Saint Francis Health System, Inc.
Community Health Needs Assessment 2020–2022
Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
About Saint Francis Health System, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Community Health Needs Assessment (CHNA) Background. . . . . . . . . . . . 2
Approach to CHNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Summary of Prioritized Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Communities Served. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Saint Francis Health System Definition of Community. . . . . . . . . . . . . . . . . . 3
Input and Participation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Saint Francis Health System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Public Health Departments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Sg2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Community Representatives and Residents. . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Process and Methods Used to Conduct the CHNA . . . . . . . . . . . . . . . . . . . . . . . . 5
Secondary Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Community Input. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Written Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Data Limitations and Information Gaps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Demographics and Social Determinants of Health. . . . . . . . . . . . . . . . . . . . . . . . 7 Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Social and Economic Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Health Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Physical Inactivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Tobacco Usage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sexually Transmitted Infections (STIs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Health Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
General Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Dental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Chronic Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Maternal and Infant Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Behavioral Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Accidental Deaths and Homicides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Identification and Prioritization of Community Health Needs. . . . . . . . . . . . . . 13
Identifying Preliminary Health Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Health Need Prioritization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Prioritized Health Needs Profiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Access to Healthcare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Lack of Health Insurance /Ability to Pay for Healthcare. . . . . . . . . . . . . . . . 19
Chronic Disease and Stroke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Behavioral Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Evaluation of Fiscal Year 2016 Implementation Strategies. . . . . . . . . . . . . . . . 25 Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Appendix A: CHNA Data Sources and Dates . . . . . . . . . . . . . . . . . . . . . . . . 34
Appendix B: List of Organizations Represented in Key Informant Interviews and Community Feedback. . . . . . . . . . . . . . . . . 40
Appendix C: Key Informant Interview Guide. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Appendix D: Saint Francis Health System Community Needs Survey. . . 42
Appendix E: Community Resources Available to Address
Prioritized Health Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Appendix F: Community Health Data Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
2020–2022 CHNA
1
Executive Summary About Saint Francis Health System, Inc.
Approach to CHNA
Saint Francis Health System, Inc. (Saint Francis) is a Catholic,
Saint Francis completed a community health needs assessment
not-for-profit health system wholly owned and operated in
to reassess the health needs of the communities served by the
Tulsa, Oklahoma whose mission is to extend the presence
hospital components of its health system: Saint Francis Hospital,
and healing ministry of Christ to all who seek its services. The
Inc., Saint Francis Hospital South, LLC, Laureate Psychiatric
health system is anchored by Saint Francis Hospital, Inc., a
Clinic and Hospital, Inc., Saint Francis Hospital Muskogee,
1,100-bed tertiary center, which includes a 162-bed Children’s
Inc. and Saint Francis Hospital Vinita, Inc. The assessment
Hospital with the region’s only level IV neonatal intensive care
included the collection and analysis of both quantitative (over
unit, a 168-bed heart hospital and Tulsa’s leading trauma and
140 public health indicators and quantitative survey methods)
emergency center. Also part of the health system are Saint
and qualitative (organization and community representative
Francis Hospital South, LLC, Saint Francis Hospital Muskogee,
interviews and qualitative survey methods) data to identify
Inc., Saint Francis Hospital Vinita, Inc., Saint Francis Glenpool
and create a comprehensive list of health needs for each
and Laureate Psychiatric Clinic and Hospital, Inc.—a 90-bed
community. The assessment was adopted by the Saint Francis
private, psychiatric facility. Additionally, Saint Francis employs
Health System Board of Directors on April 23, 2019.
over 350 physicians and 121 advanced practice providers through Warren Clinic, Inc., which serves the region with over 90 locations throughout eastern Oklahoma.
Community Health Needs Assessment (CHNA) Background
Summary of Prioritized Needs In September 2018, the Saint Francis CHNA steering committee reviewed all the preliminary identified health needs and agreed upon an established objective prioritization framework. Using this framework, the steering committee then completed an
A community health needs assessment is an essential function
exercise to score each health need, the results of which yielded
for Saint Francis Health System, Inc., as it helps to identify
the prioritized list of four significant health needs facing the
the major health needs of the community and offers insight
community:
into what services may be offered to address those needs. Understanding the major health needs of each community supports the prioritization of strategies that can improve the wellness of those community populations, including medically underserved or vulnerable populations (e.g. poor, uninsured or underinsured, various racial/ethnical populations, etc.).
1.
Access to healthcare (primary care/screening and primary care/specialty providers)
2. Behavioral health (substance abuse and mental health) 3. Chronic disease and stroke
Additionally, an effective health needs assessment includes partnering with organizations and community agencies, through which information and resources can be shared to deploy strategies maximizing the benefit and impact to the communities. 2
Saint Francis Health System
4. Lack of health insurance/ability to pay for healthcare
Communities Served Saint Francis Health System Definition of Community The Saint Francis Health System primary service area covers Cherokee County, Craig County, Creek County, Haskell County, Mayes County, McIntosh County, Muskogee County, Okmulgee County, Rogers County, Sequoyah County, Tulsa County and Wagoner County.
2020–2022 CHNA
3
Input and Participation Saint Francis Health System
Community Representatives and Residents
The Saint Francis Health System CHNA was created by Saint
Various key information interviews were conducted across
Francis in collaboration with Sg2. The Saint Francis steering
the region among specific community-based organizations to
committee was composed of a group representing system
identify and prioritize health needs for the populations they
leadership with longstanding and diverse experiences in the
serve (see Appendix B for a list of organizations). In addition, a
organization and in the community.
multi-modal consumer survey was distributed to identify and guide prioritization of health needs incorporating input from residents in the Saint Francis community. Special efforts were made to target vulnerable populations through the distribution
Public Health Departments
of the survey to clients at key community health access points.
The Tulsa City County and Craig County health departments provided input into the identification of health needs through key informant interviews. The Tulsa City County Health Department also provided input into the prioritization of the health needs. With the exception of Tulsa and Oklahoma counties,
which
have
independent
city-county
health
departments, county health departments in Oklahoma are under the jurisdiction of the Oklahoma State Department of Health and Oklahoma State Board of Health.
Sg2 Sg2 is a health care consulting, analytics and intelligence firm with experience performing community health needs assessments and implementation strategy plans for healthcare organizations across the country.
4
Saint Francis Health System
Process and Methods Used to Conduct the CHNA Secondary Data
Community Input
SOURCES
SOURCES
Secondary data was utilized from various sources including
Saint Francis contracted with Sg2 and Survey Sample
aggregated data from the Community Commons data
International to conduct the primary research. Community
platform (www.communitycommons.org), which aggregates
input was provided by a broad range of community members
over 140 indicators from publicly available data sources, such
through key informant interviews, focus groups and a multi-
as the Behavioral Risk Factor Surveillance System and National
modal consumer survey of over 600 community residents.
Vital Statistics System from the Centers for Disease Control and Prevention, the American Community Survey from the US
Individuals with knowledge, information and expertise relevant
Census Bureau, and the US Department of Health and Human
to the health needs of the community were consulted. These
Services. Data was analyzed by zip code, race and ethnicity
individuals included representatives from county and state
when available.
public health departments as well as leaders, representatives and members of vulnerable populations (including medically
Additional local secondary data was utilized from planning
underserved, low income or minority populations) and other
reports prepared by the Tulsa City County Health Department,
individuals with strong expertise in local health needs.
the Oklahoma State Department of Health and the Urban Institute. For details on specific sources and dates of the data
Furthermore, to ensure input from community members as
used, please see the appendix. Institutional data from Saint
well as vulnerable populations, a multi-modal survey was
Francis was used to evaluate progress on implementation plan
distributed through a targeted audience panel as well as in
strategies from the previous CHNA.
person at various key community health access points.
METHODOLOGY FOR COLLECTION, INTERPRETATION
KEY INFORMANT INTERVIEWS
AND ANALYSIS OF SECONDARY DATA Sg2 conducted primary research via key informant interviews Information collected from secondary sources was grouped
with 17 individuals from various organizations. Key informants
into the following categories: demographics, socioeconomic
included community and public health representatives from
factors, clinical care, health behaviors and health outcomes.
organizations such as Morton Comprehensive Health Services, Grand Nation Inc., George Kaiser Family Foundation, Tulsa City
Secondary data indicators were compared to Healthy People
County Health Department, Craig County Health Department,
2020 targets and county, state and national averages to
Oklahoma
assess whether the indicators performed poorly against these
(University of Oklahoma), Saint Francis and others. Please see
benchmarks. Additionally, indicator data for racial/ethnic
Appendix B for a complete listing of key informant titles, areas
subgroups were reviewed to determine whether there were
of expertise and communities represented.
State
University
Medical
Center,
OU–Tulsa
disparate outcomes and conditions among groups in the community.
2020–2022 CHNA
5
Process and Methods Used to Conduct the CHNA Continued
Experts were interviewed in person or by telephone for
Written Comments
approximately one hour. Experts were asked to identify the top needs of their constituencies, including specific populations,
Saint Francis published the previous CHNA online on the
communities or areas with greater health needs; drivers of
hospital’s website and provided the public an opportunity to
health needs, including social determinants of health; barriers
submit questions or feedback by emailing chna@saintfrancis.
to accessing healthcare; and suggested solutions for the
com. Additionally, Saint Francis Hospital Vinita, Inc., acquired
health needs they identified, including existing resources,
from Craig General Hospital, published its CHNA online on
development of new resources or community partnerships.
the hospital website as well as the Oklahoma State University Center for Rural Health blog site. At the time of this CHNA
Stakeholders within Saint Francis were asked additional
report, Saint Francis has not received any written comments for
questions pertaining to their facility or system role, including
either CHNA. Saint Francis will continue to track any feedback
available services, gaps in services, barriers patients encounter
to ensure relevant input is considered and addressed.
when seeking care, and current and historical efforts by the facility to address health disparities. CONSUMER SURVEY
Data Limitations and Information Gaps
A multi-modal community health needs survey instrument
Approximately 150 secondary indicators were used to identify
was developed and distributed online and via hard copy
the broad health needs faced by a community. However, there
in person. See Appendix D for the hard copy version of the
are some limitations with this data. Disaggregated data around
questionnaire.
age, ethnicity, race and gender are not available for all data indicators, which limits the ability to examine disparities of
ONLINE SURVEY
health within the community. Additionally, data is not always
An online survey to respondents living within the Saint Francis
collected on a yearly basis, meaning that some data is several
service areas was administered. The survey sample was
years old. Finally, there are significant challenges in collecting
census-balanced by age and gender to ensure a relatively
data for certain subpopulations, such as individuals with
representative sample of the population (adults aged 18+).
undocumented status, homeless individuals and incarcerated
Approximately 260 online surveys were completed.
individuals, among others.
IN-PERSON SURVEY In order to ensure community input from individuals that may lack the means or ability to access the Internet, including vulnerable or disadvantaged populations, a condensed paper survey was distributed in person at various community health access points. The survey was offered in English and Spanish to be as inclusive of community residents as possible. Approximately 340 paper surveys were completed.
6
Saint Francis Health System
Demographics and Social Determinants of Health Demographics The Saint Francis Health System community covers approximately 1,200,000 people, with approximately 630,000 in Tulsa County alone. About 61 percent of the population is below 65 years old, indicating a slightly younger population than the state and the US. The community is also home to a significant rural population outside of Tulsa County. Rural populations constitute a vulnerable population that in general is more likely to face healthcare access issues given distances traveled for care and limited physician manpower.
COMMUNITY DEMOGRAPHIC PROFILE Total Population
1,154,388
RACE White
70%
African American
7%
Asian/Pacific Islander/Native Hawaiian
2%
Native American/Alaska Native
9%
Other Race
3%
Multiple Race
9%
ETHNICITY Hispanic/Latino
8%
Non-Hispanic/Latino
92%
Percent Rural Population
28%
Note: Urban areas are identified using population density, count and size thresholds. Urban areas also include territory with a high degree of impervious surface (development). Rural areas are all areas that are not urban. Sources: US Census Bureau, American Community Survey, 2012–2016. 2020–2022 CHNA
7
Demographics and Social Determinants of Health Continued
Social and Economic Factors
EDUCATIONAL ATTAINMENT
INSURANCE
A lower percentage of adults aged 25 and up in the Saint Francis Health System community pursue bachelor’s degrees,
The Saint Francis Health System community has a higher
relative to the state and the US. Craig, Haskell, and McIntosh
uninsured rate (16 percent of the population) relative to the
counties experience relatively poorer outcomes, with less than
US (12 percent of the population) but is on par with the state.
15 percent of adults possessing a bachelor’s degree.
EMPLOYMENT
FOOD INSECURITY
The Saint Francis Health System community unemployment
Lack of access to food in the Saint Francis Health System
rate is tracking with the state and the US at approximately
community is moderately higher than in the US and in line with
four percent.
the state (26 percent). However, lack of access to healthy food outlets** is a major issue in certain counties within the Saint
POVERTY
Francis community.
The poverty rate* (below 200 percent of the federal poverty
Nearly 70 percent of the population in the Saint Francis Health
level) in the Saint Francis Health System community is 37
System community lives in a census tract with no or low access
percent, which is in line with the state but slightly higher than
to healthy food outlets, which is significantly higher than the
the US (34 percent). Several counties (Sequoyah, Haskell,
rate for the US (50 percent). Craig County reports that 100
Craig, Cherokee, McIntosh, Okmulgee, Muskogee and Mayes)
percent of its population lives in a census tract with no or low
experience extremely high poverty rates of nearly 50 percent.
access to a healthy food outlet. Wagoner and Rogers counties
In these counties, over 70 percent of children are eligible for
report rates of approximately 90 percent.
free or reduced-price lunch, compared to 53 percent in the US and 62 percent in the state.
Note: *The poverty rate is defined as the percentage of individuals living in households with income below 200 percent of the Federal Poverty Level. **The Centers for Disease Control and Prevention defines healthy food outlets or retailers as supermarkets, larger grocery stores, supercenters and produce stores. Sources: US Census Bureau, American Community Survey, 2012–2016; US Department of Labor, Bureau of Labor Statistics, 2018; US Department of Agriculture, Economic Research Service, USDA- Food Access Research Atlas, 2015; Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, 2011; National Center for Education Statistics, NCES - Common Core of Data, 2015–2016. 8
Saint Francis Health System
Health Behaviors Alcohol Consumption
Sexually Transmitted Infections (STIs)
The percentage of adults in the Saint Francis Health System
The Saint Francis Health System community rates for common
community estimated to drink excessively is 13 percent, which
STIs such as chlamydia (574 per 100,000 population) and
is similar to the state and below the US average (17 percent).
gonorrhea (193 per 100,000 population) exceed the state and US rates. Within the community, Tulsa and Muskogee counties show extremely high rates of STIs. Gonorrhea rates
Physical Inactivity
in Tulsa County (268 per 100,000 population) and Muskogee County (235 per 100,000 population) are over two times the national average.
The Saint Francis Health System community reported 28 percent of its population is physically inactive, similar to the state but higher than the US (22 percent). Within the community, Haskell County experiences the highest rates of inactivity (38 percent), followed by Creek, McIntosh and Muskogee counties.
Tobacco Usage Tobacco usage in the Saint Francis Health System community is also similar to the state (25 percent), but worse than the national average (18 percent). Cigarette smoking is especially prevalent in in Muskogee, Creek, Sequoyah and McIntosh counties, followed by Mayes County and Tulsa.
Sources: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Accessed via the Health Indicators Warehouse. US Department of Health & Human Services, Health Indicators Warehouse, 2006–2012; US Department of Health & Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2015; Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2013.
2020–2022 CHNA
9
Health Outcomes General Health
Native Americans and African Americans suffer worse cancer outcomes, with severe disparities in lung and breast cancer
Nineteen percent of the population in the Saint Francis Health
incidence and cancer mortality.
System community reports poor general health, which is in line with the state but higher than the US rate of 16 percent.
CARDIOVASCULAR AND STROKE
Sequoyah and Muskogee counties have the highest selfreported rates of poor general health in the community, at 27
The Saint Francis Health System community is in line with
percent and 26 percent respectively.
national benchmarks for high cholesterol rates, and moderately higher for high blood pressure and heart disease incidence. However, the coronary heart disease mortality rate is far
Dental Health
higher in the Saint Francis Health System community than the US. Craig and Muskogee counties have extremely high rates (327.6 and 309.7 deaths per 100,000 population, respectively)
The percentage of the population reporting poor dental health
relative to the national average of 168.2.
in the Saint Francis Health System community is similar to the state (approximately 22 percent) but significantly higher
In addition, the stroke rate for Muskogee County is extremely
than the US (16 percent). Sequoyah and Okmulgee counties
high relative to the US (1.6 times the national average) as well
reported the highest rates of poor dental health in the
as the rest of the Saint Francis community.
community, at 35 percent and 36 percent respectively. Significant racial disparities impact cardiovascular health in the community, with African Americans experiencing worse
Chronic Diseases
outcomes for coronary heart disease mortality and stroke mortality. The stroke mortality rate for African Americans is approximately twice the Healthy People 2020 recommended
CANCER
target (34 per 100,000 population).
The Saint Francis Health System community is in line with
DIABETES
national incidence rates for the most common cancer types except lung cancer. Lifestyle factors such as smoking
The rate of adult diabetes diagnosis in the Saint Francis Health
contribute to markedly higher incidence rates—such as in
System community is 11 percent, which is line with the state
Muskogee County, where lung cancer rates are 1.5 times the
of Oklahoma but slightly higher than the national rate (nine
national average.
percent). Within the Saint Francis community, the counties with the highest diabetes rates are Haskell (15 percent) and
The cancer mortality rate for the Saint Francis Health System community is 184 deaths per 100,000 population, which is significantly higher than the state, the US and Healthy People 2020 benchmarks (161 deaths per 100,000 population).
10
Saint Francis Health System
Cherokee (14 percent).
OBESITY
Behavioral Health
The Saint Francis Health System community obesity rate (BMI
DEPRESSION
> 30) is 32 percent, which is in line with the state but slightly higher than the US (28 percent). The highest obesity rates
About 20 percent of the Medicare-aged population in the Saint
within the Saint Francis Health System community are Haskell
Francis Health System community suffers from depression,
and McIntosh, at approximately 39 percent.
which is similar to the state but higher than the US (17 percent). Depression rates are consistent across the counties within the Saint Francis community.
Maternal and Infant Health
SUICIDE
The infant mortality rate in the Saint Francis Health System
The suicide mortality rate in the Saint Francis Health System
community is eight deaths per 1,000 births, which is similar to
community is 20 deaths per 100,000 population, which is
the state rate but higher than the national rate (seven deaths
twice the Healthy People 2020 target rate. The suicide rates
per 1,000 births) and the Healthy People 2020 target (six
for the state and US are eight deaths per 100,000 population
deaths per 1,000 births).
and 13 deaths per 100,000 population, respectively.
Approximately nine percent of births in the Saint Francis Health
Within the Saint Francis community, Creek and McIntosh
System community are considered low birth weight (under 2.5
counties have very high suicide rates (27 deaths per 100,000
kilograms). The Healthy People 2020 benchmark for low birth
and 24 deaths per 100,000, respectively).
rate is eight percent of total births. State and national rates are in line with the Healthy People 2020 benchmark.
DRUG POISONING
Health disparities greatly affect maternal and infant health in
The drug poisoning mortality rate for the Saint Francis Health
Oklahoma. Caucasians are in line with Healthy People 2020
System community is 21 deaths per 100,000 population, which
goals; however, African Americans are nearly twice as likely to
is similar to the state rate but higher than the US rate (16 deaths
suffer from both infant mortality and low birth weight.
per 100,000) and the Healthy People 2020 target (10 deaths per 100,000 population). Pockets of the Saint Francis Health System community experience extremely high mortality rates, such as McIntosh County (29 deaths per 100,000 population) and Muskogee County (32 deaths per 100,000 population).
2020–2022 CHNA
11
Health Outcomes Continued
Accidental Deaths and Homicides
and the US rate (11 deaths per 100,000 population). Within the Saint Francis community, McIntosh, Mayes and Okmulgee
According to the Oklahoma Department of Mental Health
counties have the highest rates (approximately 26 deaths per
and Substance Abuse Services (as cited in Urban Institute,
100,000 population).
2018), Oklahomans with mental illness or substance abuse are nearly 3 times as likely to die from an accident and over
Native Americans are significantly more likely than other
3.5 times as likely to die from a homicide. In addition to
groups to die from motor vehicle crashes, with a mortality rate
mental illness, racial or ethnic minorities are more likely to
of 20 deaths per 100,000 population.
experience disparate health outcomes. Accidental death rates are disproportionately high among Native Americans,
HOMICIDE
while homicides are disproportionately high among African Americans.
The homicide mortality rate in the Saint Francis Health System community is ten deaths per 100,000 population, which
UNINTENTIONAL INJURY
is significantly higher than the state and US rates, as well as the Healthy People 2020 target (six deaths per 100,000
The unintentional injury mortality rate for the Saint Francis
population).
Health System community is 57 deaths per 100,000 population, which is similar to the state rate but higher than the US rate
African Americans are far more likely than other groups to die
and the Healthy People 2020 target (36 deaths per 100,000
from a homicide, with a homicide mortality rate of 34 deaths
population). Mayes and McIntosh counties experience the
per 100,000 population.
highest mortality rates within the Saint Francis Health System community (over 75 deaths per 100,000 population). Native Americans are significantly more likely than other
Other
groups to die from unintentional injuries, with a mortality rate of 72 deaths per 100,000 population.
ASTHMA
MOTOR VEHICLE CRASH
The Saint Francis Health System community adult asthma prevalence rate is in line with the US, at approximately
The motor vehicle crash mortality rate in the Saint Francis
13 percent.
Health System community is 16 deaths per 100,000 population, higher than the state rate (12 deaths per 100,000 population)
Sources: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2012–2016; State Cancer Profiles. 2011–2015; Centers for Medicare & Medicaid Services, 2015. For full source list, please see appendix. 12
Saint Francis Health System
Identification and Prioritization of Community Health Needs Identifying Preliminary Health Needs
given metric was considered to be a health disparity. To ensure that the assessment accounted for the needs of the medically
To identify the community’s health needs, Sg2 and Saint
underserved, any health issue characterized by a health
Francis gathered data on approximately 150 health indicators
disparity was identified as a health need.
and solicited community and public health department input. Health needs were preliminarily identified by three
Feedback from the Saint Francis steering committee was
major means–primary research, secondary research and the
used to further determine if the organization and community
presence of health disparities.
partners could reasonably directly impact the health need. The steering committee achieved consensus that it was unlikely
PRIMARY RESEARCH: A health issue was included as an
they could directly impact the following health issues:
important health need if it was identified in more than a third of the key informant interviews or by more than a third of
•
climate health
consumer survey respondents.
•
air quality
•
intentional injury (homicide)
SECONDARY RESEARCH: Performance metrics/indicators for health issues in the Saint Francis Health System community
As a result, 19 conditions were retained as the preliminary
were compared to state and national benchmarks. If at least
community health needs.
two indicators for a health issue failed a benchmark by 10 percent or more, or if one indicator failed a benchmark by 35 percent or more, the health issue was identified as a health need. HEALTH DISPARITY: Whenever
possible,
Health Need Prioritization
performance
Each preliminary health need was prioritized according to
indicators were analyzed by race and ethnicity to discern
criteria identified by the Saint Francis steering committee
potential health disparities among racial or ethnic minorities.
before beginning the process. The criteria are listed in the
A performance indicator where a minority group performed
table below.
25 percent worse than the highest-performing group on a
CRITERIA
DEFINITION
Affected Population
Portion and number of the community/population who are impacted
Severity of Health Need
Degree to which the health issue significantly impacts an individual’s overall health and quality of life
Clear Disparities or Inequities
Degree to which the heath issue disproportionately affects a vulnerable population (e.g., race, ethnicity, income or other) 2020–2022 CHNA
13
Identification and Prioritization of Community Health Needs Continued
As previously noted, secondary data regarding disparities or
The steering committee used the prioritization criteria to rate
inequities is primarily available for racial or ethnic disparities.
each of the health needs resulting in the ranking shown in the
However, the steering committee was asked to consider other
following table.
subgroups that may face disproportionate barriers to healthcare, such as those based on language, culture, citizenship status, economic status, sexual orientation, age, gender or others.
PRIORITIZATION OF HEALTH NEEDS PRELIMINARY PRIORITIZATION
HEALTH NEED
PRIORITIZATION RANKING
Lack of health insurance
1
Education
2
Access to healthcare providers (primary or specialty) Substance abuse (including tobacco)
3 (tie)
Ability to pay for healthcare Access to healthy food/groceries Access to primary care (screenings)
5 (tie)
Chronic diseases (diabetes, cancer, heart disease) Stroke Housing/homelessness Mental health
10 (tie)
Poverty Access to dental care Transportation
13 (tie)
Domestic violence
15
Physical activity
16
Child abuse/neglect
17
Sexual health
18
Safety (motor vehicle crash, unintentional injury)
19
14
Saint Francis Health System
FINAL PRIORITIZATION After the preliminary prioritized health needs were identified, the steering committee selected a final list of priority needs by considering additional criteria, such as Saint Francis’ scope of services as a health provider and its ability to effectively address the priority health need. The priority health needs to be addressed in the implementation plan are as follows: 1.
Access to healthcare (primary care/screening and primary care/specialty providers)
2. Behavioral health (substance abuse and mental health) 3. Chronic disease and stroke 4. Lack of health insurance/ability to pay for healthcare
2020–2022 CHNA
15
Prioritized Health Needs Profiles The following priority health need profiles highlight qualitative
COMMUNITY SURVEY
and quantitative data for each of the health needs, including key input from community members and representatives.
Approximately 29 percent of survey respondents listed access to healthcare as a top health issue for their households (including themselves).
Access to Healthcare
PERFORMANCE COMPARED TO BENCHMARKS
INTERVIEWS
ACCESS TO PROVIDERS Provider-per-population indicators suggest that in general
Community representatives identified several barriers that
there is an adequate number of providers in Tulsa, but not in
hinder individuals in the community from accessing care.
rural areas. Additionally, providers may be distributed unevenly
The most common barriers mentioned were the cost of
such that individuals in outlying communities must travel great
care, transportation, language barriers and fear due to
distances for care.
undocumented status. The supply of mental health providers in the Saint Francis Health Medically underserved or vulnerable populations commonly
System community is higher than the national average, but as
identified included ethnic and racial minority groups including
noted in the Urban Institute in its planning report “Prevention,
Native Americans, African Americans and Hispanics/Latinos,
Treatment and Recovery: Toward a 10-Year Plan for Improving
as well as immigrants, non-English speakers, the uninsured,
Mental Health and Wellness in Tulsa,� regional challenges such
those falling below the poverty line, and rural populations.
as fragmentation in care can prevent patients from accessing
Representatives noted the limited scope of specialty services
mental health providers and resources (Urban Institute, 2018).
in rural communities due to recruitment and retention
Additionally, there are shortages in subspecialties like child
challenges.
and adolescent psychiatry.
Community representatives emphasized the importance of strengthening the safety net available to meet the needs of the medically underserved, noting challenges to state funding and healthcare resources such as Federally Qualified Health Centers (FQHCs). Finally, community representatives identified the recruitment and retainment of providers as a key challenge in rural markets, limiting the scope of specialty services provided in the community.
16
Saint Francis Health System
SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Access to Dentists: Dentists per 100,000 Pop.
53.8
57.5
65.6
Access to Mental Health Providers: Providers per 100,000 Pop.
341.6
375.0
202.8
Access to Primary Care Providers: Providers per 100,000 Pop.
85.7
71.3
87.8
Primary Care Visit: Percentage of Adults with Routine Checkup in Past Year
66%
65%
68%
Access to FQHCs: FQHCs per 100,000 Pop.
2.5
2.8
2.7
Provider Shortages: Percentage of Population Living in a HPSA
37%
45%
33%
METRIC
FQHC = Federally Qualified Health Center; HPSA = health professional shortage area; Pop. = Population. Sources: US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. 2015; University of Wisconsin Population Health Institute, County Health Rankings, 2018; US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File, 2014; Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2015; US Department of Health & Human Services, Centers for Medicare & Medicaid Services, Provider of Services File, 2016; US Department of Health & Human Services, Health Resources and Services Administration, 2016.
2020–2022 CHNA
17
Prioritized Health Needs Profiles Continued
Screenings and other preventive care methods can identify
chronic diseases in the Saint Francis community, particularly
and reduce risk factors for costly chronic diseases. Relative
for diabetes.
to the US, there is opportunity to improve screening rates for
SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Diabetes Exam: Percentage Medicare Enrollees with Diabetes with Annual Exam (Hemoglobin A1c Test)
77%
78%
85%
Mammogram: Percentage Female Medicare Enrollees with Mammogram in Past 2 Years
55%
56%
63%
Pap Test: Percentage Female Adults with Pap Test in the Past 3 Years
75%
73%
79%
Colon Cancer Screening: Percentage Adults Ages 50 and Older Ever Screened for Colon Cancer
56%
54%
61%
No Recent Dental Exam: Percentage Adults Without Dental Exam in the Past Year
42%
42%
30%
METRIC
Sources: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care, 2014; Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse, 2006-2012; Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010.
18
Saint Francis Health System
Lack of Health Insurance/Ability to Pay for Healthcare INTERVIEWS Community representatives discussed concerns about the high uninsured rate in Tulsa and northeastern Oklahoma given the state’s decision not to expand Medicaid. The uninsured face enormous barriers in accessing healthcare. However, representatives noted that simply having insurance is not enough to guarantee access, given high deductibles, copays and other out-of-pocket costs borne by the patient. Additionally,
community
representatives
reported
that
government-pay patients may face barriers to accessing primary care physicians due to limited physician willingness to provide services. Community representatives noted that rural populations often delay or forgo seeking care due to high costs; this may cause severe detrimental health effects and result in costly, high-acuity care when these individuals do seek medical attention. COMMUNITY SURVEY The ability to pay for healthcare was identified as a top need by half of all community respondents when considering their household’s health needs, making it the highest ranked health issue. Lack of health insurance was ranked lower, suggesting that ability to pay is a broader health issue that includes, but
PERCENTAGE OF SURVEY RESPONDENTS CONSIDERING LACK OF HEALTH INSURANCE/ ABILITY TO PAY A TOP HOUSEHOLD ISSUE Ability to Pay for Healthcare
Lack of Health Insurance
50%
28%
also extends beyond, health insurance.
2020–2022 CHNA
19
Prioritized Health Needs Profiles Continued
PERFORMANCE COMPARED TO BENCHMARKS Uninsured rates in the Saint Francis Health System community are similar to the state but fall below US benchmarks, particularly within rural areas. Uninsured rates also demonstrate major differences among racial and ethnic groups in Oklahoma. Hispanic/Latinos and non–Hispanic blacks in Oklahoma are far more likely to be uninsured (nearly 3 times and 1.6 times, respectively) than non–Hispanic whites.
METRIC
Uninsured Population
UNINSURED ADULTS BY RACE AND ETHNICITY OKLAHOMA AND THE US, 2015
Source: US Census Bureau, Small Area Health Insurance Estimates, 2015.
20
Saint Francis Health System
SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
16%
16%
12%
Chronic Disease and Stroke INTERVIEWS Community representatives discussed certain pockets of the community with high mortality rates for cardiovascular issues, noting the connection between chronic disease and lack of access to healthy food in those zip codes. Community representatives also shared concerns about poor diet and tobacco usage, which they saw as prevalent within the community and responsible for the high observed prevalence of chronic diseases, particularly in rural areas. COMMUNITY SURVEY Approximately 21 percent of community survey respondents considered chronic disease as a top health issue for their households. PERFORMANCE COMPARED TO BENCHMARKS The Saint Francis Health System community falls significantly below the US on several measures of morbidity and mortality.
METRICS SIGNIFICANTLY DIFFERENT THAN A BENCHMARK (25 PERCENT OR MORE) SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Poor Dental Health
22%
22%
16%
Mortality-Cancer
183.8
183.4
160.9
Mortality-Coronary Heart Disease
152.4
143.0
99.6
Mortality-Lung Disease
58.3
62.9
41.3
METRIC
Sources: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006–2010; Centers for Disease Control and Prevention, National Vital Statistics System, 2012–2016.
2020–2022 CHNA
21
Prioritized Health Needs Profiles Continued
Racial health disparities in the Saint Francis Health System community contribute to significantly worse outcomes for racial minorities, particularly for African Americans and Native Americans.
RACIAL HEALTH DISPARITIES
RACIAL GROUP ADVERSELY IMPACTED
American Indian/ Alaska Native
Black or African American
VALUE
US BENCHMARK
Colon and Rectum Cancer Incidence Rate
67.5
39.8
Coronary Heart Disease Mortality, Age-Adjusted Death Rate
175.3
99.6
Lung Cancer Incidence Rate
104.8
61.2
Lung Disease Mortality, Age-Adjusted Death Rate
62.9
41.3
Prostate Cancer Incidence Rate
140.0
115.0
Stroke Mortality, Age-Adjusted Death Rate
53.5
43.3
Cancer Mortality, Age-Adjusted Death Rate
231.5
160.9
Coronary Heart Disease Mortality, Age-Adjusted Death Rate
192.7
99.6
Lung Cancer Incidence Rate
89.4
61.2
Prostate Cancer Incidence Rate
207.7
114.8
Stroke Mortality, Age-Adjusted Death Rate
67.2
43.3
METRIC
(RATES PER 100,000 POP.)
Pop. = Population. Sources: State Cancer Profiles, 2009–2013; Centers for Disease Control and Prevention, National Vital Statistics System, 2012–2016.
22
Saint Francis Health System
Behavioral Health
COMMUNITY SURVEY
INTERVIEWS
While a lower percentage of individuals reported mental health and substance abuse as issues for their household, community
Community
representatives
discussed
the
significant
respondents consider behavioral health a significant issue for
challenges in preventing and treating mental health and
their communities. Respondents in Vinita were more likely to
substance abuse in the community, given limited funding
prioritize mental health and substance abuse as health needs,
and a currently disjointed behavioral health system of care.
likely a reflection of the community’s unique experience with
Community representatives frequently mentioned the lack
the deinstitutionalization of mental health and the rise of
of psychiatric services in the region, particularly for children
group homes for adults with mental illness in Vinita.
and adolescents. They estimated that current behavioral health resources are addressing only a fraction of the current community need, resulting in significant burden to primary care doctors—as well as inpatient and emergency department capacity, where many behavioral patients must wait for appropriate care. Additionally, in Vinita, representatives discussed the history of deinstitutionalization of the state mental health hospital in the community, which contributes to the high prevalence of chronic mental illness still observed today.
PERCENTAGE OF SURVEY RESPONDENTS CONSIDERING BEHAVIORAL HEALTH A TOP ISSUE FOR THEIR COMMUNITY Substance Abuse
Mental Health
26%
25%
Common mental health issues mentioned included depression and anxiety. Substance abuse was also frequently mentioned, such as when community representatives noted the impact of opioids, amphetamines and alcohol in the Saint Francis community. Respondents also discussed the detrimental effects of substance abuse among the Native American population. Additionally, community representatives frequently shared concerns about social determinants of mental health, such as high rates of childhood trauma, abuse and adverse childhood events (ACES); perceptions of family dysfunction; and a “culture of violence” in the region.
2020–2022 CHNA
23
Prioritized Health Needs Profiles Continued
PERFORMANCE COMPARED TO BENCHMARKS The Saint Francis Health System community performs poorly on several measures of behavioral health, including depression and mortality due to drug poisoning and suicide. Some of the most common drugs contributing to unintentional poisonings in the state are prescription drugs and narcotic analgesics (Oklahoma State Department of Health, 2016). Unintentional poisoning death rates are highest in the eastern part of the state, especially southeastern Oklahoma. Within the Saint Francis Community, Mayes, Muskogee, Sequoyah and McIntosh counties experience poisoning death rates significantly higher than the state, with Muskogee County among the top 5 counties in the state.
SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Depression: Percentage of Medicare Beneficiaries with Depression
20%
19%
17%
Drug Poisoning Mortality: Age-Adjusted Death Rate (per 100,000 Pop.)
20.8
20.4
15.6
Suicide Mortality: Age-Adjusted Death Rate (per 100,000 Pop.)
20.1
19.1
13.0
METRIC
Pop. = Population. Sources: Centers for Medicare and Medicaid Services, 2015; Centers for Disease Control and Prevention, National Vital Statistics System. 2012– 2016.
24
Saint Francis Health System
Evaluation of Fiscal Year 2016 Implementation Strategies Saint Francis Health System Implementation of Previous CHNA The following is a review and evaluation of implementation activities carried out over the past three years related to the previous fiscal year 2016 CHNA and implementation strategy (fiscal years 2017–2019). In the fiscal year 2016 CHNA implementation strategy plan, Saint Francis identified the following needs to address: •
Access to healthcare
•
Alcohol and drug abuse
•
Chronic diseases
•
Poor diet, inactivity and obesity
•
Tobacco use
•
Mental health
The information in the following tables lists the progress on each of the initiatives during fiscal years 2016, 2017 and 2018.
2020–2022 CHNA
25
Evaluation of Fiscal Year 2016 Implementation Strategies Continued
Access to Healthcare DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
The Xavier Medical Clinic The Xavier Medical Clinic is an entity fully owned and operated by Saint Francis, offering the resources of volunteer physicians and other healthcare professionals to uninsured or underserved populations. The Xavier Medical Clinic seeks to provide free, limited outpatient primary healthcare services, facilitate referrals to volunteer specialists, provide prenatal care, educate in good health practices and increase access to traditional healthcare.
Patients at the Xavier Medical Clinic are referred to Saint Francis Hospital, Inc. for inpatient care including childbirth, as well as surgery and ancillary services.
FY 2016: • 6,200 medical visits were provided; 356 deliveries were provided through referrals to Saint Francis Hospital, Inc. • Saint Francis provided financial support to the Xavier Medical Clinic that exceeded $1.6M. FY 2017: • 7,262 medical visits were provided; 469 deliveries were provided through referrals to Saint Francis Hospital, Inc. • Saint Francis provided financial support to the Xavier Medical Clinic that exceeded $1.7M. • The Xavier Medical Clinic was remodeled to accommodate a more permanent medical staff presence and a larger volume of patients. FY 2018: • 8,990 medical visits were provided; 410 deliveries were provided through referrals to Saint Francis Hospital, Inc. • Saint Francis provided financial support to the Xavier Medical Clinic that exceeded $1.7M. • Ophthalmology, cardiology and wound care clinics were offered at the Xavier Medical Clinic. FY 2019: In process.
26
Saint Francis Health System
Access to Healthcare Continued DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Medicaid Advocacy For the past several years, Saint Francis has actively worked with members of the Oklahoma state legislature and other local stakeholders to advance strategies to expand health insurance coverage as laid out by the Patient Protection and Affordable Care Act and to maximize public health funding in the state of Oklahoma critical to the community cost of health services and quality of life.
Patients presenting at Saint Francis Hospital, Inc., Saint Francis Hospital South, LLC, Saint Francis Hospital Muskogee, Inc. and Saint Francis Hospital Vinita, Inc. without insurance will be visited by financial counselors should they elect to and be assisted with the Medicaid enrollment process.
Saint Francis has worked alongside the Tulsa Regional Chamber and hospital affiliates to support Medicaid expansion and oppose managed Medicaid bills. Key initiatives created by or supported by the Tulsa Regional Chamber are as follows: FY 2016: • Promotion of Arkansas expansion plan • Launch of MakeOKBetter marketing campaign to broaden state healthcare coverage and accept federal funds through the Insure Oklahoma public-private partnership FY 2018: • Proposed House Bill (HB 1033xx) to fund the Oklahoma Health Care Authority (OHCA), graduate medical education and the teacher shortage • OHCA reimbursement rate increase of three percent to SoonerCare (Oklahoma Medicaid) providers FY 2019: In process.
Outpatient Expansion and Provider Recruitment As the employed physicians of Saint Francis, Warren Clinic, Inc. has a goal to expand the base of available primary care physicians in northeastern Oklahoma. The health system plans to continue to expand the physical presence of Warren Clinic, Inc. sites along with urgent care clinics, as well as providing specialty clinics in communities where access to specialty services is limited.
Recruited physicians will provide primary care and specialty care services to the patients served by Saint Francis Hospital, Inc., Saint Francis Hospital South, LLC, and Laureate Psychiatric Clinic and Hospital, Inc.
FY 2016: • 324 net number of physicians • 43 physicians newly recruited • 23 physicians left FY 2017: • 352 net number of physicians • 53 physicians newly recruited • 27 physicians left FY 2018: • 366 net number of physicians • 41 physicians recruited • 23 physicians left FY 2019: In process.
2020–2022 CHNA
27
Evaluation of Fiscal Year 2016 Implementation Strategies Continued
Access to Healthcare Continued DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Community Health Offerings An integral part of providing excellent healthcare for fellow community members—of all ages—is the promotion of fitness and healthy lifestyles. Community health efforts include Warren Clinic, Inc. flu vaccine clinics, the Health Zone at Saint Francis’ annual Health and Wellness Expo, and Saint Francis Medical Town Hall events.
The vaccine clinics will be provided by Saint Francis Hospital, Inc., Saint Francis Hospital South, LLC, John 3:16 Mission, Night Light Tulsa and Warren Clinic, Inc.
FY 2016: • 2,500 flu vaccines were provided; in addition, flu vaccines were provided to all infants below 6 years of age at the Children’s Hospital. • Newborn vaccines were given to all infants born at Saint Francis Hospital and Saint Francis Hospital South, LLC. • Three town halls were held to promote cardiovascular screenings. • Five educational events were held to raise community mental health awareness. FY 2017: • 2,715 flu vaccines were provided. • Saint Francis Health system partnered with the Muskogee Health Department and Pittsburg County Health Department to provide 8,000 vaccinations to children. • Six town halls were held to promote cardiovascular screenings. • Four educational events were held to raise community mental health awareness. FY 2018: • 2,825 flu vaccines were provided. • 6,060 newborn vaccines were provided. • Three town halls were held to promote cardiovascular screenings. • Eight educational events were held to raise community mental health awareness. FY 2019: In process.
28
Saint Francis Health System
Access to Healthcare Continued DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Laureate Psychiatric Clinic and Hospital, Inc. As a part of Saint Francis, Laureate Psychiatric Clinic and Hospital, Inc., offers substance abuse counseling for adults on an inpatient basis, and adults and adolescents on an outpatient basis.
This strategy is met via programs and services available at Laureate Psychiatric Clinic and Hospital, Inc.
FY 2016: • Intensive Outpatient Program (IOP) saw 4,780 total individual visits with approximately 2,140 for substance abuse counseling. • IOP also provided 3,673 group therapy visits for substance abuse counseling and 2,698 group therapy visits for mental health. FY 2017: • Intensive Outpatient Program (IOP) saw 4,958 total individual visits with approximately 2,300 for substance abuse counseling. • IOP also provided 3,711 group therapy visits for substance abuse counseling and 3,039 group therapy visits for mental health. FY 2018: • Intensive Outpatient Program (IOP) saw 4,784 total individual visits with approximately 2,450 for substance abuse counseling. • IOP also provided 3,995 group therapy visits for substance abuse counseling and 3,027 group therapy visits for mental health. FY 2019: In process.
2020–2022 CHNA
29
Evaluation of Fiscal Year 2016 Implementation Strategies Continued
Chronic Diseases DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
The physician providers of Saint Francis Hospital, Inc. and Saint Francis Hospital South, LLC, will meet the needs of chronic disease patients including cardiology, oncology, primary care, pulmonology, endocrinology, mental health, home health, nephrology, neurology and radiology.
FY 2016: • Use of patient risk stratification by Warren Clinic, Inc. to identify high risk patients and tailor care coordination, including education on chronic diseases and the development of care plans for complex chronic care patients • Development and implementation of colorectal cancer screening for at-risk patients • Transition of care clinic for high risk heart failure patients, including the creation of a new care pathway • Development of guidelines for management of chronic obstructive lung disease
Service Lines Service lines that cater to the needs of chronic disease patients include cardiology, oncology, primary care, pulmonology, endocrinology, mental health, home health, nephrology, neurology and radiology.
FY 2017: • Establishment of disease management programs for key conditions including chronic diseases like diabetes and congestive heart failure • Participation in Oncology Care Model with Warren Clinic, Inc. Medical Oncology Group to drive continuity of care across the care continuum for oncology patients • Comprehensive stroke center designation FY 2018: • Implementation of home monitoring strategies to track patients with chronic obstructive pulmonary disease and congestive heart failure (CHF) • Use of readmission risk assessment for Medicare patients with focus on diabetes and CHF FY 2019: In process.
30
Saint Francis Health System
Poor Diet/Inactivity, Obesity DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Obesity Events The Children’s Hospital at Saint Francis and Health Zone host Childhood Obesity Conferences that include public town halls featuring educational programs and guest lecturers of national renown.
These events are hosted open to the public on the campus of Saint Francis Hospital, Inc.
FY 2016: • Five Health Zone pediatric obesity reduction events and eleven weight reduction classes were held. FY 2017: • Four Health Zone pediatric obesity reduction events and seven weight reduction classes were held. FY 2018: • Nine Health Zone pediatric obesity reduction events and six weight reduction classes were held. FY 2019: In process.
Health Fairs Through the Health Zone, a medically based fitness facility offering an array of exercise equipment, classes and programs, Saint Francis Hospital, Inc., puts on a series of health fairs that are free and open to the public
The health fairs are hosted by departments of Saint Francis Hospital, Inc., and any volunteer clinical/ provider participation is fulfilled by employees of Saint Francis Hospital, Inc., Saint Francis Hospital South, LLC, and Laureate Psychiatric Clinic and Hospital, Inc.
FY 2016: • Saint Francis participated in 27 health fairs or other community events. FY 2017: • In partnership with various community organizations, Saint Francis participated in 9 community health fairs attended by 3,200 people. FY 2018: • Saint Francis participated in 24 health fairs or other community events, including: • City of Tulsa Health Fair, attended by 2,000 people • Tulsa community college health fairs, attended by 200 people • Vinita health fair attended by 100-150 people FY 2019: In process.
Saint Francis Tulsa Tough Saint Francis Tulsa Tough is a three-day cycling festival attracting professional and amateur racers across the country.
Saint Francis sponsors Saint Francis Tulsa Tough and contributes over $250,000 annually to the event.
FY 2016: • 4,681 participants, including 1,846 Grand Fondo participants and 2,835 criterium participants FY 2017: • 4,760 participants, including 1,683 Grand Fondo participants and 3,077 criterium participants FY 2018: • 4,599 participants, including 1,597 Grand Fondo participants and 3,022 criterium participants FY 2019: In process. 2020–2022 CHNA
31
Evaluation of Fiscal Year 2016 Implementation Strategies Continued
Tobacco Use DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Cancer Screening Program Saint Francis Hospital, Inc., offers low-dose computerized tomography (CT) screening to both employees and the public who are high risk for developing lung cancer.
The screenings are conducted at Saint Francis Hospital, Inc.
FY 2016: • 413 low-dose lung cancer CT scans offered to community FY 2017: • 584 low-dose lung cancer CT scans offered to community FY 2018: • Cancer screening program provided to 4 community organizations • Over 700 low-dose lung cancer CT scans offered to community FY 2019: In process.
Clear Direction Program Clear Direction is a six week-long tobacco cessation program for adults offered through the Health Zone.
Counseling or assistance is delivered by trained, non-smoking counselors or healthcare providers at the Health Zone, Laureate Psychiatric Clinic and Hospital, Inc. or Warren Clinic, Inc. and smokers are directed to the state website okhelpline.com (1-800-QUIT NOW) created from TSET (Tobacco Settlement Enodwment Trust)
FY 2016: • 14 tobacco cessation classes were provided. • 59 Saint Francis employees enrolled in Clear Direction classes at no cost to the employee. • 7,085 of 25,211 (28.10%) identified tobacco users received cessation FY 2017: • Eight tobacco cessation classes were provided. • 33 Saint Francis employees enrolled in Clear Direction classes at no cost to the employee. • 11,792 of 24,584 (47.97%) identified tobacco users received cessation FY 2018: • Eight tobacco cessation classes or events were held. • 41 Saint Francis employees enrolled in Clear Direction classes at no cost to the employee. • 14,048 of 26,129 (53.76%) identified tobacco users received cessation FY 2019: In process.
32
Saint Francis Health System
Mental Health DESCRIPTION
ENTITY-SPECIFIC ACTIONS TAKEN
PROGRESS TO DATE
Laureate Psychiatric Clinic and Hospital, Inc. Laureate Psychiatric Clinic and Hospital, Inc., (Laureate) offers mental health counseling and treatment for adults on an inpatient basis, and children, adolescents and adults on an outpatient basis. Laureate offers qualified psychologists, licensed therapists, nurse practitioners and physicians when medications are involved. Patients, families and caregivers are encouraged to gain positive long-term results through regular outpatient visits.
This strategy is met via programs and services available at Laureate.
FY 2016: • Laureate embedded a second social worker in a primary care office with highly positive patient and physician results. • The Progressive Care Unit opened to take patients of all ages including the senior population, allowing for expansion of the senior behavioral health program. FY 2017: • Laureate provided psychiatry and geriatric psychiatry teleconsults to referring regional providers. FY 2018: • Laureate, Muskogee and Vinita programs linked as part of a system-wide behavioral health concept. • Renovation of behavioral health unit at Saint Francis Hospital Muskogee, Inc. FY 2019: In process.
2020–2022 CHNA
33
Appendix A: CHNA Data Sources and Dates Demographics INDICATOR VARIABLE
DATA SOURCE
Families with Children Female Population Foreign-Born Population Hispanic Population Male Population Median Age Population Age 0–4 Population Age 18–24 Population Age 18–64 Population Age 25–34 Population Age 35–44 Population Age 45–54
US Census Bureau, American Community Survey. 2012–2016.
Population Age 5–17 Population Age 55–64 Population Age 65+ Population Geographic Mobility Population in Limited English Households Population Under Age 18 Population with Any Disability Population with Limited English Proficiency Total Population Veteran Population Change in Total Population Urban and Rural Population
34
Saint Francis Health System
US Census Bureau, Decennial Census. 2000– 2010.
Social and Economic Factors INDICATOR VARIABLE
DATA SOURCE
Lack of Social or Emotional Support
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012.
Teen Births
Centers for Disease Control and Prevention, National Vital Statistics System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012.
Violent Crime
Federal Bureau of Investigation, FBI Uniform Crime Reports. 2012–2014.
Food Insecurity Rate
Feeding America. 2014.
High School Graduation Rate (NCES)
National Center for Education Statistics, NCES-Common Core of Data. 2008–2009.
Children Eligible for Free/Reduced Price Lunch
National Center for Education Statistics, NCES-Common Core of Data. 2015–2016.
Households with No Motor Vehicle Housing Cost Burden (30%) Income-Families Earning Over $75,000 Income-Inequality (GINI Index) Income-Median Family Income Income-Per Capita Income Income-Public Assistance Income Insurance-Population Receiving Medicaid Insurance-Uninsured Population Population Receiving SNAP Benefits (ACS)
US Census Bureau, American Community Survey. 2012–2016.
Population with Associate’s Degree or Higher Population with Bachelor’s Degree or Higher Population with No High School Diploma Poverty-Children Below 100% FPL Poverty-Children Below 200% FPL Poverty-Population Below 100% FPL Poverty-Population Below 185% FPL Poverty-Population Below 200% FPL Poverty-Population Below 50% FPL Insurance-Uninsured Children
US Census Bureau, Small Area Health Insurance Estimates. 2014.
Insurance-Uninsured Adults
US Census Bureau, Small Area Health Insurance Estimates. 2015.
Population Receiving SNAP Benefits (SAIPE)
US Census Bureau, Small Area Income & Poverty Estimates. 2015.
High School Graduation Rate (EdFacts)
US Department of Education, EdFacts. 2014–2015.
Student Reading Proficiency (Fourth Grade) Head Start
US Department of Health & Human Services, Administration for Children and Families. 2016.
Unemployment Rate
US Department of Labor, Bureau of Labor Statistics. February 2018. 2020–2022 CHNA
35
Appendix A: CHNA Data Sources and Dates Continued
Clinical Care INDICATOR VARIABLE
Dental Care Utilization High Blood Pressure Management HIV Screenings Lack of a Consistent Source of Primary Care Recent Primary Care Visit
DATA SOURCE
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2006–2010.
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2011–2012..
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2015.
Cancer Screening-Pap Test Cancer Screening-Sigmoidoscopy or Colonoscopy
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012.
Pneumonia Vaccination Lack of Prenatal Care
Centers for Disease Control and Prevention, National Vital Statistics System. Centers for Disease Control and Prevention, Wide-Ranging Online Data for Epidemiologic Research. 2007–2010.
Cancer Screening-Mammogram Diabetes Management-Hemoglobin A1c Test
Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care. 2014.
Preventable Hospital Events Access to Mental Health Providers
University of Wisconsin Population Health Institute, County Health Rankings. 2018.
Federally Qualified Health Centers
US Department of Health & Human Services, Center for Medicare & Medicaid Services, Provider of Services File. December 2016.
Access to Primary Care
US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. 2014.
Access to Dentists
US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. 2015.
Facilities Designated as Health Professional Shortage Areas Population Living in a Health Professional Shortage Area
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US Department of Health & Human Services, Health Resources and Services Administration, Health Resources and Services Administration. April 2016.
Health Behaviors INDICATOR VARIABLE
Tobacco Usage-Former or Current Smokers
DATA SOURCE
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2011–2012.
Tobacco Usage-Quit Attempt Fruit/Vegetable Consumption Alcohol Consumption
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2005–2009.
Tobacco Usage-Current Smokers
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012.
Physical Inactivity
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2013.
Alcohol Expenditures
US Census Bureau, American Community Survey. 2012–2016.
Fruit/Vegetable Expenditures Soda Expenditures
Nielsen, Nielsen SiteReports. 2014.
Tobacco Expenditures Walking or Biking to Work
US Census Bureau, American Community Survey. 2012–2016.
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Appendix A: CHNA Data Sources and Dates Continued
Health Outcomes INDICATOR VARIABLE
DATA SOURCE
Poor Dental Health
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2006–2010.
Asthma Prevalence Heart Disease (Adult) High Cholesterol (Adult)
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 2011–2012.
Overweight High Blood Pressure (Adult) Poor General Health Diabetes (Adult) Obesity STI-HIV Prevalence STI - Chlamydia Incidence STI-Gonorrhea Incidence
Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2013. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. US Department of Health & Human Services, Health Indicators Warehouse. 2013. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. US Department of Health & Human Services, Health Indicators Warehouse. 2014.
Mortality-Cancer Mortality-Coronary Heart Disease Mortality-Drug Poisoning Mortality-Heart Disease Mortality-Homicide Mortality-Lung Disease
Centers for Disease Control and Prevention, National Vital Statistics System. 2012– 2016.
Mortality-Motor Vehicle Crash Mortality-Stroke Mortality-Suicide Mortality-Unintentional Injury Low Birth Weight
Centers for Disease Control and Prevention, National Vital Statistics System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012.
Depression (Medicare Population) Diabetes (Medicare Population) Heart Disease (Medicare Population) High Blood Pressure (Medicare Population) High Cholesterol (Medicare Population)
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Saint Francis Health System
Centers for Medicare and Medicaid Services. 2015.
Health Outcomes Continued INDICATOR VARIABLE
DATA SOURCE
Cancer Incidence-Cervical
State Cancer Profiles. 2009–2013.
Cancer Incidence-Breast Cancer Incidence-Colon and Rectum Cancer Incidence-Lung
State Cancer Profiles. 2010–2014.
Cancer Incidence-Prostate Mortality-Premature Death
University of Wisconsin Population Health Institute, County Health Rankings. 2014– 2016.
Infant Mortality
US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. 2006–2010.
Mortality-Pedestrian Motor Vehicle Crash
US Department of Transportation, National Highway Traffic Safety Administration, Fatality Analysis Reporting System. 2011–2015.
Other Aron, Laudan, et al. Prevention, Treatment, and Recovery: Toward a 10-Year Plan for Improving Mental Health and Wellness in Tulsa. Urban Institute, March 2018, www.urban.org/sites/default/files/publication/97656/prevention_treatment_and_recovery_toward_a_10-year_plan_for_improving_mental_health_and_wellness_in_tulsa_0.pdf. Nguyen, Claire. Fatal Unintentional Poisoning Surveillance System: Data Update. Oklahoma State Department of Health, 2016, https://www.ok.gov/health2/documents/UP_Data_Charts_Tables.pdf “Tulsa County Community Health Improvement Plan.” Tulsa City County Health Department, Feb. 2, 2017, www.tulsa-health.org/ tulsa-county-community-health-improvement-plan.
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Appendix B: List of Organizations Represented in Key Informant Interviews and Community Feedback
SECTOR
ORGANIZATION
EXAMPLE OF VULNERABLE POPULATIONS SERVED
Catholic Charities of Eastern Oklahoma
Low-income, minority and immigrant populations
George Kaiser Family Foundation
Low-income and minority populations
Grand Nation, Inc.
Low-income and Native American populations
Morton Comprehensive Health Services
Low-income and minority populations
Oklahoma State University Medical Center
Low-income and minority populations
OU-Tulsa (University of Oklahoma)
Low-income, minority and rural populations
Saint Francis Health System, Inc.
Low-income, minority and rural populations
University of Tulsa
Low-income and minority populations
Craig County Health Department
Low-income, minority and rural populations
Tulsa City County Health Department
Low-income and minority populations
Community Health Entities
Public Health Entities
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Saint Francis Health System
Appendix C: Key Informant Interview Guide General Information •
Individual information: • Current position and role • Previous relevant experiences • Confirm contact information in case of follow-up requests
Internal Stakeholder Questions •
What are the strengths of [Facility Name]?
•
What are the unmet needs of residents in the [Facility Name] service area?
•
Could you identify some broad areas of social determinants of health that need to be addressed within the [Facility Name] service area that impact community health and ability to access care?
•
Could you share your thoughts about [Facility Name] in terms of: • Clinical, office and administrative staff engagement with patients • Level of community engagement • Available services and gaps in services • Patients’ satisfaction with services and with interactions with clinical and office staff
•
What are some areas of community health improvement that you can identify for your facility/services provided/staff/ equipment?
•
What types of barriers do patients of [Facility Name] encounter when seeking services (eg, not enough translators, lack of social workers)?
•
What is [Facility Name] doing to address health disparities in the service area? • Medical/clinical services • Non-clinical • Social determinants of health (eg, food, housing, stress, addiction, social support, etc)
Internal and External Stakeholder Questions •
What is your vision of a healthy community?
•
Are there any known major risks for community safety?
•
What are the most important health needs that have the greatest impact on overall health in the community?
•
What are the specific populations that are most adversely affected by the health needs you just mentioned?
•
What resources need to be developed or increased to address these health needs?
•
Who might be responsible for funding the change you suggest? Similarly, who should be responsible for moving those ideas forward?
•
What are the opportunities for community partners and Saint Francis to address top health issues? Who are some current or potential partners that we have not yet engaged who could help to impact these issues? 2020–2022 CHNA
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Appendix D: Saint Francis Health System Community Needs Survey The Community Health Needs Survey appears on the following four pages.
42
Saint Francis Health System
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44
Saint Francis Health System
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Saint Francis Health System
Appendix E: Community Resources Available to Address Prioritized Health Needs Resources potentially available to address identified needs include services and programming provided by hospitals, federally qualified health centers, rural health centers, county health departments, state departments and other community organizations and government agencies, among others. Below are some potential resources to address prioritized community health needs, found through publicly available information sources as of October 2018:
Access to Healthcare (Primary Care/Screening and Primary Care/Specialty Providers) Arms Around Broken Arrow (BA)
Morton Comprehensive Health Services, Inc.
Arubah Community Clinic
Neighbor for Neighbor
Broken Arrow Neighbors
Neighbors Along the Line
Catholic Charities
Oklahoma Department of Human Services
Cherokee Nation Health
Oklahoma Project Woman
Community Health Connection
Owasso Community Resources
Day Center for the Homeless
Pathways to Health
Free Clinic Coalition
Pelivan Transit
Good Samaritan Health Services
Planned Parenthood of the Heartland
Indian Health Care Resource Center of Tulsa
South Tulsa Community House
Life Senior Services
Take Charge!
The Oklahoma State Department of Health, Chronic Disease Service Tulsa County Medical Society Tulsa County Social Services Tulsa Dream Center Tulsa Healthcare Project Tulsa City County Health Department Veterans Affairs Health Services Xavier Medical Clinic
Lack of Health Insurance/Ability to Pay for Healthcare Claim Your Coverage Coalition
LIFE Senior Services
Community Health Connection
Morton Comprehensive Health Services, Inc.
Oklahoma State University (OSU) Center for Health Sciences
Chronic Disease and Stroke American Cancer Society American Diabetes Association American Heart Association American Lung Association American Stroke Association Arms Around BA Arubah Community Clinic Ascension St. John Broken Arrow Neighbors
Cancer Treatment Center of America-Southwestern Regional Medical Center Cherokee Nation Health Community Health Connections
Morton Comprehensive Health Services Neighbor for Neighbor Oklahoma Health Initiatives
Healthy Hearts for Oklahoma Initiative
Oklahoma State University Medical Center (OSUMC)
Hillcrest Health System
South Tulsa Community House
Indian Healthcare Resource Center
Tulsa City County Health Department
Kindred Hospital
University of Oklahoma (OU) Physicians Clinic
Koweta Indian Health Facility
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Appendix E: Community Resources Available to Address Prioritized Health Needs Continued
Behavioral Health American Cancer Society
DaySpring Behavioral Health
OU-Tulsa (University of Oklahoma)
Area Program of Assertive Community Treatment (PACT) Teams
Family and Children’s Services
Parkside Psychiatric Hospital
Grand Lake Hospital
Red Rock Behavioral Health Services
Grand Nation, Inc.
Rose Rock Recovery
Hillcrest Health System
Shadow Mountain Behavioral Health System
Indian Health Care Resource Center of Tulas
Tobacco Free Coalition for Tulsa County
Mental Health Association of Oklahoma
Tobacco Settlement Endowment Trust
Morton Comprehensive Health Services, Inc.
Tulsa Center for Behavioral Health
National Alliance on Mental Illness-Tulsa
Tulsa-City County Health Department
Counseling and Recovery Services of Oklahoma
Oklahoma Tobacco Helpline
Veterans Affairs Health Services
CREOKS Health Services
OSU Center for Health Sciences
Veteran Affairs Behavioral Health Clinic
Ascension St. John Brookhaven Hospital, Indian Healthcare Resource Center of Tulsa Center for Therapeutic Interventions Cherokee Health-Healthy Nation Program Community Outreach Psychiatric Emergency Services (COPES)
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Appendix F: Community Health Data Detail Social and Economic Factors SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Percent of pop. aged 25 and up with bachelor’s degree or higher, 2016
25%
24%
30%
Unemployment rate, 2018
4%
4%
4%
Percent of pop. with low food access, 2015
25%
26%
22%
Percent of pop. in census tracts with low or no healthy food access
69%
68%
50%
Grocery stores (per 100,000 pop.), 2016
14.3
16.3
21.2
Health Insurance
Percentage of pop. without medical insurance, 2016
16%
16%
12%
Language Proficiency
Percent of pop. aged 5 and up with limited English proficiency, 2016
4%
4%
9%
Percent of pop. under age 18 below 200 percent FPL, 2016
49%
49%
43%
Percent of pop. at or below 200% FPL, 2016
37%
38%
34%
Percent of pop. using public transit for commute to work, 2016
1%
0%
5%
Percent of households with no motor vehicle
6%
6%
9%
CATEGORY
METRIC
Educational Attainment
Employment
Food Insecurity
Poverty
Transportation
FPL = Federal Poverty Level; Pop. = Population. Sources: US Census Bureau, American Community Survey, 2012-2016; US Department of Labor, Bureau of Labor Statistics, March 2018; US Department of Agriculture, Economic Research Service, USDA-Food Access Research Atlas, 2015; Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, 2011; US Census Bureau, County Business Patterns; US Census Bureau, Small Area Health Insurance Estimates, 2016. 2020–2022 CHNA
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Appendix F: Community Health Data Detail Continued
Health Behaviors SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
Estimated percent of adults drinking excessively, 2012
13%
14%
17%
Physical Inactivity
Percent adults with no leisure time physical activity, 2013
28%
28%
22%
Tobacco Usage
Percent of pop. smoking cigarettes (current smokers), 2012
25%
25%
18%
Chlamydia infection rate (per 100,000 pop.), 2014
573.9
536.5
456.1
Gonorrhea infection rate (per 100,000 pop.), 2014
193.3
159.4
110.7
HIV/AIDS prevalence rate (per 100,000 pop.), 2014
187.6
171.8
353.2
CATEGORY
METRIC
Alcohol Consumption
STIs
Sources: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2005–2009; Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2013; US Census Bureau, American Community Survey. 2012–2016. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. US Department of Health & Human Services, Health Indicators Warehouse. 2006–2012; Institute for Health Metrics and Evaluation (IHME), US County Profile.
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Saint Francis Health System
Health Outcomes CATEGORY
Cancer
SAINT FRANCIS HEALTH SYSTEM COMMUNITY
OK
US
HEALTHY PEOPLE
Breast cancer incidence rate, 2014
122.1
117.8
123.5
-
Colon and rectum cancer incidence rate, 2014
41.7
42.2
39.8
38.7
Lung cancer incidence rate, 2014
72.9
70.8
61.2
-
Prostate cancer incidence rate, 2014
109.6
108.3
114.8
-
Cancer mortality, 2014
183.8
99.8
160.9
160.6
METRIC
Diabetes
Percent of Medicare FFS beneficiaries with diabetes, 2015
11%
11%
9%
-
High Blood Pressure
Percent of adults with high blood pressure, 2012
33%
32%
28%
-
High Cholesterol
Percent of adults with high cholesterol, 2012
40%
42%
39%
-
5%
5%
4%
-
Coronary heart disease mortality (per 100,000 pop.), 2016
152.4
71.6
99.6
103.4
Obese
Percent of adults aged 20 and up with BMI >30.0, 2013
32%
33%
28%
-
Overweight
Percent of adults aged 18 and up reporting BMI of 25.0–30.0, 2012
35%
35%
36%
-
Lung Disease
Age-adjusted death rate (per 100,000 pop.), 2016
58.3
18.8
41.3
-
Stroke
Age-adjusted death rate (per 100,000 pop.), 2016
43.3
43.6
36.9
33.8
Homicide
Age-adjusted death rate (per 100,000 pop.), 2016
9.7
7.1
5.5
5.5
Motor Vehicle Crash
Age-adjusted death rate (per 100,000 pop.), 2016
16.0
12.2
11.3
-
Unintentional Injury
Unintentional injury death rate (per 100,000 pop.), 2016
56.8
59.6
41.9
36.0
Infant Mortality
Infant deaths (per 1,000 births), 2010
7.9
7.8
6.5
6.0
Low Birth Weight
Percent of births considered low birth weight (<2,500 g), 2012
9%
8%
8%
8%
Asthma
Percent of adults aged 18 and up with asthma, 2012
14%
14%
13%
-
Percent of adults with heart disease, 2012 Heart Disease
Sources: State Cancer Profiles, 2010–2014; Centers for Medicare and Medicaid Services. 2015; Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Accessed via the Health Indicators Warehouse. US Department of Health and Human Services, Health Indicators Warehouse, 2006–2012; Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System and additional data analysis by CARES, 2011–2012; Centers for Disease Control and Prevention, National Vital Statistics System, Accessed via CDC WONDER, 2012–2016; Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2013. 2020–2022 CHNA
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