Wagoner Community Hospital Community Health Needs
Transcription
Wagoner Community Hospital Community Health Needs
AE-10316 Wagoner Community Hospital Community Health Needs Assessment Summary and Implementation Strategy Community Health Needs Assessment documents available online at: www.okruralhealthworks.org Lara Brooks, Extension Associate, OSU, Stillwater Phone: 405-744-9827, Fax: 405-744-9835, Email: [email protected] Brian Whitacre, Associate Professor and Extension Economist, OSU, Stillwater 405-744-6083 Alan Parnell, Wagoner County Extension Director, Coweta 918-486-4589 Darla Heller, Wagoner County Extension, Coweta 918-486-4589 Corie Kaiser, Director, Oklahoma Office of Rural Health, Oklahoma City 405-840-6500 Oklahoma Office of Rural Health OSU Center for Rural Health Oklahoma Cooperative Extension Service Oklahoma State University February 2013 Contents Introduction ................................................................................................................................................... 1 Oklahoma Cooperative Extension and Oklahoma Office of Rural Health’s Roles .................................. 2 Wagoner Community Hospital Medical Services Area Demographics ........................................................ 2 Figure 1. Wagoner Community Hospital Medical Services Area ......................................................... 3 Table 1. Population of Wagoner Community Hospital Medical Service Area .................................... 4 Table 2. Existing Medical Services in the Wagoner Community Hospital Medical Services Area ..... 5 Table 3. Age Groups - Percent of Total Population for Wagoner County and Oklahoma ................... 6 Table 4. Race and Ethnic Groups- Percent of Total Population for Wagoner County and Oklahoma . 6 Summary of Community Meetings ............................................................................................................... 6 Economic Impact and Community Health Needs Assessment Overview, October 6, 2011..................... 7 Table 5. Wagoner Community Hospital Medical Service Area Health Sector Impact on Employment and Income and Retail Sales and Sales Tax .......................................................................................... 8 Community Survey Design and Results, October 6, 2011- November 8, 2011 ....................................... 9 Table 6. Zip Code of Residence ............................................................................................................ 9 Figure 2. Summary of Hospital Usage and Satisfaction ..................................................................... 10 Table 7. Type of Specialist Visits ....................................................................................................... 11 Figure 3. Access to Primary Care Physicians ..................................................................................... 12 Table 8. Top Concerns about Healthcare in Community .................................................................... 13 Table 9. Additional Services offered at Wagoner Community Hospital ............................................ 13 Primary Care Physician Demand Analysis, November 8, 2011 ............................................................. 14 Table 10. Primary Care Physician Office Visits Given Usage By Local Residents in the Wagoner, Oklahoma Medical Service Areas....................................................................................................... 14 Health Data and Community Health Needs Recommendations ................................................................. 15 Community Health Needs Implementation Strategy .................................................................................. 15 Community Health Needs Assessment Marketing Plan ............................................................................. 16 Appendix A- Hospital Services/Community Benefits ................................................................................ 17 Appendix B- Survey Form .......................................................................................................................... 18 Appendix C- Health Data and Sources Presentation................................................................................... 20 Introduction New requirements for nonprofit, 501 (c)(3), hospitals were enacted under the Patient Protection and Affordable Care Act (ACA), passed on March 23, 2010. One of the most significant of the new requirements is the Community Health Needs Assessment (CHNA) that must be conducted during taxable years after March 23, 2012 and submitted with IRS form 990. A CHNA must then be completed every three years following. While the requirements are fairly new, the IRS has made strides in defining hospitals that must complete the CHNA as well as details of what is expected in the CHNA report to be submitted. At this time the only entities that must complete the CHNA are hospital organizations defined as: An organization that operates a State-licensed hospital facility Any other organization that the Secretary determines has the provision of hospital care as its principal function or purpose constituting the basis for its exemption under section 501 (c)(3). The general goal behind the requirement is to gather community input that leads to recommendations on how the local hospital can better meet and serve residents’ needs. The community input is typically derived from a community survey and a series of open meetings. Local health data are presented. Community members then identify and prioritize their top health needs. After listening to community input, the hospital defines an implementation strategy for their specific facility. The implementation strategy is a written plan that addresses each of the health needs identified in the community meetings. To meet Treasury and IRS guidelines an implementation strategy must: Describe how the hospital facility plans to meet the health need, or Identify the health need as one the hospital facility does not intend to meet and explain why the hospital facility does not intend to meet the health need1 After the needs are identified that the hospital can address, the implementation strategy must take into account specific programs, resources, and priorities for that particular facility. This can include existing programs, new programs, or intended collaboration with governmental, nonprofit, or other health care entities within the community.2 1 Internal Revenue Service. 2011. Notice and Requests for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals. Internal Revenue Bulletin: 2011-30. 2 Ibid 1 The facility must make the recommendations and implementation strategy widely available to community members. The facility must adopt the implementation strategy in that same taxable year. Oklahoma Cooperative Extension and Oklahoma Office of Rural Health’s Roles The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service have transitioned the previous Community Health Engagement Process program to meet the needs of CHNA. The Community Health Engagement Process proved to be very successful during its nearly 20 year history of working with rural hospitals and healthcare providers to increase awareness of the local health sector. This program is available to all rural facilities in Oklahoma free of charge. The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service work closely with the hospital and community members to develop an economic impact of the local health sector, develop and analyze a local health services survey, and gather and analyze local health data. The community meetings are facilitated by a resource team that includes Corie Kasier of the Oklahoma Office of Rural Health and Dr. Brian Whitacre and Lara Brooks of Oklahoma Cooperative Extension Service. After the meetings conclude, the resource team assists the hospital in developing their implementation strategy. After implementation, the resource team will assist in evaluation of the strategies implemented and provide continued assistance with data and resources. This document discusses the steps taken to conduct a CHNA for Wagoner Community Hospital in 2011 through 2012. It begins with a description of the hospital’s medical service area, including a demographic analysis, and then summarizes each meeting that took place during the CHNA process. The report concludes by listing the recommendations that came out of the process and presenting the hospital’s implementation strategy and marketing plan. Wagoner Community Hospital Medical Services Area Demographics Figure 1 displays the Wagoner Community Hospital medical services area. Wagoner Community Hospital and all other area hospitals are delineated in the figure. The surrounding hospitals are identified in the table below by county along with their respective bed count. The medical service areas were estimated based on conversations with hospital personnel and proximity to other facilities. 2 Figure 1. Wagoner Community Hospital Medical Service Area Primary Medical Services Area Secondary Medical Services Area City County Hospital Tahlequah Cherokee Tahlequah City Hospital Pryor Mayes INTEGRIS Mays County Medical Center Muskogee Muskogee Muskogee Community Hospital, LLC Muskogee Muskogee Muskogee Regional Medical Center Claremore Rogers Claremore Regional Hospital Wagoner Wagoner Wagoner Community Hospital *13 General Medical Surgical Hospitals in Tulsa Area No. of Beds 100 52 45 275 81 100 3 As delineated in Figure 1, the primary medical service area of Wagoner Community Hospital includes the zip code tabulation area of Wagoner (74467) and Okay (74446). This area experienced population growth of 3.4% from the 2000 decennial Census to the 2010 Census (Table 1); however, the zip code tabulation area of Okay was not recognized in the 2010 Census. It can be assumed that Okay’s population is reflected in Wagoner’s totals. Table 1 also displays population projections made by ESRI. The population is projected to experience another increase of 7.0% by 2015. The secondary medical services area is comprised of the zip code areas of Chouteau, Coweta, Fort Gibson, Hulbert, and Porter. The secondary medical services area experienced a population increase of 18.9% from the 2000 decennial Census to 2010. Population projections for the secondary medical service area anticipate a 6.4% increase from 2010 to 2015. Table 1. Population of Wagoner Community Hospital Medical Service Area Populations Population by Zip Code City 2000 Census 2010 Census 2010 ESRI 2015 ESRI Primary Medical Service Area 74467 Wagoner 13,780 14,995 18,212 19,492 74446 Okay 723 n/a n/a n/a Total 14,503 14,995 18,212 19,492 % Change 2000 to 2010 Census 3.4% % Change from 2010 ESRI 7.0% Secondary Medical Service Area 74337 Chouteau 4,841 5,060 4,850 4,959 74429 Coweta 10,445 14,445 14,664 16,101 74434 Fort Gibson 8,430 9,067 8,794 9,242 74441 Hulbert 4,589 5,362 6,053 6,248 74454 Porter 2,906 3,179 3,523 3,749 Total 31,211 37,113 37,884 40,299 % Change 2000 to 2010 Census 18.9% % Change from 2010 ESRI 6.4% Table 2 displays the current, as of October 2011, existing medical services in the Wagoner Community Hospital primary medical services area. This includes 8 physician offices, 3 dental offices, 3 optometrist offices, 2 chiropractor offices, a nursing home, 2 home health services, a hospice service, an EMS service, a county health department local office, and 5 pharmacies. These medical services are centered around Wagoner Community Hospital. Wagoner Community Hospital is a 100 bed medical facility located in Wagoner County, Oklahoma. Services offered by Wagoner Community Hospital include acute inpatient services, 4 physical therapy, laboratory, radiology (including CT, MRI, and EKG), social services, a telemedicine program, general surgery, bariatric surgery, and behavioral health. The hospital also offers outpatient services such as sleep lap, digital mammography, cardiology testing, reclast therapy, EGD, colonoscopy, cataract surgery, and orthopedic surgery. The hospital also provides care through clinics including primary care, prenatal care, orthopedics, and senior services. A complete list of hospital services and community activities can be found in Appendix A. Table 2. Existing Medical Services in the Wagoner Community Hospital Medical Services Area Count Service 1 Hospital, Wagoner Community Hospital 8 Physician Offices 3 Dental Offices 3 Optometrist Offices 2 Chiropractor Offices 1 Nursing Home 2 Home Health Services 1 Hospice Service 1 EMS Service 1 County Health Department Location (Wagoner) 5 Pharmacies In addition to examining the total population trends of the medical service areas, it is important to understand the demographics of those populations. Table 3 displays trends in age groups for Wagoner County in comparison to the state of Oklahoma. Since 1990, the age group of 45-64 has seen substantial growth. This age group has gone from accounting for 20.3% of the total population in 1990 to accounting for 27.1% in 2010. This trend is present at the state level as well. The age group of 65+ has experienced growth fluctuations over this same time span that mirrors those of the state. The age group to experience the largest decline is the 25-44 range. In 1990, this cohort accounted for 31.7% of the total population. In 2010, this cohort declined to only 26.4% of the total population. 5 Table 3. Age Groups - Percent of Total Population for Wagoner County and Oklahoma Wagoner County State of Oklahoma 1990 2000 2010 1990 2000 2010 Age Groups Census Census Census Census Census Census 0-14 15-19 20-24 25-44 45-64 65+ Totals 24.4% 8.3% 5.5% 31.7% 20.3% 9.7% 100.0% 23.0% 7.9% 5.1% 28.5% 25.4% 10.2% 100.0% 22.3% 6.9% 4.9% 26.4% 27.1% 12.5% 100.0% 22.3% 7.4% 7.1% 30.6% 19.1% 13.5% 100.0% 21.2% 7.8% 7.2% 28.3% 22.3% 13.2% 100.0% 20.8% 7.0% 7.6% 26.0% 25.2% 13.5% 100.0% Changes in racial and ethnic groups can impact the delivery of healthcare services, largely due to language barriers and dramatically different prevalence rates for specific diseases, such as diabetes. A noticeable trend in Oklahoma is the growth in the Hispanic origin population. In 1990, this cohort accounted for 2.7% of the population. A substantial increase followed, and in 2010, those of Hispanic origin accounted for 8.9% of the total population. This same trend is somewhat evident in Wagoner County with an increase from 1.3% in 1990 to 4.8% in 2010. Table 4 displays these trends. Table 4. Race and Ethnic Groups- Percent of Total Population for Wagoner County and Oklahoma Wagoner County State of Oklahoma 1990 2000 2010 1990 2000 2010 Race/Ethnic Groups Census Census Census Census Census Census White 85.1% 78.1% 73.4% 81.0% 74.1% 68.7% Black 4.1% 3.7% 3.7% 7.4% 7.5% 7.3% Native American 9.1% 9.2% 9.7% 7.8% 7.7% 8.2% Other 0.4% 1.4% 1.5% 1.1% 1.5% 1.9% Two or more Races -5.3% 7.0% -4.1% 5.1% Hispanic Origin 1.3% 2.4% 4.8% 2.7% 5.2% 8.9% Summary of Community Meetings Wagoner Community Hospital hosted three community meetings starting in between October 6, 2011 and April 4, 2012. The Oklahoma Office of Rural Health and Oklahoma Cooperative Extension Service facilitated these meetings. Summaries of the information presented at each meeting are included below in chronological order. 6 Community members in attendance at these meetings included: - Hospital representatives Representatives from the City Literacy Center Chamber of Commerce Local Department of Human Services representatives Local Health Department representatives Eastern Oklahoma Development District Retired individuals Funeral director Average attendance at each of the community meetings was 10-15 people. Economic Impact and Community Health Needs Assessment Overview, October 6, 2011 The first community meeting was held to discuss the economic impact of the health sector and explain the process and need of the Community Health Needs Assessment. Table 5 below summarizes the overall economic impact of the health sector on the Wagoner County, Oklahoma economy. A representative from the Wagoner Community Hospital contacted health service entities in each of the sectors listed for the medical service area. Along with identifying each establishment, the hospital representative also gathered information on the number of full time equivalent (FTE) employees per establishment. When available, payroll information was also collected from the establishments. When payroll information was not available, payroll was estimated using state level averages from the Bureau of Labor Statistics. The health sector in the Wagoner Community Hospital medical services area employs 390 FTE individuals. After applying a countyspecific employment multiplier to each respective sector, there is a total employment impact of 475 FTE employees. The same methodology is applied to income. The local health sector has a direct income impact of AE- 11034, The Economic over $19 million. When the appropriate income multiplier is applied, Impact of the Health Sector on the Wagoner the total income impact is over $22 million. The last two columns Community Hospital examine the impact this has on the retail sector of the local community. Recent data suggest that 18.5% of one’s income in Wagoner County will Medical Service Area (30 pages) be spent on goods and services locally. Therefore, if we just examine the impact made on retail from those employed in the health sector, this would account for over $4.1 million spent locally, generating $41,507 on a 1% tax. 7 Table 5. Wagoner Community Hospital Medical Service Area Health Sector Impact on Employment and Income and Retail Sales and Sales Tax (1) (2) (3) (4) (5) (6) (7) (8) (9) Employment Income Retail 1 Cent Sales Health Sectors Employed Multiplier Impact Income Multiplier Impact Sales Tax Hospitals 162 1.28 207 $8,474,113 1.18 $9,975,904 $1,845,542 $18,455 Physicians, Dentists, & Other Medical Professionals 64 1.24 79 $4,348,115 1.16 $5,032,691 $931,048 $9,310 Nursing and Protective Care 75 1.12 84 $2,688,060 1.14 $3,074,595 $568,800 $5,688 Other Medical & Health Services & Home Health 62 1.21 75 $2,476,956 1.16 $2,872,928 $531,492 $5,315 Pharmacies 27 1.10 30 $1,354,212 1.09 $1,480,014 $273,803 $2,738 Total 390 475 $19,341,456 $22,436,132 $4,150,684 $41,507 SOURCE: 2008 IMPLAN database, Minnesota IMPLAN Group, Inc.; Local data for employment, employee compensation and proprietor's income; income estimated based on state average incomes if local data not available * Based on the ratio between Wagoner County retail sales and income (18.50%) – from 2010 County Sales Tax Data and 2009 Personal Income Estimates from the Bureau of Economic Analysis. 8 Community Survey Design and Results, October 6, 2011- November 8, 2011 A survey was designed to gauge hospital usage, satisfaction, and community health needs. The survey was available in paper format. The surveys were distributed to community members during the economic impact meeting (October 6, 2011). The survey was also made available through the Wagoner Chamber of Commerce, the Wagoner Rotary Club, the City of Wagoner, and copies were mailed to the rural water districts. A copy of the survey form can be found in Appendix B. Community members were asked to return their completed surveys to Wagoner Community Hospital. The survey ran from October 6, 2011 through November 1, 2011. A total of 237 surveys were completed in the Wagoner Community Hospital medical services area. The survey results were presented at the November 8, 2011, community meeting. Table 6 below shows the survey respondent representation by zip code. Wagoner accounted for the largest share of survey respondents with a percentage of 86.0. AE-11043, Wagoner Community Hospital Medical Service Area Survey Results (27 pages) Table 6. Zip Code of Residence Response Category 74467 74014 No Response Other Total Wagoner Broken Arrow No. 203 2 11 21 237 Percentage 86.0% 1.0% 5.0% 9.0% 100.0% Hospital Utilization and Satisfaction The survey focused on several health topics of interest to the community. Highlights of the results include: - 72.0% using local (Wagoner) hospital services (Figure 2) o Common responses: St. Johns Tulsa (9.0%), Hillcrest Tulsa (4.0%) and Oklahoma Muskogee Regional Medical Center (4.0%) 9 - - Services used most often: o 26.0% emergency room o 26.0% radiological imaging o 21.0% laboratory 81.0% satisfied with services received at Wagoner Community Hospital o Quality of care (20.0%) and friendly/knowledgeable (17.0%) were the most common reasons for satisfaction Figure 2. Summary of Hospital Usage and Satisfaction 72.0% Hospital Usage 53.0% 81.1% Hospital Satisfaction 85.5% 0.0% 20.0% Wagoner Community Hospital 40.0% 60.0% 80.0% 100.0% Other OK Hospital Survey Averages Specialist Visits Summary highlights include: - Most common specialist visits displayed in Table 7 Only 6.6% of specialist visits occurred in Wagoner 73.0% of specialist visits requested further testing, laboratory work and/or x-rays 23% had further testing completed in Wagoner o Common responses on where other testing took place: Tulsa (63%), Muskogee (10%), and Broken Arrow (3%) 10 Type of Specialist Table 7. Type of Specialist Visits No. Cardiologist (9 visits in Wagoner) General Surgeon (6 visits in Wagoner) Orthopedist (7 visits in Wagoner) OB/GYN (0 visits in Wagoner) Urology (0 visits in Wagoner) No Response Total Percent 69 23% 54 18% 46 15% 43 14% 35 12% 56 18% 303 100% Some respondents answered more than once. Primary Care Physicians Summary highlights include: - - 62% uses a family doctor for most routine healthcare o Those who responded they did not use a family doctor noted Other (38%), Specialist (25%), Rural Health Clinic (13%) and Health Department (13%) as type of provider used for routine care 56% of total survey respondents have visited a primary care physician in the Wagoner service area in the past 24 months 89% were satisfied with the quality of care received from a primary care physician in the Wagoner service area o Quality of care (24%) and friendly/knowledgeable staff (18%) were the most reported reasons of satisfaction 11 Additional Services and Concerns Survey respondents were asked a variety of questions to gauge concerns or potential gaps in services. Figure 3 shows the results of the series of questions pertaining to survey respondents’ view of the availability of primary care physicians. Figure 3. Access to Primary Care Physicians Enough primary care physicians 24.0% Able to get appointment with physician 50.0% 79.0% 0% Yes 26.0% 20% No 40% 3.0% 18.0% 60% 80% 100% Don't know Survey respondents were then asked to identify what concerns them most about healthcare in their community. The largest share (48%) responded they do not know or didn’t respond. Lack of confidence in the hospital’s ability to provide care (15%) was the next most common response. No concerns and overall healthcare cost/ insurance coverage/ billing followed with 8 percent of total responses. The top list of concerns can be found in Table 8. 12 Table 8. Top Concerns about Healthcare in Community Concern No. Lack of Confidence in Hospital’s Ability to Provide Care 31 No Concerns 16 Cost/Insurance Coverage/Billing 16 Lack of Specialty Services 15 Keeping Health Services Available Locally 14 Concern with ER Care 12 Other 36 Don’t Know/No Response 97 Total 237 Percent 15% 8% 8% 7% 7% 6% 15% 48% 100% Survey respondents were then asked what additional services they would like to see offered at Wagoner Community Hospital. No additional services accounted for 14 responses (6%) followed by more specialists in general (2%) and specifically cardiology (2%). The most common responses can be found in Table 9. Table 9. Additional Services offered at Wagoner Community Hospital Services No. Percent No Additional Services 14 6% More Specialists in General 5 2% Cardiology 5 2% More Physicians 4 2% Improved EMS Services 4 2% Urology 4 2% Preventative Programs 2 1% Dermatology 2 1% OB/GYN 2 1% More Equipment 1 0% Dietary/Nutrition Counseling 1 0% Other 30 13% Don’t Know/No Response 163 69% Total 237 100% 13 Primary Care Physician Demand Analysis, November 8, 2011 A demand analysis of primary care physicians was completed for the zip codes that comprise the Wagoner Community Hospital primary and secondary medical services areas. This analysis examined average primary care physician rates by gender and by age groups. Once age- and gender-specific coefficients were applied, total primary care physician visit numbers were calculated by service area. Table 10 displays potential primary care physician rates by shares of service area. For example, if 90% of residents in the primary medical services area and 10% of residents in the secondary medical services area utilize services of primary care physicians in the Wagoner Community Hospital medical services area, a total of 33,590 annual visits would occur. This would suggest that the Wagoner Community Hospital medical services area would need 8.0 FTE primary care physicians to meet the needs of their existing population. Table 10 displays the estimated number of visits by share of medical services area. AE-11036, An Analysis of the Demand for Primary Care Physicians in the Wagoner, Oklahoma, Medical Service Area (11 pages) Table 10. Primary Care Physician Office Visits Given Usage By Local Residents in the Wagoner, Oklahoma Medical Service Areas Usage by Residents of Secondary Service Area 5% 70% 24,113 Usage by Residents of Primary Service Area 75% 80% 85% 90% 25,577 27,041 28,504 29,968 95% 31,431 100% 32,895 10% 27,736 29,199 30,663 32,127 33,590 35,054 36,518 15% 31,358 32,822 34,286 35,749 40,140 34,981 36,444 37,908 39,372 37,213 40,835 38,676 20% 42,299 43,763 25% 38,603 40,067 41,531 42,994 44,458 45,921 47,385 30% 42,226 43,689 45,153 46,617 48,080 49,544 51,008 35% 45,848 47,312 48,776 50,239 51,703 53,166 54,630 40% 49,471 50,934 52,398 53,862 55,325 56,789 58,253 45% 53,093 54,557 56,021 57,484 58,948 60,411 61,875 50% 56,716 58,179 59,643 61,107 62,570 64,034 65,498 If 90% primary medical service area and 10to 15% secondary medical service area, then the usage would be: 33,590 to 37,213 total primary care physician office visits for an estimated 8.0 to 8.9 Total Primary Care Physicians Based on 83.7 average weekly primary care physician visits with a 50 week year 14 Health Data and Community Health Needs Recommendations At the April 4, 2012 community meeting, several locationspecific sources of health data were presented in addition to data from the Wagoner County Data and Information Report (the full presentation of health related data is located in Appendix C). Following the presentation, community members were then asked to identify their top concerns from evaluating the data, survey results, and their experience within the community. The top health concerns identified were as follows: Quality of care concerns when visiting the emergency room The prevalence of various cancers in the Wagoner service area A high infant mortality rate Mood disorders The lack of public transportation Marketing of the importance of a healthy lifestyle AE-10111Economic Data, Health/Behavioral Data, Education Data, Traffic Accident Data, and Crime Data for Wagoner County and the State of Oklahoma (59 pages) Community Health Needs Implementation Strategy Based off the telephone survey results there seemed to be a concern from the community regarding the quality of care received when visiting the local emergency room. Hospital leadership recognizes that concern and is working to earn the community’s trust in the hospital services Hospital leadership is also working to improve the curb appeal of the hospital as they know residents do not want to visit a hospital that does not look visually appealing; which is directly tied to the confidence patients have in the quality of care given. Hospital leadership and board are working to increase the specialty care services available to the community as well as marketing current services through a wide variety of media outlets. 15 The prevalence of various cancers in the Wagoner service area is major concern and seen as significant health problems to the Wagoner community. Focus education on the benefits of screening and early detection Focus education efforts on behavioral changes proven to help o Smoking cessation programs o Healthy eating and weight reduction o Exercise programs There is an alarming high rate of infant mortality in the Wagoner area. The community members were not aware of the high infant mortality rate, but see it as a major concern and will work together to find the source of the issue and strive to lower the risks associated with it. Because of the busy lives many people lead with an increasing amount of stress, mood disorders are seen as a significant concern in the Wagoner community. Target efforts on helping the community cope with stress and behavioral changes that will make the residents less anxious/depressed The lack of public transportation is also a major concern of the community. Because there are no public transportation available in the Wagoner service area, community members have to rely on other modes of transportation to and from doctor appointments/hospital visits. Hospital leadership will examine all possibilities to increase access to healthcare Wagoner civic groups and Wagoner Community Hospital are engaged in a number of things to keep the community informed and active. Perhaps the education and activities need to be more focused and directed to different methods of reaching the population. The community members made a profound discovery at the final needs assessment meeting: get more people eating fruits and vegetables, smoking less and exercising more which will lead to better moods and less illness that will in turn lower the prevalence of cancer in the area and create a healthier community. Community Health Needs Assessment Marketing Plan The recommendation report and implementation plan will be made available on Wagoner Community Hospital’s website. Copies will also be available upon request at the hosptial 16 Appendix A- Hospital Services/Community Benefits 17 Appendix B- Survey Form 18 19 Appendix C- Health Data and Sources Presentation 20 21 22 23 24 25 26 27 28