2020-2022 UChicago Medicine Ingalls Strategic Implementation Plan

INTRODUCTION Serving Chicago’s south suburbs since 1923, Ingalls is a comprehensive, patient-centered system of care that serves more than 234,305 outpatients each year and more than 14,601 inpatients annually at the 473-bed hospital. 1,2 Ingalls provides a comprehensive range of services including orthopedics, cancer, eye care, neurosciences, inpatient and outpatient surgery, and behavioral health. Ingalls is designated as a Det Norske Veritas, DNV-Certified Primary Stroke Center of Excellence, and in 2018 Ingalls was awarded a three-year accreditation as a Comprehensive Community Cancer Program with Commendation—the highest achievable award for a community hospital through the Commission on Cancer. In 2016, the University of Chicago Medicine and Ingalls Health System joined forces in an alliance that combined a top community hospital in Chicago’s Southland with one of the country’s leading academic medical institutions. Ingalls is now part of the UChicago Medicine brand, which comprises the University of Chicago Medical Center, Biological Sciences Division and Pritzker School of Medicine.

This document outlines the Strategic Implementation Plan corresponding with the 2018-2019 Community Health Needs Assessment (CHNA). The plan builds on Ingalls relationship to UCM and its commitment to community partnerships to improve health and well-being in the Southland. The development process for the implementation plan involved several steps, which were overseen by the Community Benefit Steering Committee and the Community Benefit Management Team with input from subject matter experts at Ingalls and community stakeholders.

TARGET AREA AND PRIORITY POPULATION Figure 1: Ingalls Service Area (Ingalls SA)

Ingalls, located in Harvey, IL, one of Chicago’s south suburbs, made the decision to streamline its 2018 CHNA service area (SA) to focus on the 13 zip codes of Thornton Township. This change will allow Ingalls to establish a strategic focus in the highest need communities within Ingalls’ catchment area. The 2015 CHNA service area included a broader geography covered by 29 zip codes. The 2018 CHNA service area zip codes include the following cities/municipalities: Harvey, Riverdale, Dolton, Dixmoor, Phoenix, Hazel Crest, East Hazel Crest, Markham, Homewood, Burnham, Hegewisch and South Deering communities of Chicago, Posen, South Holland, Calumet City, Lansing, Glenwood, Blue Island, Calumet Park, and Thornton.

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Inpatient number excludes births (FY 2018) Outpatient visit number excludes ER visits (FY 2018)

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COMMUNITY HEALTH NEEDS ASSESSMENT To understand the current health outcomes in the Ingalls SA, Ingalls partnered with 37 nonprofit hospitals in Cook County, Illinois, through a membership collaborative called the Alliance for Health Equity led by the Illinois Public Health Institute (IPHI). The CHNAs provided data regarding the health status, behaviors, and needs of populations in the Ingalls SA. The CHNAs were used to identify health issues of concern in the Ingalls SA and to help make informed, data-driven decisions regarding the allocation of resources and effort.

Methods As the coordinating agency for the collaborative CHNA, the Alliance for Health Equity worked with the Illinois and Chicago and Cook County Departments of Public Health to carry out a collaborative CHNA process between March 2018 and March 2019. The CHNA process is adapted from the Mobilizing for Action through Planning and Partnerships (MAPP) framework, a community-engaged strategic planning framework that was developed by the National Association for County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). The MAPP framework promotes a system focus, emphasizing the importance of community engagement, partnership development, and data-driven decision-making. The Alliance for Health Equity chose this inclusive, community-driven process to leverage and align with health department assessments and to actively engage stakeholders including community members in identifying and addressing strategic community health priorities to advance health equity.

Primary data for the CHNA was collected through four methods: 

Community resident surveys

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Community resident focus groups

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Health care and social service provider focus groups

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Two stakeholder assessments led by the Chicago Department of Public Health—Forces of Change Assessment and Health Equity Capacity Assessment

Process for Determination of Health Priorities Building on the past two CHNAs, the Community Benefit and Evaluation team worked with the Community Benefit Steering Committee and the Community Benefit Management Team to prioritize the health issues for Ingalls’ next three years of community benefit programming for fiscal years 2020 - 2022. These constituencies were strategically selected for their respective understanding of community perspectives, community-based health engagement, and community health education efforts.

Using the CHNA as a foundational tool, the process included a multi-pronged approach to determine health issue prioritization.

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1. First, the Data Priority Setting Team, which included the Manager of Community Benefits and Community Affairs and staff from UCM’s Community Benefit and Evaluation Team, reviewed and compared the 2019 Ingalls SA health outcome data to previous CHNA health outcome data. New data and health issues that were worse than previous years were slated for consideration.

2. Next, the Community Benefit Management Team reviewed the data and ranked the most severe indicators by considering existing programs and resources and following the Internal Revenue Service (IRS) 501r and Catholic Health Association selection criteria noted below in Figure 2.

3. Lastly, the Data Priority Setting Team compiled this information and presented the proposed priority framework to both the Community Benefit Management and Steering Committees to discuss the merit of selecting each proposed priority health issue and made recommendations for the selection of the health issues for Ingalls’ next three years of community benefit programming from FY 2020–2022. Input from a group of community stakeholders was also incorporated.

Figure 2: Criteria for Selecting Health Priority Areas

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INGALLS SELECTED HEALTH PRIORITY AREAS The framework for the priority health areas are organized under three primary domains.   

Prevent and manage chronic diseases: heart disease, diabetes & asthma Increase access to maternal health services Promote cancer awareness

These will serve as the designated issue areas for official reporting and are the principle health concern that Ingalls community benefit efforts will target. (see Figure 3).

This framework retains three of the health priority issues from the FY16 Strategic Implementation Plan: Heart Disease, Cancer Care, and Maternal Health. 3 In the fiscal year 2016 Strategic Implementation Plan, access to care and nutrition, physical activity & weight were also selected as priority health areas. Access to care is an overarching factor that affects all of the health domains. Additionally, nutrition, physical activity & weight are key components of preventing and managing both heart disease and diabetes and they will be emphasized under our efforts related to both of those chronic diseases.

Figure 3: Framework for Community Benefit Priorities (Fiscal Years 2020-2022)

Prevent and manage chronic diseases

Heart Disease

Diabetes

Increase access to maternal health services

Promote cancer awareness

Prenatal Care

Breast cancer

Prostate Cancer

Asthma

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The previous priority health areas were (1) Heart Disease & Stroke, (2) Cancer Care, (3) Infant Health & Family Planning.

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SIGNIFICANT HEALTH ISSUES THAT WILL NOT BE ADDRESSED In acknowledging the wide range of priority health issues that emerged from the CHNA process, Ingalls determined that it could only effectively focus on those which fit within the current resources available. While Food Insecurity was not selected as a health priority area for 20202022, it affects the health status of the whole community. Consequently, it will be addressed in relationship to each of the priority health areas with a focus on the chronic disease domain.

Ingalls will not directly address Mental Health & Substance Abuse or STI/HIV; it will not ignore these issues either. Ingalls will leverage its internal resources to continue to address these as well as other issues. Also, Ingalls will diligently work with community partners, including the local public health department, organizations and Federal Qualified Health Centers to address issues in its shared community.

DEVELOPMENT PROCESS FOR THE STRATEGIC IMPLEMENTATION PLAN To conduct the implementation planning process, Ingalls considered the findings of the CHNA in the context of the many community-focused activities in which physicians and staff members were engaged. The CHNA results, the priority selection framework and proposed strategic implementation plan were also shared with a group of community stakeholders for their input and feedback.

For each priority area, subject matter experts within Ingalls were invited to identify current and planned activities, and to think of ideas for potential partnerships and interventions that could further address the identified needs within each priority area over the next three-year period of this implementation plan. This plan echoes a cooperative, purposeful process based on evidence, extensive consideration of community needs, and opportunities for positive impact that build on existing strengths of the institution and its partnerships. The Strategic Implementation Plan also considers opportunities to create new and/or expand partnerships with individuals and organizations in the Chicago southland for FY2020 – FY2022.

INGALLS APPROACH TO ADDRESSING SELECTED HEALTH PRIORITY AREAS Ingalls applies resources to the following approaches to executing community benefit investments and programming: Care Delivery Initiatives: A myriad of initiatives that provide direct health, medical, or wellness services to community members. These services are executed in multiple ways that include leveraging Ingalls resources and partnering with community health centers and communitybased clinical services.

Community Benefit Grants: Grant making provided to community-based organizations that implement programs to address the Ingalls health priority areas within the Ingalls service area.

Community-Based Education & Outreach: Programs that promote learning and educational forums, primarily around the Ingalls health priority areas, amongst community members from the South Suburbs. These activities are intended to better inform and educate the community regarding health and promote health self-management practices.

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Partnerships: Innovative partnerships with a community health lens that leverage technology, cross sector collaborations and multi-disciplinary application learning’s to improve health and engage the community.

Each health priority area will incorporate aspects of the above methods. The plans and actions tied to each of Ingalls’ health priority areas are grounded in the following principles and criteria to ensure successful implementation and sustainability: Summary of Issue: A brief outline of the rationale for addressing the issue as well as the needs identified within the health issue area    

Goal: The community benefit health priority areas’ long-term expectation of what should happen as a result of programming.

Objectives: The community benefit health priority areas’ expected results to be achieved as an outcome of programming.

Strategy: Ingalls approach to implement programming and the types of actions that will be included in the programming.

Indicators: The measure of the efforts or activities. These indicators will gauge the success of a program or activities implementation.

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1. PREVENT AND MANAGE CHRONIC DISEASES – ASTHMA, DIABETES AND HEART DISEASE ASTHMA Summary of Issue

Several zip codes in Ingalls’ service area have high rates of Emergency Department (ED) visits for asthma for adults. Zip codes 60827, 60426, 60419, and 60429 have the highest rates of ED visits due to asthma in Ingalls’ area (Harvey, Hazel Crest, Dixmoor, Dolton, Markham, Phoenix, and Riverdale.) Communities with higher rates of ED visit due to asthma tend to have higher rates of individuals with uncontrolled asthma.

Goal Reduce the incidence of uncontrolled asthma among adults and children in the hospital’s service area.

Objectives  Increase education for persons with asthma.  Increase understanding of asthma triggers and environmental modification.

Strategy  Increase asthma education and outreach events.

Indicators  Number of asthma educational and outreach events conducted in the community.  Number of individuals who attend asthma education and events in the community.

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DIABETES Summary of Issue Diabetes related deaths have increased across Ingalls SA since 2006. Several communities in the area are substantially higher including Blue Island, Dolton, Glenwood, Harvey, Hazel Crest, Markham and Riverdale. The diabetes related mortality rate for non-Hispanic black residents in South Suburban Cook County is 75/100,000.

Goal Improve the health and quality of life for those at risk for living with diabetes focusing on prevention and management.

Objectives  Empower community residents with knowledge and skills to prevent and manage diabetes.  Increase prevention behaviors in persons at high risk for diabetes and pre-diabetes.

Strategy  Leverage Dietetic Internship program and partner with community organizations to provide community-based education and/or programming that address diabetes prevention and management (examples include, eye care, wound care, and monitoring blood sugars).  Dietetic Internship program will partner with emergency food programs to host an educational series for clients who self-report being pre-diabetic or diabetic.  Educate clinical staff on food security categorization and nutrition implications as it relates to managing and preventing diabetes.

Indicators  Number of community partners identified to host education events in Thornton Township.  Number of participants who attend diabetes education at emergency feeding programs.  Number of staff trained on food security categorization.  Number of awareness events conducted.  Number of Community Benefit grants awarded to programs that support healthy eating and lifestyle behaviors.

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HEART DISEASE Summary of Issue Heart disease is the leading cause of death in Blue Island, Calumet City, Dixmoor, Dolton, Glenwood, Harvey, Homewood, Lansing, Markham, Phoenix, South Holland and Thornton. Heart disease mortality rates range from 174/100,000 in Posen and Lansing to over 265/100,000 in Harvey and Markham. Most cities and villages in Ingalls SA are substantially higher than US coronary heart disease mortality rate of 129/100,000. Overall coronary heart disease mortality rate in South Suburban Cook is 134/100,000.

Goal Address risk factors associated with heart disease, which will potentially reduce incidence and prevalence of heart disease in Thornton Township.

Objectives  

Increase the number of healthy lifestyle events in the community with an emphasis on the prevention of heart disease with heart healthy education and nutrition.

Increase the number of blood pressure screenings provided in the community.

Strategies     

Collaborate with community partners to provide access points for community members to receive heart healthy education and free blood pressure screenings.

Provide learning opportunities to residents in Thornton Township focused on healthy eating, as well as identifying behaviors that support heart disease prevention and management.

Implement food insecurity screening tool at various patient access points in the hospital (ER, social workers) to identify patients who may need nutrition intervention to manage heart disease.

Identify process for clinical staff to follow that links patients diagnosed with heart disease and who are determined food insecure to available resources.

Provide funds to community organization through the Community Benefit Grant program that support programs/activities promoting lifestyle changes to prevent and manage heart disease.

Indicators       

Number of heart health education sessions offered in a community setting aimed to encourage positive behaviors that prevent and manage heart disease.

Amount of Community Benefit grant dollars invested in organizations that provide education to help individuals adopt healthy lifestyle behavior changes.

Implementation of food insecurity screening tool & its incorporation into the electronic medical record (EMR).

Number of staff trained on food security categorization.

Number of patients referred to community resources that address food insecurity.

Number of community residents that participate in heart healthy education and/activities.

Increase the number of individuals who have access to heart disease prevention and management and nutrition education.

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2. INCREASE ACCESS TO MATERNAL HEALTH SERVICES PRENATAL CARE Summary of Issue Women who live in low-income areas are less likely to engage in or have access to prenatal care.

Because of this, they are significantly at higher risk for adverse outcomes for both the mother and child.

The infant mortality rate in south suburban Cook is 10.2% compared to 6.2% in suburban Cook and 6.3 % in Illinois. The low birth weight rate in south suburban Cook County is 8.1% compared to 5.9% in suburban Cook County. Generally, adequate prenatal care encompasses medical care by a clinical physician, education, access to social services, and nutrition education opportunities.

Goal Increase access to prenatal care for women.

Objectives   

Reduce the number of women in Thornton Townships who are without prenatal care.

Reduce the number of women who present to the ER and are discharged without prenatal resources.

Reduce the number of women who present to the ER and Labor & Delivery without medical insurance to continue prenatal care.

Strategies  Increase outreach to at-risk populations, linking them to the Healthy Baby Network, a community 

outreach program comprised of healthcare providers, retailers, government agencies, schools and community organizations that work together to coordinate prenatal care for pregnant women.

Identify barriers to participation in early prenatal care and evidenced-based programs that support maternal health.

Indicators  

Number of pregnant women who actively participate in the Healthy Baby Network.

Birth weights of babies delivered at Ingalls Memorial Hospital

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3. INCREASE CANCER AWARENESS – BREAST, PROSTATE AND LUNG CANCER BREAST CANCER Summary of Issue Cancer mortality is the leading cause of death in four of the 13 zip codes in Ingalls SA: Burnham, Hazel Crest, Posen, and Riverdale. Screening is effective in identifying some types of cancers in early stages.

Some cancers are highly treatable in early stages, including breast cancer (using mammography).

Goal Decrease the breast cancer mortality rate of women in Thornton Township.

Objectives   

Increase the number of women who have mammograms.

Provide access to information that increases knowledge on screening guidelines.

Provide increased access to education that supports healthy diets for cancer (breast) patients.

Strategies    

Increase the number of women who have an annual breast cancer screening.

Increase breast cancer outreach.

Increase in knowledge of breast cancer care of women who live in Thornton Township.

Increase the number of breast cancer community talks and educational opportunities, including survivorship meetings.

Indicators    

Number of outreach events.

Number of participants who attend outreach events.

Number of breast cancer screenings.

Number of community talks, education sessions and survivorship meetings offered in Thornton Township.

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PROSTATE CANCER Summary of Issue Cancer is the leading cause of death in Burnham, Hazel Crest, Posen and Riverdale. There were 480 reported incidents of prostate cancer in Ingalls SA Between 2011-2015.

Prostate cancer is the most common cancer in men other than skin cancer. Although the survival rate for prostate cancer is higher compared to other forms of cancer, the incident rate in Ingalls SA is higher than lung cancer and colon cancer.

Goal The goal is encourage regular exams to support early diagnosis.

Objectives 

Improve early detection of prostate cancer in men.

Strategies  

Increase outreach that promotes prostate cancer screenings and exams.

Host community events that focus on providing information about the risk factors that increase a man’s risk of getting prostate cancer.

Indicators  

Number of outreach events.

Number of men who attend events.

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COMMUNITY BENEFIT REPORT COMMUNICATION Ingalls’ CHNA and strategic implementation plan have both been approved and adopted by the UCM Board of Directors in May 2019 and is publicly available online. In addition, Ingalls will share the CHNA and this strategic implementation plan with the community (e.g., community members, local political representatives, healthcare providers, and community based organizations) and also make copies available upon request.

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