By Jeffrey Alderman Archives

Ascension St. John is one of the oldest and largest health care providers in Oklahoma, serving people across four counties – Tulsa, Creek, Nowata and Washington. Like all nonprofit health systems, every three years Ascension St. John undertakes a community health needs assessment (CHNA). The data gathered through this process help the organization to identify unmet health needs – for example, access to care, mental health services, prevention programs — and then plans ways to address them. As the introduction to the 2019 CHNA report notes, “CHNAs are essential to community building and health improvement efforts. These powerful tools have the potential to be catalysts for immense community change.”

For its current CHNA endeavor, Ascension St. John reached out to Associate Professor of Community Medicine Jeffrey Alderman to recruit him as the lead on primary and secondary data collection. In addition to serving as a physician on the organization’s staff for many years, Alderman directs several courses in health care delivery sciences for undergraduate and graduate students.

First-hand research experience in public health

a group of eight students and their professor standing in two rows facing the camera — Back row: Mary Beth Sawyer, Madison Hemenway, Kristin Huang, Jason Lu, Jeff Alderman Front row: Caiton Wilmoth, Cassie Vestal, Ann Marie Flusche, Natasha Chaalan

In that capacity, Alderman recognized a unique opportunity for University of Tulsa students to get involved and experience the methodologies and rigors of public health research. “My goal,” said Alderman, “was to create a real-world, hands-on experience for students to learn about boosting health care access, affordability, equitability and quality, as well as patient satisfaction. Given the ongoing impact of COVID-19, I also thought that students would find it fascinating to gain insight into the pandemic’s population health effects.”

That was exactly the result for biological science junior Madison Hemenway: “I knew that some Tulsa families were suffering but had no idea how heavily COVID-19 impacted their lives. With children at home logging onto online school, and parents out of work, there was a perfect storm that resulted in huge amounts of stress on families. Some people dealt with that stress by abusing alcohol and drugs, others reported experiencing interpersonal violence at home.”

Additionally, Alderman discerned, involvement in Ascension St. John’s CHNA would shed light for students on the roles played by government, health systems, nonprofit organizations and the business community.

“Ascension St. John is honored to collaborate with Dr. Alderman and his students on the data collection for our 2022 CHNAs,” said Annie R. Smith, the organization’s community benefit director. “The input collected from the CHNAs is used to identify our community’s most pressing needs and address them through the promotion of a healthier, more equitable community. I am elated to share this capacity-building opportunity with TU’s students as they emerge as new leaders making positive and sustainable changes in our community.”

A unique learning opportunity

Alderman’s independent study course – HCDS 4993: Community Health Needs Assessment – ran through fall 2021. Nine students enrolled, representing an array of majors, including exercise and sports science, anthropology, psychology and biology (pre-med). A number of them did so because they had an eye on public health as the basis of all or part of their careers.

Rather than attend traditional classes, throughout the semester the students met one on one and several times as a large group with Alderman. The point of these meetings was to receive mentorship, while allowing the students to share and compare findings, and ask questions about community participatory research.

Outside of these gatherings, the students were responsible for completing a series of data-gathering steps:

They called key stakeholders in the four-county Ascension St. John service area, querying individuals about the strengths of and challenges facing the health of their communities. Students employed a standard set of 14 questions, including how the COVID-19 pandemic has affected people’s lives.
They visited one or more “vulnerable population group” settings (e.g., Morton Comprehensive Health, Community Health Connection, Tulsa County Sheriff’s Office, The Equality Center, Catholic Charities) where they meet with health leaders and patients/clients. Students again employed a standard set of questions.
They researched known databases, looking for secondary data, such as demographics, disease rates, insurance status and childhood outcomes.

After each encounter, the students gathered and submitted their raw data to Alderman. They also then drew on that information to develop summaries of their main findings.

“An eye-opening experience”

One of Alderman’s students, sophomore Natasha Chaalan, found the course to be “an eye-opening experience, revealing all the flaws in Oklahoma’s health care system.” Pursuing a degree through the accelerated exercise and sports science to athletic training master’s program, Chaalan found that a common theme arising from her research was lack of health literacy among individuals, a problem that, she noted, has “severely affected” communities’ overall health. In addition, Chaalan and her teammates found that difficulty accessing transportation was also a key issue, especially for elderly patients.

For junior Caiton Wilmoth, “working on the CHNA offered me a look at the many layers of Tulsa. Our city is much more diverse than I had ever imagined,” said this biochemistry major, “and many people require a lot of help with meeting their basic needs. I had no idea I was so lucky in the world.”

Anthropology junior Kristin Huang, meanwhile, learned about health care as it is really experienced by thousands of people and found herself motivated to bring about positive change: “I wish that the disparity gaps in our community weren’t so wide. To me, the public school system especially needs a lot of help. But this independent study experience left me empowered and believing that someday I might help fix the system.”

Community health beyond theory

For their final assignment, Alderman had students write an academic “reflection” paper approximately 10 pages in length. This paper combined elements of their research findings with insights both on what they learned about community health as well as what they would recommend changing in order to bring about improvements.

Having taught courses on community medicine for years, Alderman saw his fall 2021 students energized by the “real encounters” they gained throughout the Tulsa region. “They learned about physical and mental health, as well as the social determinants of health, in a manner that everyday classroom teaching can never match,” remarked Alderman. “In turn,” noted Alderman, the benefit for Ascension St. John was the ability to work with smart, enthusiastic young people who were familiar with the area, rather than outsourcing the project to external consultants.” Alderman and his students are also grateful for the help and support they received along the way from the Tulsa Health Department.

Oxley College of Health Sciences programs will prepare you for success in a number of in-demand professions. But if one of our existing majors or minors doesn’t fit your career goals, consider designing and completing your own interdisciplinary health sciences major. Learn more here or send an email to robin-ploeger@utulsa.edu.

By: Jeffrey Alderman, MD

It’s no longer a surprise – but acknowledging bad news still hurts. You may need to sit down, and perhaps sip from a cup of tea, while reading the 2019 Commonwealth Fund Scorecard on State Health System Performance. Unsurprisingly, Oklahoma ranked 50th out of 51 states (which includes D.C.) – a slight drop compared to the 2018 report. Compared with our neighbors, the report indicates we Sooners are just plain unhealthy. But under the veneer of numbers and statistics, it is important to study the complicated and nuanced reasons why our citizens continue to follow a downward trajectory of poor health.

Unhealthy attitudes and social determinants

Several longstanding forces drive Oklahoma’s multiple indicators of poor health and inadequate social wellness. For example, we might point toward our long tradition of individualism. We value self-reliance, while shunning help from others, which includes seeking help for medical ailments. In other words, we often put off going to the doctor until we are critically ill.

Other factors contribute to our poor health. Inherent in our state is low literacy about health and wellness, coupled with a culture of unhealthy eating and reduced physical activity. Taken together, these factors lead to soaring rates of obesity, diabetes and cardiovascular disease. Oklahoma also suffers from relatively high rates of poverty and inequality. So-called food deserts dominate our state, making it hard to purchase healthy, nutritious food.

Medicaid expansion in Oklahoma – on the horizon?

Statewide policy is yet another factor that drives Oklahoma’s poor health. We are just one of 13 states that chose not to expand Medicaid – a safety-net program for those unable to afford health insurance individually or through an employer. It is difficult to draw clear conclusions, but states that expanded Medicaid have witnessed dramatic performance improvements, including better access to care and rising health outcomes, especially among rural dwellers.

Efforts to expand Medicaid in Oklahoma have simmered for several years and may now be reaching a boiling point. This June, our state’s supreme court rejected an effort to block a statewide ballot question from appearing in 2020 – a victory for those favoring Medicaid expansion. This is good news for those who are poor and lack health insurance.

In praise of “Care Management”

With Medicaid expansion comes the advent of strategies such as Care Management (CM). Leveraging professionals such as registered nurses and social workers, CM helps people live healthier lives. Trained care managers work directly with patients to address a variety of issues, including prenatal care, mental health, cancer prevention and the promotion of healthier lifestyles. The state-funded Sooner Health Access Network based at the University of Oklahoma-Tulsa is a shining example of a successful CM program. In just a few short years, it has made great strides in helping Medicaid recipients across the state achieve better health and better health literacy.

No magic bullet will rocket Oklahoma’s outcomes from 50^th to first in the nation. Improving the health of our people requires many small, iterative changes – each of which will slowly chip away at our poor rankings. Expanding Medicaid would be a good start by extending health care coverage to and improving medical access for our poorest citizens. But to truly create change, state-funded CM programs must be scaled upward. Connecting our citizens with skilled clinicians builds trust and relationships, which, in turn, drives healthy communities.

Jeffrey Alderman, MD, is the director of the Institute for Healthcare Delivery Sciences and an associate professor of community medicine at The University of Tulsa’s Oxley College of Health Sciences.

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