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2022Community Health NeedsAssessment

2 I Community Health Needs AssessmentTABLE OF CONTENTSINTRODUCTION......................................................................................................................................5-15Executive Summary...............................................................................................................................................7-11Background.......................................................................................................................................................................11SBL Fayette County Hospital Services..................................................................................................12-14Local Impact of COVID.......................................................................................................................................14-15ESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPS.........................17 DATA COLLECTION...........................................................................................................................17-21Secondary Data.....................................................................................................................................................17-19Primary Data............................................................................................................................................................19-21DATA ANALYSIS...................................................................................................................................23-65Demographics.......................................................................................................................................................23-26Social Determinants of Health....................................................................................................................27-29Health and Wellness Indicators...............................................................................................................30-63- Chronic Illness...................................................................................................................................................50-63- Substance Use..........................................................................................................................................................64- Mental and Behavioral Health...............................................................................................................65-68- Health Professional Shortage Area...........................................................................................................69- Healthcare Workforce.................................................................................................................................70-72Emergency Preparedness..................................................................................................................................73Copyright ©2022 by the Illinois Critical Access Network (ICAHN). All rights reserved. The contents of this publication may not be copied, reproduced, replaced, distributed, published, displayed, modied, or transferred in any form or by any means except with the prior permission of ICAHN. Copyright infringement is a violation of federal law subject to criminal and civil penalties.

SBL Fayette County Hospital I 3IDENTIFICATION AND PRIORITIZATION OF NEEDS.........................................................75-76Process................................................................................................................................................................................75Description of the Community Health Needs Identied...............................................................76 RESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDS.........................................79Hospital Resources....................................................................................................................................................79Healthcare Partners or other Resources including Telemedicine.........................................79Community Resources...........................................................................................................................................79DOCUMENTING AND COMMUNICATING RESULTS................................................................81 IMPLEMENTATION STRATEGY....................................................................................................83-87Planning Process.........................................................................................................................................................83Implementation Strategy..............................................................................................................................84-87REFERENCES AND APPENDIX....................................................................................................89-90

SBL Fayette County Hospital I 5INTRODUCTIONThe rst hospital in Vandalia, built by and called the Mark Greer Hospital, was opened in 1925.It served the community well until the healthcare needs of the community exceeded the hospital’s capacity in 1949. At this point, Dr. Greer sold his hospital to Fayette County.In that same year, a county-wide referendum was introduced and passed, and it created the Fayette County Hospital District.A Governing Board was formed for the new Fayette County Hospital District, and the members began work to plan for and build a new hospital that would be larger than the original and better able to meet local healthcare needs. The new hospital was opened in 1955, and it has grown many times since 1955 in order to continue to meet the growing demands for its services.There have been several additions to the hospital including a long-term care facility, which opened in 1972.The Fayette County Hospital District remains the owner of the hospital today.During the 1980s, the District Board members recognized that the hospital business is extremely complex, and they decided to sign a contract with what is now known as Barnes Jewish Christian Hospital in St. Louis for that large hospital to operate Fayette County Hospital.That contract endured for approximately 15 years, before a contract was signed with a dierent entity, which was created for the sole purpose of operating the hospital, beginning on January 1, 2005.AdolescentsAdultsSeniorsEarly Childhood AdolescentsAdultsSeniors

6 I Community Health Needs AssessmentMISSION STATEMENT To provide high quality healthcare close to home.VALUES Develop healthcare services appropriate for the community, support the practice development of our local physicians, be a good employer in our community, support the development of the Fayette County business environment, and operate with high quality and strong nancial stewardship.That entity is Heartland Health System, which was owned by investors from Indiana, Ohio, and Kentucky. It was then acquired by Sarah Bush Lincoln Health Center, eective July 1, 2019.So, Heartland Health System is 100% owned by Sarah Bush Lincoln Health Center, and the hospital is now called Sarah Bush Lincoln (SBL) Fayette County Hospital & Long Term Care. SBL Fayette County Hospital operates around the following Mission, Values, and Vision:VISION To aggressively grow to meet the community’s needs, to excel at customer service, making us the hospital of choice, to create a superior workplace for our employees, to strengthen the hospital’s role in the community and to build nancial strength required to pursue this vision.

SBL Fayette County Hospital I 7Provisions in the Aordable Care Act (ACA) require charitable hospitals to conduct a Community Health Needs Assessment (CHNA). The CHNA is a systematic process involving the community to identify and analyze community health needs as well as community assets and resources in order to plan and act upon priority community health needs. This assessment process results in a CHNA report which assists the hospital in planning, implementing, and evaluating hospital strategies and community benet activities. This Community Health Needs Assessment was developed and conducted, in partnership with representatives from the community, by a consultant provided through the Illinois Critical Access Hospital Network (ICAHN). ICAHN is a not-for-prot 501(c)(3) corporation established in 2003 for the purposes of sharing resources, education, promoting operational eciencies, and improving healthcare services for member critical access and rural hospitals and their communities. ICAHN, with 57 member hospitals, is an independent network governed by a nine-member board of directors, with standing and project development committees facilitating the overall activities of the network. ICAHN continually strives to strengthen the capacity and viability of its members and rural health providers.This Community Health Needs Assessment will serve as a guide for planning and implementation of healthcare initiatives that will allow the hospital and its partners to best serve the emerging health needs of Vandalia and the surrounding area. The CHNA process was coordinated by the SBL Fayette County Hospital CEO.EXECUTIVE SUMMARY

8 I Community Health Needs AssessmentTwo focus groups met to discuss the state of overall health and wellness in the SBL Fayette County Hospital service area and to identify health concerns and needs in the delivery of healthcare and health services in order to improve wellness and reduce chronic illness for all residents. The focus groups included representation of healthcare providers, community leaders, community services providers, schools, faith-based organizations, local elected ocials, public health, and others. Several members of these groups provide services to underserved and unserved persons as all or part of their roles. The ndings of the focus groups were presented, along with secondary data analyzed by the consultant, to a third group for identication and prioritization of the signicant health needs facing the community. The group consisted of representatives of public health, community leaders, healthcare providers, and community services providers.

SBL Fayette County Hospital I 9IDENTIFICATION AND PRIORITIZATION ADDRESSING THE NEED At the conclusion of their review and discussion, the identication and prioritization group advanced the following needs:1. Improve local access to mental health care– Improve local access to counselors and support persons for mentalhealth issues and substance use disorders, especially for low incomeunserved and underserved residents– Improve local access to a psychiatrist– Improve community prevention eorts for substance use for youthand adults– Address social determinants (poverty, housing, food access, homeless-ness) that impact mental health and substance use– Improve access to services at all levels for persons over age 18 withsubstance use disorders2. Improve local access to geriatric services3. Improve community education about available local resources for physical and mental health and wellness education and services4. Improve local access to pediatric servicesThe results of the assessment process were then presented to senior sta at SBL Fayette County Hospital through a facilitated discussion for development of a plan to address the identied and prioritized needs.Improve Local Access to Geriatric ServicesImprove Substance Use Prevention EortsImprove Local Access to Mental Health CareImprove Local Access to Pediatric Services

10 I Community Health Needs AssessmentADDRESSING THE NEED CREATING THE PLANThe senior sta addressed the needs with the following strategies:1. Improve local access to mental health care– Improve local access to counselors and support persons for mentalhealth issues and substance use disorders, especially for low incomeunserved and underserved residents– Improve local access to a psychiatrist– Improve community prevention eorts for substance use for youthand adults– Address social determinants (poverty, housing, food access, homeless-ness) that impact mental health and substance use– Improve access to services at all levels for persons over age 18 withsubstance use disorders• SBL Fayette County Hospital will continue to explore creating a local mental health clinic.• SBL Fayette County Hospital will continue to explore utilization of an Advanced Practice Nurse, oering mental health through telehealth.• SBL Fayette County Hospital will collaborate with Sarah Bush Lincoln Health Care to improve local access to mental health and substance use disorder.• SBL Fayette County Hospital will collaborate with the Fayette County Health Department to promote a community-based coalition of law enforcement, providers, and other interested groups and parties to address substance abuse prevention and promote local substance use disorder services.

SBL Fayette County Hospital I 112. Improve local access to geriatric services• SBL Fayette County Hospital will explore expansion of the Senior Renewal program to create a support group for families of seniors facing chronic illness or mental health issues.• SBL Fayette County Hospital will explore resources for local access to senior care specialists.3. Improve community education about available local resources for physical and mental health and wellness education and services• SBL Fayette County Hospital will collaborate with the Fayette County Health Department and other community partners and providers to expand awareness of available local resources for education and information.• SBL Fayette County Hospital will explore development of a webpage for information about available local resources for mental and physical health and wellness services and care.The Community Health Needs process is conducted every three years. In response to issues identied and prioritized and the implementation strategy developed to address them, SBL Fayette County Hospital, as a government-owned hospital, has been exempt from the process since the requirement began. This year, SBLFCH chose to go through the formal CHNA process as a matter of best practices.BACKGROUND

12 I Community Health Needs AssessmentVandaliaBrownstownPatokaRamseyGreenvilleSt. PeterFor the purpose of this CHNA, SBL Fayette County Hospital has dened its primary service area and populations as the general population within the geographic area in and surrounding Fayette County. The area also includes portions of Bond County and small portions of other surrounding counties which share zip codes with locations in Fayette County. The hospital’s patient population includes all who receive care without regard to insurance coverage or eligibility for assistance. A total of 37,486 people live in the 1,081.14 square-mile service area dened for this assessment, according to the U.S. Census Bureau American Community Survey 2015-2019 5-year estimates. The population density for this area, estimated at 35 persons per square mile, is less than the national average population density of 92 persons per square mile. The service area includes the following communities:AREA SERVED BY SBL FAYETTE COUNTY HOSPITALSt. ElmoMulberry GroveSBL Fayette County Hospital Service AreaMay 17, 2022©2022 Esri Page 1 of 1

SBL Fayette County Hospital I 13SBL Fayette County Hospital Service Area Key Facts15 ZIP Codes Prepared by Esri62011 (Bingham) et al. Geography: ZIP Code KEY FACTS37,486Population41.1Median Age2.4AverageHousehold Size$51,057Median HouseholdIncomeEDUCATION13%No High SchoolDiploma39%High SchoolGraduate32%Some College16%Bachelor's/Grad/Prof DegreeBUSINESS1,207Total Businesses12,129Total EmployeesEMPLOYMENT49.2%White Collar32.1%Blue Collar18.7%Services4.8%UnemploymentRateINCOME$51,057Median HouseholdIncome$25,568Per Capita Income$132,702Median Net WorthHouseholds By IncomeThe largest group: $50,000 - $74,999 (18.2%)The smallest group: $200,000+ (2.8%)Indicator▲Value Diff<$15,000 12.2% +2.7%$15,000 - $24,999 11.6% +3.7%$25,000 - $34,999 10.0% +2.1%$35,000 - $49,999 15.0% +3.7%$50,000 - $74,999 18.2% +1.7%$75,000 - $99,999 13.3% +0.5%$100,000 - $149,999 13.4% -3.6%$150,000 - $199,999 3.5% -4.4%$200,000+ 2.8% -6.3%Bars show deviation from IllinoisThis infographic contains data provided by Esri, Esri and Data Axle. The vintage of the data is 2021, 2026. © 2022 EsriThe infographic above highlights some of the key facts of that data and provides a snapshot of the population served by SBL Fayette County Hospital. The data on the following pages will take a deep dive into the demographics of SBL Fayette County Hospital’s service area and will oer insight to both the commonality and complexity of the SBL Fayette County Hospital audience. The average household size in the area, at 2.4, is lower than both Illinois (3.0) and the U.S. (2.5) overall average. Median age is 41.1 years, which is higher than Illinois and the U.S. benchmark. The highest level of education is high school graduate, followed by some college.SBL Fayette County Hospital Service Area – Key Facts

14 I Community Health Needs AssessmentNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. 2021. Source geography: CountyConrmed COVID-19 CasesLOCAL IMPACT OF COVIDCOVID-19 Conrmed Cases and MortalitiesThe COVID-19 epidemic has overshadowed many local health functions since March 2020. It has dramatically impacted overall health of the communities and the delivery of healthcare and health-related services. The broad impact has been seen throughout the communities, changing the way people work, shop, learn, and communicate. This indicator reports incidence rate of conrmed COVID-19 cases per 100,000 population. Data for this indicator are updated daily and derived from the Johns Hopkins University data feed. In the service area, there have been 4,370 total conrmed cases of COVID-19. The rate of conrmed cases is 26,277.81 per 100,000 population, which is greater than the state average of 25,188.22. Data are current as of 5/16/2022.The area’s unemployment rate of 4.8% is higher than statewide and national average. Also, as is the case in much of rural Illinois, median family household income in the service area is lower than the statewide average.

SBL Fayette County Hospital I 15COVID-19 MortalitiesIn the service area, there have been 31 total deaths among patients with conrmed cases of the coronavirus disease COVID-19. The mortality rate in the service area is 186.41 per 100,000 population, which is less than the state average of 264.54. Data are current as of 5/16/2022.COVID-19 Fully Vaccinated AdultsThis indicator reports the percent of adults fully vaccinated for COVID-19. Data is updated daily from the CDC API. Vaccine hesitancy is the percent of the population estimated to be hesitant towards receiving a COVID-19 vaccine. The Vaccine Coverage Index is a score of how challenging vaccine roll-out may be in some communities compared to others, with values ranging from 0 (least challenging) to 1 (most challenging). Data are current as of 5/16/2022.

SBL Fayette County Hospital I 17Data Collection QuantitativeQualitativeData AnalysisESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPSData CollectionDescription of Data Sources – QuantitativeQuantitative (secondary) data is collected from many resources including, but not restricted to, the following:Source DescriptionBehavioral Risk Factor Surveillance SystemThe BRFSS is the largest, continuously conducted telephone health survey in the world. It enables the Center for Disease Control and Prevention (CDC), state health departments, and other health agencies to monitor modiable risk factors for chronic diseases and other leading causes of death.SparkMap SparkMapis an online mapping and reporting platform powered by the Center for Applied Research and Engagement Systems (CARES) at the University of Missouri. US Census National census data is collected by the US Census Bureau every 10 years.Centers for Disease ControlThrough the CDC’s National Vital Statistics System, states col-lect and disseminate vital statistics as part of the US’s oldest and most successful intergovernmental public health data sharing system.SECONDARY DATA

18 I Community Health Needs AssessmentSource DescriptionCounty Health RankingsEach year, the overall health of each county in all 50 states is assessed and ranked using the latest publicly available data through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.American Communities SurveyTheAmerican Community Survey(ACS), a product of the U.S. Census Bureau, helps local ocials, community leaders, and businesses understand the changes taking place in their communities. It is the premier source for detailed population and housing information about our nation.Illinois Department of Employment SafetyThe Illinois Department of Employment Security is the state’s employment agency. It collects and analyzes employment information.National CancerInstituteThe National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients, and the families of cancer patients. Illinois Department of Public HealthThe Illinois Department of Public Health is the state agencyresponsible for preventing and controlling disease and injury, regulating medical practitioners, and promoting sanitation.HRSA The Health Resources and Services Administration of the US Department of Health and Human Services develops health professional shortage criteria for the nation and uses that data to determine the location of Health Professional Shortage Areas and Medically Underserved Areas and Populations.Local IPLANS The Illinois Project for Local Assessment of Needs (IPLAN) is a communityhealth assessment and planning process that is conducted every ve years by local health jurisdictions in Illinois.ESRI ESRI (Environmental Systems Research Institute) is an international supplier ofGeographic Information System (GIS) software, web GIS and geodatabasemanagement applications. ESRI allows for specialized inquiries at the zip code, or other dened, level.Illinois State Board of EducationThe Illinois State Board of Education administers public education in the state of Illinois. Each year, it releases school “report cards” which analyze the makeup, needs, and performance of local schools.USDA USDA, among its many functions, collects and analyzes information related to nutrition and local production and food availability.

SBL Fayette County Hospital I 19Secondary data is initially collected through the SparkMap and/or ESRI systems and then reviewed. Questions raised by the data reported from those sources are compared with other federal, state and local data sources in order to resolve or reconcile potential issues with reported data. A focus group was convened at SBL Fayette County Hospital at 8:00 am on March 9, 2022. The group included representation of healthcare providers, community members and leaders, local law enforcement, community services providers, schools, faith-based organizations, public health, and others. Some members of this group provided services to underserved and unserved persons as all or part of their roles. The group was asked rst to identify development in the community in recent years that have impacted health and wellness in positive ways. They oered the following:• The association between Sarah Bush Lincoln Health System and SBL Fayette County Hospital• The long-term care facility at SBL Fayette County Hospital• Outpatient clinics at SBL Fayette County Hospital• Emergency room services at SBL Fayette County Hospital are a strong asset to the community• SBL Fayette County Hospital is local and friendly in its approach• Local availability of an orthopedic surgeon• Communication from SBL Fayette County Hospital to the community and media during the pandemic was important and useful• SBL Fayette County Hospital is a great community partner• SBL Fayette County Hospital is a signicant employer in the community• Prompt care• Quality of physicians at SBL Fayette County Hospital has improved over time and is now very high PRIMARY DATA

20 I Community Health Needs Assessment• The new addition at SBL Fayette County Hospital has improved lab services and patient access• Inpatient and outpatient care coordinators have been added at SBL Fayette County HospitalThe group was next asked to identify needs in the county in the area of overall wellness and health as well as the delivery of healthcare and health services. The group responded with the following observations:• Improved access to local pediatric services• Local access to a psychiatrist for adults and youth• Improved access to mental health counseling for adults and youth• Increase local access to specialty services in general• Improve internal communication at SBL Fayette County Hospital in order to keep employees better informed about ongoing changes at the hospital• Get the message out to the community about all of the good things happening at SBL Fayette County Hospital• Better inform the community about the costs of local healthcare and what is being done at SBL Fayette County Hospital to address them• Updating patient care areas, especially patient rooms and the long-term care facility• Resources for memory care patients and families, ranging from local access to a specialist to support groups• Improved communication from SBL Fayette County Hospital about available local servicesA second group, made up of medical professionals and partners, convened at noon on March 10, 2022. The group was rst asked to identify development in the community in recent years that have impacted health and wellness in positive ways. They oered the following:• Improved access for recreation and exercise through programming at the YMCA• Wellness program for employees at SBL Fayette County Hospital• The new addition at SBL Fayette County Hospital showed that the hospital was invested in the community and here to stay

SBL Fayette County Hospital I 21• Collaboration among agencies, local organizations, the hospital, and others is strong• Cooperation and support between SBL Fayette County Hospital and EMS has improved• Increased local access to specialty services through SBL Fayette County Hospital• Sarah Bush Lincoln Health Care’s purchase of Fayette County Hospital oers a promise for growth and expansion of local services• Express Care• Community education from SBL Fayette County Health Department and SBL Fayette County Hospital during the pandemic has been strongThe group was next asked to identify needs in the county in the area of overall wellness and health as well as the delivery of healthcare and health services. The group responded with the following observations:• Better access to mental health providers including counselors, a psychiatrist, and MDs that can address mental health• Access to medical providers to address substance use disorders• Access to inpatient mental health and substance use care• Adequate sidewalks and bike paths for recreation and physical activity• Improved education about preventative medicine and health screenings• Health fairs to provide opportunities for community education and access to screenings• Access to exible transportation to increase access to medical appointments and care• Assistance to address cost of prescriptions• Improve COVID education• A local morgue at SBL Fayette County Hospital to benet organ donation and meet emergency needs• Ways to sustain state or federally funded programs when funding goes away

SBL Fayette County Hospital I 23Age Group EthnicityRaceDisabilityDATA ANALYSISTotal Population by Age GroupData Source: US Census Bureau, American Community Survey. 2016‐-20. Source Geography: TractDEMOGRAPHICS

24 I Community Health Needs AssessmentTotal Population by EthnicityData Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: TractTotal Population by Age Groups, SBL Fayette County Hospital Service Area

SBL Fayette County Hospital I 25Total Population by Race AloneData Source: US Census Bureau, American Community Survey. 2016‐-20. Source geography: TractTotal Population by Race Alone, SBL Fayette County Hospital Service Area

26 I Community Health Needs AssessmentPopulation with any DisabilityThis indicator reports the percentage of the total civilian non-institutionalized population with a disability. The report area has a total population of 34,543 for whom disability status has been determined, of which 5,739 or 16.61% have any disability. This indicator is relevant because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.Data Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: Tract

 SBL Fayette County Hospital I 27 SOCIAL DETERMINANTS OF HEALTHThe data and discussion on the following pages will take a look into the socialdeterminants in the SBL Fayette County Hospital service area and will oer insightinto the complexity of circumstances that impact physical and mental wellness forthe SBLFCH audience. The infographic on Page 29 provides a snapshot of theat-risk population served by SBL Fayette County Hospital.The CDC describes social determinants of health as conditions in the places wherepeople live, learn, work, and play that aect a wide range of health and quality oflife risks and outcomes. Healthy People 2030 uses a place-based framework thatoutlines ve key areas of SDoH:• Healthcare access and quality, including: - Access to healthcare- Access to primary care- Health insurance coverage- Health literacy• Education access and quality, including: - High school graduation- Enrollment in higher education- Educational attainment in general- Language and literacy- Early childhood education and development• Social and community context – within which people live, learn work  and play, including: - Civic participation- Civic cohesiveness- Discrimination- Conditions within the workplace• Economic stability, including: - Income- Cost of living- Socioeconomic status- Poverty

28 I Community Health Needs Assessment• - Employment - Food security - Housing stability• Neighborhood and built environment, including: - Quality of housing - Access to transportation - Availability of healthy food - Air and water quality - Crime and violenceSome of the social determinant indicators reected in the data include:• 4,384 households with disability• 2,117 households below the poverty level (16%)• Median household income is $51,057, which is lower than both Illinois and the U.S.• 2,494 or 8.3% of the service area are veterans

SBL Fayette County Hospital I 29AT RISK POPULATION PROFILEGeography: CountySBL Fayette County Hospital Service Area At Risk Population15 ZIP Codes Prepared by Esri62011 (Bingham) et al. Geography: ZIP Code Version 1.9© 2022 EsriSource:Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey(ACS) Data,AT RISK POPULATION PROFILE15 ZIP CodesGeography: ZIP Code37,486Population14,264Households2.40Avg SizeHousehold41.1MedianAge$51,057MedianHousehold Income$114,020MedianHome Value65WealthIndex248HousingAffordability21DiversityIndexAT RISK POPULATION4,384Households WithDisability7,481Population 65+681HouseholdsWithout VehiclePOVERTY AND LANGUAGE16%Households Belowthe Poverty Level2,117Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES34,085DaytimePopulation1,207TotalBusinesses12,129TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+010,00020,0007,0027,29223,192Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 5,321 21,647 6,751 33,719Spanish 119 812 40 971Spanish & English Well 119 726 37 882Spanish & English Not Well 0 59 4 63Spanish & No English 0 27 0 27Indo-European 47 194 95 336Indo-European & English Well 47 178 84 309Indo-European & English Not Well 0 16 7 23Indo-European & No English 0 0 4 4Asian-Pacic Island 24 68 24 116Asian-Pacic Isl & English Well 13 54 0 67Asian-Pacic Isl & English Not Well 0 9 24 33Asian-Pacic Isl & No English 13 7 0 20Other Language 10 89 0 99Other Language & English Well 10 89 0 99Other Language & English Not Well 0 0 0 0Other Language & No English 0 0 0 0SBL Fayette County Hospital Service Area At Risk Population15 ZIP Codes Prepared by Esri62011 (Bingham) et al. Geography: ZIP Code Version 1.9© 2022 EsriSource:Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey(ACS) Data,AT RISK POPULATION PROFILE15 ZIP CodesGeography: ZIP Code37,486Population14,264Households2.40Avg SizeHousehold41.1MedianAge$51,057MedianHousehold Income$114,020MedianHome Value65WealthIndex248HousingAffordability21DiversityIndexAT RISK POPULATION4,384Households WithDisability7,481Population 65+681HouseholdsWithout VehiclePOVERTY AND LANGUAGE16%Households Belowthe Poverty Level2,117Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES34,085DaytimePopulation1,207TotalBusinesses12,129TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+010,00020,0007,0027,29223,192Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 5,321 21,647 6,751 33,719Spanish 119 812 40 971Spanish & English Well 119 726 37 882Spanish & English Not Well 0 59 4 63Spanish & No English 0 27 0 27Indo-European 47 194 95 336Indo-European & English Well 47 178 84 309Indo-European & English Not Well 0 16 7 23Indo-European & No English 0 0 4 4Asian-Pacic Island 24 68 24 116Asian-Pacic Isl & English Well 13 54 0 67Asian-Pacic Isl & English Not Well 0 9 24 33Asian-Pacic Isl & No English 13 7 0 20Other Language 10 89 0 99Other Language & English Well 10 89 0 99Other Language & English Not Well 0 0 0 0Other Language & No English 0 0 0 0SBL Fayette County Hospital Service Area At Risk Population15 ZIP Codes Prepared by Esri62011 (Bingham) et al. Geography: ZIP Code Version 1.9© 2022 EsriSource:Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey(ACS) Data,AT RISK POPULATION PROFILE15 ZIP CodesGeography: ZIP Code37,486Population14,264Households2.40Avg SizeHousehold41.1MedianAge$51,057MedianHousehold Income$114,020MedianHome Value65WealthIndex248HousingAffordability21DiversityIndexAT RISK POPULATION4,384Households WithDisability7,481Population 65+681HouseholdsWithout VehiclePOVERTY AND LANGUAGE16%Households Belowthe Poverty Level2,117Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES34,085DaytimePopulation1,207TotalBusinesses12,129TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+010,00020,0007,0027,29223,192Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 5,321 21,647 6,751 33,719Spanish 119 812 40 971Spanish & English Well 119 726 37 882Spanish & English Not Well 0 59 4 63Spanish & No English 0 27 0 27Indo-European 47 194 95 336Indo-European & English Well 47 178 84 309Indo-European & English Not Well 0 16 7 23Indo-European & No English 0 0 4 4Asian-Pacic Island 24 68 24 116Asian-Pacic Isl & English Well 13 54 0 67Asian-Pacic Isl & English Not Well 0 9 24 33Asian-Pacic Isl & No English 13 7 0 20Other Language 10 89 0 99Other Language & English Well 10 89 0 99Other Language & English Not Well 0 0 0 0Other Language & No English 0 0 0 0SBL Fayette County Hospital Service Area

30 I Community Health Needs AssessmentEconomic Stability – Income and Economics Economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of educational achievement aect access to care and a community’s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community. Income – Median Family Household IncomeThis indicator reports median family household income based on the latest 5-year American Community Survey estimates. A family household is any housing unit in which the householder is living with one or more individuals related to him or her by birth, marriage, or adoption. Family income include the incomes of all family members age 15 and older.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: TractHEALTH AND WELLNESS INDICATORS

SBL Fayette County Hospital I 31Poverty – Children Below 100% FPLIn the service area, 25.30% or 1,817 children aged 0-17 are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, healthy food, and other necessities that contribute to poor health status.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: Tract

32 I Community Health Needs AssessmentPoverty – Population Below 100% FPLPoverty is considered a key driver of health status. Within the service area, 16.55% or 5,606 individuals are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, health food, and other necessities that contribute to poor health status.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: Tract

SBL Fayette County Hospital I 33Education Attainment – Associate’s Level Degree or HigherThis category contains indicators that describe the education system and the educational outcomes of the service area populations. Education metrics can be used to describe variation in population access, prociency, and attainment throughout the education system, from access to pre-kindergarten through advanced degree attainment. These indicators are important because education is closely tied to health outcomes and economic opportunity. For the selected area, 10.2% have at least a college bachelor’s degree, while 38.0% stopped their formal education attainment after high school. Note: This indicator is compared to the state average.Data Source: U.S. Census Bureau, American Community Survey, 2015-19. Source geography: County

34 I Community Health Needs AssessmentHouseholds Receiving SNAP BenetsIn the service area, an estimated 2,026 or 14.71% of households receive Supplemental Nutrition Assistance Program (SNAP) benets. The value for the service area is greater than the national average of 11.74%. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. When combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2015-2019. Source geography: Tract

SBL Fayette County Hospital I 35Area Deprivation IndexThis indicator reports the average (population weighted) Area Deprivation Index (ADI) for the selected area. The Area Deprivation Index ranks neighborhoods and communities relative to all neighborhoods across the nation (National Percentile) or relative to other neighborhoods within just one state (State Percentile). The ADI is calculated based on 17 measures related to four primary domains (education, income and employment, housing, and household characteristics). The overall scores are measured on a scale of 1 to 100 where 1 indicates the lowest level of deprivation (least disadvantaged) and 100 is the highest level of deprivation (most disadvantaged).Note: This indicator is compared to the state average. Data Source: University of Wisconsin-Madison School of Medicine and Public Health, Neighborhood Atlas, 2021. Source geography: Block Group

36 I Community Health Needs AssessmentOther Social & Economic Factors – Food Insecurity RateEconomic and social insecurity often are associated with poor health. Poverty, unemployment, and a lack of educational achievement aect access to care and a community’s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community. This indicator reports the estimated percentage of the population that experienced food insecurity at some point during the report year. Food insecurity is the household-level economic and social condition of limited or uncertain access to adequate food.Note: This indicator is compared to the state average.Data Source: Feeding America, 2017. Source geography: County

SBL Fayette County Hospital I 37Note: This indicator is compared to the state average.Data Source: Feeding America, 2017. Source geography: CountyFood Insecurity – Food Insecure ChildrenThis indicator reports the estimated percentage of the population under age 18 that experienced food insecurity at some point during the report year. Food insecurity is the household-level economic and social condition of limited or uncertain access to adequate food.

38 I Community Health Needs AssessmentFood Environment – Food Desert CensusThis indicator reports the number of neighborhoods in the service area that are within food deserts. The USDA Food Access Research Atlas denes a food desert as any neighborhood that lacks healthy food sources due to income level, distance to supermarkets, or vehicle access. The service area has a population of 28,209 living in food deserts and a total of 7 census tracts classied as food deserts by the USDA.Note: This indicator is compared to the state average. Data Source: U.S. Department of Agriculture, Economic Research Services, USDA - Food Access Research Atlas, 2019. Source geography: Tract

SBL Fayette County Hospital I 39Note: This indicator is compared to the state average. Data Source: U.S. Department of Agriculture, Economic Research Services, USDA - Food Access Research Atlas, 2019. Source geography: TractFood Environment – Low Food AccessThis indicator reports the percentage of the population with low food access. Low food access is dened as living more than 1/2 mile from the nearest supermarket, supercenter, or large grocery store. Data are from the April 2021 Food Access Research Atlas dataset. This indicator is relevant because it highlights populations and geographies facing food insecurity. Of the total population in the service area, 35.01% have low food access. The total population in the service area with low food access is 13,429.

40 I Community Health Needs AssessmentHousing and FamiliesThis category contains indicators that describe the structure of housing and families, and the condition and quality of housing units and residential neighborhoods. These indicators are important because housing issues like overcrowding and aordability have been linked to multiple health outcomes, including infectious disease, injuries, and mental disorders. Furthermore, housing metrics like home-ownership rates and housing prices are key for economic analysis.Homeless Children and YouthThis indicator reports the number of homeless children and youth enrolled in the public school system during the school year 2019-2020. According to the data source denitions, homeless is dened as lacking a xed, regular and adequate nighttime residence. Those who are homeless may be sharing the housing of other persons, living in motels, hotels, or camping grounds, in emergency transitional shelters, or may be unsheltered. Data are aggregated to the report-area level based on school district summaries where three or more homeless children are counted. In the service area, of all the 5,169 students enrolled during the school year 2019-2020, there were 348 or 1.2% homeless students, which is lower than the statewide rate of 2.6%.Note: This indicator is compared to the state average. Data Source: U.S. Department of Education, EDFacts, Additional data analysis by CARES, 2019-2020. Source geography: School District

SBL Fayette County Hospital I 41Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2015-2019. Source geography: TractAordable HousingThis indicator reports the number and percentage of housing units aordable at various income levels. Aordability is dened by assuming that housing costs should not exceed 30% of total household income. Income levels are expressed as a percentage of each county’s area median household income (AMI).

42 I Community Health Needs AssessmentInsurance – Population with Insurance by Provider Type, TotalThis indicator reports the number of individuals with various types of public or private health insurance plans. Note: Summed totals may exceed the total number of persons with insurance, as individuals may have more than one form of health insurance.

SBL Fayette County Hospital I 43Built Environment – Households with No ComputerThis indicator reports the percentage of households who don’t own or use any type of computers, including desktop or laptop, smartphone, tablet, or other portable wireless computer, and some other type of computer, based on the 2014-2019 American Community Survey estimates. Of the 13,770 total households in the service area, 2,649 or 19.24% are without a computer.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2015-2019. Source geography: Tract

44 I Community Health Needs AssessmentBuilt Environment – Households with No or Slow InternetThis indicator reports the percentage of households who either use dial-up as their only way of internet connection, or have internet access but don’t pay for the service, or have no internet access in their home, based on the 2015-2019 American Community Survey estimates. Of the 13,770 total households in the service area, 3,634 or 26.39% have no or slow internet.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2015-2019. Source geography: Tract

SBL Fayette County Hospital I 45Clinical Care and PreventionA lack of access to care presents barriers to good health. Supply of facilities and physicians, the rate of uninsurance, nancial hardship, transportation barriers, cultural competency, and coverage limitations aect access. Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community residents access services such as health screenings, routine tests, and vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and can inform program interventions.Prevention – Core Prevention Services for MenThis indicator reports the percentage of males age 65 and older who report that they are up to date on a core set of clinical preventive services. Services include: an inuenza vaccination in the past year; a PPV ever; and either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and an FOBT within the past 3 years, or a colonoscopy within the past 10 years. Within the service area, there are 33.4% men 65 and older who had core preventative services in the last one to 10 years of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

46 I Community Health Needs AssessmentPrevention – Core Prevention Services for WomenThis indicator reports the percentage of females age 65 and older who report that they are up to date on a core set of clinical preventive services. Services include: an inuenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; and either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and an FOBT within the past 3 years, or a colonoscopy within the past 10 years., and a mammogram in the past 2 years. Within the service area, there are 24.6% women 65 and older who had core preventative services in the last one to 10 years of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

SBL Fayette County Hospital I 47Health BehaviorsHealth behaviors such as poor diet, a lack of exercise, and substance abuse contribute to poor health status. Alcohol - Heavy Alcohol ConsumptionIn the service area, 3,557 or 21.39% adults self-report excessive drinking in the last 30 days, which is less than the state rate of 21.54%. Data for this indicator were based on survey responses to the 2018 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and are used for the 2021 County Health Rankings. Excessive drinking is dened as the percentage of the population who report at least one binge drinking episode involving ve or more drinks for men and four or more for women over the past 30 days, or heavy drinking involving more than two drinks per day for men and more than one per day for women, over the same time period. Alcohol use is a behavioral health issue that is also a risk factor for a number of negative health outcomes, including: physical injuries related to motor vehicle accidents, stroke, chronic diseases such as heart disease and cancer, and mental health conditions such as depression and suicide. Note: This indicator is compared to the state average. Data Source: University of Wisconsin Population Health Institute, County Health Rankings, 2018. Source geography: County

48 I Community Health Needs AssessmentPhysical InactivityWithin the service area, 5,890 or 19.8% of adults aged 20 and older self-report no active leisure time, based on the question: “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of signicant health issues, such as obesity and poor cardiovascular health. Note: In 2021, the CDC updated the methodology used to produce estimates for this indicator. Estimated values for prior years (2004-2017) have been updated in this platform to allow comparison across years. Use caution when comparing with saved assessments generated prior to November 10, 2021.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2019. Source geography: County

SBL Fayette County Hospital I 49Tobacco Usage – Current SmokersThis indicator reports the percentage of adults age 18 and older who report having smoked at least 100 cigarettes in their lifetime and currently smoke every day or some days. Within the service area, there are 21.5% adults who have smoked or currently smoke of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

50 I Community Health Needs AssessmentCHRONIC ILLNESSHealth OutcomesMeasuring morbidity and mortality rates allows assessing linkages between social determinants of health and outcomes. By comparing, for example, the prevalence of certain chronic diseases to indicators in other categories (e.g., poor diet and exercise) with outcomes (e.g., high rates of obesity and diabetes), various causal relationship may emerge, allowing a better understanding of how certain community health needs may be addressed. Cancer Incidence – All SitesThis indicator reports the age adjusted incidence rate (cases per 100,000 population per year) of cancer (all sites) adjusted to 2000 U.S. standard population age groups (under age 1, 1-4, 5-9, ..., 80-84, 85 and older). Within the service area, there were 241 new cases of cancer reported. This means there is a rate of 478.0 for every 100,000 total population.Note: This indicator is compared to the state average. Data Source: State Cancer Proles, 2014-2018. Source geography: County

SBL Fayette County Hospital I 51Top Five Most Commonly Diagnosed CentersThe table below shows counts and age-adjusted incidence rates of the ve most common newly diagnosed cancers by site for the 5-year period 2014-2018.

52 I Community Health Needs AssessmentChronic Obstructive Pulmonary DiseaseThis indicator reports the percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they had chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis. Within the service area, there were 8.9% of adults 18 and older who reported having chronic obstructive pulmonary disease of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

SBL Fayette County Hospital I 53Asthma PrevalenceThis indicator reports the percentage of adults age 18 and older who answer “yes” to both of the following questions: “Have you ever been told by a doctor, nurse, or other health professional that you have asthma?” and the question, “Do you still have asthma?” Within the service area, there were 9.8% of adults 18 and older who reported having asthma of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

54 I Community Health Needs AssessmentDiabetesThis indicator reports the percentage of adults age 20 and older who have every been told by a doctor that they have diabetes. This indicator is relevant because diabetes is a prevalent problem in the U.S. It may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. Within the service area, 2,600 of adults age 20 and older have diabetes. This represents 7.7% of the total survey population. Note: In 2021, the CDC updated the methodology used to produce estimates for this indicator. Estimated values for prior years (2004-2017) have been updated in this platform to allow comparison across years. Use caution when comparing with saved assessments generated prior to November 10, 2021.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

SBL Fayette County Hospital I 55Coronary Heart DiseaseThis indicator reports the percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they had angina or coronary heart disease. In the service area, there were 7.3% of adults 18 and older who reported having coronary heart disease of the total population. Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

56 I Community Health Needs AssessmentKidney DiseaseThis indicator reports the number and percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they have kidney disease.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

SBL Fayette County Hospital I 57High Blood PressureThis table presents the percentage of adultsever diagnosed with high blood pressure. Within the service area, there were 36.4% of adults 18 and older who reported having high blood pressure of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

58 I Community Health Needs AssessmentHigh CholesterolThis indicator reports the percentage of adults age 18 and older who report having been told by a doctor, nurse, or other health professional that they had high cholesterol. Within the service area, there were 33.6% of adults 18 and older who reported having high cholesterol of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

SBL Fayette County Hospital I 59ObesityThis indicator reports the number and percentage of adults aged 20 and older who self-report having a Body Mass Index (BMI) greater than 30.0 (obese). Respondents were considered obese if their Body Mass Index (BMI) was 30 or greater. Body mass index (weight [kg]/height [m]2) was derived from self-report of height and weight. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. Within the service area, there are a total of 6,520 adults age 20 and older who self-reported having a BMI greater than 30.0. This represents 22.8% of the survey population. Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2019. Source geography: County

60 I Community Health Needs AssessmentTeeth LossThis indicator reports the number and percentage of adults age 18 and older who report having lost all of their natural teeth because of tooth decay or gum disease. Within the service area, there were 17.1% of adults 18 and older who reported losing all natural teeth of the total population. Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018.

SBL Fayette County Hospital I 61Poor or Fair HealthIn this service area, the estimated prevalence of fair or poor health among adults aged 18 years and older was 21.2%. The value is based on the crude number of adults who self-report their general health status as “fair” or “poor.”Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

62 I Community Health Needs AssessmentPoor Physical HealthThis indicator reports the percentage of adults age 18 and older who report 14 or more days during the past 30 days during which their physical health was not good. Data were from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) annual survey. With the service area, there were 14.9% of adults 18 and older who reported poor physical health in the past month of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

SBL Fayette County Hospital I 63Teen BirthsThis indicator reports the seven-year average number of births per 1,000 female population age 15-19. Data were from the National Center for Health Statistics - Natality Files (2013-2019) and are used for the 2021 County Health Rankings. In the service area, of the 7,220 total female population age 15-19, the teen birth rate is 29.1 per 1,000, which is greater than the state’s teen birth rate of 19.4. Note: Data are suppressed for counties with fewer than 10 teen births in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via County Health Rankings, 2013-2019. Source geography: County

64 I Community Health Needs AssessmentSUBSTANCE USESubstance Use Disorder (Medicare Population) This indicator reports the percentage of the Medicare fee-for-service population with substance use disorder. Data are based upon Medicare administrative enrollment and claims data for Medicare beneciaries enrolled in the fee-for-service program. Within the service area, there are a total of 164 beneciaries with substance use disorder. This represents 2.5% of the Medicare fee-for-service beneciaries.Note: This indicator is compared to the state average. Data Source: Centers for Medicare and Medicaid Services, CMS - Geographic Variation Public Use File, 2018. Source geography: County

SBL Fayette County Hospital I 65MENTAL AND BEHAVIORAL HEALTHPoor Mental HealthThis indicator reports the percentage of adults age 18 and older who report 14 or more days during the past 30 days during which their mental health was not good. Data were from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) annual survey. Within the service area, there were 16.3% of adults 18 and older who reported poor mental health in the past month of the total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

66 I Community Health Needs AssessmentPoor Mental Health – Mental Health and Substance Use ConditionsThis indicator reports the rate of diagnoses for mental health and substance use conditions among the Medicare population. Figures are reported as age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant because mental health and substance use is an indicator of poor health.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via the 500 Cities Data Portal, 2018. Source geography: Tract

SBL Fayette County Hospital I 67Deaths of Despair (Suicide + Drug/Alcohol Poisoning)This indicator reports average rate of death due to intentional self-harm (suicide), alcohol-related disease, and drug overdose, also known as “deaths of despair,” per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. This indicator is relevant because death of despair is an indicator of poor mental health. Within the service area, there were 83 deaths of despair. This represents an age-adjusted death rate of 43.4 per every 100,000 total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, CDC - National Vital Statistics System, Accessed via CDC WONDER, 2016-2020. Source geography: County

68 I Community Health Needs AssessmentMortality – SuicideThis indicator reports the 2016-2020 ve-year average rate of death due to intentional self-harm (suicide) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. This indicator is relevant because suicide is an indicator of poor mental health. Within the service area, there are a total of 28 deaths due to suicide. This represents an age-adjusted death rate of 19.7 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, CDC-National Vital Statistics System, Accessed via CDC WONDER, 2016-2020. Source geography: County

SBL Fayette County Hospital I 69HEALTH PROFESSIONAL SHORTAGE AREA Population Living in a Health Professional Shortage AreaThis indicator reports the percentage of the population that is living in a geographic area designed as a “Health Professional Shortage Area” (HPSA), dened as having a shortage of primary medical care, dental, or mental health professionals. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. Within the service area, there are 0 people in a Health Professional Shortage Area of primary care, dental, or mental health professionals. This represents 0.00% of the total population.Note: This indicator is compared to the state average. Data Source: U.S. Department of Health & Human Services, Health Resources and Services Administration, HRSA - Health Professional Shortage Areas Database, May 2021. Source geography: HPSA

70 I Community Health Needs AssessmentHEALTHCARE WORKFORCEA lack of access to care presents barriers to good health. The supply and accessibility of facilities and physicians, the rate of uninsurance, nancial hardship, transportation barriers, cultural competency, and coverage limitations aect access. Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community residents access services such as health screenings, routine tests, and vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and can inform program interventions.Access to Care – Dental HealthThis indicator reports the number of dentists per 100,000 population. This indicator includes all dentists qualied as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice dentistry and who are practicing within the scope of that license. Within the service area, there are 14 dentists. This represents 39.35 dentists per 100,000 total population.Note: This indicator is compared to the state average. Data Source: U.S. Department of Health & Human Services, Health Resources and Services Administration, HRSA - Area Health Resource File. Accessed via County Health Rankings, 2017. Source geography: County

SBL Fayette County Hospital I 71Access to Care – Mental HealthThis indicator reports the number of mental health providers in the service area as a rate per 100,000 total area population. Mental health providers include psychiatrists, psychologists, clinical social workers, and counselors that specialize in mental healthcare. Data from the 2021 Centers for Medicare and Medicaid Services (CMS) National Provider Identier (NPI) downloadable le are used in the 2021 County Health Rankings. Within the report area, there are 25 mental health providers with a CMS National Provider Identier (NPI). This represents 152.2 providers per 100,000 total population. Note: Data are suppressed for counties with population greater than 1,000 and 0 mental health providers.Note: This indicator is compared to the state average. Data Source: U.S. Department of Health & Human Services,Health Resources and Services Administration, HRSA - Area Health Resource File, 2015. Source geography: CountyNote: This indicator is compared to the state average. Data Source: Centers for Medicare and Medicaid Services, CMS - National Plan and Provider Enumeration System (NPPES), Accessed via County Health Rankings, 2020. Source geography: County

72 I Community Health Needs AssessmentAccess to Care – Nurse PractitionersThis indicator reports the number of nurses with a CMS National Provider Identier (NPI). Nurses counted for this indicator include all advanced practice registered nurses (APRNs) and nurse practitioners, regardless of sub-specialty. Data are from the latest Centers for Medicare and Medicaid Services (CMS) National Provider Identier (NPI) downloadable le.Note: This indicator is compared to the state average. Data Source: Centers for Medicare and Medicaid Services, CMS - National Plan and Provider Enumeration System (NPPES), Accessed via County Health Rankings, 2020. Source geography: County

SBL Fayette County Hospital I 73 SBL Fayette County Hospital works with the US-HHS ASPR, the Illinois Departmentof Public Health, county health departments, the Illinois Emergency Management Agency, and other state, regional, and local partners to plan, exercise, and equipfor emergency preparedness and to ensure the ability to address a wide rangeof potential emergencies, ranging from disasters of all causes to pandemics  and terrorism.EMERGENCY PREPAREDNESS

SBL Fayette County Hospital I 75SECONDARY DATAThe ndings of the focus groups were presented, along with secondary data, analyzed by the consultant, to a third group for identication and prioritization of the signicant health needs facing the community. The group consisted of representatives of public health, community leaders, healthcare providers, law enforcement, faith-based organizations and community services providers. The group reviewed notes from the focus groups and summaries of data reviewed by the consultant which included SparkMaps, ESRI, Illinois Department of Public Health, CDC, USDA, Illinois Department of Labor, HRSA, County Health Rankings and Roadmaps, National Cancer Institute and other resources. PROCESSIDENTIFICATION AND PRIORITIZATION OF NEEDSImprove Local Access to Geriatric ServicesImprove Substance Use Prevention EortsImprove Local Access to Mental Health CareImprove Local Access to Pediatric Services

76 I Community Health Needs AssessmentAt the conclusion of their review and discussion, the identication and prioritization group advanced the following needs as being the signicant community health needs facing the SBL Fayette County Hospital service area:1. Improve local access to mental health care– Improve local access to counselors and support persons for mentalhealth issues and substance use disorders, especially for low incomeunserved and underserved residents– Improve local access to a psychiatrist– Improve community prevention eorts for substance use for youthand adults– Address social determinants (poverty, housing, food access, homeless-ness) that impact mental health and substance use– Improve access to services at all levels for persons over age 18 withsubstance use disorders2. Improve local access to geriatric services3. Improve community education about available local resources for physical and mental health and wellness education and services4. Improve local access to pediatric servicesDESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED

SBL Fayette County Hospital I 77

SBL Fayette County Hospital I 79Resources 
Hospital Resources at SBL Fayette County Hospital•  Administration• Medical sta• Director of Senior Renewal• Additional in-house resources as identiedHOSPITAL RESOURCESRESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDS• Fayette County Health Department• Sarah Bush Lincoln Health Care• Sarah Bush Lincoln Health Care Marketing and Community Outreach• Sarah Bush Lincoln Health Care Healthy Communities Director• Senior Renewal ProgramHEALTHCARE PARTNERS OR OTHER RESOURCES, INCLUDING TELEMEDICINECOMMUNITY RESOURCES• Local law enforcement• Community Resource Center• Ministerial Association• Other interested groups, organizations, and persons

SBL Fayette County Hospital I 81Documentation Online PresenceCommentsImplementationSECONDARY DATAThis CHNA Report will be available to the community on the hospital’s public website, www.sblfch.org. A hard copy may be reviewed at the hospital by inquiring at the information desk at the main entrance. No written comments were received concerning the hospital facility’s most recently conducted CHNA nor on the most recently adopted Implementation Strategy. A method for retaining written public comments and responses exists,but none were received.DOCUMENTING AND COMMUNICATING RESULTS

SBL Fayette County Hospital I 83The results of the assessment process were presented to senior sta througha facilitated discussion for development of a plan to address the identied andprioritized needs.The group reviewed the needs assessment process completed to that point andconsidered the prioritized signicant needs and supporting documents. Theyrecounted some of the steps taken to address previous Community Health NeedsAssessments. They also considered internal and external resources potentiallyavailable to address the current prioritized needs.The group then considered each of the prioritized needs. For each of the fourprioritized needs, actions the hospital intends to take were identied, along withthe anticipated impact of the actions, the resources the hospital intends to committo the actions, and the external collaborators the hospital plans to cooperate withto address the need. The plan will be evaluated by periodic review of measurableoutcome indicators in conjunction with annual review and reporting.PLANNING PROCESSIMPLEMENTATION STRATEGYImprove LocalAccess toGeriatric ServicesImproveSubstance UsePrevention EortsImprove LocalAccess to MentalHealth CareImprove LocalAccess toPediatric Services

84 I Community Health Needs AssessmentThe group addressed the needs with the following strategies:1. Improve local access to mental health care– Improve local access to counselors and support persons for mentalhealth issues and substance use disorders, especially for low incomeunserved and underserved residents– Improve local access to a psychiatrist– Improve community prevention eorts for substance use for youthand adults– Address social determinants (poverty, housing, food access, homeless-ness) that impact mental health and substance use– Improve access to services at all levels for persons over age 18 withsubstance use disordersActions the hospital intends to take to address the health need:• SBL Fayette County Hospital will continue to explore creating a local mental health clinic• SBL Fayette County Hospital will continue to explore utilization of an Advanced Practice Nurse, oering mental health through telehealth.• SBL Fayette County Hospital will collaborate with Sarah Bush Lincoln Health Care to improve local access to mental health and substance use disorder care.• SBL Fayette County Hospital will collaborate with the Fayette County Health Department to promote a community-based coalition of law enforcement, providers, and other interested groups and parties to address substance abuse prevention and promote local substance use disorder services.IMPLEMENTATION STRATEGY

SBL Fayette County Hospital I 85Anticipated impacts of these actions:SBL Fayette County Hospital anticipates that the proposed actions will begin to address the identied mental health and substance use disorder service needs and create the opportunities for local collaboration for prevention, education, and additional future services.Programs and resources the hospital plans to commit to address health need:• Administration• Medical staPlanned collaboration between the hospital and other facilities:• Fayette County Health Department• Sarah Bush Lincoln Health Care• Local law enforcement• Community Resource Center• Ministerial Association• Other interested groups, organizations, and persons2. Improve local access to geriatric servicesActions the hospital intends to take to address the health need:• SBL Fayette County Hospital will explore expansion of the Senior Renewal program to create a support group for families of seniors facing chronic illness or mental health issues.• SBL Fayette County Hospital will explore resources for local access to senior care specialistsAnticipated impacts of these actions:SBL Fayette County Hospital anticipates that these actions will help to address the concerns expressed regarding local access to senior care and information about senior health issues.

86 I Community Health Needs AssessmentPrograms and resources the hospital plans to commit to address health need: • Administration • Director of Senior RenewalPlanned collaboration between the hospital and other facilities:• Senior Renewal program• Sarah Bush Lincoln Health Care3. Improve community education about available local resources for physical and mental health and wellness education and servicesActions the hospital intends to take to address the health need: • SBL Fayette County Hospital will collaborate with Fayette County Health Department and other community partners and providers to expand awareness of available local resources for education and information.• SBL Fayette County Hospital will explore development of a webpage for information about available local resources for mental and physical health and wellness services and care.• SBL Fayette County Hospital will expand social media content to include “Did you know?” information about available resources at SBLFCH, its partners, and other local resources.Programs and resources the hospital plans to commit to address health need: • AdministrationPlanned collaboration between the hospital and other facilities:• Fayette County Health Department• Sarah Bush Lincoln Health Care Marketing and Community Outreach• Sarah Bush Lincoln Health Care Healthy Communities Director• Other interested organizations, groups, partners, and persons4. Improve local access to pediatric servicesActions the hospital intends to take to address the health need: • SBL Fayette County Hospital will explore establishing a relationship with a pediatrician to allow for local services, including post-natal care.

SBL Fayette County Hospital I 87Anticipated impacts of these actions:SBL Fayette County Hospital anticipates that, if successful, the selected actions will improve local access to pediatric care.Programs and resources the hospital plans to commit to address health need:• AdministrationPlanned collaboration between the hospital and other facilities:• Sarah Bush Lincoln Health Care

SBL Fayette County Hospital I 89Focus Groups AdministrationOrganizationsBusinessFocus Group One Sandy Michal, Realtor, RemaxTodd Stapleton, Station Manager, WKRV RadioAaron Alderson, Financial Advisor, Edward D. JonesPat Click, Insurance Broker, MRMC Insurance, LTD.Frank Roeder, retired and former member of the Fayette County Hospital FoundationJoe Lawson, Pastor and head of local Ministerial AllianceMarci Barth, CNO, SBL Fayette County HospitalGreg Starnes, CEO, SBL Fayette County HospitalREFERENCES AND APPENDIX

90 I Community Health Needs AssessmentFocus Group TwoKendra Craig, Director, Fayette County Health DepartmentBen Frazier, CEO, YMCAJe Ray, Chief of Police, VandaliaSue Holliday, Owner, File Funeral HomeBecca Sefton, Certied Nurse AnesthetistSheri Hopkins, Business Oce Manager, Corporate Compliance, and Credentialing Coordinator, SBL Fayette County HospitalMarci Barth, CNO, SBL Fayette County HospitalGreg Starnes, CEO, SBL Fayette County HospitalIdentication and Prioritization GroupSandy Michal, Realtor, Remax Joe Lawson, Pastor and head of Ministerial AllianceKendra Craig, Director, Fayette County Health DepartmentSheri Hopkins, Business Oce Manager, Corporate Compliance, and Credentialing Coordinator, SBL Fayette County HospitalMarci Barth, CNO, SBL Fayette County HospitalGreg Starnes, CEO, SBL Fayette County Hospital

SBL Fayette County Hospital I 91NOTES

  650 W. Taylor Street, Vandalia, IL 62471 • (618) 283.1232 • www.sblfch.org