Community Health Needs Assessment Mayo Clinic Health System in Waycross

Transcription

1 Community Health Needs Assessment Mayo Clinic Health System in Waycross May 30, 2016

2 Contents Executive Summary... 3 Entity Overview... 3 Summary of Community Health Needs Assessment... 4 Summary findings... 4 Our Community... 5 Geographic Area... 5 Community Definition... 5 Ware and Pierce Counties, Georgia... 6 Community Overview... 6 Introduction... 6 Demographics and socioeconomics... 7 Race and Ethnicity... 9 Socioeconomics Other economic and social factors Access to health care Economic access to care Assessing the Needs of the Community Overview Community Input Process and Methods Primary data methodology Secondary data methodology Secondary Data Health Outcomes, Behaviors, and Risk Factors Mortality and morbidity indicators Behavioral risk factors Primary Data Summary of Focus Group and Interview Findings Overview Most significant health needs Addressing the Needs of the Community Prioritization Process and Criteria Identified health needs Obesity Tobacco use Access to health care Other Available Resources Attachment A: Available Resources Advocacy/education programs offered Examples of other programs provided, sponsored, or supported County health departments Federally qualified health centers Home health agencies Hospice agencies Mental health/substance abuse resources Other health care resources Appendix Implementation Plan Impact Community Health Needs Assessment Page 2 of 37

3 Executive Summary Entity Overview Mayo Clinic Health System in Waycross includes a 231-bed acute care hospital located in Waycross, Georgia. The health system provides a broad range of services and is the only hospital in Ware County, which covers more than 892 square miles in Southeast Georgia. In addition to the wide range of typical acute care hospital services, Mayo Clinic Health System in Waycross operates: The Heart Center, focusing on detecting, diagnosing, and treating cardiovascular disease Cardiac and Pulmonary Rehabilitation Services, a program that combines exercise and education to help individuals recover from a heart attack, bypass surgery, major lung conditions, or other cardiac events Senior Behavioral Center, a 15-bed inpatient psychiatric unit designed to address the unique challenges of the aging population of the community Pierce County Nursing Home, a 78-bed nursing facility offering short-term rehabilitation and long-term care, located in Blackshear, Pierce County, Georgia Satilla Care Center, a 96-bed nursing facility offering short-term rehabilitation and long-term care, located in Waycross Express Care, a walk-in clinic designed to treat minor medical conditions, located in Waycross Multi-specialty Physician Offices in Douglas (Coffee County, Georgia) and Jesup (Wayne County, Georgia), providing Hematology/Oncology and Rheumatology services in Douglas, and General and Vascular Surgery services in Jesup. Community Health Needs Assessment Page 3 of 37

4 Summary of Community Health Needs Assessment Mayo Clinic Health System in Waycross defines its community as Ware and Pierce counties, where the majority of its patients reside, and we are able to have the greatest influence on the health of the residents of those counties. Both primary and secondary data were collected to help identify health needs within Ware and Pierce counties. Primary data collection methods included interviews and a focus group with key community representatives. The purpose of the interviews and focus group was to gain direct input from these individuals regarding the health needs, community assets, and other related topics, including primary and chronic disease needs and health issues of low-income persons and minority groups. In addition, community input was garnered from the Community Advisory Committee (CAC), as well as the Community Health Needs Assessment (CHNA) Oversight Committee. The CAC members included a wide range of community constituencies representing the broad interests of the community served, including the population with primary and chronic diseases and health issues of low-income persons and minority groups. The CHNA Oversight Committee was responsible for overseeing the CHNA process; including prioritizing health needs and developing an implementation plan to address them. Secondary data was collected from a variety of respected organizations on a broad array of health indicators and other information, then analyzed and summarized. The types of data collected included demographic, socioeconomic, chronic disease, mortality and morbidity, health status indicators, health behaviors, maternal and child health, insurance status, and general environmental information. Summary findings Community health needs were identified through primary and secondary data collection and analysis and were grouped into five major categories. The CHNA Oversight Committee prioritized these areas by using criteria related to the: scope of the health need, opportunity to intervene at the prevention level, estimated feasibility and effectiveness of possible interventions, ability to meet the need with resources available, whether addressing the need builds on existing organizational competencies, and the economic contribution to the communities, families, and employers. This process resulted in the prioritized health needs list shown below: 1. Obesity 2. Tobacco use 3. Access to health care 4. Diabetes 5. Heart disease Community Health Needs Assessment Page 4 of 37

5 Our Community Geographic Area Community Definition Mayo Clinic Health System in Waycross defines its community geographically as Ware and Pierce counties, based on its patient origin. The primary population centers are the cities of Waycross and Blackshear, with the remainder of Ware and Pierce counties being largely rural. Since the large majority of its patients live in Ware and Pierce counties, the health system is able to have the greatest influence on the health of these residents. As illustrated below, approximately 79 percent of Mayo Clinic Health System in Waycross inpatients live in these two counties. Okefenokee Health System Inpatient Origin % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 55.30% 57.21% 55.93% 24.39% 22.31% 22.72% 6.22% 7.22% 7.34% 2.76% 2.53% 3.20% 8.26% 8.15% 8.29% 3.08% 2.57% 2.52% WARE,GEORGIA PIERCE,GEORGIA Other CHARLTON,GEORGIA BRANTLEY,GEORGIA BACON,GEORGIA Community Health Needs Assessment Page 5 of 37

6 Ware and Pierce Counties, Georgia Community Overview Introduction Ware and Pierce counties are located in Southeast Georgia. Based on 2010 Census data, the population was 55,160, with 36,402 in Ware County and 18,758 in Pierce County. Ware is the largest county in Georgia, geographically, and includes a large portion of the Okefenokee Swamp. Ware and Pierce counties comprise the Waycross Micropolitan Statistical Area as defined by the U.S. Census Bureau. With a 2010 population of 14,651, Waycross is the Ware county seat and by far the most populous city in either county. Blackshear is the Pierce county seat and had a 2010 population of 3,445. The remainder of the population is dispersed throughout the two counties. The size, largely rural nature, and geography of these counties result in physical access obstacles to health care for those who live in remote portions of the area and cannot drive, such as senior citizens, the disabled, or those who cannot afford a vehicle. Community Health Needs Assessment Page 6 of 37

7 Demographics and socioeconomics Population size and age mix The populations of Ware and Pierce counties are projected to increase between 2014 and 2020, with the population ages 65 and older expected to be a significant proportion to the population growth. Age Groups Census 2010 Estimated 2014 Projected 2020 Projected Change Projected % Change Ware County 17 and Under 8,557 8,455 9, % 18 to 44 12,763 12,463 12, % 45 to 64 9,551 9,406 9, % 65 and over 5,531 5,591 7,134 1, % Ware-All Ages 36,402 35,915 38,579 2, % Pierce County 17 and Under 4,896 4,832 5, % 18 to 44 6,209 6,383 6, % 45 to 64 5,022 4,890 5, % 65 and over 2,631 2,755 3,855 1, % Pierce-All Ages 18,758 18,860 21,527 2, % Total-Ware/Pierce 55,160 54,775 60,106 5, % Georgia 9.5% U.S. 4.9% Sources: U.S. Census Bureau, American Community Survey 5-Year Estimates The Governor's Office of Planning and Budget. U.S. Census Bureau, 2014 National Projections Community Health Needs Assessment Page 7 of 37

8 The proportion of the senior population in these counties is very large, as shown in the age distribution table below. The proportion of population ages 65 and older is significantly greater, while the percentage of the population ages 18 to 44 is significantly less in both Ware and Pierce counties than the statewide figure. 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Percent of Population by Age Group Census 2010 Ages <18 Ages Ages Ages 65+ Ware Pierce Georgia U.S. Sources: U.S. Census Bureau, Census 2000 Summary File 1 and 2010 Census Summary File 1 Community Health Needs Assessment Page 8 of 37

9 % of Total Population Race and Ethnicity The most common race in Ware and Pierce counties is White, at 63.5 percent and 81.8 percent of the population, respectively. African American makes up the only other race with a significant population in Ware (28.8 percent) or Pierce (8.3 percent) County. When evaluating ethnicity, only 3.4 percent of the Ware and 4.8 percent of the Pierce population is Hispanic. 90.0% Percent of Population by Race & Ethnicity % 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% White Black or African American American Indian/Alaska Native Asian Some Other Race Two or More Races Hispanic (Ethnicity) Ware Pierce Georgia U.S. Source: U.S. Census Bureau, 2014 Community Health Needs Assessment Page 9 of 37

10 Socioeconomics The socioeconomic status for residents of both counties is significantly below that of both Georgia and the U.S. Both the median and the mean household incomes for Ware and Pierce counties are well below those for Georgia and the U.S. $80,000 $70,000 Median & Mean Household Income $68,317 $74,596 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 $53,482 $49,342 $41,685 $35,247 Median Household Income $47,462 $57,152 Mean Household Income Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates Community Health Needs Assessment Page 10 of 37

11 % of Population The proportion of population below the poverty level in Ware and Pierce counties is significantly above that of Georgia and the U.S., consistent with their relatively low level of affluence. The level of poverty in Ware County is particularly high. As shown in the chart below, a significantly larger percentage of African Americans live below the poverty level compared to Whites and Hispanics. Percent of Population Below 100% of Poverty Level % 54.7% 50.0% 40.0% 37.8% 38.6% 40.8% 30.0% 20.0% 10.0% 26.2% 20.0% 18.5% 15.6% 26.7% 25.9% 21.9% 32.4% 27.7% 24.0% 19.7% 16.7% 13.5% 12.8% 30.5% 31.2% 27.0% 27.3% 24.8% 9.6% 0.0% All Ages/Races/Ethnicities Children-All Races/Ethnicities Adults-All Races/Ethnicities White Black or African American Hispanic or Latino origin (of any race) Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates Community Health Needs Assessment Page 11 of 37

12 Other economic and social factors The unemployment rate has been lower than the state and national rates, while the proportion of households receiving food stamps is significantly high in both Ware and Pierce Counties, as indicated in the following graph. Also, the proportion of the population that does not speak English at home is substantially less in Ware and Pierce counties than statewide and nationally. Selected Economic/Social Indicators % 23.7% 20.8% 20.9% 20.0% 15.0% 15.2% 13.0% 13.4% 10.0% 8.2% 10.8% 8.8% 9.2% 5.0% 5.6% 5.5% 0.0% 2014 Unemployment Rate (Civilian Labor Force) % of Households Receiving Food Stamps % of Population Not Speaking English at Home (Ages 5+) Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates Community Health Needs Assessment Page 12 of 37

13 The proportion of the population that reported having a disability in surveys conducted by the U.S. Census Bureau is relatively high in Ware and Pierce counties compared to state and national rates. 60.0% Population with a Disability Percent of Civilian Noninstitutionalized Population % 50.0% 40.0% 43.0% 38.3% 36.3% 30.0% 20.0% 10.0% 19.2% 20.3% 12.1% 12.3% 14.3% 11.4% 5.9% 6.1% 17.2% 17.6% 10.7% 10.2% 0.0% All Ages Under 18 Years Ages Ages 65 and Older Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates The level of educational achievement is relatively low in Ware and Pierce counties compared to state and national figures. As shown below, approximately 33.3 percent of Ware and 46.5 percent of Pierce County residents ages have a high school diploma (or equivalent). Residents of these counties have significantly lower rates of college degrees compared to Georgia or the U.S. 50.0% Selected Education-Related Indicators % 40.0% 30.0% 33.3% 30.9% 29.5% 20.0% 10.0% 0.0% 7.6% 9.6% 3.8% 2.2% % High School Graduate or Equivalent % Bachelors Degree or Higher Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates Community Health Needs Assessment Page 13 of 37

14 Access to health care Access to care was the health issue most frequently mentioned by focus group and interview participants. Below is an overview of additional physical and economic factors affecting access. Physical access to care The physical inability to access care is a significant impediment to receiving health care, particularly for vulnerable populations. Because of the rural nature of much of Ware and Pierce counties, it can be difficult for many to get transportation to the doctor s office or other care provider. The two counties have limited public transportation options, consisting primarily of Ware County Transit and Pierce County Transit. These transit services charge a fare based on distance $3 to $4 each way within a 10-mile radius, higher for longer and out-of-county travel and require that rides be scheduled in advance. In Ware County, fares for seniors ages 65 and older and children five and under are discounted by 50 percent, while in Pierce County, seniors and the disabled receive a 50 percent discount. As a result of cost and other limitations, there are many circumstances for which these transportation services are not a practical option. In addition, focus group and interview participants indicated that limited family support systems for some are another barrier to care. As a result, many residents of Ware and Pierce counties may have difficulty obtaining transportation to health care. Difficulty in accessing primary care, particularly for Medicaid/PeachCare and uninsured patients was mentioned in focus groups and interviews. Telemedicine consultations in the school systems provide access to many school-aged children, but parent approval and payment is required, and sometimes hinders delivery of care. According to County Health Rankings, the population to primary care physician ratio in Pierce County (2,370:1) is significantly greater than the statewide ratio (1,540:1), indicating a shortage of primary care physicians in this county. The population to primary care physician ratio in Ware County is 1,190:1. Economic access to care Relatively low income levels in Ware and Pierce counties, as well as high poverty and disability rates, and lack of health insurance have created significant economic barriers to care for many. The uninsured and Medicaid/PeachCare enrollees were identified by focus group and interview participants as those experiencing the greatest difficulty in accessing care. Community Health Needs Assessment Page 14 of 37

15 Ware and Pierce counties exhibit a very high rate of uninsured residents compared with the statewide rate, for both children and adults under the age of 65. As shown below, nearly one-third of adults under the age of 65 have no health insurance. 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 20.9% 21.0% 18.3% 14.2% Percent Uninsured % 10.1% 8.9% 7.1% 30.8% 30.7% 25.2% 19.8% 0.0% All Ages Children (Ages <18) Ages Ware Pierce Georgia U.S. Source: U.S. Census Bureau, American Community Survey 5-Year Estimates An additional indicator of the socio-economic status of Ware and Pierce counties is hospital payer mix. As shown in the following table, the proportion of hospital inpatients covered by Medicaid and self-pay patients is relatively consistent with Georgia overall. However, the Emergency Department payer mix for Ware and Pierce county residents consist of a high proportion of Medicaid and self-pay compared with Georgia overall. Community Health Needs Assessment Page 15 of 37

16 Hospital Inpatient Payer Mix Residents of Ware/Pierce Counties, Georgia % 4.2% 5.7% 8.2% 7.3% 7.7% Emergency Department Payer Mix Residents of Ware/Pierce Counties, Georgia, % 6.0% 6.4% 16.0% 19.1% 53.3% 21.2% 18.7% 48.6% 27.0% 18.7% 41.0% All Other/Unknown Self Pay Private Medicaid Medicare 28.5% 27.2% 25.9% 13.8% 17.5% 23.8% 19.2% 17.2% 16.1% 33.6% 32.1% 28.0% All Other/Unknown Self Pay Private Medicare Medicaid Ware Pierce Georgia Ware Pierce Georgia Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed January 26, Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Emergency Room Visits Web Query Tool, accessed January 26, In addition to the uninsured and those who are covered by Medicaid/PeachCare, the increasing number of individuals enrolled in health insurance plans with high deductibles, including Health Insurance Exchange products was mentioned by focus group and interview participants as a barrier to care. These participants also indicated that uninsured, underinsured and Medicaid/PeachCare enrollees were the most likely to be medically underserved, experience the most difficulty in accessing health care, and use the emergency department for their primary care. Other access-related issues mentioned by participants were the high cost of required medications and follow-up care, and lack of access to substance abuse and other behavioral providers, pediatric specialties, and other certain specialty care not available in the community. Community Health Needs Assessment Page 16 of 37

17 Assessing the Needs of the Community Overview Mayo Clinic Health System in Waycross defined its community as Ware and Pierce counties, based on patient origin and its ability to have the greatest influence on the health of residents of these counties. Community Input In conducting the CHNA, input was obtained from a broad range of individuals, including local health department representatives, as well as the medically underserved, low-income, and minority population. Representatives of these populations provided input through several means as part of the CHNA, including participation in interviews and focus groups, as well as an external Community Advisory Committee (CAC). In addition, a CHNA Oversight Committee was responsible for overseeing the CHNA process and included individuals with significant insight into the health needs of the community, including members of the medically underserved, low-income, and minority populations. Process and Methods Both primary and secondary data were collected to assist in identifying health needs within Ware and Pierce counties. Primary data methodology Primary data collection methods included interviews and a focus group with key community representatives. To gather input from an extensive range of people who represent the broad interests of Ware and Pierce counties, a focus group and one-on-one interviews were conducted in March In total, interviews were conducted with 18 individuals and 6 focus group participants who were key community representatives. The purpose of the interviews and focus group was to gain direct input from these individuals regarding health needs, community assets, and other related topics, including primary and chronic disease needs and other health issues associated with uninsured persons, lowincome persons, and minority groups. Focus group and interview participants included community stakeholders representing health care and social services providers, school systems, religious organizations, economic organizations, political and other community officials and the elderly/senior population. Many of the focus group and interview participants represented, and were very familiar with, the health needs associated with the medically underserved, low income, minority, and populations with chronic and acute diseases in Ware and Pierce counties. Community Health Needs Assessment Page 17 of 37

18 Interviews Interviews were conducted in person, when possible, and via phone, when necessary, based on the availability of the interviewee. Interviews required approximately 30 minutes for completion. The interviewer followed the same process for each interview. The following questions were used as the basis for discussion in each interview: Interviewee s name Interviewee s occupation 1. What are the top three strengths of the community? 2. What are the top three health concerns of the community? 3. What are the health assets and resources available in the community? 4. What are the health assets or resources that the community lacks? 5. What assets or resources in the community are not being used to their full capacity? 6. What are the barriers to obtaining health services in the community? 7. What is the single most important thing that could be done to improve the health in the community? 8. What changes or trends in the community do you expect over the next five years? 9. What other information can be provided about the community that has not already been discussed in this interview? Focus Group A focus group was conducted to allow participants to provide information about their experiences in the community and ways in which they thought the services and resources provided to the community could be improved. Each participant provided their name and occupation, and participated in discussion led by the following questions: What is your vision for a healthy community? What is your perception of the hospital overall and of specific programs and services? What can the hospital do to improve health and quality of life in the community? The information provided in the focus group was compiled with other information used to complete the CHNA so that the individuals responsible for providing specific information could not be identified. All participants were encouraged to share their ideas, opinions, and experiences, including any positive or negative feedback. The focus group session required approximately one hour to complete, and followed this agenda: Session opening 10 minutes o Introductions o Explanation of the purpose of the focus group o Definition of the service area Questions concerning the community 40 minutes o Three questions were presented, one at a time. Session conclusion 10 minutes o Summary of findings o Closing discussion Community Health Needs Assessment Page 18 of 37

19 Community Advisory Committee and Oversight Committee In addition to interview and focus group participants, community input was garnered from the CAC, as well as the Mayo Clinic Health System in Waycross CHNA Oversight Committee. The CAC included representatives from: Childers Family YMCA City of Waycross Pierce County Board of Education Salus Telehealth Ware County Board of Education Ware County Health Department CAC members participated in a session where the CHNA preliminary findings were presented, and they were able to provide additional feedback regarding the findings. The CHNA Oversight Committee included the following representatives from Mayo Clinic Health System in Waycross: Emergency Department Medical staff (2) Operations Administration Public Affairs Social Services Representatives of the CHNA Oversight Committee reviewed and discussed the implications of the primary and secondary data analyses, identified priority community health needs, and developed implementation strategies to address them. Secondary data methodology Secondary data was collected using a variety of publicly available data from numerous respected organizations and agencies, and regarding a broad range of issues. The types of data included demographics, socio-economics, insurance status, chronic disease and mortality/morbidity information, health status indicators, health behaviors, behavioral risk factors, and maternal and child health indicators for residents of Ware and Pierce counties. In many cases, secondary data for the counties were compared with state and national indicators, when applicable and available. The secondary data was then summarized. Information gaps Every attempt was made to collect relevant and recent primary and secondary data reflecting the health status and social determinants of health in Ware and Pierce counties. In some cases, the ability of Mayo Clinic Health System in Waycross to assess all community health needs may have been limited by a lack of existing or recent small-area estimate information relevant to Ware and/or Pierce counties. Community Health Needs Assessment Page 19 of 37

20 Secondary Data Health Outcomes, Behaviors, and Risk Factors Mortality and morbidity indicators Although generally declining, overall age-adjusted mortality rates in Ware and Pierce counties remain significantly higher than statewide and national rates ,065 Age-Adjusted Death Rates - All Causes Per 100,000 population 1,190 1,237 1, , ,182 1,225 1, Ware Pierce Georgia U.S Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed January 26, 2016; Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Jan 26, As shown below, mortality rates in Ware and Pierce counties are significantly higher than Georgia and U.S. rates for many of the leading causes of death, including cardiovascular disease, cancer (Pierce County, in particular), chronic lung disease, and accidents. Community Health Needs Assessment Page 20 of 37

21 Per 100,000 Population Per 100,000 Population Age-Adjusted Mortality Rates by Cause Ware Pierce Georgia U.S Diseases of the Circulatory System Cancer Diseases of the Respiratory System External Causes (accidents) Infectious/Parasitic Disease Diseases of the Digestive System The overall mortality rate for African Americans is relatively consistent with rates for Whites in Ware County, while in Pierce County, the mortality rate for Whites is higher than for African Americans. Age-Adjusted Mortality Rates by Race & Major Cause All Causes - White All Causes - Black Major C.V. Diseases - White Major C.V. Diseases - Black Cancers - White Cancers - Black Georgia Pierce Ware United States Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed 18 February 2016; Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Feb 18, When evaluating the mortality rate for the leading cancer sites, those in Pierce County are higher than in Ware County, Georgia statewide, and the U.S. for lung, breast, and colorectal cancers, with a significantly lower rate for prostate cancer mortality. Community Health Needs Assessment Page 21 of 37

22 Per 100,000 Population Age-Adjusted Mortality Rates by Selected Cancer Sites Lung/Bronchus/Trachea Breast (Female) Prostate (Male) Colorectal Georgia Pierce Ware United States Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed 18 February 2016; Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Feb 18, Community Health Needs Assessment Page 22 of 37

23 Per 100,000 Population Per 100,000 Population In evaluating the incidence of cancer, the age-adjusted cancer incidence rates are lower in Ware County, and consistent in Pierce County, compared with the Georgia and U.S. rates. For the most common cancer sites, incidence rates for Ware County are below the statewide and national rates, while incidence rates for Pierce County are slightly above the statewide and national rates. Incidence of prostate and female breast cancer in Pierce County is below the Georgia and U. S. rates, while higher than statewide and national rates for lung and colorectal cancers Age-Adjusted Incidence Rates by Selected Cancer Sites, Georgia Pierce Ware United States * * All Sites Breast (female) Prostate (male) Lung/Bronchus Colon/Rectum Melanoma Pancreas *Data not available since too few cases were reported. Source: Created by statecancerprofiles.cancer.gov on 02/18/2016. Cancer incidence rates are higher among Whites than African Americans in Pierce County; however, incidence rates are slightly higher among African Americans than Whites in Ware County. The incidence rate for prostate cancer is significantly higher among African Americans in Ware County than of African Americans in Pierce, the State of Georgia, or the U.S. 600 Age-Adjusted Cancer Incidence Rates by Race, All Sites - White All Sites - Afr. American Breast (female) - White * * * Breast (female) - Afr. American Prostate (male) - White Prostate (male) - Afr. American Lung/Bronchus - Lung/Bronchus - White Afr. American Georgia Pierce Ware United States Source: Created by statecancerprofiles.cancer.gov on 02/18/2016. Community Health Needs Assessment Page 23 of 37

24 Per 100,000 Population Another indicator for morbidity is hospital discharge and emergency department visit rates. Hospital discharge rates are higher for residents of Ware and Pierce counties than Georgia overall for several causes, including heart disease, influenza/pneumonia, diabetes, and asthma. At the same time, hospital discharge rates for stroke and cancers are generally consistent with or lower than statewide rates Age-Adjusted Hospital Discharge Rates by Selected Cause, Georgia Pierce Ware *Rheumatic Fever and Heart Diseases, Hypertensive Heart Disease, Obstructive Heart Disease (incl. Heart Attack), Hardening of the Arteries, Aortic Aneurysm and Dissection **Motor Vehicle Crashes (MVC), Falls, Accidental Shooting, Drowning, Fire and Smoke Exposure, Poisoning, Suffocation, All Other Unintentional Injuries, Suicide, Homicide, Legal Intervention Note: Hypertension defined as high blood pressure Source: Online Analytical Statistical Information System (OASIS), Mortality/Morbidity Web Query, Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP). Accessed on 2/18/2016 at Community Health Needs Assessment Page 24 of 37

25 Emergency department visit rates are significantly higher in Ware and Pierce counties than statewide for many causes, including mental/behavioral disorders, asthma, hypertension, diabetes, and influenza/pneumonia Age-Adjusted ED Visit Rates by Selected Cause Georgia Pierce Ware 0 *Rheumatic Fever and Heart Diseases, Hypertensive Heart Disease, Obstructive Heart Disease (incl. Heart Attack), Hardening of the Arteries, Aortic Aneurysm and Dissection **Motor Vehicle Crashes (MVC), Falls, Accidental Shooting, Drowning, Fire and Smoke Exposure, Poisoning, Suffocation, All Other Unintentional Injuries, Suicide, Homicide, Legal Intervention Source: Online Analytical Statistical Information System (OASIS), Mortality/Morbidity Web Query, Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP). Accessed on 2/18/2016 at The relatively high emergency department visit rates in Ware and Pierce counties are indicative of the difficulty certain populations have in accessing primary care. Community Health Needs Assessment Page 25 of 37

26 % of Respondents Behavioral risk factors The proportion of adults who are obese, diabetic, and physically inactive is greater in Ware County than Georgia overall. In Pierce County, the proportion of adults who are obese and diabetic is slightly lower than Georgia overall; however the proportion of physically inactive adults is significantly greater than statewide and national percentages Behavioral Risk Factors - Adult Diabetes, Obesity & Physical Inactivity Obesity Diabetes Physical Inactivity Georgia Pierce Ware United States Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System. Available online at: Retrieved 2/18/2016. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online] [accessed Feb 18, 2016]. URL: Obesity is one of the most significant risk factors for several diseases affecting residents of Ware and Pierce counties, including cardiovascular disease, diabetes, and hypertension. A major factor causing the substantial cardiovascular disease mortality rates in the region is the level of obesity, with one-third of the adult population in Ware and Pierce counties considered obese. One of the causes of obesity is inactivity. A high proportion of adults in Ware County and an extremely high percentage in Pierce County do not exercise. Another significant contributing factor to the high rates of cardiovascular and lung disease is the high smoking rate in Georgia s Southeast Health District 1. Approximately 21 percent of adults smoke, compared with 17 percent statewide and 18 percent nationally. With such a high proportion of adults who smoke and the negative impact smoking has on other significant diseases in the region, there is significant room for improvement. 1 Georgia Public Health District 9-2 Southeast (Waycross) is comprised of Appling, Atkinson, Bacon, Brantley, Bulloch, Candler, Charlton, Clinch, Coffee, Evans, Jeff Davis, Pierce, Tattnall, Toombs, Ware, and Wayne counties. Community Health Needs Assessment Page 26 of 37

27 Per 1,000 Live Births % of Respondents Behavioral Risk Factors - Adult Smoking, Alcohol Use & Reported Health Status, Cigarette Smoking Binge Drinking Fair to Poor Health Georgia Southeast Georgia Health District United States Source: CDC BRFSS Data, 2014, and Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS BRFSS Data, Available information for the district shows the proportion of residents who binge drink is relatively low, while the percentage who report they are in fair or poor health is significantly higher than statewide and national percentages. Maternal and child health indicators The rate of infant mortality in Ware County is above the Georgia and U.S. rates, based primarily on postneonatal, rather than neonatal mortality. Infant, Neonatal & Post-Neontal Mortality Rates, Infant Mortality Neonatal Mortality Postneonatal Mortality Georgia Pierce Ware United States (2013) Source: Online Analytical Statistical Information System (OASIS), Mortality/Morbidity Web Query, Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP). Accessed on 2/19/2016 at and CDC/NCHS, National Vital Statistics System, Mortality 2013, accessed at on 2/19/2016. Community Health Needs Assessment Page 27 of 37

28 % of Live Births The percentage of births to unmarried women is somewhat high in Ware County. However, the proportion of mothers who smoked during pregnancy is extremely high in both Ware and Pierce counties, adding further emphasis to the need to reduce smoking rates in the region, including pregnant mothers. 60.0% Selected Maternal & Child Health Indicators % 50.0% 40.0% 45.4% 42.9% 40.6% 30.0% 20.0% 10.0% 9.5% 8.9% 8.2% 8.0% 17.4% 17.7% 8.4% 6.0% 0.0% Low Birth Weight Births Births to Unmarried Women Mothers Who Smoked During Pregnancy (U.S. data from 2014) Georgia Pierce Ware United States Source: Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. Accessed on 2/19/2016. County Health Rankings County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, examines a variety of health status indicators and ranks each county within each state in terms of health factors and health outcomes. The health outcomes measure is a composite based on mortality and morbidity statistics, and the health factors measure is a composite of several variables known to affect health outcomes: health behaviors, clinical care, social and economic factors, and physical environment. Clinical Care is a composite measure of Access to Care, which examines the percent of the population without health insurance and ratio of population to primary care physicians. Quality of Care examines the hospitalization rate for ambulatory care sensitive conditions, whether diabetic Medicare patients are receiving HbA1C screening, and percent of chronically ill Medicare enrollees in hospice care in the last eight months of life. Physical Environment is a composite that examines Environmental Quality, which measures number of air pollution-particulate matter days and are pollution-ozone days. Built Environment measures access to healthy foods and recreational facilities and the percentage of restaurants that are fast food restaurants. County Health Rankings is updated annually. County Health Rankings 2016 relies on data from 2007 to 2015, with most data originating in 2013 to Data retrieved from and 9. Community Health Needs Assessment Page 28 of 37

29 Following is a summary of the indicators used to develop the 2016 rankings for Ware and Pierce counties, compared with overall Georgia and U.S. statistics. County Health Rankings (2016) Indicators Ware Pierce Georgia U.S. County County Overall Median Mortality Premature death (deaths before age 75 per 100,000 pop.) 10,100 9,400 7,300 7,700 Morbidity Poor or fair health 21% 18% 19% 16% Poor physical health days (per month) Poor mental health days (per month) Low birthweight (<2,500 grams) 10% 8% 9% 8% Health Behaviors Adult smoking 18% 18% 17% 18% Adult obesity 36% 30% 29% 31% Physical inactivity 2 30% 33% 25% 28% Access to exercise opportunities 81% 62% 75% 62% Excessive drinking 3 14% 62% 25% 17% Alcohol-impaired driving deaths (per 100,000 pop.) 29% 27% 24% 31% Sexually transmitted infections (chlamydia infections per 100,000 pop.) Teen births (per 1,000 females, ages 15-19) Clinical Care Uninsured 21% 23% 21% 17% Primary care physicians (pop. to physician ratio) 1,190:1 2,370:1 1,540:1 1,990:1 Dentists (pop. to dentist ratio) 2,090:1 6,330:1 2,060:1 2,590:1 Mental health providers (pop. to provider ratio) 830:1 3,800:1 850:1 1,060:1 Preventable hospital stays (hospitalization rate per 1,000 Medicare enrollees) Diabetic monitoring 5 86% 87% 85% 85% Mammography screening 6 65% 59% 62% 61% Social & Economic Factors High school graduation 7 83% 91% 73% 86% Some college 8 42% 51% 61% 56% Unemployment 8.1% 7.6% 7.2% 6.0% Children in poverty 41% 28% 26% 23% Children in single-parent households 43% 39% 37% 32% Violent crime rate (per 100,000) Physical Environment Air pollution particulate matter Severe housing problems 10 18% 14% 18% 14% Driving alone to work 82% 85% 79% 80% Long commute driving alone 11 18% 29% 39% 29% 1 Average # of physically unhealthy days reported in past 30 days 2 Percent of adults aged 20 and over reporting no leisure time physical activity 3 Percent of adults reporting binge or heavy drinking 4 Preventable hospital stays for ambulatory care sensitive conditions as defined by the Dartmouth Atlas 5 Percent of diabetic Medicare enrollees ages receiving HbA1c monitoring 6 Percent of female Medicare enrollees ages that receive mammography screening 7 Percent of high school freshmen that graduate from high school in four years 8 Percentage of the population ages with some post-secondary education 9 Average daily density of fine particulate matter in micrograms per cubic meter (PM2.5) 10 Percent of households with overcrowding, high housing costs, or lack of kitchen or plumbing facilities 11 Among workers who commute in their car alone, percent commuting greater than 30 minutes Community Health Needs Assessment Page 29 of 37

30 Primary Data Summary of Focus Group and Interview Findings Overview To gather input from an extensive range of people who represent the broad interests of Ware and Pierce counties, a focus group and one-on-one interviews were conducted in March In total, interviews were conducted with 18 individuals and 6 focus group participants who were key community representatives. A summary of the opinions of focus group and interview participants follows. Most significant health needs The most frequently mentioned significant health needs are as follows: Unhealthy lifestyle of population o Obesity, caused by poor diet and lack of exercise o Poor personal choices o Drug abuse and addiction o Overall lack of education/not knowing what to do or how to get care o Poor living conditions, including poor parenting skills/non-compliance of parents o Lack of healthy food/restaurant options in community Access to care o Most affected populations include uninsured/underinsured, poor/low income, unemployed/underemployed, elderly, and children o Most common causes mentioned included Transportation issues caused by cost and limited family support system Cost of care, including medications and follow-up care Need for more local specialists, including pediatric specialists Behavioral health (mental health/substance abuse) o Most common issues mention include: Undiagnosed behavioral/mental health issues of parents with school-aged children, who also have behavioral/mental health issues Inadequate supply of services, both outpatient counseling and inpatient, with Unison virtually the only provider and with few private providers Drug addiction/substance abuse issues including prescription drug abuse/addiction (e.g., pain and anti-anxiety medications) Community Health Needs Assessment Page 30 of 37

31 Addressing the Needs of the Community Prioritization Process and Criteria Community health needs were identified through primary and secondary data collection and analyses and were grouped into five major categories.these areas were prioritized by the CHNA Oversight Committee by using criteria related to the scope of the health need; opportunity to intervene at the prevention level; estimated feasibility and effectiveness of possible interventions; ability to meet the need with resources available; whether addressing the need builds on existing organizational competencies; and the economic contribution to the communities, families, and employers. The result was the identification and ranking of five significant health needs. Identified health needs Through the process described above and in the preceding section ( Assessing the Needs of the Community ), the CHNA Oversight Committee prioritized the following health needs: 1. Obesity 2. Tobacco use 3. Access to health care 4. Diabetes 5. Heart disease Mayo Clinic Health System in Waycross prioritized those health needs with the strongest alignment to its mission, ability, and capacity to address those health needs: 1. Obesity 2. Tobacco use 3. Access to health care Obesity The percentage of the population that is obese in Ware and Pierce counties is higher than the national rate, and the significance of obesity also was expressed by several focus group and interview participants. Obesity is another of the most significant risk factors for and causes of numerous other health issues experienced by Ware and Pierce County residents, including diabetes, heart disease, and hypertension. By focusing on lowering the obesity rate, Mayo Clinic Health System in Waycross is choosing to direct its efforts to the prevention level for this and other health issues caused by obesity. Community Health Needs Assessment Page 31 of 37

32 Tobacco use The prevalence of smoking among residents in the Southeast Health District is significantly higher than the Georgia and national rates, based on secondary data. It s one of the most significant risk factors for and causes of many other health issues, including cardiovascular disease, chronic respiratory disease, and lung cancer. Mayo Clinic Health System in Waycross believes it is only through addressing the root causes of the most significant health issues that the most significant needs can be addressed. Access to health care Access to health care was identified through both primary and secondary data. Access was indicated by more focus group and interview participants than any other health issue, with low-income and singleparent families mentioned as experiencing the greatest difficulty in accessing health care. Secondary data supports this concern, with a low level of affluence and a high proportion of uninsured population among residents of Ware and Pierce counties. Other Available Resources In addition to the facilities and services provided by Mayo Clinic Health System in Waycross and other providers as discussed above and in the Access to Care section of this report, Ware and Pierce counties have many health resources available for vulnerable populations and the community overall. These resources were considered when prioritizing the health needs of the community. The Attachment to this report includes a list of existing health care facilities and other resources identified during the CHNA process that are available to address the identified community health needs. This list is not comprehensive, but includes those health resources known or identified in the course of conducting the CHNA. Community Health Needs Assessment Page 32 of 37

33 Attachment A: Available Resources Below are lists of existing health care facilities and other resources identified during the CHNA process that are available to address the identified community health needs.these lists are not comprehensive, but include those health resources known or identified in the course of conducting the CHNA. The following are example programs not mentioned previously that are offered or hosted by Mayo Clinic Health System in Waycross. Advocacy/education programs offered Bullying/cyber bullying Child abuse and neglect Internet safety Parenting classes for breast feeding, child birth, epidural and sibling school S.A.F.E. (Self Awareness & Familiarization Exchange) Program Sexual harassment Stewards of Children training Tobacco cessation classes Examples of other programs provided, sponsored, or supported American Cancer Society Look Good Feel Better American Cancer Society Relay For Life American Cancer Society survivor dinner Blood pressure checks at local festivals and water stations for local races Camp Reveille health program for children (focused on obesity prevention) Community and employer health fairs First aid station for Pierce County High School band competition Nutrition program for the Ware County Weed-n-Seed Program Partnership with Blackshear Elementary School (funding for walking trail and health education) Partnership with Memorial Drive Elementary School (funding for walking track and health education) Senior Safety Day community collaboration/partnership Support groups for Alzheimer s, cancer, diabetes, domestic violence, sexual assault Teen Maze at Ware and Pierce county schools Community Health Needs Assessment Page 33 of 37