Community Health Improvement Plan 2019 - 2021 Edmonds Campus - Swedish ...

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Community Health Improvement Plan 2019 - 2021 Edmonds Campus - Swedish ...

      Edmonds Campus
  Community Health
  Improvement Plan
     2019 – 2021

Community Health Improvement Plan 2019 - 2021 Edmonds Campus - Swedish ...


EXECUTIVE SUMMARY                  2    Summary of Community Health
                                        Improvement Planning Process              10
MISSION, VISION, AND VALUES        3    Addressing the needs of
                                        the Community:
INTRODUCTION                       4
                                        • Mental Health                           10
  Who We Are                       4
                                        • Obesity and Diabetes                    12
  Our Commitment to Community      4
                                        • Homelessness                            14
OUR COMMUNITY                      6    • Drug Addiction                          14
                                        • J oint and Back Pain                   15
  Definition of Community Served   6
                                        • M ental Health —
  Age                              6
                                           Inpatient Ligature Reduction           16
  Ethnicity                        6
                                        • O besity — Nutrition Services          17
  Median Income                    7
                                        • O besity — Hospital Food Environment   18
  Poverty                          7
                                         ther Community Benefit Programs
COMMUNITY NEEDS AND ASSETS              and Evaluation Plan                       18
                                       PLAN APPROVAL                              20

                                       APPENDIX                                   21

      To Our Communities:

      As outlined in our 2018 Community Health Needs Assessment, the following social determinants of
      health emerged across the communities of all Swedish locations during the assessment process:
      mental health, drug addiction, homelessness, obesity and diabetes, and joint or back pain.

      We have completed the development of a Community Health Improvement Plan (CHIP) to specifically
      address many of these barriers, including strategies and measures, towards making our community
      a healthier place. The CHIP outlines the process of strengthening our existing programs across the
      Swedish system along with identifying new programs and resources to support those, and build
      and sustain our partnerships with key organizations to collaborate on solutions.

      The next phase will involve broad implementation of the action plans details included in this
      2019- 2022 CHIP, and monitoring and evaluating its short-term and long-term outcomes.

      As CEO, I am proud to lead Swedish in creating health for a better world.

                                 R. Guy Hudson, M.D., MBA
                                 Chief Executive Officer
                                 Swedish Health Services

1 |                                                                                 CHIP Edmonds Campus — 2019-2021

  About the Community Health Needs                              2019 - 2021 Community Health Improvement
  Assessment Process                                            Plan Priorities
  Nonprofit hospitals, public health agencies, accountable      As a result of the findings of our 2018 Swedish Edmonds
  communities of health, and others are required by             Community Health Needs Assessment (CHNA) and
  federal law, state mandates, or agency policy to              through a prioritization process aligned with our
  conduct community health needs assessment every               mission, resources and hospital strategic plan,
  three to five years. This process involves reviewing          Swedish Edmonds will focus on the following areas
  community health data, identifying and prioritizing           for its 2019-2021 Community Benefit efforts:
  community health needs, and developing a community               • Mental Health
  health improvement plan. Historically, community health
  needs assessments have been planned and conducted                • Obesity and Diabetes
  independently, but for the first time, stakeholders in King      • Homelessness
  and Snohomish Counties have aligned planning and
                                                                   • Drug Addiction (campus specific)
  assessment cycles to leverage resources and improve
  collaboration for collective impact.                             • Joint and Back Pain (campus specific)
                                                                   • Mental Health – Inpatient Ligature Reduction
  Goal of the Community Health Needs Assessment                       (campus specific)
  In April 2018, community members selected three to               • Obesity—Nutrition Services (campus specific)
  five priority areas of focus through a county-wide,
                                                                   • Obesity—Hospital Food Environment
  coordinated community health needs assessment
                                                                      (campus specific)
  process. This process provides us with the opportunity
  to collaborate, identify community needs, and move in
  the same direction as other organizations. By aligning
  our resources with and leveraging the expertise of
  community partners, our collective impacts in King
  and Snohomish Counties is even greater. Additionally,
  partners are well-positioned to align timelines and
  coordinate future improvement cycles.

2 |                                                                                     CHIP Edmonds Campus — 2019-2021

      Our Mission                                            EXCELLENCE: We set the highest standards for
      Improve the health and well-being of each              ourselves and our services. Through transfor-
      person we serve.                                       mation and innovation, we strive to improve the
                                                             health and quality of life in our communities. We
      Our Vision                                             commit to compassionate and reliable practices
      Health for a Better World                              for the care of all.
      Our Values                                             DIGNITY: We value, encourage and celebrate
      COMPASSION: We reach out to those in need.             the gifts in one another. We respect the inherent
      We nurture the spiritual, emotional, and physical      dignity and worth of every individual. We recognize
      well-being of one another and those we serve.          each interaction as a sacred encounter.
      Through our healing presence, we accompany             INTEGRITY: We hold ourselves accountable to
      those who suffer.                                      do the right thing for the right reasons. We speak
      JUSTICE: We foster a culture that promotes unity       truthfully and courageously with respect and
      and reconciliation. We strive to care wisely for our   generosity. We seek authenticity with humility and
      people, our resources, and our earth. We stand         simplicity.
      in solidarity with the most vulnerable, working to     SAFETY: Safety is at the core of every thought
      remove the causes of oppression and promoting          and decision. We embrace transparency and
      justice for all.                                       challenge our beliefs in our relentless drive for
                                                             continuous learning and improvement.

3 |                                                                                CHIP Edmonds Campus — 2019-2021

  Since 1910, Swedish has been the region’s standard-         Our Commitment to Community
  bearer for the highest-quality health care at the best      Swedish Health Services dedicates resources to improve
  value. Our mission is to improve the health and             the health and quality of life for the communities it
  well-being of each person we serve. Swedish is the          serves, with special emphasis on the needs of the
  largest nonprofit health care provider in the greater       economically poor and vulnerable. In the last five years,
                                                              Swedish spent more than $900 million in community
  Seattle area with five hospital campuses: First Hill,
                                                              benefit. We are making investments that go beyond
  Cherry Hill, Ballard, Edmonds and Issaquah. We also         just the need for free and discounted care by improving
  have ambulatory care centers in Redmond and Mill            access to care and developing new ways to help people
  Creek, and a network of more than 118 primary care          stay healthy. In 2017, we spent almost $200 million on
  and specialty clinics throughout the greater Puget          community benefit programs, including $23.9 million
  Sound area.                                                 on free and discounted care. The communities served
                                                              by Swedish hospitals are defined by the geographic
  Who We Are                                                  origins of the hospitals’ inpatients. The Primary Service
                                                              Area (PSA) was determined by identifying the ZIP Codes
  Swedish Health Services is an affiliate of the Providence   for 70% of the hospitals’ patient discharges (excluding
  St. Joseph Health. Providence St. Joseph Health is a        normal newborns). The Secondary Service Area (SSA)
  new organization created by the association between         was determined by identifying the ZIP Codes for 71%
  Providence Health & Services and St. Joseph Health          to 85% of the hospitals’’ patient discharges. The service
  with the goal of improving the health of the communities    areas for all Swedish campuses focus on King County
  it serves, especially those who are poor and vulnerable.    and Snohomish County.
  Together, our 111,000 caregivers (all employees) serve         • Swedish Ballard is located at 5300 Tallman Avenue,
  in 50 hospitals, 829 clinics and comprehensive range              NW, Seattle, WA 98107. The PSA consists of 8 cities
  of services across Alaska, California, Montana, New               and 36 ZIP Codes. The SSA consists of 18 cities
  Mexico, Oregon, Texas and Washington. In addition                 and 33 ZIP Codes.
  to Swedish, the Providence St. Joseph Health family
  includes: Providence Health & Services, St. Joseph             • Swedish Edmonds is located at 21601 76th Ave. W.,
  Health; Covenant Health in West Texas; Facey Medical              Edmonds, WA 98026. The PSA consists of 5 cities
  Foundation in Los Angeles; Hoag Memorial Presbyterian             and 9 zip codes. The SSA consists of 6 cities and 9
  in Orange County, California; Kadlec in Southeast                 ZIP Codes.
  Washington; and Pacific Medical Centers in Seattle.            • Swedish First Hill is located at 747 Broadway, Seattle,
  Bringing these organizations together increases access            WA 98122 and Swedish Cherry Hill is located at 500
  to health care and brings quality, compassionate care to          17th Avenue, Seattle, WA 98122. These hospitals
  those we serve, with a focus on those most in need.               share the same service area. The PSA consists of
                                                                    13 cities and 53 ZIP Codes. The SSA consists of 23
                                                                    cities and 35 ZIP Codes.
                                                                 • Swedish Issaquah is located at 751 NE Blakely
                                                                    Drive, Issaquah, WA 98029. The PSA consists of
                                                                    12 cities and 19 ZIP Codes. The SSA consists of
                                                                    16 cities and 28 ZIP Codes.
                                                                                                 Continued on the next page...

4 |                                                                                    CHIP Edmonds Campus — 2019-2021

  Planning for the Uninsured and Underinsured                    One way Swedish Health Services informs the public
                                                                 of FAP is by posting notices in high volume inpatient
  Our aim is to provide quality care to all our patients,
                                                                 and outpatient service areas. Notices are also posted
  regardless of ability to pay. We believe that no one should
                                                                 at location where a patient may pay their bill. Notices
  delay seeking needed medical care because they lack
                                                                 include contact information on how a patient can obtain
  health insurance. That is why Swedish Health Services
                                                                 more information on financial assistance, as well as
  has a Patient Financial Assistance Program (FAP) that
                                                                 where to apply for assistance. These notices are posted
  provides free or discounted services to eligible patients.
                                                                 in English and Spanish and any other languages that
  Our charity care program provides a 100 percent                are representative of 5% or greater of patients in the
  discount to individuals and families between                   hospital’s service area. All patients who demonstrate
  0-300 percent of the federal poverty level (formerly           lack of financial coverage by third party insurers are
  0-200 percent.)                                                offered an opportunity to complete the Patient Financial
      • For example, a family of four with a household income   Assistance application and are offered information,
         of approximately $75,000 or less would qualify.         assistance, and referral as appropriate to government
                                                                 sponsored programs for which they may be eligible.
  In addition, for individuals and families between 301-400
  percent of the federal poverty level, Swedish provides a
  discount of at least 75 percent.
        or example, a family of four with a household
       income of approximately $75,000 - $100,000
       would qualify

5 |                                                                                      CHIP Edmonds Campus — 2019-2021

  Definition of Community Served                                         Among the Swedish campuses, the Edmonds service
                                                                         area has the highest percentage of residents who are
  Population for Total Service Area, 2017
                                                                         non-Latino White (65.2%) and Hispanic or Latino (9.6%).
                                                First Hill/              The Issaquah service area has the highest percentage
                      Ballard        Edmonds                  Issaquah
                                                Cherry Hill              of Asians/Pacific Islanders (20.3%), and the Ballard
                                                                         service area has the highest percentage of Blacks/African
      Population 2,373,420 651,452 2,846,268 1,451,299
                                                                         Americans (7.4%).
  Source: Intellimed, ESRI, 2017

  Among Swedish campus service areas, Issaquah has the                   Race/Ethnicity*
  highest percentage of children (22.5%). Edmonds and
  Issaquah service areas include percentages of children                                                                 First Hill/
                                                                                                Ballard     Edmonds                    Issaquah
  higher than that of the county (21.1%). Edmonds has the                                                                Cherry Hill
  highest percentage of seniors (14.1%) among Swedish
  hospital campuses, which exceeds the percentage of                                            61.6%        65.2%         61.4%        59.7%

  seniors in the county (13.6%).
                                                                                                17.2%        16.4%         18.1%        20.3%
  2017 Population by Age, King and Snohomish Counties                     Islander
                                                                          Hispanic or
                                                                                                9.4%          9.6%         9.1%          8.4%
                            21.1%                    0-17 years           Black/African
                                                                                                7.4%          5.4%         7.0%          6.8%
                                                     18-29 years
                                                                          Two or more
        26.9%                                        30-44 years                                6.0%          5.9%         5.8%          5.3%
                                                     45-64 years          Other races/
                                                                                                3.6%          3.3%         3.5%          3.2%
                   21.8%                             65 and older
                                                                         Source: U.S. Census Bureau, American Community Survey, 2016; DP05
                                                                         *Percentages total more than 100% as some persons selected more than one
                                                                         race or ethnicity category.

                                                First Hill/
                        Ballard       Edmonds                 Issaquah   Income Poverty
                                                Cherry Hill
                                                                         In the Swedish campus service areas, the median
                        20.5%          21.8%      21.0%       22.5%      household income ranges from $69,153 in the Edmonds
      ages 0-17
                                                                         service area to $93,153 in the Issaquah service area. This
      Adults,                                                            disparity in income might influence health outcomes.
                        65.9%          64.1%      65.5%       64.6%
      ages 18-64
                                                                                                                    Continued on the next page...
                        13.6%          14.1%      13.5%       12.9%
  Source: US Census Bureau American Community Survey, B01003, 2016

6 |                                                                                                       CHIP Edmonds Campus — 2019-2021

  Median Household Income and Unemployment Rate                   Personal/Households Living at or Below Poverty Level
  Summary of Community Needs Assessment                   Identification and Selection of Significant
  Process and Results                                     Health Needs
  Secondary Data: Secondary data was collected            Significant health needs were identified from the
  from a variety of local, county, and state sources.     Community Health Needs Assessment process.
                                                          Swedish then identified priorities for the Community
  Data analyses were conducted at the most local level
                                                          Health Improvement Plan associated with the 2018
  possible for the hospitals’ service areas, given the    Swedish Edmonds CHNA. The priority health needs
  availability of the data.		                             were: Mental Health, Homelessness, Drug Addiction,
  Primary Data: Stakeholder surveys and listening         Obesity, and Diabetes.
  sessions were used to gather data and information
                                                          Community Health Needs Prioritized
  from persons who represent the broad interests of
  the community served by the hospitals. Swedish          Swedish Edmonds will focus on the following areas for its
                                                          2019-2021 Community Health Improvement Plan (CHIP):
  conducted surveys to gather data and opinions from
  community residents, and hospital leaders and staff        • Mental Health
  who interact with patients and families in the ED and      • Obesity
  specialty clinics.                                         • Homelessness
                                                             • Drug Addiction (campus specific)
  A full report and results of the 2018 Swedish              • Joint and Back Pain (campus specific)
  Edmonds Community Health Needs Assessment
                                                             • Mental Health – Inpatient Ligature Reduction
  can be accessed at:                (campus specific)
  media/Files/Providence%20Swedish/PDFs/Mis-                 • Obesity—Nutrition Services (campus specific)
                                                             • Obesity—Hospital Food Environment
                                                                (campus specific)
                                                                                           Continued on the next page...

8 |                                                                               CHIP Edmonds Campus — 2019-2021

  Needs Beyond the Hospital’s Service Program
  The following community health needs identified in the 2018 Swedish CHNA campus reports may not be addressed
  as part of the current CHIP. An explanation is provided below:

                BALLARD                  EDMONDS             FIRST HILL/CHERRY HILL                ISSAQUAH

      Alcohol overuse           Alcohol overuse             Joint or back pain            Homelessness
      High blood pressure       High blood pressure         High blood pressure           Cancer
      Joint or Back Pain        Joint or back pain          Cancer                        Age-related diseases
      Cancer                    Cancer                      Alcohol overuse               Texting while driving
      Smoking                   Stroke                      Age-related diseases          Alcohol overuse
      Age-related diseases      Smoking                     Teeth/oral health issues      High blood pressure
      Stroke                    Asthma                      Smoking                       Environmental factors
                                                                                          Alzheimer’s disease/
      Environmental factors     Environmental factors       Environmental factors
      Texting while driving     Texting while driving       Stroke                        Teeth/oral health issues
      Asthma                    Heart disease               Asthma                        Asthma
                                                                                          Lack of access to
      Teeth or oral issues      Teeth/oral health issues    Heart disease
                                                                                          needed medications
      Crime                     Age-related diseases        Texting while driving         Stroke
                                                            Alzheimer’s disease/
      Heart disease             Crime                                                     Child abuse and neglect
      Alzheimer’s disease/      Lack of access to           Lack of access to             Lack of access to
      dementia                  medical providers           healthy food                  medical providers
      Lack of access to         Alzheimer’s disease/
                                                            Crime                         Smoking
      needed medications        dementia
      Lack of access to                                     Lack of access to
                                Child abuse and neglect                                   Heart disease
      medical providers                                     medical providers
                                                            Lack of access to             Sexually transmitted
      Child abuse and neglect   Domestic violence
                                                            needed medications            infections
      Lack of access to a       Lack of access to
                                                            Child abuse and neglect       Domestic Violence
      grocery store             needed medications
      Sexually transmitted      Lack of access to
                                                            Domestic violence
      infections                needed medications
                                                            Sexually transmitted
      Domestic violence

  Some of these areas are out of our scope of our            address medical needs in housing situations, people
  current community health program expertise, and            may be able to stay housed longer.
  other non-profits in the community are providing           No hospital facility can address all the health needs
  robust services. However, we see the interconnect-         present in the community. We are committed to
  edness of health, housing, education, and income.          our mission through Swedish Community Benefits
  If we can improve the health of our workforce, they        granting program and partnering with like-minded
  will be better caregivers and more able to contribute      organizations in service to our community.
  to the economic vitality of our service area. If we can

9 |                                                                                    CHIP Edmonds Campus — 2019-2021

  Summary of Community Health Improvement Planning Process
  Swedish Medical Center, Edmonds participated in the King County Hospitals for a Healthier Community
  (HHC) as part of a countywide Community Health Needs Assessment. HHC is a collaborative of hospitals
  and/or health systems in King County and Public Health-Seattle & King County.


  Goal (Anticipated Impact): Implement a new program               Develop a psychology postdoctoral fellow training
  that provides mental health peer support in Swedish              program that provides mental health care in the Swedish
  emergency departments (ED). This program will be                 community irrespective of patient’s ability to pay, while
  adapted from the ED Connect program implemented by               creating a much needed workforce to support integrated
  Hoag Hospital Newport Beach ED in partnership with the           behavioral health (BH) care.
  National Alliance on Mental Health (NAMI). To accomplish         Scope (Target Population): People in the Edmonds
  this goal and implement a pilot project, Swedish will ex-        community
  plore partnering with Navos, one of the largest providers
  of community mental health services in Washington State.

   OUTCOME MEASURE                                                         BASELINE    FY19 TARGET            FY21 TARGET

   Facilitate full implementation of Mental Health peer support                          1 selected           Swedish-wide
   program in ED                                                                          campus                roll-out
   Integrate program at Swedish recognized clinics without behav-          N/A (new
                                                                                          2 clinics             2-4 Clinics
   ioral health services (BHS) at a reduced cost                           measure)

          STRATEGY(IES)                   STRATEGY MEASURE                 BASELINE    FY19 TARGET            FY21 TARGET

   Construct a Swedish
                                         Complete Swedish ED                                                Plan for Swedish-
   NAMI ED Connect                                                            0       1 approved plan
                                            Connect Plan                                                       wide roll-out
   implementation plan
                                       Swedish ED Connect plan                                              Plan for Swedish-
   Explore pilot with Navos                                                   0       1 approved plan
                                        collaborates with Navos                                                wide roll-out
                                                                                                                Initiate full
   Set up for Swedish-wide             Unfold ED Connect to the                         1 campus in
                                                                              0                               Swedish-wide
   system                                  Swedish system                               2019-2020
                                                                                                             roll out in 2021
                                     2019- Develop plan and have
   In 2019, develop a                  successful recruitment of 2
   psychology postdoctoral            post-doctoral candidates to                                               TBD – but
   program for primary care          provide services in 2020-2021                                             anticipate if
   that will serve anyone in           Identify Swedish Primary Care                                           program is
                                                                                      patient visits per
   the Swedish community              clinics in high need communities                                       successful, we
                                                                              0         postdoctoral
   irrespective of their ability     that do not currently have access                                       can continue to
                                                                                       fellow per year
   to pay, while creating a          to behavioral health (BH) services                                     expect 800-1000
   much needed workforce           (and have space for them to practice)                                    patient visits per
   to support integrated             Visits with postdoctoral fellow                                         fellow per year
   BH care                           will be provided free of charge
                                              for all patients
                                                                                                      Continued on the next page...

10 |                                                                                       CHIP Edmonds Campus — 2019-2021

          STRATEGY(IES)                    STRATEGY MEASURE                 BASELINE       FY19 TARGET         FY21 TARGET

                                    Adapt a workshop series that can
   Conduct mental
                                     be offered at hospital campuses                                         5 workshops per
   health workshops in                                                           0         5 workshops
                                   for any individual in the community                                        year per fellow
   the community
                                             to attend for free.
                                     Each year postdoctoral fellows
                                                                                                               recruitment of
                                     will be trained in a system that
                                                                                                               2 postdoctoral
                                     provides high quality BH care.                       Recruitment of
   Assemble next generation                                                                                   fellows per year
                                     They will be a generalist that is           5        2 postdoctoral
   of mental health providers                                                                                  (with hopes of
                                     capable of meeting the needs                            fellows
                                                                                                              accepting more
                                    of all patients with a behaviorally
                                                                                                               with adequate
                                            influenced concern.

  Evidence Based Sources                                           Key Community Partners
  Pingitore, D. P. (1999). Postdoctoral training in                NAMI ED Connect:
  primary care health psychology: Duties, observations,                   • Navos Behavioral Health Consortium
  and recommendations. Professional Psychology:
  Research and Practice, 30(3), 283-290. http://dx.doi.                   • HOAG Memorial Hospital Presbyterian
  org/10.1037/0735-7028.30.3.283                                   Postdoctoral Fellow Training: Current relationships exist
  Larkin, K. T., Bridges, A. J., Fields, S. A., & Vogel, M. E.     between the Primary Care BH team and multiple local
  (2016). Acquiring competencies in integrated behavioral          universities.
  health care in doctoral, internship, and postdoctoral
  programs. Training and Education in Professional                 Resource Commitment
  Psychology, 10(1), 14-23.             NAMI ED Connect
                                                                          • Leader and staff time to research and plan the pilot
  Johnstone, B., Frank, R. G., Belar, C., Berk, S.,
  Bieliauskas, L. A., Bigler, E. D., . . . Sweet, J. J. (1995).           • Time for the peer counselors
  Psychology in health care: Future directions. Professional                 (dependent on pilot plan)
  Psychology: Research and Practice, 26(4), 341-365.               Postdoctoral Fellow Training: This program would                     require at least a 0.5 FTE to adequately provide support,
                                                                   supervision, leadership, recruitment, and program
  Other Sources                                                    development. Additional resource commitment would
                                                                   include clinic space and supplies.
  Health Care Blog:
  Hoag and NAMI:

11 |                                                                                          CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact):                                            and risk of diabetes in diverse communities
       • Increase awareness on the importance of healthy         Scope (Target Population): Members of the community
          eating and exercise                                     contacted at public events, with focused outreach in
       • • Reduce the prevalence of childhood obesity            low-income communities

   OUTCOME MEASURE                                              BASELINE              FY19 TARGET              FY21 TARGET

   Percentage of “at risk” community members (those
   who screen positive for diabetes, prediabetes, or
   with high glucose levels) who are given information             0%                     50%                       TBD
   for appropriate follow-up (Primary provider, Swedish
   diabetes center, YMCA, other community clinics)

        STRATEGY(IES)          STRATEGY MEASURE                 BASELINE              FY19 TARGET              FY21 TARGET

   Sponsor Urban
                           Funding: healthy living, well-
   Games (See                                             $5,000 in 2018         $20,000 in 2019             TBD
                           ness programs and outreach
   description below)
   Diabetes screening   Number diabetes screening           Hosted 4 tables in Host more than 4              TBD
   and health education and health education tables         2018 covering the tables covering the
   at Urban Games       hosted at Urban Games               following topics:  following topics:
                                                            1. Prediabetes      1. Diabetes resources
                                                                screening tool       and prediabetes
                                                                and education        screening
                                                            2. Blood pressure   2. Blood pressure
                                                                and CPR        3. Ask the Medical
                                                                education          Doctor or Registered
                                                            3. Swedish sports     Nurse (brief consult
                                                                medicine           on site)
                                                                                 4. Swedish Sports
                                                                                 5. Expanded outreach
   Prediabetes             Number of community              Glucose testing      At least one                At least one
   screening at            events where Swedish             at three events      community event             community
   community events        participates by administering    in 2018              for three Swedish           event for all
                           prediabetes screenings and/      Prediabetes          campuses during             five Swedish
                           or glucose testing. Events       screening            quarters three and          campuses
                           will include community           in 2018              four community              during quarters
                           outreach events and health                            outreach events 2019        three and four
                           fairs, including Swedish                                                          community
                           sponsored events, walks/                                                          outreach events
                           runs, races, etc.
   Offer monthly online    # of views of monthly       745 views                 1,000+ views                TBD: Broaden
   cooking classes         Facebook Live cooking class (January                  Increase community          community
   through Facebook        videos which are open to    2019 video)               partner outreach and        partner outreach
   Live, #SwedishEats      the community and promote                             awareness                   and awareness
                           healthy eating lifestyles
                                                                                                      Continued on the next page...

12 |                                                                                       CHIP Edmonds Campus — 2019-2021

  Evidence Based Sources                                      Resource Commitment
  Centers for Disease Control and Prevention:                 • Fiscal contribution $5000        • Hours to set-up and staff tables at Urban Games       • Hours to set-up and staff tables at campus
  tional-diabetes-statistics-report.pdf                          community events
  American Diabetes Association: https://professional.
                                                                 URBAN GAMES INFORMATION
                                                                 Urban Games’ vision is a bold community en-
  Taking Control of Your Diabetes Conference and Health
                                                                 gagement initiative that seeks to build community
                                                                 self-advocacy and individual self-agency centered
                                                                 on health and wellness. Partnering with Youth
  Other Sources
                                                                 Centric, a social purpose organization, Urban
  Swedish online cooking class videos (Swedish Eats):            Games proposes the following goals and outcomes:
                                                                    • Engage 1,000 Urban Games Youth
                                                                       Ambassadors in year round activities and
                                                                       programs who are committed healthy living
  Key Community Partners
                                                                       and wellness practices.
  • American Diabetes Association
                                                                    • Develop a data-informed wellness baseline
  • Garfield Community Center                                          for each of the Youth Ambassadors
  • Seattle Park and Recreation, City of Seattle                       for monitoring, coaching, and intervention,
                                                                       as appropriate.
  • Austin Foundation
                                                                    • Track over 10M activity hours (1,000 UG
  • Clean Greens and Fresh Bucks                                       Youth Ambassadors x 30 minutes per day
  • Seattle Chapter Jack n Jill, Inc.                                  x over 365 days).
  • Mary Mahoney Professional Nurses Association                    • Demonstrate through data analysis how a
  • iUrban Teen                                                        focused community based effort can improve
                                                                       health outcomes
  • Treehouse
  • Black Farmer Collaborative
  • Northwest Kidney Center
  • Asian Counseling Referral Services (ACRS)
     Community Farm

13 |                                                                                  CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): Develop ongoing partnerships          ally, this consortium will work to address upstream health
  with community-based organizations and city and county           needs, such as behavioral health, and social determinants
  entities whose focus is homelessness and providing               of health, such as employment.
  support for families experiencing homelessness in King           Scope (Target Population): Families experiencing
  and Snohomish Counties. Build collaborative relationships        homelessness or unstably housed (i.e. couch surfing)
  to identify and develop strategies and pathways to reduce        in King and Snohomish Counties.
  homelessness and provide supportive housing. Addition-

   OUTCOME MEASURE                                 BASELINE                            FY19 TARGET          FY21 TARGET

   Develop collaborative     782 family households (2,624 individuals)
   strategies focused on     experiencing homelessness in King County (2018)1           House 10%
                                                                                                         House 10% + of
   moving a percent of       21 family households (60 individuals) experiencing         of homeless
                                                                                                         homeless families
   the homeless families     chronic homelessness in Snohomish County (2018)2              families
   to stable housing.

               STRATEGY(IES)                                           BASELINE        FY19 TARGET          FY21 TARGET

                                                # of partners
   Meet with housing advocates and                                   5 community       12 community
                                                 within the
   community partners in King and                                       partner           partner               TBD
   Snohomish Counties                                                  meetings          meetings
                                               # of individuals                                         Fully funded housing
                                                in families with                                         strategies align with
   Fully integrated housing                      children in the                         Establish       housing advocates
   collaborative strategies with a            point in time count                         housing            and Swedish
                                                                  with community
   focus on unhoused families.                    identified as                         collaborative     goals focused on
                                                  experiencing                                          families experiencing
                                                homelessness                                                homelessness.
   Explore assets to invest in innovative
   ways to provide transitional housing
   to meet the needs of unhoused                     TBD                 TBD                TBD                 TBD
   families and partner with Providence
   Supportive Housing.
   Administer behavioral health services                                                Establishing
   and training and education resources              TBD                 TBD            targets in 6            TBD
   to transition families to stable housing                                               months

  Evidence Based Sources                                           Key Community Partners
  All Home:             Plymouth Housing       YWCA
  time-pit-count/                                                  Capitol Hill Housing   Congregation for
  Seattle/King County Coalition on Homelessness:                   Wellsprings              the Homeless                                         West Seattle Help Link Vision House
                                                                   Ballard Help Line      Solid Ground
  City of Seattle:
                                                                   Mary’s Place           Seattle Chamber of Com-
                                                                   Seattle King County    merce – Housing Connector
  Resource Commitment                                                Public Health        Providence St. Joseph
                                                                   City of Seattle        Health
  Swedish Community Health Investment Division
                                                                   United Way             Others
  PSJH Housing Learning Collaborative

14 |                                                                                         CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): Initiate Suboxone therapy in      Scope (Target Population): Edmonds ED patients who
  the Edmonds Emergency Department (ED) to transition          present with OUD, opioid withdrawal, and/or opioid
  patients to the Suboxone clinic, Ideal Option, to assist     overdose. Treat with evidence based guidelines for brief
  in treatment of opioid use disorder (OUD) as outlined in     education, intervention, and withdrawal management.
  the Opioid Treatment Network Grant contract. Conduct         Work with care team to navigate patients to a Suboxone
  follow-up phone calls with all patients presenting with      clinic for establishing care and maintenance Suboxone
  opioid withdrawals or opioid overdose to offer recovery      therapy.
  supports and resources as outlined in the SURGE Grant.

                                                                                                      FY19       FY21
   OUTCOME MEASURE                                                                       BASELINE
                                                                                                     TARGET     TARGET

   Percent of patients that follow up from the emergency department (ED) to a
                                                                                            0%         50%       80%
   medication assisted therapy service provider.

                                                        STRATEGY                                      FY19       FY21
           STRATEGY(IES)                                                                 BASELINE
                                                        MEASURE                                      TARGET     TARGET

   Begin opioid dependence                  # of opioid dependence treatments
                                                                                             0          10        20
   treatment at Edmonds ED                  initiated per month at Edmonds ED
   Behavioral Health Assessment
                                         % of patients with follow-up appointments
   Team (BHAT) schedules
                                        scheduled at Ideal Option (# of patients with
   follow-up appointments at                                                                0%        100%       100%
                                       follow-up appointments scheduled/ total # of
   Ideal Option for every patient
                                       patients referred for follow-up appointments)
   who is induced in the ED
   BHAT conducts follow-up
                                        % of follow-up phone calls conducted after
   phone calls on all patients who
                                     discharge (# of follow-up phone calls conducted/
   presented with opioid with-                                                              0%        100%       100%
                                        total # of patients with opioid withdrawal or
   drawal or opioid overdose and
                                           opioid overdose discharged from ED)
   are discharged from the ED

  Evidence Based Sources                                       Key Community Partners
  Substance Abuse and Mental Health Services                   Initially, Swedish Edmonds, Snohomish Health District,
  Administration (SAMHSA):           Health Care Authority of Snohomish County, SAMHSA,
  substances/opioids-or-opiates                                Ideal Option, Consistent Care. Eventually, will add other
  Centers for Disease Control and Prevention (CDC):            medication assisted therapy service providers.
                                                               Resource Commitment
  University of Washington Alcohol & Drug Abuse Institute:
                                                               The BHAT and the ED physician group will be doing this
                                                               work 24/7 – anticipate 0 to 10 hours of work per week.
                                                               Ideal Option - 1 hour of work per week.
  Washington Recovery Help Line: http://www.warecove-
  The Start with One campaign:

15 |                                                                                    CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): The goal is to increase par-        seek to learn about effective surgical options for joint
  ticipation in hospital sponsored, provider-led educational     and back pain from multiple causes. Joint and back
  seminars on surgical spine and joint options.                  pain was one of the top ten problem areas identified
  Scope (Target Population): The target population for           by Swedish Edmonds stakeholders in the Community
  this initiative is residents within the service area who       Health Needs Assessment (CHNA) primary data survey.

                                                                                                       FY19       FY21
   OUTCOME MEASURE                                                                     BASELINE
                                                                                                      TARGET     TARGET

   # people who attend spine and joint presentations at Swedish Edmonds                 2018 - 8         20       TBD

                                                               STRATEGY                                FY19       FY21
                  STRATEGY(IES)                                                        BASELINE
                                                               MEASURE                                TARGET     TARGET

   Advertise spine and joint presentations                   # of advertised
   at Swedish Edmonds in the local papers/             presentation schedules in           0             2          4
   social media sites                                  print and on social media
   Communicate Swedish Edmonds spine
   and joint presentations at local community          # of brochures distributed          0            100        300
                                                           % of web-based
   Explore feasibility of web-based patient
                                                         education video pilot            0%           50%        100%
   education video pilot
                                                      implemented and rolled out
   Collaborate with Swedish-wide service line
   leaders to explore feasibility of partnering     Implementation of collaborative
                                                                                          N/A           TBD       TBD
   with local community organization to estab-       functional restoration program
   lish a functional restoration program

  Evidence Based Sources                                         Key Community Partners
  Pre-operative patient education reduces length of stay         Swedish Medical Group, Proliance Surgeons, Western
  after knee joint arthroplasty: https://www.ncbi.nlm.nih.       Washington Medical Group, Verdant Health Com-
  gov/pmc/articles/PMC3293278/                                   mission, City of Lynnwood, City Of Edmonds, City of
  The effectiveness of orthopedic patient education in im-       Mountlake Terrace, Edmonds Senior Center, Lynnwood
  proving patient outcomes: a systematic review protocol:        Senior Center, Edmonds Beacon, My Edmonds News
                                                                 Resource Commitment
  Web-Based Patient Education in Orthopedics:                    Business Development 40 hours; Swedish Marketing
  Systematic Review:           and Communications 20 hours; Provider 12 hours

16 |                                                                                     CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): To create and maintain a             Swedish Edmonds has a 25-bed inpatient mental health
  ligature-free environment for inpatient psychiatry to           unit. Average daily census is 24. In 2018 we admitted
  reduce risk of suicide and self-harm. A ligature risk is        550 patients requiring acute mental health treatment.
  anything that can be used for the purpose of hanging            Patients are admitted on a voluntary basis and an invol-
  or strangulation. This initiative will standardize use of the   untary basis per court- ordered treatment.
  suicide risk assessment tool in the Edmonds Emergency           Suicide is a growing concern across the nation, and the
  Department (ED) and reduce ligature risk for inpatient          Joint Commission, Det Norske Veritas (the hospital
  psychiatry patients.                                            accreditation organization used by Swedish), Department
  Scope (Target Population): Patient in the ED and                of Health, and Centers for Medicare and Medicaid
  inpatient psychiatry patients. Mental Health was one            Services have mandated hospitals to assure that patient
  of the top ten problem areas identified by Swedish              care areas are ligature-free to reduce suicide risk.
  Edmonds stakeholders in the Community Health Needs
  Assessment (CHNA) primary data survey.

   OUTCOME MEASURE                                                 BASELINE                   FY19 TARGET

   % of identified ligature risks reduced/eliminated                  0%                           TBD             TBD
                                                                                         EPIC will have this
                                                          Risk for Suicide is assessed
                                                                                         tool built into the
   Standardized suicide risk assessment                    on patients in the ED using
                                                                                         new platform for use      TBD
   tool in the ED                                          the Columbia Suicide Risk
                                                                                         on the inpatient unit
                                                                 Screening Tool
                                                                                         starting in June, 2019

                                                                  STRATEGY                                FY19     FY21
                    STRATEGY(IES)                                                         BASELINE
                                                                  MEASURE                                TARGET   TARGET

   Conduct initial ligature risk assessment in the            % of ligature risk
   behavioral health unit                                assessment in the behavioral       100%          N/A      N/A
                                                            health unit completed
   Develop process for periodic follow-up
                                                                     TBD                    TBD           TBD      TBD
   assessments at predefined intervals
   Risk reduction strategies implemented                             TBD                    TBD           TBD      TBD

  Evidence Based Sources                                          Key Community Partners
  Centers for Medicare and Medicaid                               Snohomish County Designated Crisis Responders
  Washington Department of Health                                 Compass Health
  The Joint Commission on Accreditation                           Verdant Health
  of Health Organizations                                         NBBJ Architects
  Det Norske Veritas
                                                                  Resource Commitment
                                                                  Swedish Health Services

17 |                                                                                      CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): To integrate specialized               Scope (Target Population): The target population for
  nutrition services into the offices of select specialty and       this initiative are residents within the service area who
  primary care providers, providing in-clinic support one           require nutrition service referrals. Obesity was one of the
  to two times per month, to improve patient access to              top ten problem areas identified by Swedish Edmonds
  those services, patient compliance with nutrition service         stakeholders in the Community Health Needs Assessment
  referrals, and care coordination between family physicians,       (CHNA) primary data survey.
  specialty care physicians and registered dietitians.

                                                                                                                      FY21 TAR-
   OUTCOME MEASURE                                               BASELINE               FY19 TARGET

   Launch limited scope trial in one specialty clinic              N/A       Launched trial in one specialty clinic     TBD
   Analyze trial data to determine effectiveness &
                                                                   N/A        Completed analysis of trial data          TBD
   feasibility of program expansion

   Add additional locations to program, dependent on                                                                     two
                                                                   N/A                       N/A                      additional
   trial data review                                                                                                  locations

                                               STRATEGY                                     FY19                      FY21 TAR-
              STRATEGY(IES)                                      BASELINE
                                               MEASURE                                     TARGET                       GET

   Registered Dietician to work with
   nursing staff to develop identification   Completion of                         Completion of criteria
                                                                   N/A                                                  N/A
   criteria for patients who would           referral criteria                       by July 1, 2019
   benefit from nutrition services
   Launch pilot in Wound Healing              Number of
   Clinic. Provide RD support two            patients seen          0                         10                        TBD
   days a month.                             by RD in clinic
                                                                                50% of patients seen by RD
                                             Blood glucose                    in clinic achieved improvement
   RD to provide medical nutrition              control                                  in HBG A1C
   therapy and augment chronic
                                                Wound              TBD            TBD - The new instance                TBD
   disease management in the
                                                healing                       of the electronic health records
   outpatient setting
                                               outcomes                       will allow for tracking of wound
                                                                                       healing outcomes

  Evidence Based Sources                                            Key Community Partners
  Integrating nutrition services into primary care: https://        Swedish Medical Group
  What’s Missing from Your Plate? Nutrition Services                Resource Commitment
  Integration in Primary Care:              RD 16 hours per month
  news/339918/Whats-Missing-from-Your-Plate-Nutrition-              Manager support 4-6 hours per month

18 |                                                                                          CHIP Edmonds Campus — 2019-2021


  Goal (Anticipated Impact): The goal of this initiative is     Swedish Edmonds will be patients, visitors and Swedish
  to create food and beverage environments to ensure            Edmonds caregivers. Obesity was one of the top ten
  healthy food and beverage options are the routine, easy       problem areas identified by Swedish Edmonds stake-
  choice for caregivers and visitors.                           holders in the Community Health Needs Assessment
  Scope (Target Population): The target population for          (CHNA) primary data survey.

   Outcome Measure                                                                    Baseline   FY19 Target   FY21 Target

   Modify Café food and beverage environments to expand on fresh, seasonal
   ingredients to replace less healthy options: % of total Café food and beverage        TBD        20%          50%
   offerings that are to be replaced with healthier choices
   Modify inpatient food and beverage environments to expand on fresh,
   seasonal ingredients to replace less healthy options: % of total inpatient food       TBD        20%          50%
   and beverage offerings that are to be replaced with healthier choices

                                                                                                   FY19          FY21
               STRATEGY(IES)                         STRATEGY MEASURE                BASELINE
                                                                                                  TARGET        TARGET

                                                 Number of healthy foods sold
   Smart Market Vending Machine                 (fruits, salad, yogurts) vs. non-       TBD         TBD          TBD
                                              healthy options (chips, candy, soda)
   Reducing Café Portion Size                   Number of calories per serving          TBD         TBD          TBD
                                                                                                 100% on
                                                   % of fried food eliminated
   Eliminate fried food from patient menus                                               0%      May 14,         100%
                                                     from patient menus

  Evidence Based Sources                                        Key Community Partners
  Centers for Disease Control and Prevention:                   TBD
                                                                Resource Commitment

  Other Community Benefit Programs and Evaluation Plan

   INITIATIVE/COMMUNITY NEED                                                                        POPULATION
                                              PROGRAM NAME                DESCRIPTION
   BEING ADDRESSED                                                                                 (Low Income or
                                                                                                 Broader Community)

                                              Edmonds Food
   Access & Food Security                                          Edmonds Food Donations            Low Income
                                              Bank Donations
   Access & Food Security                     Meals on Wheels            Food Donation               Low Income
   Cancer Patients                            SCI Community         Support Group Therapy        Broader Community

19 |                                                                                     CHIP Edmonds Campus — 2019-2021

  This community health improvement plan was adopted on May 14, 2019 by the authorized body of the hospital on
  May 14, 2019. The final report was made widely available on May 15, 2019.

  R. Guy Hudson, M.D., MBA 						Date
  Chief Executive Officer
  Swedish Health Services

  Kristen Swanson, MSN							Date
  Chair Board of Trustees
  Swedish Health Services

  Joel Gilbertson								Date
  Senior Vice President, Community Partnerships
  Providence St. Joseph Health

  Sarah Zabel 								Date
  Chief Operating Officer, Swedish Edmonds

  Sherry Williams, MPA                                              Request a copy, provide comments or view electronic
  Regional Director Community Health Investment                     copies of current and previous community health needs
  Swedish Health Services                                           assessments:
  206-386-3407                                                      mission-outreach/community-engagement/communi-
  206-386-6000                                                      ty-needs-assessment/assessments-site-list

  1 Per § 1.501(r)-3 IRS Requirements, posted on hospital website

20 |                                                                                      CHIP Edmonds Campus — 2019-2021

  Definition of Terms                                         which a campus organizes its key priority efforts.
                                                              Each effort should be entered as a program in CBISA
  Community Benefit: An initiative, program or activity
                                                              Online (Lyon Software). Please be sure to report on
  that provides treatment or promotes health and
                                                              all your Key Community Benefit initiatives. If a campus
  healing as a response to identified community needs
                                                              reports at the initiative level, the goal (anticipated
  and meets at least one of the following community
                                                              impact), outcome measure, strategy and strategy
  benefit objectives:
                                                              measure are reported at the initiative level. Be sure to
      a. Improves access to health services;
                                                              list all the programs that are under the initiative. Note:
      b. Enhances public health;
                                                              All Community Benefit initiatives must submit financial
      c. Advances increased general knowledge; and/or
                                                              and programmatic data in CBISA Online.
      d. Relieves government burden to improve health.
  Community benefit includes both services to the poor        Program: A program is defined as a program or service
  and broader community.                                      provided to benefit the community (in alignment
                                                              with guidelines) and entered in CBISA Online (Lyon
  To be reported as a community benefit initiative or         Software). Please be sure to report on all community
  program, community need must be demonstrated.               benefit programs. Note: All community benefit
  Community need can be demonstrated through                  programs, defined as “programs”, are required
  the following:                                              to include financial and programmatic data into
      a. Community health needs assessment developed         CBISA Online.
          by the campus or in partnership with other
          community organizations;                            Goal (Anticipated Impact): The goal is the desired
      b. D  ocumentation that demonstrates community         ultimate result for the initiative’s or program’s efforts.
           need and/or a request from a public agency or      This result may take years to achieve and may
           community group was the basis for initiating or    require other interventions as well as this program.
           continuing the activity or program; or             (E.g. increase immunization rates; reduce obesity
      c. The involvement of unrelated, collaborative tax-    prevalence.).
          exempt or government organizations as partners      Scope (Target Population): Definition of group being
          in the community benefit initiative or program.     addressed in this initiative: specific description of
  Health Equity: Healthy People 2020 defines health           group or population included (or not included, if
  equity as the “attainment of the highest level of health    relevant) for whom outcomes will be measured and
  for all people. Achieving health equity requires valuing    work is focused. Identify if this initiative is primarily for
  everyone equally with focused and ongoing societal          persons living in poverty or primarily for the broader
  efforts to address avoidable inequalities, historical and   community.
  contemporary injustices, and the elimination of health      Outcome measure: An outcome measure is a
  and health care disparities.”                               quantitative statement of the goal and should answer
  Social Determinants of Health: Powerful, complex            the following question: “How will you know if you’re
  relationships exist between health and biology, genetics,   making progress on goal?” It should be quantitative,
  and individual behavior, and between health and             objective, meaningful, and not yet a “target” level.
  health services, socioeconomic status, the physical
  environment, discrimination, racism, literacy levels,
  and legislative policies. These factors, which influence
  an individual’s or population’s health, are known as
  determinants of health. Social determinants of health
  are conditions in the environment in which people are
  born, live, learn, work, play, worship, and age that
  affect a wide range of health, functioning, and quality-
  of-life outcomes and risks.
  Initiative: An initiative is an umbrella category under

21 |                                                                                    CHIP Edmonds Campus — 2019-2021

21601 76th Ave. W.                                     We do not discriminate on the basis of race, color, national origin, sex, age, or

Edmonds, WA 98026
                                                       disability in our health programs and activities.

T 425-640-4000

© 2019 SWEDISH HEALTH SERVICES. ALL RIGHTS RESERVED.                                                          COMM-19-0205-B 5/19
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