Holdenville General Hospital Medical Service Area Health Indicators

O K
R HW
Oklahoma
Rural Health Works
Holdenville General Hospital Medical
Service Area Health Indicators and
Outcomes
Oklahoma Office of Rural Health
Center for Rural Health
OSU Center for Health Sciences
Oklahoma Cooperative Extension Service
Oklahoma State University
May 2014
AE-14016
Holdenville General Hospital Medical Service Area Health
Indicators and Outcomes
Lara Brooks, Extension Associate, OSU, Stillwater
405-744-9827
Cody Peel, Student Assistant, OSU Stillwater
405-744-9827
Brian E. Whitacre, Associate Professor and Extension Economist, OSU, Stillwater
405-744-6083
Corie Kaiser, Director, Oklahoma Office of Rural Health, Oklahoma City
405-840-6500
Aubie Keesee, Hughes County Extension Director, Holdenville
405-379-5470
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
OSU Center for Rural Health
Oklahoma State University
May 2014
Introduction
Various sources of health indicators and outcomes have been compiled in this report.
The overall aim of this report is to create a conversation to identify health priorities that the local
community, alongside the local hospital, would like to tackle. No recommendations from the
Oklahoma Office of Rural Health, Oklahoma Cooperative Extension Service, or Oklahoma Rural
Health Works are made in this report.
Health Expenditures and Uninsured
This set of county maps show spatial trends in health care costs, insurance coverage, and
even those who forego seeing a physician due to cost barriers. The first map displays the county
percentage (below 65 years of age) that is uninsured. Hughes County’s uninsured rate of 24.9%
is higher than the state rate of 21.4%. The Census defines insured as individuals who have
insurance through a current or former employer, insurance purchased directly from a company,
Medicare, Medicaid, TRICARE, VA, or other type of health coverage. It is noted that
individuals whose sole provider is Indian Health Services are counted as uninsured since IHS
does not provide comprehensive coverage.1
1
U.S. Census, Small Area Health Insurance Estimates (SAHIE), FAQs:
http://www.census.gov/did/www/sahie/about/faq.html#q3
1
The next two maps further divide the uninsured rates by adults and children. In the next
map, the state rate of uninsured adults is 26%. Hughes County again has a higher rate of 30.5%.
In terms of uninsured children, Hughes County (12.2%) is higher than the state rate of 10.7%.
2
The next figure displays health care costs through price-adjusted Medicare spending per
enrollee (2011 data). Hughes County’s figure of $10,396 is slightly lower than the state’s
average of $10,447. Variance in county-level Medicare spending data could be due to
higher/lower levels of health for the county residents, or could reflect the propensities of local
doctors/hospitals to order discretionary tests.
3
The next sections of this report focus on health factors (including clinical care, health
behaviors, socioeconomic and environmental factors) and health outcomes (quality and longevity
of life).
Health Factors
The health factors section presents various health attributes analyzed by the County
Health Rankings and Roadmaps Program through the University of Wisconsin Population Health
Institute, and the Robert Woods Johnson Foundation.
The next map displays county adult obesity rates (2010 data). Hughes County’s adult
obesity rate (33.8%) is lower than most of the surrounding counties. Pontotoc (39.3%), Seminole
(38.7%), Okfuskee (35.1%), McIntosh (35.0%), and Pittsburg (34.1%) all have higher obesity
4
rates than Hughes County. Coal (33.2%) was the only neighboring county with a lower obesity
rate.
The following table displays measures of health factors for Hughes County compared to
the national benchmark and Oklahoma. The bold italicized categories are the areas identified by
County Health Rankings and Roadmaps as areas to explore. Hughes County’s overall rank in the
state in terms of health factors is 74 (1=best and 77= worst). Adult smoking, adult obesity,
access to exercise opportunities, teen birth rate, uninsured, preventable hospital stays, diabetic
screening, some college, unemployment, injury deaths, and drinking water violations are all
areas identified as needing further exploration.
5
Health Factors (Overall Rank 74)
Category (Rank)
Health Behaviors (77)
Adult Smoking
Adult Obesity
Food Environment Index
Physical Inactivity
Access to Exercise Opportunities
Excessive Drinking
Alcohol-Impaired Driving Deaths
Sexually Transmitted Infections
Teen Birth Rate
Clinical Care (51)
Uninsured
Primary Care Physicians
Dentists
Mental Health Providers
Preventable Hospital Stays
Diabetic Screening
Mammography Screening
Social & Economic Factors (70)
High School Graduation
Some College
Unemployment
Children in Poverty
Inadequate Social Support
Children in Single-Parent Household
Violent Crime Rate
Injury Deaths
Physical Environment (68)
Air-Pollution- Particulate Matter
Drinking Water Violations
Severe Housing Problems
Driving Alone to Work
Long Commute- Driving Alone
Hughes
County
37%
34%
6.6
34%
15%
39%
354
72
25%
2,769:1
3,080:1
1,400:1
96
73%
59%
82%
42%
8.0%
30%
25%
40%
165
99
10.4
62%
13%
78%
34%
Error
Margin
25-50%
28-40%
Top U.S.
Performers
Oklahoma
14%
25%
8.7
21%
85%
10%
14%
123
20
24%
32%
7.1
31%
64%
13%
34%
385
55
11%
1,051:1
1,439:1
536:1
46
90%
71%
22%
1,597:1
1,891:1
438:1
77
78%
55%
76-125
70%
4.4%
13%
14%
20%
64
49
78%
58%
5.2%
24%
20%
33%
479
83
9-16%
74-83%
29-39%
9.5
0%
9%
71%
15%
10.3
18%
14%
82%
24%
28-41%
62-82
23-28%
83-110
63-83%
49-70%
36-48%
23-38%
17-35%
31-48%
Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health
Institute; Robert Wood Johnson Foundation
6
The following figure shows each county’s health factor rank by shade. Generally, the
southeast quadrant of the state tends to have higher, less favorable, rankings in comparison to
other areas. Hughes County’s rank of 74 is the least favorable in the area. Pittsburg (rank of 41)
and Pontotoc (rank of 36) have significantly lower rankings than Hughes County. Seminole
(rank of 65), Okfuskee (rank of 66), McIntosh (rank of 71), and Coal (rank of 69) are in the same
shaded group as Hughes.
Access to Care
The following figures display access to care in terms of primary care, dental and mental
health providers. Each rate is calculated by county population per 1 provider. Therefore, smaller
ratios represent more providers per county.
The first map shows the county population per primary care physicians. The state rate is
1,597 people per one primary care physician. There were five primary care physicians in 2011
7
resulting in a rate of 2,769 people per one provider in Hughes County. This is less favorable
than the state rate of 1,597 people per one provider.
The next map displays other primary care providers such as nurse practitioners, physician
assistants and clinical nurse specialists (2013 data) that can assist in covering primary care needs
for each respective area. The ratio for Hughes County was a population of 2,767 per one other
primary care provider.
8
According to the data (2012), there were five dental providers in Hughes County. This
creates a ratio of 3,080 per 1 dentist. This is dramatically higher than the state rate of 1,890 per 1
dentist.
9
The next figure is calculated in the same manner with county population per 1 mental
health provider. All of the white counties represent no mental health providers in the county.
There were 11 mental health providers in 2013 resulting in a rate of 1,400 people per one
provider in Hughes County. This is less favorable than most of the neighboring counties. The
state rate is a population of 437 people per 1 mental health provider.
The next map displays the share of the county population who have adequate access to
locations for physical activity, which is a measure of both parks and recreational facilities. This
is a combination of local, state, and national parks, and businesses (NAICS 713940) such as
gyms, YMCAs, and dance studios. The definition of adequate access is <1 mile in an urban
setting, and <3 miles for rural areas. The rate in Hughes County is 15 percent which is lower
than all surrounding counties and the state rate.
10
The next figure displays the share of the county population who are low income and do
not live near a grocery store. Distance to a grocery store is measured by more than 10 miles
away in a rural area and more than one mile in an urban area. Low income is defined as having a
median family income at or below 200 percent of the federal poverty level. Hughes County had
9 percent of county residents meet both criteria- the same as the state rate.
11
The next figure displays the share of the county population who did not have access to a
reliable source of food during the past year. The formula for calculating food insecure includes
poverty, unemployment, median income, and various other measures to quantify populations
who at one point during the past year might not have been able to afford food. Hughes County
had 19 percent of residents who met the definition of food insecure in 2011.
12
Health Outcomes
The following figure shows the percent of the county population aged 20 and over with
diabetes (2010 data). Hughes County’s rate of 14% is higher than the state rate of 11%. Hughes
County is higher than all neighboring counties except Coal (14%), which has the same rate, and
McIntosh (15%), which has a higher rate.
13
The following table and map show health outcomes for Hughes County compared to the
national benchmark and the state rate. Hughes County’s overall rank is 53 (out of the 77
counties in Oklahoma). The length of life ranking (66 out of 77) displays the years of potential
life lost before the age of 75. Therefore, if a life is lost at age 25, this would mean 50 years of
life are lost. These rates are also represented per 100,000 population. The next section (quality
of life, overall rank of 21) shows self-reported health status, such as the number of poor health
days. Ideally, these rates would be low. Hughes County residents report the fewer poor physical
health days than the state rate and even the top U.S. performers. However, the low birth weight
rate of 7.6 percent, which is lower than the state rate, is still higher than the top U.S. performers’
rate.
14
Health Outcomes (Overall Rank 53)
Category (Rank)
Hughes
County
Error
Margin
Top U.S.
Performers
Oklahoma
Length of Life (66)
Premature Death
Quality of Life (21)
Poor or Fair Health
Poor Physical Health Days
Poor Mental Health Days
Low Birth Weight
12,385
10,22914,542
18%
14-23%
3.6
7.6%
2.1-5.2
6.1-9.1%
5,317
9,291
10%
2.5
2.4
6.0%
19%
4.3
4.2
8.3%
Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute;
Robert Wood Johnson Foundation
The following figure shows county health outcomes rankings by shading. Hughes
County (rank of 53) has a more favorable rank than all of the neighboring counties including
Okfuskee (rank of 57), McIntosh (rank of 71), Pittsburg (rank of 66), Coal (rank of 75), Pontotoc
(rank of 63), and Seminole (rank of 73).
15
OK 2 Share Data, Oklahoma State Department of Health
The final table displays various data measures obtained from the Oklahoma State
Department of Health’s OK 2 Share data source. The data are derived from the Behavioral Risk
Factor Surveillance Survey (BRFSS), which is the world’s largest ongoing telephone health
survey system. The percentages displayed represent the share of the population that fits into the
“yes” category of each variable. State comparison rates are available to the right.
When comparing available data, many Hughes County variables mirror the state rates.
However, some differences do exist. In particular, a smaller share (7.6%) of Hughes County
residents reported binge drinking, consuming more than five drinks on one occasion compared to
the state rate of 12.7 percent. Fewer Hughes County residents have ever received an asthma
diagnosis ever compared to the state (5.1% in Hughes County compared to 9.1% at the state
level). However, more Hughes County residents have received a diabetes diagnosis than the
state average (15.0% in Hughes County compared to 10.3% at the state level). Fewer residents
of Hughes County reported being satisfied or very satisfied with life than the state average (89.9
percent compared to 94.2 percent). In terms of residents always or usually receiving emotional
support, 72.1 percent reported in this category which is somewhat lower than the stat rate of 79.5
percent. When asked about health coverage, 73.6 percent of Hughes County residents reported
yes compared to 80.1 percent of state residents. Only 15.1 percent of Hughes County residents
reported needing to see a health care provider but could not afford the cost compared to 17.6
percent at the state level. Hughes County had more current smokers (27.2 percent compared to
25.3 percent at the state level). The obesity rate in Hughes County (29.0%) was less than the
state rate (30.1%). It must be noted that these statistics do vary from what is reported through
16
County Health Rankings. Also, the OK2Share data are rates from 2007-2010 while the County
Health Rankings are of more recent years.
17
Topic
Variable
Binge Drinking (5+ drinks on one occasion)
Angina diagnosis
Heart Attack Diagnosis
Stroke Diagnosis
Told by doctor to take aspirin
Home blood stool test ever (adults age 50+)
Colorectal Cancer Screening
Sigmiodoscopy or colonoscopy ever (adults age 50+)
Asthma Diagnosis
Current Asthma
Diabetes diagnosis ever
Diabetes
Use special equipment for health condition
Disability
Activities limited
Satisfied or very satisfied with life
Emotional Support and Life Satisfaction
Satisfied or very satisfied
Not Satisfied
Always or Usually get support
Always or usually
Sometimes, rarely, or never
Do you have any health care coverage? (18+)
Health Care access
Do you have any health care coverage? (18-64)
Needed a doctor last year but cost was too high
Do you have a personal doctor or health care provider
Source: Oklahoma Department of Health, OK 2 Share Data, Behavioral Risk Factor Surveillance Survey Data
Alcohol Consumption
Cardio Vascular Disease
Hughes
County
OK
2007-2010 % 2007-2010 %
N/A
12.7
5.9
5.3
5.4
5.5
N/A
3.9
40.7
24.7
N/A
19.4
N/A
57.4
9.1
9.3
22.0
10.4
12.8
9.3
31.2
25.3
86.6
13.4
94.1
5.9
70.5
29.5
N/A
N/A
16.6
82.3
79.8
20.2
80.5
76.5
17.7
78.7
1
Topic
Variable
Flu shot in past 12 months (age 18+)
Flu shot in past 12 months (adults age 65+)
Flu shot or spray in past 12 months (age 18+)
Pneumonia shot ever (adults age 65+)
Current Smoker
Tobacco Use
Smoker Status
Current every day smoker
Current some day smoker
Former smoker
Never smoker
Weight
Weight Control
Normal
Overweight
Obese
Leisure time physical activity
Source: Oklahoma Department of Health, OK 2 Share Data, Behavioral Risk Factor Surveillance Survey Data
Immunizations
Hughes
County
OK
2007-2010 % 2007-2010 %
69.3
42.7
N/A
73.1
69.3
43.5
N/A
71.9
21.7
24.9
N/A
N/A
N/A
N/A
18.7
6.2
24.2
50.9
34.1
32.7
33.2
66.1
33.4
35.8
30.8
69.4
2