South Central Regional Medical Center Community Health Needs Assessment and Action Plan

South Central Regional Medical Center Community Health Needs Assessment and Action Plan September, 2013 LOUISVILLE KY WASHINGTON DC www.healthcarestrategygroup.com

Purpose South Central Regional Medical Center undertook assessment of the health needs of Jones County MS in support of SCRMC s mission to serve the health needs of its community and to meet statutory requirements: 1) Conduct a Community Health Needs Assessment (CHNA) with input from persons representing the broad interests of the community served 2) Adopt an implementation strategy to address the needs identified in the CHNA 3) Make the assessment and implementation strategy readily available to the community via the hospital s web site and other vehicles, as needed to inform the public. 2

CHNA Content Requirements Findings and Action Plan Description of the community served and how that was determined Description of the process and methods used to conduct the CHNA Description of information gaps that may impact ability to assess needs Identity of any collaborating partners Identity and qualifications of any third party assisting with the CHNA Description of how input from the community was gathered and used Prioritized description of the health needs identified in CHNA Description of existing health care facilities and services within the community available to meet the needs identified. 3

SCRMC was assisted by the Healthcare Strategy Group, LLC (HSG) in conducting this analysis and developing the implementation strategy. HSG is particularly skilled in the evaluation of community health needs and working with area providers to develop programs and services to address those needs. 4

Defining the community served Generally defined by a geographic area (county, group of zip codes, etc.) May target populations (e.g., aging, children, women, teens, young adult, etc.) May focus on a particular chronic disease, health risk factor, etc. The community is defined as: Jones County, Mississippi Significant Health Issues of Jones County 5

Jones County Health Status Indicators 6

Jones County Mortality Statistics 2009-2011 Jones Co. Mississippi United States Jones Co. Cause of Death 3-Year Avg. 3-Year Avg. 3-Year Avg. % Diff w/us Heart Disease 247.0 251.3 193.7 27.5% Cancer 205.8 209.0 185.2 11.1% Cerebrovascular Disease 53.1 50.4 41.8 27.1% Hypertension 9.8 16.8 10.8-9.0% Chronic Lower Respiratory 54.5 55.1 45.1 20.8% Diabetes 18.7 31.6 22.8-18.0% HIV Disease 5.9 4.6 2.8 113.3% MVAs 31.4 23.7 11.4 174.6% SOURCES: CDC and Mississippi Department of Health crude mortality rates 7

Jones County Health Rankings HEALTH OUTCOMES Jones County National State Take Aways: Mortality (Premature Death Before Age 75) 11,605 5,466 10,811 Premature Death Twice US rate Morbidity Measures Twice US rates Source: County Health Rankings & Roadmaps, collaboration of Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute 8

Jones County Health Rankings Health Outcomes Weight Jones Co 2012 Natl Benchmark (1) MS State Rank (of 82) Health Factors 17 Health Behaviors 30% 22 Adult Smoking 10% 21% 14% 24% Adult Obesity 7.5% 37% 25% 36% Physical Inactivity 2.5% 33% 21% 33% Excessive Drinking 2.5% 7% 8% 11% MV Crash Death Rate 2.5% 38 12 31 Sexually transmitted infections 2.5% 694 84 803 Teen Birth Rate 2.5% 79 22 65 Clinical Care 20% 33 Uninsured Adults 5% 23% 11% 21% PCP Ratio 5% 1,874:1 631:1 1,563:1 Preventable Hospital Stays 5% 85 49 95 Diabetic Screening 2.5% 83% 89% 80% Mammography Screening 2.5% 55% 74% 58% Take Aways: STDs are a significant issue Teen birth rate is very high MV Crash death rate is of concern PCP ratio shows underserved market Mammography screening is too low (1) 90th percentile, only 10% are better Source: County Health Rankings & Roadmaps, collaboration of Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute 9

Analysis During the 5 year period from 2007-2011, Jones County has experienced a greater improvement in teen pregnancy rate than the overall State of Mississippi. The teen pregnancy rate in Jones County decreased by more than 24 pregnancies per 1,000 during this 5 year period while the overall state of Mississippi only experienced a 13 pregnancy per 1,000 improvement. While our goal is to continue to reduce the teen pregnancy rate through abstinence education, the improvement realized during the last several years is demonstrated the programs South Central has provided to the schools. 10

Teen Pregnancy Rate from 2007-2011 The Mississippi State Department of Health defines teen pregnancy rate as the number of pregnancies of women ages 10 to 19 per 1,000 women in this age group. The following are the teen pregnancy rates as determined and reported by the Mississippi State Department of Health for the years 2007 to 2011: Jones County Sstst 2011 30.4 2010 40.8 2009 46.6 2008 46.9 2007 54.6 State of Mississippi 2011 30.1 2010 33.4 2009 39.0 2008 40.6 2007 43 11

Analysis continues. In 2005, Jones County s teen pregnancy rate (55) was significantly higher than the state average (43). Now, 5 years later Jones County has improved such that it is now in line with the state average (30.4 vs. 30.1). The most significant improvements in Jones County s teen pregnancy rates have occurred since 2009. There was a 6 pregnancies per 1,000 improvement from 2009 to 2010 and a 10 pregnancies per 1,000 improvement from 2010 to 2011. The 2012 statistics have not been released yet. 12

Jones County Cancer Statistics Cancer Site Incidence Rate (2) Incidence Jones County, Mississippi 2006-2010 Average Annual Count Met Healthy People objective (1) Annual Death Rate Mortality Average Deaths per Year Trend Avg. Annual Percent Change Lung & Bronchus 72.7 56 No 64.2 50 Stable -0.70 Breast 106.5 43 No 21.2 9 Stable -1.70 Prostate 150.7 52 No 30.2 8 Falling -2.90 Colon & Rectal 43.8 33 Yes 13.4 10 Stable -0.30 Oral Cavity & Pharynx 11.9 9 * * 3 or fewer ** ** Uterus 20.1 8 * * 3 or fewer ** ** Ovary 7.8 3 * * 3 or fewer ** ** Melanoma of the Skin 23.1 16 * * 3 or fewer ** ** Cervix 12.8 4 * * 3 or fewer ** ** * Data suppressed to ensure confidentiality and stability of rate estimates. ** Data too sparse to provide stable estimates of annual rates needed to calculate trend (1) Healthy People 2020 Objectives provided by the Centers for Disease Control and Prevention (2) Incidence Rates (cases per 100,000 per year) are age-adjusted. Rates are for invasive cancer only. SOURCE: National Cancer Institute State Cancer Profiles, State Cancer Registry, CDC National Program of Cancer Registry 13

Cancer Awareness Prevention and Screening 14

Fertility Statistics 2011 Jones County Mississippi United States Total Live Births Ages 15-44 965 39,695 Ages 15-19 133 5,362 15-19 per 1000 total births 137.8 135.1 91.9 Births to Unmarried Mothers # Live Births to Unmarried 513 21,658 Per 1000 total births 531.6 545.6 408.4 By age cohort Under 15 4 97 15-19 120 4,826 15-19 per 1000 total births 124.4 121.6 80.9 Live Births w/ low birth weight # Births under 2500 grams 91 4,705 Per 1000 (total births) 94.3 118.5 81.0 # Births under 1500 grams 14 872 Per 1000 total births 14.5 22.0 14.0 Fetal Deaths # FDs of residents 10 4.4 Per 1000 total births 10.3 10.1 6.05 Source: Mississippi State Department of Health, Center for Disease Control Take Aways Teen birth rate is 1.5 times that of the US Teen birth rate of unmarried mothers is 1.5 times that of the US Jones County has a slightly higher teen birth rate than the state 20

Jones County Poverty Statistics Poverty Category Jones County % Total Households United States % Total Households Overall 23.00% 16.00% All Families 17.10% 11.70% w/related children under 18 years 28.00% 22.20% w/related children under 5 years only 19.60% Married couple families 9.50% w/related child under 18 yrs 15.90% w/related child under 5 only 12.70% Female householder, no husband present 41.30% 31.40% w/related children under 18 years 52.60% w/related children under 5 only 60.40% Take Aways Of Jones County Female householder families, over half of these families with children under age 18 are living in poverty and that number grows to 60% with children under age 5. Source: 2010 US Census 21

Jones County Household Types Household Types Jones County United States Number % Total % Total Family households 17,809 70.5 66.4 w/own children under 18 yrs 7,535 29.8 29.8 Husband-wife family 12,215 48.4 48.4 w/own children under 18 yrs 4,643 18.4 20.2 Male householder (no wife) 1,351 5.4 5 w/own children under 18 yrs 636 2.5 2.4 Female householder (no husband) 4,243 16.8 13.1 w/own children under 18 yrs 2,256 8.9 7.2 Householder living alone 6,467 25.6 26.7 Male 65 and over living alone 748 3 2.7 Female 65 and over living alone 1,976 7.8 6.7 SOURCE: 2010 US Census 22

Community Opinion Health Issues and Contributors 23

Input from the community In-person interviews (45 interviewees) Community Business Leaders Community Church Leaders Housing Authority Hospital Leadership Community Primary and Specialty Care Physicians Focus groups (11 participants) County Health Department School Leadership Municipal/Cultural Association Leaders Community Business Leaders Physician opinion survey (38 medical staff) 24

Community input sought regarding Significant community health problems Contributors to community health problems Personal behaviors Community issues that impact health Provider issues Access to Care issues Underserved population groups In what ways underserved Opinion on priority needs to address 25

Community Health Problems Community Health Problems Interviews Response Hospital Board Community Medical Staff Hospital Leadership Medical Staff Survey Community Focus Groups Obesity/overweight 3 6 17 8 8 X 43 Diabetes 4 2 12 6 10 X 35 Heart Disease 4 6 9 2 6 X 28 Teenage Pregnancy 2 8 6 2 2 X 21 Aging related health problems 3 1 2 4 4 X 15 Mental Health 2 4 3 3 12 Cancer 1 2 3 2 1 9 Lung Disease 1 2 2 5 End of Life care 1 1 1 3 Stroke/HTN 1 1 2 Low Birth Weight 1 1 2 Infectious/contagious disease 1 1 2 Hypertension 1 1 Asthma 1 1 Sexually Transmitted Diseases X 1 Child abuse X 1 Drug Addiction X 1 Total 26

Contributors- Personal Behaviors Personal Behaviors that Impact Health Interviews Response Hospital Board Community Medical Staff Hospital Leadership Medical Staff Survey Community Focus Groups Poor eating habits 4 7 17 7 10 X 46 Physical inactivity 2 5 16 6 10 X 40 Smoking/tobacco use 2 2 9 3 8 24 Not going to the doctor for checkups/screenings 1 4 6 6 2 19 Alcohol/drug abuse 2 3 6 4 4 19 Participating in unsafe sex 1 4 2 1 X 9 Not going to the dentist for preventive checkups 1 2 1 1 5 Not getting immunizations 1 2 1 4 Reckless/drunk driving 1 1 2 Not getting prenatal care 1 1 Violent behavior 1 1 Not using child safety seats/seat belts 1 1 Total 27

Contributors Community Factors Response Community Issues That Impact Health Interviews Hospital Board Community Medical Staff Hospital Leadership Medical Staff Survey Community Focus Groups Low income/poverty 4 6 16 7 10 X 44 Lack of or inadequate health insurance 3 3 10 7 7 30 Droppping out of school 3 6 5 3 2 X 20 Insufficient prevention/education services 2 2 8 3 1 X 17 Lack of good jobs/healthy economy 3 2 1 2 3 X 12 Lack of recreational facilities 1 1 4 2 2 X 11 Insufficient access to healthy food 1 2 2 2 3 X 11 Lack of positive teen activities 1 4 3 1 X 10 Lack of healthy family activities 1 1 3 2 2 X 10 Insufficient transportation options 1 4 2 3 10 Total 28 Continued on the following slide

Contributors Community Factors Continued from the previous slide Community Issues That Impact Health Interviews Response Hospital Board Community Medical Staff Hospital Leadership Medical Staff Survey Community Focus Groups Insufficient elder care options 2 1 4 1 8 Insufficient specialty healthcare services 1 2 1 3 7 Insufficient child care options 1 1 1 1 1 5 Child Neglect and Abuse 1 1 2 4 Elder Neglect and Abuse 1 1 1 3 Domestic Violence 1 2 3 Lack of affordable housing 1 1 1 3 Problems w/ family, mentoring & parenting 1 1 X 3 Lack of handicapped accessible recreational 1 1 2 Lack of resources for aging population 1 X 2 Rape/Sexual Assault 1 1 Insufficient access to primary care physician 1 1 Total 29

Access/Resource Issues 30

Community Physician Needs Interviews Physician Focus Specialty Need Board Comm. Physician Leadership Survey (1) Group Total N=5 N=9 N=22 N=8 N=38 N=11 Orthopedics 4 10 8 29 X 52 Neurology 2 2 10 3 34 X 52 Vascular Surgery 1 1 10 1 32 45 Adult primary care 1 8 3 29 X 42 Urology 1 9 5 26 41 Rheumatology 6 23 29 Hospitalists 3 2 22 27 Pulmonology/Critical Care 3 2 22 27 Oncologist 1 1 5 1 17 X 26 Endocrinology 2 6 16 24 Infectious Disease 2 22 24 Pediatrics/Adolescent Med 2 19 X 22 Heart Care 2 4 14 X 21 (1) Physician Survey responses of "immediate" or "moderate" need Continued on the following slide 31

Community Physician Needs Interviews Physician Focus Specialty Need Board Comm. Physician Leadership Survey (1) Group Total N=5 N=9 N=22 N=8 N=38 N=11 Psychiatry 2 1 17 20 Obstetrics & Gynecology 1 1 1 17 20 Nephrology 3 1 15 19 Gastroenterology 1 16 17 Psychiatry 17 17 Dermatology 5 9 14 Allergy 2 12 14 Ophthalmology 1 1 12 14 Anesthesia services 1 11 12 Breast care 1 1 Maternal/Fetal Medicine 1 1 Neurosurgery 1 1 GYN Oncology 1 1 Emergency Medicine 1 1 To treat HIV patients X 1 (1) Physician Survey responses of "immediate" or "moderate" need 32

Underserved Population Groups Response Group/Needs of Group Hospital Board Community Interviews Medical Staff Hospital Leadership Community Focus Groups Medical Staff Survey Working poor/uninsured 2 1 7 4 X 7 22 Access to affordable healthcare 2 1 4 2 X X 11 Afforable wellness/exercise programs 3 1 X 5 Jobs that provide affordable health insurance 1 2 3 Affordable healthy food X X 2 Preventive care/screening/health education X 1 Transportation options X 1 Low income minorities 1 2 4 3 X 2 13 Access to affordable healthcare 1 2 3 X X 8 Afforable wellness/exercise programs 2 1 X 4 Translators for hispanics 1 X 2 Education and opportunity 1 X 2 Neighborhood clinics 1 1 Improved access to Internal Medicine X 1 Total Continued on the following slide 33

Underserved Population Groups Response Group/Needs of Group Hospital Board Community Interviews Medical Staff Hospital Leadership Community Focus Groups Medical Staff Survey Teenagers 1 1 X 4 7 Addressing teenage pregnancy 2 X 3 Primary care physicians who understand teens 1 X 2 Role models/positive feedback 1 1 Lifestyle/Risk Behavior education and support X 1 Mental Health care X 1 Elderly 2 5 7 Transportation options 1 X 2 Weekly visits for those living alone and frail 1 1 Affordable healthcare for those on fixed income 1 1 PCPs willing to manage complex cases X 1 Help with getting medications X 1 Improved access to specialty care X 1 Total Continued on the following slide 34

Underserved Population Groups Response Group/Needs of Group Hospital Board Community Interviews Medical Staff Hospital Leadership Community Focus Groups Medical Staff Survey Children 1 X 2 4 Insufficient access to pediatricians 1 X 1 Mental Health care X Education/support for single parents X Patients without a PCP 1 1 2 Campaign to get them linked with a PCP 1 1 Insufficient primary care base X Disabled/special needs 1 1 2 Access to affordable healthcare 1 1 Magnolia Plan members 1 1 Local providers that will accept rates 1 1 Worker's Compensation 1 1 Total 35

Other Issues Impacting Access Interviewees and Focus Group Jones County has no public transportation No local providers caring for HIV patients No local, comprehensive women s health program No local providers focused on teen health issues Lack of wellness center-type services for low income Few support resources for aging population Lack of focus on addressing cultural/generational issues Lack of support resources for single parent households Insufficient local trauma care resources No focused education/support services to address obesity No program addressing needs of adult males 36

Summary of Health Issues In Jones County, MS 37

Significant Health Issues Significant Health Issues Heart Disease/Obesity Obesity Significant Contributors Cancer Teen Pregnancy HIV MVA fatalities Premature death (before age 75) Low Birth Weight Sexually Transmitted Disease Physical Inactivity Drug & Alcohol Abuse/Health Education Drug & Alcohol Abuse Lack of car seat and belt restraint use Lack of resources for Low Income Insufficient primary care providers Unprotected Sex Cerebrovascular Disease Unhealthy diets 38

Current Local Resources Obesity Obesity Obesity Obesity Health Issue Local Resource Resource Sufficiency Obesity for employees at SCRMC Teen Pregnancy Health Department Laurel Surgery Clinic South Central Wellness Center South Central Nutritional Services Department South Central Human Resources Department TGIF 39

SCRMC LEADING THE REGION South Central Regional Medical Center has been a leader in Health Education and Outreach Programs since 1990. The South Central Health System is Committed to a Healthier Jones County. 40

KEY HEALTH ISSUES TARGETED BY SCRMC Action Plans Developed. In The Following Section Of This Document You Will See The Community Health Issues Targeted For The 2013/2014 Year & The Suggested Action Plans To Address Each Issue. 41

HEALTH ISSUE 1. TEENAGE PREGNANCY 42

Implementation Plan: Teenage Pregnancy. Contributor: Unprotected Sex. Promote abstinence campaign in the public schools. Include the negative impact of alcohol and drugs on the body. Conduct the TGIF retreat. (11 th & 12 th grade students) Teach the student instructors the complete abstinence based curriculum/campaign Include the negative impact of drugs & alcohol in the curriculum. Conduct practice sessions where the student instructors teach each other the curriculum. Schedule the dates the student teachers will provide training in the classrooms with school counselors. Assign student teachers to each instruction session. Pre-test students before training begins. Provide post-test to students at the conclusion of training. Evaluate results or program. Monitor teen pregnancy rate. Continue to support the Crisis Pregnancy Center by providing leased space at no cost. 43

HEALTH ISSUE 2. OBESITY 44

Implementation Plan: Obesity Contributor: Poor eating habits and lack of exercise. Provide Health Education To The Community Focusing on Obesity Develop a schedule for the year for HealthBreak, South Central Vision, Health Fairs, and Community Education Programs (Speaking of Women Seminars, PJ s and Pearls Event) including topics associated with obesity including: Good Nutrition The Importance of Getting Regular Check Ups The Importance of Exercise Calorie Counting How To Read Food Labels Understanding Good and Bad Cholesterol Understanding High Blood Pressure. Understanding Heart Disease Impact of Diabetes On The Body Appropriate Weight By Height and Gender Monitor the number of individuals receiving the information. 45

Implementation Plan: Obesity Target Group: South Central Employees Develop a health program focusing on healthy eating and exercise for South Central employees. Develop a true diet plate program. Mark healthy foods in the cafeteria so employees will begin to understand what foods are healthy and those that are unhealthy. Promote the importance of a well balanced diet & exercise. Provide portion information so employees will understand the correct amount of food that should be eaten. Add more fruits and vegetables in the cafeteria. Enhance the salad bar, but educate about the appropriate portion size & calories in dressing. Include healthy snacks in the vending machines. Mark the healthy snacks so employees will know the difference. Encourage employees to drink 8, 8 oz. glasses of water a day. Explain the benefits of drinking water instead of soft drinks. Develop pre test at the beginning of the initiative and post test at the conclusion of the program. Also monitor reported weight loss. 46

HEALTH ISSUE 3. CANCER 47

Implementation Plans: Cancer Contributor: Poor Nutrition, Tobacco Use, Sun Exposure, Lack of Screenings and Lack of Regular Health Check Ups Develop programs which will promote prevention and early detection of cancer. Include the following topics in HealthBreak segments, on South Central Vision, at Health Fairs, in Articles, in STAT (Employee Newsletter): Breast Cancer Prostate Cancer Lung Cancer Skin Cancer Teach a smoking cessation program for employees. Offer available seats to the industrial community. Screen for cancer during the year at Wellness Wednesday Screenings, Health Fairs, and Industrial events. Document the number of individuals diagnosed with cancer during the screenings. Monitor cancer death rates by diagnosis. 48

SCRMC Current Annual Contribution $$$ toward a Healthier Jones County Program Annual SCRMC $$$ Anticipated Annual Cost Of Uncompensated Care FY/14 $12,625,000. Health Education/Screening Costs FY/14 $ 46,000. Cost To Revamp Cafeteria to Promote Healthy Eating FY/14 $ 2,300. TOTAL $12,673,300. 49

KEY HEALTH FACTORS Issues Not Addressed in the 2013/2014 Plan And Why: Most all of the health problems identified through South Central Regional Medical Center s Community Health Needs Assessment occur due to poor nutrition and exercise, and the lack of community education. To be effective, we are targeting 3 key areas this year. The areas targeted this year are cancer, poor health and nutrition, and teen pregnancy. Others will be selected later. 50