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Community Health Needs Assessments

At least once every three years, Chase Brexton Health Care takes a look at the needs of our communities through an in depth community health needs assessment.

You may review or download the entire 2021 Community Health Needs Assessment here.

In the fall of 2021, Chase Brexton Health Care completed our latest needs assessment of our communities. Completed at least once every three years, in alignment with the Health Resources and Services Administration (HRSA) requirements, this assessment helps Chase Brexton to meet the health care needs of the communities we serve.   

More than 860 Chase Brexton patients, staff, leadership, board members, and community partners responded to surveys. The surveys were delivered as a questionnaire or a one-on-one interview with our independent evaluation and research team, Renaye James Healthcare Advisors. The firm also evaluated the answers and proposed improvements and opportunities for Chase Brexton to better meet the needs of our communities and patients.

In the tabs below, you will find a brief summary of the findings, by topic and respondent. The answers are in order of their importance to each group of respondents.

Respondents shared what they see as the most prevalent health issues for our communities.

Patients: Mental health; Diabetes/pre-diabetes; Alcohol/drug addiction; Heart disease/hypertension

Staff: Diabetes/pre-diabetes; Alcohol/drug addiction; Mental health

Leadership/Board: Heart disease/high blood pressure; Mental health; Diabetes/pre-diabetes

Community Partners: Diabetes/pre-diabetes; Mental health; Alcohol/drug addiction

Respondents shared what they see as the most problematic social and environmental issues facing our communities.

Patients: Poverty; Community violence; Access to appointments 

Staff: Poverty; Availability of/access to appointments; Neighborhood safety/community violence

Leadership/Board: Neighborhood/community violence; Poverty; Housing/homelessness lack of job opportunities; Limited access to healthy foods

Community Partners: Neighborhood safety/community violence; Housing/homelessness; Poverty

Respondents shared what they see as the biggest issues preventing access to healthcare through Chase Brexton.

Patients: Cost; Lack of insurance; Hard to get timely appointments

Staff: Cost; Lack of transportation; Hard to get timely appointments; Lack of insurance

Leadership/Board: Fear or mistrust of doctors; Cost too expensive/inability to pay; Lack of transportation

Community Partners: Costs; Fear or mistrust of doctors; Lack of transportation

Respondents shared what they see as the most important things Chase Brexton can focus on to improve their services.

Patients: Phone service; Timelier appointments; Easier scheduling process; Friendlier phone staff

Staff: Provider longevity; Phone service; Timelier appointments

Leadership/Board: Timelier appointments; Providing services in neighborhoods; Provider longevity 

Community Partners: Uncertain

Respondents shared what services they believe are most vital to add to Chase Brexton's list of services.

Patients: Mobile medical services; Gastroenterology

Staff: Mobile medical services; Gastroenterology; Aging/Alzheimer’s services

Leadership/Board: Mobile medical services; Aging/ Alzheimer’s services

Community Partners: Mobile medical services

What are Social Determinants of Health?

The US Department of Health and Human Services outlines factors that affect a persons health based on where people are born, and how people live, play, and age. These factors are called social determinants of health.

Social determinants of health have a direct impact on a person's health, well-being, and quality of life. These determinants are organized into five categories:

  1. Economic stability (income, employment),
  2. Education (graduation rate),
  3. Health care access,
  4. Built environment (transportation, housing), and
  5. Social communities (food environment, migration)

Wonder how your address affects you and your community members? Take a look at Robert Wood Johnson Foundation's County Health Rankings.


More than 80% of the 861 individuals surveyed strongly agreed or agreed that Chase Brexton has a strong commitment to diversity, equity, and inclusion. 

Additionally, 77% of those asked strongly agreed or agreed that Chase Brexton is true to its mission: to provide compassionate and integrated high quality health care that honors diversity, addresses health inequities, and advances wellness in the communities we serve.


The 2021 Community Health Needs Assessment found that Chase Brexton Health Care has developed a robust service delivery system throughout its areas of service in Maryland to address the social determinants of health for our patients. The Assessment also found that there are several opportunities to improve care for our patients and communities. Among others, the following suggestions have been made:

  • Explore the use of peer recovery coaches;
  • Create care coordination agreements with local urgent care centers and emergency departments allow for the clinical teams to receive prompt documentation or communication of visits to ensure continuity of care;
  • Augment patient centered care model by adding care managers;
  • Address provider staffing issues by creating provider teams which will work to accommodate patients with acute needs or same-day needs;
  • Work with advocacy partners at the state and national level to campaign for continued ability to provide telehealth services after the public health emergency ends. 

Ultimately, the report concludes, Chase Brexton Health Care continues to ensure that all patients receive the care they need, meeting them where they live, work, worship, and play, in a way that is culturally competent and equitable.