Table of Contents

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

Oklahoma Office of Rural Health Partnership .......................................................................................... 2

Previous Community Health Needs Assessment- Priorities, Implementation, and Evaluation .................... 3

Jackson County Memorial Hospital Medical Services Area Demographics ................................................ 5

Figure 1. Jackson County Memorial Hospital Service Areas ............................................................... 6

Table 1. Jackson County Memorial Hospital Medical Service Area Population ................................. 8

Table 2. Existing Medical Services in the Jackson County Memorial Hospital Medical Services Area .............................................................................................................................................................. 9

Table 3. Percent of Total Population by Age Group for Jackson County Memorial Hospital Medical Service Areas, Jackson County and Oklahoma ................................................................................... 10

Table 4. Percent of Total Population by Race and Ethnicity for Jackson County Memorial Hospital Medical Service Areas, Jackson County and Oklahoma .................................................................... 11

Summary of Community Meetings ............................................................................................................. 12

Economic Impact and Community Health Needs Assessment Overview, September 16, 2015 ............ 12

Table 5. Jackson County Memorial Hospital Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax ................................................................. 12

Health Data, September 30, 2015 ........................................................................................................... 13

Table 6. Health Factors (Overall Rank 30) ........................................................................................ 14

Table 7. Health Outcomes (Overall Rank 42) .................................................................................... 15

Community Survey Methodology and Results, September 16- October 14, 2015 ................................. 16

Table 8. Zip Code of Residence ......................................................................................................... 17

Table 9. Type of Specialist Visits ....................................................................................................... 18

Figure 2. Summary of Hospital Usage and Satisfaction Rates ........................................................... 19

Table 10. Top Concerns in the Altus Area ......................................................................................... 20

Table 11. Additional Services Survey Respondents Would Like to See Offered At Jackson County Memorial Hospital .............................................................................................................................. 21

Primary Care Physician Demand Analysis, October 14, 2015 ............................................................... 22

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Altus, Oklahoma Medical Service Area ........................................................................................................ 22

Community Health Needs Implementation Strategy .................................................................................. 23

Community Health Needs Assessment Marketing Plan ............................................................................. 24

Appendix A- Hospital Services/Community Benefits ................................................................................ 25

Appendix B Community Meeting Attendees .............................................................................................. 26

Appendix C- Meeting 1 Materials, September 16, 2015 ........................................................................... 28

Appendix D- Meeting 2 Materials, September 30, 2015 ........................................................................... 31

Appendix E- Survey Form and Meeting 3 Materials, October 14, 2015 ................................................... 34

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 Office of Rural Health Partnership

The Oklahoma Office of Rural Health makes this program available to all rural facilities in Oklahoma free of charge. The Oklahoma Office of Rural Health works 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 and Lara Brooks of the Oklahoma Office of Rural Health.

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 Jackson County Memorial Hospital in 2015. 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, and concludes with the implementation strategy and marketing plan.

3

Previous Community Health Needs Assessment- Priorities, Implementation,

and Evaluation

Jackson County Memorial Hospital worked in collaboration with the Oklahoma State Department of Health through the MAPP process to complete their first Community Health Needs Assessment in 2012. The hospital adopted the priorities identified through the MAPP process along with hospital-specific implementation steps. The following identifies each priority and implementation steps taken. This information was revisited and presented at the first Community Health Needs Assessment Meeting on September 16, 2015. The priorities and actions listed were accessed from the Jackson County Memorial Hospital website.

1)Diabetes-The JCMH Diabetes Center is recognized by the American Diabetes Association for providing diabetes education. Participants include Type I, Type II, and gestational diabetes. The Diabetes Center is staffed by a Registered Nurse and a Registered Dietitian. · The program objective is to empower patients with self-management techniques through realistic education and counseling. · Appointments are generated by a primary care physician referral. · Financial assistance is offered to all patients citing financial difficulty. The JCMH Diabetes Center of Excellence staff also educates hospital inpatients The JCMH Diabetes Center of Excellence staff provides a free, monthly Diabetes Support Group with topics including nutrition, self-management, foot care, eye health. Health Screenings Free screenings are provided throughout the county and southwest Oklahoma as requested by organizations and events that include blood sugar, blood pressure, cholesterol screening, and body mass Index measurements. An annual “Healthy Heart” screening with a full lipid panel and A1-C blood test is offered in February for $15. Results are mailed to participants’ home address and to the physician identified at registration. Registered Nurses and a Registered Dietitian staff the screening event with provide free educational material and consultation.

2) Cancer Center-Jackson County Memorial Hospital and The JCMH Campus of the Cancer Centers of Southwest Oklahoma provide free screenings to people in Jackson County and southwest Oklahoma. · Skin Cancer screening · Prostate screening · Lung Cancer screening for high risk smokers · Colon screening take-home kits The Patient Protection and Affordability Care Act of 2010 provides insured individuals · Screening colonoscopy · Screening mammogram with no deductible or co-payment to the insured. Jackson County Memorial Hospital Jackson County Memorial Hospital has two board certified surgeons on staff who perform screening colonoscopies as well as general surgical procedures that include gastro and abdominal surgery. The Cancer Centers of Southwest Oklahoma The Cancer Centers of Southwest Oklahoma is a partnership between Jackson County Memorial Hospital, Comanche County Memorial Hospital, Jackson County Memorial Hospital 2013 Community Health Needs Assessment Implementation Strategy 5 and Duncan Regional Hospital. The center on the JCMH Campus opened in 2008 and provides cancer care including cancer research and clinical trials. An advanced team of medical oncologists, radiation oncologists, radiation therapists, and registered nurses staff the three centers. Jackson County Tobacco Education Committee Jackson

4

County Tobacco Education Committee (JCTEC) is a subcommittee of Jackson County Community Health Action Team (JCCHAT) developed to counter the tobacco influence in Jackson County. JCTEC is funded as a “Community of Excellence” community through an initiative of Oklahoma Tobacco Settlement Endowment Trust. JCTEC is comprised of many community sectors from the county. These sectors include business, government, faith-based, education, healthcare, media, law enforcement, public health, organizations serving youth, substance abuse organizations, disparate population-based organizations, and concerned citizens. JCMH includes the Oklahoma Tobacco Helpline, 1-800-Quit Now, link on its website and has available printed educational material to patients and visitors. JCMH is a tobacco free campus inside and out. It adopted a tobacco-free policy in 2008. It applies to all hospital buildings and vehicles, and to staff, patients, and visitors.

3) Heart Disease and Stroke- JCMH treats approximately 100 stroke patients per year. The JCMH Emergency Department is a primary stroke center through the Oklahoma State Department of Health since 2011. Qualifications for a Stroke Center are to perform a CT scan and have results within 45 minutes of the patient’s arrival to the hospital or 45 minutes of beginning of symptoms for an inpatient. Performance Improvement oversight is conducted on stroke-patient charts to ensure the CT results and the TPA began within the first hour. JCMH adapted protocols to ensure treatment meets standards and protocols. Educational hand out information is given to patients in ED. Signs of a stroke: F- facial droop A- arm weakness S- speech difficulty T- time essential to get help Heart disease is triaged the Emergency Department for chest pain or symptoms of a Myocardial Infarction. An EKG is performed within 10 minutes of arrival. If indicated, Thrombolytic is given within 30 minutes. Critical patients are transferred to a cardiac facility immediately. Free health screenings are provided throughout the county and southwest Oklahoma as requested by organizations and events that include blood sugar, blood pressure, cholesterol screening, and Body Mass Index measurements. An annual “Healthy Heart” screening with a full lipid panel and A1-C blood test is offered in February for $15. Results are mailed to participants’ home address and to the physician identified at registration. Registered Nurses and a Registered Dietitian staff the screening event and provide free educational material and consultation. To quickly and accurately diagnose and treat patients with Congestive Heart Failure, JCMH created a specialized team to educate patients on managing CHF at home. Details include consuming a low sodium diet and maintaining fluid restriction as directed by the physician. Performing daily weights and to report a weight gain of greater than 2 pounds in one day or greater than 5 pounds in one week. Patients are encouraged to take their prescribed medications and to keep all scheduled physician appointments. Patients and their families receive education about the daily “Zones of Heart Failure Management,” which detail symptoms that the patient might be experiencing and instruct accurate and timely responses.

Awareness of Community Outreach

A question was included on the community survey (complete methodology detailed on page 16) to gauge survey respondents’ awareness of current community programs offered by the

5

hospital. Forty-nine or 22.2 percent of the total respondents indicated they were aware of community programs offered by the hospital. When asked to list the programs, the top response was diabetes education/outreach/awareness/support groups with 28.9 percent of the total. Homecare and hospice (10.5%), Health fair/screenings (9.2%), and Dietary classes (5.3%) followed. The complete listing is included in the following table.

Please list community programs:

Response Category No. % Diabetes education/Outreach/Awareness/Support groups 22 28.9% Homecare and Hospice

8 10.5%

Health fair/Screenings

7 9.2% Dietary classes

4 5.3%

JCCHAT

4 5.3% Cancer support group

4 5.3%

Rehabilitation/Physical therapy

3 3.9% Counseling

2 2.6%

Prenatal classes

2 2.6% Involvement in fundraisers, community boards

2 2.6%

Smoking cessation

2 2.6% Free clinic

2 2.6%

Alzheimer's at Tamarack

1 1.3% WIC

1 1.3%

5K run

1 1.3% Cooking classes

1 1.3%

Kids' University Nutrition

1 1.3% School BMI project

1 1.3%

CHP team

1 1.3% In-services by providers

1 1.3%

Dialysis

1 1.3% CPR

1 1.3%

Blood pressure

1 1.3% Volunteer program

1 1.3%

Grief counseling

1 1.3% Charity care

1 1.3%

Total 76 100.0%

Jackson County Memorial Hospital Medical Services Area Demographics

Figure 1 displays the Jackson County Memorial Hospital medical services area. Jackson County Memorial Hospital 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.

6

Figure 1. Jackson County Memorial Hospital Service Areas

7

As delineated in Figure 1, the primary medical service area of Jackson County Memorial Hospital includes the zip code area of Altus, Martha, Olustee, Blair, Sweetwater, Mangum, Duke, Medicine Park, Granite, and Hollis. The primary medical service area experienced a decline in population from 2000 Census to the 2010 Census of 5.1 percent. This same service area experienced another decrease of 1.4 percent from the 2010 Census to the latest available, 2009-2013, American Community Survey.

The secondary medical services area is comprised of the zip code areas Sentinel, Hobart, Lone Wolf, Willow, Leedey, Mountain Park, Snyder, Headrick, Elmer, Gould, Vinson, Dodson, TX, Childress, TX, and Vernon, TX. The secondary medical service area experienced a decrease in population of 6.7 percent from 2000 to 2010 followed by another population decrease of 0.2 percent from 2010 to the 2009-2013 American Community Survey.

City County Hospital

No. of

Beds

Sayre Beckham Sayre Memorial Hospital, Inc. 31 Carnegie Caddo Carnegie Tri-County Municipal Hospital 17 Lawton Comanche Comanche County Memorial Hospital 283 Lawton Comanche Southwestern Medical Center 199 Mangum Greer Quartz Mountain Medical Center 25 Hollis Harmon Harmon Memorial Hospital 25 Altus Jackson Jackson County Memorial Hospital 99 Hobart Kiowa Elkview General Hospital 38 Frederick Tillman Memorial Hospital and Physician Group 37 Cordell Washita Cordell Memorial Hospital 25 Childress, TX Childress, TX Childress Regional Medical Center n/a Wellington, TX Collingsworth, TX Collingsworth General Hospital 13 Quanah, TX Hardeman, TX Hardeman County Memorial Hospital n/a 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 Vernon, TX Wilbarger, TX North Texas State Hospital n/a

8

Table 1. Jackson County Memorial Hospital Medical Service Area Population

2000 2010 2009-2013 % Change % Change Population by Zip Code Population Population Population 2000-2010 2010-09-13 Primary Medical Service

Area

73521 Altus 23,130 21,636 21,812 -6.5% 0.8%

73556 Martha 311 166 173 -46.6% 4.2% 73560 Olustee 881 829 609 -5.9% -26.5% 73526 Blair 2,264 2,133 2,095 -5.8% -1.8% 73666 Sweetwater 103 180 189 74.8% 5.0% 73554 Mangum 3,528 3,614 3,466 2.4% -4.1% 73532 Duke 643 600 513 -6.7% -14.5% 73557 Medicine Park 417 427 302 2.4% -29.3% 73547 Granite 2,205 2,319 2,269 5.2% -2.2% 73550 Hollis 2,780 2,512 2,504 -9.6% -0.3%

Total 36,262 34,416 33,932 -5.1% -1.4%

Secondary Medical Service Area

73664 Sentinel 1,086 1,184 1,167 9.0% -1.4% 73651 Hobart 4,433 4,268 4,345 -3.7% 1.8% 73655 Lone Wolf 1,054 864 735 -18.0% -14.9% 73673 Willow 335 319 352 -4.8% 10.3% 73564 Leedey 593 551 483 -7.1% -12.3% 73559 Mountain Park 524 540 604 3.1% 11.9% 73566 Snyder 1,786 1,674 1,662 -6.3% -0.7% 73549 Headrick 337 296 406 -12.2% 37.2% 73539 Elmer 229 218 177 -4.8% -18.8% 73544 Gould 315 268 242 -14.9% -9.7% 73571 Vinson 125 87 126 -30.4% 44.8% 79230 Dodson, TX 182 158 189 -13.2% 19.6% 79201 Childress, TX 7,682 7,040 7,166 -8.4% 1.8% 76384 Vernon, TX 13,963 12,991 12,748 -7.0% -1.9%

Total 32,644 30,458 30,402 -6.7% -0.2%

SOURCE: Population data from the U.S. Bureau of Census, Decennial Census 2000, 2010 and American Community Survey 2009-2013(July 2015)

Table 2 displays the current existing medical services in the primary service area of the Jackson County Memorial Hospital medical services area. Most of these services would be expected in a service area of Altus’s size: 3 physician offices and clinics, 4 dental offices, 5

9

optometry offices, 2 chiropractic offices, 2 nursing homes, 1 home health provider, Jackson County Health Department, 1 physical therapy provider, 5 counseling and mental health providers, and 6 pharmacies. Jackson County Memorial Hospital is a 99 bed hospital located in Jackson County. The hospital also has provider clinics, home health and hospice, rehabilitative services, a counseling center, and Tamarack Assisted Living. The hospital provides acute inpatient services, a 24/7 emergency department, an outpatient medical clinic with family practice, general surgery, podiatry and nephrology services. The hospital also has a cancer center, a counseling center, and a Diabetes Center of Excellence. A complete list of hospital services and community involvement activities can be found in Appendix A.

Table 2. Existing Medical Services in the Jackson County Memorial Hospital Medical

Services Area

Count Service

1 Hospital: Jackson County Memorial Hospital 3 Physician offices 4 Dental offices 5 Optometry offices 2 Chiropractic offices 2 Nursing Homes 1 Home health provider 1 Physical therapy provider 5 Counseling and mental health providers 1 County Health Department: Jackson County 6 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 Jackson County in comparison to the state of Oklahoma. Overall, the over 65 age group accounts for a larger share of the local population when compared to the state rate, according to the 2009-2013 American Community Survey. This cohort accounted for 13.8 percent of the total population at the state level. This is compared to 14.0 percent of the population of the primary medical service area, 15.7 percent of the secondary medical service area, and 13.1 percent of Jackson County. The 45-64 age group accounts for a sizeable share of the population in the primary (24.2%) and secondary (26.5%) service areas and Jackson County (24.1%). This is compared to the state share of 25.5 percent of the total population.

10

Table 3. Percent of Total Population by Age Group for Jackson County Memorial

Hospital Medical Service Areas, Jackson County and Oklahoma

Primary Medical Service Area

Secondary Medical Service Area

Jackson County Oklahoma Age

Groups 2010 Census

0-14 20.8% 19.5% 21.7% 20.7% 15-19 7.0% 7.3% 7.4% 7.1% 20-24 7.3% 6.6% 7.7% 7.2% 25-44 26.3% 24.1% 25.7% 25.8% 45-64 24.8% 26.3% 24.5% 25.7% 65+ 13.8% 16.2% 12.9% 13.5% Totals 100.0% 100.0% 100.0% 100.0%

Total Population 34,416 30,458 26,446 3,751,351

09-13 ACS

0-14 20.9% 19.9% 22.0% 20.7% 15-19 6.5% 7.3% 6.6% 6.9% 20-24 8.0% 6.2% 8.4% 7.3% 25-44 26.5% 24.4% 25.8% 25.8% 45-64 24.2% 26.5% 24.1% 25.5% 65+ 14.0% 15.7% 13.1% 13.8% Totals 100.0% 100.0% 100.0% 100.0%

Total Population 33,932 30,402 26,280 3,785,742

SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2009-2013 (www.census.gov [August 2015]).

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 percent of the total state population. The latest American Community Survey data of 2009-2013 suggest that this population group has experienced an increase to 9.1 percent of the total population. This trend is

11

evident in Jackson County and both medical service areas. The share of the population identified as of Hispanic Origin accounted for 19.9 percent of the primary medical service area’s population in 2009-2013 and 21.0 percent of the secondary medical service area during the same time period. This population group accounts for 21.4 percent of Jackson County’s population.

Table 4. Percent of Total Population by Race and Ethnicity for Jackson County Memorial

Hospital Medical Service Areas, Jackson County and Oklahoma

Primary Medical

Service Area Secondary Medical

Service Area Jackson County Oklahoma Race/Ethnic

Groups 2010 Census White 74.3% 80.1% 72.8% 72.2% Black 7.6% 7.2% 7.5% 7.4%

Native American 1 2.0% 1.8% 1.8% 8.6%

Other 2 11.6% 8.0% 13.0% 5.9% Two or more Races 3 4.6% 2.9% 4.9% 5.9% Hispanic Origin 4 19.5% 21.4% 20.9% 8.9% Total Population 34,416 30,458 26,446 3,751,351

09-13 ACS White 76.3% 82.8% 76.4% 73.5% Black 7.3% 7.2% 7.0% 7.2% Native American 1 1.8% 2.0% 1.3% 7.0%

Other 2 8.1% 5.3% 7.6% 4.5% Two or more Races 3 6.5% 2.7% 7.5% 7.8% Hispanic Origin 4 19.9% 21.0% 21.4% 9.1% Total Population 33,932 30,402 26,280 3,785,742 SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2009-2013 (www.census.gov [August 2015]). 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.

12

Summary of Community Meetings

Jackson County Memorial Hospital hosted four community meetings between September 16, 2015 and October 28, 2015. The Oklahoma Office of Rural Health 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:

Jackson County Memorial Hospital representatives

City of Altus City council Jackson County Health

Department

Oklahoma Turning Point Oklahoma Department of

Human Services Red Rock The local Community Action

Agency

Average attendance at the community meetings was 6-17 community members. Community members were invited to attend the Community Health Needs Assessment meetings through postings on the Jackson County Memorial Hospital Facebook page, and an article was placed in the Altus Times. Local health coalition members (JCCHAT, Jackson County Community Health Action Team) were emailed before each meeting and encouraged to invite members of the community they serve. This representation is through various groups including: Salvation Army, pregnancy centers, public health, homeless shelters, and volunteer programs. Significant efforts were made to include and obtain information from representatives of the local public health sector, and community members who had great knowledge of health concerns facing low-income and racially diverse populations.

Economic Impact and Community Health Needs Assessment Overview, September 16,

2015

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. The economic impact of the health sector was reviewed at this meeting (and is summarized below).

Table 5 below summarizes the overall economic impact of the health sector on the Jackson County, Oklahoma economy. A form requesting information was sent to all health care providers in the medical service area. Local providers were asked to share their employment levels and of those employees how many were physicians/optometrists/dentists/pharmacists/etc. 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 Jackson County Memorial Hospital medical service area employs 1,207 FTE individuals. After applying a county-specific employment multiplier to each respective sector, there is a total employment impact of 1,660 FTE employees. The same

11

methodology is applied to income. The local health sector has a direct income impact of nearly $67.4 million. When the appropriate income multiplier is applied, the total income impact is over $84.2 million. The last two columns examine the impact this has on the retail sector of the local community. Recent data suggest that just 28.8% of personal income in Jackson 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 $24.2 million spent locally, generating $242,526 on a 1% tax. A copy of the meeting materials that were distributed can be found in Appendix C.

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:

• Value vs. Volume in health care Focus on preventative care (addition of providers will help)

• Access to care Closure of free clinic JCMH will be providing more of a health home through the Rural Health Clinic model

• Medication Assistance Program Previously offered through Southwestern OK Community Action Agency

• Excitement from community New providers coming to Altus, patients do not have to leave community

12

Table 5. Jackson County Memorial Hospital 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 730 1.44 1,050 $43,091,491 1.27 $54,898,990 $15,810,909 $158,109

Physicians, Dentists, & Other Medical Professionals 89 1.38 123 $6,528,221 1.19 $7,792,407 $2,244,213 $22,442

Nursing Homes & Home Health 250 1.22 304 $10,360,518 1.21 $12,561,037 $3,617,579 $36,176

Other Medical & Health Services 100 1.35 135 $4,572,864 1.19 $5,459,373 $1,572,299 $15,723

Pharmacies 38 1.27 48 $2,803,464 1.25 $3,498,675 $1,007,619 $10,076

Total 1,207

1,660 $67,356,558

$84,210,483 $24,252,619 $242,526

SOURCE: 2013 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 Jackson County retail sales and income (28.8%) – from 2015 County Sales Tax Data and 2013 Personal Income Estimates from the Bureau of Economic Analysis.

13

Health Data, September 30, 2015

A community meeting was held September 24, 2015, to examine various sources of local health data. 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 and the 2014 Oklahoma State of the State’s Health Report compiled by the Oklahoma State Department of Health. 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: 43), clinical care (rank: 22), social and economic factors (rank: 29), and physical environment (rank: 55). Jackson County’s overall health factors rank is 30. This suggests, in general, the health status of Jackson County residents is somewhat comparable to that of neighboring counties. Areas of concern include Jackson County’s adult smoking rate, adult obesity rate, the physical inactivity rate, sexually transmitted infections rate, teen birth rate, the share of uninsured individuals, and preventable hospital stays are all less desirable than the top U.S. performers. All health factors variables are presented in Table 6 along with Jackson 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 Jackson County ranks very poorly compared to the national benchmark).

14

Table 6. Health Factors (Overall Rank 30)

Category (Rank) Jackson

County

Error

Margin

Top U.S.

Performers Oklahoma

Health Behaviors (43) Adult Smoking 23% 17-30% 14% 24%

Adult Obesity 34% 28-40% 25% 32%

Food Environment Index 6.9 8.4 6.7

Physical Inactivity 35% 29-40% 20% 30%

Access to Exercise Opportunities 58% 92% 72%

Excessive Drinking 9% 6-15% 10% 13%

Alcohol-Impaired Driving Deaths 33% 14% 33%

Sexually Transmitted Infections 675 138 442

Teen Birth Rate 73 67-80 20 54

Clinical Care (22) Uninsured 21% 19-23% 11% 21%

Primary Care Physicians 1,874:1 1,045:1 1,567:1

Dentists 2,609:1 1,377:1 1,805:1

Mental Health Providers 580:1 386:1 285:1

Preventable Hospital Stays 112 100-124 41 71

Diabetic Screening 86% 78-94% 90% 78%

Mammography Screening 66% 56-76% 71% 55%

Social & Economic Factors (29) High School Graduation 75% 78%

Some College 62% 56-69% 71% 58%

Unemployment 5.2% 4.0% 5.4%

Children in Poverty 26% 19-33% 13% 24%

Income Inequality 4.1 3.5-4.6 3.7 4.6

Children in Single-Parent Household

33% 26-40% 20% 24%

Social Associations 11.8 22.0 11.8 Violent Crime Rate 221 59 468

Injury Deaths 74 60-90 50 86

Physical Environment (55) Air-Pollution- Particulate Matter 9.8 9.5 10.3

Drinking Water Violations 92% 0% 23%

Severe Housing Problems 13% 10-16% 9% 14%

Driving Alone to Work 82% 79-86% 71% 82%

Long Commute- Driving Alone 9% 6-11% 15% 25%

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

15

The following figure depicts each county’s rank by shade. Jackson County’s overall health factors ranking is more favorable than all of the neighboring counties.

In terms of health outcomes, considered, today’s health, Jackson County’s ranking is 42nd 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 42)

Category (Rank) Jackson

County

Error

Margin

Top U.S.

Performers Oklahoma

Length of Life (30)

Premature Death 9,563 8,236-10,890

5,200 9,121

Quality of Life (57) Poor or Fair Health 18% 14-22% 10% 19%

Poor Physical Health Days 4.0 2.9-5.1 2.5 4.3

Poor Mental Health Days 3.6 2.5-4.7 2.3 4.2

Low Birth Weight 9.9% 8.8-10.9% 5.9% 8.3%

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

16

The following figure shows county health outcomes rankings by shades. Jackson County’s rank is less favorable than Greer and Harmon Counties, is comparable to Tillman, and outpaces Kiowa County. All meeting materials distributed at this meeting can be found in Appendix D.

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:

• Child immunizations • Alzheimer's • Low birth weight • Dental visits

Community Survey Methodology and Results, September 16- October 14, 2015

A survey was designed to gauge hospital usage, satisfaction, and community health needs. The survey was available in both paper and web format. The survey was distributed electronically to all JCCHAT (Jackson County Community Action Team) members. JCCHAT members were urged to share the survey with the populations they serve. Jackson County Memorial Hospital received the electronic survey link, and it was posted on the hospital’s homepage and Facebook page. Also, a link to the survey was included in an article from the hospital in the local newspaper, Altus Times. Paper copies were available at the Altus Library and at the front desk at the hospital. Jackson County Health Department and the City of Altus also distributed hard-copy surveys. Community members in attendance also received a follow-up email with a PDF copy of the survey and the electronic survey link. A copy of the survey

17

form and results can be found in Appendix E. Community members were asked to return their completed surveys to Jackson County Memorial Hospital.

The survey ran from September 16, 2015 to September 30, 2015. A total of 221 surveys from the Jackson County Memorial Hospital medical service area were completed. Of the surveys returned, 168 were electronic surveys. The survey results were presented at the October 14, 2015, community meeting.

Table 8 below shows the survey respondent representation by zip code. The largest share of respondents was from the Altus (73521) zip code with 181 responses or 81.9 percent of the total. Blair followed with 9 responses, and Mangum had 6.

Table 8. Zip Code of Residence

Response Category No. % 73521- Altus

181 81.9%

73526- Blair

9 4.1% 73554- Mangum

6 2.7%

73566- Snyder

3 1.4% 73547- Granite

2 0.9%

73549- Headrick

2 0.9% 73559- Mountain Park

2 0.9%

73560- Olustee

2 0.9% 73570- Tipton

2 0.9%

73561- Oscar

2 0.9% 73542- Frederick

2 0.9%

73544- Gould

1 0.5% 73531- Devol

1 0.5%

73523- Altus AFB

1 0.5% 73673- Willow

1 0.5%

73505- Lawton

1 0.5% 73501- Lawton

1 0.5%

73055- Marlow

1 0.5% Don't know/No response

1 0.5%

Total 221 100.0%

18

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

Primary Care Physician Visits

- 74.7% of respondents had used a primary care physician in the Altus service area during the past 24 months

- 90.0% of those responded being satisfied - Only 38 respondents or 17.2% of the survey respondents believe there are enough

primary care physicians practicing in the Altus area - 67.9% of the respondents would consider seeing a midlevel provider for their

healthcare needs - 65.2% responded they were able to get an appointment with their primary care

physician when they needed one

Specialist Visits

Summary highlights include:

- 53.8% of all respondents report some specialist visit in past 24 months - Most common specialty visited are displayed in Table 9 - Only 17.1% of specialist visits occurred in Altus

Table 9. Type of Specialist Visits

Type of Specialist No. Percent

Top 5 Responses

Orthopedist/Orthopedic Surg. 23 14.0%

(10 visits in Altus)

Otolaryngologist 15 9.1%

(2 visits in Altus)

Cardiologist 11 6.7%

(3 visits in Altus)

Gastroenterologist 11 6.7%

(0 visits in Altus)

Dermatologist 10 6.1%

(0 visits in Altus)

All others 94 35.3%

(13 visits in Altus)

Total 164 100.0%

Some respondents answered more than once.

19

62.1%

85.9%

71.2%

85.6%

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

Hospital Usage

Hospital Satisfaction

Jackson County Memorial Hospital Other OK Hospital Survey Averages

Hospital Usage and Satisfaction

Survey highlights include:

- 71.2% of survey respondents that have used hospital services in the past 24 months used services at Jackson County Memorial Hospital

o Comanche County Memorial Hospital, Lawton (8.8%) and OU Medical Center, Oklahoma City (3.3%) followed

o The most common response for using a hospital other than Jackson County Memorial Hospital was availability of specialty care (35.7%) and physician referral (28.6%)

o The usage rate of 71.2% was higher than the state average of 62.1% for usage of other rural Oklahoma hospitals surveyed

- 85.6% of survey respondents were satisfied with the services received at Jackson County Memorial Hospital

o This is slightly below the state average for other hospitals (85.9%) - Most common services used at Jackson County Memorial Hospital:

o Laboratory (23.4%) o Emergency Room (21.2%) o Diagnostic imaging (including mammography) (20.4%)

Figure 2. Summary of Hospital Usage and Satisfaction Rates

20

Local Healthcare Concerns and Additional Services

Survey respondents were asked what concerns them most about healthcare in their community. The most common response Lack of providers/Retaining providers/Qualified providers (24.8%), followed by No concerns/Receive good care/Don’t know (13.7%) and Lack of specialists (10.6%). Table 10 displays all responses and the frequencies.

Table 10. Top Concerns in the Altus Area

Response Category No. % Lack of providers/Retaining providers/Qualified providers 56 24.8% No Concerns/ Receive good care/Don't Know 31 13.7% Lack of specialists: including dermatology, cardiology, neurology, otolaryngology 24 10.6% Quality of care

14 6.2%

Cost of care

12 5.3% Wait times/Appointment availability

11 4.9%

Keeping local facility/Reimbursements/Cost to provide care 6 2.7% Outdated equipment/technology

3 1.3%

Patient/Community perception of local care

3 1.3% Cancellations/No shows for appointments

2 0.9%

Medical coverage/Cost for uninsured

2 0.9% Impersonal care: too many forms, not the same provider 2 0.9% Long wait/Availability of mental health services

2 0.9%

Emergency care/Improved ER care

2 0.9% Not aware of services

2 0.9%

Some services are charged out-of-network costs

2 0.9% Need for speech therapy

1 0.4%

Privacy

1 0.4% Unnecessary tests

1 0.4%

Lack of Spanish interpreters

1 0.4% Some specialists are not covered under certain insurance providers 1 0.4% Smoking

1 0.4%

Blood work

1 0.4% Language barriers with providers

1 0.4%

Hospitalist program

1 0.4% Care in outlying areas: Eldorado, Olustee, Tipton, Snyder 1 0.4% Level of trauma care provided

1 0.4%

Obesity

1 0.4% Cooperation between hospital and city

1 0.4%

Too political

1 0.4% Quality of life

1 0.4%

Water

1 0.4% No response

36 15.9%

Total 226 100.0%

Survey respondents also had the opportunity to identify what additional services they would like to see offered in their community. The most common response was specialists,

21

collectively with 34.9 percent of the total followed by No additional services/Satisfied with what is available/Don’t know (11.9%). Table 11 displays the full listing of responses.

Table 11. Additional Services Survey Respondents Would Like to See Offered At Jackson

County Memorial Hospital

Response Category No. % Specialists: Dermatologist (16); Cardiologist (15); Specialists in general (8); Endocrinologist (7); Rheumatologist (6); Gastroenterologist (5); Otolaryngologist (5); General surgeon (4); Neurologist (4); Pulmonologist (2); Pediatrician (2); Oncologist (2); Orthopedist specializing in back pain (2); Urologist (1); Pain Management (1); Urogynecologist (1) 82 34.9% No additional services/Satisfied with what is available/Don't know 28 11.9% Cardiac care/Procedures

8 3.4%

Walk in clinic/Urgent care

8 3.4% NICU/Neonatal services

6 2.6%

More providers/Primary care physicians/Improved providers 5 2.1% Mental health services/Improved mental health services 3 1.3% Low cost dental/Dental for SoonerCare patients

3 1.3%

Anything to benefit community/hospital

2 0.9% Breast MRI/Breast services

2 0.9%

Outpatient care/speech therapy

2 0.9% Diabetes care

1 0.4%

Natural/Holistic medicine

1 0.4% Updated appearance of facilities

1 0.4%

Continue speech pathology for children

1 0.4% Public pharmacy

1 0.4%

Optical services

1 0.4% Community services including classes, support groups 1 0.4% MRI

1 0.4%

Improved cafeteria food

1 0.4% Low cost screening services

1 0.4%

Extended physical therapy for elderly patients

1 0.4% More providers for geriatric services

1 0.4%

More bilingual nursing/clinical staff or interpreter on staff 1 0.4% Wound care

1 0.4%

More privacy when checking in (ER and physician offices) 1 0.4% Services for children

1 0.4%

Concerned about continuity of care through hospitalist program 1 0.4% Drug rehab

1 0.4%

Nursing home

1 0.4% Satellite clinic in Snyder

1 0.4%

Acceptance of Global Health Insurance

1 0.4% Faster ER services

1 0.4%

Wellness program

1 0.4% Hours of operation

1 0.4%

Inpatient psychiatry services

1 0.4% Not aware of services

1 0.4%

No response

60 25.5% Total 235 100.0%

22

Primary Care Physician Demand Analysis, October 14, 2015 A demand analysis of primary care physicians was completed for the zip codes that

comprise the Altus primary and secondary medical services areas. 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 Altus medical services area, a total of 54,509 annual visits would occur. This would suggest that the Altus medical services area would need 13.0 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 Altus, Oklahoma Medical Service Area

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% 40,996 43,744 46,493 49,241 51,989 54,738 57,486

10% 43,516 46,265 49,013 51,761 54,509 57,258 60,006 15% 46,037 48,785 51,533 54,281 57,030 59,778 62,526 20% 48,557 51,305 54,053 56,802 59,550 62,298 65,046 25% 51,077 53,825 56,574 59,322 62,070 64,818 67,567 30% 53,597 56,345 59,094 61,842 64,590 67,339 70,087 35% 56,117 58,866 61,614 64,362 67,111 69,859 72,607 40% 58,638 61,386 64,134 66,882 69,631 72,379 75,127 45% 61,158 63,906 66,654 69,403 72,151 74,899 77,647 50% 63,678 66,426 69,175 71,923 74,671 77,419 80,168

If 90% primary medical service area and 10 to 15% secondary medical service area, then

the usage would be: 54,509 to 57,030 total primary care physician office visits in the Altus area for an estimated 13.0 to 13.6 Total Primary Care Physicians.

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

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 item was added to the list:

• Need for neonatal services • Drug and alcohol abuse- can then cause serious health concerns

23

Need for substance abuse/mental health services • Access to healthy foods • Increasing community members’ physical activity • Access for uninsured- increasing funds/coverage for Insure OK,

ACA navigators present in community, but many individuals still fall into coverage gap due to income

Community Health Needs Implementation Strategy

During the October 28, 2015, 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.

• Continue to increase access to care in local community- This priority includes both access to primary care providers and specialists. It was noted that travel burdens face many elderly residents and their care givers to travel outside of the community for physician visits. It was also noted there is a perception of low availability of providers, thus, increasing the scheduling and visiting of providers outside of Altus.

In terms of new services to Altus and scheduled to come to Altus, several new primary care providers have been added and have either started seeing patients or will be shortly. The hospital is already promoting the availability of “same-day” appointments to help with the misperception of low availability of local providers. The hospital is hoping to add telepsych services in the near future. This will allow patients to stay in Altus and still see this specialty. It was also noted by hospital administration to continue to focus on doing what we can do really well, so patients will not feel the need to leave the community with the notion of bigger city, higher quality of care. In terms of referrals made, hospital administration is also striving to make sure there is an access agreement in place for referrals to help with the cost burden patients face. It was also noted that many VA patients are transported to Oklahoma City to receive services. There are currently ongoing talks of offering services in Altus to assist in this travel burden. The need for mental health services both access for patients who need services and more providers in the community to see patients and manage medication.

• Wellness and Prevention- This priority as a whole was mentioned through the need of various topics from public health education to healthy foods to patient advocacy.

Specifically, community members noted the need for education on taking preventative steps, environmental preventions to health such as mowing grass to alleviate mosquitos which can lead to health concerns. Outreach on healthy foods, cooking classes and preparing healthy meals, healthy eating habits and walking programs were noted as needs in the community. It was also noted to move existing education outreach to different locations to reach a more diverse audience. Also, the need for education resources and outreach in Spanish (from a Spanish as a first language perspective). The need for patient advocacy was identified as a resource for those who find themselves in a caregiver situation. Oftentimes, family members are not aware of services and resources.

24

Patient advocacy can help patients who do not have a caregiver or even those who do locate resources and services more efficiently.

• Move Altus towards being a Certified Healthy Community The hospital is already a Certified Healthy Business and is committed to maintaining this status to help the city move towards certification.

• It was noted that the items identified align more with quality assurance type activities rather than performance improvement priorities, as identified in the last CHNA.

Community Health Needs Assessment Marketing Plan

The hospital will make the Community Health Needs Assessment Summary available upon request at Jackson County Memorial Hospital, and a copy will be available to be downloaded from the hospital’s website (www.jcmh.com). This document will also be available on the OSU Center for Rural Health blog site: (http://osururalhealth.blogspot.com/p/chna.html).

25

Appendix A- Hospital Services/Community Benefits

26

Appendix B Community Meeting Attendees

Altus Community Health Needs Assessment

Meeting #1 Economic Impact and Process Overview

16-Sep-15

First Name Last Name Title Organization

Dennie Christian Turning Point Consultant Oklahoma State Dept. of Health

Debbie New Accreditation Coord. Oklahoma State Dept. of Health

Amanda Reimer Marketing Director Jackson County Memorial Hospital

Barbara Burleson Planning Dicrector City of Altus

Haley Rinkenbaugh RD/LD Jackson County Memorial Hospital

Steve Hartgraves CEO Jackson County Memorial Hospital

Altus Community Health Needs Assessment

Meeting #2 Health Indicators and Outcomes Presentation

30-Sep-15

First Name Last Name Title Organization

Dennie Christian Turning Point Consultant Oklahoma State Dept. of Health

Debbie New Accreditation Coord. Oklahoma State Dept. of Health

Amanda Reimer Marketing Director Jackson County Memorial Hospital

Barbara Burleson Planning Dicrector City of Altus

Karen Weaver Regional Director Jackson County Health Dept.

Steve Hartgraves CEO Jackson County Memorial Hospital

27

Altus Community Health Needs Assessment

Meeting #3 Survey Results and Primary Care Physician Demand Analysis

14-Oct-15

First Name Last Name Title Organization

Amanda Reimer Marketing Director Jackson County Memorial Hospital

Barbara Burleson Planning Dicrector City of Altus

Karen Weaver Regional Director Jackson County Health Dept.

Haley Rinkenbaugh RD/LD Jackson County Memorial Hospital

Ramona Noble SSIR OK Department of Human Services

Tephanie Carman HLP Coordinator SOCAG

Shaundra Covey HLP Coordinator SOCAG

Liz Moon Ex. Director Life Service at Pathways

Jeanne Brandon Ex. Director SWYS

Jennifer Paxton Admin. Serv. Man. SWYS

Amanda Bernascini ESG Coord. SWYS

David Braddock Dobbs & Braddock

Melanie Ellis FSP SOC Red Rock

Samantha Sims FSR; RRSOC Red Rock

Summer Langford CC; RRSOC Red Rock

Kelly Baker SOCAG RSVP Director SOCAG RSVP

Steve Hartgraves CEO Jackson County Memorial Hospital

Altus Community Health Needs Assessment

Meeting #4: Health Concern Prioritization and Implementation Discussion

30-Sep-15

First Name Last Name Title Organization

Amanda Reimer Marketing Director Jackson County Memorial Hospital

Barbara Burleson Planning Dicrector City of Altus

Chris Riffle Altus Council City of Altus

Victoria Cleveland Wellness Coordinator Jackson County Health Department

Aleida Burchett GP Literacy Council Altus Library

Ida Fay Winters Coordinator Great Plains Literacy Council

Steve Hartgraves CEO Jackson County Memorial Hospital

28

Appendix C- Meeting 1 Materials, September 16, 2015

29

30

31

Appendix D- Meeting 2 Materials, September 30, 2015

32

33

34

Appendix E- Survey Form and Meeting 3 Materials, October 14, 2015

35

36

37

38

39