Mayo Clinic Health System in Waycrossmayoclinichealthsystem.org/~/media/Shared Files/Documents/CHNA/2013...Entity Overview: Mayo Clinic Health System (MCHS) in Waycross includes a

Mayo Clinic Health System in Waycross

September 30, 2013

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Table of Contents Executive Summary................................................................................................................................ 3

Our Community ....................................................................................................................................... 5

Assessing the Needs of the Community ........................................................................................ 15

Addressing the Needs of the Community ..................................................................................... 31

Appendix A: Other Resources .......................................................................................................... 33

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Executive Summary Enterprise Overview:

Mayo Clinic is a not-for-profit, worldwide leader in patient care, research and education. Each year Mayo Clinic serves more than one million patients from communities throughout the world, offering a full spectrum of care from health information, preventive and primary care to the most complex medical care possible. Mayo Clinic provides these services through many campuses and facilities, including 24 hospitals located in communities throughout the United States, including Arizona, Florida, Georgia, Iowa, Minnesota and Wisconsin.

A significant benefit that Mayo Clinic provides to all communities, local to global, is through its education and research endeavors. Mayo Clinic reinvests its net operating income funds to advance breakthroughs in treatments and cures for all types of human disease, and bring this new knowledge to patient care quickly. Through its expertise and mission in integrated, multidisciplinary medicine and academic activities, Mayo Clinic is uniquely positioned to advance medicine and bring discovery to practice more efficiently and effectively.

In addition, through its Centers for the Science of Health Care Delivery and Population Health Management, Mayo Clinic explores and advances affordable, effective health care models to improve quality, efficiency and accessibility in health care delivery to people everywhere.

Entity Overview:

Mayo Clinic Health System (MCHS) in Waycross includes a 231-bed acute care hospital located in Waycross, Ga. MCHS in Waycross provides a broad range of services and is the only hospital in Ware County, which covers more than 892 square miles in southeast Georgia. In addition to the wide range of typical acute care hospital services, MCHS in Waycross operates:

• The Heart Center, focusing on detecting, diagnosing and treating cardiovascular disease

• Cardiac and Pulmonary Rehabilitation Services, a program that combines exercise and education to help individuals recover from a heart attack, bypass surgery, major lung conditions or other cardiac events

• The Rehabilitation Institute, a free-standing 20-bed rehabilitation unit located in Waycross

• Senior Behavioral Unit, a 15-bed psychiatric unit designed to address the unique challenges of the aging population of the community

• Pierce County Nursing Home, a 78-bed hospital-based nursing facility offering short-term rehabilitation and long-term care located in Blackshear, Pierce County, Ga.

• Satilla Care Center, a 96-bed hospital-based, nursing facility offering short-term rehabilitation and long-term care located in Waycross

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• Convenient Care, an urgent care center located in Waycross

Summary of Community Health Needs Assessment:

MCHS in Waycross defined its community as Ware and Pierce counties, where the majority of its patients reside, and we are able to have the greatest influence on the health of the residents of these counties. Both primary and secondary data were collected to help identify health needs within Ware and Pierce counties. Primary data collection methods included interviews and focus groups with key community representatives. The purpose of the interviews and focus groups was to gain direct input from these individuals regarding health needs, community assets and other related topics, including primary and chronic disease needs and health issues associated with uninsured persons, low income persons and minority groups. In addition, community input was garnered from the Community Advisory Committee (CAC), as well as the Mayo Clinic Health System in Waycross Community Health Needs Assessment (CHNA) Oversight Committee. The CAC members included a wide range of community constituencies representing the broad interests of the community served, including the population with primary and chronic diseases and health issues of uninsured persons, low-income persons and minority groups. The CHNA Oversight Committee was responsible for overseeing the CHNA process, including prioritizing health needs and developing an implementation plan to address them. Secondary data was collected from a variety of respected organizations on a broad array of health indicators and other information, then analyzed and summarized. The types of data collected included demographic, socio-economic, chronic disease, mortality and morbidity, health status indicators, health behaviors, maternal and child health, insurance status and general community/environmental information. Summary findings Community health needs were identified through primary and secondary data collection and analysis and were grouped into five major categories. These areas were prioritized by the CHNA Oversight Committee by using criteria related to the scope of the health need; opportunity to intervene at the prevention level; estimated feasibility and effectiveness of possible interventions; ability to meet the need with resources available; whether addressing the need builds on existing organizational competencies; and the economic contribution to the communities, families and employers. This process resulted in the prioritized health needs list shown below:

1. Smoking/tobacco use 2. Obesity 3. Access to health care 4. Substance abuse 5. Mental health

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Our Community Geographic area:

Community Definition:

Mayo Clinic Health System in Waycross defined its community geographically as Ware and Pierce counties, based on its patient origin. The primary population centers are the cities of Waycross and Blackshear, with the remainder of Ware and Pierce counties being largely rural. Since the large majority of its patients live in Ware and Pierce counties, MCHS in Waycross is able to have the greatest influence on the health of these residents. As demonstrated below, approximately 79 percent of MCHS in Waycross inpatients live in these two counties.

Mayo Clinic Health System in Waycross Inpatient Origin 2010 – 2012

Source: Georgia Hospital Association HERMES 2.0, accessed April 19, 2013.

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Ware and Pierce Counties, Ga.

Mayo Clinic Health System in Waycross

Community Overview: Introduction Ware and Pierce counties are located in southeastern Georgia. Based on 2010 Census data, the population of was 55,070, with 36,312 in Ware County and 18,758 in Pierce County. Ware is the largest county in Georgia geographically, and includes a large portion of the Okefenokee Swamp. Ware and Pierce counties comprise the Waycross Micropolitan Statistical Area as defined by the U.S. Census Bureau. With a 2010 population of 14,651, Waycross is the Ware county seat and by far the most populous city in either county. The Blackshear is the Pierce county seat and had a 2010 population of 3,445. The remainder of the population is dispersed throughout the two counties. The size, largely rural nature and geography of these counties result in physical access obstacles to health care for those who live in remote portions of the area and cannot drive, such as senior citizens, the disabled or those who cannot afford a vehicle.

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Demographics and socio-economics Population size and age mix Ware and Pierce counties are projected to grow slightly between 2013 and 2018, with the population ages 65 and older expected to be a significant proportion of the population growth; the 17 and under age group also is projected to increase in Ware County. The proportion of the senior population in these counties is very large, as shown in the age distribution table. The proportion of population ages 65 and over is significantly greater, while the percentage of the population ages 18 to 44 is significantly less in both Ware and Pierce counties than the statewide figure.

Population Trends By Age Group and Total

Source: Nielsen Claritas, 2013.

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Percent of Population by Age Group

Census 2010

Source: U.S. Census Bureau, 2013.

Race and ethnicity The most common race in Ware and Pierce counties is White, at 66.4 percent and 86.9 percent of the population, respectively. African-American makes up the only other race with a significant population in Ware (29.5 percent) or Pierce (8.9 percent) County. When evaluating ethnicity, only 3.3 percent of the Ware and 4.7 percent of the Pierce population is Hispanic.

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Percent of Population by Race & Ethnicity Census 2010

Source: U.S. Census Bureau, 2013.

Socio-economics The socio-economic status for residents of both counties is significantly below that of both Georgia and the U.S. Both the median and mean household incomes for Ware and Pierce counties are well below those for Georgia and the U.S.

Median & Mean Household Income 2007 – 2011

Source: 2007-2011 American Community Survey 5-Year Estimates; US Census Bureau, 2013.

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The proportion of population below the poverty level in Ware and Pierce counties is significantly above that of Georgia and the U.S., consistent with their relatively low level of affluence. The level of poverty in Ware County is particularly high. As shown in the chart below, a significantly larger proportion of children live in poverty than adults. Also, a much larger percentage of African-Americans live below the poverty level compared with Whites. Hispanics in Ware County experience a higher level of poverty than in Georgia or the U.S. overall.

Percent of Population Below 100% of Poverty Level 2007 – 2011

* Estimates have an extremely high margin of error. Source: 2007-2011 American Community Survey 5-Year Estimates; US Census Bureau, 2013.

Other economic and social factors The unemployment rate has been relatively high in Ware County, while the proportion of households receiving food stamps has been high in both in Ware and Pierce counties, as indicated in the following graph. Also, the proportion of the population that does not speak English at home is substantially less in Ware and Pierce counties than statewide and nationally.

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Selected Economic/Social Indicators 2007 – 2011

Source: Bureau of Labor Statistics, April 19, 2013; 2007-2011 American Community Survey 5-Year Estimates; US Census Bureau, 2013.

The proportion of the population that reported having a disability in surveys conducted by the U.S. Census Bureau is relatively high in Ware and Pierce counties compared with both the statewide and national rates.

Population with a Disability Percent of Civilian Non-Institutionalized Population

2009 – 2011


The level of educational achievement is relatively low in Ware and Pierce counties compared to state and national figures. As shown below, approximately 19 percent of Ware and 22 percent of Pierce County residents 25 years of age and over have not graduated from high school, and residents of these counties have significantly lower rates of bachelor’s degrees compared with Georgia or the U.S. overall.

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Selected Education-Related Indicators 2007 – 2011


Access to health care Access to care was the health issue most frequently mentioned by focus group and interview participants. Below is an overview of additional physical and economic factors affecting access. Physical access to care The physical inability to access care is a significant impediment to receiving health care, particularly for vulnerable populations. Because of the rural nature of much of Ware and Pierce counties, it can be difficult for many to get transportation to the doctor’s office or other care provider. The two counties have limited public transportation options, consisting primarily of Ware County Transit and Pierce County Transit. These transit services charge a fare based on distance — $3 to $4 each way within a 10-mile radius, higher for longer and out-of-county travel — and require that rides be scheduled in advance. In Ware County, fares for seniors ages 65 and older and children five and under are discounted by 50 percent, while in Pierce County, seniors and the disabled receive a 50 percent discount. As a result of cost and other limitations, there are many circumstances for which these transportation services are not a practical option. In addition, focus group and interview participants indicated that limited family support systems for some is another barrier to care. As a result, many residents of Ware and Pierce counties may have difficulty obtaining transportation to health care. Difficulty in accessing primary care, particularly for Medicaid/PeachCare and uninsured patients, was mentioned in focus groups and interviews. According to www.countyhealthrankings.org, the population to primary care physician ratio in Pierce County (2,351:1) is significantly greater than the statewide ratio (1,611:1), indicating a shortage of primary care physicians in this county.

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Economic access to care Relatively low income levels in Ware and Pierce counties, as well as high poverty and disability rates, and lack of health insurance have created significant economic barriers to care for many. The uninsured and Medicaid/PeachCare enrollees were identified by focus group and interview participants as those experiencing the greatest difficulty in accessing care. Ware and Pierce counties exhibit a very high rate of uninsured residents compared with the statewide rate, for both children and adults under the age of 65. As shown below, nearly one-third of adults under the age of 65 have no health insurance.

Percent Uninsured 2009 – 2011


An additional indicator of the socio-economic status of Ware and Pierce counties is hospital payer mix. As shown in the following table, the proportion of hospital inpatients covered by Medicaid and self-pay patients is relatively consistent with Georgia overall. However, the emergency department payer mix for Ware and Pierce County residents consist of a high proportion of Medicaid and self-pay compared with Georgia overall.

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Hospital Inpatient Payer Mix

Residents of Ware/Pierce Counties Georgia 2010

Emergency Department Payer Mix Residents of Ware/Pierce Counties Georgia

2010

Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed April 23, 2013.

In addition to the uninsured and those who are covered by Medicaid/PeachCare, the increasing number of individuals enrolled in health insurance plans with high deductibles was mentioned by focus group and interview participants as a growing barrier to care. These participants also indicated that uninsured, underinsured and Medicaid/PeachCare enrollees were the most likely to be medically underserved, experience the most difficulty in accessing health care and use the emergency department for their primary care. Other access-related issues mentioned by participants were the high cost of required medications and follow-up care, and lack of access to substance abuse and other behavioral providers, dental services, and certain specialty care not available in the community.

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Assessing the Needs of the Community Overview:

Mayo Clinic Health System in Waycross defined its community as Ware and Pierce counties, based on patient origin and its ability to have the greatest influence on the health of residents of these counties. Community Input:

In conducting the CHNA, input was obtained from a broad range of individuals, including local health department representatives, as well as the medically underserved, low-income and minority population. Representatives of these populations provided input through several means as part of the CHNA, including participation in interviews and focus groups and an external CAC. In addition, a CHNA Oversight Committee was responsible for overseeing the CHNA process and included individuals with significant insight into the health needs of the community, including members of the medically underserved, low-income and minority populations. Process and Methods:

Both primary and secondary data were collected to assist in identifying health needs within Ware and Pierce counties. Primary data methodology Primary data collection methods included interviews and focus groups with key community representatives. To gather input from an extensive range of people who represent the broad interests of Ware and Pierce counties, focus groups and one-on-one interviews were conducted in March and April 2013. In total, interviews were conducted with 23 individuals and 13 focus group participants who were key community representatives. The purpose of the interviews and focus groups was to gain direct input from these individuals regarding health needs, community assets and other related topics, including primary and chronic disease needs and other health issues associated with uninsured persons, low income persons and minority groups. Focus group and interview participants included community stakeholders representing health care and social services providers, school systems, religious organizations, economic organizations, political and other community officials and the elderly/senior population. Many of the focus group and interview participants represented, and were very familiar with, the health needs associated with the medically underserved, low income, minority and populations with chronic and acute diseases in Ware and Pierce counties.

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Questions were asked about an array of health topics, including what the most significant health needs are in the counties and why; what groups of residents are underserved; what are the most significant health needs of each group; and issues associated with the medically underserved, low income, minority and population with chronic and acute diseases. The opinions of focus group and interview participants were summarized and ranked according to the responses given. In addition, community input was garnered from the CAC, as well as the MCHS in Waycross CHNA Oversight Committee. The CAC included representatives from:

• Ware County Health Department • The Ware County Children’s Initiative • Brunel Street Church of God • Hospice Satilla • City of Waycross • Ware County school system • Baptist Village Retirement Communities

CAC members were interviewed initially to receive their input regarding significant community health needs. They then participated in a session where the CHNA preliminary findings were presented, and they were able to provide additional feedback regarding the findings. The CHNA Oversight Committee included the following representatives from Mayo Clinic Health System in Waycross:

• Medical staff (2) • Social Services • Emergency Department • Government Relations • Finance • Chief Administrative Officer

Representatives of the CHNA Oversight Committee participated in four meetings over the course of five months and reviewed and discussed the implications of the primary and secondary data analyses, identified priority community health needs and developed implementation strategies to address them. Secondary data methodology Secondary data was collected using a variety of publicly available data from numerous respected organizations and agencies and regarding a broad range of issues. The types of data included demographics, socio-economics, insurance status, chronic disease and mortality/morbidity information, health status indicators, health behaviors, behavioral risk factors and maternal and child health indicators for residents of Ware and Pierce counties. In many cases, secondary data for the

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counties were compared with state and national indicators, when applicable and available. The secondary data was then summarized. Information gaps Every attempt was made to collect relevant and recent primary and secondary data reflecting the health status and social determinants of health in Ware and Pierce counties. In some cases, the ability of MCHS in Waycross to assess all community health needs may have been limited by a lack of existing or recent small-area estimate information relevant to Ware and/or Pierce counties. External assistance MCHS in Waycross engaged Alexander Consulting Group, Inc. (ACG) to assist in conducting the CHNA. ACG facilitated meetings of the CHNA Oversight Committee and CAC, conducted interviews and focus groups, performed the secondary data analyses and drafted the CHNA report.

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Secondary Data – Health Outcomes, Behaviors and Risk Factors: Mortality and morbidity indicators Although generally declining, overall age-adjusted mortality rates in Ware County, and Pierce County in particular, remain significantly higher than statewide and national rates.

Age-Adjusted Mortality Rates – All Causes Per 100,000 Population

Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Mortality/Morbidity Web Query Tool, accessed April 20, 2013; CDC, National Center for Health Statistics, CDC Wonder, Underlying Cause of Death 2006-2010 age-adjusted to the 2000 US standard population, accessed April 9, 2013.

As shown below, mortality rates in Ware and Pierce counties are significantly higher than Georgia and U.S. rates for many of the leading causes of death, including cardiovascular disease, cancer (Pierce County, in particular), chronic lung disease and accidents.

Age-Adjusted Mortality Rates by Cause 2006 – 2010


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The overall mortality rate for African-Americans is relatively consistent with rates for Whites in Ware County while, in Pierce County, the mortality rate for Whites is higher than for African-Americans.

Age-Adjusted Mortality Rates by Race & Major Cause 2006 – 2010


When evaluating the mortality rate for the leading cancer sites, those in Pierce County are higher than in Ware County, Georgia statewide and the U.S. for lung and colorectal cancers, with a significantly lower rate for prostate cancer mortality. At the same time, the rate of breast cancer mortality in Ware County is slightly higher than in Pierce County, Georgia and national rates.

Age-Adjusted Mortality Rates by Selected Cancer Sites 2006 – 2010


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In evaluating the incidence of cancer, the age-adjusted cancer incidence rates are lower in Ware County, and consistent in Pierce County, compared with the Georgia and U.S. rates. For the most common cancer sites, incidence rates for Ware and Pierce counties are below the statewide and national rates for female breast cancer. Incidence of prostate cancer in Pierce County is below the Georgia and U.S. rates, while higher than statewide and national rates for lung and colorectal cancers.

Age-Adjusted Incidence Rates by Selected Cancer Sites 2005 – 2009

* Data not available since too few cases were reported. Source: CDC statecancerprofiles.cancer.gov, 2005-2009 age-adjusted to the 2000 US standard population, accessed April 10, 2013.

Cancer incidence rates are higher among Whites than African-Americans in Ware and Pierce counties. However, the incidence rate for prostate cancer is significantly higher among Ware County African-Americans that among Whites.

Age-Adjusted Cancer Incidence Rates by Race 2005 – 2009

* Data not available since too few cases were reported. Source: CDC statecancerprofiles.cancer.gov, 2005-2009 age-adjusted to the 2000 US standard population, accessed April 10, 2013.

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Another indicator for morbidity is hospital discharge and emergency department visit rates. Hospital discharge rates are higher for residents of Ware and Pierce counties than Georgia overall for several causes, including accidents, influenza/pneumonia, diabetes and asthma. At the same time, hospital discharge rates for mental/behavioral disorders, heart disease, cancer and stroke are generally consistent or lower than statewide rates.

Age-Adjusted Hospital Discharge Rates by Selected Cause 2006 – 2010


Emergency department visit rates are significantly higher in Ware and Pierce counties than statewide for many causes, including mental/behavioral disorders, asthma, hypertension, diabetes and heart disease.

Age-Adjusted ED Visit Rates by Selected Cause 2006 – 2010


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The relatively high emergency department visit rates in Ware and Pierce counties are indicative of the difficulty certain populations have in accessing primary care. Behavioral risk factors The proportion of adults who are obese, diabetic and receive no exercise is greater in Ware and Pierce counties than in Georgia overall.

Behavioral Risk Factors — Adult Diabetes, Obesity & Lack of Exercise 2009

* Adults that report not participating in physical activity or exercise during the past 30 days other than their regular job. Source: CDC BRFSS Survey Data, 2013.

Obesity is one of the most significant risk factors for several diseases affecting residents of Ware and Pierce counties, including cardiovascular disease, diabetes and hypertension. A major factor causing the substantial cardiovascular disease mortality rates in the region is the level of obesity, with nearly one-third of the adult population in Ware and Pierce counties considered obese. One of the causes of obesity is inactivity. A high proportion of adults in Pierce County, and an extremely high percentage in Ware County, do not exercise, which is consistent with the level of obesity. Another significant contributing factor to the high rates of cardiovascular and lung disease, is the high smoking rate in both counties. Approximately one-quarter of adults smoke, compared with 19 percent statewide and nationally. With such a high proportion of adults who smoke, and the negative impact smoking has on other significant diseases in the region, there is considerable room for improvement.

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Behavioral Risk Factors — Adult Smoking, Alcohol Use & Reported Health 2005 – 2011

* Percent of adults that report either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men) drinks per day on average. Source: CDC BRFSS Survey Data, 2013.

Available information for Ware County shows the proportion of residents who drink excessively is relatively low, while the percentage who report they are in fair or poor health is relatively high compared with Georgia overall and the U.S. Maternal and child health indicators The rate of infant mortality in Ware County is above the Georgia and U.S. rates, based primarily on neonatal, rather than post-neonatal mortality.

Infant, Neonatal & Post-Neonatal Mortality Rates 2007 – 2011

* Data not available since too few cases were reported. Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Infant Mortality Web Query Tool, accessed April 21, 2013; CDC, National Center for Health Statistics, CDC Wonder, Underlying Cause of Death 2006-2010 age-adjusted to the 2000 US standard population, accessed April 9, 2013; CDC National Vital Statistics Reports, Volume 61, Number 8, January 24, 2013.

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The level of inadequate prenatal care, low birth weight births and births to unmarried women is somewhat high in Ware County. However, the proportion of mothers who smoked during pregnancy is extremely high in both Ware and Pierce counties, adding further emphasis to the need to reduce smoking rates in the region, including pregnant mothers.

Selected Maternal & Child Health Indicators 2007 – 2011

* U.S. data is for 2009 for low weight births and 2010 for births to unmarried women. Source: Georgia Department of Public Health, Office of Health Indicators for Planning, OASIS Maternal/Child Web Query Tool, accessed April 21, 2013; CDC, National Center for Health Statistics; CDC National Vital Statistics Reports, Volume 60, Number 2, November 17, 2011; CDC NCHS Data Brief, Number 89, April 2012; and CDC, NCHS National Vital Statistics report, Vol. 1, No. 1, August 28, 2012.

County Health Rankings County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, examines a variety of health status indicators and ranks each county within each state in terms of “health factors” and “health outcomes.” The health outcomes measure is a composite based on mortality and morbidity statistics, and the health factors measure is a composite of several variables known to affect health outcomes: health behaviors, clinical care, social and economic factors, and physical environment.

• Clinical Care is a composite measure of Access to Care, which examines the percent of the population without health insurance and ratio of population to primary care physicians.

• Quality of Care examines the hospitalization rate for ambulatory care sensitive conditions, whether diabetic Medicare patients are receiving HbA1C screening, and percent of chronically ill Medicare enrollees in hospice care in the last eight months of life.

• Physical Environment is a composite that examines Environmental Quality, which measures the number of air pollution-particulate matter days and air pollution-ozone days.

• Built Environment measures access to healthy foods and recreational facilities and the percentage of restaurants that are fast food restaurants.

County Health Rankings is updated annually. County Health Rankings 2013 relies on data from 2004 to 2012, with most data originating in 2008 to 2010.

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Following is a summary of the indicators used to develop the 2013 rankings for Ware and Pierce counties, compared with overall Georgia and U.S. statistics.

County Health Rankings (2013)

Indicators Ware County

Pierce County Georgia U.S.

Mortality

Premature death (deaths before age 75 per 100,000 pop.) 1

9.993 10,962 7,697 8,025

Morbidity

Poor or fair health 21% n/a 16% 17%

Poor physical health days (per month) 5.4 6.1 3.5 3.8

Poor mental health days (per month) 4.0 3.5 3.4 3.4

Low birth weight (<2,500 grams) 10.2% 8.9% 9.5% 8.3%

Health Behaviors

Adult smoking 25% 24% 19% 21%

Adult obesity 31% 29% 28% 30%

Physical inactivity2 35% 29% 24% 28%

Excessive drinking3 9% n/a 14% 15%

Motor vehicle crash death rate (per 100,000 pop.) 20 36 16 22

Sexually transmitted infections (chlamydia infections per 100,000 pop.) 746 251 466 315

Teen birth rate (per 100,000 female pop.) 89 81 50 46

Clinical Care

Uninsured 22% 23% 22% 18%

Primary care physicians (pop. to physician ratio) 1,299:1 2,351:1 1,611:1 2,596:1

Dentists (pop. to dentist ratio) 2,281:1 6,317:1 2,249:1 3,630:1

Preventable hospital stays (hospitalization rate per 1,000

Medicare enrollees)4

90 106 68 79

Diabetic screening5 87% 79% 84% 84%

Mammography screening6 62% 60% 64% 63%

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County Health Rankings (2013)

Indicators Ware County

Pierce County Georgia U.S.

Social & Economic Factors

High school graduation7 76% 84% 67% 82%

Some college8 41% 44% 59% 54%

Unemployment 11.7% 9.8% 9.8% 8.7%

Children in poverty 36% 32% 27% 25%

Inadequate social support9 25% n/a 21% 19%

Children in single-parent households 38% 33% 36% 31%

Violent crime rate (per 100,000) 424 121 437 274

Physical Environment

Daily fine particulate matter10

10.3 10.7 12.0 11

Drinking water safety11

0% 13% 2% 9%

Access to recreational facilities12

11 5 8 8

Limited access to healthy foods13

14% 4% 8% 8%

Fast food restaurants (per total restaurants) 54% 75% 50% 45%

1 Age-adjusted to the 2000 U.S. population 2 Adults that report not participating in physical activity or exercise during the past 30 days other than their regular job. 3 Based on BRFSS criteria for binge or heavy drinkers. 4 Preventable hospital stays for ambulatory care sensitive conditions as defined by the Dartmouth Atlas. 5 Percent of diabetic Medicare enrollees receiving HbA1c screening. 6 Percent of female Medicare enrollees ages 67 to 69 receiving at least one screening over a two year period. 7 Percent of high school freshmen that graduate from high school in four years. 8 Percentage of the population age 25-44 with some post-secondary education. 9 Percentage of adults without social/emotional support, calculated by the CDC using BRFSS data. 10 Average daily measure of fine particulate matter in micrograms per cubic meter (PM2.5). 11 Percentage of the population getting drinking water from public water systems with at least one health-based violation. 12 Number of recreational facilities per 100,000 population. 13 Percent of population with a low income and live more than one mile from supermarket/large grocery store in an urban area or greater than 10 miles

from a supermarket/large grocery store in a rural area. Source: www.countyhealthrankings.org, 2013.

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Primary Data – Summary of Focus Group and Interview Findings; Overview To gather primary input from individuals who represent the broad interests of Ware and Pierce counties, focus groups and one-on-one interviews were conducted by ACG representing 36 individuals on March 19, 20, 26, 27 and April 10, 2013, including 23 interview and 13 focus group participants. Topics included:

• What do you believe are the most significant health needs in Ware and Pierce counties? o Why are they significant?

• What groups of residents in Ware and Pierce counties are underserved, and what do you

believe are the most significant health needs of each group, including o Medically underserved population? o Low-income population? o Minority population? o Acute and Chronic disease groups?

A summary of the opinions of focus group and interview participants follows, in descending order of frequency in which they were mentioned.

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Most significant health needs The most frequently mentioned significant health needs are as follows:

• Access to care o Most affected populations include uninsured/underinsured, poor/low income,

unemployed/ underemployed, elderly and children o Most common causes mentioned include:

Difficulty accessing primary care, resulting in use of the emergency department for primary care

Transportation issues caused by no public transportation and limited family support systems

Cost of care, including medications and follow-up care required Need for more physicians, including pediatricians Lack of access to specialty care

• Behavioral health (mental health/substance abuse)

o Most common issues mentioned include: Inadequate supply of services, both outpatient counseling and inpatient, with

Unison virtually the only provider and with few private providers Drug addiction/substance abuse issues include meth and prescription drug

abuse/addiction (e.g., pain and antianxiety medications) Behavioral health issues result in high use of emergency department

• Unhealthy lifestyle of population

o Most common causes mentioned include: Obesity, caused by poor diet and lack of exercise Poor diet/eating habits, with people making poor food choices Smoking habits, caused by the area culture (tobacco farming, etc.) Limited health prevention efforts Drug addiction Overall lack of education/not knowing what to do Poor living conditions, including poor parenting skills

• Dental services

o Most common issue mentioned was difficult to access for low income/uninsured and Medicaid/PeachCare recipients

• Diabetes

o Most common causes mentioned include poor diet/lack of access to proper nutrition and culture

• Hypertension

o Causes mentioned include poor diet and obesity

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• Other significant health needs mentioned by more than one individual include geriatric/elderly care, teen pregnancy, children’s specialty care, heart disease and cancer.

Medically underserved population Most frequently mentioned characteristics of the medically underserved population are as follows:

• Uninsured/underinsured, including low income population (just above income to qualify for Medicaid)

• Mental health population, including people with medical comorbidities • Medicaid/PeachCare patients

Most frequently mentioned issues for this population include:

• Overuse of the emergency department, including mental health patients • Lack of transportation options, for the elderly in particular • Mental health problems, including prescription drug abuse • Putting off seeing physicians and dentists until condition worsens • Medicaid/PeachCare patients having difficulty accessing care, for specialists in particular • People with diabetes, many of whom are unable to afford medication/insulin and, as a result,

are noncompliant • People with heart disease, such as congestive heart failure.

Low-income population Most frequently mentioned issues associated with the low-income population include:

• Poor diet, including less access to healthy foods (less healthy foods are cheaper) and lack of education

• Teen pregnancy • Lack of access for preventive care, including lack of education and lack of consistency with

providers • Lack of access to supplies/medications • Lack of transportation options • Lack of access to pediatricians • Overuse of the emergency department

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Minority population The African- American and Hispanic population were mentioned by many respondents as the most significant minorities in Ware and Pierce counties. The Asian/Indian and Transient/Homeless population were mentioned by a few respondents, but are thought to be relatively small groups in Ware and Pierce counties. Most frequently mentioned characteristics of African-Americans and Hispanics in the two counties are listed below.

• African-Americans o More likely to suffer from conditions such as diabetes, hypertension, heart disease,

sickle cell anemia and stroke o Poor diet and obesity tend to be more prevalent o Tend to receive less health prevention and screening o Higher teen pregnancy rate o Several individuals believe health issues are mostly the same as overall population.

• Hispanics

o Language barrier exists, resulting in children interpreting for parents o Less likely to access health care services if illegal o Several individuals believe health issues are mostly the same as overall population.

Population with acute and chronic diseases The most frequently mentioned acute and chronic diseases, together with causes and associated issues suggested by respondents are listed below.

• Cancer, including childhood cancer o Causes include smoking/tobacco use

• Diabetes o Causes include poor diet, obesity, and lack of education, exercise and preventive

services • Heart disease/Congestive Heart Failure

o Causes include smoking/tobacco use, poor diet, obesity, genetics, diabetes, stress, and lack of exercise and preventive services

• Obesity o Causes include lifestyle choices (inactivity, poor diet, etc.) and genetics

• Asthma • COPD/lung disease

o Causes include smoking • Hypertension • Sexually transmitted disease • Stroke • Teen pregnancy

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Addressing the Needs of the Community Prioritization Process and Criteria:

Community health needs were identified through primary and secondary data collection and analyses and were grouped into five major categories. These areas were prioritized by the CHNA Oversight Committee by using criteria related to the scope of the health need; opportunity to intervene at the prevention level; estimated feasibility and effectiveness of possible interventions; ability to meet the need with resources available; whether addressing the need builds on existing organizational competencies; and the economic contribution to the communities, families and employers. The result was the identification and ranking of five significant health needs.

Identified Health Needs:

Through the process described above and in the preceding section (“Assessing the Needs of the Community”) the CHNA Oversight Committee prioritized the following health needs:

1. Smoking/tobacco use 2. Obesity 3. Access to health care 4. Substance abuse 5. Mental health

Mayo Clinic Health System in Waycross prioritized those health needs with the strongest alignment to its mission and ability and capacity to address those health needs:

1. Smoking/tobacco use 2. Obesity 3. Access to health care

Smoking/tobacco use The prevalence of smoking among Ware and Pierce County residents is significantly higher than the Georgia and national rates, based on secondary data. It’s one of the most significant risk factors for and causes of many other health issues, including cardiovascular disease, chronic respiratory disease and lung cancer. MCHS in Waycross believes it is only through addressing the root causes of the most significant health issues that the most significant needs can be addressed.

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Obesity Similar to smoking, the percentage of the population that is obese in Ware and Pierce counties is higher than statewide, and the significance of obesity also was expressed by several focus group and interview participants. Obesity is another of the most significant risk factors for and causes of numerous other health issues experienced by Ware and Pierce County residents, including diabetes, hypertension and heart disease. By focusing on lowering the obesity rate, MCHS in Waycross is choosing to direct its efforts to the prevention level for this and other health issues caused by obesity. Access to health care Access to health care was identified through both primary and secondary data. Access was indicated by more focus groups and interview participants than any other health issue, with uninsured, underinsured and Medicaid recipients mentioned as experiencing the greatest difficulty in accessing health care. Secondary data supports this concern, with a low level of affluence and a high proportion of uninsured population among residents of Ware and Pierce counties. Substance abuse and mental health Substance abuse and mental health were mentioned by many focus group and interview participants as significant health issues in Ware and Pierce counties. Although there is little secondary data to support these concerns, it is apparent that treatment options to address this health issue are limited. Due to several factors, including a limited opportunity to intervene at the prevention level, relatively low expected effectiveness of possible interventions, and lack of competency to address these needs beyond the services provided through its Senior Behavioral Unit, MCHS in Waycross believes it is most appropriate to focus its efforts on smoking/tobacco cessation, obesity and access to health care.

Other Available Resources:

In addition to the facilities and services provided by MCHS in Waycross and other providers as discussed above and in the Access to Care section of this report, Ware and Pierce counties have many health resources available for vulnerable populations and the community overall. These resources were considered when prioritizing the health needs of the community. The Attachment to this report includes a list of existing health care facilities and other resources identified during the CHNA process that are available to address the identified community health needs. This list is not comprehensive, but includes those health resources known or identified in the course of conducting the CHNA.

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Attachment A: Available Resources Below are lists of existing health care facilities and other resources identified during the CHNA process that are available to address the identified community health needs. These lists are not comprehensive, but include those health resources known or identified in the course of conducting the CHNA. The following are example programs not mentioned previously that are offered or hosted by Mayo Clinic Health System in Waycross.

Advocacy/education programs offered • Bullying/cyber bullying • Child abuse and neglect • Diabetes survival skills classes • Healthy dating relationships • Internet safety • Parenting classes for breast feeding, child birth, epidural and sibling school • S.A.F.E. (Self Awareness & Familiarization Exchange) Program • Sexual harassment • Steward of children training • Tobacco cessation classes

Examples of other programs provided, sponsored or supported • American Cancer Society Look Good Feel Better • American Cancer Society Relay For Life • American Cancer Society survivor dinner • Blood pressure checks at local festivals and water stations for local races • Camp Huff-n-Puff for children with asthma • Camp Reveille health program for children (focused on obesity prevention) • Community and employer health fairs • Emory University Humphrey Fellowship students host • First aid station for Pierce County High School band competition • Live Healthy in Faith toolkit for faith community to promote nutrition and physical activity • Nutrition and hydration training for Ware County school system athletes • Nutrition program for the Weed-n-Seed Program • Okefenokee Technical College funding for full-time nurse instructor • Partnership with Memorial Drive Elementary School (funding for walking track and health education) • Saddle Up therapeutic • Satilla Miracle League Softball League for disabled • Senior Safety Day community collaboration/partnership • Support groups for Alzheimer’s, cancer, diabetes, domestic violence, sexual assault • Teen Maze at Ware County High School • Weight Watchers program host • Women’s Health Blitz

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The following is a list of other existing health care facilities and other resources identified during the CHNA process that are available to address the identified community health needs. County health departments

• Southeast Health District-locations in Ware and Pierce Counties, includes services for children and adolescents (Babies Can’t Wait, breast feeding, Children 1st, Children’s Medical Services, health checks, immunizations, health screenings, teen services, WIC program); women’s health (cancer screenings, family planning, Perinatal Health Partners and Best Babies programs); adult health (health promotion SHAPP program, immunizations); infectious diseases; and environmental health

Federally qualified health centers

• McKinney Community Health Center, Inc. (locations in Ware and Pierce counties) Home health agencies

• Care One home health services • Health Department home care services • Ware visiting nurses service

Hospice agencies

• Hospice Satilla Mental health/substance abuse resources

• Alcoholics Anonymous • Bethesda House of Mercy • Fetal Alcohol Syndrome Support Group • Harrell Learning Center • MADD • Narcotics Anonymous • Treatment Center of Waycross • Unison Behavioral Health, including outpatient (adult, child and adolescent); adult day

treatment; adult residential services through St. Illa, Garden Gate and Supportive Living/Shelter Plus Care; and developmental disabilities services

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Other organizations

• American Cancer Society • Baptist Village • Blackshear Recreation Department • Boys to Men • Concerted Services, Inc. (includes Elderly Services program, Ware County Food Bank, Head

Start programs, Early Head Start program, Pre-K program) • Diabetes in the Area of Waycross Gathering for Support (DAWGS) • Dialysis Facilities, Inc. • Diversified Resources, Inc./SOURCE • Georgia Lions Camp for the Blind • Harrell Learning Center • Kingdom Care • Magnolia House Shelter for Abused Women • Mary Street Mission • Megan House Easter Seals • Pierce County Department of Family & Children’s Services • Pierce County Family Connections Collaborative • Pierce County schools • Rainbow Partners • Salvation Army • Satilla Advocacy Services • Satilla Health Foundation • Southeast Cancer Unit, Inc. • Southeast Georgia Area Agency on Aging • The ARC of Satilla • Ware County Children’s Initiative • Ware County Department of Family & Children’s Services • Ware County Recreation Department • Ware County school system • YMCA of Waycross