Flagstaff Medical Center 2012 Community Health Needs Assessment

Transcription

1 Flagstaff Medical Center 2012 Community Health Needs Assessment In the Spring of 2012, Flagstaff Medical Center (FMC) embarked on a comprehensive Community Health Needs Assessment (CHNA) process to identify and address the key health issues for our community. One of the nicest things about living in Northern Arizona is you don't have to travel to get excellent healthcare. Since 1936, Flagstaff Medical Center, a member of Northern Arizona Healthcare, has provided high quality healthcare services to the residents and visitors to Northern Arizona. We are dedicated to patient centered care with a personal touch. FMC is accredited by DNV Healthcare, the newest hospital accreditation organization deemed by Center for Medicare and Medicaid Services (CMS) to accredit hospitals, and FMC is licensed by the State of Arizona. Founded by Dr. Charles Sechrist as Flagstaff Hospital, the 25 bed hospital was donated to the community of Flagstaff in Today, FMC remains a not for profit hospital, governed by a volunteer board of directors. We treat every patient, regardless of their ability to pay. FMC invests in your community hospital to ensure we are providing the best and safest care, close to home. We provide key services to Northern Arizona residents and visitors, including a regional trauma center; open heart surgery; high tech imaging; a cancer center; surgical services; orthopedic services; women, infants and children s services and more. FMC currently has: 267 inpatient beds Close to 200 physicians on our active medical staff 12,669 annual inpatient hospital visits 96,111 annual outpatient hospital visits 40,551 annual Emergency department visits More than 1,251 babies born each year at FMC Approximately 50 medical specialties 5,675 annual inpatient surgeries *Statistics updated Sept Accreditation Flagstaff Medical Center is nationally accredited by DNV Healthcare. Definition of the Community Served [IRS Form 990, Schedule H, Part V, Section B, 1a, 2] Flagstaff Medical Center completed its last Community Health Needs Assessment in CHNA Community Definition The study area for the survey effort (referred to as the FMC Service Area or Flagstaff Region in this report) includes the following residential ZIP Codes in Flagstaff, AZ, and surrounding communities: 86001, 86002, 86004, 86011, 86015, 86017, 86018, 86023, 86024, 86038, 86046, 86320, and A geographic description is illustrated in the following map. 1

2 2012 PRC Community Note that for purposes of relatable comparison with previous studies conducted in the area, trend data represents only the Flagstaff ZIP Codes of 86001, 86002, 86003, 86004, 86011, and Demographics of the Community [IRS Form 990, Schedule H, Part V, Section B, 1b] The population of the hospital s Flagstaff service area is estimated at 65,914 people. It is predominantly non Hispanic White (64.4%), but also has substantial Native American (11.7%) and Hispanic (18.4%) populations. Median household income is below the state average at $48,758 and 21.1% of our population remains below the poverty level. US Census QuickFacts Flagstaff (city), Arizona People QuickFacts Flagstaff Arizona Population, 2011 estimate 65,914 6,467,315 Population, 2010 (April 1) estimates base 65,870 6,392,015 Population, percent change, April 1, 2010 to July 1, % 1.2% Population, ,870 6,392,017 2

3 Persons under 5 years, percent, % 7.1% Persons under 18 years, percent, % 25.5% Persons 65 years and over, percent, % 13.8% Female persons, percent, % 50.3% White persons, percent, 2010 (a) 73.4% 73.0% Black persons, percent, 2010 (a) 1.9% 4.1% American Indian and Alaska Native persons, 11.7% 4.6% percent, 2010 (a) Asian persons, percent, 2010 (a) 1.9% 2.8% Native Hawaiian and Other Pacific Islander, percent, 2010 (a) 0.2% 0.2% Persons reporting two or more races, 3.6% 3.4% percent, 2010 Persons of Hispanic or Latino origin, percent, 18.4% 29.6% 2010 (b) White persons not Hispanic, percent, % 57.8% Living in same house 1 year & over, percent, 71.3% 80.1% Foreign born persons, percent, % 13.9% Language other than English spoken at 17.6% 27.1% home, percent age 5+, High school graduate or higher, percent of 90.4% 85.2% persons age 25+, Bachelor's degree or higher, percent of 42.0% 26.4% persons age 25+, Veterans, , ,449 Mean travel time to work (minutes), workers age 16+, Housing units, ,254 2,844,526 Homeownership rate, % 66.6% Housing units in multi-unit structures, percent, % 20.6% Median value of owner-occupied housing $294,400 $197,400 units, Households, ,360 2,344,215 Persons per household, Per capita money income in the past 12 $23,232 $25,784 months (2011 dollars), Median household income, $48,758 $50,752 Persons below poverty level, percent, % 16.2% Business QuickFacts Flagstaff Arizona Total number of firms, , ,529 Black-owned firms, percent, % 2.0% American Indian- and Alaska Native-owned S 1.9% 3

4 firms, percent, 2007 Asian-owned firms, percent, % 3.3% Native Hawaiian and Other Pacific Islanderowned F S firms, percent, 2007 Hispanic-owned firms, percent, % 10.7% Women-owned firms, percent, % 28.1% Manufacturers shipments, 2007 ($1000) 1,314,248 57,977,827 Merchant wholesaler sales, 2007 ($1000) 405,856 57,573,459 Retail sales, 2007 ($1000) 1,174,377 86,758,801 Retail sales per capita, 2007 $19,717 $13,637 Accommodation and food services sales, 294,467 13,268, ($1000) Geography QuickFacts Flagstaff Arizona Land area in square miles, , Persons per square mile, , FIPS Code Counties Coconino County (a) Includes persons reporting only one race. (b) Hispanics may be of any race, so also are included in applicable race categories. D: Suppressed to avoid disclosure of confidential information F: Fewer than 100 firms FN: Footnote on this item for this area in place of data NA: Not available S: Suppressed; does not meet publication standards X: Not applicable Z: Value greater than zero but less than half unit of measure shown 4

5 Existing Healthcare Facilities & Resources [IRS Form 990, Schedule H, Part V, Section B, 1c] Flagstaff Center recognizes that there are many existing healthcare facilities and resources within the community that are available to respond to the health needs of residents. These organizations include the following: Acute Care Hospitals/Emergency Rooms Flagstaff Medical Center Federally Qualified Health Centers & Other Safety Net Providers Coconino County Public Health Services District Flagstaff Medical Center s Team Health Primary Care Native Americans for Community Action NorthCountry Health Care (FQHC) Northern Arizona University Health Services Poore Medical Clinic Sacred Peaks Health Center Nursing Homes/Adult Care Arizona Senior Care Centers Comfort Care Assisted Living Center Eldercare Springs Emeritus at Flagstaff Infinia Northern Arizona Council of Governments Area Agency on Aging Northern Arizona Senior in Action Coalition Pine Meadows Ranch The Peaks Mental Health Services/Facilities Flagstaff Medical Center Behavior Health Services National Alliance on Mental Illness Native Americans for Community Action North Country Healthcare Behavioral Health Northern Arizona Regional Behavioral Health Authority Northern Arizona University Health and Psychology Center Southwest Behavioral Health Services The Guidance Center Emergency Medical Services (EMS) 5

6 Guardian Air Transport Guardian Medical Transport Flagstaff Fire Summit Fire Highlands Fire Pinewood Fire Department Home Healthcare Abrio Care Comfort Keepers Northern Arizona Homecare Nurses Network Tender Hearts senior Care Hospice Care Northern Arizona Hospice Northland Hospice School Health Services Flagstaff Unified School District Other Community Based Resources American Cancer Society Cooperative Extension Program Flagstaff Food Link Flagstaff Shelter Services Planned Parenthood Flagstaff Red Cross of Northern Arizona United Way of Northern Arizona YMCA of Flagstaff 6

7 How CHNA Data Were Obtained [IRS Form 990, Schedule H, Part V, Section B, 1d] CHNA Goals & Objectives This Community Health Needs Assessment, a follow up to similar studies conducted in 1996 and 2010, is a systematic, data driven approach to determining the health status, behaviors and needs of residents in the Flagstaff Medical Center (FMC) Service Area. Subsequently, this information may be used to inform decisions and guide efforts to improve community health and wellness. A Community Health Needs Assessment provides information so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This Community Health Needs Assessment will serve as a tool toward reaching three basic goals: To improve residents health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio economic factors which have historically had a negative impact on residents health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late stage diseases resulting from a lack of preventive care. This assessment was conducted on behalf of Flagstaff Medical Center by Professional Research Consultants, Inc. (PRC). PRC is a nationally recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments such as this in hundreds of communities across the United States since CHNA Methodology This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes primary research (the PRC Community Health Survey) and secondary research (vital statistics and other existing health related data); these quantitative components allow for trending and comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through a Key Informant Focus Group. Community Health Survey The survey instrument used for this study is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues. The final survey instrument was developed by the Flagstaff Medical Center and PRC, and is similar to the previous surveys used in the region, allowing for data trending. A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Community Health Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview methodology one that incorporates both landline and cell phone interviews was 7

8 employed. The primary advantages of telephone interviewing are timeliness, efficiency and randomselection capabilities. The sample design used for this effort consisted of a random sample of 400 individuals age 18 and older in the FMC Service Area. Once the interviews were completed, these were weighted in proportion to the actual population distribution so as to appropriately represent the FMC Service Area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total population of community members in the defined area with a high degree of confidence. Public Health, Vital Statistics & Other Data A variety of existing (secondary) data sources was consulted to complement the research quality of this Community Health Needs Assessment. Data were obtained from the following sources (specific citations are included with the graphs throughout this report): Arizona Department Health Services Arizona Department of Public Safety Centers for Disease Control & Prevention National Center for Health Statistics US Census Bureau US Department of Health and Human Services US Department of Justice, Federal Bureau of Investigation Note that secondary data reflect county level data for Coconino County, Arizona. Community Stakeholder Input [IRS Form 990, Schedule H, Part V, Section B, 1h & 3] As part of the Community Health Needs Assessment, a focus group was held on May 22, 2012, among of 18 key informants in the community, including: representatives from public health; physicians; other health professionals; social service providers; and other community leaders. A list of recommended participants for the focus group was provided by Flagstaff Medical Center. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Participants included a representative of public health, as well as several individuals who work with lowincome, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Focus group candidates were first contacted by letter to request their participation. Follow up phone calls were then made to ascertain whether they would be able to attend. Confirmation calls were placed the day before the groups were scheduled to ensure a reasonable turnout. Audio from the focus group session was recorded, from which verbatim comments in this report are taken. There are no names connected with the comments, as participants were asked to speak candidly and assured of confidentiality. NOTE: These findings represent qualitative rather than quantitative data. The groups were designed to gather input from participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are based on perceptions, not facts. 8

9 Information Gaps [IRS Form 990, Schedule H, Part V, Section B, 1i] While this assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the community s health needs. For example, certain population groups such as the homeless, institutionalized persons, or those who only speak a language other than English or Spanish are not represented in the survey data. Other population groups for example, pregnant women, lesbian/gay/bisexual/transgender residents, undocumented residents, and members of certain racial/ethnic or immigrant groups might not be identifiable or might not be represented in numbers sufficient for independent analyses. In terms of content, this assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed. Vulnerable Populations [IRS Form 990, Schedule H, Part V, Section B, 1f] The CHNA analysis and report yielded a wealth of information about the health status, behaviors and needs for our population. A distinct advantage of the primary quantitative (survey) research is the ability to segment findings by geographic, demographic and health characteristics to identify the primary and chronic disease needs and other health issues of vulnerable populations, such as uninsured persons, lowincome persons, and racial/ethnic minority groups. For additional statistics about uninsured, low income, and minority health needs please refer to the complete PRC Community Health Needs Assessment report, which can be viewed online at Public Dissemination [IRS Form 990, Schedule H, Part V, Section B, 5 5c] This Community Health Needs Assessment is available to the public using the following URL: HealthForecast.net is an interactive, dynamic tool designed to share CHNA data with community partners and the public at large. This site: Informs readers that the CHNA Report is available and provides instructions for downloading it; Offers the CHNA Report document in a format that, when accessed, downloaded, viewed, and printed in hard copy, exactly reproduces the image of the report; Grants access to download, view, and print the document without special computer hardware or software required for that format (other than software that is readily available to members of the public without payment of any fee) and without payment of a fee to the hospital organization or facility or to another entity maintaining the website. Links to this dedicated HealthForecast.net site are also made available at RHMC s hospital website at: Flagstaff Medical Center will provide any individual requesting a copy of the written report with the direct website address, or URL, where the document can be accessed. Flagstaff Medical Center will also maintain at its facilities a hardcopy of the CHNA report that may be viewed by any who request it. 9

10 Health Needs of the Community [IRS Form 990, Schedule H, Part V, Section B, 1e] Areas of Opportunity for Community Health Improvement The following health priorities represent recommended areas of intervention, based on the information gathered through this Community Health Needs Assessment and the guidelines set forth in Healthy People From these data, opportunities for health improvement exist in the region with regard to the following health areas (see also the summary tables presented in the following section). These areas of concern are subject to the discretion of area providers, the steering committee, or other local organizations and community leaders as to actionability and priority. Areas of Opportunity Identified Through This Assessment Access to Health Services Family Planning Heart Disease and Stoke Injury & Violence Prevention Mental Health & Mental Disorders Oral Health Suicides Insurance Instability Difficulty Accessing Healthcare (Composite) Cost as a Barrier to Physician Visits Having a Medical Home Routine Checkups (Adults) Preventive Cancer Screenings Ratings of Local Healthcare Births to Unwed Mothers Births to Teens Stroke Prevalence & Deaths Hypertension Prevalence High Cholesterol Screening, Prevalence & Management Unintentional Injury Deaths (Including Motor Vehicle Crashes) Violent Deaths (Including Firearm Related Deaths, Homicide & Suicide) Prevalence of Firearms (Including Homes With Children) Regular Dental Visits Dental Insurance Coverage Respiratory Diseases Pneumonia/Influenza Deaths Sexually Transmitted Diseases Chlamydia Incidence Gonorrhea Incidence Substance Abuse Cirrhosis/Liver Disease Deaths Drug Induced Deaths Illicit Drug Use 10

11 Prioritization Process [IRS Form 990, Schedule H, Part V, Section B, 1g, 6g] After reviewing the Community Health Needs Assessment findings, the Flagstaff Medical Center Senior Management Team met on Tuesday, October 23, 2012, to determine the health needs to be prioritized for action in FY2013 FY2014. During the detailed presentation of the CHNA findings, senior management members, through a process of understanding key local data findings (Areas of Opportunity) ranked identified health issues against the following established, uniform criteria: Magnitude. The number of persons affected, also taking into account variance from benchmark data and Healthy People targets. Impact/Seriousness. The degree to which the issue affects or exacerbates other quality of life and healthrelated issues. Feasibility. The ability to reasonably impact the issue, given available resources. Consequences of Inaction. The risk of not addressing the problem at the earliest opportunity. Prioritization Results From this exercise, the Areas of Opportunity were prioritized as follows: Access to Healthcare Services Heart Disease & Stroke Mental Health & Mental Disorders Respiratory Disease Injury & Violence Prevention Substance Abuse Family Planning Sexually Transmitted Diseases Oral Health Community Wide Community Benefit Planning [IRS Form 990, Schedule H, Part V, Section B, 6c 6d] As individual organizations begin to parse out the information from the 2012 Community Health Needs Assessment, it is Flagstaff Medical Center s hope and intention that this will foster greater desire to embark on a community wide community health improvement planning process. Flagstaff Medical Center has expressed this intention to partnering organizations and is committed to being a productive member in this process as it evolves. 11

12 Flagstaff Medical Center Medical Center FY2012 FY2014 Implementation Strategy For more than 75 years, Flagstaff Medical Center has demonstrated its commitment to meeting the health needs of the northern Arizona region. This summary outlines Flagstaff Medical Center s plan (Implementation Strategy) to address our community s health needs by 1) sustaining efforts operating within a targeted health priority area; 2) developing programs and initiatives to address identified health needs; and 3) promoting an understanding of these health needs among other community organizations and within the public itself. Hospital-Level Community Benefit Planning Priority Health Issues To Be Addressed In consideration of the top health priorities identified through the CHNA process and taking into account hospital resources and overall alignment with the hospital s mission, goals and strategic priorities it was determined that Flagstaff Medical Center would focus on developing and/or supporting strategies and initiatives to improve: Access to Health Services Heart Disease and Stroke Mental Health & Mental Disorders Respiratory Disease Integration with Operational/Strategic Planning [IRS Form 990, Schedule H, Part V, Section B, 6e] In FY14, Flagstaff Medical Center includes a 6 Objectives addressing Access to Healthcare and 5 objectives addressing Heart Disease and Stroke within its strategic plan. Priority Health Issues That Will Not Be Addressed & Why [IRS Form 990, Schedule H, Part V, Section B, 7] In acknowledging the wide range of priority health issues that emerged from the CHNA process, Flagstaff Medical Center determined that it could only effectively focus on those which it deemed most pressing, most underaddressed, and most within its ability to influence. 12

13 Health Priorities Not Chosen for Action Substance Abuse Oral Health Injury & Violence Prevention Family Planning and Sexually Transmitted Diseases Reason FMC has limited resources, services and expertise available to address alcohol, tobacco and other drug issues. Other community organizations have infrastructure and programs in place to better meet this need. Limited resources excluded this as an area chosen for action. FMC believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. FMC believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. FMC believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. Implementation Strategies & Action Plans [IRS Form 990, Schedule H, Part V, Section B, 6f 6h] The following displays outline Flagstaff Medical Center s plans to address those priority health issues chosen for action in the FY2013 FY2015 period. 13

14 ACCESS TO HEALTH SERVICES Community Partners Goal Outcome Measures Indian Health Organizations Local Primary Care Providers Local Healthcare organizations Clinical Integration partners Improve access to primary care Increase the number of people who have a medical home Offer cancer screenings Percent of patients successfully enrolled in new care models. Number of non emergent ED visits by FMC employees/dependents Number of new patients in new Primary Care clinic Number of participants in cancer screenings Timeframe Scope Strategies & Objectives FY2013 FY2015 High priority patients Local communities in Flagstaff Tribal communities Create collaborative continuum of care models o Define process and approve timelines for inter organizational care model development with Indian Health and other health care partners Open primary care clinic in Flagstaff o Increase the number of patients in the FMC primary care medical home. o Provide an Innovative, integrated approach to primary care and chronic disease management that will reduce utilization of ED and Inpatient Services Offer cancer screening throughout the year o Colorectal cancer screening o Skin Cancer screening o Prostate Cancer screenings o Breast Cancer self exam classes Improve the number of adults 65 and older in the Sunnyside community who are part of a medical home. Anticipated Outcomes Patients will receive on coordinated care post discharge Readmissions will be reduced Community members will have more access to primary care FMC employees and dependents will use primary care rather than ED for non emergent care Community members will be offered cancer screenings Results Pending 14

15 Heart Disease and Stroke Community Partners Goal Flagstaff Unified School District Care Coordination network Diabetes Together network Public Library Grantors Reduce CHF readmission Implement continuum of care models for CHF. Decrease the prevalence of obese/overweight children in FUSD K 5 grades. Offer community members for cholesterol, blood pressure and glucose Provide stroke education to community Outcome Measures percentage of overweight and obese children in FUSD K 5 grades % of patients appropriately enrolled each month in CHF care transitions program Number of community members screened for high blood pressure, cholesterol and glucose Number of community members educated about stroke Timeframe Scope FY2013 FY2015 Children in FUSD K 5 grades Patients with CHF. Community members Strategies & Objectives Strategy #1: Reduce 30 day Readmission Rate for Patients Following Hospitalization for CHF Strategy #2: Enroll patients with CHF in continuum care program Strategy #3: Reduce obese/overweight percentile through increased school activity time, health education and wellness promotion Strategy #4: Offer community screenings at a variety of locations and times throughout Flagstaff. Strategy #5: Provide community stroke prevention and warning signs education Anticipated Outcomes Results Reduction in CHF readmission. Established continuum of care models for CHF. The prevalence of obese/overweight children in FUSD K 5 grades will decrease. Community members will be aware of CVD risk and where they can go for follow up. Pending 15

16 Mental Health and Mental Disorders Community Partners Northern Arizona Regional Behavioral Health Authority The Guidance Center AA Coconino Justice Coalition Flagstaff Police Department Drug/DUI courts Coconino Coalition for Children and Youth Goal To reduce the burden of Mental health issues in our Flagstaff Community Outcome Measures Partnering with local agencies and organizations to reduce suicides The percentage of Flagstaff residents able to receive mental health care. Timeframe Scope FY2012 FY2014 Flagstaff community members coping with mental health issues. Community Prevention Projects FMC is involved with for Mental Health and Suicide Anticipated Outcomes Coconino Justice Coalition (CJCC): legal issues with mentally ill AA Group meetings on BHU Crisis calls from community: intake / referrals For Flagstaff Police Department o De escalation skill training o CIT: crisis intervention training NACA: Suicide Prevention Grant collaboration Health fairs Screenings o Depression o Substance abuse Internal / External to FMC debriefing crisis intervention DUI/Drug Court treatment programs Mental Health / Veteran Court hearings Title 36 (ED intake) short term crisis Trauma START: screenings and brief intervention / assessment o Referrals at discharge for patients with alcohol and drug use issues Talks and presentations for community groups RN and SW students rotate through department CPI training (de escalation) for sitters and ED staff Mental health and substance abuse information for new grads Provide meeting site for monthly National Association of Substance Abuse Counselors (NASAC) meetings Reduction in the number of suicides in our area Results Pending 16

17 Respiratory Disease Community Partners Local primary care providers Local healthcare organizations Goal Reduce the number of Pneumonia / Influenza deaths Outcome Measures The number of deaths from Influenza and Pneumonia Timeframe Scope FY2013 FY2015 FMC Employees and dependants Patients Strategy #1: All FMC employees and providers required to receive annual influenza vaccine. Strategy #2: All patients will be screened for having received annual pneumonia and influenza vaccine Strategies & Objectives Other FMC prevention strategies include: Tobacco Cessation Education Blood Borne pathogen training for victim advisors (County Health Department) Fantastic Voyage (Children education) Grade school hand washing training Hand Hygiene safety with families Infection Control Week haunted house Isolation education with patient families Local construction companies: infection prevention education Movies on the Square (community education) Nursing Homes infection prevention Thorpe Senior Center: talks Certified Asthma Educators Community Health Fairs RT, EMT, Paramedic and RN students rotate through department Anticipated Outcomes The number of deaths from Pneumonia and Influenza will decrease. Results Pending 17

18 Adoption of Implementation Strategy [IRS Form 990, Schedule H, Part V, Section B, 6a-6b] On June 4, 2013, the Board of Flagstaff Medical Center, which includes representatives from throughout the Flagstaff region, met to discuss this plan for addressing the community health priorities identified through our Community Health Needs Assessment. Upon review, the Board approved this Implementation Strategy and the related budget items to undertake these measures to meet the health needs of the community. FMC Board Approval & Adoption: By Name & Title Date 18