Chatuge Regional Hospital Community Health Needs Assessment
Transcription
Chatuge Regional Hospital Community Health Needs Assessment
Chatuge Regional Hospital Community Health Needs Assessment Prepared by: Stuart H. Tedders, PhD, MS Jiann-Ping Hsu College of Public Health Georgia Southern University 2015 Chatuge Regional Hospital: Community Health Needs Assessment ! ACKNOWLEDGMENTS I would like to acknowledge the hard work of all parties involved in this Community Health Needs Assessment initiative. First, it is important to acknowledge the commitment and hard work of the hospital staff who contributed to the success of this project. Equally important is the commitment and hard work of the members of the Community Advisory Committee, as well as other community members not formally associated with this group, who contributed to the successful completion of this project. Together, they recognized the importance of this initiative and the importance of collaboration in order to improve the overall health status. It would have been impossible to reach this milestone without their dedication to a quality product. ! ! "! Chatuge Regional Hospital: Community Health Needs Assessment ! ABOUT THE PRINCIPAL INVESTIGATOR Stuart H. Tedders, PhD, MS served as the Principal Investigator for this project. "!#$%&'(!)*! +(,,-.!/(),0&$.!1,2!3(44(,5!$%%(#4(4!/(),0&$!6)7%8(,#!9)::(0(!;8(,(!8(!($,#(4!$!<6! 4(0,((!&#!<&):)0-!&#!=>?@2!!"*%(,!0,$47$%�!*,)A!/(),0&$!6)7%8(,#.!8(!($,#(4!$!B6!4(0,((! &#!B(4&C$:!D#%)A):)0-!*,)A!9:(A5)#!E#&'(,5&%-!F=>?>G!$#4!$!+81!&#!+7H:&C!I($:%8!*,)A! %8(!E#&'(,5&%-!)*!6)7%8!9$,):&#$!F=>>JG2!!1,2!3(44(,5!$CC(K%(4!$!L)H!$5!$#!"55&5%$#%! +,)*(55),!$%!B(,C(,!E#&'(,5&%-!B(4&C$:!6C8)):!FBE6BG!%($C8�!C)#C(K%5!)*!K7H:&C!8($:%8! %)!7#4(,0,$47$%(!A(4&C$:!5%74(#%52!!17,�!8&5!%&A(!$%!BE6B.!8(!$:5)!4('(:)K(4!$!M((#! &#%(,(5%!&#!;),M�!;&%8!,7,$:!/(),0&$!C)AA7#&%&(5!$#4!;$5!#$A(4!/(),0&$!N7,$:!I($:%8! 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F6(C,(%$,-.!3,($57,(,G.!%8(!6%$%(!V**&C(!)*!N7,$:!I($:%8!"4'&5),-!<)$,4!F6(C,(%$,-G.!%8(! 6%$%(;&4(!",($!I($:%8!D47C$%&)#!9(#%(,!F"ID9G!"4'&5),-!9)7#C&:.!$#4!B),(8)75(!6C8)):! )*!B(4&C&#(!"ID9!"4'&5),-!<)$,42!!1,2!3(44(,5!C7,,(#%:-!5(,'(5!$5!%8(!C8$&,!)*!%8(! B$0#):&$!9)$5%:$#45!"ID9!:)C$%(4!$%!/(),0&$!6)7%8(,#!E#&'(,5&%-2!!!! ! ! #! Chatuge Regional Hospital: Community Health Needs Assessment ! TABLE OF CONTENTS I. Executive Summary ........................................................................................................ 5 II. Introduction ........................................................................................................ 10 a. The Patient Protection & Affordable Care Act ...................................................... 10 b. IRS Compliance ..................................................................................................... 10 c. Phases of a Needs Assessment ............................................................................... 12 d. Project Purpose and Overview ............................................................................... 14 III. Methodology ........................................................................................................ 15 a. Steering Group Membership .................................................................................. 15 b. Target Area ............................................................................................................. 15 c. Community Advisory Committee Membership ..................................................... 15 d. Sites Visits .............................................................................................................. 15 e. Data Collection Approaches ................................................................................... 16 f. Community-Based Assets ...................................................................................... 17 g. Prioritization Strategy ............................................................................................. 17 IV. Results: Secondary Data Analysis ..................................................................................... 19 a. Demographics ......................................................................................................... 19 b. Health & Socio-Economic Indicators ..................................................................... 22 c. Physician Workforce Survey .................................................................................. 23 d. Overview of Morbidity ........................................................................................... 24 e. Overview of Mortality ............................................................................................ 25 f. Trends in Morbidity ................................................................................................ 26 g. Trends in Mortality ................................................................................................. 44 h. Maternal & Child Health ........................................................................................ 57 V. Results: Community-Based Survey ................................................................................... 62 a. Demographic Characteristics.................................................................................. 62 b. Community Perception ........................................................................................... 65 c. Behavioral Patterns ................................................................................................. 69 d. Access and Barriers to Healthcare .......................................................................... 70 e. Community Resources and Services ...................................................................... 72 f. Community Health ................................................................................................. 74 VI. Results: Key Stakeholder Interviews.................................................................................. 78 VII. Community Assets ........................................................................................................ 79 VIII. Summary of Community Issues .......................................................................................... 82 IX. Prioritization ........................................................................................................ 83 X. ........................................................................................................ 84 References XI. List of Appendices ! ........................................................................................................ 85 ! $! Chatuge Regional Hospital: Community Health Needs Assessment ! EXECUTIVE SUMMARY Purpose The purpose of this project was to provide technical assistance to Chatuge Regional Hospital in completing the Community Health Needs Assessment (CHNA) as mandated by the IRS. The project is organized around an 8-step process that includes (1) identifying project objectives, (2) identifying the project framework, (3) initiating contact with the hospital site, (4) forming the steering groups, advisory groups, and outlining data collection techniques, (5) managing and analyzing the data, (6) reporting preliminary results, (7) prioritizing identified issues, and (8) disseminating the final CHNA document. This report will elaborate more thoroughly on the specifics associated with each step in the methodology section. Service (target) Area ! The target area for the CHNA relied on a county-based definition. Zip code data from each hospital were used to establish the general threshold for determining a county as part of the CHNA target. ! The specific target area for Chatuge Regional Hospital was Towns County, GA and Clay County, NC. Community Advisory Committee Membership ! The Community Advisory Committee (CAC) was a key component of community engagement in the process as required by the IRS mandate. The CAC was composed of 1525 members representing a cross-section of the defined community (target area). Site Visits ! Three community visits (meetings) were scheduled for each site throughout the project period, and each visit had a specific purpose including a general introduction, data collection, and prioritization of health issues. Data Collection Approaches ! The secondary data reports were generated using data collected from multiple online sources including the Georgia Department of Public Health’s Online Analytical Statistical Information System (OASIS), County Health Rankings, the U.S. Census Bureau, and the Georgia Board for Physician Workforce’s 2010 Physician Workforce Profile. ! Primary data were collected using a tested community-based survey. Through the assistance of the CAC, a minimum of 400 surveys were distributed to a cross-section of the defined target area. ! ! %! Chatuge Regional Hospital: Community Health Needs Assessment ! ! Primary data were also collected using a key stakeholder interview conducted by members of the hospital staff. Only 3 key stakeholders were interviewed. ! Community assets were identified using the two primary data collection methods described above, as well as a compilation of health related resources in the target area, including hospitals, health services, counseling services, youth organizations, community organizations and rehabilitation services. Prioritization Strategy ! A two-stage process was used to complete the prioritization of issues in each community. The first stage involved a presentation of emergent issues by the principal investigator. This initial list was generated through an observational review of primary and secondary data. The second stage involved, a discussion of this initial list with members of the CAC followed by the use of the Hanlon Method to obtain the final prioritization of issues. Results: Secondary Data Analysis ! The majority of the population in both counties is white (>=97.0%). ! Diabetic and mammography screenings are at or above the state averages. ! The numbers of preventable hospital stays are lower than the state average. Morbidity ! Cardiovascular diseases are the largest cause of morbidity, particularly among men. ! In the service area, rates of stroke are below the state averages. ! Obstructive Heart Disease (OHD) is higher among males in the service area, but slightly lower among females. ! The rates of respiratory diseases are higher than the state average for males but lower among females. ! Rates of asthma are lower than the state averages. ! The cancer morbidity rate is either at (males) or below (females) the state average. ! Hospital discharge rates for diabetes are lower than state averages. Mortality ! Rates of cardiovascular disease mortality in the service area are lower than the state of Georgia average. ! Total stroke mortality rate is higher than the state average. ! ! &! Chatuge Regional Hospital: Community Health Needs Assessment ! ! Rates of obstructive heart failure were lower than the state average. ! The total mortality rates for respiratory disease are higher than the state average. ! The total age-adjusted cancer mortality rate is approximate or resembles the state average. Maternal and Child Health ! The percentage of births receiving less than five prenatal care visits is considerably lower than the state average. ! The infant mortality rate is slightly lower than the Georgia rate. ! The percentage of low birth weight babies is slightly lower than the Georgia rate. ! The percentage of low birth weight births for teen mothers is higher than the state rate. Results: Community-Based Survey ! A total of 179 surveys were completed and returned to Georgia Southern University for analysis. ! Considerably more females (70.1%) completed this survey than males (29.9%). ! Most respondents were white (97.2%). ! Nearly 60.9% of all participants were between the ages of 25 and 54 years old. ! Approximately 37.6% of respondents reported having some college education and 20.2% of respondents reported having a high school diploma or the equivalent. ! Nearly 11.0% of participants reported household incomes of less than $25,000 per year. ! A considerable proportion of the respondents reported having access to transportation (99.4%). ! Overall, quality of life in the community is very high. Respondents characterized the community as safe, good place to live and raise children. Moreover, most participants agreed the community had a strong educational system and health care system. However, the economic viability of the community was a concern. ! Approximately 41.3% of respondents perceived their health status as “good,” and 39.1% perceived their health status as “very good.” ! Most respondents (80.1%) reported not using tobacco. ! ! '! Chatuge Regional Hospital: Community Health Needs Assessment ! Results: Key Stakeholder Interviews ! Key stakeholders identified 6 major health concerns. These concerns were aging population, cancer, heart disease, tobacco, diabetes, and obesity. In addition, key stakeholders identified 4 significant health behaviors that included drug & alcohol abuse, domestic violence, healthy diet, and lack of exercise. Community Assets ! An inventory of community assets and resources is outlined in this report. Prioritization ! According to the results, “Overweight/Obesity” ranked highest according to the calculated BPR score. This issue was followed by “ Diabetes/Metabolic Disorders,” “Heart Disease/Vascular Disease,” “Mental Health,” “Cancer”, “Substance Abuse”, “Accidents,” and “Respiratory System Disease”. ! ! (! Chatuge Regional Hospital: Community Health Needs Assessment ! [THIS PAGE IS INTENTIONALLY LEFT BLANK] ! ! )! Chatuge Regional Hospital: Community Health Needs Assessment ! INTRODUCTION General population health is perhaps the single most important factor in determining the success of a community. The United Health Foundation suggests the overall health status of Georgia is relatively poor, ranking 37th in the nation. Although, some health status indicators are “fair” to “good,” many others such as infant mortality, total mortality, cardiovascular disease, infectious disease, and lack of health insurance consistently rank in the lower quartile. Moreover, the health behaviors of Georgians contribute to poor health, and the state public health officials report that a significant number of residents are obese, smoke cigarettes, are physically inactive, and do not engage in recommended disease screening behaviors. In addition, many Georgians, particularly those residing in rural areas, are at a significant disadvantage socially, culturally, and economically. In short, the poor health of Georgians reduces the efficiency of Georgia’s workforce, increases health care costs, and reduces longevity and quality of life. A comprehensive approach to assessing the population health status of a given community is an effective means of fully understanding the nature of the challenges faced by rural Georgians. The following narrative outlines Georgia Southern University’s conceptual framework for developing a comprehensive profile of health issues in select communities in the state. Moreover, the relation between this conceptual framework and the specific project deliverables will be discussed. The Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010 required all nonprofit tax-exempt hospitals to complete a community assessment every three years to evaluate the health needs and assets of the community. Regulated by the Internal Revenue Service (IRS), this mandate became effective on March 23, 2012. In addition, these hospitals are required to develop an implementation strategy designed to address priorities identified through the assessment process. Hospitals that do not complete this mandated activity risk losing their nonprofit status and face a $50,000 penalty. In response to this legislation, the Georgia Department of Community Health through the State Office of Rural Health (SORH) funded faculty from Georgia Southern University’s Jiann-Ping Hsu College of Public Health to assist 18 nonprofit rural hospitals to comply with this federal mandate. Specifically, Georgia Southern University was charged with providing technical assistance to these nonprofit hospitals in addressing the Community Health Needs Assessment (CHNA) mandated as outlined in the Patient Protection and Affordable Care Act. IRS Compliance According to the IRS mandate, the implementation strategy must be adopted by the end of the same taxable year in which the CHNA was conducted. The CHNA must be conducted in the taxable year that the written report of its findings is available to the public, and the governing body of the hospital must approve the plan. In addition, the specific processes and methods used for the CHNA, the sources of data, dates of the data collection, and the analytical methods applied. Any information gaps must be identified, and the CHNA must identify all collaborating organizations. Third parties, name, titles, and affiliations of individuals consulted also must be recognized in the CHNA written description. ! ! *+! Chatuge Regional Hospital: Community Health Needs Assessment ! Moreover, the contribution from federal, tribal, regional, state or local health departments as well as from leaders, representatives, or members of medically underserved, low-income, and minority populations must be recognized in the report. Existing health care facilities and other resources within the community must be addressed to ensure input from all required sources, and the prioritization of all the community health needs identified must follow the CHNA. Upon completion of the CHNA, a written plan must be presented that addresses each of the community health needs. This plan should describe the hospital’s plan to meet each identified need, or to explain why the hospital cannot meet a specific need. The implementation strategy must be tailored to the specific hospital facility and must be attached to hospital’s annual Form 990. Failure to meet the CHNA with respect to any taxable year may result in the imposition of a $50,000 excise tax. In addition, failure to meet stated requirements may place hospital’s tax exempt status in jeopardy. Outlined below is a checklist pertinent to successful completion of the CHNA and the Implementation Plan. Timing: ! The implementation strategy must be adopted by the end of the same taxable year in which the CHNA was conducted ! The CHNA is considered to be conducted in the taxable year that the written report of its findings is made widely available to the public ! The implementation strategy is considered to be adopted when it is approved by the governing body of the hospital Requirements of the CHNA: ! Description of the community served and the community was defined. ! Description of the processes and methods used to conduct the CHNA. ! Description of the sources and dates of the data and other information used in the CHNA. ! Description of the analytical methods applied to the CHNA. ! Identification of any information gaps that impact the ability to assess the community’s health. ! A list of all collaborating organizations in conducting the CHNA. ! Identification of third parties with which the hospital contracted to assist in conducting CHNA, along with qualifications of such third parties. ! Description of how input from parties representing broad interests of community served were solicited. ! Description of community interaction. ! ! **! Chatuge Regional Hospital: Community Health Needs Assessment ! ! Name and title of at least one individual representing collaborating organizations. ! Description of how the hospital solicited input from persons with special knowledge of or expertise in public health. ! Description of how the hospital took into account input from federal, tribal, regional, state or local health departments or agencies, with current data or other information relevant to the CHNA. ! Description of how the hospital took into account input from leaders, representatives, or members of medically underserved, low-income, and minority populations, and populations with chronic disease needs. ! Prioritized description of all of the community health needs identified through the CHNA and the process/criteria used in prioritization of such needs ! Description of existing health care facilities and other resources within the community available to meet the health needs of the community. ! Identification (names, titles, and affiliations) of individuals consulted in the CHNA process. Phases of a Needs Assessment Simply defined, a community health assessment is a planned and methodical approach to identifying a profile of problems and assets. It is important to note, comprehensive assessments are not only focus on documented or perceived community health issues/problems, but they focus on the positive aspects of the community also known as assets. The community assessment process is the framework by which program planners identify gaps or discrepancies between a real state and an ideal state. In practice, community assessments enable communities to accomplish several important tasks. These specific tasks are best described in general terms and include an ability to illustrate community priorities, validate the need for health initiatives, develop effective health promotion strategies, and identify and leverage community resources to solve problems. Health assessments, if done properly, are a starting point for solving complex community problems. Unfortunately, tangible solutions to these complex problems often prove to be elusive, unrealistic, and/or ineffective. However, a properly conducted health assessment will maximize the likelihood of developing solutions that work. In most instances, the community assessment process is most effective using a multi-step approach to reach specific thresholds. In order to function effectively, as well as maximize the likelihood of improving health status, the community assessment process should resemble a “Continuous Quality Improvement” loop. The conceptual steps in a generalized model to completing a comprehensive assessment are a five-step process and should include the following: (1) Engaging the Community, (2) Defining the Issues, (3) Establishing Community Priorities, (4) Designing a Strategy for Intervention, and (5) Evaluating the Impact. These steps or phases are explained more thoroughly in the narrative outlined below. ! ! *"! Chatuge Regional Hospital: Community Health Needs Assessment ! Step 1: Engaging the Community The community assessment process begins through community engagement. Typically, assessment experts are “outsiders” to the community, so they generally lack credibility in the community. Community engagement is necessary for achieving ownership in the process, thereby enhancing likely participation in the remaining phases of the assessment. Moreover, community engagement helps to gauge overall community readiness to address specific problems or issues. Step 2: Defining the Issues The specific approach used to define the issues in a given community varies according to availability of resources and overall readiness of stakeholders. Although the availability of resources to complete the process is dependent on a number of factors, the ability of a community to tap these resources is static and cannot be controlled in many ways. However, community readiness is a factor than can often be modified depending on the political landscape of the community, the willingness to embrace collaboration, and a commitment to improve the health status. Defining the issues in a given community can vary from a methodologically rigorous approach to a more generalized approach to gathering the necessary data. Additionally, the methodological approaches to defining issues may rely on qualitative, quantitative, or a mixed methods approach. Step 3: Establishing Community Priorities After defining the community issues, stakeholders need to adopt a strategy for establishing priorities. This is a particularly important process because the results of the prioritization strategy effectively remove certain issues from consideration due to fiscal, personnel, or readiness constraints of the community. Most often, prioritization strategies rely on multiple considerations including, but not being limited by, the size of the issue, the seriousness of the issue, the ability to modify the issue, and the ethical and legal implications of either modifying or not modifying the issue. Step 4: Designing a Strategy for Intervention After completion of the prioritization of issues, as well as gaining consensus on the specific issues to address, the next step in the assessment process involves designing strategies for intervention. Several considerations must be taken into account when designing interventions including the identification of culturally appropriate leverage points for change and establishing measurable and meaningful objectives. Step 5: Evaluating the Impact The last step in the assessment process is evaluating the impact of intervention efforts. Typically, evaluation efforts require the community to identify short term, intermediate term, and long term outcomes that reflect a logical progression of desired change. These outcomes must be linked to the measureable objectives established in Step 4. Successful evaluation strategies include defining appropriate metrics that have been innately linked to the specific outcomes, thereby providing the ability to note changes in a particular issue. At the end of Step 5, communities should use the lessons learned from the evaluation to implement continuous quality improvement. This should always involve informing the stakeholders in order to sustain ! ! *#! Chatuge Regional Hospital: Community Health Needs Assessment ! community engagement. Therefore, Step 1 begins again and the entire assessment process repeats itself. In referencing the five steps of completing a comprehensive community assessment, Georgia Southern University was only funded to complete steps 1 – 3. It is the responsibility of the hospital and governing authority of the hospital to complete steps 4 and 5 of this process in the form of a written implementation plan to the IRS. Project Purpose and Overview The purpose of this project was to provide technical assistance to Chatuge Regional Hospital in completing the Community Health Needs Assessment (CHNA) as mandated by the IRS. The project is organized around an 8-step process that includes (1) identifying project objectives, (2) identifying the project framework, (3) initiating contact with the hospital site, (4) forming the steering groups, advisory groups, and outlining data collection techniques, (5) managing and analyzing the data, (6) reporting preliminary results, (7) prioritizing identified issues, and (8) disseminating the final CHNA document. This report will elaborate more thoroughly on the specifics associated with each step in the methodology section. ! ! *$! Chatuge Regional Hospital: Community Health Needs Assessment ! METHODOLOGY This section outlines the specific procedures for completing the CHNA project. This project was approved by the Institutional Review Board at Georgia Southern University – Project Number: I=]R[[ (Appendix A). Steering Group Membership The hospital was responsible for forming a Steering Group. It was recommended that the Steering Group consist of 5-7 members from the hospital. However, the hospital was given the latitude to include other key stakeholders from the community. For Chatuge Regional Hospital, Steering Group members were recruited from both Towns and Clay counties. The Steering Groups members’ names and contact information can be found in Appendix B. Target Area The medical service area (target) relied on a county-based definition. It was determined to rely on the same medical service area used for the previous CHNA. As such, inclusion or exclusion of a particular county was dependent upon the proportion of hospital visits/stays at each hospital. Specifically, zip code data from each hospital were used to establish the general threshold for determining a county as part of the CHNA target. Although there was some variation with regard to each site, service areas were defined based on the proportions of inpatients and/or outpatients stays/visits during the 2011 calendar year. Community Advisory Committee Membership The Community Advisory Committee (CAC) is a key component of community engagement in the process as required by the IRS mandate. Recruitment of CAC membership was based on participation during the last CHNA cycle. Specific channels to communicate with potential members to serve as on the CAC were determined by hospital representatives. It was recommended that the CAC be composed of 15-25 members representing a cross-section of the defined community (target area). Hospitals, in particular the Steering Groups, were specifically instructed to recruit people, or agencies, representing traditionally underserved and minority populations within the target area. In addition, hospitals were encouraged to seek diversity with respect to race, ethnicity, social, economic, and education backgrounds. A list of CAC members for this cycle can be found in (Appendix C). Site Visits After the initial contact with the hospital, three community visits (meetings) were scheduled. Each visit had a specific agenda for moving the CHNA forward. A standard PowerPoint presentation was prepared and delivered for the last two meeting. The specific purpose of each meeting is outlined below. Meeting 1: The purpose of the first meeting was to make personal contact with the hospitals’ site leaders, as well as other key personnel in the hospital. Specifically, the principal investigator presented information about the Patient Protection and Affordable Care Act and the role of community assessment, contractual obligations of Georgia Southern University, a conceptual approach to data collection, instructions for clearly defining the medical service area, project timeline of activities, and brainstorming about Steering Group and CAC recruitment and ! ! *%! Chatuge Regional Hospital: Community Health Needs Assessment ! membership. A copy of the Meeting 1 attendance roster can be found in the Appendix (Appendix D). Specific tasks to be completed following the first meeting included beginning the process of recruiting CAC members and formalizing the community-based survey. In addition, it was determined interviews, rather than focus groups, would be conducted to expedite the data collection process. Meeting 2: The purpose of the second meeting was to meet with Community Advisory Committee (CAC) members to provide an overview of project activities and initiate data collection. The specifics of data collection will be discussed later in this section. The second meeting relied on a standard PowerPoint presentation. The presentation content included an overview of community demographics and key health related indicators, an overview of the project, and instructions for collecting data. Data collection efforts were first initiated by surveying CAC members using the community-based survey. In general, this took approximately 10 to 15 minutes. CAC members were also given instructions for distributing the survey to the community. A copy of the Meeting 2 presentation and the attendance roster can be found in Appendix E Specific tasks to be completed following the second meeting included monitoring survey distribution, prompting CAC members to forward completed surveys to the hospital, forwarding completed surveys to Georgia Southern University and negotiating the logistics of hosting the third community meeting. Meeting 3: The purposes of Meeting 3 were two-fold: 1) to relay the results of data collection to the community; and 2) to prioritize the issues that emerged from data collection. After data collection and analysis were completed, a PowerPoint presentation was prepared and delivered to CAC members and other guests of the hospital. The presentation included an overview of the project, a review of data collection approaches, select secondary data highlights, and select primary data highlights (community-based survey and interviews). Prioritization of emerging issues was a central theme of Meeting 3. Prioritization was completed using a two-stage process. The first stage was a tentative identification of the issues by the principal investigator. This rank was determined by an informed inspection of the data prior to the 3rd meeting. The second stage was the actual prioritization phase that relied on the Hanlon Method. More specificity with respect to prioritization will be discussed more thoroughly in one of the sections below. A copy of the Meeting 3 presentation and the attendance roster can be found in Appendix F. Data Collection Approaches Secondary Data Collection and Analysis The secondary data reports were generated using data collected from multiple online sources. The sources of data for the project were the Georgia Department of Public Health’s Online Analytical Statistical Information System (OASIS), County Health Rankings, the U.S. Census Bureau, and the Georgia Board for Physician Workforce’s Physician Workforce Profile. Most ! ! *&! Chatuge Regional Hospital: Community Health Needs Assessment ! demographic, physician workforce, preventive care services, insurance rates, and health behavior statistics were reported as percentages. However, all morbidity and mortality data were reported as age-adjusted rates in order to allow for a fair comparison with the state rates. In order to reduce variability of all point estimates, reported rates are based on ten-year aggregates. All data were exported, stored, and managed in Microsoft Excel. In addition, graphs for the secondary data analysis section were generated using Microsoft Excel. Primary Data Collection: Survey Development and Distribution As mentioned previously, a draft community-based survey was provided during the first site visit. This survey was validated by the steering committee and can be found in Appendix G. Prior to Meeting 2, 400 copies of the survey were made and taken to the meeting. These surveys were numbered sequentially and distributed at the conclusion of Meeting 2. CAC members were asked to take the surveys and distribute them to their personal network. The decision to distribute a specific number of surveys was left to each CAC member. Therefore, the number distributed by each CAC member varied according to the size of their personal network and their overall willingness to participate in this project. Because the surveys were numbered, the hospital was able to track individual CAC members and the number of surveys they intended on distributing. The hospital was given approximately 6 to 8 weeks to forward the completed surveys to Georgia Southern University. All surveys were manually entered into SPSS for Windows. Only descriptive statistics were used for this report. Primary Data Collection: Interviews Key community stakeholders were identified and interviewed by designated hospital staff. This approach was determined to be the most efficient and effective means of gathering additional data. A copy of the interview guide can be found in Appendix H. The exact approach to recruit and interview stakeholders was determined by hospital representatives. Community-Based Assets Community-based assets were identified using by creating an inventory of health related resources in the target area. The primary goal of asset identification was to create a list of all the groups and organizations that could potentially have a positive influence on community health. In order to provide relevant information about tangible community assets in rural Georgia, the project team used the online version of the Yellow Pages. The inventory included hospitals, health services, counseling services, youth organizations, community organizations and rehabilitation services. The final inventory contained names, phone numbers, addresses, and services offered. Prioritization Strategy As mentioned previously, a two-stage process was used to complete the prioritization of issues in each community. The first stage involved a tentative identification of issues by the principal investigator. The Hanlon Method, stage two, was used for the final prioritization of issues. The Hanlon Method calculates a Basic Priority Rating (BPR) for each problem identified in the assessment process. This prioritization scheme considers four dimensions of each problem and includes the size of the problem (measured by incidence, prevalence or percentage of the population affected) ranked on a scale from 0 to 10 (denoted as A). The seriousness of the ! ! *'! Chatuge Regional Hospital: Community Health Needs Assessment ! problem (measured by economic loss, impact of other populations, or overall severity as indicated by mortality/morbidity) is ranked on a scaled from 0 to 20 (denoted as B), and the effectiveness of interventions (measured by how well previous interventions have worked) is ranked on a scale from 0 to 10 (denoted as C). Finally, a measure known as the PEARL (Propriety, Economics, Acceptability, Resources, and Liability) is ranked on a scale of either 1 or 2 (denoted as D). This last measure (PEARL) assesses issues of ethics, legality, and economics in addressing a given problem. The formula for calculating the BPR is as follows: BPR = [(A + B)C/3] D Participants were given a prioritization sheet with instructions (Appendix I) and asked to complete a final ranking of the mutually agreed upon issues. Given that a PEARL measure assigned as 0 would effectively remove an issue from consideration, participants were not asked to assign a value to the D term in the BPR equation. The results of this exercise yielded the final ranking of issues in a given community. The final calculations to obtain the BPR were completed by the project team. Meeting Minutes Recorded minutes for all meetings can be found in Appendix J. ! ! *(! Chatuge Regional Hospital: Community Health Needs Assessment ! RESULTS: SECONDARY DATA ANALYSIS Purpose The purpose of this report is to provide a profile of the health characteristics of Chatuge Regional Hospital’s service area. The report provides both health statistics and contextual information. The context of the service area’s health is framed by the demographic data, socio-economic indicators, health behaviors statistics, and the physician workforce profile. Subsequently, the morbidity and mortality statistics, along with maternal and child health data, are presented in order to understand of the relative magnitude of the health problems. As a basis for comparison, the local rates are juxtaposed with state data. Demographics Demographic Characteristics 2013 Census Population† Persons under 5 years† Persons under 18 years† Person 65 years and over† Male† Female† White persons† Black persons† Median Household income (2008-2012)† Homeownership rate (2008-2012)† High school graduates† Bachelor's degree or higher† Percent Uninsured‡ † Towns County 10,771 3.5% 14.2% 31.6% Clay County 10,584 4.2% 18.4% 24.1% 52.0% 97.7% 1.1% $35,843 85.1% 85.6% 22.2% 22% 50.6% 97.0% 1.0% $38,536 81.3% 85.9% 20.2% 22% Georgia 9,992,167 6.7% 25.6% 10.7% 51.1% 59.7% 31.4% $49,604 66% 84.4% 27.8% 22% U.S. Census Bureau: State & County QuickFacts County Health Rankings: University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation ‡ Service Area Demographics: Chatuge Regional Hospital’s service area is a rural community. The vast majority (97%) of the population is white. African Americans and other races only constitute a few percentage points of the county’s population. Unlike most rural areas, the percentage of the population with high school diplomas is similar to the state average, though the medical household income is somewhat lower. ! ! *)! Chatuge Regional Hospital: Community Health Needs Assessment ! U.S. Census Bureau: American Fact Finder, American Community Survey: Demographics & Housing Estimates Age Distribution: Chatuge Regional Hospital’s service area is skewed to the older population categories. Over 1 in 4 people in Towns County are older than sixty-five years old. ! ! "+! Chatuge Regional Hospital: Community Health Needs Assessment ! ! ! "*! Chatuge Regional Hospital: Community Health Needs Assessment ! Health and Socio-Economic Indicators Health Behaviors Towns County 15% 27% 28% 10% Adult Smoking Adult Obesity Physical Inactivity Excessive drinking Clay County 21% 26% 29% 5% Georgia 18% 28% 25% 14% County Health Rankings: University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation Health Indicators: Health outcomes in the community are best understood in the context socio-economic factors and health behaviors since they are powerful influences on a population’s health. In the table below indicates that residents in the service area face higher rates of childhood poverty. Unlike most rural areas in the state, the literacy rates and employment rates are similar to the state averages. The health behavior indictors on the table of the following page labeled, ‘Preventive Care Services’ show that while similar to the state averages, the rates of risk-taking behaviors are still problematic in the service area. County Health Rankings: University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation ! ! ""! Chatuge Regional Hospital: Community Health Needs Assessment ! Screening and Hospital Stays Towns County 89% 69% 61 Diabetic screening Mammography screening Preventable hospital stays Clay County 93% 67% 30 Georgia 84% 61% 65 County Health Rankings: University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation Physician Workforce Summary Georgia Board for Physician Workforce Report 2011 Physician workforce: Towns County had a total of fifteen physicians. All of the physicians in the county were either in Family Practice or Internal Medicine. The county did not have a pediatrician or gynecologist. Total Number of Practicing Physicians in 2010 Towns Family Practice 7 Internal Medicine 3 Pediatric OB/GYN 0 0 General Surgery 0 Total 14 Georgia Board for Physician Workforce Report 2011 ! ! "#! Chatuge Regional Hospital: Community Health Needs Assessment ! Overview of Morbidity (2003-2012) Major Sources of Morbidity and Low Birth Weight Cause of Morbidity Service Area Georgia All Causes† 7,688.7 9,207.1 Major Cardiovascular Disease† 1,028.7 1,310.2 Cancers† 237.8 257.6 Respiratory Disease† 849.5 911.1 Infectious Disease† 222.6 335.8 Diabetes† 79.8 137.1 Low Birth Weight‡ 7.2% 9.4% †Age-adjusted, deduplicated discharge rate per 100,000. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Proportion of live births with weight below 2,500 g Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! "$! Chatuge Regional Hospital: Community Health Needs Assessment ! Overview of Mortality (2003-2012) Summary of Major Causes of Mortality Cause of Death Service Area Georgia All Causes† 800.4 861.8 Major Cardiovascular Disease† 213.8 278.1 Cancers† 178.7 178.8 Respiratory Disease† 94.6 86.8 Infectious Disease† 15.0 29.5 Diabetes† 7.1 21.5 Infant Mortality Rate‡ 7.2 7.7 †Age-adjusted Death Rate per 100,000 ‡ Deaths per 1,000 live births Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! "%! Chatuge Regional Hospital: Community Health Needs Assessment ! Trends in Morbidity All Major Cardiovascular Diseases: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 1,899 1,008.6 1,203.1 Non-white 48 4,518.3 1,562.1 Total 1,947 1,028.7 1,310.2 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us One would expect higher rates of cardiovascular disease in a service area with a high proportion of older adults. The rates presented in this report are age-adjusted. This type of rate controls for the age of the population. Comparing age-adjusted local and state rates answers the question, “Are there abnormally high rates of disease in this area,” and NOT the question “Are the rates in this area higher than the state average.” As the graph indicates, the rates of cardiovascular disease in the service area are actually lower than what one would expect given the age distribution of Towns County’s population. .//%0"12'%3"'4-25"678/"'%9-6$"6$6:%.;$<.4186#$4*%9$48&/-7"#$4% 9-67,"';$%!"#$%&$'%())*)))%=>%?$@4$'*%A))B<A)(A%.5$'";$% !"#$%&$'%())*)))% !,'+& !))+& !)#!%(& !"#$%$& !"++& *#"%#& *,+& #'(%'& #"+& 34567& 8049:;.& )'+& ")+& +& -./0& 102./0& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! "&! Chatuge Regional Hospital: Community Health Needs Assessment ! High Blood Pressure: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 38 20.7 32.6 Non-white 1 * 142.6 Total 39 21.0 65.1 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us From 2001-2010, no African Americans were discharged from the hospital for complications of high blood pressure. Because there are so few African Americans in the service area, the rates for hospital discharges for high blood pressure could not be calculated. .-/,%01223%4'$556'$7%8/$983:65#$3*%;$36&1-<"#$3%;-5<,"'/$% !"#$5%&$'%())*)))%=>%?$@3$'*%A))B9A)(A%8C$'"/$% !"#$%&$'%())*)))% )'% ('% &'% $$#"% $'#$% &$#!% !"#$% 01234% 5-1678+% '% *+,-% .-/+,-% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! "'! Chatuge Regional Hospital: Community Health Needs Assessment ! Stroke: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 271 144.8 180.1 Non-white 5 496.3 271.3 Total 276 146.9 205.9 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted rates of stroke for the population are close to what would be expected given the age distribution of the hospital service area. .#'/0$1%23$425678#$5*%9$57&:-;"#$5%9-8;,"'3$%!"#$8%&$'%())*)))%<=% >$?5$'*%@))A4@)(@%2B$'"3$% '"*& !"#$%&$'%())*)))% '**& #"*& #**& #**$+& !"#$%& !'($)& !"*& !('$!& 23456& 7/389:-& !**& "*& *& ,-./& 0/1-./& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! "(! Chatuge Regional Hospital: Community Health Needs Assessment ! Obstructive Heart Disease: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 703 384.2 429.4 Non-white 23 2,015.8 342.9 Total 726 394.3 406.8 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us One would expect higher rates of obstructive heart disease (OHD) in a service area with a high proportion of older adults. The rates presented in this report are age-adjusted. This type of rate controls for the age of the population. Comparing age-adjusted local and state rates answers the question, “Are there abnormally high rates of disease in this area,” and NOT the question “Are the rates in this area higher than the state average.” As the graph indicates, the rates of OHD in the service area are what one would expect in the state of Georgia given the age distribution of Towns County’s population. ./0#'12#-3$%4$"'#%5-0$"0$6%78$97:;10#$:*%5$:1&<-2"#$:%5-02,"'8$% !"#$0%&$'%())*)))%/=%>$?:$'*%@))A9@)(@%73$'"8$% %,,& !"#$%&$'%())*)))% +,,& ",,& !"#$%& !(!$#& !,,& *,,& #,,& ''($)& '%*$+& ',,& 34567& 8049:;.& ),,& ,& -./0& 102./0& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! ")! Chatuge Regional Hospital: Community Health Needs Assessment ! All Respiratory Diseases: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 1,315 846.9 883.2 Non-white 11 1,058.2 933.5 Total 1,326 849.5 911.1 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The rates of respiratory diseases for the population are similar to the state averages. .//%!$0&-'"#1'2%3-0$"0$04%.5$6.7890#$7*%3$79&/-:"#$7%3-0:,"'5$% !"#$0%&$'%())*)))%;2%<$=7$'*%>))?6>)(>%.@$'"5$% *"##& !"#$%&$'%())*)))% *###& !"#$%& )!*$!& )!#$#& '!($#& )##& %##& 23456& +##& 7/389:-& "##& #& ,-./& 0/1-./& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #+! Chatuge Regional Hospital: Community Health Needs Assessment ! Asthma: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 42 41.9 80.0 Non-white 1 * 146.2 Total 43 42.7 103.2 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The rates of asthma for the population are lower than the state averages, especially in white females. ./#,0"1%.2$3.456/#$4*%7$46&8-9"#$4%7-/9,"'2$%!"#$/%&$'%())*)))% :;%<$=4$'*%>))?3>)(>%.@$'"2$% !"#$%&$'%())*)))% $'(% **#)% $((% "(% )"#'% +(% &(% &'#(% !"#$% 23456% 7/389:-% '(% (% ,-./% 0/1-./% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #*! Chatuge Regional Hospital: Community Health Needs Assessment ! External Causes: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 552 407.3 490.6 Non-white 7 761.9 394.4 Total 559 409.0 470.2 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us External causes of hospital visits include injuries from any type of accident, including both intentional and unintentional causes. The hospital discharge rates are similar to the states averages. ./#$'0"1%2"34$45%67$869:34#$9*%;$93&1-<"#$9%;-4<,"'7$%!"#$4%&$'% ())*)))%=>%?$09$'*%@))A8@)(@%6B$'"7$% !"#$%&$'%())*)))% +$$#$% ($$#$% !"!#$% !'"#*% !)"#$% &'(#&% !$$#$% &$$#$% 23456% "$$#$% 7/389:-% *$$#$% $#$% ,-./% 0/1-./% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #"! Chatuge Regional Hospital: Community Health Needs Assessment ! All Cancers: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 421 234.8 244.7 Non-white 11 898.8 290.6 Total 432 237.8 257.6 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The cancer rates are similar to the state averages. .//%0"12$'34%.5$6.7893#$7*%:$79&/-2"#$7%:-32,"'5$%!"#$3%&$'% ())*)))%;<%=$17$'*%>))?6>)(>%.@$'"5$% !"#$%&$'%())*)))% (''$'& !"#$%& !")$*& !+'$'& !'"$(& !('$+& !''$'& ,+'$'& 34567& ,''$'& 8049:;.& +'$'& '$'& -./0& 102./0& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! ##! Chatuge Regional Hospital: Community Health Needs Assessment ! Breast Cancer: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Females Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 21 13.7 18.9 Non-white 0 0.0 23.8 Total 21 13.6 20.3 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The breast cancer hospital discharge rate is lower than the state average. !"#$%&$'%())*)))% .'$"/#%0"12$'3%45$64789/#$7*%:$79&;-2"#$7%:-/2,"'5$%!"#$/%&$'% ())*)))%<=%>$17$'*%?))@6?)(?%4A$'"5$% "(#(% *"#(% *(#(% &"#(% &(#(% !"#(% !(#(% )"#(% )(#(% "#(% (#(% &"#'% !"#$% +,-./% 01,2345% +,-./% 01,2345% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #$! Chatuge Regional Hospital: Community Health Needs Assessment ! Prostate Cancer: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Males Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 43 21.7 16.1 Non-white 3 * 21.3 Total 46 22.9 17.5 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The rate of prostate cancer in the service area was higher than the state average. .'/0#"#$%1"23$'4%56$7589:0#$8*%;$8:&<-3"#$8%;-03,"'6$%!"#$0%&$'% ())*)))%=>%?$28$'*%@))A7@)(@%5B$'"6$% ,(#(% !"#$%&$'%())*)))% "(#(% +(#(% !"#$% &!#'% !(#(% &(#(% 87931% *(#(% )(#(% (#(% -./01% 23.4567% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #%! Chatuge Regional Hospital: Community Health Needs Assessment ! Lung Cancer: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 60 29.7 34.8 Non-white 1 * 34.2 Total 61 30.0 34.8 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The rates of lung cancer were lower than that state average. ./01%2"03$'4%51$6578/9#$7*%:$7/&;-3"#$7%:-93,"'1$%!"#$9%&$'% ())*)))%<=%>$07$'*%?))@6?)(?%5A$'"1$% +)#)% !"#$%&$'%())*)))% ')#)% $)#)% $"#'% !"#$% "&#$% !)#)% "(#"% 23456% ")#)% 7/389:-% *)#)% )#)% ,-./% 0/1-./% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #&! Chatuge Regional Hospital: Community Health Needs Assessment ! Colon Cancer: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 54 26.8 35.3 Non-white 2 * 43.8 Total 56 27.5 37.6 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The service area’s rates of colon cancer are lower than the state averages. ./0/1%."12$'3%45$64789:#$7*%;$79&0-2"#$7%;-:2,"'5$%!"#$:%&$'% ())*)))%<=%>$17$'*%?))@6?)(?%4A$'"5$% )(#(% !"#$%&$'%())*)))% *(#(% "(#)% "(#(% !"#$% !'#(% !(#(% &'#'% 12345% 6.2789,% &(#(% '(#(% (#(% +,-.% /.0,-.% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #'! Chatuge Regional Hospital: Community Health Needs Assessment ! Diabetes: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 96 80.7 94.3 Non-white 1 * 241.8 Total 97 79.8 137.1 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The service area’s rates of hospital discharges for diabetes are similar to the state averages. .-"/$#$01%23$425670#$5*%.$57&8-9"#$5%.-09,"'3$%!"#$0%&$'%())*)))% /:%;$<5$'*%=))>4=)(=%2?$'"3$% )(#(% !"#$%&$'%())*)))% *(#(% "(#)% "(#(% !"#$% !'#(% !(#(% &'#'% 12345% 6.2789,% &(#(% '(#(% (#(% +,-.% /.0,-.% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #(! Chatuge Regional Hospital: Community Health Needs Assessment ! All Infectious and Parasitic Diseases: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 316 223.4 288.0 Non-white 5 356.5 444.5 Total 321 222.6 335.8 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The service area’s rates of hospital discharges as a result of infectious and parasitic diseases are lower than the state averages. .//%012$3#-456%"17%8"'"6-#-3%9-6$"6$6:%.;$<.7=56#$7*%9$75&/-3"#$7% 9-63,"';$%!"#$6%&$'%())*)))%>?%@$17$'*%A))B<A)(A%.C$'";$% #++$+& !*($)& !**$!& !"#$%& !"#$%&$'%())*)))% !"+$+& '("$)& !++$+& '"+$+& 23456& '++$+& 7/389:-& "+$+& +$+& ,-./& 0/1-./& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! #)! Chatuge Regional Hospital: Community Health Needs Assessment ! HIV/AIDS: Deduplicated Discharges & Age-Adjusted, Deduplicated Discharge Rates per 100,000 Service Area (Discharges) † Service Area (Rate) ‡ Georgia (Rate) White 2 * 8.4 Non-white 0 0.0 76.8 Total 2 * 32.3 ‡ †Average number of unique persons that sought care at a hospital during a calendar year. Deduplicated discharge: people are counted only once if readmitted for the same chronic condition during a calendar year. ‡ Ten year average age-adjusted, deduplicated discharge rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us From 2001-2010, less than one person per year went to the hospital as a result of HIV/AIDS. Because of the low rates of hospital discharge for this disease, rates could not be calculated. As a result, in the table below only contains rates for the state. ./012/345%26$7289:;#$8*%3$8:&<-="#$8%3-;=,"'6$%!"#$;%&$'%())*)))% >?%@$A8$'*%B))C7B)(B%2D$'"6$% !"#$%&$'%())*)))% &!"!# %$"!# %7"8# %!"!# -./01# 2*.345(# $"!# !"!# 7"7# !# 6# '()*# +*,()*# +,-#$% * Insufficient number of discharges to calculate a rate Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $+! Chatuge Regional Hospital: Community Health Needs Assessment ! Sexually Transmitted Disease (STD) Rate: Total STD Cases and New STD Cases per 100,000 Service Area (Cases) † Service Area (Rate) ‡ Georgia (Rate) White 67 66.3 96.3 Non-white 38 2,240.6 1,633.6 Total! 105 102.1 643.2 ‡ † Yearly average number of new STD cases per year from 2003-2012 ‡ Average STD Incidence rate from 2003-2012 ! Total case number includes cases with unknown race NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us In general, females have higher rates of STDs. Two factors contribute to this phenomenon. 1) Female reproductive anatomy is more susceptible to contracting an STD, and 2) females are less likely to have symptoms for common STDs and therefore less likely seek treatment. In Towns County, the rates of STDs are lower than the state averages. .$/0"112%3'"456-##$7%8-5$"5$%!"#$9%.38%!"#$5%&$'%())*)))%:2% ;$47$'*%<))=><)(<%?@$'"A$% ('&#&% (!$#"% !"#$%&$'%())*)))% (*&#&% ()&#&% "&#'% (&&#&% +&#&% '&#&% *&#&% 23456% $$#'% !"#$% 7/389:-% )&#&% &#&% ,-./% 0/1-./% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $*! Chatuge Regional Hospital: Community Health Needs Assessment ! Chlamydia Rate: New Chlamydia Cases and Cases per 100,000 People Service Area (Cases) † Service Area (Rate) ‡ Georgia (Rate) White 62 61.3 71.7 Non-white 33 1,945.8 1,116.8 Total! 95 92.4 443.5 ‡ † Average number of new STD cases per year from 2003-2012 ‡ Average STD Incidence rate from 2003-2012 ! Total case number includes cases with unknown race NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Because the number of STD cases among black males and black females was low, rates could not be calculated for those demographic categories. The chlamydia rate among whites in the service area is similar to the state average. .,/"012-"%!"#$3%.,/"012-"%!"#$4%&$'%())*)))%51%6$72$'*% 8))9:8)(8%;<$'"=$% ((&")# (&*"*# !"#$%&$'%())*)))% (**"*# $%"$# $*"*# %*"*# +*"*# 23456# !!"!# 7/389:-# &'"'# &*"*# *"*# ,-./# 0/1-./# +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $"! Chatuge Regional Hospital: Community Health Needs Assessment ! Gonorrhea Rate: New Gonorrhea Cases and Cases per 100,000 People Service Area (Cases) † Service Area (Rate) ‡ Georgia (Rate) White 2 * 15.7 Non-white 5 294.8 463.4 Total! 7 6.8 175.0 ‡ † Average number of new STD cases per year from 2003-2012 ‡ Average STD Incidence rate from 2003-2012 ! Total case number includes cases with unknown race NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The number of cases was too low to calculate rates by gender within the race classifications. ./0/'',$"%!"#$1%./0/'',$"%!"#$2%&$'%())*)))%34%.$05$'*% 6))786)(6%9:$'";$% !"#$%&$'%())*)))% %$!"!# %%!# %!!"!# ,-./0# $!"!# 6!"7# !"!# 1)-234'# 5# !# &'()# *)+'()# +,-#$% * Insufficient number of cases to calculate a rate Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $#! Chatuge Regional Hospital: Community Health Needs Assessment ! Trends in Mortality All Major Cardiovascular Diseases: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 414 214.5 263.9 Non-white 1 * 316.4 Total 415 213.8 278.7 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Major cardiovascular diseases include high blood pressure, obstructive heart failure, stroke, heart disease, and hardening of the arteries. As an aggregate, cardiovascular diseases are the largest cause of morbidity and mortality in the service area. The rates in Towns County are lower than one would expect given the age distribution of the county. .//%0"12'%3"'4-25"678/"'%9-6$"6$6:%.;$<.4186#$4%02'#"/-#=%!"#$6% &$'%())*)))%>=%?$@4$'*%A))B<A)(A%.5$'";$% (#'$'& !"#$%&$'%())*)))% (''$'& (%)$%& !"#$%& !!!$!& !#'$'& !''$'& %"'$%& %#'$'& 01234& %''$'& 5-1678+& #'$'& '$'& *+,-& .-/+,-& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $$! Chatuge Regional Hospital: Community Health Needs Assessment ! Stroke: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 103 53.0 45.7 Non-white 0 0.0 61.5 Total 103 52.7 50.0 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The total stroke mortality rate for the service area is similar to the state average. .#'/0$1%23$425678#$5%9/'#":-#;%!"#$8%&$'%())*)))%<;%=$>5$'*% ?))@4?)(?%2A$'"3$% &(#($ !"#$%&$'%())*)))% "(#($ !"#"$ %&#'$ %!#&$ !(#($ %%#'$ %(#($ 23456$ +(#($ 7/389:-$ *(#($ )(#($ (#($ ,-./$ 0/1-./$ +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $%! Chatuge Regional Hospital: Community Health Needs Assessment ! High Blood Pressure: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 14 6.8 9.1 Non-white 0 0.0 23.0 Total 14 6.7 12.4 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Mortality rates for blood pressure comprise a small proportion of deaths in comparison with other type of cardiovascular diseases. The mortality rates for high blood are similar to the state averages. .-/,%01223%4'$556'$7%8/$983:65#$3%;2'#"1-#<%!"#$5%&$'%())*)))%=<% >$?3$'*%@))A9@)(@%8B$'"/$% !"#$%&$'%())*)))% ')"($ !"#$ '("($ !"'$ %"&$ 01234$ 5-1678+$ )"($ ("($ 9$ *+,-$ .-/+,-$ +,-#$% * Insufficient number of deaths to calculate a rate Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $&! Chatuge Regional Hospital: Community Health Needs Assessment ! Obstructive Heart Disease: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 121 63.0 102.4 Non-white 1 * 98.5 Total 122 63.1 101.9 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Obstructive heart disease (OHD) includes heart attacks. Rates of OHD are lower than the state averages. ./0#'12#-3$%4$"'#%5"-61'$7%89$:8;<10#$;%=>'#"6-#?%!"#$0%&$'%())*)))% /?%@$A;$'*%B))C:B)(B%83$'"9$% ("+#+% (&!#)% !"#$%&$'%())*)))% ($+#+% (,+#+% (++#+% !"#$% *$#$% )+#+% 34567% "+#+% &!#'% $+#+% 8049:;.% ,+#+% +#+% -./0% 102./0% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $'! Chatuge Regional Hospital: Community Health Needs Assessment ! All Respiratory Diseases: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 194 95.0 94.3 Non-white 0 0.0 59.5 Total 194 94.6 86.8 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted mortality rates in the service area are similar to the state averages. .//%!$0&-'"#1'2%3-0$"0$04%.5$6.7890#$7%:1'#"/-#2%!"#$0%&$'%())*)))% ;2%<$=7$'*%>))?6>)(>%.@$'"5$% !+#$#& !"#$%&$'%())*)))% !"#$#& !"#$%& !!!$(& !##$#& '%$"& )#$#& )*$%& 34567& ,#$#& 8049:;.& +#$#& "#$#& #$#& -./0& 102./0& +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $(! Chatuge Regional Hospital: Community Health Needs Assessment ! All Cancers: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 337 179.4 175.1 Non-white 1 * 187.7 Total 338 178.7 178.8 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted mortality rates for the service area were similar to the state averages. The service area experiences twenty-eight deaths, on average, per year. .//%0"12$'34%.5$6.7893#$7%:;'#"/-#<%!"#$3%&$'%())*)))%=<%>$17$'*% ?))@6?)(?%.A$'"5$% !'"$"% !"#$%&$'%())*)))% !"#$!% !&#$(% !""$"% &'#$&% &'"$"% &)'$*% 12345% &""$"% 6.2789,% '"$"% "$"% +,-.% /.0,-.% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! $)! Chatuge Regional Hospital: Community Health Needs Assessment ! Breast Cancer: Deaths & Age-Adjusted Mortality Rates per 100,000 Females Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 12 8.2 12.1 Non-white 0 0.0 16.7 Total 12 8.2 13.4 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Breast cancer mortality rate in the service area is similar to the state average. On average, one person dies from breast cancer per year in the service area. .'$"/#%0"12$'3%45$64789/#$7%:;'#"<-#=%!"#$/%&$'%())*)))*% >))?6>)(>%4@$'"5$% ($#$% !"#$%&$'%())*)))% &'#$% &!#'% &$#$% !'#$% !"#$% )*+,-% !$#$% ./*0123% '#$% $#$% )*+,-% ./*0123% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %+! Chatuge Regional Hospital: Community Health Needs Assessment ! Prostate Cancer: Deaths & Age-Adjusted Mortality Rates per 100,000 Males Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 17 8.4 7.7 Non-white 0 * 17.3 Total 17 8.3 9.9 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted mortality rate for prostate cancer in the area was similar to the state average. .'/0#"#$%1"23$'4%56$7589:0#$8%;/'#"<-#=%!"#$0%&$'%())*)))*% >))?7>)(>%5@$'"6$% '&#&% !"#$%&$'%())*)))% !"#$% !&#'% !&#&% 324.,% "&#&% &#&% ()*+,% -.)/012% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %*! Chatuge Regional Hospital: Community Health Needs Assessment ! Colon Cancer: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 24 12.6 15.2 Non-white 0 0.0 20.9 Total 24 12.5 16.6 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted death rates for colon cancer are less than state averages. ./0/1%."12$'3%45$64789:#$7%;/'#"0-#<%!"#$:%&$'%())*)))%=<%>$17$'*% ?))@6?)(?%4A$'"5$% !"#$%&$'%())*)))% )+#&% !$#(% )&#&% !+#&% !"#$% !&#'% !)#*% !&#&% 23456% 7/389:-% +#&% &#&% ,-./% 0/1-./% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %"! Chatuge Regional Hospital: Community Health Needs Assessment ! Lung Cancer: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 112 57.7 55.3 Non-white 1 * 44.5 Total 113 57.8 52.8 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The age-adjusted lung cancer death rates are similar to the state averages. The rates for males are nearly twice the rates for females. Health behaviors, such as smoking habits, could be the explanation for the difference. ./01%2"03$'4%51$6578/9#$7%:;'#"<-#=%!"#$9%&$'%())*)))%>=%?$07$'*% @))A6@)(@%5B$'"1$% ')#)% !"#$%&$'%())*)))% ,)#)% ")#)% "&#(% !"#$% !)#)% &'#"% $)#)% &(#!% &)#)% 34567% +)#)% 8049:;.% *)#)% ()#)% )#)% -./0% 102./0% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %#! Chatuge Regional Hospital: Community Health Needs Assessment ! All Infectious Diseases: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 25 15.2 22.8 Non-white 0 0.0 45.7 Total 25 15.0 29.5 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The mortality rates for infectious diseases are lower than the state averages. .//%012$3#-456%7-6$"6$68%.9$:.;<56#$;%=4'#"/-#>%!"#$6%&$'%())*)))% ?>%@$1;$'*%A))B:A)(A%.C$'"9$% !"#$%&$'%())*)))% &*#*% $*#*% $'#$% !(#)% !"#$% !&#&% !*#*% 12345% 6.2789,% *#*% +,-.% /.0,-.% +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %$! Chatuge Regional Hospital: Community Health Needs Assessment ! HIV/AIDS: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 0 0.0 2.0 Non-white 0 0.0 14.4 Total 0 0.0 6.1 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The service area did not experience a death due to HIV/AIDS in the last ten years. AS a result, the rates for each race are zero. ./012/345%26$7289:;#$8%<='#">-#?%!"#$;%&$'%())*)))%@?%A$B8$'*% C))D7C)(C%2E$'"6$% !"#$%&$'%())*)))% )"!# ("!# $"$# $"!# 01234# '"!# 5-1678+# !"%# &"!# !"!# !"!# !"!# *+,-# .-/+,-# +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %%! Chatuge Regional Hospital: Community Health Needs Assessment ! Diabetes: Deaths & Age-Adjusted Mortality Rates per 100,000 Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 13 6.7 17.4 Non-white 1 * 34.1 Total 14 7.1 21.5 ‡ † Average number of deaths per year from 2003-2012 ‡ Age-adjusted mortality rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Since there were so few deaths from diabetes, the rates could not be calculated. The service area, on average, experiences one death per year from diabetes. .-"/$#$01%23$425670#$5%89'#":-#;%!"#$0%&$'%())*)))%/;%<$=5$'*% >))?4>)(>%2@$'"3$% *)")$ !"#$%&$'%())*)))% &%")$ &'"&$ &)")$ '("($ '%")$ ')")$ 12345$ !"#$ 6.2789,$ %"&$ %")$ )")$ +,-.$ /.0,-.$ +,-#$% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %&! Chatuge Regional Hospital: Community Health Needs Assessment ! Maternal and Child Health Prenatal care: Number and Proportion of Births Less Than 5 Prenatal Care Visits Service Area (Births) † Service Area (Rate) ‡ Georgia (Rate) White 3 * 4.4% Non-white 0 0.0% 7.3% Total 3 * 5.5% ‡ †Average number of births without at least 5 prenatal care visits per calendar year from 2003-2012. ‡ Percentage of births without at least 5 prenatal care visits per year from 2003-2012. Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The percentage of births receiving less than five prenatal care visits was very low in the service area. More than 99% of births received at least five prenatal care visits. !#"%'&'3)4'#"5)!"#$"%&'(")*+)6-#&0)#"$"-.-%()78)!#"%'&'3)4'#")9-1-&1) 6"&:""%);<<=>;<?;) !"#$"%&'(")*+),-.")/-#&01)) +"!# *"!# )"!# '"'# ("!# '"!# 7286920# &"!# %"!# $"!# !"!# :# ,-./0# 12-3456# 20-&") *Insufficient number of discharges to calculate a rate Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %'! Chatuge Regional Hospital: Community Health Needs Assessment ! Infant Mortality Rate: Deaths & Mortality Rates per 1,000 Live Births Service Area (Deaths) † Service Area (Rate) ‡ Georgia (Rate) White 6 7.4 6.0% Non-white 0 0.0 11.1% Total 6 7.2 7.7% ‡ † Average number of infant deaths (aged 0-11 months) per year from 2003-2012 ‡ Average Infant Mortality Rate from 2003-2012 Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The infant mortality rate in the service area is similar to the state average for the white population. 012"1#%34'#"5,#6%!"#$7%89$:8;<=.#$;%34'#"5,#6%!"#$.%&$'%()***%>,?$% +,'#-.)%@**A:@*(@%8?$'"9$% !"#$%&$'%()***%+,'#-.% '"!# &"!# 4"%# %"!# ()*+,# -.)/012# $"!# !"!# 3# ()*+,# -.)/012# /-,#$% *Insufficient number of discharges to calculate a rate Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %(! Chatuge Regional Hospital: Community Health Needs Assessment ! Low Birth Weight: Percentage of Births Less Than 2500g (5lbs 8oz.) Service Area (Births) † Service Area (Rate) ‡ Georgia (Rate) White 60 7.4% 7.3% Non-white 0 0.0% 12.2% Total 60 7.2% 9.4% ‡ †Average number of low birth births per year from 2003 to 2012 ‡ Ten year average low birth weight rate from 2003-2012 Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The percentage of low birth weight babies is similar to the state average for the white population. !"#$"%&'(")*+),-.")/-#&01)23455()) ,*7)/-#&0)6"-(0&8)!"#$"%&'(")*+)/-#&01)9'.-%()'),*7)/-#&0)6"-(0&) +#*:)355;<35=3) *&"&$ %"&$ !"%$ !"#$ )"&$ +,-./$ ("&$ 01,2345$ '"&$ &"&$ +,-./$ 01,2345$ 60-&") Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! %)! Chatuge Regional Hospital: Community Health Needs Assessment ! Low Birth Weight for Teen Births: Percentage of Births Less Than 2500g (5lbs 8oz.) for Mothers Aged 10-19 Service Area (Births) † Service Area (Rate) ‡ Georgia (Rate) White 10 10.3% 8.7% Non-white 0 0.0% 14.0% Total 10 10.1% 11.5% ‡ † Average number of low birth weight births from 2003-2012 for mothers aged 10-19 ‡ Average Percentage of Birth below 2500g for mothers aged 10-19 from 2003-2012 Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us Even though the total rate is similar to the state average, this comparison is misleading. When comparing Towns County’s rate to the rate for the white population in Georgia, it becomes evident that the low birth weight rate for teen mothers is actually slightly higher in the service area. ,*7)/-#&0)8'&")!"#$"%&'("9)!"#$"%&'(")*+),-.")/-#&01):%;"#)3455() +*#)<*&0"#1)=">'?"1)@(";)A5BACD)355EB35A3)@."#'(") !"#$"%&'(")*+),-.")/-#&01)23455() !$#'% !)#'% !"#$% !(#'% &#!% !'#'% *#'% +,-./% $#'% 01,2345% )#'% (#'% '#'% +,-./% 01,2345% 60-&") Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! &+! Chatuge Regional Hospital: Community Health Needs Assessment ! Teen Birth Rate: Live Births per 1,000 Females Aged 10-19 Service Area (Births) † Service Area (Rate) ‡ Georgia (Rate) White 97 14.9 19.6 Non-white 2 * 29.8 Total 99 14.7 24.0 ‡ † Average number of births from 2003-2012 ‡ Average Teen Birth Rate from 2003-2012 NSR: Not statistically reliable Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us The teen birth rate in the service area is less than the state average. !"#$%&"'()*%+$'%,-...%/$012$%3$$4*% 3$$4%&"'()%61($*7%!"#$%&"'()*%+$'%,-...%/$012$*%89$:%,.;,<-% =..>;=.,=%8#$'19$% )(#'% !$#&% )'#'% !(#'% !"#$% *+,-.% !'#'% /0+1234% (#'% '#'% *+,-.% /0+1234% 5)"($% Georgia Department of Public Health OASIS. Retrieved from www.oasis.state.ga.us ! ! &*! Chatuge Regional Hospital: Community Health Needs Assessment ! RESULTS: COMMUNITY-BASED SURVEY A total of 280 surveys were distributed in the community and 179 surveys were completed and returned to Georgia Southern University for analysis. This represents a response rate of 63.9%. As is the case with most survey work, missing values are most likely noted with all assessed variables. However, this analysis is limited only to those participants addressing a specific survey question. Therefore, table values not equaling 179 indicate the presence of missing values. Demographic Characteristics The following section contains specific information related to the demographic characteristics of all participants completing this community-based survey. Distribution of Participants by Gender Gender Male Female Total Frequency 53 124 177 Valid Percent 29.9 70.1 100.0 As is typical with community-based efforts, considerably more females (70.1%) completed this survey than males (29.9%). Distribution of Participants by Race/Ethnicity Ethnicity Frequency White, Non-Hispanic Black/African-American Hispanic/Latino Asian/ Pacific Islander Other Total 171 0 2 0 3 176 Valid Percent 97.2 0.0 1.1 0.0 1.7 100.0 Almost all survey respondents were white (97.2%). However, this proportion is representative of the racial demographics observed for the service area. ! ! &"! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Participants by Age Age 18-24 25-34 35-44 45-54 55-64 65 And Older Total Frequency Valid Percent 7 35 35 35 39 21 172 4.1 20.3 20.3 20.3 22.7 12.2 100.0 Nearly 55.2% of all participants completing the community-based survey were between the ages of 45 and 65+ years old. Only 4.1% of participants were 18 to 24 years old, and 20.3% of participants were between the ages of 25 and 34. Therefore, the age distribution suggests an adequate cross-section of participation. Distribution of Participants by Marital Status Marital Status Frequency Single 18 Married 133 Separated 2 Living Together 5 Divorced 15 Widowed 5 Other 0 Total 178 Valid Percent 10.1 74.7 1.1 2.8 8.4 2.8 0.0 100.0 Most participants (74.7%) were married while 10.1% of participants were single. Additionally, 8.4% of survey participants indicated they were divorced. The relative proportions of other categories were minimal. Distribution of Participants by Educational Status Level Of Education Frequency Less Than High School High School Or GED Some College Bachelor's Degree Advanced Degree Other Total ! 2 36 67 38 26 9 178 ! Valid Percent 1.1 20.2 37.6 21.3 14.6 5.1 100.0 &#! Chatuge Regional Hospital: Community Health Needs Assessment ! Approximately 37.6% of respondents reported having some college education, and 20.2% of respondents reported having a high school diploma or the equivalent. Only 1.1% of respondents indicated they had less than a high school education. Distribution of Participants by Household Income Household Income Frequency Valid Percent Under $25,000 $25,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000 Or More Don't Know/Not Sure Total 19 70 46 19 14 4 172 11.0 40.7 26.7 11.0 8.1 2.3 100.0 Approximately 11.0% of participants reported household incomes of less than $25,000 per year. Distribution of Participants by Home Ownership Status Home Ownership Frequency Yes No Total 142 34 176 Valid Percent 80.7 19.3 100.0 Most survey participants (80.7%) reported owning their home. Distribution of Participants by Access to Reliable Transportation Access To Transportation Frequency Yes No Total 172 1 173 Valid Percent 99.4 0.6 100.0 A considerable proportion of those surveyed reported having access to transportation (99.4%). However, it is important to note that this does not necessarily indicate they own transportation. ! ! &$! Chatuge Regional Hospital: Community Health Needs Assessment ! Community Perception This section illustrates factors related to community perception. Specifically, participants were asked to rate their community in terms of quality of life, economic growth, safety, and education. Individual Perception of Quality of Life in the Community My Community Is A: Good Place To Live Frequency Valid Percent Strongly Agree Agree No Opinion Disagree Strongly Disagree Total 117 58 2 0 0 177 66.1 32.8 1.1 0.0 0.0 100.0 Among those surveyed, 98.9% of participants either “agree” (32.8%) or “strongly agree” (66.1%) that their community is a good place to live. Individual Perception of the Economy My Community Has: Strong Economic Growth Frequency Valid Percent Strongly Agree Agree No Opinion Disagree Strongly Disagree Total 11 42 22 81 16 172 6.4 24.4 12.8 47.1 9.3 100.0 However, most participants feel that economic growth in the community is not optimal. Among those responding to this survey, 56.4% of participants either “disagree” (47.1%) or “strongly disagree” (9.3%) that economic growth is adequate in their community. Individual Perception of the Health Care System My Community Has A: ! Strong Health Care System Frequency Valid Percent Strongly Agree Agree No Opinion Disagree 17 80 21 47 10.1 47.3 12.4 27.8 ! &%! Chatuge Regional Hospital: Community Health Needs Assessment ! Strongly Disagree Total 4 169 2.4 100.0 Most participants “agree” (47.3%) or “strongly agree” (10.1%) the health care system is strong in their community. Individual Perception of the Family Oriented Nature of the Community My Community Is A: Good Place To Raise Children Strongly Agree Agree No Opinion Disagree Strongly Disagree Total Frequency Valid Percent 105 64 7 1 0 177 59.3 36.2 4.0 0.6 0.0 100.0 Among those responding to this survey, 95.5% of participants either “agree” (36.2%) or “strongly agree” (59.3%) that the community is a good place to raise children. Individual Perception of Community Safety My Community Is A: Safe Community Frequency Valid Percent Strongly Agree Agree No Opinion Disagree Strongly Disagree Total 82 89 5 1 0 177 46.3 50.3 2.8 0.6 0.0 100.0 Most participants agree that the community is a safe place to live. Approximately 96.6% of respondents either “agree” (50.3%) or “strongly agree” (46.3%) that the community is safe. ! ! &&! Chatuge Regional Hospital: Community Health Needs Assessment ! Individual Perception of the Educational System My Community Has A: Strong Education System Frequency Valid Percent Strongly Agree Agree No Opinion Disagree Strongly Disagree Total 65 80 20 6 1 172 37.8 46.5 11.6 3.5 0.6 100.0 The educational system of the community ranked fairly high. Approximately 85.0% of those responding indicated that they either “agree” (46.5%) or “strongly agree” (37.8%) that the community has a solid educational system. Distribution of Reported Perception of the Factors Influencing Health and Disease in the Community Factor Influencing Health Valid Percent Physical Inactivity Overweight/Obesity Tobacco Use Substance Abuse HIV/AIDS Mental Health Injury and Violence Environmental Quality Immunizations Access to Healthcare Other 63.1 76.0 43.6 52.5 0.6 16.2 5.6 4.5 1.1 26.8 0.6 Based on data gathered from the survey, overweight/obesity (76.0%) is perceived to be the most significant factor influencing health and disease in the community. However, substance abuse (52.5%), physical inactivity (63.1%), and tobacco use (43.6%) are commonly reported factors that influencing health status. ! ! &'! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Reported Perception of Substance Abuse in the Community Substance Abuse Issue Valid Percent Prescription Drugs/Pills 66.5 Alcohol 46.4 Drinking and Driving 20.7 Huffing (Inhaling Glue, Dust-Off, Etc.) 1.1 Other Hard Drugs (Cocaine, Crack, Heroin) 5.0 Using Someone Else’s Prescription Drugs/Pills 33.0 Marijuana 31.3 Methamphetamine 57.5 Tobacco 23.5 Do Not Know 5.6 Other 1.1 Community perception of substance abuse in the community is illustrated in the table above. According to these data, abuse from prescription drugs/pills (66.5%), methamphetamine (57.5%), and alcohol (46.4%) are the most significant problems facing this community. Distribution of Reported Perception of the Top Causes of Illness/Death in the Community Cause of Illness/Death Valid Percent Blood Poisoning Accidents Alzheimer’s Disease Cancer COPD Diabetes Influenza/Pneumonia Kidney Disease Liver Disease Heart Disease Homicide Hypertension Motor Vehicle Accidents Parkinson’s Disease Stroke Suicide Other 0.0 20.1 7.3 83.8 22.9 30.2 1.1 3.9 4.5 69.8 0.0 8.9 12.3 1.1 23.5 2.8 4.5 According to survey participants, cancer (83.8%) and heart disease (69.8%) are perceived to be the top causes of illness and death in the community. Other health issues of note include accidents (20.1%), diabetes (30.2%), COPD (22.9%), and stroke (23.5%). ! ! &(! Chatuge Regional Hospital: Community Health Needs Assessment ! Behavioral Patterns This section illustrates participant responses to a series of behavioral questions. The tables below indicate community patterns in terms of perceived health status, tobacco use, and screening behaviors. Perception of Individual Health Status Perceived Health Status Excellent Very Good Good Fair Poor Don't Know/Not Sure Total Frequency Valid Percent 19 70 74 14 1 1 179 10.6 39.1 41.3 7.8 0.6 0.6 100.0 Approximately 41.3% of respondents perceived their health status to be “good” and 39.1% perceived their health status to be “very good”. Only 10.6% of participants stated their health status was “excellent”. Distribution of Tobacco Use Tobacco Use Yes No Total Frequency Valid Percent 35 141 176 19.9 80.1 100.0 Most participants (80.1%) reported not using tobacco. Distribution of Colonoscopy Screening in Individuals Over 50 Years of Age Received Colonoscopy Screen Frequency Valid Percent Yes No Total 64 26 90 71.1 28.9 100.0 According to those surveyed, 71.1% of participants over the age of 50 years reported having had a colonoscopy. Distribution of Annual Prostate Screening in Males Over 40 Years of Age Received Annual Prostate Screen Frequency Valid Percent Yes No Total ! 27 23 50 ! 54.0 46.0 100.0 &)! Chatuge Regional Hospital: Community Health Needs Assessment ! According to those surveyed, 54.0% of men over 40 years old reported having had an annual prostate screening examination. Distribution of Annual Mammography Screening in Females Over 40 Years of Age Received Annual Mammography Screen Frequency Valid Percent Yes No Total 60 30 90 66.7 33.3 100.0 According to those surveyed, 66.7% of women over the age of 40 reported having had an annual mammography screening examination. Distribution of Cervical Cancer Screening in Females Over 40 Years of Age Received Cervical Cancer Screen Frequency Valid Percent Yes 95 76.0 No 30 24.0 Total 125 100.0 According to those surveyed, Approximately 76.0% of women over 40 years old indicated they have had a cervical cancer screening examination. Access and Barriers to Healthcare The following section contains specific information related to healthcare access and real, or perceived barriers to access. Distribution of Healthcare Access/Utilization for Illness Healthcare Setting Frequency Health Department Hospital Emergency Room Urgent Care Center Doctor’s Office I Do Not Receive Care Other Total 24 1 3 10 128 9 3 178 Valid Percent 13.5 0.6 1.7 5.6 71.9 5.1 1.7 100.0 According to the data reported in the table above, 71.9% of respondents indicated accessing healthcare for illness occurred at the doctor’s office. ! ! '+! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Healthcare Access/Utilization for Annual Physicals/Check-Ups Healthcare Setting Frequency Valid Percent I Do Not Receive Annual 19 10.7 Physicals OB/GYN or Women’s Health 45 25.4 Provider Doctor’s Office 95 53.7 Health Department 17 9.6 Other 1 0.6 Total 177 100.0 According to those participating in this survey, 10.7% report not receiving an annual physical examination. Among those reporting to receive the examination, most visit either a doctor (53.7%) or a women’s health provider (25.4%). Distribution to Healthcare Access Difficulty Receiving Healthcare Yes No Total Frequency 31 146 177 Valid Percent 17.5 82.5 100.0 Approximately 18.0% of participants reported having had difficulty receiving healthcare. Distribution of Reported Barriers to Healthcare Access Barriers to Healthcare Access No Health Insurance Insurance Did Not Cover Health Condition Deductible/Co-Pay Too High Provider Did Not Accept Insurance Hospital Did Not Accept Insurance Dentist Did Not Accept Insurance Unable to Travel to Provider Did Not Know Where to Go for Care Could Not Get an Appointment The Wait Was Too Long Other Valid Percent 15.6 25.1 27.9 3.9 1.1 4.5 0.0 2.8 5.0 6.1 14.5 The table above illustrates reported barriers to healthcare access. Reporting “a high deductible/co-pay” is the most frequently reported barrier to health care access. The failures of insurance to cover a specific health condition (25.1%) and having “no insurance” (15.6%) were also commonly reported barriers. ! ! '*! Chatuge Regional Hospital: Community Health Needs Assessment ! Community Resources and Services The following section contains specific information related to community resources and specific services necessary to improve overall health. Distribution of Reported Services Necessary to Improve Quality of Life in the Community Services to Improve Quality of Life Valid Percent Animal Control Child Care Options Elder Care Options Services for Disabled People More Affordable Health Services Better/Healthier Food Choices More Affordable/Better Housing Number of Healthcare Providers Culturally Appropriate Health Services Counseling/Mental Health/Support Group Services Substance Abuse Services Better/More Recreational Facilities (Parks, Trails) Healthy Family Activities Positive Teen Activities Transportation Options Availability of Employment Higher Paying Employment Road Maintenance Road Safety None 5.6 15.6 10.1 5.0 30.7 8.9 13.4 19.0 0.6 15.1 17.3 15.1 8.9 20.7 3.9 52.5 44.1 4.5 1.7 1.1 When asked about necessity of services to improve quality of life, the availability of employment opportunities (52.5%) was the most common service cited. Higher paying jobs (44.1%), positive teen activities (20.7%), and more affordable health services (30.7%) were also commonly reported services needed to improve quality of life in the community. ! ! '"! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Reported Sources for General Health-Related Information Sources for General Health-Related Information Valid Percent Friends/Family Doctor/Nurse Pharmacist Church Internet My Child’s School Hospital Health Department Help Lines Books/Magazines Television Other 14.8 43.8 4.0 0.6 23.9 0.0 1.1 6.8 0.0 3.4 1.1 0.6 Based on results from the survey, health providers including doctors and nurses (43.8%), the Internet (23.9%), and family/friends (14.8%) are the most common sources for general healthrelated information. Distribution of Reported Sources for Local Health News and Events Sources for Local Health News/Events Billboards Email Updates Magazines Blogs Family/Friends Direct Mail Newspapers Church Internet Radio School Television Workplace Social Media (Facebook, Twitter) Other Valid Percent 5.6 11.7 5.0 2.2 48.0 3.4 55.3 23.5 29.1 22.3 12.3 17.3 46.9 26.3 1.7 The most common sources for local health news and events reported by participants include newspapers (55.3%), by family or friends (48.0%), and the workplace (46.9%). However, social media (26.3%) and the Internet (29.1%) were also commonly reported sources too. ! ! '#! Chatuge Regional Hospital: Community Health Needs Assessment ! Community Health This section illustrates community perspectives of factors (or issues) impacting health, barriers to health, and reported health conditions of respondents. Distribution of Reported Issues Affecting Quality of Life in the Community Issues Affecting Quality of Life Valid Percent Pollution (Air, Water, Land) Dropping Out of School Low Income/Poverty Job Opportunities Homelessness Lack of/Inadequate Health Insurance Hopelessness Discrimination/Racism Lack of Community Support Lack of Higher Paying Jobs Neglect and Abuse Elder Abuse Child Abuse Domestic Violence Violent Crime (Murder, Assault) Theft Rape/Sexual Assault Drug/Alcohol Abuse None 1.1 7.3 63.1 66.5 0.0 20.7 0.6 1.7 5.0 51.4 5.6 1.1 2.2 6.7 1.1 3.4 0.6 49.2 1.7 According to survey participants, job opportunities (66.5%), lack of higher paying jobs (51.4%), low income/poverty (63.1%), drug/alcohol abuse (49.2%), and lack of health insurance (20.7%) are the most commonly reported issues affecting overall quality of life in the community. ! ! '$! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Reported Behaviors for Health Education Purposes Health Behaviors Targeted for Health Education Healthy Eating/Nutrition Exercise/Fitness Weight Management Dental Hygiene/Preventive Care Annual Physicals/Screening Prenatal Care Flu Shots/Immunization Emergency/Disaster Preparedness Child Safety Seats Motor Vehicle Safety Smoking Cessation/Tobacco Use Prevention Child Care/Parenting Elder Care Care for Special Needs/Disabled Family Members Prevention of Pregnancy & Sexually Transmitted Disease End of Life Resources (Hospice, Living Wills, Etc.) Substance Abuse Prevention Suicide Prevention Stress Management Anger Management Domestic Violence Prevention Crime Prevention Rape/Sexual Abuse Prevention None Valid Percent 31.3 20.7 20.1 16.2 18.4 3.4 11.7 19.6 1.7 5.0 14.5 12.8 12.8 14.0 12.8 12.8 27.9 1.7 11.2 3.9 14.5 1.7 0.0 2.2 Specific health behaviors to be targeted for health education are illustrated in the table above. According to these data, health eating/nutrition (31.3%), weight management (20.1%), substance abuse prevention (27.9%), emergency/disaster preparedness (19.6%), smoking/tobacco cessation (14.5%), and exercise/fitness (20.7%) were the behaviors most commonly reported by survey participants. ! ! '%! Chatuge Regional Hospital: Community Health Needs Assessment ! Distribution of Reported Behaviors that Most Significantly Impact Child Health in the Community Behaviors Impacting Child Health Valid Percent Dental Hygiene 38.0 Nutrition 54.2 Eating Disorders 14.5 Asthma Management 2.8 Contagious Disease 7.3 Diabetes Management 7.3 Tobacco 24.6 Drug Abuse 48.6 Sexual Intercourse 19.6 Alcohol 26.8 Internet Safety 20.1 Sexually Transmitted Diseases 10.6 Mental Health Issues 12.8 Suicide Prevention 0.6 Other 1.7 Participants indicated the importance of nutrition (54.2%) and drug abuse (48.6%) in the context of child health. Other important behaviors perceived to impact child health include alcohol (26.8%), dental hygiene (38.0%), Internet safety (20.1%), and tobacco (24.6%). Distribution of Reported Barriers to Physical Activity Barriers to Physical Activity Exercise Is Not Important No Access to Facilities No Time No Child Care No Partners Dislike of Exercise Cost Too Much No Safe Facilities Too Tired Physically Disabled Don’t Know Get Exercise at Work Fear of Working Out Don’t Know How to Get Started Other ! Valid Percent 1.7 10.1 46.9 8.9 2.8 20.1 7.3 2.8 40.8 1.7 10.6 11.2 10.1 7.3 7.8 ! '&! Chatuge Regional Hospital: Community Health Needs Assessment ! According to respondents to the community health survey, 29.6% of those participating indicated they get adequate physical activity. Specific barriers to being physically active include time (46.9%), fatigue (40.8%), and dislike of exercise (20.1%). Distribution of Reported Barriers to Healthy Diet/Nutrition Barriers to Healthy Diet/Nutrition Dislike of Fruits/Vegetables Do Not Know How to Prepare Likely to Spoil Before Prepared/Eaten No Access to Fresh Fruits/Vegetables Do Not Know Where to Buy Them Do Not Think About Eating Fruits/Vegetables Do Not Have Time to Prepare Fruits/Vegetables Too Expensive Do Not Think They Are Important to Eat Not Available During the Off-Season Other Valid Percent 14.0 4.5 33.0 1.1 0.0 30.7 20.1 39.7 1.1 7.8 5.6 When asked about proper diet and nutrition, 34.6% of respondents indicated they consume at least five or more servings of fruits and vegetables each day. Specific barriers to healthy eating include expense (39.7%), the likelihood of spoilage (33.0%), not thinking about eating fresh fruits/vegetables (30.7%), and too much time to prepare (20.1%). Distribution of Reported Health Conditions Conditions Valid Percent Asthma Depression/Anxiety High Blood Pressure High Cholesterol Diabetes (Not During Pregnancy) Osteoporosis Overweight/Obesity Angina/Heart Disease Cancer 10.9 25.0 33.5 29.9 10.8 5.4 38.9 4.3 9.8 According to survey participants, overweight/obesity (38.9%) is the most commonly reported health condition in the community. Other conditions of note include high blood pressure (33.5%), depression/anxiety (25.0%), and high cholesterol (29.9%). ! ! ''! Chatuge Regional Hospital: Community Health Needs Assessment ! RESULTS: KEY STAKEHOLDER INTERVIEWS In Towns and Clay Counties, only 3 interviews with key stakeholders were conducted. Among those interviewed, there was unanimous agreement about overall quality of life in the community. Specific issues of safety, environmental quality and the fact the community was ideal for child rearing were referenced. Only two negative comments were identified. One negative comment focused on a perception there was limited healthcare resources in the community. The other negative comment referenced a lack of mental health resources (facilities and/or providers) in the target area. Key stakeholders identified 6 major health concerns. These concerns are as follows: ! Aging population ! Cancer ! Heart disease ! Tobacco ! Diabetes ! Obesity In addition, key stakeholders identified 4 significant health behaviors. These behaviors are as follows: ! Drug & alcohol abuse ! Domestic violence ! Healthy diet ! Lack of exercise ! ! '(! Chatuge Regional Hospital: Community Health Needs Assessment ! COMMUNITY ASSETS Towns County Assets Name of the Company Phone Number Address 98$%70(!N(0&)#$:!I)5K&%$: (706) 896-2222 I)5K&%$:5, B(4&C$:!^$H5 E#&)#!/(#(,$:!I)5K&%$:.! P#C2\E#&)#!9)7#%-!_)#T DA(,0(#C-!3,$#5K),% 3,&!6%$%(!E,):)0-!"55)C&$%(5 (706) 435-8108 a(%(,$#5!V*!W),(&0#!b$,5 (706) 896-8387 a(%(,$#5!)*!W),(&0#!b$,5! (706) 896-1953 DA),-!I($,%!9(#%(, (706) 896-7662 110 S Main Street, Hiawassee, GA 30546 103 Church Street, Hiawassee, GA 30546 110 S Main Street, Hiawassee, GA 30546 1329 Sunnyside Road, Hiawassee, GA 30546 75 Lakeview Circle, Hiawassee, GA 30546 110 S Main Street, Hiawassee, GA 30546 E#&)#!/(#(,$:!I)5K&%$: (706) 745-2111 35 Hospital Road, Blairsville, GA 30512 I)5K&%$:5, _7,5�! I)A(5TP#%(,A(4&$%(!9$,(! W$C&:&%-, _7,5�!I)A(5T 6M&::(4!_7,5�!W$C&:&%- B-!6(#&),!9$,( (888) 644-5592 Hiawassee Area I)A(!I($:%8!6(,'&C(5, ":`8(&A(,d5!9$,(!c! 6(,'&C(5, "55&5%(4!^&'�! W$C&:&%&(5 I)A(!P#5%($4!6(#&),!9$,(! (706) 835-3800 15 Earnest Street, Blairsville, GA <,$55%);#!B$#),!f!D:(0$#%! 6(#&),!^&'�! (706) 896-4285 108 Church Street, Hiawassee, GA /(),0&$!I($:%8!6(,'&C(5! _(%;),M (770) 466-7771 Bankers Blvd., Monroe, GA 30655 I)A(!I($:%8!6(,'&C(5.! "55&5%(4!^&'�!W$C&:&%&(5.! ":`8(&A(,e5!9$,(!c! 6(,'&C(5! I)A(!I($:%8!6(,'&C(5.! "55&5%(4!^&'�!W$C&:&%&(5.! ":`8(&A(,e5!9$,(!c! 6(,'&C(5! +(,5)#$:!9$,(!I)A(5, "55&5%(4!^&'�!c!D:4(,! 9$,(!6(,'&C(5, D:4(,:-! ! (706) 896-7191 ! Services Hospitals I)5K&%$:5, B(4&C$:! 6(,'&C(!V,0$#&`$%&)#5 9)AA7#&%-! V,0$#&`$%&)#5 9)AA7#&%-! V,0$#&`$%&)#5! I)5K&%$:5, +8-5&C&$#5!c! 67,0()#5.!9$,4&):)0-, +8-5&C&$#5!c!67,0()#5 ')! Chatuge Regional Hospital: Community Health Needs Assessment ! I)A(5 I($:%8!6%,((%!T!+,)*(55&)#$:! 1,70.!":C)8):!$#4!1_"! 3(5%� (888) 407-7650 Hiawassee Area 1,70!3(5%�, 6$*(%-! 9)#57:%$#%5, I7A$#! N(5)7,C(!9)#57:%$#%5 "'&%$!9)AA7#&%-!+$,%#(,5 (706) 896-6263 "'&%$!9)AA7#&%-!+$,%#(,5! (706) 745-5911 1100 Jack Dayton Circle, Young Harris, GA 30582 41 Hospital Street, Suite 100, Blairsville, GA 30512 38(!D5K)5&%)!P#5%&%7%(.!P#C2! (678) 712-3405 /(),0&$!B)7#%$! 9)AA7#&%-!6(,'&C(5! (706) 745-5911 B(#%$:!I($:%8!6(,'&C(5, ":C)8):&5A!P#*),A$%&)#!c! 3,($%A(#%!9(#%(,5 B(#%$:!I($:%8!6(,'&C(5.! 67&C&4(!+,('(#%&)#! 6(,'&C(5.!1,70!"H75(!c! "44&C%&)#.!":C)8):&5A!c! 3,($%A(#%! 9)7#5(:�!6(,'&C(5.! ":C)8):&5A.!1,70!"H75(!c! "44&C%&)#! ":C)8):!c!1,70! 3,($%A(#%! 48 Haralson Place, Suite 3, Blairsville, GA 30512 41 Hospital Street, Suite 100, Blairsville, GA 30512 Clay County, NC Assets Name of the Company Phone Number I($:%8!1(K$,%A(#%!&#!9:$-! 9)7#%-! 9:$-!9)7#%-!9$,(!9(#%(, (828) 389-8052 I6I!_7%,&%&)#!9(#%(, Address Services 1 Riverside Circle, Hayesville, NC 28904 86 Valley Hideaway Drive, Hayesville, NC 28904 I($:%8!6(,'&C(5! (828) 389-0007 18 Creekside Circle, Hayesville, NC 28904 I($:%8!c!1&(%!W))4! +,)47C%5 /))4!68(K8(,4!I)A(!c! I)5K&C( (828) 389-6311 165 Highway 64 W. Suite 6, Hayesville, NC 28904 I)5K&%$:5, I)5K&C(5, I)A(!I($:%8!6(,'&C(5 /))4!68(K8(,4!I)A(!c! I)5K&C( (828) 321-4113 379 Whitaker Lane, Andrews, NC 28901 I)5K&%$:5.!I)5K&C(5.! I)A(!I($:%8!6(,'&C(5 9:$-!9)7#%-!6(#&),!9(#%(,g! W$A&:-!9$,(0&'(,!67KK),%! /,)7K! (828) 586-5501 196 Ritter Road, Hayesville, NC 28904 +,&A$,-!"0�!c! 1&5$H&:&%-!6(,'&C(5! ! (828) 389-9941 ! I)5K&%$:5, B(4&C$:! 9:&#&C5, _7,5�! I)A(5T6M&::(4! _7,5�!W$C&:&%- (+! Chatuge Regional Hospital: Community Health Needs Assessment ! 38(!I$-(5'&::(!I)75(g! 67KK),%!/,)7K! 9:$-!9)7#%-!+,(5(,'$%&)#! 9(#%(, (828) 389-8700 480 Old Highway 64 West, Hayesville, NC 28904 151 Yellow Jacket Drive, Hayesville, NC 28904 +,&A$,-!"0�!c! 1&5$H&:&%-!6(,'&C(5! D47C$%&)#$:!6(,'&C(5 "::!"H)7%!3,($%A(#% (877) 414-5329 Serving the Hayesville Area 9)7#5(:�!6(,'&C(5, 1,70!"H75(!c! "44&C%&)#!9(#%(,5, ":C)8):&5A! P#*),A$%&)#!c! 3,($%A(#% I$-(5'&::(!/,)7K! (828) 389-8302 S7:&$#!W2!h(&%8!":C)8):!c! 1,70!"H75(!3,($%A(#%! 9(#%(,! W,-(!N(0&)#$:!B(4&C$:! 9(#%(,!6)7%8!9$AK75! <(8$'&),$:!I($:%8!6(,'&C(5! W$A&:-!67KK),%!_(%;),M! (828) 257-6200 989 Hiawassee Street, Hayesville, NC 28904 201 Tabernacle Road, Black Mountain, NC 28711 420 N. Center Street, Hickory, NC 28601 ":C)8):!c!67H5%$#C(! "H75(! ":C)8):!c!67H5%$#C(! "H75(! 116 Jackson Street, Sylva, NC 28779 6 Cold Branch Road, Hayesville, NC 28904 391 Courthouse Drive, Hayesville, NC 28904 55 Riverside Circle, Hayesville, NC 28904 54 Church Street, Hayesville, NC 28904 W$A&:-!6(,'&C(5! (828) 389-0277 (828) 328-2226 (828) 586-0661 (828) 837-9155 6)7%8;(5%(,#!98&:4! 1('(:)KA(#%!9)AA&55&)#! 9:$-!9)7#%-!3,$#5K),%$%&)#! (828) 389-0644 1(K$,%A(#%!)*!6)C&$:! 6(,'&C(5!3,$#5K),%$%&)#! 9:$-!9)7#%-!a(%(,$#5! 6(,'&C(!V**&C(! a"B9!"58('&::(.!_9!N7,$:! I($:%8!P#&%&$%&'(! (828) 389-6301 (828) 389-3355 (828) 298-7911 ext. 4337 P.O. Box 118, Hayesville, NC 28904 1100 Tunnel Road, Asheville, NC 28805 <(8$'&),$:!I($:%8! 6(,'&C(5! W$A&:-!6(,'&C(5! 3,$#5K),%$%&)#! 3,$#5K),%$%&)#! a(%(,$#!6(,'&C(5! a(%(,$#!6(,'&C(5! ! ! ! ! ! ! ! ! ! ! (*! Chatuge Regional Hospital: Community Health Needs Assessment ! SUMMARY OF COMMUNITY ISSUES ! !"#$%& '()*+$#,& !+)-%#./")& 0"*(.$"1& 2(31+4(3)& & 5".-"+6"1& 2(31+4(3)& 73$".6+"8)& !"#$%&'()"#)"&& *+),+-.)/"-"%#-& 0.12(3.1)& 45"$6"(78%94:")(%;& 0#1,"$& <7(17& =.>+-#3.1& 0#1,"$& !"#$%&'()"#)"& !(78&?-..2&=$"))+$"& !"#$%&'()"#)"& 0#1,"$& 0"$":$.5#),+-#$& '()"#)"& =1"[email protected](#& !(78&08.-")%"$.-& '(#:"%")& !"#$%&'()"#)"& 04='& =$"71#1,;9 08(-2:($%8&A))+")& '">$"))(.19<1B("%;& & C%$./"& & A1D",3.+)& '()"#)"& =1"[email protected](#& *"1%#-9?"8#5(.$#-& '().$2"$)& <)%8@#& 04='& '(#:"%")& *"1%#-9?"8#5(.$#-& '().$2"$)& E"1(%.+$(1#$;& C;)%"@&'()"#)"& '(#:"%")& & <,,(2"1%)& & 4:")(%;& & <-F8"(@"$G)& H#--)& 0#1,"$& & *.%.$&I"8(,-"& <,,(2"1%)& C+:)%#1,"&<:+)"& & J(21";&'()"#)"& C">3,"@(#& 4)%".>.$.)()& & !;>"$%"1)(.1& & '.@")3,& I(.-"1,"& '(#:"%")& C%$./"& !"#$%&'()"#)"& <-F8"(@"$G)& C+(,(2"& *"%#:.-(,&'()"#)")& K(5"$&'()"#)"& ! ("! Chatuge Regional Hospital: Community Health Needs Assessment ! PRIORITIZATION As outlined below, eight health-related issues emerged from the data. A. B. C. D. E. F. G. H. Accidents Respiratory System Disease Diabetes/Metabolic Disorders Mental Health Substance Abuse Heart Disease/Vascular Disease Overweight/Obesity Cancer During the 3rd meeting, these data were presented to participants. The table below illustrates the results of the prioritization exercise. Prioritization Results # Ranking Issue Size of Problem* Seriousness of Problem* Effectiveness of Possible Intervention* Basic Priority Ranking Accidents 8 2.7 5.6 3.3 9.2 Respiratory System Disease 8 3.3 5.5 3.1 8.9 Diabetes/Metabolic Disorders 8 3.3 7.6 3.9 14.0 Mental Health 8 3.6 7.9 3.3 12.5 Substance Abuse 8 3.9 7.7 2.6 9.9 Heart Disease/Vascular Disease 8 3.7 7.4 3.7 13.7 Overweight/Obesity 8 3.8 7.7 3.9 14.8 Cancer 8 3.3 7.7 3.2 11.7 Community Issue *Represent average score of all participants ranking a particular issue According to the results, “Overweight/Obesity” ranked highest according to the calculated BPR score. This issue was followed by “ Diabetes/Metabolic Disorders,” “Heart Disease/Vascular Disease,” “Mental Health,” “Cancer”, “Substance Abuse”, “Accidents,” and “Respiratory System Disease”. ! ! (#! Chatuge Regional Hospital: Community Health Needs Assessment ! REFERENCES 1. Center for Rural Health, The University of North Dakota School of Medicine and Health Sciences. Checklist for Community Health Needs Assessment Written Report and Implementation Strategy. Retrieved from Ruralhealth.und.edu/projects/flex/files/checklist_chna.pdf 2. County Health Rankings and Roadmaps (2014). Retrieved from http://www.countyhealthrankings.org/app/georgia/2014/pulaski/county/1/overall 3. Oasis Morbidity and Mortality Web Query Tool (2014). Georgia Department of Public Health. Retrieved from http://oasis.state.ga.us/oasis/oasis/qryMorbMort.aspx 4. Oasis Maternal and Child Health Web Query Tool (2014). Georgia Department of Public Health. Retrieved from http://oasis.state.ga.us/oasis/oasis/qryMCH.aspx 5. OASIS Animated Charting Tool - Population Pyramids (2014). Georgia Department of Public Health. Retrieved from http://oasis.state.ga.us/oasis/oasis/countypop/index.aspx 6. Behavioral Risk Health Surveillance System Retrieved from http://www.cdc.gov/brfss/ 7. Physician Workforce Primary Care/Core Specialties (2010). Georgia Board for Physician Workforce. Retrieved from http://gbpw.georgia.gov/sites/gbpw.georgia.gov/files/imported/GBPW/Files/2008%2 0Physician%20Profile-%20Final%208-8-11.pdf 8. The Yellow Pages (2014). Retrieved from http://www.yellowpages.com and http://www.yp.com 9. United Health Foundation (2014). Retrieved from http//www.americashealthrankings.org 10. U.S. Census Bureau: State and County Quickfacts (2014). Retrieved from http://quickfacts.census.gov/qfd/states/13/13235.html ! ! ($! Chatuge Regional Hospital: Community Health Needs Assessment ! LIST OF APPENDICES A. Institutional Review Board Approval B. Steering Group Members C. CAC Members D. Meeting 1 Attendance Roster (September 8, 2014) E. Meeting 2 Attendance Roster and Presentation (October 10, 2014) F. Meeting 3 Attendance Roster and Presentation (January 9, 2015) G. Community Health Survey H. Interview Guide I. Prioritization Sheet J. Meeting Minutes ! ! (%!