Community Health Needs Assessment | Piedmont Columbus Regional

FY22

PIEDMONT

COLUMBUS REGIONAL

- MIDTOWN AND

NORTHSIDE

COMMUNITY HEALTH NEEDS

ASSESSMENT

Introduction

P. 3

TABLE OF

CONTENTS

FY19 CHNA progress

P. 7

FY22 CHNA

P. 11

FY22 Employee and

community input

P. 33

Methodology + Approval

P. 39

FY22 priorities

P. 4

Appendices: Federal poverty levels,

stakeholders interviewed, sources,

employee survey

P. 41

Community benefit

P. 8

As a not-for-profit healthcare system, the mission of Piedmont Columbus is

healthcare marked by compassion and sustainable excellence in a progressive

environment, guided by physicians, delivered by exceptional professionals, and

inspired by the communities we serve.

PCR - FY22 CHNA - 3

Introduction

In our commitment as a not-for-profit health system, Piedmont Healthcare studied the region’s

community health needs for its Community Health Needs Assessment (CHNA), a triennial

process required by the Internal Revenue Service due to our tax-exempt status. A CHNA is a

measurement of the relative health or well-being of a given community. It's both the activity and

the end-product of identifying and prioritizing unmet community health needs, which is done by

gathering and analyzing data, soliciting the feedback of the community and key stakeholders, and

evaluating our previous work and future opportunities.

Through this assessment, we hope to better understand local health challenges, identify health

trends in our community, determine gaps in the current health delivery system and craft a plan to

address those gaps and the identified health needs. This is the fourth Piedmont CHNA, with the

others having been conducted in 2013, 2016 and 2019. The 2022 Piedmont CHNA will serve as

a foundation for developing our community benefit strategies and further strengthening our

community-focused work.

About the hospitals

Piedmont Columbus Regional dates to 1836 when the local hospital was a small building on the

Chattahoochee River. It is now the region’s healthcare leader, offering compassionate care and

an unwavering commitment to patients. Piedmont Columbus Regional consists of two hospitals,

a cancer center, and over 35 physician practice locations. Piedmont Columbus Regional joined

the Piedmont family in March 2018.

Midtown Campus is a 583-bed, acute care hospital and features a regional Level II trauma

center, one of only six perinatal centers in the state with a Level III Neonatal Intensive Care Unit

and is the only Piedmont facility with a Children’s Hospital. It has been home to the Family

Medicine Program since 1972. The nationally recognized program, which was the first of its kind

in Georgia and one of the first in the Southeast, has graduated over 500 family physicians.

Northside Campus is a 100-bed, acute care hospital specializing in an extensive range of

surgical and emergency services, physical rehabilitation, and a state-of-the-art sleep lab.

Piedmont Columbus Regional has garnered national acclaim in clinical quality, patient

satisfaction, stroke care, oncology, and pediatrics. Piedmont Columbus Regional is also the lead

agency for Safe Kids Columbus.

Note that all statistics and information in this report is for both hospitals combined.

PCR - FY22 CHNA - 4

Community benefit

FY20

FY21

Care for low-income and other

vulnerable patients

$24,393,860

$20,151,268

Community health services

$338,017

$326,816

Health professions education

$7,720,822

$6,984,847

Bad debt

$22,617,982

$21,365,684

Piedmont Columbus is a not-for-profit hospital, meaning it is exempt from paying certain taxes. In

exchange for those exemptions, federal and some state laws require that communities receive

from their hospitals certain benefits, appropriately called community benefit. These programs are

generally meant as programs intended to increase access to care and boost the health of the

community, with a focus on low-income populations and others who face unique challenges to

being healthy. Since our last CHNA, in FY20 and FY21 combined, Piedmont Columbus provided

$103.8 million in community benefit. Specifically, Piedmont Columbus provided:

Key programs include: the hospital's mobile unit, which provides place-based services to low-

income and other vulnerable populations. The mobile unit consists of a registered nurse, a

licensed medical social worker, a family practice resident, and a PharmD resident under the

medical direction of a staff physician. The hospital also conduct extensive community health

education, including efforts focused on prevention and treatment of diabetes and stroke.

ZIP code

No. of

patients -

FY20

No. of visits -

FY20

No. of

patients -

FY21

No. of visits -

FY21

31907

3,768

7,207

3,902

7,949

31903

2,649

5,505

3,327

7,278

31906

2,164

4,379

2,623

5,682

31904

1,959

3,913

2,337

4,821

31901

1,102

2,351

1,169

2,675

31909

1,024

1,744

1,176

2,094

36867

977

1,320

181

234

36869

906

1,199

168

238

36870

391

495

115

31805

136

261

274

481

PCR - FY22 CHNA - 5

Financial assistance

Piedmont Healthcare provides financial assistance to qualifying low-income patients at or below

300 percent the Federal Poverty Level. Patients qualify for financial assistance in one of two ways:

either through presumptive eligibility, in which the patient's file is automatically scanned for certain

indicators that mean he or she would qualify for financial assistance, or via manual application by

the patient or his or her representative. Below is a list of the top ten ZIP codes by volume of

patients receiving financial assistance at the hospital during the last two fiscal years.

Please note we provided financial assistance to patients outside of these ten ZIP codes as well.

Examining ZIP code data can help us to better target specific communities that may have unique

challenges due to social determinants of health, such as having a low income, poor housing conditions,

or limited access to healthy foods.

PCR - FY22 CHNA - 6

Medicaid

Piedmont provides services to patients who receive benefits through the state/federal public

insurance program Medicaid, which covers the cost of care for low-income patients who: are

pregnant, are a child or teenager, are 65 and older, are legally blind, have a disability, or need

nursing home care. Below is a list of the top ten ZIP codes by volume of patients receiving care at

the hospital as a Medicaid beneficiary during the last two fiscal years.

ZIP code

No. of patients

- FY20

No. of visits -

FY20

No. of patients

- FY21

No. of visits -

FY20

31907

20,359

50,316

19,816

50,399

31904

11,644

28,512

11,451

28,027

31909

10,538

23,465

10,615

24,442

31903

9,731

25,775

9,180

25,007

31906

8,982

23,256

8,767

22,910

36867

5,992

13,468

5,712

12,968

36869

5,754

12,831

5,648

12,629

31901

3,074

8,627

2,569

7,566

36877

1,921

5,062

1,837

5,015

31820

923

1,318

1,138

1,712

Please note we provided care to Medicaid beneficiaries outside of these ten ZIP codes as well.

Examining ZIP code data can help us to better target specific communities that may have unique

challenges due to social determinants of health, such as having a low income, poor housing

conditions, or limited access to healthy foods.

With each priority, we will work to achieve greater health equity by reducing the impact of poverty

and other socioeconomic indicators for that priority. This means we will prioritize programming and

investment in areas that directly address issues related to income and poverty and others who

face particular challenges in accessing care due to disability, race, English proficiency, educational

attainment and other areas of socioeconomic status. Additionally, whenever possible, health

education will be available in the languages found within the community, with special attention

spent on outreach to those populations.

When possible, we will work to address other issues that arose during the CHNA, such as violence

and Alzheimer's Disease, even though those are not listed in the above priority list. Throughout

the CHNA process, violence was a prevalent issue, and we'll partner with community

organizations to the best of our ability to address the issue. Additionally, when possible, we will

weigh in on issues of growth and traffic, though those are outside the realm of us being able to

directly impact those issues.

FY22 Priorities

A key component of the CHNA is to identify the top health priorities we'll address over fiscal years

2023, 2024, and 2025. These priorities will guide our community benefit work. They are, in no

order of importance:

Ensure affordable access to health, mental, and dental care for all

community members, and especially those that are low income and/or

uninsured

PCR - FY22 CHNA - 7

Reduce preventable instances of and death from cancer

Decrease preventable instances of diabetes and decrease the number of

patients with uncontrolled diabetes

Decrease the impact of and deaths from stroke

Reduce rates of obesity and increase access to healthy foods and

recreational activities

PCR - FY22 CHNA - 8

Progress since last CHNA

Increase access points for appropriate and affordable health care for all community

members, and especially those who are uninsured and those with low incomes

Decrease deaths from cancer and increase access to cancer programming for those living

with the disease

Decrease preventable instances of diabetes and decrease the number of patients with

uncontrolled diabetes

Reduce rates of obesity and increase access to healthy foods and recreational activities

Decrease the impact of and deaths from stroke

Reduce opioid and related substance abuse and overdose deaths

In the hospital's FY19 CHNA, six health priorities were identified to address over the following

three years. These priorities were:

To address these priorities, we:

We prioritized increasing access to care by utilizing key community stakeholders to provide

meaningful input to critical areas of consideration. We created a steering committee to

increase access to care by assisting with clinical policies and guidelines for the operations

of the mobile unit. The committee focused on critical components to increase access to

care for high-risk populations identified in the CHNA and discussed how to utilize hospital

services for the community during the pandemic.

During clinical visits, the mobile unit team consists of a registered nurse, a licensed

medical social worker, a family practice resident and a PharmD resident under the medical

direction of a staff physician. The clinical team assesses each patient, provides acute

medical treatment and calls in prescriptions to local pharmacies as necessary. Referrals to

the Piedmont Columbus emergency department if medically necessary. The mobile unit

served 1,512 indigent patients from July 01, 2019, to March 01, 2020, when activities

ceased due to COVID. From Valley Rescue and Safe House clinics, the hospital treated

254 patient through medical encounters. Of those, seven were referred to the emergency

department and 71 were referred to community partners for follow-up.

We deployed a mobile unit clinic team comprised of a family practice resident, a pharmacy

resident, and a registered nurse to conduct weekly clinics to reduce emergency

admissions. COVID-19 significantly impacted the mobile unit activities and was suspended

for 12 months until March 2021. The mobile unit served 287 indigent patients between

March 1, 2020, and July 1, 2021. There were 50 patient encounters from Valley Rescue

and Safe House clinics. Additionally, 19 patients were referred to community partners for a

follow-up. Before the mobile unit resumed in March, there were 24 mobile unit patients

seen in the emergency department. After March, we saw 13

PCR - FY22 CHNA - 9

Progress since last CHNA, cont'd

mobile unit patients in the emergency department. The mobile unit social worker assisted 21

patients with additional personal needs.

After COVID-19 cases significantly decreased, we resumed a modified schedule with the

mobile unit. We continued weekly clinics at Safe House and Valley Rescue to target indigent

populations and provided education to assist with vaccine hesitancy and offer vaccines.

We prioritized decreasing deaths from cancer and increasing access to cancer programming

by increasing local awareness of and local opportunities for lung cancer screening. We

continued distributing a brochure titled "Lung Cancer Screening, Shared Decision-Making

Guide." The instructional guide explains the details of our Low-Dose CT Scan Lung Cancer

Screening. There has been a total of 651 patients in the Lung Cancer Screening program.

We also worked to address cultural barriers to cancer prevention and education for the Latino

community. We conducted two screening events for colorectal and prostate cancer by

outreaching to Latino and African American churches in local counties. The effectiveness of

outreach quality depended on the number of Latino participants at the annual free prostate

cancer screenings. In 2021, the prostate cancer screening event had 4.16 percent

Hispanic/Latino participants, a decline from the previous year, when we had a higher rate of

Hispanic/Latino population participation.

We worked with the community to overcome barriers to screenings and increase cancer

screenings for colorectal, prostate, and skin cancer. We partnered with the West Central

Georgia Cancer Coalition for a community-wide drive-through Colorectal Cancer Screening.

Piedmont Columbus Regional used Community Educational Events to distribute Stool

Screening FIT Kits. In FY21, 159 FIT kits were distributed, 67 kits returned, and six came

back positive. The patients who received positive kits received follow-up care. We provided

surveys to measure outreach quality for the event, and we received mostly positive feedback.

We prioritized decreasing the impact of and deaths from stroke by increasing EMS as the

preferred mode of transportation by 10 percent over the next three years. We increased EMS

as the preferred mode of arrival for stroke patients by 13 percent in FY21 by increasing the

community's knowledge of the stroke survival campaign of F.A.S.T. During FY20, EMS as the

method of arrival was 62 percent for all stroke encounters and, in FY21, it was 75 percent,

which is evidence of the success of the campaign.

We prioritized reducing rates of obesity and increasing access to healthy foods and

recreational activities by supporting healthy food access for low-income children. Our

community outreach department partnered with Amerigroup to host two Mobile Market Day

PCR - FY22 CHNA - 10

Progress since last CHNA, cont'd

Performed COVID-19 screenings at PCR Midtown and J.B.A.C.C. from March 2020 to March

2021.

Coordinated three COVID-19 vaccination clinics with follow-up clinics to administer second

doses of the Moderna vaccine. Piedmont Columbus Regional also served as vaccinators in

the clinics.

events despite challenging COVID-19 protocols. We targeted families from the surrounding area

in at-risk populations identified in the CHNA and provided fresh fruit, vegetables, and educational

materials.

We prioritized decreasing preventable instances of diabetes and number of patients with

uncontrolled diabetes by increasing the number of Outpatient Diabetes Self-Management

Education attendees. Due to COVID-19, we suspended the Outpatient Diabetes Self-

Management Education program following the February 8, 2020, class. Later in the year, we

moved the course to the virtual platform Zoom. In-person courses resumed in November 2021.

We also worked to address uncontrolled diabetes by continuing the accredited Diabetes

Prevention Program, focusing on at-risk populations as identified in our CNHA. A total of three

participants in Cohort III of the Diabetes Prevention Program completed the program in

September 2021, meeting all completion criteria. This program was offered virtually and in

person to accommodate CDC guidelines.

Finally, we incorporated and initiated a glycemic management/diabetes management rotation

with medical and pharmacy residents, which remained active throughout 2020 and 2021, despite

the COVID-19 pandemic.

Due to the pandemic and the suspension of most community outreach activities in FY20 and

FY21, Piedmont Columbus Regional assisted with the following:

Additionally, in FY20, the hospital provided $57,500 in grants to local nonprofit organizations with

programming that aligned with our FY19 CHNA. Through of these programs, in October 2019,

Piedmont Columbus Regional partnered with the Boys and Girls Clubs of Chattahoochee Valley

to host a flu clinic. A total of 76 flu shots were administered to children with an additional 45

parents/guardians who received flu education from the hospital’s chief of pediatrics.

In both years the hospital maintained its accredited Diabetes Prevention Program, which focuses

on at-risk populations as identified in its CHNA. Activities included: ongoing diabetes education

that includes information on diabetes management, physical activity, medication usage,

complication prevention and how to cope with this chronic disease; nutrition education that

focuses on food

PCR - FY22 CHNA - 11

Progress since last CHNA, cont'd

choices and improving blood sugar control; and education to reduce the negative impact of

diabetes, reduce heart disease risk factors and improve weight management.

The hospital also regularly offered stroke awareness educational materials and blood pressure

screenings at health fairs and community events to achieve and maintain stroke certification

through community awareness. Additionally, the hospital has had extensive outreach to the

community to provide cancer education and screenings, including prostate and lung cancer

screenings.

As part of a Piedmont Healthcare systemwide effort, Piedmont Columbus was an active

participant in anti-opioid work, which included: active participation on the systemwide task force,

tracking opioid prescriptions within the hospital and by providers, utilizing Epic EMR tools to

monitor opioid use, offering patients and the community ways to safely dispose of unused

medication, and providing ongoing education on opioid prescribing. The advent of COVID-19

precluded local take-back day activities, in which we’d traditionally partner with local law

enforcement to host an event in which community members were encouraged to bring in any

unused prescriptions for safe disposal.

Piedmont Columbus’s Community Outreach department partnered with the Muscogee County

School District, Amerigroup, Feed the Valley, and University of Georgia Cooperative Extension

to host various farmers markets throughout the year for at-risk populations identified in the

CHNA. Fresh fruit and vegetables, interactive food demonstrations and nutritional education

were provided at the events. University of Georgia Cooperative Extension also provided free

cooking classes in select low-income housing areas where the attendees were given tips on how

to shop for healthy food items on a budget and how to prepare healthy meals with ingredients

they may already have in the home.

Piedmont Columbus also facilitated education sessions hosted by our dietitians for the annual

Muscogee County School District Professional Development Training for the teachers and

administrators.

Community

Health Needs

Assessment

FY22

In Muscogee County, an average 195,739 people lived in the 216.44 square mile area each year

between 2015 and 2019. The population density for this area, estimated at 904 persons per

square mile, is much greater than the state average population density of 181 people per square

mile and the national average population density of 92 persons per square mile. The ZIP code

with the highest concentration of people was 31906, where 30 percent of the county's population

called home. Muscogee is mostly urban, as 97 percent of community members live within an

urban setting. The ZIP code with the highest concentration of the rural population was 31801 and,

like in most of Georgia, rural populations in Muscogee are overwhelmingly white. Muscogee

County is growing, having seen a 9 percent increase in total population between 2010 and 2020.

About 14 percent of the population were veterans in 2020, and more than half were between the

ages of 35 and 54. Eighteen percent of the population - about 34,150 people - lived with a

disability. Most of that population were 65 or older.

About 25 percent of the population were 17 or younger, 13 percent were over the age of 65, and

the remaining population were between the ages of 18-64. Between 2015 to 2019, about 40

percent of all Muscogee County residents were white, 46 percent were black or African American,

7.6 percent were Hispanic/Latino, 2.5 percent were Asian, and the remaining were comprised of

other races. About 5 percent of the population were born outside of the US and 2.2 percent of the

total population did not have citizenship status in 2020.

Black

46%

White

40%

Hispanic/Latino

7.6%

Asian

2.5%

PCR - FY22 CHNA - 13

About the community

While Piedmont Columbus serves patients from

all over northeast Georgia, for purposes of this

CHNA, we consider our community to be

Muscogee County. We do this in recognition of

the direct impact of our tax-exempt status on

county residents.

The chart to the left represents a

breakdown of races within the

community. The community is still

predominately white, though that is

shifting. Minority populations have

steadily grown in recent years, with

Hispanic or Latino populations leading

growth at 36 percent from 2010 to

2020, as compared to 7.11 percent for

all other races. This is on-trend with

Hispanic/Latino population growth

throughout the state.

PCR - FY22 CHNA - 14

Root causes of poor health

In conducting the FY22 CHNA, we recognized two main issues that emerged that are root

causes of poor health.

Poverty and health

Poverty is the most significant indicator of health as those living at or near poverty are more

likely to die from cancer, heart disease and diabetes than those with higher incomes. This is

due to several factors that go beyond income, such as education, housing and simple

geography, things commonly dubbed “social determinants of health.” This means that

factors outside your immediate physical self can play a huge role in your health, even

including how long you live. Life expectancy can vary as much as 30 years between the

richest and poorest Georgia counties. Muscogee County has a poverty rate much higher

than state and national averages, with about 21 percent of the population living at or below

poverty. Minorities far more likely to live in poverty. For example, 27 percent of black

populations lived in poverty, on average between 2015 and 2020, versus only 13 percent of

whites.

Insurance status and health outcomes

In 2020, 12 percent of the population had no form of insurance. Insurance status and health

are inextricably linked. Being uninsured is generally a marker of low-income, as the

overwhelming majority of those that are uninsured are also within certain ranges of the

Federal Poverty Level. This means these populations are also likely to face the myriad of

other social determinants of health (SDH), like housing and food insecurity.

No insurance can mean no access to primary and specialty care, due to cost and/or

provider availability. Conditions that could have been treated affordably in a community

setting are often not and, because of this, those without insurance statistically suffer worse

health outcomes than their insured counterparts. Diseases like cancer are often diagnosed

later, and manageable conditions such as hypertension can elevate to dangerous levels.

Across the state, adults aged 18 to 64 are most likely to be uninsured, and that's true in

Muscogee County. In 2020, 18 percent of nonelderly adults were uninsured, as compared to

5.11 percent of those under age 18 and 1 percent for those 65 and older.

As with other indicators, race matters. Approximately 18 percent of Hispanic/Latino

populations were uninsured, 12 percent of Asians were uninsured, 13 percent of blacks or

African Americans were uninsured, and 9.14 percent of whites were uninsured.

PCR - FY22 CHNA - 15

Community and income

Between 2015 and 2019, the median household income was $46,408, which is lower than state

and national levels, which are $58,700 and $62,843, respectively. When broken down by the

four dominant races in the community, income disparities are evident.

White Black or African American Hispanic/Latino

Asian

Muscogee County Georgia United States

$100,000

$75,000

$50,000

$25,000

Of employers in the community, the largest sector by employment size is retail trade, which

employed 13,570 community members at an average annual wage of $27,310 in 2019 according

to the US Department of Commerce. Administrative and support and waste management and

remediation services was the second largest sector, with 12,488 people employed at an average

annual wage of $20,111. Transportation and warehousing was the third largest sector, with

10,566 people employed at an average annual wage of $28,159.

Unemployment and labor force participation

According to the 2015-2019 American Community Survey, 122,444 people in the community were

part of the labor force, and only 3,500 -- about 4.5 percent -- were unemployed as of January

2022. This figure has steadily decreased since last year, when in January 2021, 5.9 percent of

the labor force was unemployed. When looking back further, the rate is nearly three times less

than the unemployment rate in 2012.

This indicator is relevant because unemployment creates financial instability and barriers to

access including insurance coverage, health services, healthy food, and other necessities that

contribute to poor health status.

Murder

Rape

Robbery

Assault

Burglary

Larceny

Vehicle

Theft

395

806

2,138

6,052

705

PCR - FY22 CHNA - 16

Community safety and violence

Juvenile arrests

Within the county, in 2018, there were 54 juvenile arrests. Juvenile arrests can illustrate one

aspect of the complex societies in which youth live. Juvenile arrests are the result of many

factors such as policing strategies, local laws, community and family support, and individual

behaviors. Youth who are arrested face disproportionately higher morbidity and mortality.

Those who are arrested and incarcerated experience lower self-reported health, higher rates

of infectious disease and stress-related illnesses, and higher body mass indices.

For a county its size, Muscogee County has significant violence issues. Community level risk factors

for violence include increased levels of unemployment, poverty and transiency; decreased levels of

economic opportunity and community participation; poor housing conditions; gang activity,

emotional distress and a lack of access to services.

Below is a chart breaking down offenses in 2017, as reported to the Georgia Bureau of

Investigation. This is the last year for which this information is publicly available.

Firearm fatalities

Firearm fatalities are a critical public health issue as they are largely preventable. Most firearm

fatalities are the result of suicides and homicides. Between 2016 and 2020, there were 257

firearm fatalities in Muscogee County, resulting in a rate of 25.6 per every 100,000 people, much

higher than the state and national rates of 16.0 and 12.2, respectively.

Incarceration rate

The Opportunity Atlas estimates the percentage of individuals born in each census tract who were

incarcerated at the time of the 2020 Census. According to the Atlas data, 2.9 percent of the county

population were incarcerated, slightly higher than the state average of 2.1 percent.

Violent crime is a critical public health issue as it is often largely preventable. Between 2015 and

2019, there were a total 3,672 violent crimes reported in Muscogee County, a figure that includes

homicide, rape, robbery, domestic violence, and aggravated assault. This equates to a violent

crime annual rate of 606.9 per every 100,000 people, a figure significantly higher than the state

and national rates of 373.1 and 416, respectively.

Violent crime

PCR - FY22 CHNA - 17

Community safety and violence, cont'd.

The chart below illustrates trauma activations at the hospital for calendar years 2020, 2021, and

2022. As illustrated, both February and March saw significant increases over the last two years.

The chart below illustrates gunshot wounds as presented at the hospital for calendar years 2020,

2021, and 2022. As illustrated, February, March and April saw significant increases over the last

two years.

PCR - FY22 CHNA - 18

Vulnerability and Deprivation indexes

The Area Deprivation Index (ADI) ranks neighborhoods and communities relative to all

neighborhoods across the nation and the state. ADI is calculated based on 17 measures related to

four primary domains: education, income and employment, housing, and household

characteristics. The overall scores are measured on a scale of 1 to 100 where 1 indicates the

lowest level of deprivation (least disadvantaged) and 100 is the highest level of deprivation (most

disadvantaged). Muscogee County ranks in the 62nd percentile for Georgia and 68th in the

national percentile, both of which are on the high side of the midrange.

Area Deprivation Index

Social Vulnerability Index

The Social Vulnerability Index is the degree to which a community exhibits certain social

conditions, including high poverty, low percentage of vehicle access, or crowded households,

that may affect that community’s ability to prevent human suffering and financial loss in the event

of disaster. These factors describe a community’s social vulnerability.

The social vulnerability index is a measure of the degree of social vulnerability in counties and

neighborhoods, where a higher score indicates higher vulnerability. Muscogee County has a

social vulnerability index score of 0.90, which is much higher than the state score of 0.57. Broken

down by themes:

Muscogee County Georgia US

Socioeconomic

Household

Minority status

Housing and transportation

Social vulnerability

0.75

0.5

0.25

PCR - FY22 CHNA - 19

A person's income status is directly related to their health status, and predictably the more

money you have, the healthier you tend to be.

At or below 50% FPL

At or below 100% FPL

At or below 185% FPL

At or below 200% FPL

Income and poverty

The chart to the left demonstrates how many

community members live in poverty or near-

poverty. In 2020, approximately 21 percent of

the county lived at or below the Federal

Poverty Level (FPL).

In 2022, the FPL placed a family of four as

having a total household income of $27,750.

Even when living at twice the FPL, families

are likely unable to afford many of life's

basics.

By far, the poorest ZIP code within

Muscogee County is 31903, where 42

percent of the population lived in poverty in

2020.

In Muscogee County, like most of the state,

minorities are more likely to live in poverty.

For example, in 2020, 27 percent of blacks or

African Americans and 19 percent of

Hispanic/Latino populations in Muscogee

County were living at or below poverty, as

compared to 13 percent of whites.

The Georgia Supplemental Nutrition Assistance Program (SNAP) is a federally funded program

that provides monthly benefits to low-income households to help pay for the cost of food. A

household may be one person living alone, a family, or several unrelated individuals cohabitating

who routinely purchase and prepare meals together. SNAP enrollment and poverty rates are co-

related.

In Muscogee County, nearly 18 percent of households received SNAP benefits in December 2020,

representing about 13,067 households. Black populations are far more likely to receive SNAP

benefits than any other demographic --- 40 percent all SNAP recipients are black or

Hispanic/Latino, as compared to 18 percent of white recipients. The ZIP code with the highest

amount of SNAP recipients was 301903, where 39 percent of the population received SNAP

benefits.

SNAP Benefits

PCR - FY22 CHNA - 20

Housing

On average, between 2015 and 2019, the median rent cost for a home in Muscogee was $906,

with some areas higher than others. For example, the median rent in 31905 was $1,512.

According to 2020 USDA data, the average adult male spends between $193 and $358 on

groceries per month, and the average adult female spends between $174 and $315. In

Muscogee County, in 2020, basic utilities average $101 per month, and internet averaged $59.

As the family size grows, costs increase, and households are increasingly burdened. None of

the above reflects the impact of COVID-19 on housing stock, income, and increased cost of

living, meaning the situation is likely worse than before.

Cost-burdened households

Of the 75,984 total occupied households in Muscogee County between 2015 and 2019, 26,767

community members -- about 37 percent -- lived in cost burdened households, in which housing

costs were 30 percent or more of total household income. Approximately 18 percent of

households had costs that exceeded 50 percent of the household income, which places the

household in significant financial strain.

Substandard housing

This indicator reports the number and percentage of owner- and renter-occupied housing

units having at least one of the following conditions: 1) lacking complete plumbing facilities, 2)

lacking complete kitchen facilities, 3) 1 or more occupants per room, 4) selected monthly

owner costs as a percentage of household income greater than 30 percent, and 5) gross rent

as a percentage of household income greater than 30 percent. Of all households in the

county, 27,532 (about 37.84 percent) have one or more substandard conditions. This is worse

than the state average of 30.1 percent.

Area Median Income and affordable housing

This indicator reports the number and percentage of housing units at various income levels

relative to Area Median Income (AMI). The AMI is the midpoint of a region's income

distribution, meaning that half of households in a region earn more than the median and half

earn less than the median. A household's income is calculated by its gross income, which is

the total income received before taxes and other payroll deductions.

Affordability is defined by assuming that housing costs should not exceed 30 percent of total

household income. Income levels are expressed as a percentage of the county's AMI. About

65 percent of housing units are affordable at 100 percent AMI, which means that housing is

not affordable for the remaining 35 percent of the population. This is slightly worse than the

state rate of 67.13 percent of housing units affordable at 100 percent AMI.

Food insecurity happens when a person or family does not have the resources to afford to eat

regularly. This can happen due to affordability issues, particularly for households facing

unemployment, and especially so if they were already low-income. As with many health indicators,

minorities are much more likely than their white counterparts to experience food insecurity.

Neighborhood conditions can affect physical access to food. For example, people living in some

urban areas, rural areas, and low-income neighborhoods may have limited access to full-service

supermarkets or grocery stores. Predominantly black and Hispanic neighborhoods tend to have

fewer full-service supermarkets than predominantly white and non-Hispanic neighborhoods.

Communities that lack affordable and nutritious food are commonly known as “food deserts.”

PCR - FY22 CHNA - 21

Food deserts and food insecurity

Healthy dietary behaviors are supported by access to healthy foods, and grocery stores are a

major provider of these foods. There were 36 grocery stores in the county, a rate of 18.96 per

every 100,000 people, which is on par with state and national rates of 17.46 and 20.66,

respectively. Grocery stores are defined as supermarkets and smaller grocery stores primarily

engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and

vegetables; and fresh and prepared meats, fish, and poultry. Delicatessen-type

establishments are also included, and convenience stores and large general merchandise

stores that also retail food, such as supercenters and warehouse club stores, are excluded.

Grocery stores

Low food access is defined as living more than 0.5 mile from the nearest supermarket,

supercenter, or large grocery store. This indicator is relevant because it highlights populations

and geographies facing food insecurity. According to the 2019 Food Access Research Atlas

database, about 30 percent of the total population in the county have low food access,

meaning about 57,404 county residents may struggle to access healthy foods. This is

between the state and national rates of 30.89 percent and 22.22 percent, respectively. ZIP

code 31905 has the worst rate of low food access at 99.4 percent.

Low food access

In Muscogee County, in 2019, 11 of the county's 53

census tracts were food deserts, as shown in the map

to the right. About 46,281 people lived within these

census tracts. These tracts almost directly correspond

with census tracts demonstrating retailers who are

authorized to take SNAP benefits. In Muscogee County,

like with most of the state, those retailers tend to be

convenience and discount stores that carry limited, if

any, healthy foods. Increasingly, discount stores like

Dollar General do have some sort of produce section,

but that is inconsistent among communities.

Insurance status is directly related to a person's ability to access care, and this is particularly

true for non-emergent care and specialty care. Health insurance makes a difference in whether

and when people get necessary medical care, where they get their care, and ultimately, how

healthy they are. Uninsured people are far more likely than those with insurance to postpone

health care or forgo it altogether. The consequences can be severe, particularly when

preventable conditions or chronic diseases go undetected.

Compared to those who have health coverage, people without health insurance are more likely

to skip preventive services and report that they do not have a regular source of health care.

Adults who are uninsured are over three times more likely than insured adults to say they have

not had a visit about their own health to a doctor or other health professional’s office or clinic in

the past 12 months. They are also less likely to receive recommended screening tests such as

blood pressure checks, cholesterol checks, blood sugar screening, pap smear or mammogram

(among women), and colon cancer screening. Part of the reason for poor access among the

uninsured is that half do not have a regular place to go when they are sick or need medical

advice, while most insured people do have a regular source of care.

Employer or

Union

Self-

purchased

TRICARE

Medicare

Medicaid

50.67%

12.76%

19.72%

19.42%

25.13%

5.74%

PCR - FY22 CHNA - 22

At the crux of healthcare is access, which is determined by a few factors: availability of

providers, insurance status, and ability to pay.

Insurance

Access to care

In Muscogee County, in 2019, about 12 percent of the population were uninsured, a figure lower

than the state rate of 16 percent and higher than the national figure of 11 percent. As with other

indicators, these rates are much worse for minorities, particularly Hispanic/Latino populations,

which had an uninsurance rate of 33.1 percent. Rates, overall, have steadily declined. In 2011,

approximately 18 percent of all adults were uninsured.

The below table demonstrates the type of insurance for those who had coverage in 2020, by

percentage of the population. Note this doesn't equal 100 percent, as some community members

have two types of coverage.

Insurance coverage

PCR - FY22 CHNA - 23

Access to dental and primary care

Dental care and dental outcomes

Research shows that losing your teeth will shorten your lifespan. Missing nine teeth for

nine years or more reduces lifespan compared to a contemporary who maintains their

teeth.

The lower your income and education level, the more likely you are to lose your teeth,

which results in even fewer economic opportunities, creating a poverty cycle. For

example, it is difficult to gain employment if you have visible missing teeth.

The individual will inevitably struggle with eating certain foods, limiting their options,

which can be detrimental for lower-income populations already facing food insecurity.

Dental care is crucial to health, as dental conditions that go unchecked can lead to decay,

infection and tooth loss. Within the county, in 2018, 58.3 percent of adults went to the

dentist in the past 12 months. That year, 18.1 percent of the county reported having lost

most or all natural teeth because of tooth decay or gum disease. This is an impactful

measure in multiple ways:

It's important to note that there are few options for low-income patients needing dental

care. While most dental services for children enrolled in the low-income public health

insurance program PeachCare are covered, for adults covered by Medicaid, only

emergency dental care is provided. There are limited options for low-income dental care

services within the county, and there are few -- if any, at a given time -- options for low-

cost dental services that go beyond cleaning, basic fillings, and extractions. For example, if

you have lost even one tooth, you have few, if any, options for implants that aren't at full

retail cost. In Georgia, the cost to replace a single tooth can range from $3,000 to $4,500,

out of pocket.

Primary care and routine check-ups

In 2019, about 79 percent of adults aged 18 or older saw a doctor for a routine check-up the

previous year, a measure that is likely over-reported and is lower than both state and national

averages. For Medicare recipients, this number drops to 74 percent of adult beneficiaries, which

is below both state and national averages. Routine check-ups are a critical component to

maintaining good health and identifying conditions that can be treated affordably in a community-

based setting. Absent that, even simple-to-treat conditions can escalate to deeper issues,

eventually requiring more intensive care, later stage diagnoses, or reduced life expectancy.

As with most other indicators, race and income play heavily into this. White populations are far

more likely to receive preventive care than their white counterparts (76.5 percent among black

populations compared to 86.49 percent among white populations statewide), and those with

insurance are also much more likely to go to the doctor for a routine check-up than those without

insurance.

PCR - FY22 CHNA - 24

Ischemic heart

and vascular

disease - 1

All COPD except

asthma - 4

Trachea,

bronchus and

lung cancer - 5

Alzheimer's

Disease - 6

Cerebrovascular

disease - 3

Essential

hypertension and

hypertensive renal

and heart disease - 8

Below are the eight leading causes of age-adjusted death, in total between 2016 and 2020. The

dials indicate how severe the rate is, as compared to the rest of the state.

White: Ischemic heart disease and vascular disease; all COPD except asthma; Alzheimer's

disease

Black or African American: Ischemic heart disease and vascular disease; cerebrovascular

disease; diabetes

Asian: Ischemic heart disease and vascular disease; cerebrovascular disease; trachea,

bronchus, and lung cancer

Hispanic/Latino: Ischemic heart disease and vascular disease; diabetes; essential

hypertension and hypertensive renal and heart disease

When broken down by race, the leading causes of death shift. Below is a list of the top three

causes of death, by race.

All other races had numbers too small to report.

Causes of death

Diabetes - 7

COVID-19 - 2

PCR - FY22 CHNA - 25

Heart disease and stroke

Heart disease is a leading cause of death for both women and men in Muscogee County. In

2020, the age-adjusted death rate was 262.9 deaths for every 100,000 people, which is far

worse than both state and national rates, which were 72.4 and 91.5 heart-related deaths per

100,000 people, respectively. Even so, this rate has steadily declined over the last few years.

Between 2016 and 2020, there were 507 deaths due to stroke, representing an age-adjusted

death rate of 50 deaths per every 100,000 people. Men are more likely to die from stroke than

women, as are black populations. Below is a chart demonstrating the death rate broken down by

race, per every 100,000 people, between 2016 and 2020.

There are several potential reasons for this, including a higher poverty rate among black

populations, which impacts all areas of life, including access to primary health care and healthy

foods. Hypertension and other related chronic conditions also tend to be higher among black

populations, as do obesity and diabetes, all of which tend to occur at a younger age than they do

for their white counterparts. Finally, neighborhoods matter. In Muscogee County, black

populations tend to live in communities with lower walkability rates and more limited access to

healthy foods.

Hospitalizations

The hospitalization rate for heart disease and stroke among Medicare recipients have steadily

decreased over the last five years. The cardiovascular disease hospitalization rate in 2018 was

8.9 hospitalizations per every 1,000 Medicare beneficiaries, which is better than state and

national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke, though, is

above state and national rates, with 9.7 hospitalizations per every 1,000 Medicare

beneficiaries, as compared to the state rate of 9.3 and the national rate of 8.4.

White Black Asian or Pacific Islander Hispanic or Latino

Cancer Site

New Cases

(Annual

Average)

Cancer Incidence

Rate (Per 100,000

Population)

1 - Breast

148

133

2 - Lung and bronchus

132

64.8

3 - Prostate

125

130.5

4 - Colon and rectum

48.2

5 - Melanoma of the skin

20.4

PCR - FY22 CHNA - 26

Cancer

Although heart disease leads in county deaths, cancer remains a critical issue within the

community. The cancer incidence rate for Muscogee County each year, on average between

2014 and 2018, was 490.4 per every 100,000 people, which equates to a diagnosis rate of an

average 1,001 new cases each year. Below is a chart showing cancer diagnoses, by site,

between 2014 and 2018, the last year for which this data is available.

When comparing to state and national average, though, Muscogee County does fare better in

terms of overall diagnosis. This means one of two things: there are either fewer incidence rates

of cancer within the community or there are fewer screenings for all members of the community,

therefore resulting in fewer diagnoses.

When broken down by cancer site, though, the breast cancer incidence rate of 133 is higher than

state and national rates, which are 128.4 and 126.8 diagnoses per every 100,000 people, on

average each year. Other diagnosed cancer sites are below state and national averages.

Poverty is directly related to increased incidence rates of cancer, as those with lower levels of

education and lower levels of income experience higher rates of cancer diagnoses. They are also

more likely to die from certain cancers – particularly lung cancer and colorectal cancer. For

survivors, income and socioeconomic status are significant predictors of quality of life after

cancer. Increased income allows patients to maintain a level of comfort that people with low SES

might not be able to afford, meaning that even if a low-income patient survives cancer, their

quality of life after will be worse than someone more well off.

PCR - FY22 CHNA - 27

Hospitalizations and ER visits

In FY21, Piedmont Columbus treated patients through approximately 103,347 emergency room

visits, an increase from the year before, when the hospitals treated patients through about

82,400 visits. This is likely in part due to the impact of COVID-19 and a wariness among

patients to visit a hospital.

Preventable hospitalizations among Medicare beneficiaries

Preventable hospitalizations include hospital admissions for one or more of the following

conditions: diabetes with short-term complications, diabetes with long-term complications,

uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic

obstructive pulmonary disease, asthma, hypertension, heart failure, bacterial pneumonia, or

urinary tract infections. Rates are presented per 100,000 beneficiaries. In 2020, there were

34,252 Medicare beneficiaries in the county, and the preventable hospitalization rate was 2,874,

which is better than the state rate of 3,503 during the same time. As with other health indicators,

African Americans were twice as likely to experience preventable hospitalizations than other

races in 2020.

Muscogee County Georgia US

2015 2016 2017 2018 2019 2020

6,000

4,000

2,000

Emergency department visits

The below chart demonstrates the five-year trend for preventable hospitalizations over the last five

years.

Inpatient stays

In 2020, there were 34,252 Medicare beneficiaries in the county. Approximately 2,711 total

beneficiaries, or 14.3 percent, had a hospital inpatient stay, resulting in a rate of stay of 218 visits

per every 1,000 beneficiaries. The rate of inpatient stays in the county was lower than the state

rate of 230.0 during the same time.

PCR - FY22 CHNA - 28

Chronic conditions

Diabetes

Kidney disease

In 2019, 17,911 of adults aged 20 and older had diabetes, equaling 12.1 percent of the county's

population, which is higher than the state rate of 9.8 percent. Diabetes is a prevalent problem in

the US, often indicating an unhealthy lifestyle, and puts individuals at risk for further health

issues. This rate has remained somewhat steady over the years. For example, ten years earlier,

in 2009, the diabetes diagnosis rate was 11.2 percent.

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in

its effects or a disease that comes with time. As with most health indicators, low-income

households are most at risk for developing chronic diseases and for premature deaths. Such

households are more vulnerable for several reasons, including their inability to cover medical

expenses and diminished access to health care facilities.

Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney

function. Your kidneys filter wastes and excess fluids from your blood, which are then removed in

your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes and

wastes to build up in your body. In 2019, 3.6 percent of the county's population had a diagnosis of

kidney disease, a rate worse than the state and national percentages of 3.22 percent and 3.1

percent, respectively.

In 2019, 31 percent of adults 18 and older of the total population reported having high

cholesterol, which is on par with state and national rates. Too much cholesterol puts you at

risk for heart disease and stroke, two of the main causes of death within the county.

High cholesterol

Multiple chronic conditions among Medicare populations

This indicator reports the number and percentage of the Medicare fee-for-service population

with multiple (more than one) chronic conditions. Data are based upon Medicare administrative

enrollment and claims data for Medicare beneficiaries enrolled in the fee-for-service program.

Within the county, there were 14,014 beneficiaries with multiple chronic conditions based on

administrative claims data in the latest report year, representing 75.3 percent of the total

Medicare fee-for-service beneficiaries, which is higher than state and national rates. Twenty-

three percent of these beneficiaries have six or more chronic conditions.

High blood pressure

In 2019, 39.1 percent of adults 18 and older had a diagnosis of high blood pressure. This is higher

than the state and national rates of 35.5 percent and 32.6 percent, respectively. High blood

pressure can damage your arteries by making them less elastic, which decreases the flow of

blood and oxygen to your heart and leads to heart disease.

PCR - FY22 CHNA - 29

Infectious diseases

HIV/AIDS

Chlamydia

Infectious diseases are an issue in Muscogee County, as with most communities. Most

infectious diseases have only minor complications. But some infections — such as

pneumonia, AIDS, and meningitis — can become life-threatening. A few types of infections

have been linked to a long-term increased risk of cancer. For example, human papillomavirus

is linked to cervical cancer.

Gonorrhea

Chlamydia is a common STD that can cause infection among both men and women. It can

cause permanent damage to a woman's reproductive system. This can make it difficult or

impossible to get pregnant later. Chlamydia can also cause a potentially fatal ectopic

pregnancy (pregnancy that occurs outside the womb). In Muscogee County, in 2018, there

were 1,722 confirmed cases of chlamydia, resulting in a rate of about 887.36 infections per

every 100,000 people. This is much higher than the state rate of 632.2 confirmed cases per

every 100,000 people.

Gonorrhea is an STD that can cause infection in the genitals, rectum, and throat. It is very

common, especially among young people ages 15-24 years. Untreated gonorrhea can

cause serious and permanent health problems in both women and men. In women,

gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory

disease (PID). In Muscogee County, in 2018, there were 291.7 confirmed cases of

gonorrhea for every 100,000 people. This is much higher than the state rate of 200.10

confirmed cases per every 100,000 people.

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If

HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). While there

is no cure for HIV/AIDS, if treated, most can live a relatively healthy life. In Muscogee

County, in 2018, there were 676.5 confirmed cases of HIV/AIDS for every 100,000 people.

This is higher than the state rate of 624.90 confirmed cases per every 100,000 people.

Influenza and pneumonia

Within the county, between 2016 and 2018, there were a total 183 deaths due to influenza

and pneumonia, representing an age-adjusted death rate of 18 per every 100,000 people,

which is higher than the state and national rates of 13.6 and 13.6, respectively. In Muscogee

County, men are nearly twice as likely to die from influenza or pneumonia than women, and

black men are especially susceptible.

PCR - FY22 CHNA - 30

COVID-19

Without a doubt, COVID-19 is easily one of the most impactful health events to happen within

both the community and the world.

Historic undervaccination

Sociodemographic barriers

Resource-constrained health system

Health care accessibility barriers

Irregular care-seeking behaviors.

Approximately 54 percent of the county was fully vaccinated as of May 12, 2022. An

estimated 15 percent of the county's adults are hesitant about receiving the vaccine, and the

county had a COVID-19 vaccine coverage index (CVAC) of 0.70. This score represents how

challenging vaccine rollout may be in some communities compared to others, with values

ranging from 0 (least challenging) to 1 (most challenging). CVAC ranks states and counties

on barriers to coverage through 28 indicators across five themes:

The CVAC can help contextualize progress to widespread COVID-19 vaccine coverage,

identifying underlying community-level factors that could be driving low vaccine rates.

0 5,000 10,000 15,000 20,000 25,000

Muscogee County

Georgia

In Muscogee County, there have been 38,253 total confirmed cases of COVID-19. The rate of

confirmed cases is 19,701.79 per 100,000 population, which is less than the state average of

23,188.84. Data are current as of May 12, 2022.

0 100 200 300 400 500

Muscogee County

Georgia

In the county, there have been 823 total deaths among patients with confirmed cases of COVID-19.

The mortality rate in the report area is 423.88 per 100,000 population, which is greater than the state

average of 347.92. Data are current as of May 12, 2022.

PCR - FY22 CHNA - 31

Youth and children

There were approximately 48,489 children and youth under the age of 18 in Muscogee County in

2020, representing 25 percent of the county's population. The ZIP code with the highest number

of children was 31903, according to the Census Bureau. Approximately 3.4 percent of students

were homeless in 2020 -- about 1,086 kids.

Access - Head Start and preschool enrollment

Head Start is a program designed to help children from birth to age five who come from families

at or below poverty level. This helps these children become ready for kindergarten while also

providing the needed requirements to thrive, including health care and food support. In 2019,

Muscogee County had 12 Head Start programs, with a rate of 8.49 programs per 10,000

children under 5 years old in 2020. This rate is between state and national rates of 6.83 and

10.53, respectively. Approximately 44 percent of all children aged 3 to 4 were enrolled in

preschool in 2020, a rate lower than state and national figures of 50.26 percent and 48.32

percent, respectively.

In 2019, 30 percent of children lived in households where only one parent is present, and the

overwhelming majority of those were led by a single woman. Statistically, compared to married

parents, single parents tend to be poorer (because there is not a second earner in the family)

and less well-educated (in part because early childbearing interrupts or discourages education,

and single parent households tend to be led by younger parents).

Single-parent households

Of all children, 53 percent lived at or below 200 percent of the Federal Poverty Level (FPL), which

was $55,500 gross household income for a family of four in 2022. The highest percentage of poor

children was in the 31903 ZIP code, where 87 percent of children lived in poverty in 2020.

Overall, in Muscogee, black children were three times more likely to live in poverty than white

children.

Additionally, 78 percent of county children qualified for free or reduced-price lunch in the 2019-

2020 school year, a figure far above state and national rates of 60 percent and 50 percent,

respectively. Free or reduced-price lunches are served to qualifying students in families with

income under 185 percent (reduced price) or under 130 percent (free lunch) of the US FPL as part

of the federal National School Lunch Program (NSLP).

English and math 4th grade proficiency

Of 9,883 students tested, 71.6 percent of 4th graders tested below the "proficient" level in the

English Language Arts portion of state standardized tests in the 2018-2019 school year, which is

worse than the state rate of 60.8 percent and the national rate of 53.8 percent. Reading

proficiency is key; up until 4th grade, students are learning to read. After that, they are reading to

learn. For the math portion of the test, 69.6 percent of 4th graders tested below the "proficient"

level, according to the latest data. Students in the county tested worse than the statewide rate of

46.1 percent.

PCR - FY22 CHNA - 32

Risky behaviors

Alcohol use

Excessive alcohol use can lead to a myriad of health issues, including liver disease, depression,

injuries, violence, and cancer. In Muscogee County, in 2018, 17.5 percent of adults self-reported

excessive drinking in the last 30 days, which was less than the state rate of 16.81 percent. Data for

this indicator were based on survey responses to the 2018 Behavioral Risk Factor Surveillance

System (BRFSS) annual survey, the last year for which data is available. Based on preliminary

national data, these rates likely increased during 2020, in which alcohol use increased during

COVID-19 quarantine periods.

Muscogee County Georgia US

0% 5% 10% 15% 20% 25%

Excessive drinking

Binge drinking

The below chart shows self-reported excessive and binge drinking rates in 2018. Binge drinking is

defined as adults aged 18 and older who report having five or more drinks (men) or four or more

drinks (women) on an occasion in the past 30 days. Excessive drinking is when binge drinking

episodes occurred multiple times within the last 30 days.

Behaviors are directly related to health outcomes, leading to increased risks of cardiovascular

disease, cancer, liver diseases, hepatitis, and sexually transmitted diseases.

Tobacco use

Within the county in 2019, 20.6 percent adults reported being a current smoker, which is

higher than both state and national rates. Smoking is directly related to a myriad of health

issues, including cancer.

Insufficient sleep

Approximately 44 percent of county residents reported regularly sleeping less than seven

hours most nights, on average, in 2019. Sleep is an essential function that allows your body

and mind to recharge, leaving you refreshed and alert when you wake up. Healthy sleep also

helps the body remain healthy, fight diseases, and maintain good mental health. Without

enough sleep, the brain cannot function properly.

PCR - FY22 CHNA - 33

Health factors

Obesity

Certain health factors have a strong impact on overall health, including obesity and physical

inactivity.

In 2019, 34.1 percent of county residents aged 20 and older were obese, meaning they had a

body mass index of 30 percent or more. Obesity rates have steadily risen in Muscogee County,

where ten years ago, 24.5 percent of the population were considered obese. Obesity is directly

linked to several health issues, including diabetes and heart disease.

Physical inactivity

Within the county in 2019, 27.6 percent of adults aged 20 and older self-report no active leisure

time, based on the question: "During the past month, other than your regular job, did you

participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or

walking for exercise?"

Even so, Muscogee does have ample opportunity for its community members to be outside or to

exercise. For example, 45 percent of county residents live within a half-mile of a park, a figure

much higher than state and national rates of 17.42 percent and 38.01 percent, respectively.

Additionally, there were 23 recreation and fitness places within the county in 2019, resulting in a

rate of 12.11 facilities per every 100,000 people, which is better than state and national rates.

Soda expenditures

This indicator reports soft drink consumption by census tract by estimating expenditures for

carbonated beverages, as a percentage of total food-at-home expenditures. Soda is directly

related to obesity and poor dental health. In Muscogee County, households spent an average

4.64 percent of their food budget on sodas in 2019, which is worse than average state and

national expenditures, which were 4.18 percent and 4.02 percent, respectively. Some ZIP codes

spent more on soda, such as 31901, which had a rate much higher than other ZIP codes at 5.03

percent.

In Muscogee County, as throughout the state and nation, the poorer you are, the more likely you

are to be obese. Additionally, Hispanic/Latino and black populations are much more likely to be

obese than their white counterparts.

2012 2013 2014 2015 2016 2017 2018 2019

40%

30%

20%

10%

PCR - FY22 CHNA - 34

Mental health

Opioid and substance use

Deaths of Despair

Deaths of despair -- suicide, drug and alcohol poisoning, and alcoholic liver disease—are at

their highest rate in recorded history, according to the Centers for Disease Control and

Prevention (CDC). In Muscogee County, the average rate of death due despair was 37.4

people every 100,000 people in 2020, a number that has steadily risen since 2010, when it

was 29.5 people per every 100,000 people. This is most common among white adults with

four-year degrees.

Specifically, suicide rates in the county continue to climb, and are among leading causes of

death for middle-age white men.

Mental health is a critical driver of overall health, as being in a good mental state can keep

you healthy and help prevent serious health conditions. A study found that positive

psychological well-being can reduce the risks of heart attacks and strokes. On the other hand,

poor mental health can lead to poor physical health or harmful behaviors.

Providers in Muscogee County prescribed 102.428 prescriptions per every 100 people in

2020, the last year for which data is available. This is higher than most Georgia counties,

though it does represent a decline from 2019, when the rate was 107.5 prescriptions.

Deaths from opioids, heroin, and fentanyl are shown below.

Poor mental health days

In 2018, the last year for which data is available, county members reported an average 4.8

poor mental health days over the last 30 days, which is worse than the state average of 4.2

poor mental health days. This is a statistic that likely sharply increased in 2020 and 2021,

when the severe mental impact of COVID-19 was felt throughout the community. Additionally,

in 2018, 17 percent of adults reported being in frequent mental distress, which is 14 or more

poor mental health days within a 30-day period. This statistic also likely increased during 2020

and 2021.

Opioids Heroin Fentanyl

0 2.5 5 7.5 10

2018

2019

2020

PCR - FY22 CHNA - 35

In March 2022, we launched an online employee survey to solicit community input on key health

issues. A total 1,053 system employees responded, including 94 Piedmont Columbus employees.

Below are the results of that survey. You can find all survey questions in the appendix.

Employee survey

The employees who

responded worked in:

Clinical

31%

Administration

26%

Environmental services

14%

Food services

11%

Programmatic

Other

They worked at:

Piedmont Athens: 13.12%

Piedmont Atlanta: 9%

Piedmont Cartersville: 2.98%

Piedmont Columbus: 8.93%

Piedmont Eastside: 4.31%

Piedmont Fayette: 7.69%

Piedmont Healthcare: 4.29%

Piedmont Henry: 5%

Piedmont Macon: 4.4%

Piedmont Mountainside: 5.83%

Piedmont Newnan: 7.38%

Piedmont Newton: 3.33%

Piedmont Physicians: 4.4%

Piedmont Rockdale: 4.64%

Piedmont Walton: 3.45%

Multiple locations: 5.98%

Other: 5.36%

Q: What do you think are the five

most important factors for a

healthy community? The top five

answers were:

Access to health care

Access to healthy foods

Economic opportunity for everyone

Healthy behaviors and lifestyle

Good place to raise children

Q: What do you think are the five

most important health problems in

your community? The top five

answers were:

Aging problems

Poverty

Mental health problems

COVID-19

Heart disease and stroke

PCR - FY22 CHNA - 36

Employee survey, cont'd

Not getting vaccinations to prevent

disease, including COVID-19

Poor diet

Alcohol abuse

Tobacco use

Lack of exercise

Q: What do you think are the five

riskiest behaviors in your community?

The top five answers were:

Q: How would you rate the overall health of your community?

Healthy

20%

Somewhat healthy

20%

Unhealthy

20%

Somewhat unhealthy

20%

Very healthy

16%

Very unhealthy

Unable to pay co-pays and

deductibles

No insurance

Lack of access to transportation

Fear (e.g., not ready to face or

discuss health problem)

Don't understand the need to see a

doctor

Q: What issues do you think may

prevent community members from

accessing care? The top five answers

were:

PCR - FY22 CHNA - 37

Employee survey, cont'd

Access to low-cost mental health services

Financial assistance to those who qualify

Access to dental care services

Community-based programs for health

Expanded access to specialty physicians

Q: What do you think are the top five most important actions in improving the health of

community members living within Piedmont communities? The top five answers were:

Q: What is your vision for a healthy community? Some answers were:

A healthy community includes access to affordable healthcare, healthy food, safe housing,

quality education, and stable jobs.

A place where people are healthy enough to move about and enjoy life.

One that is educated, with access to health services both financially and geographically.

Families and individuals who care for each other.

A community who has access to services, I have been an ER nurse for nearly a decade and the

mental health population continues to grow. There are not many resources for these patients;

Advantage is great but it would be wonderful to have a local Piedmont facility to help with these

patients.

Affordable housing that is safe.

More community care clinics where underserved communities can have access to "affordable"

healthcare.

Using healthcare for prevention instead of trying to treat most problems after onset.

Free little food pantries on different blocks in towns, with healthy food choices.

A healthy community to me would be a place where social and financial factors do not stop a

person for asking for help when in need. If everyone was able to get healthcare assistance, the

community would be a healthy place as a whole.

PCR - FY22 CHNA - 38

Employee survey, cont'd

Q: What is the single most pressing issue that you believe our patients face? Most answers

centered around cost, with some health factors. Among the answers:

Q: What are one or two things we can do better to serve our patients/our community? Some

answers were:

Barriers to accessing health care including lack of health insurance and poor socioeconomic

status.

Medical bills.

Affordable, really affordable, health care for everyone.

Financial insecurity (including but not limited to people living at or below poverty lines).

Mental health.

Drug use, obesity, and heart failure are things that could probably be helped if they had the access

to the right facilities.

Uninsured and underinsured people are so underserved. There are so many people who don't

access care until they are falling apart and end up hospitalized simply because they couldn't afford

to see a doctor and pay out of pocket rates.

Low healthcare literacy.

Include better discharge instructions on how to stay well at home. Also have a health hotline to triage

calls before heading to emergency room.

Participate in community clinics that offer reduced cost preventative services (wellness, vaccines,

chronic illness management) in challenged communities.

Get more involved in schools, as healthy behaviors start early.

Make non-emergent care more viable for uninsured and underinsured populations.

Help lower income patients with housing and food issues, and provide discharge instructions that are

viable for these patients.

Push the Governor to accept federal funding to fully expand Medicaid under the ACA.

PCR - FY22 CHNA - 39

As a part of our process, we interviewed 37 statewide key stakeholders and policymakers that

represent public health, low-income populations, minorities, chronic conditions, older adults, and

lawmakers. These interviews were conducted for people representing the entire region, including

Muscogee County. Answers carried certain themes. Below is a summary of comments.

Community stakeholders

Access to Care

Almost all of the stakeholders interviewed identified having more access to care as a continuing and

growing need in all areas including primary and specialty healthcare, mental health, and dental

services. It was stated that current services are not able to keep up with the need. There is an

ongoing concern over chronic health concerns such as diabetes, hypertension, obesity, and

respiratory disease. These conditions were often paired with a concern around the high number of

residents living in food deserts, without access to grocery stores, further perpetuating these health

concerns.

There is an ongoing concern over emergency rooms being used for all health issues, generally with

patients waiting to receive care when they are in a crisis situation, rather than accessing preventive

care. Some interviewees reported a concern over how cumbersome it is to navigate the health

system when specialist care or follow up appointments are needed, as well as transportation being

a large barrier in getting to the appropriate appointments, which often leads to patients opting not to

seek care until there is a true emergency.

Multiple interviewees referenced an increasing need for affordable and culturally sensitive mental

health resources for all ages. Mental health needs are reported to be rising since the COVID-19

pandemic, but currently local resources are unable to keep up with the demand for services.

In addition to the need for services, several interviewees stated they are seeing a distrust of the

healthcare system by those receiving services, therefore agencies are having to work diligently to

“build trust that outlasts your patient’s mistrust” in order to improve the health outcomes that are

causing the problem at hand.

Interviewees expressed a need for specialists in the Columbus area in order to meet the needs

including Neurology, Psychology, OBGYN, Oncology, and Pediatric specialists. In addition, there is

a concern over the difficulty in recruiting and retaining specialists to the area. Currently, patients are

frequently traveling outside of Columbus to receive treatment, particularly for pediatric care and

cancer care.

Crime and Violence

All stakeholders expressed a concern over the uptick in crime rates in the area. Currently, the

Columbus area has a higher murder per capita rate than other comparable cities, stakeholders

stated. Local agencies are seeing a correlation between the growing mental health concerns and

the crime taking place. Victims are all ages, including the youngest children. Some stakeholders

suggested implementing a stronger police presence to combat this issue.

PCR - FY22 CHNA - 40

Community stakeholders, cont'd.

Social Determinants of Health

Poverty rates in Columbus are higher than other comparable cities, something most stakeholders

noted.

The limited amount of affordable housing was discussed by most interviewees, further citing that

those who can afford their rent are often unable to cover the cost of their utilities. There is evidence

to support that lacking seasonally appropriate heating and cooling leads to poor health outcomes. In

addition, there are high rates of homelessness in Columbus, however, there are a number of active

initiatives in place to combat this. In addition, interviewers stated an issue with landlords holding

property simply for income but not upholding suitable living conditions to maintain these properties.

Many stakeholders with housing are housed in food deserts, lacking access to grocery stores to

fulfill these nutritional deficits. Children with nutritional deficits are unable to develop appropriately

and have poor health outcomes and performance in school. Furthermore, those living in proximity to

a grocery store often still are unable to afford their nutritional needs.

Jobs in the area are available but few offer a livable wage for employees, forcing many people to

allocate a high percentage of their income going towards cost of living to cover basic needs.

Many stakeholders recognized these concerns as a multi-generational issue but noted that the

community is lacking methods to offer those experiencing poverty a way to work out of it. Overall

funding was cited as a large issue to addressing these concerns.

Community survey

In March 2022, we launched an online survey asking community members to weigh in on the health

issues within the community. Fifty-three Muscogee residents responded. Overall, responses fell in

line with stakeholder interviews, with limited economic opportunity, poverty and income, and

violence as top-cited concerns. Most respondents felt the community was either "somewhat

healthy" or "healthy." Many rated issues of health education, health literacy, and risky behaviors as

barriers to good health, with problems in accessing affordable housing and healthy foods listed as

key barriers.

Q: What issues do you think may prevent

community members from accessing care?

The top five answers were:

Unable to pay co-pays and deductibles

No insurance

Lack of access to transportation

Fear (e.g., not ready to face or discuss

health problem)

Don't understand the need to see a doctor

Q: What do you think are the five most

important health problems in your

community? The top five answers were:

Mental health problems

Violence

Dental health problems

Poverty

Heart disease and stroke

PCR - FY22 CHNA - 41

The number of persons affected;

The seriousness of the issue;

Whether the health need specifically affected persons living in poverty or reflected health

disparities; and,

Availability of community and/or hospital resources to address the need.

The Piedmont Columbus CHNA was led by the Piedmont Healthcare community benefits team

and consulting organization Public Goods Group, with significant input and direction from

Piedmont Columbus's leadership and Community Outreach Manager, as well as Piedmont

Healthcare's Department of External Affairs.

The CHNA started with an analysis of available public health data. We looked at our Piedmont

service region, which spans the northeast section of the state. We paid particular attention to the

home counties of our hospitals, which is reflected in this CHNA. We focused on the home

counties in the individual CHNAs due to the local impact of our tax-exempt status.

Once our community was established, we interviewed key stakeholders who have a particular

expertise or knowledge of our communities. Specifically, we interviewed representatives of local

and regional public health entities, minority populations, faith-based communities, local business

owners, the philanthropic community, mental health agencies, elected officials and individuals

representing our most vulnerable patients.

An internal survey was also conducted throughout the healthcare system for both clinical and

non-clinical employees. Information was gathered on knowledge and understanding of community

benefit and current programs, as well as suggestions for how we can better serve our patients

and communities. Approximately 1,053 employees spanning the system responded. Additionally,

we conducted a community-based survey that was widely advertised to the community.

Once both qualitative and quantitative data were gathered, we authored the preliminary report.

Several key community health needs emerged during the assessment process. The chosen

priorities were recommended by the community benefit department with sign-off from hospital and

board leadership. The following criteria were used to establish the priorities:

While the priorities reflect clinical access and certain conditions, all priorities are viewed through

the lens of health disparities, with particular attention paid to improving outcomes for those most

vulnerable due to income and race. The priorities we chose reflected a collective agreement on

what hospital leadership, staff and the community felt was most important and within our ability to

positively impact the issue. Once priorities were chosen, we then authored the CHNA and

presented our findings and recommendations to the hospital's board of directors for their input

and approval.

Methodology

PCR - FY22 CHNA - 42

Hospital leadership then reviewed the CHNA and provided input. We incorporated their input

into the final CHNA report, which is this report. We then presented our findings and

recommended priorities to the hospital board of directors.

Once we established our priorities, we presented the CHNA to the board of directors for

approval on June 02, 2022.

Approval

PCR - FY22 CHNA - 43

Appendices

Appendix one: Stakeholders interviewed

In February and March 2022, we interviewed 35 stakeholders to gain their insight to the

community and health challenges the community faces. Specifically, we talked to:

Dr. Beverly Townsend (District Health

Director, District 4 Public Health, PCR

Board)

John Dale Hester (Board Chair, Piedmont

Columbus)

Rebecca Rumer (SVP, Columbus Bank &

Trust, PCR Board Member)

Dr. William Roundtree (Family Medicine

Doctor, PCR Board Member)

Warren Steele, II (PCR Board Member),

Dr. Shane Darrah (Cardiologist, PCR

Board Member)

Dr. Susan McWhirter (Pediatrician, PCR

Board Member)

Travis Wade (SVP, Synovus Securities,

PCR Board Member)

Rhea Bentley (Coordinator, UGA

Extension)

Ben Moser (President/CEO, United Way of

the Chattahoochee Valley)

Melissa Thomas (PCR Foundation Board),

Skip Henderson (Columbus Mayor)

Pat Frey (VP, Home for Good)

Wanda Amos (PCR Foundation Board)

Matthew Barkley (PCR Foundation Board)

Norm Bennett (PCR Foundation Board)

David Johnson (PCR Foundation Board)

Belva Dorsey (CEO, Enrichment Services

Program)

Dr. Rebecca Reamy (Piedmont Physician

and Director of Pediatric ER)

Rem Houser (PCR Foundation Board)

Justin Etheridge (PCR Foundation Board)

Neil Richardson (Executive Director,

Safehouse Ministries)

Billy Holbrook (Chief Development

Officer, MercyMed of Columbus)

Guy Sims (PCR Foundation Board)

Alex Stepanouk (PCR Foundation Board)

Dr. Kendall Handy (Piedmont Physician,

Chief of OBGYN, PCR Foundation Board)

Philip Badcock (PCR Foundation Board)

Sara Lang (CEO, Valley Healthcare)

Vann Ellison (CEO and President, Valley

Rescue Mission)

Hamilton Hilsman (PCR Foundation

Board)

Mallory Harris (PCR Foundation Board)

Mandy Flynn (Aflac Community Partner)

Rob Ward (PCR Foundation Board)

Phil Shuler (Mayor’s Commission)

Dr. Gregory Foster (Piedmont Physician,

Head of Family Medicine Residency

Program)

Jack Lockwood (DPH West Georgia)

Asante Hilts (DPH West Georgia)

Category

Data Source

Demographics

US Census Bureau, Decennial Census, 2020.

Demographics

US Census Bureau, American Community Survey, 2015-19.

Demographics

University of Wisconsin Net Migration Patterns for US Counties,

2010-20.

Income and

Economics

US Census Bureau, American Community Survey, 2015-19.

Income and

Economics

US Census Bureau, Business Dynamics Statistics, 2018-19.

Income and

Economics

US Department of Commerce, US Bureau of Economic Analysis,

2019.

Income and

Economics

US Department of Commerce, US Bureau of Economic Analysis,

2019.

Income and

Economics

US Department of Labor, Bureau of Labor Statistics, Jan. 2022.

Income and

Economics

IRS - Statistics of Income, 2018.

Income and

Economics

US Census Bureau, American Community Survey, 2015-19.

PCR - FY22 CHNA - 44

Appendix two: Sources for data

We utilized numerous data sources throughout the CHNA process. Due to the high volume in this

report, we did not individually cite each statistic. That said, we provide a list of all data sources

below. Please contact the Piedmont Healthcare community benefit department at

[email protected] for questions on specific data points.

Category

Data Source

Income and

Economics

US Census Bureau, American Community Survey, University of

Missouri, Center for Applied Research and Engagement Systems,

2007-11.

Income and

Economics

US Department of Agriculture, National Agricultural Statistics

Service, Census of Agriculture, 2017.

Income and

Economics

US Department of Commerce, US Bureau of Economic Analysis,

2016.

Income and

Economics

National Center for Education Statistics, NCES - Common Core of

Data, 2020-21.

Income and

Economics

US Census Bureau, Small Area Income and Poverty Estimates,

2020.

Education

US Department of Health & Human Services, HRSA -

Administration for Children and Families, 2019.

Education

US Census Bureau, American Community Survey, 2015-19.

Education

National Center for Education Statistics, NCES - Common Core of

Data, 2020-21.

Education

US Department of Education, EDFacts, 2018-19.

Education

US Census Bureau, American Community Survey, 2014-18.

Education

U.S. Department of Education, US Department of Education - Civil

Rights Data Collection, 2017-18.

Housing and Families

US Census Bureau, American Community Survey, 2015-19.

PCR - FY22 CHNA - 45

Appendix two: Sources for data, cont'd

Category

Data Source

Housing and Families

US Department of Housing and Urban Development, 2019.

Housing and Families

US Department of Housing and Urban Development, US

Census Bureau, American Community Survey, 2019.

Housing and Families

Eviction Lab, 2016.

Housing and Families

US Census Bureau, American Community Survey, 2011-15.

Housing and Families

Federal Financial Institutions Examination Council, Home

Mortgage Disclosure Act, 2014.

Housing and Families

US Census Bureau, Decennial Census, US Census Bureau,

American Community Survey, 2015-19.

Housing and Families

US Department of Housing and Urban Development, 2014.

Housing and Families

US Census Bureau, Census Population Estimates, 2019.

Housing and Families

US Department of Housing and Urban Development, 2020-Q4.

Other Social &

Economic Factors

University of Wisconsin-Madison School of Medicine and Public

Health, Neighborhood Atlas, 2021.

Other Social &

Economic Factors

Feeding America, 2017.

Other Social &

Economic Factors

US Department of Education, EDFacts, 2019-20.

PCR - FY22 CHNA - 46

Appendix two: Sources for data, cont'd

Category

Data Source

Other Social &

Economic Factors

US Census Bureau, American Community Survey, 2015-19.

Other Social &

Economic Factors

Opportunity Insights, 2018.

Other Social &

Economic Factors

US Census Bureau, American Community Survey, 2015-2019.

Other Social &

Economic Factors

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2020.

Other Social &

Economic Factors

US Census Bureau, Small Area Health Insurance Estimates,

2019.

Other Social &

Economic Factors

Opportunity Nation, 2018.

Other Social &

Economic Factors

US Census Bureau, Decennial Census, University of Missouri,

Center for Applied Research and Engagement Systems, 2020.

Other Social &

Economic Factors

US Census Bureau, Small Area Income and Poverty Estimates,

2019.

Other Social &

Economic Factors

Pennsylvania State University, College of Agricultural Sciences,

Northeast Regional Center for Rural Development, 2014.

Other Social &

Economic Factors

Centers for Disease Control and Prevention and the National

Center for Health Statistics, CDC - GRASP, 2018.

Other Social &

Economic Factors

Debt in America, The Urban Institute, 2021.

PCR - FY22 CHNA - 48

Appendix two: Sources for data, cont'd

Category

Data Source

Other Social &

Economic Factors

Centers for Disease Control and Prevention, National Vital

Statistics System, 2013-19.

Other Social &

Economic Factors

Federal Bureau of Investigation, FBI Uniform Crime Reports,

2014; 2016.

Other Social &

Economic Factors

Federal Bureau of Investigation, FBI Uniform Crime Reports,

2014; 2016.

Other Social &

Economic Factors

Townhall.com Election Results, 2016.

Physical Environment

US Environmental Protection Agency, 2018-19.

Physical Environment

Centers for Disease Control and Prevention, CDC - National

Environmental Public Health Tracking Network, 2015.

Physical Environment

Centers for Disease Control and Prevention, CDC - National

Environmental Public Health Tracking Network, 2016.

Physical Environment

EPA - National Air Toxics Assessment, 2014.

Physical Environment

US Environmental Protection Agency, 2019.

Physical Environment

US Census Bureau, County Business Patterns, 2019.

Physical Environment

National Broadband Map, Dec. 2020.

Physical Environment

US Census Bureau, American Community Survey, 2015-19.

PCR - FY22 CHNA - 49

Appendix two: Sources for data, cont'd

Category

Data Source

Physical

Environment

US Department of Health & Human Services, US Food and Drug

Administration Compliance Check Inspections of Tobacco Product

Retailers, 2018-20.

Physical

Environment

Climate Impact Lab, 2018.

Physical

Environment

Multi-Resolution Land Characteristics Consortium, National Land

Cover Database, 2016.

Physical

Environment

Federal Emergency Management Agency, National Flood Hazard

Layer, 2019.

Physical

Environment

Center for Disease Control and Prevention, CDC National

Environmental Public Health Tracking, 2017-19.

Physical

Environment

Federal Emergency Management Agency, National Risk Index,

2020.

Physical

Environment

US Census Bureau, Decennial Census, ESRI Map Gallery, 2013.

Physical

Environment

US Department of Agriculture, Economic Research Service,

USDA - Food Access Research Atlas, 2019.

Physical

Environment

US Department of Agriculture, National Agricultural Statistics

Service, Census of Agriculture, 2017.

Physical

Environment

Centers for Disease Control and Prevention, CDC - Division of

Nutrition, Physical Activity, and Obesity, 2011.

Physical

Environment

US Department of Agriculture, Food and Nutrition Service, USDA -

SNAP Retailer Locator, 2021.

PCR - FY22 CHNA - 50

Appendix two: Sources for data, cont'd

Category

Data Source

Physical Environment

US Department of Agriculture, National Agricultural Statistics

Service, Census of Agriculture, 2012.

Physical Environment

US Fish and Wildlife Service, Environmental Conservation

Online System, 2019.

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, Mapping Medicare

Disparities Tool, 2019.

Clinical Care and

Prevention

Centers for Disease Control and Prevention, Behavioral Risk

Factor Surveillance System, 2018.

Clinical Care and

Prevention

Dartmouth College Institute for Health Policy & Clinical Practice,

Dartmouth Atlas of Health Care, 2019.

Clinical Care and

Prevention

Centers for Disease Control and Prevention, CDC - Atlas of

Heart Disease and Stroke, 2016-18.

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, Mapping Medicare

Disparities Tool, 2020.

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2020.

Clinical Care and

Prevention

Centers for Disease Control and Prevention, National Vital

Statistics System, Centers for Disease Control and Prevention,

Wide-Ranging Online Data for Epidemiologic Research, 2019.

Clinical Care and

Prevention

Centers for Disease Control and Prevention, CDC - FluVaxView,

2019-20.

Clinical Care and

Prevention

Centers for Disease Control and Prevention, Behavioral Risk

Factor Surveillance System, 2019.

PCR - FY22 CHNA - 51

Appendix two: Sources for data, cont'd

Category

Data Source

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2015-18.

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2018-19.

Clinical Care and

Prevention

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2015-16.

Health Behaviors

University of Wisconsin Population Health Institute, County Health

Rankings, 2018.

Health Behaviors

Child and Adolescent Health Measurement Initiative, National

Survey of Children's Health, 2018.

Health Behaviors

Centers for Disease Control and Prevention, National Center for

Chronic Disease Prevention and Health Promotion, 2019.

Health Behaviors

Centers for Disease Control and Prevention, National Center for

HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2018.

Health Behaviors

Centers for Disease Control and Prevention, Behavioral Risk

Factor Surveillance System, 2018.

Health Behaviors

US Census Bureau, American Community Survey, 2015-19.

Health Outcomes

Centers for Medicare and Medicaid Services, CMS - Geographic

Variation Public Use File, 2018.

Health Outcomes

State Cancer Profiles, 2014-18.

PCR - FY22 CHNA - 51

Appendix two: Sources for data, cont'd

Category

Data Source

Health Outcomes

State Cancer Profiles, 2014-18.

Health Outcomes

Centers for Disease Control and Prevention, Behavioral Risk

Factor Surveillance System, 2019.

Health Outcomes

Centers for Disease Control and Prevention, National Center

for Chronic Disease Prevention and Health Promotion, 2019.

Health Outcomes

Centers for Disease Control and Prevention, National Center

for Chronic Disease Prevention and Health Promotion, 2018.

Health Outcomes

Centers for Medicare and Medicaid Services, 2018.

Health Outcomes

Centers for Disease Control and Prevention, National Vital

Statistics System, 2016-20.

Health Outcomes

University of Wisconsin Population Health Institute, County

Health Rankings, 2013-19.

Health Outcomes

Institute for Health Metrics and Evaluation, 2017.

Health Outcomes

Centers for Disease Control and Prevention and the National

Center for Health Statistics, U.S. Small-Area Life Expectancy

Estimates Project, 2010-15.

Health Outcomes

US Department of Transportation, National Highway Traffic

Safety Administration, Fatality Analysis Reporting System,

2015-19.

Health Outcomes

University of Wisconsin Population Health Institute, County

Health Rankings, 2017-19.

PCR - FY22 CHNA - 52

Appendix two: Sources for data, cont'd

Category

Data Source

Health Outcomes

Centers for Disease Control and Prevention, Behavioral Risk

Factor Surveillance System, 2018.

Health Outcomes

Centers for Medicare and Medicaid Services, Mapping

Medicare Disparities Tool, 2019.

Healthcare Workforce

Centers for Medicare and Medicaid Services, CMS - National

Plan and Provider Enumeration System (NPPES), May 2021.

Healthcare Workforce

US Department of Health and Human Services, Substance

Abuse and Mental Health Services Administration, Feb. 2022.

Healthcare Workforce

US Department of Health & Human Services, Health

Resources and Services Administration, HRSA - Area Health

Resource File, 2015.

Healthcare Workforce

Centers for Medicare and Medicaid Services, CMS - National

Plan and Provider Enumeration System (NPPES), 2021.

Healthcare Workforce

Centers for Medicare and Medicaid Services, CMS - National

Plan and Provider Enumeration System (NPPES), 2020.

Healthcare Workforce

US Department of Health & Human Services, Health

Resources and Services Administration, HRSA - Area Health

Resource File, 2017.

Healthcare Workforce

US Department of Health & Human Services, Center for

Medicare & Medicaid Services, Provider of Services File, Sept.

2020.

Healthcare Workforce

US Department of Health & Human Services, Center for

Medicare & Medicaid Services, Provider of Services File,

2019.

PCR - FY22 CHNA - 53

Appendix two: Sources for data, cont'd

Category

Data Source

Healthcare Workforce

US Department of Health & Human Services, Health Resources

and Services Administration, HRSA - Health Professional

Shortage Areas Database, May 2021.

COVID-19

Johns Hopkins University, 2022.

COVID-19

Google Mobility Reports, Feb. 01, 2022.

COVID-19

Centers for Disease Control and Prevention and the National

Center for Health Statistics, CDC - GRASP, 2022.

PCR - FY22 CHNA - 54

Appendix two: Sources for data, cont'd

Appendix three: Employee survey

From March 01 to March 31, 2022, the hospital placed online an employee survey meant to

capture employees' thoughts on challenges within our communities and suggestions on how the

hospital can improve its community's health. Below is the survey these employees received.

Administrative

Clinical

Environmental Services

Food Services

Programmatic

Other: Please describe

In our commitment as a not-for-profit health system, Piedmont is currently studying the region’s

community health needs for its Community Health Needs Assessment. As a member of our

community, we invite you to take this 15-minute survey so that your feedback can be heard

and included in identifying health priorities which we’ll address over the next three years.

Thank you for your time and input.

1. What type of role do you have?

2. Are you an employee or are you a contract employee?

PCR - FY22 CHNA - 55

Appendix three: Employee survey, cont'd.

From wherever our patients come

All of Georgia

The hospital’s county

Other: Please describe

3. What is your home zip code?

4. How do you define the community you serve in your role?

Access to health care (e.g., family doctor)

Access to healthy food

Arts and cultural events

Civic participation

Clean environment

Ethnic and cultural diversity

Financial assistance for health care at the hospital

Healthy behaviors and lifestyles

High retirement rates

Emergency preparedness

Good place to raise children

Low adult death and disease rate

Low crime/safe neighborhoods

Low infant deaths

Low level of child abuse

Parks and recreation

Low- and no-cost options for health care within the community

Quality of care

Quality of housing or housing availability

Religious or spiritual values

Social cohesion

Strong family life

Strong school district

Transportation and walkability

Other: Please describe

5. In the following list, what do you think are the five most important factors for a healthy

community? We consider this to be those factors which most improve the quality of life in a

community.

PCR - FY22 CHNA - 56

Appendix three: Employee survey, cont'd.

Aging problems (e.g., arthritis, hearing/vision loss, etc.)

Cancers

Child abuse / neglect

COVID-19

Dental problems

Diabetes

Domestic violence

Firearm-related injuries

Heart disease and stroke

High blood pressure

HIV/AIDS

Homicide

Infant death

Infectious diseases

Mental health problems

Motor vehicle crash injuries

Poverty

Rape/sexual assault

Respiratory/lung disease

Sexually transmitted diseases (STDs)

Social isolation

Suicide

Teenage pregnancy

Terrorist activities

Health illiteracy

Built environment

Housing insecurity

Neighborhood environmental risk (e.g., pollution, high lead exposure)

Other: Please describe

6. In the following list, what do you think are the five most important health problems in our

community? Please check five.

Very unhealthy (most have three or more chronic conditions such as heart disease or diabetes)

Unhealthy (most have one or two chronic conditions such as heart disease or diabetes)

Somewhat unhealthy

Somewhat healthy

Healthy

Very healthy (most have no chronic conditions such as heart disease or diabetes)

7. How would you rate the overall health of our community?

PCR - FY22 CHNA - 57

Appendix three: Employee survey, cont'd.

No insurance

Unable to pay co-pays and deductibles

Language barriers

Lack of access to transportation

Unable to use technology to find doctors, schedule appointments, manage online care

Fear (e.g., not ready to face or discuss health problem)

Don’t understand the need to see a doctor

Don’t know how to find doctors

Cultural/religious beliefs

Lack of availability of doctors

8. What issues do you think may prevent community members from accessing care?

Access to local inpatient mental health services

Access to local outpatient mental health services

Access to low-cost mental health services

Access to health care services

Access to dental care services

Additional access points to affordable care within the community

Cancer awareness and prevention

Community-based health education

Community-based programs for health

Curbing tobacco use, such as banning indoor smoking

Expanded access to specialty physicians

Financial assistance for those who qualify

Free or affordable health screenings

Increased social services

More options for paying for care

Opioid awareness and prevention campaigns

Partnerships with local charitable clinics

Programs that address issues of housing

Programs that address food insecurity

Safe places to walk and play

Substance abuse rehabilitation services

Other: Please describe

9. Of the following, what do you think are the top five things most important in improving the

health of community members living in our communities?

PCR - FY22 CHNA - 58

Appendix three: Employee survey, cont'd.

10. What is your vision for a healthy community?

11. What is the single most pressing issue you feel our patients face?

12. What are one or two things we can do better to serve our patients/our community?

13. Do you have questions about this survey or community health in general?

Family

size

100%

150%

200%

300%

400%

$13,590

$20,385

$27,180

$40,770

$54,360

$18,310

$27,465

$36,620

$54,930

$73,240

$23,030

$34,545

$46,060

$69,090

$92,120

$27,750

$41,625

$55,500

$83,250

$111,000

$32,470

$48,705

$64,940

$97,410

$129,880

$37,190

$55,785

$74,380

$111,570

$148,760

$41,910

$62,865

$83,820

$125,730

$167,640

$46,630

$69,945

$93,260

$139,890

$186,520

Data on the poverty threshold is created by the US Census Bureau, which uses pre-tax

income as a yardstick to measure poverty. The statistical report on the poverty threshold is

then used by the HHS to determine the federal poverty level (FPL). Below are the rates for

2022.

Appendix four: Employee survey, cont'd.