table of contents - mercy

Table of Contents

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

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

Previous Community Health Needs Assessment- Priorities, Implementation, and Evaluation .................... 2

Mercy Hospital Logan County Medical Services Area Demographics ........................................................ 4

Figure 1. Mercy Hospital Logan County Medical Service Areas ......................................................... 5

Table 1. Population of Mercy Hospital Logan County Medical Service Areas ................................... 6

Table 2. Existing Medical Services in the Mercy Hospital Logan County Medical Services Area...... 7

Table 3. Percent of Total Population by Age Group for Mercy Hospital Logan County Medical

Service Areas, Logan County and Oklahoma ....................................................................................... 8

Table 4. Percent of Total Population by Race and Ethnicity for Mercy Hospital Logan County

Medical Service Areas, Logan County and Oklahoma ......................................................................... 9

Summary of Community Meetings ............................................................................................................. 10

Economic Impact and Community Health Needs Assessment Overview, November 5, 2015............... 10

Table 5. Mercy Hospital Logan County Medical Service Area Health Sector Impact on Employment

and Income, and Retail Sales and Sales Tax ........................................................................................ 13

Health Data, November 12, 2015............................................................................................................ 14

Table 6. Health Factors (Overall Rank 18) ........................................................................................ 15

Community Survey Methodology and Results, November 4- December 2, 2015 .................................. 18

Table 8. Zip Code of Residence ......................................................................................................... 19

Table 9. Type of Specialist Visits ....................................................................................................... 20

Figure 2. Summary of Hospital Usage and Satisfaction Rates ........................................................... 21

Table 10. Top Healthcare Concerns in the Guthrie Area ................................................................... 22

Table 11. Additional Services Survey Respondents Would Like to See Offered at Mercy Hospital

Logan County ...................................................................................................................................... 23

Primary Care Physician Demand Analysis, December 2, 2015 .............................................................. 24

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Guthrie,

Oklahoma Medical Service Area ........................................................................................................ 24

Community Health Needs Implementation Strategy .................................................................................. 25

Community Health Needs Assessment Marketing Plan ............................................................................. 27

Appendix A- Hospital Services/Community Benefits ................................................................................ 28

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

Appendix C- Meeting 1 Materials, November 5, 2015 .............................................................................. 33

Appendix D- Meeting 2 Materials, November 12, 2015 ........................................................................... 36

Appendix E- Survey Form and Meeting 3 Materials, December 2, 2015 .................................................. 38

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 Mercy Hospital Logan

County 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. The report concludes by listing the recommendations that came out of the process and

presenting the hospital’s implementation strategy and marketing plan.

Previous Community Health Needs Assessment- Priorities, Implementation,

and Evaluation

Mercy Hospital Logan County worked with the Oklahoma Office and Oklahoma

Cooperative Extension Service in 2013 to complete their first Community Health Needs

Assessment. During that time, health concerns were identified by community members and then

prioritized by community members in focus group-style meetings. The following identifies each

priority, implementation taken, and an evaluation or impact of the implementation.

Priority: Engage Community

Service Implemented/Partnerships: Summer Backpack Program

The hospital partnered with the county health department to serve local youth by continuing the

backpack feeding program for seven weeks during the summer months (July 15, 2014 through

August 3, 2014). Approximately 100 youth were served and benefited from this program.


Service Implemented/Partnerships: Meals on Wheels Assistance

3

Each week two Mercy Hospital Logan County staff members deliver meals for the Meals on

Wheels program. This is an ongoing collaboration; therefore, the number of individuals who

have benefitted is a continually increasing number.


Service Implemented/Partnerships: Volunteer at Hands of Jesus Food Bank

Three individuals from Mercy Hospital Logan County volunteer twice per week for 2.5 hours

each time. This is an ongoing collaboration, and the exact number of individuals who have

benefited from this collaboration is difficult to determine.

Priority: Health Education

Service Implemented/Partnerships: Community Health Fair and Kid-Friendly Health Fair

Mercy Hospital Logan County partnered with local healthcare providers to host a community

health fair, and a kid-friendly health fair. Approximately 30 individuals benefited from this

event.

Priority: Health Education

Service Implemented/Partnerships: School physicals

Mercy Hospital Logan County provided athletic physicals to 407 youth from Guthrie, Coyle, and

Crescent Schools.

Mercy Hospital Logan County participates as a board member for the Logan County Board of

Health and the Logan Community Services. Mercy Hospital Logan County also participates in

the OBI Blood Drive.

Awareness of Community Outreach

A question was included on the community survey (complete methodology detailed on

page 18) to gauge survey respondents’ awareness of current community programs offered by the

hospital. Forty-three individuals or 12.6 percent of the total indicated they were aware of

community programs. Survey respondents were then asked to list which programs they knew.

The most commonly responded programs were health fairs and athletic physicals with five

responses each. The table below outlines all programs listed by the survey respondents.

4

Please list community programs:

Response Category No. %

Health fair 5 13.9%

Athletic physicals

5 13.9%

Diabetic education/Awareness

4 11.1%

Weight management/Weight loss

4 11.1%

Blood drives

4 11.1%

Mercy Financial Assistance

2 5.6%

Volunteer at Hands of Jesus

2 5.6%

Health education

2 5.6%

CPR

1 2.8%

Backpacks of food during summer for children

1 2.8%

GetFit

1 2.8%

Volunteer meals on wheels

1 2.8%

Food/Meals for students

1 2.8%

Hiring events

1 2.8%

Food at Christmas

1 2.8%

Free clinic

1 2.8%

Total 36 100.0%

Mercy Hospital Logan County Medical Services Area Demographics

Figure 1 displays the Mercy Hospital Logan County medical services area. Mercy

Hospital Logan County 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.

5

Figure 1. Mercy Hospital Logan County Medical Service Areas

As delineated in Figure 1, the primary medical service area of Mercy Hospital Logan

County includes the zip code areas of Guthrie, Crescent, Langston, Meridian, and Mulhall. The

primary medical service area experienced a population increase of 7.7 percent from the 2000

Census to the 2010 Census (Table 1). This same service area experienced another population

increase of 0.3 percent from the 2010 Census to the latest available, 2009-2013, American

Community Survey.

City County Hospital No. of Beds

Enid Garfield St. Mary’s Regional Medical Center 245

Enid Garfield INTEGRIS Bass Baptist Health Center 182

Enid Garfield INTEGRIS Bass Pavilion 24

Kingfisher Kingfisher Kingfisher Regional Hospital 25

Guthrie Logan Mercy Hospital Logan County 25

Perry Noble Perry Memorial Hospital 26

Edmond Oklahoma INTEGRIS Health Edmond 40

Edmond Oklahoma Edmond- AMG Specialty Hospital 37

Edmond Oklahoma Summit Medical Center 9

Stillwater Payne Stillwater Medical Center 117

6

The secondary medical services area is comprised of the zip code Cashion, Coyle,

Edmond, Marshall, and Orlando. The secondary medical service area experienced an increase in

population of 366 percent from 2000 to 2010 followed by a population increase of 2.1 percent

from 2010 to the 2009-2013 American Community Survey. The large increase in population

from the 2000 to the 2010 decennial Census was due to the addition of the Edmond, 73025, zip

code. This area was not present during the 20000 Census.

Table 1. Population of Mercy Hospital Logan County Medical Service Areas

2000 2010 2009-2013 % Change % Change

Population by Zip Code Population Population Population 2000-2010 2010-09-13

Primary Medical Service

Area

73044 Guthrie 18,391 20,226 20,834 10.0% 3.0%

73028 Crescent 3,199 3,454 3,432 8.0% -0.6%

73050 Langston 1,688 1,370 824 -18.8% -39.9%

73058 Meridian 256 332 396 29.7% 19.3%

73063 Mulhall 685 691 663 0.9% -4.1%

Total 24,219 26,073 26,149 7.7% 0.3%

Secondary Medical Service Area

73016 Cashion 1,367 1,850 1,591 35.3% -14.0%

73027 Coyle 1,059 1,493 1,406 41.0% -5.8%

73025 Edmond n/a 11,579 12,018 n/a 3.8%

73056 Marshall 436 441 654 1.1% 48.3%

73073 Orlando 551 541 575 -1.8% 6.3%

Total 3,413 15,904 16,244 366.0% 2.1%

SOURCE: Population data from the U.S. Bureau of Census, Decennial Census 2000, 2010 and

American Community Survey 2009-2013(October 2015)

Table 2 displays the current existing medical services in the primary service area of the

Mercy Hospital Logan County medical services area. Most of these services would be expected

in a service area of Guthrie’s size: one clinic (outside of the hospital’s clinics), five dental

offices, two optometry offices, three chiropractic offices, four nursing care facilities, one assisted

living facility, one home health provider, one hospice provider, the Logan County Health

Department, two EMS providers, one rehabilitation provider, three counseling and/or mental

7

health treatment providers, one durable medical equipment provider, and seven pharmacies..

Mercy Hospital Logan County is a 25 bed critical access hospital located in Logan County. The

hospital provides acute and swing bed inpatient services, 24-hour emergency department, case

management, diagnostic radiology (CAT Scan, MRI, Ultrasound, Nuclear Medicine, and

Mammography), and rehabilitation services. A complete list of hospital services and community

involvement activities can be found in Appendix A.

Table 2. Existing Medical Services in the Mercy Hospital Logan County Medical Services

Area

Count Service

1 Hospital: Mercy Hospital Logan County

1 Physician clinic

5 Dental offices

2 Optometry offices

3 Chiropractic offices

4 Nursing care facilities

1 Assisted living facility

1 Home health provider

1 Hospice provider

1 County Health Department: Logan County

2 EMS providers

1 Rehabilitation provider

3 Counseling and/or mental health treatment

providers

1 Durable medical equipment provider

7 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 Logan County in

comparison to the state of Oklahoma. Overall, the over 65 age group has experienced an

increase in population across all geographies from the 2010 Census to the latest, 2009-2013

American Community Survey. This cohort accounted for 13.8 percent of the total population at

the state level. In terms of the medical service areas, this age group accounted for 15.0 percent

of the primary medical service area, 12.4 percent of the secondary medical service area, and 13.9

percent of the population of Logan County. The 45-64 age group accounts for the largest share

of the population in the primary (27.3%) and secondary (27.8%) service areas and Logan County

(26.8%). This is compared to the state share of 25.5 percent of the total population.

8

Table 3. Percent of Total Population by Age Group for Mercy Hospital Logan County

Medical Service Areas, Logan County and Oklahoma

Primary Medical

Service Area

Secondary Medical

Service Area

Logan

County Oklahoma Age

Groups

2010 Census

0-14 18.9% 24.1% 20.7% 20.7%

15-19 9.9% 8.1% 8.6% 7.1%

20-24 7.9% 3.4% 6.5% 7.2%

25-44 21.9% 23.9% 23.8% 25.8%

45-64 27.0% 30.2% 27.7% 25.7%

65+ 14.3% 10.2% 12.6% 13.5%

Totals 100.0% 100.0% 100.0% 100.0%

Total

Population 26,073 15,904 41,848 3,751,351

09-13 ACS

0-14 18.7% 23.8% 20.1% 20.7%

15-19 8.5% 8.1% 7.4% 6.9%

20-24 8.2% 4.2% 7.0% 7.3%

25-44 22.4% 23.8% 24.7% 25.8%

45-64 27.3% 27.8% 26.8% 25.5%

65+ 15.0% 12.4% 13.9% 13.8%

Totals 100.0% 100.0% 100.0% 100.0%

Total

Population 26,149 16,244 42,871 3,785,742

SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2009-

2013 (www.census.gov [October 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

9

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

not as evident in Logan County and both medical service areas. The share of the population

identified as of Hispanic Origin accounted for 4.0 percent of the primary medical service area’s

population in 2009-2013 and 2.2 percent of the secondary medical service area during the same

time period. The Hispanic Origin population accounted for 5.3 percent of the total population

from 2009-2013 in Logan County.

Table 4. Percent of Total Population by Race and Ethnicity for Mercy Hospital Logan

County Medical Service Areas, Logan County and Oklahoma

Primary Medical

Service Area

Secondary Medical

Service Area Logan County Oklahoma Race/Ethnic

Groups

2010 Census

White 78.5% 89.1% 81.0% 72.2%

Black 12.1% 3.3% 9.1% 7.4%

Native American 1 3.2% 2.7% 3.3% 8.6%

Other 2 1.8% 1.8% 2.5% 5.9%

Two or more Races 3 4.4% 3.0% 4.1% 5.9%

Hispanic Origin 4 4.2% 6.3% 5.2% 8.9%

Total Population 26,073 15,904 41,848 3,751,351

09-13 ACS

White 78.9% 88.1% 82.1% 73.5%

Black 11.6% 4.2% 9.1% 7.2%

Native American 1 4.3% 2.2% 3.4% 7.0%

Other 2 0.8% 1.6% 1.5% 4.5%

Two or more Races 3 4.4% 3.9% 3.9% 7.8%

Hispanic Origin 4 4.0% 2.2% 5.3% 9.1%

Total Population 26,149 16,244 42,871 3,785,742

SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2009-

2013 (www.census.gov [October 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.

10

Summary of Community Meetings

Mercy Hospital Logan County hosted four community meetings between November 5,

2015 and December 9, 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:

Mercy Hospital Logan County representatives

Mercy Clinic Logan County representatives

Logan County Health Department

Guthrie Public Schools

City leadership

Guthrie Police

County Commissioner

Langston University

Neighborhood Solutions

Sooner Success

Retired individuals

Guthrie Chamber of Commerce

Average attendance at the community meetings was 20-25 community members.

Community members were invited to participate through the Guthrie Chamber of Commerce,

and announcements were made at local civic groups (Lions, Rotary, etc.). Ads were placed in

the local newspapers and the Logan County Partnership were notified. The hospital tried to

invite anyone who wanted to attend within the community. The hospital made significant

efforts to reach a diverse and representative population of the medical service area and patients

served including low income and racially diverse populations. Representatives from the public

health sector were included to provide insight into what they see from a public health and

underserved population perspective of community needs.

Economic Impact and Community Health Needs Assessment Overview, November 5, 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 Logan

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

11

information was not available, payroll was estimated using state level averages from the Bureau

of Labor Statistics.

The health sector in the Mercy Hospital Logan County medical service area employs 721

FTE individuals. After applying a county-specific employment multiplier to each respective

sector, there is a total employment impact of 1,000 FTE employees. The same methodology is

applied to income. The local health sector has a direct income impact of nearly $39 million.

When the appropriate income multiplier is applied, the total income impact is over $46.6 million.

The last two columns examine the impact this has on the retail sector of the local community.

Recent data suggest that just 33.8% of personal income in Logan County will be spent on taxable

goods and services locally. Therefore, if we just examine the impact made on retail from those

employed in the health sector, this would account for over $15.7 million spent locally, generating

$157,835 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:

• Behavioral health needs in county- available resources, Northcare and children and

family services

- Availability of psychiatrist for medication management

- NorthCare no longer accepting BCBS

• Labor and delivery- patients referred to OKC, no local OB services

• Need for telemedicine- psychiatric services, dermatology

- Currently have tele-hospitalist and tele-stroke

- In process of getting telepsych

- Keep patients in community

- Alleviate travel burdens

• Neurology- neuropsych testing- travel burden for patient to get to services

• RHC on Division sees a larger Medicaid population- larger service area (Shawnee,

Stillwater, Perry, Enid)- many patients started using these providers because of Take

Charge program

- Limits on number of visits for adults, not for children

- SoonerCare matching back to patients

• Service for children

• Transportation- trolley services cut because of grants

• Telepsych

• Elderly population- services for when they get home, caregivers

• Do have many more elderly patients than data

• Rural EMS services- Crescent EMS service closed, longer wait for patients, Guthrie

picking up area

12

• Community EMR- in between EMS getting there, help patient calm down during the wait

• Pas/NPs cannot write narcotics, thus pushing patients to other RHCs

• Indigent prescription drug program- previously had provider at hospital- a community

person would be great to assist

13

Table 5. Mercy Hospital Logan County 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 141 1.52 215 $12,504,399 1.27 $15,824,179 $5,348,573 $53,486

Physicians, Dentists, & Other

Medical Professionals 62 1.47 91 $4,727,717 1.14 $5,392,714 $1,822,737 $18,227

Nursing Homes & Home

Health 359 1.28 460 $12,206,591 1.16 $14,219,222 $4,806,097 $48,061

Other Medical & Health

Services 120 1.53 183 $6,757,830 1.17 $7,886,131 $2,665,512 $26,655

Pharmacies 39 1.30 51 $2,783,040 1.21 $3,374,430 $1,140,557 $11,406

Total 721

1,000 $38,979,577

$46,696,677 $15,783,477 $157,835

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 Logan County retail sales and income (33.8%) – from 2014 County Sales Tax Data and 2013 Personal Income

Estimates from the Bureau of Economic Analysis.

14

Health Data, November 12, 2015

A community meeting was held November 12, 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:

30), clinical care (rank: 21), social and economic factors (rank: 15), and physical environment

(rank: 46). Logan County’s overall health factors rank is 18. This suggests, in general, the

health status of Logan County residents is somewhat comparable to that of neighboring counties.

Areas of concern include Logan County’s smoking rate, adult obesity rate, and alcohol-impaired

driving deaths are all less desirable than the top U.S. performers. Also, the county population

per primary care and dental providers as well as the high school graduation rate are areas of

concern for Logan County. All health factors variables are presented in Table 6 along with

Logan 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 Logan County ranks very poorly compared to the national benchmark).

15

Table 6. Health Factors (Overall Rank 18)

Category (Rank) Logan

County

Error

Margin

Top U.S.

Performers Oklahoma

Health Behaviors (30)

Adult Smoking 23% 17-29% 14% 24%

Adult Obesity 34% 30-39% 25% 32%

Food Environment Index 6.9 8.4 6.7

Physical Inactivity 29% 25-34% 20% 30%

Access to Exercise Opportunities 59% 92% 72%

Excessive Drinking 18% 13-26% 10% 13%

Alcohol-Impaired Driving Deaths 52% 14% 33%

Sexually Transmitted Infections 364 138 442

Teen Birth Rate 27 24-30 20 54

Clinical Care (21)

Uninsured 19% 17-21% 11% 21%

Primary Care Physicians 14,555:1 1,045:1 1,567:1

Dentists 7,404:1 1,377:1 1,805:1

Mental Health Providers 592:1 386:1 285:1

Preventable Hospital Stays 56 48-63 41 71

Diabetic Screening 84% 77-92% 90% 78%

Mammography Screening 60% 52-68% 71% 55%

Social & Economic Factors (15)

High School Graduation 79% 78%

Some College 61% 55-67% 71% 58%

Unemployment 4.9% 4.0% 5.4%

Children in Poverty 17% 12-21% 13% 24%

Income Inequality 4.7 4.0-5.3 3.7 4.6

Children in Single-Parent

Household 18% 13-22% 20% 24%

Social Associations 10.5 22.0 11.8

Violent Crime Rate 132 59 468

Injury Deaths 71 60-83 50 86

Physical Environment (46)

Air-Pollution- Particulate Matter 10.3 9.5 10.3

Drinking Water Violations 15% 0% 23%

Severe Housing Problems 12% 9-14% 9% 14%

Driving Alone to Work 83% 80-86% 71% 82%

Long Commute- Driving Alone 49% 44-54% 15% 25%

Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health

Institute; Robert Wood Johnson Foundation

16

The following figure depicts each county’s rank by shade. Logan County’s ranking is

comparable to Noble, Kingfisher and Payne Counties and is more favorable than Lincoln and

Oklahoma Counties.

In terms of health outcomes, considered, today’s health, Logan County’s ranking

is 7th 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 7)

Category (Rank) Logan

County

Error

Margin

Top U.S.

Performers Oklahoma

Length of Life (3)

Premature Death 6,893 6,006-7,780 5,200 9,121

Quality of Life (27)

Poor or Fair Health 18% 14-22% 10% 19%

Poor Physical Health Days 4.4 3.5-5.4 2.5 4.3

Poor Mental Health Days 4.4 3.4-5.3 2.3 4.2

Low Birth Weight 7.5% 6.6-8.4% 5.9% 8.3%

Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute;

Robert Wood Johnson Foundation

17

The following figure shows county health outcomes rankings by shades. Logan County’s

ranking is again comparable to Noble, Kingfisher and Payne Counties and is more favorable than

Lincoln and Oklahoma Counties. 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:

Amenities and activities for younger families to do and utilize in town

- Have activities for youth year-round (not just for the summer at the park)

Basketball gyms, swimming pools,

ATV safety training course at fairgrounds will have a walking trail,

biking trail will be available and open to public- will have lighting

and distance signage- will be completed in the near future

Highland Park trails do have lighting- not heavily utilized and

vandalized

Alcohol impaired driving deaths- people leave community and come back in

(proximity to I35)

Availability of jobs

Many people driving into OKC metro area to work

Adult day services- Capture both seniors and developmentally delayed individuals

to help with activities of daily living

- Services medically fragile students for when they graduate school-

services available to those who cannot care for self, but do not need

nursing care

Severe housing problems for seniors in Logan County, status of homes, upkeep

Look up youth prevention data- drugs

18

Need more sidewalks (walkability community survey)

- Some sidewalk availability is ODOT responsibility

- The brick sidewalks are part of historical society, difficult for homeowners

maintain

Community Survey Methodology and Results, November 4- December 2, 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 link was shared with

all Mercy Hospital Logan County and clinic employees who were encouraged to share the survey

with friends, family and neighbors. The link was also shared with the Rotary Club, Guthrie

Chamber of Commerce, and Logan County Partnership members. Hard copies were made

available at the hospital and clinics. Surveys were also distributed at the first community

meeting on November 5, 2015. 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 form

and results can be found in Appendix E. Community members were asked to return their

completed surveys to Mercy Hospital Logan County.

The survey ran from November 5, 2015 to November 19, 2015. A total of 341 surveys

from the Mercy Hospital Logan County medical service area were completed. Of the surveys

returned, 199 were electronic responses. The survey results were presented at the December 2,

2015, community meeting.

Table 8 below shows the survey respondent representation by zip code. The largest share

of respondents was from the Guthrie (73044) zip code with 249 responses or 73 percent of the

total. Edmond (73034) followed with 24 responses. Edmond (73012) and Coyle (73027) each

had 6 responses or 3.0 percent of the total.

19

Table 8. Zip Code of Residence


73044- Guthrie

249 73.0%

73034- Edmond

24 7.0%

73028- Crescent

17 5.0%

73012- Edmond

6 1.8%

73027- Coyle

6 1.8%

73050- Langston

5 1.5%

73013- Edmond

4 1.2%

73003- Edmond

3 0.9%

73025- Edmond

3 0.9%

74074- Stillwater

3 0.9%

74059- Perkins

2 0.6%

73045- Harrah

2 0.6%

73058- Pawnee

1 0.3%

73073- Orlando

1 0.3%

73109- Oklahoma City

1 0.3%


1 0.3%


1 0.3%


1 0.3%


1 0.3%


1 0.3%


1 0.3%

73750- Kingfisher

1 0.3%

74062- Ripley

1 0.3%

73038- Fort Cobb

1 0.3%

73030- Davis

1 0.3%

74075- Stillwater

1 0.3%

74076- Stillwater

1 0.3%

No Response

2 0.6%

Total 341 100.0%

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

the results include:

Primary Care Physician Visits

- 64.2% of respondents had used a primary care physician in the Guthrie service area

during the past 24 months

- 92.2% of those responded being satisfied

20

- Only 89 respondents or 26.1% believe there are enough primary care physicians

practicing in Guthrie

- 59.8% of the respondents would consider seeing a midlevel provider for their

healthcare needs

- 73.9% responded they were able to get an appointment with their primary care

physician when they needed one

Specialist Visits

Summary highlights include:

- 55.4% of all respondents report some specialist visit in past 24 months

- Most common specialty visited are displayed in Table 9

- Only 2.5% of specialist visits occurred in Guthrie

Table 9. Type of Specialist Visits

Type of Specialist No. Percent

Top 5 Responses

Cardiologist 43 15.1%

(0 visits in Guthrie)

Orthopedist/Orthopedic Surg. 42 14.8%


Neurologist/Neurosurgeon 19 6.7%


Dermatologist 18 6.3%


OB/GYN 16 5.6%


All others 146 51.4%


Total 284 100.0%

Some respondents answered more than once.

Hospital Usage and Satisfaction

Survey highlights include:

- 46.8% of survey respondents that have used hospital services in the past 24 months

used services at Mercy Hospital Logan County

o Mercy Hospital Oklahoma City (13.9%), INTEGRIS Health, Edmond (7.5%)

and OU Medical Center, Edmond and Oklahoma City (5.8%) followed

21

57.4%

85.9%

46.8%

81.9%

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

Hospital Usage

Hospital Satisfaction

Mercy Hospital Logan County Other OK Hospital Survey Averages

o The most common response for using a hospital other than Mercy Hospital

Logan County was availability of specialty care (including surgery and labor

and delivery) (29.4%) followed by physician referral (24.6%)

o The usage rate of 46.8% was lower than the state average of 57.4% for usage

of other rural Oklahoma hospitals surveyed

- 81.9% of survey respondents were satisfied with the services received at Mercy

Hospital Logan County

o This is below the state average for other hospitals (85.9%)

- Most common services used at Mercy Hospital Logan County:

o Emergency Room (26.8%)

o Diagnostic Imaging (25.9%)

o Laboratory (20.8%)

Local Healthcare Concerns and Additional Services

Survey respondents were asked what concerns them most about healthcare in their

community. The most common response was No concerns/Receive good care/Don’t know

(17.0%) followed by Lack of providers/Availability of providers/Wait times/Physician turnover

(13.9%). Table 10 displays all responses and the frequencies.

Figure 2. Summary of Hospital Usage and Satisfaction Rates

22

Table 10. Top Healthcare Concerns in the Guthrie Area


No Concerns/ Receive good care/Don't Know 61 17.0%

Lack of providers/Availability of providers/Wait times/Physician turnover 50 13.9%

Quality of care

27 7.5%

Lack of specialists

19 5.3%

Emergency room care/Physician coverage of primary care 19 5.3%

Seeing a midlevel rather than a physician

10 2.8%

More choices of services/Level of care

6 1.7%

Access to surgeries

6 1.7%

Possibility of losing hospital/Reduction of services 6 1.7%

Reputation of the hospital

6 1.7%

Need for updated/New facility

3 0.8%

More marketing of existing services

2 0.6%

EMS transfers/Transports

2 0.6%

Privacy concerns

2 0.6%

Not doing enough for community or surrounding communities 2 0.6%

Difficulty getting a referral

2 0.6%

Distance to services

2 0.6%

Cost of care

2 0.6%

Lack of rural emergency management

1 0.3%

Lack of communication

1 0.3%

Lack of relationship with healthcare providers

1 0.3%

Consistency

1 0.3%

Not having the right facilities or equipment to treat patients 1 0.3%

Promotion of diet and exercise

1 0.3%

Obesity in county

1 0.3%

Not having enough medical help

1 0.3%

Care for children and infants

1 0.3%

Need for geriatric care

1 0.3%

Mental health

1 0.3%

Flu

1 0.3%

Distance to services

1 0.3%

EMS services in Crescent

1 0.3%

Nowhere healthy to eat out

1 0.3%

No private practices

1 0.3%

Telemedicine

1 0.3%

No response

115 32.0%

Total 359 100.0%

23

Survey respondents also had the opportunity to identify what additional services they

would like to see offered at Mercy Hospital Logan County. The most common response was No

additional services/Don’t know/Not aware of current services (19.5%). The next most common

response was collectively specialists (13.6%). Table 11 displays the full listing of responses.

Table 11. Additional Services Survey Respondents Would Like to See Offered at Mercy

Hospital Logan County


No additional services/Don’t know/Not aware of current services 73 19.5%

Specialists: Specialists in general (16); Orthopedist (5); Dermatologist (4);

Pediatrician (4); OB/GYN (4); Pain Management (3); Otolaryngologist (3);

Cardiologist (3); Allergist (3); Pulmonologist (2); Podiatrist (1); Psychologist

(1); Neurologist (1); Urologist (1) 51 13.6%

Surgery/Minor surgeries/Outpatient

surgery/Endoscopy/Orthopedics 35 9.4%

Emergency medicine/Physicians covering ER/Improved ER service 8 2.1%

More physicians/Full time physicians/Physician availability 8 2.1%

Maternity/Labor and delivery 8 2.1%

Mental health services/Counseling services 6 1.6%

More diagnostic testing: MRI, CT, MRI on weekends 5 1.3%

Wellness program/Fitness program 4 1.1%

Improve quality of care 3 0.8%

Health education/Nutrition education 3 0.8%

Fitness center/Gym 3 0.8%

Advanced emergency services 2 0.5%

Free clinic/Indigent care/Saturday for sports injuries 2 0.5%

Walk in clinic/Weekend clinic 2 0.5%

Acupuncture 1 0.3%

Mammography 1 0.3%

All services 1 0.3%

Children’s services 1 0.3%

Enhanced patient menu for special diets 1 0.3%

Vision 1 0.3%

More medical help 1 0.3%

Chemotherapy 1 0.3%

Infusion 1 0.3%

Bariatric program 1 0.3%

Yoga/Meditation 1 0.3%

Transportation without a 3 day advance 1 0.3%

Oral health 1 0.3%

Patient representative 1 0.3%

First time mothers program 1 0.3%

Address childhood obesity 1 0.3%

More telemedicine 1 0.3%

No response 144 38.5%

Total 220 100.0%

24

Primary Care Physician Demand Analysis, December 2, 2015

A demand analysis of primary care physicians was completed for the zip codes that

comprise the Guthrie 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 Guthrie

medical services area, a total of 41,679 annual visits would occur. This would suggest that the

Guthrie medical services area would need 10.0 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 Guthrie, Oklahoma Medical Service Area

Usage by Residents of Primary Service Area

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

Usa

ge

by R

esid

ents

of

Sec

ondar

y

Ser

vic

e A

rea

5% 31,688 33,858 36,027 38,197 40,367 42,537 44,706

10% 33,000 35,169 37,339 39,509 41,679 43,848 46,018

15% 34,311 36,481 38,651 40,820 42,990 45,160 47,330

20% 35,623 37,793 39,962 42,132 44,302 46,472 48,641

25% 36,934 39,104 41,274 43,444 45,613 47,783 49,953

30% 38,246 40,416 42,585 44,755 46,925 49,095 51,264

35% 39,558 41,727 43,897 46,067 48,237 50,406 52,576

40% 40,869 43,039 45,209 47,378 49,548 51,718 53,888

45% 42,181 44,350 46,520 48,690 50,860 53,029 55,199

50% 43,492 45,662 47,832 50,002 52,171 54,341 56,511

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

the usage would be: 41,679 TO 42,990 total primary care physician office visits in the

Guthrie area for an estimated 10.0 to 10.3 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 concerns were identified:

Many community members are not aware of the community work that the hospital does-

more marketing on services and activities outside of patient care

25

The rate of obesity was high- many fast food restaurants, three grocery stores in county-

no access in Coyle and Langston

The rate of no leisure time physical activity

Community Health Needs Implementation Strategy

During the December 9, 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.

• Transportation- The lack of or transportation barrier was noted as a high priority for

the community. Guthrie does have public transportation available through the local

trolley service. However, increased restrictions and funding cuts have impacted the

amount of assistance provided in the community. It was noted that lack of

transportation can negatively impact access to care for many community members.

– The hospital noted further examination of how the existing services

can be subsidized to expand transportation services including

transporting patients from their home to clinic visits. It was also

noted about maybe having individuals sign up in advance and

undergo a screening process to create a “preferred rider” group. The

preferred rider status would be to ensure that those individual would

not abuse the services, but rather, use the services for medical and

healthcare needs.

• Elderly population- Increased services and resources for elderly residents were also

noted as a high concern. In particular, access to groceries and healthy foods and

adult day care services in community were noted as specific needs.

– Co-op offering of foods, people would have the option to sponsor a

family. Look into partnering with meals on wheels to provide

groceries in addition to meals

– St. Johns in Edmond provides a one day a week service for those

– There are currently 2 drop off points in the Guthrie area for groceries

(similar to bountiful baskets) through a co-op program. It was noted

to possibly expand on existing program through increased marketing

and membership. It was also noted that maybe look into the

opportunity for individuals to scholarship or sponsor a family.

• Right now, the family has to pick up the groceries and

go online to sign up and retrieve information about the

program. Community members noted that finances and

technology can both be barriers for individuals who

need assistance.

• Community members mentioned the possibility of tying

in with existing delivery programs such as meals on

wheels.

• The community does have a community garden.

However, it is underutilized. It was also discussed that

26

moving the garden to Highland Park could be an option

to engage a larger share of the community.

• Increasing telemedicine services

– Transform existing clinic to serve just telemedicine services

– Mercy built virtual care center in St. Louis, this should be available to

all of Mercy

• The need for a community health advocate- This priority was mentioned along with

increasing marketing of existing services and getting the word out in the

community. It was further noted that having a resource an individual or

organization that encompasses a variety of services and providers in the community

(health department, hospital, civic, and city) serve as a go-to resource for questions

providers and community members might have.

– In terms of existing programs, the Logan County Partnership meets

monthly with about 20 healthcare professionals present sharing what

is available.

– There is a community resource list, but there is not an official owner

of the document or designated person to keep it updated.

– Further, community members discussed the best way to reach the

community: attend neighborhood meetings, churches, etc. to get the

word out of existing services.

• Indigent prescription drug program- The hospital previously had a full time position

that completed the paperwork for patients. This program and the individual

completing the paperwork were available to the entire community, not just the

hospital patients. It would be nice to have a partnership with a local person to

complete paperwork.

– The community would like to see someone (or group) offering the

assistance of completing the paperwork for community members.

– This could be an opportunity for civic organizations to volunteer to

complete the paperwork.

– Next steps would include checking to see if any local pharmacies

provide a delivery service

– Also, for those who do not have any type of delivery service, it could

be beneficial to cross patients who need prescription drug deliveries

with those receiving other types of deliveries such as meals on

wheels.

• Community members also noted the need for increased mental health and

behavioral health services and the need for primary care in the community at this

moment. There will be three more physicians coming to the community in August

2016. While these items were identified, they were not indicated as the top

priorities for the hospital to address for this community health needs assessment.

27

Community Health Needs Assessment Marketing Plan

The hospital will make the Community Health Needs Assessment Summary and

Implementation Strategy Plan available upon request at Mercy Hospital Logan County, and a

copy will be available to be downloaded from the hospital’s website

(https://www.mercy.net/practice/mercy-hospital-logan-county). This document will also be

available on the OSU Center for Rural Health blog site:

(http://osururalhealth.blogspot.com/p/chna.html).

28

Appendix A- Hospital Services/Community Benefits

29

Appendix B Community Meeting Attendees

Guthrie Community Health Needs Assessment

Meeting 1: Overview of Process and Economic Impact of Health Sector

5-Nov-15

First Name Last Name Title Organization

Rose Gathers Practice Manager Mercy

Wende Arnold Lab Manager Mercy

Anita Everett MTS-CRM Mercy

Robin Channel DON Mercy

Dawn Dean Radiology Manager Mercy

Kim Hoisington ED Manager Mercy

Jessica Zan Med Surg Manager Mercy

Teresa Hommertzheim Logistics Supervisor Mercy

Tonja Robinson Dir. Finance Mercy

Amy Cronin Support Services Supervisor Mercy

Brandy Parks County Coordinator Sooner Success

Jim Smith Retired

Doug Ogle Personnel Director Guthrie Public Schools

Janice Ruhl Care Manager, Logan Mercy Hospital Logan County

Courtney McLemore Wellness Coordinator Logan County Health Dept.

Mikeal Murray Accreditation Coordinator Logan County Health Dept.

Justin Fortney PIO Logan County Health Dept.

Mary Jo Messelt HR Manager Mercy

Josh Tucker CEO Mercy Hospital Logan County

Funmi Adams Admin Resident Mercy OKC

Glenda Bronson

Mercy OKC

30


Meeting 2: Health Indicators and Outcomes

12-Nov-15


Glenda Bronson

Mercy OKC

Vickie Downing Boyd Quality Compliance Mercy Hospital Logan County

Dottie Taylor Admin Asst. Neighborhood Solutions

Robin Channel DON Mercy Hospital Logan County

Kim Hoisington RN-Manager ED Mercy Hospital Logan County

Dawn Dean Radiology Manger Mercy Hospital Logan County



Don Sweger Chief of Police Guthrie Police Dept.

Jim Ahlgren Human Resources Director City of Guthrie


Sue DuCharme CEO Solo3 Neighborhood Solutions



Dan Gatlin Pastor First Assembly

Brandy Parks County Coordinator Sooner Success

Jessica McCaslin Patient Access Supervisor Mercy Hospital Logan County

Steve Gentling Mayor City


Dan Newton Financial Advisor Edward Jones Investments


Carolyn Kernegay Board Member Mercy Hospital Logan County


Cynthia Buckley AVP/Director of HR Langston Univeristy

31


Meeting 3: Survey Results and Primary Care Physician Demand Analysis

2-Dec-15


Glenda Bronson

Mercy OKC



Peggy Thompson

Connie Burdick

Mercy Hospital Logan County

Teresa Hommertzheim Mercy Hospital Logan County


Jim Smith Retired




Bruce Johnson

City of Guthrie







32


Meeting 4: Health Concern Prioritization and Implementation Discussion

9-Dec-15

First

Name Last Name Title Organization

Glenda Bronson

Mercy OKC


Kim Hoisington

Emergency Department

Manager Mercy



Connie Burdick

Mercy Hospital Logan County

Cody Mosley

Community and Economic Dev.

Director City of Guthrie






Jim Smith Retired



Heady

CEO Chamber

33

Appendix C- Meeting 1 Materials, November 5, 2015

36

Appendix D- Meeting 2 Materials, November 12, 2015

38

Appendix E- Survey Form and Meeting 3 Materials, December 2, 2015

table of contents - mercy

Documents