registry Director.

Methods:Primary Data Collection: This assessment was collected using a convenience sample of patients who were awaiting their appointment or had finished and were awaiting their prescriptions in all clinical areas. To power the assessment , the N-(number to ascertain statistical significance) was determined by utilizing the epidemiological information provided by the Cancer Registry Director. USC Norris Cancer Hospital served 23,815 individual patients in 2014, thus indicating that 409 surveys should be disseminated to yield sufficient power.

The survey questions were curated from the 2013 Community Needs Assessment Report. Qualtrics Analytic software was utilized to gather the necessary data. Question options categorized on a Likert scale of importance (not important to very important), yes and no responses, and multiple choice questions.

The surveys were administered on an iPad which patients could use to answer confidentially and anonymously in outpatient lobbies, radiation oncology clinic waiting areas, day hospital, and USC Norris Cancer Hospital inpatient care units. There were 238 surveys collected between mid-September and December 2015.

Secondary Data Collection:Information was used from the 2013 USC Norris Community Health Needs Assessment to gather geographical information concerning the residency of Norris Cancer Hospital’s clients (Community Needs Assessment, 2015) as a resource for understanding the barriers identified in the geographical community which were applied to the USC Norris Cancer Hospital patient population.

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Demographic ProfilePopulation by Age:

Data Source: Community Needs Assessment, 2015The majority of the population represented ages 40-65 (48.63%) of the population, followed by participants over the age of 65 (34.38%), and adults aged 25-39, which represented 12.50%. The age groups least represented in this study were youth aged 18-25 and those who preferred not to say their age, 9.38% and 3.13% respectively.

Race and Ethnicity:

Non-Hispanic whites represented the majority of the patients served at NCH in 2012. 43.16% of respondents reported identifying as non-Hispanic white, followed by Latino/Hispanics, following at 34.74%. 4.21% of the surveyors preferred not to identify, 16.84% identified as Asian, 5.26% identified as black and 4.21% identified as other. 5.27% of those surveyed were of Pacific Islander or Native American descent, and 7.37% identified as other. The survey indicates a disproportionate rate of white patients relative to their population in not only Los Angeles County but also in SPA 7, which holds a majority Latino/Hispanic population.

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# Answer Bar Response %1 18-25 22 9.38%2 25-39 31 12.50%3 40-65 96 40.63%4 Over 65 82 34.38%5 Prefer not to say 7 3.13%

Total 238 100.00%

# Answer Bar Response %1 White/Caucasian 102 43.16%2 Black/African American 13 5.26%3 Asian 40 16.84%4 Hispanic/ Latino 83 34.74%

5 American Indian or Alaskan Native 7 3.16%

6 Native Hawaiian/Pacific Islander 5 2.11%

7 Other: 18 7.37%8 Prefer not to say 10 4.21%

Total 100.00%

Data Source: Showcase

Ninety-three percent of respondents indicated that English was their preferred language, followed by Spanish at 5.2%. Contrastingly, the surrounding areas have high rates of preferred and/or monolingual Spanish speakers.

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Geographic Location:

Data Source: Showcase

The key delineates the gradient colors that represent population densities of patients served in that area. Areas with a high density of patients are represented by darker green, while populations living in the light green area are less represented among populations served by Norris Cancer Hospital. Residents of SPA 3 and 5 were highly represented in this population.

Survey administered to USC Norris Cancer Hospital Patients:

USC Norris Cancer Hospital Patient Survey Standard 4

What is your sex?

Male

Female

Prefer not to say

What is your age?

18-25

25-39 4

40-65

Over 65

Prefer not to say

What is your race/ethnicity? (Please select one or more)

White/Caucasian

Black/African American

Asian

Hispanic/ Latino

American Indian or Alaskan Native

Native Hawaiian/Pacific Islander

Other:

Prefer not to say

Which of the following best describes your current employment status: (check one)

Homemaker full time

Student full time

Retired

Employed full time

Employed part time

Self-employed full time

Self-employed part time

Unemployed for less than 1 year

Unemployed for more than 1 year

Not working because of illness or injury

Your zip code is?

Which of the issues below, if any, made it harder for you to get the cancer care that was needed? Please select all that apply.

Don’t know how to access services

Financial / no insurance / underinsured

Transportation

Location of services 5

Language barriers

Appointment scheduling/scheduling conflicts

Wait times

Housing

Lack of social support

Other (specify):

None of the above

What is your most common method of transportation to Norris?

Drive self

Companion (spouse/friend) provides transportation

Public transportation (Taxi, train, bus, etc.)

Walk

Other:

Based on your experience as a patient, please indicate how important or unimportant you believe the following cancer support services are for someone diagnosed with cancer. Using a 5 point scale, rank the following services.

Very Important Important Slightly

Important Not Very

Important Indifferent

Individual Counseling (for patient and/or family members)


Support Groups (for patient and/or family members)

Family Counseling

Psychiatric Services

Pastoral Counseling/Chaplaincy

Support Groups (for patient and/or family

members)



Family Counseling



Family Counseling



Family Counseling



Psychiatric Services Individual Counseling (for patient

Support Groups (for patient and/or

Family Counseling



6

Very Important Important Slightly

Important Not Very

Important Indifferent

and/or family members)

family members)




Family Counseling



Other



Family Counseling



Does your primary caregiver or spouse, have to take time away from work/other obligations to support your treatment schedule?

Yes

No

Are they employed full time?

Yes

No

Are they a full time homemaker/caretaker?

Yes

No

Are you satisfied with the hours of operation of the Day Hospital?

Yes

No

Comment:

Would you be willing to be seen in the Day Hospital for infusion on the day after your physician visit if you had a minimal wait time?

Yes

No

Comment:

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Are you satisfied with the days of the week that the Day Hospital operates?

Yes

No

If no, would Saturday appointments be more convenient?

Yes

No

Do you know about myUSCchart, our patient portal?

Yes

No

How often do you access myUSCchart?

Never

Once every 6 months

Once a Month

Twice a Month

Once a Week

More than once a Week

Other: (specify)

What information would you like to be available on myUSCchart?

* Thank you for your participation in our survey.*

Survey Results

Quantitative Results:8

General Barriers To CareWhich of the issues below, if any, made it harder for you to get the cancer care that was needed? Please select all that apply.

# Answer Bar Response %

1 Don’t know how to access services 31 13.16%

2 Financial / no insurance / underinsured 51 21.05%

3 Transportation 44 18.42%

4 Location of services 81 34.21%

5 Language barriers 38 15.79%

6 Appointment scheduling/scheduling conflicts 69 28.95%

7 Wait times 81 34.21%

8 Housing 25 10.53%

9 Lack of social support 25 10.53%

10 Other (specify): 25 10.53%

Total 100.00%

Transportation and wait times were perceived to be the largest barriers to care for this population. Relative to this area, the majority of the population must travel across SPAs in order to receive care,, indicating that this is a large barrier for this population.

Mode of Transportation

What is your most common method of transportation to Norris?

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# Answer Bar Response %

1 Drive self 112 47.31%

2 Companion (spouse/friend) provides transportation 100 41.94%

3 Public transportation (Taxi, train, bus, etc.) 5 2.15%

4 Walk 10 4.30%

5 Other: 10 4.30%

Total 237 100.00%

There are fewer than average barriers to care than the general population in terms of transportation, as most have their own, private methods of transportation (89.25%).

Counseling Services

Based on your experience as a patient, please indicate how important or unimportant you believe the following cancer support services are for someone diagnosed with cancer. Using a 5-point scale, rank the following services.

# Question Very Important Important Slightly

ImportantNot Very Important Indifferent Response Average

Value

1Individual Counseling (for patient and/or family members)

136 53 5 21 20 235 1.90

2Support Groups (for patient and/or family members)

88 70 26 24 27 235 2.31

3 Family Counseling 83 72 24 24 29 232 2.35

4 Psychiatric Services 70 77 27 25 33 232 2.45

5Pastoral Counseling/Chaplaincy

53 53 32 44 56 238 2.99

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6 Other 19 2 6 9 9 45 3.05

A majority of the participants considered counseling and support important or very important during the treatment process (64%), with individual counseling considered the most important factor for this assessment. Pastoral counseling and chaplaincy was considered the least important factor and type of support during their treatment process.

Does your primary caregiver or spouse, have to take time away from work/other obligations to support your treatment schedule?

There was an

even distribution of answers for the convenience of scheduling and/or transportation for primary caregivers or spouses.

Are you employed full time?

A small majority of patients are not employed fulltime, indicating that they can be seen during work hours.

Are they a fulltime homemaker/caretaker?

The majority of respondents reported that their primary caretaker was not their fulltime caregiver, but likely has other responsibilities to attend to as well.

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# Answer Bar Response %1 Yes 124 52.17%2 No 114 47.83%

Total 238 100.00%


Total 238 100.00%


Total 235 100.00%

Are you satisfied with the hours of operation at the Day Hospital?

Overwhelmingly, those surveyed are satisfied with the hours of operations at the Day Hospital.

Would you be willing to be seen in the Day

Hospital for infusion on the day after your physician visit if you had a minimal wait time?

When

surveyed, many denoted that they were not aware of this procedure, and that they would be willing to receive infusions as an additional therapeutic measure.

Are you satisfied with the days of the week that the Day Hospital operates?

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# Answer Bar Response %1 Yes 212 90.32%2 No 10 4.30%3 Comment: 15 5.38%

Total 235 100.00%

# Answer Bar Response %1 Yes 134 60.67%2 No 50 22.47%3 No Comment: 37 16.85%

Total 221 100.00%


Total 231 100.00%

The large majority of patients (83.87%) were satisfied with the scheduling of the Day Hospital.

If no, would Saturday appointments be more convenient?

Many respondents stated that they would not prefer Saturday appointments (58.51%).

Do you know about myUSCchart, our patient portal?

Two-thirds of participants knew about the patient portal (67.53%), but do not utilize the services (73.12%)

How often do you access

myUSCchart?

Qualitative results13


Total 233 100.00%


Total 190 100.00%

# Answer Bar Response %1 Never 168 73.12%2 Once every 6 months 6 2.15%3 Once a Month 17 7.53%4 Twice a Month 7 3.23%5 Once a Week 12 5.38%6 More than once a Week 2 1.08%7 Other: (specify) 17 7.53%

Total 229 100.00%

What information would you like to be available on myUSCchart?

As demonstrated in the survey above, patients were able to comment on any other concerns they had that were not addressed in the survey. A total of 56 additional written comments were received. The sample below represents a sample of the most requested comments; 10% of all comments dealt with improved explanation of blood tests, 23% of comments inquired about improved explanation of tests, results, prognosis and plans of actions, access to files in different formats represented 6% of comments, and appointments and authorizations represented 32% of commentary. Twenty-Eight percent of commenters stated they didn’t know what could be improved with the portal service.

Barriers to Examine: The clients stated that their greatest problem is the location of services (34.21%), wait times (34.21%) and scheduling (28.95%), despite the disinterest in Saturday appointments. There should be another solution on the 2017 Community Needs Assessment to address potential solutions to patient dissatisfaction.

Conclusion: The participants surveyed were generally satisfied with their experience with USC Norris Cancer Hospital. Although location of services and wait times were identified as barriers to care for this population, there were generally positive reviews for this survey. The largest barrier identified was transportation, with the recommendation that further investigation into which specific community resources requested be assessed. These results will be forwarded to the Cancer Committee for them to utilize in the development of their navigation program.

Limitations: Because this was a convenience sample, randomization was not possible. Furthermore, the power N (409) was not reached for this study to reach statistical significance relative to the population served. This limits the generalizability of this study; however, there is still important information to be collected from the study conducted.

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Text EntryExplanation of terms from blood results All tests and results ,prognosis,plan of actonWe like the chart. Would be good to access mir scans but understand this can’t be donecopies of all tests posted as PDFs filesDon't knowApps,authorizations

Many patients did not answer the full survey, and some were unaware of the meaning of some of the questions. There were also some language barriers with clients who did not have access to the survey in their preferred language. As explained in the 2013 Community Assessment Survey, questions about community resources and barriers should be expanded for further analysis (such as a response for alternative solutions to barriers).

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