COMMUNITY HEALTH NEEDS ASSESSMENT SOUTH GEORGIA MEDICAL CENTER BERRIEN CAMPUS

Transcription

1 COMMUNITY HEALTH NEEDS ASSESSMENT SOUTH GEORGIA MEDICAL CENTER BERRIEN CAMPUS July 14, 2014 DRAFT Allison McCarthy MBA Principal 70 Old Field Road Plymouth, MA Telephone/Fax: (508)

2 TABLE OF CONTENTS Section Page Executive Summary... 3 Introduction and Background. 5 Study Methodology 5 Organizational Profile.. 6 Community Profile. 6 Expert Interviews 8 Community Survey 10 Secondary Data 16 Appendix.. 23 SGMC Campus Community Health Needs Assessment page 2

3 EXECUTIVE SUMMARY South Georgia Medical Center (SGMC) is pleased to present our 2014 Community Health Needs Assessment for the SGMC Campus. As a non-profit healthcare organization, we are required to prepare an assessment every three years for all hospitals in our system. The report describes the community served, the process used to conduct the assessment and action plans to address those health issues identified as priorities. South Georgia Medical Center partnered with Barlow/McCarthy, a national healthcare consulting firm with experience in preparing community health needs assessments to complete the project. In order to support the process, data and information was collected from a number of sources including: 1. Interviews with community leaders and others knowledgeable about public health 2. Community survey of County residents 3. Secondary data compiled by other agencies and organizations The following represents a summary of key findings obtained from County residents participating in the community survey. 8% of survey respondents rated their current health status as either poor or failing. 13% of County residents reported that a household member had not received healthcare that was needed during the past 12 months. The primary reasons offered for not receiving needed healthcare included cost (both doctors and prescriptions) and the lack of health insurance. 12% of survey respondents indicated that at least one member of the household currently lacks healthcare insurance coverage. The majority (78%) of respondents have a personal or family doctor to cover the basic healthcare needs of the household. Those without a personal doctor primarily use urgent care, walk-in clinics or local emergency departments for their basic healthcare needs. 84% of respondents reported appointments for a non-emergency situation could be scheduled in less than one week with their personal or family doctor. 28% of respondents reported they drive 10 miles or less to access their personal physician; however, over one-third (36%) indicated they have longer drives of 20 miles or more to see their primary care provider. Among those seeing a specialist for healthcare in the past two years, one-third traveled outside their local community to access specialty care. Residents travel most frequently for Orthopedics, Cardiology, Neurology, OB/GYN and Gastro-intestinal services. The primary reason residents migrate out of their community for specialty care is due to a lack of physicians in the local area. SGMC Campus Community Health Needs Assessment page 3

4 The following risk factors and difficult to access healthcare services were identified by County residents as negatively impacting the health of the community. Community Survey Rank Risk Factors Healthcare Access 1 Illegal substance abuse Cancer 2 Under/uninsured Medical weight loss 3 Smoking/tobacco Use Mental healthcare 4 Teen/unwanted pregnancy Stroke 5 Childhood obesity Walk-in clinics/urgent care 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 Stroke Mental health Motor vehicle accidents Child abuse Tobacco use Poverty (1) Includes all status indicators where the county score falls outside of national targets and/or acceptable standards by a statistically significant margin. Interviews with community leaders and those knowledgeable about public health identified the following as significant issues negatively impacting the health of County residents. Rank Risk Factor 1 Tobacco use 2 Illegal substance abuse 3 Teen pregnancy 4 Obesity in children and adults 5 Alcohol use 6 Sexually transmitted diseases 7 Poverty 8 Mental health 9 Diabetes SGMC Campus Community Health Needs Assessment page 4

5 INTRODUCTION AND 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 their tax-exempt 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/incidence in the community as well as prevention and other programs currently available. 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 community health needs. STUDY METHODOLOGY In order to satisfy regulatory requirements, a multi-step process was employed to conduct and complete a Community Health Needs Assessment 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 priorities and appropriate responses and interventions. Step 2: Collect and Analyze Input from the Community. This phase included both qualitative and quantitative components, which were designed to explore the current state of the local healthcare market including access to care and preventive services, unmet needs and behavioral risk factors present in the community. First, interviews were conducted with individuals who represent the broad interests of the community and are knowledgeable about public health issues. Secondly, a survey of County residents was completed and the data incorporated with information from public health experts to provide input from the community. SGMC Campus Community Health Needs Assessment page 5

6 Step 3: Collect and Analyze Secondary Data Sources. 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 community data was compared to national and state benchmarks when available to highlight areas of concern. 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 resource requirements, implementation timelines, specific goals and objectives 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 South Georgia Health System is a not-for-profit healthcare delivery system serving a multicounty area in South Georgia and North Florida. The system consists of South Georgia Medical Center, Smith Northview Hospital, South Georgia Medical Center Lanier Campus, South Georgia Medical Center Campus and Clinch Memorial Hospital. SGMC Campus has been a part of the Nashville, GA community since 1965 and includes 51 acute care beds and 12 geriatric/psychiatric beds that serve the residents of County. COMMUNITY PROFILE County is located north of Valdosta, GA in South Georgia. As of 2012, the county population was 19,372 with an age distribution that closely mirrors the state overall. The county is predominantly white/caucasian (86.5%) with black/african Americans comprising approximately 11.5% of the population and Hispanics/Latinos 5.0%. 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 page 6

7 County SGMC Campus Demographic Profile (2012) Demographics County GA Population 19,372 9,812,460 Under 5 yrs 6.5% 7.0% Under 18 yrs 24.9% 25.4% 65 and over 14.6% 11.0% Females 50.4% 51.1% White/Caucasian 86.5% 63.2% Black/African American 11.5% 31.0% Hispanic/Latino 5.0% 9.1% High school graduate or higher 72.2% 84.0% Bachelor's degree or higher 11.3% 27.5% Housing units 8,847 4,102,992 Homeownership rate 70.2% 66.8% Median house value 74, ,200 Households 7,213 3,490,754 Persons per household Per capita income 16,885 25,383 Median household income 32,512 49,736 Persons below poverty level 23.7% 16.5% SGMC Campus Community Health Needs Assessment page 7

8 EXPERT INTERVIEWS A total of six interviews were completed with community leaders and those with public health expertise (a list of participants is included in 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 teen/unwanted pregnancy, substance use/abuse (illegal, alcohol, tobacco), lack of adequate insurance coverage and obesity in children and adults. Teenage pregnancy Illegal substance abuse Under or uninsured families Alcohol Obesity in adults and children Smoking and tobacco use Unwanted pregnency STD's Mental Health Poor nutrition Poverty & unemployment rate Child neglect Domestic abuse Poor transportation Risk Factors Number of Mentions SGMC Campus Community Health Needs Assessment page 8

9 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. 1. Smoking 2. Illegal Substance Abuse 3. Teen Pregnancy 4. Obesity in Children and Adults 5. Alcohol Use 6. Sexually Transmitted Diseases 7. Poverty 8. Mental Health 9. Diabetes The final portion of the interviews discussed healthcare services not readily available in County, creating access barriers to care and/or the need for residents to migrate out of their community for care. Respondents identified a community need for the following services to improve access and the quality of healthcare available to County residents. 1. Primary care 2. Specialty care including Obstetrics & Gynecology, Cardiology, Psychiatry, Gastrointestinal and Radiology 3. Pediatric care including children with special needs SGMC Campus Community Health Needs Assessment page 9

10 COMMUNITY SURVEY A blended web and telephone survey of County residents was completed to collect input from the public and community at large. The web portion was conducted first through a posted link on the SGMC Internet site and promoted by the organization through local media. The telephone survey included randomly selected households in County and was used to ensure appropriate geographic and demographic representation. A total of 68 surveys were completed which provides a margin of error of approximately +/- 12% at the 95% confidence level. Health Status When asked to rate their health status on an A to F grading scale, approximately 46% of respondents reported being in good health (A = well and active ) while 8% of residents reported below average health status with a rating of D or F. The remainder of the respondent base rated their current health status as either B (18%) or C (28%). D, 1% Health Status F - Health is failing, 7% C - OK, 28% A - Well and active, 46% B, 18% Health Insurance Coverage The majority of individuals and/or households have some type of health insurance. Employerbased plans are the most common type of insurance coverage followed by Medicare. Approximately 11% are covered under Medicaid and/or a state plan while 12% of the respondent base indicated that at least one member of the household currently lacks healthcare insurance coverage. By far, the most common reason for lacking insurance coverage is cost. SGMC Campus Community Health Needs Assessment page 10

11 Health Insurance Coverage None, 12% Employer provided, 43% Other, 7% State plan, 7% Medicare, 19% Medicaid, 4% Individual/family plan, 7% Risk Factors Respondents were asked to identify social and behavioral factors that impact the overall health of the community. Results are summarized below and represent the percentage of respondents rating the factors as a major problem in their community. Risk factors rated as a major problem by 40% or more of respondents included illegal substance abuse, lack of adequate insurance coverage, tobacco use, teen/unwanted pregnancy, obesity in both adults and children and alcohol abuse. Risk Factor Illegal substance abuse 73% Under or uninsured families 48% Smoking and tobacco use 46% Teenage/unwanted pregnancy 46% Childhood obesity 45% Adult obesity 41% Alcohol abuse 41% Poor nutrition in children 36% Motor vehicle accidents 32% Domestic/child abuse or neglect 26% Poor nutrition in adults 25% Mental health issues 21% Infectious diseases like HIV, TB etc. 18% Violent crime & sexual assault 14% Access to childhood vaccinations 0% SGMC Campus Community Health Needs Assessment page 11

12 Healthcare Access Approximately 13% of County residents reported that a household member had not received healthcare that was needed during the past 12 months. The primary reasons offered for not receiving needed healthcare included cost (both doctors and prescriptions) and the lack of health insurance. However, respondents indicated the inability to find a doctor and/or get an appointment were not major access barriers to healthcare. County residents also identified a number of healthcare services that are difficult to access and not readily available in the local community. Services identified by 10% or more of respondents as lacking in the community included cancer treatment and screenings, weight loss services, mental healthcare, stroke care, urgent care and pregnancy-related healthcare. Respondents also noted residents are forced to travel outside their local community to access many of these healthcare services. Primary Care Healthcare Access Cancer 26% Medical weight loss services 20% Mental health care 18% Stroke 18% Walk in clinics/urgent care 15% Healthcare for pregnant women 11% Cancer screenings 10% Asthma 8% Children with special needs 7% Healthcare for women in general 7% Healthcare for seniors 7% Family doctors 6% Imaging services like X-rays 6% Alcohol/drug abuse treatment 6% Diabetes 0% Emergency services 0% Heart disease 0% Eye care 0% Dental care 0% The majority (78%) of respondents have a personal or family doctor to cover the basic healthcare needs of the household. By far, the most common type of personal doctor is a Family Medicine physician or General Practitioner. Those without a personal doctor primarily use urgent care, walk-in clinics or local emergency departments for their basic healthcare needs. SGMC Campus Community Health Needs Assessment page 12

13 Approximately 61% of respondents reported appointments for a non-emergency situation could be scheduled the same or next day with 84% of appointments available in less than one week. Respondents are also generally satisfied with the hours available for patient care at their personal doctor or primary care provider office with only 6% stating the hours are not convenient. Appointment Wait Time 4 weeks, 0% More than 4 3 weeks, 0% weeks, 2% Between 1 and 2 weeks, 15% Same day, 38% Less than 1 week, 23% Next day, 23% Convenience of Office Hours SGMC Campus Community Health Needs Assessment page 13

14 Approximately 28% of respondents reported they drive 10 miles or less to access their personal physician; however, over one-third (36%) indicated they have much longer drives of 20 miles or more to see their primary care provider. Travel Distance 0-5 miles, 19% +20 miles, 36% 6-10 miles, 9% miles, 17% miles, 19% Specialty Care Nearly two-thirds of respondents (65%) reported seeing a healthcare specialist in the past two years. Specialty services most frequently accessed include Orthopedics, Cardiology, Neurology, OB/GYN and GI. Among those seeing a specialist, one-third (34%) traveled outside their local community to access specialty care. The primary reason residents migrate out of their community for specialty care is due to a lack of local physicians. Other reasons offered for seeking specialty care outside the immediate community included physician referral, patient preference and use of specialty facilities such as the VA. SGMC Campus Community Health Needs Assessment page 14

15 No specialists available in the community Specialty Outmigration Doctor recommendation Other Reputation of specialist Better quality of care You/family member used specialist in the past Specialists in the community have full practices More up to date technology Health insurance dictated specialist Family/friend recommendation 0% 5% 10% 15% 20% 25% 30% 35% 40% SGMC Campus Community Health Needs Assessment page 15

16 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 environmental 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 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. However, a recent report by the Robert Wood Johnson Foundation estimated that approximately 26% of all County residents do not currently have health insurance coverage. The number of primary care providers and dentists in County is also inadequate to support community needs. Adults with Health Insurance NA 100% Red < 75.3 Green >= 81.1 Yellow = In-between Children with Health Insurance NA 100% Red < 91.0 Green >= 94.2 Yellow = In-between Primary Care Provider Rate 23 NA Red < 33 Green >= 52 Yellow = In-between Dentist Rate 2 NA Red < 19 Green >= 30 Yellow = In-between SGMC Campus Community Health Needs Assessment page 16

17 Cancer Profile 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. Breast cancer incidence is also slightly above the acceptable range, although mammography screening in the Medicare population is well above the benchmark. Colorectal cancer incidence and age-adjusted death rates are both below target and/or national benchmarks in addition to the prostate incidence rate. NOTE: All statistics developed by the National Cancer Institute. Breast Cancer NA 20.6 Red > 26.5 Green <= 23.4 Yellow = In-between Cancer Red > Green <= Yellow = In-between Colorectal Cancer Red > 20.9 Green <= 17.9 Yellow = In-between Lung Cancer Red > 66.6 Green <= 57.3 Yellow = In-between Prostate Cancer NA 21.2 Red > 29.4 Green <= 24.9 Yellow = In-between All Cancer Incidence Rate NA Red > Green <= Yellow = In-between Breast Cancer Incidence Rate NA Red > Green <= Yellow = In-between Cervical Cancer Incidence Rate NA NA Red > 10.2 Green <= 8.6 Yellow = In-between Colorectal Cancer Incidence Rate Red > 54.8 Green <= 48.5 Yellow = In-between Lung and Bronchus Cancer Incidence Rate 85.1 NA Red > 85.4 Green <= 74.6 Yellow = In-between Mammography Screening: Medicare Population 67.4% NA Red < 59.1 Green >= 64.8 Yellow = In-between Oral Cavity and Pharynx Cancer Incidence Rate NA NA Red > 13.6 Green <= 11.6 Yellow = In-between Prostate Cancer Incidence Rate NA Red > Green <= Yellow = In-between SGMC Campus Community Health Needs Assessment page 17

18 County Health Rankings County ranks in the top 50% of GA counties for low morbidity rate and physical environment indicators but falls in the lower 25% of counties for clinical care and the health behaviors dimension e.g. tobacco/alcohol use, diet/exercise, teen birth rate. Rankings for mortality and social/economic factors 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. Clinical Care Ranking 125 NA Red > 117 Green <= 78 Yellow = In-between Health Behaviors Ranking 155 NA Red > 117 Green <= 78 Yellow = In-between Morbidity Ranking 74 NA Red > 117 Green <= 78 Yellow = In-between Mortality Ranking 92 NA Red > 117 Green <= 78 Yellow = In-between Physical Environment Ranking 32 NA Red > 117 Green <= 78 Yellow = In-between Ranking 95 NA Red > 117 Green <= 78 Yellow = In-between Diabetes Profile All diabetes indicators in County fall outside the accepted benchmarks including prevalence, age-adjusted death rate and diabetic screening among the Medicare population. 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 <= 10.3 Yeloww = In-between Diabetes 22.7 NA Red > 30.1 Green <= 20.1 Yellow = In-between Diabetic Screening: Medicare Population 81.0% NA Red < 80.1 Green >= 83.7 Yellow = In-between SGMC Campus Community Health Needs Assessment page 18

19 Obesity Profile While adult obesity is above the national target, pre-school obesity among low income households is below average. The percent of sedentary adults not participating in any physical activity in the past 30 days is also above the acceptable range. NOTE: The obesity indicators are developed by a number of state agencies and national organizations. Family Planning All of the family planning indicators are above benchmark ranges including infants born to mothers with less than 12 years of education and both teen birth and pregnancy rates. NOTE: The family planning indicators are developed and maintained by the Georgia Department of Public Health. Heart Disease & Stroke Adults who are Obese 31.0% 30.6% Red > 32.8 Green <= 30.9 Yellow = In-between Adults who are Sedentary 30.0% 32.6% Red > 30.2 Green <= 27.9 Yellow = In-between Low-Income Preschool Obesity 13.2% NA Red > 16.1 Green <= 14.0 Yellow = In-between Infants Born to Mothers with <12 Yrs Education 22.4% NA Red > 28.1 Green <= 21.7 Yellow = In-between Teen Birth Rate 32.7 NA Red > 34.2 Green <= 27.1 Yellow = In-between Teen Pregnancy Rate Red > 41.3 Green <= 31.0 Yellow = In-between Both age-adjusted death rates due to stroke and heart disease are above acceptable target and benchmark ranges. NOTE: The heart disease and stroke indicators are developed and maintained by the Georgia Department of Public Health. Stroke Red > 64.7 Green <= 53.9 Yellow = In-between Age-Adjusted Death Rate due to High Blood Pressure NA NA Red > 17.9 Green <= 11.9 Yellow = In-between Obstructive Heart Disease NA Red > Green <= Yellow = In-between SGMC Campus Community Health Needs Assessment page 19

20 Infectious Diseases Both chlamydia and gonorrhea incidence rates are below benchmarks, while the AIDS prevalence rate is above the state average. NOTE: The infectious disease indicators are developed and maintained by the Georgia Department of Public Health. Influenza and Pneumonia NA NA Red > 27.2 Green <= 21.3 Yellow = In-between AIDS Prevalence Rate NA State Avg=242.1 Chlamydia Incidence Rate NA Red > Green <= Yellow = In-between Gonorrhea Incidence Rate 98.1 NA Red > Green <= Yellow = In-between Syphilis Incidence Rate NA NA State Avg=9.1 Health Prevention &Safety Violent crime, death due to motor vehicle accidents and child abuse rates are above benchmark ranges, while death rates due to falls and poisonings are below average. NOTE: These indicators are compiled by a number of national agencies and organizations. Falls Red > 9.4 Green <= 7.6 Yellow = In-between Poisonings Red > 13.1 Green <= 8.6 Yellow = In-between Violent Crime Rate NA Red > Green <= Yellow = In-between Motor Vehicle Collisions per 100K pop Red > 31.9 Green <= 24.2 Yellow = In-between Child Abuse Rate 29.8 NA Red > 16.6 Green <= 11.1 Yellow = In-between SGMC Campus Community Health Needs Assessment page 20

21 Maternal Fetal & Infant Health Rates for preterm births and babies with low birth weight are both below benchmark ranges; however, tobacco use by mothers during pregnancy is above the national target. NOTE: These indicators are developed and maintained by the Georgia Department of Public Health. Babies with Low Birth Weight 7.5% 7.80% Red > 12.2 Green <= 10.2 Yellow = In-between Babies with Very Low Birth Weight NA 1.40% Red > 2.7 Green <= 1.9 Yellow = In-between Infant Mortality Rate NA 6 Red > 11.3 Green <= 6.7 Yellow = In-between Mothers who Smoked During Pregnancy 10.8% 1.40% Red > 14.1 Green <= 10.2 Yellow = In-between Preterm Births 11.8% 11.40% Red > 14.8 Green <= 12.7 Yellow = In-between Mental Health All mental health indicators exceed targets and benchmarks. NOTE: Inadequate social support is the percentage of adults who report they do not get the social and emotional support they need. 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 Georgia Department of Public Health or the County Health Rankings compilation. Suicide Red > 14.6 Green <= 11.6 Yellow = In-between Inadequate Social Support 26.0% NA Red > 22.3 Green <= 19.1 Yellow = In-between Poor Mental Health Days 4.2 NA Red > 4.0 Green <= 3.4 Yellow = In-between Alzheimer's Disease NA NA Red > 36.4 Green <= 27.2 Yellow = In-between SGMC Campus Community Health Needs Assessment page 21

22 Substance Abuse Tobacco use rates are well above the Healthy People 2020 target, while excessive alcohol usage is below the national target. NOTE: The substance abuse indicators are developed by the County Health Rankings compilation. Adults who Drink Excessively 10.0% 25.30% Red > 18.0 Green <= 14.5 Yellow = In-between Adults who Smoke 32.0% 12% Red > 24.9 Green <= 20.9 Yellow = In-between Wellness & Lifestyle All wellness and lifestyle indicators fall outside the acceptable ranges. NOTE: These indicators are compiled by a number of national agencies and organizations. Poor Physical Health Days 3.9 NA Red > 4.4 Green <= 3.7 Yellow = In-between Self-Reported General Health Assessment: Poor or Fair 20.0 NA Red > 20.3 Green <= 16.0 Yellow = In-between Recreation and Fitness Facilities units/1,000 population Persons with a Disability NA 11.8% Compared to state average Economy & Social Profile All social-economic indicators fall outside acceptable ranges with the exception of the percent of single-parent households. NOTE: These indicators are collected by the U.S. Census Bureau. Median Household Income 32,215 NA Red < 36,948 Green >= 42,445 Yellow = In-between Children Living Below Poverty Level 36.1% NA Red > 26.8 Green <= 20.4 Yellow = In-between Families Living Below Poverty Level 17.8% NA Red > 14.1 Green <= 10.4 Yellow = In-between People 65+ Living Below Poverty Level 15.5% NA Red > 13.6 Green <= 10.0 Yellow = In-between Single-Parent Households 27.0% NA Red > 35.8 Green <= 29.5 Yellow = In-between High School Graduation 75.2% 82..4% Red < 74.5 Green >= 79.6 Yellow = In-between SGMC Campus Community Health Needs Assessment page 22

23 APPENDIX Interview Participants Name Organization Title Loren Nix GA Partnership TeleHealth Liaison Kristin Powell Dogwood Senior Health Center Social Worker Regina Hughes County Health Department Nurse Manager Travis Harper City of Nashville and County EMS Mayor and paramedic Dr. William Nash SGMC Campus Chief of Staff Karen Spires SGMC Campus Nurse Manager SGMC Campus Community Health Needs Assessment page 23