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Stroud Regional Medical Center 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

Jessica Riggin, Lincoln County Extension Director, Chandler 405-258-0560

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

December 2014

Table of Contents

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

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

Stroud Regional Medical Center Medical Services Area Demographics ..................................................... 2

Table 1. Population of Stroud Regional Medical Center Medical Service Area .................................. 4

Table 2. Existing Medical Services in the Stroud Regional Medical Center Medical Services Area ... 5

Table 3. Percent of Total Population by Age Group for Stroud Regional Medical Center Medical Service Areas, Lincoln County and Oklahoma ..................................................................................... 6

Table 4. Percent of Total Population by Race and Ethnicity for Stroud Regional Medical Center Medical Service Areas, Lincoln County and Oklahoma ....................................................................... 7

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

Economic Impact and Community Health Needs Assessment Overview, October 30, 2014................... 8

Table 5. Stroud Regional Medical Center Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax ................................................................. 10

Health Data, November 6, 2014.............................................................................................................. 11

Table 6. Health Factors (Overall Rank 43) ........................................................................................ 12

Table 7. Health Outcomes (Overall Rank 30) .................................................................................... 13

Community Survey Methodology and Results, October 25- November 18, 2014 ................................. 14

Table 8. Zip Code of Residence ......................................................................................................... 16

Table 9. Type of Specialist Visits ....................................................................................................... 17

Figure 2. Summary of Hospital Usage and Satisfaction Rates ........................................................... 18

Table 10. Top Healthcare Concerns in the Stroud Area .................................................................... 19

Table 11. Additional Services Survey Respondents Would Like to See Offered at Stroud Regional Medical Center .................................................................................................................................... 20

Primary Care Physician Demand Analysis, November 18, 2014 ........................................................... 21

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Stroud, Oklahoma Medical Service Areas ....................................................................................................... 21

Community Health Needs Implementation Strategy .................................................................................. 22

Community Health Needs Assessment Marketing Plan ............................................................................. 25

Appendix A- Hospital Services/Community Benefits ................................................................................ 26

Appendix B Community Meeting Attendees .............................................................................................. 28

Appendix C- Survey Form ......................................................................................................................... 30

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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

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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 Stroud Regional Medical Center 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.

Stroud Regional Medical Center Medical Services Area Demographics Figure 1 displays the Stroud Regional Medical Center medical services area. Stroud Regional Medical Center 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.

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As delineated in Figure 1, the primary medical service area of the Stroud Regional Medical Center includes the zip code area of Stroud, Milfay, Chandler, Sparks, and Davenport. The primary medical service area experienced a population increase of 14.3 percent from the

City County Hospital No. of Beds Bristow Creek Bristow Medical Center 30 Drumright Creek Drumright Regional Hospital 15 Sapulpa Creek St. John Sapulpa, Inc. 25 Prague Lincoln Prague Community Hospital 25 Stroud Lincoln Stroud Regional Medical Center 25

Okemah Okfuskee Creek Nation Community Hospital 25 Cushing Payne Hillcrest Hospital Cushing 99 Stillwater Payne Stillwater Medical Center 117 Shawnee Pottawatomie CNG Cornerstone Hospital of Oklahoma 34 Shawnee Pottawatomie St. Anthony Shawnee Hospital 102 Seminole Seminole INTEGRIS Seminole Medical Center 32

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1990 Census to the 2000 Census (Table 1). This same service area experienced another population increase of 3.0 percent from the 2000 Census to 2010.

The secondary medical services area is comprised of the zip code areas Depew, Paden, and Agra. The secondary medical service area experienced a decrease in population of 14.1 percent from 1990 to 2000 followed by a population increase of 10.1 percent from 2000 to 2010.

Table 1. Population of Stroud Regional Medical Center Medical Service Area

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

Primary Medical Service Area

74079 Stroud 4,898 4,896 4,504 0.0% -8.0%

74046 Milfay n/a n/a 115 n/a n/a 74834 Chandler 6,506 6,896 7,590 6.0% 10.1% 74869 Sparks 330 599 710 81.5% 18.5% 74026 Davenport n/a 1,019 896 n/a -12.1%

Total 11,734 13,410 13,815 14.3% 3.0%

Secondary Medical Service Area

74028 Depew 2,224 1,799 1,881 -19.1% 4.6%

74860 Paden 1,508 1,496 1,653 -0.8% 10.5% 74824 Agra 1,327 1,052 1,253 -20.7% 19.1%

Total 5,059 4,347 4,787 -14.1% 10.1%

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

Table 2 displays the current existing medical services in the primary service area of the Stroud Regional Medical Center medical services area. Most of these services would be expected in a service area of Stroud’s size: 7 physician offices and clinics, 3 dental offices, 2 optometry offices, 1 chiropractic office, 2 nursing homes, 3 home health providers 1 hospice provider, 3 EMS providers, a county health department, 2 mental health providers, and 2 pharmacies. Stroud Regional Medical Center is a 25 bed critical access facility located in Lincoln County, Oklahoma. A few of the services offered by Stroud Regional Medical Center acute inpatient services, observation, swing bed, laboratory, radiology including CT, MRI, and

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Ultrasound, wound care, and Telemedicine. Stroud Regional Medical Center provides outpatient services such as physicals, physical therapy, ultrasounds, BCA-eye care, and dermatology. A complete list of hospital services and community involvement activities can be found in Appendix A.

Table 2. Existing Medical Services in the Stroud Regional Medical Center Medical Services Area

Count Service 1 Stroud Regional Medical Center 7 Physician offices and clinics 3 Dental offices 2 Optometry offices 1 Chiropractic office 2 Nursing Homes 3 Home health providers 1 Hospice provider 3 EMS providers 1 County health department 2 Mental health providers 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 Lincoln 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 27.7 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. In terms of population over the age of 65, the primary (15.9%) and secondary (15.6%) medical service area has a larger share compared to the state average (13.5%).

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Table 3. Percent of Total Population by Age Group for Stroud Regional Medical Center Medical Service Areas, Lincoln County and Oklahoma


Secondary Medical Service Area

Lincoln County Oklahoma Age

Groups 2000 Census

0-14 21.3% 22.0% 22.0% 21.2% 15-19 8.7% 8.3% 8.3% 7.8% 20-24 4.9% 5.6% 5.0% 7.2% 25-44 25.8% 25.9% 26.7% 28.3% 45-64 23.7% 25.0% 24.1% 22.2% 65+ 15.7% 13.3% 13.9% 13.3% Totals 100.0% 100.0% 100.0% 100.0% Total

Population 13,410 4,347 32,080 3,450,654

2010 Census

0-14 20.9% 21.0% 20.8% 20.7% 15-19 7.3% 8.1% 7.2% 7.1% 20-24 5.2% 5.4% 5.0% 7.2% 25-44 23.1% 22.2% 22.9% 25.8% 45-64 27.7% 27.6% 28.8% 25.7% 65+ 15.9% 15.6% 15.3% 13.5% Totals 100.0% 100.0% 100.0% 100.0% Total

Population 13,815 4,787 34,273 3,751,351

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

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 not as evident in the Stroud medical service area and Lincoln County. For example, those of Hispanic Origin account for 2.4 percent of the total population in the primary medical service area, 2.3 percent of the secondary medical service area, and 2.4 percent of Lincoln

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County’s population. In terms of racial break outs, there are really no significant differences between the five racial groups in the primary and secondary medical service areas compared to the state.

Table 4. Percent of Total Population by Race and Ethnicity for Stroud Regional Medical Center Medical Service Areas, Lincoln County and Oklahoma


Secondary Medical Service

Area

Lincoln County Oklahoma Race/Ethnic

Groups 2000 Census White 85.0% 81.3% 86.4% 76.2% Black 4.1% 2.8% 2.5% 7.6% Native American 1 6.6% 10.9% 6.6% 7.9%

Other 2 0.8% 0.4% 0.7% 2.4%

Two or more Races 3 3.5% 4.7% 3.8% 4.5% Hispanic Origin 4 1.6% 1.0% 1.5% 5.2% Total Population 13,410 4,347 32,080 3,450,654

2010 Census White 85.7% 81.0% 85.9% 72.2% Black 2.8% 2.5% 1.8% 7.4% Native American 1 5.8% 9.6% 6.5% 8.6%

Other 2 0.9% 0.6% 0.8% 4.1%

Two or more Races 3 4.8% 6.2% 5.1% 5.9% Hispanic Origin 4 2.4% 2.3% 2.4% 8.9% Total Population 13,815 4,787 34,273 3,751,351 SOURCE: U.S. Census Bureau, Census data for 2000 and 2010 (www.census.gov [October 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.

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AE-14121, The Economic Impact of the Health Sector on the Stroud Regional Medical Center Medical Service Area (30 pages)

Summary of Community Meetings Stroud Regional Medical Center hosted four community meetings between October 30,

2014 and December 3, 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:

- Stroud Regional Medical Center Representatives

- CREOKS representative

- Lincoln County Health Department

- Home health - City officials

Average attendance at the community meetings was 9 community members. The entire Stroud community was invited to participate in the needs assessment. An open invitation was sent to the Stroud Chamber of Commerce distribution list. Open meeting invitations were also published twice in the Lincoln County News and four times in the Stroud American newspapers.

Economic Impact and Community Health Needs Assessment Overview, October 30, 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-14121 was reviewed at this meeting (and is summarized below).

Table 5 below summarizes the overall economic impact of the health sector on the Lincoln County, Oklahoma economy. A representative from Stroud Regional Medical Center 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.

The health sector in the Stroud Regional Medical Center medical service area employs 386 FTE individuals. After applying a county-specific employment multiplier to each respective sector, there is a total employment impact of 462 FTE employees. The same methodology is

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applied to income. The local health sector has a direct income impact of nearly $17.7 million. When the appropriate income multiplier is applied, the total income impact is over $20 million. The last two columns examine the impact this has on the retail sector of the local community. Recent data suggest that just 15.7% of personal income in Lincoln 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 nearly $3.1 million spent locally, generating $31,408 on a 1% tax.

At the conclusion of the meeting, community members were asked to identify their top health concerns based on the demographic information presented and their local expertise. The following concerns were identified:

Transportation Specialists- Pediatrician in particular Community engagement (between health sector and community) Behavioral health- lack of qualified workforce

o Transportation for behavioral health patients (Due to transportation limitations, behavioral health counselors have to make home visits for patients.)

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Table 5. Stroud Regional Medical Center 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 49 1.28 63 $1,920,343 1.13 $2,179,113 $342,121 $3,421

Physicians, Dentists, & Other Medical Professionals 63 1.29 81 $4,305,073 1.14 $4,888,768 $767,537 $7,675

Nursing Homes 142 1.14 162 $4,805,016 1.12 $5,388,595 $846,009 $8,460

Home Health 30 1.12 34 $1,598,544 1.10 $1,764,139 $276,970 $2,770

Other Medical & Health Services 91 1.19 108 $4,344,696 1.14 $4,968,108 $779,993 $7,800

Pharmacies 11 1.25 14 $725,964 1.12 $816,323 $128,163 $1,282

Total 386

462 $17,699,636

$20,005,045 $3,140,792 $31,408 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 Lincoln County retail sales and income (15.7%) – from 2013 County Sales Tax Data and 2012 Personal Income Estimates from the Bureau of Economic Analysis.

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AE-14079, Economic Data, Health/Behavioral Data, Education Data, Traffic Accident Data, and Crime Data for Lincoln County and the State of Oklahoma (45 pages)

AE-14123, Stroud Regional Medical Center Medical Service Area Health Indicators and Outcomes (23 pages)

Health Data, November 6, 2014 A community meeting was held November 6, 2014, to

examine various sources of local health data in addition to the community survey results. Data were presented from the Lincoln County Data and Information Report (AE-14079). Health Data were also presented from the Stroud Regional Medical Center Medical Service Area Health Indicators and Outcomes Report (AE-14123).

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: 42), clinical care (rank: 45), social and economic factors (rank: 36), and physical environment (rank: 72). Lincoln County’s overall health factors rank is 43. This suggests, in general, the health status of Lincoln County residents is somewhat comparable or less favorable to that of neighboring counties. Areas of concern include Lincoln County’s smoking rate, adult obesity rate, physical inactivity rate and county resident’s access to exercise opportunities are all less desireable than the top U.S. performers. Also, the rate of uninsured individuals, the county populaiton ratio to primary care physicians, the number of preventable hospital stays, and the share of Medicare recipients receiving mammography screenings, are all areas of concern in Lincoln County. All health factors variables are presented in Table 6 along with Lincoln 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 Lincoln County ranks very poorly compared to the national benchmark). A more detailed report on Lincoln County’s health factors and outcomes can be found in AE-14123.

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Table 6. Health Factors (Overall Rank 43)

Category (Rank) Lincoln County

Error Margin

Top U.S. Performers Oklahoma

Health Behaviors (42) Adult Smoking 27% 22-33% 14% 24%

Adult Obesity 32% 27-37% 25% 32%

Food Environment Index 7.5 8.7 7.1 Physical Inactivity 44% 38-50% 21% 31%

Access to Exercise Opportunities 24% 85% 64%

Excessive Drinking 11% 6-18% 10% 13% Alcohol-Impaired Driving Deaths 30% 14% 34% Sexually Transmitted Infections 278 123 385 Teen Birth Rate 46 67-81 20 55 Clinical Care (45) Uninsured 22% 20-24% 11% 22%

Primary Care Physicians 3,795:1 1,051:1 1,597:1

Dentists 3,799:1 1,439:1 1,891:1 Mental Health Providers 795:1 536:1 438:1 Preventable Hospital Stays 89 79-98 46 77

Diabetic Screening 82% 74-89% 90% 78% Mammography Screening 46% 39-53% 71% 55%

Social & Economic Factors (36) High School Graduation 78% 78%

Some College 49% 44-54% 70% 58%

Unemployment 5.1% 4.4% 5.2% Children in Poverty 25% 19-30% 13% 24% Inadequate Social Support 21% 17-27% 14% 20% Children in Single-Parent Household 29% 24-34% 20% 33% Violent Crime Rate 147 64 479 Injury Deaths 95 81-110 49 83 Physical Environment (72) Air-Pollution- Particulate Matter 10.4 9.5 10.3 Drinking Water Violations 56% 0% 18%

Severe Housing Problems 11% 10-13% 9% 14% Driving Alone to Work 81% 79-84% 71% 82% Long Commute- Driving Alone 46% 42-50% 15% 24%

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

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The following figure depicts each county’s rank by shade. Lincoln County’s overall health factors ranking is less favorable than Payne and Logan Counties but is comparable to Creek and Pottawatomie Counties.

In terms of health outcomes, considered, today’s health, Lincoln County’s ranking is 30th 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 7.

Table 7. Health Outcomes (Overall Rank 30)

Category (Rank) Lincoln County

Error Margin

Top U.S. Performers Oklahoma

Length of Life (31)

Premature Death 9,517 8,306-10,728 5,317 9,291

Quality of Life (38) Poor or Fair Health 18% 15-22% 10% 19% Poor Physical Health Days 4.7 3.7-5.7 2.5 4.3 Poor Mental Health Days 4.5 3.3-5.6 2.4 4.2 Low Birth Weight 8.0% 7.0-9.0% 6.0% 8.3% Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute; Robert Wood Johnson Foundation

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The following figure shows county health outcomes rankings by shades. Lincoln County’s rank is less favorable than Payne and Logan Counties but is comparable to Oklahoma County. However, Lincoln County’s rank is more favorable than Creek, Pottawatomie, and Seminole Counties.

At the conclusion of the meeting, community members were once asked to identify what health concerns stand out in the data the presented and their local expertise. The health concerns identified include:

Mental health- availability of psychiatrist and psychologists Need for a pediatrician Lack of local specialists in general for patients

o Patients having to travel to OKC or Tulsa for specialists visits Transportation for physician and specialist visits Available parks and walking trails do not have lighting or are not safe Coordination of care between local primary care physicians and specialists in metro areas Lack of on-call primary care physicians

o Patients then have to use the ER which in turn creates a coordination of care concern

Community Survey Methodology and Results, October 25- November 18, 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 October 30, 2014. The electronic survey link was emailed out to community members immediately following the October 30th meeting. Community members present at the meeting each took a survey, and

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AE-14128 Stroud Regional Medical Center Medical Service Area Survey Results (30 pages)

many took extra surveys to distribute to friends, neighbors, and colleagues. The survey was also made available at the local health fair on October 25. Hard copy surveys were delivered to two local pharmacies, a nursing center in Chandlers, a physician’s office, Wellston Senior Citizens’ Center, Wellston Family Medical Clinic and Pharmacy, Davenport Senior Citizens’ Center, and the public school in Davenport. The electronic survey link was made available on the hospital’s website. The survey link was shared with the Stroud

Chamber of Commerce and then forwarded to the Chambers in Chandler, Prague, Bristow, Cushing, and Drumright since the medical service area touches parts of these communities. A copy of the survey form can be found in Appendix C. Community members were asked to return their completed surveys to Stroud Regional Medical Center.

The survey ran from October 25, 2014 to November 14, 2014. A total of 79 surveys from the Stroud Regional Medical Center medical service area were completed. Of the surveys returned, 16 were electronic responses, and 63 were hard copy surveys. The survey results were presented at the November 18, 2014, community meeting. Report AE-14128 contains all survey results.

Table 8 below shows the survey respondent representation by zip code. The largest share of respondents was from the Stroud (74079) zip code with 45 responses or 57.0 percent of the total. Davenport followed with 10 respondents, and Chandler had 8 respondents.

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Table 8. Zip Code of Residence Response Category No. % 74079- Stroud

45 57.0%

74026- Davenport

10 12.7% 74834- Chandler

8 10.1%

74881- Wellston

3 3.8% 74023- Cushing

2 2.5%

74028- Depew

2 2.5% 74840- Earlsboro

1 1.3%

74864- Prague

1 1.3% 74137- Tulsa

1 1.3%

90503- Torrance, CA

1 1.3% 74804- Shawnee

1 1.3%

74074- Stillwater

1 1.3% 74030- Drumright

1 1.3%

73099- Yukon

1 1.3% No Response

1 1.3%

Total 79 100.0% The survey focused on several health topics of interest to the community. Highlights of the results include:

Primary Care Physician Visits

- 64.6% of respondents had used a primary care physician in the Stroud service area during the past 24 months

- 94.1% of those responded being satisfied - Only 15 respondents or 19.0% believe there are enough primary care physicians

practicing in Stroud - 73.4% of the respondents would consider seeing a midlevel provider for their

healthcare needs - 73.4% responded they were able to get an appointment with their primary care

physician when they needed one

Specialist Visits

Summary highlights include:

- 53.2% of all respondents report some specialist visit in past 24 months - Most common specialty visited are displayed in Table 9 - Only 11.4% of specialist visits occurred in Stroud

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Table 9. Type of Specialist Visits

Type of Specialist No. Percent

Top 5 Responses

Cardiologist 8 11.4%

(2 visits in Stroud)

Orthopedist 7 10.0%


OB/GYN 6 8.6%


Primary Care/Internal Med 5 7.1%

(1 visit in Stroud)

Dermatologist 4 5.7%


All others 40 57.1%


Total 70 100.0%

Some respondents answered more than once.

Hospital Usage and Satisfaction

Survey highlights include:

- 61.0% of survey respondents that have used hospital services in the past 24 months used services at Stroud Regional Medical Center

o OU Medical Center in Oklahoma City (6.8%) and Mercy Hospital in Oklahoma City (5.1%) followed

o The most common response for using a hospital other than Stroud Regional Medical Center was availability of specialty care (43.5%) and physician referral (30.4%)

o The usage rate of 61.0% was slightly lower than the state average of 62.0% for usage of other rural Oklahoma hospitals surveyed

- 83.3% of survey respondents were satisfied with the services received at Stroud Regional Medical Center

o This is below the state average for other hospitals (85.5%) - Most common services used at Stroud Regional Medical Center:

o Laboratory (28.7%) o Diagnostic Imaging (20.2%)

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62.0%

85.5%

61.0%

83.3%

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

Hospital Usage

Hospital Satisfaction

Stroud Regional Medical Center Other OK Hospital Survey Averages

Figure 2. Summary of Hospital Usage and Satisfaction Rates

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Local Healthcare Concerns and Additional Services

Survey respondents were asked what concerns them most about healthcare in their community. The most common response was lack of providers/retaining providers/aging providers (18.9%) followed by no concerns/don’t know (10.0%), access to specialists (including pediatricians, orthopedists, dermatologists, endocrinologists, and cardiologists) which accounted collectively for 7.8 percent of the total. Table 10 displays all responses and the frequencies.

Table 10. Top Healthcare Concerns in the Stroud Area Response Category No. % Lack of providers/Retaining providers/Aging providers

17 18.9%

No Concerns/ Don't Know

9 10.0%

Access to specialists: Pediatricians (2); Orthopedist (1); Dermatologist (1); Endocrinologist (1); Cardiologist (1) 7 7.8% Quality of care/Expertise

7 7.8%

Long wait to get an appointment/Long wait to see physician 4 4.4% Lack of services/Services need to be expanded

3 3.3%

Capabilities/Dependability of hospital

3 3.3% Cost of care

2 2.2%

Misperceptions from previous experiences

2 2.2% Emergency health care services

2 2.2%

Having to leave town for services

2 2.2% EMS Services/Paramedic Availability

1 1.1%

Staying up-to-date

1 1.1% Acceptance of more types of insurance

1 1.1%

Availability of equipment (Open MRI, vascular equipment) 1 1.1% Possibility of losing hospital/physicians

1 1.1%

Receiving test results, good or bad

1 1.1% Many people leave town for services

1 1.1%

No response

25 27.8% Total* 90 100.0%

*Some respondents answered more than once. Average responses equal 1.14

Survey respondents also had the opportunity to identify what additional services they would like to see offered at Stroud Regional Medical Center. The most common response was specialists (17.7 %). Within this category, pain management had 5 responses, specialists in general had 2 responses, pediatrician had 2 responses, and podiatrist had 2 responses. MRI (5.2%) was the next most common response followed by some no additional services/don’t know (4.2%). Table 11 displays the full listing of responses.

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Table 11. Additional Services Survey Respondents Would Like to See Offered at Stroud Regional Medical Center

Response Category No. % Specialists: Pain Management (5); Specialists in general (2); Pediatrician (2); Podiatrist (2); Nephrologist (1); Neurologist (1); Dermatologist (1); OB/GYN (1); Pulmonologist (1); Expanded specialist visits (1) 17 17.7% MRI

5 5.2%

No additional services/ Don't know

4 4.2% More physicians in general

3 3.1%

Mammography

2 2.1% Prenatal care

2 2.1%

Host educational events/Weight Watchers

` 2 2.1% Birthing services

2 2.1%

Surgery

1 1.0% Ultrasounds

1 1.0%

Mental health services

1 1.0% Respiratory therapy

1 1.0%

Confidentiality

1 1.0% Nutritionist/Nutrition education

1 1.0%

Respite care

1 1.0% Cardiovascular health screenings

1 1.0%

DEXA scan

1 1.0% Sleep study

1 1.0%

Transportation for disabled residents to local clinics 1 1.0% Aquatic physical therapy services

1 1.0%

Wellness

1 1.0% Expanded lab

1 1.0%

Acceptance of Humana

1 1.0% Additional Medicare Providers

1 1.0%

Improved ER services

1 1.0% No response

42 43.8%

Total* 96 100.0% *Some respondents answered more than once. Average number of responses equal 1.22

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AE-14127, An Analysis of the Demand for Primary Care Physicians in the Stroud, Oklahoma, Medical Service Area (11 pages)

Primary Care Physician Demand Analysis, November 18, 2014 A demand analysis of primary care physicians was completed for

the zip codes that comprise the Stroud primary and secondary medical services areas (report AE-14127). 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 12 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 Stroud Regional Medical Center medical services area, a total of 24,911 annual visits would occur. This would suggest that the Stroud Regional Medical Center medical services area would need 6.0 FTE primary care physicians to meet the needs of their existing population. Table 12 displays the estimated number of visits by share of medical services area.

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Stroud, 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% 19,120 20,453 21,786 23,119 24,452 25,785 27,118 10% 19,579 20,912 22,245 23,578 24,911 26,244 27,577 15% 20,038 21,371 22,704 24,037 25,370 26,703 28,036 20% 20,497 21,830 23,163 24,495 25,828 27,161 28,494 25% 20,955 22,288 23,621 24,954 26,287 27,620 28,953 30% 21,414 22,747 24,080 25,413 26,746 28,079 29,412 35% 21,873 23,206 24,539 25,872 27,205 28,538 29,871 40% 22,332 23,665 24,998 26,331 27,663 28,996 30,329 45% 22,790 24,123 25,456 26,789 28,122 29,455 30,788 50% 23,249 24,582 25,915 27,248 28,581 29,914 31,247

If 90% primary medical service area and 10 to 15% secondary medical service area, then the usage would be: 24,911 to 25,370 total primary care physician office visits in the

Stroud area for an estimated 6.0 to 6.1 Total Primary Care Physicians.

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

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At the conclusion of the meeting, community members were once again asked what stood out to them from the survey results and physician demand analysis as health concerns. The following concerns were identified:

Apathy- Lack of participation/engagement from community members Marketing opportunities

o Inform service area of available services and specialties Expanding insurance coverage

o Tricare o HealthChoice

Mental health- both providers and services o Increased marketing of existing providers (some at no cost)

BOLTS Program- Behavioral Occupational Life Training Skills o Available for local manufacturing employees, but available to the entire

community for no cost o Topics include: living in balance, thinking for a change, color session (4 different

personality groups, identifying how they work together) Aging population

o In the process of building an assisted living facility that should be open by November 1 and will be located east of nursing home in Stroud.

Community Health Needs Implementation Strategy During the December 3, 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.

Transportation o Including transportation for behavioral health patients (Due to transportation

limitations, behavioral health counselors have to make home visits for patients). o Transportation for physician and specialist visits o Sooner Ride is available in the community (First Capital Trolley from Guthrie

services the area as well). This is largely open to the population receiving Medicaid benefits and requires a 3-day advance scheduling.

o COEDD in Shawnee provides limited transportation services for the elderly population that reside in southern Lincoln County who are visiting a physician in Pottawatomie County.

o The hospital is looking into options to provide a van service for patients who are being released from the hospital without a ride home.

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o In terms of transportation to specialist visits outside of Stroud, the hospital is working on marketing of existing specialty services and looking to expand services to help alleviate travel needs of patients.

Specialists o Pediatrician was mentioned at more than one meeting o Patients have to travel to OKC or Tulsa for specialist visits o Marketing opportunity for hospital to market available services and current

specialties available o The hospital currently has dermatology, OB/GYN, ophthalmology, ultrasounds,

cardiology, wound care, physical therapy, and a general surgeon in terms of specialty services.

o The hospital is looking to expand in the areas of pain management, speech therapy, occupational therapy and pediatrics.

o By increasing marketing and expanding services, this can assist with some of the transportation issues and coordination of care concerns.

Community engagement (between health sector and community), apathy o While this concern was echoed from various community members, the hospital

plans to continue to focus on providing quality of care and continue to offer services needed by the community to meet the needs of the community.

Mental health/behavioral health o Transportation issue- strained workforce o One provider (CREOKS) recently moved outside of the Lincoln County during

the needs assessment process. This will further reduce the number of providers in the county.

o The hospital currently makes referrals to CREOKS and Red Rock. o Availability of psychiatrists and psychologists- According to recent Area

Resource File data, there are no psychiatrist or psychologist located in Lincoln County.

o The hospital currently has telemedicine services and has an agreement with OU Medical, but telepsych is not one of the services offered. The resource team will place the hospital in touch with the OSU Center for Rural Health’s Telehealth team to explore further expansion options.

o BOLTS Program- Behavioral Occupational Life Training Skills Available for local manufacturing employees, but available to the entire

community for no cost. It is offered on-site at the local Service King manufacturing facility.

An open house at the facility is scheduled for December through the local Chamber of Commerce that is open to the community and Chamber members.

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Topics include: living in balance, thinking for a change, color session (4 different personality groups, identifying how they work together)

Availability of parks and walking trails o Existing parks and trails do not have lighting or are viewed as not safe o Stroud is currently a Certified Healthy Community and has successfully adopted a

city ordinance that restricts smoking in and on city owned property (both inside and outdoors). This can provide the City of Stroud opportunities for wellness grants.

o The hospital would like to develop a lighted walking trail on the hospital’s campus which would ensure community members that hospital personnel would be available and potentially offer services to those who come to exercise.

Coordination of care between local primary care physicians and specialists in metro areas o This concern was previously mentioned along with transportation and availability

of specialists in Stroud. With increased marketing of existing services and expansion of specialist offerings, this could help in coordination of care with local primary care physicians.

o Also, the increased use of electronic medical records and an increased number of providers utilizing a health information exchange in the near future can also ease the issue of coordination of care.

Lack of on-call primary care physicians o Patients then have to use the ER which in turn creates a coordination of care

concern o There is now a physician who makes hospital rounds in the same manner as a

hospitalist which enables more physicians to admit to the local hospital. o However, with aging/retiring physicians, this problem could arise again in the

near future due to lack of providers. o The resource team will connect the hospital to the director of rural medical

education at OSU Center for Health Sciences to see about the possibility of rural medical student rotations in Stroud.

Expanding insurance coverage o Tricare and HealthChoice o The hospital already accepts both health coverage plans. Also, local providers are

now able to accept these insurance/health coverage options. Aging population

o In the process of building an assisted living facility that should be open by November 1 and will be located east of nursing home in Stroud

o There are plans in the community to further explore senior/retirement housing options such as duplexes or cottages. The hope is to have these located near the assisted living facility and nursing home facility in order to make transitioning easier for residents.

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

Implementation Strategy Plan available upon request at Stroud Regional Medical Center, and a copy will be available to be downloaded from the hospital’s website (www.stroudhospital.com). This document will also be available on the Oklahoma Rural Health Works website (www.okruralhealthworks.org).

http://www.okruralhealthworks.org/

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Appendix A- Hospital Services/Community Benefits

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Appendix B Community Meeting Attendees Stroud Community Health Needs Assessment

Economic Impact Presentation 30-Oct-14

First Name Last Name Title Organization

Jan Neufeld Finance Director/City Clerk City of Chandler

Leanette Raffety Admin. Generalist Stroud Regional Medical Center

DeAnna Ukena Area Manager CREOKS CREOKS

Tommy Smith CEO Stroud Regional Medical Center

Mikeal Murray Accreditation Coord. Lincoln County Health Department

Tammie McElroy Asst DON, ER Sup. Stroud Regional Medical Center

JoAn Miller LPN, Case Manager Stroud Regional Medical Center

Lara Brooks Extension Associate OSU Extension

Rod Hargrave FLEX Coord. OK Office of Rural Health

Stroud Community Health Needs Assessment

Health Data Presentation 6-Nov-14

First Name Last Name Title Organization

Clara Hodgens Chairman SHDA


DeAnna Ukena Area Manager CREOKS CREOKS


Mikeal Murray Accreditation Coord. Lincoln County Health Department

Leo Young Personal Dev. Specialist SKM

Tammy Smith Director of Operation Amedisys Home Health

Lisa Sanders AVP of BD Amedisys Home Health

Clint Stockton Account Executive Amedisys Home Health

Donna Buchanan DON Stroud Regional Medical Center

Jennifer Nunn Health Educator Lincoln County Health Department

Lara Brooks Extension Associate Oklahoma Cooperative Extension Service

Corie Kaiser Director Oklahoma Office of Rural Health

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Survey Results and Primary Care Physician Demand Analysis Presentation

18-Nov-14 First Name Last Name Title Organization

Clara Hodgens Chairman SHDA



Lincoln County Health Department





Health Priority Discussion and Implementation Plan

3-Dec-14 First Name Last Name Title Organization





Fred Eilrich Extension State Specialist Oklahoma Cooperative Extension Service

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Appendix C- Survey Form

AE-14131 - Amazon Web Services...AE-14131 Stroud Regional Medical Center Community Health Needs...

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