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Community Health Needs Assessment ofNortheast GeorgiaDistrict 2 Public HealthHabersham Medical CenterNortheast Georgia Medical Center GainesvilleNortheast Georgia Medical Center BraseltonNortheast Georgia Medical Center BarrowNortheast Georgia Medical Center LumpkinStephens County HospitalApproved by:The Hospital Authority of Habersham County, Georgia, September 17th, 2019, posted to www.habershammedical.comNortheast Georgia Medical Center Board of Directors, August 27, 2019, posted to www.nghs.comNortheast Georgia Health System Board of Directors, September 24, 2019, posted to www.nghs.comStephens County Hospital Authority Board, September 16, 2019, posted to stephenscountyhospital.comPage 1 of 287
Community Health Needs Assessment of Northeast GeorgiaTable of ContentsExecutive Summary . 7Community Health Needs Assessment Requirement . 10CHNA Overview, Methodology, and Approach . 11Consultant Qualifications & Collaboration . 11Community Served Definition . 11Assessment of Health Needs . 13Quantitative Assessment of Health Needs – Methodology and Data Sources . 13Qualitative Assessment of Health Needs and Community Input – Approach . 14Methodology for Defining Community Need . 16Information Gaps . 16Approach to Identify and Prioritize Significant Health Needs . 17Recommended Health Needs to be Addressed by the CHNA Partners . 18Existing Resources to Address Health Needs . 18Community Health Data. 18Community Health Needs Assessment – District 2 Public Health . 19Community Served Definition . 19Demographic and Socioeconomic Summary . 20Watson Health Community Data. 30Public Health Indicators . 36Focus Groups & Interviews. 36Prioritized Significant Health Needs for District 2 Public Health . 37Community Health Needs Assessment – Habersham Medical Center . 40Community Served Definition . 40Demographic and Socioeconomic Summary . 41Watson Health Community Data. 51Public Health Indicators . 57Focus Groups & Interviews. 57Prioritized Significant Health Needs for Habersham Medical Center . 58CHNA Implementation Strategy . 59Community Health Needs Assessment – NGHS Greater Braselton Service Area . 60Community Served Definition . 60Demographic and Socioeconomic Summary . 61Watson Health Community Data. 72Page 2 of 287
Community Health Needs Assessment of Northeast GeorgiaPublic Health Indicators . 78Focus Groups & Interviews. 78Prioritized Significant Health Needs for NGHS – GBSA . 79CHNA Implementation Strategy . 80Community Health Needs Assessment – NGHS Primary Service Area. 81Community Served Definition . 81Demographic and Socioeconomic Summary . 83Watson Health Community Data. 93Public Health Indicators . 99Focus Groups & Interviews. 99Prioritized Significant Health Needs for NGHS – PSA . 100CHNA Implementation Strategy . 101Community Health Needs Assessment – NGHS Secondary Service Area 400 . 102Community Served Definition . 102Demographic and Socioeconomic Summary . 103Watson Health Community Data. 112Public Health Indicators . 118Focus Groups & Interviews. 118Prioritized Significant Health Needs for NGHS – SSA 400 . 119CHNA Implementation Strategy . 120Community Health Needs Assessment – NGHS Secondary Service Area North 121Community Served Definition . 121Demographic and Socioeconomic Summary . 122Watson Health Community Data. 131Public Health Indicators . 136Focus Groups & Interviews. 136CHNA Implementation Strategy . 138Community Health Needs Assessment – Stephens County Hospital . 139Community Served Definition . 139Demographic and Socioeconomic Summary . 140Watson Health Community Data. 150Public Health Indicators . 156Focus Groups & Interviews. 156Prioritized Significant Health Needs for Stephens County Hospital . 157CHNA Implementation Strategy . 158Page 3 of 287
Community Health Needs Assessment of Northeast GeorgiaDescription of Northeast Georgia Region Priority Health Needs . 160Mental and Behavioral Health . 160Substance Abuse . 167Access to Care – Primary Care . 169Access to Care – Preventable Hospitalizations . 170Access to Care – Insurance Coverage . 172Access to Care –Teen Pregnancy, Maternal & Child Health, and Child Mortality . 173Access to Care – Transportation . 177Chronic Disease – Diabetes . 178Chronic Disease – Cardiovascular Disease . 179Chronic Disease – Physical Activity . 180Septicemia . 182Summary . 184Appendix A: Key Health Indicator Sources . 185Appendix B: Watson Health Focus Groups and Interviews Participants . 190Appendix C: Watson Health Focus Groups and Interviews Summary . 197Advisory Board Focus Group, Northeast Georgia Health System. 197NGHS Greater Braselton Service Area (GBSA) . 197Substance Abuse . 198Mental Health and Substance Abuse . 198Obesity and Food Access . 198NGHS Primary Service Area (PSA) . 198Obesity . 199Mental Health and Addiction . 199Access to Care . 199NGHS Secondary Service Area 400 (SSA 400) . 199The underinsured population. 200Access to healthcare . 200NGHS Secondary Service Area North (SSA North). 200Lack of affordable housing . 200Lack of "living wage" employment . 201Healthcare and generational habits. 201Barrow County Focus Group . 202Access to healthcare . 202Education and generational habits . 202Dawson County Focus Group . 204Mental and Behavioral Health . 204Access to Care . 204Food Access and Nutrition . 205Gwinnett and Jackson Counties Focus Group . 206Access to Care . 206Page 4 of 287
Community Health Needs Assessment of Northeast GeorgiaSubstance Abuse . 207Food Access and Nutrition . 207Housing . 207Habersham and Stephens Counties Focus Group . 208Access to Care . 208Mental Health and Substance Abuse . 209Obesity and Food Access . 209Hall County Focus Group . 210Lack of affordable housing . 210Lack of access to health care . 210Lack of "living wage" employment . 210Healthcare and generational habits. 211Hall County Hispanic Focus Group . 212Health education - Awareness, lack of preventive care, wellness . 212Care in convenient locations . 213Cost . 213Lumpkin County Focus Group . 214Lack of affordable housing . 214Lack of access to health care . 214Lack of "living wage" employment . 215Healthcare and generational habits. 215Interviews Summary . 216Community Interviews . 216Interview Themes by Community . 217Appendix D: Additional Qualitative Data . 219Hall County Survey conducted by Bill Stiles at the Johnson Group . 219NGHS Hall County Mental and Behavioral Health Listening Sessions . 226Union General Hospital and Chatuge Regional Hospital 2018 CHNA Reports . 255Appendix E: Prioritization Session Participants . 256Appendix F: Community Resources Identified to Potentially Address SignificantHealth Needs . 258Appendix G: Federally Designated Health Professional Shortage Areas andMedically Underserved Areas and Populations . 261Health Professional Shortage Areas (HPSA). 261Medically Underserved Areas and Populations (MUA/P) . 264Appendix H: Public Health Indicators for Northeast Georgia RegionRecommended Priority Needs . 266Appendix I: Evaluation of Prior Implementation Strategy Impact . 270Habersham Medical Center Evaluation of 2016 Implementation Strategy . 270NGHS 2018 Progress Report. 271Stephens County Hospital Evaluation of 2016 Implementation Strategy . 283Page 5 of 287
Community Health Needs Assessment of Northeast GeorgiaAppendix J: CHNA Partner Meetings . 284Appendix K: Northeast Georgia Medical Center Patient Origin . 287Page 6 of 287
Community Health Needs Assessment of Northeast GeorgiaExecutive SummaryThe following organizations have partnered and collaborated to conduct a CommunityHealth Needs Assessment (CHNA) for communities they (CHNA Partners) serve innortheastern Georgia: District 2 Public Health Habersham Medical Center Northeast Georgia Medical Center Gainesville Northeast Georgia Medical Center Braselton Northeast Georgia Medical Center Barrow Northeast Georgia Medical Center Lumpkin Stephens County HospitalThese CHNA Partners understand the importance of serving the health needs of theircommunities. In order to do that successfully, they must first take a comprehensive lookat the issues that patients, families, and neighbors face when making healthy life choicesand health care decisions.Beginning in November 2018, the CHNA Partners began the process of assessing thehealth needs of the communities served by the hospital facilities and the healthdepartment with a collaborative community health needs assessment. IBM WatsonHealth (Watson Health) was engaged to help collect and analyze the data for this process,and to compile a final report to be made publicly available by September 30, 2019.The communities served by each of the CHNA Partners overlapped and combined toinclude all or part of 16 counties in northeast Georgia. While a collaborative approachwas utilized, a needs analysis was conducted for each CHNA Partner’s definedcommunity; community-specific subsections are included in this report. NortheastGeorgia Health System (NGHS) defined four communities served by their four hospitalfacilities: NGHS Greater Braselton Service Area (GBSA), NGHS Primary Service Area(PSA), NGHS Secondary Service Area 400 (SSA 400), and NGHS Secondary ServiceArea North (SSA North).Watson Health performed a quantitative and a qualitative assessment. Over 129 publichealth indicators were examined, and a benchmark analysis of the data was conducted.The analysis compared community values to the overall state of Georgia and UnitedStates (U.S.) values. For the qualitative assessment, input from over 500 people wasincluded via several different qualitative methods; focus groups, interviews, in-personsurveys, and listening sessions. Participants in these sessions included District 2 PublicHealth as well as individuals or organizations serving and/or representing the interests ofmedically underserved, low-income, and minority populations in the community.Needs were first identified when an indicator for a community was worse than the Georgiastate benchmark. A need differential analysis conducted on all of the low performingindicators determined the relative severity by using the percent difference frombenchmark. The outcome of this quantitative analysis aligned with the qualitative findingsto create a list of health needs in the community. Each health need received assignmentinto one of four quadrants in a health needs matrix. The matrix shows the convergencePage 7 of 287
Community Health Needs Assessment of Northeast Georgiaof needs identified in the qualitative data (interview and focus group feedback) andquantitative data (health indicators) and identifies the top health needs for eachcommunity.In June 2019, a session was held with the CHNA Partners and their community advisorsto identify and prioritize the significant health needs for each CHNA Partner’s community.The meeting was moderated by Watson Health and included an overview of the CHNAprocess for the communities of northeast Georgia; the methodology for determining thetop health needs; and the selection and prioritization of significant health needs for thecommunities served.The group was provided an overview of the CHNA process undertaken for northeastGeorgia. The participants reviewed the CHNA findings and the Health Needs Matrix foreach community. Working in community specific work groups, they identified thesignificant community health needs to prioritize. The community work group participantsused criteria selected by the CHNA Partners to score each community’s significant healthneeds. The list of significant health needs for each community was then prioritized basedon the overall scores.In the prioritization session described above, each community work group was taskedwith recommending up to five (5) priority needs their respective CHNA Partner shouldaddress through their CHNA implementation strategies. After each work groupestablished their recommendations, the groups reconvened to review their recommendedpriorities across the communities. Common priorities were identified, and collectively thegroup discussed areas of potential collaboration and synergies in implementation effortsbetween the CHNA Partners. The recommended priority health needs are as follows:Recommended Priority Health NeedsNote: priority needs that are common across communites are shaded based on their commonality by categorySource: IBM Watson Health, 2019Page 8 of 287
Community Health Needs Assessment of Northeast GeorgiaA description of these needs is included in the body of this report. The hospital facilitieswill each develop implementation strategies with specific initiatives to address the chosenhealth needs, to be completed and adopted by each hospital partner by February 15,2020.An evaluation of each hospital’s implementation strategy drafted after the 2016assessment is included in Appendix I of this document.The Community Health Needs Assessment for northeast Georgia has been presentedand approved by each hospital partners’ governing body, and the full assessment isavailable to the public at no cost for download and comment via each CHNA Partner’swebsite: District 2 Public Health: http://phdistrict2.org/ Habersham Medical Center: tellus@hcmcmed.org Northeast Georgia Health System: http://www.nghs.com/community-benefitresources The Stephens County Hospital: stephenscountyhospital.comThe CHNA partners collaborated with Watson Health to develop an interactive Tableaudashboard that displays the quantitative data collected as part of the 2019 CHNA. TheCommunity Health Data provides access to over 120 county-level public health indicatorsas well as proprietary Watson Health estimates for demographics, community need,disease prevalence, insurance coverage, and emergency department visits. Thedashboard is available to the community at s assessment and the corresponding implementation strategies are intended to meetthe requirements for hospital community benefit planning and reporting as set forth infederal law, including but not limited to the Internal Revenue Code Section 501(r).Page 9 of 287
Community Health Needs Assessment of Northeast GeorgiaCommunity Health Needs Assessment RequirementAs a result of the Patient Protection and Affordable Care Act (PPACA), all tax-exemptorganizations operating hospital facilities are required to assess the health needs of theircommunity through a Community Health Needs Assessment (CHNA) once every threeyears.The written CHNA Report must include descriptions of the following: The community served and how the community was determinedThe process and methods used to conduct the assessment, including sources anddates of the data and other information as well as the analytical methods appliedto identify significant community health needsHow the organization took into account input from persons representing the broadinterests of the community served by the hospital, including a description of whenand how the hospital consulted with these persons or the organizations theyrepresentThe prioritized significant health needs identified through the CHNA as well as adescription of the process and criteria used in prioritizing the identified significantneedsThe existing healthcare facilities, organizations, and other resources within thecommunity available to meet the significant community health needsAn evaluation of the impact of any actions that were taken, since the hospitalfacility(s) most recent CHNA, to address the significant health needs identified inthat last CHNAPPACA also requires hospitals to adopt an Implementation Strategy to address prioritizedcommunity health needs identified through the assessment. An Implementation Strategyis a written plan that addresses each of the significant community health needs identifiedthrough the CHNA and is a separate but related document to the CHNA report.The written Implementation Strategy must include the following: List of the prioritized needs the hospital plans to address and the rationale for notaddressing other significant health needs identifiedActions the hospital intends to take to address the chosen health needsThe anticipated impact of these actions and the plan to evaluate such impact (e.g.identify data sources that will be used to track the plan’s impact)Programs and resources the hospital plans to commit to address the health needsA description of any planned collaboration between the hospital and other facilitiesor organizations in addressing the health needsPage 10 of 287
Community Health Needs Assessment of Northeast GeorgiaCHNA Overview, Methodology, and ApproachThe following organizations have partnered and collaborated to conduct a CHNA forcommunities they serve in northeastern Georgia: District 2 Public HealthHabersham Medical CenterNortheast Georgia Medical Center GainesvilleNortheast Georgia Medical Center BraseltonNortheast Georgia Medical Center BarrowNortheast Georgia Medical Center LumpkinStephens County HospitalThese CHNA Partners began the 2019 CHNA process in November 2018 and partneredwith Watson Health to complete a CHNA for their combined communities.Consultant Qualifications & CollaborationWatson Health delivers analytic tools, benchmarks, and strategic consulting services tothe healthcare industry, combining rich data analytics in demographics, including theCommunity Needs Index, planning, and disease prevalence estimates, with experiencedstrategic consultants to deliver comprehensive and actionable Community Health NeedsAssessments.Community Served DefinitionThe communities served by each of the CHNA Partners overlap and combined includeall or part of sixteen counties in northeast Georgia. Given the overlap between theirrespective communities, the CHNA Partners collaborated to conduct this assessment ofthe northeast Georgia region. While a collaborative approach was utilized, a needsanalysis was conducted for each Partner’s defined community and community-specificsubsections are included in this report. Northeast Georgia Health System (NGHS) definedfour communities served by their four hospital facilities: NGHS Greater Braselton ServiceArea (GBSA), NGHS Primary Service Area (PSA), NGHS Secondary Service Area 400(SSA 400), and NGHS Secondary Service Area North (SSA North).Page 11 of 287
Community Health Needs Assessment of Northeast GeorgiaCombined Community Served MapNortheast Georgia Regio
Northeast Georgia Medical Center Braselton Northeast Georgia Medical Center Barrow Northeast Georgia Medical Center Lumpkin Stephens County Hospital Approved by: The Hospital Authority of Habersham County, Georgia, September 17th, 2019, posted to www.habershammedical.com Northeast Georgia Medical Center Board of Directors, August 27, 2019 .
