One factor keeping people in Dallas from getting better medical treatment is how complicated it is to navigate the health care system, particularly in neighborhoods that are home to the city's neediest populations, Parkland Hospital executives told a City Council committee Monday.
Supporting new mothers immediately after they give birth and better delivery of services to those in need of mental and emotional are two other areas that affect some of the city's neediest neighborhoods, hospital officials said. They spoke at a meeting of the council's quality of life committee to deliver a "community health needs assessment." The 2010 Affordable Care Act requires hospital and nonprofit healthcare systems to do such assessments periodically to gauge where the community's health care is falling short and come up with a plan to improve.
The assessment analyzed 15 ZIP code areas and focused on six that are most in need: 75210, 75211, 75215, 75216, 75217 and 75241. The six stretch from Garland to Irving, wrapping across Dallas' southern half.
“It’s kind of a crescent of ZIP codes that have high social needs and high health disparity,” said Michael Malaise, senior vice president of communications and external affairs at Parkland Hospital.
One of the report's areas of focus was maternal mortality, said Jessica Hernandez, community-integrated health senior vice president. While the death of a woman during her pregnancy upon delivery or soon after is not common, those deaths mostly happen in the 60 days after delivery, Hernandez said, a period usually not covered by Medicaid.
Black women have the highest risk of pregnancy-related mortality, according to the assessment. Some of the conditions that contribute to mortality are treatable, Hernandez said, such as substance abuse, heart problems or behavioral health issues.
Parkland is partnering with other organizations to create a new 12-month maternal health program beginning in October. Women who give birth will be enrolled in the program before being discharged from Parkland, Hernandez said. Healthcare representatives will meet with women and hold group classes to educate them on postpartum care. In November, medical mobile units will also be deployed in these ZIP codes as part of the program.
Other problems afflicting the neighborhoods come down to health literacy.
Many individuals told Parkland during the assessment that they didn’t know how to obtain or use medical coverage or how to navigate the healthcare system. As a result, Dallas County has one of the highest uninsured rates among urban counties in the nation.
Dallas also falls short in behavioral health services, which includes mental health and addiction treatment.
"We are lacking in the integration of those services,” Hernandez said.
Parkland is partnering with Dallas Independent School District to reach students who need professional counseling. The hospital has placed more psychologists, psychiatrists and mental health counselors in its community-oriented primary care clinics to increase capacity for dealing with behavioral health problems.
Currently, Dallas County Jail is the second-largest mental healthcare provider in Texas, said Angela Morris, Parkland's senior director of community relations, a statistic they hope to see a change in in the near future.
Many residents of these ZIP codes either don’t know they have a chronic disease or don’t know how to treat it, Hernandez said, and lack of treatment alongside poverty contributes to their poor health. Diabetes, hypertension and asthma are particular problems.
Asthma affects over six million children in the U.S. and is the leading cause of absence for children in DISD, Hernandez said. Parkland has started a texting program that educates parents about asthma and notifies them of conditions that may worsen symptoms, such as high pollen levels in the air. The hospital system has enrolled about 288 families in the program and is reaching out to an additional 800.
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The county is also seeing an increase in HIV cases, according to the assessment.
Parkland is working closely with Dallas County Health and Human Services to achieve the target goals of Fast Track Cities, an initiative allowing for faster response to AIDS and HIV prevention. The main goal of the initiative is to ensure people with HIV know they have it and are receiving treatment and that those who get treatment have an undetectable viral load.
But, to be effective, healthcare providers need to understand the communities they serve, their diversity and the needs that go along with that diversity. Through a cultural competency learning series and information from residents, Parkland and its partners seek to learn more about their communities.
At the end of the assessment's three year period, there will be an evaluation determining the success of the plans. In that time, Parkland will also provide progress reports to its board of managers monthly and to the City Council upon request. Another update on the assessment is expected next year.