Community Health Needs Assessment Mercy Hospital Oklahoma City 2012

Transcription

1 Community Health Needs Assessment Mercy Hospital Oklahoma City 2012

2 Introduction Mercy Hospital, Oklahoma City is a hospital with 381 licensed beds and serves a six county area. In 2011, the second round of community round tables was conducted to dialogue with community members and public health experts. Mercy Planning and Research provided analysis of both internal and external demographics, utilization, chronic conditions and health status. The needs assessment process involved review of both quantitative and qualitative information to attain the full scope of our community s needs. This summary is documentation that Mercy Hospital, Oklahoma City is in compliance with IRS requirements for conducting community health needs assessments. Description of Community The service area of Mercy Hospital, Oklahoma City is comprised of six counties (Oklahoma, Canadian, Cleveland, Kingfisher, Lincoln, and Logan) with a population of 1.4 million. The main campus includes the hospital and five medical buildings. The hospital is a full-service tertiary hospital with 381 licensed beds, 3,000 co-workers and 24 primary care clinic locations. Mercy Clinic is a physician-governed group practice comprised of more than 85 board-certified and board-eligible primary care physicians serving the MHC area. This provider partnership gives patients access to the best quality care in the country with access to an entire health care team and advanced services. Mercy Clinic physicians also have access to an electronic health record that is shared at Mercy facilities in four states, and patients may connect to their own health record and health teams anywhere they connect to the internet through MyMercy. Oklahoma faces a health crisis 14% of the state population is uninsured. In Oklahoma County, the uninsured represent 21.6% or 1 in 5 people. The majority of these individuals, age 19-64, are working, but their employment does not include health insurance. Being uninsured is a huge barrier to accessing the health services needed to be healthy. Lack of access to quality health care impacts more than the uninsured individual it impacts families, employers, and the community. Mercy is a strong partner in the Health Alliance for the Uninsured (HAU), which was formed to improve access to health care for the uninsured. Mercy provides a full time RN, Chronic Disease Management coordinator which works with the 17 free clinics in the greater metro area. The vice president of Mission/Ethics serves on the HAU Board of Directors and holds the position of treasurer. The president of Mercy Health Center currently serves on the Tobacco Settlement Endowment Trust (TSET) which funds initiatives that address health/ wellness improvements across Oklahoma. Staff of the Community Outreach department serve and participate in the Wellness Now program from City/Co. Health Department and Oklahoma Turning Point. Who was involved in Assessment Citizens of the community were central in the development of this needs assessment. In April of 2010 and again in July of 2011, Mercy held community roundtable events to dialogue directly with local community members about their needs, ideas, and concerns related to healthcare. Common themes included: being involved in the schools to promote and educate on health/wellness, access to health care services for all, obesity and the health risks associated with tobacco and its related problems, and diabetes. A focus on partnerships, education, and technology were listed as ways to improve health/wellness in the community. Summer 2012 Page 1

3 Mercy Planning and Research provided analysis of internal and external demographics, health resource utilization, chronic conditions and community health status. The consulting group, Sg2 was engaged by Mercy as a partner to analyze current utilization and future demand for health care services. Contracted patient satisfaction services assist Mercy on an on-going basis by measuring and providing benchmark data on patient satisfaction on in-patients, ambulatory surgery, and emergency room patients. Mercy Community Outreach co-workers collaborate with community partners for ongoing assessment of the needs in the community. Community collaborative partners include: Oklahoma State Department of Health, Oklahoma City/ County Health Department, Wellness Now Initiative, and Oklahoma Turning Point. How the Assessment was Conducted Our needs assessment involved the following five steps to attain the full scope of our community s needs. 1. Examining existing community health needs assessments. Oklahoma Health Improvement Plan (OHIP) This is a comprehensive plan to improve the health of all Oklahomans developed by the Oklahoma State Board of Health, Wellness Now Community Health Assessment, 2011 Oklahoma City and County This assessment was completed by the Oklahoma City-County Health Department s Data Analysis Section in This nine-month process includes a Community Health Status Assessment, a Community Strengths and Themes Assessment, and a Local Public Health Systems Assessment. Wellness Now Oklahoma City/County This community health improvement initiative addresses school health, obesity, tobacco use prevention, senior health, mental health, and obstacles to health. It is designed to pool community resources and expand partnerships to targeted areas with the most needs as a united force and achieve real results. Data from Mercy s Health Information Systems Department Data from Mercy s own records was pulled and used to assess the needs of the community State of the State Health Report This report that reviews multiple indicators that contribute to Oklahoma s overall health status. It summarizes Oklahoma health as a whole and identifies county specific trends. Oklahoma Turning Point Turning Point starts at the local level, building broad community support and participation in public health priority setting and action, engaging and linking affected people at the local level. Local field consultants in each county of Oklahoma provide leadership in assessing local public health needs and identifying key priorities. 2. Conduct roundtable discussions with community members Community individuals as well as experts in the public health arena were invited to attend community roundtables for input on the needs of the community. Summer 2012 Page 2

4 3. Analyze and summarize the data to prioritize needs. 4. Review community benefit activities. 5. Create an action plan in partnership with the community. Health Needs Identified Analyze and summarize the data to prioritize needs (Step 3). The analysis of the combined data collected revealed the following health needs: Diabetes, Obesity, Tobacco Prevention, Cardiac, School health, Access to care. Community Assets Identified The assessment identified a number of strong community assets which includes the hospital and its community benefit program, cardiac facility in close proximity, state and city/co. health departments dedicated to identifying, planning, and implementing programs to improve public health, school systems (public/private) that strive to increase fitness activities and nutritious meals, and the community-based initiative, Turning Point, that aims to transform and strengthen the public health system through community-based action, and the Health Alliance for the Uninsured. Summaries: Assessments and Priorities To set priorities, criteria focused on identifying disproportionate unmet needs, primary prevention strategies, advancements toward a continuum of care and a program that is collaborative and involves the community. This is reflective of the heritage of Mercy. The following priorities are: Diabetes, Access to Care, School Health, Respiratory Diseases, and Wellness. Next Steps Review community benefit activities (step 4). Using Lyon Software s CBISA tool, a review will be conducted of current community benefit activities and what Mercy was presently doing to meet the identified priorities. In addition, the community benefit activity of other in the community will be reviewed. Create an action plan (step 5). Ongoing and new collaborations with community organizations will address ways identified needs in the community. Summer 2012 Page 3

5 Mercy Hospital, Oklahoma City Community Health Implementation Plan For FY Executive Summary Background: Mercy Hospital, Oklahoma City is a hospital with 381 licensed beds and serves a six county area. In 2011, the second round of community round tables was conducted to dialogue with community members and public health experts. Mercy Planning and Research provided analysis of both internal and external demographics, utilization, chronic conditions, and health status. The needs assessment process involved review of both quantitative and qualitative information to attain the full scope of our community s needs. This report summarizes the plan for Mercy Hospital, Oklahoma City to address the identified needs from the FY12 Community Health Needs Assessment and sustain existing as well as develop new programs that respond to these needs. Target Areas and Populations The target area is the service area of Mercy Hospital, Oklahoma City. It is comprised of six counties (Oklahoma, Canadian, Cleveland, Kingfisher, Lincoln, and Logan) with a population of 1.4 million. The main campus includes the hospital and five medical buildings. The hospital is a full-service tertiary hospital with 381 licensed beds, 3,000 co-workers and 24 primary care clinic locations. Mercy Clinic is a physician-governed group practice comprised of 85 board-certified and board-eligible primary care physicians serving the Mercy area. This provider partnership offers access to a comprehensive health care team and advanced services. Mercy Clinic physicians have access to an electronic health record that is shared at Mercy facilities in four states, and patients may connect to their own health record and health teams anywhere they connect to the internet through MyMercy. Oklahoma faces a health crisis 14% of the state population is uninsured. In Oklahoma County, the uninsured represent 21.6% or 1 in 5 people. The majority of these individuals, age 19-64, are working, but their employment does not include health insurance. Being uninsured is a huge barrier to accessing the health services needed to be healthy. Lack of access to quality health care impacts more than the uninsured individual it impacts families, employers, and the community. How the Community Health Implementation Plan Was Developed The plan was developed based on identified needs and available resources: Mercy Hospital, Oklahoma City FY12 Community Needs Assessment Local community agencies/partners who serve those in need Mercy Community Outreach Department staff Mercy Hospital, Oklahoma City community benefit task force Summer 2012 Page 4

6 The Oklahoma Community Health Committee is charged with identifying community health needs and coordinating community health initiatives with the Community Master Plan and service line strategies. The committee provides guidance and direction for implementation strategy. Committee Members include: Aaron Steffens, Administration Marilyn Geiger, Philanthropy Pat Robertson, Finance Jaime Hargus, Wellness Coordinator Richard Barker, Rural Hospitals Tom Edelstein, Mission Kathryn Abbey, Mission Derek Mountford, Mercy Clinic Kristina Dover, MARCOMM Gaylene Stiles, Community Ministry Diana Scherber, Mercy Physicians Diana Love, Finance Major Needs and How Priorities Were Established After reviewing the FY12 Community Needs Assessment, five issues were identified as priorities: 1. Diabetes 2. Access to health care uninsured and underinsured as well as insured 3. School Health 4. Respiratory diseases 5. Wellness Questionnaires at community events/programs along with current reports from local health departments, confirm these identified priorities. A review of current community benefit programs found the hospital is also meeting existing community needs through the provision of charity care and Medicaid services. Description of what Mercy Hospital, Oklahoma City will do to address community needs Action Plans: 1. Diabetes: Diabetes Wellness Project, Diabetes Treatment and Prevention Program, Mercy Clinic Diabetes The Diabetes Wellness Project addresses the needs of the uninsured, economically poor prediabetics and diabetic clients. This multi-session program provides diabetes management skills, foot care resources, healthy food selection/preparation, fitness activities, and gratitude journaling. Project design attends to the mind, body, and spirit of each individual, which contributes to improved health and quality of life. Sessions are held at free/charitable clinics at no cost to the client. Summer 2012 Page 5

7 Mercy hospitals in the identified service area will receive a modified version of Diabetes Wellness Project. This will be offered in a format that can be individualized to meet the needs of each community. Mercy Hospital Diabetes Treatment and Prevention Program: This program offers education and support for in-patient and out-patient diabetics that are newly diagnosed of having difficulty controlling the disease in a group setting or individual appointments. Mercy Clinic is recruiting physicians with a specialty in diabetes. 2. Access to care: Health Alliance for the Uninsured (HAU), Project Early Detection, Mercy Clinic Breast Cancer The Health Alliance for the Uninsured is a catalyst for improved health care services for those who otherwise would be unable to obtain them. Mercy Hospital, Oklahoma City supports these efforts by assigning a Chronic Disease Management Coordinator as a resource for the free clinics and their patients. The vice president of Mission/Ethics serves on the HAU Board of Directors and holds the position of treasurer. HAU and Mercy collaborations include Super Saturdays for Women which provides specialized women s health services. This service meets a critical need for low-income uninsured women. The Cooperative Central Pharmacy which provides free onsite prescriptions to the uninsured as well as medications to partner charitable clinics is another partnership. Mercy serves the uninsured or underinsured women in need of breast health services through Project Early Detection. This includes breast health education, screenings, diagnostic procedures and appropriate treatment referrals. Community partners include social services agencies and local non-profits who serve the poor and uninsured. Mercy hospitals in the identified service area will be able to access Project Early Detection services. Mercy Clinic physicians provide breast cancer services for economically challenged clients. 3. School Health: Health Teacher, Linwood Project, Mercy In Schools, Good Shepherd School at Mercy, Project SEARCH. Health Teacher is a comprehensive K-12 curriculum that integrates health skills into online lesson plans. To date, there are 92 Oklahoma City area school districts with 488 schools that have signed the letter of participation. Linwood Project is a partnership with an inner-city low-income elementary school. This includes Mercy Mentors, a tutoring program that allows Mercy co-workers to travel to the school and tutor during work hours. An annual neighborhood health fair is held for the parents and students as well as on-going support/ referral for those in need of specialty health services. Staff of the Community Outreach department serves on the Smart Start Community Council which strives to prepare young children to attend school. Mercy in Schools works with school districts to tailor a model which best serves the community. This partnership increases access to medical services, provides health education, and improves Summer 2012 Page 6

8 the mental well-being of students and staff. Components of Mercy In Schools includes: Call Sam, Access to medical services through the UCO campus clinic, Physician Support, and Mentorships in Medicine. Good Shepherd Catholic School at Mercy is a partnership between Mercy, University of Central Oklahoma, and the Archdiocese of OKC. It is focused on serving children with autistic spectrum and similar neurological disorders. Students aged 3-9 receive individual behavioral training and education. The school has a capacity of 22 students with current enrollment of 9 students. Project SEARCH, a collaboration of Francis Tuttle Career Technology Center and Mercy, receives free office and classroom space. This program strives to prepare developmentally challenged young adults for career opportunities. Students rotate through a variety of departments at Mercy Hospital. 4. Respiratory Diseases: Tobacco Prevention, Better Breathers, Mercy Clinic respiratory The Better Breathers Support group meets monthly with an educational program and luncheon for people in the community who have chronic respiratory conditions. Tobacco Prevention will be addressed through the Tobacco Cessation Initiative for Oklahoma Hospitals. The program services will include assessing and assisting the adoption and implementation of a sustainable system for patients and co-workers for tobacco cessation. This will be channeled through the Healthification process at Mercy which is an internal employee wellness program. Mercy Hospital, Oklahoma City is a smoke-free facility and campus. The president of Mercy Hospital, Oklahoma City currently serves on the Tobacco Settlement Endowment Trust (TSET) which funds initiatives that address health/ wellness improvements across Oklahoma. Respiratory diseases will be addressed in the quarterly OUTREACH newsletter with opportunity for the community to request free publications. Mercy Clinic, has recruited several pulmonologists. 5. Wellness: Healthification, Diabetes Wellness Project, Health Teacher, Battling the Silent Killer, multiple services/resources for the community at large and across the Mercy West Region. Obesity is integrated and addressed through the Diabetes Wellness Project, Health Teacher, and Healthification programs. Healthification is the pursuit of personal well-being for Mercy coworkers and their families. It focuses on healthy eating, physical activity, emotional and spiritual well-being, and tobacco cessation. Battling the Silent Killer is an initiative which includes a fresh look at the importance of blood pressure and its role in stroke, heart, and kidney disease prevention. This program will be offered to each Mercy hospital in Oklahoma. Flu shots, quarterly OUTREACH newsletter, caregiving issues. Elder Law Day, Caregiver Conference. Summer 2012 Page 7

9 Needs not being addressed and the reasons Mercy Hospital, Oklahoma City is not directly involved with Cardiac issues due to the close proximity and partnership with the Oklahoma Heart Hospital. Approval The Mercy Hospital, Oklahoma City Governing Board, which includes representatives from the surrounding community, reviews the prior fiscal year s Community Benefit Report and approves the Community Health Implementation Plan for addressing priorities identified in the most recent Community Assessment and other plans for community benefit. Summer 2012 Page 8

10 Oklahoma City Community Health Needs Assessment Supporting Data

11 Oklahoma City, OK (6-County PSA) Demographics DEMOGRAPHIC CHARACTERISTICS Selected Area USA % Change 2000 Total Population 2011 Total Population 2016 Total Population % Change Average Household Income $59,116 $67,529 1,036, ,421,906 Total Male Population 585, , % 1,191, ,650,750 Total Female Population 605, , % 1,250, ,031,618 Females, Child Bearing Age (15-44) 248, , % 5.0% 4.0% POPULATION DISTRIBUTION Age Distribution HOUSEHOLD INCOME DISTRIBUTION Income Distribution Age Group 2011 % 2016 % USA Household Income HH Count % USA , % 275, % 20.2% <$15K 66, % 12.9% , % 47, % 4.2% $15-25K 57, % 10.8% , % 124, % 9.7% $25-50K 138, % 26.6% , % 174, % 13.3% $50-75K 92, % 19.5% , % 312, % 27.6% $75-100K 51, % 11.9% , % 147, % 11.7% Over $100K 65, % 18.3% , % 126, % 9.6% , % 42, % 3.7% Total 1,191, % 1,250, % 100.0% Total 472, % 100.0% EDUCATION LEVEL Education Level Distribution RACE/ETHNICITY Race/Ethnicity Distribution 2011 Adult Education Level Pop Age 25+ % USA 2011 Race/Ethnicity 2011 Pop % USA 2011 Less than High School 33, % 6.3% White Non-Hispanic 814, % 64.2% Some High School 64, % 8.8% Black Non-Hispanic 131, % 12.1% High School Degree 210, % 28.9% Hispanic 131, % 16.1% Some College/Assoc. Degree 242, % 28.3% Asian & Pacific Is. Non-Hispanic 36, % 4.6% Bachelor's Degree or Greater 211, % 27.7% All Others 77, % 3.0% Total 762, % 100.0% Total 1,191, % 100.0% Source: Thomson Reuters, 2011

12 Oklahoma City, OK (6-County PSA) ED Visits Below is a comparison of emergent to urgent visit volume by consumer group in the six-county Oklahoma City Primary Service Area. ED Utilization by Consumer Group: Emergent vs. Urgent Gender Age Group 2010 Emergent Visits 2010 Urgent Visits 2010 Total Visits Female ,778 69,491 83,269 Female , , ,342 Female ,606 35,806 59,413 Female ,963 13,623 48,586 Male ,165 81,234 96,399 Male ,552 74,933 97,485 Male ,776 29,233 50,008 Male ,699 8,978 31,677 TOTAL 190, , ,179 In the Oklahoma City PSA, 69% of ED visits are considered urgent. On a national scale, 68% of ED visits are considered urgent and can likely be treated in different care settings. The majority of urgent ED services in the Oklahoma City PSA are rendered to females, ages generating 34% more non-emergent volume in the ED than the next largest consumer group, males, Source: Thomson Reuters Emergency Department Estimates, 2010

13 Oklahoma City, OK (6-County PSA) Top ED Diagnosis Codes Diagnosis 3-digit ICD9 Volume %* SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST , % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS , % GENERAL SYMPTOMS , % ASTHMA 493 5, % SYMPTOMS INVOLVING HEAD & NECK 784 5, % SYMPTOMS INVOLVING DIGESTIVE SYSTEM 787 4, % DISORDERS OF URETHRA & URINARY TRACT NEC 599 3, % INJURY NEC & NOS 959 3, % OTHER & UNSPECIFIED BACK DISORDER 724 3, % BACK SPRAINS & STRAINS NEC & NOS 847 3, % Diagnosis 3-digit ICD9 Volume %* OTHER DIAGNOSES XXX 17, % GENERAL SYMPTOMS , % ACUTE UPPER RESPIRATORY INFECTION MULT SITES NOS , % OTHER & UNSPECIFIED BACK DISORDER , % BACK SPRAINS & STRAINS NEC & NOS , % SUPPURATIVE/NOS OTITIS MEDIA , % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS , % OPEN WOUND HEAD NEC , % ACUTE PHARYNGITIS , % OTHER CELLULITIS & ABSCESS , % Source: Thomson Reuters, Outpatient Health Profiles, 2009

14 Oklahoma City, OK (6-County PSA) Chronic Conditions Identified Among 18+ Population Prevalent Prevalent Cases < 65 Prevalent Cases 65+ Disease Cases % of Pop Count % of Disease Cases Count % of Disease Cases Pain/Aching of Joints 259,193 29% 193,021 75% 66,172 26% Hypertension 246,047 28% 157,646 64% 88,402 36% Low Back Pain 234,030 26% 189,455 81% 44,575 19% Arthritis 190,203 21% 118,682 62% 71,521 38% Migraine Headaches 114,484 13% 108,089 94% 6,395 6% Sinusitis 111,702 13% 91,482 82% 20,219 18% Asthma 105,166 12% 90,105 86% 15,061 14% Depression/Anxiety 92,304 10% 79,352 86% 12,952 14% Hay Fever 70,036 8% 59,941 86% 10,095 14% Diabetes 68,566 8% 42,203 62% 26,363 38% Hearing Impairment 49,656 6% 24,306 49% 25,350 51% Coronary Heart Disease 36,301 4% 15,115 42% 21,186 58% Chronic Bronchitis 34,642 4% 26,632 77% 8,010 23% Heart Attack 29,697 3% 12,346 42% 17,351 58% Stroke 22,872 3% 10,122 44% 12,750 56% Angina 18,227 2% 8,719 48% 9,508 52% Ulcers 16,446 2% 13,452 82% 2,993 18% Congestive Heart Failure 15,418 2% 6,354 41% 9,065 59% Emphysema 14,806 2% 7,360 50% 7,447 50% Weak/Failing Kidneys 13,466 2% 7,799 58% 5,667 42% Breast Cancer 11,517 1% 4,987 43% 6,530 57% Liver Condition 11,441 1% 9,318 81% 2,123 19% Prostate Cancer 8,067 1% 2,256 28% 5,811 72% Cervical Cancer 5,300 1% 4,555 86% % Skin Cancer 5,156 1% 2,944 57% 2,212 43% Colon/Rectal Cancer 4,322 0% 1,425 33% 2,897 67% Uterine Cancer 3,182 0% 1,878 59% 1,304 41% Lung Cancer 2,009 0% % 1,319 66% Source: Thomson Reuters Continuum of Care, 2011

15 Oklahoma City, OK (Oklahoma County) Chronic Conditions Identified Among 18+ Population Prevalent Prevalent Cases < 65 Prevalent Cases 65+ Disease Cases % of Pop Count % of Disease Cases Count % of Disease Cases Pain/Aching of Joints 164,345 29% 120,120 73% 44,224 27% Hypertension 159,757 28% 100,329 63% 59,427 37% Low Back Pain 148,164 26% 118,517 80% 29,647 20% Arthritis 121,737 21% 73,820 61% 47,917 39% Migraine Headaches 71,936 13% 67,663 94% 4,273 6% Sinusitis 70,367 12% 56,881 81% 13,486 19% Asthma 66,335 12% 56,303 85% 10,033 15% Depression/Anxiety 59,023 10% 50,317 85% 8,706 15% Diabetes 45,149 8% 27,318 61% 17,831 40% Hay Fever 43,647 8% 36,956 85% 6,692 15% Hearing Impairment 31,559 6% 14,748 47% 16,811 53% Coronary Heart Disease 23,543 4% 9,509 40% 14,035 60% Chronic Bronchitis 21,801 4% 16,519 76% 5,281 24% Heart Attack 19,243 3% 7,750 40% 11,494 60% Stroke 15,205 3% 6,543 43% 8,662 57% Angina 11,760 2% 5,488 47% 6,272 53% Ulcers 10,464 2% 8,447 81% 2,016 19% Congestive Heart Failure 10,112 2% 4,043 40% 6,069 60% Emphysema 9,394 2% 4,520 48% 4,875 52% Weak/Failing Kidneys 8,946 2% 5,098 57% 3,848 43% Breast Cancer 7,491 1% 3,096 41% 4,395 59% Liver Condition 7,253 1% 5,875 81% 1,378 19% Prostate Cancer 5,264 1% 1,439 27% 3,825 73% Cervical Cancer 3,270 1% 2,776 85% % Skin Cancer 3,163 1% 1,735 55% 1,428 45% Colon/Rectal Cancer 2,831 0% % 1,945 69% Uterine Cancer 2,021 0% 1,145 57% % Lung Cancer 1,312 0% % % Source: Thomson Reuters Continuum of Care, 2011

16 BENTON COUNTY, AR Oklahoma City, OK (Oklahoma County) HOW IS YOUR GENERAL HEALTH? Health Status Source: County Health Rankings Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, 2011

17 BENTON COUNTY, AR Oklahoma City, OK (Oklahoma County) HOW IS YOUR GENERAL HEALTH? Child Health Indicators Source: The Annie E. Casey Foundation, Kids Count Data Center; Oklahoma Institute for Child Advocacy

18 Oklahoma City, OK Sayre, OK, Beckham County, 121 miles west of Oklahoma City The Oklahoma City Primary Service Area (PSA) comprises six counties in central Oklahoma Mercy Locations Hospital Managed Hospital Clinic Urgent/ Convenient Care

19 FY10 Top Acute Inpatient Discharges Note: Accounts for 31% of their total 16,126 Acute IP Discharges MSDRG Description/Code FY10 Inpatient Discharges % of Total Age Breakouts Inpatient Discharges < 18 % % % % 80+ % Vaginal Delivery W/O Complicating Diagnoses (775) 1,474 9% 30 2% 1,444 98% 0 0% 0 0% 0 0% Cesarean Section W/O CC/MCC (766) 899 6% 15 2% % 1 0% 0 0% 0 0% Major Joint Replacement Or Reattachment Of Lower Extremity W/O MCC (470) 518 3% 1 0% 12 2% % % 82 16% Cesarean Section W CC/MCC (765) 472 3% 10 2% % 2 0% 0 0% 0 0% Neonate W Other Significant Problems (794) 337 2% % 0 0% 0 0% 0 0% 0 0% Esophagitis, Gastroent & Misc Digest Disorders W/O MCC (392) 331 2% 7 2% 71 21% % 84 25% 68 21% Uterine & Adnexa Proc For Non-Malignancy W/O CC/MCC (743) 265 2% 3 1% % % 17 6% 0 0% Prematurity W/O Major Problems (792) 233 1% % 0 0% 0 0% 0 0% 0 0% Nutritional & Misc Metabolic Disorders W/O MCC (641) 228 1% 10 4% 23 10% 40 18% 66 29% 89 39% Kidney & Urinary Tract Infections W/O MCC (690) 207 1% 7 3% 18 9% 31 15% 51 25% % TOTAL 4,964 31% % 3,050 61% % 447 9% 339 7% Source: Mercy Discharge Data, FY10

20 FY10 Top Inpatient Admissions from the ED Note: Accounts for 20% of their total 5,071 ED Admissions MSDRG Description/Code FY10 Inpatient Discharges Age Breakouts % of Total ED Inpatient Discharges < 18 % % % % 80+ % Esophagitis, Gastroent & Misc Digest Disorders W/O MCC (392) 177 3% 0 0% 46 26% 51 29% 48 27% 32 18% Kidney & Urinary Tract Infections W/O MCC (690) 125 2% 6 5% 10 8% 17 14% 34 27% 58 46% Nutritional & Misc Metabolic Disorders W/O MCC (641) 116 2% 4 3% 14 12% 17 15% 34 29% 47 41% Intracranial Hemorrhage Or Cerebral Infarction W CC (065) 111 2% 0 0% 4 4% 17 15% 46 41% 44 40% Intracranial Hemorrhage Or Cerebral Infarction W MCC (064) 87 2% 0 0% 6 7% 12 14% 25 29% 44 51% Appendectomy W/O Complicated Principal Diag W/O CC/MCC ( % 9 11% 60 71% 14 16% 2 2% 0 0% Transient Ischemia (069) 78 2% 0 0% 2 3% 27 35% 30 38% 19 24% Poisoning & Toxic Effects Of Drugs W/O MCC (918) 74 1% 2 3% 34 46% 24 32% 12 16% 2 3% Simple Pneumonia & Pleurisy W CC (194) 73 1% 5 7% 5 7% 17 23% 19 26% 27 37% Cellulitis W/O MCC (603) 74 1% 0 0% 16 22% 33 45% 13 18% 12 16% TOTAL 1,000 20% 26 3% % % % % Source: Mercy Discharge Data, FY10

21 Top ED Visit Volume By ICD9 Codes October 1, September 30, 2011 Note: Accounts for 16% of their total 48,559 ED Discharges ICD9 ED % of ED Age Breakouts Code Diagnosis Volume Volume < HEADACHE 1,189 2% 78 7% % % 65 5% 27 2% URINARY TRACT INFECTION, SITE NOT SPECIFIED 1,154 2% 80 7% % % % % ABDOMINAL PAIN, UNSPECIFIED SITE 1,006 2% % % % 71 7% 27 3% HEAD INJURY, UNSPECIFIED 868 2% % % % 94 11% % UNSPECIFIED OTITIS MEDIA 701 1% % 82 12% 14 2% 2 0% 0 0% ACUTE UPPER RESPIRATORY INFECTIONS OF UNSPECIFIED SITE 602 1% % % 38 6% 13 2% 3 0% NAUSEA WITH VOMITING 553 1% % % % 55 10% 24 4% ACUTE PHARYNGITIS 551 1% % % 37 7% 4 1% 4 1% SYNCOPE AND COLLAPSE 541 1% 45 8% % % 85 16% 76 14% BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC 533 1% % % 96 18% 38 7% 20 4% TOTAL 7,698 16% 2,129 28% 3,113 40% 1,230 16% 640 8% 586 8% Note: 1,356 (3%) of ED discharges did not list diagnosis Source: Epic ED Discharges, October 1, 2010 September 30, 2011

22 Fort Smith Oklahoma City, OK 1,400 1,200 1,000 Potentially Avoidable Admissions by Diagnosis Total: 1, PAA Detail by Diagnosis Group CY2009 Angina Perforated Appendix Hypertension Lower Extremity Amputation Diabetes Dehydration Adult Asthma PAA = potentially avoidable admission; CY = calendar year; angina = chest pain, chest discomfort; UTI = urinary tract infection; COPD = chronic obstructive pulmonary disease (eg, bronchitis, emphysema); CHF = congestive heart failure. Analysis excludes normal newborns, neonates and pediatrics. Sources: Mercy: Mercy Health Center; Sg2 Analysis, UTI COPD CHF Bacterial Pneumonia

23 PAA slide notes Mercy Health Center Oklahoma City Bottom line: The distribution of potentially avoidable admissions at Mercy Health Center are somewhat similar to what is seen nationally, however we should be aiming to reduce all potentially avoidable admissions. Understanding where these patients are admitted from is critical to developing programs that reduce potentially avoidable admissions. The graph here suggests opportunities exist to improve integration and care coordination for admissions related to pneumonia, UTI, dehydration and diabetes. This information serves to provide guidance on what conditions in our community may benefit from enhanced care coordination. Bacterial pneumonia potentially avoidable admissions made up approximately 24.1% (eg, 288 out of 1,196 patients) of all the potentially avoidable admissions at Mercy Health Center. UTI potentially avoidable admissions made up approximately 19.2% (eg, 230 out of 1,196 patients) of all the potentially avoidable admissions at Mercy Health Center. Dehydration potentially avoidable admissions made up approximately 13.3% (eg, 159 out of 1,196 patients) of all the potentially avoidable admissions at Mercy Health Center. The mix of CHF and COPD amongst all potentially avoidable admissions are lower than what is typically seen nationally. The percent of all admissions that are potentially avoidable is 7.5%