Community Health Needs Assessment CHI St Lukes Health

Community Health Needs Assessment CHI St. Luke’s Health Memorial San Augustine May 2016 Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Contents Project Overview 2 Summary & Implications 4 Key Findings Qualitative 6 Quantitative 8 Appendices Consumer Survey Instrument Qualitative Discussion Guide CHI St. Luke’s Health Memorial San Augustine | April 2016 11 22

Overview Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Methodology • This report summarizes the results of both qualitative and quantitative research in the primary service area for CHI St. Luke’s Health Memorial San Augustine. – Qualitative inputs were collected via both individual phone interviews with 1 doctor and 2 inperson focus groups. • 1 group of staff members at CHI St. Luke’s Health Memorial San Augustine. • 1 group among community decision makers external to CHI St. Luke’s Health Memorial San Augustine. Included in the screening for the latter group were representatives of public health agencies, community health centers, government agencies, community organizations, academics, media organizations, policy makers, elected officials, etc. – Quantitative data were collected via online and phone interviews with 36* healthcare decision makers ages 18 -74 living in the primary service area for CHI St. Luke’s Health Memorial San Augustine * CHI St. Luke’s Health Memorial San Augustine | April 2016 33 Note: small base

Summary & Implications Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Summary & Implications for Consideration Area of need Description Access To Care • • Transient, homeless, indigent, disabled and low income Very old and very young Providers • • Primary and family care providers needed Need more medical/dental resources locally in many specialty and treatment areas Awareness Communication • • What services, care, education & support are available Raising the importance of general health, healthy living/eating, exercise, nutrition & regular health care Community Education • • Preventing, understanding & living with diabetes, obesity, drug dependency Stress and stress reduction Making better decisions/choices Increased focus and investment on preventative care Problems, Programs & Improvements • • • Transitioning those using emergency rooms for regular and routine care to more appropriate alternatives Health screening program (lab fairs, health fairs, etc. ) Overcoming language barriers and transportation limitations Increasing focus & investment on prevention & wellness Plan to reverse young people exodus away from the area Explore partnership opportunities for church’s already credible and involved in the community Identify lower cost sources for meds, healthy foods and childcare Increasing mental health focus, services and care Long distance need to travel for routine and specialty healthcare More resources for sexual assault, human trafficking and school violence/bullying services Review 2014 community needs assessment done by Stephen F. Austin School of Social Work CHI St. Luke’s Health Memorial San Augustine | April 2016 55

Key Findings Qualitative Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Qualitative Summary Inputs Category Access to care Hospital Doctors & Staff Very old and very young…transient, homeless Education The importance of preventative healthcare, nutrition, stress reduction…what services exist…diabetes, making better choices, obesity Specialists PCPs Problems/ Services Can’t afford to buy food…use ER for routine care…grandparents caring for kids whose parents on drugs…childcare is too expensive…transportation limits…churches very involved in the community…language barriers…becoming retirement community so young people not staying…too expensive to eat healthy Access to care Education External Decision Makers Specific Needs Identified Problems/ Services Indigent, disabled, very young and very old, low income Stress reduction…don’t know what is available and how to access…making good nutrition choices…diabetes, obesity, HIV, drugs, containing STDs & other communicable diseases High stress area…drugs & gangs…many can’t afford food…transportation limits…need affordable dental care…seniors raising grandkids…healthy foods cost more…pollution…child molestation…expand services focused on substance abuse, mental health, child/adult abuse…need to increase focus on prevention…language barriers…need more youth resources and opportunities to keep them in county…need more and affordable child care…need more medical and dental care in area…need for good health education…need more health fairs with screening opportunities See 2014 community needs assessment done by Stephen F. Austin School of Social Work CHI St. Luke’s Health Memorial San Augustine | April 2016 77

Key Findings Quantitative Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Routine Care What kind of medical provider do you use for routine care or when you are sick? Do you use (ACCEPT MULTIPLE RESPONSES) Do you have a personal or family physician for most of your health care? KEY FINDINGS Memorial (N=300) Type of Provider Doctor's office or private clinic Community/county health or public clinic 89% 6% 7% Specialist who handles routine care 19% Hospital emergency room Hospital outpatient department Some other place 87% 14% 8% 3% 18% 16% 8% • San Augustine area residents look first and foremost to doctor’s offices or private clinics for their routine care. Specialists and hospital emergency rooms also receive significant use. This usage pattern is consistent with the whole Memorial area. • Doctor’s office or private clinic usage is highest among females, more affluent and insured respondents who have delayed prescriptions and are living with children. 4% Memorial San Augustine. . . NOTE: = significantly stronger at the 90+% confidence level CHI St. Luke’s Health Memorial San Augustine | April 2016 99

Distance Travel For Routine Care How many miles do you travel on average (one way) for most of your family's routine health care needs? What is the PRIMARY reason that you or someone in your household travel this distance for health care needs? Miles Traveled One Way Memorial (N=300) Memorial San Augustine (N=36) 39% 22% Less than 10 24% 19% 21 or more 37% Approved for insurance or health benefits 29% 17% 0% Close/convenient location 26% 15% 21% 7% Free care 0% 1% Speed of getting appointment 0% 2% Something else 11% Memorial San Augustine (N=27) CHI St. Luke’s Health Memorial San Augustine | April 2016 10 10 Memorial (N=188) 15% 11% Specialist developed long term personal relationships and positive experiences with their family provider and choose to stick with that provider. Don't Know Reason for Distance Traveled Better quality providers • One-third of these respondents have 55% 10 to 20 Personal relationship - used for years KEY FINDINGS 35% • A close/convenient location also plays an important role in their selection of a family doctor. • Regardless of the exact reason for their decision, more than half are required to travel more than 20 miles each way to satisfy their routine healthcare needs. • Insured and more affluent respondents tend to travel shorter distances to meet their routine healthcare needs…while uninsured and less affluent respondents tend to travel further. 9% NOTE: = significantly stronger at the 90+% confidence level

Confidence How confident are you that you can easily access quality health care when you or your family need it? KEY FINDINGS Memorial (N=300) 67% 27% • The majority of these residents in the Memorial San Augustine area are confident that they can easily access quality health care. • Confidence was strongest among the less Memorial San Augustine (N=36) Very 56% Likely Somewhat Not too 31% Not at all NOTE: = significantly stronger at the 90+% confidence CHI St. Luke’s Health Memorial San Augustine | April 2016 11 11 Don't Know affluent, Anglos…those who haven’t delayed health care or prescriptions, those in good health, and those insured by Medicare/Medicaid.

Delayed Health Care Or Prescriptions Have you or someone in your household delayed health care due to lack of money and/or insurance? Have you or someone in your household been unable to fill prescriptions due to lack of money and/or insurance? Memorial (N=300) 26% 74% KEY FINDINGS Memorial San Augustine (N=36) 31% 69% Yes most of these respondents have never had to delay health care or prescription purchases because of money shortage or no insurance. No • There is however a sizeable segment of the area respondents who have faced these tradeoff decisions. Likely Memorial (N=300) Memorial San Augustine (N=36) 19% 81% 28% 72% Yes No NOTE: = significantly stronger at the 90+% confidence level CHI St. Luke’s Health Memorial San Augustine | April 2016 12 12 • Consistent with the broader Memorial market, • The frequency of delayed health care is highest among younger, less affluent, less healthy and less confident individuals…those who have delayed prescriptions and have no insurance. • Those who delay filling prescriptions are younger, less healthy and less confident individuals…those living with children and those who have delayed health care as well.

Available Healthcare Services How available are the following to you and your family? % Easily or Usually Available Primary care 97% Eye & ear care 75% Dental care 69% General surgery 56% Outpatient surgery 56% 69% Care for seniors Gastrointestinal treatment 53% Orthopedic care Treatment for stroke Obstetrics services 56% 50% 42% Pediatric care Memorial San Augustine (N=36) CHI St. Luke’s Health Memorial San Augustine | April 2016 13 13 75% 74% 73% 64% 58% 56% 42% 78% 63% 47% Cancer treatment 83% 77% 67% Diabetes treatment KEY FINDINGS 86% 81% 64% Women's healthcare/surgery 94% 82% 58% Heart/cardiac care Neurology services Memorial (N=300) 58% 56% NOTE: = significantly stronger at the 90+% confidence level • Care availability levels in the Memorial San Augustine service area are highest for primary care, and eye/ear care…and lowest for pediatric care, cancer and stroke treatment. • Residents in the San Augustine area are not likely to rate availability of healthcare services a community strength since they trail the ratings for the whole of the Memorial PSA in 9 of the 15 categories measured. • Across the various types of care listed, no consistent and significant profile differences appear between those more and less likely to rate services easily or usually available.

Biggest Concerns Which of the following concern you most about health care in your area? (Max of 3) Cost of healthcare 17% Distance to hospital/emergency services 25% Lack of primar care doctors Memorial (N=300) Have delayed healthcare 26% No insurance 19% Lack of specialits Higher levels of concern Non-White 14% 13% 14% KEY FINDINGS • Memorial San Augustine area residents spread their healthcare concerns across a wide range of issues…lack of specialists, distance to the hospital/ER, costs, services not covered by insurance and lack of PCPs. • These are the same Top 5 concerns Services not covered by insurance 17% Cost of insurance 11% Delayed health care 12% 7% Customer service 3% 5% Expertise of personnel 3% 4% Long wait times to be seen 6% 4% Little/no insurance 6% 4% Memorial San Augustine (N=36) CHI St. Luke’s Health Memorial San Augustine | April 2016 14 14 Ages 35 -54 NOTE: = significantly stronger at the 90+% confidence level across the wider Memorial market, but the order is different.

Attitudes & Perceptions Please tell me how much you agree or disagree with the following statements about healthcare in your area: % Agree Higher levels of agreement Emergency medical services available Memorial (N=300) 77% 67% KEY FINDINGS Vaccinations available & affordable 67% Older, more affluent, no delays 72% Reasonable access to quality health care in my area 61% Ages 55 -74, Medicare/Medicaid 62% Adequate skilled health care available for older, frail adults 61% Ages 55 -74, Medicare/Medicaid, no kids at home 62% Hospice services are available/affordable 61% No kids at home, Medicare/Medicaid, 52% Medicare/Medicaid 51% Medicare/Medicaid or no insurance 50% Older, no delays, Medicare/Medicaid 46% Less affluent, insured, not as healthy 44% More confident, no delays 41% Children have access to nutritious food 50% People have access to basic, affordable health care 47% Seniors get help they need to stay in their homes Medical care available & affordable during pregnancy 44% 28% Seniors get enough nutritious food Access to injury/violence prevention programs 36% 25% Memorial San Augustine (N=36) CHI St. Luke’s Health Memorial San Augustine | April 2016 15 15 38% NOTE: = significantly stronger at the 90+% confidence level • With two exceptions, (pregnancy care and injury/violence prevention programs) the attitudes and perceptions of Memorial San Augustine area respondents parallel those for all of Memorial. • Among Memorial San Augustine area respondents, the highest levels of agreement are for the availability and affordability of emergency services and vaccinations. These are also the highest across all Memorial area respondents. • The lowest level of agreement in the Memorial San Augustine service area are recorded for access to injury/violence prevention programs and available & affordable care during pregnancy.

Likelihood To Use/Participate How likely are you to use or participate in the following if related directly to your health? Educational seminars and classes about health and prevention available in the community KEY FINDINGS • 1 in 4 residents of the Memorial San Augustine Memorial (N=300) 35% 18% 36% 11% • Participation likelihood tends to be higher among more affluent respondents with Medicare/Medicaid insurance. Likely Memorial San Augustine (N=36) Likely (5, 4) 28% 7% Neither (3) CHI St. Luke’s Health Memorial San Augustine | April 2016 16 16 service area say they are likely to participate in seminars and classes about health and prevention. 48% Not likely (2, 1) 17% DK/NA NOTE: = significantly stronger at the 90+% confidence level

Safety and Violence Issues Thinking about the level of violence in your community, indicate your level of agreement with the following statements. . . % Agree el safe when visiting our community public areas 56% Higher levels of agreement Memorial (N=300) Male, older, healthy, less affluent, no kids 67% KEY FINDINGS • Only half of the respondents in the man trafficking or trade of humans for sexual y or forced labor is not an area of concern in our community 44% 45% Memorial San Augustine area feel comfortable in visiting community public areas. • And even greater numbers question e have adequate resources for children who are victims of physical or sexual abuse 31% Less affluent, healthy, insured, haven’t delayed healthcare 40% the adequacy of resources for victims of abuse, human trafficking and school violence. • Memorial San Augustine area We have adequate resources for adults who are victims of physical or sexual abuse 39% Older, more confident, not delayed healthcare, Medicare/Medicaid 38% e are adequate programs in place to reduce the level of violence in our schools 39% Insured, haven’t delayed healthcare 35% Memorial San Augustine (N=36) CHI St. Luke’s Health Memorial San Augustine | April 2016 17 17 NOTE: = significantly stronger at the 90+% confidence level residents share these same attitudes at similar levels with residents in the broader Memorial market.

Last Exam How long ago did you have: % 3+ Years Or Never Screening for colon cancer Memorial (N=300) 67% Prostate cancer exam (males only) 45% Feet checked for sores/irritations 47% Pap test (females only) 44% 61% 50% 46% Mammogram (females only) 32% 33% Dental exam 33% 32% Eye exam 22% 21% KEY FINDINGS • Overall, the last exam profile among Memorial San Augustine respondents closely parallels the market-wide profile for Memorial. • 7 in 10 area respondents have not had a colon cancer screening… half of the men have not had a prostate cancer exam…and more than half of the women have not had a mammogram or pap test in the last 2 years. • Across the various types of exams Complete physical exam 19% Hemoglobin 'A 1 C' blood test 17% Blood cholesterol checked Blood pressure checked 8% 0% Memorial San Augustine (N=36) CHI St. Luke’s Health Memorial San Augustine | April 2016 18 18 20% 16% 10% 2% NOTE: = significantly stronger at the 90+% confidence level listed, there do not appear to be any significant and consistent profile differences between those who have less versus more frequent exams.

Respondent Health Problems Has a doctor told you that you, personally, have any of the following health problems or conditions? (MARK ALL THAT APPLY) High blood pressure 59% Diabetes of any type 28% Higher levels Of positive response Memorial (N=215) Older, less healthy, less affluent, men, with insurance 49% Male, older, non-White, less healthy, insured 30% KEY FINDINGS • The doctor alert profile does not yield Obesity 24% 34% Anxiety or depression eart disease or cardiology Asthma Cancer None of these 25% Female, have delayed, less healthy, with kids, more affluent 19% 21% 17% 16% Younger, Anglo, insured 21% 24% Memorial San Augustine (N=29) CHI St. Luke’s Health Memorial San Augustine | April 2016 19 19 Older, insured 10% Older, less affluent 22% NOTE: = significantly stronger at the 90+% confidence level significant differences between Memorial San Augustine residents and those in the broader Memorial market. • Those alerted to one of these problems average 2. 7 items on the list compared to an average of 2. 0 for the whole of Memorial.

Activity & Program Participation To what extent does a health problem or disability keep you from participating fully in work, school, or other activities? Have you ever taken part in a program offered by your doctor or health care provider to help you manage a health problem? Memorial (N=215) 18% Memorial San Augustine (N=29) A lot (8 -10) 14% KEY FINDINGS 65% • Few residents (1 in 5) of the Memorial San 21% 17% Somewhat (4 -7) Augustine area have a health problem or disability that interferes a lot in their participating fully in work, school or other activities. 59% A little (1 -3) DK/NA Likely Memorial (N=215) Memorial San Augustine (N=29) 28% 70% respondents have taken part in a program offered by their doctor to help them manage a health problem nearly identical to those who earlier said they were likely to participate in educational seminars & classes about health & prevention available in the community. • Those who have taken part in a program are more often younger, non-White, insured and more affluent. 24% 76% Yes CHI St. Luke’s Health Memorial San Augustine | April 2016 20 20 • 1 in 4 Memorial San Augustine No DK/NA NOTE: = significantly stronger at the 90+% confidence level

Ever Used Have you ever used any of the following? % Ever Used Higher levels of use Memorial (N=215) KEY FINDINGS Chiropractor 45% Older, more affluent 36% • This ever-used profile among Herbal medicines or treatments Doctor of Osteopathy 17% 7% 12% Homeopathy which uses natural products 14% Acupuncture 14% Insured, more affluent 11% Memorial San Augustine (N=29) CHI St. Luke’s Health Memorial San Augustine | April 2016 21 21 NOTE: = significantly stronger at the 90+% confidence level Memorial San Augustine residents once again closely resemble the same profile for all of Memorial.

Appendices Copyright 2016 by Saurage Research, Inc. All rights reserved. No part of this document may be reproduced by any means whatsoever without permission in writing from Saurage Research, Inc.

Consumer Survey Instrument CHI St. Luke’s Health Memorial San Augustine | April 2016 23 23

Consumer Survey Instrument (continued) CHI St. Luke’s Health Memorial San Augustine | April 2016 24 24

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Consumer Survey Instrument (continued) CHI St. Luke’s Health Memorial San Augustine | April 2016 26 26

Consumer Survey Instrument (continued) CHI St. Luke’s Health Memorial San Augustine | April 2016 27 27

Consumer Survey Instrument (continued) CHI St. Luke’s Health Memorial San Augustine | April 2016 28 28

Group Discussion Guide CHI St. Luke’s Health Memorial San Augustine | April 2016 29 29

Physician Interview CHI St. Luke’s Health Memorial San Augustine | April 2016 30 30