2021-2022 Ingalls Community Health Needs Assessment

Community Health Needs Assessment 2021-2022

Table of Contents IRS Form 990, Schedule H Compliance

3

Introduction

4

Community Health Needs Assessment Process and Methods

8

Results DEMOGRAPHIC CHARACTERISTICS

16

GENERAL COMMUNITY INPUT

21

SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH

24

HEALTH OUTCOMES, MORBIDITY, AND MORTALITY

44

Conclusion

59

Appendix I: Primary Data Tools – Community Response Survey, Focus Group Guides, Key Informant Interview Guides

64

Appendix 2: Evaluation Report FY 2020-2022

81

Appendix 3: Data Sources

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Ingalls Memorial Hospital

IRS Form 990, Schedule H Compliance For nonprofit hospitals, a Community Health Needs Assessment (CHNA) serves to satisfy certain requirements of tax reporting, pursuant to provisions of the Patient Protection & Affordable Care Act of 2010. To understand which elements of this report relate to those requested as part of hospitals’ reporting on IRS Form 990, Schedule H, the following table cross-references related sections.

Section

Description

Part V Section B Line 3a

A definition of the community served by the hospital facility

8

Part V Section B Line 3b

Demographics of the community

11

Part V Section B Line 3c

Existing healthcare facilities and resources within the community that are available to respond to the community’s health needs

Part V Section B Line 3d

How data was obtained

Part V Section B Line 3e

The significant health needs of the community addressed by the hospital facility

Throughout

Part V Section B Line 3f

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

Throughout

Part V Section B Line 3g

The process for identifying and prioritizing community health needs and services to meet community health needs

65-66

Part V Section B Line 3h

The process for consulting with persons representing the community’s interests

Part V Section B Line 3i

The impact of any actions taken to address the significant health needs identified in the hospital facility’s prior CHNA(s)

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69 9-14

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9-10 Appendix 2

Ingalls Memorial Hospital

UChicago Medicine Ingalls Memorial Hospital (Ingalls) conducted a CHNA to identify its areas of greatest need, guide the selection of priority health areas, and determine how to commit resources where they will most effectively improve community members’ health and wellness. To complete the 2021-2022 CHNA, Ingalls partnered with Metopio and stakeholders in the hospital’s service area. Primary data for the CHNA was collected via community input surveys, resident focus groups, and key informant interviews. The process also included an analysis of secondary data from federal sources, local and state health departments, and community-based organizations.

The CHNA process involved engagement with multiple community stakeholders to prioritize health needs. Stakeholders worked to collect, organize, and interpret data. They also provided insight and expertise around the indicators to be assessed, the types of focus group questions to ask, how to interpret results, and how to prioritize the areas of highest need.

Based on community input and analysis of a myriad of data, the priorities for the communities served by UChicago Medicine Chicago Ingalls Memorial Hospital for Fiscal Years 2023–2025 are:

Prevent and manage chronic diseases specifically heart disease, diabetes, and cancer

Provide access to care and services with a focus on maternal health and mental health

Reduce health inequities driven by the social determinants of health, with special attention to food insecurity and workforce development

This report provides a thorough overview of the process that Ingalls implemented to complete the CHNA, including data collection methods, sources, and the particular context of Ingalls’ service area.

The body of the report contains results organized by the service area zip codes. Appendix 1 contains copies of the primary data tools used for the assessment. Appendix 2 is the Community Benefit Evaluation Report.

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Introduction The Community Health Needs Assessment (CHNA) is a systematic, data-driven approach to determine the health needs in the service area of the UChicago Medicine Ingalls Memorial Hospital (Ingalls).

In this process, Ingalls directly engaged community members and stakeholders to identify the issues of greatest need, as well as the largest impediments to health. With this information, Ingalls can better allocate resources to improve community health and wellness.

Directing resources toward the greatest needs in the community is critical to Ingalls’ work as a nonprofit hospital. The important work of CHNAs was codified in the Patient Protection and Affordable Care Act, Section 501(r), of the Internal Revenue Service Code, which requires nonprofit hospitals, including Ingalls, to conduct a CHNA every three years. Ingalls completed similar needs assessments in 2012, 2015, and 2018.

The process Ingalls used was designed to meet federal requirements and guidelines in Section 501(r), including: »C learly defining the community served by the hospital and ensuring that the defined community does not exclude low-income, medically underserved, or minority populations in proximity to the hospital »P roviding a clear description of the CHNA process and methods; community health needs; collaboration, including with public health experts; and existing facilities and resources in the community »R eceiving input from people representing the broad needs of the community and documenting these community comments »D ocumenting the CHNA in a written report and making it widely available to the public The following report provides an overview of the process used to complete this CHNA, including data collection methods and sources, results for Ingalls’ service area, historical inequities faced by the residents in the service area, and considerations of how COVID-19 has impacted community needs. A subsequent strategic implementation plan will detail the strategies designed to address the health needs identified in this CHNA. The data from the CHNA is organized by Ingalls service area zip codes and represents the health needs of the entire service area. This method uses the granular data available by zip code and municipality and brings to light both the differences and similarities within the communities included in the Ingalls service area.

Appendix 2 includes an evaluation of Ingalls’ past efforts to address the community needs identified in the 2018-2019 CHNA.

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Ingalls Memorial Hospital

INGALLS OVERVIEW Serving Chicago’s South Suburbs since 1923, Ingalls is a comprehensive, patient-centered system of care that serves more than 313,170 outpatients and more than 12,947 inpatients annually at the 485-bed hospital. Ingalls provides a comprehensive range of services including orthopedics, cancer care, 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,1 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. 2 In 2016, the University of Chicago Medicine (UChicago Medicine) and Ingalls joined forces in an alliance that combined a top community hospital on Chicago’s South Side with one of the country’s leading academic medical institutions. Ingalls is now part of the UChicago Medicine brand, which includes the University of Chicago Medical Center, Biological Sciences Division, and Pritzker School of Medicine. UChicago Medicine is Ingalls’ corporate parent.

Ingalls’ mission is “to provide superior healthcare in a compassionate manner, ever mindful of each patient’s dignity and individuality.”3 Ingalls’ commitment to this mission is evidenced by its superior clinical outcomes, community health initiatives, and health and wellness programs; serving diverse communities through volunteer programs, language assistance, and charity care; and expanding services to new patients in the South Suburbs.

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ASSET-BASED COMMUNITY DEVELOPMENT Ingalls implements strategies to promote health in the community and provide equitable care in the hospital through Asset-Based Community Development (ABCD),4 a strategy for sustainable community-driven development. Beyond the mobilization of a particular community, ABCD is concerned with how to link micro-assets to the macro-environment.

The appeal of ABCD lies in its premise that communities can drive the development process by identifying and mobilizing existing—but often unrecognized—assets, and thereby respond to and create local opportunities.

Ingalls employs ABCD to build on the assets that already exist in the community and mobilize individuals, associations, and institutions to leverage these assets. Part of the extensive ABCD process focuses on first identifying the unique assets of individuals, associations, and institutions before helping them work together to employ the identified assets as a group. Once identified, an individual’s assets are matched with people or groups who have a particular interest or need related to that asset. The key is to harness what is already in the community to create meaningful change.

Ingalls’ ABCD approach is executed through various departments, including: »C ommunity Benefit Department, which tracks and reports community benefit programs and services »C ommunity Relations Department, which builds relations with community organizations, individuals, and the local government to support community activities and events »V olunteer Services Department, which manages volunteer services at the hospital

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Ingalls Memorial Hospital

INGALLS SERVICE AREA Following IRS guidelines and 501(r) rules as required by the Affordable Care Act, Ingalls’ CHNA service area includes 13 zip codes covering Thornton Township in South Suburban Cook County, Illinois. The service area has not changed since the 2018-19 CHNA. The service area zip codes include the following cities/ municipalities: the Harvey, Riverdale, Dolton, Dixmoor, Phoenix, Hazel Crest, East Hazel Crest, Markham, Homewood, Burnham, Hegewisch, and South Deering neighborhoods in Chicago, as well as Posen, South Holland, Calumet City, Lansing, Glenwood, Blue Island, Calumet Park, and Thornton.

Figure 1. Ingalls Primary Service Area in relation to Cook County

While the hospital provides exceptional care to all residents in Chicago’s South Suburbs, Ingalls will use this assessment to establish priorities and commit resources that address the most pressing health issues in Thornton Township.

INGALLS MEMORIAL HOSPITAL SERVICE AREA 2021-2022 CHNA Service Area Zip Codes and Municipalities, focusing on Thornton Township 60406

Blue Island Dixmoor Riverdale Posen

60633

60406 60827 60419

60469

60426

60409

Calumet City Lansing Burnham

60409 60473

60429

60476 60430

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60430

Homewood Hazel Crest Thornton

60438

60425

60469

Lansing

Glenwood

Posen

60426

60473

Harvey Dixmoor Markham Phoenix

60425

Hazel Crest Harvey East Hazel Crest Markham

60419 Dolton

60438

60429

60476

Thornton

60633

Chicago Calumet City Burnham

60827

Chicago Blue Island Calumet Park Dolton Riverdale

South Holland Dolton Thornton

Ingalls Memorial Hospital

CHNA Process and Methods Stakeholder Engagement The CHNA process involved engagement with several internal and external stakeholders to collect, curate, and interpret primary and secondary data. Ingalls then used that data to prioritize the health needs of the community. To complete this work, Ingalls worked with stakeholders including Metopio, the UChicago Medicine Health System, the Ingalls Community Benefit Management team, and the Ingalls’ Community Advisory Council (CAC).

Metopio is a software and services company grounded in the philosophy that communities are connected through places and people. Metopio’s tools and visualizations use data to reveal valuable, interconnected factors that influence outcomes in different locations. Leaders from the UChicago Medicine Health System, representing the University of Chicago Medical Center and UChicago Medicine Ingalls Memorial Hospital, guided Metopio’s strategic direction through roles on the steering committee and various committees and workgroups.

The Ingalls Community Benefit Management Team guided the strategic direction of the CHNA while relying on the expertise of community stakeholders throughout the CHNA process. Ingalls’ partners and stakeholders provided insight and expertise about the assessment of key indicators, the types of focus group questions, how to interpret results, and how to prioritize the areas of highest need.

The Community Benefit Management Team is composed of key staff members with expertise in key areas related to Ingalls’ community benefit activities. This group discusses and validates community benefit programs and activities, monitors CHNA policies, provides input on the CHNA strategic implementation plan and strategies, reviews and approves grant funding requests, provides feedback on community engagement activities, and provides input for the Annual Report.

Ingalls’ Community Advisory Council (CAC) also provided input. In 2019, Ingalls formed its inaugural CAC, a representative group of volunteer members who live and/or work in Ingalls’ Primary Service Area (PSA). Members of the CAC act as advisors to Ingalls on issues of interest to the broader community. The CAC is an essential partner as Ingalls works to achieve its goals related to broader community interests, including access to care and effective community engagement. In this CHNA, the CAC played a key role in providing input to the survey questions, identifying community organizations for focus groups, disseminating surveys, and ensuring diverse community voices were heard throughout the process.

In alignment with Ingalls’ mission outlined on page five, engagement of both internal and external stakeholders is a critical component of assessing and addressing community health needs.

The Community Benefit Management Team developed parameters for the 2021-2022 CHNA process that helped drive Ingalls’ work: »T he CHNA builds on the prior CHNA from 2018-2019, as well as other local assessments, regional assessments, and plans. »T he CHNA provides greater insight into community health needs and strategies for ongoing community health priorities, including the Ingalls Strategic Implementation Plan.

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»T he CHNA leverages the expertise of community residents, community partners, and key stakeholders, with careful consideration and inclusion of a broad range of sectors and voices that are disproportionately affected by health inequities. »T he CHNA provides an overview of the community’s health status and highlights data related to health inequities. »T he CHNA informs strategies related to population health, connections between clinical sectors and the community, the efforts of anchor institutions, policy change, and community partnerships. »T he CHNA highlights and discusses health inequities and their underlying root causes throughout the assessment.

Data Collection Ingalls conducted its CHNA process between April 2021 and February 2022 using an adapted process from the Mobilizing for Action through Planning and Partnerships (MAPP) framework.5 This planning framework is one of the most widely used for CHNAs. It focuses on community engagement, partnership development, and participation from people who have historically been excluded from community decision-making processes. The MAPP framework was developed in 2001 by the National Association for County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC).

Primary data for the CHNA was collected through four channels: »C ommunity resident surveys »C ommunity resident focus groups »H ealthcare and social service provider focus groups »K ey informant interviews Secondary data for the CHNA were aggregated on Metopio’s data platform, and Appendix 3 includes a complete list of secondary data sources.

Community Resident Surveys Between July 2021 and November 2021, 419 residents in the Ingalls PSA contributed to the CHNA process by completing a community resident survey. The survey was available online and in paper form, and it was offered in both English and Spanish. It served as one of four primary data sources for the CHNA. Ingalls and its community partners distributed the survey through multiple channels. The survey sought input from priority populations in the Ingalls PSA that are typically underrepresented in assessment processes, including communities of color, immigrants, persons with disabilities, members of the LGBTQ+ community, and low-income residents. The survey was designed to collect information regarding: »D emographics of respondents » Health needs of the community for different age groups » Perception of community strengths » Utilization and perception of local health services

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The survey was based on a design used extensively for CHNAs and by public health agencies across Illinois; however, Ingalls sought more specific input on the needs of different age groups. Respondents were asked to identify health needs for Youth (0-17), Adults (18-64), and Seniors (65+). The final survey included 29 questions. The full community resident survey is included in Appendix 1.

Table 1 summarizes the demographics of survey respondents in the Ingalls PSA.

Table 1. Demographics of Community Input Survey Respondents in Ingalls Communities Age (n=419)

Education (n=415) 18-24

2.4%

Less than high school

0.7%

25-44

22.9%

Some high school

7.0%

45-64

50.8%

High school graduate or GED

11.1%

65 and older

23.9%

Vocational or technical school

4.8%

Some college

27.7%

College graduate

29.9%

Advanced degree

18.8%

Gender Identity (n=424) Male

21.7%

Female

76.9%

Transgender man, FTM

0.0%

Transgender woman, MTF

0.0%

Genderqueer/gender-nonconforming

Current Living Arrangements (n=415) Own my home

70.1%

0.0%

Rent my home

19.5%

Other

0.2%

Living in emergency or transitional shelter

0.2%

Decline to answer

1.2%

Living outside

0.2%

Living with a friend or family

8.4%

Other

1.4%

Orientation (n=420) Straight or heterosexual

75.7%

Lesbian or gay

1.2%

Average Number of Children in Home

0.6 16.8%

Bisexual

18.1%

Disability in Household (n=405)

Queer, pansexual, and/or questioning

0.2%

Income (n=364)

Other

0.5%

Less than $10,000

6.0%

Don't know

0.0%

$10,000 to $19,999

6.9%

Decline to answer

4.3%

$20,000 to $39,999

20.1%

Race (n=426 with multiple answers allowed)

$40,000 to $59,999

14.8%

American Indian or Alaska Native

0.5%

$60,000 to $79,999

16.2%

Asian or Mideast Asian

0.7%

$80,000 to $99,999

14.6%

Black or African-American

73.6%

Over $100,000

21.4%

Choose to not disclose

3.3%

Hispanic/Latino(a)

7.8%

More than one race

4.0%

Unknown

0.5%

White

10.7%

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Community Focus Groups and Key Informant Interviews A critical part of robust primary data collection for the CHNA involved speaking directly to community members, partners, and leaders that live and/or work in the Ingalls PSA. This was done through focus groups and key informant interviews.

As part of the CHNA process, Ingalls held four focus groups between September and November 2021, each covering a specific health area. All focus groups were coordinated by Ingalls and facilitated by Metopio. Ingalls sought to ensure groups included a broad range of individuals from underrepresented priority populations in the Ingalls PSA. Focus group health topic areas are listed below: » Adult health » Youth health » Maternal and child health » Healthcare and social service providers Due to the COVID-19 pandemic, Ingalls conducted most of its focus groups virtually over Zoom.

In-person and virtual focus groups lasted 90 minutes and had up to 12 community members participate in each group.

In addition to the four focus groups, the Community Benefit Management Team identified eight key informants for one-on-one interviews. Key informants were chosen based on their areas of expertise to further validate themes that emerged from the surveys and focus groups. Each interview was conducted virtually and lasted 30 minutes.

Secondary Data Ingalls used a common set of health indicators to understand the prevalence of morbidity and mortality in the Ingalls PSA, then compared these statistics to benchmark regions at the county, state, and federal levels. Building on previous CHNA work, these measures have been adapted from the County Health Rankings model6 (see Figure 2 on the following page). Where possible, Ingalls used data with stratifications so that health inequities could be explored and better articulated. Given the community input on economic conditions and community safety, Ingalls sought more granular datasets to illustrate hardship. A full list of data sources can be found in Appendix 3.

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Figure 2. Adapted County Health Rankings and Roadmaps Model

Length of Life

Health Outcomes

Quality of Life Tobacco Use

Health Behaviors

Diet & Exercise Sexual Activity

Clinical Care

Access to Care Quality of Care Education

Health Factors

Employment

Social & Economic Factors

Income Family & Social Support

Community Safety

Physical Environment

Air & Water Quality Housing & Transit Alcohol & Drug Use

Policies and Programs

Behavioral Health

Trauma Mental Health

Modified from: County Health Rankings and Roadmaps Model, 2014, http://www.countyhealthrankings.org/

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Data Needs and Limitations Ingalls and Metopio made substantial efforts to comprehensively collect, review, and analyze primary and secondary data; however, there are limitations to consider when reviewing CHNA findings. » Population health and demographic data are often delayed in their release, so data are presented for the most recent years available for any given data source. » Variability in the geographic level at which data sets are available (ranging from census tract to statewide or national geographies) presents an issue, particularly when comparing similar indicators collected at disparate geographic levels.

Wherever possible, the most relevant localized data are reported. » Due to variations in geographic boundaries, population sizes, and data collection techniques for suburban and city communities, some datasets are not available for the same periods or at the same level of localization throughout the county. » Gaps and limitations persist in data systems for certain community health issues, including mental health and substance use disorders for both youth and adults, crime reporting, environmental health statistics, and education outcomes.

Additionally, these data are often collected and reported from a deficit-based framework that focuses on the needs and problems in a community, rather than the community’s assets and strengths. A deficit-based framework contributes to systemic bias that presents a limited view of a community’s potential.

Ingalls, Metopio, and all stakeholders were deliberate in discussing these limitations throughout the development of the CHNA and the selection of the Fiscal Years 2023-2025 health priority areas.

Consideration of COVID-19 A significant question considered during the creation of this CHNA was, “Is the pandemic its own health issue, or is it a contributing factor to existing community health needs?”

The COVID-19 pandemic exposed the longstanding structural drivers of health inequities. In 2020, COVID-19 became the third leading cause of death in the Ingalls PSA. Early in the pandemic, the Ingalls PSA experienced high case rates and case fatality rates compared to Illinois and the U.S. While causal factors remain difficult to pinpoint, several important determinants of health are more pronounced in the Ingalls PSA, including inequitable access to care, higher rates of chronic disease, a lack of safe transportation options, and high rates of employment in essential work—putting employees at increased risk of adverse working conditions. These vulnerabilities certainly exacerbated the spread and impact of COVID-19 throughout the Ingalls PSA. As demonstrated in the survey results in Table 2, most community members were not directly impacted by a COVID-19 diagnosis or hospitalization, but they did experience challenges in delayed medical care, loss of income, and feelings of depression. In focus groups and key informant interviews, community members emphasized the importance of addressing the compounding barriers to health equity, including access to jobs, housing, food, safety, and care. All of these components are necessary for both long-term community resilience and weathering public health crises now and in the future.

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Table 2. Community Input Survey Responses to COVID-19 Questions (n=400) Were you or anyone in your household diagnosed with COVID-19 since March 2020?

% of Respondents

Yes

21.5

No

78.5

Were you, or was anyone in your household, hospitalized since March 2020 due to COVID-19?

Yes

5.2

No

94.8

Because of the pandemic, did you delay or avoid medical care?

Yes

33.0

No

67.0

Have you, or has anyone in your household, had a loss of employment income during the pandemic (since March 2020)?

Yes

28.3

No

71.7

During the pandemic (since March 2020), how often have you been bothered by feeling down, depressed, or hopeless?

Not at all

63.8

Several days every month

30.3

More than half the days every month

4.3

Nearly every day

1.8

COMMUNITY INPUT

“After being home for a year, we are trying to learn to communicate again,” one youth community member commented in reference to a large number of fights happening at school now that in-person classes have resumed.

Note: Survey responses were collected between July 2021 and November 2021, prior to the omicron coronavirus variant surge.

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CHNA Results DEMOGRAPHIC CHARACTERISTICS The Ingalls PSA has undergone significant population changes over the last decade. The 2015-2019 estimates from the American Community Survey revealed that the Ingalls PSA’s population declined by 4.9%, while the total population of Cook County increased by 1.6%, and South Suburban Cook County (SSCC)’s decreased by 2.2%. Currently, 256,994 people live in the Ingalls PSA. The Black population saw a 0.6% increase since the previous CHNA, and the Hispanic/Latinx population grew by 2.5%.

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Ingalls Memorial Hospital

Black individuals still make up the majority of the Ingalls PSA population at 62.5%, compared to 22.5% of the population in Cook County and 35.6% in SSCC. Hispanic/Latinx people account for 19.8% in the Ingalls PSA population (26.2% county-wide and 14.9% SSCC-wide) and non-Hispanic White individuals represent 14.4% of the Ingalls PSA population (40.5% county-wide and 44.6% SSCC-wide). Asian & Pacific Islander individuals make up 0.6% of the Ingalls PSA population (7.8% county-wide and 1.9% SSCC-wide), Native Americans make up 0.1% in all three areas, and people identifying as two or more races account for 2.1% in both the Ingalls PSA and SSCC (2.6% county-wide).

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Ingalls Memorial Hospital

Females represent 53.8% of the Ingalls PSA population and males represent 46.2%. This is a slightly larger difference than in Cook County (51.5% female, 48.5% male) and SSCC (52.4% female, 47.6% male). The median age in the Ingalls PSA is 37.0 years old, which is the same as Cook County and almost three years younger than SSCC’s median age of 40.3.

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Ingalls Memorial Hospital

In the Ingalls PSA, 3.19% of households have limited English proficiency, compared to 6.81% of households in Cook County and 2.71% in SSCC. Limited English proficiency households are primarily concentrated in three zip codes in the Ingalls PSA: 60406 (4.3%), 60426 (3.6%), and 60633 (5.17%).

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Ingalls Memorial Hospital

The Ingalls PSA has only a slightly higher percentage of residents with a disability (11.2%) than SSCC (11.0%), Cook County (10.4%), and the state (11.2%). Disability is defined as one or more sensory disabilities or difficulties with everyday tasks.

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GENERAL COMMUNITY INPUT Community residents who participated in focus groups and the survey provided in-depth input about how specific health conditions impact community and individual health. Key insights from this community input are highlighted below.

Community Survey Priorities In the community survey, resident participants were asked to rank their perceptions of the top health needs of three different age groups: Youth (0-17 years old), Adults (18-64 years old), and Seniors (65+ years old). Stratifying priority health needs and opportunities for improvement by age provides a more granular understanding of community needs.

The following question was asked for each of the three age groups, and the top five responses across all respondents are shown below. Mental health, obesity, and access to healthy food were identified as top issues for both Youth and Adults, while diabetes and cancer were considered major issues for Adults and Seniors. No single issue made the top five for all three age groups.

Figure 3. Tell us what you think are the 5 most important health problems in the area where you live for Youth (0-17 years old).

Figure 4. Tell us what you think are the 5 most important health problems in the area where you live for Adults (18-64 years old).

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Figure 5. Tell us what you think are the 5 most important health problems in the area where you live for Seniors (65 years and up).

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Community Focus Group Highlights Community residents who participated in focus groups and the survey provided in-depth input about how specific health conditions impact community and individual health. Cross-cutting themes that emerged from all focus groups included:

»M ental health and stress Participants noted key challenges, including the difficulty of talking about stress and mental health with family and friends, the lack of available treatment, and mental health stigma in the community. Participants also talked about how trauma is all around them, caused, in part, by economic hardship and crime.

One participant said, “These weigh on everyone’s psyche, regardless of age, education, and income.”

» Chronic diseases such as heart disease and diabetes. Adults and Seniors discussed the high cost of medications and the challenge of finding providers. Youth participants were aware of the diseases affecting their parents but were unsure of how to help.

A community member noted, “There are lots of times where I ask myself, should I buy food or medicine?”

»A dditional burdens for residents created by the social and structural determinants of health. Participants described the communities in the Ingalls PSA as having many abandoned buildings and extensive gang activity. They noted that the response time from police felt slow if a reported crime was not a shooting. Additionally, residents discussed a discrepancy between elected officials and the demographics of the community, creating the feeling that certain voices are not heard.

A community member noted, “Mental health problems are everywhere, but nobody talks about it because they don’t know how to talk about it.”

»A need for better health education and resources. Waitlists for social services are lengthy, and communication between social service groups is flawed and fractured. Churches are a critical asset that can serve as a central point for health services.

A participant in the Community Safety focus group said, “Can’t get a step ahead because every door is closed. Can’t pay a bill because you can’t get a job.”

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SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH Community residents who participated in focus groups and the community resident surveys also provided in-depth input about how social and structural determinants of health—such as education, economic inequities, housing, food access, access to community services and resources, and community safety and violence—impact community and individual health. Figure 6 below shows the top 10 elements survey respondents believe are necessary for a healthy community. This is followed by secondary data insights that measure the social and structural determinants of health.

Figure 6. What do you think are the most important things for a healthy community?

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Hardship One way to measure a location’s overall economic distress is with the Hardship Index—a score calculated by the U.S. Census. It is a comparison of economic conditions, scored 0 to 100, with a higher score indicating worse economic conditions. It incorporates unemployment, education, per capita income, crowded housing, poverty, and age dependency into a single score. Age dependency is defined as the ratio of people not in the labor force to those who are. The Hardship Index score for the Ingalls PSA is 71.6, which is over 20 points higher than the score for Cook County (50.4) and SSCC (51.4).

Hardship Index

Data source: American Community Survey (Calculated by Metopio)

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Poverty Poverty and its corollary effects are present throughout the Ingalls PSA. The median household income is $52,563 and the poverty rate is 18.7%. In comparison, Cook County has a median household income of $73,644 and 13.0% of residents live in poverty. In SSCC, the median household income is $71,230 and 12.6% of residents live in poverty. The poverty rate is even more pronounced for children in the Ingalls PSA, with 30.2% of those ages 0-4 and 26.3% of those ages 5-17 living in poverty. In the Ingalls PSA, 31.0% of households are considered “severely rentburdened,” meaning a household spends more than 50% of its income on rent. For Cook County and SSCC, the percentages are 22.4% and 27.0%, respectively.

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Unemployment The unemployment rate in the Ingalls PSA (12.9%) is significantly higher than the rate in SSCC (8.9%) and Cook County (7.0%), over double the rate in Illinois (5.9%) and the U.S. (5.4%). Even when accounting for fluctuations during the height of the COVID-19 pandemic in 2020, those notable differences remained true.

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Another measure of potential economic stress is disconnected youth, defined as residents aged 16-19 who are neither in school nor employed. For the Ingalls PSA, the percentage is 10.9%— compared to 7.5% in Cook County, 7.0% in SSCC, and 6.4% in Illinois. (Note: There is a significant margin of error with this dataset.)

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Education The high school graduation rate in the Ingalls PSA is 87.4%, which is in line with Cook County and SSCC averages (87.9% and 90.8% respectively). Inequity in education starts to become apparent when looking at post-secondary education. In the Ingalls PSA, 58.0% of residents 25 or older have any post-secondary education, including less than one year. This number is 65.1% in Cook County and 62.9% in SSCC. But only 29.4% of Ingalls PSA residents have completed a post-secondary degree, such as an associate’s or bachelor’s degree or higher, compared to 47.2% in Cook County and 37.6% in SSCC.

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Housing Housing stability is a basic necessity for a healthy community. It includes access to safe, quality, and affordable housing and the support systems needed to maintain that housing. Especially for individuals and families caught in a cycle of poverty, trauma, violence, mental illness, substance abuse, or other chronic diseases, housing can dramatically impact their health and health trajectory.

Populations in the Ingalls PSA are disproportionately and severely burdened by rent and housing costs compared to residents of Cook County, SSCC, and Illinois. Households are considered severely rent-burdened when they spend more than 50% of their income on rent. Rent costs do not include utilities, insurance, or building fees.

Interviews with key informants revealed that housing in the Ingalls PSA is “too expensive” and “not in good condition.” Many residents live in geographical proximity to hazardous waste management and superfund sites which emit pollutants and increase the likelihood of negative health outcomes for nearby neighborhoods. Additionally, participants from the focus group described their community as having many abandoned houses and stores, which further facilitates gang activity.

Issues of housing quality and affordability persist in the Ingalls PSA and must be addressed at the root level in order to achieve a healthy community. .

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Proximity to Superfund sites

Proximity to hazardous waste management sites

Data source: Environmental Protection Agency (EPA) (EJSCREEN)

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Access to Care The rate of those without insurance in the Ingalls PSA is 9.1%—higher than Cook County’s 8.8%, and SSCC’s and Illinois’s 6.8%. Many residents rely on government health insurance for coverage, especially Medicaid. The percentage of residents covered by Medicaid is a third higher in the Ingalls PSA (31.4%) than in Cook County (20.1%) and SSCC (21.3%). The total number of individuals enrolled in Medicaid in the Ingalls PSA is 97,948.

COMMUNITY INPUT

Adult and Youth focus group participants discussed chronic diseases such as diabetes, hypertension, and various cancers, identifying them as the most pressing health issues. Participants noted that managing these diseases is difficult because of economic hardship and access issues.

Adults must often decide between buying food or medication. Participants identified that health service providers need better communication skills and cultural sensitivity training.

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Access to care is especially important for people with disabilities and seniors, particularly those who live alone. The percentage of individuals living with disabilities (11.1%) is slightly greater than in Cook County (10.7%) and SSCC (10.9%), and of 32% of seniors live alone in the Ingalls PSA.

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There are currently only 11 Federally Qualified Health Centers (FQHCs) operating in the Ingalls PSA. According to data from the Health Resources and Services Administration, most of the Ingalls PSA is designated as a Health Professional Shortage Area (HPSA).7 A geographic HPSA represents a shortage of primary care, dental care, and mental health providers for an entire group of people within a defined geographic area.

Federally Qualified Health Centers

Data source: Provider of Services Files

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Food Access Limited access to food in the Ingalls PSA restricts the options residents have to be healthy. Food insecurity is defined as the household-level economic and social condition of limited or uncertain access to adequate food. The Ingalls PSA has more food insecure residents (12.8%) than SSCC (11.7%), but fewer than Cook County (15.0%). Over half of the people living in a food desert in Cook County—an area without a supermarket for at least one mile in any direction—live in the South Suburbs and Ingalls PSA. Low food access means living in a low-income household that also exists within a food desert. Low food access affects 62.14% of residents in the Ingalls PSA, compared to 68.55% in SSCC and 38.65% in Cook County.

COMMUNITY INPUT

Adult and Youth focus group participants said they knew what healthy foods to eat, but that accessing them was a challenge because most communities don’t have grocery stores. “We haven’t built an environment to be healthy,” one participant said. Another participant noted that food insecurity is generational.

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Maternal Health Mothers in the Ingalls PSA face many challenges during pregnancy and when raising their children; however, some maternal health measures in the service area have improved over the past decade.

Teen birth rates in the service area have significantly dropped since data collection began in 2007.

In 2019, teen birth rates per 1,000 women in the service area were lower than those in Cook County and Illinois. In SSCC, there are 8.3 ±0.1 deaths per 1,000 live births. (The rate in the United States is 5.569 deaths per 1,000 live births.)

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Secondary data for the PSA was not available, but county-wide, over 8% of babies have a low birth weight. The percentage is similar among the White and Hispanic or Latino populations, but higher for non-Hispanic Blacks.

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Mothers in the service area continue to face disparities in support. Women in the Ingalls PSA are much more likely to give birth without their partners present (62.5%) as compared to Cook County (31.1%) and Illinois as a whole (27.4%). When children are born in the Ingalls PSA, they are more than twice as likely to live in a single-parent household compared to Cook County and Illinois.

COMMUNITY INPUT

Key informant interviews revealed that service providers rely on connections across institutions to get community members enrolled in health and social services. Daycares, schools, and maternal health sites serve as key places for organizations to provide services to families. This is particularly important when transportation is an issue.

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Single-parent households generally require more support during and after pregnancy from family and service providers, but focus group participants reported that they receive insufficient and disconnected care. Participants shared that mothers often “go it alone” because they are not aware of social services that are available to them, such as WIC benefits for those who are pregnant. Even when they are aware of social services, mothers said that it is difficult to get to the available services because of limited transportation options in the service area. Additionally, the care that they do receive does not meet all their health needs. One participant expressed the need to have mental health services as part of prenatal care.

After giving birth, mothers reported experiencing insufficient support in caring for children. Focus group participants shared that it is difficult to find quality childcare and schools in the service area.

This creates barriers for mothers’ own educational and career advancement and makes it difficult to prepare children for school. Once children are in school, focus group participants reported that they have trouble ensuring their children are accounted for 24/7. This may be related to the limited availability of after-school activities. Participants also shared that there are not many “familyoriented” spaces in the community, which contributes to mothers’ feelings of isolation.

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Violence and Community Safety Community safety and violence recovery is a top priority for residents who contributed to this CHNA. Violence recovery is especially important to residents because the Ingalls PSA has significantly high rates of violent crimes—a category that combines homicide, criminal sexual assault, robbery, aggravated assault, and aggravated battery—compared to both Cook County and Illinois.

Youth in the Ingalls PSA describe their community as having some strong, family-oriented blocks, but noted that the overall community is dangerous. In the Youth focus group, participants shared that “everyone has witnessed a shooting or knows someone who was shot,” leading “most people [to] stay in their own units” and creating a widespread sense of “social isolation.” Focus group participants highlighted the need for building relationships, both with other individuals and across the broader community, to help achieve a healthy community. Currently, “everyone is [just] concerned for their safety.” Connectivity is especially important for young people in the Ingalls PSA, where one out of 10 teenagers is considered to be “disconnected” (neither enrolled in school nor employed). To cultivate belongingness, the community needs to show “compassion, love, and concern” that residents say is otherwise missing.

COMMUNITY INPUT

Adult and Youth focus group participants emphasized the prevalence of stress, mental health issues, and trauma in their community. Both adults and youth also discussed the attached stigma of talking about traumatic issues within families.

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HEALTH OUTCOMES, MORBIDITY, AND MORTALITY Leading Causes of Death The leading causes of death in the Ingalls PSA mirror those for the rest of Cook County. However, almost all the causes disproportionately impact the non-Hispanic Black population. This list comprises the top 10 causes of death in SSCC in 2020, as collected by the Illinois Department for Public Health:

1. Heart disease 2. Cancer 3. COVID-19

COVID-19 case rate

4. Accidents* 5. Stroke 6. Chronic Lower Respiratory Disease 7. Alzheimer’s Disease 8. Diabetes 9. Kidney Disease 10. Influenza and Pneumonia

In 2020, COVID-19 quickly became the third leading cause of death in the PSA, the county, and the state.

Additional stratifications are not yet available, but we know the pandemic had an outsized impact on minority communities, especially ones also experiencing economic hardship.

Data sources: The New York Times (based on reports from state and local health agencies), Various state health departments (COVID dashboards)

*Accidents include motor vehicle deaths, workplace deaths, and assault (homicides), among others. When causes of death are stratified by age, the second leading cause of death for those ages 1-44 is homicide.

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Hospital and Emergency Department Utilization One community member noted, “Everything is fragmented. We’re always getting referred out of the community for care, so a lot of people just avoid going to the doctor altogether until it gets really bad.”

This sentiment is reflected in hospital utilization data where the emergency department visit rates for both hypertension and Type 2 diabetes in the Ingalls PSA are in the highest 1% in Illinois.

Chronic conditions like these are considered ambulatory-care-sensitive conditions, meaning they are best treated in an outpatient setting. The high prevalence of emergency visits related to these conditions indicates community members struggle to manage chronic diseases for a variety of reasons including, but not limited to, a lack of access to care, prescription costs, and lifestyle choices.

Chronic diseases, especially heart disease, diabetes, and certain cancers, are some of the most common health challenges for Adults and Seniors in the Ingalls PSA. The Ingalls PSA has some of the highest emergency department visit rates of uncontrolled diabetes, Type 2 diabetes, hypertension, and heart failure in the state.

COMMUNITY INPUT

All youth focus group participants have an awareness of chronic diseases in adults, especially diabetes and hypertension. Adult participants noted that accessing care, especially with specialists, is a huge challenge. “You have to wait months for appointments,” one resident noted. Participants also want more community-based screenings for chronic disease and cancer.

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Heart Disease Heart disease mortality has a disparate impact on the Black community in Cook County. The mortality rate is 26% higher than that of other racial and ethnic groups. As noted earlier, the Emergency Department (ED) visit rate for hypertension in the Ingalls PSA is among the highest in the state. Additionally, the ED visit rate for heart failure is in the 90th percentile. It had been on an upward trajectory until 2020, when the pandemic might have limited ED utilization.

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The Ingalls PSA also has a higher percentage of residents with high blood pressure when compared to SSCC and the rest of Cook County. High blood pressure affects nearly 40% of the adult population.

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Diabetes The rate of diabetes is 15% higher in the Ingalls PSA than in SSCC. Additionally, the rate has remained unchanged for several years.

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The rate of obesity, which is a risk factor for Type 2 diabetes, is nearly 35% in the Ingalls PSA. This is a few percentage points higher than the rest of the county and state.

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The declines in emergency department visit rates in 2020 may be an effect of hesitancy to use health services during the pandemic, but further investigation is needed. In addition to these two specific chronic conditions, the overall preventable chronic emergency department visit rate in the Ingalls PSA is in the top 10% compared to the rest of the state.

The utilization of emergency services for chronic disease follows similar disparities for zip codes as the social determinants. The map below shows a concentration of utilization from residents living in 60426 and 60827.

Preventable chronic emergency department (ED) visit rate

Data source: IHA COMPdata Informatics (Calculated by Metopio)

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Cancer The cancer diagnosis rate for Seniors in the Ingalls PSA is in line with the rest of the South Suburbs, but slightly above the rate for Cook County. The diagnosis rates for prostate cancer, lung cancer, and colorectal cancer are significantly higher than in the rest of the region. In addition, the distant/systemic cancer diagnosis rate, which refers to diagnoses of Stage 4 or metastatic cancer, is higher than this rate in Cook County, on average. This disparity is especially pronounced in 60473 and 60476. This is important because when cancer is diagnosed at a later stage, it has a worse prognosis. Vulnerable communities tend to have lower cancer screening rates, leading to later diagnosis of cancer, and ultimately disparate outcomes. 8

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Environmental factors are also a concern when considering the cancer burden in the Ingalls PSA. The Inhalation Cancer Risk of the Environmental Protection Agency’s Environmental Justice Index is a weighted index of vulnerability to lifetime inhalation cancer risk. It measures exposure to airborne carcinogens, weighted by population vulnerability, and is reported as a percentile nationally, where 0 = lowest exposure and 100 = highest exposure. This index also factors in demographic vulnerabilities, such as income and race, to highlight the disproportionate impact of environmental hazards. The Ingalls PSA’s score is in the 77th percentile, which is 24 points higher than SSCC and 18 points higher than Cook County.

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Behavioral Health, Substance Abuse, and Violent Crime The Ingalls PSA has one of the highest behavioral health ED visit rates in the state for adults.

The maps below show the rates for 18 to 39-year-olds and 40 to 64-year-olds. The ED visit rates are significantly higher in zip codes 60426, 60827, and 60419.

Behavioral health ED visit rate

Behavioral health ED visit rate

Data source: IHA COMPdata Informatics (Calculated by Metopio)

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ED visits for substance use are also prevalent in the Ingalls PSA. The ED visit rate is in the top 5% for the state, according to IHA COMPdata Informatics, with a concentration of visits originating in zip codes 60426 and 60827.

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Lastly, surveys, focus groups, key informants, utilization data, and secondary data identified violent crime as a major issue in the Ingalls PSA. The Assault by Firearms ED visit rate is in the 95th percentile in Illinois and over double the rate for Cook County. Many of the patients seeking treatment for gunshots live in zip codes 60827 and 60426. The map below shows the ED visit rate for assaults by firearms for young adults ages 18-39 over five years.

Preventable chronic emergency department (ED) visit rate

Data source: IHA COMPdata Informatics (Calculated by Metopio)

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Conclusion PRIORITIZATION OF HEALTH NEEDS Building on the past three CHNAs, the Community Benefit and Evaluation team worked with the Community Benefit Management Team to prioritize health issues for Ingalls’ next three years of community benefit programming for FY 2023-2025. These stakeholders 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. »F irst, the Data Priority Setting Team, which included the Director of Community Affairs and Volunteer Services and staff from UCM’s Community Benefit and Evaluation Team, reviewed and compared the 2022 Ingalls PSA health outcome data to previous CHNA health outcome data. New data indicators and health issues that were more severe than in previous years were slated for further consideration. »N ext, 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) 501(r) guidance. » Lastly,

the Data Priority Setting Team compiled this information and presented the proposed priority framework to both the Community Benefit Management Team and the CHNA Steering Committee. The group received input from community stakeholders and discussed the merit of each proposed priority health issue.

They then made recommendations for the selection of the health issues for Ingalls’ next three years of community benefit programming for FY 2023–2025.

The framework for the priority health areas expanded from the 2018-2019 CHNA. These priorities are organized into three domains:

Prevent and manage chronic diseases

Provide access to care and services

Reduce inequities caused by social determinants of health

Heart Disease

Maternal Health

Food Insecurity

Diabetes

Mental Health

Workforce Development

Cancer

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This framework retains four of the health priorities from the FY 2020-2022 Strategic Implementation Plan: heart disease, diabetes, cancer, and maternal health. In the FY 2020-2022 Strategic Implementation Plan, asthma was also selected as a priority health area. During the last cycle, Ingalls invested resources to address asthma. As a result of these efforts and other factors, there was a decline in asthma emergency department visits. Consequently, asthma was removed as a priority health area for the FY 2023-2025 Strategic Implementation Plan. The hospital will continue to invest resources in sustaining this positive outcome by supporting existing programs.

Additionally, violence was found to be a health area of need in the CHNA. After receiving feedback from various stakeholders, we determined that violence is not a main priority at this time. However, we will invest time and energy to support organizations that promote protective factors for youth, violence prevention initiatives, and programs that support greater connectedness in our area.

These three domains and seven corresponding issues will serve as the designated issue areas for official reporting and are the principal health concerns that Ingalls’ community efforts will target.

They are the result of rigorous data collection and analysis in partnership with the community.

These domains represent a coordinated strategy to create long-term health and prosperity in our community.

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Adoption by the Board University of Chicago Medical Center’s Board of Directors Government and Community Relations Committee received the 2021-2022 CHNA report, FY 2020-2022 Evaluation Report, and FY 2023-2025 Strategic Implementation Plan for review and formally approved all three documents in May 2022.

Contact for Feedback Any questions or concerns regarding the CHNA, Strategic Implementation Plan, and the Community Benefit Evaluation Report can be sent to communitybenefit@ingalls.org.

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Endnotes 1 D et Norske Veritas. Stroke Care Certification Programs. https://www.dnv.us/assurance/healthcare/ stroke-certs.html 2 A merican College of Surgeons. Commission on Cancer. https://www.facs.org/quality-programs/ cancer/coc 3 U Chicago Medicine. Vision 2025: Advancing the Forefront. https://www.uchicagomedicine.org/ about-us/2025-vision 4 M cKnight, J. (2017). Asset-Based Community Development: The Essentials. ABCD Institute. https://resources.depaul.edu/abcd-institute/publications/publications-by-topic/Documents/ ABCD-%20The%20Essentials%20-2.pdf 5 N ational Association of County and City Health Officials. Mobilizing for Action through Planning and Partnerships (MAPP). https://www.naccho.org/programs/public-health-infrastructure/ performance-improvement/community-health-assessment/mapp 6 C ounty Health Rankings and Roadmaps. Measures and Data Sources. https://www. countyhealthrankings.org/explore-health-rankings/measures-data-sources 7 H uman Resources and Services Administration, Health Workforce. (2021, February). What Is Shortage Designation? https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation 8 M orère, J.F., Eisinger, F., Touboul, C., Lhomel, C., Couraud, S., Viguier, J. 2018. Decline in Cancer Screening in Vulnerable Populations? Results of the EDIFICE Surveys. Curr Oncol Rep, 20(1):17. doi: 10.1007/s11912-017-0649-7. PMID: 29508084.

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Community Resources in UChicago Medicine Ingalls Memorial Service Area Ceda Center for Community Action

Restoration Ministries, Inc.

53 E 154th St.

253 E 159th St.

Harvey, IL 60426

Harvey, IL 60426

(708) 339-3610

(708) 333-3370

Thornton Township Food and General Assistance Center

The South Suburban Council

15340 Page Ave.

Hazel Crest, IL 60429

Harvey, IL 60426

(708) 647-3333

1909 Cheker Square

(708) 596-6040 Aunt Martha’s Harvey Health Outreach Center Catholic Charities

15420 Dixie Hwy.

15300 Lexington Ave.

Harvey, IL 60426

Harvey, IL 60426

(877) 692-8686

(708) 596-2222 Aunt Martha’s Youth Center Family Christian Health Center

191 W 155th Pl.

31 W 155th St.

Harvey, IL 60426

Harvey, IL 60426

(708) 331-0735

(708) 596-5177 The Cancer Support Center 2028 Elm Road Homewood, IL 60430 (708) 798-9171

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Appendix 1: rimary Data Tools – Community Response Survey, P Focus Group Guides, Key Informant Interview Guides Primary data was collected through the main channels: »

community surveys

»

focus groups

»

key informant interviews

The instruments used for each are included in this appendix.

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Figure 1. Community Health Needs Assessment Survey

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Figure 2. Focus Group Moderator Guides

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6.

7.

8.

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6.

6.

7.

8.

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4.

5.

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Figure 3. Key Informant Interview Guide

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Appendix 2: Evaluation Report FY 2020-2022

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Community Benefit Evaluation Report Fiscal Years

2020-2022

Appendix 2: Community Benefit Evaluation Report

Table of Contents Background

84

Evaluation Report Methods

88

Findings PREVENT AND MANAGE CHRONIC DISEASE

90

INCREASE ACCESS TO MATERNAL HEALTH

94

PROMOTE CANCER AWARENESS

95

COVID-19 Pandemic Response

97

Conclusion

98

Appendix

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Appendix 2: Community Benefit Evaluation Report

Background The University of Chicago Medicine Ingalls Memorial Hospital (Ingalls) has a long history of community-based programming designed to improve the health and vitality of residents living within the Ingalls Primary Service Area (PSA), which covers the entire Chicago Southland area and includes locations in the following communities: Calumet City, Crestwood, Flossmoor, Harvey, South Holland, and Tinley Park, IL. These programs span a myriad of health issues and are implemented using a variety of methods. The results of these endeavors often inform further programming, with the ultimate goal of improving health outcomes among residents within the Ingalls PSA. All Ingalls community benefit investments and programs are framed by the Ingalls community benefit program. With an overarching goal to improve the health of the community, Ingalls adheres to a set of system-wide goals as a pathway to achieve impact in the community. Following guidelines from the IRS and the Catholic Health Association (CHA), a leader in community benefit, Ingalls defines community benefit as “programs and services undertaken by nonprofit hospitals designed to improve health and increase access to healthcare in the communities they serve.” This definition critically informs our community benefit strategic framework by providing a roadmap to maximize community benefit dollars to address unmet community needs. This roadmap also provides an important snapshot, allowing us to look back on our collective efforts while evaluating our impact on goals tied to each priority health area.

WHAT IS COMMUNITY BENEFIT?

In line with the Internal Revenue Service (IRS) and the Catholic Health Association (CHA), Ingalls defines community benefit as programs and services undertaken by nonprofit hospitals designed to improve health in the communities they serve and increase access to healthcare.

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Appendix 2: Community Benefit Evaluation Report

Purpose This report provides a comprehensive summary of Ingalls’ and community partners’ shared efforts to address the 2018-2019 Community Needs Health Assessment (CHNA) health priority areas and the overall impact of select Ingalls’ community-based programs since the adoption of the FY 2020-2022 Ingalls’ Strategic Implementation Plan (SIP). Ingalls recognizes that achieving population-level impact is an iterative process that will require will require piloting and scaling programs, as well as building effective systems to implement the most beneficial programs for the community.

One of the key goals of community benefit is to demonstrate Ingalls’ reach and impact across its service area, learning from the experience and strategies implemented over the past three years.

Although there are limitations in quantifying impact (e.g., program turnover, inconsistent program reporting, adaptations of programs), we have determined key core processes and outcome-level metrics to establish a snapshot of the programs’ broad-scale impact on the community and its identified issues.

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Appendix 2: Community Benefit Evaluation Report

Looking Back: Ingalls Service Area, 2018-2019 Ingalls’ PSA focuses on the 13 zip codes of Thornton Township. The Ingalls’ CHNA service area zip codes include the following cities/municipalities: the 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.

Based on 2015–2019 estimates from the American Community Survey (ACS), Ingalls’ service area is home to a total population of 256,994 residents. This service area has undergone significant population changes over the last decade, which are further detailed in the 2021-2022 CHNA.

Figure 1. Ingalls 2018-2019 Community Benefit Service Area: Study Area

INGALLS MEMORIAL HOSPITAL SERVICE AREA Zip Codes and Municipalities

60406

Blue Island Dixmoor Riverdale Posen

60633

60406 60827 60419

60469

60426

60409

Calumet City Lansing Burnham

60409 60473

60429

60476 60430

60430

Homewood Hazel Crest Thornton

60438

60425

60469

Lansing

Glenwood

Posen

60426

60473

Harvey Dixmoor Markham Phoenix

60425

Hazel Crest Harvey East Hazel Crest Markham

60419 Dolton

60438

60429

60476

Thornton

60633

Chicago Calumet City Burnham

60827

Chicago Blue Island Calumet Park Dolton Riverdale

South Holland Dolton Thornton

1 Ingalls’ PSA’s 13 zip codes are as follows: 60406, 60409, 60419, 60425, 60426, 60429, 60430, 60438, 60469, 60473, 60476, 60633, 60827 Community Benefit Evaluation Report FY 2020-2022

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Appendix 2: Community Benefit Evaluation Report

Looking Back: Priority Health Areas of Focus for FY 2020-2022

Figure 2. Community Benefit Priority Health Areas (2020-2022)

Ingalls’ priority health area goals are rooted in Organizational Commitment, Community Engagement, Demonstration of Value, and Equity across all community-based initiatives.

Programs presented in this evaluation report qualify as community-based programs or services supporting residents in the Ingalls service area.

Priority health area goals were defined in the FY 2020-2022 SIP (see Figure 2) and adopted as Ingalls’ Community Benefit Health Priority Goals.

I. PREVENT AND MANAGE CHRONIC DISEASE

Asthma Diabetes Heart Disease

II. INCREASE ACCESS TO MATERNAL HEALTH

III. PROMOTE CANCER AWARENESS

Prenatal Care

Breast Cancer Prostate Cancer

Figure 3. Community Benefit Priority Health Area Goals (FY 2020-2022)

Asthma Diabetes Heart Disease

Reduce the incidence of uncontrolled asthma among adults and children in the Ingalls PSA.

Improve the quality of life for those at risk of

developing diabetes, focused on disease prevention and management

Address risk factors associated with heart disease

which will potentially reduce incidence and prevalence of heart disease in the Ingalls PSA.

Prenatal Care

Increase access to prenatal care for women.

Breast Cancer

Decrease breast cancer mortality rate of women in

Prostate Cancer

the Ingalls PSA.

Encourage regular exams to support cancer diagnosis.

2 2 018-2019 Community Health Needs Assessment 3 2 016 UCMC Selected Health Priority Areas were organized under domains Pediatric, Adult, Adult and Pediatric, rather than by broad health topics as demonstrated in the FY 2020-2022 SIP Community Benefit Evaluation Report FY 2020-2022

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Appendix 2: Community Benefit Evaluation Report

Evaluation Report Methods This evaluation report shares the programmatic efforts undertaken across the Ingalls PSA to meet the goals and outcomes outlined in the FY 20202022 Strategic Implementation Plan, as aligned with the 2018–2019 CHNA priority health areas. This report compiles rich qualitative and quantitative data collected from a wide array of stakeholders, including data from community benefit grantees, program operations and evaluation data, and community event logs—with results organized under each priority health area of the 2018–2019 CHNA.

Evaluation Report Data Identified programs and services shared specific process and outcome metrics that demonstrated impact on the priority health areas and goals. Programs addressing priority health areas internally, as well as those implemented by partner organizations, were required to incorporate one or more measures listed in the FY 2020-2022 SIP, which allowed for aggregating specific results across all programs.

Because of the varied program structures and approaches under Ingalls’ portfolio of community benefit efforts, the Community Benefit Team defined three overarching areas to organize data sources and reporting mechanisms to further clarify the comprehensive picture of community benefit in the Ingalls PSA. Figure 4. Evaluation Report Data Sources

Community-Based Partners Community-based programs provide Ingalls with data around established criteria based on program goals and objectives. These data include process and outcome-level measures, often captured through activity logs, standard or customized designed reporting templates, surveys, and qualitative reports.

Ingalls Departments Multiple Ingalls department staff work collaboratively with community partners and internal stakeholders to track and log program activities and services to capture process-level data.

Data Systems Ingalls staff utilize databases and/or internal tracking templates to document and report programs and services as requested.

The Ingalls Community Benefit Team organized the collected programs and services data, aggregated them under corresponding select priority health area(s), and used the data to better understand the impact to share with community stakeholders.

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Evaluation Report Development Using the process outlined above, the Ingalls Community Benefit Team was able to evaluate the breadth and impact of community benefit initiatives by integrating evaluation methods for monitoring, assessment, and reporting. For completed programs, both process and outcome measures (if available) are presented, while only the process measures are presented for programs that are ongoing or are in their infancy. Unless a statistical test is noted, outcome measures (change in knowledge or behavior) presented are pre/post percentage changes for which statistical significance cannot be assessed. When possible, overall reach across focus areas is presented using process-level metrics. The following report sections highlight key programmatic results aligned with the Ingalls selected health priority areas identified through the FY 2020-2022 Strategic Implementation Plan.

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Findings Ingalls’ primary mechanisms for scaling efforts to address the priority health areas were to leverage its community benefit grant program and engage in community-based education and outreach.

While the grant program served as the primary pillar for community benefit, additional programs such as health screenings and wellness programs were supported from 2020 to 2022.

Unless otherwise noted, all data are for FY 2020–2022

Community Benefit Health Priority Areas:

I. PREVENT AND MANAGE CHRONIC DISEASE Asthma Building upon the FY 2016-2019 and FY 2020-2022 Strategic Implementation Plans, Ingalls continued to collaborate with community-based organizations and community health centers to implement programs that addressed environmental factors and asthma management behaviors. Ingalls provided grants to the American Heart Association and Family Christian Health System to provide asthma resources and education to the Ingalls PSA.

Goal

Reduce the incidence of uncontrolled asthma among adults and children in the Ingalls PSA.

Objectives

» Increase the number of asthma education and outreach events conducted in the community. » Increase the number of individuals who attend asthma education and events in the community.

Impact

» Increased asthma education and outreach.

The following programs demonstrate the impact on asthma as a priority health area, in alignment with the above goals and objectives.

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Asthma Awareness

Transforming Communities and Building a Sustainable Culture of Health (American Heart Association, 2020 Grantee):

(Family Christian Health System, 2019 Grantee): Conducted 1,015 school physicals, distributed 50 kits to children with asthma, and administered 1,132 flu shots.

Gave a 30-minute virtual tobacco/vaping presentation to 600+ middle-school students and offered deeper engagement via a follow-up survey and conversations with 18 students.

Diabetes Diabetes-related deaths in the Ingalls PSA have been on the rise since 2006. To address the prevalence and incidence of this complex chronic condition, Ingalls has worked to scale educational efforts. These efforts include engaging in community-based education and outreach and providing resources to address food insecurity.

Goal

Improve the health and quality of life for those at risk of diabetes, focusing on disease prevention and management » Increase the number of community partners that can host education events in the Ingalls PSA » Increase the number of participants who attend diabetes education at emergency feeding programs

Objectives

» Increase the number of awareness events conducted » Increase the number of staff trained on food security categorization » Implement screening tool and incorporate it into the electronic medical record (EMR) » Increase the number of Community Benefit grants awarded to programs that support healthy eating and lifestyle behaviors Chronic Disease Education

» Leveraged the Dietetic Internship program and partnered with community organizations to provide community-based education and/or programming that addressed diabetes prevention and management (examples include eye care, wound care, and monitoring blood sugars) Food Insecurity

Impact

» The Dietetic Internship program partnered with emergency food programs to host an education series for clients who self-report being pre-diabetic or diabetic » Educated clinical staff on food security categorization and nutrition related to managing and preventing diabetes » Implemented the food insecurity screening at various patient access points in the hospital (e.g., ER, social workers) to identify patients who may need nutrition intervention to manage diabetes » Identified a process for clinical staff to follow that links patients diagnosed with diabetes and who are determined food insecure to available resources in the community

The following programs are included to demonstrate impact on diabetes as a priority health area, in alignment with the above goals and objectives.

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Food Insecurity Protocol (Food Pantries):

Nutrition Community Service Schedule (NCSS):

Distributed $13,213 worth of food, including 210 twenty-pound boxes of fresh fruits and vegetables.

Hosted eight educational sessions and demonstrations.

Dietetic Internship Community Talks (DICT):

» An estimated* 1,271 individuals

(adults and children) benefited from the pantries.

Food Pantry Program:

Hosted a total of 25 educational sessions and demonstrations, six of which were specific to diabetes and food insecurity.

Distributed PPE, educational materials, recipes, and two weeks of groceries to 37 families (serving a total of 122 adults and children).

*Signing-in was not a requirement to utilize the food pantries and not all individuals were comfortable completing the sign-in.

Heart Disease Heart disease has been a reoccurring health priority for the Ingalls PSA. To address this chronic condition, Ingalls has leveraged community partners and grantees to educate residents on the importance of nutrition and disease management, and offered yoga and other fitness classes to promote physical movement and health.

Goal

Address risk factors associated with heart disease to reduce the incidence and prevalence of heart disease in the Ingalls PSA » Increase the number of heart-health education sessions offered in a community setting, aimed to encourage positive behaviors that prevent and manage heart disease

Objectives

» I ncrease the number of Community Benefit grant dollars invested in organizations that provide education to help individuals adopt healthy lifestyle behavior changes » I ncrease the number of community residents that participate in heart-healthy education and activities » I ncrease the number of individuals who have access to heart disease prevention and management and nutrition education »C ollaborated with community partners to provide access points for community members to receive heart-health education and free blood pressure screenings

Impact

»P rovided learning opportunities to residents in Ingalls PSA focused on healthy eating, and identified behaviors that support heart disease prevention and management »P rovided funds to community organizations through the Community Benefit Grant program that promote lifestyle changes to prevent and manage heart disease

The following programs are included to demonstrate impact on heart disease as a priority health area, in alignment with the above goals and objectives.

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EmPowered Health – Impacting Hypertension

Restoration Ministries* (2020 Grantee):

(American Heart Association, 2019 Grantee):

Taught yoga classes to 28 students from April 2021 to October 2021.

Reached 194 patients and provided 6,163 families with food boxes.

*Class fitness programming was severely limited due to COVID-19. Additional Zumba, boxing, and other fitness classes will be offered in the future.

Z-Hope Community Initiative – Fit & Finer Fitness and Stork’s Nest Program (Pearl Foundation, 2019 Grantee):

Internal Efforts to Address Chronic Disease and Cancer: Hosted 32 educational sessions, seven of which were specific to heart disease, reaching 175 individuals.

Reached 105 individuals through the Fit & Finer program.

Dietetic Internship Community Talks (DICT):

Transforming Communities and Building a Sustainable Culture of Health (American

Hosted a total of 25 educational sessions and demonstrations, one of which was specific to heart disease.

Heart Association, 2020 Grantee): This program addressed youth tobacco use and vaping in the Harvey community through peer-to-peer education, social media, and targeted programming, aimed to engage and involve youth in solutions. In total, grantees reached over 500 community members.

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II. INCREASE ACCESS TO MATERNAL HEALTH Prenatal Care Building upon the FY 2016-2019 and FY 2020-2022 Strategic Implementation Plans, Ingalls continued to collaborate with community-based organizations and implemented internal programming to address prenatal care education and access. Community outreach programming included enrolling patients in the Healthy Baby Network, a unique network of local healthcare providers, retailers, government agencies, schools, and community organizations that work together to coordinate prenatal care, education, and social services for pregnant women.

Goal Objectives

Impact

Increase access to prenatal care for women » Increase the number of pregnant women who actively participate in the Healthy Baby Network » Increase the number of babies delivered at Ingalls Memorial Hospital with a healthy birth weight » Increased 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 » I dentified barriers to participation in early prenatal care and evidence-based programs that support maternal health

The following programs are included to demonstrate the impact on prenatal care as a priority health area, in alignment with the above goals and objectives:

Healthy Baby Network:

Dietetic Internship Community Talks (DICT):

Enrolled 115 patients in the Healthy Baby Network, resulting in 88 deliveries, 73 of which were full-term and 69 of which were within normal birth weight.

Hosted a total of 25 educational sessions and demonstrations, one of which was specific to prenatal health.

Z-Hope Community Initiative – Fit & Finer Fitness and Stork’s Nest Program (Pearl Foundation, 2019 Grantee): Reached 11 people through the Birth Equity program and 21 people through the Stork’s Nest program.

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III. PROMOTE CANCER AWARENESS Breast Cancer Promoting breast cancer awareness was added as a health priority to decrease the breast cancer morbidity and mortality rate in the Ingalls PSA. Ingalls promoted cancer education and preventative care through a variety of grants and community outreach events.

Goal

Decrease the breast cancer mortality rate for women in the Ingalls PSA » Increase the number of outreach events » Increase the number of participants who attend outreach events

Objectives

» Increase the number of breast cancer screenings » I ncrease the number of community talks, education sessions, and survivorship meetings offered in the Ingalls PSA » Increased the number of women who have an annual breast cancer screening » Increased breast cancer outreach

Impact

» Increased the knowledge of breast cancer care for women living in the Ingalls PSA » I ncreased the number of breast cancer community talks and educational opportunities, including survivorship meetings

The following programs are included to demonstrate the impact on breast cancer as a priority health area, in alignment with the above goals and objectives:

Kick It Cancer (Cancer Support Center, 2020 Grantee):

4Cs (Cancer Support Center,

» Hosted 36 meetings reaching a total of

Hosted a total of 10 education sessions reaching a total of 249 individuals, with one breast cancer-specific panel reaching 10 individuals.

2021 Grantee):

1,021 individuals, and had 776 public service announcement views on social media. » The breast cancer panel reached 33 live

Increasing Mammography in the Southland (Family Christian

participants and recorded 117 virtual views.

Breast & Prostate Awareness

Health Center, 2021 Grantee):

(Barbara W Smith Family Life Center, 2020 Grantee):

» Completed 200+ weekly reminder phone calls

to women due for mammograms or in need of follow-ups, resulting in a 5% increase in mammograms completed.

» Provided bi-monthly fresh food giveaways

that served 780 individuals.

» Distributed 1,200 boxes of fresh fruits

» Hosted Zoom presentations on healthy eating

and vegetables.

with dietetic interns that reached 45 people.

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Internal Efforts to Address Chronic Disease and Cancer:

Dietetic Internship Community Talks (DICT):

Hosted 32 educational sessions, five of which were specific to cancer, and reached 81 individuals.

Hosted a total of 25 educational sessions and demonstrations, one of which was specific to breast cancer.

Prostate Cancer The diagnosis rate of prostate cancer is significantly higher in the Ingalls PSA than in Cook County, emphasizing the need for a targeted approach to address this health priority. Ingalls leveraged community outreach and grant support to increase prostate cancer awareness and screening access.

Goal

Objectives

Impact

Encourage regular exams to support early diagnosis of prostate cancer » Increase the number of outreach events » Increase the number of men who attend events » I ncreased outreach that promotes prostate cancer screenings and exams »H osted community events that focus on the risk factors of prostate cancer

The following programs are included to demonstrate the impact on prostate cancer as a priority health area, in alignment with the above goals and objectives:

Kick It Cancer (Cancer Support Center, 2020 Grantee):

4Cs (Cancer Support Center,

» Hosted 36 meetings reaching a total of

Hosted a total of 10 education sessions reaching a total of 249 individuals, with three prostatecancer-specific panels reaching 73 individuals.

2021 Grantee):

1,021 individuals, and had 776 public service announcement views on social media. » The prostate-cancer-specific panels recorded

Internal Efforts to Address Chronic Disease and Cancer:

15 virtual views.

Breast & Prostate Awareness

Hosted 32 educational sessions, five of which were specific to cancer, reaching 81 individuals.

(Barbara W Smith Family Life Center, 2020 Grantee): » Provided bi-monthly fresh food giveaways

that served 780 individuals. » Hosted Zoom presentations on healthy eating

with dietetic interns that reached 45 people.

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COVID-19 Pandemic Response In 2020, COVID-19 became the third leading cause of death in the Ingalls PSA, and the pandemic exposed the longstanding structural drivers of health inequities. In response, Ingalls Memorial Hospital partners offered valuable resources and support to serve those who struggled to stay healthy. A few notable contributions included: » 43,000 COVID-19 tests administered to Ingalls employees and the public in 2020. »$ 12,000 in emergency relief funds donated to community-based organizations. These funds helped organizations deal with the gaps in programs caused by COVID-19. » 10,800 meals (12,957 pounds), worth nearly $3,600, donated to local food pantries as a result of Ingalls Memorial dietetic interns’ online food drive. » 1 ,961 Ingalls Memorial employees were vaccinated at community events and through employee health. » 500 cloth masks donated to patients, handmade by members of Volunteer Services. »4 28 employee hours spent on COVID-19 vaccination outreach events for the City of Harvey.

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Conclusion Ingalls is committed to working with local partners to address the needs of the broader community. By actively listening to the concerns of residents, Ingalls will continue to work with the community to determine the most appropriate way to address overarching needs, while continuously iterating and strengthening its existing processes, structures, and programs to ensure that residents receive the highest quality of care. Ingalls will continue to monitor each program regularly and adjust its programming accordingly.

Plans to address the next three years of Ingalls’ community benefit focus are outlined in the Ingalls Memorial Hospital FY 2023–2025 Strategic Implementation Plan.

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Appendix Programs Table PROGRAM

4Cs*

Asthma Awareness*

Breast & Prostate Cancer Awareness*

Dietetic Internship Community Talks

EmPowered Health*

Food Insecurity Protocol (Food Pantries)

Food Pantry Program

HEALTH DOMAIN

Breast Cancer, Prostate Cancer

Asthma

Breast Cancer, Prostate Cancer

Breast Cancer, Diabetes, Heart Disease, Prenatal Care

Heart Disease

Diabetes

Diabetes

Community Benefit Evaluation Report FY 2020-2022

DESCRIPTION

PARTNER

4Cs partnered with local leaders to bring cancer education and resources directly to members of the Hazel Crest, Burnham, Posen, and Riverdale communities.

Cancer Support Center (2021 Grantee)

In partnership with the American Lung Association, Family Christian Health System hosted community events that provided asthma education and resources, and the ability to schedule primary care visits to Southland residents.

Family Christian Health System (2019 Grantee)

As a partnership between the Barbara W Smith Family Life Center and residents of Thornton Township, the Cancer Community Connection provided education to the community to reduce the incidence of cancer.

Barbara W Smith Family Life Center (2020 Grantee)

Dietetic interns hosted educational sessions, fairs, and demonstrations related to health and nutrition.

Multiple organizations, including Barbara W Smith Family Life Center and Family Christian Health Center

EmPowered Health addressed youth tobacco use through education on the causal relationship between tobacco use and chronic conditions such as asthma and heart disease. An additional component of this program included peer-to-peer education through social media platforms.

American Heart Association (2019 Grantee)

Ingalls created a protocol and processes to identify patients at risk for food insecurity. Patients were then connected to and/or provided with resources.

Dietetic Internship Program (Cheryl Bacon lead), with input from multiple internal and external departments and programs

The program provided nutritional support to community members and their families who are navigating a cancer diagnosis while facing food insecurity. Each family was given a PPE kit, educational materials including recipes, and groceries to last approximately two weeks.

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PROGRAM

Healthy Baby Network

Increasing Mammography in the Southland*

Internal Efforts to Address Chronic Disease and Cancer

Kick It Cancer*

KidsFest

Nutrition Community Service Schedule

Restoration Ministries*

HEALTH DOMAIN

DESCRIPTION

PARTNER

The Network is a community outreach program composed of healthcare providers, retailers, government agencies, schools, and community organizations that coordinate prenatal care for pregnant women.

Network of partners, including: Aunt Martha's Healthcare Network, Ceda Center for Community Action, ECHO Family Enrichment, Family Christian Health Center, and many others

With a goal to address disparities in breast cancer outcomes for Black women in the Southland, the Family Christian Health System leveraged AI and tailored care coordination to increase access to quality breast cancer screening.

Family Christian Health System (2021 Grantee)

Breast Cancer, Diabetes, Heart Disease, Prostate Cancer

Ingalls’ internal programming addressed chronic disease prevention and management and promoted cancer awareness through educational sessions.

Multiple departments

Cancer Support Center (2020 Grantee)

Breast Cancer, Prostate Cancer

The Cancer Support Center leveraged partnerships with legislative offices, civic organizations, and providers from Federally Qualified Health Centers (FQHC) to bring in-person cancer screenings to the Hazel Crest, Burnham, Posen, and Riverdale communities.

Provided free annual physical exams to school-aged children.

Family Christian Health Center

Hosted educational sessions, fairs, and demonstrations related to health and nutrition.

Dietetic Internship Program (Cheryl Bacon lead), with input from multiple internal and external departments and programs

Harvey Fitness Club provided fitness programs such as weight training, boxing, rope jumping, dance, and yoga to address heart disease and diabetes in the community.

Restoration Ministries (2020 Grantee)

Prenatal Care

Breast Cancer

Other

Diabetes

Heart Disease

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PROGRAM

Transforming Communities and Building Sustainable Culture of Health

Z-Hope Community Initiative*

HEALTH DOMAIN

Asthma, Heart Disease

Heart Disease, Prenatal Care

DESCRIPTION

PARTNER

Program addressing youth tobacco use and vaping in the Harvey community through peer-to-peer education, social media, and targeted programming, aimed to engage and involve youth in solutions.

American Heart Association (2020 Grantee)

Z-Hope hosted Fit and Finer events led by fitness instructors and healthcare providers at the Markham Recreational Center to advocate for healthy lifestyles and help manage chronic conditions such as diabetes, asthma, and heart disease. Z-Hope’s Stork’s Nest program provided prenatal health, nutrition, and parenting education to expecting mothers with the goal of increasing the number of healthy births in the community.

Pearl Foundation (2019 Grantee)

*Part of the Community Impact Grant

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Contact for Feedback Any questions or concerns regarding the CHNA, Strategic Implementation Plan, or Community Benefit Evaluation Report can be sent to communitybenefit@ingalls.org.

Appendix 3: Data Sources Secondary data that was used throughout this report was compiled from Metopio’s data platform.

Under each graphic in this report, there is a label that cites the data source for that visual.

Primary sources of this data come from: »A merican Community Survey »B ehavioral Risk Factor Surveillance System »C enters for Disease Control PLACES data »C enters for Medicare and Medicaid Services: Provider of Services Files, National Provider Identifier »C hicago Police Department »D ecennial Census (2010 and 2020 census data) »D iabetes Atlas »E nvironmental Protection Agency »F BI Crime Data Explorer » I llinois Department of Healthcare and Family Services » I llinois Department of Public Health » I llinois Hospital Association COMPdata Informatics »N ational Vital Statistics System »T he New York Times »S tate Health Department COVID dashboards »U nited States Department of Agriculture: Food Access Research Atlas

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Contact for Feedback Any questions or concerns regarding the CHNA, Strategic Implementation Plan, and the Community Benefit Evaluation Report can be sent to communitybenefit@ingalls.org.