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2022Community Health NeedsAssessment

2 I Community Health Needs AssessmentTABLE OF CONTENTSINTRODUCTION............................................................................................................................................5Executive Summary..............................................................................................................................................6-10Background...............................................................................................................................................................10-11Midwest Medical Center Services...........................................................................................................12-14Local Impact of COVID.....................................................................................................................................14-15ESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPS.........................17 DATA COLLECTION............................................................................................................................17-25Secondary Data.....................................................................................................................................................17-19Primary Data............................................................................................................................................................19-25DATA ANALYSIS...................................................................................................................................27-73Demographics........................................................................................................................................................27-30Social Determinants of Health....................................................................................................................31-50Health and Wellness Indicators................................................................................................................59-73- Chronic Illness...................................................................................................................................................59-67- Substance Use..................................................................................................................................................68-69- Mental and Behavioral Health................................................................................................................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.

Midwest Medical Center 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...............................................................81IMPLEMENTATION STRATEGY....................................................................................................83-87Planning Process.........................................................................................................................................................83Implementation Strategy..............................................................................................................................83-87REFERENCES AND APPENDIX....................................................................................................89-91

Midwest Medical Center I 5INTRODUCTIONMidwest Medical Center has been serving the healthcare needs of the surrounding area since 2008. Midwest Medical Center’s commitment – and impact – is seen in the growth and progress it is experiencing that is very dierent from many national rural health trends. At Midwest Medical Center, the mission is: AdolescentsAdultsSeniorsEarly Childhood AdolescentsAdultsSeniorsA Healthy Community Midwest Medical Center will provide the caring, competent, cost- eective healthcare every member of this great community deserves.

6 I Community Health Needs AssessmentProvisions 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 58 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 Galena and the surrounding area. The CHNA process was coordinated by the Executive Assistant. Three focus groups met to discuss the state of overall health and wellness in the Midwest Medical Center 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. EXECUTIVE SUMMARY

Midwest Medical Center I 7The focus groups included representation of healthcare providers, community leaders, community services providers, schools, a community college, 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.

8 I Community Health Needs AssessmentIDENTIFICATION 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 access to mental healthcare– Counselors and other providers and resources to improve accessto behavioral mental healthcare– Counselors and other providers and resources to improve accessto care for substance use disorders2. Improve access to physical healthcare – Pain Clinic– Cardiac care– Dialysis– Oncology3. Improve access to available, exible transportation4. Increase information to the community about available local health and wellness activitiesImprove accessto mental healthcareImprove access to physicalhealthcareImprove access totransportationIncrease information to community about health and wellness servicesIncrease resources for seniors

Midwest Medical Center I 95. Increase resources for seniors– Independent living opportunities– Transitional senior housing– Education about local resources, insurance, and Medicare – and supplemental and advantage plans – and Medicaid– ScreeningsThe results of the assessment process were then presented to senior sta at Midwest Medical Center through a facilitated discussion for development of a plan to address the identied and prioritized needs.ADDRESSING THE NEED CREATING THE PLANThe group addressed the needs with the following strategies:• Midwest Medical Center will complete and maintain a web-based local resource guide for mental health services and other local medical resources• Midwest Medical Center will construct a new outpatient wing that will include room for expanding behavioral health services• Midwest Medical Center will explore and evaluate the possibility of adding inpatient mental health services• Midwest Medical Center will continue to evaluate establishing a pain clinic • Midwest Medical Center will create space for an infusion center and explore and evaluate adding oncology services at that location• Midwest Medical Center will continue to evaluate the need for local dialysis services• Midwest Medical Center will explore expansion of cardiac services• Midwest Medical Center will explore collaboration with surrounding hospitals and providers to facilitate oering identied services locally• Midwest Medical Center will explore and evaluate a third-party marketing consultant to assist with identifying and executing a more robust plan for marketing Midwest Medical Center, its services, and its partners

10 I Community Health Needs Assessment• Midwest Medical Center will expand its direct marketing campaign• Regarding education, Midwest Medical Center will continue to explore partnerships with local groups and agencies for opportunities to expand education about local resources for insurance and assistance navigating Medicare and Medicaid• Regarding health screenings, Midwest Medical Center will continue to explore partnerships with local groups and agencies for ways to expand access to health screenings, especially for seniors and underserved and unserved community members• Regarding housing opportunities for seniors, although these issues are beyond the scope or capability of Midwest Medical Center to resolve, MMC will support any organized local government or community-based eort to address these needs to the extent it is reasonable and appropriateBACKGROUNDThe 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, Midwest Medical Center has taken the following steps since the last CHNA. • Midwest Medical Center expanded its telehealth program to include adult and youth psychiatric care.• Midwest Medical Center retained a fulltime Licensed Clinical Social Worker (LCSW) to the hospital and clinic.• Midwest Medical Center developed a community marketing program around “Brain Health.”• Midwest Medical Center explored grant opportunities to provide community mental health education and information.• Midwest Medical Center educated healthcare providers about available local mental health services.• Midwest Medical Center continued participation in the countywide ad hoc committee to address EMS issues.

Midwest Medical Center I 11• Midwest Medical Center continues to explore in-house, non-emergency transportation options.• Midwest Medical Center expanded chronic care management.• Midwest Medical Center continued participation in the Illinois Rural Community Care Organization (IRCCO).• Midwest Medical Center expanded wellness and nutrition education.• Midwest Medical Center expanded reduced fee lab work and free blood pressure check programs to provide more opportunities for information and access to services.• Midwest Medical Center was unable to explore oering Mental Health First Aid, due to COVID challenges.• Midwest Medical Center was unable to explore hospital involvement as a volunteer sponsor or employer of EMS, due to COVID challenges.• Midwest Medical Center was unable to explore collaboration with the Chamber of Commerce and large employers to provide sta for ambulances, due to COVID challenges.• Midwest Medical Center was unable to expand “Welcome to Medicare” programs to include additional topics, due to COVID challenges.• Midwest Medical Center was unable to educate local healthcare providers about local services for seniors, due to COVID challenges.• Midwest Medical Center was unable to support the continued expansion of Jo Daviess Transit, due to COVID challenges.

12 I Community Health Needs AssessmentGalenaMenomineeEast DubuqueStocktonWarrenElizabeth Apple RiverFor the purpose of this CHNA, Midwest Medical Center has dened its primary service area and population as the general population within the geographic area in Jo Daviess County. A total of 21,588 people live in the 600.91 square mile report area dened for this assessment, according to the U.S. Census Bureau American Community Survey 2015-‐19 5-‐year estimates. The population density for this area, estimated at 36 persons per square mile, is less than the national average population density of 92 persons per square mile. The service area includes seasonal and part-time housing related to recreation and tourism in the following census designated places: The Galena Territory and Apple Canyon Lake. The following communities are located in the service area:AREA SERVED BY Midwest Medical CenterScales MoundHanoverNoraMidwest Medical Center Service AreaJune 24, 2022©2022 Esri Page 1 of 1

Midwest Medical Center I 13Key Facts - Midwest Medical Center Service AreaJo Daviess County, IL Prepared by EsriJo Daviess County, IL (17085) Geography: County KEY FACTS21,683Population50.3Median Age2.2AverageHousehold Size$63,113Median HouseholdIncomeEDUCATION6%No High SchoolDiploma36%High SchoolGraduate30%Some College27%Bachelor's/Grad/Prof DegreeBUSINESS1,128Total Businesses9,863Total EmployeesEMPLOYMENT53.0%White Collar30.1%Blue Collar16.9%Services1.5%UnemploymentRateINCOME$63,113Median HouseholdIncome$38,834Per Capita Income$220,654Median Net WorthHouseholds By IncomeThe largest group: $50,000 - $74,999 (19.6%)The smallest group: $150,000 - $199,999 (4.9%)Indicator▲Value Diff<$15,000 6.0% -2.4%$15,000 - $24,999 8.6% +1.6%$25,000 - $34,999 9.8% +2.7%$35,000 - $49,999 13.5% +3.0%$50,000 - $74,999 19.6% +3.9%$75,000 - $99,999 15.3% +2.3%$100,000 - $149,999 17.5% -1.1%$150,000 - $199,999 4.9% -4.3%$200,000+ 4.9% -5.6%Bars show deviation from 17 (Illinois)This infographic contains data provided by Esri, Esri-Data Axle. The vintage of the data is 2022, 2027. © 2022 EsriThe infographic above highlights some of the key facts of that data and provides a snapshot of the population served by Midwest Medical Center. The data on the following pages will take a deep dive into the demographics of Midwest Medical Center’s service area and will oer insight to both the commonality and complexity of the Midwest Medical Center audience. The average household size in the area, at 2.2, is lower than both Illinois (3.0) and the U.S. (2.5) overall average. Median age is 50.3 years, which is higher than Illinois (38.6) and the U.S. (38) benchmark. The largest level of education is high school graduate, followed by some college.Midwest Medical Center 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. 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 4,321 total conrmed cases of COVID-19. Data are current as of 6/24/2022.The area’s unemployment rate of 1.5%. Median family household income in the service area is $63,113, which is lower than the statewide average ($65,886) and slightly higher than the U.S. ($62,843).

Midwest Medical Center I 15COVID-19 MortalitiesNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. Source geography: CountyIn the service area, there have been 36 total deaths among patients with conrmed cases of the coronavirus disease COVID-19. Data are current as of 6/24/2022.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 6/24/2022.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention and the National Center for Health Statistics, CDC - GRASP, 2022. Source geography: County

Midwest Medical Center 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.

Midwest Medical Center 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. Three focus groups were convened at Midwest Medical Center on May 17, 2022. The 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 this group provided services to underserved and unserved persons as all or part of their roles. In response to a request to identify positive developments in health and healthcare in the service area of Midwest Medical Center, the groups put forward the following: Focus Group One – Medical Professionals and Partners, Community Members, and Law Enforcement• Midwest Medical Center and Jo Daviess County Health Department collaborated very well to address COVID-related needs for the communities• Midwest Medical Center has improved access to its facility and services• There is discussion of possible expansion of physical therapy and tness• Midwest Medical Center has increased local access to specialty care• Communities rallied to provide for services to youth required by COVID• There is a new meal program at the Workshop• Jo Daviess Health Department expanded services and outreach during COVID• Midwest Medical Center and JDHD cooperated to meet special needs of rst responders during COVID• Heart monitors for Galena Territory and Scales Mound EMS are being upgradedPRIMARY DATA

20 I Community Health Needs Assessment• The call center was developed for COVID• Virtual care and services emerged during COVID• Midwest Medical Center expanded mental health services• Volunteerism is strong across the communities• Midwest Medical Center continued to grow and plan during COVIDThe group was then asked to identify needs that continue to exist in the areas of health, wellness, and the delivery of healthcare and health services for all residents of the service area. The group identied:• Cancer of all types seems high• Increase access to local services at Midwest Medical Center• Address the declining fulltime population• Increase mental health services for acute cases in the Emergency Roomo Create access to local bedso Improve transportation access for distant bedso Increase access to available distant beds, including access for substance use disorderso Alternatives to the emergency room and the jail• Identify services for the homeless• Address aordable housing issues• Identify poverty in the community and look for ways to reduce it• Plan for retention and replacement of key sta at MMC• Transportation for distant tertiary care• Dental services for unserved and underserved residents• Reliable and exible transportation to medical appointments and servicesOur communities are intimate. There is empathy here, and people take care of one another. They pulled together and worked together duringCOVID.

Midwest Medical Center I 21• Address area workforce shortages• Review locations of satellite services for ultimate usage and possible expansion• Aordable and accessible access to services on all levels for persons with substance use disorders• Address stang needs for local ambulances• Local services for enrollment in Medicaid and related services• Expand access to in-home care, medical, and custodial• Expand available stang for in-home care of complex patients• Improve community awareness of services at Midwest Medical Center• Plan for sustainable long-term funding for ambulance services• Expand local access for services for memory care• Expand wellness awareness among youth and young adults• Expand access to aordable day care throughout the service areaFocus Group Two – Medical Professionals and Partners and Community Leaders, Public Health, Agencies, and Organizations The second group identied positive developments in the last three to ve years:• Stigma around mental health issues has been reduced• Jo Daviess Health Department responded strongly to COVID with emerging and expanded services• Midwest Medical Center expanded surgical sta and surgical services• Communities came together in collaboration on many fronts during COVID• Telehealth• COVID-related funding allowed several expanded resources for youth• Midwest Medical Center has expanded critical care services• The pandemic led to new and expanded collaboration among area healthcare providers• Outdoor dining during COVID led to new avenues for socialization

22 I Community Health Needs Assessment• The pandemic led to creative solutions for existing and new community and health issues• Mental health/brain health services at Midwest Medical Center• Improved access and expanded services at Midwest Medical Center has built community condence• Virtual services for education• Ingenuity in response to the pandemic• Midwest Medical Center turns no one away – increasing access to services and creating community pride• Diabetes and chronic care management in the Clinic has improved signicantly as a result of inter-departmental cooperation and sta growth• Overall growth of activity in the communityThe group was then asked to identify needs and gaps that continue to exist in the areas of health, wellness, and the delivery of healthcare and health services for all residents of the service area. The group identied:• Improve access to chronic pain care• Recruit and retain local mental healthcare providers at all levels• Identify youth with developmental disabilities and provide services for them• Improve exibility of transportation to and from local appointments and services• Community resource guide that is well publicized and easily accessed• Address healthcare stang services• Improve access to transportation to distant mental health services• Increase resources and support for persons with substance use disorders• Improve access to transportation for distant mental health beds• Aordable housing• Access to dental care for unserved and underserved residents• Addiction treatment

Midwest Medical Center I 23• Housing alternatives for persons leaving care or services in circumstances where returning to a previous environment would not serve them well• Expand collaboration with services in Dubuque• Identify poverty and focus local services and education resources about health and wellness to those persons and locations• Daycare • Create opportunities for low/no cost opportunities for recreation, exercise, and wellness education• Increase access to healthy foods for unserved and underserved residents• Expand access to urgent care outside of Galena• Improve local access to support services for seniors• Improve local access to memory care• Stang for EMS• Develop consistent advanced directive forms, policies, and practices• Access to referrals for Medicaid patients• Improve education for persons returning home from services Focus Group Three – Medical Professionals and Partners and Community Leaders, Public Health, Agencies, and Organizations The third group identied positive developments in the last three to ve years:• Expansion of services at Midwest Medical Center, including telepsychiatry• Importance of Midwest Medical Center to the community became even more evident during the pandemic• Midwest Medical Center Clinic at Elizabeth and Dr. Harmston• Cooperation between Midwest Medical Center and EMA to COVID• Ease of access to services at Midwest Medical Center• Midwest Medical Center responded to the demand related to critically ill patients during the pandemic• “The quality of local physicians here seems better than our former urban physicians”

24 I Community Health Needs Assessment• Emergency Room sta is caring, competent, and empathetic• Collaboration among Midwest Medical Center, Jo Daviess Health Department, Jo Daviess EMA, EMS, and other providers strengthened during COVID and continues post-pandemic• Midwest Medical Center met the pandemic head on and delivered quality care for every patient • Midwest Medical Center has improved access for specialty care and services• The Physical Therapy Department at Midwest Medical Center is “just wonderful”• The physical therapy tness center provides opportunities for exercise• Midwest Medical Center collaborates with schools for sports physicals and trainers• The food at Midwest Medical Center is goodThe group was then asked to identify needs and gaps that continue to exist in the areas of health, wellness, and the delivery of healthcare and health services for all residents of the service area. The group identied:• The level of community collaboration achieved during the pandemic needs to continue• Turn lane from highway into Midwest Medical Center• Improve access to the next bed for acute mental health patients in the emergency room• Address criticism of Midwest Medical Center on social media and spread word of mouth • Explore gaps in specialty services• Address space and stang needs for expanding services at Midwest Medical Center• Improve eorts to prevent substance abuse• Improve access to treatment for substance use disorders

Midwest Medical Center I 25• Local access to cancer care• Midwest Medical Center needs to be better at “tooting its own horn”• Improve access to mental health services, inpatient and outpatient• Improve education for navigating Medicaid• Local access to dialysis• Improve eorts to prevent suicide and other deaths of despair• Flexible transportation to and from appointments• Improve local access to senior services• Improve local access for in-home care

Midwest Medical Center I 27Age Group EthnicityRaceDisabilityDATA ANALYSISTotal Population by Age GroupData Source: US Census Bureau, American Community Survey. 2016‐-20. Source Geography: TractDEMOGRAPHICS

28 I Community Health Needs AssessmentData Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: TractTotal Population by Age Groups, Midwest Medical Center Service AreaTotal Population Change, 2010-2020According to the United States Census Bureau Decennial Census, between 2010 and 2020, the population in the service area fell by -643 persons, a change of -2.84%. A signicant positive or negative shift in total population over time impacts healthcare providers and the utilization of community resources.

Midwest Medical Center I 29Total Population Change by Race, 2010-2020Data Source: US Census Bureau, American Community Survey. 2016‐-20. Source geography: TractTotal Population by Race Alone, Midwest Medical Center Service Area

30 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 21,276 for whom disability status has been determined, of which 3,047 or 14.32% 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

Midwest Medical Center I 31SOCIAL DETERMINANTS OF HEALTHThe data and discussion on the following pages will take a look into the socialdeterminants in the Midwest Medical Center service area and will oer insightinto the complexity of circumstances that impact physical and mental wellnessfor the Midwest Medical Center audience. The infographic on Page 33 provides asnapshot of the at-risk population served by Midwest Medical Center.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

32 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:• 2,795 households with disability• 979 households below the poverty level• Median household income is $63,113, which is lower than Illinois ($65,886) and slightly higher than the U.S. ($62,843).

Midwest Medical Center I 33AT RISK POPULATION PROFILEGeography: CountyMidwest Medical Center Service Area - At Risk PopulationJo Daviess County, IL Prepared by EsriJo Daviess County, IL (17085) Geography: County Version 1.9© 2022 EsriSource: Esri, ACS, Esri-Data Axle,U.S. Census Bureau2022, 2027, 2016-2020,AT RISK POPULATION PROFILEJo Daviess County, ILGeography: County21,683Population9,730Households2.21Avg SizeHousehold50.3MedianAge$63,113MedianHousehold Income$169,773MedianHome Value88WealthIndex144HousingAffordability20DiversityIndexAT RISK POPULATION2,795Households WithDisability6,118Population 65+539HouseholdsWithout VehiclePOVERTY AND LANGUAGE10%Households Belowthe Poverty Level979Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES19,663DaytimePopulation1,128TotalBusinesses9,863TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+04,0008,00012,0003,8536,11812,099Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 2,972 10,980 5,854 19,806Spanish 162 256 78 496Spanish & English Well 161 167 58 386Spanish & English Not Well 1 73 20 94Spanish & No English 0 16 0 16Indo-European 5 62 35 102Indo-European & English Well 5 56 35 96Indo-European & English Not Well 0 0 0 0Indo-European & No English 0 6 0 6Asian-Pacic Island 3 64 17 84Asian-Pacic Isl & English Well 3 64 17 84Asian-Pacic Isl & English Not Well 0 0 0 0Asian-Pacic Isl & No English 0 0 0 0Other Language 0 3 15 18Other Language & English Well 0 1 12 13Other Language & English Not Well 0 2 3 5Other Language & No English 0 0 0 0Midwest Medical Center Service Area - At Risk PopulationJo Daviess County, IL Prepared by EsriJo Daviess County, IL (17085) Geography: County Version 1.9© 2022 EsriSource: Esri, ACS, Esri-Data Axle,U.S. Census Bureau2022, 2027, 2016-2020,AT RISK POPULATION PROFILEJo Daviess County, ILGeography: County21,683Population9,730Households2.21Avg SizeHousehold50.3MedianAge$63,113MedianHousehold Income$169,773MedianHome Value88WealthIndex144HousingAffordability20DiversityIndexAT RISK POPULATION2,795Households WithDisability6,118Population 65+539HouseholdsWithout VehiclePOVERTY AND LANGUAGE10%Households Belowthe Poverty Level979Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES19,663DaytimePopulation1,128TotalBusinesses9,863TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+04,0008,00012,0003,8536,11812,099Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 2,972 10,980 5,854 19,806Spanish 162 256 78 496Spanish & English Well 161 167 58 386Spanish & English Not Well 1 73 20 94Spanish & No English 0 16 0 16Indo-European 5 62 35 102Indo-European & English Well 5 56 35 96Indo-European & English Not Well 0 0 0 0Indo-European & No English 0 6 0 6Asian-Pacic Island 3 64 17 84Asian-Pacic Isl & English Well 3 64 17 84Asian-Pacic Isl & English Not Well 0 0 0 0Asian-Pacic Isl & No English 0 0 0 0Other Language 0 3 15 18Other Language & English Well 0 1 12 13Other Language & English Not Well 0 2 3 5Other Language & No English 0 0 0 0Midwest Medical Center Service Area - At Risk PopulationJo Daviess County, IL Prepared by EsriJo Daviess County, IL (17085) Geography: County Version 1.9© 2022 EsriSource: Esri, ACS, Esri-Data Axle,U.S. Census Bureau2022, 2027, 2016-2020,AT RISK POPULATION PROFILEJo Daviess County, ILGeography: County21,683Population9,730Households2.21Avg SizeHousehold50.3MedianAge$63,113MedianHousehold Income$169,773MedianHome Value88WealthIndex144HousingAffordability20DiversityIndexAT RISK POPULATION2,795Households WithDisability6,118Population 65+539HouseholdsWithout VehiclePOVERTY AND LANGUAGE10%Households Belowthe Poverty Level979Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES19,663DaytimePopulation1,128TotalBusinesses9,863TotalEmployeesPOPULATION BY AGEUnder18 18to65 Aged65+04,0008,00012,0003,8536,11812,099Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 2,972 10,980 5,854 19,806Spanish 162 256 78 496Spanish & English Well 161 167 58 386Spanish & English Not Well 1 73 20 94Spanish & No English 0 16 0 16Indo-European 5 62 35 102Indo-European & English Well 5 56 35 96Indo-European & English Not Well 0 0 0 0Indo-European & No English 0 6 0 6Asian-Pacic Island 3 64 17 84Asian-Pacic Isl & English Well 3 64 17 84Asian-Pacic Isl & English Not Well 0 0 0 0Asian-Pacic Isl & No English 0 0 0 0Other Language 0 3 15 18Other Language & English Well 0 1 12 13Other Language & English Not Well 0 2 3 5Other Language & No English 0 0 0 0Midwest Medical Center Service Area

34 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 Household IncomeThis indicator reports median household income based on the latest 5-year American Community Survey estimates. This includes the income of the householder and all other individuals 15 years old and over in the household, whether they are related to the householder or not. Because many households consist of only one person, average household income is usually less than average family income.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2016‐20. Source geography: Tract

Midwest Medical Center I 35Poverty – Population Below 100% FPLPoverty is considered a key driver of health status. Within the service area, 9.56% or 2,031 individuals for whom poverty status is determined 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: The total population measurements for poverty reports are lower, as poverty data collection does not include people in group quarters.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2016‐20. Source geography: Tract

36 I Community Health Needs AssessmentPoverty – Children Below 100% FPLIn the service area, 12.30% or 495 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. 2016-20. Source geography: Tract

Midwest Medical Center I 37Poverty – Children Eligible for Free/Reduced Price LunchFree or reduced price lunches are served to qualifying students in families with income between under 185% (reduced price) or under 130% (free lunch) of the U.S. federal poverty threshold as part of the federal National School Lunch Program (NSLP). Note: The states below have more than 80% public schools labeled as “not reported” in 2020-2021. For consistency, these states still have their values calculated with the limited records on all geographic levels (unless there is not a single record reported in the selected area). Use with caution when comparing to other years. For 2020-2021, watch out for Alaska, Arizona, Delaware, District of Columbia, Illinois, Massachusetts, Montana, Ohio, Oregon, Tennessee, Virginia, America Samoa, and the Northern Mariana Islands.Note: This indicator is compared to the state average. Data Source: National Center for Education Statistics, NCES - Common Core of Data, 2019-20. Source geography: Address

38 I Community Health Needs AssessmentEducation AttainmentThis 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 service area, 16.4% have at least a college bachelor’s degree, while 34.8% stopped their formal education attainment after high school. Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2016-20. Source geography: County

Midwest Medical Center I 39Food 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

40 I Community Health Needs AssessmentFood Environment – Food Desert Census TractThis 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 3,102 people living in food deserts and a total of one census tract classied as a food deserts by the USDA.Note: This indicator is compared to the state average. Data Source: U.S. Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas, 2019. Source geography: Tract

Midwest Medical Center I 41Food 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 one-half 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. Within the service area, 17.23% of the total population have low food access. The total population in the service area with low food access is 3,907.Note: This indicator is compared to the state average. Data Source: U.S. Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas, 2019. Source geography: Tract.

42 I Community Health Needs AssessmentTeen 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 (2014-2020) and are used for the 2022 County Health Rankings. In the service area, of the 3,843 total female population age 15-19, the teen birth rate is 13.0 per 1,000, which is less 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, 2014-2020. Source geography: County

Midwest Medical Center I 43Area 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 domain (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.

44 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.

Midwest Medical Center I 45Note: 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 DistrictHomeless Children & 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, homelessness 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 1,488 students enrolled during the school year 2019-2020, there were 10 or .70% homeless students, which is lower than the statewide rate of 2.61%. Note: Data are available for 60.0% of school districts in the service area, representing 74.90% of the public school student population.

46 I Community Health Needs AssessmentA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).Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2015-2019. Source geography: Tract

Midwest Medical Center I 47Housing Quality – Substandard HousingThis indicator reports the number and percentage of owner- and renter-occupied housing units having at least one of the following conditions: 1) lacking complete plumbing facilities; 2) lacking complete kitchen facilities; 3) with one or more occupants per room; 4) selected monthly owner costs as a percentage of household income greater than 30%; and 5) gross rent as a percentage of household income greater than 30%. Selected conditions provide information in assessing the quality of the housing inventory and its occupants. This data is used to easily identify homes where the quality of living and housing can be considered substandard. Of the 10,069 total occupied housing units in the service area, 2,384 or 23.68% have one or more substandard conditions.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-2020. Source geography: Tract

48 I Community Health Needs AssessmentHouseholds With No ComputerThis indicator reports the percentage of households who don’t own or use any types of computers, including desktop or laptop, smartphone, tablet, or other portable wireless computer, and some other type of computer, based on the 2016-2020 American Community Survey estimates. Of the 10,069 total households in the service area, 1,017 or 10.10% are without a computer.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-2020. Source geography: Tract

Midwest Medical Center I 49Households 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 their service, or have no internet access in their home, based on the 2016-2020 American Community Survey estimates. Of the 10,069 total households in the service area, 1,663 or 16.52% have no or slow internet. Note: The ACS2016-20 questions about internet/computer usage are not asked for the group quarters population, so data do not include people living in housing such as dorms, prisons, nursing homes, etc.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-2020. Source geography: Tract

50 I Community Health Needs AssessmentBroadband Access – Percent by Time PeriodThe table below displays temporal trends in high-speed internet availability as the percent of the population with access to broadband in the service area.

Midwest Medical Center I 51Heathcare 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 13 dentists. This represents 61.2 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: CountyHEALTH AND WELLNESS INDICATORS

52 I Community Health Needs AssessmentAccess 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, counselors, marriage and family therapists, and mental health providers that treat alcohol and other drug abuse as well as advanced practice nurses specializing in mental healthcare. Data from the 2020 Centers for Medicare and Medicaid Services (CMS) National Provider Identier (NPI) downloadable le are used in the 2021 County Health Rankings. Within the service area, there are 19 mental health providers with a CMS National Provider Identier (NPI). This represents 89.5 providers per 100,000 total population. 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

Midwest Medical Center I 53Access to Care – Primary CareThis indicator reports the number of primary care physicians per 100,000 population. Doctors classied as “primary care physicians” by the AMA include: General Family Medicine MDs and DOs, General Practice MDs and DOs, General Internal Medicine MDs and General Pediatrics MDs. Physicians age 75 and over and physicians practicing subspecialties within the listed specialties are excluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. Within the service area, there are 10 primary care physicians. This represents 47.09 providers 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

54 I Community Health Needs AssessmentPoor or Fair HealthThis indicator reports the percentage of adults age 18 and older who self-report poor or fair health (age-adjusted to the 2000 standard). Data were from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and are used for the 2021 County Health Rankings. This indicator is relevant because it is a measure of general poor health status. Within the service area, the estimated prevalence of fair or poor health among adults aged 18 years and older was 18.50%. This 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, 2019. Source geography: Tract

Midwest Medical Center I 55This indicator reports the percentage of males age 65 and older who report that they are up-to-date on a core set of clinical preventative 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 ve years and an FOBT within the past three years, or a colonoscopy within the past 10 years. Within the service area, there are 36.40% men age 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: TractPrevention – Core Preventative Services for Men

56 I Community Health Needs AssessmentThis indicator reports the percentage of females age 65 and older who report that they are up-to-date on a core set of clinical preventative 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 ve years and an FOBT within the past three years, or a colonoscopy within the past 10 years, and a mammogram in the past two years. Within the service area, there are 31.50% women age 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: TractPrevention – Core Preventative Services for Women

Midwest Medical Center I 57Insurance – Insured Population and Provider TypeHealth insurance coverage is considered a key driver of health status. In the service area, 20,185 total civilians have some form of health insurance coverage. Of those, 78.95% have private insurance, e.g. insurance purchased through an employer or union, through direct purchase (e.g. on a health exchange) or have Tricare or other military health insurance. In addition, 42.77% have a form of public health insurance. Public health coverage includes the federal programs: Medicare, Medicaid, and VA Health Care (provided through the Department of Veterans Aairs), as well as the Children’s Health Insurance Program (CHIP). This indicator is relevant because insurance provides access to healthcare including regular primary care, specialty care, and other health services that prevent poor health status. Note: Percentages may exceed 100% as individuals may have more than one form of health insurance.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-2020. Source geography: Tract

58 I Community Health Needs AssessmentThis indicator reports the percentage of adults age 18 and older who report having been to the dentist or dental clinic in the previous year. Within the service area, there are 66.50% of adults who went to the dentist in the past year 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 PLACES Data Portal, 2018.Dental Care Utilization

Midwest Medical Center I 59Health 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 relationships may emerge, allowing a better understanding of how certain community health needs may be addressed.Poor Dental HealthThis 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 16.5% of adults age 18 and older who reported losing all natural teeth of the total population and 12.30% reporting poor dental health in general.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 PLACES Data Portal, 2018.CHRONIC ILLNESS

60 I Community Health Needs AssessmentChronic Conditions – Asthma Prevalence (Adult)This 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 8.80% 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 PLACES Data Portal, 2019. Source geography: TractTop Five Most Commonly Diagnosed CancersThe table below shows counts and age-adjusted incidence rates of the ve most common newly diagnosed cancers by site for the ve-year period of 2014-2018.

Midwest Medical Center I 61Chronic Conditions – Chronic Obstructive Pulmonary Disease (Adult)This 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 8.70% 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 PLACES Data Portal, 2019. Source geography: Tract

62 I Community Health Needs AssessmentChronic Conditions – Diabetes (Adult)This indicator reports the number and percentage of adults age 20 and older who have ever 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, 1,838 of adults age 20 and older have diabetes. This represents 7.6% 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, National Center for Chronic Disease Prevention and Health Promotion, 2019. Source geography: County

Midwest Medical Center I 63Chronic Conditions – Kidney Disease (Adult)This 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 PLACES Data Portal, 2019: Source geography: Tract

64 I Community Health Needs AssessmentChronic Conditions – Coronary Heart Disease (Adult)This 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. Within the service area, there were 8.60% 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 PLACES Data Portal, 2019. Source geography: Tract

Midwest Medical Center I 65Chronic Conditions – High Blood Pressure (Adult)This 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 have high blood pressure. Women who were told high blood pressure only during pregnancy and those who were told they had borderline hypertension were not included. Within the service area, there were 38.50% 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 PLACES Data Portal, 2019. Source geography: Tract

66 I Community Health Needs AssessmentChronic Conditions – High Cholesterol (Adult)This 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 38.30% of adults age 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 PLACES Data Portal, 2019. Source geography: Tract

Midwest Medical Center I 67Chronic Conditions – Alzheimer’s Disease (Adult)This indicator reports the number and percentage of Medicare fee-for-service population with Alzheimer’s Disease. 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 were 211 beneciaries with Alzheimer’s Disease based on administrative claims data in the latest report year. This represents 7.1% of the total Medicare fee-for-service beneciaries.Note: This indicator is compared to the state average. Data Source: Centers for Medicare & Medicaid Services, CMS - Chronic Conditions Warehouse, 2018. Source geography: County

68 I Community Health Needs AssessmentAlcohol – Heavy Alcohol ConsumptionIn the service area, 3,979 or 23.13% of adults self-report excessive drinking in the last 30 days, which is less than the state rate of 22.95%. Data for this indicator were based on survey responses to the 2019 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and are used for the 2022 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 heaving drinking involving more than two drinks per day for man 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: There are a number of evidence-based interventions that may reduce excessive/binge drinking. Examples include raising taxes on alcoholic beverages, restricting access to alcohol by limiting days and hours of retail sales, and screening and counseling for alcohol abuse (Centers for Disease Control and Prevention, Preventing Excessive Alcohol Use, 2020).Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Accessed via County Health Rankings, 2019. Source geography: CountySUBSTANCE USE

Midwest Medical Center I 69Note: This indicator is compared to the state average. Data Source: Centers for Medicare and Medicaid Services, CMS - Chronic Conditions Warehouse, 2018. Source geography: CountyAlcohol Use Disorder (Medicare)Within the service area, there were 46 beneciaries with alcohol use disorder based on administrative claims data in the latest report year. This represents 1.6% of the total Medicare fee-for-service beneciaries.

70 I Community Health Needs AssessmentPoor Mental HealthHealth behaviors such as poor diet, a lack of exercise, and substance abuse contribute to poor health status. This 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 12.70% 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 PLACES Data Portal, 2019. Source geography: TractMENTAL AND BEHAVIORAL HEALTH

Midwest Medical Center I 71Mortality – 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. Rates are summarized for service areas from county level data, only where data is available. 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: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

72 I Community Health Needs AssessmentDeaths 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. Rates are resummarized for service areas from county level data, only where data is available. This indicator is relevant because deaths of despair is an indicator of poor mental health. Within the service area, there were 42 deaths of despair. This represents an age-adjusted death rate of 38.2 per every 100,000 total population.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System, Accessed via CDC WONDER, 2016-2020. Source geography: County

Midwest Medical Center I 73Midwest Medical Center 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 pandemicsand terrorism.EMERGENCY PREPAREDNESS

Midwest Medical Center I 75The steering group, comprised of representatives from both focus groups – including a local public health department and schools – including members serving persons likely to be unserved, underserved or otherwise experiencing unmet needs, met on May 24, 2022 to identify and prioritize signicant health needs. 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. Following the review, the group identied and then prioritized the following as being the signicant health needs facing the Midwest Medical Center service area.PROCESSIDENTIFICATION AND PRIORITIZATION OF NEEDSImprove accessto mental healthcareImprove access to physicalhealthcareImprove access totransportationIncrease information to community about health and wellness servicesIncrease resources for seniors

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 Midwest Medical Center service area:1. Improve access to mental healthcare– Counselors and other providers and resources to improve accessto behavioral mental healthcare– Counselors and other providers and resources to improve accessto care for substance use disorders2. Improve access to physical healthcare – Pain Clinic– Cardiac care– Dialysis– Oncology3. Improve access to available, exible transportation4. Increase information to the community about available local health and wellness activities5. Increase resources for seniors– Independent living opportunities– Transitional senior housing– Education about local resources, insurance, and Medicare – and supplemental and advantage plans – and Medicaid– ScreeningsDESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED

Midwest Medical Center I 77

Midwest Medical Center I 79Resources PartnersVolunteersGovernment
Services at Midwest Medical Center• Administration• Clinic• Providers• Clinic Director• MarketingHOSPITAL RESOURCES RESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDS• Jo Daviess Health Department• Surrounding hospitals and providers• EMS providers• Marketing Consultant• Other partnersHEALTHCARE PARTNERS OR OTHER RESOURCES, INCLUDING TELEMEDICINECOMMUNITY RESOURCES• Jo Daviess County Sheri• 708 Board• Jo Daviess Transit• Senior Resource Center• Local insurance brokers/nancial planners• Other interested organizations or persons

Midwest Medical Center I 81Documentation Online PresenceCommentsImplementationThis CHNA Report will be available to the community on the hospital’s public website, www.midwestmedicalcenter.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

Midwest Medical Center 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 on May 25, 2022.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 threeprioritized 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 accessto mentalhealthcareImprove accessto physicalhealthcareImproveaccess totransportationIncrease information tocommunity about healthand wellness servicesIncreaseresourcesfor seniors

84 I Community Health Needs AssessmentThe group addressed the needs with the following strategies:1. Improve access to mental healthcare– Counselors and other providers and resources to improve accessto behavioral mental healthcare– Counselors and other providers and resources to improve accessto care for substance use disordersActions the hospital intends to take to address the health need:• Midwest Medical Center will complete and maintain a web-based local resource guide for mental health and other local medicalresources.• Midwest Medical Center will explore cooperative transport programs with South Central Transit.• Midwest Medical Center will construct a new outpatient wing that will include room for expanding behavioral health services. • Midwest Medical Center will explore and evaluate the possibility of adding inpatient mental health services.Anticipated impacts of these actions:Midwest Medical Center anticipates that the actions set out above will address key needs identied and will lead to further resolution with time.Programs and resources the hospital plans to commit to address health need:• Administration• Clinic• ProvidersPlanned collaboration between the hospital and other facilities:• 708 BoardIMPLEMENTATION STRATEGY

Midwest Medical Center I 852. Improve access to physical healthcare – Pain Clinic– Cardiac care– Dialysis– OncologyActions the hospital intends to take to address the health need:• Midwest Medical Center will continue to evaluate establishing a pain clinic.• Midwest Medical Center will create space for an infusion center and explore and evaluate adding oncology services at that location.• Midwest Medical Center will continue to evaluate the need for local dialysis services.• Midwest Medical Center will explore expansion of cardiac services. • Midwest Medical Center will explore collaboration with surrounding hospitals and providers to facilitate oering identied services locally.Anticipated impacts of these actions:Midwest Medical Center anticipates that the actions identied will lead to signicant resolution of the issues presented.Programs and resources the hospital plans to commit to address health need:• Administration• Clinic DirectorPlanned collaboration between the hospital and other facilities:• Surrounding hospitals and providers

86 I Community Health Needs Assessment3. Improve access to available, exible transportationActions the hospital intends to take to address the health need:Midwest Medical Center will explore and evaluate the components of the transportation issues and work internally and with external partnersto nd solutions.Anticipated impacts of these actions: Midwest Medical Center anticipates that the identied action will clarify the scope of transportation needs, allow for cooperative discussion, and then, collaboration to resolve these issues.Programs and resources the hospital plans to commit to address health need: • AdministrationPlanned collaboration between the hospital and other facilities:• Jo Daviess Transit• Jo Daviess Health Department• Jo Daviess Sheri• EMS providers4. Increase information to the community about available local health and wellness activitiesActions the hospital intends to take to address the health need:• Midwest Medical Center will engage a third-party marketing consultant to assist with identifying and executing a more robust plan for marketing Midwest Medical Center, its services, and its partners.• Midwest Medical Center will expand its direct marketing campaignAnticipated impacts of these actions: Midwest Medical Center anticipates that the steps to be taken will address the identied needs in a short time.Programs and resources the hospital plans to commit to address health need: • Administration• MarketingPlanned collaboration between the hospital and other facilities:• Consultant• Jo Daviess Health Department

Midwest Medical Center I 875. Increase resources for seniors– Independent living opportunities– Transitional senior housing– Education about local resources, insurance, and Medicare – and supplemental and advantage plans – and Medicaid– ScreeningsActions the hospital intends to take to address the health need:• Regarding education, Midwest Medical Center will continue to explorepartnerships with local groups and agencies for opportunities to expand education about local resources for insurance and assistance navigatingMedicare and Medicaid.• Regarding health screenings, Midwest Medical Center will continue to explore partnerships with local groups and agencies for ways to expand access to health screenings, especially for seniors and the underserved and unserved community members.• Regarding housing opportunities for seniors, although these issues are beyond the scope or capability of Midwest Medical Center to resolve, MMC will support any organized local government or community- based eort to address these needs to the extent it is reasonable and appropriate.Anticipated impacts of these actions: Midwest Medical Center anticipates that a collaborative eort to address each of these issues will result in the best opportunity for increasing education and screening for seniors and others and for realizing solutions to local housing needs.Programs and resources the hospital plans to commit to address health need: • AdministrationPlanned collaboration between the hospital and other facilities:• Jo Daviess Health Department• Senior Resource Center• Local insurance brokers/nancial planners• Other interested organizations or persons

Midwest Medical Center I 89Focus Groups AdministrationOrganizationsBusinessFocus Group One• Barb Hocker, Galena Area Chamber of Commerce• Beth Kropp, 24 Hour Care• Melissa Niemann, 24 Hour Care• Brianne Van Hemert, Administrator, Midwest Senior Care• Cheri Martensen, Imaging Director, Midwest Medical Center• Dave Kizior, Board Member, Midwest Medical Center• Donna Ferry, Board Member, Midwest Medical Center• Dr. Barb Sloan, Board Chair, Midwest Medical Center• Helen Kilgore, Board Member, Midwest Medical Center• Jennifer Berning, Physical Therapy Director, Midwest Medical Center• Kevin Turner, Jo Daviess County Sheri• Ocer Keith Brandel, Jo Daviess County• Mark Moran, City of Galena Administrator• Matthew Carroll, Board Member – MMC• Sandra Schleicher, Jo Daviess County Health DepartmentREFERENCES AND APPENDIX

90 I Community Health Needs AssessmentFocus Group Two • Ann Heim, Illinois Program Director, Riverview Center• Renee Smith, Riverview Center• Colleen Farrell, President, 708 Mental Health Board• Deb Borley, East Dubuque School Nurse• Dr. Elizabeth Gullone, Family Practice Physician• Dr. Cullen Kehoe, Emergency Medicine Physician• Dr. Matthew Gullone, Family Medicine Physician• Dr. Nicole Jedlicka, Podiatry Physician• Dr. Ralph Losey, Emergency Medicine Physician• Dr. Kenneth Schiman, Orthopedic Surgeon• Dr. William Farrell, Orthopedic Surgeon• Jamie Petras, Stockton Dental Center• Kristen Timmerman, Pharmacist• Katie Meusel, Midwest Health Clinic Director, Midwest Medical Center• Kelli Jackson, Controller, Midwest Medical Center• Marie Schumacher, DON, Midwest Medical Center• Samantha Rojemann, Jo Daviess Health Department• Tracy Bauer, CEO, Midwest Medical CenterFocus Group Three • Bill Caron, Director, CTE Academy• Kathy Gereau, The HOPE Foundation• Jill Muehleip, Principal, Galena Primary School• Kristen Patterson, HR Director, Midwest Medical Center• Mike Simmons, Emergency Manager, Jo Daviess County• Terry Renner, Mayor of Galena

Midwest Medical Center I 91Identication and Prioritization Group • Jamie Petras, Stockton Dental Center• Lori Stangl, Jo Daviess Health Department• Samantha Rojemann, Jo Daviess Health Department• Donna Ferry, Board Member, Midwest Medical Center• Helen Kilgore, Board Member, Midwest Medical Center• Brianne Van Hemert, Administrator, Midwest Senior Care• Dr. Richard Farrell, Internal Medicine Physician• Tracy Bauer, CEO, Midwest Medical CenterStrategy and Implementation Group • Tracy Bauer, CEO, Midwest Medical Center• Kristen Patterson, HR Director, Midwest Medical Center• Kelli Jackson, Controller, Midwest Medical Center• Deb Hoppman, CNO, Midwest Medical Center

One Medical Center Drive • Galena, IL 61036www.midwestmedicalcenter.org • 815.777.1340