Community Health Needs Assessment

1. Community Health Needs Assessment CHI St. Luke’s Health Memorial San Augustine • May 2016

2. Contents

3. Overview

4. 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 in-person 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 * Note: small base

5. Summary & Implications

6. Summary & Implications for Consideration

7. Key Findings Qualitative

8. Qualitative Summary

9. Key Findings Quantitative

10. 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? Memorial (N=300) Key Findings • 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. 87% Type of Provider 7% 18% 16% 8% 4% NOTE: = significantly stronger at the 90+% confidence level

11. 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 Key Findings • One-third of these respondents have developed long term personal relationships and positive experiences with their family provider and choose to stick with that provider. • 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. Memorial (N=188) Reason for Distance Traveled 29% 15% 17% 21% 7% 1% 2% 9% NOTE: = significantly stronger at the 90+% confidence level

12. Confidence How confident are you that you can easily access quality health care when you or your family need it? Key Findings • 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 affluent, Anglos…those who haven’t delayed health care or prescriptions, those in good health, and those insured by Medicare/Medicaid. Likely NOTE: = significantly stronger at the 90+% confidence

13. 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? Key Findings • Consistent with the broader Memorial market, most of these respondents have never had to delay health care or prescription purchases because of money shortage or no insurance. • There is however a sizeable segment of the area respondents who have faced these tradeoff decisions. • 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. Likely NOTE: = significantly stronger at the 90+% confidence level

14. Available Healthcare Services How available are the following to you and your family? % Easily or Usually Available Memorial (N=300) Key Findings • 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. 94% 86% 83% 82% 81% 78% 77% 75% 75% 74% 73% 64% 63% 58% 58% 56% NOTE: = significantly stronger at the 90+% confidence level

15. Biggest Concerns Which of the following concern you most about health care in your area? (Max of 3) Memorial (N=300) Higher levels of concern 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 across the wider Memorial market, but the order is different. 26% Have delayed healthcare 14% No insurance 14% Non-White 13% 12% Ages 35-54 Delayed health care 7% 5% 4% 4% 4% NOTE: = significantly stronger at the 90+% confidence level

16. Attitudes & Perceptions Please tell me how much you agree or disagree with the following statements about healthcare in your area: Memorial (N=300) % Agree Higher levels of agreement 77% Key Findings • 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. 72% Older, more affluent, no delays 62% Ages 55-74, Medicare/Medicaid Ages 55-74, Medicare/Medicaid, no kids at home 62% No kids at home, Medicare/Medicaid, 52% 51% Medicare/Medicaid Medicare/Medicaid or no insurance 50% Older, no delays, Medicare/Medicaid 46% 44% Less affluent, insured, not as healthy 41% More confident, no delays 38% NOTE: = significantly stronger at the 90+% confidence level

17. 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 service area say they are likely to participate in seminars and classes about health and prevention. • Participation likelihood tends to be higher among more affluent respondents with Medicare/Medicaid insurance. Likely NOTE: = significantly stronger at the 90+% confidence level

18. Safety and Violence Issues Thinking about the level of violence in your community, indicate your level of agreement with the following statements... % Agree Memorial (N=300) Higher levels of agreement Key Findings • Only half of the respondents in the Memorial San Augustine area feel comfortable in visiting community public areas. • And even greater numbers question the adequacy of resources for victims of abuse, human trafficking and school violence. • Memorial San Augustine area residents share these same attitudes at similar levels with residents in the broader Memorial market. Male, older, healthy, less affluent, no kids 67% 45% Less affluent, healthy, insured, haven’t delayed healthcare 40% Older, more confident, not delayed healthcare, Medicare/Medicaid 38% Insured, haven’t delayed healthcare 35% NOTE: = significantly stronger at the 90+% confidence level

19. Last Exam How long ago did you have: % 3+ Years Or Never Memorial (N=300) 61% 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 listed, there do not appear to be any significant and consistent profile differences between those who have less versus more frequent exams. 51% 50% 46% 33% 32% 21% 20% 16% 10% 2% NOTE: = significantly stronger at the 90+% confidence level

20. Respondent Health Problems Has a doctor told you that you, personally, have any of the following health problems or conditions? (MARK ALL THAT APPLY) Memorial (N=215) Higher levels Of positive response Older, less healthy, less affluent, men, with insurance 49% Key Findings • The doctor alert profile does not yield 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. Male, older, non-White, less healthy, insured 30% 25% Older, insured Female, have delayed, less healthy, with kids, more affluent 19% 16% 10% Younger, Anglo, insured 10% 22% Older, less affluent NOTE: = significantly stronger at the 90+% confidence level

21. 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? Key Findings • Few residents (1 in 5) of the Memorial San Augustine area have a health problem or disability that interferes a lot in their participating fully in work, school or other activities. • 1 in 4 Memorial San Augustine 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. Likely NOTE: = significantly stronger at the 90+% confidence level

22. Ever Used Have you ever used any of the following? % Ever Used Memorial (N=215) Higher levels of use Key Findings • This ever-used profile among Memorial San Augustine residents once again closely resemble the same profile for all of Memorial. 36% Older, more affluent 17% 12% Insured, more affluent 11% 11% NOTE: = significantly stronger at the 90+% confidence level

23. Appendices

24. Consumer Survey Instrument

25. Consumer Survey Instrument (continued)

26. Consumer Survey Instrument (continued)

27. Consumer Survey Instrument (continued)

28. Consumer Survey Instrument (continued)

29. Consumer Survey Instrument (continued)

30. Group Discussion Guide

31. Physician Interview