Brunswick Campus Community Health Needs Assessment April 2019 Approved by the SGHS, Inc. Board of Directors April 24, 2019 1 SGHS Community Health Needs Assessment, Brunswick Campus April 24, 2019 A Message from Michael D. Scherneck Southeast Georgia Health System is pleased to present its Community Health Needs Assessment (CHNA) for the three years ending April 30, 2019. Building on the work done in its Fiscal Year 2016 CHNA and to better understand the health needs of the community, we surveyed nearly 1,000 community members and sought input from public health officials, local Federally Qualified Health Centers, and medical professionals practicing in the area. We also conducted focus groups in each of our service area counties to refine and prioritize high needs areas for their specific counties. The focus group findings, along with high needs areas identified from surveys and public data, were reviewed and prioritized. Among the essential health needs identified through this process were the following: . Increased access to primary care; . Targeted health education and screenings in areas of high need; . Coordination with other community providers to improve maternal and neonatal health outcomes; . Assistance in locating resources for recently discharged patients to support successful and stable transitions home; . Raised awareness about available resources for mental health care treatment; and . Identification and recruitment of specialty physicians in areas of high need. The CHNA provides the Health System with a road map to assist us in determining how we can invest in the community’s health needs to achieve maximum impact, especially for our most vulnerable citizens. It also provides an opportunity to work collaboratively – through, among others, the 300 physicians on its medical staff and more than 400 nurses employed at the Brunswick Campus – with key partners in our community to continue to make Southeast Georgia a healthier place to live. We are excited to continue to invest in the community’s health and look forward to implementing solutions to gaps in care identified through this important work. Sincerely, Michael D. Scherneck President & Chief Executive Officer Southeast Georgia Health System, Inc. 2 SGHS Community Health Needs Assessment, Brunswick Campus Table of Contents WHY PERFORM A COMMUNITY HEALTH NEEDS ASSESSMENT? 6 The System and its Obligations to Stakeholders 6 An Overview of the Process 7 Information Gathering Steps 7 Prioritization Steps 8 DATA AND COMMUNITY INPUT ABOUT PRIORITIES WILL GUIDE THE IMPLEMENTATION STRATEGY 8 Expert Survey Priorities: FQHCs and Public Health Interviews and Professional Survey 9 Community Focus Group Priorities 10 Survey Respondent Priority Concerns 11 Public and Hospital Data Point to Issues that Affect Residents 12 Steering Committee Priority Needs and Concerns 12 DEFINING THE SERVICE AREA: DEMOGRAPHICS, GEOGRAPHY AND SPECIAL POPULATIONS SERVED BY THE BRUNSWICK CAMPUS 14 Geographic Service Area 14 A Description of the Populations Served by the Brunswick Campus 15 Brunswick Campus Discharges 15 Demographics 15 Area Population 15 Population by Age 16 Population by Race, Nativity, and Language 17 Population by Type of Household, Family, and Marital Status 18 Population by Educational Attainment 19 Population by Income 20 Population by Employment Status 21 Special Populations 21 Low Income Residents 21 Vulnerable Children and Families 22 Veterans 23 Special Populations: Residents without Health Insurance 23 Persons with Disabilities 25 Homeless 26 3 SGHS Community Health Needs Assessment, Brunswick Campus Economic Characteristics of Service Area 27 Economic Indicators 27 Owner Occupied Housing, Median Gross Rent, and Building Permits, 2017 27 Computer and Broadband Access 27 Unemployment 28 Commuting Population 29 Government Transfer Payments by Category 29 Supplemental Nutrition Assistance Program 30 Other Community Factors 30 Crime 30 Transportation 30 COUNTIES IN PERSPECTIVE: WHERE ARE THE GREATEST NEEDS? 31 Brantley County in Perspective 32 Camden County in Perspective 34 Charlton County in Perspective 36 Glynn County in Perspective 38 McIntosh County in Perspective 40 Wayne County in Perspective 42 IDENTIFYING NEEDS THROUGH ANALYSIS OF PUBLIC AND HOSPITAL DATA 44 Morbidity 44 Top 12 Discharges from Brunswick SGHS Campus by County for Service Area Counties 44 Heart Disease, Hypertension, and Stroke 46 Diabetes 47 Diseases of the Respiratory System 48 Estimated Prevalence of Lung Diseases 48 Cancer 48 Hospital Discharges for Cancer 48 Average Annual Incidence Rate of All Cancers 49 Top Five Causes of ER Visits by County 49 Emergency Room Visits for Ambulatory Care Sensitive Conditions 50 Perinatal Outcomes 50 Prevalence of HIV 51 Self-Reported Poor or Fair Health and Mental Distress 51 Mortality 52 Top Ten Causes of Premature Death by County, 2013 – 2017 (Years of Potential Life Lost 52 4 SGHS Community Health Needs Assessment, Brunswick Campus Years of Potential Life Lost Before 75, Males and Females 54 Age-Adjusted Death Rate/100,000 55 Life Expectancy by County 56 Fetal and Infant Mortality Rates 56 Injury Deaths by County, Counts and Proportions of Deaths, 2017 (Georgia DPH, 2018) 57 Drug Overdose Deaths 57 Motor Vehicle Fatalities, 2017, Related Causes, and Pedestrian or Bicyclist Fatalities 58 Death Rates from Major Chronic Diseases 58 Cancers 59 Health Behaviors 60 Obesity and Physical Inactivity 60 Smoking and Substance Abuse 61 Sexually Transmitted Disease Rates Per 100,000 62 Perinatal Period Behavioral Risk Factors 62 Vaccination Rates for Children at 24 Months 64 IDENTIFYING NEEDS THROUGH SURVEY DATA AND INTERVIEWS 65 Public Survey 65 Expert Survey and Interviews 65 Public Survey Findings 66 Survey Demographics 66 Health Status 69 Insurance Status 69 Sources and Access to Health Care 70 Self-Reported Health Status 75 Health Behaviors 77 Public Survey Data Analysis 80 Physician, Nurse Practitioner, and Physician Assistant Survey Responses 83 Public Health Leadership/Federally Qualified Health Center Interview Questions and Responses: State of Health in SGHS Service Area 85 REFERENCES 94 APPENDIX A: COMMUNITY FOCUS GROUP MEETING ATTENDEE LISTS 98 Brantley Focus Group Participants 98 Camden Focus Group Participants 98 Charlton Focus Group Participants 99 5 SGHS Community Health Needs Assessment, Brunswick Campus Glynn Focus Group Participants 99 McIntosh Focus Group Participants 99 Wayne Focus Group Participants 100 Steering Committee Members 100 APPENDIX B: CONTRACTOR 101 APPENDIX C: SGHS, INC. BOARD OF DIRECTORS 102 APPENDIX D: COMMUNITY PARTNERS WHO SUPPORTED THIS EFFORT 103 APPENDIX E: COMMUNITY RESOURCES 105 APPENDIX F: IMPACT OF ACTIONS TAKEN AS OF RESULT OF FY 2016 CHNA 133 6 SGHS Community Health Needs Assessment, Brunswick Campus Why Perform a Community Health Needs Assessment? The System and its Obligations to Stakeholders Southeast Georgia Health System (SGHS) is a two-hospital system that serves the residents of southeast coastal Georgia. The Brunswick Campus, which has provided services at its current location since 1954, is a 300-bed hospital primarily serving Glynn, Brantley, Charlton, Camden, McIntosh, and Wayne counties as a regional referral center. The Camden Campus is a 40-bed community hospital located in St. Marys primarily serving Camden, Charlton, and Brantley counties. In addition to these two hospitals, SGHS owns and operates two long-term care facilities, three immediate care centers, a freestanding imaging center, and several primary care and specialty physician practices. The service area designations are based on two things: discharges from hospitals of county residents and the geography of the region, which would make these counties the natural market area for the Brunswick Campus of SGHS either as a primary or secondary source of care. Like all non-profit hospitals in the United States, Southeast Georgia Health System’s Brunswick Campus must comply with provisions of the Patient Protection and Affordable Care Act (Public Law No. 111-148), which requires all non-profit hospitals to conduct a community health needs assessment (CHNA) every three years. IRS requirements for the hospital include the following tasks: . Define the communities served by the hospital; . Consider input from a diverse array of persons, including experts and those with special needs or those who represent persons with special needs, to identify and prioritize high health needs and risks in the service area; . Identify resources to meet priority needs; . Use the CHNA to develop a Community Implementation Strategy, which must be approved by the Board of Directors. The Community Health Needs Assessment and Implementation Strategy must include the following components: . A review of the 2016 Implementation Strategy to determine progress on initiative areas where ongoing work is needed, thereby providing a feedback loop for the next Implementation Strategy; . Identification of health needs and risks that affect the service area; . Development of the 2019 Implementation Strategy for addressing those needs through hospital and other community resources. 7 SGHS Community Health Needs Assessment, Brunswick Campus The CHNA also provides a welcome opportunity for the hospital to engage with and get feedback from the community in determining priority needs in order to match hospital and other community resources with those needs. This assessment and the forthcoming Implementation Strategy development are vital parts of the system’s strategic planning process. Through