HOSPITAL AUTHORITY OF VALDOSTA & LOWNDES COUNTY, GEORGIA COMMUNITY HEALTH NEEDS ASSESSMENT SGMC LANIER CAMPUS

Transcription

1 HOSPITAL AUTHORITY OF VALDOSTA & LOWNDES COUNTY, GEORGIA COMMUNITY HEALTH NEEDS ASSESSMENT SGMC LANIER CAMPUS July 16, 2015 DRAFT Allison McCarthy Principal 70 Old Field Road, Plymouth, MA Tel/Fax:

2 TABLE OF CONTENTS EXECUTIVE SUMMARY... 1 INTRODUCTION & BACKGROUND... 2 STUDY METHODOLOGY... 3 ORGANIZATIONAL PROFILE... 4 COMMUNITY PROFILE... 4 EXPERT INTERVIEWS... 5 SECONDARY DATA... 7 APPENDIX... 13

3 EXECUTIVE SUMMARY The Hospital Authority of Valdosta and Lowndes County, Georgia is pleased to present the 2015 Community Health Needs Assessment (CHNA) for the SGMC Campus. As a non-profit healthcare organization, our obligation is to conduct this type of study every three years for all of the system s hospitals. The report describes the assessment process, the primary health concerns identified and the action plan to be implemented by The Hospital Authority of Valdosta and Lowndes County, Georgia for the communities served by SGMC Campus. The Hospital Authority of Valdosta and Lowndes County, Georgia partnered with Barlow/McCarthy, a national healthcare consulting firm with experience in preparing community health needs assessments, to complete the study and support the development of the action plan. The data and information collected for the assessment included: 1. Interviews with community leaders and others knowledgeable about public health 2. Secondary health status data and indicators compiled by other agencies and organizations Risk Factors Interviews with community leaders and those knowledgeable about public health identified the following risk factors, based on magnitude and severity, as negatively impacting the health of County residents. Rank Risk Factor 1 Under/Uninsured Population 2 Tobacco Use 3 Alcohol Abuse 4 Obesity in Children and Adults 4 Mental Health 4 Child Abuse/Neglect 4 Teen Pregnancy Health Access Respondents also identified the following healthcare services as not readily available and/or difficult to access within County. Rank Services 1 Primary care including urgent/walk-in services 2 Eye care 3 Women's services including OB/GYN 4 Other specialty care e.g. cardiovascular, stroke, cancer, orthopedics 5 Dialysis services 6 Diabetes management and education Community Health Needs Assessment, SGMC Campus page 1

4 Health Status s The following health status indicators obtained from secondary data sources were found to fall outside acceptable benchmarks or established targets. Status s (1) Primary Care Dental Care Cancer Lung Cancer Mammography Screening Clinical Care Ranking (2) Diabetes Incidence and Screening High Blood Pressure Preterm Births Mental Health Alzheimers Disease Poor Physical Health Days (3) Poor Self-Reported Health Status Poverty Level (1) Includes all status indicators where the county score falls outside of national targets and/or acceptable standards by a statistically significant margin. (2) Clinical Care Ranking - uninsured, primary care physicians, mental health providers, dentists, preventable hospital stays, diabetic monitoring and mammography screening (3) Poor Physical Heath Days - average number of days that adults reported their physical health was not good in the past 30 days Community Health Needs Assessment, SGMC Campus page 2

5 INTRODUCTION & BACKGROUND The Patient Protection and Affordable Care Act requires all non-profit hospitals to prepare a Community Health Needs Assessment (CHNA) at least once every three years to maintain taxexempt status. The CHNA must include input from persons who represent the broad interests of the community including those with special knowledge or expertise in public health. The CHNA must also be made widely available to the public and include an implementation plan describing how the organization will address the community s health needs. The role of the CHNA is to identify factors that affect the health of the community and determine the availability and/or need to build resources to address these issues. More specifically, the objectives of the assessment include: Explore the current state of the local healthcare market including access to care, quality of care and unmet needs of the community. Quantify health status indicators such as disease prevalence and incidence as well as socioeconomic and other risk factors that may affect the health of the community. Compare local results to national and state benchmarks when available to highlight areas of concern. Prioritize community health needs based on analysis of both quantitative and qualitative data. Develop an action plan with specific tactics describing how the organization will address the health needs of the community. STUDY METHODOLOGY In order to satisfy regulatory requirements, a multi-step process was employed to conduct and complete the Community Health Needs Assessment (CHNA) for the SGMC Campus. The process is described below. Step 1: Establish a Multidisciplinary CHNA Team. The CHNA Team provided project oversight and assisted with the selection of community priorities and appropriate responses and interventions on the part of SGMC. Step 2: Collect Input from the Community. This phase was designed to explore the current state of the local healthcare market including access to care and preventive services, as well as unmet needs and behavioral risk factors present in the community. To collect this information, interviews were conducted with individuals who represent the broad interests of the community and are knowledgeable about public health issues. Step 3: Collect Secondary Data. In this phase, secondary data compiled by other agencies and organizations was collected and summarized to quantify a number of health status indicators along with demographics, socioeconomic and other environmental factors that may affect the health of the community. The local data for County was compared to national and state benchmarks when available to highlight areas of concern. Community Health Needs Assessment, SGMC Campus page 3

6 Step 4: Prioritize Community Health Issues. The key to success is selecting a manageable number of priority issues based on the data and available resources and capabilities. At this stage, the CHNA Team prioritized community health needs using a rating system that included both quantitative and qualitative factors. Step 5: Develop Community Health Action Plans. Once priorities were established, the CHNA Team developed specific tactics to address these health issues and concerns including specific goals and objectives, resource requirements, implementation timelines and a plan to measure progress. Step 6: Make Assessment Available to the Public. The final requirement is to make the assessment widely available to the public. This document describes the community, the process used to conduct the assessment, how community input was included and action plans including appropriate interventions to address those health issues identified as priorities. ORGANIZATIONAL PROFILE The Hospital Authority of Valdosta and Lowndes County, Georgia is a not-for-profit healthcare delivery system serving a multi-county area in South Georgia and North Florida. The system consists of South Georgia Medical Center, Smith Northview Hospital, South Georgia Medical Center Campus, South Georgia Medical Center Berrien Campus and Clinch Memorial Hospital. SGMC Campus (formally Louis Smith Memorial Hospital established in 1950) operates as a 25-bed critical access hospital providing acute and sub-acute care in Lakeland, Georgia. SGMC Campus is the winner of Georgia Trends Top Critical Access Hospitals and recognized by the Georgia Hospital Association for Quality and Patient Safety. COMMUNITY PROFILE County is located northeast of Valdosta, GA. As of 2014, the county population was 10,373 with an age distribution that is slightly younger than the state overall. The county is predominantly white/caucasian (72.1%) with black/african Americans comprising approximately 23.0% of the population and Hispanics/Latinos 5.2%. Education level and other economic indicators such as per capita income and median house value are below statewide standards while poverty rates are higher. SGMC Campus Community Health Needs Assessment, SGMC Campus page 4

7 Demographic Profile (2014) Demographics County GA Population 10,373 10,097,343 Percent change ( ) 3.0% 4.2% Under 5 yrs 7.7% 6.7% Under 18 yrs 25.0% 24.9% 65 yrs and over 11.6% 12.0% Females 49.0% 51.1% White/Caucasian 72.1% 62.5% Black/African American 23.0% 31.4% Hispanic/Latino 5.2% 9.2% High school graduate or higher 76.4% 84.7% Bachelor's degree or higher 12.0% 28.0% Housing units 4,250 4,109,896 Homeownership rate 60.9% 65.1% Median house value $111,800 $151,300 Households 3,725 3,518,097 Persons per household Per capita money income $17,264 $25,182 Median household income $39,452 $49,179 Persons below poverty level 26.7% 18.2% EXPERT INTERVIEWS A total of eight interviews were completed with community leaders and those with public health expertise (a list of participants is included in the Appendix). A script was developed to guide the discussions and ensure consistency in the content and questions across interviews. Discussion topics included: Social and behavioral risk factors impacting community health Barriers affecting access to healthcare in the local community Quality of healthcare available in the local community including improvement opportunities Healthcare not readily available and/or those services residents would like to see available in County When asked to identify risk factors impacting community health, respondents identified the following items most frequently including obesity in both adults and children, tobacco use, illegal substance abuse and alcohol abuse/excessive drinking. Community Health Needs Assessment, SGMC Campus page 5

8 Risk Factors Obesity In Children And Adults Smoking and Tobacco Use Illegal Substance Abuse Alcohol Abuse Under/Uninsured Teenage Pregnancy Poor Nutrition in Children And Adults Domestic/Child Abuse or Neglect Mental Health Issues Motor Vehicle Accidents Infectious Diseases (HIV, STDs, etc.) Other Number of Mentions Interview respondents were also asked to rank risk factors based on the magnitude and severity of the problem. The following is a rank ordered list of the risk factors identified during the interviews. NOTE: Some risk factors were rated equally and are noted in the list below. 1. Under/Uninsured Population 2. Tobacco Use 3. Alcohol Abuse 4. Obesity in Children and Adults 4. Mental Health 4. Child Abuse/Neglect 4. Teen Pregnancy The final portion of the interviews discussed healthcare services not readily available in County, leading to access barriers and/or the need for residents to seek care outside their local community. Respondents identified a need for the following services to improve access and the quality of healthcare available to County residents. 1. Primary care including urgent/walk-in services 2. Eye care 3. Women s services including OB/GYN 4. Other specialty care e.g. cardiovascular, stroke, cancer, orthopedics 5. Dialysis services 6. Diabetes management and education Community Health Needs Assessment, SGMC Campus page 6

9 SECONDARY DATA Secondary data compiled by other agencies and organizations was collected and summarized to quantify a number of health status indicators as well as socioeconomic and other risk factors that may affect the health of the community. The local community data was compared to national and state benchmarks when available to highlight areas of concern. Target values are part of the Healthy People 2020 initiative which includes science-based, 10- year national objectives for improving the health of all Americans. Other benchmarks have been developed by a number of state agencies and national organizations with expertise in these areas e.g. Georgia Department of Public Health, Centers for Disease Control and Prevention, National Institute of Health and National Cancer Institute. NOTE: Not all secondary data is available for County due to small sample sizes and the lack of statistical validity for some of the health status indicators. Color key for secondary data tables: GREEN = score is within acceptable range YELLOW = score is outside acceptable range but not by a statistically significant margin RED = score is outside acceptable range by a statistically significant margin Healthcare Access The Healthy People 2020 national target is to increase the proportion of the population with health insurance to 100%. However, no U.S Census data is currently available for adult and children insurance coverage rates in County. A recent report by the Robert Wood Johnson Foundation estimated that approximately 23% of County residents under the age of 65 do not currently have health insurance coverage compared to 21% for the state overall. The number of primary care providers and dentists in County is also inadequate to support community needs. NOTE: Other primary care provider rate is based on the number of advanced care providers in the community versus population size. Note: Other primary care provider rate is based on the number of advanced care providers in the community versus population size. Cancer Profile Adults with Health Insurance NA 100% Red < 76.5 Green >= 81.6 Yellow = In-between Children with Health Insurance NA 100% Red < 91.5 Green >= 94.5 Yellow = In-between Primary Care Provider Rate 19 NA Red < 33 Green >= 50 Yellow = In-between Other Primary Care Provider Rate 10 NA Red < 32 Green >= 50 Yellow = In-between Dentist Rate 10 NA Red < 24 Green >= 37 Yellow = In-between While the overall cancer incidence rate is below the national benchmark, the age-adjusted death rate due to cancer is well above the benchmark range along with the age-adjusted death rate for lung cancer. While breast cancer incidence and death rates are both below all targets and benchmarks, mammography screening in the Medicare population is well below the Community Health Needs Assessment, SGMC Campus page 7

10 acceptable range. Colorectal cancer incidence and age-adjusted death rates are both below targets and national benchmarks while the prostate incidence rate is slightly above average. NOTE: All statistics developed by the National Cancer Institute. Age-Adjusted Death Rate due to Breast Cancer Red > 25.5 Green <= 22.6 Yellow = In-between Age-Adjusted Death Rate due to Cancer Red > Green <= Yellow = In-between Age-Adjusted Death Rate due to Colorectal Cancer Red > 20.0 Green <= 17.1 Yellow = In-between Age-Adjusted Death Rate due to Lung Cancer Red > 63.7 Green <= 54.6 Yellow = In-between Age-Adjusted Death Rate due to Prostate Cancer NA 21.8 Red > 27.2 Green <= 23.2 Yellow = In-between All Cancer Incidence Rate NA Red > Green <= Yellow = In-between Breast Cancer Incidence Rate 88.0 NA Red > Green <= Yellow = In-between Cervical Cancer Incidence Rate NA 7.1 Red > 9.9 Green <= 8.0 Yellow = In-between Colorectal Cancer Incidence Rate Red > 51.0 Green <= 45.2 Yellow = In-between Lung and Bronchus Cancer Incidence Rate 82.2 NA Red > 81.4 Green <= 71.2 Yellow = In-between Mammography Screening: Medicare Population 47.2% NA Red < 55.6 Green >= 61.4 Yellow = In-between Oral Cavity and Pharynx Cancer Incidence Rate NA NA Red > 13.7 Green <= 11.8 Yellow = In-between Prostate Cancer Incidence Rate NA Red > Green <= Yellow = In-between County Health Rankings County ranks in the top 50% of GA counties for the majority of County Health Rankings but falls in the lower 25% of counties for the clinical care dimension. Rankings for morbidity also fall in the lower half of all GA counties. NOTE: County Health Rankings is an annual compilation of vital statistics completed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Each indicator is a composite score based on the following measures: Clinical Care - uninsured, primary care physicians, mental health providers, dentists, preventable hospital stays, diabetic monitoring and mammography screening. Health Behaviors adult smoking, adult obesity, physical inactivity, access to exercise opportunities, excessive drinking, alcohol-impaired driving deaths, sexually transmitted infections, teen births and a food environment index. Morbidity poor or fair health, poor physical health days, poor mental health days and low birth weight. Mortality premature death. Physical Environment daily fine particulate matter, drinking water violations, severe housing problems, driving alone to work and long commute while driving alone. Social and Economic high school graduation, some college, unemployment, children in poverty, income inequality, children in single-parent households, social associations, violent crime rate and injury death rate. Community Health Needs Assessment, SGMC Campus page 8

11 Clinical Care Ranking 158 NA Red > 119 Green <= 80 Yellow = In-between Health Behaviors Ranking 74 NA Red > 119 Green <= 80 Yellow = In-between Morbidity Ranking 93 NA Red > 119 Green <= 80 Yellow = In-between Mortality Ranking 60 NA Red > 119 Green <= 80 Yellow = In-between Physical Environment Ranking 29 NA Red > 119 Green <= 80 Yellow = In-between Social and Economic Factors Ranking 44 NA Red > 119 Green <= 80 Yellow = In-between Diabetes Profile The percentage of adults aged 20 and older in County with diabetes is below the national benchmark; however, the age-adjusted death rate is well above the accepted level. The diabetic screening rate (HbA1c) among the Medicare population is also below the benchmark. NOTE: The diabetes indicators are developed by a number of state agencies and national organizations. Adults with Diabetes 11.0% NA Red > 11.7 Green <= 11.1 Yeloww = In-between Age-Adjusted Death Rate due to Diabetes 64.0 NA Red > 34.3 Green <= 26.1 Yellow = In-between Diabetic Screening: Medicare Population 72.0% NA Red < 82.0 Green >= 85.3 Yellow = In-between Obesity Profile Both adult obesity and pre-school obesity among low income households are higher than national benchmarks. However, the percentage of sedentary adults is less than the national target. NOTE: Sedentary adults (ages 20 and up) include individuals who did not participate in any physical activities other than their regular job during the past 30 days. The obesity indicators are developed by a number of state agencies and national organizations. Adults who are Obese 32.0% 30.5% Red > 33.7 Green <= 31.2 Yellow = In-between Adults who are Sedentary 27.0% 32.6% Red > 30.9 Green <= 27.6 Yellow = In-between Low-Income Preschool Obesity 15.5% NA Red > 16.1 Green <= 13.9 Yellow = In-between Family Planning Teen pregnancy and birth rates and the percentage of infants born to mothers with less than 12 years of education are below average when compared to other Georgia counties. NOTE: The family planning indicators are developed and maintained by the Georgia Department of Public Health. Community Health Needs Assessment, SGMC Campus page 9

12 Infants Born to Mothers with <12 Yrs Education 12.8% NA Red > 24.2 Green <= 20.1 Yellow = In-between Teen Birth Rate 15.4 NA Red > 31.6 Green <= 24.2 Yellow = In-between Teen Pregnancy Rate Red > 36.5 Green <= 26.6 Yellow = In-between Heart Disease & Stroke Age-adjusted death rate due to stroke is well above the Healthy People 2020 target, while the death rate due to high blood pressure is also substantially above accepted standards. However, the age-adjusted death rate for heart disease is below the overall state benchmark. NOTE: The heart disease and stroke indicators are developed and maintained by the Georgia Department of Public Health. Age-Adjusted Death Rate due to Stroke Red > 53.2 Green <= 44.3 Yellow = In-between Age-Adjusted Death Rate due to High Blood Pressure Age-Adjusted Death Rate due to Obstructive Heart Disease Infectious Diseases 28.8 NA Red > 19.8 Green <= 13.3 Yellow = In-between 67.3 NA Red > Green <= 91.5 Yellow = In-between Incidence rates for infectious diseases in County are below the state benchmarks with the exception of Gonorrhea. NOTE: The infectious disease indicators are developed and maintained by the Georgia Department of Public Health. Age-Adjusted Death Rate due to Influenza and Pneumonia 16.0 NA Red > 24.5 Green <= 18.8 Yellow = In-between AIDS Prevalence Rate 76.9 NA State Avg=234.7 Chlamydia Incidence Rate NA Red > Green <= Yellow = In-between Gonorrhea Incidence Rate NA Red > Green <= 98.0 Yellow = In-between Syphilis Incidence Rate 0.0 NA State Avg=9.3 Health Prevention & Safety Violent crime and child abuse rates exceed state-based benchmarks, while death rates due to falls and motor vehicle collisions are below average. NOTE: These indicators are compiled by a number of national agencies and organizations. Community Health Needs Assessment, SGMC Campus page 10

13 Age-Adjusted Death Rate due to Falls Red > 10.9 Green <= 8.1 Yellow = In-between Age-Adjusted Death Rate due to Poisonings NA NA Red > 16.2 Green <= 12.7 Yellow = In-between Violent Crime Rate NA Red > Green <= Yellow = In-between Age-Adjusted Death Rate due to Motor Vehicle Collisions 16.0 NA Red > 22.8 Green <= 17.7 Yellow = In-between Child Abuse Rate Red > 14.3 Green <= 10.3 Yellow = In-between Maternal Fetal & Infant Health Preterm birth rate is above the national target, while the very low birth weight rate is also slightly above the benchmark range. However, the low birth weight rate is below both national and state benchmarks. Tobacco use by mothers during pregnancy is below the state average but above the Healthy People 2020 target. NOTE: These indicators are developed and maintained by the Georgia Department of Public Health. Mental Health Babies with Low Birth Weight 5.6% 7.8% Red > 12.3 Green <= 9.4 Yellow = In-between Babies with Very Low Birth Weight 2.0% 1.4% Red > 2.6 Green <= 1.9 Yellow = In-between Infant Mortality Rate NA 6.0 State Avg = 6.8 Mothers who Smoked During Pregnancy 7.0% 1.4% Red > 14.3 Green <= 10.8 Yellow = In-between Preterm Births 14.3% 11.4% Red > 13.6 Green <= 11.4 Yellow = In-between All mental health indicators exceed acceptable benchmark levels including the Alzheimer s death rate and poor mental health days. NOTE: Poor mental health days is the average number of days that adults report their mental health was not good in the past 30 days. These indicators are developed and maintained by the County Health Rankings compilation. Age-Adjusted Death Rate due to Suicide NA 10.2 Red > 16.1 Green <= 13.2 Yellow = In-between Inadequate Social Support NA NA Red > 22.3 Green <= 19.1 Yellow = In-between Poor Mental Health Days 4.5 NA Red > 4.1 Green <= 3.5 Yellow = In-between Age-Adjusted Death Rate due to Alzheimer's Disease 52.5 NA Red > 39.3 Green <= 29.2 Yellow = In-between Substance Abuse Tobacco use rate in County is below the County Health Rankings benchmark range but substantially above the Health People 2020 target level. NOTE: The substance abuse indicators are developed by the County Health Rankings compilation. Community Health Needs Assessment, SGMC Campus page 11

14 Adults who Drink Excessively NA 25.4% Red > 18.6 Green <= 16.3 Yellow = In-between Adults who Smoke 20.0% 12.0% Red > 24.9 Green <= 20.8 Yellow = In-between Wellness & Lifestyle All wellness and lifestyle indicators fall outside the acceptable ranges; including poor physical health days, self-reported health as poor or fair and access to recreation and fitness facilities in the county. NOTE: These indicators are compiled by a number of national agencies and organizations. Poor Physical Health Days 4.6 NA Red > 4.4 Green <= 3.7 Yellow = In-between Self-Reported General Health Assessment: Poor or Fair 22.0 NA Red > 20.9 Green <= 16.5 Yellow = In-between Recreation and Fitness Facilities 0.00 NA 0.06 units/1,000 population Persons with a Disability NA 12.6% Compared to state average Socio-Economic Profile All social-economic indicators fall outside acceptable ranges with the exception of the percent of single-parent households. Median income and high school graduation rate are below benchmark ranges, while all poverty indicators are above nationally-based standards. NOTE: These indicators are collected by the U.S. Census Bureau. Median Household Income 39,452 NA Red < 38,183 Green >= 44,157 Yellow = In-between Children Living Below Poverty Level 33.7% NA Red > 29.4 Green <= 22.5 Yellow = In-between Families Living Below Poverty Level 22.2% NA Red > 15.2 Green <= 11.5 Yellow = In-between People 65+ Living Below Poverty Level 21.7% NA Red > 12.8 Green <= 9.5 Yellow = In-between Single-Parent Households 21.4% NA Red > 37.7 Green <= 31.3 Yellow = In-between High School Graduation 72.3% 82..4% Red < 70.2 Green >= 76.6 Yellow = In-between Community Health Needs Assessment, SGMC Campus page 12

15 APPENDIX Interview Participants Name Organization Title Rachel Hubbard UGA Extension I County Family & Consumer Sciences Agent Geoff Hardy SGMC Lakeland Villa Administrator Amy Lollis Family Connections Director Kristy Music Berrien and Campus Rehab Director David Bauch SGMC System Director of EMS Alex Lee Farmers & Merchants Bank Vice President Chairman County Commissions Jane Phillips Dr. Bruce Herrington Office Manager Wonda McRae F & M Bank Member of Advisory Board Community Health Needs Assessment, SGMC Campus page 13