Joint Community Health Needs Assessment

Joint Community Health Needs Assessment 2013 Adventist Midwest Health Adventist Bolingbrook Hospital Adventist GlenOaks Hospital Adventist Hinsdale Hospital Adventist La Grange Memorial Hospital 1 P a g e

Table of Contents Project Goals... 3 Expected Outcomes... 4 Executive Summary... 5 Mission, Vision, Values... 9 A Message from Adventist Midwest Health President and CEO; David L. Crane... 11 About Adventist Midwest Health Hospitals... 12 CHNA Components... 16 CHNA Report... 17 The Adventist Midwest Health Community... 17 Adventist Midwest Health Community Benefit Assets... 25 CHNA Methodology... 30 Community and Public Health Input... 35 Prioritized Health Needs... 37 Measures and Resources to Address Identified Health Needs... 44 CHNA Contact... 46 2 P a g e

Project Goals Simply put, a Community Health Needs Assessment is the ongoing process of evaluating the health needs and assets of a community. It is systematic and it is data-driven. Assessment outcomes are analyzed to understand the health status, behaviors and needs of residents in the community. Identified health needs are prioritized so that effective plans may be put in place to address the most critical health needs. The process is perpetual. Community needs change. Well-implemented plans lead to opportunities to address other, more salient needs. One must assess needs, prioritize needs, implement a plan, assess plan effectiveness, modify the plan if indicated, and again assess the needs. Each cycle of this process, each turn of the wheel, allows an organization to drill down to a deeper understanding of how it can position itself to be the best community health asset possible. Assess Health Needs Modify the Plan, as Indicated Prioritize Needs Assess Plan Effectiveness Implement a Plan to Address Needs 3 P a g e

Expected Outcomes Community Health Needs Assessments must ultimately result in Community Benefit. It is the expectation of Adventist Midwest Health that our continued systematic approach to study Community need will continue to result in benefit to the Community. The Catholic Health Association, in A Guide for Planning and Reporting Community Benefit ISBN 0-87125-282-1, defines community benefit as programs or activities that provide treatment or promote health and healing as a response to identified community needs and meet at least one of the four objectives below. Accordingly, and in response to the force of our Mission and our commitment to the needs of our Community, our Community will appreciate direct and meaningful benefit from our hospitals in response to this Community Health Needs Assessment. Improved Access to Healthcare Services Enhance population health Advance increased general knowledge Reduce the burden of government to improve health 4 P a g e

Executive Summary Adventist Midwest Health is a network of four not-for-profit hospitals in Chicago s western and southwestern suburbs. As a part of the Adventist Health System, Adventist Midwest Health brings a long tradition of health care to Illinois and Wisconsin. Our national network of 44 campuses in 10 states makes us part of the largest not-for-profit Protestant hospital system in the country. We take a holistic, whole-person approach to wellness, providing medical and spiritual support for our patients and their families. Adventist Midwest Health includes four hospitals in Chicago s western and southwestern suburbs (Adventist Bolingbrook, Adventist GlenOaks, Adventist Hinsdale, and Adventist La Grange Memorial Hospitals), with more than 5,100 employees and more than 2,600 physicians on staff. These hospitals, clinically integrated and tied by common Community, Mission, Vision, and Values, embarked on a Community Health Needs Assessment to define and ultimately respond to the specific health needs of the Community they serve. As a not-for-profit health care organization, the four hospitals in Adventist Midwest Health embrace a rich tradition of providing benefit to the community, with the ultimate goal of improving community health and increasing access to care. All of the net income (profit margin) generated by the hospital is reinvested back into hospital programs and services. This benefits the patients and communities we serve rather than individual owners or shareholders. Under new federal regulations that govern charitable hospital organizations, a Joint Community Health Needs Assessment ( CHNA ) was conducted by the four Chicago-area Adventist Midwest Health hospitals to assist in identifying the most significant health needs of the community served. The hospitals are in the same Metropolitan Service Area ( MSA ) and collaborated to conduct a Joint Community Health Needs Assessment in 2013. The facilities worked together with the state and local health departments (three) and other partners in the MSA. The Joint Report identifies all of the collaborating hospital facilities by name on both the cover page and full report, and was approved by their respective Hospital Boards in December 2013. This CHNA will serve to guide the next phase of the Community Health Needs Assessment Process: Development of an Implementation Strategy to address these identified needs. Adventist Midwest Health Community - Defined This CHNA assessed needs specific to the four hospitals in the Adventist Midwest Health Community. Statistically significant samples of residents participated in the CHNA, representing the demographic makeup of the Community. For the purpose of this Community Health Needs Assessment, the Adventist Midwest Health Community is defined by the primary and secondary zip codes for patients who receive safety net and general acute care services at our hospitals. Safety net services are those services 5 P a g e

which generate a low or negative margin and would not be provided if the decision were based purely on financial indicators. Safety net services include psychiatric care, prenatal care, pediatric services, inpatient rehabilitation and emergency care. As a not-for-profit health care provider, our commitment is to provide these necessary services to the Community we serve despite the impact on revenue. Methodology Data collection, aggregation and analysis were completed with the goal of identifying the top presenting healthcare needs in the Adventist Midwest Health Community. The hospitals created a Community Health Needs Assessment Committee ( CHNAC ) that represented the broad community as well as low income, minority and underserved populations. The CHNAC worked with the hospitals to analyze the data and prioritize the issues to be addressed by the Adventist Midwest Health hospitals. 1. Data Collection: Many community partners were engaged to promote the collection of meaningful data. This included a partnership through the Metropolitan Chicago Healthcare Council leading to use of a third party vendor to conduct primary data collection of Community residents through telephone survey and focus groups. Adventist Bolingbrook Hospital participates actively in the Will County MAPP Collaborative, with distribution of written surveys to a representative sample of residents in the Community in order to obtain primary data relating to health priorities. Secondary quantitative and qualitative data were collated and analyzed from county, state, and national sources). Multiple focus groups and forums were held throughout the Community through the Metropolitan Healthcare Council and the Will County MAPP Collaborative. Care was taken in all data collection to promote participation by a representative sample of the community, including medically underserved, low-income and minority populations. 2. Data Aggregation: Key health indicators identified through both primary and secondary data collection were collated and presented in an excel spreadsheet so that data comparisons across sources could be made. 3. Data Analysis: Community Health Needs Assessment Committees inaugurated by Adventist Midwest Health were presented with the key health indicators (37 in total). The Committees (including hospital executives, clinical experts, hospital strategic planning and marketing staff, and community members representing the broader interests of the Community) participated in a data analysis and formal prioritization process using analysis tools to support decision-making. The key health indicators that initially fell out as potentially problematic were compared to additional secondary data sources for additional support. Input from those Served The CHNA was conducted under the premise that primary source data was mandatory (collecting first-hand data directly from the individuals living in our Community). Care was taken 6 P a g e

Prioritization to assure the individuals sampled for primary source data collection represented the Community demographics. A statistically significant threshold was met for three of the four hospitals represented in this CHNA, providing confidence that the results can be generalized to the community. For the remaining hospital, additional data collection was sought from those racial groups that were underrepresented during initial primary data collection. Multiple focus groups were held to gather community perception of health needs. Composition of focus groups, with intent, included leaders and community members who could speak directly to the needs of the medically underserved, those with low income and minority populations. Top identified needs (those needs where Hospital, County, and State outcomes were markedly lower than Healthy People 2020 goals) were the following: Access to Healthcare [lack of insurance]: Consequences of loss of health insurance include delayed diagnosis, decreased opportunities for effective treatment options at a later stage of diagnosis, greater likelihood of spread of communicable disease and health apathy. As healthcare reform unfolds, Adventist Midwest Health will be in a unique position to contribute to timely acquisition of health insurance for those with the most substantive healthcare and financial needs through partnership with the Centers for Medicare and Medicaid Services. Access to Healthcare [lack of awareness of services Adventist Bolingbrook Hospital]: Primary data collected in the Bolingbrook zip codes indicate that respondents with significant health needs are not aware of the resources in the community that are available to meet those needs. Adventist Bolingbrook Hospital s participation in the MAPP Initiative will promote community education and enhance the ability of public and private Community advocates to work collaboratively to bring services to those with the most substantive needs: the medically underserved, low-income, and minority populations. Influenza Vaccination [18-64 years]: In Illinois and Adventist Midwest Health Communities the adult population under 65 falls substantively below the Healthy People 2020 goal for receipt of the influenza vaccination. Those individuals with financial need or who lack access to care are less likely to receive the vaccine. The CDC reports that although younger adults typically experience a less severe influenza and there is less frequent hospitalization than very young and very old people, a study of 18-49 year olds (through one reported economic modeling analysis) revealed that the influenza caused five million illnesses, 2.4 million outpatient visits, thirty-two thousand hospitalizations, and 680 deaths. Impact on the individual, the Community, the healthcare system, and the Government (for those individuals receiving government funded care) is high. 7 P a g e

Pneumococcus Vaccine [65 years and older]: According to the CDC, invasive disease from pneumococcus is a major cause of illness and death in the United States, with an estimated 43,500 cases and 5,000 deaths among persons of all ages in 2009. Eighty-four percent of those who are infected and nearly all deaths occurred in adults. Individuals with financial need and decreased access to care are less likely than the insured to be vaccinated. Efforts to raise awareness and provide vaccination to those in need leads to potential for preserved health status and decreased risk for pneumonia-related hospitalization or death. A single vaccine in an underprivileged adult who would have otherwise developed pneumonia can save a life and relieve the Government of preventable and costly medical care. Hypertension [over 18 y/o): Heart disease and stroke, both caused by high blood pressure, are the first and third leading causes of death in the U.S. Twenty-eight percent of adults in Illinois have high blood pressure. Primary data collection in the Adventist Midwest Health Community reveals even higher self-reports of hypertension (up to 42% surrounding Adventist GlenOaks Hospital). The poor and those with decreased access to care are less likely to be diagnosed than those with the financial means to receive regular health checkups. The outcome for those left unchecked is escalation of disease, further damaging organ systems that results in decreased quality of life, as well as increased burden on the Government to pay for care that could have been avoided with appropriate screening. Measures and Resources The Adventist Midwest Health hospitals will develop a Community Health Plan (implementation strategy) based on the health priorities noted above. Measures of success for each identified health need priority will be developed by the Community Health Needs Assessment Committee following a full review and discussion of related implications. The Chicago Metropolitan area is home to 119 hospitals. Duplication of service and availability of like resources to meet community need is evident. Key to successfully meeting health needs identified in this CHNA is leveraging these services and resources in a manner that has the highest impact on community health with appropriate preservation of resources. To that end, Adventist Midwest Health will work collaboratively with Community Partners to implement improvement strategies in a meaningful way. Mechanisms of partnership include active participation in Metropolitan Chicago Healthcare Council efforts to unite providers across the Chicago Metro area to align benefit activities. Additionally, work through the County Health Departments MAPP Initiatives provides both resources and informational guidance to promote benefit to the Community for selected measures. 8 P a g e

Our Vision Adventist Midwest Health is an integrated health care system of outstanding quality. We work as a partner with patients, families, and healers to achieve optimal health for our patients and the communities we serve. We provide unsurpassed value by using practices based on the most up-todate evidence and by coordinating comprehensive care for every patient in a highly personal environment. Our Mission 9 P a g e

Our Values Excellence: For quality care and service with optimal outcomes that seek to exceed patient expectatation Christian Service Motivation: Offering compassion, respect, and the belief that every life has value. Stewardship: Enhancing staff development, nurturing the environment, conserving resources, and offering value for services Integrity: That generates trust, and offers consistency in decision-making. 10 P a g e

Our Community; Our Commitment By David L. Crane, President/Chief Executive Officer, Adventist Midwest Health Every live man with a gift must divide it with others, or pay the penalty of having it shrink away and finally shrivel up altogether it is what we give away that we really keep. Dr. David Paulson; Founder Adventist Hinsdale Hospital (1904) Within Adventist Midwest Health hospitals, there is a special effort in place to create memorable experiences for our patients and for our community. We want those we serve to feel God s compassion, grace and truth through our hands, giving them hope and healing. We call this effort Transforming Care ~ Transforming Lives. But what does this really mean? When Jesus healed, he focused on transforming the lives of those he touched. This is our commitment to our patients and our community. We want to transform lives through the care, compassion and expertise provided by our employees, nurses and physicians. Each day, these care providers apply the gifts they bring to make a positive change in peoples lives. This is such an important assignment. It s not one I take lightly. In order to fulfill our mission of extending the healing ministry of Christ, we work as partners to achieve optimal health for our patients and the community we serve. We do this in the midst of a changing healthcare environment. Reimbursement changes and reform are creating a highly competitive healthcare market demanding that hospitals reduce costs and improve quality and safety. Hospitals that don t change to meet new industry demands will not survive. We have a once in a lifetime chance to re-create our organization so we can survive in this radically new healthcare environment and continue our commitment to our patients and to community. 11 P a g e

About our Hospitals: Adventist Bolingbrook Hospital Bolingbrook, IL Rick Mace, CEO/President Adventist Bolingbrook Hospital opened in 2008 as the first new hospital to be built in Illinois in more than 25 years. This state-of-the-art facility has 138 beds (all private rooms) and specializes in cardiac care, interventional radiology, orthopedics, surgery, oncology and women s care. The Emergency Department is among the top 5 percent in the nation according to HealthGrades, placing the hospital in an exclusive group of high-performing hospitals; providing confidence to individuals in the Community with emergent medical needs that quality care is readily available, regardless of their ability to pay. Recent designation as a Chest Pain Center augments the available emergency services. The hospital opened its new wound care center in 2013 and has also established an agreement with VNA Health Care to offer a Federally Qualified Health Center on the hospital campus to provide care for the uninsured and underinsured. 2012 Statistics: 138 beds Inpatient Admissions: 5,419 Outpatient Visits: 46,741 12 P a g e

About our Hospitals: Adventist GlenOaks Hospital Glendale Heights, IL Bruce C. Christian, CEO/President Adventist GlenOaks Hospital has served Chicago s western suburbs for more than 30 years in Glendale Heights. The 146-bed hospital offers a full range of services including emergency care, surgery, cardiology, oncology, obstetrics, behavioral health, interventional radiology, orthopedics and more. The Therapeutic Day School provides an environment for students in third grade through high school that blends academic education with therapies that nurture each student s emotional growth and independence. The hospital is an accredited Chest Pain Center and certified Primary Stroke Center. As the only Disproportionate Share Hospital in DuPage County, the hospital is a safety net for the most vulnerable and underserved populations providing care many patients cannot access elsewhere. 2012 Statistics: 146 beds Inpatient Admissions: 4,975 Outpatient Visits: 15,386 13 P a g e

About our Hospitals: Adventist Hinsdale Hospital Hinsdale, IL Michael J. Goebel, CEO/President For more than a century, Adventist Hinsdale Hospital has provided superior health care with Christian compassion. The hospital s new $75 million patient pavilion, which opened in 2012, features private suites and an environment that promotes comfort and healing. The 276-bed hospital is an accredited Chest Pain Center and certified Primary Stroke Center, and a comprehensive Breast Care Center. The hospital offers highly-specialized services and technologies to treat a variety of serious health concerns such as heart disease, cancer, stroke, neurological issues, orthopedic problems and pediatric conditions. The hospital has a Level III Neonatal Intensive Care Unit and the da Vinci Robotic surgical system. It is the only teaching hospital in DuPage County. 2012 Statistics: 276 beds Inpatient Admissions: 13,000 Outpatient Visits: 165,000 14 P a g e

About our Hospitals: Adventist La Grange Memorial Hospital La Grange, IL Lary Davis, CEO/President Since its opening in 1955, Adventist La Grange Memorial Hospital has maintained a high level of medical excellence in the community. The 205-bed hospital is a leader in comprehensive oncology services, advanced cardiac care, women s health and maternity care, emergency and geriatrics. The hospital is an accredited Chest Pain Center, a certified Primary Stroke Center and a comprehensive Breast Care Center. The hospital has been named a Top Performer on Key Quality Measures by the Joint Commission for exemplary performance in the areas of heart attack, heart failure, pneumonia and surgical care. The hospital offers the da Vinci Robotic surgical system, physicial rehabilitation services and is a family medicine teaching hospital. 2012 Statistics: 205 beds Inpatient Admissions: 8,400 Outpatient Visits: 67,000 15 P a g e

Community Health Needs Assessment Adventist Midwest Health: 2013 Community Health Needs Assessment Assessment Report Components This Community Health Needs Assessment Report documents steps taken by the four Adventist Midwest Health hospitals to capture representative, reliable, and comprehensive information on the health needs and assets of our Communities. The Report, in total, provides readers with a comprehensive view of presenting health needs and Adventist Midwest Health s identified priorities for taking action. It also serves as an organizational tool for developing a plan to address identified needs and ultimately effectively guiding benefit to most appropriately impact our Community s health. Report components are below. AMH Community Defined Current Community Benefit Assets Assessment Methodology Community Input Obtained Prioritized Health Needs Existing Resources to Meet Needs 16 P a g e

The Adventist Midwest Health Community Bear one another s burdens, and so fulfill the law of Christ. Galatians 6:2 Our Community - Defined For the purpose of this Community Health Needs Assessment, the Adventist Midwest Health Community is defined by the primary and secondary zip codes for patients who receive safety net and general acute care services at our hospitals. Safety net services are those services which generate a low or negative margin and would not be provided if the decision was based purely on financial indicators. Safety net services include psychiatric care, prenatal care, pediatric services, inpatient rehabilitation and emergency care. As a not-for-profit health care provider, our commitment is to provide these necessary services to the Community we serve despite the fact that revenue is not appreciated. 80% of the patients receiving care at Adventist Midwest Health live within our Primary and Secondary service areas. Primary Service Area: The primary service area is based on the first sixty percent (60%) of our patients origin. Secondary Service Area The secondary service area represents the next twenty percent (20%) of our patients origin. The four AMH hospitals are located in Cook, DuPage and Will Counties. The zip codes are noted in the chart below. 17 P a g e

Adventist Midwest Health Primary and Secondary Zip Codes 60101 ADDISON PRIMARY 60558 WESTERN SPRINGS PRIMARY 60108 BLOOMINGDALE PRIMARY 60559 WESTMONT PRIMARY 60139 GLENDALE HEIGHTS PRIMARY 60561 DARIEN SECONDARY 60154 WESTCHESTER PRIMARY 60126 ELMHURST SECONDARY 60188 CAROL STREAM PRIMARY 60133 HANOVER PARK SECONDARY 60439 LEMONT PRIMARY 60137 GLEN ELLYN SECONDARY 60440 BOLINGBROOK PRIMARY 60148 LOMBARD SECONDARY 60446 ROMEOVILLE PRIMARY 60162 HILLSIDE SECONDARY 60458 JUSTICE PRIMARY 60172 ROSELLE SECONDARY 60480 WILLOW SPRINGS PRIMARY 60181 VILLA PARK SECONDARY 60490 BOLINGBROOK2 PRIMARY 60185 WEST CHICAGO SECONDARY 60501 SUMMIT ARGO PRIMARY 60187 WHEATON SECONDARY 60513 BROOKFIELD PRIMARY 60402 BERWYN SECONDARY 60514 CLARENDON HILLS PRIMARY 60435 JOLIET SECONDARY 60515 DOWNERS GROVE PRIMARY 60441 LOCKPORT SECONDARY 60516 DOWNERS GROVE2 PRIMARY 60455 BRIDGEVIEW SECONDARY 60517 WOODRIDGE PRIMARY 60457 HICKORY HILLS SECONDARY 60521 HINSDALE PRIMARY 60532 LISLE SECONDARY 60523 OAK BROOK PRIMARY 60546 RIVERSIDE SECONDARY 60525 LA GRANGE PRIMARY 60563 NAPERVILLE SECONDARY 60526 LA GRANGE PARK PRIMARY 60564 NAPERVILLE2 SECONDARY 60527 WILLOWBROOK PRIMARY 60565 NAPERVILLE3 SECONDARY 60534 LYONS PRIMARY 60585 PLAINFIELD2 SECONDARY 60544 PLAINFIELD PRIMARY 60586 PLAINFIELD3 SECONDARY 60638 CHICAGO SECONDARY 18 P a g e

Adventist Midwest Health Primary and Secondary Service Areas Adventist Midwest Health lies within a highly-populated suburban area beginning just west of the third largest city in the United States (Chicago, IL). Healthcare service providers in the Primary and Secondary Service Areas are, accordingly, many and varied, with 9 hospitals in our service area [see below]. Primary Service Area Secondary Service Area AMH Facilities Non-AMH Hospitals/Facilities 19 P a g e

The Greater Chicago Healthcare Market Expanding beyond the Primary and Secondary Service Areas (see below), the Chicago Metropolitan area is home to 119 Hospitals, each with an obligation to serve the Communities they serve. Shared ownership of community wellness through planned partnerships promotes health outcomes in an effective and efficient manner. Population Growth 2000-200 More than 30% 20% - 30% 10% - 20% 0% - 10% Less than 0% + + 1 2 Academic Medical Centers Advocate Alexian Brothers (Ascension) Loyola (Trinity) RHC - Provena Centegra CDH Delnor Vanguard Other 20 P a g e

Our Community Residents HOSPITAL Primary Service Area Primary Inpatient Service Lines Age [Projected Growth by 2016] Race/Ethnicity [Projected Growth by 2016] Adventist Bolingbrook Bolingbrook, Woodridge, Lemont, Romeoville, and Plainfield. General Medicine [28.4%] Cardiac Services [26.4%] 0-17 years [5.7%] 18-44 years [1.8%] 45-64 years [14.5%] Hispanic [30%] Asian [23%] Multiracial [18%] Obstetrics [23.8%] 65+ YEARS [21.6%] Black [13%] Adventist GlenOaks Glendale Heights, Bloomingdale, Addison, and Carol Stream. General Medicine [14.7%] Cardiac Services [16.7%] 0-17 years [-3.5%] 18-44 years [-4.9%] 45-64 years [-4.8%] Pacific Islander [22%] Native American [21%] Obstetrics [22.6%] 65+ YEARS [21.6%] Black [16%] Hispanic [14%] Adventist Hinsdale Hinsdale, Oak Brook, Westchester, La Grange Park, Brookfield, La Grange, Willowbrook, Darien, Clarendon Hills, Westmont, Woodridge and Downers Grove. General Medicine [22.7%] Cardiac Services [22.3%] Obstetrics [32.9%] 0-17 years [-2.7%] 18-44 years [-2.5%] 45-64 years [-2.15] 65+ YEARS [11.7%] Asian [20%] Native American [16%] Hispanic [13%] Black [13%] Adventist La Grange Memorial La Grange, La Grange Park, Westchester, Brookfield, Lyons, Summit/Argo, Justice, Willow Springs, Willowbrook and Western Springs. General Medicine [38.8%] Cardiac Services [40.8%] Obstetrics [16.9%] 0-17 years [.6%] 18-44 years [-3.2%] 45-64 years [-2.3] 65+ YEARS [8.2%] Native American [12%] Hispanic [12%] Multiracial [11%] Black [7%] Notable projected trends across the Adventist Midwest Health Community in the next three years include substantive growth in individuals 65 years and over, limited growth in the percentage of children, and an increase in racial diversity. 21 P a g e

US Census Data DuPage County Median age (years) 38.2 ( X ) 16 years and over 717,588 78.3 18 years and over 689,494 75.2 21 years and over 656,171 71.6 62 years and over 135,104 14.7 65 years and over 106,398 11.6 RACE Number Percent Total population 916,924 100.0 One Race 896,528 97.8 White 714,140 77.9 Black or African American 42,346 4.6 American Indian and Alaska Native 2,415 0.3 Asian 92,304 10.1 Asian Indian 42,233 4.6 Chinese 13,092 1.4 Filipino 15,254 1.7 Japanese 1,369 0.1 Korean 4,758 0.5 Vietnamese 3,747 0.4 Other Asian [1] 11,851 1.3 Native Hawaiian and Other Pacific Islander 217 0.0 Native Hawaiian 50 0.0 Guamanian or Chamorro 47 0.0 Samoan 28 0.0 Other Pacific Islander [2] 92 0.0 Some Other Race 45,106 4.9 INCOME and BENEFITS (IN 2011 INFLATION-ADJUSTED DOLLARS) Number Percent Total households 335,651 335,651 Less than $10,000 10,554 3.1% $10,000 to $14,999 8,192 2.4% $15,000 to $24,999 20,974 6.2% $25,000 to $34,999 25,263 7.5% $35,000 to $49,999 37,669 11.2% $50,000 to $74,999 59,441 17.7% $75,000 to $99,999 49,399 14.7% $100,000 to $149,999 62,355 18.6% $150,000 to $199,999 29,651 8.8% $200,000 or more 32,153 9.6% Median household income (dollars) 77,598 (X) Mean household income (dollars) 103,296 (X 22 P a g e

US Census Data Cook County Median age (years) 35.3 Percent 16 years and over 4,108,936 79.1 18 years and over 3,962,395 76.3 21 years and over 3,750,384 72.2 62 years and over 766,376 14.8 65 years and over 620,329 11.9 RACE Number Percent Total population 5,194,675 100.0 One Race 5,062,905 97.5 White 2,877,212 55.4 Black or African American 1,287,767 24.8 American Indian and Alaska Native 21,559 0.4 Asian 322,672 6.2 Asian Indian 93,730 1.8 Chinese 62,392 1.2 Filipino 64,349 1.2 Japanese 11,446 0.2 Korean 37,008 0.7 Vietnamese 13,522 0.3 Other Asian [1] 40,225 0.8 Native Hawaiian and Other Pacific Islander 1,724 0.0 Native Hawaiian 430 0.0 Guamanian or Chamorro 542 0.0 Samoan 202 0.0 Other Pacific Islander [2] 550 0.0 Some Other Race 551,971 10.6 INCOME AND BENEFITS (IN 2011 INFLATION-ADJUSTED DOLLARS) Number Percent Total households 335,651 335,651 Less than $10,000 10,554 3.1% $10,000 to $14,999 8,192 2.4% $15,000 to $24,999 20,974 6.2% $25,000 to $34,999 25,263 7.5% $35,000 to $49,999 37,669 11.2% $50,000 to $74,999 59,441 17.7% $75,000 to $99,999 49,399 14.7% $100,000 to $149,999 62,355 18.6% $150,000 to $199,999 29,651 8.8% $200,000 or more 32,153 9.6% Median household income (dollars) 77,598 (X) Mean household income (dollars) 103,296 (X) 23 P a g e

US Census Data Will County Median age (years) 35.4 ( X ) 16 years and over 503,512 74.3 18 years and over 480,606 70.9 21 years and over 454,661 67.1 62 years and over 80,601 11.9 65 years and over 62,814 9.3 RACE Number Percent Total population 677,560 100.0 One Race 662,104 97.7 White 514,664 76.0 Black or African American 75,743 11.2 American Indian and Alaska Native 1,703 0.3 Asian 30,833 4.6 Asian Indian 11,100 1.6 Chinese 3,729 0.6 Filipino 8,191 1.2 Japanese 342 0.1 Korean 1,824 0.3 Vietnamese 1,086 0.2 Other Asian [1] 4,561 0.7 Native Hawaiian and Other Pacific Islander 136 0.0 Native Hawaiian 36 0.0 Guamanian or Chamorro 30 0.0 Samoan 14 0.0 Other Pacific Islander [2] 56 0.0 Some Other Race 39,025 5.8 INFLATION-ADJUSTED DOLLARS) Number Percent Total households 335,651 335,651 Less than $10,000 10,554 3.1% $10,000 to $14,999 8,192 2.4% $15,000 to $24,999 20,974 6.2% $25,000 to $34,999 25,263 7.5% $35,000 to $49,999 37,669 11.2% $50,000 to $74,999 59,441 17.7% $75,000 to $99,999 49,399 14.7% $100,000 to $149,999 62,355 18.6% $150,000 to $199,999 29,651 8.8% $200,000 or more 32,153 9.6% Median household income (dollars) 77,598 (X) Mean household income (dollars) 103,296 (X) 24 P a g e

Community Benefit Assets Seek the peace and prosperity of the city to which I have carried you because if it prospers, you too will prosper. Jeremiah 29:7 Adventist Midwest Health Community Health Commitment Adventist Midwest Health has a rich tradition of Community giving. We are committed advocates of our Community s health. AMH Community Health Commitment Individuals with financial need are prioritized for healthcare service As a not-for-profit healthcare provider, we have a duty to improve community health The AMH Community Benefit Program is guided in collaboration with health resources available in the Community The AMH Community Benefit Program is synchronized with strategic initiatives AMH leaders must be engaged advocates for the Community Benefit Program 25 P a g e

Prioritizing Health Service for those in Poverty Medically Underserved Population: The community of Bolingbrook was designated by the Federal Government as a Medically Underserved Population ( MUP ) in 2003. Medically underserved populations include populations experiencing health disparities or at risk of not receiving adequate medical care as a result of being uninsured or underinsured or due to geographic, language, financial or other barriers. Adventist Bolingbrook Hospital was built in 2008 in response to this designation, replacing a free-standing emergency department with a hospital that operates a breadth of safety net services that are now available to these underserved individuals in the community. Federally-Qualified Healthcare Center: In partnership with the VNA, Adventist Bolingbrook Hospital opened a Federally-Qualified Healthcare Center ( FQHC ) at the Hospital in 2013. FQHCs provide access to primary care in areas where primary care resources are constrained. Family Practice Medicine Programs: Adventist Hinsdale and Adventist La Grange Memorial Hospitals each operate a Family Medicine Center. These centers are staffed by Resident Program Faculty and up to fifty Family Practice Residents, serving patients in Western Cook and DuPage Counties with significant financial need and decreased access to care. A high percentage of Medicaid patients are seen in these clinics. The Hinsdale Family Medicine Center currently provides more free-of-charge immunizations to children in DuPage County than any other health care provider. Disproportionate Share Hospital: Adventist GlenOaks Hospital is the only designated Disproportionate Share Hospital ( DSH ) in DuPage County, serving the healthcare needs of a high percentage of Medicaid patients requiring inpatient stays. Community Partnerships Adventist Midwest Health has engaged in meaningful partnerships with Community providers to best meet the needs of those served. Integration of cross-organizational strengths provides a complement of unique services, with depth and breadth to reach specific Community need. Access DuPage is a collaborative and unique partnership of hospitals, physicians, local government, human services agencies, and community groups working together locally to address the national health care crisis. Individuals with limited access to care have healthcare opportunities that would not otherwise be met. Adventist Hinsdale Hospital supports Access DuPage through subsidies and through care provision to those in need at no cost (this occurs through inpatient service, outpatient service, and through the Family Medicine Center). With the advent of the Healthcare Exchange and Medicaid expansion, there are anticipated changes in this unique and beneficial healthcare collaborative. 26 P a g e

Illinois Department of Public Health Breast and Cervical Cancer Screening Program: The Hinsdale Family Medicine Center participates in cooperation with the Illinois Department of Public Health in a Breast and Cervical Cancer Screening Program. This program provides free cancer screening to individuals with health need who are financially unable to pay for service. The Aging Resource Center ( ARC ) Program: ARC is offered through Aging Care Connections and is a grant-based healthcare program located within Adventist La Grange Memorial Hospital. ARC liaisons work closely with hospital case managers and discharge planners to provide older adults and their families with a unique plan for transition to home by linking them to necessary community resources prior to discharge. This proactive approach, with integrated care from the inpatient care team and the ARC liaisons, has provided benefit to thousands of patients and their families, with the ultimate goal of linking patient/family to community support services, better management of chronic disease and decreased readmissions to the hospital. Community Nurse Health Association: Community Nurse Health Association serves as a community healthcare center for residents of the western suburbs of Chicago, focusing on those who have limited access to care. Adventist La Grange Memorial Hospital collaborates with this organization to provide healthcare to uninsured patients treated at the center who require acute care services. Additionally, Adventist La Grange Memorial Hospital Family Practice Residency Program has a 20-year history of providing clinic services through this clinic. Open ARMS Breast Cancer Outreach Fund In partnership with Adventist Hinsdale Hospital, the Hinsdale Hospital Foundation Open Arms fund was established in 2011 to support breast cancer patients and their families by funding programs that bring hope and healing as they help patients and families navigate the difficult journey through cancer diagnosis, treatment, and recovery. Donations to the Open Arms Fund make possible the best diagnosis, technology, and treatment programs to optimize the lives of those individuals in the community who have been diagnosed with breast cancer. Proceeds from the Open Arms Fund in 2012 were directed to Adventist Hinsdale Hospital for providing free mammograms to 40 women over the age of 40 who don t have health insurance. Wellness House The Wellness House is a community-based organization that provides education, support and empowerment to enrich the physical and emotional lives of individuals with cancer and their families. It is located in Hinsdale, Illinois, offered at no cost to participants, and is a complement to medical treatment; treatment received through the comprehensive services of Adventist Midwest Health providers. Through donations and participation in community events and sponsorships, Adventist Hinsdale Hospital extends its Mission into the important work of this organization that touches the lives of so many. Association of Physicians of Pakistani Decent of North America (APPNA Clinic) The Pakistani Descent Physician Society IL (PPS), in corporation with Association of Pakistani Descent Physicians of North America, opened a free health clinic in the Adventist Hinsdale Hospital service area 27 P a g e

in 2009. Free primary healthcare services are provided in this clinic to individuals in the community who have limited access to care. Patients requiring further diagnostic testing are referred to Adventist Hinsdale Hospital, where free diagnostic services are provided based on the financial need of the patient. Education 1. Family Practice Residency Programs: Adventist Hinsdale and Adventist La Grange Memorial Hospitals support the educational needs of nearly 50 Family Practice Residents through two separate Family Practice Residency Programs. The Hinsdale Program is the only Family Practice Residency Program in DuPage County. The educational support of Family Practice Physicians is critical. These family doctors care for the entire span of generations; the minimally ill and the terminally ill. The number of medical school graduates in the U.S. who choose primary care is half of what it was in 1999. A recent study published in the Annals of Family Medicine predicts that due to population growth/aging and insurance expansion, the number of primary care office visits will increase significantly through 2025 (from 462 million in 2008 to 565 million in 2025). This translates into a 2025 need for an additional 52,000 primary care physicians. (Annals of Family Medicine; November/December 2012; Volume 10 no. 6 pp. 503-509). According to The Department of Health and Human Services Strategic Plan, more than 64 million people currently live in a primary-care health professional shortage area (http://www.hhs.gov/secretary/about/goal5.html). 2. Clinical Affiliation Experience: The Department of Health and Human Resource identifies the following critical healthcare shortages: primary care physicians, nurses, behavioral health and long-term care workers, as well as public health and human service professionals. At the same time, need for healthcare is increasing as the population ages and as quality of care concerns become front and center in a pay for performance healthcare model. Adventist Midwest Health contracts with 96 colleges/universities to provide a site for clinical training of healthcare professionals at no charge (with over 100,000 hours of training provided to nurses and allied health professionals in 2012). Physicians, nurses and other allied healthcare providers have the opportunity to develop clinical skills necessary to enter the workforce at this time when a shortage of skilled healthcare workers is evident. Research Through research the most promising treatments and cures are discovered. Research is an important public good in the health care system; a place where translational knowledge emerges from scientific research, underpinning the quality of care provided to the community at large. Adventist Midwest Health supports an active research program, with oversight of nearly 200 clinical trials in 2012. 28 P a g e

Community Benefit Provided in 2012 Charity Care: $13,192,987 Language Assistance Services: $331,117 Government-sponsored Indigent Healthcare: $54,735,470 Subsidized Health Services: $786,945 Bad Debt: $2,517,101 Donations: $877,647 Volunteer Services: $486,627 Education: $11,285,002 Research: $505,206 Other: $2,548, 537 Total Community Benefit (2012): $87,266,639 29 P a g e

Assessment Methodology Data Sources To enrich knowledge of the health status and assets in the Adventist Midwest Health Community, an eclectic approach to data gathering was sought. This allowed for collecting first-hand data that both described our Community thoughts about health needs, and quantified those needs using statistically sound analysis. It also provided a chance to build on the solid research analysis methodology from our secondary data sources charged with measuring population health. The result is a comprehensive, integrated picture that provides a base from which to build meaningful benefit. Quantitative Data Primary Data Secondary Data Numeric Qualitative Data Descriptive New; First-hand Already Published Our Community Health Needs Assessment Partners: Primary Data Sources: Quantitative and Qualitative Data 1. Metropolitan Chicago Healthcare Council: Adventist GlenOaks, Hinsdale and La Grange Memorial Hospitals partnered with the Metropolitan Chicago Healthcare Council, and Professional Research Consultants ( PRC ), as a subcontracted vendor, to promote comprehensive and statistically sound methods of assessing the needs of the Adventist Midwest Health Community. The survey instrument used is based on the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Other public health surveys and customized questions were developed by PRC relative to health promotion and disease prevention (See Appendix A for a list of questions from the survey instrument). PRC collected primary research from the AMH-defined community using random-sampling telephone surveys, which are considered to provide the most reliable and timely information regarding an individual s health status and 30 P a g e

needs. Focus was placed on the individual s experience and behaviors that are both geographically and demographically sensitive. The sample design used consisted of a stratified random sample of individuals aged 18 years and older in the Adventist GlenOaks, Adventist Hinsdale, and Adventist La Grange Memorial Hospital service areas. Sample size follows: 224 for Adventist GlenOaks Hospital; 361 for Adventist Hinsdale Hospital; and 202 for Adventist La Grange Memorial Hospital. Following data collection, the sample was weighted in proportion to the actual population distribution at the ZIP Code level so that estimates reflect the area as a whole. All administration of the surveys, data collection and data analysis were conducted by PRC. The sample design and the quality control procedures used in the data collection promote a representative sample. Findings of this research may be generalized to the total population of community members with a high degree of confidence. This data was augmented with primary data from focus groups and community health panels, allowing for a broader reach into the communities. Focus groups for Cook County (Adventist La Grange Memorial Hospital) and DuPage County (Adventist GlenOaks and Adventist Hinsdale Hospital) occurred on June 21 st, 2012 and June 19 th, 2012 respectively. There was added benefit of discussionbased input from a pre-selected list of community stakeholders who, because of position, have an ability to identify primary health concerns of the related community. A list of recommended participants to be included in the focus groups was provided by the Metropolitan Chicago Healthcare Council, with input from Chicago Metropolitan Hospital constituents. Participants included representatives of public health, individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. 2. Will County Department of Public Health Collaborative: Adventist Bolingbrook Hospital participated actively in the Will County MAPP Collaborative, providing a rich base of both primary and secondary data useful in determining health priorities of the Community. MAPP is a community-wide strategic planning tool used for improving public health by helping communities prioritize public health issues, identifying resources for addressing those issues, and taking action. The Will County Collaborative is a county-wide effort which includes members from a variety of sectors including public health, medical, behavioral health, social services, education, business, government, faith based, and law enforcement. Community Health Needs Assessment was completed through focus groups and through distribution of written surveys. 31 P a g e

Focus Groups: Focus groups were conducted with a variety of service providers; employees of corporations; major donors; and clients of service provider agencies; community leaders; African American communities, Hispanic communities, and Faith-based communities. Two-hundred twenty workers and residents participated, representing all sectors of the county. A concerted effort was made to include minorities, the underserved, and those with less than a college education. Community Member Surveys: Four primary assessments were conducted through the Will County MAPP initiative: Community Health Status Assessment, Forces of Change Assessment, Local Public Health Systems Assessment, and the Community Themes and Strengths Assessment. 5000 surveys were sent to a random sample of Will County residents. Four-hundred sixty-six surveys were returned. Additional surveys were distributed in the African American and Hispanic communities. One percent of respondents were under the age of 25. The racial breakdown of White and Asian respondents closely represented the demographics of the county, while the African American and Hispanic individuals were underrepresented. Secondary Data Sources: A variety of secondary data, both qualitative and quantitative was accessed to complement the research generated by PRC (for Adventist GlenOaks, Hinsdale and La Grange Memorial Hospital) and the Will County MAPP initiative, by Adventist Bolingbrook Hospital. Data was collected at the County level, the State level, the Federal level (through the Centers for Disease Control, the local health departments, Healthy People 2020, the Behavioral Risk Factor Surveillance System, National Health and Nutrition Examination Survey, and US Census Data). 1. Local Health Departments: Public health surveillance provides for ongoing, systematic collection of data for use in public health action. In order for local health departments in the State of Illinois to become certified by the Illinois Department of Public Health, they are required, per 77 IL Administrative Code Section 600.410, to complete an Illinois Project for Local Assessment of Needs ( IPLAN ) or similar planning process. The process must involve community participation in order to identify community health problems, set priorities, and implement a community health plan to address these priorities. The planning process used by the three county health departments serving the Adventist Midwest Health Community (Will, DuPage, and Cook) is called 32 P a g e

MAPP Mobilizing for Action through Planning and Partnership. MAPP is a community-wide strategic planning tool used for improving public health by helping communities prioritize public health issues, identifying resources for addressing those issues, and taking action. Community-based planning promotes community ownership, creates an infrastructure of broader support and looks to the strengths/weaknesses of the local public health system [not solely the function of the local health department]. Thus, Adventist Midwest Health has a role in participating in MAPP processes, understanding MAPP outcomes and participating in local health department recommended actions to improve community health status. A key component of the MAPP process is to minimize health disparities within the community served. Four assessments are completed as part of the MAPP process: (1) The Local Public Health System Assessment; (2) The Community Themes and Strengths Assessment; (3) The Forces of Change Assessment; and (4) The Community Health Status Assessment. 2. Healthy People 2020: Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to: A. Encourage collaborations across communities and sectors. B. Empower individuals toward making informed health decisions. C. Measure the impact of prevention activities Measurable objectives and goals are developed through Healthy People 2020, providing a benchmark for comparing Adventist Midwest Health Community Health Needs Assessment outcomes and guiding selection of health need priorities and outcome expectations. 3. Behavioral Risk Factor Surveillance System: In 1984, the Centers for Disease Control and Prevention (CDC) initiated the state-based Behavioral Risk Factor Surveillance System (BRFSS)--a cross-sectional telephone survey that state health departments conduct monthly via phone with a standardized questionnaire and technical assistance from CDC. BRFSS is used to collect prevalence data among adult U.S. residents regarding their risk behaviors and preventive health practices that can affect their health status. Respondent data are forwarded to CDC to be aggregated for each state, returned with standard tabulations, and published at year's end by each state. Over 350,000 adults are interviewed each year. 33 P a g e

4. National Health and Nutrition Examination Survey: This survey is designed to assess the health and nutritional status of adults and children in the United States. The survey combines interviews and physical exams, providing information on undiagnosed diabetes, caloric intake, elevated blood levels, etc. 5. US Census Bureau: US Census online tool was used to access quantitative data defining the counties in which Adventist Midwest Health hospitals reside. 34 P a g e

Community and Public Health Input Community and Public Health input is imperative in any Community Health Needs Assessment process. Perceived and demonstrated needs necessarily guide more focused assessments, prioritization of needs, and implementation plans. Input should be representative, assuring the broad interests of the community are addressed. Persons with Special Knowledge of or Expertise in Public Health: Public Health input was obtained in the following ways: 1. Adventist Bolingbrook Hospital full integration into the MAPP Planning Process through the Will County Department of Public Health. As noted above focus groups, including 220 individuals, were conducted with a variety of service providers, employees of corporations, major donors and clients of service provider agencies, community leaders, African American, Hispanic and Faith-based communities. 2. Key Informant Focus Groups: As part of the Community Health Needs Assessment process for Adventist GlenOaks, Hinsdale and La Grange Memorial Hospitals, four focus groups were held through Professional Research Consultants. In total, 31 key informants took part, including physicians, other health professionals, social service providers, and other community leaders. Each county-level group included representatives with expertise in public health. 3. Adventist Hinsdale sub-committee participation on the DuPage County Department of Public Health MAPP initiative. Local Health Departments with Current Data Relevant to the Health Needs of the Community Serviced Full access to and integration of Public Health surveillance and assessment findings was completed to guide assessment activities, provide comparative data, and assist in prioritization of health needs. Top health priorities identified by Adventist Midwest Health County Health Departments follow: Cook County Du Page County Will County Chronic Disease Prevention Overweight/Obesity Access to Healthcare Sexual Health Improvement - Access to Healthcare Services Asthma Youth Violence Prevention Youth Mental Health Mental Health Violence Access to Healthcare Services Infectious Disease Obesity Diabetes Behavioral Health and Substance Abuse 35 P a g e

Leaders, Representatives, or Members of Medically Underserved, Low-income, and Minority Populations, and Populations with Chronic Disease Needs in the Community Served by the Hospital 1. Key informant groups noted above included community leaders and social service providers representing and serving the medically underserved, minority, and chronic disease communities. Focus groups for Cook County (Adventist La Grange Memorial Hospital) and DuPage County (Adventist GlenOaksand Adventist Hinsdale Hospital) occurred on June 21 st, 2012 and June 19 th, 2012 respectively. 2. Primary data collection was completed through telephone survey, reaching a representative sample of the Adventist Midwest Health primary and secondary service areas. This includes members of the community who are medically underserved, low-income, minorities and who have chronic disease needs. 3. Participation of community representatives on internal hospital operations committee charged with oversight of the Community Health Needs Assessment process. 36 P a g e

Prioritized Health Needs Data Analysis Assessment findings compiled from primary and secondary data sources were analyzed both in isolation and through comparison of like measures. A spreadsheet was developed isolating each key health indicator from across the reported health surveys. A determination was made whether the key indicator measure was exact across the reported health surveys (e.g. the percentage of individuals between 18 and 64 years of age stating that they lack health insurance coverage) or relatable (e.g. age-adjusted cancer deaths, in which measurement criteria may have differed for the same key indicator topic across reported health surveys). The result is a comprehensive spreadsheet of thirty-eight (38) key health indicators comparing Adventist Midwest Health primary data with the health surveys below (See Appendix B): Healthy People 2020 Illinois Survey Data US Survey Data DuPage County Health Department Data Cook County Health Department Data Adventist Bolingbrook Hospital Primary and Secondary Data Collection through the Will County MAPP Initiative Adventist GlenOaks Hospital Primary Data Collection Adventist Hinsdale Hospital Primary Data Collection Adventist La Grange Memorial Hospital Primary Data Collection Following comprehensive review of data outcomes, trends were identified and comparative analysis was initiated by the Community Health Needs Assessment Committee, with keen focus on key indicators that fell substantively short of Healthy People 2020 goals. Data and information from the County Health Department MAPP initiatives was collated and related to above surveys, as well as the above-noted National Surveys (Behavior Risk Factor Surveillance System and National Health and Nutrition Examination Service). This additional comparative analysis provided a basis for further understanding needs and recommendations for serving individuals residing within the Counties for each Adventist Midwest Health Hospital. The data analysis was augmented with integration of internal hospital data supporting the hospital s key strategic initiatives, and how these initiatives may tie to opportunities to benefit the Community (see below). 37 P a g e

Chronic Disease Prevention [hypertension, blood cholesterol] Summary of Comparative Analysis of Key Health Indicators Primary Data Collection Secondary Data Internal Hospital Data X X X Youth Services X X X Cancer Treatment X X Violence Prevention X Access to Healthcare Services X X Awareness of Services X Behavioral Health and Substance Abuse X X Diabetes Pneumococcus Vaccination X X Priority Selection 1. Community Health Needs Assessment Committee Following data collection and initial analysis, Adventist Midwest Health Hospitals formed a Community Health Needs Assessment Committee (Adventist GlenOaks, Hinsdale, and La Grange Memorial Hospitals formed a committee representing all three hospitals to review data from the Metropolitan Chicago Healthcare Council). Adventist Bolingbrook Hospital formed a committee representing their hospital integration into Will County MAPP initiatives. The Community Health Needs Assessment Committee includes hospital clinical and administrative staff, as well as members representing the broader interests of the Community. Committee Charter: Review summaries of compiled health data and statistical information and provide input on opportunities, trends, gap areas, and other conclusions that may be drawn from a review of primary, secondary, quantitative data, and qualitative data. Formulate determinations of health priorities that should be addressed in the Assessment Period taking into account AMH resources and abilities to influence outcomes with respect to identified priorities; Consider possible opportunities for collaboration with other organizations, including related organizations, other hospital organizations, and state and local health agencies; 38 P a g e

Review and provide feedback on the written Community Health Needs Assessment Report that will document sources and dates of health data, analytical methods applied to the data, descriptions of the sources of community input, prioritized descriptions of all community health needs identified and the process used in prioritizing needs; Actively participate in development of an Implementation Strategy to address those community health needs prioritized through the CHNA; and Provide support and assist Adventist Midwest Health in ongoing cycle of assessing and addressing Community Health needs and provision of meaningful benefit based on those needs. The Community Health Needs Assessment Committees identified Health Priorities from identified Community Health Needs Assessment outcomes based on the following: (1) Would the benefit, if provided, generate a low or negative margin; or (2) Does it respond to the needs of special populations; or (3) Does the benefit supply services that would likely be discontinued if the decision were made on a purely financial basis. Top identified needs (those needs where Hospital, County, and State outcomes were markedly lower than Healthy People 2020 goals) were the following: Access to Healthcare Awareness of Services - Adventist Bolingbrook Hospital Access to Primary and Secondary Services Adventist Bolingbrook Hospital Lack of health insurance - Adventist GlenOaks, Hinsdale, and La Grange Memorial Hospitals Prevention and Management of Chronic Care Issues Heart Disease [blood cholesterol levels] Pneumococcus Vaccine [65 years and older] Influenza Vaccination [18-64 years] Hypertension [over 18 years] Youth Services [Adventist Bolingbrook Hospital] Behavioral Health and Substance Abuse The Community Health Needs Assessment teams narrowed the selected priorities using a prioritization considerations that considered the following: (1) Does Adventist Midwest Health have the ability to effectively meet the need?; (2) Is this service already offered in a manner that supports need within or outside of Adventist Midwest Health?; (3) Is this a high-impact priority meaning, will it impact community health in a meaningful way?; and (4) Assets: Does Adventist Midwest Health have the resources necessary to address this priority? 39 P a g e

2. Tools used to support priority selection: A Decision Tree Process assisted the Committee in reaching the Final Priority Selections: Many Consider collaborating with others Identified Need: E.g., Lack Health Insurance Is the hospital able to effectively meet this need? YES. With ACA, increased ability to impact NO. What other groups are working on this need? What other groups are working on this need? Few Many Seriously consider this as a Priority Hospital has no role Few Encourage/support others who are meeting this need An Impact Analysis Matrix whereby Committee Members discussed where on a four-quadrant matrix a given priority would fall. The Committee was guided away from those priorities that had lower overall impact on the Community, particularly if the related resource needs were high. High Impact on Commuinity - Low Resource Need High Impact on Community- High Resource Need Low Impact on Community - Low Resource Need Low Impact on Community- High Resouce Need 40 P a g e