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Community Health Needs Assessment

July 2016

Meadows Regional Medical Center Community Health Needs Assessment

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TABLE OF CONTENTS

PAGE Introduction and Background .................................................................................................................................... 1 Factors that Determine Health .................................................................................................................................. 2 The Process: Methodology and Activities ................................................................................................................... 4 Key Findings and Results: Interviews, Focus Group, Community Survey .................................................................. 11 Interview Results ................................................................................................................................................................................. 11

Hispanic Focus Group ........................................................................................................................................................................... 12 Community Survey Results .................................................................................................................................................................. 13 Key Findings and Results: Analysis of Secondary Sources ........................................................................................................ 18 Secondary Sources Used in the Analysis ............................................................................................................................................. 18 Social & Economic Factors and Demographic Profile ......................................................................................................................... 19 Health‐related Behaviors ..................................................................................................................................................................... 19 Health Service Utilization .................................................................................................................................................................... 21 Health Status, Vital Statistics and Health Outcomes ........................................................................................................................... 22 Clinical Care and Health Resources ..................................................................................................................................................... 24 Targeted Community Health Needs and Issues ........................................................................................................ 26 Mortality Rates and Health Behaviors ................................................................................................................................................ 26 Community Planning Session .............................................................................................................................................................. 30 MRMC's Prioritized Community Health Needs and Service Initiatives ..................................................................... 33


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Appendix A: Community Survey Results Appendix B: Detailed Data Analysis Appendix C: Community Resources: Licensed Health Facilities and Services


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INTRODUCTION AND BACKGROUND Meadows Regional Medical Center (MRMC), located in Vidalia, Georgia, is a 57‐bed, non‐profit, regional referral center serving south central Georgia. MRMC is the sole community provider located within its primary service area of Toombs County and is responsible for serving a total population of approximately 174,000, which includes the residents of Toombs County and ten other counties. Mandated by the Patient Protection and Affordable Care Act (ACA), all non‐profit hospitals must conduct a community health needs assessment every three years and implement strategies to address unmet needs. Each hospital within a system must have its own community health needs assessment. Although the community health needs assessment is a requirement placed upon non‐profit hospitals to ensure they are serving the true needs of the community, it can also be an important part of the hospitals’ overall planning process. By analyzing the community and identifying unmet health needs, each hospital will have the opportunity to develop initiatives to improve the health of, and add value to, the communities that it serves. To help address the healthcare needs of the residents of southeastern Georgia most effectively, MRMC began the process of conducting a community health needs assessment in March 2016. Working with The Strategy House, a healthcare consulting firm, MRMC collected and analyzed data from numerous sources, which it used to profile the health status of its community, identify and prioritize the most important health needs of the residents, and develop service initiatives to help address these needs. The following report describes MRMC’s process and the results of its analysis. To comprehend fully the content of this report, one should read it in its entirety, including all appendices.


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FACTORS THAT DETERMINE HEALTH There are many determinants to health. According to the World Health Organization1, factors such as “where we live, the state of our environment, genetics, our income and education level, and our relationship with friends and family all have considerable impact on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.” Healthy People 20202 points out that the interrelationship among these factors determines the health of an individual or population. For providers whose goal is to improve the health status of its community, initiatives that target several of these factors are the most likely to be effective.

Income and social status – higher income and social status are linked to better health Education – low education levels are linked with poor health, more stress and lower self‐confidence Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads

all contribute to good health Employment and work conditions – people in employment are healthier, particularly those who have more

control over their working conditions Social support network – greater support from families, friends and communities is linked to better health Biology and genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of

developing certain illness ‐ examples of biological and genetic determinants include: - Age - Sex - HIV status - Inherited conditions, such as sickle‐cell anemia, hemophilia, and cystic fibrosis

1 Source: World Health Organization, www.who.int 2 Healthy People 2020, www.healthypeople.gov


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- Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer - Family history of disease

Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health

Health services – access and use of services that prevent and treat disease influence health. Barriers to health services may include

- Lack of service availability - High costs - Lack of insurance - Limited language access

Gender – men and women suffer from different types of diseases at different ages


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THE PROCESS: METHODOLOGY AND ACTIVITIES MRMC’s approach to conducting its community needs assessment included an analysis of a wide range of demographic and health‐related information from both primary and secondary sources. In general, this approach attempted to collect and analyze sufficient breadth and depth of data to provide a picture of the health status of the community and to identify its important healthcare needs. The following activities and analyses were included in MRMC’s community health needs assessment: “COMMUNITY” DEFINED Based on patient origin data, MRMC identified eleven counties as representing the “community” that it serves or its "service area". The counties included Appling, Candler, Emanuel, Evans, Jeff Davis, Montgomery, Tattnall, Telfair, Toombs, Treutlen and Wheeler. Exhibit 1, on page five, presents a map of the "community" or service area. COMMUNITY INTERVIEWS Individual interviews were conducted with community and hospital representatives that had special knowledge and expertise in local public health issues. The purpose of the interviews was to obtain their insights into the health of the community, including, but limited to, the community's most critical and common health issues, populations within the community that have the greatest challenge in achieving and maintaining good health and specific initiatives that could have the greatest impact on improving the health of the community. MRMC has provided a list of the individuals interviewed in Exhibit 2:


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Exhibit 1


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Exhibit 2

List of Community Interviewees

Interviewee Title/PositionKaren McColl, MD OB/GYN and Chief Medical Officer, MRMCBill Torrance Manager, City of Vidalia Michael Williams, MD General SurgeonFrances Acosta, MD Stanley Health Clinic Nancy Stanley Mercy Medical Clinic Susan McLendon Mercy Medical Clinic Amanda Rose, RN Emergency Department Director, MRMCValerie Pittman, RN Nurse Manager, MRMC David L. Hatmaker, MD Emergency Medicine Physician, MRMCAshley Burche Social Services, DFACS Jennie Denmark CEO, East Georgia Healthcare CenterJessica Longtin Spanish Interpreter, MRMCAndrea Hinojosa Executive Director, SE GA Communities ProjectKelly Stuckless The RefugeRalph Goethe CEO, Boys and Girls Club of Toombs CountyTonya King Toombs County Health DepartmentTabitha Hutto, RN Nurse Manager, Toombs County Health DepartmentWillis NeSmith Mayor, City of Lyons


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FOCUS GROUP Of particular interest to MRMC were the health needs of its Hispanic/migrant community. To ensure that the Hispanic/migrant community had a voice in the assessment, a focus group was conducted that included 15 members of this community. The goal of the focus group was to gather additional information about the unmet health needs and gaps in healthcare services for this growing community. COMMUNITY SURVEY To gather health‐related information and opinions from the broader community, MRMC used a 31‐question survey. The survey was available through MRMC’s internet site during a three‐week period in June 2016. In addition, paper copies of the survey were available for community members without internet access or who preferred a paper survey. MRMC received 846 completed responses. This survey results were anonymous and included questions on the following major topics:

Demographic information about the respondent Individual health information about the respondent Information on the health status of the community and community health needs

DEMOGRAPHIC PROFILE In addition to gathering demographic information through the interviews, focus group and community survey, MRMC collected and analyzed additional demographic information from secondary sources. The following demographic information was collected on residents living in the eleven counties:

Current population estimates Projected population growth


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Household income and poverty characteristics Educational levels attained Profile of residents’ race and ethnicity Unemployment rates

COMMUNITY HEALTH‐RELATED BEHAVIORS MRMC also collected Information on the community’s behavioral health risk factors from secondary sources. The analysis compared this information to national and state benchmarks. Included was an assessment of the following health‐related behaviors:

Smoking Obesity Binge drinking Motor vehicle deaths Physical inactivity Teen pregnancy Rates of sexually transmitted disease Mentally unhealthy days

HEALTH RESOURCE UTILIZATION This assessment analyzed and compared utilization of healthcare resources in the community to state benchmarks. Among the utilization measures that MRMC analyzed were the following:

Overall hospital discharges/discharge rates by age cohort Service line discharges Outmigration and utilization of hospitals outside of the service area


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Emergency department discharges/rates by age cohort HEALTH STATUS, VITAL STATISTICS AND HEALTH OUTCOMES The study also analyzed a number of indices reflecting the health status of the community, which included the following data and information:

Overall mortality rates Cancer and cardiovascular incidence rates Years of potential life lost ("YPLL") Birth rates and percent of low weight births Poor mental and physical health days Overall statewide rankings for health outcomes

CLINICAL CARE AND HEALTH RESOURCE ANALYSIS Finally, the assessment looked at the availability of health resources in the community compared to state and national benchmarks. The analysis included the following data:

Health professionals including physicians and dentists Federal and state health professional shortage areas Health institutions including general hospital beds, psychiatric and substance abuse beds, nursing home

beds, personal care beds, child care services and home health Indicators of clinical care including uninsured adults, diabetic screening and mammography screening

DATA SOURCES In addition to its primary data sources (interviews, focus group and community surveys), secondary data sources that MRMC used in this analysis included:


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Nielsen Inc., a national supplier of demographic and socio‐economic data County Health Rankings, sponsored by the Robert Wood Johnson Foundation and the University of

Wisconsin Population Health Institute Georgia Department of Community Health, Healthcare Facility Regulations Division, Office of Health

Planning Georgia Department of Public Health U.S. Census Data Georgia Hospital Association, HIDI database Physician Characteristics and Distribution, 2015, American Medical Association Governor’s Office of Planning and Budget (Georgia) U.S. Department of Health and Human Services


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Key Findings and Results: Interviews, Focus Group and Community Survey INTERVIEW RESULTS Eighteen community interviews were conducted in person or by phone. The interviews, which lasted approximately 30 to 45 minutes, included open‐ended questions that asked the interviewee to assess the following areas:

The overall health of the community The challenges in achieving and maintaining a healthy community The most critical and common health issues in the community and the contributing factors to these issues Obstacles to addressing these health‐related issues Initiatives that could have the greatest impact on improving the health status of the community

Among the responses from the interviews were the following general observations:

The residents that live in the service area are less healthy compared to Georgia residents, as a whole, and U.S. residents

Major contributors to the poorer health status in the community include: - Poor nutrition and obesity - Poverty and the overall lower socioeconomic level of the area's residents - Lack of transportation options, especially for poor residents and Hispanic/migrant residents - Overall lack of health knowledge and noncompliance with medical advice - Poor access to primary care providers, which are in short supply

Interviewees identified the following health diseases/conditions as being of particular concern: - Mental health disease - Substance abuse


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- Heart disease, including hypertension - Teen pregnancy - Diabetes

Coinciding with the issues and concerns identified previously, some of the more pressing health needs in the community include:

- Addressing obesity and poor nutrition - Providing more mental health services - Offering transportation alternatives - Expanding health education - Increasing funding for healthcare services - Improving access to primary care services

The following community groups were identified as being most "at risk" for poor health - Residents of the more rural counties surrounding Toombs County without access to healthcare

resources - Minority populations, including African American and Hispanic/migrant residents - Residents living in or near poverty

HISPANIC/MIGRANT FOCUS GROUP To understand better the health needs of the Hispanic/migrant community, the needs assessment included a focus group of 15 members of the Hispanic/migrant community, the majority of who were undocumented. Two interpreters, who also participated in the discussion, assisted the focus group. The major issue identified in the focus group was the lack of access to appropriate medical interpreters for those with limited English language skills. The hospital's two medical interpreters are not available 24/7 and there can be problems understanding the medical interpreters due to dialect differences. Often, the adults' bilingual children provide interpretation, but the children do not fully understand the medical information and advice that the healthcare provider is conveying, which creates misinformation. In addition, many bilingual adult residents in the community charge by


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the hour to provide health interpretation service, often as much as $50, which can be cost‐prohibitive due to long waits to see a provider. Additional issues facing the Hispanic/migrant community include:

Lack of healthcare insurance, including Medicaid, which makes healthcare services cost prohibitive When healthcare services are obtained, due to the high costs, accounts often end up delinquent and are

sent to collection3 Reliance on free screenings and clinics, which are limited and, often, have appointment wait times that are

up to two months Primarily due to language challenges, being unaware of free or discounted health and social services that

are available to the Hispanic/migrant community Not having a regular primary care physician Poor access to transportation, due to the undocumented status of most Hispanics/migrants and their

inability to obtain a driver's license Lack of access to dental care

SURVEY RESULTS A 31‐question survey was prepared and available electronically to the community by internet. For community members without internet access, or who preferred a paper survey, paper copies of the survey were available through MRMC. In addition to being available upon request, MRMC distributed paper surveys, which were available in its emergency department, physician offices and at the Mercy Medical Clinic, which provides services

3 One participant made a special point of saying that he does not mind paying for healthcare services but that the services cost so much that they are unaffordable without insurance, which is not available to him and his family.


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to the poor and uninsured. If requested, MRMC made an interpreter available for respondents with limited English skills. The survey covered three broad areas:

Demographic information about the respondent (11 questions) Individual health information about the respondent (7 questions) Information on the health status of the community and community health needs (13 questions)

In general, the survey respondents were female, white, relatively affluent and relatively well educated. The respondents were primarily residents of Toombs County (52%) and Montgomery County (14%). Out of the residents living in Montgomery or Toombs County, 42% live in the city of Vidalia, which represented about one in four of the total respondents. Respondents were long‐time residents with over 75% having lived for more than 10 years in the community. The respondents were fairly representative of the overall age distribution in the community, although females outnumbered male respondents about five to one and represented 85% of total respondents. Compared to the racial characteristics of the community, white respondents were somewhat overrepresented accounting for 82% of total respondents versus 70% for the community. The respondents also reported a higher annual income compared to the overall community. In addition, only 10.5% of the respondents reported not having any health insurance, which was lower than the percentage for the overall community. MRMC has presented a detailed analysis of the survey results in APPENDIX A of this report. The following are some of the highlights from the community responses with a focus on issues of health status, access and community health needs: Health Status ‐ Survey respondents rated their own health good and were positive about their community and the adequacy of available healthcare services. However, respondents did not agree and were less positive about the overall health of the community.


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The community rated their level of agreement on a series of statements related to themselves and their communities' healthy behaviors. The following statements received the strongest agreement and consensus4:

- My health is generally good - Our community is a good place to raise children - Our community is a good place to grow old - The healthcare services in our community are adequate - I am satisfied with the quality of life in our community

There was less agreement and consensus on the following statement: - The overall health of our community is good

Access ‐ Access to physician services was not an issue for the vast majority of respondents, although a more than one in 10 respondents reported having some difficulty seeing a physicians. The primary reason for not being able to see a physician was difficulty in getting an appointment. In addition, if respondents left the community for health services it was usually for medical/doctor services that were not available in the community.

Forty percent of respondents stated that they could always see a doctor when needed, 47% said that they could only “usually” see a doctor when needed and 10% said they could only "sometimes" see a doctor when needed. Less than 3% could only see a doctor “seldom” or “never” when needed.

When asked why they could not see a doctor, 50% stated that they could not get an appointment while approximately 21% stated that it was too expensive or they could not afford to see a doctor. Just over 6% stated that they could not see a doctor because of lack of insurance.

4 Consensus was defined as the difference between the number of respondents scoring “1” or “2” and respondents scoring “9” or “10”. The greater the difference in the number of respondents scoring “1” or “2” and respondents scoring “9” or “10” , the more consensus there was among the respondents.


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Twenty‐three percent of the respondents never go outside of the community for their health services while 61% seldom or sometimes go outside of the community. Approximately 7% of respondents always go outside of the community for healthcare and about 9% usually go outside the community for healthcare. Respondents primarily go outside the community for the following services:

- Medical/doctor services (71%) - Surgical procedures (37%) - Dental appointments (36%) - Hospitalization (28%) - Outpatient treatment (25%) - Laboratory or other tests (22%) - X‐rays (20%)

The primary reason for going outside of the community for health services is the unavailability of services in the community (39%), and a perception of better quality outside of the community (31%).

Community Health Needs ‐ Respondents reported that the most important community needs were related to alcohol/drug abuse services, mental health services, obesity, non‐emergency transportation and access to primary care physicians.

Respondents cited access to healthcare services as the most important factor needed to have a healthy community

Respondents identified alcohol/drug abuse as having the greatest impact on the health of the community. Respondents identified primary care/family doctors as the most important health services that affect the

health of community followed closely by emergency health services Survey respondents identified overweight/obesity as the greatest threat to the health of community

residents followed by cancer


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When asked to identify the top health, environmental and social issues for the community, respondents identified overweight/obesity and alcohol/drug abuse as the top issues, followed by cancer, affordable health services, and job creation/unemployment

The community was most dissatisfied with alcohol/drug abuse treatment services, mental health services and non‐emergency transportation

Respondents identified family/general practice as the most needed physician specialty in the community with allergy, immunology being the second most needed specialty

Not having enough choice was the primary reason respondents gave for needing more physicians in the community


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Key Findings and Results: Analysis of Secondary Data Sources SECONDARY DATA SOURCES USED IN THE ANALYSES Presented below are the study's major findings from data obtained from secondary sources, including proprietary and public sources. The analysis reflects national as well as state data. Data sources included the following:

Nielsen Inc., a national supplier of demographic and socio‐economic data County Health Rankings, sponsored by the Robert Wood Johnson Foundation and the University of

Wisconsin Population Health Institute Georgia Department of Community Health, Healthcare Facility Regulations Division, Office of Health

Planning Georgia Department of Public Health Georgia Hospital Association, HIDI Physician Characteristics and Distribution, 2015, American Medical Association Governor’s Office of Planning and Budget (Georgia) U.S. Department of Health and Human Services

SOCIAL & ECONOMIC FACTORS AND DEMOGRAPHIC PROFILE Important social and economic characteristics of MRMC’s community that have the potential to affect its health and health needs include the high percentage of senior adults in the community, the poorer economic status of community residents and the higher percentage of minority residents. Major findings of the analysis include the following:

The population base in the eleven‐county service area is approximately 174,000 in 2016 Compared to the Georgia, low population growth is projected in the eleven‐county area from 2016 to 2021

(0.5% annual growth or approximately 4,534 residents)


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The area has a larger percentage of seniors (15.8%) compared to Georgia (13.2%) Although the service area is older, with a higher percentage of seniors, growth in the senior population is

lower than Georgia Every county in the service area has a lower median household income compared to Georgia ($49,200) and

the U.S. Top Performers ($53,700) The unemployment rate is higher in the eleven‐county area when compared to Georgia and the U.S There is a lower percentage of minorities in the area (30.9%) compared to Georgia (37.9%), but significantly

higher than the U.S. (22.6%) When compared to social and economic factors identified in “County Health Rankings”5 the eleven‐county

service area ranked significantly behind the recommended targets across most indices. Areas of greatest concern included:

- Children in poverty (301% of recommended target) - Unemployment (259% of recommended target) - Single‐parent households (205% of recommended target)

Please see Appendix B for a more detailed analysis of the social, economic and demographic characteristics of the eleven counties. HEALTH‐RELATED BEHAVIORS One of the most important findings of the analysis is the high percentage of residents in the community that exhibit behaviors that result in poor health and poor health outcomes. Unlike genetic and socio‐economic factors, residents have the potential to modify and change these unhealthy behaviors. In general, when compared to statewide averages, service area residents exhibit behaviors that result in poorer health and poorer health outcomes. 5 Source: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute


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The following identifies the most important findings related to health‐related behaviors:

Teenage birth rates for all eleven service area counties occur at a higher rate than Georgia Area residents are hospitalized more frequently for conditions that routinely can be treated in an

ambulatory care setting ‐ this can be related to individual behaviors such as failure to use ambulatory services, fearfulness, cultural background and insufficient language skills, medication nonadherence and overprotective caregivers.6

The area has a much higher rate of motor vehicle crash deaths (209% of recommended target) A greater percentage of adults are physically inactive and do not exercise A greater percentage of adults are obese (30%+) compared to the recommended targeted of 29% A greater percentage of adults smoke (139% of recommended target) When compared to health behavior factors identified in “County Health Rankings”. the eleven‐county area

ranked significantly behind the recommended targets. Areas of greatest concern included: - Sexually transmitted disease ("STD") (284% of recommended target)7 - Teen birth rates (388% recommended target) - Motor vehicle crash deaths (209% of recommended target)

Exhibit 3 on page 22 profiles the service area's health behaviors compared to Georgia and identifies those areas (red), which of are particular concern. Please see Appendix B for a more detailed analysis of health‐related behavioral characteristics in the eleven counties.

6 Freund, T. et al, Strategies for Reducing Potentially Avoidable Hospitalization for Ambulatory Care‐Sensitive Conditions, Annals of Family Medicine, 2013;11(4): 363‐370. 7 Although the STD rate for all area counties was much higher than the recommended target, with the exception of Emanuel County and Evans County, the STD rate was lower for area counties than the statewide STD rate.


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HEALTH SERVICE UTILIZATION Often, an analysis of the community’s utilization of hospital services can help identify important issues related to access and service availability as well as health status and health needs. In general, residents of the service area utilize hospital services at a rate higher than the state of Georgia. Please see the following:

Overall inpatient discharges per 1,000 residents are higher than the state of Georgia in 2015 (101.3 per 1,000 vs. 80.2 per 1,000); this holds true for all age cohorts as well

The 2015 rate of emergency room discharges are higher for the service area (693.0 per 1,000) when compared to the state (498.3 per 1,000); this holds true for all age cohorts as well

A number of possible explanations may account for these higher utilization rates:

In general, residents have poorer health, which results in higher hospital utilization and use of hospital services

Residents do not have adequate access to primary and preventative health care and, therefore, do not receive needed services until hospital care is required

Residents without health insurance will often inappropriately utilize hospital resources, in particular, emergency room services

Please see Appendix B for a more detailed analysis of health service utilization in the eleven counties.


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Exhibit 3 Summary Analysis of Health Behaviors

(% of Georgia)

Health Behaviors Appling Candler Emanuel Evans Jeff Davis Montgomery Tattnall Telfair Toombs Treutlen Wheeler

Smoking 106% 118% 124% 112% 106% 106% 118% 129% 112% 106% 124%

Obesity 121% 110% 117% 121% 103% 128% 121% 110% 114% 114% 117%

No Leisure-Physical Activity >20 age 120% 124% 120% 120% 124% 120% 120% 128% 108% 136% 132%

STD Rate 74% 40% 140% 105% 59% 76% 50% 65% 70% 98% 37%

Teen Birth 205% 164% 174% 214% 200% 112% 183% 152% 186% 155% 183%

Vehicle Motor Vehicle Crash Death Rate 214% 157% 179% 186% 200% 157% 186% 121% 200% 221% 150%

Avg # Mentally Unhealthy Days 103% 110% 113% 105% 100% 103% 103% 108% 108% 103% 100%

Avg # Physical Unhealthy Days 110% 121% 123% 113% 108% 110% 115% 126% 115% 108% 110%

% of Population <65 without health insurance 114% 114% 110% 114% 110% 114% 124% 100% 110% 100% 110% Hospitalization Rate for Ambulatory Care Sensitive Conditions per 1,000 193% 164% 162% 125% 224% 122% 155% 200% 116% 89% 207%

Excessive Drinking 88% 88% 81% 88% 94% 94% 94% 88% 88% 94% 100% Source: County Health Rankings, 2016 HEALTH STATUS, VITAL STATISTICS AND HEALTH OUTCOMES In general, based on an analysis of health status, vital statistics and health outcomes, the health of MRMC’s community is relatively poor. Of concern is the higher mortality rates in the community, especially the high rate of deaths from respiratory diseases, and the corresponding higher rate of years of life lost. The following are highlights from MRMC’s review of health status, vital statistics and health outcomes data:

The eleven‐county area has a higher overall age‐adjusted mortality rate (63.2 per 100,000) compared to Georgia (800.4 per 100,000)


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Specific causes with especially high mortality rates include: - Respiratory diseases (39% higher than state) - Cardiovascular (34% higher than state) - Digestive diseases (37% higher than state) - Nervous System Diseases (23% higher than state) - Endocrine, Nutritional and Metabolic Diseases (17% higher than state) - External causes8 (15% higher than state) - Infectious and Parasitic Diseases (9% higher than state) - Cancer (6% higher than state)

Correspondingly, the service area counties have a higher rate of years of life lost (10,163.4 to 11,779 per 100,000) when compared to the state (7,477.6 per 100,000)

There is a higher teen birth rate in the area counties (47 per 1,000 to 90 per 1,000) when compared to the state (42 per 1,000)

The percentage of low weight births in service area counties (8.2% to 18.4%) is generally slightly higher than the state (9.5%)

Service area residents have a greater number of poor physical and mental health days when compared to the state

Compared to the state (19%), Jeff Davis County and Treutlen County residents had the same percentages reporting poor or fair health, while the rest of the counties had higher percentages.

When compared to “health outcomes” identified in “County Health Rankings”. Emanuel County ranked the poorest (148)9, followed by Appling County (131). Toombs County ranked 119 out of 159 counties for health outcomes.

8 Includes motor vehicle crashes, falls, accidental shooting, drowning, fire & smoke, exposure, poisoning, suicide, homicide and legal intervention 9 The rankings are out of 159 Georgia counties with higher rankings indicating poorer performance.


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Please see Appendix B for a more detailed analysis of the health status, vital statistics and health outcomes of the four counties. CLINICAL CARE AND HEALTH RESOURCES An important consideration in analyzing the health needs of the community is the need for clinical and other health‐related resources. Although not unique to south central Georgia, a major need for MRMC’s community is the need for additional physicians. In addition, access to appropriate clinical care services and diagnostic screening services was below statewide results and national standards. Please see the following summary:

Based on MRMC's physician manpower study for the 11‐county service area, there is a need for almost 200 additional physicians in the community

- The need is especially strong for primary care physicians in the community where there is a need for approximately 62 additional family practitioners and internists

- In addition, there is a need for 17 psychiatrists There is a need for more dentists in the community, demonstrated by the number of dentists per 100,000,

which is significantly fewer than both statewide and U.S. rates. Further supporting the need for additional physicians in the eleven‐county area is each county's

designation by the U.S. Department of Health and Human Services as a Health Professional Shortage Area ("HPSA") for:

- Primary care (family/general practice, general internal medicine, pediatrics and OB/GYN) - Mental health (psychiatrists, clinical psychologists, clinical social worker, psychiatric nurse specialists,

marriage and family therapist) - Dentistry (dentists)

A slightly higher percentage of the service area county residents are without health insurance (21% to 26%) when compared to the state (21%) and well above the targeted percentage (11%), which restricts access to health resources and clinical care


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All service area counties except for Treutlen (49 per 1,000 Medicare recipients) have higher rates of preventable hospital stays (64 to 143 per 1,000 Medicare recipients) when compared to the state rate (55 per 1,000 Medicare recipients), suggesting access problems to appropriate clinical care and health resources.

Access to HbAIc screening for diabetic Medicare enrollees was slightly below statewide percentages and national benchmarks.

Access to mammography screening for female Medicare enrollees was below statewide percentages and national benchmarks

Please see Appendix B for a more detailed analysis of the clinical care and health resources of the eleven counties.


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TARGETED COMMUNITY HEALTH NEEDS AND ISSUES As part of its planning process to identify and prioritize specific community health needs, MRMC

Ranked the top health needs and issues in the community based on mortality rates and health behaviors Conducted a health planning session with broad community representation during which participants

reviewed relevant community health needs data and information and prioritized health needs MORTALITY RATES AND HEALTH BEHAVIORS MRMC ranked the top health needs and issues in the community based on mortality rates as reported by the Georgia Department of Public Health10 and health behaviors as reported by County Health Rankings. The analysis ranked the factors based on a comparison of community mortality rates and health behavior factors relative to state averages, identifying those factors where the difference between local results and state averages were the greatest. Exhibit 4 on page 26 ranks causes of deaths in the community from the most important (red) to the least important (green). Based on the analysis of mortality rates, the top 5 ranking causes of death in the community included:

Motor vehicle accidents All other chronic liver disease and cirrhosis Alzheimer's Disease Ischemic heart and vascular disease All COPD, except asthma

10 Source: OASIS, Community Health Needs Assessment Dashboard, Department of Public Health


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In addition, other causes, with mortality rates higher than the state average, included: Cerebrovascular disease Septicemia Malignant neoplasms of the trachea, bronchus and lung Nephritis, nephrotic syndrome and nephrosis Pneumonia All other disease of the nervous system


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Exhibit 4 Profile of Causes of Death in the Community

Age‐Adjusted

Death Rate per 100,000 Cause of Death GA Service Area % of GAMotor vehicle accidents 12.3 22 178.9%All other chronic liver disease and cirrhosis 5 8.1 162.0%Alzheimers disease 27.8 44.9 161.5%Ischemic heart and vascular disease 88.5 136.6 154.4%All COPD except asthma 44.1 68 154.2%Cerebrovascular Disease 42.1 57.6 136.8%Septicemia 15.8 19.4 122.8%Malignant neoplasms of the trachea, bronchus and lung 47.1 57.1 121.2%Nephritis, nephrotic syndrome and nephrosis 18.6 22 118.3%Pneumonia 16.3 18.7 114.7%All other Diseases of the nervous system 11.9 13.5 113.4%Diabetes mellitus 22.7 24.4 107.5%Malignant neoplasms of colon, rectum and anus 15.4 15.8 102.6%Malignant neoplasm of the breast 12.7 12.9 101.6%Essential (primary) hypertension and hypertensive renal, and heart disease 28.6 26.2 91.6%All other Mental and behavioral disorders 50.7 39.4 77.7% MRMC also ranked individual behaviors that most impact the health status of the community. Based on data from County Health Rankings, the analysis identified those behaviors, which negatively deviated from the state average (red) and those that positively deviated from the state average (green). HOW ABOUT HOSPITALIZATION RATE FOR AMBULATORY CARE SENSITIVE CONDITIONS? Please see Exhibit 5:


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Exhibit 5

Profile of Community Health Behaviors Health Behaviors State Avg. Service Area Avg. % of GA Avg.Vehicle Motor Crash Death Rate per 100,000 14.0 25.1 179.2%Teen Birth Rate per 1,000 Females Ages 15‐19 42.0 73.6 175.3%% of Adults, Age 20 and Over, No Physical Activity 25.0% 30.7% 122.9%% of Adults Reporting BMI 30+ 29.0% 33.6% 116.0%Avg # Physically Unhealthy Days 3.9 4.5 114.5%% of Adults that Report Smoking 100+ Cigarettes 17.0% 19.5% 114.4%Excessive Drinking 16.0% 14.5% 90.3%Sexaully Transmitted Infections per 100,000 514.8 381.0 74.0% Based on the analysis of community health behaviors, the top 3 areas concern are:

Vehicle motor crashes Teen birth rates Lack physical activity

In addition, other health behaviors that were worst than statewide averages and were of concern included

Obesity Physically unhealthy days Smoking


Page 30

COMMUNITY PLANNING SESSION As part of the process, MRMC conducted a 3.5‐hour community health needs planning session with 20 representatives of the community and MRMC. Exhibit 6 identifies the meeting's participants.

Exhibit 6

Community Health Needs Planning Meeting Participants

Name Organization Title Lynn Addison Brewton Parker College Assistant Professor of Business Brian Bishop Bishop‐Durden Insurance Group, Inc. Owner Steve Brown Brown Insurance Group Owner Jennifer Clark Rogers State Prison Deputy Warden of Care & Treatment Diana Coursey Vidalia Women's Center Practice Manager Kailey Dees State Farm Insurance Owner Ralph Goethe Boys & Girls Club Director Michelle Johnson Toombs‐Montgomery Chamber SVP Economic Development Alan Kent MRMC CEO Terri Lewis R.T. Stanley Health Center Practice Manager Pollyann Martin The Temples Company Board Member Susannah Meredith, MD Vidalia Women's Center OB/GYN Greg Morris State of Georgia Representative Eddie Toole Handy Andy ??? Nancy Stanley Mercy Clinic Director Terry Thompson MRMC VP ‐ Operations Daphne Walker Lyons Better Hometown Director Susan McLendon Mercy Clinic/MRMC Rural Community Health Nurse Specialist Elizabeth Harvill MRMC Director of Marketing and Community Relations Alan Kent MRMC President & CEO


Page 31

The main purpose of the meeting was to review and discuss the preliminary results and findings of the community health needs assessment and to prioritize the major health‐related needs of the community. Information that was reviewed included the individual interviews, community health needs survey and the analysis of all secondary data sources. An additional purpose of the meeting was to give representatives of the community and MRMC the opportunity to talk about and understand what services are currently being provided by the various community organizations and to begin conversations that identify ways that the community organizations and MRMC could work together to better coordinate services. At the conclusion of the planning session, participants were asked to identify the "top 3 community health needs" from 1 to 3. A scoring system was used to ranked the top needs. The scoring system gave a value of "3" to the top ranked health need, a "2" to the health need ranked second and a "1" to the heath need ranked third. Twelve of the 20 participants completed the ranking11. The planning group participants identified the following top five priorities. Please see Exhibit 7.

Exhibit 7 Top Community Health Needs

Overall Ranking Community Health Need Overall Score

1 Health Education/Programs/Wellness 312 Mental Health Services 93 Access to Primary Care 74 Access (Overall) 55 Healthcare Funding 5

11 Several of the participants were not able to remain for the entire planning session.


Page 32

By far, the greatest community health need was for health education, health‐related programs and wellness programs. Of the respondents, 83% rated health education/programs/wellness as the number one need in the community and 92% rated it as one of the top three needs in the community. Forty‐two percent of the respondents identified mental health services as one of the top three community health needs and 25% identified access to primary care as one of the top three needs.


Page 33

MRMC'S PRIORITIZED COMMUNITY HEALTH NEEDS AND SERVICE INITIATIVES A summary analysis of both primary and secondary data identified the following top health needs for MRMC's community:

Exhibit 8 Summary of Top Community Health Needs

Lifestyles and Behaviors Social Services Diseases Health Services Smoking Obesity/nutrition Physical inactivity Vehicle‐related deaths Teen pregnancies

Language Interpretation

Transportation Health funding Unemployment

Mental illness Substance abuse Heart disease COPD Cerebrovascular disease Cancer

Primary care Behavioral health Health education/wellness

Based on a review of all of the inputs from the community health needs assessment, MRMC identified four broad health needs of the community and identified those service initiatives that it plans to undertake, or continue, to meet these needs. The following are the top community health needs and associated service initiatives:


Page 34

Promote healthy behavior with specific preventive education and outreach programs geared towards lowering obesity rates and encouraging healthy eating Service initiatives:

Develop healthy dietary alternatives in MRMC's cafeteria and promote/encourage healthy dietary choices among its employees, physicians and visitors.

Provide healthy food alternatives in MRMC's vending machines.

Collaborate with local organizations and groups to develop programs that promote healthy dietary choices

and weight management throughout the community.

Launch a structured initiative to encourage a healthy lifestyle including good nutrition and physical activity. Develop a plan to address the shortage of mental health/substance abuse resources Service initiatives:

Develop a psychiatric telemedicine program.

Work closer with community partners to coordinate access to existing mental health/substance abuse resources.

Explore the potential to partner with existing psychiatric residency programs i.e. Medical College of Georgia

or Coliseum Medical Center, to initiate a clinical rotation at MRMC.


Page 35

Improve access to care Service initiatives:

Train additional medical translators and develop technology‐based systems for the hospital and for physician offices to fill gaps in the communication needs of Hispanic/migrant patients.

Recruit additional primary care providers, including physicians and mid‐level providers, especially for the

counties in the secondary service area. Develop extended hour options for primary care services, possibly including the development of urgent

care centers. Explore the potential for an employee health center/clinic.

Pursue current community health initiatives In addition, to the new initiatives identified above, MRMC will continue to pursue its current community health initiatives. To enhance the effectiveness of these initiatives, MRMC will:

Create greater awareness of the initiatives and improve coordination of services with existing hospital and community resources.

Develop strategies to encourage greater participation and compliance.


Page 36

The following is a list of MRMC's current initiatives:

Exhibit 9 MRMC's Current Community Health Need Initiatives

Current Initiative Focus Breast Cancer Education Screening and Treatment Program Disease ‐ Breast cancer Diabetes Education and Clinical Care Program Disease ‐ Diabetes care Community Lifestyle Intervention Classes Lifestyle ‐ Obesity and diabetes care Cabbage Patch Prenatal Education Program Lifestyle ‐ Prenatal care Mothers Utilizing Mentoring Support (MUMS) Lifestyle ‐ High‐risk pregnancy MRMC AED Education and Placement Program Disease ‐ Cardiac emergencies Mercy Medical Clinic Health Service ‐ Indigent primary care Compassionate Care Dental Clinic Health Service ‐ Low‐cost dental care

Appendix A Community Survey Results

Survey Respondent CharacteristicsQ1 Q9Q1 – Q9

• 846 total respondents330 l t MRMC• 330 are employees at MRMC

• Over 52% were residents of Toombs County– 13.5% Montgomery County residents– 7.0% Tattnall County residents

26 8% li i h i f Vid li– 26.8% live in the city of Vidalia• 74.9% had been residents for more than 10 years• 63% were between the ages of 35 and 64• Over 85% were female• Over 82% were white and approximately 12% were black• 98% had completed high school with 40% having completed college• Just under 5% were unemployed and 8% were retired• The largest percentage (24 2%) reported annual HHI of $25 000 to $49 999• The largest percentage (24.2%) reported annual HHI of $25,000 to $49,999

– $50,000 to $74,999 (19.5%)– $75,000 to $99,999 (17.4%)– $100,000 to $199,999 (12.3%)– $15,000 to $24,999 (13.5%)$15,000 to $24,999 (13.5%)

Q10: Select the types of insurance that you have:Q yp y

87 9%100.0%

87.9%

64.7%70.0%80.0%90.0%

51.9%

40.0%50.0%60.0%

17.3%10.5%

1.0%10.0%20.0%30.0%

1.0%0.0%

Health Dental Vision Long‐term care

I do not have any ins rance

Do not know

insurance

Q11: If you have health insurance, what kind(s)Q y , ( )

46.3%50.0%

35.0%

40.0%

45.0%

28.0%

20 0%

25.0%

30.0%

7.8%

4 3%

9.4%10.0%

15.0%

20.0%

4.3%2.1% 2.7% 1.9%

3.7%

0.0%

5.0%

Private –Commercial

Managed care (HMO,

Medicare Medicaid Exchange (Obamacare)

Other government

Do not know Do not have health

Other

PPO) insurance

Q12: Do you know the amount of your deductible?Q y y

54 8%60.0%

54.8%

50.0%

29.8%30.0%

40.0%

10.1%

20.0%

10.1%5.3%

0.0%

10.0%

N L th $3 000 $3 000 $5 000 M th $5 000No Less than $3,000 $3,000‐$5,000 More than $5,000

Q13: How do you rate your health?Q y y

37.0% 37.6%40.0% 37.0%

30.0%

35.0%

20.0%

25.0%

13.6%10.0%

10.0%

15.0%

1.8%0.0%

5.0%

E cellent Ver good Good Fair PoorExcellent Very good Good Fair Poor

Hispanics Rate Their Health Poorestp

30.0%

5.9%

20 0%

25.0%

2.9%

15.0%

20.0%

17.5%20.6%

8.5%

1.4%

5.0%

10.0%

0.0% 0.0%0.0% 0.0%0.0%Asian Black Hispanic White Other

Fair PoorFair Poor

Note: The category “Native American” accounted for only 1 response and was not included in this summary exhibit.

Less Affluent Rate Their Health Poorest

40 0%45.0%

6.0%

25 0%30.0%35.0%40.0%

33.7%5.4%

10 0%15.0%20.0%25.0%

11.7% 9.1% 5.6% 8.5%2.0% 4.2%

1.0%

1.0%0.0%5.0%

10.0%

<$14 9 $15‐$24 9 $25‐$49 9 $50‐$74 9 $75‐$99 9 $100‐$199 9 $200+<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+

Annual Household Income

Fair Poor

Q14: Where do you generally go for routine health ?care?

85.7%90.0%

60 0%

70.0%

80.0%

40.0%

50.0%

60.0%

5 2%10 0%

20.0%

30.0%

1.0% 1.9% 5.2% 3.0% 1.2% 2.0%0.0%

10.0%

Physician’s office

Hospital emergency

Health department

Urgent care center

Free or charity clinic

Federally qualified

Other

room health center

Blacks and Hispanics Rely More on the Health Department and Community Clinics for Routine Health p y

Care25.0%

16.7%

20.6%20.0%

16.7%15.5%

15.0%

3.9%5 0%

10.0%

3.9%

0.0%0.0%

5.0%

Asians Blacks Hispanics Whites OthersAsians Blacks Hispanics Whites Others

Less Affluent Rely More on the Health Department and C it Cli i f R ti H lth C

35.0%

Community Clinics for Routine Health Care

29.3%

25 0%

30.0%

20.0%

25.0%

9.9%10.0%

15.0%

4.6%2.5%

0.7% 0.0% 0.0%0.0%

5.0%

$ $ $ $ $ $ $ $ $ $ $ $<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+

Q15: Can you see a doctor when you need to?Q y y

47.0%50.0%

40.1%

35 0%

40.0%

45.0%

25.0%

30.0%

35.0%

10.0%10 0%

15.0%

20.0%

1.9% 1.0%0.0%

5.0%

10.0%

Al a s Us all Sometimes Seldom Ne erAlways Usually Sometimes Seldom Never

Less Affluent Report Having More Difficulties Seeing a D t Wh N d d

Seldom or Never

Doctor When Needed

6.3% 6.3%6.0%

7.0%

Se do o e e

4.0%

5.0%

2.0%

1 3% 1.4%

3.0%

2.0%

3.0%

1.3% %

0.0%0.0%

1.0%

$ $ $ $ $ $ $ $ $ $ $ $<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+

Hispanics Report Having More Difficulties Seeing a D t Wh N d d

Seldom or Never

Doctor When Needed

16.7%

14 0%

16.0%

18.0%

Se do o e e

8.8%10.0%

12.0%

14.0%

5.9%

4 0%

6.0%

8.0%

2.0%

0.0%0.0%

2.0%

4.0%

Asian Blacks Hispanics Whites OtherAsian Blacks Hispanics Whites Other

Q16: When you cannot see a doctor, what is the i ?primary reason?

60.0%

50.2%50.0%

30.0%

40.0%

20.6%

12.3%20.0%

6.2% 5.9%3.3% 1.4%

0.0%

10.0%

No insurance My insurance Too Doctor wouldn’t Can’t get an Lack of OtherNo insurance My insurance doesn't cover what I needed

Too expensive/can’t

afford

Doctor wouldn t take my insurance

Can t get an appointment

Lack of transportation

Other

Less Affluent Report Not Being Able to See a Doctor Due to No Insurance, Too Expensive, Lack of , p ,

Transportation

90 0%

26.2%41 8%60 0%

70.0%80.0%90.0%

13.9%

9.2%2.0% 0.0%

41.8% 42.8% 56.9%60.8% 69.3%

68.8%30.0%40.0%50.0%60.0%

29.2%

9.2% 3.1% 3.3% 0.0% 1.3% 0.0%

28.6%32.1%

20.3%15.9% 6.7%

0.0%

0.1%0.0%

0.0%0.0%0.0%

10.0%20.0%30.0%

<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+


No Insurance Too expensivepLack of transportation Can't get an appointment

Q17: Do you regularly go outside your community for h lth i ?health services?

31 2%35.0%

29.8%31.2%

22 5%25.0%

30.0%

22.5%

15 0%

20.0%

25.0%

7.1%9.4%10.0%

15.0%

0.0%

5.0%

Al a s Us all Sometimes Seldom Ne erAlways Usually Sometimes Seldom Never

Outside of Montgomery and Toombs people travel t id f th i it f h lth ioutside of their community for health services

60.0%

15 4%40 0%

50.0%

15.4%

31.0%

10.0%30.0%

40.0%

33.3% 30.0%

15 1%

20.7% 15.1%11.8%

7.5%

14 3% 5.4%10.0%

20.0%

10.3% 10.3% 15.1% 11.8% 10.0%0.0%

6.3%1.4%

14.3% 5.4%6.2%

0.0%Treutlen Jeff Davis Wheeler Tattnall Other Appling Emanuel Candler Montgomery Toombs

Always UsuallyAlways Usually

Q18: If you regularly go outside your community for h lth i h t i ?health services, what services?

80.0%

70.6%

60.0%

70.0%

35.6% 36.7%40.0%

50.0%

25.1%27.8%

22.4%19.7%

7 8%10 0%

20.0%

30.0%

7.8%

0.0%

10.0%

Medical –doctor

Outpatient treatment

Hospitalization Dental appointment

Laboratory or other tests

X‐rays Surgical procedures

Other

appointment

Residents of Toombs and Montgomery Counties travel f di l i t t d i l dfor medical appointments and surgical procedures

160.0%

65 9%100 0%

120.0%

140.0%

65.9%

39 0%60.0%

80.0%

100.0%

68.2%33.8% 29.1%

13 3% 20.5% 8 6% 7 3% 11 3%

39.0%29.3%

34.2% 19.5%24.4% 14.6% 7.3%20.0%

40.0%

13.3% 8.6% 7.3% 11.3%0.0%Medical –doctor

appointment

Surgical procedures

Dental appointment


Hospitalization Laboratory or other tests

X‐rays Other

Toombs MontgomeryToombs Montgomery

Residents outside Toombs and Montgomery Counties travel for di l i t t d d t l i t tmedical appointments and dental appointments

73.1%80.0%

%

60.0%

70.0%

42.9%37.7%

34.9% 33.1% 32.6% 30.9%30.0%

40.0%

50.0%

5.1%10.0%

20.0%

0.0%Medical –doctor

appointment

Dental appointment

Surgical procedures

Hospitalization Laboratory or other tests


X‐rays Other

All Oth C tiAll Other Counties

Q19: If you regularly go outside your community for h lth i h t i th i ?health services, what is the primary reason?

39 2%45.0%

39.2%

30.9%30.0%

35.0%

40.0%

15.2%15 0%

20.0%

25.0%

30.0%

4.1% 5.3% 5.3%5.0%

10.0%

15.0%

0.0%Services not

available in my community

Quality is better outside my community

Local doctors don’t take my insurance

Closer to my place of work

Cannot schedule a timely

appointment for

Other

local doctors

People in Toombs and Montgomery Counties travel outside the it f h lth i t il bl i th itcommunity for health services not available in the community

90.0%

45 0%60.0%

70.0%80.0%

45.0%37.5%

30 0%40.0%50.0%60.0%

34.0% 29.3% 24.0%7 3% 3 3%

7.5%

5.0%5.0% 0.0%10.0%

20.0%

30.0%

7.3% 3.3% 2.0%0.0%Services not

available in my community


Other Cannot schedule a timely appointment for local doctors



Toombs MontgomeryToombs Montgomery

People outside Toombs and Montgomery Counties travel for the i t il bl i th itservices not available in the community

41.1%45.0%

35.1%

30.0%35.0%40.0%

23.2%

15.0%20.0%25.0%

7.7%4.2%

1.8%0.0%5.0%10.0%

Services not available in my community


Other Cannot schedule a timely

appointment for local doctors



All Other CountiesAll Other Counties

Q20: Where do you receive most of your health‐related i f ti ?information?

70.0%60.4%

50.0%

60.0%

30.0%

40.0%

10.8%

2 %

19.3%

4 2%10.0%

20.0%

2.4% 4.2%1.0% 1.9%

0.0%Family and friends

Doctor/ nurse/

Newspaper/ books/

/

Internet Hospital Health Department

Other

pharmacist magazine/TV

Blacks Rely Less on “Myself” for Keeping Healthy

120.0%

16 8%2.9% 11.2%

0.0%9.5% 5.9% 6.4%

80 0%

100.0%

100.0%%

100.0%

16.8%

60.0%

80.0%

71.6%85.3% 80.4%

20.0%

40.0%

0.0%Asian Black Hispanic White Other

Myself Church/Faith DoctorsMyself Church/Faith Doctors

Note: The category “Native American” accounted for only 1 responses and was not included in this summary exhibit.

Less Affluent Rely Less on “Myself” for Keeping Healthyy y p g y

120 0%

12.8% 13 3%11.3% 9.9% 4.0% 4.2%11.0%

8.3% 7.7%3.1% 7.1% 5.0%

80 0%

100.0%

120.0%

85 0% 90 0% 91.7%

20.6%13.3%

60.0%

80.0%

64.4%78.9% 74.9%

85.0% 83.0% 90.0% 91.7%

20.0%

40.0%

0.0%<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+


Self Church/Faith Doctors

Q21: In your opinion, what are the THREE most important FACTORS needed to have a healthy p y

community?

78 6%90.0%

78.6%

60.0%

70.0%

80.0%

46.1%

32.8% 29.0% 27.9%30 0%

40.0%

50.0%

60.0%

27.9%

10.0%

20.0%

30.0%

0.0%Access to health care ser ices

Healthy behaviors and

lifest les

Health insurance co erage

Good jobs and strong

econom

Health education

services lifestyles coverage economy

Q22: In your opinion, what are the THREE BEHAVIORS that have the greatest impact on the health of our g p

community?

61 6%70.0%

61.6%

49.6%46.4%50.0%

60.0%

29.6% 28.0%30.0%

40.0%

10.0%

20.0%

0.0%Alcohol/drug

abusePoor eating

habitsLack of physical

activityDelaying

dental/health care

Not taking medications as

directedcare directed

Q23: In your opinion, what are the THREE most important HEALTH SERVICES that affect the health of p

community’s residents?

53 7%60.0%

53.7%49.8%

41.9%40 0%

50.0%

34.7%

21.6%30.0%

40.0%

10.0%

20.0%

0.0%Primary

care/family d t

Emergency health services

Local hospitals Wellness/ preventive

h lth

Mental health services

doctors health programs

Q24: In your opinion, what are the THREE Greatest Th t t th h lth f it ’ id t ?Threats to the health of community’s residents?

46.3%50.0% %42.8%

32.8% 32.8%35 0%

40.0%

45.0%

32.8% 32.8%29.8%

25.0%

30.0%

35.0%

10.0%

15.0%

20.0%

0.0%

5.0%

Overweight/obesity Cancer Heart disease and Alcohol and drug Diabetesstroke abuse

Less Affluent More Likely to Identify Violence/Crime/Homicide as Threats to Health of the / /

Community8.7%9 0%

10.0%

7.3%

6 0%7.0%8.0%9.0%

5.0%4.4% 4.2% 4.2%

4.0%5.0%6.0%

1.0%1.0%2.0%3.0%

0.0%<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+


Q: 25: On a scale of 1 to 10,with “1” being strongly disagree and “10” being strongly agree, rate your level g g g y g , y

of agreement with the following:

21.3%

21.5%

4.0%

2.6%

The health care services in our community are adequate

I am satisfied with the quality of life in our community

25.5%

25.6%

2.3%

1.8%

Our community is a good place to raise children

Our community is a good place to grow old

adequate

36.5%

16.9%

2.3%

2.4%

My health is generally good

Our community is a safe place to live

4.4%5.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

The overall health of our community is good

"1" or "2" "9" or "10"

Q26: What are the FIVE greatest strengths of our it ?community?

73.2%80.0% 73.2%

60.0%

70.0%

47.7%44.2%

29.7% 28.5%30 0%

40.0%

50.0%

28.5%

10.0%

20.0%

30.0%

0.0%

10.0%

Local 24‐hour police, fire and

Access to health care for everyone

Living in a friendly community

Access to parks and recreation

Living in a clean and healthy

rescue services environment

Q27: Please choose the top FIVE health, environmental, and social issues that you think our community shouldand social issues that you think our community should

focus on in the immediate future?

52.2%50.0%

60.0%

42.3%39.9%

35.8%40.0%

50.0%

25.0%

20.0%

30.0%

0 0%

10.0%

0.0%Overweight/obesity Alcohol and drug

abuseCancer Affordability of

health servicesChild abuse

Least Affluent More Likely to Identify Domestic Violence, Health Services for Homeless, and Teenage , , g

Pregnancies as Issues Affecting Community

28 6% 24 5%

100.0%

120.0%

26.0% 27.4%13.9% 20.6%

28.6% 24.5%

27.8% 25.0%

24.5%20.8%

40 0%

60.0%

80.0%

27.3% 24.5% 25.8% 21.3% 18.9% 9.9% 8.3%

14.3% 18.9% 16.5%15.0%

9.8%

2.0% 12.5%

16.1%

12.9%16.7%

19.8%

0 0%

20.0%

40.0%

0.0%<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+


Domestic violence Health services for homelessDomestic violence Health services for homelessTeenage pregnancies Child Abuse

Most Affluent More Likely to Identify Access to Health Services, Diabetes, Mental Health and Heart , ,Disease/Stroke as Issues Affecting Community

200.0%

250.0%

25 0%25.0%

46 9% 52 5%63.6% 59.4%

70.8%

100.0%

150.0%

18.2% 12.3% 21.7% 16.9% 20.3% 21.8% 33.3%15.6% 17.0%18.6% 12.5% 20.3% 22.8%

37.5%6.5% 5.7%

8.8%6.9%

9.1% 10.9%

25.0%

9.1% 12.3%15.5% 21.9%

19.6% 21.8%41.6% 42.5%46.9% 52.5%

0 0%

50.0%

0.0%<$14.9 $15‐$24.9 $25‐$49.9 $50‐$74.9 $75‐$99.9 $100‐$199.9 $200+


Diabetes Mental health Tobacco useDiabetes Mental health Tobacco useHeart Disease/Stroke Overweight/Obesity

Differences in Issue Priorities Among Income Groups

Lower 2 Upper 2 Difference

Overweight/Obesity 42.1% 61.6% 19.5%Overweight/Obesity 42.1% 61.6% 19.5%

Domestic Violence 25.7% 9.6% 16.1%

Teenage Pregnancy 26.8% 13.6% 13.2%Health Services for theHealth Services for the Homeless 16.9% 4.0% 12.9%

Heart Disease and Stroke 10.9% 22.4% 11.5%

Job Creation/Unemployment 19 7% 29 6% 9 9%Job Creation/Unemployment 19.7% 29.6% 9.9%

Diabetes 14.8% 24.0% 9.2%

Access To Health Education 4.4% 13.6% 9.2%

Mental Health 16.4% 25.6% 9.2%

Alcohol and Drug Abuse 38.8% 48.0% 9.2%

Q28: What would encourage you to choose MRMC th th i t h it l i th it ?rather than going to a hospital in another community?

27 7%30.0% 27.7%

25.0%

18.7%17.6%

12 5%15.0%

20.0%

12.5%

7.9%6.8%

5 0%

10.0%

5.0%3.8%

0.0%

5.0%

0.0%Convenience Quality of care is

equal to outside care

Previous positive experience with

MRMC

Personal physician

affiliated with MRMC

Trust Previous positive experience with MRMC‐affiliated

physician

Other Cost

Q29: What would encourage you to choose a hospital t id th it th th h MRMC?outside the community rather than choose MRMC?

60.00%

50.6%50.00%

30.00%

40.00%

9.9% 9 5% 8 4% 8 4%

20.00%

9.9% 9.5% 8.4% 8.4% 6.8%4.5%

2.0%0.00%

10.00%

Services not Personal Cost Reputation Previous Competency Other Previous available at MRMC

physician affiliated with

another hospital

pnegative

experience with MRMC

p ynegative

experience with MRMC‐affiliated

physician

Q30: Services With the Highest Satisfaction(on a scale of 1 to 10, with 1 being high dissatisfied and 10 being (on a scale of to 0, with being high dissatisfied and 0 being

highly satisfied)

“9” or “10”

53.4% 51.7%

40 7%50.0%

60.0%

9 o 0

40.7% 39.5% 38.6%

30.0%

40.0%

10.0%

20.0%

0.0%Pharmacy Hospice Local hospital Primary

care/Family ph s ser ices

Ambulance

phys. services

Q30: Services With the Lowest Satisfaction(on a scale of 1 to 10, with 1 being high dissatisfied and 10 being (on a scale of to 0, with being high dissatisfied and 0 being

highly satisfied)

“1” or “2”

13.5%12.0%

14.0%

16.0%1 or 2

9.4%

8.0%

10.0%

12.0%

5.1% 5.1%

4.0%

6.0%

0.0%

2.0%

Alcohol/drug b t t t

Mental health Non‐emergency t t ti

Local hospital Nursing homeabuse treatment transportation

Q31: Top Needed SpecialtiesQ p p

Responses411 392

351 330 320 309 305350400450

espo ses

309 305 287 281 274

200250300

50100150

0

Q31: Reasons there is a needQ

Responses

3,830

3 5004,0004,500

espo ses

1 7482 0002,5003,0003,500

1,7481,254 1,057

679427 217500

1,0001,5002,000

2170

500

Not enough choice

Other High Costs Takes too long to get an

See a nurse or PA and not a

Poor quality Not taking patients

appointment doctor

Q31: Reason for More PhysiciansT 3 S i ltiTop 3 Specialties

Reason for Need First Second ThirdToo long for an appointment

Family Practice Allergy, Immunology Dermatology

Not taking patients Family Practice Allergy Immunology Internal MedicineNot taking patients Family Practice Allergy, Immunology Internal Medicine

Poor quality Emergency Medicine Psychiatry Hospital Medicine

Not enough choice Neurology Psychiatry Plastic Surgery

High costs Emergency Medicine Hospital Medicine Cancer Specialist

See a nurse or PA Family Practice Allergy, Immunology Pediatrics

Q32: Do you believe any of the following disparities i t i it ?exist in your community?

53.9%60.0% 53.9%

40.0%

50.0%

18.2% 17.4%14.1% 12 8% 12 7%

20.0%

30.0%

12.8% 12.7%

0.0%

10.0%

Identifying Healthcare Disparities by h ldHousehold Income

Lower 2 Upper 2 Difference

Socioeconomic 10.6% 30.0% 19.4%

No 56.3% 43.6% 12.7%

Education 14 1% 24 5% 10 5%Education 14.1% 24.5% 10.5%

Age 16.9% 11.8% 5.1%

Geography 4.9% 9.1% 4.2%

Race 14.1% 15.5% 1.4%

Identifying Healthcare Disparities by RaceIdentifying Healthcare Disparities by Race

66.7%70.0%

43 8%

55.0%

50.0%

60.0%

40.0% 40.0%43.8%

25 0%

33.8%

30.0%

40.0%

20.0% 20.0%

11.3%

25.0%

20.0% 18.8%21.3%

13.8%12.5%8.3% 8.3%

12.5%8.3%

19.2%16.5%

13.1%10.0% 11.8%

8.4% 8.2%10.0%

20.0%

0.0% 0.0% 0.0% 0.0%0.0%4.2%

0.0%

%

Socioeconomic Education Age Race Disability Cultural Ethnicity

Asian Black Hispanic White

I do not believe there are any healthcare Asian Black Hispanic Whitehealthcare

disparities in the community

Appendix B Detailed Data Analysis

2020 Physician Requirements

30.1EMANUEL

CANDLERTREUTLEN12.2

EVANS

CANDLER

MONTGOMERY

TREUTLEN

9.0

15.216.2

16.7

TOOMBS

TATTNALL

TELFAIR

EVANSWHEELER

30+1.9

16.2

30.7 39.5

APPLING

JEFF DAVIS

15 ‐ 30<15Surplus(9.9)

27.3

2020 County‐specific Physician Requirements

2020 Physician RequirementsCounty Surplus DeficitTattnall 39.5Telfair 30.7Emanuel 30.1Appling 27 3Appling 27.3Montgomery 16.7Wheeler 16.2Evans 15.2Truetlen 12.2Candler 9.0Toombs 1.9Jeff Davis 11 9Jeff Davis 11.9Total 198.8

Note: Totals may not add due to rounding

Physician Need, High Need

Specialty Net RequirementSpecialty Net Requirement Family Practice 35.62Internal Medicine 26.29Psychiatry 17.40Pediatrics 17.14Obstetrics/Gynecology 12.34Ophthalmology 7.88General Surgery 7 51General Surgery 7.51Anesthesiology 6.58Neurology 5.87

Note: Specialties highlighted in red were identified as a top need in the community survey

Physician Need, Moderate Need

Specialty Net Requirement Cardiology 5.68Orthopedic Surgery 5 33Orthopedic Surgery 5.33Emergency Medicine 5.15Gastroenterology 4.71Otolaryngology 4.66Urology 4.24Hematology/Oncology 4.20General Practice 3.01Dermatology 2 98Dermatology 2.98Physical Med & Rehab 2.44Neurosurgery 2.25Allergy, Immunology 1.67Neonatology/Perinatology 1.60Infectious Disease 1.49Endocrinology 1.49Thoracic Surgery 1 40Thoracic Surgery 1.40


Physician Need, Low Need and Surplus

Specialty Net Requirement Critical Care 1.27Nephrology 1.24Radiation Oncology 1.24Rheumatology 1.22

lVascular Surgery 1.12Plastic Surgery 1.09Cardiovascular 0.94Occupational Medicine 0 92Occupational Medicine 0.92Pulmonology 0.12Pathology ‐1.37Radiology ‐15.76


Service Area Map Meadows RegionalService Area Map Meadows Regional

Primary Service Area

Secondary Service Area

EMANUEL

yCANDLER

MONTGOMERY

TREUTLEN

TOOMBS

TATTNALL

TELFAIR

EVANSMONTGOMERY

WHEELER

APPLING

JEFF DAVIS

TELFAIR

Population By County

32,18935,000

Population By County

23,858

26,418

30,628

24,623

28,706

25,000

30,000

19,640

14,060 13,925

20,766

14,216 14,052 14,422 14,36015,000

20,000

12,561 13,045,

9,910

,

7,5587,454

10,611

7,9737,86910,000

15,000

0

5,000

Appling Candler Emanuel Evans Jeff Davis Montgomery Tattnall Telfair Toombs Treutlen Wheeler

2015 2020

Source: Office of Planning and Budget, Apr 2011 Release

Age Cohort %, 2020

13 2% 13 1%

100%

Age Cohort %, 2020

15.7% 16.3% 15.3% 15.5% 15.4% 13.8% 13.2% 15.3% 17.7%13.1% 14.7%

70%

80%

90%

57.7% 58.3% 57.6% 59.1% 56.9% 61.0% 66.1% 65.6%56.2% 62.3%

69.9%50%

60%

20%

30%

40%

26.6% 25.4% 27.1% 25.5% 27.7% 25.2%20.7% 19.0%

26.2% 24.6%15.4%

0%

10%

Appling Candler Emanuel Evans Jeff Davis Montgomery Tattnall Telfair Toombs Treutlen Wheeler

% of Population 0‐17 % of Population 18‐64 % of Population 65+

Source: Office of Planning and Budget, Apr 2011 Release Note: Totals may not add to 100% due to rounding

% Annual Growth, 65+ 2015‐2020% Annual Growth, 65 2015 2020

4.5%

3.9%

3.5% 3.5%3.3%

3.1% 3.1%3 0%

3.5%

4.0%

3.0%

2.7%

2.4% 2.4%2.5%

3.0%

0.9%1 0%

1.5%

2.0%

0.9%

0.0%

0.5%

1.0%

Source: Office of Planning and Budget, Apr 2011 Release

Montgomery Appling Candler Evans Tattnall Wheeler Toombs Telfair Emanuel Jeff Davis Treutlen

Median Household Income, 2014

$60,000

Median Household Income, 2014

$49,200

$53,700

$

$50,000

$36,600 $36,400 $35,200 $34,000 $34,000 $33,300 $32,500 $31,800$30,300 $30,100 $29,200$30,000

$40,000

$10 000

$20,000

$0

$10,000

Appling Montgomery Jeff Davis Tattnall Toombs Evans Treutlen Candler Wheeler Emanuel Telfair

GA US Top Performers

Source: County Health Rankings, 2016

Population Distribution by Race 2014

2.5% 2.3% 2.2% 3.3% 2.4% 1.8% 2.4% 2.1% 3.2% 1.6% 1.4%6.4% 9.4%

100%

Population Distribution by Race 2014

19.7% 24.5%34.2% 31.2%

15.6%26.8% 29.5%

36.6%26.0% 32.3%

38.4% 31.5%

13.2%

70%

80%

90%

77.8% 73.2%82.0%

71.4% 68 1% 70 8%77.4%40%

50%

60%

63.6% 65.5%71.4% 68.1%

61.3%70.8% 66.1%

60.2% 62.1%

10%

20%

30%

0%

White Black Other

Source: Census

% Hispanic 2015

14 4% 11 7% 11 6% 11 4% 11 6% 10.9% 9.3% 6.1% 5.4% 4.4% 2.5%9.4%

100%

% Hispanic 2015

14.4% 11.7% 11.6% 11.4% 11.6% 10.9%

70%

80%

90%

85.6% 88.3% 88.4% 88.6% 88.4% 89.1% 90.7% 93.9% 94.6% 95.6% 97.5%90.6%

40%

50%

60%

10%

20%

30%

0%

Non‐Hispanic Hispanic

Source: Census

Unemployment Rate May, 2016Unemployment Rate May, 2016

7.6%8.0%

7.1%6.9% 6.8%

6.5%6.3%

6.1%

5 2%

6.0%

7.0%

5.2%4.8%

4.3%4.0%

4.7%4.7%

4.0%

5.0%

2.0%

3.0%

0.0%

1.0%

Wheeler Toombs Emanuel Montgomery Telfair Appling Treutlen Jeff Davis Tattnall Evans Candler

Source: US Department of Labor ‐ Bureau of Labor Statistics, 2016

GA & US Unemployment Rate

Children In Poverty, 2014Children In Poverty, 2014

45%

50.0%

45% 44%42%

40% 39% 39% 38% 38% 37% 37%

35.0%

40.0%

45.0%

31%

26%25.0%

30.0%

13%

10.0%

15.0%

20.0%

0.0%

5.0%

Emanuel Candler Telfair Treutlen Evans Jeff Davis Tattnall Toombs Appling Wheeler Montgomery



Children In Single‐Parent Households, 2010 20142010‐2014

60%

52%49% 49%

47%

43% 43%41%

39%

50%

39% 38% 37% 36%37%

30%

40%

21%

10%

20%

0%

10%

Telfair Emanuel Evans Candler Appling Tattnall Treutlen Toombs Wheeler Montgomery Jeff Davis

Georgia US Top Performers


% of Adults That Report Smoking >= 100 i d l kCigarettes and Currently Smoke, 2014

25%

22%21% 21%

20% 20%19% 19%

18% 18% 18% 18%

17%

20%

17%

14%15%

5%

10%

0%Telfair Emanuel Wheeler Candler Tattnall Evans Toombs Appling Jeff Davis Montgomery Treutlen



% of Adults That Report BMI >=30, 2012% of Adults That Report BMI 30, 2012

37%40%

35% 35% 35%34% 34%

33% 33%32% 32%

30%

29%30%

35%

25%

20%

25%

10%

15%

0%

5%

Montgomery Appling Evans Tattnall Emanuel Wheeler Toombs Treutlen Candler Telfair Jeff Davis



Excessive Drinking (Binge plus Heavy) 2014Excessive Drinking (Binge plus Heavy) 2014

18%

16%

15% 15% 15% 15%

14% 14% 14% 14% 14%

13%

16%

14%

16%

12%

8%

10%

12%

4%

6%

0%

2%

Wheeler Jeff Davis Montgomery Tattnall Treutlen Appling Candler Evans Telfair Toombs Emanuel



Sexually Transmitted Infections per 100,000 2013

720 6

800.0

720.6

542.6600.0

700.0

502.3

392.7 381.1358.8

336.4303 5

514.8

400.0

500.0

303.5

256.1

206.9 190.2

134 1

200.0

300.0

134.1

0.0

100.0

Emanuel Evans Treutlen Montgomery Appling Toombs Telfair Jeff Davis Tattnall Candler Wheeler



Teen Birth Rate per 1,000 Female l iPopulation Ages 15‐19, 2007 ‐ 2013

90

100

9086 84

78 77 7773

6965 64

70

80

90

65 64

47

42

50

60

42

1920

30

40

0

10

Evans Appling Jeff Davis Toombs Tattnall Wheeler Emanuel Candler Treutlen Telfair Montgomery



Motor Vehicle Crash Death Rate per 100,000 2007 ‐ 2013

35

3130

28 28

26 2625

25

30

22 2221

17

15

20

14

12

10

15

0

5

Treutlen Appling Jeff Davis Toombs Evans Tattnall Emanuel Candler Montgomery Wheeler Telfair



% of Adults Reporting Fair or Poor Health, 2014

30%

26%

24%23% 23%

22%21% 21%

20% 20%

25%

19% 19%19%

15%

20%

12%

5%

10%

0%

5%

Telfair Emanuel Candler Tattnall Wheeler Evans Toombs Montgomery Appling Jeff Davis Treutlen



Avg. Number of Mentally Unhealthy Days d i ( dj d)Reported in Past 30 Days (age‐adjusted), 2014

4 5

5.0

4.5 4.4 4.3 4.3 4.2 4.1 4.1 4.1 4.1 4.0 4.04.0

3.5

4.0

4.5

2.8

2.5

3.0

1.0

1.5

2.0

0.0

0.5

Emanuel Candler Telfair Toombs Evans Appling Montgomery Tattnall Treutlen Jeff Davis Wheeler



Avg. Number of Physically Unhealthy Days d iReported in Past 30 Days, 2014

6.0

4.9 4.8 4.74.5 4.5 4.4 4.3 4.3 4.3 4.2 4.2

5.0

3.9

2.93.0

4.0

1 0

2.0

0.0

1.0

Telfair Emanuel Candler Tattnall Toombs Evans Appling Montgomery Wheeler Jeff Davis Treutlen



% of Adults 20 or Older with no Leisure‐i h i l i iTime Physical Activity, 2012

40.0%

34.0%33.0%

32.0%31.0% 31.0%

30.0% 30.0% 30.0% 30.0% 30.0%

27.0%30.0%

35.0%

25.0%

20.0%20.0%

25.0%

10.0%

15.0%

0.0%

5.0%

Treutlen Wheeler Telfair Candler Jeff Davis Appling Emanuel Evans Montgomery Tattnall Toombs



% of Population <65 Without Health Insurance 2013

30%

26%

24% 24% 24% 24%23% 23% 23% 23%

21% 21%21%

25%

15%

20%

11%

5%

10%

0%

5%

Tattnall Appling Candler Evans Montgomery Emanuel Jeff Davis Toombs Wheeler Telfair Treutlen



Hospitalization Rate for Ambulatory Care Sensitive Conditions per 1,000 MedicareSensitive Conditions per 1,000 Medicare

Enrollees, 2013140

123

114110

106

90100

120

90 8985

69 6764

60

80

49

40

60

0

20

Jeff Davis Wheeler Telfair Appling Candler Emanuel Tattnall Evans Montgomery Toombs Treutlen



Summary Analysis of Health Behaviors

H lth B h i A li C dl E l EJeff D i

MontgoT tt ll T lf i T b T tl Wh l

(% of Georgia)

Health Behaviors Appling Candler Emanuel Evans Davis mery Tattnall Telfair Toombs Treutlen Wheeler

Smoking 106% 118% 124% 112% 106% 106% 118% 129% 112% 106% 124%

Obesity 121% 110% 117% 121% 103% 128% 121% 110% 114% 114% 117%

No Leisure‐Physical Activity >20 age 120% 124% 120% 120% 124% 120% 120% 128% 108% 136% 132%No Leisure Physical Activity >20 age 120% 124% 120% 120% 124% 120% 120% 128% 108% 136% 132%

STD Rate 74% 40% 140% 105% 59% 76% 50% 65% 70% 98% 37%

Teen Birth 205% 164% 174% 214% 200% 112% 183% 152% 186% 155% 183%Vehicle Motor Vehicle Crash Death Rate 214% 157% 179% 186% 200% 157% 186% 121% 200% 221% 150%Rate 214% 157% 179% 186% 200% 157% 186% 121% 200% 221% 150%

Avg # Mentally Unhealthy Days 103% 110% 113% 105% 100% 103% 103% 108% 108% 103% 100%

Avg # Physical Unhealthy Days 110% 121% 123% 113% 108% 110% 115% 126% 115% 108% 110%

% of Population <65 without health% of Population <65 without health insurance 114% 114% 110% 114% 110% 114% 124% 100% 110% 100% 110%Hospitalization Rate for Ambulatory Care Sensitive Conditions per 1,000 193% 164% 162% 125% 224% 122% 155% 200% 116% 89% 207%

Excessive Drinking 88% 88% 81% 88% 94% 94% 94% 88% 88% 94% 100%


Primary Care Physicians per 100,0002013

120.0

95.296.2

100.0

48.845 7

64.960.0

80.0

45.7 43.7

36.9 36.1

26.7

19.620 0

40.0

12.6

0.0

20.0

Toombs Appling Candler Emanuel Evans Telfair Jeff Davis Tattnall Wheeler Montgomery Treutlen

N/AN/A



Dentists per 100,0002014

74 6

80.0

74.6

60.0

70.0

44.1 48.5

40.0

50.0

27.5

14.7 13.2 12.1 11.9 10.8

20.0

30.0

10.8 9.26.7

0.0

10.0

Toombs Evans Treutlen Emanuel Telfair Tattnall Appling Candler Jeff Davis Montgomery Wheeler

N/A N/A



% of Diabetic Medicare Enrollees that i b iReceive HbA1c Screening, 2013

100%

89%86% 86% 85% 84% 83% 82% 82%

79%

73%70%

85%90%

70%

80%

90%

50%

60%

20%

30%

40%

0%

10%

Treutlen Emanuel Tattnall Montgomery Toombs Jeff Davis Candler Evans Appling Telfair Wheeler



Percent of Female Medicare Enrollees that i h iReceive Mammography Screening, 2013

80%

58% 57% 57% 56% 55% 55% 55%53% 53%

62%

71%

60%

70%

49%46%

40%

50%

20%

30%

0%

10%

Montgomery Candler Treutlen Appling Emanuel Jeff Davis Toombs Evans Tattnall Telfair Wheeler



County Overall Health Outcomes Ranking2011 ‐ 2013

148160

131

121 119115

109120

140

109 106

92

79 7680

100

45

40

60

0

20

Note: Higher number poorer ranking


Emanuel Appling Treutlen Toombs Jeff Davis Telfair Montgomery Candler Tattnall Evans Wheeler

Standard Mortality RatioStandard Mortality RatioCounty RatioAppling HighAppling High

Candler High

Emanuel High

Evans High

Jeff Davis High

Montgomery Expectedg y p

Tattnall Expected

Telfair Expected

T b Hi hToombs High

Treutlen High

Wheeler Expected

Source: Oasis

Standard Mortality Ratio

Overall Cancer CardiovascularRespiratory Diseases

Endocrine, Nutri.,

Metabolic Diseases

Nervous System Diseases

Digestive Diseases Total

A li3

Appling

Candler3

Emanuel4

Evans1

Jeff Davis3

M t0

Montgomery

Tattnall1

Telfair2

Toombs3

Treutlen1

Wh l1

Wheeler

Total 8 2 7 2 0 2 1 22

Source: Oasis

Low Birth Weight 2014 (<2500 grams)Low Birth Weight 2014 ( 2500 grams)

18.4%20.0%

13.4% 13.2%14.0%

16.0%

18.0%

12.4%11.9% 11.8% 11.7%

9.1%8.5% 8.5% 8.2%

9.5%10.0%

12.0%

4.0%

6.0%

8.0%

0.0%

2.0%

Montgomery Evans Candler Toombs Treutlen Appling Tattnall Wheeler Emanuel Telfair Jeff Davis

Source: Oasis

GA

Live Births per 1,000 Females ages 15‐44, 20142014

90

80.1 78.575 74.7

71.4 69.7 69.2 68.3 67.0

57 8 62 0

70

80

57.854.8

62.0

40

50

60

20

30

0

10

Toombs Emanuel Jeff Davis Appling Wheeler Evans Treutlen Candler Tattnall Telfair Montgomery

Source: Oasis

GA

Age Adjusted Death Rate Cancer, 2014Age Adjusted Death Rate Cancer, 2014

225 8

250

225.8214.4

191.6 187.8 186.5 181.9169.3

162 1 159 9

200

162.1 159.9 157.0

121.0

164.3

150

50

100

0Jeff Davis Candler Treutlen Appling Toombs Montgomery Evans Emanuel Wheeler Tattnall Telfair

Source: Oasis

GA

Age Adjusted Discharge Rate of Cancer, 2014

333.0350.0

298.7

279.6

259.5 259.3 257.6 255.7247.1

239.1250.0

300.0

217.5

162.6

231.5

150.0

200.0

100.0

150.0

0.0

50.0

Wheeler Treutlen Montgomery Toombs Emanuel Candler Evans Appling Jeff Davis Tattnall Telfair

Source: Oasis

GA

Age‐Adjusted Death Rate Major di l iCardiovascular Diseases, 2014

372.1 371.7 366.5400

366.5353.7 349.9

311.4 308.3288.0

272.8260 3

300

350

260.3

175.1

237.2

200

250

100

150

0

50

Jeff Davis Candler Emanuel Wheeler Toombs Appling Evans Montgomery Telfair Tattnall Treutlen

Source: Oasis

GA

Premature Death Rates (YPPL) – All2010 ‐ 2014

Rank Disease Georgia Community % of Georgia Percentile Rank

1 I h i H t Di d V l Di 541 9 1 016 2 187 5% 4th Q i til1 Ischemic Heart Disease and Vascular Disease 541.9 1,016.2 187.5% 4th Quintile

2 Motor Vehicle Crashes 412.2 757.2 183.7% 4th Quintile

3 Malignant Neoplasms of the Trachea, Bronchus and Lung 354.5 564.1 159.1% 4th Quintile

4 All COPD Except Asthma 175.5 401.7 228.9% Top Quintile

5 Accidental Poisoning and Exposure to Noxious Substances 322.1 361.1 112.1% 3rd Quintile

6 Cerebrovascular Disease 211 308.9 146.4% 4th Quintile

7 All Other Diseases of the Nervous System 170.6 299.3 175.4% Top Quintile

8 Assault (Homicide) 270 7 290 8 107 4% 4th Quintile8 Assault (Homicide) 270.7 290.8 107.4% 4th Quintile

9 Diabetes Melititus 192.5 261.9 136.1% 4th Quintile

10 Septicemia 123.3 211.1 171.2% 4th Quintile

11 Malignant Neoplasms of the Colon, Rectum and Anus 140.9 186.3 132.2% 4th Quintile

12 Pneumonia 79.9 143.5 179.6% 4th Quintile

13 All Other Endocrine, Nutritional and Metabolic Diseases 106.3 137.4 129.3% 3rd Quintile

14 All Other Chronic Liver Disease and Cirrhosis 65.7 111.5 169.7% 4th Quintile

15 SIDS 87 2 110 9 127 2% 3rd Quintile15 SIDS 87.2 110.9 127.2% 3rd Quintile

Source: Oasis

Premature Death Rates (YPPL) –f i iAfrican Americans 2010 ‐ 2014

Rank Disease Georgia Community % of Georgia Percentile Rank

1 Ischemic Heart Disease and Vascular Disease 585 7 895 9 153 0% 4th Quintile1 Ischemic Heart Disease and Vascular Disease 585.7 895.9 153.0% 4th Quintile

2 Motor Vehicle Crashes 430 668.9 155.6% 4th Quintile

3Essential (Primay) Hypertension and Hypertensive Renal, and Heart Disease 413.9 487.3 117.7% 3rd Quintile

4 C b l Di 325 9 411 8 126 4% 3 d Q i til4 Cerebrovascular Disease 325.9 411.8 126.4% 3rd Quintile

5 Malignant Neoplasms of the Trachea, Bronchus and Lung 304.7 409.7 134.5% 3rd Quintile

6 All Other Diseases of the Nervous System 212.8 331.2 155.6% 4th Quintile

7 Malignant Neoplasms of the Colon, Rectum and Anus 173.8 273.5 157.4% 4th Quintile

8 Septicemia 174 269 154.6% 4th Quintile

9 Pneumonia 95.5 188.5 197.4% 4th Quintile

10 All COPD Except Asthma 91.9 160.9 175.1% 4th Quintile

11 All Other Endocrine, Nutritional and Metabolic Diseases 129.9 159.6 122.9% 3rd Quintile

12 Suffocation 64.2 102.2 159.2% N/A

13 Accidental Drowning and Submersion 56.6 87.4 154.4% N/A

14 Malignant Neoplasms of Bladder, Kidney, Renal and Pelvi 45.9 82.8 180.4% Top Quintile

15 Malignant Neoplasms of the Stomach 40 6 75 9 186 9% Top Quintile15 Malignant Neoplasms of the Stomach 40.6 75.9 186.9% Top Quintile

Source: Oasis

Age‐adjusted Death Rates – All2010 ‐ 2014

Rank Disease Georgia Community % of Georgia Percentile RankRank Disease Georgia Community % of Georgia Percentile Rank

1 Ischemic Heart Disease and Vascular Disease 88.5 136.6 154.4% Top Quintile

2 All COPD Except Asthma 44.1 68 154.2% Top Quintilep p Q

3 Malignant Neoplasms of the Trachea, Bronchus and Lung 47.1 57.1 121.2% 4th Quintile

4 Cerebrovascular Disease 42.1 57.6 136.8% Top Quintile

5 Alzheimers Disease 27.8 44.9 161.5% Top Quintile

6 Motor Vehicle Crashes 12.3 22 178.9% 4th Quintile

7 All Other Chronic Liver Disease and Ccirrhosis 5 8.1 162.0% 4th Quintile

Source: Oasis

2015 IP Discharges per 1,0002015 IP Discharges per 1,000

108 8

120

108.8

102.3 101.3

82.8 80.6 80.2

100

60

80

20

40

0

20

2013 2014 2015

Source: GHA HIDI, OPB Population Projections 4/2011 release

SA GA

2015 IP Discharge Rates 1,0002015 IP Discharge Rates 1,000

350.0

296.6

256.7

250.0

300.0

150.0

200.0

68.0

88.0

58.275.5

100.0

150.0

0.0

50.0

0‐17 18‐64 65+

Source: GHA HIDI, OPB Population Projections 4/2011 release

SA GA

“Top 10” IP Service Lines 2015M d S i AMeadows Service Area

754Neurology

1,127

886

754

Gastroenterology

Infectious Disease

Neurology

1,163

1,142

Orthopedics: Surgical

General Medicine

1,975

1,369

1,330

Newborn

General Surgery

Cardiology

2,165

2,128

Pulmonary Medicine

Obstetrics

0 500 1,000 1,500 2,000 2,500

Source: GHA HIDI

Comparison of “Top 10” Service Lines(P f T l Di h ) 2015(Percent of Total Discharges) 2015

3 8%4.2%Neurology

5.6%

4.4%

3.8%

5.1%

4.1%

Gastroenterology

Infectious Disease

Neurology

6.6%

5.8%

5.7%

6.5%

5.6%

5.3%

Cardiology

Orthopedics: Surgical

General Medicine

9.8%

6.8%

13 0%

12.2%

6.1%

Ob i

Newborn

General Surgery

10.8%

10.6%

8.2%

13.0%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

Pulmonary Medicine

Obstetrics

Source: GHA HIDI

GA SA

Service Area Discharges from Hospitalsid h iOutside the Service Area

1,2801400

1,185

1,004

850

1000

1200

682613

561 541 522442

391 375

600

800

391 375 348

229 228 222

0

200

400

0

Source: GHA HIDI

Service Area Discharges from Hospitalsh hOther than MRMC

746800

600

700

326300 282 279

243300

400

500

243 227198

177154 145

120 10985100

200

0

Source: GHA HIDI

Emergency Discharges per 1,000Emergency Discharges per 1,000

800

621.6644.7

693.0

507.7 509.9 498 3

600

700

507.7 498.3

300

400

500

100

200

300

0

2013 2014 2015

SA GASA GA

Source: GHA HIDI, Office of Planning and Budget, June 2016 Release

2015 Emergency Discharge Rates2015 Emergency Discharge Rates

718 8755.8800.00

585.6

718.8

539.3501 9

600.00

700.00

391.1

501.9

400.00

500.00

100.00

200.00

300.00

0.00

100.00

0‐17 18‐64 65+

SA GASA GA

Source: GHA HIDI, Office of Planning and Budget, June 2016 Release

Health Professional Shortage AreasHealth Professional Shortage Areas

Health Professional Shortage Area Primary Medical Care Mental Health DentalShortage Area Primary Medical Care Mental Health Dental

Appling Exists Exists Exists

Candler Exists Exists Exists

Emanuel Exists Exists Exists

Evans Exists Exists Exists

Jeff Davis Exists Exists Exists

Montgomery Exists Exists Exists

Tattnall Exists Exists Exists

T lf i E i t E i t E i tTelfair Exists Exists Exists

Toombs Exists Exists Exists

Treutlen Exists Exists Exists

Wheeler Exists Exists Exists

Appendix C Community Resources: Licensed Health Facilities and Services

Agency Phone FaxDivision of Aging/APS 888-774-0152CUSTOMER SERVICE/DFACS 877-423-4746REPORTS FOR CPS 912-538-5850Appling County DFACS 912-366-1010Candler County DFACS/Metter 912-685-2163 912-685-3690Emanuel County DFACS/Swainsboro 478-289-2453Evans County DFACS/Claxton 912-739-1222Jeff Davis DFACS/Hazlehurst 912-375-3942 912-375-7997Montgomery DFACS/Mt Vernon 912-583-3722Tattnall DFACS/Glennville 912-654-5191 912-654-5180Tattnall DFACS/Reidsville 912-557-7721 912-557-7774Telfair DFACS/McRae 229-868-3030 229-868-3033Toombs DFACS/Vidalia 912-526-8117 912-526-3046Treutlen DFACS/Soperton 912-529-3757 912-529-4325Wheeler County DFACS/Alamo 912-568-7127 912-568-7196

Appling Health Dept/Baxley 912-367-4601 912-367-1096Bacion Cty/Alma, GA 912-632-4712Bulloch Cty/Statesboro, GA 912-764-3800 912-871-1901Candler Health Dept/Metter 912-685-5765 912-685-7448Jeff Davis Health Dept/HazlehurstMontgomery Health Dept/Mt Vernon

912-375-2425912-583-2585

912-375-3845

Tattnall Health Dept/Glenville 912-654-5290 912-654-5293Tattnall Health Dept/Reidsville 912-557-7850 912-557-7854Toombs Health Dept./Vidalia 912-526-8108 912-526-6504Treutlen Health Dept/Soperton 912-529-4217Wheeler Health Dept./Alamo 229-568-7167

DEPARTMENT OF FAMILY AND CHILDREN SERVICES

COUNTY HEALTH DEPARTMENTS

Altamaha Home Care 800-660-7385 912-367-4037Amedisys/Care One 912-537-9004 912-537-0235Amedisys/Dublin 866-666-6932 478-272-4671Amicita/Ga HHC 912-538-8000 912-538-0506GA Home Health/R'ville 912-557-6787INFUSION PARTNERS/Sav. 877-832-5605 912-232-1221Ogeechee HBC/Statesboro, GA 800-624-8078 912-681-6442St Joe HBC/Augusta 800-635-1013Three Rivers HHC/Dublin, GA 478-275-2027 478-275-9539Three Rivers HHC/McRae, GA 229-868-4327 229-868-7944Three Rivers HHC/Vidalia, GA 912-537-9192 912-537-9194Trinity HHC/Augusta 800-533-3949University HHC/Augusta 706-722-9011University HHC/Metter 888-257-2357 478-237-2050VNA/McRae 800-422-5879 229-868-2471

Nat'l Hospice/Pallative Organization 800-338-8619 703-837-1233Community Hospice 912-537-0063 912-537-2005Community Hospice House 912-537-0957 912-537-0576Hospice Advantage 912-764-6222 912-764-3050Hospice of S. GA/Jesup 912-588-0080 912-588-0082Ogeechee Area Hospice/Statesboro 800-236-1142 912-489-8247Pearls of Life/Claxton 912-739-4990 912-739-4933Savannah Hospice Hosue 912-355-2490Serenity Hospice/Dublin 478-272-2015 478-272-4691Serenity Hospice/Vidalia 912-537-1410 912-537-3128Southern Care Hospice 912-537-2273 912-537-2213Spanish Oaks Hospice 912-739-0502 912-739-0520United Hospice/Swainsboro 800-624-3845 478-237-6670Vista Care/Macon 888-493-8779 478-953-1044Vista Care/Savannah 912-330-0460Bethany Hospice - Claxton 912-739-0058

HOME HEALTH AGENCIES

HOSPICE AGENCIES

Appling Hospital 912-367-9841 912-367-1272Candler County Hospital 912-685-5741 912-685-3905Emanual Medical Center 478-289-1100Evans Memorial Hospital 912-739-2611Jeff Davis Hospital 912-375-7781Meadows Regional Medical Center 912-535-5555Optim Medical Center - Tattnall 912-557-1000

Kindred Hospital/Atlanta 404-873-2871 404-876-4794Kindred Hosp/Green Cove Spr, FL 904-284-9230 904-284-6612Regency Hospital/Macon 478-803-7400 478-803-7525Select Specialty/Augusta 706-731-1181 706-731-1190Select Specialty /Savannah 912-819-7929 912-819-5972Warm Springs 706-655-5262 706-655-5258

Alma/Twin Oaks Nursing Home 912-632-7293Anna Marie Nursing Home 803-278-2170Bethany Nursing Center 912-537-7922 912-537-0216Bethany Nursing Center/Millen 478-982-2531Bethany Assisted Living 912-538-9700 912-538-5702Dublin/Shamrock Nursing Home 478-272-1133 478-275-0548Dublin/Southland Care Center 478-272-1666 478-275-2146Eastman/Heart of GA Nursing Home 478-374-5571 478-374-5573Eastman/Middle GA Nursing Home 478-374-4733 478-374-1688Fizgerald/Life Care Center 229-423-5621 229-423-8723GA Home/War Veterans 478-445-4295 478-445-5583Metter/Azalea Nursing Home 912-685-5703 912-685-3357Midway Healthcare 912-884-3361 912-884-2127Statesboro/Brown's Nursing Home 912-764-9631Satesboro Nursing Home 912-764-3916Swainsboro/Emanuel County Nursing Home 478-289-1100 478-289-1255Treutlen Nursing Home 912-529-4418 912-529-3322

LTAC/LONG-TERM ACUTE CARE

HOSPITALS

NURSING HOMES

Alamo Drugs 912-568-7414 912-568-1875Allcare Pharmacy 912-526-3200 912-526-6930Barnes Pharmacy/Baxley 912-367-7708 912-367-4732Bowen s Pharmacy/Lumber City 912-363-4381 912-363-7756Candler Pharmacy/Metter 912-685-2000 912-685-3901Chapman Pharmacy 912-538-0053 912-538-0498HAZLEHURST, GA 912-375-3218City Drug Store 912-537-4147 912-537-1914CVS - Vidalia 912-537-8766 912-538-0567CVS - Baxley 912-367-7024 912-367-7720CVS - Hazelhurst 912-375-7729 912-375-0814The Drug Store/Claxton 912-739-9393 912-739-9033The Drug Store/Reidsville 912-557-4338 912-557-6078Dennard Drugs/Soperton 912-529-4545 912-529-6161Frank's Pharmacy/Hazelhurst 912-375-4269Fred's Pharmacy/McRae 229-868-4913 229-868-6316Fulghum's Pharmacy/Baxl ey 912-367-2488 912-366-0179Glenwood Pharmacy 912-523-5094 912-523-5137Hardie' s Drug Store/Hazlehurst 912-375-2945 912-375-0632Ideal Pharmacy/Lyons 912-526-8531 912-526-0248Keith' s Pharmacy/Hazlehurst 912-379-9979Kemp's Pharmacy/Claxton 912-739-2745

PHARMACIES

Lumber City Pharmacy 912-363-4979 912-363-8453Medical Arts Pharmacy/HHMedicine Cabinet/Hazlehurst 912-379-9979 912-379-9982

Metter Pharmacy 912-685-2000 912-685-3901Mt Vernon Pharmacy 912-583-2216 912-583-2217Phillip's Pharmacy 912-537-3049 912-537-3040Plaza Pharmacy/Swainsboro 478-237-6621Reidsville Pharmacy 912-557-4000 912-557-4080Rhines Pharmacy 229-385-5351Rite Aid/Claxton 912-739-0406Rite Aid/Glennville 912-654-1147Rite Aid/Metter 912-685-5170Rite Aid/vidalia 912-538-0311 912-538-8054Ryal's Pharmacy 229-868-6735Shoprite Pharmacy/Swainsboro 478-237-7032Smith 's Pharmacy/McRae 229-868-2580 229-868-2520Soperton Pharmacy 912-529-3234 912-367-1132Stan' s Pharmacy/Baxley 912-367-1155 912-654-2212Strickland Pharmacy/Glennville 912-654-2184 912-537-4846Sweet Onion Pharmacy 912-537-4747 912-557-6078The Drug Store, Reidsville 912-557-4701 912-537-4169Vidalia Pharmacy 912-537-4134Wal-Mart Pharmacy/Baxley 912-367-3234Wal-Mart Pharmacy/Dublin 478-272-7017Wal-Mart Pharmacy/Hazlehurst 912-375-3646Wal-Mart Pharmacy/Swainsboro 478-237-3524Wal-Mart Pharmacy/Vidalia 912-537-7765Wal-Mart Pharmacy/Statesboro 912-764-2110Wilkes Pharmacy/Cobbtown 912-684-2765 912-684-2029Wilson Pharmacy/Swainsboro 478-237-8835

Albany, GA/Palmyra Reg. Rehab 912-535-5523Advantage Rehab & Sports/Dublin 800-422-1189 478-743-8833Atlanta Rehab Institute 800-962-2741 404-250-9315Bass Therapy/Dublin 478-272-7494 478-272-2616Bass Therapy/Swainsboro 478-237-4017 478-237-3074Bass Therapy/Wrightsville, GA 478-864-7967 478-864-9723Baxley/Appling Out-pt Rehab 912-367-9841 912-366-8688Candler Rehab/Sav. 912-819-8292 912-819-8010Central GA Rehab/Macon 478-201-6500 478-757-0835Coliseum Park Rehab/Macon 478-765-4333 478-751-0238Claxton, GA/Jack Strickland Therapy 912-739-5025 912-739-5125Southern Health & Rehab/Dublin,GA 478-296-2881 478-296-2885Fairview Park Rehab 478-274-3274 478-274-3280Fairview Park Out-pt 478-274-3880 478-274-3185Hazlehurst,GA/Trinity Rehab 912-375-2009 912-379-0081Meadows Wellness Center 912-538-7555 912-277-2099Memorial Health/Sav./Amy Carter 912-350-0266 912-350-7183Sapp"s Rehab/McRae 229-868-2174 229-868-2175Satilla Rehab/Waycross 912-338-8043 912-338-8058Southeastern Orthopedic 912-537-0888Trinity Rehab/Hazlehurst 912-375-2009 912-379-0081Walton Rehab/Augusta/Tocha 706-826-5808 706-826-5812Warm Springs 706-655-5257 706-655-5258

Community Transport 800-477-4758 912-537-2005Logisticare/Reservations 888-224-7988Logisticare/Sav office 912-354-5665 912-354-5517Southeast Transport 912-538-3911Tattnall Area Transit 912-538-6266Grand S Taxi 912-245-8222T&T Taxi 912-537-2993 912-537-2971

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