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2022Community Health NeedsAssessment

2 I Community Health Needs AssessmentTABLE OF CONTENTSINTRODUCTION.......................................................................................................................................5-7Executive Summary..............................................................................................................................................7-10Background...............................................................................................................................................................11-12Pana Community Hospital Services......................................................................................................14-15Local Impact of COVID....................................................................................................................................16-17ESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPS.........................19 DATA COLLECTION...........................................................................................................................19-24Secondary Data.....................................................................................................................................................19-20Primary Data............................................................................................................................................................21-24DATA ANALYSIS...................................................................................................................................27-76Demographics.......................................................................................................................................................27-30Social Determinants of Health...................................................................................................................31-49Health and Wellness Indicators...............................................................................................................50-76- Chronic Illness...................................................................................................................................................56-71- Behavioral Health...................................................................................................................................................72- Mental Health & Substance Use..........................................................................................................73-75Emergency Preparedness..................................................................................................................................76Copyright ©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.

Pana Community Hospital I 3IDENTIFICATION AND PRIORITIZATION OF NEEDS.........................................................79-80Process...............................................................................................................................................................................79Description of the Community Health Needs Identied...............................................................80 RESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDS........................................83Hospital Resources....................................................................................................................................................83Healthcare Services and Partners.................................................................................................................83Community Resources...........................................................................................................................................83DOCUMENTING AND COMMUNICATING RESULTS...............................................................85 IMPLEMENTATION STRATEGY....................................................................................................87-91Planning Process.........................................................................................................................................................87Implementation Strategy..............................................................................................................................88-91REFERENCES AND APPENDIX....................................................................................................93-95

Pana Community Hospital I 5INTRODUCTIONThe original Huber Memorial Hospital was created as the dream of Dr. Jacob Huber, a physician in Pana for 50 years. Dr. Huber’s last will and testament provided that money from his estate be used to build a modern hospital in the city of Pana, Illinois. After his death, a Catholic order of nuns was contacted to own and operate the hospital. Ground-breaking was held on May 12, 1913, and at the ceremony more than 2,000 people were in attendance. The hospital construction was completed, and the building readied for occupancy on May 10, 1914.The Sisters of Misericorde of Montreal, Quebec, Canada, continued ownership and operation of Huber Memorial Hospital until January 20, 1966. With great surprise to the citizens of Pana, they made an announcement that they would be selling the six-acre hospital complex. This immediately set the community into action to attempt a purchase of the facility.Through an entire community eort, the hospital was purchased and the nal sale documents were signed on June 20, 1967. The community had worked together and successfully raised over $500,000. The hospital was then re-named and since has been known as Pana Community Hospital.It became necessary to institute a fund drive in 1975 for the renovation of the internal structure of the hospital, making it compliant with state standards. The price tag was $1.3 million. Once again, the community rallied and successfully raised over $800,000 for the renovation.AdolescentsAdultsSeniorsEarly Childhood AdolescentsAdultsSeniors

6 I Community Health Needs AssessmentA new addition to the hospital campus of Pana Community Hospital was completed in May 1990, with the opening of the Medical Mall. This expansion houses physician oces as well as those of consulting physicians. This addition of the Medical Mall enables Pana Community Hospital to be more accessible.Pana Community Hospital’s mission and values lay their path as a leading partner in assuring community-based quality healthcare.MISSION To be a leading partner in assuring community-based quality healthcare.VISION To achieve our mission, we promote a vision striving:• In partnership with other community healthcare providers, we seek to develop a comprehensive system of healthcare services to assist our neighbors in reaching their personal maximum for health.• To provide programs that promote health education and wellness.• To enhance our personalized care concept in the provision of services to our community.• To maintain an environment which promotes satisfaction and opportunity for the patient, their family, the employee, and the physician.• To maintain the hospital’s ability to support the delivery of quality healthcare at reasonable costs, in accordance with community needs and the healthcare regulatory environment.• To demonstrate by actions and results the commitment to continuous quality improvement.VALUES To achieve our vision, we promote these values:People – Believing that all human life is sacred and every human is special to God, we value all that we serve and those with whom we work. We encourage all persons to express ideas, and we consider and value suggestions from others. We work together as a team and treat each other with respect. We expect all persons associated with the organization to be of sound character and living out a high standard of values. We expect all behavior and resulting performance of individuals to be based upon the values of honesty, integrity, condentiality, and fairness. All inter-actions between persons should be professional and courteous.

Pana Community 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.EXECUTIVE SUMMARYVALUES continuedService – We value listening, caring, and being sensitive to the needs of others. We respond to patients, family members, each member of the hospital team, and whomever else we may serve in a manner that clearly indicates our desire to not only meet their needs, but to exceed their expectations.Communications – We value continuously improving eective communication within the organization and with all the public served by members of our team.Performance Improvement – We value continually improving upon everything we do to achieve excellence in performance. This concept of improvement applies to people as well as encouraging personal growth and learning for all members of our team.Resource Use – We value our resources and recognize that we will fulll our mission only if we successfully manage our nancial and other resources. Therefore, we actively create innovative, cost-eective systems throughout the organization to continually improve the management of all resources used.

8 I Community Health Needs AssessmentICAHN, 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 Pana and the surrounding area. The CHNA process was coordinated by the Chief Financial Ocer.Two focus groups met to discuss the state of overall health and wellness in the Pana Community 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. Some members of these groups provided 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.

Pana Community 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. Expand access to local mental health services, including counseling, psychiatry, and professional consultation, especially for uninsured and under-insured2. Address homelessness3. Improve access to day care, especially for healthcare workforce4. Expand local prevention eorts and services for substance abuse and substance use disorders5. Expand local availability of in-home careThe results of the assessment process were then presented to the senior sta at Pana Community Hospital through a facilitated discussion for development of a plan to address the identied and prioritized needs.Expand Accessto Local Mental HealthServicesAddress HomelessnessImprove Accessto Day CareExpand Local Prevention Eorts for Substance AbuseExpand Local Availability of In-Home Care

10 I Community Health Needs AssessmentADDRESSING THE NEED CREATING THE PLANThe group addressed the needs with the following strategies:• Pana Community Hospital will attempt to recruit a Licensed Clinical Social Worker, a Licensed Clinical Professional Counselor, or a Psychiatric Advanced Practice Nurse to provide services at an outpatient location.• Pana Community Hospital will explore telehealth access to psychiatrist support for the clinician.• Pana Community Hospital will explore a model for providing expanded mental health services for uninsured and under-insured persons.• Pana Community Hospital will seek grants or other funding to support expanded mental health services for uninsured and under-insured persons.• Pana Community Hospital will continue to partner with community organizations, local governments and agencies, and other interested groups and persons to collaborate towards a community-wide strategy to address local homelessness. • Pana Community Hospital will investigate and analyze opportunities to provide day care services to employees of Pana Community Hospital Association.• Pana Community Hospital will explore opportunities to provide in-home nursing services.

Pana Community Hospital I 11The 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, Pana Community Hospital has taken the following steps since the 2019 CHNA.2019 Pana Community Hospital Community Health Needs Assessment Priority #1 – Access to Local Services for Mental Health– Pana Community Hospital supported an internal candidate seeking a Master’s in social work with the plan to obtain Licensed Clinical Social Worker certification. The individual received a Master’s in social work and shortly thereafter took a community development position with the City of Pana.– Pana Community Hospital continues to explore telepsychiatry. Once sufficient Licensed Clinical Social Workers or similarly certified professionals are in place, Pana Community Hospital will finalize telepsychiatry services.– Pana Community Hospital pursued and implemented crisis intervention and evaluation services in the Emergency Department.– The COVID pandemic limited Pana Community Hospital’s ability to address other areas of need.Priority #2 – Improve Life Skills– Pana Community Hospital recruited a Director of Business Development whose responsibilities include addressing this and other community needs.– Under the Director of Business Development’s guidance, Pana Community Hospital implemented a children’s summer meal program in conjunction with a local foundation to help feed students in need over the summer months when the school lunch program is not available.– Pana Community Hospital continued its role in providing “High School to Healthcare” classes for area high school students to introduce them to healthcare careers and other opportunities available at Pana Community Hospital.– The COVID pandemic limited Pana Community Hospital’s ability to address other areas of need.BACKGROUND

12 I Community Health Needs AssessmentPriority #3 – Address the Needs of the Homeless in the Community– Pana Community Hospital provided a variety of services to homeless persons that presented at the Emergency Department.– The COVID pandemic limited Pana Community Hospital’s ability to address other areas of need.Priority #4 – Maintain the Vitality and Viability of the Community as a Safe and Healthy Place for All Ages to Live and Thrive– Pana Community Hospital staff are encouraged to and do participate in Pana Pride.– The Pana Community Hospital Director of Business Development plays an integral role in the community Interagency Council which provides a platform for community organizations to network and provide information on community events and services available within the community.– Pana Community Hospital supported the transition of the internal Licensed Clinical Social Worker employee to a community development role with the City of Pana.– The COVID pandemic limited Pana Community Hospital’s ability to address other areas of need.

Pana Community Hospital I 13

14 I Community Health Needs AssessmentPana Service Area - SOUTHNovember 18, 2022©2022 Esri Page 1 of 1AssumptionOconeeRosamondCowdenOhlmanTower HillHerrickOwanecoLakewoodFor the purpose of this CHNA, Pana Community Hospital has dened its primary service area and populations as the general population within the geographic area in and surrounding Pana, IL. The hospital’s patient population includes all who receive care without regard to insurance coverage or eligibility for assistance. A total of 19,191 people live in the 688 square mile service area dened for this assessment, according to the U.S. Census Bureau American Community Survey 2016-‐20 5-‐year estimates. The population density for this area, estimated at 28 persons per square mile, is less than the national average population density of 92 persons per square mile.Pana Service Area Map - NORTHNovember 18, 2022©2022 Esri Page 1 of 1PanaNokomisRamseyMillersvilleAREA SERVED BY PANA COMMUNITY HOSPITAL

Pana Community Hospital I 15KEY FACTS18,380Population43.1Median Age2.3AverageHousehold Size$53,292Median HouseholdIncomeEDUCATION9%No High SchoolDiploma50%High SchoolGraduate26%Some College14%Bachelor's/Grad/Prof DegreeBUSINESS647Total Businesses6,283Total EmployeesEMPLOYMENT44.1%White Collar34.4%Blue Collar21.5%Services2.2%UnemploymentRateINCOME$53,292Median HouseholdIncome$29,420Per Capita Income$154,112Median Net WorthHouseholds By IncomeThe largest group: $50,000 - $74,999 (23.7%)The smallest group: $200,000+ (2.9%)Indicator▲Value Diff<$15,000 10.1% -0.1%$15,000 - $24,999 12.0% +0.9%$25,000 - $34,999 9.3% -0.6%$35,000 - $49,999 13.9% +1.2%$50,000 - $74,999 23.7% +2.1%$75,000 - $99,999 13.9% -0.4%$100,000 - $149,999 11.0% -1.9%$150,000 - $199,999 3.3% -2.0%$200,000+ 2.9% +0.8%Bars show deviation from Christian CountyThis infographic contains data provided by Esri, Esri-Data Axle. The vintage of the data is 2022, 2027. © 2022 EsriKey FactsPana Community Hospital Service Area (12 Zip Codes)Geography: ZIP CodeThe data on the following pages will take a deep dive into the demographics of Pana Community Hospital’s service area and will oer insight to both the commonality and complexity of the Pana Community Hospital audience. The infographic above highlights some of the key facts of that data and provides a snapshot of the population served by Pana Community Hospital.The average household size of the area, at 2.3, is lower than both Illinois (3.00) and the U.S. (2.50). Median age is 43.1 years, which is higher than both Illinois (38.6) and the U.S. (38.0). The largest education segment is high school graduate, followed by some college.The unemployment rate of 2.2% is lower than both Illinois (4.6%) and the U.S. (3.6%)Also, median family household income in the service area ($53,292) is lower than both the Illinois’ median family household income ($65,886) and the U.S. ($61,937).Pana Community Hospital Service Area – Key Facts

16 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, 2022. Source geography: CountyConrmed COVID-19 CasesThis indicator reports incidence rate of conrmed COVID-19 cases per 100,000 population. Data for this indicator are updated daily and derived from Johns Hopkins University’s data feed. In Christian County, there have been 12,204 total conrmed cases of COVID-19. The rate of conrmed cases is 37,366 per 100,000 population, which is greater than the state average of 30,098. Data are current as of 11/14/2022.COVID-19 Conrmed CasesLOCAL IMPACT OF COVID

Pana Community Hospital I 17COVID-19 MortalitiesNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. 2021. Source geography: CountyIn Christian County, there have been 116 total deaths among patients with conrmed cases of the coronavirus disease COVID-19. The mortality rate in the report area is 355.16 per 100,000 population, which is greater than the state average of 271.63. Data are current as of 11/14/2022.COVID-19 Fully VaccinatedNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. 2021. Source geography: CountyThis 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 concerning the vaccine roll-out may be in some communities compared to others, with values ranging from 0 (least concerning) to 1 (most concerning). Data are current as of 11/14/2022.

Pana Community Hospital I 19Data 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

20 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.

Pana Community Hospital I 21Secondary 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. Two focus groups were convened at Pana Community Hospital. Group 1 consisted of medical professionals, providers, hospital sta, nursing home and assisted living providers, and county health department personnel. In response to a request to identify positive developments in health and wellness of the community, the group referenced: Group 1: Medical professionals and partners, nursing home and assisted living providers, and county health department personnel• Three new orthopedic providers at Pana Community Hospital• Pana Pride and the Pana Chamber of Commerce are working together toward positive economic development goals• Urgent Care• Drive-through COVID testing at Pana Community Hospital• We survived COVID!• Christian County Health Department provides access to eye glasses for eligible persons• Growth at the hospital, both facilities and services, at Pana Community Hospital• Growth in the community• New services and providers at Pana Community Hospital• Pana Community Hospital provides home-delivered meals in the community• Pana Community Hospital has acquired a new clinic• Pana Community Hospital has expanded surgical services• New community ambulance servicePRIMARY DATA

22 I Community Health Needs Assessment• Improved access to mental health services, including emergency department utilization of telehealth for patients in crisis at Pana Community Hospital• New family practitioner • New electronic health records program• Heritage Health has improved rating and added in-house CNA training• Pana Community Hospital has entered into formal cooperation and information-sharing with other area hospitals• Pana Community Hospital has added in-house 3T MRI and daily ultrasound servicesWhen asked to identify health and wellness needs that remain in the service area of Pana Community Hospital, the group advanced the following issues and concerns:• Address delay in transfers out of the Emergency Department• Improve access to mental health counseling and psychiatric services• Improve access to day care• Provide opportunities for recreation, exercise, and activities for youth beyond sports• Improve prevention and access to treatment and services for persons facing substance use disorders involving methamphetamine, alcohol, and drugs in general• Provide life skills education for youth• Improve access to specialists for uninsured and under-insured• Improve access to services for seniors, including in-home care and provider visits• Expand electronic medical record access to provide easy sharing of information beyond the local systemThe COVID response demonstrated the strength of the team at Pana Community Hospital.

Pana Community Hospital I 23• Increase cooperation between mental healthcare providers and schools• Reduce repeat visits (“frequent yers”) to the Emergency Department• Increase access to cheaper, more aordable lab work• Local access to dental care (availability for under-insured and uninsured) and transportation• Improve access to in-home care• Address homelessness• Educate youth about healthy lifestyles• Address homelessnessGroup 2: Community leaders, local ocials and law enforcement, and other business and community organization representationRecent positive developments identied included:• Food pantry is more accessible• New ambulance service• Improvements at Community Missions Center• Population growth in Pana• New memory care facility• New youth sports opportunities in Pana• Pana Pride is making improvements in the community• Road and street improvements• Law enforcement is collaborating with schools• Safe Passages Program• SavMor Pharmacy• Expansion of surgical services at Pana Community Hospital• Improved law enforcement and re training• Fiber infrastructure

24 I Community Health Needs Assessment• Improved access to specialists through Pana Community Hospital• Planning for downtown Pana• Cooperation within faith-based community• Pana’s commitment to job growth• Proactive city governance in Pana• Wellness Center at Pana Community HospitalHealth and wellness needs facing the communities were identied as:• Improve mental health awareness• Local support and services for substance use disorders and mental health issues – all types of services• Community education about use of ambulances• Community education about mental health/stigma• Improve access to cancer care services• Increase options for memory care• Market former memory care facility• Community education about dementia and Alzheimer’s• Improve early childhood intervention and reduce stigma• Better address domestic violence• Address homelessness• Local access to specialists in gerontology, dermatology, gastroenterology, and rheumatology• Improve access to local and distant mental healthcare, especially for youth• Substance use prevention education and programs• Improve access to dental and vision care, especially for under-insured, uninsured, and youth• Expand access to food for youth• Create a community wellness consciousness• Provide community education about access to insurance• Address delay in Emergency Department transfers• Recruit nurses• Provide parenting and life skills’ education in the community

Pana Community Hospital I 25

Pana Community Hospital 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 AssessmentTotal Population by EthnicityData Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: TractTotal Population by Age Groups, Pana Community Hospital Service Area

Pana Community Hospital I 29Total Population by Race AloneData Source: US Census Bureau, American Community Survey. 2016‐-20. Source geography: TractTotal Population by Race Alone, Pana Community Hospital 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 service area has a total population of 18,999 for whom disability status has been determined, of which 2,827 or 14.88% have any disability. This indicator is relevant because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.Total Population Change, 2010-2020According to the United States Census Bureau Decennial Census, between 2010 and 2020, the population in the service area fell by -935 persons, a change of -4.81%. A signicant positive or negative shift in total population over time impacts healthcare providers and the utilization of community resources.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2016-20. Source geography: TractNote: This indicator is compared to the state average. Data Source: US Census Bureau, Decennial Census, 2020. Source geography: Tract

Pana Community Hospital I 31The data and discussion on the following pages will take a look into the social determinants in the Pana Community Hospital service area and will oer insight into the complexity of circumstances that impact physical and mental wellness for the Pana Community Hospital audience. The infographic on Page 33 provides a snapshot of the at-risk population served by Pana Community Hospital.The CDC describes social determinants of health as conditions in the places where people live, learn, work, and play that aect a wide range of health and quality of life risks and outcomes. Healthy People 2030 uses a place-based framework that outlines 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 - PovertySOCIAL DETERMINANTS OF HEALTH

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:• 2,235 households with disability• 1,062 households below the poverty level (13%)• Median household income is $53,292 which is lower than both Illinois and the U.S.Veteran PopulationThis indicator reports the percentage of the population age 18 and older that served (even for a short time), but is not currently serving, on active duty in the U.S. Army, Navy, Air Force, Marine Corps, or the Coast Guard, or that served in the U.S. Merchant Marine during World War II. Of the 14,955 population of the service area, 1,370 or 9.16% are veterans.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2016-20. Source geography: Tract

Pana Community Hospital I 33AT RISK POPULATION PROFILEGeography: CountyAT RISK POPULATION PROFILEPana Community Hospital Service Area (12 Zip Codes)Geography: ZIP Code18,380Population7,890Households2.25Avg SizeHousehold43.1MedianAge$53,292MedianHousehold Income$94,863MedianHome Value60WealthIndex262HousingAffordability13DiversityIndexAT RISK POPULATION2,235Households WithDisability4,001Population 65+353HouseholdsWithout VehiclePOVERTY AND LANGUAGE13%Households Belowthe Poverty Level1,062Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES16,067DaytimePopulation647TotalBusinesses6,283TotalEmployeesPOPULATION BY AGEUnder18 18to64 Age65+04,0008,00012,0003,7974,00110,558Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 3,210 10,439 3,951 17,600Spanish 25 89 26 140Spanish & English Well 25 82 24 131Spanish & English Not Well 1 7 2 10Spanish & No English 0 0 0 0Indo-European 2 82 7 91Indo-European & English Well 2 82 5 89Indo-European & English Not Well 0 0 2 2Indo-European & No English 0 0 0 0Asian-Pacic Island 2 111 3 116Asian-Pacic Isl & English Well 1 60 1 62Asian-Pacic Isl & English Not Well 0 51 2 53Asian-Pacic Isl & No English 1 1 0 2Other Language 0 3 2 5Other Language & English Well 0 3 0 3Other Language & English Not Well 0 0 2 2Other Language & No English 0 0 0 0Source: Esri, ACS, Esri-Data Axle. Esri forecasts for 2022, 2027, 2016-2020. © 2022 EsriAT RISK POPULATION PROFILEPana Community Hospital Service Area (12 Zip Codes)Geography: ZIP Code18,380Population7,890Households2.25Avg SizeHousehold43.1MedianAge$53,292MedianHousehold Income$94,863MedianHome Value60WealthIndex262HousingAffordability13DiversityIndexAT RISK POPULATION2,235Households WithDisability4,001Population 65+353HouseholdsWithout VehiclePOVERTY AND LANGUAGE13%Households Belowthe Poverty Level1,062Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES16,067DaytimePopulation647TotalBusinesses6,283TotalEmployeesPOPULATION BY AGEUnder18 18to64 Age65+04,0008,00012,0003,7974,00110,558Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 3,210 10,439 3,951 17,600Spanish 25 89 26 140Spanish & English Well 25 82 24 131Spanish & English Not Well 1 7 2 10Spanish & No English 0 0 0 0Indo-European 2 82 7 91Indo-European & English Well 2 82 5 89Indo-European & English Not Well 0 0 2 2Indo-European & No English 0 0 0 0Asian-Pacic Island 2 111 3 116Asian-Pacic Isl & English Well 1 60 1 62Asian-Pacic Isl & English Not Well 0 51 2 53Asian-Pacic Isl & No English 1 1 0 2Other Language 0 3 2 5Other Language & English Well 0 3 0 3Other Language & English Not Well 0 0 2 2Other Language & No English 0 0 0 0Source: Esri, ACS, Esri-Data Axle. Esri forecasts for 2022, 2027, 2016-2020. © 2022 EsriAT RISK POPULATION PROFILEPana Community Hospital Service Area (12 Zip Codes)Geography: ZIP Code18,380Population7,890Households2.25Avg SizeHousehold43.1MedianAge$53,292MedianHousehold Income$94,863MedianHome Value60WealthIndex262HousingAffordability13DiversityIndexAT RISK POPULATION2,235Households WithDisability4,001Population 65+353HouseholdsWithout VehiclePOVERTY AND LANGUAGE13%Households Belowthe Poverty Level1,062Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES16,067DaytimePopulation647TotalBusinesses6,283TotalEmployeesPOPULATION BY AGEUnder18 18to64 Age65+04,0008,00012,0003,7974,00110,558Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 3,210 10,439 3,951 17,600Spanish 25 89 26 140Spanish & English Well 25 82 24 131Spanish & English Not Well 1 7 2 10Spanish & No English 0 0 0 0Indo-European 2 82 7 91Indo-European & English Well 2 82 5 89Indo-European & English Not Well 0 0 2 2Indo-European & No English 0 0 0 0Asian-Pacic Island 2 111 3 116Asian-Pacic Isl & English Well 1 60 1 62Asian-Pacic Isl & English Not Well 0 51 2 53Asian-Pacic Isl & No English 1 1 0 2Other Language 0 3 2 5Other Language & English Well 0 3 0 3Other Language & English Not Well 0 0 2 2Other Language & No English 0 0 0 0Source: Esri, ACS, Esri-Data Axle. Esri forecasts for 2022, 2027, 2016-2020. © 2022 EsriPana Community Hospital Service Area

34 I Community Health Needs AssessmentNote: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey, 2016-20. Source geography: TractEconomic 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.

Pana Community Hospital I 35Poverty – Population Below 100% FPLPoverty is considered a key driver of health status. Within the service area, 13.59% or 2,577 individuals for whom poverty status is determined are living in household 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 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, 20.37% or 847 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

Pana Community Hospital I 37Education Attainment This 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. Educational attainment is calculated for persons over 25 and is an estimated average for the period from 2016 to 2020. For the service area, 10.6% have at least a college bachelor’s degree, while 47.3% stopped their formal educational attainment after high school.

38 I Community Health Needs AssessmentSNAP BenetsThe Supplemental Nutrition Assistance Program, or SNAP, is a federal program that provides nutrition benets to low-income individuals and families that are used at stores to purchase food. This indicator reports the average percentage receiving SNAP benets during the month of July during the most recent report year.Note: This indicator is compared to the state average.Data Source: US Census Bureau, Small Area Income and Poverty Estimates, 2019. Source geography: County

Pana Community Hospital I 39Homeless Students Enrolled in Public Schools This 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 night-time 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 service area level based on school district summaries where three or more homeless children are counted. In the service area, of all the 2,822 students enrolled during school year 2019-2020, there were 110 or 3.90% homeless students, which is higher than the statewide rate of 2.61%. Note: Data are available for 100.00% of the school districts in the service area, representing 100.00% of the public school student population.Note: This indicator is compared to the state average. Data Source: US Department of Education, EDFacts. Additional data analysis by CARES, 2019-20202. Source geography: School District

40 I Community Health Needs AssessmentYoung People Not in School and Not WorkingThis indicator reports the percentage of youth ages 16-19 who are not currently enrolled in school and who are not employed. The service area has a total population of 964 people between these ages, of which 131 are not in school and not employed.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey, 2016-202.. Source geography: Tract

Pana Community Hospital I 41Housing 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. A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 the 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, 2016-20. Source geography: Tract

42 I Community Health Needs AssessmentOther Social & Economic FactorsEconomic 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. Food Insecurity RateThis 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, 2020. Source geography: County

Pana Community Hospital I 43Food Desert Census TractsThis 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 5,894 living in food deserts and a total of two 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 Service, USDA - Food Access Research Atlas, 2019. Source geography: TractPana

44 I Community Health Needs AssessmentInsurance – Insured Population and Provider TypeHealth insurance coverage is considered a key driver of health status. In the service area, 17,914 total civilians have some form of health insurance coverage. Of those 73.60% 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, 43.92% 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, 2016-20. Source geography: County

Pana Community Hospital I 45Built Environment – Households 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 8,210 total households in the service area, 1,336 or 16.27% are without a computer. 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

46 I Community Health Needs AssessmentPopulation in Limited English HouseholdThis indicator reports the percentage of the population aged 5 years and older living in limited English-speaking households. A limited English-speaking household is one in which no household member 14 years old and over speaks only English at home, or no household member speaks a language other than English at home and speaks English “very well.” In the service area, 26 individuals, or 0.14% live in limited English households. This indicator is signicant as it identies households and populations that may need English-language assistance.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-20. Source geography: Tract

Pana Community Hospital I 47Area 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 housing 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, 2020. Source geography: Block Group

48 I Community Health Needs AssessmentOpportunity IndexThis indicator reports the Opportunity Index score for the service area. The Opportunity Index includes indicators within four dimensions of community well-being: economy, education, health, and community. The overall score combines 16 underlying indicators for states, and 14 for counties. The Opportunity Index score has a potential range of 0 (indicating no opportunity) to 100 (indicating maximum opportunity). Note: This indicator is compared to the state average. Data Source: Opportunity Nation, 2018. Source geography: County

Pana Community Hospital I 49Social Vulnerability IndexThe degree to which a community exhibits certain social conditions including high poverty, low percentage of vehicle access, or crowded households, may aect that community’s ability to prevent human suering and nancial loss in the event of disaster. These factors describe this community’s social vulnerability. The Social Vulnerability Index is a measure of the degree of social vulnerability in counties and neighborhoods across the United States, where a higher score indicates higher vulnerability. The service area has a Social Vulnerability Index score of 0.44, which is less than the state average of 0.49.

50 I Community Health Needs AssessmentClinical 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. Access 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 sub-specialties within the listed specialties are excluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues and is used in the 2022 County Health Rankings.. Within the service area, there are six primary care physicians. This represents 33.72 providers per 100,000 total population. Note: Data are suppressed for counties with population greater than 2,000 and 0 primary care physicians.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, 2019. Source geography: HEALTH AND WELLNESS INDICATORS

Pana Community Hospital I 51Access to Care – Dental Health This 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. Data from the 2020 Area Health Resources File (AHRF) are used in the 2022 County Health Rankings. Within the service area, there are 7 dentists. This represents 38.8 dentists per 100,000 total population. Note: Data are suppressed for counties with population greater than 4,000 and 0 dentists.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, 2020. Source geography:

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 are dened psychiatrists, psychologists, licensed 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 2021 Centers for Medicare and Medicaid Services (CMS) National Provider Identier (NPI) downloadable le are used in the 2022 County Health Rankings. Within the service area, there are 12 mental health providers with a CMS National Provider Identier (NPI). This represents 66.6 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. Centers for Medicare & Medicaid Services, CMS - National Plan and Provider Enumeration System (NPPES), Accessed via County Health Rankings, 2021. Source geography: County

Pana Community Hospital I 53Access 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. Within the service area, there are two nurses with a CMS National Provider Identier. This represents 10.81 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), October 2022. Source geography: Address

54 I Community Health Needs AssessmentAccess to ExerciseThis indicator reports the percentage of individuals in a county who live reasonably close to a location for physical activity. Locations for physical activity are dened as parks or recreational facilities. The numerator is the total 2010 population living in census blocks with adequate access to at least one location for physical activity and the denominator is the 2010 resident county population. This indicator is used in the 2022 County Health Rankings. Within the service area, there are 9,207 people with adequate access to locations for physical activity. This represents 47.81% of the total population, which is less than the state rate of 86.79%.Note: This indicator is compared to the state average. Data Source: Business Analyst, ESRI, YMCA & US Census Tigerline Files, Accessed via County Health Rankings, 2010 & 2020. Source geography: County

Pana Community Hospital I 55Dental Care UtilizationThis 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 61.40% adults age 18+ who went to the dentist in the past year of the total population age 18+. 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

56 I Community Health Needs AssessmentCHRONIC ILLNESS Health 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.Top 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.

Pana Community Hospital I 57Cancer 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 156 new cases of cancer reported. This means there is a rate of 594.7 for every 100,000 total population.Note: This indicator is compared to the state average. Data Source: State Cancer Proles, 2014-18. Source geography: County

58 I Community Health Needs AssessmentChronic Conditions – Alzheimer’s Disease 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 359 beneciaries with Alzheimer’s Disease based on administrative claims data in the latest report year. This represents 10.4% of the total Medicare Fee-for-Service beneciaries.Note: This indicator is compared to the state average. Data Source: State Cancer Proles, 2014-18. Source geography: CountyNote: This indicator is compared to the state average. Data Source: Centers for Medicare & Medicaid Services - Chronic Conditions, 2018. Source geography: County

Pana Community Hospital I 59Chronic 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 report area, there were 9.50% 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.

60 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.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

Pana Community Hospital I 61Chronic 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, 1,427 adults age 20 and older have diabetes. This represents 8.2% 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

62 I Community Health Needs AssessmentChronic 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 they had high blood pressure only during pregnancy and those who were told they had borderline hypertension were not included. Within the service area, there were 36.30% 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 PLACES Data Portal, 2019. Source geography: Tract

Pana Community Hospital I 63Chronic Conditions – High Cholesterol (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 cholesterol. Within the service area, there were 35.50% 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 PLACES Data Portal, 2019. Source geography: Tract

64 I Community Health Needs AssessmentChronic Conditions – Kidney 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 have kidney disease. Within the report area, there were 3.20% of adults 18 and older with kidney 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

Pana Community Hospital I 65Chronic Conditions – Obesity (Adult)This indicator reports the number and percentage of adults aged 20 and older who self-report a Body Mass Index (BMI) greater than 30.0 (obese). Respondents were considered obese if their 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 3,403 adults age 20 and older who self-reported having a BMI greater than 30.0. This represents 23.7% of the 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

66 I Community Health Needs AssessmentChronic Conditions – Stroke (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 had a stroke. Within the report area, there were 3.90% of adults 18 and older who reported having a stroke 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

Pana Community Hospital I 67Poor 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. Within the service area, there were 14.70% of adults 18 and older who reported poor physical health in the past month of the total population age 18 and older.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.

68 I Community Health Needs AssessmentAdults with Poor or Fair General HealthThis indicator reports the number and percentage of adults age 18 and older who self-report their general health status as “fair” or “poor”. Within the service area, the estimated prevalence of fair or poor health among adults aged 18 years and older was 20.30%.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

Pana Community Hospital I 69Poor Dental Health – Teeth Loss (Adults)This 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 16.30% of adults 18 and older who reported losing all natural teeth of the total population age 18 and older.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.

70 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 les (2014-2020) and are used for the 2022 County Health Rankings. In the service area, of the 3,472 total female population ages 15-19, the teen birth rate is 25.8 per 1,000, which is greater than the state’s teen birth rate of 17.8. 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, CDC - National Vital Statistics System, Accessed via County Health Rankings, 2014-2020. Source geography: County

Pana Community Hospital I 71Heavy Alcohol ConsumptionIn the service area, 6,123 or 23.70% of adults self-report excessive drinking in the last 30 days, which is greater 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 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. 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 dates 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 the PLACES Data Portal, 2019.

72 I Community Health Needs AssessmentBEHAVIORAL HEALTH Deaths of Despair – Suicide + Drug/Alcohol PoisoningThis 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 death of despair is an indicator of poor mental health. Within the service area, there were 56 deaths of despair. This represents an age-adjusted death rate of 51.2 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

Pana Community Hospital I 73MENTAL HEALTH AND SUBSTANCE USEPoor Mental Health (Adults)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 15.40% of adults 18 and older who reported poor mental health in the past month of the total population age 18 and older.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

74 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. Rates are resummarized for service areas from county level data, only where data are available. This indicator is relevant because suicide is an indicator of poor mental health. Within the service area, there are a total of 20 deaths due to suicide. This represents an age-adjusted death rate of 20.1 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

Pana Community Hospital I 75Mortality – Motor Vehicle Crash (Alcohol Involved)Motor vehicle crash deaths are preventable and are a leading cause of death among young persons. This indicator reports the crude rate of persons killed in motor vehicle crashes involving alcohol as a rate per 100,000 population. Fatality counts are based on the location of the crash and not the decedent’s residence. Within the service area, there are a total of nine deaths due to motor vehicle crash involving alcohol. The crude rate per 100,000 total population is 6.1.Note: This indicator is compared to the state average. Data Source: US Department of Transportation, National Highway Trac Safety Administration, Fatality Analysis Reporting System, 2016-2020. Sour geography: Address

76 I Community Health Needs AssessmentPana Community 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 range ofpotential emergencies, ranging from disasters of all causes to pandemicsand terrorism.EMERGENCY PREPAREDNESS

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Pana Community Hospital I 79SECONDARY 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, and community services providers. The group reviewed notes from the focus groups and summaries of data reviewed by the consultant which included SparkMap, ESRI, Illinois Department of Public Health, CDC, USDA, Illinois Department of Labor, HRSA, County Health Rankings and Roadmaps, National Cancer Institute, and other resources.IDENTIFICATION AND PRIORITIZATION OF NEEDSExpand Accessto Local Mental HealthServicesAddress HomelessnessImprove Accessto Day CareExpand Local Prevention Eorts for Substance AbuseExpand Local Availability of In-Home CarePROCESS

80 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 Pana Community Hospital service area:1. Expand access to local mental health services including counseling, psychiatry, and professional consultation, especially for uninsured and under-insured2. Address homelessness3. Improve access to day care, especially for healthcare workforce4. Expand local prevention eorts and services for substance abuse and substance use disorders5. Expand local availability of in-home careDESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED

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Pana Community Hospital I 83Resources PartnersVolunteersGovernmentHOSPITAL RESOURCES• Executive team• Quad County Home Services• Business Development Manager• Plant Operations Manager•  Accounting• Human ResourcesRESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDSHEALTHCARE PARTNERS OR OTHER RESOURCES INCLUDING TELEMEDICINE• Local health departments• Illinois Department of Public Health• Members of ICAHN and the area hospital alliance that have experiencewith day careCOMMUNITY RESOURCES• Schools• Other interested organizations and persons• Dementia safe communities• Community organizations• Faith-based organizations• Local governments• Law 

Pana Community Hospital I 85Documentation Online PresenceCommentsImplementationSECONDARY DATAThis CHNA Report will be available to the community on the hospital’s public website, www.panahospital.com. 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

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The Implementation Strategy was developed through a facilitated meetinginvolving key administrative sta at Pana Community Hospital on October 11,2022. The group reviewed the needs assessment process completed to thatpoint and considered the prioritized signicant needs and supporting documents.They discussed steps taken to address the previous Community Health NeedsAssessment. 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 vecategories, actions the hospital intends to take were identied along with theanticipated 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 measurable outcome indicatorsin conjunction with annual review and reporting.IMPLEMENTATION STRATEGYExpand Accessto LocalMental HealthServicesAddressHomelessnessImprove Accessto Day CareExpand LocalPrevention Eorts  for Substance AbuseExpand LocalAvailability ofIn-Home CarePLANNING PROCESS

88 I Community Health Needs AssessmentThe group addressed the needs with the following strategies:1. Expand access to local mental health services including counseling, psychiatry, and professional consultation, especially for uninsured and under-insuredActions the hospital intends to take to address the health need:• Pana Community Hospital will attempt to recruit a Licensed Clinical Social Worker, a Licensed Clinical Professional Counselor, or a Psychiatric Advanced Practice Nurse to provide services at an outpatient location.• Pana Community Hospital will explore telehealth access to psychiatrist support for the clinician.• Pana Community Hospital will explore a model for providing expanded mental health services to uninsured and under-insured persons.Anticipated impacts of these actions:Pana Community Hospital anticipates that the steps identied above will expand access to local mental health services including counseling, psychiatry, and professional consultation, especially for uninsured and under-insured.Programs and resources the hospital plans to commit to address health need:• Chief Executive Ocer• Specialty Clinic Practice Manager• Primary care medical staPlanned collaboration between the hospital and other facilities:• Telehealth resourcesIMPLEMENTATION STRATEGY

Pana Community Hospital I 892. Address homelessnessActions the hospital intends to take to address the health need:The mission of Pana Community Hospital is “to be a leading partner in assuring community-based quality healthcare. Pana Community Hospital recognizes the presence and impact of homeless persons within its service area and oers appropriate care to those that present for services.”• Pana Community Hospital will continue to partner with community organizations, local governments and agencies, and other interested groups and persons to collaborate toward a community-wide strategy to address local homelessness.Anticipated impacts of these actions:Pana Community Hospital anticipates that local homelessness will be addressed through focused community collaboration.Programs and resources the hospital plans to commit to address health need:• Executive team• Business Development ManagerPlanned collaboration between the hospital and other facilities:• Local governments• Schools• Faith-based organizations• Community action agencies• Community leaders• Other interested organizations and persons

90 I Community Health Needs Assessment3. Improve access to day care, especially for healthcare workforceActions the hospital intends to take to address the health need:• Pana Community Hospital will investigate and analyze opportunities to provide day care services to employees of Pana Community Hospital Association.Anticipated impacts of these actions: Pana Community Hospital anticipates that a solution to day care needs for healthcare sta may be possible.Programs and resources the hospital plans to commit to address health need:• Business Development Manager• Executive Team• Plant Operations Manager• Accounting• Human ResourcesPlanned collaboration between the hospital and other facilities:• Illinois Department of Public Health• Members of ICAHN and the area hospital alliance that have experience with day care4. Expand local prevention eorts and services for substance abuse and substance use disordersActions the hospital intends to take to address the health need:• Pana Community Hospital will attempt to recruit a Licensed Clinical Social Worker, a Licensed Clinical Professional Counselor, or a Psychiatric Advanced Practice Nurse to provide services at an oupatient location.• Pana Community Hospital will explore telehealth access to psychiatrist support for the clinician.• Pana Community Hospital will support collaborative eorts to address community needs related to substance abuse and substance use disorders.

Pana Community Hospital I 91Anticipated impacts of these actions: Pana Community Hospital anticipates that these steps will improve access to services for persons facing substance abuse or with substance use disorders.Programs and resources the hospital plans to commit to address health need:• Executive TeamPlanned collaboration between the hospital and other facilities:• Community organizations• Faith-based • Local governments• Law enforcement• Health Department5. Expand local availability of in-home careActions the hospital intends to take to address the health need:• Pana Community Hospital will explore opportunities to provide in-home nursing servicesAnticipated impacts of these actions: Pana Community hospital anticipates that availability of in-home nursing care will expand the scope and access of in-home care.Programs and resources the hospital plans to commit to address health need:• Executive Team• Quad County Home ServicesPlanned collaboration between the hospital and other facilities:• Interested organizations and persons• Dementia safe communities

Pana Community Hospital I 93Focus Groups AdministrationOrganizationsBusinessGroup 1: Medical professionals and partners, nursing home and assisted living providers, and county health department personnelDennis Yap, MD, Pana Community HospitalWalter H. Cunnington, MD, Pana Community HospitalMarlon T. Muneses, MD, Pana Community HospitalCatherine D. Teodoro, MD, Pana Community HospitalDebra Anklam, FNP, Pana Community HospitalMarc Scholes, FNP, Pana Community HospitalTabitha Wilhour, FNP, Pana Community HospitalColleen Rakers, FNP, Pana Community HospitalJennifer Weekly, FNP, Pana Community HospitalWhitney Carruthers, FNP, Pana Community HospitalTricia Harkins, DON, Christian County Health DepartmentCarl Portz, Administrator, Heritage HealthLora Jones, Community Relations Director/Marketing, Peterson Health CareSam Burton, Social Worker, Pana Community HospitalTrina Casner, CEO, Pana Community HospitalREFERENCES AND APPENDIX

94 I Community Health Needs AssessmentJames Moon, CFO, Pana Community HospitalVickie Coen, CNE, Pana Community HospitalDianne Bailey, CIO, Pana Community HospitalKatie Sinclair, HR Manager, Pana Community HospitalCarol Chandler, Director of Business Development, Pana Community HospitalGroup 2: Community leaders, local ocials and law enforcement, and other business and community organization representationSarah Myer, Board Chairperson, Pana Community Hospital Nathan Pastor, Mayor, City of PanaKirby Casner, Economic Development Director, City of PanaDaniel Bland, Chief of Police, City of PanaRod Bland, Fire Chief, City of PanaJason Bauer, Superintendent, Pana CUSD #8Cheri Wysong, Principal, Pana CUSD #8David Kennedy, Funeral Director/Owner, Kennedy & Sons Funeral Directors PCKevin Kennedy, Oce Manager Funeral Associate, Kennedy & Sons Funeral Directors PCKylie Anderson, Captain, City of Pana Fire DepartmentAl Stupek, VP, Taylorville Community Credit Union, PanaRev. Jessica Baldyga, Pastor, First United Methodist ChurchRev. Leon Go, Council Member, United in Faith ChurchBen Moore, President, Pana Lions ClubSusan McGrath, Editor, Pana News PalladiumTim Christer, Owner, Save-A-LotJohn and Jackie Metzger, Volunteers, Pana Mission CenterLinda Dressen, President, Delta Theta TauBill Schmitz, President, Eagles

Pana Community Hospital I 95Identication and Prioritization GroupWalter H. Cunnington, MD, Pana Community HospitalMarlon T. Muneses, MD, Pana Community HospitalJennifer Weekly, FNP, Pana Community HospitalTricia Harkins, DON, Christian County Health DepartmentJohn Metzger, Pharmacist, Walgreen’sCarol Chandler, Director of Business Development, Pana Community HospitalIdentication and Prioritization GroupTrina Casner, CEO, Pana Community HospitalJames Moon, CFO, Pana Community HospitalVickie Coen, CNE, Pana Community HospitalDianne Bailey, CIO, Pana Community HospitalKatie Sinclair, HR Manager, Pana Community Hospital

101 East Ninth Street, Pana, IL 62557 • 217.562.2131 • www.panahospital.com