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Photo by Holly Yonemoto

Licensed vocational nursing students from Beaumont Adult School participate in a rotation at San Gorgonio Memorial Hospital. In photo (from left) are Lilliana Lara, Jessicah Martin watch instructor Bonnie Ryan demonstrate a patient suction setup process. Developing more healthcare workers was a priority in the hospital’s 2016 community needs assessment.

Based on a comprehensive study, the Pass area needs to focus on prevention and management of chronic diseases, improve access to health services, and increase mental and behavioral health when it comes to dealing with substance abuse.

Those findings were recommendations based on the 2019 San Gorgonio Memorial Hospital Community Health Needs Assessment released at the end of 2019 in collaboration with Rancho Cucamonga-based HC2 Strategies, Inc. and Los Angeles-based Communities Lifting Communities.

The study analyzed metrics such as social and economic factors like poverty and educational attainment; health systems and access to health coverage; public health and prevention indicators such as cigarette smoking, diabetes and substance abuse rates; and physical environment.

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Andrew Gardner, a member of the San Gorgonio Memorial Hospital’s board of directors, says that the study “gives us the data needed to create and revise our long-term and short-term goals as we work with the community to service health needs and create a high level of quality care.”

“The CHNA is very informative: it gives us invaluable information regarding not only the factual statistics of our primary service area, but also the weight of importance placed on health matters” by the hospital’s constituents,” Gardner says.

Clinical psychiatrist Joe Dunn had not had a chance to review the report, but helped craft mental health components of the study.

“Mental health is definitely a priority that can have a domino effect in the community,” Dunn says. “When you’re not dealing with mental health properly, there ends up a lot of visits to the emergency room, which may not be the most appropriate place to with those issues. Providing programs helps clients address physical needs, and gives them a place where they can be themselves and receive support in a structured program without losing their independence.”

A few of the components from the study are outlined in this report.

Social and economic factors: employment, poverty and educational attainment

According to the study, for every 10,000 children within San Gorgonio Memorial Hospital’s primary service area, there are a higher number of Head Start facilities compared to the rest of Riverside County; the averages for adults having less than a high school education is lower in this area at 15.8 percent compared to the county at 18.9 percent and the state at 17.5 percent; the hospital’s service area enjoys a lower housing cost burden (paying more than 30 percent of income for housing) compared to 42.1 percent throughout the county and 44.6 percent around the state.

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Key findings also show that the homeless count in the county was higher in 2019 at 2,811 unsheltered adults, compared to 2018’s 2,316; and when it came to unintentional injuries, Riverside County had the highest rate of drug-induced deaths when adjusted by age per 100,000 at 16.4 compared to 12.7 in the rest state; and the county also witnessed a higher rate of motor vehicle accidents (age-adjusted) at 12 per 100,000 compared to 9.5 for the state.

When it comes to reading proficiency, 59.4 percent of fourth-graders scored “not proficient” or worse compared to 57 percent and 55 percent for the county and state. The report refers to a study by the Anne E. Casey Foundation that suggests “Children who do not read proficiently by the end of third grade are four times more likely to leave school without a diploma than a proficient reader.”

Graduation rates within the hospital’s service area were also lower than the county’s and state’s: 15.8 percent of those older than 25 who were surveyed did not have a high school diploma, compared to 18.9 percent for the county and 17.5 percent for the state.

The percentage of adults 25 and older who attained a bachelor’s degree or higher in the hospital’s service area was only 20.9 percent — slightly less than the county’s 21.5 percent, and lower than the state’s 32.6 percent.

Unemployment in the hospital’s service area show that 11.4 percent of those between the ages of 16 to 19 are unemployed, compared to 8.9 percent in the county and 7 percent in the state.

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“Addressing unemployment levels is important to community development” since such conditions “can lead to financial instability and serve as a barrier to healthcare access and utilization,” particularly since many people secure healthcare through their employer, the report claims.

The Pass area’s service region has a higher poverty level for children under 18 at 21.7 percent, compared to 21.3 percent in the county and 20.8 percent in the state.

The study notes that “Poverty is a particularly strong risk factor for disease and death, especially among children,” citing claims by the National Center for Children in Poverty, which points out that “The single biggest threat to children’s well-being is poverty. Poverty limits a child’s ability to learn and contributes to poor health and mental health issues.”

Further, 16.6 percent of the area’s population is below the poverty level, compared to 15.6 percent for the county and 15.1 percent for the state.

The county has a higher percentage of its population receiving Supplemental Nutritional Assistance Program benefits and Public Assistance Income: 12.3 percent of county residents receive SNAP benefits compared to 11.2 percent of others in the state, and 3.63 percent receive public assistance income or Temporary Assistance to Needy Families with 3.63 percent of county residents receiving such benefits compared to 3.58 percent for all of California.

The study highlights the fact that in 2014 Banning and Beaumont combined had the lowest count of violent crimes with 199 — the same year the county reported its lowest violent crime count of 6,260.

In 2018 Banning-Beaumont’s share was 343 violent crimes and the county’s was 7,360 (with a county peak in 2016 at 7,447).

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The study concludes that, when it comes to social and economic well-being, “Hospitals and health systems are stepping outside of their traditional roles and beginning to collaboratively address social, economic and environmental conditions that contribute to poor health in the communities they serve.”

Further, “Strategic multi-sectoral inverventions can help address the issues that have the greatest impact on people’s health to move the dial on education and unemployment, helping to create a positive ripple effect on homelessness and unintentional injuries for the betterment of the community.”

Health system accessibility: prenatal care, violence, uninsured and the homeless

The Community Health Needs Assessment starts out its analysis of the health system started with examining prenatal care and outcomes following birth.

“Engaging in prenatal care decreases the likelihood of maternal and infant health risks,” the report states. “These indicators can also highlight a lack of access to preventative care, a lack of health knowledge, insufficient provider outreach, and/or social barriers preventing care utilization of health care services.”

A majority of the county’s women received prenatal care in their first trimester — 83.5 percent — which is right in line with the state’s average.

The study also identifies what it refers to women who received “adequate or adequate plus” prenatal care, referring to women who receive prenatal care by the fourth month of pregnancy, and 110 or more of recommended visits are achieved.

Teen births in the county are double that of the state’s: 37.1 teens out of every 1,000 between 15 to 19 years-old gave birth, compared to 15.7 per 1,000 statewide.

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The study depicts women in the county were slightly behind the state average when it comes to breastfeeding.

“Breastfeeding protects against diarrhea, common childhood illnesses such as pneumonia, and may have longer-term health benefits such as reducing the risk of overweight and obese children and adolescents,” the study claims.

Its statistics report that 92.4 percent of women in the county initiated breast feeding, compared to 94 percent statewide.

Infant mortality rates are higher in Riverside County according to the study, with 5.3 deaths per 1,000 live births in the county compared to 4.4 per 1,000 statewide.

When it comes to access to healthcare — whether it was mental health, primary care, dentists, or health insurance — the county was behind.

In the county, there were 50.6 dentists per 100,000 residents compared to 83.4 in the state.

There were just 187.4 mental health care providers per 100,000 in the county, compared to 327.8 per 100,000 throughout the state.

And there were only 41.8 primary care physicians per 100,000 county residents compared to similar populations statewide, where there are 78.5 primary care physicians per 100,000.

In Riverside County 12.3 percent of the population was uninsured, compared to 8.9 percent of state residents, and 30.4 percent of the county’s residents received Medi-Cal, compared to 27.3 percent statewide.

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Photo by Holly Yonemoto

Students from Beaumont Adult School take a pause from their rotation on Jan. 3. Developing a larger healthcare workforce was a priority from the previous 2016 community needs assessment.

The hospital’s service area has a higher number of community health centers and federally qualified health centers compared to the county and state.

San Gorgonio Memorial Hospital’s primary service area boasts 3.99 federally qualified health centers per 100,000 residents compared to 2.01 countywide and 2.91 statewide.

There were 809,411 visits to emergency rooms in Riverside County in 2017; 47,158 of them were visits to the ER at San Gorgonio Memorial Hospital.

The hospital’s highest percentages of visits based on diagnosis were essential (primary) hypertension at 14.53 percent; acute upper respiratory infection with 6.78 percent; urinary tract infections (5.82 percent) and type 2 diabetes mellitus without complications at 5.76 percent; and rounding out the top five was nicotine dependency at 5.49 percent.

Visits to emergency rooms by homeless individuals were higher in San Bernardino County than Riverside County: in San Bernardino County there were 1,117 visits in 2017 compared to 1,344 in Riverside County that year.

“Homelessness and health concerns often go hand-in-hand,” the study states. “An acute behavioral health issues, such as an episode of psychosis, may lead to homelessness, and homelessness itself can exacerbate chronic medical conditions or lead to debilitating substance abuse problems,” the report says.

The report points to a homeless count that was coordinated the morning of Jan. 29, 2019 by the Department of Public Social Services and the County of Riverside Continuum of Care network.

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According to the numbers generated for that report, there were 2,821 sheltered and unsheltered homeless adults and children countywide, which was 21 percent higher than the count from the year before.

“This information is useful as it helps develop strategies to decrease homelessness and its associated health conditions with all community and county organizations involved,” the study says.

The study showed that, at the start of 2019, there were 181 youth between 18-24 who were unsheltered in the county, and 83 who had a place to stay; there were 15 without shelter that were under 17, and 199 who had shelter; 131 unsheltered homeless youth did not provide ages.

Also under the guise of social and economic factors is a focus on violence and injury prevention.

Injury, according to the Centers for Disease Control and Prevention, is the leading cause of death for children and adults between the ages of 1-45 in the United States, which includes violence and unintentional injuries such as vehicular accidents.

“High rates of violent crimes can deter residents from pursuing healthy behaviors such as walking for leisure, or to and from work or school,” the study states.

Included in that category is child abuse, of which the county surpasses state instances: in 2015, the last year data was compiled by the study, there were 8.4 cases per 1,000 children statewide as opposed to 9.6 cases per 1,000 kids countywide, based on figures from the Annie E. Casey Foundation.

Unintentional injuries per 100,000 in the county exceeded those of the state: 12 motor vehicle crash deaths per 100,000 in the county compared to 9.5 per 100,000 in the state; and 16.4 drug-induced deaths for the same numbers of victims in the county, compared to 12.7 deaths per 100,000 statewide.

According to the study, “When looking at violent crimes, between 2014-18, Banning-Beaumont saw the highest counts in 2018 and the lowest in 2014,” while Riverside County as a whole saw its highest count in 2016 and its lowest in 2014.

“Rates of violent crimes in a community not only compromises individuals’ real and perceived safety, but can be detrimental to overall mental health,” the study says.

The study notes “Hospitals and health systems are stepping outside of their traditional roles and beginning to collaboratively address the social, economic and environmental conditions that contribute to poor health in the communities they serve,” and various combined interventions “can help address the issues that have the greatest impact on people’s health to move the dial on education and unemployment, helping to create a positive ripple effect on homelessness and unintentional injuries for the betterment of community.”

Where analysis goes from here

The 125-page study is comprehensive, and can be viewed on San Gorgonio Memorial Hospital’s website at sgmh.org/wp-content/uploads/2019/12/12.9_Draft_San-Gorgonio-2019-CHNA_R11.pdf .

The Record Gazette has provided insight into the first few components of the study.

Other areas of the study discuss topics such as mortality, mental health, sexually transmitted infections, hospitalization visits for cancer, asthma, heart disease, tobacco use and diabetes (within the San Gorgonio Memorial Hospital’s service area, the city of Banning had the highest admissions for diabetes short-term complications and uncontrolled diabetes, whereas Cabazon had the highest admissions for hypertension and asthma in younger adults), according to key findings published in the study.

In light of the 2016 Community Health Needs Assessment, the hospital strived to address priorities based on the critical issues identified three years earlier, which included tackling diabetes, obesity and healthcare workforce development.

To address those findings, the hospital offered free health and nutrition classes, weight management programs, introduced an organic farmer’s market every Tuesday morning, and implemented healthier selections in its cafeteria.

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Photo by Holly Yonemoto

Vendors at the Jan. 7 farmer’s market in San Gorgonio Memorial Hospital’s parking lot. The idea to promote nutrition every Tuesday from 8 a.m. to 1 p.m.  stemmed from the 2016 hospital’s community needs assessment.

As for the 2019 survey, “There’s a lot of good information in this, but the most important part is putting together our action plan” says hospital CEO Steven Barron. “Next month during the board retreat we will work on the action plan” to determine how to tackle the top topics picked by the community, “and come up with ways we can partner with organizations to address these needs, since we can’t do everything on our own, like for the homeless issue, for instance: we don’t house people at the hospital, but because a lot of homeless people come through our hospital, we can help direct them to partners” who can assist them with their needs, Barron says.

According to Holly Yonemoto, chief business development officer for San Gorgonio Memorial Hospital, the hospital’s board wants to focus on three specific health needs for its 2019 survey, including prevention and management of chronic diseases (including diabetes, obesity, asthma, heart disease, cancer and nutrition and physical activity); access to health services (affordability and insurance, transportation, and addressing the shortage of health care workers and specialty physicians); and mental and behavioral health (substance abuse) — which will be discussed at the February board retreat.

One person not satisfied with the study is hospital board member Lanny Swerdlow, a registered nurse who was a point of contact for the study as a representative of the LGBTQ community, and also assisted the study’s coordinators in getting in touch with the Morongo reservation to have a representative of the Native American population available as a point of reference for the study.

“It lacked certain information on certain demographics,” Swerdlow said, referring specifically to the Native American and the gay and lesbian communities. “A lot of those details were omitted, but we only spent $40,000” on the study, which was “a pittance” Swerdlow acknowledged, when hospitals can spend upwards of $100,000 for the government-required assessments.

“The hospital has to be careful how it spends its money, and I understand that,” Swerdlow says. “The information reported was good information, but in my opinion it was not detailed enough.”

The study may be viewed on the hospital’s website at sgmh.org/wp-content/uploads/2019/12/12.9_Draft_San-Gorgonio-2019-CHNA_R11.pdf .

Staff Writer David James Heiss may be reached at dheiss@recordgazette.net , or by calling (951) 849-4586 x114.

Staff Writer David James Heiss may be reached at dheiss@recordgazette.net , or by calling (951) 849-4586 x114.

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