Methodology
Introduction
The 2019 District of Columbia Community Health Needs Assessment (DC CHNA) is a comprehensive analysis and review of multiple population health indicators and outcomes affecting the quality of life of District residents. In continuation of the DC Healthy People 2020 framework to measure progress towards the District’s health goals and objectives, this assessment will provide updated data using recent-year statistics. DC Health developed this interactive report by utilizing the wealth of information collected through various survey instruments, disease registries, and other databases maintained within and administered by DC Health as well as by Federal and District partners. All data in this report, unless indicated otherwise, were compiled by the Center for Policy, Planning, and Evaluation. Data are specific to District residents unless indicated otherwise.
Structure
The DC CHNA was guided by several frameworks in its development. The goal of the assessment is to broaden and deepen the community’s understanding of public health issues and resources in the District. The data included can be used across all sectors to make informed policy and programmatic decisions as well as support the development of topic-specific assessments and improvement plans. The content serves as a comprehensive health status assessment of District residents and is organized around a modified version of the County Health Rankings Model, pictured below:
Modifications include additions of topic areas into the specific determinants, notably Food Security, Social Support and Intimate Partner Violence/Sexual Violence. Additionally, Policies and Programs were incorporated throughout the pages and is not a standalone section.
As pictured in the Population Health Drivers graphic, above, structural determinants of health, such as history, societal conditions, social policy, and the economic system, are interwoven throughout the CHNA. These determinants are used to provide additional context to each topic area and highlight the deeper root causes of health inequities.
Format
The DC CHNA is formatted as a series of interactive webpages. The content included on the platform will be updated as new data and information are available, and as community input is received, both will be incorporated on a continuous basis. Each page includes the following four sections along with topic-specific sections where indicated:
• Background
• Topic-Specific Sections
• Assets and Resources
• Policies and Promising Practices
• Data Resources and Citations
Process & Timeline
The last DC-wide CHNA was published in 2014, followed by the community health improvement plan, or DC Healthy People 2020 in 2016. The DC Healthy People 2020 Annual Update and Action Plan as well as several distinct topic-specific reports have been updating important health status indicators since 2016. A multi-sector advisory committee has been meeting quarterly to give input and help craft the upcoming comprehensive CHNA as a part of the city’s community health improvement process. Community engagement has been incorporated through varied tactics and using various tools, and mechanisms for including continuous, meaningful engagement into the process have been implemented.
The development process to produce the DC CHNA has and will continue to represent a continuous engagement with stakeholders, community members, and partners to include the most relevant and to-date data, evidence, and assets.
Data Sources
The primary and secondary data sources included in the DC CHNA analysis span over 50 sources at the community level, District-level, and National-level, including:
Primary Sources
• Behavioral Risk Factor Surveillance System (BRFSS)
• DC Cancer Registry
• DC CHNA Resident Survey
• DC Immunization Registry
• DC Pregnancy Risk Assessment and Monitoring System (PRAMS)
• DC Vital Records
• Health Professionals Licensing Data System (DC Health)
• HIV/AIDS, Hepatitis, STD, and TB Administration Data Systems (DC Health)
• Human Resources Data (DC Health)
• School Health Data System (DC Health)
• Women Infants and Children Program Data (DC Health)
Secondary Sources
Organizations
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare and Medicaid Services (CMS)
• DC Department of Behavioral Health
• DC Department of Energy and Environment
• DC Department of Fire and Emergency Medical Services (FEMS)
• DC Department of Insurance, Securities and Banking
• DC Department of Transportation
• DC Department of Youth Rehabilitation Services
• DC Health Care Finance
• DC Hospital Association
• DC Metropolitan Police Department
• DC Office of the Chief Medical Examiner
• DC Office of the State Superintendent of Education
• US Environmental Protection Agency
• US Federal Bureau of Investigation
• US Census
• US Department of Agriculture
Select Data Systems
• Adult Protective Services Data
• DC Trauma Registry
• DC Youth Risk Behavioral Survey
• Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)
• Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
• National EMS Information System (NEMSIS)
• National Healthcare Safety Network (NHSN)
• National Immunization Survey
• National Institutes of Health – National Cancer Institute
• National Survey on Drug Use and Health (NSDUH)
• ParkScore
• State Tobacco Activities Tracking & Evaluation System (STATE)
• Uniform Data System
• WalkScore
Health Status Data
Health indicators are measurements of health status or health determinants. Because population health outcomes are impacted by factors unrelated to clinical health, this assessment uses a holistic model of population health that includes data on health status in addition to other modifiable determinant categories, including access to and quality of health care services, social factors, behavioral factors, community conditions and resources, and the physical environment. Building off of the DC Healthy People 2020 framework, the 2019 DC Community Health Needs Assessment provides updates to many of the 150+ indicators and objectives outlined in the original plan.
Community Data
The first steps of the community assessment process involved two essential activities: organizing the planning process and engaging with planning partners. The purpose of this phase was to structure the planning process in a way that builds engaged stakeholders as active partners.
DC CHNA Survey
The DC CHNA survey was the primary tool used to solicit District residents’ direct input. The survey instrument was developed to better identify the needs and strengths of our city and residents. Residents were told that the information they provided would be used in the resulting 2019 DC Community Health Needs Assessment, as well as planning for future services, programs, policies, and better coordination among organizations. The survey instrument was launched in collaboration with the District of Columbia Hospital Association and developed together with community members, subject matter experts from various sectors, local government, community organizations, health care providers, academia, and other stakeholders. The English language survey consisted of 31 questions and the Spanish language survey consisted of 30 questions. The Spanish survey omitted a question asking how long the respondent lived in the District. The survey was available electronically on the OurHealthyDC.org platform as well as in physical printed copies. The survey was promoted to partners and community members using digital outreach strategies (i.e. social media platforms and email campaigns) and in-person outreach (i.e. attending community events, community meetings, canvasing hospitals and DC Health Vital Records). The survey was open from May 28, 2019 through July 31, 2019. A total of 843 responses were collected.
All Survey Respondents by Residence
Source: DC CHNA Survey 2019
Our Healthy DC
Our Healthy DC is an online community engagement forum that supports continuous, meaningful engagement through discussion groups and information sharing. It is used to track current priority actions that are part of the DC Healthy People 2020 Action Plan as well as solicit public comments on sections of the DC CHNA. Entities working on collective impact projects can also use the platform to organize partners and create a virtual space to house the project.
Community Conversations
Following the release of the 2018 District of Columbia Health Equity Report, community conversations were conducted in each of the 8 wards of the city to present the results of the report and gain feedback from residents on their lived experience.
Stakeholder Input
Stakeholder input, defined as input from representatives of organizations who work with and serve residents of the District, was solicited primarily through the Public Health Integrated Advisory Committee (PHIAC). The PHIAC is an advisory committee that meets quarterly to support two DC Health processes:
1. The Community Health Improvement Process (DC CHNA and DC Healthy People 2020/2030)
2. The Preventive Health and Health Services Block Grant process (from Centers for Disease Control and Prevention)
The PHIAC reviewed and provided feedback on the structure of the DC CHNA, engaged in asset and resource mapping activities, prioritized emerging issues, and reviewed and provided feedback on individual sections.
Additionally, key informant interviews were conducted in Summer 2018 and in-house and partner subject matter experts were asked to review sections specific to their expertise.
