Baptist Beaumont Hospital

Community Health Needs Assessment and Implementation Plan June 2016 Table of Contents Section 1: Community Health Needs Assessment ...... 2 Executive Summary ...... 3 Process and Methodology ...... 13 Baptist Beaumont Hospital Biography ...... 17 Study Area ...... 22 Demographic Overview...... 24 Health Data Overview ...... 34 Phone Interview Findings ...... 88 2013 CHNA Prioritized Health Needs ...... 99 Input Regarding the Hospital’s Previous CHNA ...... 101 Evaluation of Hospital’s Impact ...... 103 2016 Preliminary Health Needs ...... 115 Prioritization ...... 117 Resources in the Community ...... 122 Information Gaps ...... 129 About Community Hospital Corporation ...... 131 Appendix ...... 133 Summary of Data Sources ...... 134 Demographic Data Findings ...... 138 Health Data Findings ...... 148 Interviewee Biographies ...... 201 Priority Ballot ...... 204

Section 2: Implementation Plan ...... 207 Section 3: Feedback, Comments and Paper Copies ...... 235

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 1 Section 1: Community Health Needs Assessment

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 2 EXECUTIVE SUMMARY

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 3 Executive Summary A comprehensive, six‐step community health needs assessment (“CHNA”) was conducted for Baptist Beaumont Hospital (BBH) by Community Hospital Corporation (CHC). This CHNA utilizes relevant health data and stakeholder input to identify the significant community health needs in Jefferson and Orange Counties in Texas.

The CHNA Team, consisting of leadership from BBH, met with staff from CHC on May 16, 2016 to review the research findings and prioritize the community health needs. Five significant community health needs were identified by assessing the prevalence of the issues identified from the health data findings combined with the frequency and severity of mentions in community input.

The CHNA Team participated in a prioritization process using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital’s capacity to address the need. Once this prioritization process was complete, the hospital leadership discussed the results and decided to address all of the five prioritized needs in various capacities through hospital specific implementation plans.

The five most significant needs, as ranked during the May 16th prioritization meeting, are listed below: 1. Access to Mental and Behavioral Health Care 2. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 3. Access to Affordable Care and Reducing Health Disparities Among Specific Populations 4. Need for Increased Emphasis on Collaborative Continuum of Care 5. Access to Specialty Care Services

BBH’s implementation plan addresses all of the five identified needs, and BBH leadership developed an implementation plan to identify specific activities and services which directly address all five priorities. The objectives were identified by studying the prioritized health needs, within the context of the hospital’s overall strategic plan and the availability of finite resources. The plan includes a rationale for each priority, followed by objectives, specific implementation activities, responsible leaders, annual updates and progress, and key results (as appropriate). Please see the “Implementation Plan” section of this report for further details.

The BBH Board reviewed and adopted the 2016 Community Health Needs Assessment and Implementation Plan on June 27, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 4 Priority #1: Access to Mental and Behavioral Health Care ‐In 2016, the rate of mental health care providers per 100,000 population in the report area (79.2 per 100,000) was lower than the state (102.3 per 100,000) rate and significantly lower than the national rate (202.8 per 100,000). When broken out by county, both Jefferson County (97.5 per 100,000) and Orange County (23.9 per 100,000) had a lower rate of mental health care providers than the state and the nation. ‐Four of the interviewees noted access to mental and behavioral health services as one of the biggest needs in the community. ‐Similar to primary and specialty care, interviewees noted that resources are inadequate for those without a pay source and high deductibles and medication costs were mentioned as a deterrent to seeking appropriate care. One interviewee specifically stated: "Many call about being off medications for months, but can't get any more or can't afford them and can't get back in to see someone for another two months." ‐Interviewees also discussed a lack of awareness regarding available resources and a stigma around accessing services. One interviewee raised concern around the lack of awareness of existing resources, stating: "There is not enough knowledge as to what are the available resources for folks who present substance abuse problems...I don't think the medical community really knows what to do with those folks." ‐One interviewee mentioned that there is a need for bilingual psychiatric services in the area, stating: "With counseling staff, there has also been a lack of bilingual psychiatric services." Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles ‐Overall mortality rates in Jefferson and Orange Counties were higher than the state rates in 2011, 2012, and 2013. Between 2011 and 2013, Orange County had a higher overall mortality rate than Jefferson County and a much higher overall mortality rate than Texas. ‐Infant mortality rates in the report area (7.4 per 1,000 births) are higher than the state (6.2 per 1,000 births) and national rates (6.5 per 1,000 births). When broken out by county, Jefferson County (7.2 per 1,000 births) and Orange County (8.1 per 1,000 births) both have higher rates than the state and the nation. ‐Heart disease is the leading cause of death in both Jefferson and Orange Counties, as well as the state (2013). Jefferson County’s heart disease mortality rate increased between 2011 and 2013, Orange County’s rate decreased, and Texas’ rate remained relatively stable. In 2013, heart disease mortality rates in Jefferson County (213.5 per 100,000) and Orange County (219.3 per 100,000) were substantially higher than mortality rates in Texas (170.7 per 100,000). ‐In comparison to their respective peer county groupings, Jefferson County (131.8 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (160.8 per 100,000) ranked within the least favorable quartile for coronary heart disease deaths between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (103.4 per 100,000) and the U.S. median (126.7 per 100,000). ‐Cancer is the second leading cause of death in both Jefferson and Orange Counties, as well as the state (2013). Between 2011 and 2013, Jefferson County’s and Texas’ cancer mortality rates decreased, while Orange County’s rate increased. In 2013, Jefferson and Orange Counties (176.1 and 191.8 per 100,000) had higher cancer mortality rates than Texas (156.1 per 100,000).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 5 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued ‐In comparison to their respective peer county groupings, Jefferson County (195.2 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (201.8 per 100,000) ranked within the least favorable quartile for cancer death rates between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (161.4 per 100,000) and the U.S. median (185.0 per 100,000). ‐Both Jefferson (48.9 per 100,000) and Orange (61.2 per 100,000) Counties have higher lung and bronchus cancer mortality rates than the state (43.4 per 100,000). ‐Jefferson (23.0 per 100,000) and Orange (23.1 per 100,000) Counties have very consistent female breast cancer mortality rates, as compared to the state (21.0 per 100,000). ‐Jefferson County (28.4 per 100,000) has a higher male prostate cancer mortality rate, as compared to Orange County (17.8 per 100,000) and the state (19.5 per 100,000). ‐Jefferson (19.7 per 100,000) and Orange (18.2 per 100,000) Counties have higher rates of colon and rectum cancer mortality rates than the state (15.3 per 100,000). ‐Orange County (87.6 per 100,000) has a much higher lung and bronchus cancer incidence rate as compared to Jefferson County (64.4 per 100,000) and the state (58.1 per 100,000). ‐Female breast cancer incidence rates in Jefferson (57.8 per 100,000) and Orange (60.3 per 100,000) Counties remain below the state (60.6 per 100,000). ‐Jefferson County (128.5 per 100,000) has a significantly higher rate of male prostate cancer incidence as compared to Orange County (97.0 per 100,000) and the state (115.7 per 100,000). ‐Jefferson (47.2 per 100,000) and Orange (45.6 per 100,000) Counties have higher rates of colon and rectum cancer incidence than the state (40.2 per 100,000). ‐Jefferson and Orange Counties ranked within the two middle quartiles of their respective peer groupings for the rate of female breast cancer incidence rates (114.7 per 100,000 and 118.4 per 100,000, respectively) and male prostate cancer incidence rates (151.4 per 100,000 and 122.1 per 100,000, respectively) between 2006 and 2010. ‐Both Jefferson (50.4 per 100,000) and Orange (54.6 per 100,000) Counties ranked within the least favorable quartile of their respective peer county groupings for colon and rectum cancer incidence rates between 2006 and 2010. ‐While Jefferson County (65.4 per 100,000) ranked within the two middle quartiles for lung and bronchus cancer incidence rates between 2006 and 2010, Orange County (94.6 per 100,000) ranked within the least favorable quartile of its peer county grouping. ‐While chronic lower respiratory disease mortality rates in Texas remained relatively stable between 2011 and 2013, rates in Jefferson and Orange Counties increased. Orange County has the 9th highest rate of chronic lower respiratory disease deaths, as compared to all other counties in the state (2013). In 2013, chronic lower respiratory disease mortality rates in Orange County (79.9 per 100,000) were higher than Jefferson County (50.4 per 100,000), as well as the state (42.3 per 100,000).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 6 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued ‐In comparison to their respective peer county groupings, Jefferson County (46.7 per 100,000) ranked within the two middle quartiles and Orange County (73.3 per 100,000) ranked at the very top of the least favorable quartile for chronic lower respiratory disease death rates between 2005 and 2011. Orange County ranked above the U.S. median (49.6 per 100,000). ‐Mortality rates due to accidents in Orange County and Texas steadily decreased between 2011 and 2013. Rates in Jefferson County increased. Accident mortality rates in Orange County (46.7 per 100,000) and Jefferson County (44.6 per 100,000) were higher than the state (36.8 per 100,000) in 2013. In 2013, the leading causes of fatal accidents in Jefferson and Orange Counties were due to motor vehicle accidents and accidental poisonings and exposure to noxious substances. ‐In comparison to their respective peer county groupings, both Jefferson County (48.1 per 100,000) and Orange County (85.6 per 100,000) ranked within the least favorable quartiles for unintentional injury death rates between 2005 and 2011. Jefferson County ranked above the Healthy People 2020 Target (36.0 per 100,000), and Orange County ranked above both the Healthy People 2020 Target and the U.S. median (50.8 per 100,000). ‐Cerebrovascular disease mortality rates decreased in Orange County and the state between 2011 and 2013, while Jefferson County’s rates increased. Orange County has the 12th highest rate of cerebrovascular disease mortality as compared to all other counties in the state. Jefferson County has the 16th highest rate (2013). In 2013, Orange County had the highest cerebrovascular disease mortality rate (57 per 100,000) as compared to Jefferson County (55 per 100,000) and the state (40.1 per 100,000). ‐In comparison to their respective peer county groupings, Jefferson County (60.0 per 100,000) and Orange County (54.6 per 100,000) both ranked within the least favorable quartile for stroke deaths between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (34.8 per 100,000) and the U.S. median (46.0 per 100,000). ‐Chlamydia rates in Jefferson County have recently increased, while rates in Orange County and the state have recently decreased (2012‐ 2014). In 2014, Jefferson County (560.6 per 100,000) had higher rates of Chlamydia as compared to Orange County (248.1 per 100,000) and the state (475.0 per 100,000). ‐Gonorrhea rates in Jefferson County have steadily increased, while rates in Orange County and the state remain steady (2012‐2014). In 2014, Jefferson County (241.0 per 100,000) had significantly higher Gonorrhea rates than Orange County (48.3 per 100,000) and the state (127.7 per 100,000). ‐In 2012, the percent of adults (age 20+) ever diagnosed with diabetes by a doctor in the report area (10.7%) was higher than the state (9.2%) and national (9.1%) rates. When broken out by county, Jefferson County (11.4%) had a higher rate of adults with diabetes than the state, while Orange County (8.6%) ranked below the state. ‐In comparison to their respective peer county groupings, Jefferson County (10.9%) ranked within the upper end of the two middle quartiles and Orange County (6.8%) ranked within the most favorable quartile for the percent of adults living with diagnosed diabetes between 2005 and 2011. Jefferson County ranked above the U.S. median (8.1%).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 7 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued ‐In 2012, over one‐third (35.2%) of adults (age 20+) in the report area reported that they have a Body Mass Index (BMI) greater than 30.0 (obese), as compared to 28.2% in the state and 27.1% in the nation. When broken out by county, Jefferson County (36.7%) had a significantly higher rate of adult obesity than the state, while Orange County (30.8%) ranked just slightly above the state. ‐In 2014, HSR 6/5S (34.2%) had a higher prevalence rate of obesity than the state (31.9%). Obesity prevalence rates in adults (age 18+) in HSR 6/5S and the state appear to be increasing (2012‐2014). ‐In comparison to their respective peer county groupings, Jefferson County (35.5%) ranked within the least favorable quartile and Orange County (31.1%) ranked within the two middle quartiles for the percent of obese adults between 2006 and 2012. Both counties ranked above the U.S. median (30.4%). ‐In comparison to their respective peer county groupings, Jefferson County (4.4%) and Orange County (3.7%) both ranked within the two middle quartiles for the percent of older adults living with asthma in 2012. Both counties ranked above the U.S. median (3.6%). ‐In 2012, the percent of the adult population (age 20+) in the report area (29.3%) that self‐reported no leisure time for physical activity was higher than the state (24.0%) and national (22.6%) rate. When broken out by county, both Jefferson County (29.6%) and Orange County (28.5%) had higher rates of physical inactivity than the state and the nation. ‐In comparison to their respective peer county groupings, Jefferson County (33.7%) and Orange County (31.3%) both ranked in the least favorable quartile for the percent of adults who reported no leisure time physical activity between 2006 and 2012. Both counties ranked above the U.S. median (25.9%), and Jefferson County ranked above the Healthy People 2020 Target (32.6%). ‐The percent of the adult population (age 18+) in the report area (23.5%) that self‐reported currently smoking some days or every day was higher than the state (16.5%) and national rate (18.1%) (2006‐2012). When broken out by county, both Jefferson County (22.1%) and Orange County (27.9%) had higher rates of smoking than the state and the nation. ‐In comparison to their respective peer county groupings, Jefferson County (22.1%) and Orange County (27.9%) both ranked within the least favorable quartile for the percent of adults who reported smoking cigarettes between 2006 and 2012. Both counties ranked above the Healthy People 2020 Target (12.0%) and the U.S. median (21.7%). ‐The rate of teen (females age 15‐19) births in the report area (55.4 per 1,000) is slightly higher than the state (55.0 per 1,000) and national rates (36.6 per 1,000) (2006‐2012). When broken out by county, Orange County (57.5 per 1,000 population) has a higher rate of teen births than the state and the nation. Jefferson County fell slightly below the state at 54.8 per 1,000 population. ‐The percent of low birth weight (<2,500g) births in the report area (10.2%) is higher than the state (8.4%) and national rate (8.2%) (2006‐ 2012). When broken out by county, both Jefferson County (10.4%) and Orange County (9.6%) have a higher percent of low birth weight births than the state and the nation. ‐In 2014, the percent of female adults (age 40+) in HSR 6/5S (22.8%) that did not receive a mammogram in the past 2 years was lower than the state (29.0%), as well as all of other regions.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 8 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued ‐In 2014, the percent of adults (age 50‐75) in HSR 6/5S (41.5%) that did not have a colonoscopy in the past 10 years was slightly lower than the state (42.6%). Between 2006 and 2012, the percentage of adults (age 50+) who self‐reported that they have ever had a sigmoidoscopy or colonoscopy in the report area (56.1%) was lower than the state (57.3%) and national rate (61.3%). When broken out by county, Jefferson county (59.4%) had a higher percent of adults that have ever received a sigmoidoscopy or colonoscopy than the state, while Orange County (47.0%) had a lower percentage than the state and the nation. ‐In 2014, the percent of adults in HSR 6/5S (67.8%) that did not receive a flu shot in the past year was slightly higher than the state (66.2%). ‐Many interviewees mentioned that the prevalence of certain chronic conditions is a concern in the community. The conditions and unhealthy behaviors mentioned include: obesity, diabetes, cardiovascular and heart diseases, hypertension, and physical inactivity. ‐Along with chronic conditions, physical fitness and active lifestyles were also mentioned as significant needs. A few interviewees noted the lack of infrastructure or built environment to facilitate physical activity. One interviewee specifically stated: "We need access to parks, we have neighborhoods with no sidewalks. It's just diet and the built environment." ‐Many interviewees mentioned that restaurants in the area do not offer healthier alternatives, and one interviewee stated: "[There is a need for] availability of access to good, healthy food." Priority #3: Access to Affordable Care and Reducing Health Disparities Among Specific Populations ‐The majority of growth in both counties and the state over the next five years is expected to come from the 65 years and older population (2016‐2021). ‐The median household income in Jefferson County ($43,442) is lower than that of Orange County ($53,180), the state ($48,776) and the nation ($48,280) (2016). ‐Unemployment rates in Texas have steadily decreased since 2013. As of 2015, Jefferson and Orange Counties’ unemployment rates (7.0% and 6.5%, respectively) remain higher than the state rate (4.5%). ‐Almost 18% of residents in Jefferson County have a Bachelor’s or Advanced Degree compared to 15.1% in Orange County and about 27% in Texas. Nearly 30% of residents across the United States have an Bachelor’s or Advanced Degree. ‐In 2013‐2014, the percent of students receiving their high school diploma within four years in the report area (87.6%) was lower than the state rate (89.6%). When broken out by county, Jefferson County (86.1%) had a lower graduation rate than the state but was slightly higher than the national rate. Orange County (91.4%) had a higher graduation rate than the state and the nation. ‐Jefferson County (17.5%) has a higher percent of families living below poverty as compared to Orange County (11.0%), but both counties remain below the state rate (24.6%) (2016). ‐As of 2013, almost one‐fourth (24.0%) of the population in the report area experienced food insecurity, as compared to 17.6% in the state. When broken out by county, both Jefferson County (24.9%) and Orange County (21.5%) had higher percentages of food insecurity within their respective populations as compared to the state and the nation.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 9 Priority #3: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Continued ‐The percent of public school students that are eligible for free/reduced price lunch between 2013 and 2014 in the report area (63.6%) is slightly higher than the state (60.1%), and national (52.4%) rates. When broken out by county, Jefferson County (67.5%) had ahigher percentage of its public school students that were eligible for free or reduced price lunch than the state and the nation, while Orange County (52.5%) ranked below the state. ‐The number of food stores and other retail establishments that are authorized to accept WIC Program benefits and that carry WIC foods and food categories in the report area (8.9 per 100,000) is slightly lower than the state (9.1 per 100,000) and national rates (15.6 per 100,000) (2011). When broken out by county, Jefferson County (8.3 per 100,000) has a lower rate of WIC‐Authorized food stores than the state and the nation. Orange County (10.9 per 100,000) has a slightly higher rate than the state, but still ranks below the national rate. ‐In 2012, the percent of female Medicare Enrollees (age 67‐69) in the report area (61.4%) that received one or more mammograms in the past two years was slightly higher than the state (58.9%) and higher than the nation (63.0%). When broken out by county, Orange County (56.3%) had a lower percent of female Medicare Enrollees that received a mammogram within the past 2 years than the state and the nation. Jefferson County (63.6%) had a higher percent than the state and the nation. ‐In 2014, HSR 6/5S (42.9%) had one of the highest percentages of adults (age 65+) that did not receive a flu shot in the past year, as compared to all other regions and the state (41.2%). Between 2012 and 2014, the percent of adults (age 65+) that did not receive a flu shot in the past year in 6/5S increased, while rates in the state remained steady. ‐Between 2006 and 2012, the percent of the population (age 65+) in the study area (68.2%) that self‐reported ever having received the pneumonia vaccine was slightly higher than the state (67.7%) and national (67.5%) rates. When broken out by county, Orange County (61.7%) had a lower percent of its population (age 65+) that had ever received the pneumonia vaccination as compared to the state and the nation. Jefferson County (70.6%) had a higher percent than the state and the nation. ‐In 2014, the percent of adults (age 65+) that had never received a pneumonia shot in HSR 6/5S (34.8%) was higher than the state’s (32.1%) and all other regions. Between 2012 and 2014, the percent of adults (age 65+) that had never received a pneumonia shot in HSR 6/5S fluctuated, while the state’s rate increased. ‐Between 2010 and 2014, the percent of the population (all ages) in the report area (21.7%) that were uninsured was slightly lower than the state (21.9%), but higher than the national (14.2%) rates. When broken out by county, Jefferson County (22.9%) had a higher percent of uninsured residents than the state and the nation. Orange County (18.3%) had a lower uninsured rate than the state, but still ranked above the nation. ‐As of 2015, Jefferson County (18.0%) has the highest rate of uninsured adults (age 18‐64) as compared to Orange County (16.0%), as well as the state (16.0%) and nation (10.7%). ‐In comparison to their respective peer county groupings, Jefferson County (24.1%) and Orange County (21.7%) both ranked within the least favorable quartile for the percent of the population without health insurance in 2011. Both counties ranked above the U.S. median (17.7%). ‐In comparison to their respective peer county groupings, Jefferson County (21.1%) ranked within the least favorable quartile and Orange County (15.2%) ranked within the two middle quartiles for the percent of adults who did not see a doctor due to cost between 2006 and 2012. Both counties ranked above the Healthy People 2020 Target (9.0%), and Jefferson County ranked above the U.S. median (15.6%).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 10 Priority #3: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Continued ‐Between 2010 and 2014, one‐fourth (24.7%) of the insured population in the report area was receiving Medicaid, which is above the state (22.1%) and national rates (20.8%). When broken out by county, Jefferson County (26.1%) had a higher percent of insured residents receiving Medicaid than the state and the nation. Orange County (20.8%) had a lower percent than the state, but still ranked slightly above the nation. ‐Between 2010 and 2014, 8.2% of households in the report area had no motor vehicle, as compared to 5.9% in Texas and 9.1% in the nation. When broken out by county, Jefferson County (9.3%) had a higher percent of households with no motor vehicle than the state and the nation, while Orange County (4.8%) had a lower percent than the state and the nation. ‐Interviewees overwhelmingly agreed ability to pay and insurance coverage are strong determinants of health in the area. The majority of interviewees agreed that access to primary care and dental services are adequate in the area but only for those who have a payment source. One interviewee specifically stated: "We are getting more options if you have money, but fewer options if you're in that middle to lower income area." ‐Many of the interviewees agreed that physicians in the area are not accepting Medicaid and Medicare, which presents a barrier for those patients in seeking care, and one interviewee stated: "The physicians are going where the dollars are, and a lot of them don't want to take Medicare/Medicaid." ‐A few interviewees mentioned the cost of health care is a concern for all populations, regardless of coverage. One interviewee stated: "Affordability is a concern, even when you have insurance." ‐A couple interviewees mentioned that transportation is a particular issue for the elderly and the low income populations, and one interviewee stated: "For elderly, we need to bring the services to where the people are. In areas where there is not public transportation it makes it very difficult for poor people and seniors." Priority #4: Need for Increased Emphasis on a Collaborative Continuum of Care ‐In 2014, HSR 6/5S (34.1%) had a higher percent of adults that had no personal doctor than the state (32.9%), as well as the majority of other regions. ‐In 2012, the rate of primary care physicians per 100,000 population in the report area (52.9 per 100,000) was lower than the state (58.5 per 100,000) and national rate (74.5 per 100,000). When broken out by county, Orange County (28.9 per 100,000) had a lower rate of primary care physicians than the state and the nation. Jefferson County (60.8 per 100,000) ranked above the state but below the nation. ‐In comparison to their respective peer county groupings, Jefferson County (68.8 per 100,000) and Orange County (26.7 per 100,000) both ranked within the least favorable quartiles for the rate of primary care providers per 100,000 persons in 2011. Orange County ranked below the U.S. median (48.0 per 100,000). ‐As of April 2016, 100% of the population in both Jefferson and Orange Counties are living within a HPSA. ‐In 2013, the rate of dental care providers per 100,000 population in the report area (46.2 per 100,000) was lower than the state (51.5 per 100,000) and national rates (63.2 per 100,000). When broken out by county, Orange County (26.5 per 100,000) had a lower rate of dentists than the state and the nation. Jefferson County (52.7 per 100,000) had a slightly higher rate of dentists than the state but still ranked below the nation.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 11 Priority #4: Need for Increased Emphasis on a Collaborative Continuum of Care ‐In 2012, the rate of preventable hospital events in the report area (69.3 per 1,000 Medicare Enrollees) was higher than that of the state (62.9 per 1,000) and the nation (59.2 per 1,000). When broken out by county, Jefferson County (64.8 per 1,000 Medicare Enrollees) and Orange County (80.8 per 1,000 Medicare Enrollees) had higher rates of preventable hospital events than the state and the nation. ‐Interviewees discussed the need for collaboration among health care professionals, including specialists. Issues include: more patient‐ centered care, emphasis on prevention, and more comprehensive care. One interviewee specifically stated: "Emergency to follow up care is bad. If the PCP is the ER, and a family doesn’t have a doctor, then transitioning to follow up care or outpatient is lacking. That goes back again to the lack of specialists." ‐Interviewees also discussed the need for increased patient education. Issues include: the need to provide more information about how to access healthcare coverage, and misuse of the emergency room / lack of understanding of resources. ‐Other concerns regarding the continuum of care include: long wait times and difficulty in making appointments, and transitions between care settings. One interviewee emphasized longer wait times and the fragmented continuum of care, stating: "If you are on Medicaid, if you’re not using one of the FQHCs, and even then, you wait long periods of time there. If you are uninsured or under insured, they’re going to wait a very long time." Priority #5: Access to Specialty Care Services ‐Interviewees agreed that access to specialist services is a big need in the community. Specialties mentioned include: psychiatry and psychology, OB/GYN services, pediatrics, and affordable emergency care. One interviewee emphasized the lack of specialists by stating: "We have plenty of primary care providers, but not enough specialists." ‐A few interviewees mentioned that patients needing specialty services are typically referred out to Houston or Galveston to access care, and one interviewee stated: "We have very few specialty care providers…high risk patients are sent to Galveston or Houston to be seen." ‐One interviewee specifically discussed affordable emergency services for minors as a need in the area, stating: "There's not a reasonably priced emergency service for minor care.“

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 12 PROCESS AND METHODOLOGY

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 13 Process and Methodology

Background and Objectives This CHNA is designed in accordance with CHNA requirements identified in the Patient Protection and Affordable Care Act and further addressed in the Internal Revenue Service final regulations released in December 29, 2014. The objectives of the CHNA are to: • Meet federal government and regulatory requirements • Research and report on the demographics and health status of the study area, including a review of state and local data • Gather input, data and opinions from persons who represent the broad interest of the community • Analyze the quantitative and qualitative data gathered and communicate results via a final comprehensive report on the needs of the communities served by BBH • Document the progress of previous implementation plan activities • Prioritize the needs of the community served by the hospital • Create an implementation plan that addresses the prioritized needs for the hospital

Scope of CHNA Report The CHNA components include: • A description of the process and methods used to conduct this CHNA, including a summary of data sources used in this report • A biography of BBH • A description of the hospital’s defined study area • Definition and analysis of the communities served, including both a demographic and a health data analysis • Findings from phone interviews that collected input from people who represent a broad interest in the communities, including: • State, local, tribal or regional governmental public health department (or equivalent department or agency) with knowledge, information or expertise relevant to the health needs of the community; • Members of a medically underserved, low‐income or minority populations in the community, or individuals or organizations serving or representing the interests of such populations • A description of the progress and/or completion of community benefit activities documented in the previous implementation plan • The prioritized community needs and separate implementation plan, which intend to address the community needs identified • A description of additional health services and resources available in the community • A list of information gaps that impact the hospital’s ability to assess the health needs of the community served

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 14 Process and Methodology Continued

Methodology: BBH worked with CHC in the development of its CHNA. BBH provided essential data and resources necessary to initiate and complete the process, including the definition of the hospital’s study area and the identification of key community stakeholders to be interviewed. CHC conducted the following research: • A demographic analysis of the study area, utilizing demographic data from Truven Health’s Market Expert • A study of the most recent health data available • Conducted one‐on‐one phone interviews with individuals who have special knowledge of the communities, and analyzed results • Facilitated the prioritization process during the CHNA Team meeting on May 16, 2016 The methodology for each component of this study is summarized below. In certain cases methodology is elaborated in the body of the report. • BBH Biography • Background information about BBH, mission, vision, values and services provided were provided by the hospital or taken from its website • Study Area Definition • The study area for BBH is based on hospital inpatient discharge data from July 2014 – June 2015 and discussions with hospital staff • Demographics of the Study Area • Population demographics include population change by race, ethnicity, age, median income analysis, unemployment and economic statistics in the study area • Demographic data sources include, but are not limited to, Truven Health’s Market Expert, the U.S. Census Bureau and the United States Bureau of Labor Statistics • Health Data Collection Process • A variety of sources, which are all listed in the reference section of this report, were utilized in the health data collection process • Health data sources include, but are not limited to, the Robert Wood Johnson Foundation, Texas Department of Health and Human Services, Community Commons, Community Health Status Indicators, Enroll America, United States Census Bureau, and the Centers for Disease Control and Prevention

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 15 Process and Methodology Continued

• Interview Methodology • BBH provided CHC with a list of persons with special knowledge of public health in Jefferson and Orange Counties, including public health representatives and other individuals who focus specifically on underrepresented groups • From that list, ten in depth interviews were conducted using a structured interview guide • Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported • Evaluation of Hospital’s Impact • A description of the progress and/or completion of community benefit activities documented in the previous implementation plan • BBH provided CHC with a report of community benefit activity progress since the previous community health needs assessment • Prioritization Strategy • Five significant needs were determined by assessing the prevalence of the issues identified in the health data findings, combined with the frequency and severity of mentions in the interviews • Three factors were used to rank those needs during the CHNA Team May 16, 2016 • See the prioritization section for a more detailed description of the prioritization methodology

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 16 BAPTIST BEAUMONT HOSPITAL BIOGRAPHY

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 17 About Baptist Beaumont Hospital

For over sixty years, Baptist Hospitals of Southeast Texas has been dedicated to providing quality health services in a Christian environment. Our Partners in Caring–our physicians, our nurses and staff, practice a philosophy that inspires an environment of teamwork, respect, encouragement, opportunity and trust. Our efforts continue each day as we strive to offer newer and better programs, services and technologies for the members of our community. Baptist Hospital’s award‐winning care is complemented by being recognized by the Center for Improvement in Healthcare Quality (CIHQ) for disease specific certification as a Primary Stroke Center and for Quality Care in the performance of Hip and Knee Surgical Procedures. The Joint Rejuvenation Program was recently recognized by Blue Cross as a Blue Distinction Center for Knee and Hip Replacement. Additionally the Cancer Institute was accredited as a Comprehensive Breast Center by the National Accreditation Program for Breast Centers and as a Community Comprehensive Cancer Center through the ACS Commission on Cancer.

Baptist Beaumont Hospital’s focus on innovation implemented the Medivance’s Cooling Technology, the only one in Southeast Texas, is a precise noninvasive patient cooling device that is used at more than seventy percent of the nation’s top hospitals. The newest member of the Emergency Department is the RP‐6 mobile robot system, made by InTouch Health, the robot allows doctors to “virtually” consult with patients, family members, and healthcare staff at a moment’s notice, even if miles away from the hospital. Another addition to services offered at Baptist Beaumont Hospital is the Stryker Orthopedic Navigation System offering a technology option that helps facilitate accurate implant alignment and proper ligament balancing, which are the most important prerequisites for the artificial knee joint stability, durability and sufficient range of motion. Navigated total knee replacement is an extremely successful way to treat qualifying patients with severe knee pain.

Source: Baptist Hospitals of Southeast Texas’ Website, “About Us;” http://www.bhset.net/About‐Us.aspx; data accessed June 21, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 18 About Baptist Beaumont Hospital Cont.

As a part of the commitment to the members of our community, Baptist Beaumont Hospital partnered with the Beaumont Foundation and the Reaud Foundation to open the Albert E. and Gena Reaud Family Shelter. The 3.2 million dollar project boasts 19 private bedrooms, dining area, kitchenette and prayer garden. With the addition of a fifty‐two bed patient tower, a convenient care clinic, a new 64 slice CT Scanner and MRI that allows physicians new innovations in technology, and the newly established Infant Transport Team, Baptist Beaumont Hospital continues to carry its commitment to Southeast Texas into the twenty‐first century.

Since 1949, Baptist Hospitals of Southeast Texas has continuously invested in the latest medical instruments, equipment and technology to assure the right healthcare for Southeast Texas is right here. In the hands of our highly skilled Partners in Caring–our doctors, nurses and technicians, we; • Bring new hope to countless cancer and heart patients; • Assure that healthcare for kids is just the right size; and • Help us safely deliver the next generation of sons and daughters and brothers and sisters.

The strongest and most unique aspect of Baptist Hospitals continues to be a dedicated staff of employees, physicians and volunteers helping the community to heal, providing compassionate care and services. Together, we continue to assist the community in meeting our vision of providing high quality healing healthcare and Sacred Work in a Christian environment.

Source: Baptist Hospitals of Southeast Texas’ Website, “About Us;” http://www.bhset.net/About‐Us.aspx; data accessed June 21, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 19 Mission, Vision, and Values

Mission The Baptist Hospitals of Southeast Texas are not‐for‐profit, community‐owned, health care facilities with spiritual values, dedicated to providing high quality health services and Sacred Work in a Christian environment.

Vision Baptist Hospitals of Southeast Texas will be the premier healthcare system by creating the best possible outcomes with exceptional patient care experiences. We will accomplish this by keeping quality (best clinical outcomes, excellent customer service and a reasonable or commensurate price) at the core of everything we do.

Values We are committed to assisting and meeting the health care needs of the individuals in our diverse communities We are stewards of community resources and are committed to being medically, socially, financially, legally, and environmentally responsible. We are devoted to providing superior quality, cost‐efficient, innovative and compassionate care. We collaborate with our patients, families, physicians, employees, volunteers, vendors, and communities to achieve our purpose. We support teaching programs that develop the health care professionals of tomorrow. We support education and implementation of innovative technology to expand our knowledge and learn how to provide better care. We provide holistic health care which addresses with dignity the physical, social, psychological, and spiritual needs of individuals. We are committed to the growth and development of the intellectual and spiritual capabilities of our employees. We have high ethical standards and expect integrity, fairness, and respect in all our relationships We recognize that effective, quality healthcare encourages and supports an environment focused on safe practices.

Source: Baptist Hospitals of Southeast Texas’ Website, “About Us;” http://www.bhset.net/About‐Us.aspx; data accessed June 21, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 20 Our Services

• Baptist Cancer Care • Outpatient Physical • Rehabilitation Services • Cardiovascular Services Medicine • Parish Nursing • Children’s Services • Speech‐Language • Chaplaincy Services • Imaging Services Pathology Services • Wound Healing Center • Emergency Services • School of Radiology • Joint Replacement • Behavioral Health Technology Surgery Services • Reaud Guest House • Interventional • Surgical Services • Pulmonary Radiology • Women’s Services Rehabilitation • Diabetes Management

Source: Baptist Hospitals of Southeast Texas’ Website, “Our Services;” http://www.bhset.net/Health‐Services.aspx; data accessed June 23, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 21 STUDY AREA

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 22 Baptist Beaumont Hospital

Jefferson County makes up 50.5% of discharges. Orange County makes up 20.8% of discharges.

indicates the hospital

Baptist Beaumont Hospital Inpatient Origin by County FY 2015 FY 2015 Cumulative County State % of Total Discharges % of Total Jefferson TX 8,197 50.5% 50.5% Orange TX 3,370 20.8% 71.3% All Others 4,659 28.7% 100.0% Total 16,226 100.0%

Source: Hospital inpatient discharge data by DRG; July 2014 ‐ June 2015; Normal Newborns MS‐ DRG 795 excluded. BBH Patient Types: Psych, Gero‐Psych, Acute and Rehab included.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 23 DEMOGRAPHIC OVERVIEW

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 24 Overall Population Change

Projected Population Growth (2016 ‐ 2021)

7.2% 3.9% 2.4%

Jefferson County Orange County Texas

Overall Population Growth 2016‐2021 2016‐2021 % Geographic Location 2010 2016 2021 Change Change Jefferson County 252,273 253,862 259,987 6,125 2.4% Orange County 81,837 84,292 87,556 3,264 3.9% Texas 25,145,561 27,611,503 29,594,059 1,982,556 7.2%

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 25 Population by Race/Ethnicity

Jefferson County Orange County Texas Race/Ethnicity (2016) Race/Ethnicity (2016) Race/Ethnicity (2016) 0.5% 0.3% 1.1% 1.5% 1.6% 3.8% 0.3% 1.4% 4.5% 7.5% White Non‐Hispanic 8.4% 19.7% Black 41.4% 42.8% Hispanic 39.0% Asian American Indian 33.4% 81.0% All Others 11.7%

Race/Ethnicity Projected Growth (2016‐2021)

Jefferson County Orange County Texas

24.0% 20.1% 19.5% 17.1% 14.4% 16.7% 15.6% 11.8% 9.2% 10.6% 9.4% 7.2% 4.7% 1.7% 1.7% 2.3% 3.1%

‐4.5% White Non‐Hispanic Black Hispanic Asian American Indian All Others

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 26 Population by Age

Jefferson County Orange County Texas Age (2016) Age (2016) Age (2016)

13.9% 12.0% 23.7% 15.8% 24.1% 26.2%

25.3% 24.1% 26.7% 37.1% 33.5% 37.7%

Age Projected Growth (2016‐2021) 23.2% Jefferson County Orange County Texas 17.6% 15.2%

6.7% 3.9% 3.7% 4.6% 2.4% 1.4% 1.9%

‐1.7% ‐3.8%

<18 18‐44 45‐64 65+

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 27 Median Age

• As of 2016, Jefferson County has a lower Median Age 2010 2016 2021 median age (36.3) than

Orange County (38.7) 41.2 41.7 38.4 38.7 39.0 38.9 39.2 39.5 40.2 and Texas (39.2). 36.0 36.3 36.8 • Jefferson County, Orange County, and

Texas’ median ages are Jefferson County Orange County Texas United States projected to slightly increase by 2021.

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 28 Median Household Income

• As of 2016, Jefferson County had a lower median household Median Household Income 2016 2021 income ($43,442) than Orange County ($53,180),

$58,351 Texas ($48,776) and the $53,180 $53,013 $51,808 $48,776 $48,280 United States ($48,280). $43,442 $46,109 • Median household incomes are expected to Jefferson County Orange County Texas United States increase in the study area, Texas and the United States by 2021.

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 29 Poverty

• As of 2013, almost one‐ fourth (24.0%) of the population in the report area experienced food J: 24.9% insecurity, as compared to O: 21.5%

Note: the Report Area is defined as Jefferson and Orange Counties. A green 17.6% in the state. dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. • More than 17% of Families Below Poverty (2016) families in Jefferson 24.6% County are living in 17.5%

poverty, compared to 11.0% 11.7% 11% in Orange County and nearly 25% in Texas. Jefferson County Orange County Texas United States

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Food Insecurity Definition: the household‐level economic and social condition of limited or uncertain access to adequate food. Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 30 Educational Attainment

• Almost 18% of residents Education Bachelor / Advanced in Jefferson County have Degree (2016)

a Bachelor’s or Jefferson County Orange County Texas United States Advanced Degree compared to 15.1% in 29.4% Orange County and 27.2% 17.9% about 27% in Texas. 15.1% • Nearly 30% of residents

across the United States Jefferson County Orange County Texas United States have an Bachelor’s or Advanced Degree.

Source: Truven Health’s Market Expert; data accessed April 11, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 31 Unemployment

• Unemployment rates in Texas have steadily Unemployment Rates decreased since 2013. 2013 2014 2015 • As of 2015, Jefferson and Orange Counties’

unemployment rates 10.8% 8.3% 10.3% 8.0% 7.0% 6.5% 6.2% 5.1% 4.5% (7.0% and 6.5%, Jefferson County Orange County Texas respectively) remain higher than the state rate (4.5%).

Source: Bureau of Labor Statistics, Local Area Unemployment Statistics; http://www.bls.gov/lau/#tables; data accessed May 10, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 32 Children in the Study Area

• The percent of public school students that are eligible for free/reduced price lunch between 2013 and 2014 in the J: 67.5% report area (63.6%) is slightly O: 52.5% higher than the state (60.1%), and national (52.4%) rates. • In 2013‐2014, the percent of students receiving their high school diploma within four years J: 86.1% in the report area (87.6%) was O: 91.4% lower than the state rate (89.6%). Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state.

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Definition: receiving a high school diploma within four years.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 33 HEALTH DATA OVERVIEW

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 34 Data Methodology

• The following information outlines specific health data: – Mortality, chronic diseases and conditions, health behaviors, natality, mental health and healthcare access • Data Sources include, but are not limited to: – Texas Department of State Health Services – Texas Cancer Registry – Enroll America – Community Commons – Community Health Status Indicators (CHSI) – The Behavioral Risk Factor Surveillance System (BRFSS) • The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, on‐going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Currently, data are collected monthly in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. • It is a state‐based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. For many states, the BRFSS is the only available source of timely, accurate data on health‐related behaviors. • States use BRFSS data to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. Many states also use BRFSS data to support health‐related legislative efforts. – The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute – United States Census Bureau • Data Levels: Nationwide, state, health service region and county level data

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 35 County and Health Region Map

County Health Service Name Region

Jefferson 6/5S Orange 6/5S

Source: Texas Department of State Health Services, Center for Health Statistics; Last updated July 31, 2015; http://www.dshs.state.tx.us/chs/vstat/annrpts.shtm; data accessed March 29, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 36 County Health Rankings (2016)

• The County Health Rankings rank 241 counties in Texas (1 being the best, 241 being the worst). 2016 County Health Jefferson Orange • Various factors go into these rankings. For Rankings County County example: Health Outcomes 188 206 – Health Behaviors: LENGTH OF LIFE 144 220 • Adult smoking QUALITY OF LIFE 202 130 • Adult obesity Health Factors 232 165 • Physical inactivity HEALTH BEHAVIORS 241 149 • Sexually transmitted infections CLINICAL CARE 31 54 • Teen births SOCIAL & ECONOMIC FACTORS 232 203 – Clinical Care: PHYSICAL ENVIRONMENT 211 212 • Uninsured Note: Green represents the best ranking for the county, and red represents the worst ranking. • Primary care physicians • Dentists • Mental health providers • Preventable hospital stays

Source: County Health Rankings & Roadmaps; www.countyhealthrankings.org; data accessed April 7, 2016. Note: Please see the appendix for full methodology. Note: County Health Rankings rank 241 out of the 254 counties in Texas.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 37 Leading Causes of Death (2013)

Ranking Jefferson County Orange County Texas

1 Diseases of the Heart Diseases of the Heart Diseases of the Heart

2 Malignant Neoplasms Malignant Neoplasms Malignant Neoplasms Chronic Lower Respiratory Chronic Lower Respiratory Cerebrovascular Diseases 3 Diseases Diseases Chronic Lower Respiratory Cerebrovascular Diseases Cerebrovascular Diseases 4 Diseases 5 Accidents Alzheimer's Disease Accidents

6 Alzheimer's Disease Accidents Alzheimer's Disease

7 Diabetes Mellitus Intentional Self‐Harm Diabetes Mellitus Nephritis, Nephrotic Syndrome Septicemia Septicemia 8 and Nephrosis Nephritis, Nephrotic Syndrome Nephritis, Nephrotic Syndrome Diabetes Mellitus* 9 and Nephrosis and Nephrosis

10 Influenza and Pneumonia Septicemia* Influenza and Pneumonia

*Note: Age‐adjusted rates use the 2000 population standard; "‐" indicates that the numerator is too small for rate calculation. Use caution when interpreting rates based on low numbers.

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed January 16, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 38 Selected Causes of Death State/County Comparison, Age‐Adjusted Death Rate, 2013

Disease Jefferson County Orange County Texas Diseases of the Heart 213.5 219.3 170.7 Malignant Neoplasms 176.1 191.8 156.1 Chronic Lower Respiratory 50.4 79.9 42.3 Diseases Cerebrovascular Diseases 55.0 57.0 40.1 Alzheimer's Disease 39.4 54.2 24.4 Accidents 44.6 46.7 36.8 Intentional Self‐Harm 8.5 25.5 11.6 Nephritis, Nephrotic 15.6 20.4 15.9 Syndrome and Nephrosis

Green indicates that the county’s rate is lower than the state’s rate for that disease category. Red indicates that the county’s rate is higher than the state’s rate for that disease category. Note: Age‐adjusted rates use the 2000 population standard; "‐" indicates that the numerator is too small for rate calculation. Use caution when interpreting rates based on low numbers

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 39 Mortality

Overall Mortality Age‐adjusted Death Rate per 100,000 • Overall mortality rates in 2011 2012 2013 Jefferson and Orange 1,200 Counties were higher 1,000 than the state rates in 800 2011, 2012, and 2013. 600 400

• Between 2011 and 2013, 200

Orange County had a 0 higher overall mortality Jefferson County Orange County Texas 2011 2012 2013 rate than Jefferson AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED County and a much DEATH RATE DEATH RATE DEATH RATE higher overall mortality Jefferson County 2,324 848.0 2,390 867.6 2,397 867.4 rate than Texas. Orange County 863 960.1 945 1,017.2 943 988.8 Texas 167,997 744.0 173,935 751.0 178,501 749.2

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 40 Diseases of the Heart Mortality

• Heart disease is the leading Diseases of the Heart cause of death in both Jefferson Age‐adjusted Death Rate per 100,000 2011 2012 2013 and Orange Counties, as well as 300

the state (2013). 250 • In 2013, heart disease mortality rates in Jefferson County (213.5 200 per 100,000) and Orange County 150 (219.3 per 100,000) were 100 substantially higher than mortality rates in Texas (170.7 50 per 100,000). 0 Jefferson County Orange County Texas • Jefferson County’s heart disease mortality rate increased 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION between 2011 and 2013, Orange DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED County’s rate decreased, and DEATH RATE DEATH RATE DEATH RATE Texas’ rate remained relatively Jefferson County 503 183.1 531 191.3 597 213.5 stable. Orange County 212 234.7 229 241.6 213 219.3 Texas 37,955 170.8 38,987 170.8 40,150 170.7

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 41 Disease of the Heart Mortality Peer County Rankings

Coronary Heart Disease Deaths, Jefferson County (2005‐2011) • In comparison to their Age‐adjusted Death Rate per 100,000 Persons respective peer county groupings, Jefferson County 131.8 (131.8 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (160.8 per 100,000) Note: Jefferson and Orange Counties are within ranked within the least different peer county groups.

favorable quartile for coronary Coronary Heart Disease Deaths, Orange County (2005‐2011) heart disease deaths between Age‐adjusted Death Rate per 100,000 Persons 2005 and 2011. 160.8 • Both counties ranked above the Healthy People 2020 Target (103.4 per 100,000) and the U.S. median (126.7 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 42 Malignant Neoplasms Mortality

Malignant Neoplasms Age‐adjusted Death Rate per 100,000 2011 2012 2013 • Cancer is the second leading 250 cause of death in both Jefferson and Orange Counties, as well as 200 the state (2013). 150

• Between 2011 and 2013, Jefferson 100 County’s and Texas’ cancer 50 mortality rates decreased, while Orange County’s rate increased. 0 Jefferson County Orange County Texas • In 2013, Jefferson and Orange 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION Counties (176.1 and 191.8 per DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED 100,000) had higher cancer DEATH RATE DEATH RATE DEATH RATE Jefferson County 522 191.1 511 186.0 488 176.1 mortality rates than Texas (156.1 Orange County 169 176.7 189 193.8 193 191.8 per 100,000). Texas 37,121 160.2 38,096 159.5 38,289 156.1

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 43 Malignant Neoplasms Mortality Peer County Rankings

Cancer Deaths, Jefferson County (2005‐2011) • In comparison to their respective Age‐adjusted Death Rate per 100,000 Persons peer county groupings, Jefferson 195.2 County (195.2 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (201.8 per 100,000) ranked within the least Note: Jefferson and Orange Counties are within favorable quartile for cancer different peer county groups. death rates between 2005 and Cancer Deaths, Orange County (2005‐2011) 2011. Age‐adjusted Death Rate per 100,000 Persons • Both counties ranked above the 201.8 Healthy People 2020 Target (161.4 per 100,000) and the U.S. median (185.0 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 44 Cancer Mortality by Type Age‐Adjusted Rates per 100,000, 2008‐2012

• Both Jefferson (48.9 per 100,000) and Orange (61.2 per 100,000) Counties have higher lung and bronchus cancer mortality rates than the state (43.4 per 100,000). • Jefferson (23.0 per 100,000) and Orange (23.1 per 100,000) Counties have very consistent female breast cancer mortality rates, as compared to the state (21.0 per 100,000). • Jefferson County (28.4 per 100,000) has a higher male prostate cancer mortality rate, as compared to Orange County (17.8 per 100,000) and the state (19.5 per 100,000). • Jefferson (19.7 per 100,000) and Orange (18.2 per 100,000) Counties have higher rates of colon and rectum cancer mortality rates than the state (15.3 per 100,000). Lung & Bronchus Cancer Female Breast Cancer Age‐adjusted Mortality Rates per 100,000; 2008‐2012 Age‐adjusted Mortality Rates per 100,000; 2008‐2012 100 100 80 61.2 80 60 48.9 43.4 60 40 40 23.0 23.1 21.0 20 20 0 0 Jefferson County Orange County Texas Jefferson County Orange County Texas Male Prostate Cancer Colon & Rectum Cancer Age‐adjusted Mortality Rates per 100,000; 2008‐2012 Age‐adjusted Mortality Rates per 100,000; 2008‐2012 100 100 80 80 60 60 40 28.4 40 17.8 19.5 19.7 18.2 15.3 20 20 0 0 Jefferson County Orange County Texas Jefferson County Orange County Texas Source: Texas Cancer Registry, Cancer Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016. Note: All rates are per 100,000. Rates are age‐adjusted to the 2000 U.S. Standard Population.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 45 Cancer Incidence by Type Age‐Adjusted Rates per 100,000, 2008‐2012

• Orange County (87.6 per 100,000) has a much higher lung and bronchus cancer incidence rate as compared to Jefferson County (64.4 per 100,000) and the state (58.1 per 100,000). • Female breast cancer incidence rates in Jefferson (57.8 per 100,000) and Orange (60.3 per 100,000) Counties remain below the state (60.6 per 100,000). • Jefferson County (128.5 per 100,000) has a significantly higher rate of male prostate cancer incidence as compared to Orange County (97.0 per 100,000) and the state (115.7 per 100,000). • Jefferson (47.2 per 100,000) and Orange (45.6 per 100,000) Counties have higher rates of colon and rectum cancer incidence than the state (40.2 per 100,000). Lung & Bronchus Cancer Female Breast Cancer Age‐adjusted Incidence Rates per 100,000; 2008‐2012 Age‐adjusted Incidence Rates per 100,000; 2008‐2012 140 140 120 120 100 87.6 100 80 64.4 58.1 80 57.8 60.3 60.6 60 60 40 40 20 20 0 0 Jefferson County Orange County Texas Jefferson County Orange County Texas Male Prostate Cancer Colon & Rectum Cancer Age‐adjusted Incidence Rates per 100,000; 2008‐2012 Age‐adjusted Incidence Rates per 100,000; 2008‐2012 140 128.5 115.7 140 120 97.0 120 100 100 80 80 60 60 47.2 45.6 40.2 40 40 20 20 0 0 Jefferson County Orange County Texas Jefferson County Orange County Texas Source: Texas Cancer Registry, Cancer Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed January 18, 2016. Note: All rates are per 100,000. Rates are age‐adjusted to the 2000 U.S. Standard Population.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 46 Cancer Incidence by Type Peer County Rankings

• Jefferson and Orange Counties ranked within the two middle quartiles of their respective peer groupings for the rate of female breast cancer incidence rates (114.7 per 100,000 and 118.4 per 100,000, respectively) and male prostate cancer incidence rates (151.4 per 100,000 and 122.1 per 100,000, respectively) between 2006 and 2010. • Both Jefferson (50.4 per 100,000) and Orange (54.6 per 100,000) Counties ranked within the least favorable quartile of their respective peer county groupings for colon and rectum cancer incidence rates between 2006 and 2010. • While Jefferson County (65.4 per 100,000) ranked within the two middle quartiles for lung and bronchus cancer incidence rates between 2006 and 2010, Orange County (94.6 per 100,000) ranked within the least favorable quartile of its peer county grouping. Cancer Incidence by Type, Peer County Ranking Age‐adjusted Incidence Rates per 100,000, 2006‐2010 Jefferson County Orange County

151.4 114.7 118.4 122.1 94.6 65.4 50.4 54.6

Lung & Bronchus Female Breast Male Prostate Colon & Rectum

Note: Jefferson and Orange Counties are within different peer county groups.

Source: Centers for Disease Control and Prevention Community Health Status Indicators, data from the State Cancer Registry and the CDC’s National Program of Cancer Registries Cancer Surveillance System, http://wwwn.cdc.gov/CommunityHealth; data accessed March 14, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 47 Chronic Lower Respiratory Disease Mortality

• Chronic Lower Respiratory Diseases While chronic lower respiratory Age‐adjusted Death Rate per 100,000 disease mortality rates in Texas 2011 2012 2013 remained relatively stable between 90 80 2011 and 2013, rates in Jefferson 70 and Orange Counties increased. 60 50 • In 2013, chronic lower respiratory 40 disease mortality rates in Orange 30 County (79.9 per 100,000) were 20 10 higher than Jefferson County (50.4 0 per 100,000), as well as the state Jefferson County Orange County Texas (42.3 per 100,000). 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION • Orange County has the 9th highest DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE rate of chronic lower respiratory Jefferson County 114 42.8 131 47.1 137 50.4 disease deaths, as compared to all Orange County 65 70.3 80 84.0 79 79.9 other counties in the state (2013). Texas 9,115 42.1 9,520 42.5 9,787 42.3

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 48 Chronic Lower Respiratory Disease Mortality Peer County Rankings

Chronic Lower Respiratory Disease, Jefferson County (2005‐2011) • In comparison to their Age‐adjusted Death Rate per 100,000 Persons respective peer county 46.7 groupings, Jefferson County (46.7 per 100,000) ranked within the two middle quartiles and Orange County (73.3 per 100,000) ranked at Note: Jefferson and Orange Counties are within the very top of the least different peer county groups. favorable quartile for chronic lower respiratory disease Chronic Lower Respiratory Disease, Orange County (2005‐2011) Age‐adjusted Death Rate per 100,000 Persons death rates between 2005 and 73.3 2011. • Orange County ranked above the U.S. median (49.6 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 49 Accidents Mortality

• Mortality rates due to accidents in Accidents Orange County and Texas steadily Age‐adjusted Death Rate per 100,000 decreased between 2011 and 2011 2012 2013 2013. Rates in Jefferson County 100 increased. 80 • Accident mortality rates in Orange 60 County (46.7 per 100,000) and 40 Jefferson County (44.6 per 20

100,000) were higher than the 0 state (36.8 per 100,000) in 2013. Jefferson County Orange County Texas • 2011 2012 2013 In 2013, the leading causes of AGE‐ AGE‐ AGE‐ LOCATION fatal accidents in Jefferson and DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Orange Counties were due to Jefferson County 92 35.0 96 36.7 118 44.6 motor vehicle accidents and Orange County 61 74.4 51 63.8 39 46.7 Texas 9,301 38.1 9,267 37.2 9,341 36.8 accidental poisonings and exposure to noxious substances.

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016. Accident mortality rates include: motor vehicle crashes, other land transport accidents, water transport accidents, air and space transport accidents, falls, accidental shootings, drownings, fire and smoke exposures, poisonings, suffocations, and all other unintentional injuries.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 50 Unintentional Injury (Including Motor Vehicle) Mortality Peer County Rankings

Unintentional Injury (Including Motor Vehicle), Jefferson County (2005‐2011) Age‐adjusted Death Rate per 100,000 Persons • In comparison to their respective peer county 48.1 groupings, both Jefferson County (48.1 per 100,000) and Orange County (85.6 per 100,000) ranked within the least favorable quartiles for unintentional injury death Note: Jefferson and Orange Counties are within rates between 2005 and different peer county groups. 2011. • Jefferson County ranked Unintentional Injury (Including Motor Vehicle), Orange County (2005‐2011) above the Healthy People Age‐adjusted Death Rate per 100,000 Persons 2020 Target (36.0 per 85.6 100,000), and Orange County ranked above both the Healthy People 2020 Target and the U.S. median (50.8 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 51 Cerebrovascular Disease Mortality

• Cerebrovascular disease Cerebrovascular Diseases mortality rates decreased in Age‐adjusted Death Rate per 100,000 Orange County and the state 2011 2012 2013 between 2011 and 2013, while 70 Jefferson County’s rates 60 increased. 50 • In 2013, Orange County had the 40 highest cerebrovascular disease 30 mortality rate (57 per 100,000) 20 as compared to Jefferson County 10 (55 per 100,000) and the state 0 (40.1 per 100,000). Jefferson County Orange County Texas th • Orange County has the 12 2011 2012 2013 AGE‐ AGE‐ AGE‐ highest rate of cerebrovascular LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED disease mortality as compared DEATH RATE DEATH RATE DEATH RATE to all other counties in the state. th Jefferson County 139 50.6 151 53.6 150 55.0 Jefferson County has the 16 Orange County 54 59.9 54 58.5 56 57.0 highest rate (2013). Texas 9,058 41.6 9,297 41.7 9,238 40.1

Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm; data accessed March 31, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 52 Cerebrovascular Disease Mortality Peer County Rankings

Stroke Deaths, Jefferson County (2005‐2011) • In comparison to their Age‐adjusted Death Rate per 100,000 Persons respective peer county 60.0 groupings, Jefferson County (60.0 per 100,000) and Orange County (54.6 per 100,000) both ranked within the least favorable Note: Jefferson and Orange Counties are within different peer county groups. quartile for stroke deaths Stroke Deaths, Orange County (2005‐2011) between 2005 and 2011. Age‐adjusted Death Rate per 100,000 Persons • Both counties ranked above 54.6 the Healthy People 2020 Target (34.8 per 100,000) and the U.S. median (46.0 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 53 Communicable Diseases

Chlamydia Rates per 100,000 Population • Chlamydia rates in Jefferson County have 600

recently increased, while rates in Orange 500 County and the state have recently 400 2012 decreased (2012‐2014). 300 2013 • In 2014, Jefferson County (560.6 per 2014 100,000) had higher rates of Chlamydia 200 as compared to Orange County (248.1 100 per 100,000) and the state (475.0 per 0 100,000). Jefferson County Orange County Texas • Gonorrhea rates in Jefferson County have Gonorrhea Rates per 100,000 Population steadily increased, while rates in Orange 600 County and the state remain steady 500 (2012‐2014). 2012 400 • In 2014, Jefferson County (241.0 per 2013 2014 100,000) had significantly higher 300 Gonorrhea rates than Orange County 200 (48.3 per 100,000) and the state (127.7 100

per 100,000). 0 Jefferson County Orange County Texas

Source: Texas Department of State Health Services, 2014 STD Surveillance Report, https://www.dshs.state.tx.us/hivstd/reports/; data accessed January 18, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 54 Chronic Conditions Diabetes Mellitus

• In 2012, the percent of adults (age 20+) ever diagnosed with diabetes by a doctor in the report area (10.7%) was higher than the state (9.2%) and national (9.1%) rates. • In 2014, Health Service Region (HSR) 5/6S (10.7%) had a similar prevalence rate of diabetes compared to J: 11.4% the state (11.0%). O: 8.6% • Diabetes prevalence rates in adults (age 18+) in both

HSR 6/5S and the state have remained relatively Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red steady between 2012 and 2014. dial indicates that the county has a worse rate than the state. Diabetes Diabetes Prevalence Rates, Adults (age 18+), 2014 Prevalence Rates, Adults (age 18+), 2012‐2014 2012 2013 2014

16.5% 12.3% 14.5% 13.5% 9.1% 10.9% 10.7% 9.1% 11.0% 11.0% 10.7% 10.7% 10.6% 10.9% 11.0%

HSR 1HSR 2/3 HSR HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas 4/5N

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Has a doctor, nurse, or other health professional ever told you that you have diabetes?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 55 Adult Diabetes Peer County Rankings

Adult Diabetes, Jefferson County • In comparison to their Percent, Adults (age 20+), 2005‐2011 respective peer county 10.9% groupings, Jefferson County (10.9%) ranked within the upper end of the two middle quartiles and Orange County (6.8%) Note: Jefferson and Orange Counties are within ranked within the most different peer county groups. favorable quartile for the Adult Diabetes, Orange County percent of adults living with Percent, Adults (age 20+), 2005‐2011 diagnosed diabetes 6.8% between 2005 and 2011. • Jefferson County ranked above the U.S. median (8.1%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 56 Chronic Conditions Obesity

• In 2012, over one‐third (35.2%) of adults (age 20+) in the report area reported that they have a Body Mass Index (BMI) greater than 30.0 (obese), as compared to 28.2% in the state and 27.1% in the nation. • In 2014, HSR 6/5S (34.2%) had a higher prevalence rate J: 36.7% of obesity than the state (31.9%). O: 30.8% • Obesity prevalence rates in adults (age 18+) in HSR Note: the Report Area is defined as Jefferson and Orange Counties. A green 6/5S and the state appear to be increasing (2012‐ dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 2014). Obesity Obesity Prevalence Rates, Adults (age 18+), 2014 Prevalence Rates, Adults (age 18+), 2012‐2014 2012 2013 2014 39.9% 41.7% 34.2% 32.5% 31.0% 32.4% 33.0% 31.9% 28.5% 34.2% 31.9% 27.8% 28.9% 29.2% 30.9%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: BMI is (weight in lbs. divided by (height in inches squared)) times 703. Recommended BMI is 18.5 to 24.9 Overweight is 25.0 to 29.9 Obese is => 30.0.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 57 Adult Obesity Peer County Rankings

Adult Obesity, Jefferson County Percent, Adults (age 20+), 2006‐2012 • In comparison to their 35.5% respective peer county groupings, Jefferson County (35.5%) ranked within the least favorable quartile and Orange Note: Jefferson and Orange Counties are within County (31.1%) ranked different peer county groups. within the two middle Adult Obesity, Orange County quartiles for the percent of Percent, Adults (age 20+), 2006‐2012

obese adults between 31.1% 2006 and 2012. • Both counties ranked above the U.S. median (30.4%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 58 Chronic Conditions Asthma

• In 2011‐2012, the percent of adults (age 18+) in the report area (10.3%) that had ever been told by a health professional that they had asthma was lower than the state (11.6%) and national (13.4%) rate.

• In 2014, HSR 6/5S had one of the lowest prevalence rates of J: 9.8% asthma (9.6%) as compared to all other regions and the state (11.1%). O: 11.5% • Asthma prevalence rates in adults (age 18+) in HSR 6/5S and Note: the Report Area is defined as Jefferson and Orange Counties. A green the state have remained relatively steady (2012‐2014). dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state.

Asthma Asthma Prevalence Rates, Adults (age 18+), 2014 Prevalence Rates, Adults (age 18+), 2012‐2014

2012 2013 2014

13.1% 12.6% 12.6% 9.9% 11.7% 12.2% 11.1% 12.6% 9.6% 9.5% 8.9% 8.6% 9.6% 10.9% 11.1%

HSR 1HSR 2/3 HSR HSR HSR 7HSR 8HSRHSR 11 Texas HSR 6/5S Texas 4/5N 6/5S 9/10

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Has a doctor, nurse, or other health professional ever told you that you had asthma?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 59 Older Adult Asthma Peer County Rankings

Older Adult Asthma, Jefferson County • In comparison to their Percent, Medicare Beneficiaries (age 65+), 2012 respective peer county 4.4% groupings, Jefferson County (4.4%) and Orange County (3.7%) both ranked within the Note: Jefferson and Orange Counties are within two middle quartiles for different peer county groups.

the percent of older Older Adult Asthma, Orange County adults living with asthma Percent, Medicare Beneficiaries (age 65+), 2012

in 2012. 3.7% • Both counties ranked above the U.S. median (3.6%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 60 Chronic Conditions Arthritis

• In 2014, HSR 6/5S had a similar rate of adult arthritis (20.3%) as compared to the state (19.4%). • Between 2012 and 2014, arthritis prevalence rates in adults (age 18+) in HSR 6/5S overall slightly decreased, while rates in the state steadily decreased. Arthritis Arthritis Prevalence Rates, Adults (age 18+), 2014 Prevalence Rates, Adults (age 18+), 2012‐2014

2012 2013 2014

27.1% 21.9% 22.3% 21.2% 20.3% 19.7% 20.6% 20.0% 19.4% 21.4% 20.2% 20.3% 21.3% 20.7% 19.4%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 61 Health Behaviors Physical Inactivity

• In 2012, the percent of the adult population (age 20+) in the report area (29.3%) that self‐reported no leisure time for physical activity was higher than the state (24.0%) and national (22.6%) rate. • In 2014, the prevalence of adults that do not participate in

physical activity HSR 6/5S (28%) was similar the state J: 29.6% (27.6%). O: 28.5% • The percent of adults (age 18+) that do not participate in

leisure time physical activity in HSR 6/5S and the state Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red remained relatively steady between 2012 and 2014. dial indicates that the county has a worse rate than the state.

No Leisure Time Physical Activity No Leisure Time Physical Activity Percent, Adults (age 18+), 2014 Percent, Adults (age 18+), 2012‐2014 2012 2013 2014 36.3% 35.3% 31.5% 32.4% 28.0% 28.3% 24.7% 27.6% 22.8% 27.4% 29.9% 28.0% 27.2% 30.1% 27.6%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: During the past month, did you participate in any physical activities or exercises such as running, golf, gardening or walking for exercise?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 62 Physical Inactivity Peer County Rankings

Physical Inactivity, Jefferson County • In comparison to their Percent, Adults (age 18+), 2006‐2012

respective peer county 33.7% groupings, Jefferson County (33.7%) and Orange County (31.3%) both ranked in the least favorable quartile for the percent of adults who Note: Jefferson and Orange Counties are within reported no leisure time different peer county groups. physical activity between Physical Inactivity, Orange County 2006 and 2012. Percent, Adults (age 18+), 2006‐2012 31.3% • Both counties ranked above the U.S. median (25.9%), and Jefferson County ranked above the Healthy People 2020 Target (32.6%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 63 Health Behaviors Binge Drinking

• In 2014, HSR 6/5S (15.2%) had a very similar percent of adults at risk of binge drinking, as compared to the state (16.3%). • The percent of adults (age 18+) at risk for binge drinking in HSR 6/5S and the state remained steady between 2012 and 2014.

Binge Drinking Binge Drinking Percent At Risk, Adults (age 18+), 2014 Percent At Risk, Adults (age 18+), 2012‐2014

2012 2013 2014

18.2% 18.7% 19.4% 15.1% 15.2% 15.4% 16.3% 13.7% 16.7% 9.6% 15.1% 15.0% 15.2% 16.2% 16.3%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, data from the National Center for Chronic Disease Prevention and Health Promotion, www.communitycommons.org; data accessed March 14, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: During the past 30 days, what is the largest number of drinks you had on any occasion? Respondents are classified as “at risk” for binge drinking if males reported consuming 5 or more and females reported consuming 4 or more alcoholic beverages at one time.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 64 Health Behaviors Smoking

• The percent of the adult population (age 18+) in the report area (23.5%) that self‐reported currently smoking some days or every day was higher than the state (16.5%) and national rate (18.1%) (2006‐2012). • In 2014, the prevalence of current, every day smokers in HSR 6/5S (7.5%) was slightly lower than the state (8.7%). J: 22.1% • In 2012‐2014, the percent of adults (age 18+) that self‐ reported being a current smoker that smokes every day in O: 27.9% HSR 6/5S and the state steadily decreased. Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Smoking Smoking Prevalence of Everyday Smokers, Adults (age 18+), 2014 Prevalence of Everyday Smokers, Adults (age 18+), 2012‐2014 2012 2013 2014

16.3% 12.0% 10.4% 7.7% 9.8% 8.7% 11.5% 7.5% 7.4% 7.1% 9.5% 9.0% 7.5% 9.9% 8.7%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Four‐level smoker status: Current Smoker ‐ Every Day, Current Smoker ‐ Some Days, Former Smoker, Never Smoker

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 65 Adult Smoking Peer County Rankings

Adult Smoking, Jefferson County • In comparison to their Percent, Adults (age 18+), 2006‐2012 respective peer county 22.1% groupings, Jefferson County (22.1%) and Orange County (27.9%) both ranked within the least favorable quartile for the percent of adults who Note: Jefferson and Orange Counties are within reported smoking cigarettes different peer county groups. between 2006 and 2012. Adult Smoking, Orange County Percent, Adults (age 18+), 2006‐2012 • Both counties ranked above 27.9% the Healthy People 2020 Target (12.0%) and the U.S. median (21.7%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016. Definition: Do you now smoke cigarettes every day, some days, or not at all? Persons are considered smokers if they reported smoking every day or some days.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 66 Natality

• Infant mortality rates in the report area (7.4 per 1,000 births) are higher than the state (6.2 per 1,000 births) and J: 7.2 national rates (6.5 per 1,000 births). O: 8.1 • The percent of women who do not obtain prenatal care during their first trimester of pregnancy in the report area (30.2%) is lower than the state (39.5%), but higher than the national J: 30.2% rate (17.3%) (2007‐2010). O: SUPPRESSED • The rate of teen (females age 15‐19) births in the report area (55.4 per 1,000) is slightly higher than the state (55.0 per 1,000) and national rates J: 54.8 (36.6 per 1,000) (2006‐2012). O: 57.5

Note: the Report Area is defined as Jefferson and Orange Counties. A green dial Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; indicates that the county has a better rate than the state, and a red dial indicates that data accessed May 5, 2016. the county has a worse rate than the state. Late or No Prenatal Care Definition: the percentage of women who do not obtain prenatal care during their first trimester of pregnancy.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 67 Natality Continued

• The percent of low birth weight (<2,500g) births in the report area (10.2%) is higher than the state

(8.4%) and national rate (8.2%) J: 10.4% (2006‐2012). O: 9.6% • The number of food stores and other retail establishments that are authorized to accept WIC Program benefits and that carry WIC foods and food categories in the report area (8.9 per 100,000) is slightly lower than the state (9.1 per 100,000) and national rates (15.6 per J: 8.3 100,000) (2011). O: 10.9

Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state.

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 68 Mental Health

• In 2012, the percentage of Medicare Beneficiaries in the report area (15.6%) with depression was lower than the state (16.2%) and national rate (15.4%). • In 2014, HSR 6/5S (12.9%) had a lower prevalence rate of diagnosed adult depressive disorders as compared to the state (14.6%) and the majority of other regions. J: 16.1%

• Between 2012 and 2014, the prevalence of adults (age O: 14.5% 18+) in HSR 6/5S that have been diagnosed with a

depressive disorder steadily decreased, while rates in Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red the state remained steady. dial indicates that the county has a worse rate than the state. Depressive Disorders Depressive Disorders Prevalence Rates, Adults (age 18+), 2012‐2014 Prevalence Rates, Adults (age 18+), 2014 2012 2013 2014

18.2% 17.6% 14.8% 16.5% 15.7% 14.0% 14.6% 12.1% 12.9% 16.3% 13.2% 12.9% 15.5% 16.0% 14.6%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Has a doctor, nurse, or other health professional ever told you that you have a depressive disorder including depression, major depression, dysthymia, or minor depression?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 69 Preventive Care Screenings ‐ Mammography

• In 2012, the percent of female Medicare Enrollees (age 67‐69) in the report area (61.4%) that received one or more mammograms in the past two years was slightly higher than the state (58.9%) and higher than the nation (63.0%). • In 2014, the percent of female adults (age 40+) in HSR 6/5S (22.8%) that did not receive a mammogram in the past 2 years was lower than the state (29.0%), as well as all of other regions.

No Mammogram in the Past 2 Years Percent, Female Adults (age 40+), 2014

33.6% 36.7% 35.2% 26.3% 28.9% 28.0% 29.2% 29.0% J: 63.6% 22.8%

O: 56.3%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state.

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Females 40 years and older who had a mammogram within the past 2 years

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 70 Preventive Care Screenings ‐ Colonoscopy

• Between 2006 and 2012, the percentage of adults (age 50+) who self‐reported that they have ever had a sigmoidoscopy or colonoscopy in the report area (56.1%) was lower than the state (57.3%) and national rate (61.3%). • In 2014, the percent of adults (age 50‐75) in HSR 6/5S (41.5%) that did not have a colonoscopy in the past 10 years was slightly lower than the state (42.6%).

No Colonoscopy in the Past 10 Years Percent, Adults (age 50‐75), 2014

58.1% 51.7% 46.3% 46.0% 42.6% 38.0% 41.5% 41.2% 37.8% J: 59.4%

O: 47.0%

Note: the Report Area is defined as Jefferson and Orange Counties. A green HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state.

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Males and females 50‐75 years who have not had a colonoscopy in the past 10 years ‐ Used to calculate CRCREC

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 71 Preventive Care Immunizations –Influenza Vaccine (18‐64 Years)

• In 2014, the percent of adults in HSR 6/5S (67.8%) that did not receive a flu shot in the past year was slightly higher than the state (66.2%). • Between 2012 and 2014, the percent of adults (age 18‐64 years) that did not receive a flu shot in the past year steadily decreased in HSR 6/5S and the state.

No Flu Shot in the Past Year No Flu Shot in the Past Year Percent, Adults (age 18‐64), 2014 Percent, Adults (age 18‐64), 2012‐2014

2012 2013 2014

73.8% 72.1% 75.2% 65.9% 67.8% 66.0% 66.2% 61.0% 63.2% 72.6% 71.4% 67.8% 70.9% 69.0% 66.2%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: During the past 12 months, have you had either a seasonal flu shot or a seasonal flu vaccine that was sprayed in your nose?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 72 Preventive Care Immunizations –Influenza Vaccine (65+ Years)

• In 2014, HSR 6/5S (42.9%) had one of the highest percentages of adults (age 65+) that did not receive a flu shot in the past year, as compared to all other regions and the state (41.2%). • Between 2012 and 2014, the percent of adults (age 65+) that did not receive a flu shot in the past year in 6/5S increased, while rates in the state remained steady.

No Flu Shot in the Past Year No Flu Shot in the Past Year Percent, Adults (age 65+), 2012‐2014 Percent, Adults (age 65+), 2014 2012 2013 2014

58.1% 42.9% 38.6% 42.4% 39.2% 41.2% 37.8% 42.9% 40.6% 41.2% 29.8% 32.2% 37.6% 37.7% 39.0%

HSR 1HSR 2/3 HSR HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas 4/5N

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: During the past 12 months, have you had either a seasonal flu shot or a seasonal flu vaccine that was sprayed in your nose?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 73 Preventive Care Immunizations – Pneumococcal Vaccine (18‐64 Years)

• In 2014, the percent of adults that had never received a pneumonia shot in HSR 6/5S (69.2%) was consistent with the state’s rate (69.7%). • Between 2012 and 2014, the percent of adults (age 18‐64 years) that reported never having received a pneumococcal vaccination in HSR 6/5S steadily decreased, while the state’s rate remained stable.

No Pneumonia Shot Ever No Pneumonia Shot Ever Percent, Adults (age 18‐64), 2014 Percent, Adults (age 18‐64), 2014 2012 2013 2014

69.8% 68.9% 69.2% 67.8% 70.0% 70.1% 68.9% 69.7% 63.3% 72.3% 70.8% 69.2% 71.3% 68.5% 69.7%

HSR 1HSR 2/3 HSR HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas 4/5N

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Have you ever had a pneumonia shot?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 74 Preventive Care Immunizations – Pneumococcal Vaccine (65+ Years)

• Between 2006 and 2012, the percent of the population (age 65+) in the study area (68.2%) that self‐reported ever having received the pneumonia vaccine was slightly higher than the state (67.7%) and national (67.5%) rates. • In 2014, the percent of adults (age 65+) that had never

received a pneumonia shot in HSR 6/5S (34.8%) was higher J: 70.6% than the state’s (32.1%) and all other regions. O: 61.7% • Between 2012 and 2014, the percent of adults (age 65+) that had never received a pneumonia shot in HSR 6/5S Note: the Report Area is defined as Jefferson and Orange Counties. A green fluctuated, while the state’s rate increased. dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. No Pneumonia Shot Ever No Pneumonia Shot Ever Percent, Adults (age 65+), 2014 Percent, Adults (age 65+), 2012‐2014 2012 2013 2014

39.4% 34.8% 31.4% 32.7% 32.1% 34.8% 32.1% 32.1% 28.1% 25.9% 28.0% 27.1% 30.7% 27.6% 29.7%

HSR 1HSR 2/3 HSR 4/5NHSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Have you ever had a pneumonia shot?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 75 Health Care Access Uninsured

• Between 2010 and 2014, the percent of the population (all ages) in the report area (21.7%) that were uninsured was slightly lower than the state (21.9%), but higher than the J: 22.9% national (14.2%) rates. O: 18.3% • According to Enroll America, between 2013 and 2015, Jefferson County Note: the Report Area is defined as Jefferson and Orange Counties. A green dial indicates that the county has a better rate than the state, and a red experienced the greatest decline in dial indicates that the county has a worse rate than the state. uninsured rates as compared to Uninsured Orange County, as well as the state Percent, Adults (age 18‐64), 2013 & 2015 and national levels. 2013 2015 2013‐2015 % Change 26.0% • As of 2015, Jefferson County (18.0%) 21.0% 21.3% 18.0% has the highest rate of uninsured 16.0% 16.0% 16.4% 8.0% 10.7% adults (age 18‐64) as compared to 5.0% 5.3% Orange County (16.0%), as well as the 5.7%

state (16.0%) and nation (10.7%). Jefferson County Orange County Texas United States

Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Source: Enroll America, County‐Level Snap Shots, www.enrollamerica.org; data accessed March 14, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 76 Uninsured Peer County Rankings

Uninsured, Jefferson County • In comparison to their Percent, Adults (under age 65), 2011

respective peer county 24.1% groupings, Jefferson County (24.1%) and Orange County (21.7%) both ranked within the Note: Jefferson and Orange Counties are within least favorable quartile for different peer county groups. the percent of the Uninsured, Orange County population without health Percent, Adults (under age 65), 2011 21.7% insurance in 2011. • Both counties ranked above the U.S. median (17.7%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 77 Health Care Access Medical Cost Barriers

• In 2014, the percent of adults that reported experiencing a medical cost barrier in the past 12 months in HSR 6/5S (18%) was similar to the state rate (17.6%). • Between 2012 and 2014, the percent of adults (age 18+) that needed medical care but could not receive it due to cost in HSR 6/5S and the state decreased.

Medical Cost Barriers Medical Cost Barriers Prevalence Rates, Adults (age 18+), 2014 Prevalence Rates, Adults (age 18+), 2012‐2014 2012 2013 2014

25.3% 22.4% 22.0% 17.7% 16.8% 18.0% 18.3% 17.6% 22.5% 20.9% 13.3% 18.7% 18.0% 19.3% 17.6%

HSR 1HSR 2/3 HSR 4/5NHSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 78 Medical Cost Barriers Peer County Rankings

Cost Barrier to Care, Jefferson County • In comparison to their Percent, Adults (age 18+), 2006‐2012 respective peer county groupings, Jefferson County 21.1% (21.1%) ranked within the least favorable quartile and Orange County (15.2%) ranked within the two middle quartiles for Note: Jefferson and Orange Counties are within the percent of adults who did different peer county groups. not see a doctor due to cost Cost Barrier to Care, Orange County between 2006 and 2012. Percent, Adults (age 18+), 2006‐2012 • Both counties ranked above the Healthy People 2020 Target 15.2% (9.0%), and Jefferson County ranked above the U.S. median (15.6%).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016. Definition: Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 79 Health Care Access Personal Doctors

• In 2014, HSR 6/5S (34.1%) had a higher percent of adults that had no personal doctor than the state (32.9%), as well as the majority of other regions. • Between 2012 and 2014, the percent of adults in HSR 6/5S that reported not having a personal doctor slightly decreased, while rates in the state remained steady.

No Personal Doctor No Personal Doctor Percent, Adults (age 18+), 2014 Percent, Adults (age 18+), 2012‐2014 2012 2013 2014 34.1% 35.1% 35.0% 31.3% 32.6% 32.9% 28.8% 26.7% 25.8% 35.0% 34.2% 34.1% 32.9% 33.1% 32.9%

HSR 1HSR 2/3 HSR 4/5N HSR 6/5S HSR 7HSR 8HSR 9/10 HSR 11 Texas HSR 6/5S Texas

Source: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services; data accessed January 6, 2016. Definition: Do you have one person you think of as your personal doctor or health care provider?

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 80 Health Care Access Providers

• In 2012, the rate of primary care physicians per 100,000 population in the report area (52.9 per 100,000) was lower than the state (58.5 per 100,000) and national rate (74.5 per J: 60.8

100,000). O: 28.9 • In 2013, the rate of dental care providers per 100,000 population in the report area (46.2 per 100,000) was lower than the state (51.5 per 100,000) and national rates (63.2 per J: 52.7 100,000). O: 26.5 • In 2016, the rate of mental health care providers per 100,000 population in the report area (79.2 per 100,000) was lower than the state (102.3 per 100,000) rate and significantly

lower than the national rate (202.8 per J: 97.5 100,000). O: 23.9 Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed June 23, 2016. Definition: Doctors classified as "primary care physicians" by the AMA include: General Family Medicine MDs and DOs, General Practice MDs and DOs, Note: the Report Area is defined as Jefferson and Orange General Internal Medicine MDs and General Pediatrics MDs. Physicians age 75 and over and physicians practicing sub‐specialties within the listed specialties Counties. A green dial indicates that the county has a better are excluded. rate than the state, and a red dial indicates that the county has Definition: All dentists ‐ qualified as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice a worse rate than the state. dentistry and who are practicing within the scope of that license. Definition: Psychiatrists, psychologists, clinical social workers, and counselors that specialize in mental health care.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 81 Health Care Access Peer County Rankings

Primary Care Provider Access, Jefferson County • In comparison to their Rate per 100,000 Persons, 2011 respective peer county groupings, Jefferson County 68.8 (68.8 per 100,000) and Orange County (26.7 per 100,000) both ranked within Note: Jefferson and Orange Counties are within the least favorable quartiles different peer county groups. for the rate of primary care Primary Care Provider Access, Orange County providers per 100,000 Rate per 100,000 Persons, 2011 persons in 2011.

• Orange County ranked below 26.7 the U.S. median (48.0 per 100,000).

Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for Jefferson and Orange Counties, http://wwwn.cdc.gov/CommunityHealth/; data accessed May 3, 2016. Definition: Primary care physicians are those who identify as practicing general practice, internal medicine, obstetrics and gynecology, or pediatrics.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 82 Health Care Access Medically Underserved Areas / Populations (MUA/P) • The Index of Medical Underservice (IMU) scale is from 1 to 100, where 0 represents ‘completely underserved’ and 100 represents ‘best served’ or ‘least underserved.’ • Each service area or population group found to have an IMU of 62.0 or less qualifies for designation as a Medically Underserved Area or Medically Underserved Population.

Source: Health Resources and Services Administration, Data Warehouse, http://datawarehouse.hrsa.gov/; data accessed May 8, 2016. Definition: Medically Underserved Areas/Populations are areas or populations designated by HRSA as having: too few primary care providers, high infant mortality, high poverty and/or high elderly population.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 83 Health Care Access Medically Underserved Areas / Populations (MUA/P)

Jefferson County Index of Medical Service Area Name Designation Type Underservice Designation Date Update Date Score Low Inc –Jefferson Service Medically Underserved 45.90 01/18/1995 01/18/1995 Area Population Port Arthur/Jefferson Medically Underserved 49.30 05/04/1994 03/18/2008 Service Area Area Low Inc – Inner City Medically Underserved 55.60 02/28/2003 02/28/2003 Beaumont Population Orange County Index of Medical Service Area Name Designation Type Underservice Designation Date Update Date Score Medically Underserved Med Ind –Vidor Service Area –Governor’s 0.0 09/29/1995 09/29/1995 Area Exception Medically Underserved 05/11/1994 Orange Service Area 57.87 05/11/1994 Area

Source: Health Resources and Services Administration, Data Warehouse, http://datawarehouse.hrsa.gov/; data accessed May 8, 2016. Definition: Medically Underserved Areas/Populations are areas or populations designated by HRSA as having: too few primary care providers, high infant mortality, high poverty and/or high elderly population.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 84 Health Care Access Health Professional Shortage Areas (HPSA)

• Health Professional Shortage Area (HPSA) designations are based on general HPSA designation criteria, plus additional criteria and guidelines specific to each of the three types of designations: • Primary Care J: 100.0% • Dental Health O: 100.0% • Mental Health • All Federally Qualified Health Centers and Note: the Report Area is defined as Jefferson and Orange Counties. A those Rural Health Clinics that provide green dial indicates that the county has a better rate than the state, and access to care regardless of ability to pay a red dial indicates that the county has a worse rate than the state. receive automatic facility HPSA designation. • HPSA Scores range from 1 to 26, where the higher the score, the greater the priority for assignment of clinicians. • As of April 2016, 100% of the population in both Jefferson and Orange Counties are living within a HPSA. Source: Health Resources and Services Administration, Data Warehouse, http://datawarehouse.hrsa.gov/; data accessed May 7, 2016. Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data accessed May 5, 2016. Definition: Health Professional Shortage Areas (HPSAs) are designated by HRSA as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 85 Health Care Access Health Professional Shortage Areas (HPSA)

Jefferson County HPSA Name Designation Type Discipline Class HPSA Score Update Date Gulf Coast Health Center Comprehensive Health Center Primary Care 18 03/01/2012 Gulf Coast Health Center Comprehensive Health Center Dental Health 20 03/01/2012 Gulf Coast Health Center Comprehensive Health Center Mental Health 17 03/01/2012 Triangle AIDS Network Comprehensive Health Center Primary Care 20 08/01/2015 Triangle AIDS Network Comprehensive Health Center Dental Health 18 08/01/2015 Triangle AIDS Network Comprehensive Health Center Mental Health 16 08/01/2015 Federal Correctional Complex ‐ Correctional Facility Mental Health 12 05/06/2013 Beaumont Jefferson County HPSA Geographic High Needs Dental Health 6 03/30/2012 Orange County HPSA Name Designation Type Discipline Class HPSA Score Update Date Vidor Community Health Clinic, Rural Health Clinic Primary Care 0 02/12/2004 Inc. Orange County HPSA Geographic Primary Care 7 09/23/2013 Orange County HPSA Geographic Dental Health 11 04/17/2012

Source: Health Resources and Services Administration, Data Warehouse, http://datawarehouse.hrsa.gov/; data accessed May 7, 2016. Definition: Health Professional Shortage Areas (HPSAs) are designated by HRSA as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 86 Barriers to Care

• Cost of health care may delay or inhibit patients from seeking preventive care. – Between 2010 and 2014, one‐fourth (24.7%) of the insured population in the report area was receiving J: 26.1% Medicaid, which is above the state (22.1%) and national rates (20.8%). O: 20.8% • Lack of adequate and available primary care resources for patients to access may lead to increased preventable hospitalizations. – In 2012, the rate of preventable hospital events in the report area (69.3 per 1,000 Medicare Enrollees) was higher than that of the state (62.9 per 1,000) and the J: 64.8 nation (59.2 per 1,000). O: 80.8 • Lack of transportation is frequently noted as a potential barrier to accessing and receiving care. – Between 2010 and 2014, 8.2% of households in the report area had no motor vehicle, as compared to 5.9% of Texas. J: 9.3%

O: 4.8%

Note: the Report Area is defined as Jefferson and Orange Counties. A Source: Community Commons, Health Indicator Report: logged in and filtered for Jefferson and Orange Counties, TX, www.communitycommons.org; data green dial indicates that the county has a better rate than the state, and accessed May 5, 2016. a red dial indicates that the county has a worse rate than the state. Definition: Ambulatory Care Sensitive (ACS) conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequate primary care resources were available and accessed by those patients.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 87 PHONE INTERVIEW FINDINGS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 88 Overview

• Conducted ten interviews with the two groups outlined in Internal Revenue Service Final Regulations issued December 29, 2014. • Discussed the health needs of the community, access issues, barriers and issues related to specific populations • Gathered background information on each interviewee

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 89 Interviewee Information

• Sally Broussard: Chief Administrative Officer, Spindletop Center • Rasheeda Daugherty: Executive Director, March of Dimes • Carol Fernandez: President/Chief Executive Officer, Catholic Charities of Southeast Texas • Colleen Halliburton: Community Services Division Director, Southeast Texas Regional Planning Commission • Karyn Hawkins: President/Chief Executive Officer, United Way of Beaumont and North Jefferson County • Chester Jourdan: Executive Director, American Red Cross of Southeast and Deep East Texas • John Neely: Executive Director, Southeast Texas Council on Alcohol and Drug Abuse • Michael Perez: Executive Director, Salvation Army Boys & Girls Club of Beaumont • Seth Stephens: SmartHealth Clinic/Disease Management Director, Baptist Hospitals of Southeast Texas • Sherry Ulmer: Director, Beaumont Public Health Department

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 90 Interviewee Characteristics

•Work for a state, local, tribal or regional governmental public health department (or equivalent department or agency) with knowledge, information or expertise relevant to the health needs of the community 10%

•Member of a medically underserved, low‐income or minority populations in the community, or individuals or organizations serving or representing the interests of such populations 90%

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 91 Community Need Summary

• Interviewees discussed the following as the most significant health issues: – Barriers to Accessing Care • Affordability of Care and Insurance Coverage • Transportation – Access to Specialty Care Services – Access to Mental and Behavioral Health Services – Prevalence of Chronic Conditions and Access to Healthy Lifestyle Resources – Fragmented Continuum of Care

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 92 Barriers to Accessing Care Affordability of Care and Insurance Coverage

• Interviewees overwhelmingly agreed ability to pay and insurance coverage are strong determinants of health in “We are getting more options if the area. you have money, but fewer • The majority of interviewees agreed options if you’re in that middle that access to primary care and dental to lower income area.” services are adequate in the area but “The physicians are going only for those who have a payment where the dollars are, and a lot source. of them don't want to take • Many of the interviewees agreed that Medicare/Medicaid.” physicians in the area are not accepting Medicaid and Medicare, “Affordability is a concern, even which presents a barrier for those when you have insurance.” patients in seeking care. • A few interviewees mentioned the cost of health care is a concern for all populations, regardless of coverage.

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 93 Barriers to Accessing Care Transportation

• Many interviewees raised concern “We have public transportation that allows around public transportation in the for those to come and go to their medical area and its unreliability for patients appointments... At the same time, that needing transportation resources. system is not very good. Sometimes they • The majority of interviewees noted show, sometimes they don’t.” transportation as a barrier to “Transportation is a huge problem in our seeking care, especially when community. Accessing the services means patients are referred out of the area having to get there, and we don’t have any for care. transit systems that connect Orange County • The lack of dependable public to Jefferson County for the purposes of transportation resources to get to health care unless you’re on Medicaid.” and from medical appointments was “For elderly, we need to bring the services to discussed as a concern. where the people are. In areas where there is • A few interviewees mentioned that not public transportation it makes it very transportation is a particular issue difficult for poor people and seniors.” for the elderly and the low income populations.

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 94 Access to Specialty Care Services

• Interviewees agreed that access to “We have plenty of primary care specialist services is a big need in the providers, but not enough community. Specialties mentioned specialists.” include: – Psychiatry and Psychology “There is a huge need for – OB/GYN Services pediatrics and obstetrics, from – Pediatrics what I hear and see.” – Affordable Emergency Care “We have very few specialty • A few interviewees mentioned that care providers…high risk patients needing specialty services are patients are sent to Galveston or typically referred out to Houston or Houston to be seen.” Galveston to access care. “There’s not a reasonably priced • One interviewee specifically discussed emergency service for minor affordable emergency services for care.” minors as a need in the area.

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 95 Access to Mental and Behavioral Health Services

• Four of the interviewees noted access to mental and behavioral health “We have a lack of residential treatment services as one of the biggest needs in for addiction disorders.” the community. “Many call about being off medications • Similar to primary and specialty care, for months, but can’t get any more or resources are inadequate for those can’t afford them and can’t get back in to without a pay source. High deductibles see someone for another two months.” were mentioned as a deterrent to “There is not enough knowledge as to seeking appropriate care. what are the available resources for folks • Interviewees also discussed a lack of who present substance abuse problems... awareness regarding available I don’t think the medical community really knows what to do with those folks.” resources and a stigma around accessing services. “With counseling staff, there has also • One interviewee mentioned that there been a lack of bilingual psychiatric services.” is a need for bilingual psychiatric services in the area.

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 96 Prevalence of Chronic Conditions and Access to Healthy Lifestyle Resources

• Many interviewees mentioned that the prevalence of certain chronic conditions “[There is a need for] availability and is a concern in the community. access to good, healthy food.” • The chronic conditions and unhealthy behaviors mentioned include: “We have high rates of diabetes, – Obesity cardiovascular disease, including – Diabetes hypertension, and we have a lot of untreated psychiatric patients... – Cardiovascular and heart diseases Cardiovascular issues due to diet – Hypertension because of what we eat, sedentary – Physical inactivity lifestyles.” • Along with chronic conditions, physical fitness and active lifestyles were also “We need access to parks, we have mentioned as significant needs. A few neighborhoods with no sidewalks. interviewees noted the lack of It’s just diet and the built infrastructure or built environment to environment.” facilitate physical activity. • Many interviewees mentioned that restaurants in the area do not offer healthier alternatives. Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 97 Fragmented Continuum of Care

• Interviewees discussed the need for collaboration among health care professionals, including specialists. Issues “Emergency to follow up care is bad. include: If the PCP is the ER, and a family – More patient‐centered care doesn’t have a doctor, then – Emphasis on prevention transitioning to follow up care or – More comprehensive care outpatient is lacking. That goes back • Interviewees also discussed the need for again to the lack of specialists.” increased patient education. Issues include: “If you are on Medicaid, if you’re – Need to provide more information about not using one of the FQHCs, and how to access healthcare coverage even then, you wait long periods of – Misuse of the emergency room / lack of understanding of resources time there. If you are uninsured or • Other concerns regarding the continuum under insured, they’re going to wait of care include: a very long time.” – Long wait times – Transitions between care settings

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 98 2013 CHNA PRIORITIZED HEALTH NEEDS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 99 2013 CHNA Prioritized Health Needs

1. Access to Primary Care and Specialist Services 2. High Mortality Rates for Prominent Diseases 3. Access to Mental Health Services 4. Fragmented Continuum of Care 5. Health Disparities Among Specific Populations 6. Unhealthy Lifestyles and Behaviors in the Community 7. Poor Air Quality

Source: Baptist Beaumont Hospital, 2013 Community Health Needs Assessment and Implementation Plan, http://www.bhset.net/About‐Us/Community‐Health‐Needs‐ Assessment.aspx; data accessed June 23, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 100 INPUT REGARDING THE HOSPITAL’S PREVIOUS CHNA

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 101 Consideration of Previous Input

• IRS Final Regulations require a hospital facility to consider written comments received on the hospital facility’s most recently conducted CHNA and most recently adopted Implementation Strategy in the CHNA process. • The hospital made every effort to solicit feedback from the community by providing a feedback mechanism on the hospital’s website. However, at the time of this publication, written feedback has not been received on the hospital’s most recently conducted CHNA and Implementation Strategy. • To provide input on this CHNA please see details at the end of this report or respond directly to the hospital online at the site of this download.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 102 EVALUATION OF HOSPITAL’S IMPACT

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 103 Evaluation of Hospital’s Impact

• IRS Final Regulations require a hospital facility to conduct an evaluation of the impact of any actions that were taken, since the hospital facility finished conducting its immediately preceding CHNA, to address the significant health needs identified in the hospital’s prior CHNA. • This section includes activities completed based on the 2013 to 2016 Implementation Plan.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 104 Baptist Hospitals of Southeast Texas 2013 Implementation Plan Update on Accomplishments

PRIORITY 1: Access to Primary Care and Specialist Services Objective #1: Provide access to primary care and specialist services in the community

 Newly recruited primary care and specialists o Oncology – 1 o Psychiatry – 1 o Cardiology – 1 o Primary Care – 3 o Pediatrics – 1 o Neuro Surgery – 1 o General Surgery – 1 o Podiatry – 1 o Gastroenterology – 1 o Urology – 1 o Pediatric Surgeon – 1 o Orthopedics – 1 o Thoracic Surgeon – 1  Baptist Beaumont will provide opportunities for better community access to medical services through: o Houston Healthcare Connect – data includes 20 counties, 37 organizations, 27 hospitals, 4200 physicians contributing health information to one central database o Mobile Web Page application – monthly educational topics and reminders to over 400 enrolled in health reminders o Partner with Congregational Health Ministry (Parish Nursing) to provide a Faith Community Nursing Program – 111 nurses trained with 30 added from 2013 – 2014, certification takes three years and first FCN’s scheduled for 2016 *** this number will not change – takes three years for certification which will take place this year and new class begins this Spring. o Involvement with health outreach services such as health screenings and trainings – 28,039 lives touched with educational presentation, health screen and education

Priority 2: High Mortality Rates for Prominent Diseases Objective #1: Implement a variety of programs that aim to reduce the high mortality rates of prominent disease such as cancer and cerebrovascular disease.

 The Julie Rogers Gift of Life Free Mammogram Program – since inception, 21,272 mammograms have been performed for medical underserved women averaging about 2100 mammograms per year  The Julie & Ben Rogers Cancer Institute offering free prostate screening – free prostate screens provided annually averaging approximately 350 per year.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 105  Implementation of DNV Stroke Certification Program – Designated as Primary Stroke Center o Educational Programs – see listing of classes – 28,039 o Monthly Stroke Meetings – Stroke Wise monthly support group established o Partnering with City of Beaumont for “Let’s Move” initiative

Priority 3: Access to Mental Health Services Objective #1: Provide a point of access for mental health services in the community  Only inpatient and outpatient psychiatric and chemical dependency program between Houston and New Orleans. o Addition of new services:  Tranquility Out Patient Services – for those adults who require maximum support and therapy and who would rather receive outpatient treatments. Intensive outpatient is designed for adults who are stable but still need group therapy  Intensive Outpatient Program – comprehensive treatment for individuals experiencing abuse or dependency to drugs/alcohol. This program enables clients to seek treatment for addiction while continuing to work and take care of their family. This is a 6 week program.  Partner with Spindletop MHMR for 72 hours for qualified patients. o Partnership continues with Spindletop MHMR to handle 72 hour qualified admissions  Implementation of Detox Program o Creation of Inpatient Detox Program – an intensive therapeutic structure, providing medical and detoxification stabilization and 24‐hour nursing care for patients experiencing critical symptoms. Patients will participate in a 12‐Step Recovery Program o Evaluate Crisis Stabilization Unit – partner with Spindletop MHMR to create an alternative to hospitalization for mental health and substance abuse crisis patients

Priority 4: Fragmented Continuum of Care Objective #1: Engage in efforts to improve the fragmented continuum of care

 Participate in Nursing Home/Community Health partnership Quarterly nursing home consortium – in progress – approximately 35 – 55 in attendance Quarterly home health consortium – not established Extended bi‐annual educational program – in progress (Hand washing, CAUTI, Wound Care, MRSA)

Priority 5: Unhealthy Lifestyles and Behaviors in the Community Objective #1: Implement programs and provide educational opportunities that seek to address unhealthy lifestyles and behaviors in the community.  Offering numerous classes, speakers to civic groups, industrial partners, media and health fairs – over 28,039 community members education on various topics ‐ see listing of classes and topics  Quarterly community seminars  Support Groups continue with monthly meetings for Stroke Wise, Cancer Support Group, Diabetes Education, and Bariatric Support Group  Community Health Screening – see listing of events

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 106  55+ Membership Luncheon – monthly luncheons with medical topic – 80/100 in attendance each month  Positive Points Program – All Saint’s Episcopal School, Regina Howell Elementary, Helen Park Elementary, Sims/Hatton Elementary. Projects include Kids Klub Marathon Club, Positive Points Program, Science Fairs. Program designed to promote random acts of kindness, courtesy toward others, good listening skills and respect for adults.  Partner with Beaumont ISD, Vidor ISD, Nederland ISD and Hardin Jefferson ISD for Partners in Education Program – bringing healthcare specialist to schools for education for healthy lifestyles  Established BISD Advisory Group that meets monthly at Baptist Beaumont Hospital for educational wellness topics.  Quarterly Lunch and Learns with EMS continue  Tobacco Awareness – classes offered within organization and to outside organizations coordinated through Dauphin Center.

Objective #2: implement a variety of activities that aim to address unhealthy lifestyles and behaviors among employees and staff.  Promote employee wellness – coordinated through Human Resources (gym memberships, wellness fairs, healthy snack distribution)  Offer Need Specific Programs – Weight Watchers, Biggest Loser, healthy cafeteria choice  CHIPP – employee incentive payout distributed following successful completion of CMS – System’s Improvement Agreement  Diabetes Management – via UMR  Weight Management – gym memberships. Weight Watchers. Biggest Loser, healthy cafeteria choice  Provide and Highlight healthy choice in cafeteria – provide via email ‐ Daily Terrace Tid Bit  Promote Fitness Opportunities – all local gyms and wellness allowed for payroll deduct  Promote fitness opportunities – hospital wide participation in Mach of Dimes WalkAmerica, American Cancer Society Relay for Life, Alzheimer’s Memory Walk, American Cancer Strides for Life, American Heart Walk.  Corporate sponsor for Gusher Marathon – hosting over 2,000 participants  Provide mental health educations via EAP – coordinated via Human Resources  Tobacco‐free new hire policy implemented

Priority 6: Health Disparities among Specific Populations Objective #1: Implement and offer programs that aim to reduce health disparities by targeting specific populations  Designated as a Texas Ten Step Facility – 92% of all new moms received breast feeling education from Board Certified Lactation Consultant, also offer moms the opportunity to participate in the Being a Mom Prenatal Classes  Designate a 55+ Program – monthly program established with attendance between 80 ‐ 100  HIV Education – grant for free HIV testing in Emergency Department with over 12,000 tested annually.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 107  Holiday Season – Angel Tree Project, employee adopting 125 children in the CPS program, Santa for Senior, employees adopted 75 seniors from area nursing homes and hosted a Christmas celebration for 75 children at Buckner Children’s Village – local orphanage in Beaumont.

Priority 7: Poor Air Quality Objective #1: Contribute to efforts to reduce poor air quality in the community  Baptist is a smoke‐free campus  Provides smoking cessation classes – see attached listing of classes  No smoking new hire policy implemented

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 108 Date Community Education Where Total Audience

July 2014 Diabetic Management Baptist Beaumont Hospital 110 Adults

July 2014 Diabetic Education Baptist Beaumont Hospital 25 Adults

July 2014 HIV/Education/Testing Baptist Beaumont Hospital 1073 Adults

July 2014 COPD, CHF, Pneumonia Orange Christian Services 16 Adults

July 2014 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 75 Adults

July 2014 COPD, CHF, Pneumonia United Christian Care 11 Adults

July 2014 COPD, CHF, Pneumonia Pine Forrest Baptist Church 38 Adults

July 2014 COPD, CHF, Pneumonia Baptist Orange Hospital 1 Adults

July 2014 Lung Health Education Golden Kiwanis Club 10 Adults

July 2014 Diabetes Education Baptist Beaumont Hospital 100 Adults

August 2014 Infusion Therapy Baptist Orange Hospital 70 Adults

August 2014 COPD, CHF, Pneumonia Orange Christian Services 28 Adults

August 2014 COPD, CHF, Pneumonia Back to School Bash 700 Adults

August 2014 COPD, CHF, Pneumonia West Orange District Health Fair 82 Adults

August 2014 COPD, CHF, Pneumonia United Christian Care 14 Adults

August 2014 COPD, CHF, Pneumonia Pine Forrest Church Food Bank 32 Adults

August 2014 COPD, CHF, Pneumonia United Way Kickoff Breakfast 58 Adults

August 2014 Diabetes Education Baptist Beaumont Hospital 20 Adults

August 2014 Infusion Therapy Baptist Orange Hospital 80 Adults

August 2014 HIV Education/Testing Baptist Beaumont Hospital 1050 Adults

September 2014 Shingles/Pertussin Injections All Saints Episcopal School 56 Adults

September 2014 Behavioral Health Gateway Village Senior Homes 30 Adults

September 2014 HIV Education/Testing Baptist Beaumont Hospital 1097 Adults

September 2014 Diabetes Education Baptist Beaumont Hospital 20 Adults

September 2014 Virtue of the Month All Saints Episcopal School 300 Children

September 2014 Flu Injections Community Christian 30 Adults

September 2014 Childhood Diseases Baptist Beaumont Hospital 60 Adults

September 2014 COPD, CHF, Pneumonia Orange Christian Services 205 Adults

September 2014 COPD, CHF, Pneumonia Baptist Orange Hospital 42 Adults

September 2014 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 86 Adults

September 2014 COPD, CHF, Pneumonia St. Mary’s Catholic School 36 Adults

September 2014 COPD, CHF, Pneumonia Bridge City Elementary School 80 Adults

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 109 September 2014 COPD, CHF, Pneumonia United Christian Care 56 Adults

September 2014 COPD, CHF, Pneumonia Pine Forrest Baptist Church 28 Adults

September 2014 COPD, CHF, Pneumonia Community Christian School 30 Adults

September 2014 COPD Baptist Beaumont Hospital 100 Adults

September 2014 COPD, CHF, Pneumonia Sabine House Assisted Living 40 Adults

October 2014 Virtue of the Month All Saints Episcopal School 300 Children

October 2014 Flu Shot Clinic Regina Howell Elementary 45 Adults

October 2014 Diabetes Education Baptist Beaumont Hospital 25 Adults

October 2014 Cholesterol Testing Senior Celebration 285 Adults

October 2014 Head and Neck Cancer Senior Celebration 90 Adults

October 2014 Fall Prevention Senior Celebration 210 Adults

October 2014 Chest Pain Senior Celebration 205 Adults

October 2014 Smoking Cessation Senior Celebration 145 Adults

October 2014 Blood Pressure Senior Celebration 385 Adults

October 2014 Lung Function Testing Senior Celebration 110 Adults

October 2014 Bullying in Schools Baptist Beaumont Hospital 65 Adults

October 2014 Flu Shot Clinic All Saints Episcopal School 45 Adults

October 2014 Health Screening All Saints Episcopal School 22 Adults

October 2014 HIV Testing Baptist Beaumont Hospital 1059 Adults

October 2014 Knee and Hip Health Baptist Beaumont Hospital 15 Adults

October 2014 Flu Shot Clinic Community Christian School 24 Adults

October 2014 Health Screenings Community Christian School 24 Adults

October 2014 Airborne Pathogens City of Port Neches 22 Adults

October 2014 COPD, CHC, Pneumonia Orange Christian Services 56 Adults

October 2014 COPD, CHF, Pneumonia Baptist Orange Hospital 191 Adults

October 2014 COPD, CHF, Pneumonia Granger Chevrolet 100 Adults

October 2014 COPD, CHF, Pneumonia St. Francis Catholic Church Picnic 82 Adults

October 2014 COPD, CHF, Pneumonia North Early Learning Center 50 Adults

October 2014 COPD, CHF, Pneumonia Heritage Center 16 Adults

October 2014 COPD, CHF, Pneumonia AgLife Extension Office 8 Adults

October 2014 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 92 Adults

October 2014 COPD, CHF, Pneumonia Little Cypress Baptist Church 15 Adults

October 2014 COPD, CHF, Pneumonia North Early Learning Center 22 Adults

October 2014 COPD, CHF, Pneumonia Orange County Social Services 34 Adults

October 2014 COPD. CHF, Pneumonia United Christian Care 52 Adults

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 110 October 2014 COPD, CHF, Pneumonia Pine Forrest Baptist Church 31 Adults

October 2014 COPD, CHF, Pneumonia St. Henry Catholic Church 84 Adults

October 2014 COPD, CHF, Pneumonia Little Cypress Intermediate School 50 Adults

October 2014 COPD, CHF, Pneumonia Mauriceville Middle School 54 Adults

October 2014 COPD, CHF, Pneumonia Twelve Oaks Housing 6 Adults

October 2014 Diabetes Education Baptist Beaumont Hospital 23 Adults

October 2014 COPD Baptist Orange Hospital 80 Adults

October 2014 COPD, CHF, Pneumonia Winfree Baptist Church 22 Adults

November 2014 Diabetes Education Baptist Beaumont Hospital 20 Adults

November 2014 HIV Education Baptist Beaumont Hospital 65 Adults

November 2014 Virtue of the Month All Saints Episcopal School 300 Children

November 2014 Prostate Screening Exams Baptist Beaumont Hospital 124 Adults

November 2014 HIV Education Baptist Beaumont Hospital 1065 Adults

November 2014 Airborne Pathogens Baptist Beaumont Hospital 30 Adults

November 2014 Trans Aortic Valve Educ. Baptist Beaumont Hospital 110 Adults

November 2014 Chest Pain Education Lamar University 100 Adults

November 2014 Bariatric Surgery Education Baptist Beaumont Hospital 15 Adults

November 2014 COPD, CHF, Pneumonia Orange Christian Services 22 Adults

November 2014 COPD, CHF, Pneumonia Baptist Orange Hospital 55 Adults

November 2014 COPD, CHF, Pneumonia Orange County Jail 82 Adults

November 2014 COPD, CHF, Pneumonia James Zay Housing 3 Adults

November 2014 COPD, CHF, Pneumonia Community Christian School 42 Adults

November 2014 COPD, CHF, Pneumonia United Christian Care 32 Adults

November 2014 COPD, CHF, Pneumonia First Baptist Church, Orange 56 Adults

November 2014 COPD, CHF, Pneumonia Bridge City Ministerial Alliance 22 Adults

November 2014 Trans Aortic Valve Replacement Baptist Beaumont Hospital 100 Adults

November 2014 COPD, CHF, Pneumonia Bridge City Elementary 50 Adults

December 2014 HIV Testing Baptist Beaumont Hospital 1061 Adults

December 2014 Diabetes Education Baptist Beaumont Hospital 25 Adults

December 2014 Virtue of the Month All Saints Episcopal School 300 Adults

December 2014 COPD, CHF, Pneumonia Orange Christian Services 31 Adults

December 2014 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 82 Adults

December 2014 COPD, CHF, Pneumonia United Christian Care 26 Adults

December 2014 COPD, CHF, Pneumonia First Baptist Church 38 Adults

December 2014 COPD, CHF, Pneumonia Baptist Orange Hospital 4 Adults

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 111 January 2015 COPD, CHF, Pneumonia Orange Christian Services 21 Adults

January 2015 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 71 Adults

January 2015 COPD, CHF, Pneumonia United Christian Care 47 Adults

January 2015 COPD, CHF, Pneumonia Pine Forrest Baptist Church 68 Adults

January 2015 COPD, CHF, Pneumonia Baptist Orange Hospital 9 Adults

January 2015 COPD, CHF, Pneumonia Auburn Apartments 10 Adults

January 2015 COPD, CHF, Pneumonia Whataburger 41 Adults

January 2015 Osteoporosis Baptist Beaumont Hospital 100 Adults

January 2015 Free HIV Testing Baptist Beaumont Hospital 1200 Adults

January 2015 Diabetes Education Baptist Beaumont Hospital 30 Adults

January 2015 Virtue of the Month All Saints Episcopal School 400 Adults

January 2015 Behavioral Health Raintree Senior Living 52 Adults

February 2015 Free HIV Testing Baptist Beaumont Hospital 1205 Adults

February 2015 Cardiac Testing Baptist Beaumont Hospital 78 Adults

February 2015 Diabetes Testing Baptist Beaumont Hospital 28 Adults

February 2015 Virtue of the Month All Saints Episcopal School 400 Children

February 2015 COPD, CHF, Pneumonia St. Mary’s Soup Kitchen 81 Adults

February 2015 COPD, CHF, Pneumonia United Christian Services 29 Adults

February 2015 COPD, CHF, Pneumonia Pine Forrest Baptist Church 23 Adults

February 2015 COPD, CHF, Pneumonia Orange Christian Services 17 Adults

February 2015 COPD, CHF, Pneumonia Maplecrest Baptist Church 14 Adults

February 2015 COPD, CHF, Pneumonia Orange County Sheriff’s Dept. 17 Adults

February 2015 Nutrition Education Baptist Orange Hospital 80 Adults

March 2015 Free HIV Testing Baptist Beaumont Hospital 1209 Adults

March 2015 Diabetes Education Baptist Beaumont Hospital 29 Adults

March 2015 Virtue of the Month All Saints Episcopal School 400 Children

March 2015 COPD, CHF, Pneumonia Orange Christian Services 28 Adults

March 2015 COPD, CHF, Pneumonia United Christian Care 28 Adults

March 2015 COPD, CHF, Pneumonia Mauriceville Baptist Church 47 Adults

March 2015 Knee and Hip Replacement Baptist Beaumont Hospital 100 Adults

March 2015 COPD, CHF, Pneumonia Pine Forrest Baptist Church 24 Adults

April 2015 Ethics Training Baptist Beaumont Hospital 60 Adults

April 2015 Trauma Training Baptist Beaumont Hospital 65 Adults

April 2015 Stroke Education Baptist Beaumont Hospital 100 Adults

April 2015 Virtue of the Month All Saints Episcopal School 300 Children

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 112 April 2015 Diabetes Education Baptist Beaumont Hospital 25 Adults

April 2015 Free HIV Testing Baptist Beaumont Hospital 1250 Adults

April 2015 Healthy Eating Bapitist Orange Hospital 80 Adult

April 2015 COPD, CHF, Pneumonia Orange Christian Services 14 Adults

April 2015 COPD, CHF, Pneumonia United Christian Church 12 Adults

April 2015 COPD, CHF, Pneumonia Pine Forest Church 18 Adults

April 2015 COPD, CHF, Pneumonia St. Mary Church 75 Adults

April 2015 COPD, CHF, Pneumonia Supportive Housing 32 Adults

April 2015 COPD, CHF, Pneumonia United Christian Services 21 Adults

April 2015 COPD, CHF, Pneumonia Orange Christian Services 10 Adults

May 2015 Stroke Education Vista Elementary 40 Children

May 2015 Testicular Cancer Education West Brook High School 750 Children

May 2015 Trauma Education Baptist Beaumont Hospital 100 Adults

May 2015 Breast Cancer Awareness West Brook High School 250 Children

May 2015 Mental Health Education Port Arthur Community Center 127 Adults

May 2015 Understanding the ER Baptist Orange Hospital 80 Adults

May 2015 Stroke Education Baptist Beaumont Hospital 250 Adults

May 2015 Stroke Education Baptist Beaumont Hospital 65 Adults

May 2015 Suicide Prevention Baptist Beaumont Hospital 75 Adults

May 2015 Stroke Education Baptist Orange Hospital 50 Adults

May 2015 Mental Health Education Theodore John Library 75 Adults

May 2015 Mental Health Education Paradise Baptist Church 50 Adults

May 2015 Virtue of the Month All Saints Episcopal School 300 Children

May 2015 Diabetes Education Baptist Beaumont Hospital 27 Adults

May 2015 Senior Care Baptist Beaumont Hospital 100 Adults

May 2015 COPD, CHF, Pneumonia Orange Senior Rally 302 Adults

May 2015 COPD, CHF, Pneumonia Orange Christian Services 12 Adults

May 2015 COPD, CHF, Pneumonia United Christian Church 16 Adults

May 2015 COPD, CHF, Pneumonia Pine Forest Church 10 Adults

May 2015 COPD, CHF, Pneumonia St. Mary’s Church 68 Adults

May 2015 COPD, CHF, Pneumonia United Christian Services 11 Adults

May 2015 Free HIV Testing Baptist Beaumont Hospital 1250 Adults

June 2015 Diabetes Education Baptist Beaumont Hospital 28 Adults

June 2015 Emergency Services Baptist Beaumont Hospital 80 Adults

June 2015 Free HIV Testing Baptist Beaumont Hospital 1259 Adults

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 113 June 2015 Ethics Education Baptist Beaumont Hospital 60 Adults

June 2015 Trauma Education Baptist Beaumont Hospital 65 Adults

June 2015 Stroke Education Baptist Beaumont Hospital 100 Adults

28,039

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 114 2016 PRELIMINARY HEALTH NEEDS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 115 2016 Preliminary Health Needs

• Access to Affordable Care and Reducing Health Disparities Among Specific Populations • Access to Mental and Behavioral Health Care • Access to Specialty Care Services • Need for Increased Emphasis on a Collaborative Continuum of Care • Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 116 PRIORITIZATION

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 117 The Prioritization Process

• On May 16, 2016 leadership from BBH including Bryan Chandler (Vice President of Business Development) and Mary Poole (Director of Public Relations) met with CHC to review findings and prioritize the community’s health needs. • Leadership ranked the health needs based on three factors: – Size and Prevalence of Issue – Effectiveness of Interventions – Hospital’s Capacity • See the following page for a more detailed description of the prioritization process.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 118 The Prioritization Process

• The CHNA Team utilized the following factors to evaluate and prioritize the significant health needs.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 119 Health Needs Ranking

• Hospital leadership ranked the five significant health needs based on the three factors discussed, resulting in the following list (in descending order):

1. Access to Mental and Behavioral Health Care 2. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 3. Access to Affordable Care and Reducing Health Disparities Among Specific Populations 4. Need for Increased Emphasis on a Collaborative Continuum of Care 5. Access to Specialty Care Services

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 120 Final Priorities

• Hospital leadership decided to address all of the ranked health needs. The final health priorities that BBH will address through its Implementation Plan are, in descending order:

1. Access to Mental and Behavioral Health Care 2. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 3. Access to Affordable Care and Reducing Health Disparities Among Specific Populations 4. Need for Increased Emphasis on a Collaborative Continuum of Care 5. Access to Specialty Care Services

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 121 RESOURCES IN THE COMMUNITY

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 122 Additional Resources in the Community • In addition to the services provided by Baptist Beaumont Hospital, other charity care services and health resources that are available in Jefferson and Orange Counties are included in this section.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 123 List of Services Available in Jefferson and Orange Counties Organization Area Primarily Address City St Zip Phone Website Services Provided Name Served Hardin, Jasper, http://www.redcr American Red Cross, 3620 Eastex Armed Forces‐SAF, Disaster Services, Health and Safety Services, Volunteer & Jefferson and Tyler Beaumont TX 77703 409‐832‐1644 oss.org/tx/beaum Beaumont Chapter Fwy Youth Services, International Services Counties ont

Provide overnight accommodations for family members of patients in local 2675 McFaddin http://www.anay Anayat House Beaumont TX 77702 409‐833‐0649 medical facilities. Their goal is to provide an affordable, safe and restful St athouse.org/ place to sleep and relax while friends and family members recuperate.

http://www.cityof Beaumont Public Immunization clinic, STD clinic, tuberculosis clinic, and other health Beaumont PO Box 3827 Beaumont TX 77704 409‐980‐8311 beaumont.com/h Health promotion services ealth_admin.htm

Boys' Haven is a non‐profit, charitable institution, licensed by the Texas Department of Family and Protective Services. They receive funding from the state, United Way, grants, and individual donors. Boys' Haven is a general residential operation that serves boys ages 5 to 17 and provides a port for stormy times in boy's lives. Many of these boys come from single parent Boy's Haven of 3655 N Major http://www.boys Jefferson County Beaumont TX 77713 409‐866‐2400 homes and are in need of a more structured environment. Several of them America, Inc. Drive haven.com/ are here long term and plan to stay with us until they graduate high school. Boys' Haven also accepts referrals from Juvenile Probation Departments and the Department of Family and Protective Services. The program is based on the principles of discipline and hard work rather than punishment, a program where natural consequences occur and privileges are earned.

The agency provides speech‐language diagnostic evaluations and therapeutic remediation to individuals of all ages that are experiencing Jefferson, Orange, communication disorders. The communication disorder may be affecting Capland Speech 2660 Aero http://www.capla articulation, language (comprehension, expression, reading, writing), voice Hardin and Port Arthur TX 77640 409‐729‐2227 Therapy Center Drive ndcenter.com/ or fluency. Swallowing disorders are also treated at the agency, usually for surrounding counties the client that is experiencing complications as a result of a neurological condition or disease. Additionally, the agency offers a hearing screening program to identify clients with potential hearing impairments.

Chambers, Hardin, We are a tax‐exempt, multi‐program service organization serving nine Jasper, Jefferson, http://www.catho counties in Southeast Texas. Inspired by the social teachings of the Church, Catholic Charities of 2780 Eastex we currently provide services in the areas of children and family services, liberty, Newton, Beaumont TX 77703 409‐924‐4400 liccharitiesbmt.or Southeast Texas Fwy immigration services, parish and social ministry, and advocacy. All services Orange, Polk and g/ are available to anyone, regardless of their religion, race, color, sex, national Tyler Counties origin, age, disability or citizenship status.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 124 List of Services Available in Jefferson and Orange Counties Organization Area Primarily Address City St Zip Phone Website Services Provided Name Served The goal of to organization it to meet the individual needs of students of potential by working closely in a coordinated and collaborative effort with school personnel, parents and family, repositioned agency staff, community volunteers, community businesses, and social service agencies. The main Communities in 950 Pine St, Southeast Texas Beaumont TX 77701 409‐951‐1810 http://cisset.org/ objective of the organization is to develop public/private partnerships for Schools Ste 500 dropout prevention designed to connect appropriate human services with youth in addressing such critical issues as school attendance, literacy, job preparedness, teen pregnancy, drug and alcohol abuse, teen suicide, and school violence.

The Crisis Center offers confidential and free services to all victims of sexual assault and other victims of general crisis in the Southeast Texas area. Our http://www.rapes caseworkers are trained, sensitive members of the community who provide Crisis Center of Jefferson, Orange PO Box 3208 Beaumont TX 77704 409‐835‐3355 uicidebeaumont.o crisis intervention, follow‐up, support for family members, legal & medical Southeast Texas and Hardin counties rg accompaniment and information. Our Crisis Center exists for victims of rape and sexual assault. We are committed to victims, their trauma, their courage and the resolution of their crisis.

Women and Children's Shelter, Counseling Program, Batterers' Intervention http://www.westr and Prevention Program (BIPP), Marriage Workshops, Kids Connection Family Services of Southeast Texas 3550 Fannin St Beaumont TX 77701 409‐833‐2668 engthenfamilies.o communication workshops, TransParenting workshops for children of Southeast Texas rg/ divorced/divorcing parents, Active Parenting, Employee Assistance Program (EAP), Camp STEAM, and Christine's Resale Shops

Gift of Life provides Southeast Texans extensive educational outreach that focuses on breast, prostate, testicular, ovarian, and other gynecological 2390 Dowlen http://www.giftof Gift of Life Southeast Texas Beaumont TX 77706 409‐833‐3663 cancers; free mammograms and prostate cancer screenings with access to Rd lifebmt.org/ follow‐up treatment for medically underserved women and men; and a tobacco prevention program, which targets both adults and children.

Orange, Hardin, Gulf Coast Health Center is proud to offer patients comprehensive medical Gulf Coast Health 1301 W Park http://www.gulfc care including: adult medicine, primary care, women's health, dental services Newton, Jasper and Orange TX 77630 409‐886‐4400 Center, Inc. (FQHC) Ave, Ste C oasthc.org/ (ages 6 months to adults), behavioral health services and social services and Jefferson Counties outreach. Help those with physical disabilities find their own path in life with dignity and grace, assist them in mapping their journey through therapy, education, and guidance, help individuals in building on their own strengths, provide http://www.hugh Hughen Center Southeast Texas 2849 Ninth Ave Port Arthur TX 77642 409‐983‐6659 support and encouragement along the way. The Hughen Center, Inc. encenter.org/ provides the care, education, and treatment of children and adults with physical disabilities regardless of race, creed, religion, color, or national origin.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 125 List of Services Available in Jefferson and Orange Counties Organization Area Primarily Address City St Zip Phone Website Services Provided Name Served https://www.hotr Member of the Texas State University System and state institution of higher as.com/sys/profil education. Services offered at LIT Dental Hygiene Clinic include dental Hardin, Jefferson and e.taf?profiletype= exams, dental referrals, cleanings, screenings for oral cancer, dental x‐rays, Lamar University 802 E Lavaca St Beaumont TX 77710 409‐880‐8860 Orange Counties program&textonl fluoride treatments, education, sealants and nutritional counseling. $25 for y=&recordid=547 the general public, $15 for senior citizens aged 64 and older, $10 for those 439 on public assistance, $10 for x‐rays only Provides total family care, preventative health, dental exams, prenatal Legacy Community 4450 Highland www.legacycom Jefferson County Beaumont TX 77705 409‐242‐2542 counseling and referrals, well‐baby care, gynecology services based on a Health Services Ave munityhealth.org sliding scale.

Nutrition and Jefferson and Hardin 4590 Concord http://www.senio Meals on Wheels, congregate or group dining services, transportation, Beaumont TX 77703 409‐892‐4455 Services for Seniors Counties Road rmeals.org/ CareNet medical alert, and AniMeals

Orange Community Provides senior adults nutritional hot meals at noon during the work week at Orange County 103 N 5th St Orange TX 77630 409‐886‐2186 ‐ Action Association its centers and Meals On Wheels delivered to homebound individuals.

Provides overnight accommodations for family members of patients in local 3120 College www.reaudguest Reaud Guest House Jefferson County Beaumont TX 77701 409‐212‐6500 medical facilities. Provides affordable housing, toiletries and food in a safe Street house.org environment. http://www.usno drugs.com/Texas/ Right Choice of 3212 Concord, Provides substance abuse education, referrals, screening, assessment, and Orange County Orange TX 77630 409‐670‐9524 Orange/Right_Ch Orange County Ste C outpatient treatment services. oice_of_Orange_ County

Samaritan Counseling The Samaritan Counseling Center of Southeast Texas provides the following Jefferson, Orange 7980 Anchor http://www.sccse Center of Southeast Port Arthur TX 77642 409‐727‐6400 services: Play Therapy, Mental Health Treatment, Specialized Treatments, and Hardin counties Dr t.org/ Texas Assessment Services, and Work Place Trainings & Services.

The Shorkey Center exists to provide services for the individual with special 855 South http://www.shork needs. These services include effective physical, occupational, and speech Shorkey Center Southeast Texas Beaumont TX 77701 409‐838‐6568 Eighth St ey.org/ rehabilitation; direct education services including therapy for children with autism and other related disorders; and parent assistance support.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 126 List of Services Available in Jefferson and Orange Counties Organization Area Primarily Address City St Zip Phone Website Services Provided Name Served

Treatment includes individual counseling, group counseling and education on how to maintain an alcohol/drug free lifestyle after discharge. Services are provided in a structured living environment which teaches non‐chemical coping life skills. Right Choice offers a maximum of 14.5 hours of combined individual and group activities per week and a minimum of 3.0 hours per week. The degree of intensity is determined individually. Right Choice utilizes a multitude of approaches to include brief intervention, relapse prevention Southeast Texas therapy, behavioral therapy, motivational counseling, and includes models 4675‐C from the Texas Christian University/DATOS program as well as others. The Council on Alcohol & http://www.setca Southeast Texas Washington Beaumont TX 77707 409‐842‐2408 HARBOR program is an indicated school based curriculum program designed Drug Abuse da.org/ Blvd to reduce personal risk factors and build protective factors for youth that (SETCADA) have been identified as being at a greater risk than their peers for use of alcohol, tobacco, or other drugs and/or related behaviors. Target population includes middle and elementary school youth that have been identified as at risk. The HARBOR program includes a family component to involve family members in activities with their youth. Each student is offered the opportunity to participate in off campus activities that are designed to provide alternative activities that will enhance the bonds between the youth and their families, community and peer associations.

Our vision is to eliminate hunger and inadequate nutrition in Southeast Southeast Texas 3845 S ML King http://setxfoodba Texas. The following programs have been established to do just that: Southeast Texas Beaumont TX 77705 409‐839‐8777 Food Bank Jr Pkwy nk.org/ Backpack Program, Mobile Pantry, Nutrition Education Classes, Retail Store Pickup Program, School Tools and Texas Second Chance.

As a private, nonprofit, non‐governmental organization, the Southeast Texas Hospice is dedicated to caring for terminally ill patients and their families. "Golden Triangle" Our staff carefully coordinates services with the patient, their family, and Southeast Texas 912 W Cherry http://www.setxh Region of Southeast Orange TX 77631 409‐886‐0622 physicians to design a care plan that is patterned to meet the specific needs Hospice PO BOX 2385 ospice.com/ Texas of the patient. This approach insures that each terminally ill patient we serve receives compassionate, quality care in the privacy of their home from loving family members, friends, and the Hospice care team.

Southeast Texas Area Agency on Aging, Community Development, Disaster Recovery, Regional Planning Hardin, Jefferson and 2210 Eastex http://www.setrp Experience Corps, Foster Grandparent Program, Homeland Security and Beaumont TX 77703 409‐899‐8444 Commission Orange Counties Fwy c.org Emergency Planning, Public Safety, Retired Senior Volunteer Program, (SETRPC) Substance Abuse Division and Transportation and Environmental Resources

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 127 List of Services Available in Jefferson and Orange Counties Organization Area Primarily Address City St Zip Phone Website Services Provided Name Served Spindletop offers outpatient psychiatric services, crisis screening and Beaumont and http://www.spind assessment, substance abuse services, community services, work placement, Spindletop Center 655 S 8th St Beaumont TX 77701 409‐839‐1000 Orange Counties letopmhmr.org/ intellectual developmental disabilities services, and early childhood intervention (ECI). The Arc of Greater Beaumont is an organization devoted exclusively to serving local individuals with disabilities and improving quality of life for them and their families. The services and programs they offer include adult 700 North St, http://www.arcof socialization and leisure activities, "Empowered for Employment" a specially The Arc Greater Beaumont Beaumont TX 77701 409‐838‐9012 Ste Q bmt.org/ designed program to teach Arc members, people who have intellectual and developmental disabilities (IDD), how to obtain and retain employment), summer day camps, children and family services, and self advocacy programs. Ubi Caritas provides total family care, preventive health, Texas health steps (children's physical, arthritis programs, osteoporosis treatment, nutritional 4450 Highland http://www.ubica Ubi Caritas Beaumont Beaumont TX 77705 409‐832‐1924 evaluations, weight control, prenatal counseling and referrals, pain Ave ritas.org/ management, well‐baby care, senior care, and dental services based on sliding scale.

UTMB Clinic http://www.utmb 2014 North Orange/Orange Orange Orange TX 77630 409‐883‐6119 .edu/rmchp/utmb Offers health care services to men, women and children. 10th St RMCHP locations.html

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 128 INFORMATION GAPS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 129 Information Gaps

• While the following information gaps exist in the health data section of this report, please note that every effort was made to compensate for these gaps in the interviews conducted by Community Hospital Corporation. – This assessment seeks to address the community’s health needs by evaluating the most current data available. However, published data inevitably lags behind due to publication and analysis logistics. For example, state mortality data is currently only available through 2013. – The most significant information gap exists within this assessment’s ability to capture various county‐level health data indicators, including arthritis, binge drinking, influenza immunization, and pneumonia vaccination (age 18‐64 population). Data for these indicators are reported at the Health Service Region level.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 130 ABOUT COMMUNITY HOSPITAL CORPORATION

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 131 About CHC Corporation

• Community Hospital Corporation owns, manages and consults with hospitals through three distinct organizations –CHC Hospitals, CHC Consulting and CHC ContinueCare, which share a common purpose of preserving and protecting community hospitals. • Based in Plano, Texas, CHC provides the resources and experience community hospitals need to improve quality outcomes, patient satisfaction and financial performance. For more information about CHC, please visit the website at: www.communityhospitalcorp.com

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 132 APPENDIX ‐ SUMMARY OF DATA SOURCES ‐ DEMOGRAPHIC DATA FINDINGS ‐ HEALTH DATA FINDINGS ‐ INTERVIEWEE BIOGRAPHIES ‐ PRIORITY BALLOT

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 133 SUMMARY OF DATA SOURCES

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 134 Summary of Data Sources

• Demographics – This study utilized demographic data from Truven Health Market Expert. – This study also used demographic data collected by Community Commons, a site which is managed by the Institute for People Place and Possibility, the Center for Applied Research and Environmental Systems, and Community Initiatives. Data can be accessed at http://www.communitycommons.org/. – The United States Bureau of Labor Statistics Local Area Unemployment Statistics provides unemployment statistics by county and state; http://www.bls.gov/lau/#tables. • Health Data – The County Health Rankings are made available by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The Rankings measure the health of nearly all counties in the nation and rank them within states. The Rankings are compiled using county‐level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically‐informed weights. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Building on the work of America's Health Rankings, the University of Wisconsin Population Health Institute has used this model to rank the health of Wisconsin’s counties every year since 2003; http://www.countyhealthrankings.org/.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 135 Summary of Data Sources

• Health Data Continued – The Community Health Status Indicators (CHSI) 2015 is an online web application that produces health status profiles for each of the 3,143 counties in the United States and the District of Columbia. Each county profile contains indicators of health outcomes (mortality and morbidity); indicators on factors selected based on evidence that they potentially have an important influence on population health status (e.g., health care access and quality, health behaviors, social factors, physical environment); health outcome indicators stratified by subpopulations (e.g., race and ethnicity); important demographic characteristics; and HP 2020 targets. • A key feature of CHSI 2015 is the ability for users to compare the value of each indicator with those of demographically similar “peer counties,” as well as to the U.S. as a whole, and to HP 2020 targets. Selection of the method and variables for the new peer county groupings was based on an iterative process that was guided by the advice of subject matter experts (internal and external to CDC) including representatives from academia and architects of the original CHSI. The analysis yielded 89 peer groupings based on the following 19 county‐level equivalent variables for all 3,143 U.S. counties, including (but not limited to): population size, growth, density, and mobility; percent children and elderly; sex ratio; overall and elderly poverty levels; and unemployment. Please see the appendix for a full description of the CHSI methodology. • More information can be accessed at http://wwwn.cdc.gov/CommunityHealth/home.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 136 Summary of Data Sources

• Health Data Continued – Texas Health Data is provided by the Texas Department of State Health Services. The site provides access to Texas public health statistics and community health data including, but not limited to, mortality, natality, behavioral risk factors, and communicable diseases; http://healthdata.dshs.texas.gov/home. – This study utilizes Health Service Region level data from the Behavioral Risk Factor Surveillance System (BRFSS), provided by the Texas Department of State Health Services; http://healthdata.dshs.texas.gov/HealthRisks/BRFSS. – The United States Census Bureau’s Small Area Health Insurance Estimates provide insured and uninsured rates by county up to the year 2013; http://www.census.gov/did/www/sahie/data/interactive/. – This study also used health data collected by Community Commons, a site which is managed by the Institute for People Place and Possibility, the Center for Applied Research and Environmental Systems, and Community Initiatives. Data can be accessed at http://www.communitycommons.org/. – Enroll America is a health care enrollment coalition that provides information regarding uninsured rates at the county level. Data can be accessed at https://www.enrollamerica.org/. • Phone Interviews – CHC conducted interviews on behalf BBH from July 28, 2015 – August 10, 2015. – Interviews were conducted and summarized by Valerie Hayes, Planning Analyst.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 137 DEMOGRAPHIC DATA FINDINGS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 138 Overall Population Growth Overall Population Growth 2016‐2021 2016‐2021 % Geographic Location 2010 2016 2021 Change Change Jefferson County 252,273 253,862 259,987 6,125 2.4% Orange County 81,837 84,292 87,556 3,264 3.9% Texas 25,145,561 27,611,503 29,594,059 1,982,556 7.2% Source: Truven Health's Market Expert (accessed April 11, 2016)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 139 Population by Race/Ethnicity Jefferson County 2016‐2021 2016‐2021 % Race/Ethnicity 2010 2016 2021 Change Change White Non‐Hispanic 112,503 105,058 100,331 ‐4,727 ‐4.5% Black 84,500 84,895 86,821 1,926 2.3% Hispanic 42,899 49,886 57,072 7,186 14.4% Asian 8,589 9,668 10,813 1,145 11.8% American Indian 747 772 808 36 4.7% All Others 3,035 3,583 4,142 559 15.6% Total 252,273 253,862 259,987 6,125 2.4% Orange County 2016‐2021 2016‐2021 % Race/Ethnicity 2010 2016 2021 Change Change White Non‐Hispanic 67,895 68,309 69,488 1,179 1.7% Black 6,922 7,068 7,286 218 3.1% Hispanic 4,766 6,312 7,824 1,512 24.0% Asian 835 893 957 64 7.2% American Indian 340 408 476 68 16.7% All Others 1,079 1,302 1,525 223 17.1% Total 81,837 84,292 87,556 3,264 3.9% Texas 2016‐2021 2016‐2021 % Race/Ethnicity 2010 2016 2021 Change Change White Non‐Hispanic 11,397,345 11,826,504 12,031,781 205,277 1.7% Black 2,886,825 3,236,542 3,533,064 296,522 9.2% Hispanic 9,460,921 10,770,670 11,911,611 1,140,941 10.6% Asian 966,346 1,234,583 1,474,773 240,190 19.5% American Indian 80,586 90,730 99,277 8,547 9.4% All Others 353,538 452,474 543,553 91,079 20.1% Total 25,145,561 27,611,503 29,594,059 1,982,556 7.2% Source: Truven Health's Market Expert (accessed April 11, 2016)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 140 Population by Age Jefferson County 2016‐2021 2016‐2021 % Age Cohort 2016 % of Total 2021 % of Total Change Change <18 60,106 23.7% 61,528 23.7% 1,422 2.4% 18‐44 94,250 37.1% 96,031 36.9% 1,781 1.9% 45‐64 64,271 25.3% 61,840 23.8% ‐2,431 ‐3.8% 65+ 35,235 13.9% 40,588 15.6% 5,353 15.2% Total 253,862 100.0% 259,987 100.0% 6,125 2.4% Orange County 2016‐2021 2016‐2021 % Age Cohort 2016 % of Total 2021 % of Total Change Change <18 20,333 24.1% 20,621 23.6% 288 1.4% 18‐44 28,208 33.5% 29,242 33.4% 1,034 3.7% 45‐64 22,474 26.7% 22,082 25.2% ‐392 ‐1.7% 65+ 13,277 15.8% 15,611 17.8% 2,334 17.6% Total 84,292 100.0% 87,556 100.0% 3,264 3.9% Texas 2016‐2021 2016‐2021 % Age Cohort 2016 % of Total 2021 % of Total Change Change <18 7,247,559 26.2% 7,532,274 25.5% 284,715 3.9% 18‐44 10,396,903 37.7% 10,879,403 36.8% 482,500 4.6% 45‐64 6,644,010 24.1% 7,089,711 24.0% 445,701 6.7% 65+ 3,323,031 12.0% 4,092,671 13.8% 769,640 23.2% Total 27,611,503 100.0% 29,594,059 100.0% 1,982,556 7.2% Source: Truven Health's Market Expert (accessed April 11, 2016)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 141 Median Age Median Age Geographic Location 2010 2016 2021 Jefferson County 36.0 36.3 36.8 Orange County 38.4 38.7 39.0 Texas 38.9 39.2 39.5 United States 40.2 41.2 41.7 Source: Truven Health's Market Expert (accessed April 11, 2016)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 142 Median Household Income Median Income 2015 ‐ 2020 Change Geographic Location 2016‐2021 2016‐2021 % 2016 2021 Change Change Jefferson County $43,442 $46,109 $2,667 6.1% Orange County $53,180 $58,351 $5,171 9.7% Texas $48,776 $53,013 $4,237 8.7% United States $48,280 $51,808 $3,529 7.3% Source: Truven Health's Market Expert (accessed April 11, 2016)

Economic Analysis 2015 Economic Analysis Families Household Education Average Median Geographic Location Below Income Bachelor / Income Income Poverty $100K+ Advanced Jefferson County $62,345 $43,442 17.5% 17.4% 17.9% Orange County $69,189 $53,180 11.0% 20.2% 15.1% Texas $65,609 $48,776 24.6% 24.6% 27.2% United States $63,215 $48,280 11.7% 24.3% 29.4% Source: Truven Health's Market Expert (accessed April 11, 2016)

Unemployment Annual Average Unemployment Rates (%) Geographic Location 2013 2014 2015 Jefferson County 10.8% 8.3% 7.0% Orange County 10.3% 8.0% 6.5% Texas 6.2% 5.1% 4.5%

Source: Bureau of Labor Statistics, Local Area Unemployment Statistics; Rates shown are a percentage of the labor force (accessed April 11, 2016)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 143 Poverty Thresholds for 2015 by Size of Family and Number of Related Children Under 18 Years

Related children under 18 years

Size of family unit Eight None One Two Three Four Five Six Seven or more

One person (unrelated individual).….. Under 65 years...... ……… 12,331 65 years and over...... ……… 11,367

Two people...... ……….. Householder under 65 years...... 15,871 16,337 Householder 65 years and over...…. 14,326 16,275

Three people...... …………… 18,540 19,078 19,096 Four people...... …………… 24,447 24,847 24,036 24,120 Five people...... ……………… 29,482 29,911 28,995 28,286 27,853 Six people...... ……………… 33,909 34,044 33,342 32,670 31,670 31,078 Seven people...... …………… 39,017 39,260 38,421 37,835 36,745 35,473 34,077 Eight people...... ……………… 43,637 44,023 43,230 42,536 41,551 40,300 38,999 38,668 Nine people or more...... ………… 52,493 52,747 52,046 51,457 50,490 49,159 47,956 47,658 45,822 Source: U.S. Census Bureau, Poverty, https://www.census.gov/hhes/www/poverty/data/threshld/; data accessed February 25, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 144 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 145 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 146 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 147 HEALTH DATA FINDINGS

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 148 Texas Jefferson (JEF) , TX Orange (ORA) , TX Health Outcomes 188 206

Length of Life 144 220

Premature death 6,600 8,400 10,600

Quality of Life 202 130

Poor or fair health 20% 20% 15%

Poor physical health days 3.5 3.7 3.2

Poor mental health days 3.0 3.3 3.1

Low birthweight 8% 10% 10%

Health Factors 232 165

Health Behaviors 241 149

Adult smoking 15% 18% 16%

Adult obesity** 28% 37% 31%

Food environment index** 6.4 4.6 5.6

Physical inactivity** 24% 30% 29%

Access to exercise opportunities 84% 70% 69%

Excessive drinking 17% 17% 18%

Alcohol-impaired driving deaths 32% 29% 26%

Sexually transmitted infections** 498.3 511.5 304.9

Teen births 52 53 56

Clinical Care 31 54

Uninsured 25% 24% 19%

Primary care physicians 1,680:1 1,660:1 3,770:1

Dentists 1,880:1 1,760:1 3,630:1

Mental health providers 990:1 1,030:1 4,170:1

Preventable hospital stays 58 56 63

Diabetic monitoring 84% 85% 82%

Mammography screening 58% 61% 55%

Social & Economic Factors 232 203

HighBaptist school Beaumontgraduation** Hospital Community Health Needs Assessment88% and Implementation 90% Plan 91% June 2016 Community Hospital Corporation Page 149 Some college 59% 51% 53%

Unemployment 5.1% 8.2% 7.9%

Children in poverty 25% 32% 22%

Income inequality 4.9 5.6 4.7

Children in single-parent households 33% 46% 32%

Social associations 7.8 11.8 11.1

Violent crime** 422 652 389

Injury deaths 54 64 98

Physical Environment 211 212

Air pollution - particulate matter 9.6 9.5 9.6

Drinking water violations Yes Yes

Severe housing problems 18% 17% 12%

Driving alone to work 80% 85% 88%

Long commute - driving alone 36% 19% 30%

** Compare across states with caution 2016 Note: Blank values reflect unreliable or missing data

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 150 All Causes, Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 2,324 848.0 2,390 867.6 2,397 867.4 Orange County 863 960.1 945 1,017.2 943 988.8 Texas 167,997 744.0 173,935 751.0 178,501 749.2 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Diseases of the Heart (I00‐I09, I11, I13, I20‐I51), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 503 183.1 531 191.3 597 213.5 Orange County 212 234.7 229 241.6 213 219.3 Texas 37,955 170.8 38,987 170.8 40,150 170.7 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Malignant Neoplasms (C00‐C97), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 522 191.1 511 186.0 488 176.1 Orange County 169 176.7 189 193.8 193 191.8 Texas 37,121 160.2 38,096 159.5 38,289 156.1 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Chronic Lower Respiratory Diseases (J40‐J47), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 114 42.8 131 47.1 137 50.4 Orange County 65 70.3 80 84.0 79 79.9 Texas 9,115 42.1 9,520 42.5 9,787 42.3 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 151 Cerebrovascular Diseases (I60‐I69), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 139 50.6 151 53.6 150 55.0 Orange County 54 59.9 54 58.5 56 57.0 Texas 9,058 41.6 9,297 41.7 9,238 40.1 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Alzheimer's Disease (G30), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 119 42.2 106 37.5 112 39.4 Orange County 26 30.0 36 40.8 50 54.2 Texas 5,394 26.3 5,168 24.6 5,284 24.4 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Accidents (V01‐X59, Y85‐Y86), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 92 35.0 96 36.7 118 44.6 Orange County 61 74.4 51 63.8 39 46.7 Texas 9,301 38.1 9,267 37.2 9,341 36.8 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Diabetes Mellitus (E10‐E14), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 78 28.0 75 27.3 73 26.4 Orange County 20 22.3 16 ‐ 17 ‐ Texas 5,060 22.1 5,127 21.8 5,262 21.6 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 152 Septicemia (A40‐A41), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 35 13.4 33 12.1 44 16.0 Orange County 15 ‐ 20 21.5 15 ‐ Texas 3,420 15.2 3,616 15.7 3,879 16.4 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Nephritis, Nephrotic Syndrome and Nephrosis (N00‐N07, N17‐N19, N25‐N27), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 44 16.3 57 21.1 44 15.6 Orange County 15 ‐ 18 ‐ 20 20.4 Texas 3,405 15.4 3,522 15.5 3,727 15.9 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Influenza & Pneumonia (J09‐J18), Deaths per 100,000 Population, Age‐Adjusted, 2011‐2013 2011 2012 2013 AGE‐ AGE‐ AGE‐ LOCATION DEATHS ADJUSTED DEATHS ADJUSTED DEATHS ADJUSTED DEATH RATE DEATH RATE DEATH RATE Jefferson County 43 15.7 41 14.9 40 14.1 Orange County 12 ‐ 9 ‐ 12 ‐ Texas 3,049 14.0 2,978 13.4 3,338 14.4 Source: Texas Health Data, Deaths of Texas Residents; Last Updated July 31, 2015; http://soupfin.tdh.state.tx.us/death10.htm (accessed September 23, 2015)

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 153 Female Breast Cancer Mortality, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 23.0 Orange County 23.1 Texas 21.0 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Male Prostate Cancer Mortality, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 28.4 Orange County 17.8 Texas 19.5 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Colon and Rectum Cancer Mortality, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 19.7 Orange County 18.2 Texas 15.3 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Lung and Bronchus Cancer Mortality, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 48.9 Orange County 61.2 Texas 43.4 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 154 Female Breast Cancer Incidence, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 57.8 Orange County 60.3 Texas 60.6 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Male Prostate Cancer Incidence, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 128.5 Orange County 97.0 Texas 115.7 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Colon and Rectum Cancer Incidence, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 47.2 Orange County 45.6 Texas 40.2 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Lung and Bronchus Cancer Incidence, Age‐adjusted Rates per 100,000 Population, 2008‐2012 Location Rate Jefferson County 64.4 Orange County 87.6 Texas 58.1 Source: Texas Cancer Registry, Cancer Mortality and Incidence File, http://www.cancer‐rates.info/tx/index.php; data accessed May 5, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 155 Chlamydia, Age‐adjusted Rates per 100,000 Population, 2012‐2014 Location 2012 2013 2014 Jefferson County 533.8 486.5 560.6 Orange County 299.0 301.3 248.1 Texas 488.0 486.4 475.0 Source: Texas Department of State Health Services, 2014 STD Surveillance Report, https://www.dshs.state.tx.us/hivstd/reports/; data accessed January 18, 2016. Gonorrhea, Age‐adjusted Rates per 100,000 Population, 2012‐2014 Location 2012 2013 2014 Jefferson County 179.8 198.2 241.0 Orange County 48.9 47.6 48.3 Texas 124.1 126.6 127.7 Source: Texas Department of State Health Services, 2014 STD Surveillance Report, https://www.dshs.state.tx.us/hivstd/reports/; data accessed January 18, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 156 Diabetes, Prevalence Rates, 2012 ‐ 2014 Has a doctor, nurse, or other health professional ever told you that you have diabetes? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 9.5% 11.4% 9.1% HSR 2/3 10.1% 11.0% 10.9% HSR 4/5N 11.9% 14.4% 12.3% HSR 6/5S 11.0% 10.7% 10.7% HSR 7 8.9% 10.3% 9.1% HSR 8 12.1% 13.6% 14.5% HSR 9/10 13.2% 13.8% 13.5% HSR 11 19.5% 13.6% 16.5% Texas 10.6% 10.9% 11.0% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 157 Obesity, Prevalence Rates, 2012 ‐ 2014 Four‐level BMI Categories: Underweight, Normal Weight, Overweight, Obese 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 26.0% 32.5% 32.5% HSR 2/3 28.3% 28.8% 31.0% HSR 4/5N 35.1% 34.9% 32.4% HSR 6/5S 27.8% 28.9% 34.2% HSR 7 27.9% 29.3% 28.5% HSR 8 30.5% 38.3% 33.0% HSR 9/10 36.4% 33.1% 39.9% HSR 11 42.3% 41.1% 41.7% Texas 29.2% 30.9% 31.9% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 158 Binge Drinking, Prevalence Rates, 2012 ‐ 2014 During the past 30 days, what is the largest number of drinks you had on any occasion? 2012 2013 2014 LOCATION % AT RISK % AT RISK % AT RISK HSR 1 13.1% 13.2% 13.7% HSR 2/3 15.0% 16.3% 15.1% HSR 4/5N 11.3% 11.4% 9.6% HSR 6/5S 15.1% 15.0% 15.2% HSR 7 15.6% 19.9% 18.2% HSR 8 20.0% 20.3% 18.7% HSR 9/10 18.5% 14.5% 19.4% HSR 11 17.4% 16.5% 15.4% Texas 16.2% 16.7% 16.3% Note: Binge Drinking = More than 5 drinks on one occasion for men or 4 drinks on one occasion for women Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 159 Smoking, Prevalence Rates, 2012 ‐ 2014 (CURRENT SMOKER ‐ EVERY DAY) Four‐level smoker status: Current Smoker ‐ Every Day, Current Smoker ‐ Some Days, Former Smoker, Never Smoker 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 15.6% 11.2% 12.0% HSR 2/3 12.2% 10.7% 10.4% HSR 4/5N 18.9% 15.2% 16.3% HSR 6/5S 9.5% 9.0% 7.5% HSR 7 9.8% 10.4% 7.7% HSR 8 11.6% 8.7% 7.4% HSR 9/10 15.6% 9.3% 9.8% HSR 11 5.5% 7.6% 7.1% Texas 11.5% 9.9% 8.7% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 160 No Flu Shot in the Past Year, Age 18‐64, 2012‐2014 Flu shot in the past year ‐ ages 18‐64 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 73.1% 68.2% 73.8% HSR 2/3 69.4% 68.0% 61.0% HSR 4/5N 64.1% 66.4% 65.9% HSR 6/5S 72.6% 71.4% 67.8% HSR 7 67.9% 66.8% 63.2% HSR 8 69.7% 67.9% 66.0% HSR 9/10 73.5% 70.0% 72.1% HSR 11 76.0% 73.6% 75.2% Texas 70.9% 69.0% 66.2% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 161 No Flu Shot in the Past Year, Age 65+, 2012‐2014 Flu shot in the past year ‐ age 65+ 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 43.4% 35.2% 29.8% HSR 2/3 41.4% 39.0% 38.6% HSR 4/5N 50.9% 37.8% 42.4% HSR 6/5S 37.6% 37.7% 42.9% HSR 7 36.4% 37.0% 32.2% HSR 8 34.8% 40.0% 39.2% HSR 9/10 43.5% 45.2% 58.1% HSR 11 42.3% 36.6% 37.8% Texas 40.6% 39.0% 41.2% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 162 Depressive Disorders, Prevalence Rates, 2012 ‐ 2014 Has a doctor, nurse, or other health professional ever told you that you have a depressive disorder including depression, major depression, dysthymia, or minor depression? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 18.9% 16.1% 12.1% HSR 2/3 14.6% 16.6% 14.8% HSR 4/5N 19.2% 18.5% 16.5% HSR 6/5S 16.3% 13.2% 12.9% HSR 7 15.8% 16.6% 18.2% HSR 8 16.6% 17.8% 15.7% HSR 9/10 15.6% 13.9% 17.6% HSR 11 13.5% 15.2% 14.0% Texas 15.5% 16.0% 14.6% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 163 Arthritis, Prevalence Rates, 2012 ‐ 2014 Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 28.7% 24.1% 21.9% HSR 2/3 22.4% 20.6% 21.2% HSR 4/5N 28.4% 32.4% 27.1% HSR 6/5S 21.4% 20.2% 20.3% HSR 7 22.1% 20.8% 19.7% HSR 8 23.6% 22.7% 20.6% HSR 9/10 21.4% 23.7% 22.3% HSR 11 20.4% 20.1% 20.0% Texas 21.3% 20.7% 19.4% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 164 Asthma, Prevalence Rates, 2012 ‐ 2014 Has a doctor, nurse, or other health professional ever told you that you had asthma? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 14.5% 16.6% 9.9% HSR 2/3 10.9% 15.1% 11.7% HSR 4/5N 10.4% 12.8% 13.1% HSR 6/5S 8.9% 8.6% 9.6% HSR 7 13.4% 14.2% 12.6% HSR 8 11.3% 12.9% 12.6% HSR 9/10 11.8% 12.2% 12.2% HSR 11 9.6% 8.0% 9.5% Texas 10.9% 12.6% 11.1% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 165 No Personal Doctor Do you have one person you think of as your personal doctor or health care provider? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 30.7% 24.9% 31.3% HSR 2/3 27.7% 25.8% 26.7% HSR 4/5N 24.7% 22.9% 28.8% HSR 6/5S 35.0% 34.2% 34.1% HSR 7 27.6% 29.4% 25.8% HSR 8 29.3% 31.0% 32.6% HSR 9/10 35.8% 32.6% 35.1% HSR 11 39.2% 42.2% 35.0% Texas 32.9% 33.1% 32.9% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 166 Medical Cost Barriers, Prevalence Rates, 2012 ‐ 2014 Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 16.7% 19.3% 17.7% HSR 2/3 19.7% 17.3% 16.8% HSR 4/5N 20.2% 19.4% 22.4% HSR 6/5S 22.5% 18.7% 18.0% HSR 7 15.1% 16.3% 13.3% HSR 8 19.3% 20.8% 18.3% HSR 9/10 23.5% 21.7% 22.0% HSR 11 32.9% 31.4% 25.3% Texas 20.9% 19.3% 17.6% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 167 No Pneumonia Shot Ever, Age 18‐64, 2012‐2014 Have you ever had a pneumonia shot? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 71.6% 60.7% 69.8% HSR 2/3 68.2% 67.0% 68.9% HSR 4/5N 64.3% 60.7% 63.3% HSR 6/5S 72.3% 70.8% 69.2% HSR 7 66.1% 68.7% 67.8% HSR 8 72.2% 68.2% 70.0% HSR 9/10 72.5% 68.6% 70.1% HSR 11 77.6% 71.2% 68.9% Texas 71.3% 68.5% 69.7% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012-2014 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 168 No Pneumonia Shot Ever, Age 65+, 2012‐2014 Have you ever had a pneumonia shot? 2012 2013 2014 LOCATION PERCENT PERCENT PERCENT HSR 1 36.1% 27.9% 28.1% HSR 2/3 26.7% 25.4% 25.9% HSR 4/5N 24.3% 25.3% 28.0% HSR 6/5S 27.6% 39.4% 34.8% HSR 7 23.4% 29.8% 27.1% HSR 8 29.6% 29.2% 30.7% HSR 9/10 39.4% 41.6% 31.4% HSR 11 43.1% 39.0% 32.7% Texas 29.7% 32.1% 32.1% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012-2014 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 169 Mammogram Past 2 Yrs Age 40+, Female Adults (age 40+), 2014 Females 40 years and older who had a mammogram within the past 2 years 2014 LOCATION % AT RISK HSR 1 26.3% HSR 2/3 28.9% HSR 4/5N 33.6% HSR 6/5S 22.8% HSR 7 28.0% HSR 8 29.2% HSR 9/10 36.7% HSR 11 35.2% Texas 29.0% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012-2014 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 170 Colonoscopy in the Past 10 Years, Age 50‐75, 2014 Males and females 50‐75 years who have not had a colonoscopy in the past 10 years ‐ Used to calculate CRCREC 2014 LOCATION % AT RISK HSR 1 46.3% HSR 2/3 38.0% HSR 4/5N 46.0% HSR 6/5S 41.5% HSR 7 41.2% HSR 8 37.8% HSR 9/10 58.1% HSR 11 51.7% Texas 42.6% Note: N = sample size less than 50, estimate not displayed Note: All reported rates are weighted for Texas demographics and the probability of selection Software: Prepared using SAS 9.4 Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2012-2014 Prepared by: Texas Behavioral Risk Factor Surveillance System, Center for Health Statistics, Texas Department of State Health Services Date: January 6, 2016

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 171 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 172 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 173 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 174 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 175 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 176 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 177 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 178 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 179 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 180 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 181 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 182 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 183 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 184 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 185 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 186 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 187 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 188 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 189 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 190 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 191 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 192 Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 193 All Counties in Texas- Uninsured Rates by major demographic groups The Enroll America/Civis Analytics uninsured model provides our best estimate of uninsured rates by geography and demographic group. For smaller geographies — such as ZIP codes and counties — and demographic groups that contain fewer people, Enroll America’s estimates may show increased variation from the actual uninsured rate in these areas.

Total Uninsured Rates Race Gender Age % of Population

2015 2013 Decrease % of Uninsured Total Uninsured Uninsured Uninsured from 2013 to Black White Hispanic Asian Male Female 18 - 34 35 - 44 45 - 54 55 - 64 Uninsured Population Population Rate Rank County Name Rate Rate 2015 Population Rank Rank Texas Total 16% 21% 5% 19% 13% 23% 13% 17% 15% 22% 14% 15% 12% ------Anderson County 18% 26% 8% 21% 17% 25% 22% 19% 17% 26% 17% 16% 14% 0.2% 72 159 72 Andrews County 19% 26% 7% 19% 16% 24% 16% 21% 19% 26% 18% 17% 15% 0.1% 131 123 126 Angelina County 19% 22% 3% 22% 17% 24% 21% 20% 18% 26% 17% 16% 15% 0.4% 40 122 45 Aransas County 17% 24% 7% 18% 16% 22% 18% 18% 16% 25% 17% 16% 14% 0.1% 106 190 100 Archer County 13% 15% 2% 16% 13% 20% 18% 14% 12% 21% 11% 10% 10% 0.0% 190 237 169 Armstrong County 15% 17% 2% 11% 15% 22% 0% 16% 15% 22% 14% 13% 11% 0.0% 241 221 231 Atascosa County 20% 28% 8% 18% 16% 23% 20% 21% 19% 28% 18% 18% 16% 0.2% 66 96 70 Austin County 15% 19% 4% 17% 13% 22% 16% 16% 14% 23% 14% 13% 11% 0.1% 98 220 90 Bailey County 24% 30% 6% 21% 18% 29% 33% 25% 22% 33% 21% 21% 17% 0.0% 182 34 190 Bandera County 16% 18% 2% 15% 16% 22% 18% 18% 16% 25% 16% 14% 13% 0.1% 118 208 108 Bastrop County 16% 21% 5% 18% 15% 22% 16% 18% 16% 25% 15% 15% 13% 0.3% 52 207 48 Baylor County 17% 23% 6% 18% 16% 20% 20% 17% 16% 23% 15% 15% 14% 0.0% 218 189 208 Bee County 21% 30% 9% 19% 18% 23% 23% 22% 20% 29% 19% 19% 15% 0.1% 92 72 97 Bell County 14% 19% 5% 16% 13% 19% 16% 15% 14% 20% 13% 13% 11% 1.1% 17 230 17 Bexar County 15% 22% 7% 17% 11% 19% 12% 16% 14% 21% 13% 14% 12% 6.5% 4 219 4 Blanco County 15% 19% 4% 17% 14% 22% 18% 16% 14% 24% 14% 13% 11% 0.0% 170 218 158 Borden County 10% 17% 7% 7% 10% 15% 0% 11% 10% 15% 8% 8% 8% 0.0% 252 249 251 Bosque County 17% 24% 7% 21% 16% 25% 23% 18% 16% 26% 15% 15% 13% 0.1% 146 188 132 Bowie County 17% 23% 6% 21% 15% 22% 18% 18% 16% 23% 15% 15% 13% 0.4% 41 187 42 Brazoria County 13% 17% 4% 13% 11% 18% 10% 14% 12% 19% 11% 11% 10% 1.0% 19 236 16 Brazos County 14% 20% 6% 18% 13% 20% 14% 15% 13% 19% 12% 13% 10% 0.6% 26 229 24 Brewster County 19% 30% 11% 25% 17% 23% 20% 21% 18% 28% 17% 16% 15% 0.0% 162 121 163 Briscoe County 25% 23% -2% 29% 23% 36% 45% 27% 24% 36% 23% 22% 20% 0.0% 236 25 239 Brooks County 28% 38% 10% 25% 23% 28% 29% 30% 26% 36% 26% 25% 22% 0.1% 148 12 168 Brown County 17% 23% 6% 19% 16% 23% 23% 18% 16% 25% 15% 16% 14% 0.2% 83 186 80 Burleson County 18% 22% 4% 19% 17% 24% 21% 19% 17% 26% 16% 16% 15% 0.1% 138 158 128 Burnet County 16% 20% 4% 16% 15% 24% 17% 17% 15% 24% 15% 15% 12% 0.2% 80 206 73 Caldwell County 20% 26% 6% 22% 17% 24% 22% 21% 18% 29% 17% 17% 15% 0.2% 73 95 81 Calhoun County 20% 27% 7% 22% 16% 25% 19% 21% 18% 28% 19% 17% 15% 0.1% 104 94 112 Callahan County 17% 22% 5% 17% 16% 22% 20% 18% 16% 24% 15% 15% 13% 0.1% 153 185 138 Cameron County 30% 36% 6% 26% 22% 31% 24% 32% 28% 39% 27% 28% 24% 2.6% 8 7 13 Camp County 22% 27% 5% 24% 20% 29% 24% 23% 21% 30% 20% 20% 17% 0.1% 150 59 151 Carson County 11% 16% 5% 11% 11% 17% 16% 12% 10% 18% 10% 8% 8% 0.0% 215 246 187 Cass County 17% 25% 8% 19% 17% 22% 21% 18% 16% 24% 15% 15% 14% 0.1% 96 184 94 Castro County 26% 30% 4% 23% 19% 31% 24% 27% 24% 35% 23% 23% 19% 0.0% 172 17 189 Chambers County 12% 16% 4% 13% 12% 17% 15% 13% 12% 19% 11% 11% 10% 0.1% 93 240 71 Cherokee County 20% 26% 6% 23% 19% 29% 23% 22% 19% 29% 18% 19% 16% 0.2% 71 93 78 Childress County 16% 25% 9% 18% 15% 22% 24% 17% 15% 24% 15% 15% 13% 0.0% 199 205 192 Clay County 14% 20% 6% 14% 13% 19% 15% 15% 13% 21% 12% 12% 11% 0.0% 181 228 159 Cochran County 27% 33% 6% 30% 23% 31% 31% 28% 25% 35% 25% 23% 21% 0.0% 205 16 222 Coke County 18% 22% 4% 20% 17% 24% 24% 19% 18% 27% 18% 16% 15% 0.0% 228 157 223 Coleman County 18% 27% 9% 20% 17% 24% 21% 20% 17% 26% 17% 17% 15% 0.0% 171 156 171 Collin County 7% 11% 4% 9% 7% 12% 7% 8% 7% 12% 6% 6% 5% 1.5% 12 254 6 Collingsworth County 24% 26% 2% 23% 21% 32% 19% 25% 22% 33% 21% 22% 18% 0.0% 219 33 225 Colorado County 18% 24% 6% 21% 16% 25% 18% 18% 17% 26% 17% 15% 13% 0.1% 113 155 111 Comal County 11% 15% 4% 12% 10% 17% 12% 12% 11% 17% 10% 10% 8% 0.4% 46 245 33 Comanche County 22% 26% 4% 22% 20% 30% 19% 24% 21% 31% 20% 20% 18% 0.1% 140 58 145 Concho County 19% 20% 1% 14% 17% 25% 19% 20% 18% 28% 18% 16% 15% 0.0% 234 120 234

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 194 Cooke County 17% 21% 4% 21% 16% 27% 23% 18% 16% 25% 16% 15% 14% 0.2% 79 183 77 Coryell County 15% 20% 5% 16% 15% 19% 18% 16% 14% 22% 14% 13% 11% 0.2% 58 217 52 Cottle County 23% 21% -2% 15% 21% 31% 12% 24% 23% 32% 22% 19% 18% 0.0% 240 47 241 Crane County 19% 30% 11% 17% 16% 22% 18% 21% 17% 27% 18% 16% 14% 0.0% 201 119 202 Crockett County 22% 26% 4% 24% 18% 25% 21% 22% 21% 29% 21% 18% 16% 0.0% 204 57 212 Crosby County 22% 30% 8% 18% 18% 26% 19% 24% 21% 30% 21% 20% 17% 0.0% 192 56 195 Culberson County 29% 39% 10% 22% 25% 30% 34% 30% 28% 38% 26% 24% 23% 0.0% 217 9 229 Dallam County 24% 30% 6% 21% 21% 30% 28% 25% 22% 31% 22% 22% 19% 0.0% 175 32 186 Dallas County 17% 24% 7% 19% 13% 23% 15% 18% 16% 22% 15% 16% 13% 9.7% 2 182 2 Dawson County 23% 30% 7% 22% 18% 27% 21% 24% 22% 31% 21% 21% 17% 0.1% 141 46 148 Deaf Smith County 23% 30% 7% 19% 16% 26% 21% 24% 21% 31% 21% 21% 17% 0.1% 122 45 134 Delta County 20% 24% 4% 23% 20% 25% 22% 21% 19% 27% 18% 17% 18% 0.0% 200 92 201 Denton County 9% 12% 3% 11% 8% 14% 9% 9% 8% 14% 7% 7% 6% 1.7% 10 252 8 DeWitt County 18% 24% 6% 22% 15% 23% 21% 19% 17% 25% 16% 16% 14% 0.1% 124 154 118 Dickens County 18% 24% 6% 20% 16% 24% 21% 19% 17% 28% 15% 17% 14% 0.0% 238 153 236 Dimmit County 25% 37% 12% 19% 20% 26% 26% 27% 23% 33% 23% 22% 20% 0.1% 143 24 157 Donley County 18% 21% 3% 16% 18% 25% 24% 19% 18% 27% 17% 15% 14% 0.0% 223 152 220 Duval County 24% 33% 9% 21% 21% 26% 22% 26% 23% 32% 22% 21% 19% 0.1% 136 31 147 Eastland County 20% 26% 6% 18% 19% 26% 27% 21% 19% 28% 18% 18% 17% 0.1% 120 91 123 Ector County 23% 29% 6% 24% 19% 28% 23% 25% 22% 30% 21% 22% 18% 0.8% 23 44 29 Edwards County 25% 29% 4% 0% 19% 29% 0% 26% 24% 35% 23% 21% 18% 0.0% 237 23 240 Ellis County 14% 17% 3% 17% 12% 20% 15% 15% 13% 20% 12% 12% 10% 0.6% 27 227 25 El Paso County 25% 30% 5% 21% 20% 27% 21% 27% 24% 33% 22% 23% 20% 4.7% 6 22 7 Erath County 21% 26% 5% 20% 20% 29% 25% 22% 20% 28% 18% 18% 15% 0.2% 75 71 84 Falls County 20% 29% 9% 24% 17% 25% 20% 21% 18% 27% 19% 18% 16% 0.1% 135 90 135 Fannin County 17% 23% 6% 21% 17% 23% 19% 18% 17% 25% 16% 15% 14% 0.1% 94 181 92 Fayette County 15% 19% 4% 20% 14% 22% 19% 16% 14% 23% 14% 13% 12% 0.1% 121 216 103 Fisher County 18% 26% 8% 23% 17% 22% 22% 19% 17% 26% 17% 15% 14% 0.0% 213 151 207 Floyd County 22% 29% 7% 19% 17% 27% 19% 24% 21% 31% 20% 19% 17% 0.0% 188 55 193 Foard County 27% 29% 2% 35% 25% 33% 32% 28% 26% 35% 24% 23% 21% 0.0% 242 15 244 Fort Bend County 11% 14% 3% 14% 9% 16% 10% 11% 10% 16% 10% 9% 8% 1.8% 9 244 9 Franklin County 17% 24% 7% 21% 16% 24% 21% 17% 16% 24% 15% 14% 12% 0.0% 184 180 175 Freestone County 16% 22% 6% 20% 16% 24% 22% 17% 15% 24% 15% 15% 13% 0.1% 145 204 125 Frio County 23% 33% 10% 21% 18% 25% 22% 25% 21% 31% 21% 20% 18% 0.1% 115 43 133 Gaines County 25% 25% 0% 23% 21% 31% 26% 26% 24% 33% 22% 21% 19% 0.1% 123 21 140 Galveston County 13% 18% 5% 17% 11% 18% 12% 14% 12% 18% 11% 11% 10% 1.1% 18 235 15 Garza County 18% 26% 8% 19% 15% 22% 24% 19% 17% 25% 16% 15% 14% 0.0% 212 150 206 Gillespie County 16% 18% 2% 16% 15% 25% 19% 18% 15% 25% 15% 14% 13% 0.1% 110 203 98 Glasscock County 12% 14% 2% 5% 10% 19% 0% 13% 10% 18% 10% 9% 8% 0.0% 249 239 245 Goliad County 15% 20% 5% 14% 13% 21% 16% 17% 14% 23% 15% 12% 12% 0.0% 193 215 177 Gonzales County 23% 29% 6% 23% 19% 28% 24% 24% 22% 31% 21% 20% 17% 0.1% 102 42 119 Gray County 19% 25% 6% 22% 17% 27% 21% 20% 18% 26% 18% 18% 15% 0.1% 109 118 109 Grayson County 16% 22% 6% 20% 16% 25% 18% 17% 15% 23% 15% 15% 13% 0.5% 32 202 35 Gregg County 17% 23% 6% 22% 15% 25% 18% 18% 16% 23% 16% 16% 13% 0.5% 31 179 36 Grimes County 18% 23% 5% 22% 16% 23% 19% 19% 16% 25% 16% 15% 14% 0.1% 101 149 101 Guadalupe County 13% 17% 4% 13% 11% 19% 13% 14% 13% 19% 12% 12% 11% 0.5% 33 234 27 Hale County 23% 30% 7% 22% 18% 27% 20% 24% 22% 31% 22% 21% 18% 0.2% 74 41 88 Hall County 24% 28% 4% 30% 21% 31% 31% 25% 23% 33% 23% 21% 20% 0.0% 211 30 219 Hamilton County 18% 24% 6% 21% 18% 24% 23% 19% 17% 26% 16% 16% 15% 0.0% 185 148 178 Hansford County 19% 25% 6% 18% 16% 26% 22% 21% 17% 28% 15% 17% 14% 0.0% 198 117 197 Hardeman County 20% 27% 7% 20% 19% 26% 20% 21% 19% 28% 18% 18% 16% 0.0% 207 89 210 Hardin County 14% 20% 6% 19% 14% 18% 17% 15% 13% 21% 13% 12% 11% 0.2% 64 226 53 Harris County 16% 22% 6% 20% 12% 22% 15% 17% 15% 22% 14% 16% 12% 16.1% 1 201 1 Harrison County 18% 22% 4% 24% 16% 26% 19% 19% 17% 26% 15% 15% 14% 0.3% 49 147 47 Hartley County 13% 14% 1% 14% 12% 19% 14% 14% 13% 21% 11% 10% 10% 0.0% 227 233 205 Haskell County 20% 29% 9% 21% 18% 26% 19% 21% 19% 29% 18% 18% 16% 0.0% 195 88 198 Hays County 13% 18% 5% 20% 12% 18% 15% 14% 13% 20% 11% 11% 8% 0.6% 25 232 23 Hemphill County 15% 19% 4% 18% 14% 22% 16% 16% 14% 23% 12% 13% 11% 0.0% 221 214 209 Henderson County 17% 26% 9% 19% 17% 24% 21% 19% 16% 25% 16% 16% 15% 0.3% 48 178 46

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 195 Hidalgo County 33% 37% 4% 28% 25% 34% 27% 35% 31% 41% 29% 31% 26% 5.0% 5 4 10 Hill County 19% 25% 6% 23% 18% 26% 22% 20% 18% 27% 17% 17% 15% 0.2% 81 116 83 Hockley County 19% 26% 7% 18% 15% 24% 18% 20% 18% 26% 17% 16% 14% 0.1% 100 115 105 Hood County 16% 19% 3% 15% 15% 23% 17% 17% 14% 23% 15% 15% 12% 0.2% 60 200 55 Hopkins County 20% 24% 4% 22% 19% 28% 24% 21% 19% 27% 17% 18% 16% 0.2% 86 87 87 Houston County 21% 27% 6% 24% 20% 29% 26% 22% 20% 30% 19% 19% 17% 0.1% 108 70 117 Howard County 21% 28% 7% 21% 18% 26% 21% 22% 19% 28% 19% 19% 16% 0.2% 87 69 91 Hudspeth County 32% 34% 2% 24% 26% 36% 34% 33% 31% 42% 30% 26% 23% 0.0% 220 5 232 Hunt County 17% 22% 5% 21% 16% 25% 19% 19% 16% 24% 16% 16% 14% 0.4% 45 177 44 Hutchinson County 17% 23% 6% 20% 16% 24% 19% 18% 16% 24% 16% 15% 13% 0.1% 112 176 107 Irion County 19% 23% 4% 13% 17% 26% 33% 20% 18% 27% 17% 14% 13% 0.0% 235 114 235 Jack County 17% 24% 7% 17% 16% 23% 22% 18% 17% 24% 15% 15% 14% 0.0% 191 175 181 Jackson County 17% 22% 5% 21% 15% 22% 19% 18% 16% 24% 15% 15% 13% 0.1% 154 174 139 Jasper County 18% 27% 9% 22% 17% 24% 21% 19% 17% 25% 16% 16% 14% 0.1% 89 146 86 Jeff Davis County 20% 23% 3% 17% 18% 27% 19% 21% 19% 32% 19% 17% 15% 0.0% 232 86 230 Jefferson County 18% 26% 8% 23% 15% 25% 21% 20% 17% 25% 17% 17% 15% 1.1% 15 145 19 Jim Hogg County 25% 36% 11% 28% 23% 26% 26% 28% 23% 33% 22% 21% 19% 0.0% 179 20 191 Jim Wells County 24% 31% 7% 22% 18% 26% 21% 25% 22% 32% 22% 21% 18% 0.2% 54 29 69 Johnson County 16% 19% 3% 17% 15% 22% 18% 17% 15% 22% 14% 15% 12% 0.6% 24 199 26 Jones County 19% 26% 7% 20% 18% 25% 23% 20% 18% 27% 17% 17% 16% 0.1% 134 113 130 Karnes County 17% 28% 11% 21% 14% 22% 16% 19% 16% 25% 16% 15% 13% 0.1% 157 173 144 Kaufman County 14% 17% 3% 20% 14% 19% 17% 15% 14% 21% 12% 13% 12% 0.4% 39 225 37 Kendall County 10% 14% 4% 11% 9% 16% 10% 11% 10% 17% 9% 8% 7% 0.1% 105 248 75 Kenedy County 18% 28% 10% 0% 15% 19% 20% 19% 16% 24% 13% 13% 12% 0.0% 251 144 252 Kent County 17% 24% 7% 15% 16% 22% 14% 17% 16% 23% 14% 14% 13% 0.0% 248 172 250 Kerr County 18% 22% 4% 18% 16% 24% 21% 19% 16% 26% 16% 16% 13% 0.2% 67 143 62 Kimble County 20% 26% 6% 18% 19% 27% 25% 22% 19% 30% 19% 19% 16% 0.0% 208 85 211 King County 8% 14% 6% 0% 8% 14% 0% 9% 8% 15% 8% 6% 5% 0.0% 254 253 253 Kinney County 20% 32% 12% 27% 16% 24% 24% 21% 19% 28% 17% 17% 14% 0.0% 225 84 226 Kleberg County 22% 33% 11% 21% 19% 24% 23% 24% 21% 30% 20% 20% 17% 0.2% 77 54 89 Knox County 23% 27% 4% 25% 20% 29% 30% 25% 22% 32% 21% 21% 18% 0.0% 203 40 214 Lamar County 18% 22% 4% 23% 17% 24% 22% 19% 17% 25% 16% 16% 15% 0.2% 61 142 59 Lamb County 24% 31% 7% 21% 19% 29% 27% 25% 23% 32% 22% 22% 19% 0.1% 139 28 149 Lampasas County 17% 23% 6% 17% 16% 23% 18% 18% 16% 25% 16% 15% 14% 0.1% 116 171 110 La Salle County 25% 35% 10% 24% 21% 27% 21% 27% 24% 34% 23% 22% 20% 0.0% 176 19 188 Lavaca County 16% 21% 5% 20% 15% 23% 19% 17% 15% 23% 15% 14% 13% 0.1% 127 198 114 Lee County 15% 19% 4% 18% 14% 23% 17% 17% 14% 23% 14% 14% 12% 0.1% 152 213 131 Leon County 18% 21% 3% 20% 18% 26% 22% 19% 18% 27% 17% 16% 14% 0.1% 137 141 127 Liberty County 20% 23% 3% 22% 19% 27% 23% 21% 19% 27% 18% 18% 16% 0.3% 47 83 49 Limestone County 19% 27% 8% 21% 18% 25% 22% 20% 18% 26% 18% 17% 14% 0.1% 111 112 113 Lipscomb County 19% 21% 2% 24% 17% 29% 23% 20% 18% 27% 17% 15% 13% 0.0% 224 111 221 Live Oak County 19% 25% 6% 20% 16% 24% 22% 20% 17% 27% 18% 15% 14% 0.0% 166 110 167 Llano County 15% 20% 5% 16% 14% 23% 19% 16% 14% 23% 15% 14% 11% 0.1% 144 212 120 Loving County 19% 25% 6% 0% 18% 27% 0% 20% 19% 28% 19% 18% 15% 0.0% 253 109 254 Lubbock County 15% 22% 7% 21% 12% 20% 15% 16% 14% 20% 13% 14% 11% 1.0% 20 211 18 Lynn County 20% 25% 5% 22% 16% 26% 24% 22% 19% 29% 18% 17% 16% 0.0% 194 82 194 McCulloch County 20% 27% 7% 22% 18% 25% 18% 21% 18% 28% 17% 18% 16% 0.0% 169 81 176 McLennan County 16% 22% 6% 21% 14% 23% 16% 17% 15% 22% 14% 15% 12% 0.9% 21 197 20 McMullen County 17% 23% 6% 13% 15% 19% 0% 17% 16% 25% 15% 14% 13% 0.0% 247 170 247 Madison County 18% 24% 6% 20% 17% 25% 24% 19% 17% 26% 17% 16% 15% 0.0% 160 140 155 Marion County 20% 26% 6% 22% 20% 25% 20% 21% 19% 28% 19% 18% 17% 0.0% 161 80 164 Martin County 21% 25% 4% 14% 18% 27% 17% 22% 20% 29% 19% 17% 14% 0.0% 214 68 215 Mason County 19% 20% 1% 24% 17% 27% 25% 20% 18% 29% 16% 16% 14% 0.0% 216 108 213 Matagorda County 20% 28% 8% 20% 17% 25% 20% 21% 19% 28% 19% 18% 15% 0.2% 78 79 85 Maverick County 34% 36% 2% 29% 29% 34% 30% 36% 32% 43% 29% 30% 27% 0.4% 36 3 57 Medina County 17% 25% 8% 17% 14% 22% 18% 18% 17% 25% 16% 15% 13% 0.2% 69 169 64 Menard County 25% 22% -3% 0% 22% 33% 33% 26% 24% 35% 23% 22% 20% 0.0% 231 18 237 Midland County 16% 20% 4% 19% 12% 23% 16% 17% 15% 21% 14% 15% 11% 0.6% 28 196 28 Milam County 18% 24% 6% 21% 16% 24% 20% 19% 17% 25% 16% 16% 14% 0.1% 107 139 106

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 196 Mills County 19% 22% 3% 15% 18% 28% 13% 20% 18% 29% 18% 16% 15% 0.0% 202 107 203 Mitchell County 19% 30% 11% 17% 17% 24% 24% 21% 18% 27% 18% 18% 15% 0.0% 183 106 179 Montague County 18% 23% 5% 17% 18% 25% 18% 19% 17% 26% 16% 16% 15% 0.1% 117 138 115 Montgomery County 11% 15% 4% 13% 10% 17% 10% 11% 10% 16% 10% 10% 8% 1.4% 14 243 11 Moore County 21% 26% 5% 21% 17% 27% 28% 23% 20% 29% 19% 19% 16% 0.1% 114 67 124 Morris County 17% 25% 8% 17% 18% 24% 19% 19% 17% 26% 16% 16% 13% 0.1% 159 168 146 Motley County 19% 21% 2% 18% 18% 28% 0% 19% 19% 27% 16% 16% 16% 0.0% 245 105 249 Nacogdoches County 18% 25% 7% 22% 17% 25% 20% 19% 17% 24% 16% 16% 14% 0.2% 53 137 54 Navarro County 20% 25% 5% 22% 18% 27% 24% 21% 19% 28% 19% 19% 16% 0.2% 62 78 68 Newton County 18% 28% 10% 17% 18% 22% 18% 19% 17% 25% 17% 15% 14% 0.0% 173 136 173 Nolan County 21% 29% 8% 23% 18% 26% 22% 22% 20% 28% 20% 19% 17% 0.1% 132 66 136 Nueces County 17% 25% 8% 17% 13% 20% 14% 18% 16% 23% 16% 16% 13% 1.4% 13 167 14 Ochiltree County 21% 28% 7% 18% 18% 27% 27% 22% 20% 28% 18% 20% 15% 0.1% 158 65 162 Oldham County 14% 18% 4% 31% 13% 21% 19% 14% 13% 21% 12% 11% 10% 0.0% 239 224 228 Orange County 16% 21% 5% 20% 16% 21% 20% 17% 15% 23% 15% 15% 13% 0.4% 44 195 41 Palo Pinto County 22% 26% 4% 25% 20% 30% 28% 23% 21% 31% 20% 20% 17% 0.2% 85 53 93 Panola County 17% 23% 6% 18% 16% 24% 21% 18% 16% 24% 15% 15% 13% 0.1% 103 166 99 Parker County 12% 15% 3% 13% 11% 17% 12% 12% 11% 17% 10% 10% 9% 0.4% 38 238 31 Parmer County 22% 29% 7% 19% 18% 28% 23% 24% 21% 32% 20% 21% 16% 0.0% 164 52 174 Pecos County 23% 31% 8% 22% 18% 26% 25% 25% 22% 32% 21% 20% 16% 0.1% 130 39 141 Polk County 21% 25% 4% 23% 21% 28% 26% 23% 20% 30% 20% 19% 17% 0.2% 57 64 67 Potter County 21% 28% 7% 26% 18% 27% 25% 22% 20% 27% 19% 20% 17% 0.5% 29 63 39 Presidio County 34% 33% -1% 18% 24% 38% 38% 36% 33% 45% 31% 27% 25% 0.0% 174 2 200 Rains County 18% 25% 7% 17% 17% 24% 18% 18% 17% 25% 17% 16% 14% 0.0% 167 135 165 Randall County 11% 15% 4% 12% 10% 16% 12% 12% 10% 16% 10% 9% 8% 0.4% 42 242 30 Reagan County 22% 26% 4% 22% 17% 26% 23% 23% 20% 31% 20% 19% 16% 0.0% 209 51 216 Real County 20% 24% 4% 13% 18% 27% 16% 21% 19% 29% 19% 17% 15% 0.0% 222 77 224 Red River County 19% 27% 8% 22% 18% 25% 18% 21% 18% 27% 17% 17% 16% 0.1% 156 104 150 Reeves County 28% 36% 8% 22% 23% 29% 28% 30% 26% 36% 26% 25% 22% 0.1% 128 11 154 Refugio County 18% 26% 8% 21% 15% 21% 25% 19% 17% 25% 17% 15% 14% 0.0% 187 134 180 Roberts County 10% 16% 6% 7% 10% 17% 0% 11% 10% 16% 9% 9% 7% 0.0% 250 247 246 Robertson County 19% 24% 5% 21% 17% 24% 22% 20% 18% 26% 17% 16% 15% 0.1% 126 103 122 Rockwall County 9% 12% 3% 9% 8% 13% 10% 9% 8% 14% 8% 7% 6% 0.2% 65 251 40 Runnels County 18% 26% 8% 19% 16% 24% 21% 19% 17% 26% 18% 16% 15% 0.0% 163 133 160 Rusk County 17% 23% 6% 20% 16% 24% 19% 18% 16% 24% 16% 15% 13% 0.2% 70 165 65 Sabine County 18% 25% 7% 18% 18% 23% 22% 19% 17% 27% 17% 16% 14% 0.0% 168 132 166 San Augustine County 21% 30% 9% 24% 19% 26% 28% 22% 20% 29% 19% 19% 16% 0.0% 180 62 182 San Jacinto County 18% 24% 6% 19% 18% 24% 22% 19% 17% 26% 17% 17% 14% 0.1% 97 131 96 San Patricio County 18% 25% 7% 17% 14% 22% 16% 19% 17% 25% 16% 16% 14% 0.3% 51 130 50 San Saba County 20% 26% 6% 20% 19% 27% 22% 21% 19% 30% 18% 18% 16% 0.0% 195 76 198 Schleicher County 21% 28% 7% 33% 18% 26% 23% 22% 20% 31% 20% 17% 15% 0.0% 229 61 227 Scurry County 19% 25% 6% 18% 16% 25% 24% 20% 18% 26% 17% 17% 14% 0.1% 133 102 129 Shackelford County 16% 21% 5% 15% 16% 23% 21% 18% 15% 24% 15% 14% 13% 0.0% 226 194 217 Shelby County 22% 29% 7% 25% 21% 30% 28% 24% 22% 31% 20% 20% 18% 0.1% 95 50 104 Sherman County 23% 25% 2% 26% 20% 33% 21% 25% 22% 33% 19% 17% 17% 0.0% 230 38 233 Smith County 16% 21% 5% 21% 14% 25% 17% 17% 15% 22% 14% 15% 12% 0.9% 22 193 22 Somervell County 14% 17% 3% 14% 13% 20% 16% 15% 14% 22% 13% 12% 10% 0.0% 189 223 172 Starr County 34% 39% 5% 26% 30% 34% 31% 36% 32% 42% 30% 30% 26% 0.4% 37 1 58 Stephens County 20% 25% 5% 18% 19% 27% 25% 21% 19% 28% 19% 18% 16% 0.0% 165 75 170 Sterling County 17% 21% 4% 21% 15% 25% 16% 18% 17% 26% 15% 14% 12% 0.0% 244 164 242 Stonewall County 18% 25% 7% 15% 17% 25% 0% 19% 16% 26% 17% 15% 13% 0.0% 243 129 243 Sutton County 18% 27% 9% 13% 14% 23% 18% 20% 17% 26% 17% 16% 14% 0.0% 210 128 204 Swisher County 20% 29% 9% 20% 17% 26% 16% 22% 19% 28% 18% 18% 16% 0.0% 186 74 185 Tarrant County 14% 18% 4% 18% 12% 21% 14% 15% 13% 19% 12% 13% 10% 6.6% 3 222 3 Taylor County 16% 21% 5% 19% 14% 22% 17% 17% 15% 21% 15% 14% 12% 0.5% 30 192 32 Terrell County 18% 17% -1% 0% 16% 20% 14% 19% 16% 27% 16% 14% 12% 0.0% 246 127 248 Terry County 23% 30% 7% 25% 19% 28% 23% 25% 22% 32% 22% 21% 18% 0.1% 147 37 153 Throckmorton County 23% 23% 0% 20% 23% 29% 0% 25% 22% 32% 22% 19% 19% 0.0% 233 36 238 Titus County 24% 29% 5% 24% 21% 32% 26% 25% 22% 32% 21% 22% 18% 0.2% 84 27 95

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 197 Tom Green County 17% 23% 6% 18% 14% 22% 17% 18% 16% 23% 15% 16% 13% 0.4% 35 163 38 Travis County 11% 19% 8% 15% 10% 17% 12% 12% 11% 16% 10% 10% 8% 3.2% 7 241 5 Trinity County 19% 23% 4% 20% 19% 26% 26% 20% 18% 28% 18% 17% 16% 0.1% 151 101 143 Tyler County 18% 26% 8% 22% 18% 22% 19% 19% 17% 26% 17% 16% 15% 0.1% 129 126 121 Upshur County 17% 22% 5% 20% 17% 23% 20% 18% 16% 25% 16% 15% 13% 0.2% 76 162 74 Upton County 23% 26% 3% 21% 20% 27% 25% 24% 21% 31% 21% 18% 16% 0.0% 206 35 218 Uvalde County 24% 33% 9% 21% 18% 26% 24% 25% 22% 32% 22% 21% 17% 0.1% 90 26 102 Val Verde County 27% 33% 6% 21% 21% 29% 24% 28% 25% 34% 24% 24% 21% 0.3% 50 14 66 Van Zandt County 19% 24% 5% 21% 19% 26% 22% 20% 18% 27% 17% 16% 15% 0.2% 63 100 63 Victoria County 17% 23% 6% 20% 14% 22% 15% 18% 16% 24% 16% 16% 13% 0.4% 43 161 43 Walker County 18% 22% 4% 20% 17% 25% 23% 19% 17% 25% 17% 16% 13% 0.2% 55 125 56 Waller County 19% 22% 3% 22% 18% 24% 21% 20% 18% 26% 16% 15% 13% 0.2% 59 99 60 Ward County 21% 29% 8% 20% 18% 25% 23% 22% 20% 28% 20% 19% 16% 0.1% 155 60 156 Washington County 16% 19% 3% 19% 14% 23% 19% 17% 15% 23% 14% 14% 12% 0.1% 91 191 82 Webb County 28% 34% 6% 25% 22% 28% 23% 30% 26% 36% 24% 26% 22% 1.6% 11 10 21 Wharton County 20% 25% 5% 23% 17% 26% 23% 22% 19% 28% 18% 18% 16% 0.2% 68 73 76 Wheeler County 19% 23% 4% 21% 18% 27% 21% 20% 17% 27% 16% 16% 14% 0.0% 197 98 196 Wichita County 15% 21% 6% 21% 14% 21% 16% 16% 14% 21% 14% 14% 12% 0.5% 34 210 34 Wilbarger County 19% 25% 6% 22% 17% 24% 22% 20% 18% 26% 18% 17% 15% 0.1% 149 97 142 Willacy County 30% 43% 13% 40% 23% 31% 30% 30% 29% 37% 27% 27% 25% 0.1% 99 6 137 Williamson County 9% 13% 4% 10% 8% 13% 8% 9% 8% 14% 8% 7% 7% 1.1% 16 250 12 Wilson County 13% 18% 5% 12% 11% 18% 14% 14% 12% 20% 12% 11% 10% 0.1% 88 231 61 Winkler County 22% 31% 9% 21% 19% 27% 25% 24% 21% 30% 21% 20% 17% 0.0% 178 49 184 Wise County 15% 19% 4% 14% 14% 21% 17% 15% 14% 22% 13% 13% 11% 0.2% 56 209 51 Wood County 17% 24% 7% 20% 17% 25% 21% 18% 17% 25% 16% 15% 14% 0.2% 82 160 79 Yoakum County 22% 27% 5% 13% 17% 26% 23% 23% 21% 30% 20% 19% 16% 0.0% 177 48 183 Young County 18% 23% 5% 21% 18% 25% 19% 19% 17% 26% 16% 16% 14% 0.1% 119 124 116 Zapata County 29% 35% 6% 24% 25% 29% 24% 31% 27% 37% 25% 24% 22% 0.1% 125 8 152 Zavala County 27% 38% 11% 21% 24% 28% 25% 30% 25% 34% 25% 24% 22% 0.1% 142 13 161

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 198 TEXAS TX

2015 Estimated Uninsured Rate of 18 to 64 year olds: 16.0% 2013 Estimated Uninsured Rate of 18 to 64 year olds: 21.3% Decrease from 2013 to 2015: 5.3%

Before the first Affordable Care Act enrollment period began, Enroll America and Civis Analytics used sophisticated data targeting techniques to create a model of the uninsured population in America. Over the last three years, this model has proven to be timely and accurate, and has played a critical role in our ability to understand who and where the uninsured are and get them the help they need to enroll in coverage. This year, the model has been updated and was used to estimate insurance status for over 180 million non-elderly adult Americans. Grouping individual-level estimates by geography, race, age, gender, and other characteristics enables us to understand the landscape of the uninsured population across the country. Here we provide a detailed look at the uninsured population in Texas, put into context by plan selection data from HHS and a comparison with nationwide uninsured rates. All uninsured rates listed in this document are based on the Enroll America/Civis Analytics uninsured model.

Chart 1: Texas Uninsured Rates for 2013 and 2015 of Key Demographic Groups

Overall Race Gender Age 35 30 32 25 27 27 20 23 23 22 21 20 21 21 2013 15 19 16 16 17 17 17 16 15 15 2015 10 13 13 14

Uninsured Rate 12 11 5 0 National Texas Black White Hispanic Asian Male Female 18 - 34 35 - 44 45 - 54 55 - 64

Quick Summary State Map: 2015 Uninsured Rates by County ● The current uninsured rate in Texas is 16%. This has decreased by 5% since 2013 prior to the first open enrollment period.

● 23% of Hispanics in Texas are uninsured, 19% of African-Americans are uninsured and 22% of young adults (ages 18-34) are uninsured.

Targeting Recommendations ● Geographic - More uninsured people live in Harris County (16% of the uninsured population) and Dallas County (10% of the uninsured population) than any other county. ● Geographic - The counties with the highest uninsured rates currently are Starr County (34%), Presidio County (34%), Hidalgo County (33%) and Hudspeth County (32%). ● Demographic - Hispanic men ages 18 to 34 (32%) have the highest 2015 uninsured rates, followed by Hispanic women ages 18 to 34 (28%) Map Scale: Uninsured Rates per County and African American men ages 18 to 34 (28%). 5% 10% 15% 20%

Table 1: Distribution of Uninsured Population by Demographic Groups in Quick Summary Race [1] Gender Age Distribution of Uninsured Population, Black White Hispanic Asian Male Female 18 - 34 35 - 44 45 - 54 55 - 64 Ages 18 to 64 % 2013 Uninsured Population in Texas 7.7% 49.1% 40.8% 2.4% 50.5% 49.5% 31.9% 21.8% 30.1% 16.3% % 2015 Uninsured Population in Texas 6.6% 49.7% 41.2% 2.5% 50.0% 50.0% 36.3% 18.3% 27.7% 17.6% Change from 2013 to 2015 -1.1% 0.6% 0.4% 0.1% -0.5% 0.5% 4.5% -3.5% -2.3% 1.3%

Table 2: 2015 Uninsured Rates in Most Populous Counties Total Race Gender Age Percent

% of TX Top 10 Most Populous Counties, 2015 Black White Hispanic Asian Male Female 18 - 34 35 - 44 45 - 54 55 - 64 Uninsured Ordered by Population Size Uninsured Rate Population ### Harris County 16% 20% 12% 22% 15% 17% 15% 22% 14% 16% 12% 16% 0 0 0 ### Dallas County 17% 19% 13% 23% 15% 18% 16% 22% 15% 16% 13% 10% 0 0 0 ### Tarrant County 14% 18% 12% 21% 14% 15% 13% 19% 12% 13% 10% 7% 0 0 0 ### Bexar County 15% 17% 11% 19% 12% 16% 14% 21% 13% 14% 12% 7% 0 0 0 ### Travis County 11% 15% 10% 17% 12% 12% 11% 16% 10% 10% 8% 3% 0 0 0 ### Collin County 7% 9% 7% 12% 7% 8% 7% 12% 6% 6% 5% 2% 0 0 0 ### El Paso County 25% 21% 20% 27% 21% 27% 24% 33% 22% 23% 20% 5% 0 0 0 ### Denton County 9% 11% 8% 14% 9% 9% 8% 14% 7% 7% 6% 2% 0 0 0 ### Fort Bend County 11% 14% 9% 16% 10% 11% 10% 16% 10% 9% 8% 2% 0 0 0 ### Hidalgo County 33% 28% 25% 34% 27% 35% 31% 41% 29% 31% 26% 5% 0 0 0

Page 1 of 2 - Texas State Snapshot - Enroll America - October 2015 www.enrollamerica.org

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 199 TEXAS TX

OE2 Plan Selection Data from Health and Human Services Remaining Uninsured Estimates from June 2015 Kaiser Family Foundation Study Total OE2 Plan Selections in Texas: [2] 1,205,174 Estimated Number of Remaining Uninsured in Texas: [4] 4,425,000 Effectuated OE2 Plan Selections: [3] 966,412 % Medicaid Eligible of Remaining Uninsured 11% % Effectuated of Total Plan Selections 80% % Tax Credit Eligible of Remaining Uninsured 23% Texas plans with Advanced Premium Tax Credit (APTC): 832,334 % Ineligible for Financial Assistance of Remaining Uninsured [5] 48% % APTC of Effectuated Plans 86% % Consumers in Coverage Gap of Remaining Uninsured 17% Chart 2: Distribution of Total Plan Selections by Provided Age and Race [6,7] Distribution of Plan Selections by Age Distribution of Plan Selections by Race [6]

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 20% 40% 60% 80% 100% Texas Harris County Dallas County Tarrant County Bexar County Travis County Collin County El Paso County Denton County Fort Bend County Hidalgo County

18-25 26-34 35-44 45-54 55-64 White Latino Black Asian Other

National Map: 2015 Uninsured Rates by County ● In 2013 before the first open enrollment period, Texas's uninsured rate of 21.3% was 4.9% greater than the national uninsured rate. ● In 2015, Texas's uninsured rate of 16.0% is 5.3% greater than the current national uninsured rate.

State Comparison with National Uninsured Rate 25

20 21.3

15 16.4 16.0 2013 10 10.7 2015 Uninsured Rate 5

0 National Texas

Map Scale: Uninsured Rates per County 0% 5% 10% 15% 20%

Footnotes

[1] Civis Analytics uses a similar scoring method to assign most likely race to consumers which explains why the race distribution adds up to 100%. [2] March 10, 2015 ASPE Issue Brief with total plan selections by state from from November 15, 2015 to February 22, 2015. Full memo can be found here: http://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf [3] March 31, 2015 Effectuated Enrollment Snapshot released by the Department of Health and Human Services (HHS) on June 2, 2015. This includes all new and renewing consumers during the second open enrollment period from November 15, 2015 to February 22, 2015. Additional information can be found at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact- sheets-items/2015-06-02.html [4] Estimates of Eligibility for ACA Coverage among the Uninsured released by the Kaiser Family Foundation on June 1, 2015. Additional data and methodology can be found at: http://kff.org/uninsured/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/ [5] Ineligible for Financial Assistance is due to Income, ESI Offer, or Citizenship. [6] HHS released county level plan selection data broken down by age and race, among other groupings. These plan selections include all new and renewing consumers during the second open enrollment period. The full data file can be found at: http://aspe.hhs.gov/basic-report/2015-plan-selections-county-health-insurance-marketplace [7] Enrollments for which race is unknown was not included in this graphic. This varies between states, but 36% of plan selections had an unknown race. Other includes American Indian/Alaska Native, Native Hawaiian/Pacific Islander and Multiracial.

Additional Enroll America Research, Blogs and Maps can be found at : https://www.enrollamerica.org/research-maps/

Page 2 of 2 - Texas State Snapshot - Enroll America - October 2015 www.enrollamerica.org

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 200 INTERVIEWEE BIOGRAPHIES

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 201 Baptist Beaumont Hospital Community Health Needs Assessment Interviewee Biographies Interview Organization Name/s Title County Interviewer A B Date 4 County Area ‐ including Jefferson and Spindletop Center Sally Broussard 7/28/2015 Chief Administrative Officer Valerie Hayes x Orange Counties Sally Broussard is the Chief Administrative Officer for the Spindletop Center, a local mental health and intellectual disability authority. She has served in her current role for 34 years, and is a licensed marriage and family therapist. 5 County Area ‐ including Jefferson and March of Dimes Rasheeda Daugherty 8/10/2015 Community Director Valerie Hayes x Orange Counties Rasheeda Daugherty is the Community Director for the local March of Dimes office. She has served within her current role for over 2 years, and is originally from the area. Catholic Charities of 9 County Area ‐ including Jefferson and Carol Fernandez 7/30/2015 President / CEO Valerie Hayes x Southeast Texas Orange Counties Carol Fernandez is the President and CEO of the Catholic Charities of Southeast Texas, a social service agency providing a wide variety of programs for 9 Texas counties. She has served within her current role for over 5 years. Southeast Texas Regional Community Services Division Colleen Halliburton 8/3/2015 Hardin, Jefferson and Orange Counties Valerie Hayes x Planning Commission Director Colleen Halliburton serves as the Community Services Division Director of the Southeast Texas Regional Planning Commission, which covers Hardin, Jefferson and Orange Counties. She has a background in nonprofit management, and is originally from the area. United Way of Beaumont Karyn Hawkins 8/3/2015 President / CEO North Jefferson County Valerie Hayes x and North Jefferson County

Karyn Hawkins is the President and Chief Executive Officer of the United Way of Beaumont and North Jefferson County. She is a licensed CPA, and is originally from the area. American Red Cross of 11 County Area ‐ including Jefferson and Southeast and Deep East Chester Jourdan 8/5/2015 Executive Director Valerie Hayes x Orange Counties Texas Chester Jourdan is the Executive Director of the American Red Cross of Southeast and Deep East Texas that covers 11 counties, including Jefferson and Orange Counties. He has a Masters of Public Administration, and has served in his current role on and off since 2000. Southeast Texas Council on 6 County Area ‐ including Jefferson and John Neely 7/31/2015 Executive Director Valerie Hayes x Alcohol and Drug Abuse Orange Counties John Neely is the Executive Director of the Southeast Texas Council on Alcohol and Drug Abuse, which covers a 6 county area ‐ including Jefferson and Orange Counties. He has served in his current role for 10 years, and conducts substance abuse counseling and program management. Boys and Girls Club Michael Perez 8/5/2015 Executive Director Jefferson County Valerie Hayes x Michael Perez is the Executive Director of the Salvation Army Boys & Girls Club of Beaumont, which provides youth development services in the Beaumont area. Baptist Hospitals of SmartHealth Clinic/Disease Multi‐county area, including Jefferson Seth Stephens 7/29/2015 Valerie Hayes x Southeast Texas Management Director, ACNP and Orange Counties Seth Stephens is the Director of Disease Management Services at the Baptist Hospitals of Southeast Texas that serves Jefferson County, as well as patients from surrounding counties. He has been a Nurse Practitioner for 10 years, and runs the SmartHealth Clinic programs for the hospital.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 202 Baptist Beaumont Hospital Community Health Needs Assessment Interviewee Biographies Interview Organization Name/s Title County Interviewer A B Date Beaumont Public Health Sherry Ulmer 7/30/2015 Director Jefferson County Valerie Hayes x Department Sherry Ulmer is the Director of the Beaumont Public Health Department, which serves Jefferson County. She has been a registered nurse for 41 years, and has also done psychiatric nursing, medical surge, and home health. She has served in her current role for 3 years.

A: Work for a State, local, tribal, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community B: Member of a medically underserved, low‐income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations

Source: Baptist Hospital of Southeast Texas’ Community Health Needs Assessment Interviews conducted by Community Hospital Corporation; July 28, 2015 – August 10, 2015

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 203 PRIORITY BALLOT

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 204 Baptist Beaumont Hospital Community Health Needs Assessment Prioritization Ballot

 Please review the primary criteria we will use to identify the top community health priorities for Baptist Beaumont Hospital  Then cast 3 votes for each priority  Please scan and email to [email protected] or fax to 972-943-6401

1. Size and Prevalence of the Issue a. How many people does this affect? b. How does the prevalence of this issue in our communities compare with its prevalence in other counties or the state? c. How serious are the consequences? (urgency; severity; economic loss)

2. Effectiveness of Interventions a. How likely is it that actions taken will make a difference? b. How likely is it that actions will improve quality of life? c. How likely is it that progress can be made in both the short term and the long term? d. How likely is it that the community will experience reduction of long-term health cost?

3. Baptist Beaumont Hospital Capacity a. Are people at Baptist Beaumont Hospital likely to support actions around this issue? (ready) b. Will it be necessary to change behaviors and attitudes in relation to this issue? (willing) c. Are the necessary resources and leadership available to us now? (able)

Using the criteria listed above, please indicate how important you believe this priority is for the communities we serve, with #5 indicating the highest importance and #1 indicating the lowest importance. To cast your votes, just fill in one circle in every row.

Access to Affordable Care and Reducing Health Disparities Among Specific Populations Size and Prevalence of the issue      Effectiveness of Interventions      Baptist Beaumont Hospital Capacity     

Less Important ------More Important

Access to Mental and Behavioral Health Care Services Size and Prevalence of the issue      Effectiveness of Interventions      Baptist Beaumont Hospital Capacity     

Less Important ------More Important

Access to Specialty Care Services Size and Prevalence of the issue      Effectiveness of Interventions      Baptist Beaumont Hospital Capacity     

Less Important ------More Important

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 205 Need for Increased Emphasis on a Collaborative Continuum of Care Size and Prevalence of the issue      Effectiveness of Interventions      Baptist Beaumont Hospital Capacity     

Less Important ------More Important

Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Size and Prevalence of the issue      Effectiveness of Interventions      Baptist Beaumont Hospital Capacity     

Less Important ------More Important

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 206 Section 2: Implementation Plan

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 207 Baptist Hospitals of South East Texas Baptist Beaumont Hospital FY 2017 - FY 2019 Implementation Plan A comprehensive, six-step community health needs assessment (“CHNA”) was conducted for Baptist Beaumont Hospital (BBH) by Community Hospital Corporation (CHC). This CHNA utilizes relevant health data and stakeholder input to identify the significant community health needs in Jefferson and Orange Counties in Texas.

The CHNA Team, consisting of leadership from BBH, met with staff from CHC on May 16, 2016 to review the research findings and prioritize the community health needs. Five significant community health needs were identified by assessing the prevalence of the issues identified from the health data findings combined with the frequency and severity of mentions in community input.

The CHNA Team participated in a prioritization process using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital’s capacity to address the need. Once this prioritization process was complete, the hospital leadership discussed the results and decided to address all of the five prioritized needs in various capacities through hospital specific implementation plans.

The five most significant needs, as ranked during the May 16th prioritization meeting, are listed below: 1. Access to Mental and Behavioral Health Care 2. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 3. Access to Affordable Care and Reducing Health Disparities Among Specific Populations 4. Need for Increased Emphasis on Collaborative Continuum of Care 5. Access to Specialty Care Services

BBH leadership has developed the following implementation plan to identify specific activities and services which directly address all five priorities. The objectives were identified by studying the prioritized health needs, within the context of the hospital’s overall strategic plan and the availability of finite resources. The plan includes a rationale for each priority, followed by objectives, specific implementation activities, responsible leaders, annual updates and progress, and key results (as appropriate).

The BBH Board reviewed and adopted the 2016 Community Health Needs Assessment and Implementation Plan on June 27, 2016.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 208 Priority #1: Access to Mental and Behavioral Health Care Rationale: -In 2016, the rate of mental health care providers per 100,000 population in the report area (79.2 per 100,000) was lower than the state (102.3 per 100,000) rate and significantly lower than the national rate (202.8 per 100,000). When broken out by county, both Jefferson County (97.5 per 100,000) and Orange County (23.9 per 100,000) had a lower rate of mental health care providers than the state and the nation. -Four of the interviewees noted access to mental and behavioral health services as one of the biggest needs in the community. -Similar to primary and specialty care, interviewees noted that resources are inadequate for those without a pay source and high deductibles and medication costs were mentioned as a deterrent to seeking appropriate care. One interviewee specifically stated: "Many call about being off medications for months, but can't get any more or can't afford them and can't get back in to see someone for another two months." -Interviewees also discussed a lack of awareness regarding available resources and a stigma around accessing services. One interviewee raised concern around the lack of awareness of existing resources, stating: "There is not enough knowledge as to what are the available resources for folks who present substance abuse problems...I don't think the medical community really knows what to do with those folks." -One interviewee mentioned that there is a need for bilingual psychiatric services in the area, stating: "With counseling staff, there has also been a lack of bilingual psychiatric services."

Objective: Provide a point of access for mental health services in the community Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 1.A. BBH will continue to provide the only inpatient and outpatient psychiatric and Director of Psychiatric chemical dependency programs between xxx Houston and New Orleans. The hospital will Services focus efforts to promote these available services to the public.

1.B. Baptist Beaumont partners with the Spindletop Center to offer mental health and Director of Psychiatric xxx substance abuse treatment services. Baptist Services Beaumont pays for the first 72 hours for qualified patients, such as the uninsured.

1.C. BBH provides a detox program through Director of Psychiatric xxx its partnership with the Spindletop Center. Services

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 209 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

1.D. BBH is available to provide crisis care through its newly opened Crisis Stabilization Unit in partnership with the Spindletop Center. Director of Psychiatric The Crisis Stabilization Unit is open 24 hours xxx a day, 7 days per week, and provides a more Services affordable alternative to hospitalization. Services include group therapy, medication management, and psychiatric evaluation.

1.E. BBH therapists will continue to work with Director of Psychiatric xxx patients to refer them to appropriate facilities Services for their needed care.

1.F. In addition to the 3 recently recruited psychiatrists, BBH is currently exploring the Director of Psychiatric addition of Nurse Practitioners to the Services, Chief xxx Behavioral Health Center and is always Nursing Officer exploring the recruitment of additional psychiatrists to the area.

1.G. BBH will continue to be available to speak at local middle and high schools with regard to promoting mental or behavioral health on an as needed basis. BBH personnel Director of Marketing x x x have presented to local middle and high schools on emerging issues such as bullying, self harm, and recreational drug abuse.

1.H. BBH will continue to support the local Mental Health Association dinner every year Director of Marketing x x x in January through a donation towards their fundraising efforts.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 210 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

1.I. BBH will continue to provide a full-time psychiatric Nurse Practitioner in the Director of Psychiatric Emergency Room to screen and appropriately Services, Director of xxx address any applicable mental health patients Emergency Services that present to the Emergency Room.

1.J. BBH is an active member of the Community Mental Health Consortium, including all 3 hospitals in the area as well as law enforcement and EMS services, that Director of Marketing x x x meets quarterly to discuss how to better address mental health services in the community.

1.K. BBH will continue to strive to staff Director of Psychiatric bilingual Psychiatrists in its Behavioral Health Services, Director of xxx Center, as well as to provide a translation Business Development language line.

1.L. BBH will continue to create and release Public Service Announcements (PSA), such as its current synthetic marijuana PSA, Director of Marketing x x x regarding any emerging health issues in the area.

1.M. BBH will continue to provide Director of Psychiatric transportation for mental health patients to Services, Director of xxx get to their necessary therapy through the Chaplain Services mobile van and/or through the Chaplain Fund.

1.N. BBH will continue to provide geriatric Director of Behavioral xxx psychiatry services through its Senior Care Health Services Unit.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 211 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

1.O. BBH will continue to provide detox Director of Behavioral xxx services through its newly opened Detox Unit. Health Services

1.P. Upon discharge from the Behavioral Health Center, patients may seek available services through the Chemical Dependency Director of Psychiatric xxx Intensive Outpatient Program or the Partial Services Hospitalization Program that allows for patients to go back to work while still seeking necessary mental and behavioral health care.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 212 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles

Rationale: -Overall mortality rates in Jefferson and Orange Counties were higher than the state rates in 2011, 2012, and 2013. Between 2011 and 2013, Orange County had a higher overall mortality rate than Jefferson County and a much higher overall mortality rate than Texas. -Infant mortality rates in the report area (7.4 per 1,000 births) are higher than the state (6.2 per 1,000 births) and national rates (6.5 per 1,000 births). When broken out by county, Jefferson County (7.2 per 1,000 births) and Orange County (8.1 per 1,000 births) both have higher rates than the state and the nation. -Heart disease is the leading cause of death in both Jefferson and Orange Counties, as well as the state (2013). Jefferson County’s heart disease mortality rate increased between 2011 and 2013, Orange County’s rate decreased, and Texas’ rate remained relatively stable. In 2013, heart disease mortality rates in Jefferson County (213.5 per 100,000) and Orange County (219.3 per 100,000) were substantially higher than mortality rates in Texas (170.7 per 100,000). -In comparison to their respective peer county groupings, Jefferson County (131.8 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (160.8 per 100,000) ranked within the least favorable quartile for coronary heart disease deaths between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (103.4 per 100,000) and the U.S. median (126.7 per 100,000). -Cancer is the second leading cause of death in both Jefferson and Orange Counties, as well as the state (2013). Between 2011 and 2013, Jefferson County’s and Texas’ cancer mortality rates decreased, while Orange County’s rate increased. In 2013, Jefferson and Orange Counties (176.1 and 191.8 per 100,000) had higher cancer mortality rates than Texas (156.1 per 100,000). -In comparison to their respective peer county groupings, Jefferson County (195.2 per 100,000) ranked within the upper end of the two middle quartiles and Orange County (201.8 per 100,000) ranked within the least favorable quartile for cancer death rates between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (161.4 per 100,000) and the U.S. median (185.0 per 100,000). -Both Jefferson (48.9 per 100,000) and Orange (61.2 per 100,000) Counties have higher lung and bronchus cancer mortality rates than the state (43.4 per 100,000). -Jefferson (23.0 per 100,000) and Orange (23.1 per 100,000) Counties have very consistent female breast cancer mortality rates, as compared to the state (21.0 per 100,000). -Jefferson County (28.4 per 100,000) has a higher male prostate cancer mortality rate, as compared to Orange County (17.8 per 100,000) and the state (19.5 per 100,000). -Jefferson (19.7 per 100,000) and Orange (18.2 per 100,000) Counties have higher rates of colon and rectum cancer mortality rates than the state (15.3 per 100,000). -Orange County (87.6 per 100,000) has a much higher lung and bronchus cancer incidence rate as compared to Jefferson County (64.4 per 100,000) and the state (58.1 per 100,000). -Female breast cancer incidence rates in Jefferson (57.8 per 100,000) and Orange (60.3 per 100,000) Counties remain below the state (60.6 per 100,000). -Jefferson County (128.5 per 100,000) has a significantly higher rate of male prostate cancer incidence as compared to Orange County (97.0 per 100,000) and the state (115.7 per 100,000).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 213 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued Rationale: -Jefferson (47.2 per 100,000) and Orange (45.6 per 100,000) Counties have higher rates of colon and rectum cancer incidence than the state (40.2 per 100,000). -Jefferson and Orange Counties ranked within the two middle quartiles of their respective peer groupings for the rate of female breast cancer incidence rates (114.7 per 100,000 and 118.4 per 100,000, respectively) and male prostate cancer incidence rates (151.4 per 100,000 and 122.1 per 100,000, respectively) between 2006 and 2010. -Both Jefferson (50.4 per 100,000) and Orange (54.6 per 100,000) Counties ranked within the least favorable quartile of their respective peer county groupings for colon and rectum cancer incidence rates between 2006 and 2010. -While Jefferson County (65.4 per 100,000) ranked within the two middle quartiles for lung and bronchus cancer incidence rates between 2006 and 2010, Orange County (94.6 per 100,000) ranked within the least favorable quartile of its peer county grouping. -While chronic lower respiratory disease mortality rates in Texas remained relatively stable between 2011 and 2013, rates in Jefferson and Orange Counties increased. Orange County has the 9th highest rate of chronic lower respiratory disease deaths, as compared to all other counties in the state (2013). In 2013, chronic lower respiratory disease mortality rates in Orange County (79.9 per 100,000) were higher than Jefferson County (50.4 per 100,000), as well as the state (42.3 per 100,000). -In comparison to their respective peer county groupings, Jefferson County (46.7 per 100,000) ranked within the two middle quartiles and Orange County (73.3 per 100,000) ranked at the very top of the least favorable quartile for chronic lower respiratory disease death rates between 2005 and 2011. Orange County ranked above the U.S. median (49.6 per 100,000). -Mortality rates due to accidents in Orange County and Texas steadily decreased between 2011 and 2013. Rates in Jefferson County increased. Accident mortality rates in Orange County (46.7 per 100,000) and Jefferson County (44.6 per 100,000) were higher than the state (36.8 per 100,000) in 2013. In 2013, the leading causes of fatal accidents in Jefferson and Orange Counties were due to motor vehicle accidents and accidental poisonings and exposure to noxious substances. -In comparison to their respective peer county groupings, both Jefferson County (48.1 per 100,000) and Orange County (85.6 per 100,000) ranked within the least favorable quartiles for unintentional injury death rates between 2005 and 2011. Jefferson County ranked above the Healthy People 2020 Target (36.0 per 100,000), and Orange County ranked above both the Healthy People 2020 Target and the U.S. median (50.8 per 100,000). -Cerebrovascular disease mortality rates decreased in Orange County and the state between 2011 and 2013, while Jefferson County’s rates increased. Orange County has the 12th highest rate of cerebrovascular disease mortality as compared to all other counties in the state. Jefferson County has the 16th highest rate (2013). In 2013, Orange County had the highest cerebrovascular disease mortality rate (57 per 100,000) as compared to Jefferson County (55 per 100,000) and the state (40.1 per 100,000). -In comparison to their respective peer county groupings, Jefferson County (60.0 per 100,000) and Orange County (54.6 per 100,000) both ranked within the least favorable quartile for stroke deaths between 2005 and 2011. Both counties ranked above the Healthy People 2020 Target (34.8 per 100,000) and the U.S. median (46.0 per 100,000).

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 214 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued Rationale: -Chlamydia rates in Jefferson County have recently increased, while rates in Orange County and the state have recently decreased (2012-2014). In 2014, Jefferson County (560.6 per 100,000) had higher rates of Chlamydia as compared to Orange County (248.1 per 100,000) and the state (475.0 per 100,000). -Gonorrhea rates in Jefferson County have steadily increased, while rates in Orange County and the state remain steady (2012-2014). In 2014, Jefferson County (241.0 per 100,000) had significantly higher Gonorrhea rates than Orange County (48.3 per 100,000) and the state (127.7 per 100,000). -In 2012, the percent of adults (age 20+) ever diagnosed with diabetes by a doctor in the report area (10.7%) was higher than the state (9.2%) and national (9.1%) rates. When broken out by county, Jefferson County (11.4%) had a higher rate of adults with diabetes than the state, while Orange County (8.6%) ranked below the state. -In comparison to their respective peer county groupings, Jefferson County (10.9%) ranked within the upper end of the two middle quartiles and Orange County (6.8%) ranked within the most favorable quartile for the percent of adults living with diagnosed diabetes between 2005 and 2011. Jefferson County ranked above the U.S. median (8.1%). -In 2012, over one-third (35.2%) of adults (age 20+) in the report area reported that they have a Body Mass Index (BMI) greater than 30.0 (obese), as compared to 28.2% in the state and 27.1% in the nation. When broken out by county, Jefferson County (36.7%) had a significantly higher rate of adult obesity than the state, while Orange County (30.8%) ranked just slightly above the state. -In 2014, HSR 6/5S (34.2%) had a higher prevalence rate of obesity than the state (31.9%). Obesity prevalence rates in adults (age 18+) in HSR 6/5S and the state appear to be increasing (2012-2014). -In comparison to their respective peer county groupings, Jefferson County (35.5%) ranked within the least favorable quartile and Orange County (31.1%) ranked within the two middle quartiles for the percent of obese adults between 2006 and 2012. Both counties ranked above the U.S. median (30.4%). -In comparison to their respective peer county groupings, Jefferson County (4.4%) and Orange County (3.7%) both ranked within the two middle quartiles for the percent of older adults living with asthma in 2012. Both counties ranked above the U.S. median (3.6%). -In 2012, the percent of the adult population (age 20+) in the report area (29.3%) that self-reported no leisure time for physical activity was higher than the state (24.0%) and national (22.6%) rate. When broken out by county, both Jefferson County (29.6%) and Orange County (28.5%) had higher rates of physical inactivity than the state and the nation. -In comparison to their respective peer county groupings, Jefferson County (33.7%) and Orange County (31.3%) both ranked in the least favorable quartile for the percent of adults who reported no leisure time physical activity between 2006 and 2012. Both counties ranked above the U.S. median (25.9%), and Jefferson County ranked above the Healthy People 2020 Target (32.6%). -The percent of the adult population (age 18+) in the report area (23.5%) that self-reported currently smoking some days or every day was higher than the state (16.5%) and national rate (18.1%) (2006-2012). When broken out by county, both Jefferson County (22.1%) and Orange County (27.9%) had higher rates of smoking than the state and the nation.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 215 Priority #2: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Continued Rationale: -In comparison to their respective peer county groupings, Jefferson County (22.1%) and Orange County (27.9%) both ranked within the least favorable quartile for the percent of adults who reported smoking cigarettes between 2006 and 2012. Both counties ranked above the Healthy People 2020 Target (12.0%) and the U.S. median (21.7%). -The rate of teen (females age 15-19) births in the report area (55.4 per 1,000) is slightly higher than the state (55.0 per 1,000) and national rates (36.6 per 1,000) (2006-2012). When broken out by county, Orange County (57.5 per 1,000 population) has a higher rate of teen births than the state and the nation. Jefferson County fell slightly below the state at 54.8 per 1,000 population. -The percent of low birth weight (<2,500g) births in the report area (10.2%) is higher than the state (8.4%) and national rate (8.2%) (2006-2012). When broken out by county, both Jefferson County (10.4%) and Orange County (9.6%) have a higher percent of low birth weight births than the state and the nation. -In 2014, the percent of female adults (age 40+) in HSR 6/5S (22.8%) that did not receive a mammogram in the past 2 years was lower than the state (29.0%), as well as all of other regions. -In 2014, the percent of adults (age 50-75) in HSR 6/5S (41.5%) that did not have a colonoscopy in the past 10 years was slightly lower than the state (42.6%). Between 2006 and 2012, the percentage of adults (age 50+) who self-reported that they have ever had a sigmoidoscopy or colonoscopy in the report area (56.1%) was lower than the state (57.3%) and national rate (61.3%). When broken out by county, Jefferson county (59.4%) had a higher percent of adults that have ever received a sigmoidoscopy or colonoscopy than the state, while Orange County (47.0%) had a lower percentage than the state and the nation. -In 2014, the percent of adults in HSR 6/5S (67.8%) that did not receive a flu shot in the past year was slightly higher than the state (66.2%). -Many interviewees mentioned that the prevalence of certain chronic conditions is a concern in the community. The conditions and unhealthy behaviors mentioned include: obesity, diabetes, cardiovascular and heart diseases, hypertension, and physical inactivity. -Along with chronic conditions, physical fitness and active lifestyles were also mentioned as significant needs. A few interviewees noted the lack of infrastructure or built environment to facilitate physical activity. One interviewee specifically stated: "We need access to parks, we have neighborhoods with no sidewalks. It's just diet and the built environment." -Many interviewees mentioned that restaurants in the area do not offer healthier alternatives, and one interviewee stated: "[There is a need for] availability of access to good, healthy food."

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 216 Objective: Implement programs and provide educational opportunities that seek to address unhealthy lifestyles and behaviors in the community Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

2.A. BBH is actively participating with the City of Beaumont in the “Let’s Move” initiative in Southeast Texas. This national program is Director of Marketing x designed to promote healthy lifestyles, activities and education on wellness.

2.B. BBH will continue to reach out to the community by offering numerous classes, speakers and other informative activities. Hospital personnel are made available as Director of Marketing x x x speakers for civic groups, industrial partners, media appearance and health fairs to address health topics of particular concern to the public. 2.C. BBH will continue to host quarterly community seminars on topics such as joint replacement and bariatrics, as well as Director of Marketing x x x increase awareness of these service offerings through social media outlets.

2.D. BBH provides support groups to encourage follow-up and continued education for patients during and after an illness. BBH initiates support groups for patients and family members based on demand for the programs. Director of Marketing x x x Some of the groups currently meeting include: Stroke Wise Support Group, Bariatrics, Cancer Support Group and Diabetes Education.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 217 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

2.E. BBH partners with community organizations to host a variety of free health screenings which can include blood pressure, Director of Marketing x x x weight, glucose, pulmonary function, diabetes and heart disease on an as needed basis.

2.F. BBH partners with the Beaumont Independent School District to host educational wellness programs at school Director of Marketing x campuses on a variety of topics. The programs are provided to both school staff as well as students. 2.G. BBH will continue to partner with EMS Director of Emergency to promote better health in the community, Services, Vice xxx including quarterly lunch and learns President of Business surrounding trauma and emergency Development education. 2.H. BBH provides regular Tobacco Awareness programs in the hospital, at Director of Cancer employer locations and at community events xxx to outline the risks of smoking and tobacco Services use, including lung cancer and other pulmonary diseases.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 218 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 2.I. BBH will continue to engage in a variety of employee wellness initiatives, including: promoting employee and family wellness via Accountable Health and the Hospital Wellness Committee; offering need specific special programs; CHIP (Coronary Health Improvement Plan); smoking cessation; weight management; collaborating with Director of Human xxx hospital cafeteria providers to highlight Resources healthy food options; promoting fitness opportunities and exercise classes on campus, as well as discounted gym membership offerings; charitable fitness events; providing mental health education through the Employee Assistance Program via Beacon Health Options; and continuing to implement the tobacco-free new hire policy.

2.J. BBH will strive to maintain designation Director of Women's as a Texas Ten Step Facility by the xx Department of State Health Services and the Services Texas Hospital Association.

2.K. BBH will evaluate the opportunity to establish a Breast Milk Depot. This program involves healthy, lactating women to donate their extra breast milk to preterm and ill infants in need when a mother cannot provide Director of Women's her own breast milk. Partnering with the x Breast Milk Bank of Austin, potential donors Services are evaluated and screened. Once approved, they will be allowed to donate breast milk on site at Baptist Beaumont Hospital and the breast milk will be sent to Austin to be used by all Texas hospitals.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 219 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 2.L. BBH will continue to offer educational seminars on health, wellness and independent living issues including taking Director of Marketing x x x medications, basic first aid, health screening and defensive driving classes to the 55+ members of the population.

2.M. BBH will continue to partner with the Congregational Health Ministry (Parish Nursing) to provide a Faith Community Nursing program designed to promote the ministry of the nurse in local congregations, training and certifying nurses to become Faith Community Nurses (FCN). This program provides unreimbursed services and training to educate faith-based nurses to function in Director of Chaplain their respective congregations and assist xxx them with the implementation of their Services congregational programming. BBH, Faith Community Nurses, partnering with Congregational Health Ministry, will work together with other health professionals to provide assessment through screening and consultations (i.e., health education as appropriate for identified needs, referral for care and follow-up, coordination of health ministries' activities).

2.N. BBH will continue to participate in the annual Orange County Senior Rally and the Beaumont Senior Rally to provide pharmaceutical consulting, glucose Director of Marketing x screenings, lung screenings, pulmonary function tests, fall prevention strategies, stroke assessments, cancer screenings, and mental health screenings.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 220 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 2.O. BBH will continue its partnership with local private and public schools to provide health screenings to faculty members. Director of Marketing x Screenings are free and include height, weight, blood pressure, BMI, cholesterol, and glucose measurements.

2.P. BBH will continue to provide free immunizations to local private and public school faculty members, including influenza, Director of Marketing x shingles, pertussis and pneumonia vaccinations, as well as TB skin tests.

2.Q. BBH will continue to follow up with higher risk patients (i.e., stroke, CHF, joint Director of Advanced replacement patients) in order to provide high Practice Nursing xxx quality, follow up care with guidance if Services necessary.

2.R. BBH will continue to participate in the Community Nursing Home Consortium, which includes all local nursing homes, Skilled Director of Care Nursing Facilities, and Home Health Care xxx Agencies, to meet on a quarterly basis and Management comprehensively discuss and address any emerging issues in the area and how to address such issues.

2.S. BBH personnel serve in leadership roles and as volunteers with many agencies and Director of Marketing x x x committees in the community.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 221 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 2.T. BBH will continue to coordinate events during designated months, such as stroke awareness in May, prostate cancer in Director of Marketing x x x September, and breast cancer awareness in October, that may include the provision of low cost or free related screening services.

2.U. BBH personnel will continue to provide education and information sessions to Director of Marketing x x x organizations on an as needed basis.

2.V. BBH will continue its partnership with Hardin Jefferson High School to educate students about two year health care degrees and to promote health care careers within the high school student population. BBH provides Hardin Jefferson High School with the Director of Marketing x necessary equipment to instruct their newly created IV Therapy and Infusion class, which allows for students to get a certificate where they can immediately begin working right out of high school.

2.W. BBH will continue to serve as the corporate sponsor for the Exygon / Baptist Director of Marketing x x x Gusher Marathon. 2.X. BBH will continue to participate in the Director of Chaplain x Harvest Food Drive at the Orange hospital for Services the Orange County Food Bank.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 222 Priority #3: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Rationale: -The majority of growth in both counties and the state over the next five years is expected to come from the 65 years and older population (2016-2021). -The median household income in Jefferson County ($43,442) is lower than that of Orange County ($53,180), the state ($48,776) and the nation ($48,280) (2016). -Unemployment rates in Texas have steadily decreased since 2013. As of 2015, Jefferson and Orange Counties’ unemployment rates (7.0% and 6.5%, respectively) remain higher than the state rate (4.5%). -Almost 18% of residents in Jefferson County have a Bachelor’s or Advanced Degree compared to 15.1% in Orange County and about 27% in Texas. Nearly 30% of residents across the United States have an Bachelor’s or Advanced Degree. -In 2013-2014, the percent of students receiving their high school diploma within four years in the report area (87.6%) was lower than the state rate (89.6%). When broken out by county, Jefferson County (86.1%) had a lower graduation rate than the state but was slightly higher than the national rate. Orange County (91.4%) had a higher graduation rate than the state and the nation. -Jefferson County (17.5%) has a higher percent of families living below poverty as compared to Orange County (11.0%), but both counties remain below the state rate (24.6%) (2016). -As of 2013, almost one-fourth (24.0%) of the population in the report area experienced food insecurity, as compared to 17.6% in the state. When broken out by county, both Jefferson County (24.9%) and Orange County (21.5%) had higher percentages of food insecurity within their respective populations as compared to the state and the nation. -The percent of public school students that are eligible for free/reduced price lunch between 2013 and 2014 in the report area (63.6%) is slightly higher than the state (60.1%), and national (52.4%) rates. When broken out by county, Jefferson County (67.5%) had a higher percentage of its public school students that were eligible for free or reduced price lunch than the state and the nation, while Orange County (52.5%) ranked below the state. -The number of food stores and other retail establishments that are authorized to accept WIC Program benefits and that carry WIC foods and food categories in the report area (8.9 per 100,000) is slightly lower than the state (9.1 per 100,000) and national rates (15.6 per 100,000) (2011). When broken out by county, Jefferson County (8.3 per 100,000) has a lower rate of WIC-Authorized food stores than the state and the nation. Orange County (10.9 per 100,000) has a slightly higher rate than the state, but still ranks below the national rate. -In 2012, the percent of female Medicare Enrollees (age 67-69) in the report area (61.4%) that received one or more mammograms in the past two years was slightly higher than the state (58.9%) and higher than the nation (63.0%). When broken out by county, Orange County (56.3%) had a lower percent of female Medicare Enrollees that received a mammogram within the past 2 years than the state and the nation. Jefferson County (63.6%) had a higher percent than the state and the nation. -In 2014, HSR 6/5S (42.9%) had one of the highest percentages of adults (age 65+) that did not receive a flu shot in the past year, as compared to all other regions and the state (41.2%). Between 2012 and 2014, the percent of adults (age 65+) that did not receive a flu shot in the past year in 6/5S increased, while rates in the state remained steady. -Between 2006 and 2012, the percent of the population (age 65+) in the study area (68.2%) that self-reported ever having received the pneumonia vaccine was slightly higher than the state (67.7%) and national (67.5%) rates. When broken out by county, Orange County (61.7%) had a lower percent of its population (age 65+) that had ever received the pneumonia vaccination as compared to the state and the nation. Jefferson County (70.6%) had a higher percent than the state and the nation.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 223 Priority #3: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Continued Rationale: -In 2014, the percent of adults (age 65+) that had never received a pneumonia shot in HSR 6/5S (34.8%) was higher than the state’s (32.1%) and all other regions. Between 2012 and 2014, the percent of adults (age 65+) that had never received a pneumonia shot in HSR 6/5S fluctuated, while the state’s rate increased. -Between 2010 and 2014, the percent of the population (all ages) in the report area (21.7%) that were uninsured was slightly lower than the state (21.9%), but higher than the national (14.2%) rates. When broken out by county, Jefferson County (22.9%) had a higher percent of uninsured residents than the state and the nation. Orange County (18.3%) had a lower uninsured rate than the state, but still ranked above the nation. -As of 2015, Jefferson County (18.0%) has the highest rate of uninsured adults (age 18-64) as compared to Orange County (16.0%), as well as the state (16.0%) and nation (10.7%). -In comparison to their respective peer county groupings, Jefferson County (24.1%) and Orange County (21.7%) both ranked within the least favorable quartile for the percent of the population without health insurance in 2011. Both counties ranked above the U.S. median (17.7%). -In comparison to their respective peer county groupings, Jefferson County (21.1%) ranked within the least favorable quartile and Orange County (15.2%) ranked within the two middle quartiles for the percent of adults who did not see a doctor due to cost between 2006 and 2012. Both counties ranked above the Healthy People 2020 Target (9.0%), and Jefferson County ranked above the U.S. median (15.6%). -Between 2010 and 2014, one-fourth (24.7%) of the insured population in the report area was receiving Medicaid, which is above the state (22.1%) and national rates (20.8%). When broken out by county, Jefferson County (26.1%) had a higher percent of insured residents receiving Medicaid than the state and the nation. Orange County (20.8%) had a lower percent than the state, but still ranked slightly above the nation. -Between 2010 and 2014, 8.2% of households in the report area had no motor vehicle, as compared to 5.9% in Texas and 9.1% in the nation. When broken out by county, Jefferson County (9.3%) had a higher percent of households with no motor vehicle than the state and the nation, while Orange County (4.8%) had a lower percent than the state and the nation. -Interviewees overwhelmingly agreed ability to pay and insurance coverage are strong determinants of health in the area. The majority of interviewees agreed that access to primary care and dental services are adequate in the area but only for those who have a payment source. One interviewee specifically stated: "We are getting more options if you have money, but fewer options if you're in that middle to lower income area." -Many of the interviewees agreed that physicians in the area are not accepting Medicaid and Medicare, which presents a barrier for those patients in seeking care, and one interviewee stated: "The physicians are going where the dollars are, and a lot of them don't want to take Medicare/Medicaid." -A few interviewees mentioned the cost of health care is a concern for all populations, regardless of coverage. One interviewee stated: "Affordability is a concern, even when you have insurance." -A couple interviewees mentioned that transportation is a particular issue for the elderly and the low income populations, and one interviewee stated: "For elderly, we need to bring the services to where the people are. In areas where there is not public transportation it makes it very difficult for poor people and seniors."

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 224 Objective: Implement and offer programs that aim to reduce health disparities by targeting specific populations Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 3.A. BBH will continue to provide HIV Education in partnership with a grant from Director of Emergency xx Texas Department of State Health Services to Services provide free HIV screening and linkage to care for HIV positive patients.

3.B. The Julie Rogers Gift of Life Free Mammogram Program was established in 1993 as a collaborative effort between the Julie & Ben Rogers Cancer Institute, Baptist Hospitals of Southeast Texas and University Director of Cancer of Texas Medical Branch. The Gift of Life has xxx made mammography services available to Services women who need the examination but are unable to obtain the procedure due to financial limitations or other constraints. Baptist Beaumont participates in the program and offer free mammograms at its facility.

3.C. The Julie & Ben Rogers Cancer Institute offers free prostate screenings to promote early detection of the disease. A team of the Cancer Institute employees generously Director of Cancer xxx contribute their time and expertise to the Gift Services of Life Educational Programs. Baptist Beaumont will participate in any prostate screening events offered through the Gift of Life Program.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 225 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 3.D. BBH will continue to provide transportation to applicable patients to their Director of Care xxx respective households, and make Management arrangements for wheelchair vans or to take an ambulance as necessary.

3.E. BBH will continue to provide nearby Vice President of office space at no cost for the SANE (Sexual xxx Assault Nurse Examiner) organization that Business Development treats sexually assaulted patients.

3.F. BBH will continue its partnership with the Director of Women's Legacy Clinic to provide sliding fee scale x primary care, OB/GYN, and pediatric services Services to underserved populations.

3.G. BBH will continue its partnership with UT Houston to open its UT Physician Clinic Vice President of x near the hospital, which will provide medical, Business Development dental, and mental health services on a sliding fee scale.

3.H. BBH will continue its partnership with Jefferson County Correctional Facility to Director of Managed xxx provide care to its prisoners, including the Care provision of colonoscopies to correctional facility prisoners every other Thursday.

3.I. BBH will continue its contract with ADRIEMA to assist patients in getting them Director of Business signed up for any health coverage that they xxx may qualify for. ADRIEMA also assists in Services helping mothers and their babies sign up for Medicaid and CHIP.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 226 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 3.J. BBH will continue to provide a language Director of Care line to provide translation services for non- xxx English speaking patients and families as Management needed.

3.K. BBH will continue to host a jewelry show that donates all proceeds to the Chaplain Fund, which is used for patient medicine, Director of Marketing x x x groceries, utility bills, travel, etc. on an as needed basis.

3.L. The employees of Baptist Beaumont are dedicated to enhancing community wellness. During the holiday season, individuals collect gifts for children within the Child Protective Service Agency of Southeast Texas, and distribute gifts to senior adults as well, in conjunction with Homestead Director of Marketing x x x Homecare. The “Angel Tree” and employee participants provide children and senior adults with a joyous Christmas delivery. Equally compassionate, employees initiate a celebration, gift giving and mentoring for the inhabitants of Buckner’s Children Village.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 227 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

3.M. Baptist Beaumont has established the Positive Points Program in conjunction with Beaumont ISD, Vidor ISD, Nederland ISD and Hardin Jefferson ISD. The program involves third, fourth and fifth grade students who are awarded points from his/her teacher based on Director of Marketing x x x positive behaviors. These positive behaviors may consist of random acts of kindness, courtesy toward others, good listening skills and respect for adults. The children with the most points are taken on a field trip to the hospital where lunch is provided.

3.N. Baptist Beaumont will continue to Director of Marketing x x x participate in the Santa for Seniors program.

3.O. Baptist Beaumont will continue to participate in the Buckners Christmas Director of Marketing x x x program.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 228 Priority #4: Need for Increased Emphasis on a Collaborative Continuum of Care Rationale: -In 2014, HSR 6/5S (34.1%) had a higher percent of adults that had no personal doctor than the state (32.9%), as well as the majority of other regions. -In 2012, the rate of primary care physicians per 100,000 population in the report area (52.9 per 100,000) was lower than the state (58.5 per 100,000) and national rate (74.5 per 100,000). When broken out by county, Orange County (28.9 per 100,000) had a lower rate of primary care physicians than the state and the nation. Jefferson County (60.8 per 100,000) ranked above the state but below the nation. -In comparison to their respective peer county groupings, Jefferson County (68.8 per 100,000) and Orange County (26.7 per 100,000) both ranked within the least favorable quartiles for the rate of primary care providers per 100,000 persons in 2011. Orange County ranked below the U.S. median (48.0 per 100,000). -As of April 2016, 100% of the population in both Jefferson and Orange Counties are living within a HPSA. -In 2013, the rate of dental care providers per 100,000 population in the report area (46.2 per 100,000) was lower than the state (51.5 per 100,000) and national rates (63.2 per 100,000). When broken out by county, Orange County (26.5 per 100,000) had a lower rate of dentists than the state and the nation. Jefferson County (52.7 per 100,000) had a slightly higher rate of dentists than the state but still ranked below the nation. -In 2012, the rate of preventable hospital events in the report area (69.3 per 1,000 Medicare Enrollees) was higher than that of the state (62.9 per 1,000) and the nation (59.2 per 1,000). When broken out by county, Jefferson County (64.8 per 1,000 Medicare Enrollees) and Orange County (80.8 per 1,000 Medicare Enrollees) had higher rates of preventable hospital events than the state and the nation. -Interviewees discussed the need for collaboration among health care professionals, including specialists. Issues include: more patient-centered care, emphasis on prevention, and more comprehensive care. One interviewee specifically stated: "Emergency to follow up care is bad. If the PCP is the ER, and a family doesn’t have a doctor, then transitioning to follow up care or outpatient is lacking. That goes back again to the lack of specialists." -Interviewees also discussed the need for increased patient education. Issues include: the need to provide more information about how to access healthcare coverage, and misuse of the emergency room / lack of understanding of resources. -Other concerns regarding the continuum of care include: long wait times and difficulty in making appointments, and transitions between care settings. One interviewee emphasized longer wait times and the fragmented continuum of care, stating: "If you are on Medicaid, if you’re not using one of the FQHCs, and even then, you wait long periods of time there. If you are uninsured or under insured, they’re going to wait a very long time."

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 229 Objective: Engage in efforts to improve the fragmented continuum of care Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

4.A. BBH provides a SmartHealth Clinic designed to provide navigation for recently discharged patients with acute heart failure, COPD, Diabetes and/or hypertension. Patient demographics include uninsured, Director of Advanced indigent, Medicaid and Underserved. Practice Nursing xxx Benefits will be improved quality of care, Services increased attention to patient safety, smoother care transitions, decreased healthcare costs and improved time savings for referring providers.

4.B. BBH will participate in Nursing Home/Community Health partnerships to provide increased collaborative efforts which will improve quality and efficiency of care for Director of Case xxx patients needing home health, nursing home Management and palliative care. This includes the quarterly nursing home consortium, establishing the quarterly home health consortium, and extending bi-annual educational programs.

4.C. BBH will continue to provide a Patient Portal (YourCareCommunity.com) to increase Director of Information xxx quick access to patient medical records and Technology billing. Patients are able to access the Patient Portal through the mobile phone application.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 230 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

4.D. The on-site SmartHealth Clinic at BBH is designed to follow up with high-risk, non- compliant emergency room patients who have chronic diseases, such as diabetes, heart disease, or pulmonary disease in order to Director of Advanced keep those patients healthy and out of the Practice Nursing xx ER. Navigators at the clinic make sure that all Services of the patients' transportation needs are met and assist them in finding low-cost or free health resources that they might qualify for in the community.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 231 Priority #5: Access to Specialty Care Services

Rationale: -Interviewees agreed that access to specialist services is a big need in the community. Specialties mentioned include: psychiatry and psychology, OB/GYN services, pediatrics, and affordable emergency care. One interviewee emphasized the lack of specialists by stating: "We have plenty of primary care providers, but not enough specialists." -A few interviewees mentioned that patients needing specialty services are typically referred out to Houston or Galveston to access care, and one interviewee stated: "We have very few specialty care providers…high risk patients are sent to Galveston or Houston to be seen." -One interviewee specifically discussed affordable emergency services for minors as a need in the area, stating: "There's not a reasonably priced emergency service for minor care." Objective: Provide access to specialist services in the community Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

5.A. In addition to services already available at the hospital, Baptist Beaumont will actively recruit additional physicians, including (but not limited to): Oncology, Psychiatry, Vice President of Cardiology, Pediatrics, Primary Care (Internal xxx Medicine and Family Medicine), Neuro Business Development Surgery, General Surgery, Podiatry, Gastroenterology, Urology, Pediatric Surgeon, Orthopedics, and Thoracic Surgeon.

5.B. BBH will continue to provide Director of Information opportunities for better community access to xxx medical services through collaboration with Technology Houston Healthcare Connect.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 232 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019

5.C. Baptist Beaumont will continue implementation of the CIHQ Stroke Certified Program and grow the Stroke Education Program targeting the following counties: Orange, Jefferson, Jasper, and Hardin Chief Nursing Officer x x x Counties. This will include educational programs on the prevention of vascular diseases related to strokes, monthly stroke meetings and community and employee educational events.

5.D. Baptist Beaumont will continue to partner with the city of Beaumont in its designation from the state of Texas as a "Certified Stroke City". The certification status involves ongoing patient education, the Director of Marketing x x x hospitals’ non-smoking policy, serving on various committees and providing data to the state regarding this initiative, in order to retain certification.

5.E. BBH will continue its contract with the Director of Women's xx Legacy Clinic to do all of their infant Services deliveries. 5.F. BBH will continue to provide Telestroke Director of Emergency xxx services in partnership with UT Physicians in Services Houston. 5.G. BBH will continue to explore Director of Emergency xxx Teleneurology and Telepsychiatry Services opportunities.

5.H. BBH will continue to explore increasing Chief Nursing Officer x rotation coverage for neurological services.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 233 Estimated Year Key Results Implementation Activity Responsible Leader(s) FY FY FY Progress (As Appropriate) 2017 2018 2019 5.I. BBH will continue to provide a list of Director of Care xxx referral specialty services in both English and Management Spanish on an as needed basis. Director of Imaging Services, Director of 5.J. BBH will continue to serve as a teaching Respiratory Therapy, xxx facility for Radiology, RN, Respiratory Director of Food Therapy, and Dietetics students. Service, Assisting Chief Nursing Officer

5.K. BBH will continue its Baptist Hospital School of Radiological Technology to provide Director of Imaging xxx accepted students with clinical rotation Services education over a span of 2 years. Students graduate with an Associate's degree.

5.L. BBH will continue to incentivize its Vice President of providers through the payment of physicians xxx and specialists to be on call and increase the Business Development number of uninsured patients receiving care.

5.M. BBH will continue to partner with the UT Director of Chaplain Medical Branch in Galveston transplant clinic xxx in order to promote organ donation for Services patients with varying organ needs.

5.N. BBH will continue to provide an OB/GYN oncologist that rotates through the Chief Nursing Officer x x x clinic from UT Medical Branch on a monthly basis.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 234 Section 3: Feedback, Comments and Paper Copies

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 235 INPUT REGARDING THE HOSPITAL’S CURRENT CHNA

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 236 CHNA Feedback Invitation

• Baptist Beaumont Hospital invites all community members to provide feedback on its previous and existing CHNA and Implementation Plan. • To provide input on this or the previous CHNA, please see details at the end of this report or respond directly to the hospital online at the site of this download.

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 237 Feedback, Questions or Comments?

Please address any written comments on the CHNA and Implementation Plan and/or requests for a copy of the CHNA and Implementation Plan to:

Mary W. Poole Director of Public Relations Baptist Hospitals of Southeast Texas 3080 College Street Beaumont, TX 77701 Phone: (409) 212 – 6145 Email: [email protected]

Please find the most up to date contact information on the Baptist Beaumont Hospital website in the “Community Health Needs Assessment” section under “About Us”: http://www.bhset.net/About‐Us/Community‐Health‐Needs‐Assessment.aspx

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 238 Thank you!

Community Hospital Corporation 7800 N. Dallas Parkway, Suite 200 Plano, TX 75024 972‐943‐6400

www.communityhospitalcorp.com

Cindy Matthews ‐ [email protected] Lisette Hudson ‐ [email protected] Valerie Hayes ‐ [email protected] Jessica Noel – [email protected]

Baptist Beaumont Hospital Community Health Needs Assessment and Implementation Plan June 2016 Community Hospital Corporation Page 239