Saint Francis Health System Community Health Needs Assessment 2020-2022

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

36

Saint Francis Health System

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.

2020–2022 CHNA

37

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)

38

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.

2020–2022 CHNA

39

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

40

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

41

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

2020–2022 CHNA

43

44

Saint Francis Health System

2020–2022 CHNA

45

46

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

2020–2022 CHNA

47

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)

48

Saint Francis Health System

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

49

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.

50

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

51

2020â&#x20AC;&#x201C;2022 CHNA

53