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2015 Community Health Needs Assessment Report 2016-2018 Implementation Strategy Table of Contents Introduction | Aurora Health Care ………………………………………………………………………..

3

Part I | Aurora BayCare Medical Center ………………………………………………………………..

3 – 4

Part II | 2015 Aurora BayCare Medical Center Community Health Needs Assessment (CHNA) Report ………………………………………………………………………………………………..

5 – 21

Section 1| Community Served: Brown County ……………………………………………………

5 – 6

Section 2| How the Community Health Needs Assessment (CHNA) was conducted ……

7 – 9

Section 3| Significant health needs of the community identified through the CHNA ……

10 – 19

Section 4| Prioritized significant health needs (and reasons for not addressing significant health needs) ……………………………………………………………..……………………………

20

Section 5| Community resources and assets ……………………………….…….……………….. 21

Part III | 2016-2018 Aurora BayCare Medical Center Implementation Strategy ……………….

22 – 36

Introduction ……………………………………………………………………………………………....

22 – 23

Priority 1 | Access ……………………………………………………………………………………….

24 – 26

Priority 2 | Community Health Improvement ………………………………………………………

27 – 30

Priority 3 | Community Benefit Hospital Focus …………………………………………………….

31 – 36

Appendix A | Brown County and City of De Pere Health Departments Community Health Assessment Report (Source #1 description) …………………………………………………………….

37 – 38

Appendix B | County Health Rankings: Brown County 2015 (Source #2 description) ………… Appendix C | Brown County Health Data Report: A summary of secondary data sources (2015) (Source #3 description)……………………………………………………………………………..

39 – 40 41

Appendix D| Brown County Health Needs Assessment: A summary of key informant interviews (2015) (Source #4 description) ……………………………………………….……………...

42 – 43

Appendix E | 2014 Brown County Behavior Risk Factor Surveillance System: Local, State, and National Data Comparison (Source #5 description) …………………..…………………….…

44


2015 Community Health Needs Assessment Report 2016-2018 Implementation Strategy Introduction | Aurora Health Care Aurora Health Care, a not-for-profit, integrated health system, is Wisconsin's most comprehensive health care provider and the state's largest private employer. As caregivers, we serve more than 1.2 million patients every year. Our patients enjoy care that is coordinated across an integrated network of facilities, services and providers. Aurora’s 15 hospitals are bringing the latest technologies to communities across eastern Wisconsin and northern Illinois. Primary care clinics offer a wide array of primary and specialty physicians, diagnostic services and wellness programs. Home care, which includes nursing, durable medical equipment, hospice and therapy services, is coordinated through the Aurora at Home, a comprehensive home care service. Our pharmacies, behavioral health services and labs all work together to provide a vital link in the continuum of care. Part I | Aurora BayCare Medical Center (ABMC) Who we are. What we do Aurora BayCare Medical Center is a joint venture of Aurora Health Care and BayCare Clinic. BayCare Clinic is the largest physician-owned specialty-care clinic in Northeast Wisconsin and the Upper Peninsula of Michigan. It is comprised of over 100 specialty physicians with expertise in more than 20 specialties. BayCare Clinic physicians have served patients in Green Bay and the surrounding region for over 25 years. To learn more about BayCare Clinic, visit the BayCare web site at http://www.BayCare.net. Aurora BayCare Medical Center is committed to providing the highest quality comprehensive healthcare through superior personalized service, the advancement of medical education and research, and the most efficient use of resources. Who we serve Aurora BayCare Medical Center is a 167-bed, full-service hospital serving the Green Bay area and communities throughout northeastern Wisconsin and Michigan's Upper Peninsula. At Aurora BayCare Medical Center, patients will get the highest quality care in a healing environment that emphasizes their comfort and convenience.

Aurora BayCare Medical Center by the Numbers (2015 annualized)

• 167 licensed hospital beds More than:

• 220,573 outpatient visits • 1,681 newborn deliveries • 31,404 Emergency Department visits (includes

urgent care visits) • 15,269 surgical cases (inpatient & outpatient)

Service Excellence in: • Bariatrics Services • Cancer Care Services • Neonatal Intensive Care • Emergency Medicine and Level 2 Trauma • Heart, Lung and Vascular Center • Stroke and Neurovascular Care • Orthopedic Services • Sports Medicine & Athletic Performance • Labor and Delivery

http://www.baycare.net/


2015 Community Health Needs Assessment Report 2016-2018 Implementation Strategy

Distinctions • American Heart Association Mission Lifeline: Heart Attack Receiving Facility accreditation. This recognizes

outstanding heart care, especially in emergency situations including heart attacks.

• U.S. News & World Report named Aurora BayCare Medical Center among the Best Hospitals in Northeastern Wisconsin as part of its 2014-15 Best Hospitals rankings.

• U.S. News & World Report ranked Aurora BayCare as the eleventh-best hospital in Wisconsin.

• Truven Health AnalyticsTM named Aurora BayCare Medical Center among the nation’s 100 Top Hospitals® of 2015, a study that identifies hospitals that achieve lower mortality rates, fewer complications, shorter patient stays and reduced readmission rates.

• Truven Health Top 50 Cardiovascular Hospital 2015

• Get With the Guidelines Gold Plus Award and Target Stroke Honor Roll

• American College of Cardiology Foundations NCDR Action Registry – Get with the Guidelines – Platinum

Performance Achievement award.

To learn more about our hospital, please click here. Economic impact study – Brown County As an anchor institution, in 2014 Aurora BayCare Medical Center provided the following:

- Community Benefits: $1,912,705 - Uncompensated Care: $13,666,000

*Community Benefit Report 2014 Aurora BayCare Medical Center

Assessing community health status – an ongoing commitment Since 2003, Aurora Health Care has underwritten community health assessments and other reports of Brown County periodically, conducted in partnership with the municipal health departments. This helps the health departments focus their resources on population health issues and enables us to align our charitable resources and expertise to respond to identified community health priorities. To view community health surveys dating back to 2003, visit http://www.aurora.org/commbenefits.

https://my.aurorahealthcare.org/ahc/portal/find-a-location/locationDetail/hospital/aurora-baycare-medical-center

http://health.usnews.com/best-hospitals

http://www.aurorahealthcare.org/aboutus/community-benefits/hospitals/baycare.asp

http://www.aurora.org/commbenefits


2015 Community Health Needs Assessment Report Part II | Aurora BayCare Medical Center (ABMC) Section 1 | Community served: Brown County

Although Aurora BayCare Medical Center serves the county and beyond, for the purpose of the community health needs assessment the community served is defined as Brown County.

With over 245,000 residents, Brown County is the 4th largest County in Wisconsin. Agriculture production and agribusiness is of tremendous importance to the community. Dairying is the largest income generator, although canning, cash crops, and other livestock also contribute substantially to the income generated in this area. The largest employer in Brown County is the Oneida Tribe of Indians of Wisconsin: Business/Development Corp.1

Brown County offers higher education opportunities at three major institutions: The University of Wisconsin-Green Bay, St. Norbert College and Northeastern Wisconsin Technical College.

Green Bay is the largest city in Brown County and is home to the Green Bay Packers. The principal industry of Green Bay is that of paper-making.2 Green Bay is the home base for one of the nation's most recognized environmental quality paper converters and recycling companies. The recycling industry is fast becoming a sizable economic force in new jobs: paper, plastics, and wood products are all being recycled or processed locally. Additionally, Green Bay is the largest cheese processing, concentrating and shipping center in the U.S.3 Brown County is composed of 13 townships, nine villages and two cities, of which Green Bay is the largest.4

• Cities: De Pere and Green Bay • Villages: Allouez, Ashwaubenon, Bellevue, Denmark,

Hobart, Howard, Pulaski, Suamico, Wrightstown • Towns: Eaton, Glenmore, Green Bay, Holland,

Humboldt, Lawrence, Ledgeview, Morrison, New Denmark, Pittsfield, Rockland, Scott, Wrightstown

1 Brown County. Available at http://www.co.brown.wi.us/about_us/. Accessed July 2, 2015 2 Brown County. Available at http://www.co.brown.wi.us/about_us/. Accessed July 2, 2015 3 Brown County. Available at http://www.co.brown.wi.us/about_us/. Accessed July 2, 2015 4 Brown County. Available at http://www.co.brown.wi.us/municipalities/. Accessed July 2, 2015

http://www.uwgb.edu/

http://www.snc.edu/

http://www.snc.edu/

http://www.nwtc.edu/

http://www.co.brown.wi.us/about_us/



http://www.co.brown.wi.us/municipalities/


2015 Community Health Needs Assessment Report County health ranking According to the 2015 County Health Rankings released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, Brown County ranked number 39 out of 72 counties in health outcomes. The rankings help counties understand the many factors that influence health.5 Demographic Characteristics of Brown County and Wisconsin Characteristics Brown County Wisconsin

Total Population* 250,597 5,686,986 Median Age (years)* 36.2 38.5 Race* White (non-Hispanic) 88.4% 88.1% Black or African American (non-Hispanic) 2.3% 6.5% Asian 2.8% 2.5% American Indian and Alaska Native 2.3% 1.1% Native Hawaiian/Other Pacific Islander <0.1% --- Some other race alone 1.4% --- Two or more races 2.7% 1.7% Hispanic or Latino (of any race) 7.5% 6.3% Age* 0-14 years 20.7% 19.2% 15-44 years 40.6% 38.9% 45-64 years 26.8% 27.9% 65 years and older 11.9% 14.1% Education level of adults 25 years and older** Less than high school degree 9.6% 9.5% High school degree 32.3% 32.8% Some college/associates 31.3% 30.8% Bachelor degree or higher 26.8% 26.8% Unemployment rate (estimate)** 7.4% 5.3% Median household income (estimate)** (2013 inflation-adjusted dollars)

$27,105 $52,413

Percent below poverty in the last 12 months (estimate)** 7.2% 13.0% Note: Some totals may be more or less than 100% due to rounding or response category distribution *Data on Wisconsin from US Census (2013). Accessed at http://www.americanfactfinder.com on August 17, 2015; Data on Winnebago from the Center for Urban Population Health, Brown County Health Data Report: A summary of secondary data sources (2015). ** Data from the Center for Urban Population Health, Brown County Health Data Report: A summary of secondary data sources (2015).

5 University of Wisconsin Population Health Institute. County Health Rankings (2015). Available at http://www.countyhealthrankings.org/app/wisconsin/2015/rankings/outcomes/overall

http://www.americanfactfinder.com/


2015 Community Health Needs Assessment Report Section 2 | How the Community Health Needs Assessment (CHNA) was conducted Partnership Aurora BayCare Medical Center is an active member of the Beyond Health to Healthiest Brown County partnership to improve the health of the Brown County community. In addition to Aurora BayCare Medical Center, Beyond Health membership includes the Brown County Health Department, the City of De Pere Health Department, Bellin Health System, Hospital Sisters Health Systems’ St. Mary’s and St. Vincent’s Hospitals, the Wisconsin Division of Public Health Northeast Regional Office, and the Brown County United Way. Beyond Health seeks to improve the health of Brown County residents by conducting periodic community health needs assessments and leading community-wide action planning teams. In November 2014, the Beyond Health partnership convened to review Brown County community health assessment data with most of the data originating from the County Health Rankings. With funding from Aurora Health Care, the Center for Urban Population Health (www.cuph.org) prepared a secondary data report (2015) for Brown County. Purpose and process of the Community Health Needs Assessment In 2015, a community health needs assessment (CHNA) was conducted to 1) determine current community health needs in Brown County, 2) gather input from persons who represent the broad interests of the community and to identify community assets, 3) identify and prioritize significant health needs, and 4) develop implementation strategies to address the prioritized health needs within the context of the hospital’s existing programs, resources, strategic goals and partnerships. The process of conducting the CHNA is illustrated below and is described in this report.

http://www.cuph.org/


2015 Community Health Needs Assessment Report Data collection and analysis Quantitative data was collected through a primary source and secondary sources, and was supplemented with qualitative data gathered through key informant interviews. This community health needs assessment includes data for Brown County, since it provides some pertinent information for assessing the community health needs for Brown County. Different data sources were collected, analyzed and published at different intervals and therefore the data years (e.g., 2010, 2012, 2014, 2015) will vary in this report. The most current data available was used for the CHNA. The core data sources for the CHNA include: Source #1 | Brown County and City of De Pere Health Department Community Health Assessment Report As a state statute, health departments in Wisconsin must complete a community health assessment every five years and develop a community health improvement plan. In November 2014, the Beyond Health Community Health Improvement Plan (CHIP) Steering Committee brought together an array of community stakeholders to review community health data and provide their community knowledge and expertise in relationship to the Healthiest Wisconsin 2020 health focus areas. For further details, see Appendix A. Source #2 | County Health Rankings: Brown County 2015 The County Health Rankings measure the health of nearly all counties in the nation and rank them within states. The Rankings are compiled using county-level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically-informed weights. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Building on the work of America's Health Rankings, the University of Wisconsin Population Health Institute has used this model to rank the health of Wisconsin’s counties every year since 2003. For further description see Appendix B. Source #3 | Brown County Health Data Report: A summary of secondary data sources (2015) This report summarizes the demographic and health-related information for Brown County, including the 2015 County Health Rankings (Appendix B). Data used in the report came from publicly available data sources. Data for each indicator is presented by race, ethnicity and gender when the data is available. When applicable, Healthy People 2020 objectives are presented for each indicator. The report was prepared by the Center for Urban Population Health. For further description, see Appendix C. Source #4 | Brown County Health Needs Assessment: A summary of key informant interviews (2015) Six individual key informant interviews were conducted between August and September 2015. Each key informant was asked about gaps and unmet needs in their community, barriers and challenges to addressing these needs and priorities in high demand. Key informants included leaders and local experts representing health services, public health, support organizations, businesses, government and non-profit organizations. These key informants focus on a range of public health issues and represent the broad interest of the community served, including medically underserved, low income and minority populations. For further description see Appendix D.

http://www.americashealthrankings.org/

http://uwphi.pophealth.wisc.edu/

http://uwphi.pophealth.wisc.edu/

http://uwphi.pophealth.wisc.edu/programs/match/wchr/index.htm


2015 Community Health Needs Assessment Report Source #5 | 2014 Brown County Behavior Risk Factor Surveillance System (BRFSS): Local, State, and National Data Comparison The community health survey is a source of primary community health data. The telephone survey was completed and analyzed between March 10 and April 7, 2014. This comprehensive phone-based survey gathers specific data on behavioral and lifestyle habits of the adult. The study can be used to identify community health trends and changes over time. The report was a collaborative effort paid for by Aurora BayCare Health Care, Bellin Health System, the Brown County Health Department, Hospital Sisters Health System, Live54318 and Prevea Health. The survey was conducted by the St. Norbert College Strategic Research Institute. See Appendix E for a further description. Source #6 | Written Comments on the Current CHNA Report and Implementation Strategy Aurora Health Care invites the community to provide written comments on its current CHNA Reports and Implementation Strategies via a one-click portal on its website at http://www.aurora.org/commbenefits. Through October 2015, ABMC did not receive any comments on the current CHNA Report or Implementation Strategy. Additional sources of data and information used to prepare the Aurora BayCare Medical Center CHNA Report were considered when identifying significant community health needs and are cited within the report.



2015 Community Health Needs Assessment Report Section 3 | Significant health needs identified through the Community Health Needs Assessment (CHNA) for Brown County The significant health needs identified through the CHNA are also identified as key health issues for the state as outlined in the state health plan, Healthiest Wisconsin 2020, as well as the nation, as outlined in the Healthy People 2020, and are among major focus areas of the Centers for Disease Control and Prevention (CDC). From a local perspective, the significant health needs identified through the CHNA have an impact on community health, both for the community at-large and in particular specific areas within the community (such as neighborhoods or populations experiencing health disparities). To determine the significant health needs identified through the CHNA, the following criteria were considered:

• Burden of the health issue on individuals, families, hospitals and/or health care systems (e.g., illness, complications, cost, death);

• Scope of the health issue within the community and the health implications; • Health disparities linked with the health issue; and/or • Health priorities identified in the municipal health department Community Health Improvement Plan

(CHIP) The Healthy People 2020 definition of a health disparity:

If a health outcome is seen in greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status and geographic location all contribute to an individual’s ability to achieve good health.

Summary of municipal health department Community Health Improvement Plan (CHIP), Healthiest Wisconsin 2020 (HW2020) and Healthy People 2020 (HP2020) Municipal Health Department Community Health Improvement Plan (CHIP)

“Since 1993, Wisconsin State Statutes have required communities throughout Wisconsin to develop and implement local health plans to address health conditions impacting their residents.” This process has been referred to as the Community Health Improvement Plan (CHIP). http://www.dhs.wisconsin.gov/chip/

Healthiest Wisconsin 2020 “Healthiest Wisconsin 2020 identifies priority objectives for improving health and quality of life in Wisconsin. These priorities were chosen based on which accomplishments would offer the greatest improvements in lifelong health, and to eliminate health disparities and achieve more equal access to conditions in which people can be healthy. Priorities were influenced by more than 1,500 planning participants statewide, and shaped by knowledgeable teams based on trends affecting health and information about effective policies and practices in each focus area.” The 23 focus area profiles of HW2020 can be grouped into three categories: crosscutting, health and infrastructure. http://www.dhs.wisconsin.gov/hw2020/pdf/exesummary.pdf

Healthy People 2020 “Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People 2020 has established benchmarks and monitored progress over time in order to: • Encourage collaborations across communities and sectors • Empower individuals toward making informed health decisions • Measure the impact of prevention activities” http://www.healthypeople.gov/2020/about/default.aspx

http://www.dhs.wisconsin.gov/chip/

http://www.dhs.wisconsin.gov/hw2020/pdf/exesummary.pdf

http://www.healthypeople.gov/2020/about/default.aspx


2015 Community Health Needs Assessment Report Summary of the significant health needs identified through the CHNA for Brown County Access Unmet medical care | According to the 2015 County Health Rankings, 3% of Brown County residents reported an unmet medical care need in the past 12 months (Source #2). Contradictorily, 8% reported not seeing a doctor due to cost (Source #5). In addition, the ratio of population to primary care physicians in Brown County was 1,375:1. The population per physician ratio was greater for Brown County as compared to the state (1,215:1) and the national benchmark (945:1) (Source #2). According to the Brown County United Way’s 2014 Annual Report, health care needs was the third most requested need on the 2-1-1 information and referral service.6

- The Healthy People 2020 target is to reduce the proportion of persons who are unable to obtain or experience delay in receiving necessary medical care to 4.2%

Why is this significant? Unmet medical care can lead to further health complications and increase future costs. Access to medical care can detect and treat disease at an earlier stage, improve overall health, prevent disease and disability, and reduce preventable deaths.7

Dental services and unmet dental care | In 2014, 24% percent of respondents reported that they did not receive dental care in the last 12 months (Source #1). In Wisconsin, the ratio of the population to dentist is 1,631 people for every dentist; in Brown County, there are 1,543 people for every dentist (Source #2). The City of Green Bay was a federally designated dental health professional shortage area (Source #1).

Why is this significant? Unmet dental care can increase the likelihood for oral disease, ranging from cavities to oral cancer, which can lead to pain and disability. Access to oral health services can prevent cavities, gum disease and tooth loss, improve the detection of oral cancer and reduce future dental care costs.8

Coverage Health care coverage | In 2014, 8% of all adults reported they personally were not currently covered, comparable to the 2003 rate of 9% (Source #5). However, 13% of adults under age 65 are uninsured, the same as for Wisconsin (Source #2). In addition, 5% of all children in Brown County were without health insurance (Source #2).

- The Healthy People 2020 target for health care coverage is 100%.

Why is this significant? Adults without consistent health care coverage are more likely to skip medical care because of cost concerns, which can lead to poorer health, higher long-term health care costs and early death.9

6 Brown County United Way – 2014 Annual Report: 2-1-1 Services. Available at http://www.browncountyunitedway.org/wp-content/uploads/2014-Annual-Snapshot.pdf, accessed September 4, 2015. 7 Healthy People 2020 – Access to Health Services. U.S. Department of Health and Human Service. Available at http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services Accessed September 1, 2015. 8 Healthy People 2020 – Oral Health. U.S. Department of Health and Human Service. Available at http://www.healthypeople.gov/2020/topics-objectives/topic/oral-health. Accessed September 1, 2015. 9 Healthy People 2020 – Access to Health Services. U.S. Department of Health and Human Service. Available at http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services Accessed September 1, 2015.

http://www.browncountyunitedway.org/wp-content/uploads/2014-Annual-Snapshot.pdf

http://www.browncountyunitedway.org/wp-content/uploads/2014-Annual-Snapshot.pdf

http://www.healthypeople.gov/2020/topics-objectives/topic/oral-health

http://www.healthypeople.gov/2020/topics-objectives/topic/oral-health


2015 Community Health Needs Assessment Report Chronic disease: asthma, diabetes, heart diseases and cancer Chronic conditions such as asthma, diabetes, heart disease and cancer can result in health complications, compromised quality of life and burgeoning health care costs.10 Key informants identified chronic disease as a top five health issue in Brown County (Source #4). Asthma | In 2014, 8% of adults reported asthma (current), up slightly from 7% in 2003. This is lower compared to the 10.6% for the state and 9% for the United States (Source #5).

Why is this significant? Without proper management, asthma can lead to high health care costs.11 Management of the disease with medical care and prevention of attacks by avoiding triggers is essential.

Diabetes | In 2015, 10% of adults were being monitored for diabetes, up significantly from 4% in 2003 (Source #2). This is higher than the state and national rate of 7.4% and 8.9%, respectively.

Why is this significant? Diabetes can cause serious health complications including heart disease, blindness, kidney failure and lower-extremity amputations.12

Heart diseases| The term “heart disease” refers to several types of heart conditions, such as coronary artery disease, angina, heart failure and arrhythmias. High blood pressure, high cholesterol and smoking are key risks for heart disease.13 In 2015, the rate of adults who were hospitalized for coronary heart disease was 3.7 per 1,000 people, higher than the state rate of 3.0 per 1,000 (Source #2). In 2014, 7% of adults reported heart disease or a heart condition (Source #5).

Why is this significant? Chronic conditions such as heart disease can result in health complications, compromised quality of life and burgeoning health care costs. 14

Cancer | The burden of cancer can be described in incidence rates and mortality rates. An incidence rate is the number of newly diagnosed cancers within a population in a specific time period while the mortality rate is the number of deaths within a population in a specific time period. Preventable risk factors, such as diet and smoking, contribute to increased cases of certain types of cancer (incidence). Early identification (incidence) and treatment of cancer or pre-cancerous cells may reduce cancer as the cause of death (mortality).15 The 2008-2012 cancer age-adjusted incidence rate in Brown County was 489.6 per 100,000 population, higher compared to the state at 447.7 per 100,000. The table below compares Brown County’s age-adjusted cancer incidence and mortality rates per 100,000 population with the rates for Wisconsin (WI), national (US), and Healthy People 2020 objectives (HP2020). (Source #3).

10 Centers for Disease Control and Prevention - Chronic Disease Prevention and Health Promotion. Available at http://www.cdc.gov/chronicdisease/index.htm. Accessed September 1, 2015 11 Centers for Disease Control and Prevention - Asthma. Available at http://www.cdc.gov/asthma/default.htm. Accessed September 1, 2015 12 Centers for Disease Control and Prevention. - Diabetes Public Health Resources. Available at http://www.cdc.gov/basics/diabetes.html. Accessed September 1, 2015 13 Centers for Disease Control and Prevention - Heart Disease. Available at http://www.cdc.gov/heartdisease/index.htm. Accessed September 2, 2015 14 Centers for Disease Control and Prevention - Heart Disease. Available at http://www.cdc.gov/heartdisease/index.htm. Accessed September 2, 2015 15 CDC – Cancer Prevention and Control. Available at http://www.cdc.gov/cancer/dcpc/prevention/index.htm. Accessed September 8, 2015.

http://www.cdc.gov/chronicdisease/index.htm

http://www.cdc.gov/basics/diabetes

http://www.cdc.gov/heartdisease/

http://www.cdc.gov/heartdisease/


2015 Community Health Needs Assessment Report

Cancer Brown WI US HP2020 Status Cancer Incidence Rate 489.6 447.7 na na Female Breast Cancer Incidence Rate 128.6 125.4 122.0 na Cervical Cancer Incidence Rate 6.7 6.3 na na Male Colorectal Cancer Incidence Rate 41.2 42.4 46.1 na Female Colorectal Cancer Incidence Rate 36.6 31.6 34.9 na Male Lung/Bronchus Cancer Incidence Rate 74.4 66.7 73.0 na Female Lung/Bronchus Cancer Incidence Rate 51.2 53.4 52.0 na Prostate Cancer Incidence Rate 139.6 103.2 128.3 na Female Breast Cancer Mortality Rate 22.1 21.4 21.5 20.7 Cervical Cancer Mortality Rate 1.6 1.7 na 2.2 Male Colorectal Cancer Mortality Rate 13.8 18.6 18.1 14.5 Female Colorectal Cancer Mortality Rate 12.3 11.9 12.8 14.5 Male Lung/Bronchus Cancer Mortality Rate 58.1 56.1 57.9 45.5 Female Lung/Bronchus Cancer Mortality Rate 34.2 40.8 37.0 45.5 Prostate Cancer Mortality Rate 21.7 23.5 20.8 21.8

*If Brown County’s rate meets or exceeds the HP2020 benchmark, then a green circle () is shown under “Status”. Conversely, if the community falls below the 2020 goal, then a red triangle () is shown. If the CDC did not set a HP2020 goal in a specific health indicator, then the community’s health information is compared with the U.S. goal. If no information is available under HP2020 or national data, or community data, then “na” is displayed for “not available”.

Why is this significant? A person's cancer risk can be reduced in a number of ways including, but not limited to, receiving regular medical care and screenings, avoiding tobacco, limiting alcohol use, avoiding excessive exposure to ultraviolet rays from the sun and tanning beds, eating a diet rich in fruits and vegetables, maintaining a healthy weight and being physically active.16

Health risk behaviors: alcohol use, substance use, tobacco use, nutrition and physical activity Five modifiable health risk behaviors are responsible for the main share of premature death and illness related to chronic diseases: excessive alcohol use, substance use, tobacco use, poor nutrition and lack of physical activity.17 Alcohol use | Excessive drinking reflects the percent of adults who report either binge drinking or heavy drinking. Based on the 2014 Brown County and City of De Pere Health Department Community Health Assessment Report, 25% of Brown County adults engaged in binge drinking or heavy drinking in the past 30 days (Source #1). However, according to the 2014 Brown County BRFSS, 38% of adults reported binge drinking in the past month (Source #5). In 2015, the rate of adults who were admitted for alcohol-related hospitalizations was 2.6 per 1,000 people, higher than the state rate of 2.0 per 1,000 (Source #1). In Brown County, 53% of all driving deaths involved alcohol, compared to 39% statewide (Source #2). Beyond Health and key informants identified alcohol and drugs as a top four health issue in Brown County (Source #1, #4).

16 Centers for Disease Control and Prevention – Cancer. Available at http://www.cdc.gov/cancer/dcpc/prevention/. Accessed September 1, 2015. 17 Centers for Disease Control and Prevention-Chronic Disease Overview. Available at http://www.cdc.gov/chronicdisease/overview/index.htm. Accessed September 1, 2015

http://www.cdc.gov/cancer/dcpc/prevention/

http://www.cdc.gov/chronicdisease/overview/index.htm


2015 Community Health Needs Assessment Report According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), binge drinking is defined as alcohol consumption that brings the blood alcohol concentration to 0.08% or more; this is generally achieved through consuming 4 or more alcoholic beverages for women or 5 or more for men within approximately 2 hours. In addition, the NIAAA defines heavy drinking as drinking more than one drink for women or 2 drinks for men per day on average.18

- The Healthy People 2020 target to reduce binge drinking in the past month to 24.4% for adults and

8.6% for adolescents.

Why is this significant? Binge drinking is associated with an array of health problems including, but not limited to, unintentional injuries (e.g. car crashes, falls, burns, drowning), intentional injuries (e.g., firearm injuries, sexual assault, domestic violence), alcohol poisoning, sexually transmitted infections, unintended pregnancy, high blood pressure, stroke and other cardiovascular diseases, and poor control of diabetes. Binge drinking is extremely costly to society from losses in productivity, health care, crime and other expenses.19

Substance use | In Brown County, the rate of opiate-related deaths was 2.0 per 100,000 in 2013, lower than the state average of 5.3 deaths per 100,000 population. When combined with all other sedative-related deaths, Brown County was far below the Wisconsin rate (4.0 deaths per 100,000 population and 13.6 deaths per 100,000, respectively).20 However, in 2015, heroin deaths in Brown County was on pace to match or exceed the highest total in a decade, despite the increased use of the antidote naloxone.21 Beyond Health and key informants identified alcohol and drug use as one of the top four health issues challenging the community (Sources #1, #4).

– The Healthy People 2020 goal for drug-induced deaths is 12.6 deaths per 100,000 population.

Why is this significant? Nationally, the amount of pain medicines prescribed and sold has almost quadrupled since 1999. Every day in the U.S., 44 people die due to an overdose of prescription opioids. The overprescribing of opiates and other pain medicines leads to medicinal abuse and overdose deaths. 22

Tobacco use | In 2014, 12% of adults reported cigarette smoking in the past 30 days (current smoker), down significantly from 24% in 2003 (Source #5). In addition, 58% of current smokers tried to quit smoking in the past year, a significant increase from 41% in 2003 (Source #5).

- The Healthy People 2020 targets are to reduce cigarette smoking by adults to 12.0%. However, in 2013, 13.4% of Brown County mothers indicated smoking during pregnancy (Source #3).

- The Healthy People 2020 target is no greater than 1.4%

18 National Institute on Alcohol Abuse and Alcoholism – Alcohol & Your Health. Available at http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed August 17, 2015. 19 Centers for Disease Control and Prevention – Alcohol & Public Health. Available at http://www.cdc.gov/alcohol/index.htm. Accessed September 1, 2015 20 County Health Rankings & Roadmap – Racine County 2013. Available at http://www.countyhealthrankings.org/app/wisconsin/2015/overview. Accessed September 21, 2015 21 Green Bay Press Gazette. “Brown County heroin deaths near record pace (October 22, 2015).” Available at http://www.greenbaypressgazette.com/story/news/2015/10/21/brown-county-heroin-deaths-near-record-pace/74348062/. Accessed October 23, 2015. 22 Centers for Disease Control and Prevention – Injury Prevention & Control: Prescription Drug Overdose. Available at http://www.cdc.gov/drugoverdose/data/overdose.html. Accessed September 22, 2015

http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

http://www.cdc.gov/alcohol/

http://www.countyhealthrankings.org/app/wisconsin/2015/overview

http://www.greenbaypressgazette.com/story/news/2015/10/21/brown-county-heroin-deaths-near-record-pace/74348062/



Why is this significant? Smoking increases the risk of coronary heart disease, stroke and several types of cancer (acute myeloid leukemia, bladder, cervix, esophagus, kidney, larynx, lung, mouth, pancreatic, throat and stomach). 90% of all deaths from chronic obstructive lung disease are caused by smoking.23 In addition, research has shown that smoking during pregnancy can cause health problems for both mother and baby, such as pregnancy complications, premature birth, low birth weight infants and stillbirth.24

Nutrition | In 2014, 53% of adults reported eating the recommended fruit servings while 32% of adults reported eating the recommended vegetable servings (Source #5). Based on the 2014 Brown County and City of De Pere Health Department Brown County and City of De Pere Health Department Community Health Assessment Report, 6% of the population had limited access to healthy foods. This was higher compared to the state (5%), and higher than the national benchmark (0% of the population had limited access to healthy foods) (Source #1). In addition, 11% of the Brown County residents reported low levels of food security (Source #1). Beyond Health and key informants identified nutrition as one of the top four health issues challenging the community (Sources #1, #4).

Note: Limited access to healthy foods captures the percentage of the population who are low income and do not live close to a grocery store. Living close to a grocery store is defined differently in rural and non-rural areas; in rural areas, it means living less than 10 miles from a grocery store whereas in non-rural areas, it means less than 1 mile. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size.

Physical activity | Based on the 2015 County Health Rankings for Brown County, 20% of adults were physically inactive. This was slightly lower compared to the state and the national benchmark of 21% (Source #2). In addition, key informants identified physical activity as one of the top five health issues challenging the community (Source #4).

Note: Physical inactivity is the estimated percent of adults aged 20 and over reporting no leisure time physical activity.

Why is this significant? Inactive adults have a higher risk for obesity, coronary heart disease, type 2 diabetes, stroke, some cancers, depression and other health conditions. A healthy and balanced diet, including eating fruits and vegetables, is associated with reduced risk for many diseases, including several of the leading causes of death: heart disease, cancer, stroke and diabetes. A poor diet can lead to energy imbalance (e.g., eating more calories than one expends through physical activity) and can increase one’s risk for overweight and obesity. Healthy eating helps reduce one’s risk for developing osteoporosis, some cancers, anxiety and depression.25

23 Centers for Disease Control and Prevention – Smoking & Tobacco Use. Available at http://www.cdc.gov/tobacco/index.htm. Accessed September 1, 2015 24 Centers for Disease Control and Prevention – Smoking & Tobacco Use. Available at http://www.cdc.gov/tobacco/index.htm. Accessed September 1, 2015 25 Centers for Disease Control and Prevention – Physical Activity for a Healthy Weight. Available at http://www.cdc.gov/healthyweight/physical_activity/index.html Accessed September 1, 2015

http://www.cdc.gov/tobacco/

http://www.cdc.gov/tobacco/


2015 Community Health Needs Assessment Report Health risk factor: overweight/obesity Overweight/obesity – adults | Based on the 2014 Brown County and City of De Pere Health Department Community Health Assessment Report, 29% of adults were obese, the same level as the state (29%), and higher compared to the national benchmark (25%) (Source #1). In 2014, 64% of adults were classified as being overweight, an increase from 57% in 2003 (Source #5). Since 64% of adults in 2014 were classified as overweight, this means 36% of adults were classified as a healthy weight.

Note: The obesity measure represents the percent of the adult population (age 20 and older) that has a body mass index (BMI) greater than or equal to 30 kg/m. “Overweight” includes overweight and obese respondents who have a BMI greater than or equal to 25 kg/m.

Why is this significant? Overweight and obesity can increase the risk for high blood pressure, high cholesterol levels, coronary heart disease, type 2 diabetes, stroke, some cancers and other health conditions.26

- The Healthy People 2020 target is to reduce the percentage of adults who are obese to 30.5%.

- The Healthy People 2020 goal for healthy weight is 33.9%.

Injury Injury hospitalizations and emergency department visits | The 2013 Brown County injury hospitalizations rate was 745.6 per 100,000, which is lower compared to the state (912.4 per 100,000) but exceeds the Healthy People 2020 target. The injury emergency room visit rate for Brown County was 8,934.4 per 100,000, which is higher than the Wisconsin rate (6,864.8 per 100,000) but lower than the U.S. (9,972.0 per 100,000) (Source #3).

- The Healthy People 2020 target for injury hospitalization rate is 555.8 per 100,000; the target for injury emergency department visit is 7,533.4 per 100,000.

Why is this significant? Injuries are a leading cause of death for people ages 1 – 44 in the United States. Each year, injuries cost more than 406 billion dollars in lost productivity and medical care. They are faced with life-long mental, physical, and financial problems. Injuries can be prevented and their consequences reduced for infants, children and adults.27

Youth injury | In 2013, the total number of injury hospitalizations among Brown County youth aged 0-17 years was 133 which is a rate of 216.8 per 100,000.28 Also in 2013, the total number of injury emergency room visits among Brown County youth was 5,555 – a rate of 9,055.0 per 100,000, higher than the state rate of 7,695.5 per 100,000.29 Of the youth emergency room visits, 1,120 resulted from being struck by or striking against an object or another person.

26 Centers for Disease Control and Prevention – Physical Activity for a Healthy Weight. Available at http://www.cdc.gov/healthyweight/physical_activity/index.html Accessed September 1, 2015 27 Centers for Disease Control and Prevention – Injury Prevention and Control. Available at http://www.cdc.gov/injury/. Accessed September 1, 2015 28 Wisconsin Interactive Statistics on Health (WISH), Available at https://www.dhs.wisconsin.gov/wish/index.htm. Accessed September 8, 2015. 29 Wisconsin Interactive Statistics on Health (WISH), Available at https://www.dhs.wisconsin.gov/wish/index.htm. Accessed September 8, 2015.

http://www.cdc.gov/injury/

https://www.dhs.wisconsin.gov/wish/index.htm

https://www.dhs.wisconsin.gov/wish/index.htm



Why is this significant? The leading cause of medical spending for children is injury treatment at nearly $11.5 billion annually in the United States. Almost nine million children aged 0 to 19 years are seen in emergency departments for injuries every year.30

Reproductive health Pap test screening | In 2014, 83% of women reported having a pap smear test within three years, up significantly from 63% in 2003. (Source #5).

– The Healthy People 2020 target for women having a pap smear test within three years is 93.0%. Births receiving first trimester care | From 2011 to 2013, the percent of births receiving first trimester care in Brown County marginally decreased from 80.0% to 78.6%, but was higher compared to the state (75.6%) (Source #3).

– The Healthy People 2020 target for births receiving first trimester care is 77.9% Premature births | From 2011 to 2013, the percent of premature births (before 37 weeks) in Brown County decreased from 11.0% to 9.3%, and was lower compared to the state (10.0%) (Source #3).

- The Healthy People 2020 target for premature births is 11.4% Low birth weight | From 2011 to 2013, the percent of low birth weight births (less than 2,500 grams or approximately 5.5 pounds) in Brown County decreased significantly from 7.2% to 6.1%, and was lower compared to the state (7.0%) (Source #3).

- The Healthy People 2020 target for low birth-weight births is 7.8%

Why is this significant? Preconception and early prenatal care improves mother and infant outcomes. Babies born prematurely (three weeks or earlier than their due date) or with a low birth weight (less than 2,500 grams or about 5.5 pounds) experience a greater risk for an adverse outcome including a serious disability or death. 31

30 Centers for Disease Control and Prevention – Protect the Ones You Love: Child Injuries are Preventable. Available at http://www.cdc.gov/safechild/. Accessed September 8, 2015. 31 Centers for Disease Control and Prevention – Infant Mortality: What is the CDC doing? Available at http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality-CDCDoing.htm. Accessed September 3, 2015.

http://www.cdc.gov/safechild/

http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality-CDCDoing.htm


2015 Community Health Needs Assessment Report Mental health Mental health conditions | According to the County Health Rankings, Brown County adults reported an average of 3.2 mentally unhealthy days in the past 30 days, more than the state average of 3.0 days (Source #2). In addition, the rate of self-inflicted hospitalizations in Brown County was 80 per 100,000 people, which is lower than the state rate of 95 per 100,000 (Source #2). In 2014, 22% of adults reported that a health professional told them that they had a depressive disorder compared to 12% who were told they had a mental health condition in 2009 (Source #5). The Beyond Health and key informants all identified mental health as one of the top four health issues challenging the community (Sources #1, #4). The CDC categorizes mental health and mental illness separately. Mental health is defined as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”32 Indicators of mental health include emotional, social and psychological well-being. This definition differs from mental illness which is classified as diagnosable mental disorders or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”33 Anxiety, depression, and bipolar disorder are examples of mental illness.

Why is this significant? Mental health conditions are associated with chronic diseases such as cardiovascular disease, diabetes and obesity, and related to risk behaviors for chronic disease, such as physical inactivity, smoking, excessive drinking and insufficient sleep.34

Suicide | In 2013, there were 40 suicides in Brown County at a rate of 15.8 per 100,000, higher than the Wisconsin rate of 14.9 suicide deaths per 100,000 population (Source #3).

– The Healthy People 2020 target is 10.2 per 100,000.

Why is this significant? Suicide is a serious public health problem that can have lasting harmful effects on individuals, families and communities. While its causes are complex and determined by multiple factors, the goal of suicide prevention is to reduce factors that increase risk and increase factors that promote resilience.35

Sexual violence and other violence Sexual violence | The rate of rape for Brown County was 31.0 reports per 100,000 persons, significantly higher than Wisconsin‘s overall rate of 21.0 per 100,000 in 2012.36

32 Centers for Disease Control and Prevention – Mental Health Basics. Available at http://www.cdc.gov/mentalhealth/basics.html. Accessed September 1, 2015 33 Centers for Disease Control and Prevention – Mental Health Basics. Available at http://www.cdc.gov/mentalhealth/basics.html. Accessed September 1, 2015 34 Centers for Disease Control and Prevention – Mental Health Basics. Available at http://www.cdc.gov/mentalhealth/basics.html. Accessed September 1, 2015 35 Centers for Disease Control and Prevention – Suicide Prevention. Available at http://www.cdc.gov/ViolencePrevention/suicide/index.html. Accessed September 2, 2015 36 Wisconsin Department of Justice, Crime in Wisconsin 2012, September 2013. Available at https://wilenet.org/html/justice-programs/programs/justice-stats/library/crime-and-arrest/2012-crime-in-wi.pdf. Accessed August 11, 2015.

http://www.cdc.gov/mentalhealth/basics.html



http://www.cdc.gov/ViolencePrevention/suicide/

https://wilenet.org/html/justice-programs/programs/justice-stats/library/crime-and-arrest/2012-crime-in-wi.pdf




Note: Sexual assault and rape are underreported and the definition of sexual assault varies across different agencies; therefore, the number and rate may vary depending on the source.

Why is this significant? Sexual violence can have harmful and lasting consequences for victims, families, and communities including, but not limited to, unintended pregnancy, sexually transmitted infections, long term physical consequences, immediate and chronic psychological consequences, health behavior risks, and financial cost to victims, families and communities.37

Other violence | In addition, the rate of aggravated assault for Brown County in 2012 was 224.0 reports per 100,000 persons, higher than Wisconsin‘s overall rate of 175.0 per 100,000.38 In Wisconsin, the rate of Child Protective Services (CPS) reports was 30.7 per 1,000 children in 2013; Brown County’s rate was higher at 37.5 reports per 1,000 children.39

Why is this significant? Violence has a lasting effect throughout one’s life. Survivors of violence may suffer from physical, emotional, social and other health problems.40

37 Centers for Disease Control and Prevention – Sexual Violence: Consequences. Available at http://www.cdc.gov/violenceprevention/sexualviolence/consequences.html. Accessed July 22, 2015. 38 Wisconsin Department of Justice, Crime in Wisconsin 2012, September 2013. Available at https://wilenet.org/html/justice-programs/programs/justice-stats/library/crime-and-arrest/2012-crime-in-wi.pdf. Accessed August 11, 2015. 39 US DHHS, Child Maltreatment 2013. Available at http://www.acf.hhs.gov/sites/default/files/cb/cm2013.pdf#page=20. Accessed August 11, 2015. 40 Centers for Disease Control and Prevention – Violence Prevention. Available at http://www.cdc.gov/violenceprevention/index.html. Accessed September 1, 2015.




Section 4 | Prioritized significant health needs During 2012 an ad hoc committee of the Aurora Health Care Board of Directors’ Social Responsibility Committee undertook a five-month process to identify a common need in all Aurora Health Care service areas. The ad hoc committee presented its final recommendation to the Social Responsibility Committee in October of 2012 and, for the purpose of developing community benefit implementation strategies, a “signature community benefit focus” for all Aurora Health Care hospital facilities was determined:

• A demonstrable increase in “health home” capacity and utilization by underserved populations across Aurora’s footprint (Medicaid-eligible and uninsured)

During 2015, ABMC leaders prioritized significant needs based on the following criteria:

• Meets a defined community need (i.e., access for underserved populations) • Aligns community benefit to organizational purpose and clinical service commitment to coordinate care

across the continuum • Aligns with hospital resources and expertise and the estimated feasibility for the hospital to effectively

implement actions to address health issues and potential impact • Reduces avoidable hospital costs by redirecting people to less costly forms of care and expands the care

continuum • Has evidence-basis in cross-section of the literature for management of chronic diseases in defined

populations • Leverages existing partnerships with free and community clinics and Federally Qualified Health Centers

(FQHCs) • Resonates with key stakeholders as a meaningful priority for the Aurora hospital to address • Potential exists to leverage additional resources to extend impact • Increases collaborative partnerships with others in the community by expanding the care continuum • Improves the health of people in the community by providing high-quality preventive and primary care • Aligns hospital resources and expertise to support strategies identified in municipal health department

Community Health Improvement Plan (CHIP) Using these criteria, Aurora BayCare Medical Center has prioritized the significant health need areas to address in its implementation strategy:

• Priority #1: Access o Access and coverage including mental health and abuse-response services

• Priority #2: Community Health Improvement o Nutrition, physical activity and overweight/obesity o Alcohol and drug use

• Priority #3: Community Benefit Hospital Focus o Youth injury prevention o Chronic disease (cancer, diabetes, heart disease and inflammatory bowel disease) o Primary care, rural medicine, and emergency medical services providers o Healthcare workforce development

Significant health needs not being addressed in the implementation strategy and the reason: The implementation strategy does not include specific strategies for adult injury emergency department visits and hospitalizations as prevention and management services are part of the standard continuum of clinical care at Aurora BayCare Medical Center, BayCare Clinics and Aurora Health Care Medical Group clinics. However, the strategy is focused on youth injury prevention, specifically sports related injuries.


Section 5 | Community resources and assets The assessment identified a multitude of community resources and assets including five other hospitals and their community benefit programs, primary and specialty health care providers and dentists, municipal governments and their departments, public and private schools, and many religious organizations. The Brown County Health Needs Assessment: A Summary of Key Informant Interviews Report 2015 describes available community health resources and assets under each health issue as noted by the interviewed community members. The organizations listed as providing key informants for interviews are assets and resources for the community as well. Specific resources leveraged by AMCS are identified in the Implementation Strategy. For details, see Appendix D.

This Community Health Needs Assessment (CHNA) Report was adopted by the Social Responsibility Committee of the Aurora Health Care Board of Directors on November 17, 2015.

To submit written comments about the Community Health Needs Assessment (CHNA) report or request a paper version of the report, click here.

http://www.aurorahealthcare.org/aboutus/community-benefits/contact.asp


2016-2018 Implementation Strategy Aurora BayCare Medical Center Implementation Strategy In 2013, Aurora BayCare Medical Center (ABMC) completed and published its Community Health Needs Assessment (CHNA) Report and 2014 Implementation Strategy, which was adopted by the Social Responsibility Committee of the Aurora Health Care Board of Directors on December 19, 2013, and posted to the Aurora Health Care web site. The CHNA was conducted again in 2015, the findings of which are mostly consistent with our previous CHNA and enable us to adjust our implementation strategy accordingly. That document, which provides a comprehensive overview of the community served and significant health needs identified, is available by visiting http://www.aurora.org/commbenefits. Experience in carrying out the 2014 and 2015 Implementation Strategies informed the 2016-2018 Aurora BayCare Medical Center Implementation Strategy. As in all previous cases, our 2016-2018 ABMC Implementation Strategy is organized into three main categories in alignment with three core principles of community benefit as shown below.

Category Community Benefit Core Principle

Focus area

Priority #1: Access

Access for persons in our community with disproportionate unmet health needs

• Access including mental health

• Access to abuse-response services

Priority #2: Community Health Improvement

Build links between our clinical services and local health department community health improvement plan

• Nutrition, physical activity and overweight/obesity

• Alcohol and drug use Priority #3: Community Benefit Hospital Focus

Address the underlying causes of persistent health problems

• Youth injury prevention • Chronic disease (cancer,

diabetes, heart disease and inflammatory bowel disease)

• Primary care, rural medicine, and emergency medical service providers

• Healthcare workforce development

Principal community health improvement tool: Community Partnerships For any community health concern, it is widely recognized that a diverse team of engaged community partners is essential for implementing strategic community health improvement initiatives that make a difference. Therefore, we recognize the need to be a good community partner. Our implementation strategies strongly reinforce our role as a partner for community capacity-building to address unmet community health needs. Note: Our implementation strategies do not constitute the entirety of the community benefits our hospital provides each year. For a full accounting of the community benefits we provide each year, please see our most recent report: http://www.aurora.org/commbenefits.




2016-2018 Implementation Strategy Significant health needs/issues not specifically addressed in our 2016-2018 implementation strategy and the reason: The implementation strategy does not include specific strategies for adult injury emergency department visits and hospitalizations, as prevention and management services are part of the standard continuum of clinical care at Aurora BayCare Medical Center, BayCare Clinic and Aurora Health Care Medical Group clinics. However, the strategy is focused on youth injury prevention, specifically sports related injuries.


2016-2018 Implementation Strategy Priority 1: Access Focus | Access is an Aurora Health Care signature community benefit focus

Principal partners • Aurora Health Care Medical Group (AHCMG) • BayCare Clinic • Aurora Behavioral Health Services

41 Wisconsin Department of Justice, Crime in Wisconsin 2012, September 2013. Available at https://wilenet.org/html/justice-programs/programs/justice-stats/library/crime-and-arrest/2012-crime-in-wi.pdf. Accessed August 11, 2015.

Access According to the 2015 County Health Rankings, 3% of Brown County residents reported an unmet medical care need in the past 12 months (CHNA Source #2). Contradictorily, 8% reported not seeing a doctor due to cost (CHNA Source #5). According to the Brown County United Way’s 2014 Annual Report, access to health care was the third most requested need on the 2-1-1 information and referral service. The Healthy People 2020 target is to reduce the proportion of persons who are unable to obtain or delay in receiving necessary medical care to 4.2%

Coverage In 2014, 8% of all adults reported they personally were not currently covered, comparable to the 2003 rate of 9% (CHNA Source #5). However, 13% of adults under age 65 are uninsured, the same as for Wisconsin (CHNA Source #2). In addition, 5% of all children in Brown County were without health insurance (CHNA Source #2). The Healthy People 2020 target for health care coverage is 100%. Sexual Violence The rate of rape for Brown County was 31.0 reports per 100,000 persons, significantly higher than Wisconsin‘s overall rate of 21.0 per 100,000 in 2012.41 Sexual assault and rape are crimes which are underreported. Mental Health According to the County Health Rankings, Brown County adults reported an average of 3.2 mentally unhealthy days in the past 30 days, more than the state average of 3.0 days (CHNA Source #2). In addition, the rate of self-inflicted hospitalizations in Brown County was 80 per 100,000 people, which is lower than the state rate of 95 per 100,000 (CHNA Source #2). In 2014, 22% of adults reported that a health professional told them that they had a depressive disorder compared to 12% who were told they had a mental health condition in 2009 (CHNA Source #5). The Beyond Health and key informants all identified mental health as one of the top four health issues challenging the community (CHNA Sources #1, #4).




2016-2018 Implementation Strategy Priority 1: Access Community partners • Brown County Health Department • Brown County United Way • Community Partnership for Children (Healthy Families, Resource Centers and Early Head Start) • Family Services of Northeast Wisconsin (Brown County)/ Sexual Assault Center of Family Services • Green Bay School District • HELP of Door County • North East Wisconsin (N.E.W.) Community Clinic. Quality care for hard-working, low-income and uninsured

people of Brown County with twelve programs including the Women, Infants and Children program (WIC), Healthcare for the Homeless, two school nurses and one pediatrician at four at-risk elementary schools with three locations (including Northeast Wisconsin Technical College campus)

• Reach Counseling of Brown-Outagamie-Winnebago Counties • St. Vincent’s Hospital Sexual Assault Nurse Examiner (SANE) program • Strategic Behavioral Health Hospital • University of Wisconsin-Green Bay Foundation • University of Wisconsin-Green Bay Health Center • University of Wisconsin-Madison Target population • Medicaid-eligible and uninsured patients using our hospital emergency department (ED) for primary care and

frequent users of the ED for non-emergent reasons • Children and students with unmet health care needs • Patients with mental health conditions Intended impact • Increase in “health home” capacity and utilization by underserved populations (low-income individuals who are

uninsured and ineligible for health care coverage, such as Medicaid) using the ED for primary care • Improved access to medical care and specialty medical services for children • A coordinated information system database of at-risk children is developed through the United Way

Collaborative • Increased utilization of healthcare services by local college students • Improved access to abuse-response services for victims of sexual assault and domestic violence • Improved access to psychiatric consultation services for persons in need Measures to evaluate impact • Number of referrals to primary care and/or the N.E.W. Community Clinic • Number of children seen at the Nicolet School pediatric clinic • Number of at-risk children ages 0-4 referred to Wisconsin WIC (Women, Infants and Children) program for

services • Number of uninsured persons screened and enrolled in financial assistance programs or the Marketplace (the

health insurance exchange) by our financial advocates • Number of pediatric patients accessing specialty diagnostic and treatment services (by type) • Number of patients utilizing the telepsychiatric program services at Aurora BayCare Medical Center or being

referred to local behavioral health service See Action Plan (next page)


2016-2018 Implementation Strategy Priority 1: Access Action plan Target Date Ensure appropriate follow-up care for underserved patients using our hospital ED for primary care: • Continue to be an active financial donor to the North East Wisconsin (N.E.W.) Community Clinic

Ongoing

• Collect baseline data on the number of Medicaid-eligible and uninsured patients using our hospital ED for primary care and number of referrals to N.E.W. Community Clinic, BayCare Clinic and AHCMG

• Actively screen all uninsured patients for financial assistance programs, including Aurora’s Helping Hand Patient Financial Assistance program, and other safety net programs for which they qualify, and assist with application processes

• Through our specially trained financial advocates, inform and educate all uninsured patients at our hospital about the benefits of securing coverage through the Marketplace (the health insurance exchange) and provide assistance as needed

Support the pediatric clinic in Green Bay’s Nicolet School: • Continue to provide a full-time, bilingual pediatrician to provide medical care for children whose

families do not have the resources to pay for health services Ongoing

Increase access to pediatric specialty clinic services in partnership with UW Health • Design and open space for a pediatric specialty clinic 2015-2016 • Provide access to various pediatric specialists within the clinic 2016-2018 Address unmet health needs and reduce the number of health-related ED visits by local college students: • Designate a primary care or OB-GYN care provider to support to local students in need of health

services through the following efforts: − Provide medical services at the University of Wisconsin- Green Bay health center for at

least 4 hours per month during the academic year − Subsidize the professional costs of providing the above health care providers so that the

charge to the clinic is less than $50 for a visit − Ensure that the providers educate students on the importance of preventive screenings

Ongoing

Increase access to abuse-response services for victims of sexual assault, abuse or intimate-partner violence • Support expansion of services at Family Services of Northeast Wisconsin (Brown County) through

Aurora’s Better Together Fund grant of $47,367; monitor progress and impact

Ongoing

• Support expansion of services at HELP of Door County through Aurora’s Better Together Fund grant of $28,500; monitor progress and impact

• Support expansion of services at University of Wisconsin-Green Bay Foundation (Brown County) through Aurora’s Better Together Fund grant of $127,786; monitor progress and impact

• Support expansion of services at Reach Counseling (Brown-Outagamie-Winnebago Counties) through Aurora’s Better Together Fund grant of $30,000; monitor progress and impact

Increase access to mental health providers: • Continue telepsychiatric services or behavioral health referral to improve access to psychiatric

consultations for Aurora BayCare Medical Center patients Ongoing


2016-2018 Implementation Strategy Priority 2: Community Health Improvement Focus | Nutrition, physical activity and overweight/obesity

Based on the 2014 Brown County and City of De Pere Health Department Community Health Assessment Report, 29% of adults were obese, the same level as the state (29%), and higher compared to the national benchmark (25%) (CHNA Source #1). In 2014, 64% of adults were classified as being overweight, an increase from 57% in 2003 (CHNA Source #5). Since 64% of adults in 2014 were classified as overweight, this means 36% of adults were classified as a healthy weight. In addition, the 2015 County Health Rankings (CHNA Source #2) revealed the following: • 10% of adults were being monitored for diabetes, higher than the state and

national rate of 7.4% and 8.9% respectively • The rate of adults who were hospitalized for coronary heart disease was 3.7

per 1,000 people, higher than the state rate of 3.0 per 1,000 • 20% of adults were physically inactive; slightly lower compared to the state and

national benchmarks of 21% Principal partners • Aurora Health Care Medical Group (AHCMG) • Aurora BayCare Wellness Manager

• BayCare Clinic

Community partners • Various area school districts • Boys & Girls Club of Green Bay • Brown County Health Department • City of Green Bay

• Green Bay Area Chamber of Commerce • Live54218 • University of Wisconsin-Green Bay

Target population • Children, adolescents and adults residing in Brown County • ABMC patient population • ABMC employee population Intended impact • Growth in community interest and participation in activities that promote physical activity and healthy weight • Growth in number of patients and employees reporting increase in physical activity each year • Growth in number of patients and employees achieving and maintaining a healthy weight each year Measures to evaluate impact • Number of ABMC employees participating in the ABMC LiveFit: Prescription program • Number of Aurora BayCare employees with ABMC fitness center membership • Number of Live54218 events supported by Aurora caregivers • Number of participants in the Aurora BayCare personal training services • Number of participants in Open Streets Green Bay • Number of participants in Spooky Sprint 1K/5K/10k See Action Plan (next page)


2016-2018 Implementation Strategy Priority 2: Community Health Improvement Action plan Target date Increase the opportunities for Green Bay and Brown County residents and our employees to engage in physical activity and live a healthier lifestyle: • ABMC Wellness Manager to engage employees in fitness programs supported by our hospital Ongoing

Provide our employees and patients with information and resources to improve physical activity, healthy nutrition habits and achieve and maintain a healthy weight • Actively participate in and financially support Live54218, a community obesity prevention

initiative, for an initial three year start-up period

Ongoing

• Organize, market and financially support the 3rd Annual Open Streets Green Bay initiative, which provides 2.5 miles of open street access for residents to engage in physical activity and explore many of the streets in Green Bay on foot or bicycle that otherwise can only be traveled by car. - Provide bike helmets to participants at the event

• Sponsor and host the Spooky Sprint, a 1K, 5K and 10k run/walk, with a portion of the proceeds going to Sting Cancer. Sting Cancer is a passionate and committed collaboration of high school students and staff dedicated to reducing the effects of cancer by initiating and supporting programs and activities for the school and its community.

• Offer personal training through the staff of Aurora BayCare Medical Center Sports Medicine program and through consultation with the Aurora BayCare Bariatrics program


2016-2018 Implementation Strategy Priority 2: Community Health Improvement Focus | Addressing unhealthy alcohol and drug use

Based on the 2014 Brown County and City of De Pere Health Department Community Health Assessment Report, 25% of Brown County adults engaged in binge drinking or heavy drinking in the past 30 days (CHNA Source #1). However, according to the 2014 Brown County BRFSS, 38% of adults reported binge drinking in the past month (CHNA Source #5). In Brown County, 53% of all driving deaths involved alcohol, compared to 39% statewide (CHNA Source #2). In 2015, heroin deaths in Brown County was on pace to match or exceed the highest total in a decade, despite the increased use of the antidote naloxone.42 Beyond Health and key informants identified alcohol and drug use as one of the top four health issues challenging the community (Sources #1, #4).

Community partners • Aurora Health Care Medical Group (AHCMG) • N.E.W. Community Clinic • Aging & Disability Resource Center • Bellin Psychiatric Center • Brown County Health Dept., alcohol and drug action

group

• Libertas Treatment Center • Prevea Behavioral Health • Strategic Behavioral Health Hospital (pending

opening)

Target population • Primary care providers in Brown County • Patients over 18 years of age Intended impact • Decrease in excessive alcohol use in Brown County • The alcohol, depression and substance abuse screening tool will be successfully implemented to support a

decrease in excessive alcohol use in Brown County • A community-wide resource network for health care providers to access post screening will be packaged and

available Measures to evaluate impact • Number of AHCMG providers that implemented the alcohol, depression and substance abuse screening tool • Beyond Health to Healthiest Brown County community health improvement plan (CHIP) steering committee

reports See Action Plan (next page)

42 Green Bay Press Gazette. “Brown County heroin deaths near record pace (October 22, 2015).” Available at http://www.greenbaypressgazette.com/story/news/2015/10/21/brown-county-heroin-deaths-near-record-pace/74348062/. Accessed October 23, 2015.

http://www.greenbaypressgazette.com/story/news/2015/10/21/brown-county-heroin-deaths-near-record-pace/74348062/


2016-2018 Implementation Strategy Priority 2: Community Health Improvement

Action plan Target Date Support the Healthy Brown County 2020 alcohol and other drug use action group to address excessive alcohol use in Brown County: • Designate an Aurora caregiver to serve on the alcohol and drug use action group to support

community efforts: − Implement an alcohol, depression and substance abuse screening tool among the primary

care population (patients over the age of 18) − Coordinate resources and create an easy access resource network for providers − Support interventions that will positively impact the reduction of alcohol abuse and binge

drinking

Ongoing

• Refer patients with AODA needs to the various available community resources for AODA treatment

Support collaboration among professionals working in the fields of mental health and substance abuse to strengthen infrastructure for improving the community’s response to addiction, treatment and recovery. • Implement protocols in our clinics, hospitals and pharmacies focused on preventing opioid

overdose and opioid use disorder and expanding access to medication-assisted treatment (MAT) Ongoing


2016-2018 Implementation Strategy Priority 3: Community Benefit Hospital Focus

Focus | Youth injury prevention

In 2013, the total number of injury hospitalizations among Brown County youth aged 0-17 years was 133, which is a rate of 216.8 per 100,000. Also in 2013, the total number of injury emergency room visits among Brown County youth was 5,555 – a rate of 9,055.0 per 100,000. Of the youth emergency room visits, 1,120 resulted from being struck by or striking against an object or another person. (CHNA, Wisconsin Interactive Statistics on Health). The Wisconsin Interscholastic Athletic Association (WIAA) policy and Wisconsin law clearly identifies that the risk and prevalence of concussion and head trauma is significant. In addition, the WIAA policy and Wisconsin law acknowledges the prominent role of health care professionals as it relates to injury prevention/detection efforts within the community organizations.

Principal partners • Aurora Health Care Medical Group (AHCMG) • BayCare Clinic

• Aurora BayCare Sports Medicine

Community partners • Various area school districts Target population • Brown County residents • Students and coaches at various area school districts Intended impact • Youth injury prevention, identification and intervention is improved • Student athletic injuries are successfully diagnosed, treated and rehabilitated Measures to evaluate impact • Number of athletic trainer assessments at schools • Number of baseline concussion screenings • Number of youth sports physicals • Number of student athletes treated for a concussion (with previous concussion baseline screening) • Number of health screenings and injury assessments provided at Aurora BayCare Orthopedic and Sports

Medicine Center Action plan Target Date Support our communities and assure the safety of youth and student athletes: • Continue to partner with area school systems and community athletic organizations to offer:

- Reduced-cost youth sports physicals (proceeds donated back to the school athletic programs)

- Free pre-season baseline concussion screenings (Note: if a student experiences a head injury, the baseline screening is compared to the injury assessment.)

- Functional movement assessments and recommendations for training (as appropriate) - Licensed athletic trainer and physician support for athletic events

Ongoing

• Continue to partner with AHCMG and BayCare Clinic staff for a consistent approach to post-concussion injury management

• Continue to provide free health screenings and injury assessments by our licensed athletic trainers


2016-2018 Implementation Strategy Priority 3: Community Benefit Hospital Focus Focus | Chronic disease (including diabetes, heart disease, inflammatory bowel disease and cancer)

The 2015 County Health Rankings (CHNA Source #2) revealed the following: • 10% of adults were being monitored for diabetes, up significantly from 4% in

2003 (CHNA Source #2). This is higher than the state and national rate of 7.4% and 8.9%, respectively.

• The rate of adults who were hospitalized for coronary heart disease was 3.7 per 1,000 people, higher than the state rate of 3.0 per 1,000 (CHNA Source #2).

Based on the 2015 Brown County Health Data Report (CHNA Source #3): • The 2008-2012 cancer age-adjusted incidence rate in Brown County was 489.6.

per 100,000 population, higher compared to the state at 447.7 per 100,000. • The incidence rate for female breast cancer was 128.6 per 100,000 population

in Brown County, higher than the state and national rates (125.4 and 122.0 per 100,000, respectively).

• The incidence rate for female colorectal cancer was 36.6 per 100,000 population in Brown County, higher than the state and national rates (31.6 and 34.9 per 100,000, respectively).

Principal partners • Aurora Health Care Medical Group (AHCMG) • Aurora BayCare Medical Center Cancer Care • BayCare Clinic Community partners • Aging & Disability Resource Center of Brown

County • Wisconsin Department of Health and Human

Services

• American Heart Association • Crohn’s & Colitis Foundation of Green Bay • American Cancer Society

Target population • Our patients with diabetes • The broader population of northeast Wisconsin and Upper Michigan (cancer and heart disease) • Children and adults with inflammatory bowel disease (Crohn’s disease or colitis) and healthcare providers Intended impact • Improved health status and positive self-care behaviors for individuals with chronic disease (e.g. heart disease,

asthma, diabetes, Crohn’s/colitis) • Increased public awareness of, and knowledge about, Crohn’s/colitis/other bowel diseases • Increased public awareness of colorectal cancer prevention, diagnosis and treatment; increase in screenings

and early detection • Increased public awareness of breast cancer screening, diagnosis and treatment. • Increased public awareness and increase knowledge of prevention, risk factors and early warning signs for

heart disease and stroke


2016-2018 Implementation Strategy Priority 3: Community Benefit Hospital Focus Measures to evaluate impact • Number of participants enrolled in Living Well with Diabetes programs • Number of participants in Making Strides Against Breast Cancer Walk • Number of cancer screenings and educational sessions • Number of heart/stroke health education sessions (including the Senior Festival); approximate number of

people reached • Number of attendees at the educational sessions hosted by the Crohn’s and Colitis Foundation

Action plan Target Date Improve self-care and promote healthy lifestyles to manage diabetes: • Promote, refer patients to and co-facilitate Living Well with Diabetes, a program for people

newly diagnosed with type 2 diabetes Ongoing

• Provide diabetes workshops facilitated by nurses specially trained through the State to implement the program at the local level

Help the broader community understand and identify risk factors for cancer to increase screenings: • Provide financial support and distribute cancer prevention educational material at Making

Strides Against Breast Cancer and Runway for Life events and provide cancer expert speakers for Making Strides event (as needed)

Ongoing • Provide cancer screening information and educational sessions at a variety of community venues and events

• Coordinate and provide financial assistance for women who are age or risk eligible and who are unable to cover the cost of screening mammograms. Note: This is coordinated through our financial advocates

Help the broader community understand and identify risk factors for heart disease and stroke: • Financially support and provide educational information and screenings at the Green Bay

Senior Festival Ongoing

• Provide community education on the risk factors, early warning signs of heart attack and stroke

Continue our longstanding support for the Crohn’s & Colitis Foundation of Green Bay: • Provide information to patients and healthcare providers on Crohn’s, colitis, or bowel disease

and nutrition choices for children and adults Ongoing • Sponsor the annual walk to raise funds to advance research and better treatment options for

individuals with Crohn’s disease and colitis • Host and/or support community educational events

Logic Models (next page)


2016-2018 Implementation Strategy Priority 3: Community Benefit Hospital Focus Breast Cancer Logic Model

Colorectal Cancer Logic Model


2016-2018 Implementation Strategy Priority 3: Community Benefit Hospital Focus Focus | Health professions education: primary care, rural medicine and emergency medical service providers

Principal partners • Aurora Health Care Medical Group (AHCMG) • BayCare Clinic Community partners • Various local EMS services • University of Wisconsin (UW) - Madison Academic partner The Wisconsin Academy for Rural Medicine (WARM) is a program of the University of Wisconsin – School of Medicine and Public Health created to proactively address the current shortage of rural physicians in the State and enhance health care in rural communities. Aurora BayCare Medical Center is an academic affiliate of the UW School of Medicine and Public Health and is part of the school's statewide campus. It is one of three regional sites participating in the program, along with Marshfield Clinic and Gundersen Lutheran in La Crosse. Target population • WARM students who have completed the first two years in Madison and are needing to complete the clinical

requirements in a rural learning community (during years three and four)

43 University of Wisconsin School of Public Health, Wisconsin Academy of Rural Medicine. Available at http://www.med.wisc.edu/education/md/wisconsin-academy-for-rural-medicine-warm/history/970. Accessed October 1, 2015. 44 National Rural Health Association. What’s Different About Rural Health? The obstacles faced by rural health care providers and their patients. Available at http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care. Accessed October 1, 2015.

Based on the 2015 County Health Rankings for Brown County, the ratio of population to primary care physicians in Brown County was 1,375: 1. The population per physician ratio was greater for Brown County as compared to the state (1,215:1) and the national benchmark (945:1) (CHNA Source #2). Note: Primary care physicians include practicing physicians specializing in general medicine, family medicine, internal medicine, pediatrics, and obstetrics/gynecology. The measure represents the population per physician. According to the Wisconsin Academy for Rural Medicine:43 There is a geographic shortage and misdistribution of physicians that affects rural Wisconsin. While 28% of Wisconsin citizens live in rural areas, only 11% of physicians have rural practices. This shortage of rural physicians is projected to increase. Literature shows that rural citizens are generally less healthy, poorer, older and more likely to be uninsured.44 Recent reports from the Wisconsin Hospital Association, the Association of American Medical Colleges, and the Wisconsin Office of Rural Health have projected significant shortages of physicians in the coming decades, particularly in the primary care fields and in underserved rural and urban areas.

http://www.med.wisc.edu/education/md/wisconsin-academy-for-rural-medicine-warm/history/970


Intended impact • Prepare and encourage medical students to choose medical careers in primary care and rural medicine • Increased collaboration between local EMS providers and various local EMS services Measures to evaluate impact • Number of medical students participating in the WARM program rotation at ABMC • Percent of our WARM students who go on to post-graduate medical education programs in primary care • Standardized examination results (based on national and University of Wisconsin measures) and based on the

students’ own evaluations • Percent of EMS scholarship recipients who remain in surrounding communities • Attendees at the EMS Huddle by local and surrounding EMS personnel Future measures • Overall number of UW students who spent any time at ABMC, who train in Wisconsin and return to Wisconsin

to practice medicine • Through our substantial contact with them, we expect 60% of each participating class to practice in Wisconsin

Action plan Target Date Address the shortage of physicians in rural communities and the unmet health care needs of rural residents: • Continue to serve as a learning site for University of Wisconsin WARM program third- and

fourth-year medical students, with affiliated practices and coordination at distant sites for elective rotations in: - Anesthesiology, internal medicine, neuroscience, OB/GYN, pediatrics, primary care,

radiology, surgery, and other core (e.g. emergency department) and elective (e.g. critical care) clinical experiences

Ongoing

• Provide elective and core rotations for University of Wisconsin traditional medical students Improve educational and training opportunities for emergency medical services providers: • Provide scholarships for paramedics, in partnership with Board Certified Emergency

Physicians, to offer each spring and fall semester: - (2) $500 Emergency Medical Technicians (EMT) scholarships - (1) $500 advanced EMT scholarship and - (2) $1,000 paramedic scholarships - Note: Scholarships are selected for students of Northeast Wisconsin Technical College and

presented at the spring and fall EMS Huddle through a selection process

Ongoing

• Host EMS Huddle sessions with a guest speaker for EMTs from the surrounding area. Presentations to be based on educational needs identified in previous huddle evaluations


Appendix A | Brown County and City of De Pere Health Departments Community Health Assessment Report (Source #1)

The report is available at http://www.de-pere.org/egov/documents/1427474059_94508.pdf

http://www.de-pere.org/egov/documents/1427474059_94508.pdf



Appendix B| County Health Rankings: Brown County 2015 (Source #2) The data is available at www.countyhealthrankings.org/app/wisconsin/2015/overview Data Collection & Analysis Each year, the overall health of almost every county in all 50 states is assessed and ranked using the latest publically available data. Ranking includes health outcomes (mortality and morbidity) and health factors (health behaviors, clinical care, social and economic factors and physical environment). Most of the county level data as based on the CDC’s Behavior Risk Factor Surveillance System (BRFSS); the CDC averages seven years of data, wherever possible, to calculate each measure. Below is a snapshot of some measures for Brown County (WI).

http://www.countyhealthrankings.org/app/wisconsin/2015/overview

Aurora BayCare Medical Center - DRAFT Page 40 of 44


Appendix C| Brown County Health Data Report: A summary of secondary data sources (2015) (Source #3) The report is available at www.aurora.org/commbenefits Data Collection & Analysis: In summer 2015, the Center for Urban Population Health was enlisted to compile secondary data to supplement the community health survey and key informant interviews. This report summarizes the demographic and health-related information for Brown County. Publicly available data sources used for the Secondary Data Report Source Description American FactFinder and American Community Survey

American FactFinder provides access to data about the United States. The data comes from several censuses and surveys. The American Community Survey (ACS) is a nationwide survey designed to provide information of how communities are changing. ACS collects and produces population and housing information every year, and provides single and multi-year estimates. Source: United States Department of Commerce, US Census Bureau

Wisconsin Interactive Statistics on Health (WISH)

WISH uses protected databases containing Wisconsin data from a variety of sources and provides information about health indicators (measure of health). Select topics include Behavioral Risk Factor Survey, birth counts, fertility, infant mortality, low birth weight, prenatal care teen births, cancer, injury emergency department visits, injury hospitalizations, injury mortality, mortality, and violent death. Source: Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics

County Health Rankings & Roadmaps

Each year the overall health of almost every county in all 50 states is assessed and ranked using the latest publically available data. Ranking includes health outcomes (mortality and morbidity) and health factors (health behaviors, clinical care, social and economic factors and physical environment). Source: Collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Domestic Abuse Incident Report (DAIR)

Under Wisconsin Statutes § 968.075(9), each county is required to provide data regarding domestic abuse incidents to the Wisconsin Department of Justice’s Office of Crime Victim Services. For most counties, compliance with this requirement is achieved when the Department uses an automated system to extract county level data entered into the PROTECT system--a case management system used by Wisconsin district attorneys’ offices. The data is combined in a Department database which generates annual reports and tables. Source: Wisconsin Department of Justice, Office of Crime Victims

Wisconsin Child Abuse and Neglect Report

Data for this report is from the electronic Wisconsin Statewide Automated Child Welfare Information System (eWiSACWIS). Child Protective Service agencies use eWiSACWIS to manage their cases. The data is combined in a Department database which generates annual reports and tables. Source: Wisconsin Department of Children and Families, Child Protective Services Program

Data for each indicator is presented by race, ethnicity and gender when the data is available. In some cases data is not presented by the system from which it was pulled due to internal confidentiality policies which specify that data will not be released when the number is less than five. When applicable, Healthy People 2020 objectives are presented for each indictor. The objectives were not included unless the indicator directly matched with a Healthy People 2020 objective. Partners & Contracts: The secondary data report is sponsored by Aurora Health Care. The report was prepared by the Center for Urban Population Health.



Appendix D | Brown County Health Needs Assessment: A summary of key informant interviews (2015) (Source #4) The report is available at www.aurora.org/commbenefits Data Collection and Analysis: Six individual interviews were conducted between August and September 2015. The organizations were selected based on the following criteria:

• Provided a broad interest of the community and the health needs in Winnebago County • Comprised of leaders within the organization with knowledge or expertise relevant to the health needs of

the community, health disparities or public health, and/or • Served, represented, partnered or worked with members of the medically underserved, low income

and/or minority populations Key informants included leaders and local experts representing health services, public health, support organizations, businesses, government and non-profit organizations. Cumulatively, these organizations focus on a range of public health issues and represent the broad interests of community, including medically underserved, low-income and/or minority populations. Summary of the organizations representing the broad interest of the community Organization Description of the organizations

The description is based on information provided on the organization’s website, accessed October 23, 2015.

Brown County United Way

“Brown County United Way engages our community, mobilizes volunteers and strengthens local nonprofits to achieve measurable results and change lives.”

City of De Pere Health Department

“The City of De Pere Health Department serves to protect and promote public health across the lifespan through: education, policy development and valued services.”

Festival Foods “Festival Foods is a family-owned company operating stores strategically throughout Wisconsin. The company now operates 20 full-service, state-of-the-art supermarkets and employs more than 5,000 full and part-time associates.”

Live 54218 “Our mission is to create environments in the community that support and promote all residents daily in consuming 5 fruits and vegetables, drink 4 bottles of water, having less than 2 hours of screen time, participating in at least 1 hour of physical activity, and sleeping 8 hours a night. Our shared vision is to make the Greater Green Bay Area the healthiest community in the nation.”

UnitedHealth Group – Wellness Center

“UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities.”

The key informant interviews were conducted by Aurora Health Care. The interviewers used a standard interview script that included the following elements:

1) Each key informant was asked to rank order the top 3 to 5 major health-related issues for Brown County, which is based on the focus areas presented in Wisconsin’s State Health Plan, Healthiest Wisconsin 2020.

2) For each top-ranked health topic the informant was asked to specify existing strategies to address the issue, barriers or challenges to addressing the issue, additional strategies needed, and key groups in the community that hospitals should partner with to improve community health. Healthiest Wisconsin 2020 focus areas include alcohol and drug, chronic disease, communicable disease, environmental and occupational health, growth and development, mental health, nutrition, oral health, physical activity, reproductive & sexual health, tobacco, access, and injury and violence.

This summary presents the top five health issues in Brown County and potential resources and partnerships to address each of the community health issues.



Top five issues that emerged as key health priorities for Brown County and the identified community assets

The top five health issues that emerged as key priorities for Brown County: 1. Mental health 2. Nutrition 3. Alcohol and drugs (tied) 3. Chronic disease (tied) 5. Physical activity

Key community partners, resources and assets to address health issues:

1. Mental health: Hospitals partnering with other health care systems (Bellin Hospital Green Bay, Bellin Orthopedic Surgery Center, Bellin Health Psychiatric Center, St. Vincent Hospital and St. Mary’s Hospital Medical Center), Veterans Administration, schools, colleges, American Foundation of Counseling Services (AFCS), federally qualified health centers (FQHCs), law enforcement, United Way, Crisis Center of Family Services, health departments, Catholic Charities mental health programs and businesses.

2. Nutrition: Hospitals partnering with colleges, health departments, WIC programs, UW Extension, United Way,

hospital systems, insurances, Live54218 Coalition, restaurants, grocery stores and the Beyond Health Coalition.

3. Alcohol and drugs (tied): Hospitals partnering with other health care systems, AFCS counseling, health

departments, faith-based organizations, colleges, chambers of commerce, law enforcement, Veterans Administration, Department of Transportation, Aging and Disability Resource Center (ADRC), FQHCs, Live54218 Coalition and the Heroin Task Force.

3. Chronic disease (tied): Hospitals partnering with NEW Community Clinic and United Way’s Community

Partnership for Children.

5. Physical activity: Hospitals partnering with worksites, Live54218 Coalition, schools, Beyond Health Coalition, local public works and planning departments, Parks and Recreation departments and bike clubs.


Appendix E | 2014 Brown County Behavioral Risk Factor Surveillance System Survey: Local, State, and National Data Comparison (Source#5) The report is available at http://live54218v2.backslashinteractive.com/uploads/media_library/files/2014BrownCountyBRFSSReport1.pdf. Data collection and analysis: The 2014 Brown County Behavioral Risk Factor Surveillance System (BRFSS) Survey, a comprehensive phone-based survey, gathers specific data on behavioral and lifestyle habits of the adult population and select information about the respondent’s household. In addition, modifications of the draft Centers for Disease Control and Prevention Risk Behavior Survey questionnaire plus additional questions were made by the St. Norbert College Strategic Research Institute in consultation with the Beyond Health Coalition. Respondents were scientifically selected so that the survey would be representative of all adults 18 years old and older. The sampling strategy was two-fold. 1) A random-digit-dial landline sample of telephone numbers, which included listed and unlisted numbers. The respondent within each household was randomly selected using the Troldahl-Carter household selection technique based on the number of adults in the household (80%). 2) A cell phone-only sample where the person answering the phone was selected as the respondent (20%). At least 8 attempts were made to contact a respondent in both samples. Screener questions verifying location were included. A total of 400 telephone interviews were completed between March 10 and April 7, 2014. With a sample size of 400, we can be 95% sure that the sample percentage reported would not vary by more than ±5 percent from what would have been obtained by interviewing all persons 18 years old and older who lived in Brown County. The margin of error for smaller subgroups will be larger. When using percentages from this study, it is important to keep in mind what each percentage point, within the margin of error, actually represents in terms of total adult population. One percentage point equals approximately 1,861 adults. Throughout the report, some totals may be more or less than 100% due to rounding and response category distribution. Partners & Contracts: The report was a collaborative effort paid for by Aurora BayCare Health Care, Bellin Health System, the Brown County Health Department, Hospital Sisters Health System, Live54318 and Prevea Health. The survey was conducted by the St. Norbert College Strategic Research Institute.

http://live54218v2.backslashinteractive.com/uploads/media_library/files/2014BrownCountyBRFSSReport1.pdf

http://live54218v2.backslashinteractive.com/uploads/media_library/files/2014BrownCountyBRFSSReport1.pdf

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