Community Health Needs Assessment (Chna) Implementation Plan
COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA) IMPLEMENTATION PLAN2020 – 2022This plan encompasses implementation strategies forNortheast Georgia Medical Center Gainesville, Braselton,Barrow and Lumpkin.Gainesville Braselton Barrow Lumpkin
About this implementation planThis implementation plan strategy was developed in partnership with hospital leadership andcommunity stakeholders to address the identified priorities listed in the 2019 Community HealthNeeds Assessment. It was approved by Northeast Georgia Health System (NGHS) and NortheastGeorgia Medical Center (NGMC) boards on January 21 and 28, 2020 respectively. This planfocuses primarily on NGHS’ responsibilities in addressing the priorities, but many activities alsorequire work with community partners and those are indicated throughout the report. In thisreport, NGHS refers to all four hospital entities: Gainesville, Braselton, Barrow and Lumpkin.View the full CHNA report atwww.nghs.com.health needs.2
CHNA Implementation Plan2020 – 2022FIVE PRIORITIES - TABLE OF CONTENTSMental andBehavioral HealthPAGE 6Access to CarePAGE 12DiabetesPAGE 16Cardiovascular DiseaseSepticemiaPAGE 21PAGE 183
Why thesefive priorities?The Community Health Needs Assessment (CHNA)revealed many important health needs in the healthsystem’s service area.* Those needs varied by servicearea and included important concerns ranging fromfood access and nutrition, maternal and child health,to social isolation. All of the issues identified throughthe report are important to the health of thecommunity and to NGHS. The five priorities adopted bythe organization represent those on which we can havethe most impact based on prioritization criteria and isnot an indication of overall NGHS commitment toaddressing other pressing health concerns. Forexample, though cancer care is not listed in the fivepriorities, NGHS continues our internal emphasis oncancer care services and will report its activity via theannual Community Benefit Report.The organization chose prioritiesbased on need and areas where itcould have the most impact based onprioritization criteria.Systemwide Integration:Service area specificWhile NGHS works to care for the needs of our entireservice area as a whole, providers in each servicearea may have specific areas of focus for differentCHNA priorities. (See chart on next page.)Population Health Management –Better Outcomes for PatientsManaging population health requires providing theright level of care to the right patient at the right timeand place so the overall health of the population isimproved. Working through partnerships such asHP2, which is a physician led, clinically integratednetwork made up of hospitals and physicians workingtogether to improve quality of care while decreasingcosts for patients, payers and providers, NGHS seeksto bend the curve on disease processes that result inbetter outcomes for patients. The use of socialdeterminants of health holds significant promise forhelping providers understand more about theirpatients, leading to earlierinterventions capable ofreducing risk andpreventing adverseeffects.Community leadership:NGHS will host a community breakfast in first quarterof FY20 for regional non-profits to share the CHNAwebsite and demonstrate Tableau, the interactivedashboard that displays data evaluated via NGMC'sCHNA by area served.This dashboard was created for use by professionalsin healthcare, community-based non-profits,academia, and/or interested citizens.*See pages 17 and 18 of full report atwww.nghs.com/community-benefit-resources for adescription of the approach used to identify andprioritize significant health needs.4This event will be provided in partnership with UnitedWay of Hall County and North Georgia CommunityFoundation.
Priority Emphasis by Service AreaNGMC Gainesville/BraseltonNGMC BarrowNGHS PSANGHS GBSA44NGMC LumpkinNGHS SSA 4004Mental &Behavioral Health4NGHS SSA - North444444444Access to in County’s high cardiovascular diseasemortality rate and NGHS significant expansion ofservices along the 400 corridor represents aunique opportunity for NGHS to developinnovative solutions for reducing mortality rateswhich can be replicated across the region.PSA HallSSA North Habersham, Rabun,Stephens, Towns, Union, White4SSA 400 Dawson, LumpkinGBSA Gwinnett, Jackson, Barrow, Banks5
Mental and Behavioral HealthPSA HallSSA North Habersham, Rabun,Stephens, Towns,Union, WhiteSSA 400 Dawson, LumpkinGBSA Gwinnett,Jackson,Barrow, BanksNGMC Gainesville/BraseltonNGHS PSA4NGMC BarrowNGHS GBSA4NGHS SSA - NorthOWNERSHIP: (all service areas)NGMC GainesvilleNGMC BraseltonNGMC BarrowNGMC LumpkinndMental a althal HeBehaviorNGMC Lumpkin4NGHS SSA 4004Community Partners: United Way One Hall - Mental/BehavioralHealth Subcommittee Partnership for a Drug Free Hall Funders Physicians Health Department Indigent Clinics MoreOverall outcome measure :10 of the 16 Northeast Georgia counties hadsuicides rates higher than the state of Georgiabenchmark which was 13.1 per 100,000 population.!(See page 163 of CHNA Report for chart of suicide rates throughoutthe region.)GOAL: Working with the community, create a comprehensive system of integratedservices that recognizes and treats the mental and behavioral health needs ofpeople when and where they need care. Begin in Hall and spread out into regionwith lessons learned as appropriate.6Areas of focus have been identified as Access, Collaboration and Education.For each priority, a workplan is underway to improve measurable outcomes formental & behavioral health in our community through United Way’s One Hall Mental& Behavioral Health Subcommittee of which NGHS is a part.
On two important metrics, the NGHS service area shows a need forimmediate intervention related to the opioid crisis:All counties in Northeast Georgia exceed the state rate for opioidprescriptions per 100 persons (70.9) and over half of the counties exceedthe rate by more than two times.The Georgia state benchmark for drug overdose deaths was 12.7 per100,000. In the Northeast Georgia region, data were available for 13 ofthe 16 counties and 11 of those counties had drug overdose death rateshigher than the Georgia benchmark.TACTICS: The Partnership for Drug Free Hall is a partnership of agenciesand community members dedicated to providing Hall County, Georgia,with information, resources and actions to address the drug problemsof Hall County. NGHS provides a corporate sponsorship of 10,000/year and active leadership in the partnership. The Peer Support Program in the ED continues, matchingpatients with substance abuse related issues with Stategrant- funded Certified Addiction Recovery Empowerment (CARES)counselors to educate and support those seeking recovery. Successwill be determined by lower readmission/recidivismrates. The Peer Support Program in the NICU provides CAREScounselors to mothers-to-be who present with substance use disorders.This program has already seen tremendous success in lowering thelength of stay of babies born with Neonatal Abstinence AbuseSyndrome. Our goal is to lower the average length of stay to five daysor less in the NICU. Increase Grant Funding - NGHS will continue to pursueappropriate grants available for combating the opioid crisis. NGHS will partner with the Hall County Health Department to beginoverdose tracking to identify opportunities to mitigate overdosedeaths and point those with substance use disorder toward recoveryresources.7
MENTAL AND BEHAVIORAL HEALTHTACTICS, CONTINUED: The My GCAL app - for Apple and Android smartphones - was designed toreach Georgia’s youth in times of need. GCAL is staffed by caring professionals including licensed clinicians - who are available 24/7 to address behavioralhealth crises, make referrals for treatment, and dispatch mobile crisis responseteams. The Department of Behavioral Health and Developmental Disabilities(DHBDD) recently launched the Phone App to support the Georgia Crisis andAccess Line. NGHS will help the DBHDD improve awareness of this vitalcommunity resource. Data-Sharing Platform - partnering with AVIA and other communitypartners, NGHS is leading efforts to develop a way for agencies to coordinateservices to those with mental/behavioral health concerns via an integrated andsecure data-sharing platform. Because many providers may come in contactwith a person with mental/behavioral health concerns, a platform to facilitatecoordination of services can be a substantial support mechanism for helpingthose in greatest need.Our goal is to complete successful vendor selection during the first year and tobegin enrolling users during the second year of this implementation plan. One Hall Mental and Behavioral Health (MBH) Subcommittee, ofwhich NGHS is a part, is working to develop innovative ways for the communityto address mental and behavioral health concerns impacting the people of HallCounty. The committee has adopted a model they call “ACE,” for Access,Collaboration and Education. This model is being evaluated for use incommunities beyond Hall.We will measure our success through this tactic by surveys of awareness ofmental health, the justice initiative, education (Mental Health First Aid goals)and by the number of people trained.8
The Reach Out Campaign, spearheaded by the One Hall MBHSubcommittee, of which NGHS is a part, has been developed by ForumCommunications to destigmatize mental and behavioral health. The budget,funded by NGMC, covers the campaign cost which includes social media,videos, outdoor advertising and other community-based communications toincrease awareness and expand the community’s conversation aboutmental and behavioral health as part of general health. We will measureour success through pre and post survey results.One Hall’s Reach Outcampaign is designed todestigmatize mentalhealth concerns andimprove the publicconversation aboutmental health.For more information, go to unitedwayhallcounty.org/reachout9
Access, Collaboration, Education Across the RegionFollowing the same “ACE” model as One Hall, NGMC Gainesville, Braselton, Barrow and Lumpkin will work to improve ACCESS, COLLABORATION & EDUCATION to improve behavioral and mental health across the region. In addition, NGHS willwork to encourage the ACE framework with CHNA partners.NGMC Gainesville/BraseltonNGHS PSANGMC BarrowNGHS GBSANGMC LumpkinNGHS SSA400NGHS SSANorthEDUCATIONCOLLABORATIONACCESSData Sharing Platformallowing partners toprovide improved services10Graduate Medical EducationEmbedded Behavioral SpecialistsFunding for Mental/BehavioralHealth Justice CollaborativePartnership for Drug Free HallOne Hall - United Way MBH SubcommitteeCARES Peer Support in ERCARES Peer Support in NICUDestigmatizationcampaignPartner with Health Departmentepidemiologicalapproach to opioid overdosePSA HallSSA North Habersham, Rabun,Stephens, Towns, Union, WhiteSSA 400 Dawson, LumpkinGBSA Gwinnett, Jackson, Barrow, BanksNGPG Providers partneringwith regional providers on opioid epidemic
PsychiatryEstimated Total Year2023200 Surgery2020202120222023 Graduate Medical Education - training 24 psychiatry residents by 2023Our community, state and nation are experiencing a shortage in psychiatrists and othermental health professionals. As part of our GME program, NGHS will welcome 24psychiatry residents for training by 2023.11
Access to CareNGMC Gainesville/BraseltonNGHS PSA4NGMC BarrowNGHS GBSA4NGMC LumpkinNGHS SSA - North4OWNERSHIP: (all service areas)NGMC GainesvilleNGMC BraseltonNGMC BarrowNGMC LumpkinNGHS SSA 4004Community Partners: Funders Physicians Good News Clinics& other indigent clinics Health Department MoreCareotssAcceWork to improve access to care across the region.Outcome Measure:GME Residency Fill Slots!Working toward 200 residency slots invarious specialties by 2023(see page 10 of this document)12
TACTICS Create a coordinated regional program to assure appropriate andtimely access to specialty and surgical care. The project is designed toeliminate the barriers to care for the region’s indigent and underinsured. Consistent with overall mission, continue to meet/exceed indigentcare commitments throughout the region. Complete evaluation for becoming a Level 1 Trauma Center. Partnerships with indigent clinics such as Good News Clinics(Gainesville), Good Shepherd Clinic (Dawsonville), Community Helping Place(Dahlonega). ER admissions/readmissions and controls of chronic diseasesas measured through patient diabetes control, regulated blood pressure,congestive heart failure will be the system’s metrics for this tactic. Prenatal Program with the Hall County Health Departmentcontinues with a goal of Healthy Pregnancies and Deliveries.NGMC’s commitment is 200,000 annually. Partner with local medical transportation network, IndependentTransportation Network (ITN) Lanier. Evaluate telehealth opportunities, working with other regionalproviders (hospitals) to provide access so patients can receive care closeto home. Explore paramedicine program, learning from experience of others. Opening of NGMC Lumpkin incorporating innovative care models. Northeast Georgia Health System has partnered with HabershamMedical Center to provide emergency and inpatient care. HabershamMedical Center and NGHS are working on a five-year plan to transformHabersham Medical Center campus, with the ultimate goal for it to become aNortheast Georgia Medical Center hospital. The plan calls for NGHS to invest 3 million dollars each year, until 2024, to help Habersham Medical Centerfund capital projects to enhance and expand services for the community. NGMC’s Office of Research, working with physicians as principalinvestigators, will continue to take part in cutting-edge clinical researchstudies that have the potential to impact standard of care and improve thecare patients receive.13
ACCESS TO CARE Establish a study group; review local data across the region, examine deaths, causes,and determine possible course of action for perinatal morbidity/mortality andchild mortality Digital front door:Using technology to better serve the community, NGHS is developing what we call our“digital front door” to improve access to care without a need for a traditional medicalencounter in a physician’s office or hospital setting. Using technology, a growing percentage of the visits to physicians and other referral screenings are done digitally,increasing access and convenience throughout the region.14
ACCESS TO CARE Continue NGMC support of Foothills AHECFoothills Area Health Education Center is a community-driven,non-profit corporation, supported by federal and local sources.The mission is to increase the supply and distribution of healthcare providers,especially in medically underserved areas. Through joint efforts, communitiesexperience improved supply, distribution and retention of quality healthcare professionals. Foothills AHEC serves 31 counties in the Northeast Georgia area andNGMC supports a portion of operating costs for Foothills AHEC. Continue NGMC’s support of Safe KidsNortheast Georgia Medical Center serves as lead agency for Safe KidsGainesville/Hall County. The mission of Safe Kids is to reduceunintentional injuries and death in children 19 and under. In FY19, SafeKids provided over 131 programs and events that reached an estimated25,000 children and their family members, teachers and caregivers.Through these programs, over 3,500 safety items were distributed tofamilies who were in need of them. Safe Kids was funded in FY19 by TheMedical Center Foundation's Healthy Journey Campaign. Read Learn Succeed SupportMaternal education is highly important for birth outcomes since it canaffect infant health through multiple pathways such as higher income,better access to health insurance, increased health knowledge, bettercognitive ability, and less risky health behaviors. Early education ofchildren, beginning at birth, can begin to break the cycle of poverty.In an effort to improve school readiness and literacy for our community’schildren, NGMC has partnered with the United Way of Hall County’s ReadLearn Succeed initiative to produce a children’s book to be given to allbabies born at NGMC Gainesville and Braselton. Printed in English andSpanish, “Welcome to the World,” provides education about theimportance of reading to children every day, for at least 15 minutes,starting at birth. This book is given to babies born at NGMC. We plan tocontinue this partnership over the next 3 years. Master Facility PlanningThrough the Master Facility Planning process, NGMC is looking at whereand how services could be provided differently in the health system tomake it easier on patients and result in better outcomes. The new planfocuses on expanding facility resources to accommodate the growingpopulation in our area and improving operational efficiency throughoutthe organization.15
DiabetesNGHS PSANGMC BarrowNGHS GBSA4NGHS SSA - NorthOWNERSHIP:NGMC BraseltonNGMC Barrowe te sDiabNGMC LumpkinNGMC Lumpkin4NGHS SSA 4004Potential Partners: Health Department Indigent Clinics YMCA Physicians Chamber/United Way(Health Initiative Consortium)Of the 16 counties in the Northeast Georgia region,12 of the counties had a higher rate of diabetes prevalencein adults than the Georgia state benchmark of 11.3%.!Three counties had rates that were more than 20% greater relative to the benchmark: Hart, 13.7% Rabun, 14.7 Union, 16%Additionally, five counties exceeded the state benchmark for the diabetes death rate, all were 26%or higher than the state benchmark of 21.5 diabetes deaths per 100,000 population: Hart, 26.7 Lumpkin, 27.2 Banks, 28.2PSA Hall Barrow, 30.3SSA North Habersham, Rabun, Franklin, 34.9Stephens, Towns, Union, WhiteSSA 400 Dawson, LumpkinGBSA Gwinnett, Jackson, Barrow, Banks16
Outcome Measure:Prevent incidence of gestational diabetes giving unborn children a betterchance for more positive health outcomesThe complications of diabetes represent a significant area for NGMC to impact patientoutcomes. One of the greatest opportunities for impact on population health is preventinggestational diabetes, which is diabetes which develops during a woman’s pregnancy. Focusingon this important time in a woman’s life not only impacts the health of the mother, but also thebaby she carries.Gestational diabetes causes the babies heart rate to increase, high blood sugars in the motherand baby (overfeeding the baby and leading to very high birth weights and increased need forC-section deliveries), raises blood pressures in mothers to dangerous levels and impactsperinatal morbidity (see Access to Care in this document).NGMC will focus preventive education and intervention for women in prenatal care who fail theglucose tolerance test, which also indicates a future risk of developing Type II diabetes. A pilotprogram will be developed within one of the markets identified.NGMC will take advantage of Center for Disease Control programs and our own currentpartnership with YMCA.17
Cardiovascular DiseaseNGHS PSANGHS GBSANGHS SSA - NorthOWNERSHIP:NGMC LumpkinascularCardiov seDiseaOverall outcome measure:NGMC LumpkinNGHS SSA 4004Community Partners: Community Helping Place Good Shepherd ClinicDahlonega and Dawsonville Physicians The Heart Center ofNortheast Georgia Medical Center Health Department!Decrease heart disease death rate in Lumpkin County.Baseline: 134.8 (78% higher than the state benchmark)PSA HallSSA North Habersham, Rabun,Stephens, Towns, Union, WhiteSSA 400 Dawson, LumpkinGBSA Gwinnett, Jackson, Barrow, Banks18
TACTICS Tar Wars Program in Hall, Dawson, Lumpkin, White, Habersham, Banks and Jackson(already implemented in Barrow) to educate youth about the dangers of smoking and vaping. 50,000 has been budgeted for the next 3 years Successful opening of new hospital in Lumpkin County by 2021 The Heart Center to expand manpower in Lumpkin County Evaluate potential offering of cardiac rehabilitation in Lumpkin Compare heart disease death rate – before and after opening of NGMC Lumpkin Investments in the Treatment of Stroke: Just as “time is muscle” when treating heartdisease, “time is brain” when it comes to the treatment of stroke patients. NGMC Gainesville,which serves patients from throughout the region, will implement technology called “biplaneangiography,” allowing physicians to better visualize the complex network of blood vessels thatdeliver blood and oxygen to the brain. A neuro interventionalist will be hired to perform procedures that will result in patientsbeing able to get the care they need closer to home NGMC Gainesville is certified as a Primary Stroke Center through DNV-GLHealthcare. Emergent stroke treatment and inpatient care is provided to stroke patients bydedicated care teams who specialize in treating neurovascular conditions. NGMC Gainesville isendeavoring to expand the center's current treatment capabilities with the addition of acutestroke endovascular intervention and to ultimately gain Comprehensive Stroke Centercertification. This program advancement will further improve patient outcomes and provideacute stroke treatment and recovery services not currently available in the region.19
CARDIOVASCULAR DISEASE Continue and improve upon STEMI regional systemHosted each year by NGMC, the Northeast Georgia Regional STEMI Conferencebrings together paramedics, EMS staff and doctors from across the state. Theymeet to discuss the state of the Northeast Georgia Regional STEMI System – acollaborative effort between Northeast Georgia Medical Center and EMS in 18counties across the region to provide fast and efficient treatment to patientssuffering severe heart attacks known as STEMI (S-T Segment ElevationMyocardial Infarction).STEMI patients are in danger because their arteries are blocked, and blood isn’table to get to the heart, which causes deadly heart attacks. The STEMI Programmakes sure information about the heart attack is sent to NGMC while theambulance is en route, so a cardiologist is waiting to restore the patient’s bloodflow almost immediately after he or she arrives.20
SepticemiaNGMC Gainesville/BraseltonNGHS PSA4PSA HallSSA North Habersham, Rabun,Stephens, Towns, Union, WhiteSSA 400 Dawson, LumpkinGBSA Gwinnett, Jackson, Barrow, BanksNGMC BarrowNGHS GBSA4NGHS SSA 400OWNERSHIP:NGMC GainesvilleNGMC BraseltonNGMC BarrowNGMC LumpkinNGMC Lumpkin4Sepsis is the body’soverwhelming response toinfection that can lead toorgan damage, shock,and death.4Community Partners: Habersham Medical CenterStephens County HospitalOther regional providers Physicians The NGHS Foundation10 of 16 counties in northeastGeorgia have sepsis rates abovethe state averageSepticemiaNGHS SSA - North!Overall Outcome Measure:Using a region-wide approach, decrease the number ofdeaths (mortality rate) due to sepsis.Baseline: 8.30 as of 10/19.Target is for 2 regional providers to achieve 8.09TACTICS All providers in the region using same evidence-basedprotocols (sharing of toolkit). Create a Sepsis Alert Team to provide 24/7/365 decisionsupport to NGMC primary patient care21
SEPTICEMIA Community health approach to education (lecture series) The Formation of a Sepsis Regional Population Health Team.Outcome Measures will be the number of deaths due to sepsis, lengths ofstay, 30-day readmission rate, community awareness administered bysurveys. Funds requested for 3-year plan are 450,000 per year forregional population health team related to Sepsis. Add a Sepsis Outpatient RN Navigator to providepatient/community support in order to promote sepsis awareness,empower patients to seek care earlier, navigate high-risk patients andprovide facilitation/support to regional partners to extend sepsis work tothe entire region to reduce septic shock on presentation, 30-dayreadmissions, and sepsis mortality. Upgrade current Sepsis Coordinator to Sepsis ProgramManager to oversee the operations of the Sepsis Program.22
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See pages 17 and 18 of full CHNA report at www.nghs.com/community-benefitresources for a description of the approach used to identify and prioritize significanthealth needs. The health needs NGHS chose not to address through theprioritization process include the following:PSA: Food access and nutrition, maternal and child health, social isolation.GBSA: Maternal and child health, physical activity, injury and death, violence, childabuse, income, education, access to dental care, cancer, transportation.SSA North: Maternal and child health, cardiovascular disease, income, physicalactivity, violence, child abuse, education, access to dental care, employment,cerebrovascular disease, social isolation, cancer, COPD and respiratory disease,injury and death.SSA 400: Maternal and child health, smoking, violence/child abuse, income,access to dental care, social isolation, cancer, transportation.This is not to say that NGHS does not have any activity related to these issues. Theorganization had to choose where it could have the most impact based onprioritization criteria, and some of the needs not chosen still relate to chosen healthpriorities. For instance, Access to Care is a priority across the region. Whiletransportation on its own did not make the health priority list, it would be an issueconsidered in access to care issues. The same is true with maternal child issues.Several health indicators related to maternal child issues are considered underaccess to care. And while cancer was not chosen as a community healthimprovement priority, NGHS already has an internal emphasis on this health issueand will report its activity via the annual Community Benefit Report.24improving the health of our community in all we do
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