2023-2025 Ingalls Strategic Implementation Plan

Strategic Implementation Plan Fiscal Years

2023-2025

Ingalls Memorial Hospital Community Health Needs Assessment Strategic Implementation Plan (SIP): Fiscal Years (FY) 2023-2025

Introduction Serving Chicago’s South Suburbs since 1923, Ingalls Memorial Hospital (Ingalls) is a comprehensive, patient-centered system of care that serves more than 313,170 outpatients and 12,947 inpatients annually at its 485bed hospital.1,2 Ingalls provides a comprehensive range of services, including orthopedics, cancer, eye care, neurosciences, inpatient and outpatient surgery, and behavioral health.

Ingalls is designated as a Det Norske Veritas (DNV)-Certified Primary Stroke Center of Excellence, and in 2018, Ingalls was awarded a three-year accreditation as a Comprehensive Community Cancer Program with Commendation—the highest achievable award for a community hospital through the Commission on Cancer. In 2016, University of Chicago Medicine (UCM) and Ingalls Health System joined forces in an alliance that combined a top community hospital in Chicago’s Southland with one of the country’s leading academic medical institutions. Ingalls is now part of the UChicago Medicine brand, which includes the University of Chicago Medical Center, the Biological Sciences Division, and the Pritzker School of Medicine.

This document outlines the Strategic Implementation Plan (SIP) corresponding to the 2021–2022 Community Health Needs Assessment (CHNA). The plan builds on Ingalls’ relationship with UCM and its commitment to community partnerships that improve health and well-being in the Southland.

The development process for the implementation plan involved several steps overseen by the Community Benefit Steering Committee and the Community Benefit Management Team, with input from subject matter experts at Ingalls and community stakeholders.

1 Inpatient number excludes births (FY 2020) 2 Outpatient visit number includes ER visits and outpatient surgeries (FY 2020) Strategic Implementation Plan FY 2023-2025

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Target Area and Priority Population Ingalls, located in Harvey, IL—one of Chicago’s South Suburbs—decided to streamline its 2018-2019 CHNA primary service area (PSA) to focus on the 13 zip codes of Thornton Township. This change allowed Ingalls to establish a strategic focus in the highest-need communities of Ingalls’ catchment area. In the 2015 CHNA, Ingalls’ PSA included a broader geography covering 29 zip codes.

The 2021-2022 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, and Posen, South Holland, Calumet City, Lansing, Glenwood, Blue Island, Calumet Park, and Thornton.

Figure 1. Ingalls’ Service Area

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

Community Health Needs Assessment To understand the current health outcomes in the Ingalls PSA, Ingalls conducted a CHNA to identify the areas of greatest need and guide the hospital through the selection of priority health areas and the commitment of resources to improve community members’ health and wellness. To complete the 2021-2022 CHNA, Ingalls partnered with Metopio (a software and services company), and regional and community-based organizations in Cook County, Illinois. The CHNA includes data about the health status, behaviors, and needs of populations in the Ingalls PSA. The CHNA was used to identify the health issues of concern in the Ingalls PSA and to help make informed, data-driven decisions regarding the allocation of resources and effort.

Methods 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.

This planning framework is used widely for CHNAs. It focuses on community engagement, partnership development, and including those who have historically been excluded from decisionmaking 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 ealth care and social service provider focus groups »K ey informant interviews Secondary data for the CHNA were aggregated on Metopio’s data platform and included: »H ospital utilization data »S econdary sources including, but not limited to, the American Community Survey, the Decennial Census, the Centers for Disease Control, the Environmental Protection Agency, Housing and Urban Development, and the Chicago Department of Public Health

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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; »P opulation 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. »V ariability 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.

Whenever possible, the most relevant localized data are reported. »D ue 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. »G aps and limitations persist in data systems for certain community health issues such as mental health and substance use disorders for youth and adults, crime reporting, environmental health, and education outcomes. Additionally, these data are often collected and reported from a deficit-based framework that focuses on needs and problems in a community, rather than a community’s assets and strengths. A deficit-based framework contributes to a 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 selection of the FY 2023–2025 health priority areas.

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

In 2020, COVID-19 became the third leading cause of death in the Ingalls PSA, and the pandemic exposed longstanding structural drivers of health inequities.

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 are hard to pinpoint, several important determinants of health are more pronounced in the Ingalls PSA, including a lack of access to care; higher rates of chronic disease; high rates of “essential” employment, putting workers at increased risk of experiencing adverse working conditions; and a lack of transportation options.

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Process for Determination of Health Priorities The Ingalls Community Benefit and Evaluation team worked with the Community Benefit Management Team to prioritize the health issues for Ingalls’ next three years of community benefit programming from FY 2023–2025. The team was comprised of constituents who 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 2021-2022 Ingalls PSA health outcome data to the previous CHNA health outcome data. New health issues that were worse than in previous years were slated for consideration. »N ext, the Ingalls Community Benefit Management Team reviewed the data and ranked the most severe indicators by considering existing programs and resources and following the Internal Revenue Service (IRS) 501r guidance. »L astly, the team compiled this information and presented the proposed priority framework to both the Community Benefit Management and the CHNA Steering Committees, outlining the merits of each proposed priority health issue and making recommendations for the selection of the health issues for Ingalls’ next three years of community benefit programming from FY 2023–2025. Input from a group of community stakeholders also factored into the decision.

Figure 2. Criteria for Selecting Health Priority Areas

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Ingalls Selected Health Priority Areas Based on community input and analysis of a myriad of data, the priorities for the communities served

by Ingalls for FY 2023–2025 are:

Figure 3. FY 2023-2025 Selected Health Priorities

I. PREVENT AND MANAGE CHRONIC DISEASE

Heart Disease Diabetes Cancers

II. PROVIDE ACCESS TO CARE AND SERVICES

III. REDUCE INEQUITIES CAUSED BY THE SDOH*

Maternal Health Mental Health

Food Insecurity Workforce Development

Each domain and its corresponding issues will serve as a designated area for official reporting, and together, they are the principal health concerns that Ingalls’ community benefit 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 the community.

* Social determinants of health (SDOH) Strategic Implementation Plan FY 2023-2025

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Ingalls Memorial Hospital

Significant Health Issues That Will Not Be Addressed In acknowledging the wide range of priority health issues that emerged from the CHNA process, Ingalls determined that it could only effectively focus on those which fit within the current resources available. While violence was not selected as a health priority area for FY 2023–2025, it affects the health status of the whole community. Consequently, violence will be addressed in relation to each of the priority health areas by focusing on the social inequities caused by the social determinants of health (SDOH) and by providing access to mental health services.

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 SIP, asthma was 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 (ED) visits. Consequently, asthma is not a priority health area for the FY 2023-2025 SIP. The hospital will continue to invest resources to sustain this positive outcome by supporting existing programs.

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Development Process for the Strategic Implementation Plan To conduct the implementation planning process, Ingalls considered the findings of the CHNA in the context of the many community-focused activities in which physicians and staff members were engaged. The CHNA results, the priority selection framework, and the proposed SIP were also shared with a group of community stakeholders for their input and feedback.

For each priority area, subject matter experts within Ingalls were invited to identify current and planned activities and think about partnerships and interventions that could further address the identified needs within each priority area throughout the implementation plan. This three-year plan echoes a cooperative, purposeful process based on evidence, extensive consideration of community needs, and opportunities for positive impact that build on the existing strengths of the institution and its partnerships. The SIP also considers opportunities to create new and/or expand existing partnerships with individuals and organizations in the Chicago Southland for FY 2023–2025.

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Ingalls Memorial Hospital

Ingalls’ Approach to Addressing Selected Health Priority Areas Ingalls applies resources to the following community benefit approaches, investments, and programming: Figure 4. Implementation Approach

Care Delivery Initiatives: A myriad of initiatives that provide direct health, medical, or wellness services to community members. These services are executed in multiple ways, including leveraging Ingalls’ existing resources and partnering with community health centers and community-based clinical services.

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

Community-Based Education & Outreach: Programs that promote learning and educational forums— primarily around the Ingalls health priority areas—to community members from the South Suburbs.

These activities are intended to educate the community about health issues and teach people how to manage their health.

Partnerships: Innovative partnerships with a community health lens that leverage technology, crosssector collaborations, and multi-disciplinary application learnings to improve health and engage the community.

Policy & Advocacy: Inform population health strategies, connections between the community and clinical spheres of work, institutional advocacy efforts, policy change, and community partnerships.

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Each health priority area will incorporate elements of the above methods. The plans and actions tied to each of Ingalls’ health priority areas are structured using the following format: ummary of Issue: A brief outline of the rationale for addressing the issue, as well as S the needs that have been identified within the health issue area. »G oal: The community benefit from the health priority area’s long-term expectation of programming results. »O bjectives: The community benefit from the health priority area’s expected results, as achieved by particular programmatic outcomes. »S trategy: Ingalls’ approach to programming and the actions that will be included in that programming.

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I. HEALTH PRIORITY AREA 1:

Prevent and manage chronic diseases: heart disease, diabetes, and cancers Summary of Issue3: Heart Disease: In the Ingalls PSA, the heart disease mortality rate for non-Hispanic Black people is 26% higher than other racial and ethnic groups. In addition, the Emergency Department (ED) visit rate for hypertension is among the highest in the state and the ED visit rate for heart failure is in the 90th percentile.

Diabetes: The rate of diabetes is 15% higher in the Ingalls PSA than in South Suburban Cook County.

Cancers: The diagnosis rates for prostate cancer, lung cancer, and colorectal cancer are significantly higher in the Ingalls PSA. Additionally, the distant/systemic cancer diagnosis rate, which refers to a diagnosis of Stage 4 or metastatic cancer, is higher in the Ingalls PSA than in Cook County, on average.

Health Priority 1 Objective: Reduce the impact of heart disease, diabetes, and cancers by increasing focus on prevention, treatment, and support.

STRATEGIES Increase community education activities that focus on heart disease, diabetes, and cancer prevention and screenings

»L everage existing programs and resources, including Community Health Workers and internal clinical staff, to provide education on managing and preventing these chronic diseases.

Increase opportunities, via partnerships, for in-person and/ or virtual events that support the prevention and management of chronic diseases

»L everage the Ingalls Dietetic Internship program, the Ingalls Community Impact Grant Program, and community partner organizations to provide community-based education and/or programming that addresses heart disease, diabetes, and cancer prevention and management.

Expand access to primary care medical homes

» Expand existing programming and resources, like Community Health Workers, to help people connect to primary care homes and tackle identified barriers to care.

Ingalls continues to develop partnerships, engage in community-based education and outreach programs that target chronic diseases, and expand care delivery initiatives to meet the needs of the Ingalls PSA. Key programs that support this health priority include Community Impact Grants, the Ingalls Dietetic Internship, and the Community Health Worker program.

3 All data in this section is included in 2021-2022 Ingalls Community Health Needs Assessment.

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II. HEALTH PRIORITY AREA 2:

Provide access to care and services Summary of Issue4: Mental Health Care Services: The Ingalls PSA has one of the highest behavioral health ED visit rates in the state for adults. The ED visit rates are significantly higher in zip codes 60426, 60827, and 60419.

Maternal Health Care Services: County-wide, over 8% of babies have a low birth weight. The average among White and Hispanic or Latino populations is similar to the average for Cook County as a whole, but the number is higher for non-Hispanic Black populations. In addition, 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 (27.4%).

Health Priority 2 Objective: Increase access to maternal and mental health care services in the Southland.

STRATEGIES Increase the number of individuals who have access to maternal and mental health services

»P rovide no-cost mental health and maternal health training and educational materials to the community.

Reduce the number of individuals who present to the ED with unaddressed mental health needs

» I ncrease community screenings and referrals to mental health services.

Reduce the number of pregnant individuals who present to the ED and are discharged without prenatal resources

» Increase outreach to at-risk populations to link them to maternal and mental health services and resources.

» I dentify community partners who provide mental health services and resources.

Ingalls continues to develop partnerships, engage in community-based education and outreach programs that target maternal and mental health, and expand care delivery initiatives to meet the needs of the Ingalls PSA. Key programs that support this health priority include the Healthy Baby Network, Community Impact Grants, and the Ingalls behavioral health inpatient and outpatient service lines.

4 All data in this section is included in 2021-2022 Ingalls Community Health Needs Assessment.

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III. HEALTH PRIORITY AREA 3:

Reduce inequities caused by the social determinants of health Summary of Issue5: Food Insecurity: In the Ingalls PSA, 12.8% of residents are food insecure, compared to 11.7% of residents in South Suburban Cook County and 15.0% in Cook County. Low food access affects 62.14% of residents in the Ingalls PSA, compared to 68.55% in SSCC and 38.65% in Cook County.

Workforce: 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 living in poverty, and SSCC has a median household income of $71,230 and a 12.6% poverty rate.

The unemployment rate in the Ingalls PSA (12.9%) is significantly higher than the rate in SSCC (8.9%) and Cook County (7.0%), and it is over double the rate in Illinois (5.9%) and the U.S. (5.4%).

Health Priority 3 Objective: Reduce inequities caused by the SDOH— food access and workforce development.

STRATEGIES Demonstrate innovative programs and services that support both food access points and workforce development opportunities

Foster relationships with community partners and external stakeholders to address food access and workforce development

Create collected plans with internal and external stakeholders that support the execution of Ingalls’ community health improvement plans

» I dentify the need for food access through screenings and refer those in need to services.

» Increase local hiring.

» Develop career advancement plans for employees.

» I mprove access to healthy food.

»D evelop regular communication with emergency feeding programs in the Ingalls PSA.

» Develop plans to partner with community organizations to provide workforce development and hiring opportunities.

Ingalls continues to develop partnerships, engage in community-based education and outreach programs that address inequities caused by the social determinants of health, and expand care delivery initiatives to meet the needs of the Ingalls PSA. Key programs that support this health priority include the Community Impact Grants and efforts through the Ingalls Development Foundation and the Office of Community Affairs.

5 All data in this section is included in 2021-2022 Ingalls Community Health Needs Assessment.

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Community Benefit Report Communication Ingalls’ CHNA and SIP have both been approved and adopted by the UCM Board of Directors in May 2022 and are publicly available online. Additionally, Ingalls will share the CHNA and this SIP with the community (e.g., community members, local political representatives, healthcare providers, and community-based organizations) and make copies available upon request.

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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.