Community Health Needs Assessment 2013 · This community health needs assessment, which describes both a process and a document, is intended to document Jane Phillips Medical Center’s

Community Health Needs Assessment 2013

Jane Phillips Medical Center Community Health Needs Assessment

April 2013

Contents

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

Summary of Community Health Needs Assessment .......................................................................... 2

General Description of Hospital ......................................................................................................... 3

Community Served by the Hospital ...................................................................................... 4

Defined Community ........................................................................................................................... 4

Community Details ................................................................................................................. 5

Identification and Description of Geographical Community ............................................................. 5

Community Population and Demographics ........................................................................................ 6

Socioeconomic Characteristics of the Community .......................................................... 12

Income and Employment .................................................................................................................. 12

Poverty .............................................................................................................................................. 15

Uninsured ........................................................................................................................................ 15

Education ......................................................................................................................................... 16

Community Health Care Resources ................................................................................... 17

Hospitals ........................................................................................................................................... 17

Other Licensed Facilities and Providers ........................................................................................... 19

Health Department ............................................................................................................................ 19

Estimated Demand for Hospital Services ......................................................................................... 19

Health Status of the Community ......................................................................................... 23

Leading Causes of Death .................................................................................................................. 24

Health Outcomes and Factors ............................................................................................ 25

Nowata, Osage & Washington Counties .......................................................................................... 26

Key Informant Interviews..................................................................................................... 29

Methodology..................................................................................................................................... 29

Key Informant Profiles ..................................................................................................................... 30

Key Informant Interview Results ..................................................................................................... 30

Key Findings .................................................................................................................................... 34

Community Health Survey ................................................................................................... 35

Methodology..................................................................................................................................... 35

Jane Phillips Medical Center Community Health Needs Assessment

April 2013

Survey Instrument ............................................................................................................................ 35

Community Health Survey Results .................................................................................................. 35

Additional Items to Consider in Planning ........................................................................................ 37

Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups ....... 37

Prioritization of Identified Health Needs ............................................................................ 38

Appendices

Acknowledgements .......................................................................................................................... 42

Key Informant Interview Protocol .................................................................................................... 44

Community Health Survey Detail Results ........................................................................................ 49

Sources ............................................................................................................................................. 59


1

Introduction

IRC Section 501(r) requires health care organizations to assess the health needs of their communities and adopt implementation strategies to address identified needs. Per IRC Section 501(r), a byproduct of the Affordable Care Act, to comply with federal tax-exemption requirements, a tax-exempt hospital facility must:

• Conduct a community health needs assessment every three years.

• Adopt an implementation strategy to meet the community health needs identified through the assessment.

• Report how it is addressing the needs identified in the community health needs assessment and a description of needs that are not being addressed with the reasons why such needs are not being addressed.

The community health needs assessment must take into account input from persons who represent the broad interest of the community served by the hospital facility, including those with special knowledge of or expertise in public health. The hospital facility must make the community health needs assessment widely available to the public.

This community health needs assessment, which describes both a process and a document, is intended to document Jane Phillips Medical Center’s compliance with IRC Section 501(r). Health needs of the community have been identified and prioritized so that Jane Phillips Medical Center (Medical Center) may adopt an implementation strategy to address specific needs of the community.

The process involved:

• Collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, health care resources and patient use rates.

• Interviews with key informants who represent a) broad interests of the community, b) populations of need or c) persons with specialized knowledge in public health.

• Conducting a health survey which gathered a wide range of information which was widely distributed to members of the community.

This document is a summary of all the available evidence collected during the initial cycle of community health needs assessments required by the IRS. It will serve as a compliance document as well as a resource until the next assessment cycle.

Both the process and document serve as the basis for prioritizing the community’s health needs and will aid in planning to meet those needs.


2

Summary of Community Health Needs Assessment

The purpose of the community health needs assessment is to document compliance with new federal laws outlined above.

The Medical Center engaged BKD, LLP to conduct a formal community health needs assessment. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and employees in 29 offices. BKD serves more than 900 hospitals and health care systems across the country. The community health needs assessment was conducted from October 2012 through April 2013.

Based on current literature and other guidance from the treasury and the IRS, the following steps were conducted as part of Jane Phillips Medical Center’s community health needs assessment:

• The “community” served by the Medical Center was defined by utilizing inpatient data regarding patient origin. This process is further described in Community Served by the Hospital.

• Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties (see references in Appendices). The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by CountyHealthrankings.org. Health factors with significant opportunity for improvement were noted.

• An inventory of health care facilities and resources was prepared and estimated a demand for physician and hospital services was evaluated.

• Community input was provided through key informant interviews of 22 stakeholders and a community health survey was widely distributed. The Community Health Survey was completed by 213individuals. Results and findings are described in the Key Informant and Community Health Survey of this report.

• Information gathered in the steps above was analyzed and reviewed to identify health issues of uninsured persons, low-income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighting method that weighs 1) the size of the problem, 2) the seriousness of the problem 3) the prevalence of common themes, 4) the impact of the problem on vulnerable populations, 5) how important the problem is to the community and 6) whether or not the Hospital has existing programs which respond to the identified need.

• Recommendations based on this assessment have been communicated to the Medical Center.


3

General Description of Medical Center

The Medical Center is an Oklahoma, nonprofit organization, located in Bartlesville, Oklahoma. A board of directors governs the Hospital and ensures that medical services are available to the residents of Bartlesville and surrounding areas.

Jane Phillips Medical Center provides services to the region of northeast Oklahoma and southeast Kansas. Offering both inpatient and outpatient services, Jane Phillips’s s innovative treatments and preventive healthcare measures range from cardiac rehabilitation, cancer treatments, and heart and vascular services to labor and delivery, pulmonary, surgical and wellness care.

Jane Phillips Medical Center is one of six healthcare institutions affiliated with the Marian Health System in Tulsa, Oklahoma and is sponsored by St. John Health System. As part of Jane Phillips Medical Center, the hospital is licensed for 137 beds. People of all ages and races, men and women receive precision care at Jane Phillips every day, regardless of the way they are able to pay.

Jane Phillips Medical Center’s Mission:

“To provide healthcare and related ministries for the people served, especially the sick,

the poor, and the powerless.”


4

Community Served by the Hospital

Jane Phillips Medical Center is located in the city of Bartlesville, Oklahoma in Washington County. The city of Bartlesville is located in northeast Oklahoma and is approximately one hour north of Tulsa, Oklahoma. Bartlesville is accessible by interstate 75 as well as US-60.

Defined Community

A community is defined as the geographic area from which a significant number of the patients utilizing the Medical Center’s services reside. While the community health needs assessment considers other types of health care providers, the Medical Center is the single largest provider of acute care services. For this reason, the utilization of Medical Center services provides the clearest definition of the community. Over 50 percent of Jane Phillips Medical Center’s discharges originate in Washington County.

Based on the patient origin of acute care discharges from October 1, 2010 through September 30, 2011, management has identified the community to include select Nowata, Osage and Washington County zip codes listed in Exhibit 1. Exhibit 1 presents the Hospital’s patient origin and charges for each of the top 5 zip code areas in its community. Page 5 presents a detailed map of the Hospital’s geographical location and the number of inpatient discharges by zip code according to Exhibit 1. The zip codes are listed with corresponding demographic information in Exhibits 2 through 5.

The geographic area of the defined community based on the identified zip codes for the community covers all of Nowata, Osage and Washington Counties. The community health needs assessment will utilize the information for these counties when specific information is not available for zip codes.

Exhibit 1Jane Phillps CHNA

Summary of Inpatient Discharges by Zip Code10/1/2010 - 9/30/2011

Percent

of Total

Zip Code City Discharges Discharges

Washington County:74003 Bartlesville 1,240 19.3%74006 Bartlesville 1,787 27.8%74029 Dewey 433 6.7%

Osage County

74056 Pawhuska 413 6.4%

Nowata County74048 Nowata 404 6.3%

All Other 2,142 33.4%

Total 6,419 100.0%

Source: Jane Phillips Medical Center


5

Community Details

Identification and Description of Geographical Community

The following map geographically illustrates the Medical Center’s location and community by showing the community zip codes shaded. The bulk of the community’s population is concentrated in and around the city of Bartlesville, Oklahoma.


6

Community Population and Demographics

The U.S. Bureau of Census has compiled population and demographic data based on the 2010 census. The Nielsen Company, a firm specializing in the analysis of demographic data, has extrapolated this data by zip code to estimate population trends from 2013 through 2018. Population estimates by age and zip code for the Hospital’s community are presented after the map in Exhibit 2.

Exhibit 2 illustrates that the overall population is projected to increase slightly over the five-year period from 95,405 to 97,775. In addition, the age category that utilizes health care services the most, 65 years and over, is projected to increase from 17,002 to 19,103. The projected changes to the composition of the total community, between male and female, is projected to remain approximately the same over the five-year period.


7

Exhibit 2

Jane Phillips CHNA Community Zip Codes

Estimated 2013 Population and Projected 2018 Population

Under 15-44 45-64 65 years

Zip Code City 15 years years years and over Total Male Female

Estimated 2013 Population

Washington County:74003 Bartlesville 3,112 5,505 3,835 2,019 14,471 7,084 7,387

74006 Bartlesville 4,796 8,843 7,120 5,631 26,390 12,584 13,806

74029 Dewey 1,050 1,728 1,312 1,049 5,139 2,503 2,636

OtherWashington 1,063 1,966 1,768 1,062 5,859 2,944 2,915

Total Washington 10,021 18,042 14,035 9,761 51,859 25,115 26,744

Osage County74056 Pawhuska 1,091 1,934 1,495 1,024 5,544 2,755 2,789

Other Osage 5,536 10,023 7,629 4,196 27,384 14,053 13,331

Total Osage 6,627 11,957 9,124 5,220 32,928 16,808 16,120

Nowata County74048 Nowata 1,182 2,000 1,617 1,195 5,994 2,908 3,086

Other Nowata 840 1,615 1,343 826 4,624 2,336 2,288

Total Nowata 2,022 3,615 2,960 2,021 10,618 5,244 5,374

PROVIDER SERVICE AREA 18,670 33,614 26,119 17,002 95,405 47,167 48,238

Projected 2018 Population

Washington County:74003 Bartlesville 3,258 5,560 3,630 2,318 14,766 7,234 7,532

74006 Bartlesville 5,029 9,168 6,867 6,254 27,318 13,063 14,255

74029 Dewey 1,130 1,806 1,281 1,139 5,356 2,616 2,740

OtherWashington 1,103 2,035 1,731 1,248 6,117 3,060 3,057

Total Washington 10,520 18,569 13,509 10,959 53,557 25,973 27,584

Osage County74056 Pawhuska 1,072 1,962 1,327 1,119 5,480 2,714 2,766

Other Osage 5,557 10,187 7,274 4,746 27,764 14,179 13,585

Total Osage 6,629 12,149 8,601 5,865 33,244 16,893 16,351

Nowata County74048 Nowata 1,225 2,095 1,514 1,300 6,134 2,978 3,156

Other Nowata 802 1,696 1,363 979 4,840 2,444 2,396

Total Nowata 2,027 3,791 2,877 2,279 10,974 5,422 5,552

PROVIDER SERVICE AREA 19,176 34,509 24,987 19,103 97,775 48,288 49,487

Source: The Nielsen Company


8

Exhibit 2.1 provides the percent difference for each zip code from estimated 2013 to projected 2018 as well as the ability to compare the percent difference to the state of Oklahoma and the United States for comparison purposes. Exhibit 2.1 illustrates that the overall population is projected to increase by two-and-a-half percent over the five-year period compared to projected overall increases for Oklahoma at almost four percent and the United States at approximately three percent. Note that the age category that utilizes health care services the most, 65 years and over, is projected to increase by more than twelve percent. This increase in the 65 year and over category will have a dramatic impact on both the amount and type of services required by the community.

Exhibit 2.1


Estimated 2013 Population vs Projected 2018 Population Percent Difference

Under 15-44 45-64 65 years


Percent Difference

Washington County:74003 Bartlesville 4.7% 1.0% -5.3% 14.8% 2.0% 2.1% 2.0%

74006 Bartlesville 4.9% 3.7% -3.6% 11.1% 3.5% 3.8% 3.3%

74029 Dewey 7.6% 4.5% -2.4% 8.6% 4.2% 4.5% 3.9%

OtherWashington 3.8% 3.5% -2.1% 17.5% 4.4% 3.9% 4.9%

Total Washington 5.0% 2.9% -3.7% 12.3% 3.3% 3.4% 3.1%

Osage County

74056 Pawhuska -1.7% 1.4% -11.2% 9.3% -1.2% -1.5% -0.8%

Other Osage 0.4% 1.6% -4.7% 13.1% 1.4% 0.9% 1.9%

Total Osage 0.0% 1.6% -5.7% 12.4% 1.0% 0.5% 1.4%

Nowata County74048 Nowata 3.6% 4.8% -6.4% 8.8% 2.3% 2.4% 2.3%

Other Nowata -4.5% 5.0% 1.5% 18.5% 4.7% 4.6% 4.7%

Total Nowata 0.2% 4.9% -2.8% 12.8% 3.4% 3.4% 3.3%

PROVIDER SERVICE AREA 2.7% 2.7% -4.3% 12.4% 2.5% 2.4% 2.6%

OK 2013 Estimated (1,000s) 798 1,520 971 549 3,838 1,898 1,940

OK 2018 Projected (1,000s) 839 1,551 966 631 3,987 1,971 2,016

PERCENT DIFFERENCE 5.1% 2.0% -0.5% 14.9% 3.9% 3.8% 3.9%

U.S. 2013 Estimated (1,000s) 61,803 126,084 83,113 43,862 314,862 154,820 160,042

U.S. 2018 Projected (1,000s) 63,380 126,608 84,336 50,998 325,322 160,000 165,322

PERCENT DIFFERENCE 2.6% 0.4% 1.5% 16.3% 3.3% 3.3% 3.3%


Certain characteristics of a population can be factors in determining the health care services required by a community. The following is an analysis of the age distribution of the population for the primary community. The analysis is provided by zip code and provides a comparison to Oklahoma and the United States.


9

Exhibit 2.2


Estimated 2013 Population vs Projected 2018 Population with Percent Totals

Under 15-44 45-64 65 years


Estimated 2013 Population

Washington County:

74003 Bartlesville 21.5% 38.0% 26.5% 14.0% 100.0% 49.0% 51.0%

74006 Bartlesville 18.2% 33.5% 27.0% 21.3% 100.0% 47.7% 52.3%

74029 Dewey 20.4% 33.6% 25.5% 20.4% 100.0% 48.7% 51.3%

OtherWashington 18.1% 33.6% 30.2% 18.1% 100.0% 50.2% 49.8%

Total Washington 19.3% 34.8% 27.1% 18.8% 100.0% 48.4% 51.6%

Osage County

74056 Pawhuska 19.7% 34.9% 27.0% 18.5% 100.0% 49.7% 50.3%

Other Osage 20.2% 36.6% 27.9% 15.3% 100.0% 51.3% 48.7%

Total Osage 20.1% 36.3% 27.7% 15.9% 100.0% 51.0% 49.0%

Nowata County74048 Nowata 19.7% 33.4% 27.0% 19.9% 100.0% 48.5% 51.5%

Other Nowata 18.2% 34.9% 29.0% 17.9% 100.0% 50.5% 49.5%

Total Nowata 19.0% 34.0% 27.9% 19.0% 100.0% 49.4% 50.6%

TOTAL PROVIDER SERVICE AREA 19.6% 35.2% 27.4% 17.8% 100.0% 49.4% 50.6%

Projected 2018 Population

Washington County:

74003 Bartlesville 22.1% 37.7% 24.6% 15.7% 100.0% 49.0% 51.0%

74006 Bartlesville 18.4% 33.6% 25.1% 22.9% 100.0% 47.8% 52.2%

74029 Dewey 21.1% 33.7% 23.9% 21.3% 100.0% 48.8% 51.2%

OtherWashington 18.0% 33.3% 28.3% 20.4% 100.0% 50.0% 50.0%

Total Washington 19.6% 34.7% 25.2% 20.5% 100.0% 48.5% 51.5%

Osage County

74056 Pawhuska 19.6% 35.8% 24.2% 20.4% 100.0% 49.5% 50.5%

Other Osage 20.0% 36.7% 26.2% 17.1% 100.0% 51.1% 48.9%

Total Osage 19.9% 36.5% 25.9% 17.6% 100.0% 50.8% 49.2%

Nowata County74048 Nowata 20.0% 34.2% 24.7% 21.2% 100.0% 48.5% 51.5%

Other Nowata 16.6% 35.0% 28.2% 20.2% 100.0% 50.5% 49.5%

Total Nowata 18.5% 34.5% 26.2% 20.8% 100.0% 49.4% 50.6%

TOTAL PROVIDER SERVICE AREA 19.6% 35.3% 25.6% 19.5% 100.0% 49.4% 50.6%

ESTIMATED 2013 19.6% 35.2% 27.4% 17.8% 100.0% 49.5% 50.5%

PROJECTED 2018 POPULATION 19.6% 35.3% 25.6% 19.5% 100.0% 49.4% 50.6%

PERCENT DIFFERENCE 2.7% 2.7% -4.3% 12.4% 2.5% 2.4% 2.6%



10

In comparison to the twelve percent growth seen in the overall number of people in the 65 year and over category in Exhibit 2, Exhibit 2.1 indicates that as a percent of total population for the community, the 65 year and over category will make up 19.5 percent of the total population in 2018 compared to 17.8 percent in 2013.

While the relative age of the community population can impact community health needs, so can the ethnicity and race of a population. The following Exhibit 3 shows the population of the community by ethnicity by illustrating the Hispanic versus Nonhispanic residents. In total, the population breakdown for the community is very different from the rest of the state of Oklahoma, with the community having a significantly lower percentage of Hispanic residents in comparison to the rest of the state.

Exhibit 3


Estimated 2013 Population vs Projected 2018 Population with Percent Difference

Estimated 2013 Projected 2018 % Difference % Total

Non- Non- Non- Non-

Zip Code City Hispanic Hispanic Total Hispanic Hispanic Total Hispanic Hispanic Hispanic Hispanic

Washington County:74003 Bartlesville 1,067 13,404 14,471 1,236 13,530 14,766 15.8% 0.9% 8.4% 91.6%

74006 Bartlesville 1,445 24,945 26,390 1,745 25,573 27,318 20.8% 2.5% 6.4% 93.6%

74029 Dewey 212 4,927 5,139 237 5,119 5,356 11.8% 3.9% 4.4% 95.6%

OtherWashington 164 5,695 5,859 207 5,910 6,117 26.2% 3.8% 3.4% 96.6%

Total Washington 2,888 48,971 51,859 3,425 50,132 53,557 18.6% 2.4% 6.4% 93.6%

Osage County74056 Pawhuska 208 5,336 5,544 232 5,248 5,480 11.5% -1.6% 4.2% 95.8%

Other Osage 764 26,620 27,384 837 26,927 27,764 9.6% 1.2% 3.0% 97.0%

Total Osage 972 31,956 32,928 1,069 32,175 33,244 10.0% 0.7% 3.2% 96.8%

Nowata County74048 Nowata 170 5,824 5,994 195 5,939 6,134 14.7% 2.0% 3.2% 96.8%

Other Nowata 100 4,524 4,624 121 4,719 4,840 21.0% 4.3% 2.5% 97.5%

Total Nowata 270 10,348 10,618 316 10,658 10,974 17.0% 3.0% 2.9% 97.1%

PROVIDER SERVICE AREA 4,130 91,275 95,405 4,810 92,965 97,775 16.5% 1.9% 4.9% 95.1%

Oklahoma (1,000s) 376 3,462 3,838 445 3,542 3,987 18.4% 2.3% 11.2% 88.8%

U.S. (1,000s) 54,578 260,284 314,862 61,050 264,272 325,322 11.9% 1.5% 18.8% 81.2%


Exhibit 4 shows the population of the community by race by illustrating three different categories, white, black and other residents. In total, the population breakdown for the community is very comparable to the state of Oklahoma.


11

Exhibit 4


Estimated 2013 Population vs Projected 2018 Population with Percent Difference

Estimated 2013 Projected 2018 Percent Total

Zip Code City White BlackNative

American Other Total White BlackNative

American Other Total White BlackNative

American Other

Washington County:74003 Bartlesville 10,582 616 1,741 1,532 14,471 10,766 554 1,870 1,576 14,766 72.9% 3.8% 12.7% 10.7%

74006 Bartlesville 21,441 523 2,172 2,254 26,390 21,844 582 2,423 2,469 27,318 80.0% 2.1% 8.9% 9.0%

74029 Dewey 3,922 74 723 420 5,139 4,036 76 808 436 5,356 75.4% 1.4% 15.1% 8.1%

OtherWashington 4,409 22 895 533 5,859 4,574 22 964 557 6,117 74.8% 0.4% 15.8% 9.1%

Total Washington 40,354 1,235 5,531 4,739 51,859 41,220 1,234 6,065 5,038 53,557 77.0% 2.3% 11.3% 9.4%

Osage County74056 Pawhuska 3,231 144 1,647 522 5,544 3,095 149 1,690 546 5,480 56.5% 2.7% 30.8% 10.0%

Other Osage 19,781 674 4,611 2,318 27,384 20,114 701 4,677 2,272 27,764 72.4% 2.5% 16.8% 8.2%

Total Osage 23,012 818 6,258 2,840 32,928 23,209 850 6,367 2,818 33,244 69.8% 2.6% 19.2% 8.5%

Nowata County74048 Nowata 3,872 159 1,304 659 5,994 3,854 138 1,453 689 6,134 62.8% 2.2% 23.7% 11.2%

Other Nowata 3,386 34 778 426 4,624 3,508 30 819 483 4,840 72.5% 0.6% 16.9% 10.0%

Total Nowata 7,258 193 2,082 1,085 10,618 7,362 168 2,272 1,172 10,974 67.1% 1.5% 20.7% 10.7%

PROVIDER SERVICE AREA 70,624 2,246 13,871 8,664 95,405 71,791 2,252 14,704 9,028 97,775 73.4% 2.3% 15.0% 9.2%

Oklahoma (1,000s) 2,731 283 335 489 3,838 2,781 291 356 559 3,987 69.8% 7.3% 8.9% 14.0%

U.S. (1,000s) 225,086 40,007 3,031 46,738 314,862 228,213 41,797 3,193 52,119 325,322 70.1% 12.8% 1.0% 16.0%



12

Socioeconomic Characteristics of the Community

The socioeconomic characteristics of a geographic area influence the way residents access health care services and perceive the need for health care services within society. The economic status of an area may be assessed by examining multiple variables within the community. The following exhibits are a compilation of data that includes household income, labor force, employees by types of industry, employment rates, educational attainment and poverty for the community served by the Medical Center. These standard measures will be used to compare the socioeconomic status of the county internally as well as to the state.

Income and Employment

Exhibit 5 presents the average and median income for households in each zip code. Average income is projected to increase by approximately four to six percent between 2013 and 2018, while the median income is projected to increase slightly more than three to five percent in Washington and Nowata Counties. In Osage County, average and median income is projected to decrease significantly anywhere from six to seven percent.

Exhibit 5


Estimated Family Income and Wealth for 2010 and 2015 with Percent Difference

Estimated 2013 Projected 2018 Percent Difference

Avg. Median Avg. Median Avg. Median

Household Household Household Household Household Household

Zip Code City Income Income Income Income Income Income

Washington County:74003 Bartlesville 49,113$ 34,784$ 51,419$ 35,789$ 4.7% 2.9%

74006 Bartlesville 71,955$ 52,885$ 76,558$ 55,840$ 6.4% 5.6%

74029 Dewey 52,020$ 33,839$ 55,550$ 35,024$ 6.8% 3.5%

Osage County

74056 Pawhuska 41,235$ 29,493$ 38,230$ 27,667$ -7.3% -6.2%

Nowata County74048 Nowata 45,087$ 34,813$ 46,511$ 35,757$ 3.2% 2.7%

Oklahoma 56,987$ 42,331$ 58,530$ 43,024$ 2.7% 1.6%

United States 69,637$ 49,297$ 71,917$ 49,815$ 3.3% 1.1%


Exhibit 6 presents the average annual resident unemployment rates for Nowata, Osage and Washington Counties in Oklahoma and the United States. As Exhibit 6 illustrates, unemployment rates for Nowata and Osage County have continued to rise in recent years and still rank unfavorably when compared to the state. Washington County ranks favorably compared to the state and all three counties rank favorably in comparison to national averages.


13

Exhibit 6Jane Phillips CHNA Community

Unemployment Rates (%)2008-2012

County 2008 2009 2010 2011 2012

Nowata County 4.3 9.1 9.0 7.9 6.4 Osage County 4.2 7.9 8.1 7.4 6.0 Washington County 3.0 5.7 5.8 5.1 4.0

Oklahoma 3.7 6.7 6.9 6.2 5.2 United States 5.8 9.3 9.6 9.0 8.1

Source: FDIC

The community served by Jane Phillips Medical Center is employed largely in service providing industries. Second only to local government employment, residents in Nowata, Osage and Washington counties work in trade, transportation and utilities; as well as education and health care services. Residents also work in the manufacturing sector within the goods producing industry.

Exhibit 7Jane Phillips CHNA CommunityEmployment by Major Industry

2010

Nowata Osage Washington US

Major Industries County % County % County % Total % %

Goods-producing 390 23.1% 1,234 20.3% 2,116 23.1% 3,740 18.4% 14.7%

Natural Resources and Mining 24 1.4% 698 11.5% 1,015 11.1% 3,886 19.1% 1.4%

Construction 84 5.0% 249 4.1% 354 3.9% 518 2.6% 4.3%

Manufacturing 282 16.7% 287 4.7% 747 8.1% 646 3.2% 9.0%

Service-providing 772 45.8% 2,492 41.0% 4,686 51.1% 7,950 39.2% 68.4%

Trade, Transportation, and Utilities 258 15.3% 918 15.1% 1,613 17.6% 4,033 19.9% 19.1%

Information - 0.0% 20 0.3% 104 1.1% 118 0.6% 2.1%

Financial Activities 94 5.6% 198 3.3% 252 2.7% 915 4.5% 5.8%

Professional and Business Services 41 2.4% 167 2.8% 312 3.4% 1,928 9.5% 13.1%

Education and Health Services 252 14.9% 566 9.3% 1,427 15.6% 3,071 15.1% 14.6%

Leisure and Hospitality 127 7.5% 535 8.8% 784 8.5% 2,000 9.9% 10.2%

Other Services - 0.0% 88 1.4% 194 2.1% 613 3.0% 3.4%

Federal Government 38 2.3% 220 3.6% 580 6.3% 114 0.6% 2.3%

State Government 35 2.1% 434 7.1% 403 4.4% 142 0.7% 3.6%

Local Government 451 26.7% 1,692 27.9% 1,390 15.1% 2,316 11.4% 11.0%

Total Employment 1,686 100.0% 6,072 100.0% 9,175 100.0% 20,300 100.0% 100.0%

Source: U.S. Department of Census


14

Major employers by county with more than 50 employees include the following:

Exhibit 8

Jane Phillips CHNA CommunityEmployment by Top Employers (> 50 Employees)

County

Top Employers Nowata Osage Washington

Nowata City Schools 150-200

Oklahoma Union Schools 100-150

Hays House 100-150

Nowata County 50-100

Pizza Hut 50-100

City of Nowata 50-100

Brenntag Southwest, Inc. 50-100

South Coffeyville School 50-100

Osage Tribe 400-500

Department Of Corrections 200-300

Osage County 200-300

Wal-Mart 200-300

Pawhuska Public Schools 150-200

Superior Well Services Llc 100-150

Hominy Public Schools 100-150

Woodland School District 50-100

Tulsa Country Club 50-100

City Of Pawhuska 50-100

Barnsdall School District 50-100

ConocoPhillips Company 2500-3000

Bartlesville Independent Schools 1000-1500

Jane Phillips Memorial Medical Cent 750-1000

Wal-Mart 600-700

City of Bartlesville 350-400

Sitel 300-350

Oklahoma Wesleyan University 250-300

Million Dollar Elm Casino 200-250

Dewey Public Schools 150-200

Diversified Systems Resources 150-200

Washington County 100-150

Arc Group Homes, Inc. 100-150

Lowes Home Centers Inc 100-150

66 Federal Credit Union 100-150

Oil-Field Pipe & Supply, Inc. 100-150

Veolia Water North America 100-150

Aramark Management Services 100-150

Saddoris Textile Maintenance, Inc. 100-150

Arvest Bank Operations, Inc. 100-150

The Voice Of The Martyrs, Inc. 100-150

Heritage Health Care Inc 100-150

Source: Oklahoma Chamber of Commerce


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Poverty

Exhibit 9 presents the percentage of total population in poverty (including under age 18) and median household income for households in Nowata, Osage and Washington Counties versus the state of Oklahoma and the United States.

2010 Median 2011 MedianAll Under Household All Under Household

County Persons Age 18 Income Persons Age 18 Income

Nowata County 15.6% 24.8% 38,040$ 16.9% 26.5% 38,453$ Osage County 16.5% 22.7% 41,589$ 18.2% 24.4% 43,170$ Washington County 13.7% 21.3% 45,957$ 15.6% 24.1% 47,645$

Oklahoma 16.8% 24.4% 42,076$ 17.3% 23.9% 43,232$ United States 15.3% 21.6% 50,046$ 15.9% 22.5% 50,502$

Source: U.S. Census Bureau, Small Areas Estimates Branch

2010 and 2011Poverty Estimate: Percentage of Total Population in Poverty and Median Household Income

Jane Phillips CHNA CommunityExhibit 9

Exhibit 9 presents the percentage of total population in poverty and median household income for each county. In 2012, a family of four was considered poor if their annual household income fell below $23,050. Poverty rates for Nowata are comparable to the state averages while Osage ranks unfavorable to state averages in 2011. Washington County has a favorable rate for all persons when compared to the state and national averages. Median household income for Nowata and Osage Counties ranks unfavorable to state and national averages.

Uninsured

Exhibit 10 presents health insurance coverage status by age (under 65 years) and income (at or below 400 percent) of poverty for each county versus the State of Oklahoma.


Health Insurance Coverage Status by Age (Under 65 years) and Income (At or Below 400%) of Poverty 2010

All Income Levels At or Below 400% of FPL

Under 65 Percent Under 65 Percent Under 65 Percent Under 65 Percent

County Uninsured Uninsured Insured Insured Uninsured Uninsured Insured Insured

Nowata County 1,962 23.0% 6,562 77.0% 1,767 26.5% 4,888 73.5%Osage County 8,441 21.9% 3,032 78.1% 7,376 26.9% 20,002 73.1%Washington County 8,059 19.5% 33,180 80.5% 7,002 26.2% 19,742 73.8%

Oklahoma 666,731 21.4% 2,444,669 78.6% 594,889 27.1% 1,559,012 72.9%

Source: U.S. Census Bureau, SAHIE/ State and County by Demographic and Income Characteristics


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Education

Exhibit 11 presents educational attainment for individuals in Nowata, Osage and Washington Counties versus the state of Oklahoma and the United States.


Educational Attainment - Total Population2007-2011

State/ County

Completing High SchoolNowata County 83.2%Osage County 87.0%Washington County 88.6%Oklahoma 85.9%United States 85.4%

Bachelor's Degree or MoreNowata County 11.3%Osage County 17.6%Washington County 26.1%Oklahoma 23.0%United States 28.2%

Source: U.S. Census Bureau, Current Population Survey

Education levels obtained by community residents may impact the local economy. Higher levels of education generally lead to higher wages, less unemployment and job stability. These factors may indirectly influence community health. With the exception of Nowata County, which is slightly lower than the state and national rates, the rate which persons aged 25 and older complete high school is comparable to both state and national averages.


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Community Health Care Resources

The availability of health resources is a critical component to the health of a county’s residents and a measure of the soundness of the area’s health care delivery system. An adequate number of health care facilities and health care providers are vital for sustaining a community’s health status. Fewer health care facilities and health care providers can impact the timely delivery of services. A limited supply of health resources, especially providers, results in the limited capacity of the health care delivery system to absorb charity and indigent care as there are fewer providers upon which to distribute the burden of indigent care. This section will address the availability of health care resources to the residents Nowata, Osage and Washington Counties.

Hospitals

The Medical Center has 137 acute beds and is the main provider of medical services in the area. Exhibit 12 summarizes hospital services available to the residents of the Medical Centers service area:

Exhibit 12

Jane Phillips CHNA CommunitySummary of Acute Care Hospitals

Facility Miles from Bed Annual Annual Patient

Type Regional Size Discharges Revenue (000's) Period End

Coffeyville Regional Medical Center ST Acute Care 36 68 2,154 79,713,944$ 12/31/2011

Pawhuska Hospital Critical Access 32 10 55 2,815,787$ 9/30/2010

St. John Owasso ST Acute Care 37 32 1,678 73,395,472$ 12/31/2011

Claremore Regional Hospital ST Acute Care 50 54 392 25,619,904$ 10/31/2011

Craig General Hospital ST Acute Care 49 42 1,562 60,208,104$ 12/31/2011

Fairfax Memorial Hospital Critical Access 57 15 86 2,999,230$ 9/30/2010

Bailey Medical Center ST Acute Care 35 73 1,288 100,197,456$ 12/31/2011

Jane Phillips Nowata Health Center Critical Access 20 25 266 4,903,226$ 9/30/2010

Source: Costreportdata.com, ahd.com

The following map geographically illustrates where Jane Phillips Medical Center is located and the prox-imity of the above health care facilities to the Medical Center.


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Other Licensed Facilities

According to the Oklahoma State Department of Health, there are numerous licensed medical facilities other than hospitals in Jane Phillips Medical Center CHNA Community. They include ambulatory sur-gery centers, community mental health centers, outpatient therapy treatment centers, home care agencies and hospice. A complete listing of these resources may be found at: http://www.ok.gov/health2/documents/MFS%20MedicalFacilitiesSvc.DIR_02.15.13.pdf.

Health Departments

Each county in the Hospital’s CHNA community has a county health department. The health depart-ment’s activities include:

•Health promotion and disease prevention •Child Health Services •Chronic disease screening •WIC Services

Estimated Demand for Hospital Services

In order to define existing services and develop future plans that may affect the operations of the Hospital, this study includes an analysis of estimated demand for physician office visits, hospital emergency room visits and hospital discharges using national averages and population estimates. Current and future unmet need can be evaluated based on the changes in the size of the market for certain services as determined by applying these national average use rates to the population of the community. Exhibit 13 summarizes es-timated 2013 and projected 2018 physician office visits, emergency department visits and hospital dis-charges using national average use rates from the National Center for Health Statistics.


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Exhibit 13

Physician Office Visits, Emergency Department Visits, and Discharges

Emergency EstimatedPhysician Estimated Department Emergency Hospital Estimated

Community Office Visits Physician Visits Department Discharges CommunityAge Population per Person Office Visits per Person Visits per Person Discharges

Estimated 2013

0-14 18,670 2.57 47,982 0.46 8,532 0.03 499

15-44 33,614 2.17 73,010 0.48 16,236 0.07 2,309

45-64 26,119 4.01 104,737 0.37 9,716 0.10 2,614

65+ 17,002 7.43 126,308 0.52 8,875 0.29 4,907

Total 95,405 3.69 352,037 0.12 43,359 0.24 10,328

Primary Care Visits 56.6% 199,253

Specialty Care Visits 43.4% 152,784

Total 352,037

Projected 2018

0-14 19,176 2.57 49,282 0.46 8,763 0.03 512

15-44 34,509 2.17 74,954 0.48 16,668 0.07 2,370

45-64 24,987 4.01 100,198 0.37 9,295 0.10 2,501

65+ 19,103 7.43 141,916 0.52 9,972 0.29 5,513

Total 97,775 3.75 366,350 0.12 44,698 0.24 10,896

Primary Care Visits 56.6% 207,354

Specialty Care Visits 43.4% 158,996

Total 366,350


Based on management’s analysis of market share, the Medical Center can sustain its current utilization as it relates to physician office visits, emergency department visits and hospital discharges. Without any significant operational changes, and assuming consistent levels of competition, the Medical Center’s mar-ket share should remain approximately even through the next five years.

Examination of the population demographics suggests that the aging of the “baby boom” population will actually slightly increase the overall utilization of hospital and primary care services within the communi-ty. The prospect for significant volume increases from changes in the market demographics is unlikely.

Exhibits 14 and 15 provide detailed analysis of estimated acute care discharges, ambulatory procedures, hospital outpatient department visits and physician office visits. These exhibits categorize the utilization for estimated 2013 and projected 2018 by different age categories to assess possible growth areas. A re-view of each of the charts indicates no significant percentage increases or decreases in any category. However, potential market growth does exist in a limited number of acute care areas.


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Exhibit 14Estimated and Projected Number of Ambulatory Surgery Procedures by Procedure Category and Age: Provider Service Area

MarketUnder 15-44 45-64 65 years Under 15-44 45-64 65 years Difference

Procedure Category ICD-9-CM code Total 15 years years years and over Total 15 years years years and over Percent

Total Provider Service Area Population 95,405 18,670 33,614 26,119 17,002 97,775 19,176 34,509 24,987 19,103

All procedures 13,162 770 2,707 4,293 5,393 13,736 791 2,779 4,107 6,059 4.4%Operations on the nervous system 01-5 512 4 132 225 152 524 4 135 215 170 2.5%Operations on the eye 08-16 2,568 44 75 427 2,022 2,802 45 77 408 2,272 9.1%Operations on the ear 18-20 285 206 29 29 21 293 211 30 28 24 2.7%Operations on the nose, mouth, and pharynx 21-29 739 220 237 200 83 753 226 243 191 93 1.9%Operations on the respiratory system 30-34 189 13 22 75 79 196 14 22 72 89 3.9%Operations on the cardiovascular system 35-39 408 0 39 176 193 425 0 40 168 216 4.2%Operations on the digestive system 42-54 2,936 60 589 1,075 1,212 3,056 62 604 1,029 1,361 4.1%Operations on the urinary system 55-59 631 24 88 208 312 664 24 90 199 350 5.1%Operations on the male genital organs 60-64 206 46 47 49 65 215 47 48 46 73 4.1%Operations on the female genital organs 65-71 661 4 409 185 62 671 4 420 177 70 1.6%Operations on the musculoskeletal system 76-84 1,640 52 556 714 317 1,664 54 571 683 356 1.5%Operations on the integumentary system 85-86 969 39 253 403 274 993 40 260 386 308 2.5%Miscellaneous diagnostic and therapeutic procedures 87-99 1,330 50 210 493 578 1,387 51 215 471 649 4.3%Operations on the endocrine system, operations on the hemic and lymphatic system, and obstetrical procedures 06-07,40-41,72-75 84 5 22 34 24 19 19 0 0 0


Estimated 2013 Projected 2018


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Exhibit 15Estimated and Projected Number of Acute Care Discharges by Medical Diagnostic Category and Age: Provider Service Area

MarketUnder 15-44 45-64 65 years Under 15-44 45-64 65 years Difference

Procedure Category Total 15 years years years and over Total 15 years years years and over Percent

Total Provider Service Area Population 95,405 18,670 33,614 26,119 17,002 0 97,775 19,176 34,509 24,987 19,103

All Conditions 12,948 789 2,913 3,077 6,170 13,676 811 2,990 2,943 6,932 5.6%

Infectious and paristic diseases 364 48 46 79 191 387 49 48 75 215 6.3%Neoplasms 645 12 77 224 332 679 12 79 214 373 5.2%Endocrine, nutritional & metabolic diseases, and immunity disorders 666 58 104 179 325 702 60 107 171 365 5.5%Diseases of the blood and blood-forming organs 170 18 29 36 86 180 18 30 35 97 6.1%Mental Disorders 748 39 338 245 126 763 40 347 234 141 2.0%Diseases of the nervous system and sense organs 207 25 36 49 97 218 25 37 47 109 5.6%Diseases of the circulatory system 2,701 10 121 696 1,875 2,906 10 124 665 2,107 7.6%Diseases of the respiratory system 1,410 211 93 272 834 1,510 217 96 260 937 7.1%Diseases of the digestive system 1,361 76 232 395 658 1,433 78 238 378 739 5.3%Diseases of the genitourinary system 732 26 156 183 366 774 26 160 175 411 5.8%Complications of pregnancy, childbirth, and puerperium 140 0 140 0 0 144 0 144 0 0 2.7%Diseases of the skin and subcutaneous tissue 262 16 58 78 109 274 17 59 74 123 4.6%Diseases of the musculoskeletal system and connective tissue 764 12 84 252 417 807 12 86 241 468 5.6%Congenital anomalies 65 44 9 8 4 66 45 9 8 5 2.5%Certain conditions originating in the perinatal period 62 62 0 0 0 64 64 0 0 0 2.7%Symptoms, signs, and ill defined conditions 85 18 21 24 22 87 19 22 22 24 3.2%Injury and poisoning 1,059 74 223 262 501 1,118 76 229 251 562 5.5%Supplementary classifications 1,491 25 1,145 96 226 1,546 26 1,175 91 254 3.7%

Source: The Nielson Company

Estimated 2013 Projected 2018


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Health Status of the Community

This section of the assessment reviews the health status of Nowata, Osage and Washington County residents. As in the previous section, comparisons are provided with the state of Oklahoma and the United States. This in-depth assessment of the mortality and morbidity data, health outcomes, health factors and mental health indicators of the county residents that make up the community will enable the Hospital to identify priority health issues related to the health status of its residents.

Good health can be defined as a state of physical, mental and social well-being, rather than the absence of disease or infirmity. According to Healthy People 2010, the national health objectives released by the U.S. Department of Health and Human Services, individual health is closely linked to community health. Community health, which includes both the physical and social environment in which individuals live, work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who lives in the community. Healthy people are among a community’s most essential resources.

Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior, human biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health care and medical services. Studies by the American Society of Internal Medicine conclude that up to 70 percent of an individual’s health status is directly attributable to personal lifestyle decisions and attitudes. Persons who do not smoke, who drink in moderation (if at all), use automobile seat belts (car seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily living and exercise regularly have a significantly greater potential of avoiding debilitating diseases, infirmities and premature death.

The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining recognition and acceptance by both the general public and health care providers. Some examples of lifestyle/behavior and related health care problems include the following:

Lifestyle Primary Disease Factor

Smoking Lung cancer Cardiovascular disease Emphysema Chronic bronchitis

Alcohol/drug abuse Cirrhosis of liver

Motor vehicle crashes Unintentional injuries Malnutrition Suicide Homicide Mental illness

Poor nutrition Obesity

Digestive disease Depression

Driving at excessive speeds Trauma

Motor vehicle crashes


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Lack of exercise Cardiovascular disease Depression

Lifestyle Primary Disease Factor

Overstressed Mental illness Alcohol/drug abuse Cardiovascular disease

Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as the incidence of illness or injury and mortality is defined as the incidence of death. However, law does not require reporting the incidence of a particular disease, except when the public health is potentially endangered.

Due to limited morbidity data, this health status report relies heavily on death and death rate statistics for leading causes in death in Nowata, Osage and Washington Counties as well as the state of Oklahoma. Such information provides useful indicators of health status trends and permits an assessment of the impact of changes in health services on a resident population during an established period of time. Community attention and health care resources may then be directed to those areas of greatest impact and concern.

Leading Causes of Death

Exhibit 16 reflects the leading causes of death for residents and compares the rates, per thousand, to the state of Oklahoma and the United States average rates, per thousand.

Exhibit 16

Jane Phillips CHNA Community

Selected Causes of Resident Deaths: Number and Rate (2009)

United

Nowata Osage Washington Oklahoma States

Number Rate* Number Rate* Number Rate* Number Rate* Rate*

Diseases of the Heart 43 408.4 112 248.6 164 323.4 9,201 249.5

Malignant Neoplasm 30 285.0 102 226.4 120 236.7 7,639 207.2

Chronic Lower Respiratory Diseases 5 47.5 26 57.7 40 78.9 2,597 70.4

Cerebrovascular Diseases 9 85.5 30 66.6 43 84.8 1,960 53.2

Unintentional Injuries 11 104.5 35 77.7 28 55.2 2,285 62

Non-Rankable Causes 22 209.0 58 128.7 83 163.7 4,554 123.5

Source: Oklahoma State Department of Health


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Health Outcomes and Factors

An analysis of various health outcomes and factors for a particular community can, if improved, help make that community a healthier place to live, learn, work and play. A better understanding of the factors that affect the health of the community will assist with how to improve the community’s habits, culture and environment. This portion of the community health needs assessment utilizes information from County Health Rankings, a key component of the Mobilizing Action Toward Community Health (MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The County Health Rankings model is grounded in the belief that programs and policies implemented at the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health outcomes for communities across the nation. The model provides a ranking method that ranks all 50 states and the counties within each state, based on the measurement of two types of health outcomes for each county: how long people live (mortality) and how healthy people feel (morbidity). These outcomes are the result of a collection of health factors and are influenced by programs and policies at the local, state and federal levels.

Counties in each of the 50 states are ranked according to summaries of a variety of health measures. Those having high ranks, e.g. 1 or 2, are considered to be the “healthiest”. Counties are ranked relative to the health of other counties in the same state on the following summary measures:

• Health Outcomes--rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures.

• Health Factors--rankings are based on weighted scores of four types of factors:

o Health behaviors (six measures)

o Clinical care (five measures)

o Social and economic (seven measures)

o Physical environment (four measures)

A more detailed discussion about the ranking system, data sources and measures, data quality and calculating scores and ranks can be found at the website for County Health Rankings (www.countyhealthrankings.org).

As part of the analysis of the needs assessment for the community, the relative health status of Nowata, Osage and Washington Counties will be compared to the state of Oklahoma as well as to a national benchmark. A better understanding of the factors that affect the health of the community will assist with how to improve the community’s habits, culture and environment.

The following tables, from County Health Rankings, summarize the 2012 health outcomes for the Nowata, Osage and Washington Counties which comprise the majority of the community of Jane Phillips Medical Center. Each measure is described and includes a confidence interval or error margin surrounding it – if a measure is above the state average and the state average is beyond the error margin for the county, then further investigation is recommended.


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County Rankings

Health Outcomes--rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Nowata, Osage and Washington Counties rank favorably or comparably to the state of Oklahoma in mortality and morbidity health factors.


County Health Rankings - Health Outcomes (2012)Nowata Osage Washington NationalCounty County County OK Benchmark

MortalityRank out of 77 Oklahoma Counties 17 18 13Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) 7,619 8,634 8,042 9,488 5,466

Morbidity

Rank out of 77 Oklahoma Counties 15 25 12Poor or fair health - Percent of adults reporting fair or poor heatlh (age-adjusted) 23% 19% 15% 19% 10%Poor physical health days - Average number of physically unhealthy days reported in past 30 days (age-adjusted) 3.9 3.8 3.9 4.1 2.6 Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) 3.9 3.6 3.3 4.0 2.3 Low birthweight - Percent of live births with low birthweight (<2500 grams) 5.8% 7.9% 7.0% 8.1% 6%

Source: Countyhealthrankings.org

A number of different health factors shape a community’s health outcomes. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic and the physical environment.


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The following table summarizes the health factors for Nowata, Osage and Washington Counties and shows that the counties have significant room for improvement in the following areas:

Nowata County

Health behavior/adult smoking

Clinical care/primary care physicians

Clinical care/preventable hospital stays

Clinical care/mammography screenings

Social and economic factors/unemployment

Physical environment/limited access to healthy foods

Osage County

Health behavior/adult smoking

Health behavior/physical inactivity

Clinical care/primary care physicians

Clinical care/mammography screening

Social and economic factors/unemployment


Physical environment/fast food restaurants

Washington County

Health behavior/sexually transmitted infections

Social and economic factors/children in single-parent households


Physical environment/fast food restaurants


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Exhibit 17.1Jane Phillips CHNA Community

County Health Rankings - Health Factors (2012)Nowata Osage Washington NationalCounty County County OK Benchmark

Health BehaviorsRank out of 77 Oklahoma Counties 35 29 10Adult smoking - Percent of adults that report smoking at least 100 cigarettes and that they currently smoke 30.0% 27.0% 24.0% 25.0% 14%Adult obesity - Percent of adults that report a BMI >= 30 33.0% 32.0% 31.0% 32.0% 25%Physical inactivity - percent of adults aged 20 and over reporting no leisure time physical activity 30.0% 35.0% 30.0% 31.0% 21%Excessive drinking - Percent of adults that report excessive drinking in the past 30 days 9.0% 12.0% 9.0% 14.0% 8%Motor vehicle crash death rate - Motor vehicle deaths per 100K population 28.0 21.0 21.0 22.0 12 Sexually transmitted infections - Chlamydia rate per 100K population 168.0 185.0 234.0 413.0 84 Teen birth rate - Per 1,000 female population, ages 15-19 54.0 44.0 46.0 58.0 22 Clinical CareRank out of 77 Oklahoma Counties 55 50 2Uninsured adults - Percent of population under age 65 without health insurance 23.0% 22.0% 20.0% 21.0% 11%Primary care physicians - Ratio of population to primary care physicians 5363:1 15068:1 133:1 1152:1 631:1Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees

98.0 70.0 43.0 82.0 49 Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening 73.0% 70.0% 82.0% 77.0% 89%Mammography screening - Percent of female Medicare enrollees that receive mammorgraphy screening 50.0% 49.0% 66.0% 60.0% 74%Social & Economic FactorsRank out of 77 Oklahoma Counties 48 71 23High school graduation - Percent of ninth grade cohort that graduates in 4 years 88.0% 27.0% 82.0% 78.0%Some college - Percent of adults aged 25-44 years with some post-secondary education 54.0% 51.0% 55.0% 5.0% 68.0%Unemployment - percent of popluation 16+ unemployed but seeking work 9.2% 8.5% 6.0% 7.1% 5.4%Children in poverty - Percent of children under age 18 in poverty

25.0% 23.0% 21.0% 24.0% 13.0%Inadequate social support - Percent of adults without social/emotional support 21.0% 21.0% 15.0% 20.0% 14.0%Children in single-parent households - Percent of children that live in household headed by single parent 38.0% 29.0% 35.0% 33.0% 20.0%Violent Crime Rate - Violent Crimes per 100,000 population (age-adjusted) 422.0 495.0 301.0 510.0 73.0 Physical EnvironmentRank out of 77 Oklahoma Counties 17 65 6Air pollution-particulate matter days - Annual number of unhealthy air quality days due to fine particulate matter - - - - - Air pollution-ozone days - Annual number of unhealthy air quality days due to ozone 4 3 5 13 - Lmited Access to healthy foods - Healthy food outlets include grocery stores and produce stands/farmers' markets 3.0% 27.0% 1.0% 11.0% - Fast food restaurants - percent of all restaurants that are fast food establishments 22.0% 50.0% 45.0% 50.0% 25%Access to recreational facilities - Rate of recreational facilities per 100,000 population - 2.0 12.0 7.0 16.0

Source: Countyhealthrankings.org


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Key Informant Interviews

Interviewing key informants (community stakeholders) is a technique employed to assess public perceptions of the county’s health status and unmet needs. These interviews are intended to ascertain opinions among individuals likely to be knowledgeable about the community and influential over the opinions of others about health concerns in the community.

Methodology

Interviews with 22 key informants were conducted over a two-day period in October 2012. Interviewees were determined based on their a) specialized knowledge or expertise in public health, b) their affiliation with local government, schools and industry or c) their involvement with underserved and minority populations.

A representative from the Medical Center contacted all individuals nominated for interviewing. His knowledge of the community, and the personal relationships he held with the potential interviewees added validity to the data collection process. If the respective key informant agreed to an interview, an interview time and place was scheduled. All of the interviews were conducted at Jane Phillips Medical Center.

All interviews were conducted using a standard questionnaire. A copy of the interview instrument is included in the Appendices. A summary of their opinions is reported without judging the truthfulness or accuracy of their remarks. Community leaders provided comments on the following issues:

• Health and quality of life for residents of the primary community

• Barriers to improving health and quality of life for residents of the primary community

• Opinions regarding the important health issues that affect Nowata, Osage, and Washington County residents and the types of services that are important for addressing these issues

• Delineation of the most important health care issues or services discussed and actions necessary for addressing those issues

Interview data was initially recorded in narrative form in Microsoft Word. Themes in the data were identified and representative quotes have been drawn from the data to illustrate the themes. Interviewees were assured that personal identifiers such as name or organizational affiliations would not be connected in any way to the information presented in this report. Therefore, quotes included in the report may have been altered slightly to preserve confidentiality. This technique does not provide a quantitative analysis of the leaders’ opinions, but reveals some of the factors affecting the views and sentiments about overall health and quality of life within the community.


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Key Informant Profiles

Key informants from the community (see Appendix A for a list of key informants) worked for the following types of organizations and agencies:

• Social service agencies

• Local school system and community college

• Local city and county government

• Public health agencies

• Industry

• Faith community

• Medical providers

These health care and nonhealth care professionals provided insight into the health status of Nowata, Osage and Washington Counties through a 10-question interview (refer to the Appendices).

Key Informant Interview Results

As stated earlier, the interview questions for each key informant were identical. The questions on the interview instrument are grouped into four major categories for discussion:

1. General opinions regarding health and quality of life in the community

2. Underserved populations and communities of need

3. Barriers

4. Most important health and quality of life issues

A summary of the leaders’ responses by each of these categories follows. Paraphrased quotes are included to reflect some commonly held opinions and direct quotes are employed to emphasize strong feelings associated with the statements. This section of the report summarizes what the key informants said without assessing the credibility of their comments.

1. General opinions regarding health and quality of life in the community

The key informants were asked to rate the health and quality of life in their respective county. They were also asked to provide their opinion whether the health and quality of life had improved, declined or stayed the same over the past few years. Lastly, key informants were asked to provide support for their answers.

Majority of the key informants rated the health and quality of life in their county as “good”, “above average” or “8 on scale of 1 to 10”. Even though the key informants consistently reported the health and quality of life was good, interviewees repeatedly noted that there were extreme diversities in health and quality of life for certain residents within the community. Economic circumstances are seen to contribute largely to the dichotomy between the haves and have-nots.


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When asked whether the health and quality of life had improved, declined or stayed the same, almost half of the key informants noted that health and quality of life had improved over the last few years. Most of the remaining key informants noted that health and quality of life had declined for certain populations over the past few years.

Key informants noted that Jane Phillips does a great job at addressing the needs of the community and the partnership the Medical Center has with St. John’s in Tulsa has benefited the community. Although the hospital is providing adequate care to the community, many key informants stated there was a shortage of primary care physicians in the area and many of the primary care physicians that are in the area do not accept Medicare.

Obesity and diabetes were repeatedly referred to as chronic health conditions of the community. Many key informants noted these health conditions are a result of choices made by individuals, whether it is from a lack of knowledge or due to lifestyle habits. Poor choices in nutrition, sedentary lifestyles, and cultural factors are all contributors to chronic health issues.

Key informants voiced concerns regarding the prevalence of substance abuse, concerning both prescription and non-prescription drugs. Alcohol and tobacco use were also mentioned as major quality of life issues. Another concern noted by key informants was the number of teenage pregnancies. Increasing education at a young age, particularly within the school system, was suggested as a way to combat the above issues.

Overall, key informants value Jane Phillips’ impact on community health and recognize the Hospital as an asset to the community. The regional culture, surrounding healthy habits, or lack thereof, was generally seen as the reason behind poor health and quality of life. Lack of access to primary care physicians was seen as an issue for certain populations. Poor economic conditions and lack of jobs are seen as detriment to community health.

“[Jane Phillips] Hospital staff does a wonderful job.”

“People continue to live a certain way; it’s easy for people to eat junk food and watch TV.”

“We don’t want to take responsibility for our lifestyle.”

2. Underserved populations and communities of need

Key informants were asked to provide their opinions regarding specific populations or groups of people whose health or quality of life may not be as good as others. We also asked the key informants to provide their opinions as to why they thought these populations were underserved or in need. We asked each key informant to consider the specific populations they serve or those with which they usually work. Although responses to this question varied, many of the key informants had similar viewpoints.

Key informants felt the quality of life and health was greatly impacted based on socioeconomic status. The majority of key informants noted the health and quality of life were not as good for individuals with low income and/or no insurance or those on Medicare/Medicaid. The working poor were mentioned as the main underserved population due to their inability to obtain insurance and therefore cover the costs of healthcare. This group is already struggling to provide for the daily necessities of life, and coming up with the money to pay for medical expenses is not feasible.


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Children being raised in households with fewer financial resources were considered in need due to lack of access to services, both medical and dental. Additionally, healthy nutrition for children in these households was limited due to the cost of fruits and vegetables. Transportation was felt to be a major barrier for persons living in rural areas with few financial resources.

Newly uninsured/underinsured are considered to have issues accessing care. Although services are available, the newly uninsured/underinsured do not have necessary knowledge regarding how to access care if they do not have insurance. Respondents repeatedly noted additional needs for resources in this area as well as education on where to go to get the services needed.

According to many of the key informants, there is a lack of mental health facilities within Bartlesville and those with mental health illnesses either go undiagnosed or do not get the proper treatment. These individuals, along with the uninsured, tend to frequent the Emergency Room rather than find a primary care provider which leads to longer waits, increased costs to the hospital, and inefficient use of hospital staff.

“[We] need to break the cycle by mentoring families out of poverty.”

“Change takes time and everyone working together, coming together and coming up with a plan before problems get worse than they are now.”

“The problem is generational and it’s breaking habits that have gone on for generations.”

3.Barriers

The key informants were asked what barriers or problems keep community residents from obtaining necessary health services in their community. Responses from key informants include access to primary care physicians, lack of education and communication, lack of transportation and general decline in economic conditions.

Lack of education and communication surrounding health issues and the availability of health resources is seen as a primary barrier to health services. Education surrounding access to health services for the newly uninsured or underinsured persons is also identified as a community need. People do not understand how to access services and there is limited media access for the local community to receive information regarding education and screenings offered, specifically those individuals who are in the lower income bracket.

Being a rural community with a limited public transportation system is viewed as being a barrier to accessing regular health care for those without personal transportation. Those interviewed believe it is difficult to reach out to isolated or marginalized people in the community. There is a lack of transportation for low-income residents to receive services and a lack of personal “know-how” of the medically indigent for accessing needed services.

As previously noted, people’s attitudes and culture, surrounding health and lifestyle choices, are seen as a barrier. Bad habits are passed down from generation to generation and there are not enough resources to bring about a change. Physical activity and exercise were seen as ways to help combat


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healthy lifestyles, but key informants noted people are going to have to want to make a change in their choices.

“People are not able to get the education of the types of services, agencies, and resources that are available.”

“There needs to be better education at the younger ages.”

“Transportation is a barrier – getting people to the right resources.”

4.Most important health and quality of life issues

Key informants were asked to provide their opinion as to the most critical health and quality of life issues facing the county. The issue identified most frequently was a lack in preventative care education and measures to ensure a healthy population. Interviewees mentioned the education is out there but people who need it the most do not have access to the information and those that do continue in their current lifestyle. This not only drives up the costs of health care because many of these individuals go to the emergency room for relief instead of a primary care physician but leads to a cycle of unhealthy living patterns. People in the community either do not understand the importance of keeping up with their health by exercising, eating healthy and getting screenings or cannot afford the costs associated with these solutions.

Drug abuse was also widely mentioned among the key informants

Other issues that were reported for the general population were obesity, lack of primary care physicians, poor lifestyle choices, transportation, mental health and teenage pregnancy.

“Drugs are a major problem here.”

“People (adults) need to make the choice for themselves.”

“The hospital partnership with St. John in Tulsa benefits the community pretty well.”


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Key Findings

A summary of themes and key findings provided by the key informants follows:

• The most prevalent chronic condition noted was obesity

• Health disparities were noted for low income, uninsured and underinsured.

• Too many people are utilizing the emergency rooms for care. Continuing access to care is an is-sue.

• Many key informants felt education was key to improving health

• Transportation is a barrier to obtaining health services

• People’s attitudes and choices lead to poor health.

• Lack of primary care doctors and access to these doctors, particularly for those with Medicaid

• Nowhere for the underinsured to seek help. They overuse the ER which creates long wait times and write-offs for the hospital

• The area needs a clinic/federally qualified health center to help divert those in the ER who don’t actually have an emergency.

• Lack of mental health resources and counseling

• Information and education on healthy living and preventative care is a problem. Need to inform, educate and counsel specific categories of the community.

• Lack of motivation from citizens keeps them from getting the help they need or the preventative measures they could take to stay healthy.

• Lack of healthy food options

• People’s attitudes and choices lead to poor health. Residents are apathetic regarding wellness and health as a result of socioeconomic status and culture.

• Drug and alcohol abuse, along with teenage pregnancies are seen as a health and quality of life is-sue.

• Transportation may be an issue for people living outside the city limits and those who do not have any other means of getting around.

• Abuse of prescription drugs has become a significant problem.

• Specific populations lack general knowledge regarding health services and/or how to access those health services.

• Better physician recruitment would allow for more access to primary care physicians

• Collaboration between the Medical Center and different organizations in the area is seen as a way to better help the people in the community who are in need.


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Community Health Survey

A community survey was conducted by Jane Phillips Medical Center in order to gather broad community input regarding health issues. The survey was launched on January 26, 2012 and was closed on February 26, 2013.

The broad survey was intended to gather information regarding overall health of the community. The results of this survey yield information on different health and community factors. Areas surveyed include demographics and socioeconomic characteristics, behavioral risk factors, health conditions and access to health resources

Methodology

A web-based survey tool, Question Pro, was utilized to conduct an electronic survey. The electronic survey link was posted on Jane Phillip’s external website and also on the internal Intranet.

There were 213 surveys completed. Socio-demographic characteristics such as age, education, income and employment status were fairly comparable to the most recent census data. Over 80 percent of the survey respondents were female which is more than the 50 percent of the population that is female in the community.

Survey Instrument

The survey instrument used for this study is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions. The final survey instrument was developed by Jane Phillips representatives in conjunction with BKD.

Community Health Survey Results

The actual survey was quite detailed in nature, including many specific questions regarding general health, satisfaction with specific and general providers, and demographic information. A compilation of the actual survey results has also been included in the Appendices for each question to allow for a more detailed analysis. Health needs indicated by the survey results are:

• Assessment of Personal Health

When asked to assess their personal health status, 33 percent of the respondents described their health as being “excellent”, while 57 percent stated that their overall health was “good.”

When asked to rate their community as a “healthy community”, less than 10 percent of the respondents indicated their community was healthy or very healthy. More than 60 percent of the respondents indicated their community was “somewhat healthy”.

(See Questions 12 and 20 of Community Health Survey)


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• Health Care Access Issues

Over 90 percent of the respondents reported having health insurance with over 85 percent of health insurance being provided by private insurance companies. Health care access issues are primarily related to costs. Respondents noted the following reasons for not receiving medical care:

1. Health insurance did not cover, approve or pay for procedure or test

2. Deductible or co-pay was too high

3. Health care provider will not take my insurance

Forty-two percent of respondents noted nothing has stopped them from getting the health care needed.

Respondents were also asked what the most needed physician specialties in the community are. The top three specialties noted were:

1. General and family practice

2.Obstetrics and Gynecology

3.Neurology

(See Questions 10, 11, 15 and 16 of Community Health Survey)

What do citizens say about the health of their community?

The five most important “health problems:”

1. Obesity (adult)

2. Diabetes

3. Heart disease and stroke

4. Aging problems

5. Cancer

(See Question 18 of Community Health Survey)

The five most “risky behaviors:”

1. Drug abuse

2. Alcohol abuse

3. Tobacco use/second hand smoke

4. Lack of exercise


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5. Poor eating habits


The five most important factors for a “healthy community:”

1. Affordable and available health care

2. Affordable housing

3. Good schools

4. Job availability

5. Clean and safe environment


Additional items to consider in planning

Respondents were asked to provide input as to what items Jane Phillips Medical Center should consider in planning for the next two years. The following items were recurring suggestions provided:

1. Jane Phillips should try to increase the level of community involvement, especially in the areas of health promotion and disease programs.

2. Increased wellness programs that include general education and preventive procedures/screenings.

3. The need for qualified physicians to see and treat those who are uninsured or on Medicaid/Medicare.

4. Additional services to help the elderly and aging population.

Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups

Certain key informants were selected due to their positions working with low-income and uninsured populations. Several key informants were selected due to their work with minority populations. Based on information obtained through key informant interviews and the community health survey, the following chronic diseases and health issues were identified:

• Uninsured/low income population

Lack of access (cost)

Transportation

Limited Access to Healthy Foods

Lack of Health Knowledge/Education


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Prioritization of Identified Health Needs

Using findings obtained through the community survey and collection of primary and secondary data, Jane Phillips Medical Center completed an analysis of these inputs (see Appendices) to identify community health needs. The following data was analyzed to identify health needs for the community: Leading Causes of Death Leading causes of death that compared negatively to U.S. rates were identified as an identified health need for the community. Primary Causes for Inpatient Hospitalization The primary causes for inpatient hospitalization resulted in an identified health need for the community. Health Outcomes and Factors An analysis of the adolescent mental health facts was prepared with information obtained from the U.S. Department of Health and Human Services. Health factors and outcomes that compared negatively to U.S. rates were identified as a health need for the community. Primary Data Health needs identified through community surveys and key informant interviews were included as health needs. Needs for vulnerable populations were separately reported on the analysis in order to facilitate the prioritization process. As a result, the following summary list of needs was identified:

• Heart disease

• Limited Access to Healthy Foods

• Cancer

• Chronic Lowers Respiratory Disease

• Stroke Cerebrovascular Disease

• Adult Obesity

• Uninsured

• Drug Addiction/Substance Abuse

• Diabetes

• Adult Smoking

• Lack of Health Knowledge/Education

• Physical Inactivity

• Lack of Primary Care Physicians

• Children in Poverty

• Low Mammography Screening Rate


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• Transportation

• Aging Issues

• Teen Birth Rate

• Children in Single Parent Households

• Violent Crime Rate

• Motor Vehicle Crash Rate

• Sexually Transmitted Infections

• Lack of mental Health Facilities

To facilitate prioritization of identified health needs, a ranking and prioritization process was used. Health needs were ranked based on the following six factors. Each factor received a score between 0 and 4.

1. How many people are affected by the issue or size of the issue?

2. What are the consequences of not addressing this problem?

3. The impact of the issue on vulnerable populations.

4. How important the issue is to the community?

5. Prevalence of common themes.

6. Whether or not the Hospital has existing programs to respond to the identified need.


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Each need was ranked based on the six prioritization metrics:

Jane Phillips Medical Center

Prioritization of Health Needs

How many people are affected by the

issue?

What are the consequences of not

addressing this problem?

What is the impact on vulnerable

populations?How Important is it to the community?

How many sources identified the need?

Does the hospital have existing

programs which respond to the

identified need? Total Score *Heart Disease 4 4 0 3 4 4 19Limited Access to Healthy Foods 4 3 4 2 4 1 18Cancer 4 4 0 2 2 4 16Chronic Lower Respiratory Disease 4 4 0 0 4 4 16Stroke Cerebrovascular Disease 4 4 0 0 4 4 16Adult Obesity 4 3 0 4 3 2 16Uninsured 4 3 4 0 2 3 16Diabetes 4 3 0 4 1 4 16Adult Smoking 4 3 0 3 3 2 15Lack of Health Knowledge/Education 3 3 4 0 2 3 15Physical Inactivity 4 3 0 2 3 2 14Lack of Primary Care Physicians 4 3 0 0 2 3 12Children in Poverty 4 3 0 0 2 1 10Low Mammography Screening rate 4 2 0 0 1 3 10Drug Addiction/Substance Abuse 2 2 0 4 1 1 10Transportation 2 1 4 0 2 0 9Aging Issues 2 2 0 2 1 2 9Teen Birth Rate 4 1 0 0 2 1 8Children in Single Parent Households 4 2 0 0 1 1 8Violent Crime Rate 4 2 0 0 1 0 7Motor Vehicle Crash Rate 3 2 0 0 1 0 6Sexually transmitted infections 3 1 0 0 1 1 6Lack of Mental Health Facilities 2 2 0 0 1 0 5

*Highest potential score = 28


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Hospital management reviewed the identified needs reported in the Exhibit above. Through dis-cussion and debate, hospital management agreed on priorities Jane Phillips Medical Center should focus on for fiscal years 2014-2016. Jane Phillips Medical Center has determined priority areas to be 1.) Primary Care Access, 2.) Community Wellness, and 3.) Transportation. The hospital’s next steps include developing an implementation strategy to address these priority areas.

Jane Phillips Medical Center Correlated Community Health Need

Primary Care Access Lack of Primary Care Physicians

Uninsured

Community Wellness Chronic Diseases including: Heart Disease, Diabetes

Cancer, Respiratory Disease

Adult Obesity

Physical Inactivity

Limited Access to Healthy Foods

Health Knowledge/Health Education

Adult Smoking

Transportation to Care Transportation


APPENDICES

Community Health Needs Assessment 2013 Acknowledgements

The project Steering Committee was the convening body for this project. Many other individuals including community residents, key informants and community-based organizations contributed to this community health needs assessment.

Project Steering Committee

Special thanks to all of the following committee members for their time and commitment to this project:

Mike Moore, Chief Financial Officer, Jane Phillips Medical Center Mike Wilt, Foundation Director, Jane Phillips Medical Center Susan Herron, Vice President of Nursing, Jane Phillips Medical Center Rob Poole, Chief Information Officer, Jane Phillips Medical Center David Stire, Chief Executive Officer, Jane Phillips Medical Center Diane Garrett, Director of Quality, Jane Phillips Medical Center Brian Lawrence, Director of Development, Jane Phillips Medical Center Dr. Paul McQuillen, Medical Director, Jane Phillips Medical Center Sam Guild, Vice President Clinical Services, Jane Phillips Medical Center

Key Informants

Thank you to the following individuals who participated in our key informant interview process:

Aaron Archambo, Archambo Financial Advisors Bill Beierschmitt, Rogers State University Provost Kyle Craig, M.D., General physician Mike Dunlap, County Commissioner Lindel Fields, Tri-County Technology Superintendent Stacy Garrett, JPMC RN Clinical Supervisor Jo Griffith, ABB Patty Leach, Family Healthcare Clinic Rod Maclvaine, Grace Community Church Kathleen Rutledge, Product Evaluation Research Company Keith Sheffield, Executive Director, Samaritan Counseling Russell Vaclaw, Judge Elizabeth Welch, Daybreak Rotary Club Cindy Pribil, Director/Founder of Green Country Clinic Dianne Martinez, Bartlesville Public School Lisa Beeman, Director of Community Development and Parks & Recreation Lyn McKee, Nurse Manager of Cardiac Unit Michael Cole, Executive Director, Tulsa Area United Way Chris Rush, Editor and Publisher, The Examiner Enterprise Sherri Wilt, President of the Chamber Stevie Williams, Director of Community Relations, Eldercare of Bartlesville Tom Gorman, President of Gorman Management Company


KEY INFORMANT INTERVIEW PROTOCOL


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COMMUNITY HEALTH SURVEY DETAIL RESULTS


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SOURCES


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