Community Health Needs Assessment REPORT
LEGAL BACKGROUND The Patient Protection and Affordable Care Act requires that not-for-profit hospitals conduct a community health needs assessment at least once every three years and adopt a strategy to meet the needs identified. The needs assessment must: include input from representatives of broad interests of the community served by the facility, including those with expertise in public health issues; be widely available to the public; and show community need for an activity or program. Regents Health System, in partnership with Regents University, conducted a community health needs assessment in fall. This document outlines the process, analysis, results, and project selection. Figure Map of with Primary Community Highlighted GENERAL BACKGROUND Regents University and the not-for-profit Regents Health System have nearly a -year history of providing health-related activities and contributions (e.g., volunteer medical services) to uninsured and under-insured members of the community. GRU aspires to be a top-tier university that is a destination of choice for education, health care, discovery, creativity, and innovation. Its mission is to provide leadership and excellence in teaching, discovery, clinical care, and service as a studentcentered research university and academic health center. GRU embodies the application of research, education, and service to enhance the health of the community, producing tangible and measurable results. DEFINING OUR COMMUNITY This report defines Regents Health System s primary service area as its home county of Richmond County,. The inner-city location of GRU s main campus, including its primary clinical facilities, ensures efficient care to the un- and under-insured. Figure illustrates our primary service area. While Richmond County, is our defined community, the opportunities developed through the community health needs assessment should be available to all citizens in the local region and beyond. Table reports demographic data for Richmond County, the state, and nation. Table Demographics for County-, State-, and National- Levels Base Counts Population ( est.) Households (7-) Housing Units () % Pop. Growth - Per Capita Income (past months; $) Population by Single Race and Sex White Black/African American American Indian/Alaska Native Asian Native Hawaiian/Pacific Islander Hispanic/Latino Origin + Races Male Female Population by Age Pop, Age < 5 years Pop, Age < 8 Years Pop, Age 8 Years County: Richmond,587 73,4 86,534.% $,393 4.8% 54.4%.4%.8%.% 4.3%.4% 48.4% 5.6 7.5% 4.7% 67.8% State: 9,99,945 3,49,754 4,,99.4% $5,383 63.% 3.%.5% 3.4%.% 9.%.8% 48.9% 5.% 7.% 5.4% 73.9% National: U.S.A. 33,94,4 4,76,359 3,3,44.7% $7,95 78.% 3.%.% 5.%.% 6.7%.3% 49.% 5.8% 6.5% 3.7% 69.8% Disparities Medically Underserved Areas (MUA) 5//994 Person below poverty level (7-) 36.6 3.7% n/a 6.5% n/a 4.3% COMMUNITY HEALTH NEEDS ASSESSMENT
BENEFITTING THE COMMUNITY Our Community Health Needs Assessment fully assessed the community s health status a fundamental step in providing community benefit. The assessment resulted in activities focused on critical community needs. Community collaboration is a critical component to the success of any initiatives designed to meet community health needs (Figure ). The assessment further enables Regents Health System to connect with the community and strengthen external partnerships. These partnerships can build trust and a foundation for shared responsibility and commitment to tackle community health needs. SELECTING THE HEALTH TOPIC AND CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT Figure Inter-relationship between Community Benefit, Community Health Needs Assessment, and Community Intervention Strategy Community Benefit Inter-relationship Community Benefit Community Health Needs Assessment Community Collaboration Programs & Services Our assessment focused on pediatric asthma, a critical health concern statewide. The Department of Public Health created the Asthma Control Program to decrease asthma cases and enhance quality of life. Pediatric asthma is also a critical health concern for the primary service area. Upon learning that Augusta had pediatric asthma-related deaths from 6-8 the highest per capita rate in the nation the Centers for Disease Control and Prevention created the Asthma Coalition for Augusta. For the past five years, the coalition has provided pediatric asthma education to local schools, parents of asthma patients, and the patients themselves. Given the present demand for asthma education, the coalition continues to provide this support to the local community. However, as the data below illustrate, a high prevalence of pediatric asthma persists in the community, indicating the need for a community champion to train area doctors. Regents Health System can be that champion, and our doctors can provide the outreach and services necessary to train primary care providers and pediatricians. COMMUNITY HEALTH NEEDS ASSESSMENT 3
COMMUNITY HEALTH NEEDS ASSESSMENT Figure 3 Number of Discharges per Month from 8- Background Information The data in figures and tables 3-9, from the Hospital Association s International Classification of Diseases, compare 8- rates of asthma conditions (codes that begin with 493) in patients 7 and younger reported in Richmond County, (zip codes 385, 385, 39, 394, 396, 397, 399, and 396) with those of other areas in the state. logged 4,55 cases in that time period, 5,3 of which were from Richmond County. for State and Primary Service Area 5, Richmond County Other in Regents extracted data from Richmond County zip codes 385, 39, and 396 and collected data from University Hospital as well to provide the most updated data. The data were consistent with the Hospital Association data. Regents Health System and University Hospital reported,599 pediatric asthma cases in (figures -4 and tables 9-3). Jan. Feb Mar Apr May Jun Note. Month includes cases from 8-. Jul Aug Sep Oct Nov Dec Results Richmond County reported twice as many pediatric asthma cases as other areas of the state in 8- (5.34 versus 4.5 per, cases) and comparable hospitalization rates (figure 3, table ), with hospitalization rates peaking in the fall and winter. As the following figures and tables show, for both Richmond County and, most pediatric asthma patients are emergency room patients, under age 5, male, Black or African American-Non-Hispanic or Latino, with unspecific asthma, hospitalized a day or less, and with guardians on Medicaid. Given the longitudinal nature of the data, these trends are expected to continue in the immediate future. Thus, potential projects focused on pediatric asthma could benefit from this demographic information to help formulate project plans, specifically in terms of the primary service area. Table Number of Discharges per Month from 8- Month Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 966 48 4 98 43 4848 49 866 395 393 438 86 Richmond Co. 394 445 43 44 456 98 83 487 498 566 549 464 355 53 COMMUNITY HEALTH NEEDS ASSESSMENT 4
Figure 4 Patient Type from 8-, 4,69 of 7,934,4 Richmond County Other in 44 of,99 9 of,66 Inpatient Emergency Room Other/Outpatient Table 3 Patient Type from 8- Patient Type Richmond Co. Inpatient Emergency Room Other/Outpatient 99 7934 66 44 469 9 355 53 COMMUNITY HEALTH NEEDS ASSESSMENT 5
Figure 5 Patient Age from 8-,,4 Richmond County Other in Age Table 4 Patient Age from 8- Age 7 Age Richmond Co. 3 4 5 6 7 8 9 3 4 5 6 7 5458 444 865 773 868 983 8354 77 7539 79 678 574 459 386 338 395 396 334 58 55 48 57 484 39 344 9 38 35 64 45 43 97 6 3 355 53 Note. Age includes cases from 8-. COMMUNITY HEALTH NEEDS ASSESSMENT 6
Figure 6 Patient Race & Sex from 8- Richmond County White 8.4% Non-white 7.6% Black 63.5% Am Ind/AK.7 Asian.7 HI/Pac Isl. Hispanic. Other 6. N/A.3 Non-white 99.% Black 96.7% Am Ind/AK. Asian. HI/Pac Isl. Hispanic. Other.3 N/A. White.9 Table 5 Patient Race & Sex from 8- Race Patient Sex Richmond County Male Female Male Female White Black/African American American Indian/Alaska Native Asian Native Hawaiian/Pacific Islander Other Patient Refused to Self-Designate a Race Hispanic or Latino 58 48756 57 68 77 4773 53 3464 969 34 97 77 749 5 88 858 3 3 47 65 5 57 Subtotal Note. Race & sex include cases from 8-. a Missing Race & Sex = 7674 4677 354 353 a 53 859 COMMUNITY HEALTH NEEDS ASSESSMENT 7
Figure 7 Patient Diagnosis from 8- Asthma 838 of 5,5 Intrinsic Asthma 6 of 335 Chronic Obstructive Asthma with OPD Other Specified Asthma 76 6 of 9 6 of,63 6 Unspecified Asthma 4,37 of 6,5 Table 6 Patient Diagnosis from 8- Patient Diagnosis Richmond Co. Asthma Intrinsic Asthma Chronic Obstructive Asthma with OPD Other Specified Asthma Unspecified Asthma 55 335 9 63 65 838 6 6 6 437 355 53 COMMUNITY HEALTH NEEDS ASSESSMENT 8
Figure 8 Length of Stay from 8-, 4,535 of,53,4 Richmond County Other in 343 of 6,797 33 of,549 64 of,47 3 of 445 day days 3 days 4 days 5 days Note. Length of Stay includes cases from 8-. Table excludes days >5 due to the low amount of occurrences. Table 7 Length of Stay from 8- Length of Stay (Days) Richmond Co. 3 4 5 6 7 8 9-5 5-5- 5-3 53 6797 549 47 445 6 98 53 3 4 4535 343 33 64 3 7 3 355 53 COMMUNITY HEALTH NEEDS ASSESSMENT 9
Figure 9 Average Charges per Payer Type from 8- BCBS Comm Ins,4 Richmond County Other in Better Health HMO Mcaid Mcaid Apps Mcaid Mgd Care Mcare Mcare Mgd Care Not Reported Other OtherGovt P care for Kids POS PPO Self Pay TriCare/Champus 8, Note. Mean Costs includes cases from 8-. COMMUNITY HEALTH NEEDS ASSESSMENT
Table 8 Average Charges per Payer Type from 8- Payer Code Mean (N ) Mean Richmond Co. (N ) BCBS Comm Ins Better Health HMO Mcaid Mcaid Apps Mcaid Mgd Care Mcare Mcare Mgd Care Not Reported Other OtherGovt P care for Kids POS PPO Self Pay TriCare/Champus $,598.49 $,7.93 $,9.995 $,983.96 $,897.3546 $7,493.49 $,477.63 $,83.476 $,74.447 $,594.76 $,688.8539 $3,8.47 $,.885 $4,339.494 $3,33.478 $,9.855 $,863.7443 697 367 43 37 783 54 579 63 36 658 93 83 73 739 47 377 57 $,598.49 $3,65.4494 $,49.98 $3,74.584 $7,76.549 $,93.38 $,3.4 $,3.4 $3,83.466 $,4.7868 $,68.788 $3,97.57 $,934.37 $,885.5499 $3,696.7498 99 3 4 93 874 4 6 6 8 7 467 9 $,64.496 355 $,438.565 53 Table 9 Richmond County Hospital Cases for Figure Richmond County Hospital Cases for Frequency GRMC UH 3 469,,3 599 469 GRMC UH COMMUNITY HEALTH NEEDS ASSESSMENT
Figure Patient Type for Richmond County during,5,4 9 6 3 77 Inpatient Outpatient Table Patient Type for Richmond County during Patient Type Inpatient Outpatient Frequency 77 4 599 COMMUNITY HEALTH NEEDS ASSESSMENT
Figure Patient Age in Richmond County during 5 5 Age Age 7 Table Patient Age in Richmond County during Age 3 4 5 6 7 8 9 3 4 5 6 7 Frequency 43 3 73 45 56 6 43 96 7 68 7 5 46 46 3 5 4 599 COMMUNITY HEALTH NEEDS ASSESSMENT 3
Figure 3 Race & Ethnicity for Richmond County in Female Male White 4.4% Non-white 85.6% Black 8.9% Asian.3 Hispanic.3 Multiracial.7 Other. White 4.3% Non-white 85.7% Black 8.7% Asian. Hispanic.7 Multiracial.6 Other.5 Table Race & Sex for Richmond County in Race Sex Female Male White Black Asian Hispanic Multiracial Other 83 47 3 4 46 86 7 7 5 9 97 4 3 3 6 575 4 599 COMMUNITY HEALTH NEEDS ASSESSMENT 4
Figure 4 Payer Type for Richmond County in Managed Care/ Private Insurance 6 Medicaid,5 Self Pay 57 Champus 3 Peachcare Other 76 4 6 8, Table 3 Payer Type for Richmond County in Frequency 3 4 5 6 5 57 76 3 599 COMMUNITY HEALTH NEEDS ASSESSMENT 5
SELECTING THE PROJECT David Hefner, Executive Vice President for Clinical Affairs at Regents Health System, sits on the board of the Pediatric Health Improvement Coalition, a statewide 5(c)(3) organization that aims to transform pediatric care in. A focal point is pediatric asthma, with the coalition seeking to improve quality of care through a series of treatments. To glean best practices statewide, clinical demonstration sites will be established at each of the coalition s five hospital locations. The sites will also serve as the Community Benefit project stemming from the Community Health Needs Assessment. The project will: Recruit and train lay health care coaches to visit homes of children with asthma. Provide education programs to train parents about asthma care (emphasizing reducing exposure to environmental irritants and allergens and referring smokers to the Tobacco Quit Line), ensure the child has appropriate controller medication that is used appropriately, and ensure access to quick-relief medication at any location where the child spends more than eight hours per week. Create an asthma care database to synergize the efforts of emergency room physicians, primary care physicians, asthma care specialists, teachers, public health professionals, and health care coaches. Enlist local media to increase community awareness about asthma. Those identified by screening will be directed to local health care professionals for definitive diagnosis and initiation of care. Offer families of diagnosed children a lay health asthma coach to help coordinate care. Use health coaches to encourage the regular use of controller medications and regular health care visits. Projected health outcomes: Reduced school/day care absenteeism and improved academic performance, with de-identified attendance and grade data obtained from schools. Reduced expenses regarding emergency room care and parents /guardians absence from work. Regents project participants: Dr. Bernie Maria, Children s Hospital of Pediatrician-in-Chief and Pediatric Health Improvement Coalition Board Member/Chief Medical Officer Dr. Martha Tingen, Professor of Pediatrics and Pediatric Health Improvement Coalition Asthma Committee Board Member Mr. David Hefner, Children s Hospital of CEO, Pediatric Health Improvement Coalition Board Member, and Regional Academic Community Health Information Exchange* President *A joint 5(c) (3) venture of Regents Medical Center and the Medical Center of Central to improve coordination, timeliness, and safety of patient care via a health information exchange system. COMMUNITY HEALTH NEEDS ASSESSMENT 6