AE-14019...AE-14019 Memorial Hospital and Physician Group Community Health Needs Assessment Summary and Implementation Strategy Community Health Needs Assessment documents available

AE-14019

Memorial Hospital and Physician Group Community Health Needs Assessment Summary and Implementation Strategy

Community Health Needs Assessment documents available online at:

www.okruralhealthworks.org

Lara Brooks, Extension Associate, OSU, Stillwater Phone: 405-744-9827, Fax: 405-744-9835, Email: [email protected]

Brian Whitacre, Associate Professor and Extension Economist, OSU, Stillwater

405-744-6083

Aaron Henson, Tillman County Extension FCS Educator, Frederick 580-335-2515

Corie Kaiser, Director, Oklahoma Center for Rural Health, Oklahoma City

405-840-6500

Oklahoma Office of Rural Health

OSU Center for Rural Health

Oklahoma Cooperative Extension Service Oklahoma State University

June 2014

Table of Contents

Introduction ................................................................................................................................................................... 1

Oklahoma Cooperative Extension and Oklahoma Office of Rural Health’s Roles ................................................... 2

Memorial Hospital and Physician Group Medical Services Area Demographics ......................................................... 2

Table 1. Population of Memorial Hospital and Physician Group Medical Service Areas ................................... 4

Table 2. Existing Medical Services in Memorial Hospital and Physician Group Medical Services Area ............ 5

Table 3. Percent of Total Population by Age for Memorial Hospital and Physician Group Medical Service Areas, Tillman County and Oklahoma.................................................................................................................. 6

Table 4. Percent of Total Population by Race and Ethnicity for Memorial Hospital and Physician Group Medical Service Areas, Tillman County and Oklahoma ....................................................................................... 7

Summary of Community Meetings................................................................................................................................ 8

Economic Impact and Community Health Needs Assessment Overview, April 10, 2014 ........................................ 8

Table 5. Memorial Hospital and Physician Group Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax ....................................................................................................... 10

Community Survey Methodology and Results, April 10, 2014- May 13, 2014 ...................................................... 11

Table 6. Zip Code of Residence ......................................................................................................................... 12

Table 7. Type of Specialist Visits ....................................................................................................................... 13

Figure 2. Summary of Hospital Usage and Satisfaction Rates ............................................................................ 14

Table 8. Top Healthcare Concerns in the Frederick Service Area ..................................................................... 15

Table 9. Additional Services Survey Respondents Would Like to See Offered at Memorial Hospital and Physician Group .................................................................................................................................................. 17

Primary Care Physician Demand Analysis, May 13, 2014 ..................................................................................... 19

Table 10. Primary Care Physician Office Visits Given Usage by Local Residents in the Frederick, Oklahoma Medical Service Areas ........................................................................................................................................ 19

Health Data, May 27, 2014 ..................................................................................................................................... 20

Table 11. Health Factors (Overall Rank 47) ...................................................................................................... 21

Table 12. Health Outcomes (Overall Rank 52) .................................................................................................. 22

Community Health Needs Recommendations ............................................................................................................. 23

Community Health Needs Implementation Strategy ................................................................................................... 24

Community Health Needs Assessment Marketing Plan .............................................................................................. 26

Appendix A- Hospital Services/Community Benefits ................................................................................................. 27

Appendix B Community Meeting Attendees ............................................................................................................... 29

Appendix C- Survey Form.......................................................................................................................................... 32

1

Introduction New requirements for nonprofit, 501 (c)(3), hospitals were enacted under the Patient Protection and Affordable Care Act (ACA), passed on March 23, 2010. One of the most significant of the new requirements is the Community Health Needs Assessment (CHNA) that must be conducted during taxable years after March 23, 2012 and submitted with IRS form 990. A CHNA must then be completed every three years following.

While the requirements are fairly new, the IRS has made strides in defining hospitals that must complete the CHNA as well as details of what is expected in the CHNA report to be submitted. At this time the only entities that must complete the CHNA are hospital organizations defined as:

An organization that operates a State-licensed hospital facility Any other organization that the Secretary determines has the provision of hospital care as

its principal function or purpose constituting the basis for its exemption under section 501 (c)(3).

The general goal behind the requirement is to gather community input that leads to recommendations on how the local hospital can better meet and serve residents’ needs. The community input is typically derived from a community survey and a series of open meetings. Local health data are presented. Community members then identify and prioritize their top health needs.

After listening to community input, the hospital defines an implementation strategy for their specific facility. The implementation strategy is a written plan that addresses each of the health needs identified in the community meetings. To meet Treasury and IRS guidelines an implementation strategy must:

Describe how the hospital facility plans to meet the health need, or Identify the health need as one the hospital facility does not intend to meet and

explain why the hospital facility does not intend to meet the health need1

After the needs are identified that the hospital can address, the implementation strategy must take into account specific programs, resources, and priorities for that particular facility. This can include existing programs, new programs, or intended collaboration with governmental, nonprofit, or other health care entities within the community.2

1 Internal Revenue Service. 2011. Notice and Requests for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals. Internal Revenue Bulletin: 2011-30. 2 Ibid

2

The facility must make the recommendations and implementation strategy widely available to community members. The facility must adopt the implementation strategy in that same taxable year.

Oklahoma Cooperative Extension and Oklahoma Office of Rural Health’s Roles The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service have transitioned the previous Community Health Engagement Process program to meet the needs of CHNA. The Community Health Engagement Process proved to be very successful during its nearly 20 year history of working with rural hospitals and healthcare providers to increase awareness of the local health sector.

This program is available to all rural facilities in Oklahoma free of charge. The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service work closely with the hospital and community members to develop an economic impact of the local health sector, develop and analyze a local health services survey, and gather and analyze local health data. The community meetings are facilitated by a resource team that includes Corie Kasier of the Oklahoma Office of Rural Health and Dr. Brian Whitacre and Lara Brooks of Oklahoma Cooperative Extension Service.

After the meetings conclude, the resource team assists the hospital in developing their implementation strategy. After implementation, the resource team will assist in evaluation of the strategies implemented and provide continued assistance with data and resources.

This document discusses the steps taken to conduct a CHNA for Memorial Hospital and Physician Group in 2014. It begins with a description of the hospital’s medical service area, including a demographic analysis, and then summarizes each meeting that took place during the CHNA process. The report concludes by listing the recommendations that came out of the process and presenting the hospital’s implementation strategy and marketing plan.

Memorial Hospital and Physician Group Medical Services Area Demographics Figure 1 displays the Memorial Hospital and Physician Group medical services area. Memorial Hospital and Physician Group and all area hospitals are delineated in the figure. The surrounding hospitals are identified in the table below by county along with their respective bed count.

3

As delineated in Figure 1, the primary medical service area of the Memorial Hospital and Physician Group includes the zip code area of Frederick, Davidson, Hollister, Loveland, and Manitou. The primary medical service area experienced a population decrease of 12.3 percent from the 1990 Census to the 2000 (Table 1). This same service area experienced another decrease of 16.8 percent from the 2000 Census to 2010.

City County Hospital No. of Beds Lawton Comanche Comanche County Memorial Hospital 283 Lawton Comanche Southwestern Medical Center 199 Mangum Greer Quartz Mountain Medical Center 25 Altus Jackson Jackson County Memorial Hospital 99 Hobart Kiowa Elkview General Hospital 38 Frederick Tillman Memorial Hospital and Physician Group 37

Wichita Falls, TX Wichita, TX Kell West Regional Hospital n/a Wichita Falls, TX Wichita, TX United Regional Health Care System n/a Vernon, TX Wilbarger, TX Wilbarger General Hospital n/a

4

The secondary medical services area is comprised of the zip code areas Chattanooga, Grandfield, Snyder, and Tipton. The secondary medical service area also experienced a decline in population from the 1990 to 2000 census of 6.5 percent followed by a decline of 4.7 percent from 2000 to 2010.

Table 1. Population of Memorial Hospital and Physician Group Medical Service Areas

1990 2000 2010 % Change % Change

Population by Zip Code Population Population Population 1990-2000 2000-2010

Primary Medical Service Area

73530 Davidson 800 567 442 -29.1% -22.0%

73542 Frederick 6,196 5,472 4,659 -11.7% -14.9% 73551 Hollister 127 91 65 -28.3% -28.6% 73553 Loveland 312 74 46 -76.3% -37.8% 73555 Manitou n/a 317 214 n/a -32.5%

Total 7,435 6,521 5,426 -12.3% -16.8%

Secondary Medical Service Area

73528 Chattanooga 483 566 680 17.2% 20.1%

73546 Grandfield 1,436 1,337 1,232 -6.9% -7.9% 73566 Snyder 1,858 1,786 1,674 -3.9% -6.3% 73570 Tipton 1,513 1,259 1,128 -16.8% -10.4%

Total 5,290 4,948 4,714 -6.5% -4.7%

SOURCE: Population data from the U.S. Bureau of Census, 1990, 2000, 2010 (March 2014)

Table 2 displays the current existing medical services in the primary service area of the Memorial Hospital and Physician Group medical services area. Most of these services would be expected in a community of Frederick’s size: doctors, dentist, home health and pharmacies are present. Memorial Hospital and Physician Group is a 37 bed facility located in Tillman County, Oklahoma. Services offered by Memorial Hospital and Physician Group include acute inpatient, observation, swing bed, laboratory, radiology, EKG, and respiratory are also available at Memorial Hospital and Physician Group. In terms of outpatient services, laboratory, radiology, pulmonary function test, physical therapy, and social services are a few of the services provided.

5

A complete list of hospital services and community involvement activities can be found in Appendix A.

Table 2. Existing Medical Services in Memorial Hospital and Physician Group Medical Services Area

Count Service 1 Memorial Hospital and Physician Group 1 Physician Office/Clinic 1 Dental Office 1 Optometrist Office 1 Chiropractic Office 2 Home Health Services 1 EMS service (Tillman County EMS) 1 Counseling Service 1 Health Department (Tillman County) 2 Pharmacies

In addition to examining the total population trends of the medical service areas, it is important to understand the demographics of those populations. Table 3 displays trends in age groups for the primary and secondary medical service areas as well as Tillman County in comparison to the state of Oklahoma. The age group of 45-64 has experienced an overall increase from 2000 to 2010 for all geographies listed. In particular, this cohort accounted for 27.2 percent of the primary medical service area and 27.6 percent of the secondary medical service area in 2010. This is compared to the state rate of 25.7 percent. The primary (17.0%) and secondary (18.1%) medical service area has a larger share of the over 65 population compared to the state (13.5%).

6

Changes in racial and ethnic groups can impact the delivery of healthcare services, largely due to language barriers and dramatically different prevalence rates for specific diseases, such as diabetes. A noticeable trend in Oklahoma is the growth in the Hispanic origin population. In 2010, those of Hispanic origin accounted for 8.9% of the total state population. This trend is evident in Tillman County with 22.3% of the local population of Hispanic Origin. When examining the zip code level trends, the primary medical service area had 23.8 percent of

Table 3. Percent of Total Population by Age for Memorial Hospital and Physician Group Medical Service Areas, Tillman County and Oklahoma

Primary Medical Service Area

Secondary Medical Service Area

Tillman County Oklahoma Age

Groups 2000 Census

0-14 21.2% 21.3% 21.1% 21.2% 15-19 8.2% 8.3% 8.2% 7.8% 20-24 4.5% 4.9% 4.5% 7.2% 25-44 24.3% 24.4% 24.0% 28.3% 45-64 22.4% 22.8% 22.8% 22.3% 65+ 19.4% 18.3% 19.4% 13.2% Totals 100.0% 100.0% 100.0% 100.0% Total

Population 6,521 4,948 9,287 3,450,654

2010 Census

0-14 19.8% 21.0% 20.2% 20.7% 15-19 7.4% 7.0% 7.2% 7.1% 20-24 5.4% 4.6% 5.0% 7.2% 25-44 23.3% 21.7% 22.5% 25.8% 45-64 27.2% 27.6% 27.3% 25.7% 65+ 17.0% 18.1% 17.8% 13.5% Totals 100.0% 100.0% 100.0% 100.0% Total

Population 5,426 4,714 7,992 3,751,351

SOURCE: U.S. Census Bureau, Census data for 2000 and 2010 (www.census.gov [March 2014]).

7

the local population reported as of Hispanic Origin compared to 14.7 percent of the secondary medical service area.

Table 4. Percent of Total Population by Race and Ethnicity for Memorial Hospital and Physician Group Medical Service Areas, Tillman County and Oklahoma

Primary Medical

Service Area Secondary Medical

Service Area Tillman County Oklahoma Race/Ethnic

Groups 2000 Census White 72.5% 81.1% 74.2% 74.1% Black 9.4% 6.9% 9.0% 7.5% Native American 1 2.7% 3.2% 2.7% 7.7%

Other 2 12.0% 6.7% 10.9% 1.5%

Two or more Races 3 3.4% 2.2% 3.1% 4.1%

Hispanic Origin 4 19.3% 12.0% 17.7% 5.2% Total Population 6,521 4,948 9,287 3,450,654

2010 Census White 73.3% 77.5% 73.5% 68.7% Black 8.7% 5.9% 7.7% 7.3% Native American 1 3.4% 3.6% 3.4% 8.2%

Other 2 11.7% 8.1% 11.4% 1.9%

Two or more Races 3 3.7% 4.9% 4.1% 5.1%

Hispanic Origin 4 23.8% 14.7% 22.3% 8.9% Total Population 5,426 4,714 7,992 3,751,351 SOURCE: U.S. Census Bureau, Census data for 2000 and 2010 (www.census.gov [March 2014]). 1 Native American includes American Indians and Alaska Natives. 2 Other is defined as Asian Americans, Native Hawaiians, Pacific Islanders and all others. 3 Two or more races indicate a person is included in more than one race group. 4 Hispanic population is not a race group but rather a description of ethnic origin; Hispanics are included in the five race groups.

8

AE-14003, The Economic Impact of the Health Sector on the Memorial Hospital and Physician Group Medical Service Area (30 pages)

Summary of Community Meetings Memorial Hospital and Physician Group hosted four community meetings between April

10, 2014 and June 18, 2014. The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service facilitated these meetings. Summaries of the information presented at each meeting are included below in chronological order.

Community members in attendance at these meetings included:

- Memorial Hospital and Physician Group Representatives

- Chamber of Commerce - Frederick Fire Department - Tillman County Health

Department

- Local Technology Center - Home Health Providers - Local Youth and Community

Coalition

Average attendance at the community meetings was 12-15 community members. Community members in attendance were sought out due to their deep understanding of the community’s needs and current situation, and those who touch many different populations, both racially and economically. The community members selected included representatives from the local healthcare industry, and community leaders such as the city manager and the mayor. Also, representatives from the largest local employers and the local school were included. Community members received a meeting request invite to attend each of the meetings.

Economic Impact and Community Health Needs Assessment Overview, April 10, 2014

A meeting was held to discuss the economic impact of the health sector and explain the process and need for the Community Health Needs Assessment. Report AE-14003 was reviewed at this meeting (and is summarized below).

Table 5 below summarizes the overall economic impact of the health sector on the Tillman County, Oklahoma economy. A representative from Memorial Hospital and Physician Group contacted health service entities in each of the sectors listed for the medical service area. Along with identifying each establishment, the hospital representative also gathered information on the number of FTE employees per establishment. When available, payroll information was also collected from the establishments. When payroll information was not available, payroll was estimated using state level averages from the Bureau of Labor Statistics.

9

The health sector in the Memorial Hospital and Physician Group medical service area employs 174 FTE individuals. After applying a county-specific employment multiplier to each respective sector, there is a total employment impact of 200 FTE employees. The same methodology is applied to income. The local health sector has a direct income impact of over $8.5 million. When the appropriate income multiplier is applied, the total income impact is over $9.4 million. The last two columns examine the impact this has on the retail sector of the local community. Recent data suggest that just 15.2% of personal income in Tillman County will be spent on taxable goods and services locally. Therefore, if we just examine the impact made on retail from those employed in the health sector, this would account for over $1.4 million spent locally, generating $14,414 on a 1% tax.

10

Table 5. Memorial Hospital and Physician Group Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax

Employment Income Retail 1 Cent

Health Sectors Employed Multiplier Impact Income Multiplier Impact Sales Sales Tax

Hospitals 108 1.15 125 $4,668,417 1.10 $5,152,891 $783,239 $7,832

Physicians, Dentists, & Other Medical Professionals 14 1.19 17 $1,139,854 1.12 $1,279,490 $194,482 $1,945

Home Health & Pharmacies 32 1.12 36 $1,884,096 1.09 $2,054,832 $312,334 $3,123

Other Medical & Health Services 20 1.14 23 $894,708 1.11 $995,576 $151,328 $1,513

Total 174

200 $8,587,075

$9,482,789 $1,441,384 $14,414 SOURCE: 2012 IMPLAN database, Minnesota IMPLAN Group, Inc.; Local data for employment, employee compensation and proprietor's income; income estimated based on state average incomes if local data not available

* Based on the ratio between Tillman County retail sales and income (15.2%) – from 2012 County Sales Tax Data and 2012 Personal Income Estimates from the Bureau of Economic Analysis.

11

AE-14014 Memorial Hospital and Physician Group Medical Service Area Survey Results (30 pages)

Community Survey Methodology and Results, April 10, 2014- May 13, 2014 A survey was designed to gauge hospital usage, satisfaction, and community health needs. The survey was available in both paper and web format. The paper surveys were distributed at the hospital and during the first community meeting on April 10, 2014.

Community members present at the hospital each took a survey, and many took extra surveys to distribute to friends, neighbors, and colleagues. The survey was also distributed from the hospital’s business office, the clinic, and hospital employees through their department directory. Surveys were also completed at the local health fair. A representative from the hospital also delivered surveys to some of the larger, more trafficked businesses in town. A copy of the survey form can be found in Appendix C. Community members were asked to return their completed surveys to Memorial Hospital and Physician Group. The electronic survey was first distributed on April

10, 2014. The survey link was emailed out to all employees who were encouraged to forward it on to family, friends, and neighbors. The survey link was also shared on the hospital’s Facebook page.

The survey ran from April 10, 2014 to May 2, 2014. A total of 388 surveys from Memorial Hospital and Physician Group

medical service area were completed. Of the surveys returned, 166 were electronic responses, and 222 were hard copy surveys. The survey results were presented at the May 13, 2014, community meeting. Report AE-14014 contains all survey results.

Table 6 below shows the survey respondent representation by zip code. The largest share of respondents was from the Frederick (73542) zip code. Tipton followed with 5.2 percent of the survey results, and Davidson had 2.8 percent of the survey respondents residing in the zip code area of 73530.

12

Table 6. Zip Code of Residence Response Category No. % 73542- Frederick

299 77.1%

73570- Tipton

20 5.2% 73530- Davidson

11 2.8%

73546- Grandfield

8 2.1% 73555- Manitou

8 2.1%

73528- Chattanooga

4 1.0% 73505-Lawton

4 1.0%

73551- Hollister

4 1.0% 73552- Indiahoma

4 1.0%

73684

5 1.3% 73566- Snyder

3 0.8%

73543- Geronimo

2 0.5% 73526-Blair

1 0.3%

73538-Elgin

1 0.3% 73540- Faxon

1 0.3%

73541- Fletcher

1 0.3% 73554- Mangum

1 0.3%

73559- Mountain Park

1 0.3% 73501-Lawton

1 0.3%

79252- Quanah, TX

1 0.3% 73465

1 0.3%

74542

1 0.3% 62035- Godfrey, IL

1 0.3%

No response

5 1.3% 388 100.0%

The survey focused on several health topics of interest to the community. Highlights of the results include:

Primary Care Physician Visits

- 73.2% of respondents had used a primary care physician in the Frederick service area during the past 24 months

- 87.2% of those responded being satisfied - Only 78 respondents or 20.1% believe there are enough primary care physicians

practicing in Frederick - 65.2% of the respondents would consider seeing a midlevel provider for their

healthcare needs

13

- 66.5% responded they were able to get an appointment with their primary care physician when they needed one

Specialist Visits

Summary highlights include:

- 55.7% of all respondents report some specialist visit in past 24 months - Most common specialty visited displayed in Table 7 - Only 4.6% of specialist visits occurred in Frederick

Table 7. Type of Specialist Visits

Type of Specialist No. Percent

Top 5 Responses

Cardiologist 35 12.6%

( 3 visits in Frederick)

OB/GYN 34 12.2%

(0 visits in Frederick)

Orthopedist 31 11.2%

(0 visits in Frederick)

Gastroenterologist 29 10.4%

(0 visits in Frederick)

Neurologist 20 7.2%

(0 visits in Frederick

All others 129 46.4%

(10 visits in Frederick)

Total 158 100.0%

Some respondents answered more than once.

Hospital Usage and Satisfaction

Survey highlights include:

- 80.2% of survey respondents that have used hospital services in the past 24 months used services at Memorial Hospital and Physician Group

o Comanche County Memorial Hospital, Lawton (10.7%) and Jackson County Memorial Hospital, Altus (1.4%) followed

o The most common response for using a hospital other than Memorial Hospital and Physician Group was availability of specialty care (36.0%)

14

59.7%

85.1%

80.2%

83.5%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

Hospital Usage

Hospital Satisfaction

Memorial Hospital and Physician Group Other OK Hospital Survey Averages

o The usage rate of 80.2% was significantly higher than the state average of 60.2% for usage of other rural Oklahoma hospitals surveyed

- 83.5% of survey respondents were satisfied with the services received at Memorial Hospital and Physician Group

o This is slightly below the state average for other hospitals (85.0%) - Most common services used at Memorial Hospital and Physician Group:

o Physician Services (24.1%) o Laboratory (23.7%)

Local Healthcare Concerns and Additional Services

Survey respondents were asked what concerns them most about healthcare in their community. The most common response was availability of lack of providers (18.4%) followed by availability of appointments (10.1%), no concerns/don’t know (9.3%), and losing the hospital/existing services (5.9%). Table 8 displays all responses and the frequencies.

Figure 2. Summary of Hospital Usage and Satisfaction Rates

15

Table 8. Top Healthcare Concerns in the Frederick Service Area Response Category No. % Lack of providers

75 18.4%

Availability of appointments

41 10.1% No Concerns/ Don't Know

38 9.3%

Losing the hospital/Existing services

24 5.9% Quality of care/Concern of misdiagnosis

22 5.4%

Care in the emergency room

12 2.9% Lack of specialists

10 2.5%

Confidentiality

7 1.7% Level of care provided

6 1.5%

Prescribe too much medication

6 1.5% Updated equipment/Facilities at hospital

5 1.2%

Glad to hear more providers are coming to town

4 1.0% Emergency care

3 0.7%

Community members bypassing local care

3 0.7% Government impact on healthcare

2 0.5%

Quality of care

2 0.5% Care for uninsured

2 0.5%

Poor feedback from others

2 0.5% Distance from services

2 0.5%

Insurance issues

1 0.2% Admissions desk fulfilling receptionist duties

1 0.2%

Delay in receiving test results

1 0.2% Provide affordable care

1 0.2%

Need more nursing center rooms

1 0.2% Lack of hospital pharmacy

1 0.2%

Lack of medical equipment

1 0.2% Lack of specialized testing equipment

1 0.2%

Need a pediatrician

1 0.2% Concerns with inpatient care

1 0.2%

Heart issues

1 0.2% Child safety

1 0.2%

Hospital

1 0.2% Funding

1 0.2%

Not aware of services 1 0.2% No response

126 31.0%

Total* 407 100.0% *Some respondents answered more than once. Average responses equal 1.05

16

Survey respondents also had the opportunity to identify what additional services they would like to see offered at Memorial Hospital and Physician Group. The most common response was no additional services or don’t know (12.1%) while some type of specialist (12.1%) followed. Within this category, OB/GYN had 20 responses, specialists in general had 8 responses, pediatrician also had 8 responses, and cardiologist had 4 responses. Table 9 displays the full listing of responses.

17

Table 9. Additional Services Survey Respondents Would Like to See Offered at Memorial Hospital and Physician Group

Response Category No. % More specialists: OB/GYN (20); Specialists in general (8); Pediatrician (8); Cardiologist (4); Otolaryngologist (3); Allergist (1); Surgeon (1); Pain Management (1); Mental Health (1) 51 12.1% No additional services/ Don't know

54 12.8%

More doctors/Physician Assistants/NPs/MDs

20 4.8% Improved quality of care/Improved ER care

14 3.3%

MRI

9 2.1% 24-hour medical care in ER/Physician staffed/More ER physicians 9 2.1% Urgent care for evenings/Weekend care

6 1.4%

More appointment availability

6 1.4% Mammography

5 1.2%

More community education: parenting classes, diabetes classes, etc. 4 1.0% 24-hour pharmacy

3 0.7%

Surgery

3 0.7% More staff

3 0.7%

Assisted living

2 0.5% Diabetic care/counseling

2 0.5%

Women's health

2 0.5% Don't use services/Not sure what is available

2 0.5%

Expanded nursing home services

2 0.5% Friendlier staff

2 0.5%

Dialysis

2 0.5% EKG

2 0.5%

Stress test

2 0.5% Ability to have more tests completed locally

2 0.5%

Addiction rehabilitation

2 0.5%

18

Table 9 Continued. Additional Services Survey Respondents Would Like to See Offered at Memorial Hospital and Physician Group

Response Category No. % Sonogram

1 0.2%

Speech therapy

1 0.2% CT Scan

1 0.2%

Nursery care

1 0.2% Wound care

1 0.2%

Wellness programs

1 0.2% Advanced pharmacy

1 0.2%

Advanced physical therapy

1 0.2% Swim therapy

1 0.2%

Live psychiatric consults

1 0.2% Physicians with experience with dementia, Alzheimer's

1 0.2%

Updated facilities/Equipment

1 0.2% Psychiatric evaluations

1 0.2%

Extensive home health services

1 0.2% More physical therapists

1 0.2%

Cataract removal

1 0.2% Expanded clinic hours

1 0.2%

More food options in cafeteria

1 0.2% More clinic services

1 0.2%

Health clinics

1 0.2% Expanded education for nursing

1 0.2%

Cancer treatment

1 0.2% More advanced technology

1 0.2%

More critical care

1 0.2% Rape kits

1 0.2%

All they can afford

1 0.2% Well cleaned areas

1 0.2%

Free special screenings

1 0.2% No response

184 43.7%

Total* 421 100.0% *Some respondents answered more than once. Average number of responses equal 1.09

19

AE-14009, An Analysis of the Demand for Primary Care Physicians in the Frederick, Oklahoma, Medical Service Area (11 pages)

Primary Care Physician Demand Analysis, May 13, 2014 A demand analysis of primary care physicians was completed for

the zip codes that comprise the Memorial Hospital and Physician Group primary and secondary medical services areas (report AE-14009). This analysis examined average primary care physician visit rates by gender and by age groups. Once age- and gender-specific coefficients were applied, total primary care physician visit numbers were calculated by service area. Table 10 displays potential primary care physician rates by shares of service area. For example, if 90% of residents in the primary medical services area and 10% of residents in the secondary medical services area utilize services of primary care physicians in the Memorial Hospital and Physician Group medical services area, a total of 10,396 annual visits would occur. This would suggest that the Memorial Hospital and Physician Group medical services area would need 2.5 FTE primary care physicians to meet the needs of their existing population. Table 10 displays the estimated number of visits by share of medical services area.

Table 10. Primary Care Physician Office Visits Given Usage by Local Residents in the Frederick, Oklahoma Medical Service Areas

Usage by Residents of Primary Service Area

70% 75% 80% 85% 90% 95% 100%

Usa

ge b

y R

esid

ents

of S

econ

dary

Se

rvic

e A

rea

5% 7,826 8,351 8,877 9,402 9,928 10,453 10,979 10% 8,294 8,820 9,345 9,871 10,396 10,922 11,447 15% 8,762 9,288 9,813 10,339 10,864 11,390 11,916 20% 9,231 9,756 10,282 10,807 11,333 11,858 12,384 25% 9,699 10,224 10,750 11,276 11,801 12,327 12,852 30% 10,167 10,693 11,218 11,744 12,269 12,795 13,320 35% 10,635 11,161 11,687 12,212 12,738 13,263 13,789 40% 11,104 11,629 12,155 12,680 13,206 13,731 14,257 45% 11,572 12,098 12,623 13,149 13,674 14,200 14,725 50% 12,040 12,566 13,091 13,617 14,142 14,668 15,194

If 90% primary medical service area and 10 to 15% secondary medical service area, then the usage would be: 10,396 to 10,864 total primary care physician office visits in the Frederick area

for an estimated 2.5 to 2.6 Total Primary Care Physicians.

(Based on 83.7 average weekly primary care physician visits with a 50 week year)

20

AE-13142, Economic Data, Health/Behavioral Data, Education Data, Traffic Accident Data, and Crime Data for Tillman County and the State of Oklahoma (60 pages)

AE-14015, Memorial Hospital and Physician Group Medical Service Area Health Indicators and Outcomes (22 pages)

Health Data, May 27, 2014 A community meeting was held May 27, 2014, to

examine various sources of local health data in addition to the community survey results. Data were presented from the Tillman County Data and Information Report (AE-13142). Health Data were also presented from the Memorial Hospital and Physician Group Medical Service Area Health Indicators and Outcomes Report (AE-14015).

Various sources of health data were examined including data from the County Health Rankings and Roadmaps Program through the University of Wisconsin Population Health Institute, and the Robert Woods Johnson Foundation. The County Health Rankings program evaluates and ranks counties based on two distinct areas: Health Factors and Health Outcomes. Along with

these two areas counties receive an overall rank within their state; therefore 1=best and 77=worst.

Health factors, considered tomorrow’s health, are comprised of health behaviors (rank: 25), clinical care (rank: 55), social and economic factors (rank: 52), and physical environment (rank: 61). Tillman County’s overall health factors rank is 47. This suggests, in general, the health status of Tillman County residents is fairly similar to that of neighboring counties. However, some areas of concern remain. In particular, Tillman County’s smoking rate, adult obesity rate, food environment index (a combination of distance and income as an ability to purchase food), access to exercise opportunities, and the teen birth rate are all less desireable than the top U.S. performers. Also, the rate of uninsured individuals, the number of preventable hospital stays, and the share of Medicare recipients receiving diabetic screenings, are all areas of concern in Tillman County. All health factors variables are presented in Table 11 along with Tillman County specific data, the top U.S. performers, and the state average. The bold italicized categories are the areas identified by the County Health Rankings and Roadmaps as areas to explore (generally where Tillman County ranks very poorly compared to the national benchmark). A more detailed report on Tillman County’s health factors and outcomes can be found in AE-14015.

21

Table 11. Health Factors (Overall Rank 47)

Category (Rank) Tillman County

Error Margin

Top U.S. Performers Oklahoma

Health Behaviors (25) Adult Smoking 18% 11-28% 14% 24%

Adult Obesity 34% 27-41% 25% 32%

Food Environment Index 6.3 8.7 7.1

Physical Inactivity 33% 26-40% 21% 31% Access to Exercise Opportunities 8% 85% 64%

Excessive Drinking 10% 13% Alcohol-Impaired Driving Deaths 38% 14% 34% Sexually Transmitted Infections 323 123 385 Teen Birth Rate 74 62-86 20 55

Clinical Care (55) Uninsured 25% 23-27% 11% 22%

Primary Care Physicians 2,015:1 1,051:1 1,597:1 Dentists 2,696:1 1,439:1 1,891:1 Mental Health Providers 1,156:1 536:1 438:1 Preventable Hospital Stays 118 100-136 46 77

Diabetic Screening 73% 61-85% 90% 78%

Mammography Screening 55% 43-68% 71% 55% Social & Economic Factors (52) High School Graduation 74% 78%

Some College 51% 41-60% 70% 58% Unemployment 4.7% 4.4% 5.2% Children in Poverty 32% 23-41% 13% 24% Inadequate Social Support 14% 20% Children in Single-Parent Household 32% 21-44% 20% 33% Violent Crime Rate 373 64 479 Injury Deaths 91 64-125 49 83 Physical Environment (61) Air-Pollution- Particulate Matter 9.8 9.5 10.3 Drinking Water Violations 88% 0% 18%

Severe Housing Problems 12% 7-16% 9% 14% Driving Alone to Work 78% 73-84% 71% 82% Long Commute- Driving Alone 29% 22-35% 15% 24%

22

Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute; Robert Wood Johnson Foundation

The following figure depicts each county’s rank by shade. Tillman County’s overall health factors ranking is comparable to many of the neighboring counties. This is accurately depicted in the image.

In terms of health outcomes, considered, today’s health, Tillman County’s ranking is 52nd in the state. Health outcomes are comprised of two areas: length of life and quality of life. The variables for each of these sections are presented in Table 12.

Table 12. Health Outcomes (Overall Rank 52)

Category (Rank) Tillman County

Error Margin

Top U.S. Performers Oklahoma

Length of Life (33)

Premature Death 9,629 7,083-12,175 5,317 9,291

Quality of Life (33) Poor or Fair Health 23% 15-34% 10% 19% Poor Physical Health Days 6.8 4.1-9.4 2.5 4.3 Poor Mental Health Days 6.3 3.2-9.4 2.4 4.2 Low Birth Weight 7.7% 5.9-9.6% 6.0% 8.3% Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute; Robert Wood Johnson Foundation

23

The following figure shows county health outcomes rankings by shades. Tillman County fares more favorably than Kiowa County in terms of health outcomes, but lags, Cotton, Comanche, and Jackson Counties.

Community Health Needs Recommendations Following the presentation of the health data on May 27, 2014, county data and information report, and the community survey results, community members were then asked to identify their top concerns from evaluating the data, survey results, and their experience within the community. A discussion among meeting attendees followed, with many different observations/concerns raised. The top health concerns identified were as follows:

Priority of well child visits o Medicaid patients

Increased childhood obesity and adult obesity o Live to eat not eat to live mentality o High cost and availability of healthy foods

There is a summer feeding program for school children (18 and under)- breakfast and lunch- transportation is available through Red River Transportation

Lack of physical activity Assisted living facility (something for elderly population before nursing care) Lack of mental health providers

o Utilizing tele-mental health program

24

Dialysis o Closest facility is in Altus or Lawton

Community Health Needs Implementation Strategy During the June 18, 2014, meeting, hospital representatives and community members discussed how these concerns can be addressed. The following lists the concerns along with steps the hospital and community plan to take to remedy the situation.

Priority of well child visits (Medicaid patient) o This item was previously identified as a priority; however, after further discussion

in the community meeting, this item was not included as a priority with implementation steps.

Increased childhood obesity and adult obesity o The county Extension office provides nutrition education through the local after

school program to youth. The local health department also has a nutrition educator that provides an after school nutrition program.

o In terms of adults, the health department’s nutrition program mainly targets WIC patients and family planning patients with high a BMI.

o Live to eat not eat to live mentality o High cost and availability of healthy foods

There is a summer feeding program for school children (18 and under)- breakfast and lunch- transportation is available through Red River Transportation

There is currently a “Bountiful Baskets” program offered at the local courthouse.

A family sells seasonal fruits and vegetables in Frederick. Lack of physical activity

o The local health coalition hosts the “Wagon Wheel 5K.” This is a local 5K that encourages physical fitness.

o Community members also discussed the possibility of applying for TSET funding for a local fit trail.

Assisted living facility (something for elderly population before nursing care) o A few years ago research into expansion of the existing nursing home were

evaluated. It was decided at the time to not expand. Today there are currently 11 vacancies in the nursing home.

o It was mentioned that Laverne, Oklahoma, recently opened an assisted living facility. Community members present would like more information about the funding and set up of their current facility.

Lack of mental health providers

25

o The hospital is currently utilizing tele-health services for consults. o SW Youth Services currently has a site in Frederick to assist with youth and

adolescents. o While questions were still raised pertaining to adult referrals, it was mentioned

that there is the possibility of a facility in Altus that could provide this service. o It was discussed that many people could be leaving the community not only to

search for services, but also to help ensure anonymity. Dialysis

o Closest facility is in Altus or Lawton o During the community discussion, it was noted that a second facility will soon be

opening in Altus. o OSU Cooperative Extension Service and the Oklahoma Office of Rural Health

will also be completing a renal dialysis demand analysis to be finished in July 2014.

Teen pregnancy, Infant mortality, and Tobacco use o These three items were added at the June 18 meeting as priorities previously

identified through the local health coalition. o In terms of current implementation, there is currently an 8th grade health fair that

covers STD and birth control education. The health department also offers a 12 week teen pregnancy educational component. This program must first be approved by local education administration.

o In terms of infant mortality, prenatal care is not offered in Tillman County as Memorial Hospital does not have labor and delivery services.

o Current health department- related implementation activities include: sleep safety education (period of purple crying), health department car seat safety check and free car seats, and there is currently a social worker position open in SW OK to focus solely on the issue of infant mortality.

o Tobacco use has been a topic of both the local health coalition and local health providers. The hospital and clinic provide information to patients who would like to quit using tobacco through the hotline (1-800-QUIT-NOW). Resources are available to hospital and clinic personnel to be trained to go through the “5 A’s” with patients. This is a billable service.

26

Community Health Needs Assessment Marketing Plan The hospital will make the Community Health Needs Assessment Summary and

Implementation Strategy Plan available upon request at Memorial Hospital and Physician Group, and a copy will be available to be downloaded from the hospital’s website (www.frederickhospital.org). This document will also be available on the Oklahoma Rural Health Works website (www.okruralhealthworks.org)

27

Appendix A- Hospital Services/Community Benefits

28

29

Appendix B Community Meeting Attendees

Frederick Community Health Needs Assessment Economic Impact and Process Overview 10-Apr-14

First Name Last Name Title Organization Kerri Jacobs Clinic Supervisor Frederick Medical Clinic Ralph Washburn Director of TCEMS MHDPG Tammy Crosswhite CNO Memorial Hospital Ricky Coleman LTC Administrator Memorial Nursing Center Crystal Whitson RN, Branch Manager Aspire Home Health James Heap Fire Chief Frederick Fire Department Gary Tyler Assistant Superintendent Great Plains Technology Center Ronnie Cross Plant Manager Henniges Dennie Christian Accreditation Coordinator Greer County HD Shaina C. Turning Point Consultant OK Department of Health Shannon Vanderburg Superintendent Frederick Public Schools Kallie Clemmer RN Tillman County HD April Collam Health Educator Tillman County HD

Sharon Bennet Community Volunteer Tillman County Youth Health Coalition

Haley Hoover Director Frederick Chamber of Commerce Ryan Ade Fitness Club Owner Downtown Fitness Cindy Duncan CEO Memorial Hospital Lara Brooks Extension Associate OSU Corie Kaiser Director OK Office of Rural Health

30

Frederick Community Health Needs Assessment Survey Results and Physician Study

13-May-14 First

Name Last

Name Title Organization

Sharon Benett Volunteer Tillman Co Youth & Community Coalition

Georgia Jackson

Chamber Haley Hoover Chamber Director Chamber Kallie Clemmer RN Tillman Co Health Dept. Gary Tyler Asst. Supt Great Plains Tech Center Ryan Ade Physical Therapist Memorial Hospital James Heap Fire Chief Frederick Fire Dept. Ricky Coleman Admin, LTC Memorial Nursing Center Cindy Duncan CEO Memorial Hospital Crystal Whitson RN, Branch Mgr. Aspire Home Health Kerri Jacobs Office Mgr Frederick Medical Clinic

Shaina Cherilus Turning Point Consultant OKSDH

Robert Johnston City Manger City of Frederick Lara Brooks Extension Associate OSU Corie Kaiser Director OK Office of Rural Health

Frederick Community Health Needs Assessment Health Data Presentation and Health Priority Identification 27-May-14 First Name Last Name Title Organization Gary Taylor Assistant Superintendent Great Plains Technology Center Greg Howard Chiropractor

Ronnie Cross Plant Manager Henniges Automotive James Heap Fire Chief Frederick Fire Department Kerri Jacobs Office Manager Frederick Medical Clinic Ricky Coleman LTC Administrator Memorial Nursing Center Cindy Duncan CEO Memorial Hospital Crystal Whitson RN, Branch Manager Aspire Home Health Sharon Bennett Volunteer Tillman Co. Youth & Health Coalition April Collons Health Educator Tillman Co. Health Department Lara Brooks Extension Associate OSU Corie Kaiser Director OK Office of Rural Health

31

Frederick Community Health Needs Assessment Health Priority Discussion 18-Jun-14

First Name Last Name Title Organization Cindy Duncan CEO Memorial Hospital Ralph Washburn Director Memorial Hospital Tammy Crosswhite CNO Memorial Hospital Kerri Jacobs Clinic Manager Frederick Medical Clinic Crystal Whitson RN, Branch Manager Aspire Home Care

Robin Teel RN, Director of Clinical Services Aspire Home Care

Carol Hart FCS, 4H Educator Tillman Co. Extension

Sharon Bennett Volunteer Tillman Co. Youth & Health Coalition

Dennie Christian Turning Point OSDH Kallie Clemmer RN Tillman Co. Health Department Haley Hoover Chamber Director Frederick Chamber of Commerce Ricky Coleman LNHA Memorial Nursing Center Lara Brooks Extension Associate OSU Corie Kaiser Director OK Office of Rural Health

32

Appendix C- Survey Form

33